#107 Why You Can't Sleep (and How to Fix It) | Dr. Michael Grandner

21:12Dr. Michael Grandner:Because no, you don't. What you think is, I don't have an appetite for a couple days, but in a couple days it'll come back and I'll be fine. And when people deal with temporary sleep loss that same way, it's a similar system. The system can correct itself if you let it. But what ends up happening is when we start stressing about it, it starts creating these problems. And a lot of times it's us getting in our own way. Right.

21:39Dr. Rhonda Patrick:Let's say you had someone that has to work on their stimulus control. There's someone that likes to get into bed, they have trouble falling asleep, so they pull out their phone, they're scrolling, they're looking at social media, whatever, and maybe they're ruminating. How would you approach that? What would be your two-week fix? Great.

22:02Dr. Michael Grandner:So first of all, in addition to stimulus control, in terms of the other tools within CBTI, a lot of them focus on this idea that you want to drive your natural sleep drive, put that sleep drive in bed. And when bed is not really going to be used for sleep, you get up. And so if you're going to be on your phone, the first thing I would say is try and separate the phone from the bed. have the bed be the place where sleep is occurring not where sleep is predictably not occurring because it's not occurring when you're on your phone see if you can do that if for some reason you have to be in bed when you're on your phone i would say the thing to do is you still want to create that separation the best way to do that is maybe stand next to your bed because like i say stand it's silly and And very rarely do people actually do it, but people sometimes do.

22:59Dr. Michael Grandner:And I do this because if you're standing, if being in that proximity is important for your ability to sort of wind down or whatever, but at least A, you're not in bed, but B, the standing does something very important. And especially people in the athletic space will know this, that you don't lose touch with your body's communication to you. When you're standing, there will eventually come a point where you say, but I really want to sit down now. That's your body telling you that you're ready. Or you may be standing thinking like, what am I standing here like an idiot for? I've been here for a half an hour.

23:35Dr. Michael Grandner:What am I doing? That's your other signal that you're not ready. Sleep is not something that you do. Sleep is something that happens to you when the situation allows for this. That's a concept I borrowed from a colleague of mine, Lindsay Shaw, who's also a fantastic sleep person and sports psychophysiologist. I learned this from her. I use it all the time. It captures it really well. Sometimes sleep is not under your, your ability to sleep isn't under your control. You're awake. Like you need to wind down. Maybe you're just not ready. And if you're just not ready, laying there in bed scrolling is going to help.

24:11Dr. Michael Grandner:Go do that somewhere else. If you are getting ready, respond to those body signals. If you can't stand next to your bed, if that's a little too silly for you, sit and sit up on your bed. Don't not like just a little propped up. Your head's not on a pillow. You're not under a blanket. Sit up again. You're not going to lose touch of your body's signals. And, and worst case scenario, at least you get the head Bob. The head Bob is, is, is your friend. The head Bob means it's your body telling you you're ready. There's also like if you're watching TV or on the couch or whatever, and you're within that zone where you might be wanting to go to bed, lean forward when you're watching TV or your movie or whatever.

24:51We're scrolling because you'll get the head bulb.

24:54Dr. Michael Grandner:You won't get it when you're leaning back. You get it leaning forward. That's your signal that you're ready.

25:00Dr. Rhonda Patrick:And what happens if someone wakes up in the middle of the night and then they're ruminating?

25:06Dr. Michael Grandner:Yeah. Can't fall asleep. So again, sleep is not something you do. It's something that happens when the situation allows for it. And if the situation is not allowing for sleep in that moment, get up. If you're sitting there and you're eating and you have no appetite, you don't just sit there and stare at your food till you become hungry and it becomes more appetizing. It actually backfires. So often when people wake up in the middle of the night, it's because something naturally occurred to produce that awakening. Whether most commonly would probably be some sort of physical discomfort like pain, or maybe you sunk into your mattress a little bit and it's just a little discomforting and you need to wake up and move.

25:48Dr. Michael Grandner:Sometimes it's untreated sleep apnea, super common. You have a respiratory event that you don't know you had. If you ever wake up suddenly for no reason and you don't know why and can't get back to sleep, you know, we'll talk a little bit later about sleep apnea, but that can cause these awakenings. And when you have something that causes this awakening that arose from inside you, wasn't under your control and what ends up happening is that that physical activation escalates and just like a snow globe you know you shake up the snow globe it takes a little bit of time for it to come back down and when your snow globe got shaken up while you were asleep and you're awake you can't make it fall back down faster there's nothing you can do you can poke at it make it go slower but you can't make it go faster you just have to wait till everything settles back down.

26:37Dr. Michael Grandner:And it often doesn't take as long as people think. But what ends up happening is as your snow globe is settling, then your stress starts rising again, slowly rising. Because like, why can't I sleep? What if I can't fall asleep? What if I'm up the rest of the night? Blah, blah, blah, blah, blah, blah. And then you start stressing and freaking out about it. So now your body is ready, but your mind isn't anymore. And I got to wait for that to come down and you just prolonged it. Because you don't have control over this part, surrender that control. Recognize that you're going to get up, you can get up, take a break, wait till you're ready, try again.

27:14Dr. Michael Grandner:Just don't prolong it any more than is necessary. So sometimes surrendering control actually shortens the awakenings. Sometimes it doesn't. Sometimes, you know what, what if you're up for the entire rest of the night and you just don't go back to sleep? That's often people's fear. But the truth is, A, that's unlikely. And B, even if it does happen, you'll be fine the next day and guess what happens if you're halfway through your dinner and you just lose your appetite and you just don't eat the rest of it what happens the next day you don't die you just are a little more hungry and you'll eat a little more the next day and the system will correct itself over correcting is the problem so to kind of just for my understanding for the

27:56Dr. Rhonda Patrick:stimulus control yeah like the most important part of it like for these for these individuals that do have this like fear of like not sleeping or like it starts to you know they they just immediately get like anxiety about it the best thing is to surrender or is that like the the

28:16Dr. Michael Grandner:strongest part of the stimulus control yeah it's the performance anxiety the fear is what's creating the activation that's getting in your own way so so recognizing that it's not under your control trying to control it is not going to help nobody got to sleep faster by trying harder the enemy of sleep is effort if you're engaging in effort you're adding energy into the system and athletes especially are vulnerable to this because you know athletes are used to gaining control over their body and learning how to control their body in ways that most people just don't know how to because they haven't been trained to.

28:59Dr. Michael Grandner:So there's always a solvable problem there. Sometimes it's like, like injury recovery. Sometimes you can't make it go faster. Like if you injure yourself, you got to do what you got to do to recover. You can't, there's no like dance you can do or, or book you can read that will make that recovery go faster. You got to give it the time it needs. Similarly, this is a process that's outside of your control, trying to control it will actually make it go slower.

29:30Dr. Rhonda Patrick:Okay. And so the next part of CBTI that you hear about is the sleep restriction, which sounds awful.

29:38Dr. Michael Grandner:Worst name. I mean, so if you actually look to the original publication, they didn't even call it sleep restriction therapy. They called it restriction of time in bed, which is really what it is. it's it's a simple concept of um again a lot of these things are simple in concept but difficult in execution but the concept of sleep restriction therapy which i hate calling it that because it doesn't it's it's not about the restriction and that's the thing sleep restriction could be part of it but it isn't always the idea is let's say you're spending eight hours in bed but six hours asleep we know you physically can sleep six hours okay let me give you six hours time in bed See if you can fill it.

30:19Dr. Michael Grandner:Let's get you to the point where you can fill it. And then we'll slowly increase it from there. Actually, sleep restriction therapy has more increasing of sleep than decreasing. But there's that decrease at first. The way I explain it to people is this. It's actually not super complicated. Let's say you're trying to eat your vegetables and you've got a kid who's not eating their broccoli, right? And you put 20 pieces of broccoli on their plate and they're not eating. They can eat one or two. And then they're like, oh, I hate broccoli, blah, blah, blah. Then you say, okay, I need you to learn how to eat your broccoli.

30:47Dr. Michael Grandner:tonight I'm going to give you two pieces of broccoli can you I know you can eat that because that's what you've been eating every day I know you can eat that so you eat the two pieces of broccoli and then they say but I'm still hungry and you say great you will get three tomorrow let's see if you can eat those then they can eat the three pieces but I'm still hungry it's like okay hold off on don't eat anything else but the next day you'll be hungry enough to eat four And then you slowly, you start with what they can already do, but you don't give the other stuff that will, so you don't let them stay in bed when they're not sleeping.

31:23Dr. Michael Grandner:At least give them the opportunity they're already able to fill. At first, all the mental blocks and stuff will be there, so it might drive down their sleep a little bit in the short term for several days, maybe even up to a couple weeks. But eventually they get hungry enough where they can eat all the broccoli on their plate because you're not giving them anything else. then all of a sudden you start introducing other foods back that they actually like but they've gotten over their broccoli deal and that's what it is with sleep you drive up their natural sleep pressure you separate out um the time in bed that's not wake you make it so that being in bed you're so you go from not being able to fall asleep to not being able to stay awake because you drive up that natural sleep pressure and it's like well you have problems with your appetite fast for a little bit that'll help a lot of problems with your appetite you're going to be hungry again.

32:10Dr. Rhonda Patrick:And so this idea of not having your phone in bed is part of that.

32:14Dr. Michael Grandner:Yeah. It's part of that because you don't want to do anything in bed that is not sleep. You want, you want, you want to make it so that when you get into bed, you put your head on the pillow, you're under a blanket, your eyes are closed, you're breathing through your nose. Um, that, that, that feeling is so predictably tied with becoming unconscious in a very short amount of time that even when you get good at that. So this is, this is the power of this. When you get good of that, you're using the prediction, not just to solve a problem, but to create a benefit. Imagine you're a little bit stressed.

32:52Dr. Michael Grandner:You've got a big day tomorrow, but you've so trained yourself that that place is so predictably tied with sleep that you're stressed. You've got a big day. You've got stuff you're working on. You get into bed, close your eyes, head on pillow, under blankets, start breathing, then all of a sudden you fall asleep. You can train yourself to get the outcome you want and that gives you control. So let's say you got to wake up super early one day because you're going somewhere, you got to practice or something. You need to go to bed an hour or so earlier than you really are used to. If you've got yourself well-trained, you can use the environment as a conditioned stimulus for sleep when you want it to be.

33:35Dr. Rhonda Patrick:So how long does it take for most people to train themselves through the stimulus control, sleep restriction, where the bed is really just for, I've heard sleep and sex.

33:45Dr. Michael Grandner:Yeah, so sex is fine. That's usually not the problem. Do that in bed, out of bed, wherever you want. That's fine. Usually that's not taking up so much time. I mean, and it's not interfering with your ability to sleep. Sometimes it can help your ability to sleep.

33:59Dr. Rhonda Patrick:but that's fine but um it's probably the phones that are the biggest problem it's distractions

34:06Dr. Michael Grandner:so distraction the activation all of this stuff it's you're adding energy in instead of taking energy out relaxation is fine to do in bed but if it's brief you know if you're spending you know a half an hour meditating in bed that might be a little too long if you're i've known people who like they have this whole hour-long routine that they do like by the time that hour is done the bed is no longer predictably tied to sleep anymore. So yeah, it's about, it's about getting this stuff out. It doesn't, I'm not saying don't be on your phone, but I mean, I actually think does the sleep field telling everyone get off their phone for an hour before going to bed is not a helpful recommendation because no one's going to follow it.

34:45Dr. Michael Grandner:We should be talking about how to do it safely in a way that's not going to get in your way.

34:52Dr. Rhonda Patrick:And that comes down to what you were saying earlier, either being in another room or sitting up or standing. Yeah.

34:58Dr. Michael Grandner:And also it's what you're doing that's important. You might want to create sort of boundaries. So like maybe within a half an hour of when you're planning on going to bed, maybe switch to something that's not too mentally activating. Like if you're the kind of person where you watch the news and it gets you all worked up and angry, don't do that before going to bed. Maybe do it the hour, you know, in the earlier part of the evening. I mean, the great thing now is TV isn't live anymore. Back when I was a kid, you had to watch it when it was on and that was it. Now we can watch, we can, we can gain more control over what we're exposing ourselves to media wise.

35:36Dr. Michael Grandner:The rule of thumb I use, and this is what I use for myself. If an alarm went off right now and said, okay, time to turn it off. Could I, if the answer is yes, then it's probably okay to do within that timeframe. Cause I can easily disconnect from it. If the answer is no, no, no, five more minutes, I want to see how it ends or I want to, you know, whatever. That's probably not the thing to watch in that buffer time. Watch it before the buffer time, but don't do that in the buffer time. Like if you're scrolling and you can easily put it down. I don't know that. I don't know that that's that big of a deal, but if you're scrolling and like half an hour will go by and you wouldn't even notice and you lose that time and then you say you don't have time but you just threw away some time you know that you didn't need so like those are the sort of things you want to you want to make sure that you curate what you're doing so

36:30Dr. Rhonda Patrick:that it's not too activated why why are a lot of people that have that have insomnia why are they prescribed you know these sedatives like you know ambien or well they don't not work i mean like

36:43Dr. Michael Grandner:Like I was saying, what they do is they drive up that sleep drive so much it overpowers whatever's in the way. And it's kind of an easy solution. The thing is, honestly, it's much easier to write a prescription. Like you can go to any primary care anywhere and they can write a prescription. But if you look at every medical organization that has any recommendation around how to treat insomnia. And for athletes, you know, this includes like NCAA and IOC, who've put out sleep related materials. They all say CBTI first. And that's because every study that has ever been done shows that when you compare, when you pool the data from CBTI trials, it works shockingly well.

37:37Dr. Michael Grandner:Not only does it work reliably well, it works when you have other, like, well, what about if you're in chronic pain? Like if the pain is keeping you up, how is that you don't have conditioned arousal, you have an active thing going on? Still works in fibromyalgia, works in chronic pain, works in cancer. It actually might be better in cancer survivors than people who aren't cancer survivors because they don't want to take these medications. They're more motivated. It works in sleep apnea. It works before your sleep apnea is even treated. It helps with your insomnia. find me a condition works in older people works in younger people works in so like it's a blunt instrument it's retraining yourself to sleep it doesn't it and it works well by helping people gain control it doesn't necessarily add hours to your night but neither do sleeping pills either what it does is it removes some of those barriers about again about 85 percent of the time not 100 But it's also some people don't know how to get access to it or they read about it online and either the information they get isn't isn't great or they have exposure to it in that, you know, maybe, you know, maybe they're doing it by the book, but they might need a little flexibility with it or something.

38:50Dr. Michael Grandner:But there's lots of adaptations. I mean, we edited a textbook on how to adapt CBTI to different populations. But, you know, a lot of people just don't know it exists. And the people who do don't really understand what it is or how to find someone who knows what they're doing.

39:03Dr. Rhonda Patrick:Is that the key? Do you really have to find someone that knows what they're doing? Or can you try this yourself?

39:09Dr. Michael Grandner:Yes and yes. I mean, there are many people that I've talked to who've tried it, done it with themselves. I mean, because it's not rocket science. um the there's an art to it but the the basics of it are relatively simple it's bed equals sleep get out of bed if you're not sleeping you know compress your window of you're giving yourself too much opportunity you're not filling it compress your opportunity but then expand it again once you can fill it um some basic stuff like that uh and some people could just do that on their own and that's all it takes. Some people, they need somebody who knows what they're doing.

39:48Dr. Michael Grandner:The problem is there's not a whole ton of people who are trained in this, despite it's being around for a long time, despite the fact that it's really well supported. There's not a ton of people who are well-trained. There are some online versions available where they can automate some, some aspect of this. It's a very, it'll be very by the book, but for a lot of people, that's all it takes. you can do this over telehealth any state that you're in i can promise you there's someone who can do this via telehealth in your state so it used to be very geographically restricted it's not anymore there's a couple of good directories online of if you're looking for somebody we have a board certification you can see who's board certified in this and we it exists because it's not part of normal training so to be able to say that you're good at you have to like prove that you know what you're doing.

40:36Dr. Michael Grandner:But yeah, you can look online for people. And again, there's telehealth options too. So whatever state you're in, you can find somebody.

40:46Dr. Rhonda Patrick:What percentage of the US population has insomnia?

40:50Dr. Michael Grandner:It's a great question. For decades, any population level study has generally found kind of the same thing, mostly. And it doesn't seem to have mostly changed much, that about one out of three people in the U.S. has some sort of sleep complaint or problem or something, whether it's falling asleep, staying asleep, not feeling refreshed. That seems to be about a third of the population at least. And it seems like about one in 10 people probably would meet the criteria for an insomnia disorder if you assessed them. And then what ends up happening is they start trying to fix it on their own and they start going down paths that end up being unhelpful and then they get more frustrated and then sleep becomes more stressful and they give up and they say, like, I'm a hopeless case.

41:40Dr. Michael Grandner:I get one of these a week in clinic. So I'm the worst sleeper you've ever seen. I've tried everything. I've had this problem forever. Then six to eight sessions are better.

41:49Dr. Rhonda Patrick:Yeah. One in 10 is a lot. And, you know, I definitely think we're going to talk about some of these substances people then turn to because they think it's going to help treat their sleep problem, which they don't necessarily know is even insomnia, right? And so they're, you know, turning to things like alcohol and that doesn't really help. So, but let's, before we get to that, sleep apnea you mentioned, and that's another one that I wanted to talk about. I've known a lot of people, it seems, that have had sleep apnea. I wonder how you can tell me how common that is as well. But first, I kind of wanted to ask you, like, what are some of the non-obvious presentations that, you know, of sleep apnea that you see, especially in people who like maybe don't even report feeling sleepy.

42:32Dr. Michael Grandner:Right. So, so the thing with sleep apnea is the first thing to know about sleep apnea is it is shockingly common. It is very, very, very common. The most recent data I've seen estimates that about one out of four or five men over 30 probably has at least some sleep-related breathing issues, especially if their BMI is over 30, it's more like 50-50. It's really high. Women get it less often, but it's also shockingly common in women too. It might be more like one out of every 15 or 20 women. And then as BMI goes up, it gets more common. So it's shockingly common. it's so common that my threshold for screening for it is very low especially among otherwise fit people because the normal risk factors so like as you gain weight it it you get it more because it can crowd out your airway muscle too yeah muscle too it's because think of it this way so most mammals their airway is a straight line you know from snout all the way up and and to to to their lungs.

43:47It's a straight line from the snout to their lungs.

43:50Dr. Michael Grandner:Humans, by moving upright, we solved a lot of problems and we've gotten a lot of benefit from being upright, but it created a problem with us in that our tube now has a 90 degree angle in it. And if you're designing a pipe and you put a 90 degree angle kink in your hose, where is it going to start having problems? It's going to have problems at that. And that's what happens. So like right around that spot here, that's where we get narrowing of the airway. And so like any mass, whether it's muscle or fat or whatever, any mass, I mean, there are people who look at MRIs of like tongue fat, like, like cheeks, like anything here that whether even skinnier people with smaller airways, you know, where it's a little more compressed.

44:42Dr. Michael Grandner:it just it's it's a it's a vulnerability in in the human physiology for breathing issues and it's actually mostly fine in that you can have four or five breathing pauses per hour in the night and be in the normal range it's actually sleep apnea doesn't begin at five is mild begins the low end of mild. And it's not even until you get to 15 per hour that it becomes start becoming moderate. So many people who are in the mild range don't even have any symptoms and might not be causing any problems. We have a lot of flexibility in the system, but as you get older and neuromuscular control changes, as we put on more pressure here in the airway by gaining weight or whatever, it just becomes more and more common.

45:35Dr. Michael Grandner:And my guess is it's actually been common through history. It's just, we've written it off as something else, especially in people that don't have those obvious signs. So what are some of those less than obvious signs? I have a patient who comes in and they say, I fall asleep just fine. Actually, if I'm anything, I'm a little tired during the day, whatever. I fall asleep just fine. But then I wake up in the middle of the night because of stress. my stress wakes me up and then i have a hard time falling back asleep when i hear that i think there's greater than 50 50 chance in my mind that that was a respiratory event stress doesn't wake you up what happens is if you wake up and you're thinking i'm stressed your brain is reading signals like elevated heart rate elevated respiratory rate um indoor the the endorphins of the muscles getting tense you're reading these physical signs and then because we live in the society we live in stress is readily available we can fill that space really fast but what what was happening was wasn't the stress that woke you up it was that you know your breathing was starting to get a little bit constrained so then what happens is your airway tries to open itself up and it was trying and it wasn't it wasn't successful so it tried harder still wasn't successful tries a little harder still not successful worst case you wake yourself up and you and you can you can wake up with a gasp because you can breathe when you're awake just fine it's a different neuromuscular control system so as soon as you wake up you sort of get that that sudden awakening because you just got that little sort of a shot of adrenaline to wake you up.

47:19Dr. Michael Grandner:And like, if I just shot you up with a little bit of adrenaline during the night, you'd wake up and you would not be able to fall back asleep. Your mind would start racing and you'd have all these physical signs, but it wasn't the stress that woke you up. The stress got superimposed on it later. So when I have a patient who comes in and describes that sensation of, I wake up in the middle of the night, either because of stress or for no reason, I don't know why something wakes me up. I have no idea, but I cannot get right back to sleep immediately. Like within a few minutes, I mean, something just happens.

47:48Dr. Michael Grandner:Some flare up just happened somewhere. Um, that's, that's what I look at in athletes. Often what I'll look at is I feel like my sleep is really shallow and I don't know why, because what's happening is you might be having lots of these low level respiratory. That's the thing when you get the more severe sleep apnea, like 30 events per hour or more with, with these other presentations, but you get a lot of the mild to moderate cases in people who, you know, don't have a lot of extra weight, aren't older and have neuromuscular control issues, which just happens with age. They're younger, they're healthier, but they just might have a narrow airway.

