GUEST SERIES | Dr. Matt Walker: Improve Sleep to Boost Mood & Emotional Regulation

31:05Unfortunately common features of trauma and negative memories but the idea as I understand is to repeat the recall many times often in that safe environment such that eventually what was initially a really terrible event remains a terrible event but the emotional load of that event is removed from the person's neural. Understanding of the event is the way I've heard it described is what starts as a tragic traumatic story eventually becomes a kind of a sad boring story boring to the person who's saying it meaning it doesn't evoke as much autonomic arousal. Exactly and in some ways that's the perfect description of this overnight therapy process that it becomes a memory that is no longer triggering an emotional reaction and in some ways that's what you want if you go back to my description from an evolutionary perspective I told you that one of the functions of emotions is to read flag and prioritize the memory at the time of learning to say that it's important that's a very adaptive process.

32:21It's not as a process prioritized which things we really should be focusing on and remembering but it's not adaptive for you to hold on to that emotion long term once you've stored it and there has been some suggestion in the literature before we were doing this work that maybe one thing you can do with trauma and trauma memories is sleep deprived individuals that very first night after the trauma because we knew at the time sleep is important for memory. What you would like to do it and it's very similar to that movie sunshine spotless mind I was forget the eternal cells eternal sunshine of the spotless mind thank you and see the movie better here is good yeah and what they try to do is target in the brain these you know difficult painful experiences and just excise them from the brain and.

33:14That was the suggestion could you pop those memories out of the biography of that individual and save them the trauma I would argue that's not really what you want to do because let's say that I am I have a trauma experience where I was walking home at night from the sleep laboratory late at night and I was coming down the kind of an alley to take a shortcut and someone sticks me up with a gun maybe some violence. I don't want to remove that memory I would like to remove the trauma response associated with that memory but I would argue for me as an organism it's still very important for me to remember that that alley was associated with a bad experience and I should for go going down that very same route again I want to hold on to the memory the information I want to let go of the emotion I want to sleep.

34:10I want to sleep to remember and I want to sleep to forget and I'll come on to why I think that's relevant to PTSD when we perhaps speak about that condition and it's very very relevant but coming back to REM sleep we look back in the literature to see if we could find signs that REM sleep had this relationship with even just your basic emotional reactivity and there was some wonderful work by a gentleman that you will know from Stanford probably one of the most important things that I want to do is to get back to the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the memory of the money of the money of the money of the money of the money of the money of the money community.

34:48And I want to look back. Some of the questions that plug so I'm just listening what the MI of fragmentation Purple was, wouldn't there be contact information? What the MI type of question was? What? What can you do? What you're thinking about this was through through through through through through through through through he would take individuals because we didn't really have the first published report of these two types of sleep of Rema non -Rema until they collected the data or found the data in 1953. It was published in 1954. So in other words, we discovered that even up to then, prior to then, we just thought sleep was sleep.

35:33We didn't have any knowledge that these different stages. So in the same year that Francis Crick unveiled this incredible helical structure that was called a DNA strand. We also discovered the different stages of sleep. But in the 60s then, William DeMent, knowing that there were these two types of sleep and knowing that there was something that was going on with REM sleep where people were dreaming and he would be waking people up from these different stages and found that it's far more likely for people to report a dream. He wondered what the consequence would be if you selectively deprive people of this stage of sleep of dream sleep.

36:13So he brought individuals into his laboratory and every time they would go into REM sleep, they would go into the room, they would wake them up, have them do some mathematical problems for a two or three minutes and then put them back asleep and they go back into non -Rema and then as soon as they went back into REM, they would wake them up again. And the first night, they would have to go into the room maybe six or seven times. Till brutal. For the person in the experiment. Not too much fun. And by the end of the five days or six days, I think they were going back into the room something like 17, 18 times.

36:46Why? Because the people were building up this growing REM sleep debt and the brain had such a hunger for it that by night five of no REM sleep, all it wanted to do was rock it into this thing called REM sleep and start devouring it with high volume. But that wasn't the interesting part. The interesting part was the consequence to these subjects. They were all well adjusted perfectly normal individuals. By about day three of selective REM sleep deprivation, they started to show signs of paranoia. They started to believe people were out after them. They started to have hallucinations and delusions.

37:30And by day five, they were bordering on having aspects of quite severe psychosis. And so what all of this research has taught us in some ways is that it's almost as though REM sleep and again it's hyperbolic is the difference between sanity versus insanity. It's the thing that separates those two. And there's a wonderful quote from an American entrepreneur called E. Joseph Cosmon. And for all of the years of work that we've been doing in this field, and I've spilled so much ink over this, including in the book, he summarized it in a single sentence. The best bridge between despair and hope is a good night of sleep.

38:20And that's exactly what the data is demonstrating in terms of basic emotional brain function. Such a powerful link there. And I think it's appropriate therefore if we explore a little bit about what the link actually consists of, in a way that will provide people a kind of a compass for when they're feeling a little bit less emotionally regulated or if they would like to improve their levels of emotion regulation. This is going to be a little bit of an exploration, but you may recall this is an exploration that you and I had some years ago when we were talking about the relationship between rapid eye movement sleep and emotionality.

39:02And here you've described that the medial prefrontal cortex normally plays this kind of role, this suppressive role over the amygdala under conditions where there is something to consider, is it diverse, is it not diverse, however, is it, right? But in terms of what we know about stress and emotion, the autonomic nervous system, this incredible system that balances sympathetic, meaning alertness arousal, sometimes called the fight or flight system, and parasympathetic activation, sometimes called the rest and digest system. It's the balance of the two that dictates one's emotional state and alertness level of stress, et cetera.

39:43And I've always imagined the autonomic nervous system, the sympathetic and parasympathetic nervous system as sort of a seesaw. But on this seesaw sits us, right? And we can move back and forth across this seesaw, but there's a component of the seesaw that in my mental model, which is the hinge, how tight the seesaw is, meaning how easily or how challenging it is to tilt the seesaw off to one or the other side. And I don't know if the mechanism has been discovered, but I feel like what happens under conditions of REM deprivation or sleep deprivation, that is sleep deprivation, but you've beautifully described how it's REM deprivation in particular that can do this, that the hinge becomes loose.

40:32But the hinge doesn't become loose toward us becoming more parasympathetic and relaxed. There's an asymmetry there. It says if the seesaw now wants to flop to sympathetic activation until we're so exhausted that we just disappear into sleep. So the question is this, and maybe all we have here is opportunity for speculation. But is there any understanding of what the hinge might be and how sleep would adjust the tightness of that hinge? And if people are following this, what we're really trying to get to is you know, you described a neural circuit mechanism within the brain, but is this, for instance, the gating of the release of epinephrine adrenaline and cortisol?

41:12I mean, is that I could imagine that's regulated by the brain, but when we're deprived of REM sleep, that process becomes less poorly gated and then we just will punch out a bunch of adrenaline in response to a phone call from a close friend that you adore, but is their voice is just a little bit loud and like, oh, this is rough, et cetera. Do we understand the nature of the hinge? We do a little bit and it's something that we started off trying to test with one specific belief and then we were beautifully course corrected by the data. We thought that the hinge was going to be once you were sleep deprived and you started to slide down into that fight or flight branch that more sympathetic and away from the parasympathetic that the hinge would get ever tighter the further into that sympathetic, stress -related fight or flight dip that you had and though you would stay, it wasn't quite that simple.

42:10What we found was that when I challenge you or put you either under a very simple cardiovascular challenge, let's see, I'm just having you grip a bar for a long period of time or we have you under some other, maybe even if it's an exercise regimen, when you are in a sleep deprived state and you are largely inert and not interacting with the world, you actually are in a more strong parasympathetic state. It's almost as though you do not want to interact with the world per se and this comes on to motivation. We and others have found that one of the earliest and strongest effects of a lack of sleep is just absence of motivation.

42:58I don't want to interact with the world, I don't want to be social, I don't want to learn, I don't want to exert effort, I don't want to exercise, I just don't want to do much of anything. However, when you provoke me and you force me to interact or there is a very strong emotional event that I experience, I go all the way over into the strongly sympathetic. So it's almost as though we had the prediction that it was going to be a very tight hinge and the screw was tightening the more sympathetic you became. It was much more that you were in this sort of parasympathetic state, this sort of non -motivational state and the hinge was so loose however that even just the tiniest flick of a challenge, whoosh, you went straight over to the sympathetic.