48:28Dr. Michael Grandner:And, and so like, I'll never forget, like there was this, there was a, um, uh, an Olympic level athlete I was working with. She was, she was in the trials and she's like, she's not meeting the times I think I should, she was still faster than everybody else but she's like my intuition is telling me something is in my way from reaching what i could be doing i don't know what it is and like how you sleep it's like i feel like my sleep is kind of shallow i fall asleep just fine but i feel like i'm up a few times during the night and i don't really know if that's a problem or not so i'm like well let's see what's going on turns out she had she had mild sleep apnea got that treated better and she's like oh that was it And in the real world, it would have been missed.

49:14Dr. Michael Grandner:It would have been someone just slogging through their day. They would have just been like, oh, you know, life is hard. I'm tired. Not sleeping is good. And then probably in 30 years, she would have gotten diagnosed by the time it was more obvious if she weren't an athlete.

49:26Dr. Rhonda Patrick:So what should a person do? Like, how many, is this an every night thing where people are getting woken up? Like, if they're having apnea, is this like an every night thing? like what sort of sort of symptom clusters biomarkers can people look at short of like going and getting the thing on your finger and measuring the oxygen and you know the whole yeah

49:47Dr. Michael Grandner:i mean so so here's the thing it's normal for people to wake up in the middle of the night sometimes actually the typical adult will wake up 10 times a night or more during the night they just don't remember it's very short i mean again evolution figured this out a long time ago you wake up, no bear, back to sleep. Like that's normal. But if you're remembering more of those awakenings, if you're remembering three, four awakenings, if you have an awakening, especially waking up like with a gasp, like if you wake up like that, or you wake up with a snort, if you wake up with something like that, or if you feel like you just can't get enough sleep, Like you try and sleep a little bit more, but it doesn't help.

50:31Dr. Michael Grandner:It's like, it's just, it's just empty calories. You know, like it's not about the amount anymore. There's like something that's keeping it artificially shallow. There's lots of things that could be. It's just sleep apnea is so common. Why not take tests? Why don't you just get tested? Just go get a referral, get tested. You can do them at home now. It's easy enough. Um, in turn it's, it's, there's no real good biomarker for it yet. I know people are working on it. there's no real good biomarker except that that sleep is shallow it's fragmented and you don't know why i mean it could be something else could be inflammation it could be pain it could be environmental there's lots of things it's like if you're not breathing is there a problem with your lungs is there a problem with your airways or problem with the pollution in the air so like is it is there something that's preventing your body from being able to sleep or and and if it is sleep apnea it's so common this is why my threshold for screening is just ultra low because um if it was that and i do all the tips with you and i work out this and i do all this and you're still feeling like oh but my sleep just isn't good and i knew when day one that this was a possible reason why then i'd feel like an idiot for not even checking because like we did all this work and maybe we didn't even need to do those um at home kind of could

51:53Dr. Rhonda Patrick:if i remember doing one once like years ago when i was in graduate school and i was i think i was waking up because of stress but yeah yeah um the test came out negative but i wore this like yeah ox pulse thing i think i don't know what it was in my finger so there's there's a bunch of devices

52:05Dr. Michael Grandner:they've gotten better and smaller over the years um there's still people who do need to come into the lab those are usually reserved for when there's like another sleep disorder you're also looking for, like narcolepsy or limb movements or something, or if you're medically complicated, like you need supplemental oxygen, or if you might have heart failure or something where you need to kind of be monitored in the hospital while you're doing it for safety. Other than that, or the test you did at home was negative, but you still have a lot of symptoms and maybe it missed it because the home tests aren't as sensitive.

52:38Dr. Michael Grandner:Like you won't get false pauses, but you might get false negatives. That's the only time you'd really need to come into the lab most of the time. Usually they just give you the thing to take home. And these days you can wear it as a strap. They have ones that just go on your wrist and they measure, they measure, um, your oxygen levels during the night. And what you can see is how is your respiration tied with your O2? Cause respiration drops during the night too. And so does O2 a little bit, but if, if your respiration is dropping and then your O2 starts dipping and then it, then it opens back up again and gets recovered.

53:12like you look at these patterns of what's happening during the night and you can see in one night if

53:18Dr. Michael Grandner:someone's clearly has sleep apnea or not okay it's easy enough if you're working with someone who has

53:24Dr. Rhonda Patrick:obstructive sleep apnea like how do you go about differentiating if it's like caused by allergies or positional or you know something something like nasal congestion i don't know like yeah yeah

53:36Dr. Michael Grandner:Yeah, especially when it's more on the mild to moderate side. Right. So the great thing is the ones that are on the strap, they usually have a gyroscope in it, and they can measure your breathing separately on your side and on your back. There's a lot of people where it's just that it's on their back. That's the issue. And for those people, there's actually really simple fixes. They sell these devices where it's really just a strap you wear. in the old days they used to sew a tennis ball on the back of a t-shirt and that's all it's like whenever you rolled on it you just roll off it and they have like fancy versions of that now where that's essentially what it is where it's there's one there's a couple where it's a strap it's like a belt but like the back of the belt has a little bump on it and so like whenever you roll on it you just roll off it just stays off your back that's it um you can't force yourself to stay off your back when you're asleep you're like well i'm just going to fall asleep on my side well you can't control it when you're unconscious.

54:31Dr. Michael Grandner:So like you can see if it's positional easily in the diagnosis. And if it is, then just try and treat it positionally. And then what I would do is retest using the positional device and see if it all goes away. Cause it might, might not. Um, if it's allergies, um, this is why the, the, the sleep docs, you know, we get a lot, they get a lot of training and, and I've gotten some of this too, when I rotated in sleep medicine, like you see what to look for. So like you look at nostrils, you look at their nose, you have them breathe in, you look inside the airway in the mouth and, and like, you can see where their soft palate is.

55:03Dr. Michael Grandner:You could see their tongue. You could, you can see some of these things. Um, and you know, sometimes, you know, there's a lot of sleep medicine that's using, you know, flonase and, and some of this stuff to sort of clear up the nose. But remember the obstructions almost all the time are back here in that 90 degree angle in your airway. It's not up here. It's like people think snoring is a nose based thing. It really isn't. Sometimes you get like sort of floppy nostrils or whatever, but almost entirely it's the issues back here. It's the back of your tongue. That's also why on your back, it's worse often because gravity starts pulling stuff back or like when you open your mouth and your tongue falls back and can block the airway.

55:46Dr. Michael Grandner:So, so that's, so like you can do that in the physical exam when you go to the sleep topic and take a look at your mouth and take a look at your nose and and they'll be able to see but i'll but i'll tell you it is a vast vast minority of the time where that's actually the cause people want it to be because it's an easier fixed but um that's usually not it

56:05Dr. Rhonda Patrick:it what happens if someone has untreated sleep apnea so i mean what what happens to their sleep architecture i mean first of all maybe we should briefly mention like the sleep stages but like

56:17Dr. Michael Grandner:does it affect their sleep architecture so here's the different sleep stages stage so when you fall asleep you enter stage one stage one is super ultra light sleep if you are sort of like nod off and someone bangs the table and you're like what what was that that's stage one when they say you're asleep and you say no i wasn't that's stage one it's very light um this is also where you get hypnic jerks and you if you have one of those you were in stage one sleep um totally normal medically harmless everyone gets them um so that's stage one it's a light transitionary stage then you drop into stage two now stage two when you first drop into it you're in it pretty quickly but for most of the night that's actually what you spend the most time in stage two is sometimes called light sleep i don't like that name for it i like just calling it normal sleep it's regular sleep it's vanilla sleep it is more than 50 of the night most of the work that your brain does in sleep is done in stage two.

57:15Dr. Michael Grandner:But then you drop into stage three, which is also, you know, in our world, we call it slow wave sleep because the brainwaves are bigger and slower. A lot of people also call it deep sleep. It's not called deep because it's the good one or the most restful one even. It's called deep because your arousal threshold is the highest and it is hardest to wake you up from that sleep stage because the thinking parts of your brain are largely like detached and offline. You're not thinking during that time. Your muscles are very relaxed. This is, for athletes, this is super important because this is when growth hormone is secreted in N3 sleep at stage three or non-REM stage three sleep.

57:59Dr. Michael Grandner:But it's also highly protected. even sleep deprived people are mostly getting all of the stage three sleep their body wants like it's it's actually again evolution figured this out a long time ago you it's the hardest to wake up from and it front load it front loads it into the night so usually within the first few hours you're done with it anyway so it's not a so sleep deprivation doesn't actually eat into slow wave sleeper or deep sleep very much and people so they don't need to worry about it so much. So anyway, you get into that and then you come out of that into an episode of REM. REM sleep, a lot of people have heard of now, is weird.

58:41Dr. Michael Grandner:REM sleep is just fundamentally weird. So like this is where dreams and nightmares happen. Peak blood flow in the brain is actually REM sleep. Like your brain is extremely active. It's actually more like waking than any other sleep stage. Um, but the waves are very different from waking brain waves, but it is, it is more, more like that than, than, um, than other stages of sleep. You're also, your arousal threshold is different in that it's easier to wake up out of REM sleep, but there's also a couple of other weird things that happen that you're paralyzed. relaxed you're so so if if indeed in the deep sleep your muscles were very relaxed that's nothing compared to how muscle relaxed our muscles are in REM sleep not because they're recovering but because you're actively paralyzed uh your alpha motor neurons are hyperpolarized you cannot move uh even if you wanted to that's because otherwise you'd be acting out your dreams because you think they're real at the time it's just part of your brain has its foot on the brake while it's jamming on the accelerator at the same time and that's why it's not going anywhere that's why sometimes you see twitches where it sort of breaks through a little bit but that's it um it's fascinating and then also that's also why you get sleep paralysis sometimes where you wake up at a REM sleep but you're still a little bit paralyzed but you're also conscious and that switch forgot to get flipped really briefly so anyway so you get that REM sleep you also get the eye movements which might be looking at things but might not be it's the data are very mixed where when you if you go looking to match eye movements and REM sleep to dream content you can sometimes find it, but then sometimes you can't.

1:00:14Dr. Michael Grandner:It's fascinating. What seems to be happening between deep sleep and REM sleep, there's a really, really interesting dichotomy where they're both important for different reasons, where one of the things, the main thing that seems to be happening in the deep sleep is synaptic pruning and synaptic homeostasis. And in REM sleep, there's a lot of synaptic strengthening and connection building. And those two things work in concert with each other. Think of it this way. When you're experiencing the day, you're taking in lots of experiences and information. Some of those experiences and information are important.

1:00:54Dr. Michael Grandner:You will learn from, are related to important things. Maybe they're not super important, but they're worth keeping. And a lot of those are not that important. Like that piece of equipment over there, I don't need to remember it tomorrow. It's not, I will remember it for the next few minutes, but it's not that important to my life. It will get filtered out. So what ends up happening in slow wave sleep and in the deep sleep, the, the, the experiences from the day and all those new things floating around, they sort of get sorted and the things that are important are kept and everything else gets let, it gets let to fade.

1:01:30Dr. Michael Grandner:interestingly this similar thing happens where the spaces between your brain cells actually increases and like sort of like a like actually like a like a filter the it increases and actually waste products can start clearing out of your brain is it because you're thinking parts your brain are working a little bit less and it gives it the chance to do that who knows but it seems to happen specifically during that time just very protected the beginning of the night so when you're after a few hours into the night, that cleaning out process is done. And then the cycles toward the end of the night.

1:02:02Dr. Michael Grandner:So drop down to deep up into REM and then you cycle through, but the cycles change. The second cycle, you'll have a little bit less deep and a little more stage two and a little more REM. By your third cycle, you might have no deep left. It's all just stage two and REM, maybe a little stage one interspersed in there if you wake up and the REM episodes get longer. The dreams get more interesting. That's why the dreams in the first half of the night, you probably won't remember them anyway but if you did they're usually a little more boring where the dreams at the end of the night are the cool ones the ones with the stories and the characters and then and the blurring of reality and all that and emotion in the later parts of the night like nightmares nightmares to a sleep scientist a nightmare is a dream that wakes you up that's the definition of sort of a nightmare in our world a dream that is so where the emotion is so powerful it overcomes that that process so this is the sleep stages you go through these during the night And in REM sleep, it takes those important experiences that you segregated in deep sleep, where you got rid of all the junk, kept the good stuff.

1:03:03Dr. Michael Grandner:And REM sleep, what the dreams are doing is you're witnessing the brain rewire itself using what was left. So basically the dreams are, among other things, essentially what's happening is, okay, here's what's left. How do I, what do I do with this? How is it, how does it connect to other things? How do I sort it? How do I file it? How do I process it? And the other stuff that's floating around that I was thinking about during the day, where is that? Where do I do with that? How do I process that? So dreams are, you're witnessing your brain rewiring itself, speaking to itself in its native language of ideas and metaphors and concepts and feelings and how they relate to each other without rules.

1:03:48Dr. Michael Grandner:And so that's why all the stages are important. And in stage two, that's not happening. But in stage two, it's happening. It's a lot of the recovery and repair stuff is also happening. Because in REM, your brain's active doing this stuff. And in deep sleep, your brain's also active doing this other stuff. And in stage two is when everything else gets to happen. So all the stages are important. You cycle through them. And it's about every 90 minutes. Anyone can Google that. But it's not exact. They're different across the night. and that's also why it's easier to wake up out of stage two and REM than deep sleep but so if you woke up and you remember a dream it's because you woke up at a REM that's all that's all that means so anyway how does sleep apnea affect this can I before you get to that yeah it's so fascinating

1:04:37Dr. Rhonda Patrick:particularly the part where you're talking about you know all the new information that you're learning every day you know you're during that transition between deep and and REM you kind of your brain is like sorting it out and getting rid of the things that you don't really aren't really that important to remember. And then during REM sleep, you're like using what's left and somehow attaching it to like other memories and stuff and concepts. And sometimes they don't even seem to make sense. Like you'll like.

1:05:02Dr. Michael Grandner:They may not make logical sense or, and maybe they're wrong. I mean, you're sorting through, you're, you're, you're playing stuff out. And that's also why, like, when you're awake, a person is a person, a house is a house, a car is a car. But when you're in a dream, the rules of the universe don't apply. The concept of a car can also be the concept of a person. And that person can be somebody else too. And then it was me. And then it was my sister. And then we were in this house that I grew up in, but actually, no, it wasn't. It was really a mall. Things can happen. It's because you're not bound by the rules of the universe.

1:05:39Dr. Michael Grandner:You're just bound by how your mind is organizing that information.

1:05:43Dr. Rhonda Patrick:Well, based on what you just said, I have now a new hypothesis for why we dream, but I want to ask you, why do you think we dream?

1:05:53Dr. Michael Grandner:I think we dream because evolution figured out a long time ago that you can learn a lot by reading all the words on the page, but you can also learn some really important things by reading between the lines on the page, by reading things that aren't on the page and reading the concepts behind them. But when you're engaging in the day, so the way the brain works, which is fascinating is the brain works by shortcuts. It's extremely efficient. It's extremely efficient because it makes a gazillion guesses and shortcuts without actually doing any real work, except when it absolutely has to. So for example, it's like when you take a picture, your brain doesn't store every pixel.

1:06:38Dr. Michael Grandner:Your brain stores this line here, this line here, this sort of pattern of colors and a set of instructions and fills in the gap. Your brain stores the blueprints, not the house. And the blueprints are rolled up this. The house takes up, the building can take up a whole city block. That's why the brain is super efficient. It stores, it figures out what is the minimum amount of information it actually needs. And then what are all the assumptions it needs to make to fill in all the details. And the good thing is the universe works that like when things go farther away, they get smaller. And like, there's all kinds of rules of the way that like you are you and you will be you five minutes from now.

1:07:20Dr. Michael Grandner:And I don't have to assume, make any assumptions that that can change. There's rules to the universe. And when you're engaging with the world that way, It could be really efficient, but maybe there's, maybe there's connections that aren't explicit that might help you navigate your life. So like, let's say we're having this conversation now. Maybe you remind me of somebody who's a friend of mine from like years and years ago. And, but you're not that person. My conscious mind knows you're not that person. There's no question about that. But it may change how I speak or what my body language is going to look like or how much I choose to ramble when I tell these stories like these sorts of things.

1:08:10Dr. Michael Grandner:dreaming is about i think it's about taking the actual written words on the page of life and sorting through those connections and sorting through those unspoken and and and details that don't actually exist but do and inform our life so dreams are the difference i think between memory and experience where it's it's a difference between what you did and who you are. Like the dreams are what sort of make you that person who reacts to things based on your own history that forms those connections. But I don't know, that's my ramble of what I think dreams are.

1:08:49Dr. Rhonda Patrick:Well, thank you. Okay, so back to the sleep apnea. Yeah, sorry. Yeah, because people having these awakenings where there are multiple wakings in the night, obviously this is happening during different stages. How does sleep apnea, untreated sleep apnea affect the sleep architecture?

1:09:04Dr. Michael Grandner:That is one of sleep apnea is one of the few things that can artificially reliably dramatically reduce your slow wave deep sleep because it prevents it because you can't detach because your bodies keep trying to get your attention. the other thing it does is it dramatically increases it can dramatically increase stage one um and it can also because your sleep is more shallow and you have more of these arousals and even if you don't wake up all the way your brain is still sort of moving around the other thing it can do it can dramatically reduce your REM sleep because remember what i said about muscles and REM sleep even your respiratory muscles get weaker that's why snoring is worse than REM and or worse at the end of the night because you have more REM at the end of the night.

1:09:53Dr. Michael Grandner:So if you're already in a floppy tube trying to breathe out of this floppy tube that's already having an issue and then you make the muscles go extra limp, snoring's going to get worse. So you're going to have more awakenings out of REM. You're going to have less deep sleep and your sleep's just going to be more shallow overall. So that's why people with sleep apnea, they wake up and they feel like, it's sort of like I just ate a whole meal and I'm still hungry.

1:10:18Dr. Rhonda Patrick:Right. Right. Yeah. I wonder if anyone's, or maybe you can tell me if anyone's ever looked at, because you mentioned deep sleep is really important for this, cleaning out the toxic waste. These are protein aggregates, amyloid beta 42 being one. I wonder if anyone's ever looked at people with Alzheimer's disease to see if any of them have sleep apnea, like the untreated sleep apnea is playing a role. Oh yeah.

1:10:42Dr. Michael Grandner:Untreated sleep apnea is a known risk factor for neurodegeneration, especially when it's more severe so this is the thing mild to moderate sleep apnea is a is a gray area severe sleep apnea seems very and that's 30 events or more an hour seems very reliably tied to bad outcomes mild seems like it's really only tied to bad outcomes when you also have daytime symptoms like you're you're mostly treating like the fatigue and the memory issues whatever you can still get cell death and you can get neuronal problems because you're, think of it this way. Every time you have one of these respiratory events and you're having it, you know, maybe dozens of times per hour in the night, your oxygen drops.

1:11:27Dr. Michael Grandner:And it's not the hypoxia that's the problem. This is what a lot of people get wrong about sleep apnea. It's not really the hypoxia. It's the intermittent hypoxia. So you're not hypoxic because what'll happen is you drop a few points. Most people, unless you have some other lungs, most people with sleep apnea, their O2 doesn't drop a lot for sustained amounts of time, unless you have like emphysema or something. It'll drop a few percentage points. Then your body wakes up and then it recovers. Then it drops again. Then your body wakes up and it recovers and it drops. So it's like, it's constantly putting out all these little fires all over the place.

1:12:03Dr. Michael Grandner:The fires are never burning any houses down. They're just sprouting up all over the place. But what ends up happening is all of these cells are releasing reactive oxygen species every time this happens. So you're releasing these reactive oxygen species. This oxidative stress is happening, and then it's quelled, and then it's stressed, and then it's quelled, and then it's stressed, and then it's quelled, and it's stressed, then it's all night, four days, or months, or years, or decades usually. Imagine the stress, like your cells are trying to do their job and they're constantly dealing with all this nonsense.

1:12:42Dr. Michael Grandner:Instead, imagine trying to do your job and you're constantly having to do all this other stuff. So you're not getting the recovery function that you were built for. And so your trajectory goes slightly off. So that's why sleep, not just sleep deprivation, but also sleep, untreated sleep apnea can lead to liver problems, kidney problems, brain problems, heart issues, you know, immune system problems, because all of the, every cell that relies on oxygen starts getting stressed and some of them are more sensitive than others.

1:13:15Dr. Rhonda Patrick:Right. And you're also disrupting your sleep architecture and not getting enough sleep. Right. So, so, so people with untreated sleep apnea then probably do have problems with working memory. Yeah.

1:13:25Dr. Michael Grandner:I mean, emotional regulation, motion regulation, executive function, attention. So When your sleep is poor, whether it's sleep deprivation or sleep apnea or fragmentation or whatever, the first brain function to go is vigilant attention. Your ability to maintain focus, especially when whatever you're focusing on isn't super excited. That is usually the first brain function. That's the first warning sign that something's up. And that can start creating memory issues. But a lot of the memory issues are memory issues because sleep is really important in memory. Remember, all this stuff I was talking about is all memory-connected functions.