43:52There was no sweet spot of a tightening where you were nicely balancing between those two states and this comes back to something else that we found. That's you switching flip -flopping back and forth between parasympathetic and sympathetic. I spoke about the emotional reactivity to negative aversive events but that's only one half of what we call the affective valence domain. It's not just that you can have negative emotional reactions, of course you can have positive emotional reactions. So we did assist the study to that amygdala study and we asked rather than showing you increasingly negative images and how your amygdala would respond much more strongly to those as we provoked it, we then started to show you much more positive rewarding images.

44:50Because one hypothesis would be that you just simply slide down the scale and you move towards more negative and away from more reward -based reactivity or you could imagine that it's both that when you are sleep deprived you are equally excessively reactive to both of those domains and what we found was that it was the latter that you were very abnormally reactive, overreactive to negative events but you were equally hypersensitive to very reward -based stimuli and this fits beautifully with what we know from sleep deprivation. You are much more impulsive, you are much more reward -seeking, you are much greater in terms of your sensation -seeking and your addiction potential when you are not getting sufficient sleep is significantly higher and sure enough when we looked in the brain many of these dopamine -related circuits that you've described before were overactive when you were under -slacked.

45:55And so I bring this back because it relates to your seesaw sort of analogy. Yes, you can think about the seesaw from with sleep deprivation from a sympathetic parasympathetic. You can also think about it from a positive versus negative valence. And once again our hypothesis was that you're just going to slide down into the negative and you're just going to be less responsive to the rewarding positive. It was the opposite. You were abnormally and excessively sensitive to both of those domains which you could argue is perhaps the very worst of all adaptive responses. Absolutely. As an organism you don't want to be non -reactive.

46:36Emotions are powerful and we've spoken about the benefits you need to have emotions to be a functioning human being or organism in the wealth. They are designed to adaptively help us survive. But you can't go to the extremes. That's maladaptive rather than adaptive. But that's where you go when you are sleep deprived. It's this loose hinge and you become very very erratically and extremely reactive from a neural perspective. My understanding is that sleep deprivation definitely increases impulsivity and addictive potential. It's the worst of both worlds in this case. Given that now would probably be an appropriate time to just cue people to some of the things that they can do to improve or maximize their rapid eye movements.

47:32This was covered in detail in episodes 1 and 2. And to some extent in episodes 3 and 4 as well. But they're in reference to other things learning memory creativity, the role of naps, etc. And I'll refer people back to this beautiful formula, QQRT. It's not just about getting enough sleep. It's about the quantity indeed, but also the quality QQ, regularity and timing of sleep. Knowing one's chronotype, that is the best time to go to bed and the best time to wake up in the morning for them is going to be critical here. And I can raise my hand, both hands in fact, metaphorically and say that when I've gone to sleep early and woken up early, so for me 839 pm and then waking up at 435 am, which for me matches my chronotype, it has served as a powerful antidepressant effect.

48:31And when I've gotten an equal amount of sleep but going to bed too late for me, that is midnight 1am and sleeping in until 8 or 9am, I always carry a low level depression. Fortunately not something that need to be medicated, but it's a striking effect in the positive direction when obeying QQRT and in the negative direction when not. So maybe just for because we can provide some links to those segments and the show no captions, but maybe just for people that are here now, we were going to list out two or three things that one can do to try and maximize the quality and quantity of REM sleep without going on too much of a tangent, but at the same time we do want to highlight that addressing that QQRT formula for ourselves is going to be critical.

49:26So maybe for REM sleep, in the domain of exercise, temperature, etc. Are there any kind of quick bullet points that we can refer people to? I would say just to keep it high level and brief the single best way cheapest, non -phomological way that you can enhance your REM sleep is to just sleep an extra 15 or 20 minutes later into the morning. Don't try to put, if I tell you this is about, by the way, this is about the quantity that your sleep opportunity. Don't try to add that 30 minutes or 20 minutes if your goal is to increase REM sleep at the start of the night at the front end. Instead, take that desire that I've offered you of adding just 20 minutes or 25 minutes of extra sleep now to the last part of your night.

50:22Wake up that sort of much later, 20, 25 minutes later. That's the REM sleep rich phase. So if people go back and listen to episode one, we'll describe to you exactly how the different stages of sleep unfold across the night. And they're not evenly distributed. It's not as though you get just as much REM sleep as well as deep non -REM sleep in the first half of the night. As you do in the second, you get most of your deep sleep in the first half and you get most of your REM sleep in the second half, and particularly in the last quarter of the night. And this leads us to understand that the later into the morning hours that we go, the greater the hunger preference and the taste desire that is of your brain to start sampling from the finger buffet of all of those different stages, this thing called REM sleep.

51:12And the later that you sleep into the morning, the more of that REM sleep that you will have. And many people will have experienced this at the weekend where they have this pattern that we don't recommend based on the QQ RT. QQ R regularity goes a bit at the same time, wake up at the same time. What we see often in society is something that we call social jet lag where you're short sleeping during the week. And then at the weekend, you're out with friends or you're out sort of on the town, you go to bed late and you wake up late. And maybe you're doing that by two hours. Maybe you're normally in bed by 10 pm during the week.

51:51But now at the weekends, you're going to sleep maybe 12, 12, 30 and you're waking up two, three hours later on a Saturday and Sunday. And then the problem with that parenthetically is on Sunday evening, you've now got to go back to work the next day. So you have to push yourself back to 10, 30 or 10 o 'clock, whereas you were going to bed, let's say at 1am on Friday and Saturday night, that's a three hour time shift. And people are doing that very frequently. That's the equivalent of you and I flying back and forth from Los Angeles to New York every single weekend in terms of ossucating rhythm.

52:30And it's brutal on it. But this is separate from this notion of you're timing the final part of the QQRT. And by pushing you're timing a little bit later into the morning when you wake up, you will experience more REM sleep. And as I said, when people sleep later, they go to bed later at night and they wake up much later in the morning at the weekend. I strongly suspect that if they paid attention, they would say at weekends, I always dream more. I always can remember my dreams and there are more intense. It's not because there's something magical about how your memory recollection of dreams operates on Saturdays and Sundays.

53:11It's because you've slept in later, you've gone into that REM sleep rich preferential phase in the morning and therefore you've increased your REM sleep. So I would say that that's probably the easiest way that you can start to modulate REM sleep. So that's the terrific do. And I think we can probably summarize the top don't as don't drink alcohol because it abolishes REM sleep. Alcohol and THC are both very potent ways that will remove or obliterate your REM sleep. And we spoke about this in the episode on THC when we discussed this. I think just yesterday I got a very long email and I'm sure you get lots of emails from delightful people in the public and a gentleman just saying, I was using cannabis for probably about seven years and then I watched or listened to some of your content and I stopped and I just had this explosion of dreams.

54:12And I was never recollecting any of my dreams before. But now they came back and goodness were they vivid, they were rich, they were and I could not believe it. And that's REM sleep. And that's because during the cannabis use by way of the THC not the CBD, you've been blocking that REM sleep. You've built up that pressure just as we described in the domains studies. And then when you finally do take away the agent that is blocking the generation of REM sleep, the THC, obviously in your brain doesn't just go back to having its standard amount of REM sleep and dreaming. It has that plus it tries to get back as much of it as it possibly can by having what we call a REM sleep rebound.

54:56And that's why people when they they stop using they end up having this intense REM sleep. By the way, to your point about reward and addiction sensitivity with sleep deprivation, one of the things that we we did in a collaboration gosh this is years ago and I was at Harvard with Carl Hart who I think you I don't know if you call him. Yeah, Columbia is you know him. Yeah, he's fantastic researcher, a very interesting man too. And what we found was that a lack of sleep was not only predictive of your addiction potential. But when you went into a clinic to abstain and trying to come off some of those in here we were looking at cocaine addiction.

55:40A lack of sleep was a strong predictor of your abstinence and you falling off the wagon and going back to you. So sleep is so critical not just for maintaining or pushing you away from that addiction potential. But once you are addicted and you're trying to abstain, it gives you that lift of altitude to try to resist falling off the wagon and when sleep gets short that's when you become vulnerable again probably because your reward circuitry becomes enhanced and all of a sudden you just cannot resist the temptation anymore. I want to take a brief break and acknowledge our sponsor inside tracker.

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57:01Inside tracker also offers inside tracker pro, which enables coaches and health professionals to provide premium and personalized services by leveraging inside trackers analysis and recommendations with their clients. If you'd like to try inside tracker, you can go to inside tracker .com slash huberman to get 20 % off any of inside trackers plans. Again, that's inside tracker .com slash huberman. I think that takeaway is very clear. In order to be your best emotional self, that is in order to be able to access positive emotions to their full amplitude motivation. Learning as we also covered in a previous episode, but also to stay out of those irritable emotional traps of life and to be a regulated person, calm and joyful person, stands to reason to minimize alcohol and cannabis use unless there's some medical reason why someone should do otherwise.