1:14:09Dr. Michael Grandner:It's about sorting through information, processing information, consolidating information, integrating information. And if you're not able to do those things, you're operating inefficiently. You're not performing those functions. but memory but memory is also a function of attention where if you're not able to focus and attend even if your memory machinery was working perfectly you have nothing to process because it never got in there this is the thing with people taking sedating medications sometimes it impairs memory sometimes it impairs attention which also impairs memory

1:14:45Dr. Rhonda Patrick:you mean so it does that not while you're on it but like that's yeah wow um so i mean that's why

1:14:52Dr. Michael Grandner:A lot of these medications and stuff, and really anything that is impairing your ability to focus will have ripple effects to memory and decision making as well because the information you took in informs those other processes. I mean, just like most simply, you can't recall a memory that never got stored because your working memory couldn't process it because you didn't attend to it in the first place.

1:15:23Dr. Rhonda Patrick:Is this why men have a lot more attentional issues?

1:15:27Dr. Michael Grandner:Maybe. Maybe. I mean, there's a lot of untreated sleep apnea out there. And then there's a lot of other sleep problems, too. And they all, I mean, sleep does a lot. We live in this society that sees sleep as an unproductive use of time, especially people who are training, especially people who are trying to maximize their day. And sleep is not an unproductive use of time. Sleep is an extremely productive use of time. I mean, if you're working out and you're trying to get stronger, when you're working out, you're stressing the system so that it rebuilds back stronger, right? When do you think that other part happens?

1:16:06Dr. Michael Grandner:Not while you're working out. it's when you're recovering it's the recovery sleep should be your number one recovery protocol for any kind of performance driven person whether it's physical performance mental performance i mean when you sleep deprive people they we trade sleep for work all the time but you actually get less done and we've actually measured this you actually accomplish more on less time if you're well-rested and your brain is clear.

1:16:35Dr. Rhonda Patrick:Right. Okay, well, let's talk about treating sleep apnea. I know we can talk about CPAP and what that is, and it certainly works. Yeah, it's a blunt instrument. It works. Long-term adherence, maybe not so great. What do you find to be some of the best evidence-based non-CPAP interventions?

1:16:55Dr. Michael Grandner:Yeah, so the thing about CPAP is it's a blunt instrument because it's, think of it, it's just a split that keeps open your airway. It creates a pillow of air. So if your airway wants to collapse, it can't. And CPAP, it's continuous positive airway pressure. Continuous because it's blowing continuously. Positive airway pressure as opposed to negative pressure, which is sucking positive airway pressure is blowing. So it's just continuously blowing air in your airway to create a pillow of air to keep it open. That's all it is. It's a blunt instrument. If your airway wants to close, you blow enough air in there, it won't be able to close.

1:17:31Dr. Michael Grandner:But for some people, it's too uncomfortable or whatever. So there's other approaches. The one I tend to use the most, especially with athletes who are often presenting with more mild to moderate sleep apnea anyway, are what are called mandibular advancement devices. What these are, it's essentially a retainer you wear at night, mandibular, like your mandible advancement. So essentially it's a retainer that pushes your jaw forward. And in a nutshell, that's all it is. there's obviously a science behind it but what it does is it creates a little muscle tone here even when you don't want even when you're trying to rest so usually that's not a good thing but it creates just not enough muscle tone to keep you awake but enough muscle tone to keep this part of your airway open a little more than it normally would be and for a lot of people with especially more mild sleep-related breathing issues does the trick that's that's all it takes to knock out at least enough of those events so that you don't end up noticing it anymore.

1:18:28Dr. Michael Grandner:And you don't have to plug it in. You don't have to switch out your hose every couple months. Like it's a little easier. You do have to get it adjusted. And as your jaw remodels, you might have to do some adjustments. You do it with a, there's a whole field called sleep dentistry. It's sleep medicine dentistry, not sedation dentistry, but sleep dentistry, where it's about people diagnosing and treating sleep apnea with these dental devices. that's a very common one um there's a there's there's also um musculo myofacial therapy so like you can use the musculoskeletal system and essentially exercise these muscles so that they just carry more muscle tone that can work i mean there's there's very famous work done with like people who play the didgeridoo where they have to do the cyclical breathing it ends up strengthening certain muscles that even when you're asleep they're a little stronger and they can maintain a little more tone.

1:19:20Dr. Michael Grandner:So sometimes that can help, especially for more mild apnea cases. There's a device called Excite OSA where you put it on your tongue when you're awake and it sort of electrically stimulates your tongue muscle. So then you go to bed, it keeps a little, it's like a TENS unit kind of, where it stimulates your tongue muscle so that when you go to bed, there's a little more muscle tone in there. That seems to work okay. There's a new device, people have maybe seen commercials called inspire which just means breathe in but um it's it's sort of like a pacemaker that they install so it's an implantable electrical device that they do surgery but it's a sort of a pacemaker for your tongue muscle and so what it does is when it detects that your tongue is falling back it zaps it to open it up and that also for people for whom it's a candidate for that can also it's you don't have to again there's no equipment to replace but you do need surgery for it and and there's complications there sometimes but seems to work okay um there's more options now than ever and the technology is always getting better even with cpap there's more than 200 different kinds of masks out there so for people who don't like their device and don't like their mask because it's uncomfortable or whatever it's rare that i find a mask problem that can't be fixed if what you need is one of those.

1:20:39Dr. Rhonda Patrick:What about mouth taping?

1:20:41Dr. Michael Grandner:Mouth taping. So, all right. Mouth taping. So mouth taping for decades in the sleep medicine field, we've been using chin straps. Just like an elastic band, at night. For people who are snoring, where it's just mild snoring and they don't have sleep apnea, or their sleep apnea is mild, or their sleep apnea is due to them opening their mouth at night and their tongue falling back and they can breathe through their nose okay, chin straps have been great. They've been, again, used for decades. Mouth taping, I think, is just sort of the same thing where you're essentially just keeping your mouth closed.

1:21:21Dr. Michael Grandner:You're just keeping your mouth closed in a way that you can breathe through. It's special tape where air flows through fine. If the problem is that you're opening your mouth, I have no problem with it and it probably it may help those people but if the problem is that you actually have sleep apnea and if you don't open your mouth then you can't breathe like and you're opening your mouth to gasp for air then that's probably not what you want it's probably the opposite of what you want if if you need to open your mouth to breathe or else you're going to have your your oxygen is going to plummet don't do that but for like more mild storing cases or for people who are it's mild enough or if it helps you keep maybe you're using a nasal device or like or like strips or or um rhinomed makes these these nasal splints we can keep your nose open like if you're using one of those and you just need to keep your mouth closed i i have no real problem with it i just don't think it's gonna like cure cancer and save the world but i i feel like it's it gets overblown by people yeah it's gotten overblown and it sounds more like maybe

1:22:25Dr. Rhonda Patrick:for snoring than anything.

1:22:27Dr. Michael Grandner:Yeah, and if keeping your mouth closed during the night solves your problem, go ahead. But if you're hoping that keeping your mouth closed during the night will solve your problem and it doesn't, there are other options for you.

1:22:42Dr. Rhonda Patrick:Are there any, for people that are experimenting with some of these, perhaps the retainer or the myofunctional training? Yeah. We're going to get into sleep wearables soon, but like how do they really know it's working to this what's yeah it's tough the best way to know

1:23:00Dr. Michael Grandner:and this is not a perfect way um second best way to know is are you how do you feel during the day how's your energy level how's your ability to focus are you falling asleep whenever you stop moving a lot of people sleep after you they can't they don't stop moving because then they'll fall asleep they can't watch tv they can't watch a movie they can't go to a dark movie theater without nodding off. Like they have a hard time with that or meetings. They hate meetings because they have trouble keeping awake. If all of a sudden that's just not a problem for you, it's like your appetite isn't ramped up because you're starving all the time.

1:23:34Dr. Michael Grandner:You're actually getting good nutrition, so you're not starving. That's a good signal, but it's not a great signal. It's not, it's not a perfect signal because there's a lot of people where their sleep apnea seems to be treated just fine, but they still have some of those daytime symptoms and no one really exactly knows why. But it seems just means we need to learn more about what this condition really is and what it's doing in the brain when what's permanent and what's not permanent. We don't know yet. And I say that second best because the best is just get retested. And a lot of people with sleep apnea, if it's been a couple of years, get to do it to do the test again, do it while you're using your treatment to see.

1:24:13Dr. Michael Grandner:And for a lot of those devices, insurance requires you to do that anyway to make sure it's working fine. See if he needs to get adjusted. Because sometimes they need to get adjusted and they're not working great. Because your mouth changes or something. So that's one way. I mean, really, there's no other way besides either looking. I mean, you might in the future might even be easier to look at the wearable data. Check your oxygen levels during the night. Check your heart rate during the night. See if you have these spikes that you used to have. and most importantly, see how you feel the next day.

1:24:45Dr. Rhonda Patrick:All right. I kind of wanted to shift gears. We're going to get into the supplements because that's something everyone wants to know about. But before that, I kind of wanted to ask you a little bit about, you know, a lot of people have heard about sleep hygiene, the most important things for sleep hygiene. Yes. I mean, rapid fire. I do good sleep hygiene. I do all the sleep hygiene. Yes, yes.

1:25:04Dr. Michael Grandner:Or my sleep hygiene is bad. Like people talk about this all the time. But yeah, but there's a difference between sleep hygiene and behavioral sleep medicine. They're different things.

1:25:15Dr. Rhonda Patrick:Right. Exactly. I mean, obviously people need to have good sleep hygiene too. Like that's important. But like everything you were talking about with CBTI, like that's just one. Yeah. The sleep hygiene is just something that already needs to be done.

1:25:29Dr. Michael Grandner:Yeah. But hygiene is hygiene. Hygiene isn't medicine. So like washing your hands is hygiene. Everyone should wash their hands. More than once. You know, you should be. And if you're sick, wash your hands more. But washing your hands won't cure an infection.

1:25:46Dr. Rhonda Patrick:Right. But for people that perhaps don't have insomnia, don't have apnea.

1:25:50Dr. Michael Grandner:But everyone should still be washing their hands. Everyone should still be brushing your teeth. Even if you can't brush your way out of braces, doesn't mean you shouldn't be brushing your teeth. So sleep hygiene is all about setting yourself up for success or dealing with some of these more minor problems.

1:26:04Dr. Rhonda Patrick:Right. So I was wondering if you had any tips on some more advanced type of sleep hygiene. Like we know, we all know dark, cold, quiet. Rocket science, right? Yeah, rocket science. But like, are there any other sort of more advanced sleep hygiene techniques? Like, oh, maybe your resting heart rate or respiratory rate or something like that. Like people could.

1:26:26Dr. Michael Grandner:Some unconventional, the stuff, you know, if you Googled, if you Google sleep hygiene, What's some stuff that might not come up on those initial lists that would still be useful? One of the things that you'll see often on sleep hygiene lists is keep a regular schedule. Because predictability, the brain loves predictability. So if you keep a regular schedule, time itself becomes a cue. So if you want to eat lunch at noon every day, start eating at noon every day, and your body will learn to get hungry at that time. But what if you can't keep a regular schedule? Well, an alternative approach I would take is find other ways of building predictability into your sleep.

1:27:09Dr. Michael Grandner:For example, so one of the groups I do a lot of work with is Major League Baseball. And in Major League Baseball, when they're in season, they're constantly moving around and playing in different time zones and sleeping in different hotels. How do you keep regularity when you're constantly moving around? And so like for people whose lives are like that, what do you do? Well, I usually say, okay, stop trying to keep a regular schedule, but, but find other ways to build predictability. And so maybe have a nighttime routine that is highly predictable where you do the same things in the same order, even if you do them in different places in a different hotel room or whatever, especially if you can bring things with you, like bring the pillowcase with you as a conditioned stimulus.

1:27:58Dr. Michael Grandner:Use the same toothbrush, whether it's at home or on the road, if you travel a lot. Do the same things in the same order. So even if they're at a different time and a different place, find alternate ways to build predictability if time itself is not the predictable one. Another one is avoiding bright light at night. What if you can't? um so blue blocking glasses are great for this because and by blue blocking glasses they have to be orange or red most of the time some of the other ones will work some of the yellow ones or brown ones will work but if you put the glasses on and you look at something blue and you know that it's blue it's not going to do its job from a circadian perspective so some of them block blue for eye strain but that's different different thing so if you put on say orange tinted glasses and you can't see the color blue, then the environmental light is not going to interfere with your sleep in the same way because it's not going to send a daytime signal.

1:28:59Dr. Michael Grandner:Another one that even fewer people know about is bright light in the morning can help set your sleep up at night in three ways that are actually a little unconventional. number one by having that morning be a regular timing and a strong daytime signal i'm talking about daylight i'm talking about like outdoor light not just turn on light my bedroom light that's a couple hundred lux step outside it's thousands of lux of light getting that strong daytime signal in the morning at a predictable time starts a clock and that clock just like when you finish a meal you'll start getting hungry a certain number of hours later if you don't really have a really strong meal, you're sort of hungry all over the clock.

1:29:46Dr. Michael Grandner:You don't have that rhythm. But if you have a strong morning signal with some bright light at a predictable time, about 16 to 17 hours later, your body will expect to be ready for sleep. And if you can make that a little more regular, it makes, it's like, if you want to be, if you want to throw, if you want someone to catch a ball downfield and you throw it the same amount of, about the same distance every time, but you keep moving, the person downfield doesn't know where to stand. But if you stay still, they can predict where the ball is going to land. So like by setting that time, it creates, it sets you up for success by starting that timer.

1:30:24Dr. Michael Grandner:The second thing that it does is that it creates a circadian amplitude. So your circadian rhythm, this 24 hour cycle, it's like when you're on the couch in the dark all day, you don't have a strong daytime rhythm. so you don't have a strong nighttime rhythm. But if you get a strong daytime signal by being active and getting especially outside light, especially in the morning to start that curve going, by the time nighttime comes, you'll have an even stronger nighttime signal. And then the third thing that it does that even fewer people know about is, everyone knows that light at night is bad and that light in the morning is good.

1:31:02Dr. Michael Grandner:But light across the day matters where the more outdoor light, the more bright light, but it's mostly means outdoor light, the more light you get during the day, it inoculates you against light at night. Because if you got a really strong light daytime signal, you can get all kinds of light from screens or whatever at night, and it actually won't matter for most people. You can actually, you can, so you, again, it's lesser known, but because the system knows where it is, it's not looking for information anymore. And conflicting information will get thrown out. As opposed to, I don't know, it's light now, but I didn't get a ton of light during the day.

1:31:42Dr. Michael Grandner:Maybe it's daytime, I don't know. But you can inoculate yourself against nighttime light by getting plenty of daytime light.

1:31:47Dr. Rhonda Patrick:That's fascinating. I've noticed that, of course, when I'm traveling and I'm outside all the time, and then it's like being in my hotel, I don't usually have my dimming lot, my dimmers and everything that I usually have, but it doesn't matter because I am dead tired, you know, after being.

1:32:02Dr. Michael Grandner:This is humans lived for most of our existence in equatorial bright days, dark nights, relatively little seasonal variability all around, all around like the Mediterranean area and, and that part of the world. You know, we solved all kinds of problems by creating these walls and buildings and artificial lights and everything. We solved a lot of problems. We've created some new ones too, and we're still running the same code.

1:32:29Dr. Rhonda Patrick:Right. A couple of questions, follow-up questions for that. Do you think the time of morning light matters a lot? Like you wake up in the morning and like, is it like first thing you go outside and how long should you have to go outside for 30 minutes?

1:32:48Dr. Michael Grandner:Yeah, morning light is key. Earlier, the better. I mean, honestly, earlier, the better. and how much i would say 15 minutes is probably fine um 30 minutes is probably better like a morning walk or a morning run is actually probably perfect um and because what's happening it's not only that daytime city the other thing it's doing and we'll talk about this more when we talk about supplements but melatonin so melatonin naturally your natural melatonin will drop in the morning down to like almost from its peak to almost nothing light suppresses melatonin naturally that's what it does and so the early if your melatonin is still kind of high and it's dropping by getting that light you accelerate its ability to drop it's like coffee yeah kind of and actually this is also why I don't recommend that people caffeinate as soon as they wake up.

1:33:50Dr. Michael Grandner:I recommend people wait an hour because if you caffeinate as soon as you wake up, the amount of adenosine that that caffeine is blocking is still very low. You haven't produced enough yet to really have much of an effect. But if you drink caffeine as soon as you wake up in the morning and you feel more alert, it's probably your sleep inertia naturally coming down and your melatonin naturally getting blocked and you're feeling the effects of it and you're attributing it to the caffeine when actually you could have skipped the caffeine you probably would have felt mostly the same it's just the caffeine is still having effects later but you've missed the caffeine peak so like actually you time the caffeine a little bit later so you're saying you want to use the

1:34:34Dr. Rhonda Patrick:caffeine for you know when when you basically more need it when you're working maybe yeah

1:34:40Dr. Michael Grandner:Yeah, use the caffeine. So adenosine builds across the day and you're at your lowest levels as soon as you wake up. Why are you going to block something that you're, you know, if caffeine works mostly by blocking adenosine and your lowest levels of adenosine are first thing in the morning, why would you recommend someone block it first thing in the morning? Wait till it accumulates a little bit, especially if you, for most people, that natural sleep inertia will wear off within 10 to 60 minutes as soon as they wake up. and my favorite way to tell this story is like, you know how you wake up and you smell the coffee and then even that kind of perks you up a little bit?

1:35:19Dr. Michael Grandner:They say, yeah. And I say, did you know that there's a term for that? And they're like, oh, there is? And I say, yes, it's called placebo. And then so they laugh and like, what do you mean? I'm like, coffee doesn't work olfactory. It doesn't work through the nose. If you smell it and you start perking up, it's because you're predicting what its effects are going to be before you even ingested it. Which means when you're drinking that coffee, it's giving you a placebo effect as much as it's giving you anything else. So like, wait a little bit because you don't need it.

1:35:53Dr. Rhonda Patrick:That's why I drink decaf coffee at 11 a.m. and I feel like it's totally working and I'm totally fine with that placebo. Right, right, right.

1:36:01Dr. Michael Grandner:Because you had it in you all along.

1:36:03Dr. Rhonda Patrick:Right. So it sounds like the morning routine would be wake up, go outside. Get some water. You probably dehydrate a little bit. Get some water. Go outside, whether you're taking your puppy or dog out. I just got a new puppy. Going for a run. Yeah. But go outside for at least 15 minutes. Yeah. And then, you know, wait a little bit. Then you make your coffee. Obviously, there's some people are kind of rushing to get to work, but you can drink your coffee in the car on the way to work. Yeah.

1:36:30Dr. Michael Grandner:Or wait till you get there.

1:36:31Dr. Rhonda Patrick:Or wait till you get to work.

1:36:32Dr. Michael Grandner:Yeah.

1:36:32Dr. Rhonda Patrick:Okay. I'm going to try that.

1:36:34Dr. Michael Grandner:Yeah, I mean, and also you got to remember, caffeine doesn't reach its peak effects for at least like a half an hour after you ingest it. So, and then it'll last for a few hours afterwards. So if you want to, if you.

1:36:48Dr. Rhonda Patrick:Wait, say that again. So it doesn't reach its peak until 30 minutes later.

1:36:52Dr. Michael Grandner:Until about 30 minutes later. So if you feel it sort of right away, that wasn't sort of the effect of caffeine.

1:36:57Dr. Rhonda Patrick:Right, okay.

1:36:58Dr. Michael Grandner:And then, yeah, and then it'll trail off. Like it'll have some effects as it builds. So it's something there, but it's actually the peak effects of caffeine for alertness or about a half an hour in. So that's why what a lot of people will do is they do the whole calf nap or the nappuccino or whatever they call it, where like they drink the coffee, take a nap for 15 to 20 minutes, wake up right when the coffee starts ramping up and then they then they go. I've never heard of that. Oh, yeah, it's a thing. I mean, I don't do it, but not because I have any moral opposition to it, but it's a thing where because they leverage the delay in the caffeine reaching its effectiveness.

1:37:37Dr. Michael Grandner:So and they and they use that to limit their nap time. But we can talk about strategic napping. Yeah, let's do that.

1:37:43Dr. Rhonda Patrick:OK, well, let's talk about supplements. I mean, obviously, we're talking about behavioral interventions being absolutely the best.

1:37:49Dr. Michael Grandner:the most likely to actually help okay that's the that's that's the way i think about it it's like they don't always work and other things may sedate you more faster but they're the things that are most likely to solve your problem long term with the least negative effects what about

1:38:06Dr. Rhonda Patrick:you know you talk you were talking about early light exposure um the timing of like going to bed at the same time versus waking up in the morning at the same time how does that play a

1:38:16Dr. Michael Grandner:I would say focus more on starting the morning than timing your bedtime at the same time, because the morning will set up the evening and usually people have more control over that anyway. and the way I like to think about the evening is I think about sleep as my commute to tomorrow where instead of thinking so if you had to go to work you don't think well I'm going to wake up when I want I'm going to do everything I need to do around the house pay all my bills do all the dishes do all my chores and then when I happen to be done hope that I make it into work in time and then like, shoot, I ran out of time.

1:39:00Dr. Michael Grandner:Like that doesn't work. Instead, what you do, you think, what time do I need to leave the house? How long is it going to take me to get ready? What do I want to do in the morning? What do I want to go for that walk or whatever? What time do I need to wake up to make that happen? And that's how we should be thinking about sleep because then you should be thinking, keep going and think, okay, how much sleep do I want to get? How much time do I need to budget with a couple of awakenings during the night or whatever that's normal to get that amount of sleep. When do I want to be in bed to be able to fall asleep when I want to be able to get all the sleep I need so that I wake up naturally when I want to be woken up, fully refreshed.