57:56But the real take on message here is get as much rapid eye movement sleep as possible and don't do anything to inhibit it. Yeah, get as much sleep so focus on all of those for macros of sleep, quantity, quality, regularity and timing. And notice that if you want to try to optimize some of those that emotional reactivity imbalance, you may want to slightly over index on your REM sleep in that regard and one easy, cheap way of doing that. If you can, lifestyle permitting and again, of course I understand everyone has a life to live and pressures, but that's the way that if you were to ask me, can you do it and do it simply?

58:35Yes, you probably can. Great. You touched on trauma a little bit already, but now would be the appropriate time. I think to talk about PTSD post traumatic stress disorder, which I think we can use the definition of PTSD and trauma that the great Paul Conti, former guest on this podcast, who I did it under a serious man. Yeah, incredible. Man, what a mind on him and what a generosity of sharing information and clear ways about mental health as he did in the four episode series on mental health here. And he's been on other podcasts as well. Roda Marveless book on trauma, Paul defined trauma as some event that is aversive that changes the way that our nervous system works such that we function less well in the future.

59:24It's not that every negative event, every negative emotion associated memory is trauma. I think that's a misconception. But there are things that happen to people, or that they observe happening to other people. So there's first person trauma, third person, observational trauma, etc. And these can be single events, multiple events, you know, sadly this stuff happens. It can be neglect. So sometimes it's the absence of an event, which becomes the traumatic event that fundamentally rewire some component of neural circuitry such that we don't function as well in terms of relationship to anything, work, food, sex, sleep, relationships, baseline levels of emotionality and on and on.

1:00:10So what is the relationship between sleep and post -traumatic stress disorder specifically? I think some of what we've covered already, certainly touches on this. But PTSD seems to me that it might be its own unique case. It is because if you look at the diagnostic criteria for PTSD, firstly, you see sleep disturbance. And as I said right at the top of this episode, there is no major psychiatric disorder where there isn't some mention of sleep problems in its diagnostic criteria. But something else was intriguing about PTSD that compelled me to think about it and then create a theory around it.

1:00:53It's not just sleep problems, it's also nightmares. And specifically repetitive nightmares. In fact, repetitive nightmares form part of the diagnostic criteria for you to receive a diagnosis of PTSD. That's how reliable they are. And as I thought more about this model of overnight therapy, this notion that sleep and particularly REM sleep provides a form of emotional first aid, PTSD stood out to me as something that I had to return to to explain. Why? Because if you think about PTSD and a veteran, it is the perfect example of the process that I described of emotional deep potentiation failing.

1:01:44Because what I started to realize is that in PTSD, there is this trauma experience. And then perhaps what's happening is that sleep, the brain goes back to sleep that night and says, okay, please do your elegant trick of stripping away the emotion from the memory. And it fails. So then what happens the next night, the brain comes back and says, I'm sorry, but I still got this very emotionally charged memory. Please do your elegant dissipation, deep potentiation of the emotion from memory. And it fails again, almost like this broken record that was so indicative of these repetitive nightmares. And then when you looked at PTSD, I told you that REM sleep is a time of this remarkable decrease in neurodranolin.

1:02:32But if you look at PTSD patients, they actually have heightened levels of neurodranolin and also in the body adrenaline as well. In sleep. In sleep. And also when you look just as a basal state as well. So there's something not quite right with the neurodranolin story in REM sleep in PTSD patients. So I had just published this paper and I was up at a conference in I think it was Portland. And I presented the theory that, well, the data that we had on healthy people. And I put forward this theory of PTSD. And then later that afternoon, a psychiatrist came on the stage called Murray Raskin. And he was working a lot with PTSD vets.

1:03:24And he described data, which I couldn't believe it. One of those moments, Andrew, where you're at a scientific conference. And I think it happens maybe once in a career, if you're lucky, all of the hers on the back of my neck stood on sharp end. Because he was saying, we've got this data and we don't quite understand it. We've been treating our veterans for blood pressure, for hypertension, using a generic drug called Prazasin. And Prazasin blocks the adrenergic response in the body because you're trying to sort of tamp down that sympathetic activation in the body. So it's a regid blocker. So it's an it's an alpha adrenergic because an antagonist not a bit of it.

1:04:10So it's not a basic blocker, but it's blocking the adrenergic system. And so and it's a, you know, it's a generic pretty cheap drug, but it turns out that it crosses the blood brain barrier. So it doesn't just stay within the body. It goes up into the brain. And he said, we don't really understand it because I've been giving patients this medication, and it works to a degree, but something else happens. They come into the clinic and they say, Doc, I'm not having those nightmares anymore. They seem to have gone away. And these patients seem to start to show signs of resolution. So all of a sudden, I had had a model, a clinical model that was in search of data.

1:04:55And he had data that was in search of a theoretical model. I couldn't believe it because it's exactly what I would predict, which is that if noradrenaline is too high in PTSD, you're not processing and stripping the emotion from the memory. So it keeps coming back over and over like this repetitive nightmare. But then if you block and help bring back down that level of noradrenaline to that, which would be seen in a normal healthy person, in other certain, the emotional memory gets the chance to be processed and you finally start to get symptom resolution. So we couldn't believe it. He flew down to Berkeley.

1:05:36We spent several days together. We went out to dinner. We just could not stop talking. He subsequently did some incredible work in this area. And Prezason went on to become the FDA approved medication for PTSD and repetitive nightmares that was approved by the Veterans Administration. Bravo. And so no, it's not me. It's all of his work. No, no, no, no, no, no. You can't, no, this to me is the scientific collaborative conceptual equivalent of the old Reese's peanut butter cup commercials for those of us old enough to remember. It's two people running toward one another on the beach, one with a jar of peanut butter, one with a piece with a bar of chocolate and then they crash into one another and then they both share in the delight of the chocolate peanut butter combination, which is an amazing combination.

1:06:24But here, a far more important example, because it's led to clinical relief in patients with PTSD. So I have not making light of that at all, but this is one of the reasons to go to scientific meetings. Seriously, this is one of the reasons why scientists need to talk. This is one of the fosters hybridization of ideas, which is central to new discoveries. And in this case, a clinical discovery. I have a question about this notion of blocking nor epinephrine in the brain and body. On the one hand, it seems that during rapid eye movement sleep, we are paralyzed, or we are paralyzed. That's a fact of rapid eye movement sleep.

1:07:11The brain is recalling memories often in great detail, sometimes through symbolic representation, space time is disrupted. It's either faster, slower, because you're dreaming. And it seems that there's something powerful about being able to replay the memories and yet divorce them from certain neurochemical release in the brain and body to essentially uncouple them. And then to me, it makes perfect sense why taking a drug that would reduce the amount of sympathetic arousal in sleep would help, especially PTSD, because you said with PTSD, sort of an invasion of the noradrenaline response into rapid eye movement sleep that is inappropriate.

1:07:55So does that mean that rapid eye movement sleep in people with PTSD is not truly rapid eye movement sleep. It's as if it's been abolished and replaced with something that's kind of pseudo waking stress invaded, you know, it's like a zombie REM. And it's not good. Is that correct? It seems to be, and you can look at this in terms of the electrical activity of REM sleep, the electrical brain waves of REM sleep in these patients. And you're right, it doesn't seem to be of the same electrical quality. But what was interesting in Murray -Raskin's studies, when he started to treat patients with the preasicin and tamp down that noradrenaline, one of the other things that returned back to normality was not just that the symptoms dissipated, the REM sleep started to return with a greater amount.

1:08:47And so I think it fits very well with this notion that whatever REM sleep that was going on may not necessarily have been electrically or neurochemically identical to normative REM sleep. But when you assisted the system with a chemical to bring it back into normality, REM sleep was gifted back to the brain, an emotional resolution started to unfold. Now I should note that there have been a number of studies that have replicated the finding. Some studies have not though, and so we still need to understand exactly why this is the case. And there are other therapies that we'll probably discuss in a later episode on dreaming that are as if not more effective than that drug therapy for repetitive nightmares.