1:39:39Dr. Michael Grandner:So when do I need to start winding down? So you think backwards. And so the nighttime routine, regularity I think is important, but I think more important is thinking strategically about it and start thinking based on my goals for tomorrow, When do I need to be up and when do I want to go to bed? But the morning routine building regularity will help set you up to be tired at the time you want to be. But going into bed at a regular time when you're not ready for sleep, that's bad stimulus control. That'll set you up for problems later. So that's also why I don't stress the nighttime getting into bed.

1:40:16Dr. Michael Grandner:Because what if you're not ready? If you're not ready, if you're not hungry, don't eat. Like if you're not ready, don't sit there and count sheep for an hour. that'll just make you stressed. So that's why I focus the regularity on the morning.

1:40:30Dr. Rhonda Patrick:So you think people should try to have a consistent wake-up time in the morning?

1:40:34Dr. Michael Grandner:It's possible, but not everyone can. And maybe your wake-up time during the week is uncomfortably early and you want to sleep in on the weekends. I got no problem with that. Regularity is good, but if it means you're getting a little bit of extra recovery on the weekends, it's a trade-off. There might be a positive there.

1:40:56Dr. Rhonda Patrick:But if they do, if they are waking up early in the morning during the week, then you'd think they'd be building up enough sleep pressure to fall asleep earlier.

1:41:04Dr. Michael Grandner:Right. You'd think. And it's just that they have insomnia. And if they that assumes they're giving themselves permission to go to sleep at a time that is ideal for them. A lot of people don't give themselves permission to go to sleep. You know, we have this whole concept of revenge bedtime procrastination where you're only taking you're taking revenge on your own day. right and your own resentment of your life being too full of junk and crap to have no time for yourself and it's tough and and the way the way i put it though is i i think you're cutting off your nose to spite your face at that point when people say i know i should be going to bed earlier but you're asking me to give up the one hour in my day that's mine that i need for my own mental health.

1:41:52Dr. Michael Grandner:What do you say to that? And I say, you're right. I am not going to ask you to give up time. What if I could give you some more of your time back? What if the reason why that is the only hour in your day that you have is because you could be more efficient and productive during the day and you won't need as much buffer time on stuff if you were a little sharper. and actually that's what the data show that actually instead of asking you for time. So we did this, I went to the university and to the division one athletes across all the different sports. And I said, look, I'm not gonna ask you to sleep more but if you want to fall asleep faster, here's how you do it.

1:42:34Dr. Michael Grandner:And we'll get into what I said but I'm sure you're gonna ask. How do you fall asleep faster if you want to? If you need to wake up early, how do you fall asleep earlier than your body wants to? How do you get moving during the day? Let me teach you how to do this so that you become your own sleep expert. And if you want to get more sleep, here's what some of the benefits would be if you're not getting enough, especially in students, especially in athletes. But I'm not going to tell you what to do. Like, I don't know your life and I can't control your schedule, but here's how to make an informed choice.

1:43:04Dr. Michael Grandner:On average, time in bed increased by 40 minutes. Total sleep time increased by over an hour. Most of the time they needed, they were already in bed anyway. And they gave up those extra 40. I didn't ask for it. They found what was useful for them. And actually, they were rating themselves as their grades were better. They were more productive. Their social life was better after they were sleeping better.

1:43:33Dr. Rhonda Patrick:And so what did they do? What was the protocol?

1:43:36Dr. Michael Grandner:So first of all, I hammered stimulus control. I normalized some things like, you know, what would happen is they would freak out when they wake up. during the night and they have trouble getting back to sleep i said don't freak out just take a break five ten minutes get a drink of water whatever go back to bed and like reducing that performance anxiety hammering stimulus control um wind down routine stuff like dimming lights um gave them blue blockers you know we'd like and in terms of morning routine talked about getting light first thing in the morning um a lot of that basic stuff but really it was and it also coupled it with some education of, talked about how different sleep stages work, talked about how sleep works, not as like a, this is sleep one-on-one class, but it's more of a, look, you're an athlete.

1:44:25Dr. Michael Grandner:You're trying to do all this stuff with your body and have it in peak condition and understand what's going on to the hood. Let me teach you what you need to know about what we know about how the system works so that you can make the most informed choice that you can make. Teach them about how circadian rhythms work. Teach them about how sleep propensity builds across the day dissipates. And when they're awake in the middle of the night, it just because they haven't built up enough sleep pressure yet. So you got to give it a little bit of time before you can go back to sleep. Like teach them how these processes work so that it demystifies it a little bit.

1:44:55Dr. Michael Grandner:So even if they have an awakening, it doesn't become a stressful one. And if they want to fall asleep earlier, they can learn to program that in and create those conditions. We hammered the don't lay down in bed. So like if you're college students, their bed is also their couch and it's also their desk and it's also their whatever. So we had a sleeping part of the bed, wake part of the bed. You know, when you're in the wake part of the bed, you're sitting up, you know, you can lean back, but you're not going to lay down with your head on a pillow unless you're planning. Like, so we separated these things out, worked beautifully.

1:45:26Dr. Rhonda Patrick:How many weeks?

1:45:27Dr. Michael Grandner:We did it for a semester. So it was like, it was like eight to 10 weeks.

1:45:31Dr. Rhonda Patrick:Eight to 10 weeks. That's amazing.

1:45:32Dr. Michael Grandner:Yeah, that's like typically six to eight weeks is normal. That's usually even people who come in and say, my sleep is terrible. Often, you know, and I'll say like, look, it's extremely unusual for someone to walk in unless they have some other major medical complication that's getting in the way that within six to eight sessions, they're usually sleeping way better. Often by then they're like, you know, this isn't my problem anymore. And I'll say, you know where to find me if you need me.

1:46:00Dr. Rhonda Patrick:Well, that's awesome.

1:46:01Dr. Michael Grandner:Yeah.

1:46:01Dr. Rhonda Patrick:Okay. Well, let's talk about, let's talk about a couple of supplements. Yeah. I definitely want to get into jet lag a little bit later, but obviously the top of mind supplement people think about when they think about sleep, they think melatonin.

1:46:13Dr. Michael Grandner:Melatonin. So melatonin is a hormone. It's a very old molecule. It's in plants. It's in other stuff. It's not a sleep hormone except by association. Melatonin is the hormone of darkness. Melatonin is a nighttime signal. You produce it at night. A great example of how it's not a sleep signal. It has no sedating properties whatsoever. Melatonin doesn't. You give melatonin to a nocturnal animal, it wakes them up because it's a nighttime signal. To the degree to which your body gets a nighttime signal and that makes you sleepy, yes, it can promote sleep. Melatonin can promote sleep in humans for that reason.

1:46:57Dr. Michael Grandner:It can help you fall asleep faster. It can help you stay asleep. It can help you sleep more restfully because it's strengthening that nighttime signal. That's what it does. It's also why it is almost universally useless for insomnia. Because if you have a conditioned arousal, remember, now everyone knows what conditioned arousal is. If you have a conditioned arousal, your body already knows it's nighttime, still can't sleep. so taking melatonin is almost never going to work to treat an insomnia condition but if you don't have conditioned arousal if you don't if you just need a little bit of a boost actually melatonin probably works just fine it's also you produce it natural during the day your levels are almost non-existent they start rising in the early evening they pick up they peak during the night and then they drop off right about the time you expect the sun to come up and light suppresses it so even if you're at peak levels during the night turn on a bright bathroom light plummets then you turn the off the light as long as the clock still thinks it's nighttime it'll regenerate them again might take a delay especially the older you get the less flexible the system is, but that happens naturally.

1:48:17Now, some people, when they take melatonin,

1:48:23Dr. Michael Grandner:they might be taking the wrong dose at the wrong time. So the way we started using melatonin as a treatment for something was our natural rhythms are about 24 hours. So some creatures, they use light from the sun to, so like when you put a blanket over a bird's cage, they'll go to sleep because their natural melatonin starts spiking as soon as it's dark. And then it suppresses as soon as it's light. Humans, we have mammals, we have our own internal clock that guesses what time it is. So we could be in a cave and still keep a roughly 24 hour cycle. Otherwise the systems in our body would get all out of crack.

1:49:01Dr. Michael Grandner:But it's not precise 24 hours. It's a biological clock that is slightly longer than 24 hours in almost everybody. Not quite 25 hours, but somewhere in that gray zone. But what happens is, so it's like, if you want to, if every day of your life is a string and every day is going to be 24 hours and you had to produce the string to be the exact same length, what you do is you make all the strings slightly long and trim the edges off. That way you can guarantee they're all going to be the same. And that's what physiology does to your rhythm. It makes it slightly longer than 24 hours, then resets it in the morning to start it all over again with the morning light as it hits the reset on the rhythm.

1:49:42Dr. Michael Grandner:So blind people who can't see light, they get this. Their natural rhythm never gets reset. So it's slightly more than 24 hours. So if you were living a slightly more than 24-hour rhythm, you woke up at 6 o 'clock today, you'd wake up at 6.30 tomorrow. You'd wake up at 7 the next day. And then eventually you're waking up at 2 in the afternoon. It's miserable. And then it cycle around. It's called non-24 hour circadian rhythm disorder, where you just can't reset your rhythm with light. They found is you give someone a third to a half a milligram of melatonin in the evening and a blind person fixes the whole thing.

1:50:19Dr. Michael Grandner:Sends the nighttime signal at the time that it needs to see it and the system responds beautifully to it. You're not trying to replace their natural melatonin. That half milligram dose is the signal. It's a clock signal. It's what tells your body, hey, nighttime now. And if you give it a little bit before you're naturally going to start producing it or right around that time, it sends the signal a little early. So it's sort of like your body responds of like, oh, I didn't realize it was nighttime yet. Better get started. And it starts your own natural process a little early. So that half milligram dose in the evening, like five hours before your bedtime, that's the evening signal where your evening is hasn't even really started yet.

1:51:08Dr. Michael Grandner:You're giving your evening a little bit of boost. So that's, so it's basically like jet lagging yourself where you're, you're telling your body it's nighttime before it's actually nighttime. That's not what you're really telling. You're telling it it's evening before it's actually evening, like right around dinner or like usually two to three hours before your typical bedtime is when you start producing melatonin. melatonin, you give it a couple hours before that, it's in the zone where you're looking for it. Like if you're in the middle of the day, your body's not looking for it. It's in the zone where your body's looking for it and you can confuse the system and think it's later than it really is.

1:51:41Dr. Michael Grandner:That also means you'll wake up a little earlier because the whole thing got shifted. Same thing is if you take that low dose melatonin as soon as you wake up in the morning, that drop gets delayed a little bit so it ends so that ball lands a little further along than it expected to so your day started a little bit later than it thought it was going to so you'll stay up a little bit later the next night so you can use that half dose half milligram dose as a clock shifting dose so then why is everything over the counter like five and ten well a people think more is more and sometimes more is less, especially with melatonin.

1:52:20Dr. Michael Grandner:If it's just a nighttime signal, more is it more. Five, you can take closer to bedtime. That's a little more of a sleep promoting dose where it's more of like a, hey, body, you idiot. If you didn't know it was nighttime already, I'm going to scream it in all capital letters for you and get your act together. And it'll boost that whatever natural sleep drive you have that isn't interfered with by insomnia. It may boost it. So people who take that three to five milligrams with it, you know, closer to bedtime, it can have that sleep promoting effect. Not because the melatonin was sedating, was it sort of got, was that strong enough signal to kick you into gear a little bit.

1:53:02Dr. Michael Grandner:Now, a lot of times people will feel groggy in the morning with it. That's because you just couldn't metabolize it fast enough that you gave yourself such a big dose. You already were naturally producing it anyway. So you were, you were, oh, you overfilled your bucket. And so by the morning, you still have melatonin floating around, backfiring. So now you're telling your body it's nighttime when it's daytime because you couldn't get rid of the nighttime signal fast enough. And it had built up over time. So often when I say if you're taking melatonin at night and it's helping you, but you're feeling groggy during the day, cut your dose in half.

1:53:38Dr. Rhonda Patrick:And then there's the other problem. There was like a few studies have been published where, I mean, almost all these melatonin supplements that are out on the market have huge variations. Some of them have like 100 times more melatonin than it's actually what's on the label.

1:53:53Dr. Michael Grandner:So that's the thing where there's a lot of them out there that can be unreliable, especially from some of the manufacturers that don't have the good quality control. It is regulated by the FDA. It's just, you know, there's just not enough money for enforcement. So there's not a ton of enforcement. But any of the larger companies, they're actually going to have pretty good quality control. And they are, if you look at those, the ones that are the bigger companies that are on the shelf, they're almost always right on target for what they should be. And I say that because what's on the bottle is actually not what's supposed to be in the bottle.

1:54:33Dr. Michael Grandner:And a lot of people don't know this, but the bigger companies that have the higher quality and the higher quality control are following the law. And the law says that the amount on the bottle has to be within a certain percentage of the amount that's in the pill at the expiration date. That is the definition. So if you have a supplement that's sitting on a shelf with a three-year expiration date, and you're working with a company that's trying to do everything really well and correctly, your chemists and food scientists have to calculate exactly how much they have to put in that pill so that as it degrades naturally over time, how much will it degrade to the point to hit the target two to three years out?

1:55:21Dr. Michael Grandner:That's actually the calculation they're making. So in melatonin, that answer is usually 30 to 50%. So when you buy melatonin off the shelf and it says five, it's probably closer to eight, seven or eight when you buy it. And then two to three years later, yeah, it's five because they did their job. They followed the law and they had really high standards in their manufacturing. But it's still, you're probably taking a much, you're probably taking a higher dose. And they can't tell you because the way the law is written, it's like if you tell people what's in there is different than what's on the bottle, you've now changed the label and now you have to meet that.

1:56:03Dr. Michael Grandner:It's complicated. The law was written in the way that I think they didn't foresee this problem. But people need to know that actually, if it's a good brand, it's actually going to be higher than what's in the bottle because they're going to calculate in the overage needed to be able to degrade to the point that it hits the target. Isn't that crazy?

1:56:24Dr. Rhonda Patrick:People don't know this. So less is more for sure. Yeah. That's also why I say if you're still having effects, actually your dose might be too high. Just cut it in half.

1:56:31Dr. Michael Grandner:um the other thing that's worth mentioning about melatonin is it's actually a very potent um cellular repair molecule those effects don't really seem those defects seem to be stronger at the higher doses actually like closer to the 10 um but that's where you get more side effects too so most people don't need it like we have an immune system melatonin as a recovery molecule is a very old molecule uh our immune system probably does does the trick but that's also why when people take melatonin supplements, they get sick less. It was seen as an adjunct treatment during COVID that didn't conflict with any of the other treatments, but actually made illness recovery better.

1:57:11Dr. Michael Grandner:Melatonin is a really cool molecule. It's just misunderstood.

1:57:15Dr. Rhonda Patrick:Yeah. It's a hormone. I think it's regularly like 500 different protein encoding genes. Yeah.

1:57:20Dr. Michael Grandner:It is a hormone. What other hormone do you just like buy over the counter and sort of unlimited amounts? Like it's weird.

1:57:25Dr. Rhonda Patrick:Right. So when it comes to melatonin, I know there's like a lot of questions I get from people is, well, if you're taking melatonin supplement, are you going to then stop making endogenous melatonin?

1:57:37Dr. Michael Grandner:Yeah, there is, to my knowledge, there is no evidence that that actually ever happens, to my knowledge. It's a worry, but melatonin is so old that you're going to produce it. The way to stop producing natural melatonin would be aging. That reduces it. But to my knowledge, there is no data that shows that continual use of supplementary melatonin changes or reduces your ability to naturally produce it at night.

1:58:09Dr. Rhonda Patrick:What about, and that's also what the conclusion I came to, what about the ability to like your melatonin receptors?

1:58:16Dr. Michael Grandner:Is there remodeling? I don't know. I haven't seen anything that's concerning in any way i i just i just haven't like no one has there's no finding that's a that when when people have looked it doesn't really seem to be doing that it's it doesn't seem to change the same way other receptors do again it's a very old system it's an old built-in system that that isn't that is meant to adapt that that is meant to be able to deal with flexibility rather than respond to it super quickly um i haven't seen anything either but yeah there is

1:58:51Dr. Rhonda Patrick:I haven't seen anything either.

1:58:53Dr. Michael Grandner:Maybe findings will come out in the future when people look at it. This is the other thing that other people need to know. This is about supplements in general. That research on supplements is scarce, especially really well done research in highly controlled conditions. Not because, to be honest, not because there's any sort of conspiracy to keep the information out of people. It's just that research is extremely expensive to do. My day job is in research that research is extremely expensive to do in pharma it's because you know you can do some of that basic stuff um with with research and pharma has the deep pockets to do this and the reason they do is because they have ip racked around this why drugs are so expensive because it costs about two billion dollars to bring a drug to market and 10 years at least in supplements you don't have that IP protection.

1:59:46Dr. Michael Grandner:You can't patent a supplement that naturally occurs. You might be able to patent a molecule as an additive or something, but that's extremely rare in the supplement space. So supplement companies have no, they can't, A, they can't charge what drug companies can charge. They don't have the deep pockets to pay for this research. They don't have the IP protection around it, which would incentivize them. Why would a manufacturer spend$2 million on a clinical trial that their competitor could just take the results from and claim as their own? Like, and NIH who funds, I mean, people need to understand how absolutely fundamental NIH is to all health research in the U.S.

2:00:25Dr. Michael Grandner:I mean, every bit of health research in the U.S. absolutely depends on a healthy NIH. and NIH, as much as they fund whatever, I mean, they're dramatically underfunded already compared to the need, but supplements don't seem to ever rate as high enough priority where like they're dealing with trying to cure cancer and Alzheimer's disease and other sleep apnea and other major health conditions and supplements by definition don't treat medical conditions. They promote health, but they don't treat - They might prevent, help prevent. They might, could, they could. It's just, it's, it's. People don't understand how competitive grant applications are for NIH.

2:01:13Dr. Michael Grandner:And so to survive that competition, studying supplements is really hard. So that's why like the, the deep pockets don't have as much of an incentive to study it. So it's not that, it's not that anyone's trying to hide the research. It's that it's really expensive to do and no one's stepped up willing to pay for it.

2:01:29Dr. Rhonda Patrick:Yeah, it's why there's not a lot of high quality studies out there on supplements and you always have to take it with a grain of salt. Right. And it's like.

2:01:36Dr. Michael Grandner:It's not the supplement's fault. It's not the company's fault. It's just, you know, I would love for there to be more investment. Or if there was a public outcry that like, look, we need these studies. Yeah. Hopefully we'll get them.

2:01:48Dr. Rhonda Patrick:Well, with that said, are there any other, I mean, I've heard of a variety of supplements like magnesium, lavender, glycine, L-theanine. any, I mean, moderate evidence that some of these were.

2:02:00Dr. Michael Grandner:So a lot of them have evidence that they're definitely not nothing. None of them have beaten placebo to treat insomnia. The closest that came was valerian. But when you pool the data, it still doesn't beat insomnia, placebo for insomnia. But it is sedating. It can be calming. Magnesium also does seem to promote sleep in a number of different ways, actually more than just one way um doesn't treat and doesn't usually treat insomnia but it can help promote sleep glycine also great data on glycine showing that people who take glycine it can help fall asleep help stay asleep a little bit better a lot of these supplements it can help you fall asleep and stay asleep a little bit better some of them don't do anything to sleep per se but they work in terms of calming.

2:02:52Dr. Michael Grandner:So calming isn't sleep inducing though for people who don't have insomnia, because if you have conditioned arousal, you can be calm and still not sleep. But for people for whom a little bit of calming and relaxation is really helpful, that's where things like the L-theanine and some of these other more calming things, like the chamomile and some of that stuff that can be calming can actually be helpful. Even if they don't actually technically do anything on the sleep side. Other things that can help promote sleep, things that have anti-inflammatory and anti-oxidating properties. Remember, your body's doing a lot of that healing at night.

2:03:28Dr. Michael Grandner:And so if you can help give it those raw materials. So this is where there's certain supplements out there that actually seem to have some of those anti-inflammatory properties. And when you take them, you might be sleeping better. I mean, when people take ibuprofen, they can also sleep a little bit better because like it, it, those awakenings and arousals due to discomfort might be just a little bit less and might help you sleep through the night a little bit more. There's a few things like, but that's the difference where, where just because something is not nothing doesn't mean it is a cure all.

2:04:01Dr. Michael Grandner:It's like not black and white. A lot of these supplements can be helpful. I recommend them for all of the things that they do, but I also recommend them for none of the things that they don't do. And I think there's a gray area that I think people have a hard time wrapping their head around. Yeah.

2:04:17Dr. Rhonda Patrick:No, I'm definitely not talking about insomnia. And, you know, some people just like to have a little bit of help. And glycine is interesting. That's what I've been interested in. Have you seen any of the thermal regulation stuff on that?

2:04:29Dr. Michael Grandner:I haven't seen the thermal regulation stuff.

2:04:31Dr. Rhonda Patrick:Poor body temperature?

2:04:32Dr. Michael Grandner:But it seemed, so it's unclear to me whether that's a cause or an effect.

2:04:38Dr. Rhonda Patrick:Right.

2:04:38Dr. Michael Grandner:But either way, does it matter if that's what you're taking it for?

2:04:42Dr. Rhonda Patrick:It's more of a GABA, like more of that inhibitory.