1:09:32That is a psychological intervention rather than a pharmacological intervention. And that seems to be very effective too. In 2017, as my laboratory was starting to explore some studies on humans on fear and trauma, I visited a trauma addiction center on the East Coast. The I Who Runs It will be a guest on this podcast in the future, an amazingly talented trauma and addiction therapist by the name of Ryan Swav. And there it was that I learned about yoga needra, non -sleep deep rest. And here's why they were taking heroin addicts, gambling addicts, sex addicts, alcoholics, people with what they call behavioral process addictions and substance abuse addictions.

1:10:17And every morning after they woke up, the first thing that they would do was one hour of non -sleep deep rest, placing people into this liminal state. And I asked why. And Ryan said, this is especially important to do with addicts when they arrive in inpatient recovery in the first week. And even more so in the first three days because typically they are badly sleep deprived. And in addition to that, many of them are just not good at getting and staying asleep at night without the use of pharmacology. Or in some cases, their behavioral addictions depending on what it was. And so it was a kind of a self -directed relaxation training of sorts.

1:11:00First thing in the morning that in addition, perhaps could compensate partially for some of the sleep deprivation that they note out were experiencing when they arrived. It's also novel environment and sleepy and novel environments can be challenging. So there is as far as I know, no randomized control trials of this practice yet. But there are a good number of clinics and treatment centers that are now employing non -sleep deep rest, aka Yoganidra, for 30 minutes to an hour. First thing upon waking as one of the core components of treatment for helping people get and stay sober. I think it's absolutely fascinating because that morning time period as well can be for those who are struggling with sleep, especially difficult.

1:11:49And you and I have spoken on this podcast series about sort of awakening at night or later in the morning when you really want to be asleep and it's just a struggle to get back. And as you noted there, you were saying they often come in undislapped. And my suspicion is that they're probably getting sleep at the front end in part because they're heavily medicated. But self -medicating in terms of helping their sleep. But then of course, because they are asleep, they can't continue to mediate to which part of sleep is fragile. It's those morning hours. And therefore, if you have something that is a compensatory tool that is not going to be the trigger of saying, just get back into bed, get under those sheets and sleep.

1:12:32You know, sleep doesn't work like that. Sleep is not something that we do. Sleep is something that arrives to us with us. And if it's not, you can't force it. And it's not, it's a, like someone's name, in fact, quite the opposite, that the harder you try to remember the further you push sleep away. And when you stop, it all of a sudden comes back. But I love this idea of inserting something like that as a compensatory tool. And that's why I think you and I have discussed openly here, in fact, on this series. At some point, we're going to collaborate. And we're going to look to see exactly what is happening electrically at high fidelity mapping inside of the brain when we are going through these liminal states.

1:13:18And what is the benefit of that? Is it a very similar benefit for sleep? And it's fascinating because it's possible that what we find at the level of the brain is that it's not sleep like it's something else like maybe it's just a liminal state like. And what's also interesting is that it provides seemingly many of the benefits of sleep. But it's not sleep. In other words, you can arrive at the same destination of mental and physical health through two different routes. One thing called sleep, one thing called these liminal states, or they both operate on the same highway in terms of mechanistic transaction benefits.

1:13:59So much that we need. Well, we could stay here all night and all day, hopefully not all night. Well, we will absolutely do those studies.

1:14:12And we will have to do those tools to try and access the replenishment and recovery that comes from sleep. And when sleep is available to us, when we can access it, that's going to be the best option. There's no question. But then some of these tools in theory and in practice provide a portal to get better at sleeping as well. So yeah, I'm going to say one of the other things I'd be fascinated for us to do is not just look at that model of what happens in the morning, but can we use that for people who have the opposite insomnia problem, which is that I can't fall asleep. And we spoke about this in a previous episode of tools and techniques and methods to help you fall asleep.

1:14:51Could this be one of them where you just start to help move yourself into this liminal state, you take the stress off. One of the things I hear so much at the center when people come in, and they say, I've just I always struggle to sleep. And you go into depth. And it's because they their mind starts to roll it x through that anxiety of what I need to do and what I should do. But also then the later it gets and the absent the sleep becomes the more stress they get, not just about the next day, the more stress that they get about this thing called not being able to fall asleep. And if there's something or practice that you've taught someone that says, that's okay.

1:15:32I know this place and I know this situation. And there's a tool I have. And it's called this liminal state. And if you were to train people on that sort of that method, is it a way that they finally can then cast themselves off? And it's the it's the bridge, not necessarily just between despair and hope, but the bridge between wakefulness and sleep. So put it at the back end, at the end of the day rather than the front end. A lot for us to discover there and you know, at risk of being hyperbolic, I mean, what would be more useful than a zero -cost non -pharmacologic tool for people to get the rest in restoration they need and to get better at getting the ultimate form of restoration, which is sleep.

1:16:26Yeah. And you know, I love the paradox of it that non -sleep deep rest allows you to go into sleep deep rest. It is after all a transition or liminal state. Maybe that will become the the stage before stage one of sleep. Who knows? Who knows? Who knows? Find our staging criteria. That's right. Okay. So speaking of challenges sleeping because of one's concern, aka anxiety about the importance of sleep. What about the relationship between sleep and anxiety? Meaning, many people in the world experience low -level anxiety or have a low threshold to what could be a full -blown anxiety or panic attack, but more often than not is this feeling of being tired and wired or having a quick, you know, pre -pulse startle as we call it in our business, nerds speak for, you know, kind of a reactive to input anxiety.

1:17:25And I don't think there's any clean definition between anxiety, stress, and PTSD. These run along and continue them and they break PTSD is an anxiety disorder. It's one of many. Right. These things braid together in a way that it would be a waste of our time to try and disentangle those. But many people have anxiety that is anywhere from minor to debilitating, but that is separate from PTSD, although people with PTSD can have anxiety. So what do we know about the relationship between sleep and anxiety? And perhaps we could frame this in the context of the QQRT. You know, I'll just toss out a question that perhaps highlights what I mean.

1:18:07Is it possible that somebody's getting eight hours of sleep which for them meets their quantity requirement in the quality is relatively high, but it's not as high as it could be because the regularity and timing of their sleep isn't great. Is that person going to be more prone to anxiety than somebody who's really matched to their chronotype and is still getting enough sleep? No one's done the head to head comparison where you kind of do the co -pepsi, Dr. Pepper Sprite, QQRT challenge between all of those. What we do know is that if you look at each one independently, QQRT, quantity quality, regularity timing, if any one of those is off, it's very difficult not to see a coexisting anxiety disorder or increase in anxiety or a mood disorder.

1:18:59And I think to me, anxiety is part of that class of a broader class that I would call mood disorders. It's relevant that we make that distinction at least in my eyes and I know some people would may disagree because mood and anxiety are different than emotions and many of us clump them together. The way I think about the difference is the following, time scale, emotions are short, punctate events that usually last anywhere from seconds to too many minutes. Moved states, however, like anxiety or depression, those are operating on a slightly different time scale from minutes to hours to months to years.

1:19:45And so it's very unlikely that we can experience an emotional reaction that from a sort of a chronometry point of view lasts for two years. But you can certainly see someone who has a mood state abnormality of depression that lasts for several years or who has been chronically anxious for several years. And I'll come back to why I think that distinction is relevant for a second. To your point though, about the relationship with sleep, here again, it's a very strong bi -directional relationship. And I would say that probably in the last eight or nine years, we've been doing a considerable amount of work in sleep and anxiety rather than just sleep in both basic emotional reactivity.

1:20:29What we found is it's very strongly bi -directional that if you have anxiety, it's very difficult to sleep. And if you are having difficulty sleeping, it's very likely that you will increase your anxiety. But before we really unpacked that, we started with a very basic study similar to those that we've described. We took a group of people and we were very careful to make sure that they had completely normative levels of anxiety. They should no signs of an anxiety related disorder. And by the way, anxiety disorders are, it seems one of, if not the most common of all psychiatric conditions, just to put it in context for people listening.

1:21:13And these individuals, no signs of anxiety disorders whatsoever, they were normative. And then we had them go through a full night of sleep or we then sleep deprived them. And the next day, we were measuring their anxiety and in those people who were sleep deprived, we were actually measuring the level of anxiety every hour. So we could almost get this time lapse photography of what happened to their anxiety state as it unfolded across the sleep deprivation period. It wasn't a linear response that the more and more hours that you were awake beyond 16, the more exponential that rise in anxiety became.

1:21:58So it wasn't simply a linear dose response curve. It was an exponential meaning that there was this hockey shape swing up. And in fact, by the next morning, compared to when you'd had a full night of sleep, those individuals were so anxious that almost 50 % of the participants in that group who had no signs of anxiety before had a level of anxiety that was so strong that they would reach the diagnostic threshold for having an anxiety disorder. And that was simply by way of the absence of sleep. But again, that brought me back to this notion of this is a good experimental tool for a scientist to understand what is the benefit of sleep when it's present and the absence of sleep when it's not by taking sleep completely out of the equation by way of total deprivation.