2:04:46Dr. Michael Grandner:Yeah, it does seem to promote those inhibitory. So a lot of people who are taking workout supplements at night for recovery, like take one that's, if you're taking aminos at night, branch chain amino acids in general could be good for recovery, especially after training. and if it's got some extra glycine in it, all the better. But if it's got a lot of glutamine in it, you want to not be using that because glutamine is activating. And so, I mean, I've had athletes I've worked with who like complain, complain about their insomnia. Turns out they're taking these nighttime supplements with a whole bunch of glutamine in it.

2:05:20Dr. Michael Grandner:And that's sort of what's counter, that's what's getting in their way. So it's not just about supplements at night that can be helpful. It's avoiding stuff that can get away, like B12. B vitamins are good to take at night because they can help with recovery. B12 helps boost the ability of light to suppress melatonin. You don't want to take that at night. You want to take that in the morning. B12 is great in the morning because it can help wake you up a little more for a bunch of reasons, including its ability to help light suppress melatonin. But you don't want it at night when even a little bit of light can start getting in the way.

2:05:53Dr. Rhonda Patrick:Fascinating. So take your multivitamin in the morning, not in the evening. Yeah. Yeah.

2:05:56Dr. Michael Grandner:I have this dream one day of having like an AM vitamin and a PM vitamin where like some stuff might be better at night. Like you want to, if sleep is all about recovery and repair, put those raw materials in play at the time you want to use them. If they're going to degrade or you could just take them in the morning if they're going to hang out all day anyway. But yeah, I mean, some is some, that multivitamin you might want to take in the morning.

2:06:21Dr. Rhonda Patrick:okay let's talk about substances that affect sleep yeah this is another one i mean a lot of people will get into cbd because that's like the biggest thing now that i mean i just hear it in peer groups i hear it on the internet i hear it and just everywhere in the audience yeah um but kind of even a step ahead of that you know was was marijuana right like which has cbd and thc right they're two separate compounds right and so i kind of want to start maybe with thc yeah like

2:06:52Dr. Michael Grandner:if someone's doing the whole yeah thc is a good place to start because thc seems to have pretty reliable effects on sleep surprises nobody who's used it when i say that but it can help you fall asleep can help you stay asleep can help you feel more refreshed thc does however there's three downsides of THC. Four if you're an athlete. One is that the sleep promoting effects fade over time. So often it works great for a period of maybe a few weeks, but then you'll notice that it stops working in the same way. And so people start escalating doses for that reason. And so maybe, you know, it's short-term benefits and long-term benefits are different.

2:07:41Dr. Michael Grandner:That's number one. Number two, in a lot of people, that doesn't seem to be everybody, but in a lot of people, it can be a very potent REM sleep suppressor. A lot of people don't realize that antidepressants also, most antidepressants are potent REM suppressors. Like you can knock out 50 to 75 % of all your REM sleep of the night by taking like a Lexapro or an SSRI or THC.

2:08:06Dr. Rhonda Patrick:Does that affect memory? Because isn't REM important for incorporating? Isn't that weird, huh?

2:08:11Dr. Michael Grandner:Like, why is it, if REM sleep is so critically important, and we'll get to this when we talk about sleep stages on wearables, if REM sleep was so critically important for what it seems to do, why is it that when all these people who are taking antidepressants are not falling down, not being able to remember things? Don't know. My hypothesis is these processes are way more complicated than we realize. And when we see a decrease in REM sleep, we're not seeing a decrease in the process itself. We're seeing a decrease in an effect of the process. And in a down, like REM, what we call REM sleep as these physiologic signals and brainwave patterns, maybe it's downstream of whatever's happening under the hood.

2:08:55Dr. Michael Grandner:And just because you don't hear the downstream signal anymore doesn't mean the thing wasn't still happening to some degree. But then again, with depressed people, if their ability to process information is fundamentally flawed, and because you're, and I mean this, like when people are depressed, they see a neutral stimulus, it feels negative to them. and it makes their life more miserable, well, stop processing things emotionally then. Like, at least coming to neutral and blunting is better than, it's like, who knows? The answer is who knows? Is that a benefit? Is it impacting memory? Might that be part of what's going on in terms of THC's impacts on brain neurochemistry and some of the negative effects?

2:09:33Dr. Michael Grandner:Maybe. I don't think anyone's been able to take the time to study that pathway. So anyway, that's the second one. The third one I just did want to mention is when you stop using THC, you get, just like any kind of sedating medication, you get an insomnia rebound. And with that insomnia rebound, because it was a REM suppressor, you get a REM rebound. So you can get vivid nightmares and like really unpleasant dreams and the worst insomnia you've ever had. So then you're like, I need to take this or else my insomnia comes back when the insomnia was a withdrawal symptom. So you could become dependent on it.

2:10:11Dr. Michael Grandner:Well, psychologically, so where it's just like you get that tolerance. So like you're taking it and you're sleeping sort of normal. And then when you take it away, your insomnia ramps up, but then it'll usually fade back to baseline. It was just a reaction. But you don't know that. You think that you're using the THC to keep the bad insomnia away when really whenever you pull that Band-Aid off, it's going to hurt for a little bit, but then it'll be fine. And then the only other thing I was going to mention for athletes is the increased injury risks due to THC because of the amotivation and the coordination stuff that you get sometimes that like whatever your sleep problem is, if you're thinking of using THC for it, there's probably a better option that's less harmful.

2:10:55Dr. Rhonda Patrick:But is that if they're using the THC at night, is it the THC directly affecting the coordination or is it the indirect effect of REM sleep?

2:11:04Dr. Michael Grandner:All I know is that people who are using it more, I mean, we don't have great data on the timing of use. That would be a cool, cool study to do. But it just does seem to be that there's more injuries. There's more, there's the, there's the daytime amotivation. There's the, and amotivation being like, not just like, you know, the stoner sitting around like, oh, I don't want to do anything all day. But if you're an athlete on the field, you need every split second to make these choices, to be paying attention, to be thinking ahead and all that stuff. And if you've got just a fraction of a piece of a cloud there, it gets in your way.

2:11:41Dr. Michael Grandner:And one wrong step could be twisting something. It's just one of those things of like, there's probably a better option out there. I mean, I'm just saying. But that's THC. So THC does have effects on sleep. They could be relatively short term. they could produce a rebound when you stop taking it and there could be rem effects.

2:12:05Dr. Rhonda Patrick:But having rem effects doesn't sound like it's a good thing though.

2:12:09Dr. Michael Grandner:Maybe not. Is it the same rem effects as you get with antidepressants? Not clear. It's murky. The literature is murky. You got to remember until very recently researchers were almost not even allowed to study it because it was a scheduled substance and it was federally illegal. So anyone who takes federal money for research, and again, NIH is the lifeblood of all research, you were essentially forbidden from even studying it. Now we can sort of start and that work is being done. Canada started it because they legalized it first. So they're actually doing a lot of really great THC research up there.

2:12:44Dr. Michael Grandner:Watch the space next 10 years. I think more stuff is going to come out.

2:12:48Dr. Rhonda Patrick:Okay. What about CBD?

2:12:50Dr. Michael Grandner:CBD, much more murky of a story. CBD is a legit molecule, especially in terms of the things that it does, but the sleep data from CBD are extremely murky. About half the studies that have used CBD have shown that it could benefit sleep. The other half don't. Some of them actually show that it makes sleep worse. The dose and the timing seem to matter. The individual differences seem to matter. It also seems, so it's one of those things where like if I have a patient who says, should I try this? I would say, I won't have any objection to you doing it. I just don't have super high hopes. And to be totally honest, most of the patients that I've had say, yeah, didn't really help and, or maybe helped a little bit.

2:13:38Dr. Michael Grandner:It's also the difference between relaxation and sleep promotion. So if you have insomnia, a little bit of relaxation isn't going to be enough. But if a little bit of relaxation is all you need, maybe it'll help.

2:13:49Dr. Rhonda Patrick:What kind of dose and timing are we talking about here?

2:13:53Dr. Michael Grandner:I don't know. Is lower dose better? Yeah, it looks like there's a sweet spot for dose. You can have a dose that's too high, which can actually make sleep worse. But then again, if it's too low, then it won't be doing anything. I don't know all the doses of the different studies. That's also why there was such murkiness in the literature where people are using different doses at different combinations at different times of day. I don't have any clear answers about CBD, except I would keep an open mind with it, but expectations in check.

2:14:28Dr. Rhonda Patrick:How does it work? Does it just reduce anxiety? I mean, is it like an L-theanine kind of thing?

2:14:34Dr. Michael Grandner:See, it's from a sleep perspective, it doesn't, I haven't seen any strong data that shows that it does much to sleep-wake regulation itself, that its effects on sleep are usually secondary through anxiety and stress. I could be wrong. I am not, like, there are people who know way more about cannabis and sleep than me. But from what I've seen, it seems to be going through that indirect pathway.

2:15:02Dr. Rhonda Patrick:them and um does it affect sleep architecture at all like like does it have the REM stuff I don't

2:15:09Dr. Michael Grandner:I haven't seen anything that shows that it does in the same way I mean it's like most of the studies show it doesn't do much of anything to sleep anyway um so unlike THC yeah okay um another

2:15:22Dr. Rhonda Patrick:one that people use to help fall us help themselves fall asleep is alcohol yeah right I mean that's

2:15:26Dr. Michael Grandner:alcohol is probably the most used sleep drug in the world right right um so the thing about alcohol alcohol it would surprise nobody to tell you that alcohol can make you fall asleep faster and actually sleep a little bit deeper in the very beginning of the night but the thing about alcohol is sorry for the fact that it's not good for you for all kinds of reasons it gets out of your system very quickly you metabolize it relatively quickly and so what often happens with alcohol is when the alcohol leaves your system it creates activation creates It's a rebound. So often when people are drinking to fall asleep, they fall asleep fast, but then they wake up in the middle of the night and can't get back to sleep.

2:16:09Dr. Michael Grandner:I mean, anyone who's had sort of too much to drink and fallen asleep, they have that experience where you wake up and you're up. And you're just like, oh, I don't want to be up, but you're not falling back asleep. And it's because the alcohol creates that reaction. And one of the reasons it does that is as the alcohol molecule metabolizes and becomes acetaldehyde, it can become a neural stimulant. The acetaldehyde could become acetate, which could become a neural stimulant. And as the liver is processing the alcohol, it can create a glutamine rebound, which can be activated. So there's all these things that can end up being activated from the alcohol a couple hours in.

2:16:52Dr. Michael Grandner:that's also why like it's not a it's not a great sleep aid i mean a glass of wine after dinner is not going to for almost everybody is not going to be that big of a deal but if you're drinking enough where it's making you sleepy that's how much it's going to be waking you up later probably

2:17:11Dr. Rhonda Patrick:do you think um timing it earlier helps like if you're not so if you do it earlier than you're

2:17:17Dr. Michael Grandner:if you're if you're having wine at dinner and then you still got a few hours the alcohol is probably out of your system by the time you get to bed. The only thing you don't want is to time it so that the activating part of the alcohol being out of your system isn't when you're going to bed. So that's sort of a tricky part too. But usually, to be honest, the amount that most people are drinking, that's not so much the issue. But what's really cool is that you can see if you drink before going to bed, what's great is some of the newer wearables, they pick it up right away. you see that heart rate data, you see that, that lack of recovery happening.

2:17:52Dr. Michael Grandner:It was still a toxin that you're processing. And I've had a number of patients come in thinking like, well, I used to, you know, I used to drink some wine before going to bed and I thought that would mellow me out. And then I looked at my wearable data and realized it made my sleep crappy. It made my sleep terrible. And so I stopped. Um, and so getting that feedback can sometimes be helpful.

2:18:13Dr. Rhonda Patrick:Yeah, no, I mean, I, I will talk about wearables. Yeah, we'll definitely get into that. Um, Okay. I mean, any other of these, there's caffeine we could talk about.

2:18:22Dr. Michael Grandner:Yeah. I mean, caffeine, probably the most used psychoactive substance in the world. There's a reason why people use it. It works. It's relatively safe. Coffee is actually a great source of antioxidants and phenols, especially if you're actually just, if you're drinking it from coffee, not just the isolated caffeine molecule. it picks up peaks at around 30 ish minutes then trails off for most people four to six hours before bed is the last time they should be caffeinating in any way um some people they can drink an espresso go to bed just fine people metabolize it differently um for some people 10 to 12 hours is actually too much um where they need to stop in the morning or else there's just just enough floating around their system in the evening where they're not like jittery from caffeine, they just might have a harder time settling in.

2:19:13Dr. Rhonda Patrick:So that's a real thing. People can actually, because doesn't caffeine shift your circadian rhythm over as well?

2:19:19Dr. Michael Grandner:It's not a circadian signal as much as it can be like an alerting signal and which can change your activity rhythm, which is more of the circadian signal. I don't think, I don't know. I haven't seen anything. I could be wrong, but I haven't seen anything with caffeine itself as a potent circadian marker except that if you drink caffeine around the same time every day you can make it one um and it increases activity which is itself a circadian marker i thought there was one study

2:19:47Dr. Rhonda Patrick:maybe maybe in it was like they were giving men um caffeine it was like nighttime like close it was evening and i think it somehow shifted there well 45 minutes or so like it might have shifted well my guess is it would have shifted it would have delayed they would

2:20:06Dr. Michael Grandner:probably increase their activity level increase their light exposure delayed everything yeah so so yeah so that's why i like it delayed sleep onset but i don't know what it did to endogenous circadian timing but i'll have to look take a look i don't remember i don't remember a paper looking at so like in my world there's a difference between behavioral rhythms and circadian rhythms because there's like a circadian patterning but like if did the melatonin rise at the normal time it just got blunted because of the light you turned on and the activity you were

2:20:34Dr. Rhonda Patrick:engaging in for example right yeah um yeah so i i just i never doesn't does caffeine not do anything

2:20:41Dr. Michael Grandner:to sleep architecture if someone drinks yeah i mean like it'll it'll i mean it increases fast frequency eg activity so it'll make your sleep shallower so it'll probably I mean I'd have to look at the literature but like if I had to make a prediction my guess is it would dramatically reduce slow sleep and deep sleep because you can't you can't get into that stage if your brain's sort of still wired and active so for those people that say I can drink

2:21:04Dr. Rhonda Patrick:a cup of coffee and then go to bed 30 minutes later I may be disrupting their sleep it might

2:21:10Dr. Michael Grandner:be it might be um but also again people there's huge variability in how people metabolize caffeine also. So some people might be more resistant to it. For those people, I would really be curious to see their data.

2:21:24Dr. Rhonda Patrick:Yeah. I mean, what's the quickest you could metabolize caffeine though? I mean, 30 minutes.

2:21:29Dr. Michael Grandner:Or probably. No, that's when it's peaking. Right. I don't know.

2:21:34Dr. Rhonda Patrick:They would never feel the effect.

2:21:36Dr. Michael Grandner:Or maybe just the way it interacts with adenosine is different. Or maybe they're just so sleepy, their sleep drive is so high, it's the way adenosine is interfacing with their sleep-wake because adenosine itself isn't sedating it it builds across the day in and interfaces with that system but the adenosine itself like you can't like take adenosine and fall asleep like it's that's not how it works so maybe different you know humans are humans we're all different and you know our wire and some of the sometimes some people their system might be hooked in in a different way you're talking about like one person here and a person there and like outliers getting 20 of them to come into the lab all at the same time and look at a systematic evaluation.

2:22:20Dr. Michael Grandner:I don't know that anyone's ever really done, to be honest.

2:22:23Dr. Rhonda Patrick:Right.

2:22:23Dr. Michael Grandner:It's more like clinical reports. Yeah, I could do this and sleep fine. And I've seen people who drink coffee at night and their sleep looks fine. So like, who knows?

2:22:32Dr. Rhonda Patrick:Another one that I've talked about with Dr. Satchin Panda, who's been on the podcast a few times, is late night eating.

2:22:39Dr. Michael Grandner:Yeah.

2:22:39Dr. Rhonda Patrick:And obviously food is a substance. Yeah. Um, and at least with my conversations with Sachin, it seems like a good sort of on average time to stop eating before you go to bed seems to be at least like three hours or so before you go to bed. Um, how does, how does food affect sleep?

2:23:01Dr. Michael Grandner:Yeah. I mean, so, so he is the world's leading expert on that, on that issue of the timing. And he tells these incredible stories about how just the cellular machinery of transporting glucose fuel into the cell is partially clock dependent. And from the first bite of the day, once that machinery starts, it has a certain window of maximum efficiency that only fades. It's fascinating work. but as a psychologist i i have other perspectives on this as well where a lot of times people don't eat at night for metabolic reasons they're eating at night for emotional reasons they eat at night because they feel like it helps the mind down they eat at night because they're stressed and what's interesting is when you in a sleep deprivation study if you take somebody and you sleep-deprive them.

2:24:00Dr. Michael Grandner:There have been a number of studies that did this, and they look to see what calories they're consuming. And on average, people tend to consume about 350 to 600 extra calories per 24 hours when you sleep-deprive them in the lab. Not in the morning. If anything, they eat a little bit less first thing in the morning. Not in the middle of the day. Not snacking. not dinner but after dinner that's when all the snacking the extra snacking seems to occur especially when people are kept up past the point that their body wanted to go to sleep so if you're up and all of a sudden it's getting late and all of a sudden you're really hungry you probably should have been in bed already that was your brain telling you what are you doing up still i guess you're going to have to have another meal if you're going to keep going but because you're supposed to be in bed already.

2:24:54Dr. Michael Grandner:I was done. Like we checked out, like, are we doing another shift or what? So there, and there's reasons for this, but, but people start craving for, for a lot of years, people in the sleep world, we're talking about, is it carbs? Is it fat? Is it, I just think it's, it's energy. People are craving energy. They're craving calorie dense food. They're craving pleasurable food, food that feels good to eat, highly palatable food.

2:25:26Dr. Michael Grandner:And especially sort of like the later at night it gets. I mean, there's a reason why people generally don't crave a salad at two o 'clock in the morning. You know, even if they would during the day, it's your thinking and your emotional reasoning and your choices are fundamentally different. especially between two and five in the morning that time seems especially vulnerable um in our lab we're studying that that vulnerable time we're calling it the mind after midnight like and how you're you make different choices in that zone um all kinds of bad things like suicide spikes in that time four times greater than you would expect by chance than any other time of day spikes in that time.

2:26:11Dr. Michael Grandner:Violent crime also spikes during that time for maybe different reasons, but unhealthy eating also like 3 a.m. food. If I tell you this is the kind of food you want to eat at 3 a.m., you know what kind of food I'm talking about and it's not healthy food. Why is that? Why is that that there's this? And I don't think this is a pathological thing. I think this is a normal human function that when our brain is awake, when it wants to be asleep, especially when it's right there in that circadian dip of all kinds of other functions. It's this perfect storm of bad choices where it's reward seeking, but decreased reward processing.

2:26:48Dr. Michael Grandner:So we seek the thing that feels good, but it feels less good when we do it. So we seek it more. And our decision making is we're not thinking about tomorrow. This is also why people wake up in the middle of the night and they're all freaked out about stuff. And then in the morning they look back and they think, man i was all worked up about that but it's really not the end of the world i can i can solve this problem our brains when we're kept awake when we don't want to be that we're not our best self

2:27:19Dr. Rhonda Patrick:and it applies to food too so how does this apply to shift working and people that have these

2:27:26Dr. Michael Grandner:irregular schedules i mean no i don't know i mean we've known for years that that so like if you ask a circadian scientist, is shift work worse for you than smoking? They will usually have to stop and think and be like, ha, good question. And then you were supposed to say, I didn't realize that was a hard question. I thought it was obvious that smoking is the worst thing ever. Like if you smoke, whatever else you do, it's the smoking that's probably going to kill you. Shift work isn't good for you. Shift work is a problem. You know, shift, like we're the only species that shift works ourself on purpose.

2:28:02Dr. Michael Grandner:Like anyone who has a pet knows like they might be up for a bit during the night, but not because they have to be because, you know, mammals sometimes sleep in bouts and humans also are awake in the middle of the night for a certain amount of time. But you know, it's, it's forcing a square peg into a round hole and there's consequences. Some people may be more resilient people who are more night owls they might be more amenable to taking a night shift as long as they're able to go home at four o 'clock in the morning and go to sleep people who are early birds might be more amenable to taking a night shift as long as they can sleep between like night 8 p.m and two in the morning so for them maybe it's not as extreme a shift work as as you know maybe it's it's not as extreme but shift work in general it's a known carcinogenic it increases diabetes risk increases dementia risk like shift work isn't good but yet we live in a society that demands it someone's got to man the phones someone's got to drive the fire truck someone's got a someone's got to work the hospital um you know do all shift work occupations require shift work i don't know that's like do all factories need to run 24 7 like i don't know but it's a trade-off you know there's this phenomenon in the hospital i mean it's just it's just that's the shift work that's closest to my life where someone brings the box of donuts at the start of the shift and no one touches them because everyone knows that like they're bad for you but by the end of the shift they're all gone um decision making it gets impaired especially And what food is available in the middle of the night, too?

2:29:48What would happen if we go into a shift working setting and set up palatable but healthy food?

2:30:00Dr. Michael Grandner:Why don't we have nighttime snacks that are just healthier, that feel good to eat, that satisfy those cravings, but just don't do the same kind of damage? And why don't we make those available? I don't know. I mean, I don't know why this isn't, why everyone isn't doing this. It seems obvious to me.

2:30:20Dr. Rhonda Patrick:Just don't buy the bad processed food stuff and don't have it in your house.

2:30:24Dr. Michael Grandner:That's a good solution to not have it available.

2:30:26Dr. Rhonda Patrick:For shift workers, is there any way they can use these strategic kind of napping strategies to improve? Yeah.