1:22:50But of course, that's not real life. So we did a slightly different study. Here what we did was we tracked individuals essentially in the wild as it were just going about their daily lives. And we had different sleep tracking monitor monitoring equipment on them. So we were tracking the sleep from one night to the next to the next to the next. And from one day to the next to the next, we were tracking their level of anxiety. And what we found here was that even small perturbations in their sleep from one night to the next to the next accurately predicted their increase or decrease in their anxiety from one day to the next to the next.

1:23:33What was the critical ingredient here? Well, in the first experiment, I'd essentially manipulated both quantity and quality, the two cues of the QQRT. I'd removed the quantity of sleep. And also they had no quality of sleep. Why? Because they had no quantity of sleep. But when we looked at that day to day, night to night to night study, it wasn't quantity that was the best predictor. It wasn't shortening of quantity that determined next day increases in anxiety. It was quality. The worst the quality was night to night to night, the worst their anxiety became. So that started to lead us to think a lot more about what is it regarding the quality of sleep?

1:24:18That seemed to offer when it was present, what I would describe as an angiolithic benefit. In other words, it's lessening anxiety. A lack of sleep is an angiogenic. It's going to produce anxiety. What in sleep is angiolithic? We started off with a hypothesis that was profoundly incorrect. We thought, well, for emotions, which are the short bursts of of affective state, it was REM sleep that seemed to be the principal ingredient. Well, wouldn't that be the case for mood states? Well, here with anxiety, it wasn't. It was deep non -rem sleep and we couldn't get away from it. So what we found was that when we looked at the sleep in the laboratory and asked what was predictive from the night before?

1:25:06So we measured the anxiety the night before and then we measure it the next morning. Basically, we calculated change score as your anxiety the next morning increased, stayed the same or decreased. Then we correlate that with the different stages. What we found was that the electrical quality of your deep non -rem sleep was very much predictive of your dissipation of anxiety overnight. This helped me realize, gosh, it's much more complex. These are beautiful surprises you get from research. You have this hypothesis and you look at you see REM sleep, no signal of predictive relationship with anxiety.

1:25:49I say, of course, because idiotic, I rerun the analysis. Just go back to raw data and the REM sleep signal was so strong. rerun the analysis and you get exactly the same result. It's deep non -rem sleep. Great. Okay. Then what is that deep non -rem sleep doing to help dissipate the anxiety? But here again, was a commonality with emotion. What we found was that the greater the amount of deep non -rem sleep, the greater the re -engagement of your frontal lobe was the next day. That was predicting the dissipation of your anxiety the next morning. We really started to understand this critical bi -directional relationship, but it was a very complex one.

1:26:36Yes, anxiety can disrupt your sleep. And yes, I'll disrupt it sleep, can predict your next day anxiety, but it wasn't the same stage of sleep that we thought before. It was the opposite. It was deep non -rem sleep. What we've come to realize is that deep non -rem sleep in part seems to be almost shifting you from that sympathetic state over to the parasympathetic state. It seems to engage that nice rest and digest. It seems to reduce your heart rate. It seems to drop levels of cortisol. And we think that perhaps is a resetting brain body, literally an embodied mechanism by way of deep non -rem sleep, helping you just relieve that anxiety pressure.

1:27:27So it does come back to your question, which is, yes, quantity, if I manipulated quality, if I manipulated regularity or timing, manipulate any one of those, I can change your anxiety. But the story coming through here, if anything, was that it wasn't quantity, it was quality. I told you that from one night to the next, the quality of your sleep that we were measuring was predictive of your anxiety. And then when we bring you into the laboratory, we look at the electrical activity of your brain. I also mentioned in that episode on the first episode, another way we measure quality is not just subjectively what's going on or objectively what is the efficiency of your sleep.

1:28:09Is it filled with lots of awakenings, which was the measure that we used in the day -to -day study, night -to -night study. But we looked at the electrical quality of your sleep. Once again, it was quality that was predicting it. It's something about getting good, continuous sleep that is replete with this deep non -rem electrical brain activity that provides an angiallytic benefit to your brain the next day. I think it's strategic because so many of us deal with anxiety. And some of us would prefer not to necessarily be on medication or even look to that. Well, here again, as a strategic tool, think about your sleep.

1:28:48It really does seem to be a buffer for anxiety. Along those lines, maybe you can just recap a few of the things covered in previous episodes that are known to improve the quality and quantity of deep non -rem sleep. I can think of a couple, but you're the expert here. That's not rushed to judgment. I think it's an established fact, which is why you're here. So let's, perhaps, list a few of those off in the domains of exercise temperature, et cetera. What would you place in that? Is there a top three? Three greatest hits for improving deep non -rem sleep because of its important relationship to anxiety management or reducing anxiety?

1:29:36I think there are. The first thing I would tell you is that regularity is going to be key here. When you are giving your brain the signals of regularity, it understands exactly how to instigate that deep sleep. And that's one of the two qualitative measures of sleep that I spoke about. So QQ, the quality, the second Q I spoke about, it's regarding the continuity of your sleep and the actual quality of your sleep. Regularity is probably best for the continuity of your sleep. If you're very irregular with the timing of your sleep, your brain almost doesn't know, we are not, we are not, we are not, we are not.

1:30:19And your sleep can become quite fragmented because it's confused based on regularity. When you give it regularity, sleep starts to become more stable, more stable means that it's less likely to be littered with awakenings, meaning that it's better quality of sleep. In terms of electrical quality of sleep, we did mention this in a prior episode when we spoke about sort of food and exercise. Exercise seems to be one of those things that's very good at improving the quality of your deep sleep. And here I'm talking about the electrical quality of your deep sleep. Try to make sure that you're physically active to a degree.

1:30:59And I think this is a protocol and I think it's a meaningful protocol, but to go so to the extreme where I would say you need to do at least 32 and a half minutes on a spin bike at this wattage we can't prescribe quite at that point scientific prescription medical. And so I would say exercise is one. Then we spoke about another which was temperature. And we said that getting your bedroom cool seems to be a way to promote the increase in deep sleep. So these are two do's which is get regular, get cool, the don'ts. We've already spoken a little bit about two. One of the things that I probably didn't mention enough with alcohol, not only does it seem to compromise your rapid eye -woven sleep, but it will fragment your sleep and make your sleep more unstable.

1:31:52And an indirect consequence of that is alcohol is going to be in highest concentrations in your system after drinking in the evening with sleep in the first four to five hours. Now that depends on how quickly you metabolize it and how much you've had, but let's assume some degree of standardization. In other words, I said that alcohol will not just block your REM sleep, it will fragment your sleep, make your sleep more vulnerable to you waking up. Well, you're especially vulnerable in the first four or so hours because that's when alcohol concentration is highest in your system. And therefore the first four hours can also fall prey to the greatest culling of your sleep quality.

1:32:31And if you're removing or restricting some of that quality in the first four hours, what type of sleep are you principally restricting? You're restricting deep sleep because we've said deep sleep comes in the first half, dream sleep, REM sleep in the second half. So don'ts would be trying to stay away from excessive alcohol in the evening. We also know that alcohol is associated with longer term chronic anxiety. And the tragedy is that it's often used as a way to blunt the anxiety because alcohol is a sedative. And it can help just alleviate take, you know, take the edge off. But it's a short term, quote unquote, win for a long term loss because overall it will increase anxiety levels.

1:33:18So I would say those are some do's and perhaps a don't if you want to try to optimize your sleep quality, including the integrity of your sleep and also the electrical quality of your sleep. Terrific. I think because so many people struggle with anxiety ranging from mild to severe anxiety, the tips you just provided are going to be immensely beneficial. And in addition to that, the previous four episodes that we've record for this series, each and all include tools that is protocols for improving the Q, Q, RT aspects of sleep. So all the more reason for people to dig into those and to glean the gems that you've laid out for people because they really are very actionable.

1:34:04And you know, most all perhaps even all of the tools that we've discussed, those episodes are zero cost. They require a little bit of time investment, some thought and consideration, but they're not really that difficult to implement. They just require a little bit of being in one's own scientist of self and being your own corner when it comes to sleep. And I learned the low cost method that we mentioned was not just temperature in terms of keeping your room cool, but warm bath or shower before bed. I mentioned improved sleep. One of the things that improves most is deep non -rem sleep. So there's another technique, get your room cool to go into, but warm up to cool down to full sleep, which then keeps you cool so that you stay asleep and you'll get more deep sleep.