2:30:35Dr. Michael Grandner:I mean, so the first thing for shift work is if you can keep a reliable shift, if you want to turn your day in tonight and make that permanent, that will actually minimize the damage. You're just in a different time zone. But if you stay in that time zone, it's the shifting around that causes the, it's the unsettling the system that causes the problem. So the more infrequently you keep shifting. So I would say that.

2:30:59Dr. Rhonda Patrick:Most people have families and stuff, and they don't, they can't do it.

2:31:02Dr. Michael Grandner:That's the problem. But anyway, so napping. Napping can be great. Think of a nap like a snack, where are snacks good for you or bad for you? Well, it depends. Healthy snacks are great. A healthy snack in the middle of the day can help stave off hunger, increase your energy, increase your focus. Especially if it's kind of a healthy snack, high protein, some fiber, maybe a little bit of sugar or something in there to make it palatable, but you don't want to load it up with calories because you don't need them. Same thing with a nap. A nap on purpose that is restricted in time. before you want to wake up before you drop down into that deep sleep if you want to make it sort of like a power nap.

2:31:48Dr. Michael Grandner:And you should remember, you're dropping down to stage, but you want to wake up before you drop into stage three sleep. So how long would that nap be? So in the middle of the day, it could be an hour. The closer you get to where your body is trying to drop into it, that window shortens. So it could be just 15, 20 minutes later in the day. Sometimes you're You shouldn't nap when you're in your biological night. Don't expect to nap because you're going to drop straight into it. But the further out you are, the longer you can make it. And so that it can increase reaction time, increase focus, increase learning, increase training recovery.

2:32:27Dr. Michael Grandner:There's data that shows like even in sleep deprived people, a decent nap in the middle of the day can dramatically improve metabolism, muscle strength, all this stuff. They can be great. And that's sort of a power nap. If you're napping all the time, it's like if you're snacking all the time. It's not the snack that's the problem. It's why are you snacking? There's also a different kind of nap that shift workers can use. And I call that a sleep replacement nap. Sort of like a meal replacement shake where no one looks at that and thinks that that looks like a meal. No one's confused that it's really a meal, but it does the trick in a pinch.

2:33:03Dr. Michael Grandner:and what a sleep replacement nap is. Athletes do this too, especially when they have late games and they have to wake up in the morning. College students do this one all the time where you go through a full cycle. You actually make it all and you get a whole cycle of deep sleep, which does exactly what it does at night too. It's not quite as good, but it does the trick and you want to wake up after you've made it all the way through. In the middle of the, at night during your regular sleep period that'll take you know 90 to 100 minutes during the day it might take two to three hours to make it all the way through because you're not expecting it you're you're you you have you have a system to protect yourself from dropping into deep sleep during the day you don't your body doesn't want it there because it's trying to protect you but if you stay in your nap long enough your body's like all right i guess we're doing this and so it gets in and you get all the way through.

2:33:59Dr. Michael Grandner:And if you, if you wake up out of that feeling pretty good, you know, that counts at almost the same as nighttime sleep. It's just, most people don't have the three hours in the day to do that shift workers do. Um, and so, so they can do like either like right after a shift or before a shift or something, you can do that. Um, or even a strategic nap, like while you're on a shift, you can get a little bit of a nap and, and be sometimes be able to function. Sometimes you're too much in the middle of your biological night and that one little nap, it's like you're starving and you only get one bite and sometimes that's a little worse.

2:34:37Dr. Michael Grandner:Everyone's a little different, but think of a nap like a snack and use it strategically like you'd strategically use a snack to stave off hunger and to make it through a shift.

2:34:46Dr. Rhonda Patrick:Okay. That's great. As long as you're not drinking a lot of coffee.

2:34:50Dr. Michael Grandner:Right. Well, that too, because then a lot of times you could be drinking a lot of caffeine on your shift, but then you get home and you can't sleep.

2:34:55Dr. Rhonda Patrick:Right.

2:34:56Dr. Michael Grandner:And which makes you more tired on your next shift.

2:34:58Dr. Rhonda Patrick:So how should shift workers use coffee?

2:35:00Dr. Michael Grandner:Strategically. I mean, you should use it as, think of it as, I will drink coffee in about 30 minutes, it'll have its peak effectiveness. And I, in about six, for at least the next six hours, I will not be in a sleep window. And so the higher the dose, the longer that window goes. so what you you might want to like caffeinate at the start of the shift but not in the second half

2:35:29Dr. Rhonda Patrick:okay that makes sense um i want to kind of shift and talk about jet lag yeah and we kind of you're talking a little bit about this sort of strategic timing of melatonin yeah i was kind of light right and light um but i've heard you talk about jet lag in a way where you've talked about like Like when you get on a plane and you're going somewhere to a different time zone.

2:35:51Dr. Michael Grandner:Yeah.

2:35:52Dr. Rhonda Patrick:As soon as you get on the plane, you need to mentally be in that time zone that you're going to be in.

2:35:57Dr. Michael Grandner:Yeah.

2:35:58Dr. Rhonda Patrick:So I'd love for you to kind of walk us through, like, how does this relate? Let's say you're going to the east versus flying eastward versus westward. Yeah. Like I'm going to be going to China. Yes. Soon. A 17-hour difference from where I'm at. I mean, how am I going to get into that time zone? So yeah, let's talk a little bit about how can we help ourselves adjust to the new time zone? If you're only going somewhere for a day or two, should you try to adjust?

2:36:28Dr. Michael Grandner:So mostly the answer to that question is like mostly no. Traveling a couple time zones is totally different than traveling a bunch of time zones. It's like going to China or going to Europe is very, from the West Coast US anyway, is very different than going from New York to LA. New York to LA, it's a few hours. And you'll adjust within a couple days. You could adjust probably within two to three days, you're probably fine. Traveling that far, the circadian literature would say that it takes about an hour per day to adjust. Obviously faster going west, a little slower going east. But when you're 10 to 15 time zones away, like what is day four versus day 12 look like you're not going to slowly adjust it's going to be in it's going to be jerky so what i would say is when you get on that plane think of yourself as having had maybe just a very short day i like sleep depriving myself a little bit before these long flights um and you get on the plane i like to try and schedule my flights so that it would be great if i traveling to europe it's easier to do this where you where you time the flight so that it lands in the morning local time so you're taking off in the afternoon from the u.s and it might be three four or five six in the afternoon but you're landing at 10 a.m local time so as soon as i get on that plane i'm like okay it's nighttime i have this eight hour eight nine hour flight um this is going this is my night so i'm gonna have crappy sleep i'll sleep for sleep on the plane when i can i got my earplugs got my eye mask got my melatonin got like you know whatever um i will do what and and i'll do whatever i can to catch a little bit of sleep on the plane.

2:38:29Dr. Michael Grandner:I'll have a crappy fragmented night of sleep on the plane. Land in the morning local time, wake up. I'll make it through my day just fine. I'll power through the day because my sleep's generally good beforehand. So I'll be pretty resilient. Make it through the day. I will be exhausted by nighttime local time. And I'm essentially brute forcing my sleep-wake homeostasis, even though I'm essentially, my circadian rhythm is way off, but I'm tired when I want to be asleep and I am awake when I want to go around during the day and I'm getting the light exposure during the day. And so I spend a lot of time outdoors when I travel.

2:39:08Dr. Michael Grandner:And so I'm sort of brute forcing a little bit. It's like, I'm not going to be fully adjusted. And, you know, maybe if I'm there for a week I will be. But those first few days, I mostly make myself sleepy when I want to be unconscious at night when it's dark, even though my body thinks it's daytime and be awake when the sun is out and be moving and don't nap. I do not nap for that reason, because it's sort of like, if you're taking a snack, if you're going to have a light snack, don't have it be at dinner time, because that snack is going to be miserable. Because then you're going to wake up and you'll have dropped into deep sleep and so so no naps when you're when you're traveling yeah i would especially as you're still in the adjusting period don't give yourself mixed signals but try and and if the and and if traveling to asia is more complicated because the flight's so much longer but think of it as local time think of when you're going to land when do you want to wake up before you know it could be a few hours off it's that's probably fine to adjust to but like you know if your flight is going to be landing say like in the afternoon but you're going to be taking off like the day before or whatever on the clock think of it as you're going to be landing the next day have some crappy sleep on the plane the other thing that will help is planes are slightly hypoxic of an environment and oxygen rhythms actually there's some great data there's there there's a there's a lab in israel that's been working on this especially showing oxygen itself is a circadian signal because oxygen dips during the night when you're asleep.

2:40:45Dr. Michael Grandner:So being in a slightly hypoxic environment for an extended period of time, it's easier to trick your body into thinking it's nighttime than it's daytime. And then as soon as you leave the plane and they open the door and now it's normoxic again, that can be an alerting signal. So timing it that way is also helpful.

2:41:02Dr. Rhonda Patrick:What about exercise?

2:41:04Dr. Michael Grandner:Exercise too. exercise is an awakening signal. So, so there's not much exercise you can do on the plane, uh, without annoying everybody, at least I guess. But, um, as soon as you get off the plane, that's a great time to be moving because you want to send that daytime, daytime, daytime signal, even though you're in your biological night, say, no, no, no, it's daytime, daytime, daytime, and get light, suppress whatever natural melatonin you have, take the melatonin at night to, to cause, cause you might still be producing some of the melatonin during your biological night. which is the environmental day and not producing that melatonin at night when you want to be.

2:41:41Dr. Michael Grandner:So that's when you might supplement. Yeah. Which is why being outside is so important during the day when it's your biological night. Yes.

2:41:49Dr. Rhonda Patrick:Great. All right. Well. Yeah.

2:41:50Dr. Michael Grandner:That's the thing with jet lag. Send yourself a daytime signal when you want your body to think it's daytime. Send yourself a nighttime signal when you want it to think that it's night. and you know so you can block light as a daytime signal so and or give light as a daytime signal

2:42:05Dr. Rhonda Patrick:or and use melatonin as the nighttime signal so no sunglasses in the morning right yeah or or if

2:42:12Dr. Michael Grandner:you're going to use sunglasses make them kind of blue tinted so so even if it's even if like it's blocking the uv or whatever at least the light so it's the blue green frequency of light that sends information to the clock. That's why the orange lenses block it. But wear like a blue or green or tinted sunglasses if you're going to wear sunglasses in the morning.

2:42:31Dr. Rhonda Patrick:So that actually works where you can see it?

2:42:34Dr. Michael Grandner:There's no data on this. I just made that up. But it should work because as long as you're getting that frequency of light, it's the bluish greenish light that sends the information to the clock. But it's also, I live in Arizona. Some sunglasses, if you don't want macular degeneration, you need to wear sunglasses when you're outside. so how do you get enough light to to to influence the clock without doing retinal damage and and so that's why you know i don't know i'd love to see data on this i don't know that anyone's actually studied this if they have um i'd love to see it but that's my pet hypothesis yeah because i would

2:43:08Dr. Rhonda Patrick:imagine like you were saying earlier obviously the early morning light it's not as damaging so you play don't meet sunglasses then but you're talking about being outside yeah long like hours during the day and how that also protects you from the blue light inhibiting melatonin later.

2:43:25Dr. Michael Grandner:You want the blue light to inhibit melatonin.

2:43:28Dr. Rhonda Patrick:Right. Sorry. No, no, no. In the morning, you want it to.

2:43:32Dr. Michael Grandner:In the evening, you don't want it to.

2:43:33Dr. Rhonda Patrick:Yes.

2:43:34Dr. Michael Grandner:Yeah.

2:43:35Dr. Rhonda Patrick:Okay. So let's talk about where we do have a lot of data. And this is definitely an area that you're an expert in as well. And that is these sleep tracking devices. Lots of them out there. Aura, the Whoop, what do we have? Apple Watch, the Fitbit and Pixel. You and I are both on the scientific advisory for the Google, which is where we first met. But I want to know, what metrics do you think are truly good at being captured accurately? And which ones should we interpret with caution?

2:44:12Dr. Michael Grandner:Yes, excellent question. people need to know that using wrist-based movement to estimate whether someone was asleep or awake across a night has been around since the 1970s that data has been well worked out those algorithms are pretty robust it's actually shockingly good you can predict with about 90 percent accuracy using movement alone. And this was analog devices with, with that were on a tape backup or eventually 64 kilobytes of memory on the whole watch. With that level of technology, you could get over 90 percent accuracy minute to minute. Were you awake or were you probably asleep relative to brainwave activity?

2:44:57Dr. Michael Grandner:Sleep versus wake. That's what these devices are best at. They've always been best at. That is the data that I would trust the most with the asterisk of. It's going to be different from the brainwave activity in that the brainwave activity will pick up lots of little awakenings that that the the the movement detection probably won't. There was so so it will underestimate wake time relative to looking at brainwave activity, but it will overestimate wake time versus your self report. So if I asked you how much you slept and you said seven hours and your watch says six and a half, that's not a problem.

2:45:37Dr. Michael Grandner:You're measuring two different things because the watch is probably picking up awakenings that you don't remember. So were you physiologically awake during that time? Probably. Could it have picked up stuff erroneously? Yeah, maybe. Were you awake during that time? Probably. Does it matter? Probably not. Um, so, cause all of the guidelines and recommendations that people, you know, the seven hours of sleep guidelines. I mean, I, I, I was on one of the, the, the, the panels, I was on the ASM and SRS, the CD, the panel funded by the CDC to develop time recommendations. We were there in the room, we were arguing over this.

2:46:10Dr. Michael Grandner:And those recommendations are not based on wearable data. They're based on, on average, how much sleep do you feel like you get? Cause that is what's correlated with the health outcomes. The wearable data is a lot more murky in terms of its correlation with the health outcomes. It's different. So if you're targeting a certain amount of sleep based on guidelines, the wearable data can fall under that and you're totally fine. Like up to maybe an hour even under that and you should be totally fine. So that's, I trust it to be correct and accurate for what it is, but it doesn't mean it's measuring the same thing.

2:46:47Dr. Michael Grandner:And so I expect it to be a little different. So that's, and that is what the, what it's best at. The heart rate data are also really good separate world in that the heart, you know, photoplephysmography for getting heart rate data, that science is really well developed. And, you know, you can get really good heart rate data with pretty good resolution from the wrist and for even from the finger, you can get pretty good heart rate data. So, so yeah, in terms of the other stuff, there's, there's sort of two levels of other stuff. One is the sleep staging data. And the other one is other metrics like recovery or readiness or sleep score and all that sort of stuff.

2:47:30The sleep stage data, it's a ballpark.

2:47:34Dr. Michael Grandner:It's actually better than a lot of sleep people assume that it is in terms of its level. It's probably between 60 and 80 % accurate. So it's not nothing. It's also not perfect. but it's also not garbage. Like it's, it's helpful. It's, it's probably ballpark. Correct. Um, gotta remember what sleep stages are. We're looking at different patterns of brainwave activity. And then the 1930s, people looked at these squiggly lines on paper and put them into four buckets and then it became five and then it was back to four. Um, just, are you stage one, two, three, or REM based on the pattern of squiggly lines?

2:48:19Dr. Michael Grandner:This is humans radiant. Do they exist in nature? No, we made them up. You know, this is how humans categorize stuff based on patterns of brain activity on the outer layers of the cortex that are fluctuating during sleep. the fact that you can look at heart rate fluctuations in combination with movement and get a really good estimate about which state of brainwave patterns you happen to be in at that moment, even though two humans can't always agree when looking at the same squiggly lines, is that stage one or stage two? Is that REM? Is that REM or did they drift into stage two or stage one at this point?

2:48:57Dr. Michael Grandner:Eh, it looks kind of similar. I'll call it REM. Well, I'll call it stage two. You see this all the time. This is why we don't even use AI yet to rate these things because humans don't trust them because they can't even agree with each other. There's no gold standard that we can even train a lot of these AIs against because even the humans can't agree. So it's a moving target anyway. So the fact that you can get that close from this stuff on the wrist, I think is a miracle, but you got to keep your expectations in check. It's like playing two games of telephone going in opposite directions and using the result of one game of telephone to guess not what the source was but what the other game of telephone came up with so the fact that they're even in the same ballpark i think is great and useful but what that also means is don't read too much into it like if you if it shows very little deep first of all i can't distinguish stage one and stage two at all so they call it light usually and as i mentioned before Those are very different things.

2:49:57Dr. Michael Grandner:If you have a lot of stage one, that's bad because your sleep is super shallow. You have a lot of stage two, that's normal. That's what should be most of what sleep is. And the deep sleep detection is only about 60 to 70 % accurate at best in most people. So when people say like, it's not showing I'm getting enough deep sleep, they say, well, the algorithm isn't picking it up. It doesn't mean you're not, A, it doesn't mean you're not getting it. And B, if you weren't, as long as there's no barrier to your body obtaining, if you don't have untreated sleep apnea or chronic pain or an environmental stimulation to prevent that deep sleep from occurring or drinking alcohol or whatever, your body is doing whatever it wants to do.

2:50:38Dr. Michael Grandner:So if it doesn't want to take more, because as people get older, they take less anyway, you know, growing people, healing and recovering people usually need more. but if you're not getting it, A, does it matter? And B, how do I know you're not getting it? And so you got to interpret it with that caution. So that's the caution with the sleep stages. If I show you a brainwave tracing of sleep stages and a wearable tracing, if it's a good device, you can easily tell these are the same person on the same night if you looked at them. But if you actually counted the exact number of minutes, you would probably find that 20 to 30 % at least of those minutes didn't exactly agree with each other.

2:51:20Dr. Michael Grandner:But you can tell visually. That's why clinically I look at it visually. I don't actually count the minutes because I don't depend on it. And actually one night of data, is it worth much? It's more about the weekly trend or like trending and changing over time. That's what I care about. So that's the sleep stage of data. The third bin is the metrics like the scores with very few exceptions. Most of those scores are I give almost no attention to those. I can be ungenerous and say they're mostly made up nonsense anyway.

2:51:55Dr. Rhonda Patrick:Can you repeat what scores we're talking about?

2:51:57Dr. Michael Grandner:I'm talking about anything that's called like sleep score, sleep quality, sleep needs, sleep readiness, recovery, any of that stuff. If I'm being ungenerous, I'm saying it's mostly made up nonsense to sell devices because telling people what they want to hear. But that's not the truth either. They're not nothing. They have a lot of these companies, not all of them, but a lot of these companies have smart people working for them who are not idiots, who know how to work with the data and are trying to make prediction algorithms that are actually useful. Thing is, none of these things are published.

2:52:33Dr. Michael Grandner:None of these things have been vetted. None of these things, it's kind of like at the trust us level of like, well, how do I know what you're putting in your algorithm and how to interpret those numbers? So like if I drink alcohol the night before, but I'm otherwise totally healthy and the number looks bad, should I worry or not? Am I, is it actually impairing my ability to perform or not? Or does it look like it is because of how the algorithm is using heart rate data? I don't know because none of it's transparent and forget the transparent. I know Google did a study on the, no, it wasn't Google, it was Fitbit before it was Google, I think, where they had their sleep score and they correlated the actual global sleep score to outcomes.

2:53:13Dr. Michael Grandner:and they presented the data at a conference. As a global thing, I don't think they ever really followed up with it, but I don't know that that's, even that baseline level of, is this correlated with anything remotely useful is a step that, I mean, that they did, but I don't know that anyone else has ever really done that much. So as the literature is coming out, as more and more people are using these metrics and seeing what's it related to, what's it not related to, what does it predict reliably what does it predict unreliably what does it not predict at all even though it thinks it does as a researcher you give me a number i don't know what to do with it unless i can unless i understand how it works so i guess what i'm saying is i don't trust these numbers almost at all i almost 100 of the time completely ignore them because they don't give me any information i can use because i don't know what they mean um and at worst they're made up but at best they're really good educated guesses made with assumptions that i don't totally know so i don't know what to make of it because that i mean i'm trying to be fair and not throw them all under the bus they probably aren't useless they probably have value and they're probably not all incorrect either it's just you gave me a number and i don't know what to do with it

2:54:32Dr. Rhonda Patrick:so i i i was going to ask you what big your what the biggest misconception about these wearable devices you kind of wanted people to know like right now and i'm thinking maybe this yeah that's

2:54:42Dr. Michael Grandner:that's the big one it's also i think the biggest misconception is that accuracy matters um it's not about are they accurate or not accurate to relative to what accurate relative to your memory of the night or accurate relative to the physiology those predict different things um and even if it is accurate relative to the physiology does the number give you a useful metric that you can actually use to do anything with it? What are you going to do with that information? And if you're going to make decisions based on it, you better know what it is. And I feel like a lot of companies, like they're stuck in a bind because if they're too transparent with their algorithms, other people are just going to copy it because you can't patent an algorithm.

2:55:23Dr. Michael Grandner:So what are you going to do? How do you maintain your competitive advantage? And I mean, that's a line to walk. And as these companies, is they're just going to try and come up with better metrics and better metrics as a researcher and as a scientist and as someone who cares about public health, who has family members who ask me what to do with this information. Give me the data I need to make choices, to make an informed choice of what to do with this information. So that's probably a big misconception is that these numbers are what they say they are.

2:55:53Dr. Rhonda Patrick:Okay. Well, let's talk about actionables then. How can you practically advise people that are watching or listening to this to use their data? What data can they use and how can they make it actionable?

2:56:07Dr. Michael Grandner:Excellent question. So another saying that I attribute to a colleague of mine, Amy Athey, who's a sports psychologist, who's a colleague of mine. And she's helped me a lot on a lot of sleep stuff. And I was explaining this wearable stuff to her. and as we were developing our own trainings with this, and she came up with this way of thinking about it as a bathroom scale is not a weight loss program. And these are measurement tools. Measurement tools are not interventions. People, if you're buying this to give you information to make a change and you don't know what to do with the number it's giving you, how is it going to make a change?

2:56:52Dr. Michael Grandner:Just because it gives you a number just because it's a fancy bathroom scale that has an app and has all kinds of other metrics in it doesn't mean it's giving you useful information that you know what to do with. So the first thing in terms of creating actionable steps out of this is first to realize that it's spitting you out a number. It's measuring something. To make an informed choice of what to do with that information, you have to know what that number means. So first is I got to teach you a little bit about what these numbers mean and what these numbers don't mean. Then just like, just like when you see the amount of sleep you got, what does that number mean?

2:57:38Dr. Michael Grandner:Does it, does it mean I'm meeting guidelines or not? No, it doesn't mean that. But does it, if I see it over time, if I see I'm usually hitting six and a half, six and a half, but today I was at five. What happened? It's like it's, that is the number it's probably best at. So if I'm going to make a decision based on wearables, the first number I'm looking at is the how much sleep did I get? And where did it detect the awakenings? Because those were probably correct, especially if they were more than a couple of minutes.

2:58:06Dr. Michael Grandner:And are there discrepancies between what my memory of the night was and what the device found? And in those discrepancies might be some wisdom. So sometimes people with insomnia feel like they were up all night, but they actually got more sleep than they thought because they were up and down. So they could use the wearable device to sort of.

2:58:29Dr. Michael Grandner:Dr. Michael Grandner.

2:58:57Dr. Michael Grandner:That's what, that's without even looking at the heart rate data, sleep, sleep stages data. Then I'd look at the heart rate. Heart rate should start relatively low in the evening compared to your resting and it should be dropping. And then at some point you should have an inflection point where it sort of starts picking up again, probably around three or four in the morning. When a lot of people wake up around that time, maybe you're just kind of sensitive to that, that shift in your circadian rhythm where your, your daytime is starting up. And as some people get older, they might be more sensitive to it.

2:59:27Dr. Michael Grandner:or you might have a natural awakening around that time, but you don't have the same sleep pressure to get back to sleep. So also in that heart rate data, so like if it's staying, if your heart rate's staying high during the night, what's going on? If it's not dropping, what's going on? If it's rising during the night, what's really going on? If you see your heart rate data looks normal, then you have a couple of periods of intense fluctuation. What's going on in those periods of time? They might give you some insight that there's something under the hood that's that's causing activation that's going on.

2:59:57Dr. Michael Grandner:If you see your sleep stages, irrespective of what it gives you, if it shows that they're highly variable across the night, something's up. If it's putting deep sleep in the second half of your night, something's up. If it's putting a big bout of REM sleep in your first three or four hours of the night, something's up. It doesn't belong there. Could be, but it's unlikely. and if anything that tells me that I don't know what's going on under the hood but something is something is aberrant there not that your sleep stages are in the wrong place but that the algorithm is finding them where they don't belong and so why well what's the algorithm using if it's using movement and heart rate it means there's something unusual going on with your movement and your heart rate in that time where it doesn't belong and then you could start thinking about what that is Could that be sleep apnea and you're jerking around or something?

3:00:51Dr. Michael Grandner:Or you have limb movements. Or maybe, you know, it's a bed partner who keeps rolling over or making noise. So, like, it might give you a window into, you know, I was unconscious during this time, but something was going on during that time. And then you can start looking into what that could be.

3:01:08Dr. Rhonda Patrick:So, let's say someone is, like, their heart rate isn't dropping like it's supposed to. or what sort of things can people do to try to help with that?

3:01:21Dr. Michael Grandner:Yeah, so first I would look to see, is there anything chemically in the way? Is there alcohol? Is there medication that you're taking at night that you should be moving earlier in the day, for example? I actually see this not uncommonly where people have trouble with sleep because a medication that is perfectly acceptable to prescribe in the evening is being taken in the evening. It's just you're sensitive to it in a different way. So I see this a lot. So first see if there's something chemical or if you're eating, you're eating a food that's too metabolically active, too close to bedtime or you caffeinated too late.

3:01:55Dr. Michael Grandner:Yes, it was four hours ago, but it was still too late and it's still hanging around in there or something like that. Or you have something, something active going on. So like, do you need, is there, is there a pain issue going on? Is there some inflammation going on? Is your mattress 10 years old and needs to get replaced and it's just uncomfortable and it's creating too much activation during the night? You know, there's all kinds of reasons for that. And then if not, what's your relaxation wind down routine like? Why is your heart, are you exercising too late? And your core body temperature and your heart rate is high because of what you happen to be doing where it's not dropping.

3:02:34Dr. Michael Grandner:Why not? or maybe you need to introduce some more relaxation techniques into the evening, whether it's physical relaxation, like breathing exercises or stretching or yoga stuff or, or mental stuff. Like, you know, there's imagery exercises and other stuff and body scans or mindfulness exercises and meditation, or like a mind body approach, like, like I'm a huge fan of progressive muscle relaxation, um, where it's especially done right involves both. Um, maybe you're going to bed too hot and you need to chill out a little bit first, whether it's mentally, physically, or both.

3:03:11Dr. Rhonda Patrick:What about, I know we talked about the accuracy of being able to measure sleep stages anywhere between maybe 60 to 80%, which isn't terrible.

3:03:22Dr. Michael Grandner:No, it's not terrible, but it's not gold standard either.

3:03:26Dr. Rhonda Patrick:No, it's not gold standard. But let's say that someone is, we're not just talking about a night, but we're talking about weekly, like month, like we're seeing a consistent pattern of not getting enough either deep or REM sleep.

3:03:38Dr. Michael Grandner:Right. And so the way I would interpret that is you may or may not be not getting enough, but you're definitely exhibiting a pattern where the algorithm is saying you're not getting enough. Why? Is it the problem with the algorithm? Is it a problem with maybe you are getting it, but there's something in the peripheral system that is like, maybe your heart rate is just too variable and it's not picking it up for other reasons or something. I would say the way I do this is just like the breathing example, where it's like, if you're having trouble breathing, okay, do you have a problem with your lungs?

3:04:17Dr. Michael Grandner:You have lung disease of any kind. If so, let's figure out what that is. Treat it. Okay, lungs are fine. Do you have an airway disease? You have asthma. Do you have airway inflammation? That could be interfering with your ability of your lungs to be transferring oxygen correctly. Are those fine? If it's identifying any problems there, fix them. Okay, that's fine. Okay, well, is your air very polluted in that case? In that case, you know, maybe you need an air purifier. So from a sleep perspective, it's, is there anything physically that's preventing you from getting deep sleep if you wanted it?

3:04:50Dr. Michael Grandner:Do you have some sort of systemic inflammation going on? Do you have untreated sleep apnea? Do you have chronic pain? Do you have some, are you taking a medication that could be suppressing this? Like, is there something that's a physical barrier? Let's go down the list and rule them out. Because if there's something preventing you from getting deep sleep, let's get it out of the way. Let's unprevent it. Let's treat that condition. If there isn't, and we still see that there, then it's like, okay, well, maybe it's environmental. Do you have, is your room too hot? Is your bed too uncomfortable?

3:05:24Dr. Michael Grandner:Is your spouse snoring too loud or rolling over too much? Are you just too sensitive to light? Do you live on a street where you're asleep, but there's still cars driving by and that's creating this? Like, is there something in your environment? If we go through with somebody and their environment is fine, their sleep continuity is fine, they're falling asleep fine, they're sleeping through the night, there's no medical reason that's preventing them from getting deep sleep at all. my perspective on it is don't worry about it your body's doing what it wants to do on its terms if it wanted more if it needed more it would take it but it doesn't so forcing it may or may not be a

3:06:05Dr. Rhonda Patrick:good thing anyway um well this is a this kind of leads into the next question which is the pitfalls of these of these sleep tracking devices and i've known several people that have fallen into this pitfall and that is obsessing over their sleep data which may not fall into what they want it to be or think it should be and that actually causing worse sleep because they're just obsessed with it and i've heard you refer to this as orthosomnia yeah yeah so that was a term developed

3:06:37Dr. Michael Grandner:and invented by a colleague of mine kelly barron she's at the university of utah she's she's she's like me she studies sleep and sleep health and wearables and stuff and so she came up with this idea, um, putting a name to what we would see in clinic of people who overly fixated on the data to the point of where it was sort of like orthorexia was the idea, um, where people are obsessing over food ingredients where it's like, you're, you're missing the point here. You know, like the degree of information that these data are giving you is not the level of precision you should be using that that could even give you to be obsessing to this level of detail.

3:07:14Dr. Michael Grandner:It's, these are rough estimates. That's a fuzzy picture at best. It's a fuzzy picture that's probably true, but it's still a fuzzy picture. So just because you see things in there that might not be perfect doesn't mean they're not fine. And sleep doesn't have to be perfect to be perfectly fine. So as you're talking about conditioned arousal, what do you think is going to happen when you start obsessing in bed over your sleep metrics? You're going to start developing arousal. And so orthosomnia can be a precipitant to insomnia and it's going to make your sleep worse. And then you're going to worry about it more.

3:07:51Dr. Michael Grandner:Actually, for a lot of those people, a lot of times we'll just say, take it off. Just take it off. It's not, it's a net loss for you. It's not a net gain, but I want, but I want like, you know what? You can't handle the truth, I guess. It's sort of like, let me teach you how to be happy with the sleep you're getting. Then you can put the device back on and you're approaching it from a place of happiness and you know your sleep is fine. And this is just giving you more information. It's not, and you know your sleep is fine, as opposed to relying on this information for what it can't give you. It can't give you those answers.

3:08:27Dr. Michael Grandner:We don't have that level of precision. So there's nothing worth worrying about. I mean, at least, I mean, if you're, the way I think of it this way, if your device is giving you information, you think it's bad news, come see someone like me. We will probably, I'll look at your wearable data, but most people in my world don't even do that. They don't look at your wearable data because they don't care. If you have a problem with your sleep, I will ask you the questions I need to ask, do the tests I need to do to figure out what that problem is and use all the tools I have to fix that problem, irrespective of whatever your wearable says.

3:09:00Dr. Michael Grandner:And if that wearable is what got you into the clinic in the first place to say, hey, I thought my sleep was okay, but now I'm a little worried about it. I will say, okay, well, I'll tell you if you need to worry. Well, I'll ask some questions, figure out what's going on. Sometimes I'll say like, you know what? You have what we call normal and I can't fix normal. I might be able to optimize a little bit. I can work on that. And actually de-stressing, your sleep is more impaired because of the stress around your sleep than anything else that you're doing.

3:09:32Dr. Rhonda Patrick:It sounds much like the negative stimulus, right?

3:09:35Dr. Michael Grandner:Yeah, and so often that's the case. So if you're looking at your wearable data and you're not happy with what you see, if there's a problem that needs to be fixed, come to a sleep specialist. We will find the problem. We will fix it. If there is no problem to be fixed, if you're within the normal range, a sleep clinician is probably not going to have anything to fix for you. You might have to come to somebody who has a little more experience with optimization if you really want. If your question isn't, is this bad, but could it be better? Then you might need to go to somebody who has more experience on the performance side, who can read those numbers, read those tea leaves and say, yeah, no, this is totally fine.

3:10:18Dr. Michael Grandner:I couldn't make these numbers better if I wanted to. Or, yeah, we could do something about this.

3:10:25Dr. Rhonda Patrick:Let's talk about making these numbers better. And I know that we've kind of talked, we've touched on it a little bit. So you tell me like if there's more information that you want to share about it, but like using sleep as a cognitive performance enhancer. Yes. You talked a little bit about this.

3:10:38Dr. Michael Grandner:Yeah. I mean, think of sleep as sleep should be a joy. Sleep should be your friend. Sleep is what helps you face the next day with as much resources and resilience as possible. A colleague of mine, Teresa Aurora, she led this project that I also helped on. And we looked at, we basically scoured the entire medical literature on resilience and sleep. Because everyone talks about not getting good sleep is bad, but is getting good sleep good? And basically what we found was across the board, people, if you can sleep better, your resilience will improve. You can improve your level of resilience, whether it's physical or emotional or whatever.

3:11:21Dr. Michael Grandner:It was very, it was defined however the study, whatever the study defined it. any study, if you improve your sleep, you can improve your degree of resilience. You can improve your reaction time. You can go from normal to better. You can go from good to great. Um, there will be a ceiling, but especially athletes, especially younger athletes, like, like adolescents, young adults, you know, most people in elite sport are under 30. Younger people will benefit more from more sleep than older people will, to be honest. Um, if you're 20, it's, you know, I'm not saying more is always better, but too much is very rarely a problem for adolescents and young adults.

3:12:08Dr. Michael Grandner:Um, there is such thing as too much sleep, especially as you get older. And if you've ever like slept 10 hours in a row and woken up feeling groggy, they call it the Rip Van Winkle effect. You know, like you, it's a real thing. You can't oversleep, but it's kind of hard for a 20 year old to oversleep. I mean, there have been studies where you take, where they're already sleeping maybe six, seven hours. If you get them up to like nine, 10 hours, they're faster. They're stronger. They're mentally sharper. So first of all, just sleeping a little bit more if you're younger, that's probably the easiest thing you can do.

3:12:41Dr. Michael Grandner:And that's about budgeting time. And that's about planning your wind down routine so that you land where you want to land when you want to land there. So it might be thinking a little ahead and giving yourself permission to put stuff down.

3:12:54Dr. Rhonda Patrick:Is that harder for younger adults? Because they're, I mean, at least I know as you hit adolescence, your circadian rhythm is later. It shifts later. Yeah. So you're, I mean, I go to bed at midnight instead of, you know.

3:13:05Dr. Michael Grandner:So like when a typical adult looks at a clock and sees midnight, clock says midnight, their body says midnight. When a five-year-old looks at a clock, clock says midnight, their body's like, oh my gosh, it's three o 'clock in the morning. Why are you awake? Right? Little kids go to bed early, wake up early. When an 18-year-old looks at a clock, clock says midnight, thereby is like, it's only 9 p.m. Why are you going to bed now? And when they have to wake up at 7, they're like, oh my gosh, it's 4 in the morning. Why are you trying to wake up? So yes, they are shifted. And it changes with age. So yes, you can use light behavior and melatonin to physically shift that.

3:13:41Dr. Michael Grandner:You can do that. But they are more naturally inclined to stay up late. I mean, high school should not start before 9 a.m. Totally.

3:13:47Dr. Rhonda Patrick:100%.

3:13:48Dr. Michael Grandner:Colleges shouldn't start before 9 a.m.

3:13:50Dr. Rhonda Patrick:100%.

3:13:51Dr. Michael Grandner:It's developmentally inappropriate.

3:13:54Dr. Rhonda Patrick:It's a lot. I mean, colleges, I can't speak for that. But for like high schools, it's about the parents' work schedule. Yeah.

3:13:59Dr. Michael Grandner:It's logistics. It's not about what's better for learning or it's not about what's better for the student. I mean, and all of the data that shows that when you delay school start times, and California led the way on this. California took the step and at least pushed it to 830. Right. I don't think any other states followed yet. Um, and, um, there's tons of data on this. Uh, my colleague, Wendy Troxell, she has a fantastic Ted talk on this, um, on school start times. Um, it's just, it's wherever you look, you know, when you delay school start times, you improve everything, not just academics. Why do you think kids are so sleepy?

3:14:38Dr. Michael Grandner:Why do you think teenagers are falling asleep? You know, all these ADHD diagnoses, how many of them are just sleep deprivation? you know mental health problems depression and anxiety how much of it is just is just insufficient sleep and circadian phase shifting so like you can actually improve these outcomes by getting kids at a time that actually works for them so so there's that so yes part of this is we live in a world mostly designed by old people who make all the rules you know if you look at who's in who's in congress who's making all this legislation it's not 20 year olds and they way they're like, I wake up at five, six in the morning, just fine.

3:15:16Dr. Michael Grandner:You know, so what's your problem? You're just lazy. You know, like, I'm not saying they say that. I'm just that we live in the society of like what early to bed, early to rise. Well, it's nice if you're 60, but if you're 20 early to bed, early to rise, you know, you might have a circadian rhythm problem.

3:15:32Dr. Rhonda Patrick:But you said you can sort of use strategically light or early light exposure and then, you know, melatonin.

3:15:38Dr. Michael Grandner:Yeah. You can help with that. You can give people melatonin to, you can give melatonin That low dose half milligram melatonin is a phase shifting dose and light as a phase shifting dose of bright light. You can do that. If you get a 20-year-old up early, flood them with bright light and movement. Physical activity, exercise, movement is extremely powerful also as a phase shifter.

3:16:01Dr. Rhonda Patrick:What time of day?

3:16:02Dr. Michael Grandner:Early.

3:16:03Dr. Rhonda Patrick:Early exercise.

3:16:04Dr. Michael Grandner:Yeah, early exercise. Get them up, get them moving early. They will get tired a little earlier. Their circadian rhythm might still be a little bit off, but they'll be able to sleep. And over time, especially if you have the dim lights in the evening, those dim lights in the evening can help pave the way for, you know, even if their natural melatonin isn't going to rise, give a little bit of melatonin in the evening, force that rise a little early. You can, I mean, you can essentially jet lag yourself on purpose without traveling by doing that, by giving light and melatonin at the time you want.

3:16:39Dr. Michael Grandner:I mean, that's good to know, right? I mean, yeah, some people are more resilient to it than others. Some people are more sensitive to it than others, but you can do it. Um, and actually, um, it peaks this, this delay seems to peak in the early twenties, like 22. But then after that, like you can, you can get, I mean, I work with athletes all the time. Athletes tend to be pretty good at getting up in the morning because they wake up, they get light, they get movement first thing in the morning. and we did this study looking at looking at this called chronotype which is like sort of where in the 24 hours are you chronotype and athletes athletes maybe it's also self-selection where the the teenagers who were just super late people were less likely to survive the the training schedules to to make it to the elite level who knows or maybe they're they they've adapted to it a little bit more.

3:17:31Dr. Michael Grandner:But yeah, athletes tend to be on average, not as much of a night owl as typical people their age.

3:17:38Dr. Rhonda Patrick:Right. What's the most, if we're talking about like athletic performance, what's the most consistent sleep hack you could, you know, get a little more, get a little more

3:17:50Dr. Michael Grandner:and see how you perform because the data show over and over again, that extending sleep, especially in younger elite athletes, when I'm talking about 60 year old, but I'm talking about like 20, 20, 25 year olds, 19 year olds, 29 year olds, like do an experiment, get more sleep if you can. And there's some strategies for doing this. Because if I just say spend an extra hour in bed, we just talked about how if you can't fill that time, you might actually create an insomnia. So you might want to slowly increase the amount of time you're spending in bed, unless you're tired enough that just spending an hour in bed, you'll knock out anything.

3:18:23Dr. Rhonda Patrick:So like 15 minutes a night?

3:18:25Dr. Michael Grandner:That's how I like to do it. I like to extend it by 15 minutes See if you do that. Extend by another. Because also you don't have to find an hour in the day. You can always find 15 minutes. And that 15 minutes might buy you enough productivity where you could find the next 15 minutes.

3:18:40Dr. Rhonda Patrick:Do you go to bed earlier 15 minutes?

3:18:43Dr. Michael Grandner:Usually that's what people have more control over.

3:18:45Dr. Rhonda Patrick:Okay.

3:18:46Dr. Michael Grandner:Usually when people wake up is not what they have control over. Usually they have to wake up at a specific time. So it's about advancing bedtime little by little. But the point is you're ready for it by the time you do it. But anyway. So sometimes it's like go to bed an hour earlier. And if you're exhausted enough, you could do it. But over time, that might make your sleep shallower and you might create more arousal if you can't fill that time. So you don't want to just, I don't want us to say like, get more sleep because not everyone needs it and not, you don't know how much more.

3:19:13Dr. Rhonda Patrick:And you don't know if you can fill that time if you have insomnia anyway.

3:19:16Dr. Michael Grandner:But anyway, but the data consistently show that if you can bank a little extra sleep, first of all, on average, you might show up, it'll likely show up in your performance, but you might need to track it objectively. using something like a tracker, like, or, or, or a stopwatch, are you getting faster? Are you being able to lift better? It might not be perceptible by your memory, but it might, if, if you are 5 % faster, you won't notice, but the stopwatch will, for example.

3:19:46Dr. Rhonda Patrick:Yeah.

3:19:46Dr. Michael Grandner:So that's the first thing I would say. The other, the other most important sleep hack for athletes is sort of comes after that and it's sleep banking, bank good sleep. Um, get as much good sleep as you can while you can, because if you have a competition tomorrow and it's high stakes, you're not going to sleep great. Probable. Maybe you will, but many athletes don't. Even at the very elite level, they are not sleeping well right before competition. But if you've banged good sleep up before, like if you're already off balance and barely keeping on two feet and someone bumps into you, you're going to fall over.

3:20:25Dr. Michael Grandner:But if you're well planted and someone bumps into you, you can recover pretty well. So one to two nights of short sleep does not dramatically impair performance. It might stress you out and you might psych yourself out. That might impair your performance. But if you're coming from a place of strength, one or two nights dropping your sleep from eight down to like six or five hours, you might have some cognitive impairment, but it's going to be quite minor. A week out, it's going to be very pronounced. It builds. It's cumulative. But one or two nights isn't going to be that big of a deal if you're coming from a place of strength.