1:34:53Fantastic. Although it's a terribly unhappy topic, suicide is an important topic for us to cover here. You know, I can think of a few things more tragic than suicide. And yet sadly, it accompanies certain psychiatric conditions. I think people with men and bipolar have a 20 to 30 times greater probability of suicide than others, but suicide accompanies major depression, anxiety, PTSD. Again, it's a tough topic to get into, but an important one to get into. What is the relationship between suicide, reality and sleep? And I suppose we could look at this from the perspective of to what degree does sleep deprivation correlate with suicide or attempted suicides and what sort of inoculatory effects does sleep provide towards suicide?

1:35:58Unfortunately, we don't know much about the second part of the question, which is how can sleep be used as a risk mitigating tool when you know that there is the risk of suicide in place? There's been a number of people who are doing this work, including my colleague, Alison Harvey, again at the University of California Berkeley and Sherry Johnson, who's also there too. I would say though that the first question is quite answerable, which is what do we know firstly about how a lack of sleep can impact suicide? Some of the earliest data that we found were associational relationships. What we found is that short sleep or poor quality of sleep predicted three things.

1:36:41It predicted suicidal ideation, meaning that you had thoughts of suicide. Bad sleep seemed to predict suicide attempts and then tragically more recent data, a lack of sleep predicts suicide completion. What makes me think more closely about it, and we've been trying to get some grants and we fail to do so, so far, to do more of this work, because I'm just so compelled by it, and you're right, it's one of the most tragic situations. Those sleep relationships aren't simply happening at the same moment in time. What I mean is that the sleep disturbance that we see precedes the onset of having suicidal thoughts, it precedes the onset of suicide attempt and it precedes the suicide completion.

1:37:37So what this has been teaching me is, I've been looking at the data and we've looked at a little bit of our own data, sleep disruption when it comes to suicide is almost the canary and the coal mine. It's almost like a tragic crystal ball that when you see that sleep starting to dismantle, it is a foreshadowing sign of a very dark series of events that will unfold. In other words, could we now start to think, and this is one of the things that we want to do, is sleep a biomarker, is sleep disruption, I should say, a biomarker for upcoming suicide risk, before it begins. The idea of finding a biomarker or collection of biomarkers for suicide, I think is one of the more important missions of neuroscience, AI, and mental health.

1:38:28Generally, there's a brilliant young researcher up at the University of Washington named Sam Gold, and he's spent a lot of his career studying animal models of aggression and rage. And of course, some forms of suicide are thought to be forms of self -directed aggression and rage, in a sense. Some forms of suicide perhaps are different. I don't think we quite understand what suicide represents in the brain just yet, and I think they're having spoken to Paul Conti and others about suicide. It's clear that there are unfortunately many paths to suicide, and there's in one brain state. Nonetheless, Sam's laboratory has been developing tools that help people with suicidal tendencies, or people who have had suicidal ideation or plans in the past, with these AI -based tools where it detects changes in their voice, in their sleep patterns, and in a few other metrics that I don't recall, that together become very good predictors of later suicidal ideation.

1:39:42The idea here is that people who are prone to suicide often don't realize that they're drifting that way until it can sadly be too late. The point here is, these biomarkers are being developed. See, AI is critical, but that, according to Sam, changes in sleep patterns is absolutely central to these algorithms for allowing people to detect their own potential for suicide. I think it's critical, and we've thought about this, when we started to see these sleep signals that were preemptive, that were almost preculcative in the sense of prediction, occurred to me that we're at the stage of technological evolution, that if we get consent to many individuals who become suicidal, they are interested in some degree of support.

1:40:40And we often, but of course, some people will just recoil and go into themselves, and that's when things can get very problematic as well. But it would require some degree of consenting that if you have a history of suicide ideation in the past, what if you were to be able to consent and say, I would like to risk mitigate, and you have a wearable, like a watch, and that watch is connected to your phone, and there is a signal that can come from your watch that dials a series of phone numbers in order of preference. And when your watch starts to detect that your sleep has this, and one of the things we really want to understand is, what is the specific signature of sleep abnormalities?

1:41:28It's not just that your sleep gets short, but is it that your sleep gets longer than short, and then longer than short, but it constantly has poor quality of sleep, and the regularity is all over the place, but the chronotype timing is still in place. What specific pattern of those things is the hallmark that is most predictive of suicide? Let's say that I can come up with that algorithm finally, and then we can implement it into a watch or a tracking device of some sort. And when it starts to see that pattern, it's constantly pattern matching, and it starts to see that across whatever number of days we say, if you see this across six nights or across 13 nights, this is serious, it then triggers that phone to send a message to those individuals who are the designated support carers, and those people then reach out and start to say, how are you doing?

1:42:31Would you like to have a phone call? Can I come over? Can I make you some food? And I'd love to have a chat with you. Can you find a way to bootstrap a condition where you constantly then otherwise become a social or anti -social and lose all support network? So that would be the sort of the grandiose idea. The other thing that's very interesting is that we could measure the activity and their wakefulness at night. And the reason I bring this up is some great work by Michael Pellis and Michael Granner, who've looked at suicide, both attempts and suicide completion across the 24 -hour period. It's not constant.

1:43:15It's not that you see suicide ideation and suicide attempts and completion in a distributed manner equally across the 24 -hour period. When do they principally occur? They occur in the late middle of the night. And there's this almost a four to five -hour period, somewhere on average, and again, it's just an average, somewhere between, let's say, 1am and 4am, which turns out to be right at the lowest dip of your circadian rhythm, and it could be circadian rhythm. But I also think that there is something about, of course, the nighttimeness when no one else is around, and it is just you, bad point number one.

1:43:57Second, as we've spoken about before on this episode, negative thoughts are 10 times worse in the darkness of night than they are in the light of day. And third, at that point, if you're awake, you're not asleep. And we know sleep is providing this ballast to your mental health. So on all three of those counts, you see this very strong spike in suicide ideation, suicide attempt, and also suicide completion in this bewitching hour in the middle of the night. There's a final piece in the suicide story, though, that is only just emerging. If you are not getting sufficient sleep, you are somewhere between two to three times more likely to go into that suicidal state, which is a very significant number.

1:44:54However, when people started to measure another factor of sleep, and particularly dream sleep, which was the dream content itself, it became even more predictive. And we've not really seen this very much in psychiatric conditions. But what they found was that instead of using your sleep disruption or your lack of sleep as a predictor of your suicide risk, we use nightmares as a predictor of your suicide risk. That predictive value, that risk went from about two to three times more likely to somewhere between five to eight times more likely. There is something special going on with bad dreams and specifically nightmares that is even more predictive than this physiological thing that we call sleep itself.

1:45:47And we'll probably come on to maybe some of the reasons why dreaming, and particularly nightmares in the next episode on dreaming, could explain exactly why that is. But it's a new finding. I don't think we can say much more about it now. But it is one of the most, I think, novel findings in this psychiatric sleep story that now dreams have come above and beyond simply sleep itself as a predictor of mental illness and specifically a form that will take you alive tragically, very quickly. When I think about depression, I immediately associate that with excessive amounts of sleep after all, it's called depression.

1:46:31But what is the real link between major depression, which is the classical signs of malaise, one of the hallmark features also being a lack of optimism about the future or an endorability to sense into the future. That's what it's not the only criteria. When Dr. Carl Diceroff, the great neuroscientist that he is, was on this podcast, and of course, he's also a practicing clinical psychiatrist. When we were talking about depression, he mentioned that another hallmark of major depression is people waking up at two or three a .m. and not being able to fall back asleep. This just seems like a recipe for disaster all around that the very condition that you're trying to perhaps emulurate with additional sleep is preventing you from sleeping.

1:47:26It's like the kind of imagines. Very cruel. A whole lot of things, more diabolical in terms of the sleep science. So what's the relationship between sleep and depression? And how should one untangle that seemingly gourding and not? It is like the other conditions by directional. That depression can disrupt sleep very much and disrupt the sleep can trigger depression. Depression is interesting, by the way. Some people have conceptualized it as being different to anxiety based in some ways on memory, which is that when you think about anxiety, people consider anxiety a disorder of the future that you are constantly worried about what's coming up in the future.

1:48:13I didn't do this today, so I need to do that tomorrow. And then I've got that other thing next week, or I'm fearful of going out to see them tomorrow. I just am fearful of taking that flight tomorrow. It seems to be so much about prospective future. Whereas other people have suggested depression is the opposite. It's about rumination of the past. I went through this event. I had this bereavement. I had this painful divorce. I just can't get over my past. Now, I don't necessarily know if that's entirely true, but it is interesting in the sense that both of those abnormal prospections worry of the future, an abnormal retrospection, sort of ruminating on the past, seem to disrupt sleep.

1:49:06Before you continue, I just wanted to drill into that idea just a little bit, because I think it's a really interesting one worth exploring. Again, I'm no psychiatrist, but I have heard and have experienced that I've had a depression. I think it's my understanding is it's normal for people to experience a major depressive episode at some point in their lives. It could be situationally triggered or not, but that for others, unfortunately, they have repeating major depressive episodes. Hopefully, some people go through life never having had a depressive episode. As I recall, one of the more salient thought patterns was that I used to have something that somehow was lost, and I couldn't quite figure out what it was.

1:49:51It was this recurring feeling of things were on track, and then they got off track, but not being able to attack the progression from on track to off track to one particular event. It was this sort of sense that I had something that them was lost. Now, fortunately, for me, it eventually lifted, and it didn't get dangerously bad. But I've had some close friends who've gone through individual or several major depressions, and I hear this. This idea that they had it, or they think something was there that then they lost. I agree with you. It fits very well. If you think about the world that you just used, had is about the past.

1:50:33It's past tense. Then, if we apply the criteria that is indeed part of the criteria for determining if somebody has major depression, which is a lack of optimistic outlook on the future, one can see how one could be very much stuck in the present and focused on the past and just stuck in that spin cycle. Anyway, we're not here to decide what depression is or isn't in every case, but I'm not the psychiatrist either. But I think this distinction between anxiety being about the future in a way that disrupts one's present and depression being about often the past in a way that disrupts one's sense of the present and the future makes a lot of sense.

1:51:14It's just a nice, not nice. It's unfortunate, but it's a useful contextualization. Yeah, thank you. And I, to your question though about sleep, it's been a little bit interesting with depression. Firstly, what we know is that depression will disrupt your sleep and make your sleep shorter. And it comes back to your comment from Carl, from Carl Diceroff. We often see that patients will have problems staying asleep. They wake up in the middle of the night. They can't get back to sleep. It's problematic. And therefore, their sleep duration and their sleep quality decrease. However, on the other hand, there is an interesting question, by the way, of can you get too much sleep, which I should probably come back as there's a whole episode to do on that probably.

1:52:06But one of the places where we see quote -unquote too much sleep is in the depression literature. And to condition that we call hyper -somnia, in other words, increased or excessive degrees of sleep, hyper -somnia. But a great PhD student at Berkeley looked at the data, Kate Kaplan is a fantastic cognitive behavioral therapist now and a clinical psychologist. Looked a little bit at the data and others have looked at this too. When you examine what people were asking those patients where there is this conclusion that patients with depression can sleep too long, really what they were asking in those studies was what times you go to bed and what time do you wake up?

1:52:56And there, what you clearly find is that people with depression will be in bed for significantly longer periods of time. And the inference there, and you could argue almost the conflation, is that if you're in bed for longer, then you're sleeping for longer. And therefore, depression is a condition of hyper -somnia. But when people looked at this a little bit more in a nuanced way and asked a different question, what time did you go to sleep and what time did you wake up? That hyper -somnia phenomenon is nowhere near as strong as you would have been lent to believe otherwise from the what time did you go to bed and what time did you wake up?

1:53:36And I think part of the reason comes back to depression as a condition. When you think about depression, one of the aspects, one of the features is that you're depressed to the point where you just don't want to interact with the world. And what better place to spend if that's your mentality than this thing called bed? I just don't want to get out of bed. I'm just going to stay here and lie in bed. I'm awake. I'm not asleep. And so we don't quite know yet if depression is a condition that is associated with long sleep. We certainly know it's associated with short sleep and disrupted sleep. Or that is masquerading as this thing called hyper -somnia.

1:54:17But when you really look at the data, it's not quite so clear. That was the first peculiarity in depression that there could be this paradox of, yes, long sleep, but also not enough sleep to short sleep. One of the earliest findings in depression and sleep and has been quite well replicated is a change in REM sleep. But now it wasn't necessarily that individuals who had depression slept or had excessive amounts of REM sleep. They had a little bit more. What was interesting is that when that REM sleep emerged during the night was much earlier. And in the first episode, I was telling you that when you your head hits the pillow, you go down to the light stages of non -rem then into the deeper stages.

1:55:06And then maybe after about 50, 60, 70, 80 minutes, you'll pop up and you'll have your short REM sleep period. But that first REM sleep period in people with depression seemed to have been called up by the brain abnormally or not much earlier. So it's what we call REM sleep latency. From the moment that you fell asleep, what is the time, what is the latency of the first arrival of REM sleep? And that REM sleep latency was significantly shorter in those people with depression. REM sleep was arriving earlier. Now it's hard because you can argue and these are the most dangerous hypotheses. You can argue both sides of it.

1:55:50You can say, well, perhaps that's because Matt, you also spoke to me that REM sleep may be important for some aspects of the emotional brain. And when you are depressed, the brain knows that REM sleep is required and it calls it up on the menu of the series of dishes that you're going to be served earlier on in the night because it's needed more significantly. The other, and that's the adaptive theory, the other is the maladaptive theory, which is that arriving with your REM sleep too early does not do your brain good things. And therefore it's some abnormality of emotional processing. The data that's interesting there, is that if you look at some antidepressants, many of them will either delay the onset of REM sleep or they will reduce it significantly.

1:56:44Now there's a huge debate about the efficacy and the utility of antidepressants. And I don't have a horse in that race and I don't know enough about that literature to comment. I would simply say though that it's at least intriguing to me that some medications that are commonly prescribed as antidepressants will alter specifically REM sleep and push it later or try to reduce it down. And that would fit with the maladaptive hypothesis that this arrival of REM sleep, so early in depression and perhaps having a little too much REM sleep isn't optimal. And when you push back against that with pharmacology, i .e.

1:57:24antidepressants, you seem to get some degree of resolution or reduction in the depression symptomatology. Again, I don't think we've we clearly understand that. Another strange thing that has been often cited to me many times about sleep and depression is a literature that suggests that if you deprive people of sleep, which time and again in this episode we've said leads to bad outcomes for mental health, it does exactly the opposite in depression. But if you sleep deprive a depressed patient, you get a resolution of the depression. And that is the claim that's often made to me. Now it is a very clear set of data in the literature.

1:58:13But there are two potential concerns with it. The first concern is that not all patients respond to sleep deprivation. In fact, if you look at the data, it's somewhere between 30 to 55 % of patients will be responders to sleep deprivation. The other proportion of those patients don't respond or if anything get worse when you sleep deprive them. And then the question is, well, how would you know and right now, and there have been some brain imaging studies, some pets, studies done way back at UC Irvine and other locations where they were trying to say, is there something about the metabolic activity of your brain that can predict if you're a responder or not to sleep deprivation?

1:58:55Because at least then we would know who should we push through this quote unquote treatment and who should we not because it's going to be bad for them. That's the first issue and we don't have a clear understanding. The second issue is that as soon as those patients with depression sleep after the deprivation, the antidepressant benefit goes away and they go right back to being depressed again. So yes, it's a mechanistically interesting process. What is it about sleep deprivation that could alleviate depression? And I'll explain why I think it can. But it's not a sustainable one. It's not a clinically viable one.

1:59:36Why would it have that effect if it does? Well, you and I discussed earlier in this episode that when you are sleep deprived, not only does your emotional brain become much more responsive to negative things, also becomes much more responsive to rewarding positive things. And one of the interesting things that I think people mistake about depression, they just think that when I'm depressed, I have sad mood, I have negative mood, that's not entirely true. One of the principle features of depression is something that we call an hedonia, which is an absence of having the ability to have hedonic responses.

2:00:15In other words, you can't get pleasure from normally pleasurable things. It's not an issue about sliding down to the negative. It's the absence of being able to experience the positive that puts you on a track towards depression. And what you and I discussed earlier in this episode is some of the work that we've been doing where when you sleep deprived individuals, but you show them very rewarding based stimuli, they become much more reward sensitive. And perhaps this is why patients will respond to sleep deprivation with depression, because they're too far away from that positive end of the spectrum.