3:21:04Dr. Rhonda Patrick:So it's really about the week before your - A week or two. A week or two. Okay. Yeah. Come from that place of strength. Is this the same for a cognitive performance as well? Yeah. So sleep banking, really, it's not just about the night before.

3:21:17Dr. Michael Grandner:Right. It's not about the night before.

3:21:18Dr. Rhonda Patrick:And that's great to know because so many people stress about the night before. Yeah. If they know that ahead of time.

3:21:23Dr. Michael Grandner:Come in with confidence. It's like with nutrition. It's like, you know, it's not about what you ate today. It's about what you've been. Right. I mean, it's the same thing with the sleep on the weekends, where when people say, how much sleep do I need to make up on the weekends to make up for being sleep deprived during the week? I'm like, well, that's like saying, how much kale do I need to eat on the weekends to make up for eating nothing but cheeseburgers and pizza all week? It's like, well, it's like I was saying about weekends, like it's better to do that than just having cheeseburgers and pizza all week.

3:21:58Dr. Michael Grandner:But that's not the answer. You know, and that's also why you don't recover right away. That's why it's, you know, it's not it's not like a debt sleep debt isn't like a financial debt. It's not like you don't have to pay it all back, which is good. You just have to get back in balance and your body will start taking care of itself once you're doing the right thing.

3:22:15Dr. Rhonda Patrick:So for in terms of like recovery, injury prevention, how strong is that data that you really do?

3:22:23Dr. Michael Grandner:So, yeah, it looks like sleep. First of all, sleep is critical for recovery. And everyone knows that. Like when you're sick or when you're injured, you actually have an instinct to rest more. I mean, yes. But from injury prevention standpoint, sleep deprived people injure themselves more. We see this from all occupations. Like you crash your car more. And actually, if you ask people how well-rested you think you are, but you see how much sleep they're getting, it's how much sleep they're getting, not how well-rested they think they are that predicts drowsy driving, for example. Like, even if you say you're fully well-rested, if you're getting five or six hours of sleep, you are three times as likely to nod off behind the wheel.

3:23:03Dr. Rhonda Patrick:Wow.

3:23:03Dr. Michael Grandner:Even if you say, I am 100 % well-rested, data don't bear that out. People are not a good judge of how impaired they are due to sleep deprivation. So how much sleep you get is important in terms of those sorts of things. In terms of athletics injuries, what seems to be a bigger driver actually is our two variables, insomnia and daytime sleepiness, which are very common in college students. but actually if you're sleepy during the day, even if you're getting, if you, and if you feel like you're getting plenty of sleep at night, if you're nodding off during the day, if you're having trouble staying awake, you're more likely to hurt yourself.

3:23:42Dr. Michael Grandner:You're more likely to wink out. You're more likely to like not focus on something. You're more likely to hurt yourself. Same thing. If you have really bad insomnia, irrespective of how much sleep you're getting, that inability to sleep when you're trying is predictive. So, so one example, So we did probably what is the biggest controlled study of this, where what we did was we, again, went into a division one school, measured everybody over the summer before they showed up for classes and training. And then we just combed through every interaction with any healthcare person. And in this school, everything from I feel stressed to I twisted my ankle gets documented in their record.

3:24:28Dr. Michael Grandner:Everything. Every headache gets documented. So we just combed through to see what over the summer predicted concussions. And what we found was prior concussion history, being male, and being in a high-risk sport were the three biggest predictors of concussions, except for the sleep variables. insomnia having having a high insomnia severity and it's like which is which is a questionnaire we use to see like how much is your is your insomnia interfering with your functioning day during the day and how much is it stressful for you and daytime sleepiness saying at least two days a week i think it was a week at least two days um in a period i'm having trouble staying awake those two not amount of sleep but those two were better predictors of whether you were going to get a concussion than even the concussion variables um hasn't been replicated no one's been able to do something this large since i'd love to do it i'd love someone else to do it but this is consistent with the literature that's coming out that shows that it's not just the amount of sleep sets you up for acute sleep deprivation effects, but it's going to bear out in terms of daytime functioning.

3:25:48Dr. Michael Grandner:And if your daytime functioning is bad, then you're more likely to injure yourself. And getting better sleep is the best way to not be sleepy. Yeah.

3:26:00Dr. Rhonda Patrick:That's very interesting, your study.

3:26:04Dr. Michael Grandner:Yeah. Well, and it's actually inspired by a study that was done a bunch of years ago by a guy named Ben Potenciano, who's actually a sports person. He's a sports psychologist. And he did this project. And I read it when I was a postdoc. It was brilliant. He worked with Major League Baseball. He still works in pro sports. He's a great guy. But he did this project where he gave sleepiness questionnaires to a whole bunch of MLB players, followed them up a couple years later. I don't remember exactly the timeframe. Just look to see who's still in the majors. And you could see dose response, every one point extra increase on that scale, the likelihood of no longer being in the majors.

3:26:44Dr. Michael Grandner:And the ones who were in the clinical range who scored over a 10 at that baseline time, 75 % of them were not in the majors anymore. Incredible. One simple questionnaire more than a year in advance could predict someone's career trajectory. And so that's what gave that that gave me the idea of like wow what other simple questionnaires can predict just at screening um who's at risk yeah um i want to ask you before getting on to the rapid fire audience questions sure you um the cognitive performance when i'm very interested in just

3:27:20Dr. Rhonda Patrick:personal reasons and i'm wondering like is there let's say someone's getting pretty good-ish sleep Yeah. Like, would you have a couple of your top tips that you do you think they could still improve cognitive performance with a couple of sleep tips?

3:27:38Dr. Michael Grandner:Yes.

3:27:38Dr. Rhonda Patrick:And if so, what are they?

3:27:40Dr. Michael Grandner:Yes. So the first thing I'm going to say about the cognitive performance is caffeine can dramatically improve performance in some domains, but not others. you can you can caffeinate things like attention focus reaction time speed all that stuff but data show over and over and over again whether it's military samples whether it's sports samples you cannot caffeinate away complex decision making you just make bad decisions faster that's what happens when you caffeinate a sleep-deprived person um over and over again the data show this you can so like a great example there's this great study where they did in tennis players, semi-pro tennis players, when they took them down to five hours of sleep, impaired their serving accuracy by, if I remember correctly, something like 35%.

3:28:32Dr. Michael Grandner:It recovered, about a third of the loss was recovered when they caffeinated, but not all of it because there's other higher order stuff that's happened. That's the sort of stuff you see in the literature, that it's not fixed by caffeine. Some stuff is, some stuff isn't. So caffeine is not the answer. But one of the things that would be the answer is actually, and there's actually data on this, insulate yourself a little bit. Bubble wrap your sleep a little bit. What does that mean? if you can protect yourself against minor environmental disturbances during the night and protect the sleep you are getting, you can make it a little more consolidated, especially the deeper sleep, and get a little more benefit from it.

3:29:18Dr. Michael Grandner:So here's a great example, a simple example. Some of the best sleep technology on the market, simple cloth eye mask. There was a study, I think it was in Switzerland, where they had an eye mask, just a plain old cloth eye mask, and they had a placebo. eye mask where they cut the holes out in the middle same strap just cut the holes out improved sleep consolidation during the night these were in college students so they were in sort of noisy environments anyway but consolidated their sleep better in the night translated to better test scores the next day uh that's just one example like i'm at i'm ass and earplugs some of the best cheap sleep technology that exists yeah so darkness and dark well but it's But it's also, you might need to just, that extra layer of insulation.

3:30:06Dr. Michael Grandner:Extra layer, yeah. Like a white noise machine could be good for something like that.

3:30:10Dr. Rhonda Patrick:Don't have a puppy in your room, basically.

3:30:12Dr. Michael Grandner:Yeah, something like that. Like, yeah, anyone who has an animal in their room, another mammal in their room, like. Moving around. Yep. You're going to have more fragmented sleep.

3:30:23Dr. Rhonda Patrick:Okay, awesome. Okay, let's get to some of these rapid fire audience questions.

3:30:27Dr. Michael Grandner:Yes, let's do it.

3:30:28Dr. Rhonda Patrick:Best evidence-based way to fall asleep and stay asleep. Fall asleep faster and stay asleep.

3:30:33Dr. Michael Grandner:Yes. I'll give you two because one is cheating. The one is stimulus control. Because if you can be rigorous about stimulus control, you can get into bed anytime, anywhere. It's like when I travel to a different time zone, even if I'm in a totally different time zone, I'm so rigorous about stimulus control. I can be at a very off time zone, but the lights are out. My eyes are closed. My head's on a pillow. It's a conditioned stimulus. I fall asleep fast. So if you can train yourself that that situation is reliably paired with sleep coming soon thereafter, you can make yourself, even if you're stressed, you can fall asleep faster by putting yourself in that situation.

3:31:14Dr. Michael Grandner:Rigorous, highly empirically supported, lots of data to support this. The other one I would say is allowing sufficient wind down time with nighttime signals. Dimming lights literally and metaphorically for at least a half an hour before bed. literally meaning you want them orange you don't want them bright and blue and metaphorically i mean give yourself time and space to detach that is actually usually if you're going to bed at the right time or within your window of time if you're having trouble or your mind's racing it's because you're trying to go from 30 000 feet to parked at the gate right away just put a little bit of space in there, let yourself come to a stop and you'll find it's way easier and you don't have to fight so hard.

3:32:03Dr. Michael Grandner:If you're trying to stop at a stop sign, start breaking more than one foot in front of the stop sign. You will find it's so much easier to break wherever you want. If you're coming in a

3:32:12Dr. Rhonda Patrick:little slower, I definitely do. Number two. Um, I'm definitely now going to, I'm going to be on top of this, this control thing because I'm super interested in it. Bang for your buck.

3:32:21Dr. Michael Grandner:sleep tip in the world.

3:32:23Dr. Rhonda Patrick:Great. Okay. Awesome. Most effective pre-bed routine you've seen to shorten sleep onset?

3:32:28Dr. Michael Grandner:Yeah. So that I would say is orange lights, putting screens down if you can. If you can put down screens, reading. Reading actual paper books is great before sleep. Unless you're me, I actually suck at reading before bed because I get into it. But for most normal people, The data actually support reading because it's self-paced. If you can't maintain muscle tone, you'll know it. And you will tap right into your body signals. You won't be overstimulated. And as soon as your body's ready, you'll know it and you can put stuff down. So reading, dimmer orange light, the way to go. And that's sort of the way to go.

3:33:14Dr. Rhonda Patrick:All right. Best strategy to fall back asleep quickly after waking in the night.

3:33:19Dr. Michael Grandner:Um, if, if I were going to turn this into an algorithm, step one is if I wait, if I wake up in the middle of the night, what do I do? First step one is, okay, can I fall right back to sleep within the next two or three minutes? I try. And if I don't, then I, then I evaluate, okay, is there something going on my body right now that I actually need to get up or not? Is this something I can, and, and let whatever activation was right out. If it's going to be short, let it do not. And I guess the answer is do not add performance anxiety to it. Read the room. If you're not in control of your ability to fall asleep, if it is outside of your control, don't try and control it.

3:34:02Dr. Michael Grandner:Let it be. And don't panic. You will fall asleep just fine. If it's possible to fall asleep fine, if you didn't panic, you will. As soon as you start panicking, you're adding energy into the system.

3:34:13Dr. Rhonda Patrick:All right. Don't panic. I'm going to recap. Yeah. One proven method to increase deep sleep in healthy adults.

3:34:21Dr. Michael Grandner:Proven method. So there is some really not not that I think anyone really whether or not people need it. I don't know. But the day there is some data you can improve the deep sleep, not improve. You could potentially get more of it, get it more consolidated. Besides, the obvious is if you have a barrier, get rid of it. If it's sleep apnea or whatever. But in healthy adults, there's some actually cool data on neural stimulation where you can induce more deep sleep activity. using auditory stimulation by sort of tricking your brain to create those waves. Jury is still out on exactly, is it just creating the waveforms or are you actually getting the extra benefits of what looks like more deep sleep or does it just look like you're getting more deep sleep because your brain's creating the waveforms?

3:35:03Dr. Michael Grandner:I'm not quite sure yet, but there's actually a bit of data you can do that. And actually, like I said, with the eye mask, the environmental bubble wrapping of your sleep, because if anything is going to prevent you from getting more deep sleep, it's extra stimulation.

3:35:19Dr. Rhonda Patrick:With the auditory stimulation, is this something that you listen to while you're...

3:35:23Dr. Michael Grandner:Yeah, it's like the binaural beats kind of a thing where it induces... It basically sends waves that are in the waveforms that you want your brain to sort of create to echo them.

3:35:36Dr. Rhonda Patrick:Okay, cool.

3:35:37Dr. Michael Grandner:Yeah. It's like biofeedback, but for brainwaves.

3:35:41Dr. Rhonda Patrick:most effective way to reduce nighttime urination and wake-ups

3:35:45Dr. Michael Grandner:most people when they are peeing a lot during the night it's not because they have to pee a lot during the night it's because they're awake during the night so what i would say is first of all see if there's something that's waking you up untreated sleep apnea probably the leading cause of nocturnal frequent urination because you keep having these arousals at night and your bladder's like okay while you're awake, might as well. That usually comes afterwards. The other thing is, if you're used to getting up to go to the bathroom a lot, maybe you don't need to, and you might want to do an experiment and see if you can go back to sleep without going to the bathroom if you don't need to, and then you can get used to that too.

3:36:24Dr. Michael Grandner:Because if you can hold it till the morning, just hold it till the morning.

3:36:27Dr. Rhonda Patrick:I've done this before. In fact, I used to get up to go to the bathroom one time in the night, And now I don't get up at all to go to the bathroom. And, you know, I'll usually wake up and it's probably like around five-ish or so. And I'll feel like, oh, I could go pee. But then I just like close my eyes and go back to sleep. And guess what? You're fine. I've made it. I've made it now months without having to do that. See?

3:36:48Dr. Michael Grandner:And that's the thing. It's actually, you might have accidentally programmed yourself to do that. Remember what I said, the average person will wake up 10 times a night or more. That the awakening occurs is not the problem. that it's blossoming into something you're remembering as stressful as the problem. Take the stress out of it being like, oh, I just had one of my hundred awakenings during the night that I just happened to be conscious of this one, but nope, go back to sleep. And if you can train yourself to do that, it's actually shockingly effective. If you reduce that performance, exactly like you talked to.

3:37:19Dr. Michael Grandner:Yeah.

3:37:20Dr. Rhonda Patrick:No, I'm going to be all over the stimulus control thing. That's going to be my new thing. Okay. One actionable change that measurably improves overall sleep

3:37:27Dr. Michael Grandner:sleep quality overall sleep quality um i talked about a lot of stuff whether it's nighttime routine getting you know having the bed be a be a good place for sleep but in terms of sleep quality actually daytime morning have a day get activity don't don't sit around in the dark all day humans are not built for that eat well people who people who eat like crap especially late at night their sleep is more disturbed at night. Reduce systemic inflammation in your body. Your sleep will feel better. If you're sharing a bed with somebody and that somebody has sleep issues, drag them kicking and screaming to get tested for whatever it is they have and get it treated.

3:38:14Dr. Michael Grandner:Or get two twin XLs, put them next to each other. You can sleep with somebody but not on the same mattress. You can just put them next to each other. Like people underestimate how much this environmental stuff is shallowing out their sleep quality.

3:38:29Dr. Rhonda Patrick:My husband and I, we have our own separate blankets. Yes. On our bed.

3:38:33Dr. Michael Grandner:See, there's nothing wrong with that. There's people who talk about this as if it's a bad thing. But actually, from a sleep science perspective, you get all of the social, positive human benefits of sleep. Humans were not really meant to sleep alone. But at the same time, you get to be in your, essentially your own microclimate and environment where you get to be under control and not have it be, it's best of both worlds.

3:38:57Dr. Rhonda Patrick:Right, where I'm not feeling the movement as much.

3:39:00Dr. Michael Grandner:Exactly.

3:39:01Dr. Rhonda Patrick:For sure. Okay. How can you quickly assess if you're getting enough sleep without a lab test?

3:39:07Dr. Michael Grandner:You couldn't even do that with a lab test. We don't have a good test of are you getting enough sleep. Test number one, if I put you in an otherwise quiet, dark room for 20 minutes, could you stay conscious? if the answer is no, you're probably not getting enough sleep. And it's not, might not be amount. It might be about quality because for people with a sleep disorder like apnea, more isn't always better. More might just be, you can get an unlimited amount of sleep and still feel tired because the quality you're getting is poor. So it's just like nutrition that way. It's multidimensional, but by more, I mean more quality or quantity.

3:39:41Dr. Michael Grandner:So one is if you're having trouble staying awake during the day? Or if you, if you put yourself in a situation where it would be really easy to fall asleep, could you, like, would you fall asleep right away? If the answer is yes, something like, why are you so hungry? That like you put, if you, if you, if you put a plate of food in front of you, can you resist it? If you can't, what's up with your appetite? If it's not mealtime, you should be able to resist it. The other thing is you can experiment and get a little more and see if you feel better. If you don't, okay, good to know. Another way to tell is if you fall asleep as soon as your head hits the pillow, you probably waited too long.

3:40:22Dr. Michael Grandner:It's just like saying I cleaned my plate in 30 seconds as soon as it was put in front of me. Should have taken a little bit of time. So maybe you're going to bed too late. Maybe you're waiting a little too long. Yeah. How do you know you're getting off? Unfortunately, we don't have a good test for that.

3:40:38Dr. Rhonda Patrick:I like those. I like those.

3:40:39Dr. Michael Grandner:Yeah, it's practical.

3:40:40Dr. Rhonda Patrick:Do you really need eight hours of sleep?

3:40:41Dr. Michael Grandner:No. First of all, the recommendation these days is seven, because when we looked at the data, there was no distinguishable difference in almost all cases between seven and eight. Plus, people don't tend to have that. It's all based on recall anyway. So people don't have that much resolution. Seven's kind of the new eight. At six, people were starting to show problems on average. Are there people who sleep six hours and are fine? Yeah, I'm sure. Probably. Are there people who are sleeping five hours and are fine? Possibly. Is it you? Probably not. Think of it as a bell curve where you're probably somewhere in the middle.

3:41:15Dr. Michael Grandner:The chances that you're on an extreme outlier are low. Just because you're an outlier in one part of your life doesn't mean you're an outlier here. And athletes especially probably need more because they have a higher load on their recovery system. So you want to recover. You need to give yourself the time and space to do that. Do you need eight, though? No. Do you need seven? Maybe. But then also need for what? how much sleep do you need to not die is different than the amount of sleep you need to be optimally functioning.

3:41:44Dr. Rhonda Patrick:Yeah, optimally functioning.

3:41:45Dr. Michael Grandner:Optimally functioning. I would say most people probably need seven. By self-report, that might mean six or six and a half on your wearable. Right.

3:41:54Dr. Rhonda Patrick:Okay. And then one practical tip for aligning lifestyle with your chronotype.

3:42:00Dr. Michael Grandner:Yeah. I mean, give yourself permission to schedule stuff out in different times. You may or may not have control. I mean, if you're a night owl and you have a job that works early in the morning, I don't know what to tell you. But if you could control your day such that maybe you're doing certain things at certain times or adjusting mealtimes or adjusting where the heaviest workload of your day is, scheduling meetings at certain times, like you might be able to do that. I mean, if you're a heavy night owl, but you have to go to work in the morning, just wake up as soon, you know, give yourself as little time as possible to get there so you can stay up as late as possible and do all your household stuff at night, you know, and keep that schedule as consistent as possible seven days a week.

3:42:43Dr. Rhonda Patrick:Well, this has been very, very enlightening and interesting. I've actually learned quite a bit today. So thank you so much for coming on the show. You have a book coming out in, I think, October.

3:42:55Dr. Michael Grandner:Yeah, it's planned. It's a textbook, so it's an academic book, but it's all about, so it's a wearables book.

3:43:00Dr. Rhonda Patrick:We also have - It's all

3:43:03Dr. Michael Grandner:I've also edited a few other textbooks. There's one on sleep health, another one on sleep and sports, and another one on adapting CBTI for clinicians. I'm an academic. This is what I've got. But if people are interested in them, they're not priced like a regular book. They're priced for libraries and for academics. So if people have any questions about anything in them, just shoot me an email. I'm actually easy to find, and I'm happy to be responsive.

3:43:32Dr. Rhonda Patrick:Yeah. I mean, I'm looking forward to it. A book on wearable sleep technology written by an academic who actually knows about it. It sounds interesting to me. It'll be fun. So great. So people can look you up. You got your lab at the University of Arizona. Yep. Thank you so much for coming on the show and sharing all this really, really knowledgeable, you know, important information with everyone. And thank you for everything that you do.

3:43:52Dr. Michael Grandner:No, you're very welcome. Thanks for having me on.

3:43:55Dr. Rhonda Patrick:Thank you so much to Dr. Michael Grannner for sharing his incredible knowledge today. And thank you all for listening and supporting the podcast. If today's episode resonated with you and you're interested in even more practical science-based insights, don't forget to sign up for my free weekly email newsletter. We explore actionable topics like caffeine's effects on sleep, creatine and cognitive health, and diet's role in regulating blood pressure. For those who want to dive even deeper, joining as a Found My Fitness premium member is an excellent way to directly support our mission while accessing exclusive content like the aliquot podcast, monthly live Q &As with me, and you help keep this podcast evidence-based and unbiased.

3:44:37Dr. Rhonda Patrick:You can learn more about this membership at foundmyfitness.com forward slash premium. Once again, that's foundmyfitness.com forward slash P-R-E-M-I-U-M premium. Thank you so much for listening, and I'll catch you next time.