2:00:53They're not reward sensitive enough. They don't get a positive good feeling. Now, if you're someone who is healthy and you're sleep deprived, you go too far in the reward direction and you become vulnerable to reward and sensation seeking. But if you're depressed and you're shifted to sort of away from that and sleep deprivation brings you back closer to a normative reward based reactivity, maybe that's the reason why you get this anti -depressant benefit and why when you start sleeping again, you take away that enhanced reward sensitivity and you lose the anti -depressant benefit. So I think we still don't know enough about depression and sleep yet.

2:01:40If you were to ask me of the four quantity quality regularity and timing, which would be ideal, I would say all four are definitely players, but timing may have some of the best evidence, because it's not just about sleep when it comes to depression, it's also about your circadian rhythm, that if you are not aligned with your natural chronotype, your natural 24 -hour rhythm, circadian miss alignment when you fall out of synchrony with your natural chronotype, is a strong predictor of depression. So if there is an actionable item, first it would be to say from a big picture perspective, understand that sleep is one of the least painful available options for you as a no -cost to try to stabilize your mental health.

2:02:38Now I'm not suggesting that all psychiatric conditions are sleep disorders, that's not true, and I'm not suggesting that you should stop simply at the place of getting your sleep straight to help with your mental conditions, not at all. I am saying however that if you do get your sleep straight, it's only going to help and may help quite a significant amount based on the data, but when it comes to depression, I would say of those for QQRT, there's a very strong emerging data that circadian miss alignment, not matching your chronotype to the time when you are sleeping and the time you are awake, is one of the strongest factors.

2:03:19So if you want to say I can't do all of them at, I can't do all of this QQRT nonsense, just tell me one of them to start with, I would say don't worry, we'll get to the three others, let's just start with getting your timing right, let's understand what type you are, take the go online, you can take one of these tests, the MECU, the Morningness, Eveningness Questionnaire, you can just google it, it's free, you can do it. We'll try to link to it in the show note caption. That's great. Understand what type you are, and then try to understand, based on what time I'm currently awake in a sleep, is it matched, is it mismatched, and if it's mismatched, try to see what you can do with your lifestyle accommodating, of course, to match that, things will more than likely stop the getting better.

2:04:05Along those lines, and if I may, I'd like to just mention a recent study that I dovetails with what you just said beautifully and seems highly actionable to me, this was a study published in Nature Mental Health, which is a relatively new journal, but it involved exploring the light exposure and dark exposure patterns of, I believe it was more than 80 ,000 individuals, I have to go back and check that. But what was interesting is that when they looked at light exposure, in particular sunlight exposure, and they looked at darkness exposure across the 24 -hour schedule, what they concluded was that there was a near linear relationship between the amount of light that one gets in the morning and throughout the day, and reduction in mental health challenges in terms of depression, PTSD, there were a few others.

2:05:05Some of the effects were less robust for certain psychiatric conditions than they were for, say, depression. What was equally interesting is that darkness, the absence of light, turned out to be as important a variable as light during the day, made simple, if people tended to be in dim or dark light at night, they experienced reductions in their suicidal, depressive anxiety and PTSD symptoms, independent of how much light they were getting during the day. So what this says is get as much light as one can possibly and safely get in their eyes, by the way, in the morning and throughout the day, and then do one's very best to be in very dim or dark environments at night.

2:05:50And even go so far as to say that if you didn't get sunlight during the day, then you would be especially well off being in a very dark environment at night, and it's independent, so don't worry, yes, it's always good to get that daylight, but what that paper also teaches us is that because those things can be independent, you can still get some benefit even if though you've not made it good on your daylight during the day, getting that darkness at night is still going to be beneficial. And I should probably resolve what some people may think of as confusing. We spoke about, for example, suicide risk and it being highest in that in the depths of the darkness at night.

2:06:32I think what's clear from that paper comes onto one of the fundamental conventional tips that we spoke about in how to optimize your sleep, not just an unconventional, but conventional, which was I told you, we are a dark, deprived society and we need darkness at night to help keep our sleep regular, so the sort of the R in the QQRT. And I think there in that paper, the inference, of course, is that if you're getting dark at night, it's going to give you a nice sleep onset signal so that you are asleep at night in the darkness, and that sleep at night in the darkness provides this beneficial, not immunization, but at least palliative help to certain psychiatric conditions.

2:07:23We're not suggesting that darkness at night, if you're awake at night, however, is beneficial. That seems to be not beneficial. But it was such a great paper and very elegant in how it dissected the independent nature of these things, which fits very well with, I think, your mission in part in life, both as a scientist and as an educator, which is, how can I curate information, gather it together and give you some type of actionable boots on the ground, feet in the trenches advice as to what to do. It was a great paper. So thank you for bringing it up. Yeah, I only wish I'd done that study, but I'm so glad that others did.

2:08:04One thing that's been helpful to me to encourage more darkness and dim light at night for myself in my home environment is to think about artificial photons coming from artificial sources as sort of empty calories at night. And how sunlight provided one isn't getting a burn and people debate, how best to do that physical barrier everyone agrees on. Certain sunscreens are safe for the others. Some are very safe. Some are perhaps less safe. In any event, the point is that trying to make one's home environment dark at night is in my mind now akin to trying to avoid eating sugary, non -nutrition calories at night as well.

2:08:49It just lends itself to just overall feelings of well -being, improved sleep, and of course improved daytime wakefulness. And then getting sunlight, even on through cloud cover, in one's eyes early in the day, and as much as is safely possible throughout the day. And if one can't get sunlight, getting light from bright artificial sources seems to be the best alternative. But I think there's this asymmetry of light dark requirement in the same way that I think most everyone agrees that eating during one's active hours of the day is going to be the best way to go as opposed to eating during the less active hours of the late night and certainly prior to sleep.

2:09:29Such a good point. And since it's only you and I here and no one else watching and witnessing this, I am thoroughly going to steal that phrase of junk light and help educate people because that's a perfect description. So you've all heard of junk food. Well there's something called junk light. And if you get your whole foods during the day, just like you get your whole kind of encompassed light during the day, that's great. But then if you start binging on junk light at night, it's profoundly deleterious to your sleep and everything that sleep depends on. It's lovely. So when people hear me in future public spheres talking about junk light, you know where it came from.

2:10:16I will give you full credit. It's a delight for staying with you. Because I may have I may have lifted it from somebody else inadvertently. We all stand on the shoulders of other giants. That's right. Or other Twitter accounts or something like that. Well, I place myself firmly underneath a pedestal. But yes, we all try to stand on their shoulders of giants. Well, wherever you place yourself, the information that emerges from you and that emerged today is absolutely spectacular. You know, I can't think of topics more interesting and important than emotion regulation, anxiety, PTSD, suicides, sadly, depression.

2:10:51All of these things are tragic challenges. But they are a real part of life. Some argue even more so nowadays. Perhaps then because of the advent of so much artificial light and smartphone use in the middle of the night, who knows? It's I think it's reasonable to assume it's at least one variable. Today, you've provided a ton of depth of understanding about why sleep and these mental health and emotional states are linked. It's just a really clear logical framework for both the non -rem sleep and REM sleep and how it impacts mood and reactivity during the daytime and also some really actionable tools to improve one's mental health and emotionality.

2:11:39In addition to that, we'll refer people back to episodes one, two, three, and four, all of which include tools to improve every aspect of sleep and to really nail down the QQ RT, that quality, do you put quality first or quantity quantity? I'm just making sure that QQ RT to really nail down the quantity, quality, regularity, and timing of sleep. We can no longer consider sleep just six to eight hours or get your nine hours or get your seven hours. Clearly, there are other variables involved and you've made those variables very clear to us and you've given us the roadmap to plug in the best variables for ourselves.

2:12:19So thank you, Matt, ever so much. Thank you for allowing me to both voice and narrate the important story of sleep and mental health. It's something I'm immensely passionate about both from a personal perspective but also from a professional research perspective. Thank you for this opportunity. Well, again, thank you, Matt, and I'm very much looking forward to the sixth installment in this series on sleep, which is about a topic that everybody is fascinated with, which is dreaming. I know you're going to tell us about dreams and what they mean, perhaps what they don't mean. We'll get into dream interpretation of all things, lucid dreaming, and much, much more.

2:13:01So I really look forward to that discussion in episode six. Thank you for joining me for today's episode with Dr. Matthew Walker. To learn more about Dr. Walker's research and to learn more about his book and his social media handles, please see the links in our show note captions. If you're learning from Endor and enjoying this podcast, please subscribe to our YouTube channel. That's a terrific zero cost way to support us. In addition, please subscribe to the podcast on both Spotify and Apple. And on both Spotify and Apple, you can leave us up to a five star review. Please also check out the sponsors at the beginning and throughout today's episode.

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