Why Do You Wake Up at 2–3am? The Real Sleep Physiology Most People Miss | Dr Andy Galpin | Be Well Moments

0:00Welcome to Live Well Be Well, a show to help high performers improve their health and well-being.

0:10I can't not have you here and talk about sleep. I know that's such a big thing for you. And in our five questions for Substack, which we put out the day before, I asked you what you changed your mind on in the last year and you spoke around sleep. So I can't wait to get into this with you. So So you've mentioned continuously there's four basic pillars, you know, and sleep is one of them to really look at when it comes to human performance, but just like good general health. And that's something that I've changed my mind on a lot in the last five years. You know, I used to always think I had to get up at five, you know, the 5am club and be part of that kind of hammer, hammer, hammer, hammer, hammer, go, go, go.

0:48And the more I worked, the better I was. And actually I'm realizing that that's probably not the best way to look at things, especially for performance. So talk to me about sleep. How should we be looking at our sleep levels? And is there like a specific time that we should be trying to hit every night or is that also a load of garbage? Okay, so there's lots to think about. We just published a study this weekend. Congratulations. And it is open access. So people can go read this. You can put it in your sub stack or your newsletters if you want on all the environmental impacts or all the things in the environment that impact your sleep.

1:25um so this is led by actually a british guy greg potter uh led this this paper and it's up so you can see all the details of what i'm about to rattle off in that individual paper there's figures and there's actually a table we include that gives people specific recommendations for where to set all these environmental factors okay i'm answering the question this way because we are spending globally 60 plus billion a year on sleep and it is getting worse it's one of the few areas of health that has a huge financial impact but at the same time is getting significantly worse people are aware of obesity people are paying attention to other things i'm not saying we've solved those problems by any means but there is some hope there and there is attention we're spending more on sleep than ever and it's getting worse than ever and so the question is why?

2:21My dear friend, Matt Walker, he works with me at Absolute Rest, my company, and he's been speaking about sleep for years. His book came out and people were like, he really turned the world's lights on to sleep. So people are aware and we're spending money, but it's getting worse. So the question is why? In that paper, we make, I think, a pretty compelling argument as to some of the many, many reasons sleep, like anything, is multifactorial. You'll never find one explanation for why sleep is still getting worse. But one of the things to consider are the environmental factors. There's actually satellite imaging data that make it really clear the world is getting brighter.

3:08And there is this splash that happens, actually light that goes up splashes off of the clouds effectively in the atmosphere and comes careening back down to the world. Our physical temperature around the world is changing. Technology is changing. Lights in the home, engagements, like there's all these things, again, all in the paper, that are changing. People are living in cities more. Why this matters? There's really clear data on things like carbon dioxide concentrations in your bedroom, in your house in working environments, not from a green light, but simply because you're in a closed environment, you inhale O2, you exhale CO2.

3:47If a bunch of people are in a room with a closed window set, CO2 levels rise. If ventilation is poor, if a lot of people are in that, you're going to have a higher CO2 concentration. If that gets to a certain level, you see really, really strong changes in sleep onset, sleep quality, all architects of sleep, so REM and all your various end stages, next day arithmetic, next day executive function, next day subjective sleep and arousal and wakefulness, all change dramatically when CO2 levels in the room rise too much. So you have all these things happening and people are like, oh, it's A, B, and C, but the environmental factors alone, again, I'm not even talking about ozone layer.

4:30I'm literally just talking more humans in the same space is a difficult thing to deal with. So you have this light spraying thing that's happening throughout the globe. You have this CO2 stuff in people's rooms because they're living in more concentrated areas. We talked in the rapid fire thing about the world is more engaging. People are going to be on some type of device one way or another. And so simply procrastination. People just don't want to go to bed because the living world is really entertaining. And so you're going to put off going to bed. People are working at home more, which means people can work in different time zones much more effectively.

5:05It would be really difficult for me to run my companies 10 years ago. Now, all of my companies are remote. We're out here in the UK with absolute rest for our first time ever, but we have clients across the world. We can do that because of the internet, because of video meetings. So because of that, your expectation as an employee is to be more available during different times, right? Especially if you're trying to raise money or you're whatever, you need some, you're going to be more available in off times. That didn't happen in the past. So at night, for the most part, you are going to be left alone.

5:45You're pretty much expected to answer Slack or whatever at any time. So boundaries have completely changed. So I could go on, on, on, on, on, on. You also have, it's getting better. it used to be at 80%. It's now down to 70%. But at least the data in America will show 70 % of true clinical sleep disorders go undiagnosed. We have actually huge, huge areas that are called sleep deserts, right? So people are maybe like aware of food deserts and stuff. We have sleep deserts going on, which are these concentrated areas of extreme light, like in a city, and sound. because now the world works more overnight.

6:29So restaurants are open later, services are open later because the internet and things are exchanged. So it's harder to get more sleep in these sleep deserts. The sleep disorders persist because there have been really no changes in technology for medical sleep testing in 50 plus years. It's all the same. You have sleep hospitals, but if you run the numbers, right, you have hundreds of millions of people with sleep disorders and you have a few thousand sleep physicians. So each sleep physician is responsible for tens of thousands of diagnoses per year. Like you have no chance, right? You want to get a sleep test done, what do you do?

7:07You find a sleep hospital, you pay 5 ,000 pounds, you wait four months to get in and they check you for apnea or not and then send you home. Like, so you can just imagine whether this is a behavioral issue Work expectations, you're on your phone too much. This is an environmental issue. Air quality, or there's too much light, or it's too loud. Whether this is a pathological issue. Yeah, like a lot of people wake up at like 2, 3 a.m. and can't get to sleep. Super common. Had that question the other day when I was around a table at a wedding, and three people wake up at 3 a.m. and just like couldn't get back to sleep.

7:46Extremely common. We deal with that, and we handle that a lot of ways. It's actually like pretty easy to fix. Really? what do people do? Well, there's a handful of things. It's always, again, I will generalize. There can be many different things, but a handful of reasons why that happens. Actually, this is in our paper too. You can go read some of these things. I'll link this in the show notes. Yeah, a number of things that can be happening here. One of the biggest ones is actually your pre-sleep heart rate will predict this. So a lot of the people, you're familiar with the concept of wired and tired.

8:18Yeah. Oh yeah, far too well. Great. So I'll wind back just a touch here to settle a context. When people think, because you asked this question, and then I'll come right back to here, of what is sleep? Is it just a number, like a duration? Okay, sleep duration is one of the many components of quality sleep. Okay, so the total time, right? The average human, seven and a half hours, like is enough total time for a health perspective. For optimal performance, we're probably looking at more. for peak physical performance, certainly more. But let's just say you can get by seven and a half to eight hours total.

8:57But that's only one of the components. Component number two is actual daytime function. Are you sleepy? How's your inertia the next day? Getting out of bed? How hard is it? Or how groggy? Is your brain sharp the next day? Are you feeling energy throughout the day? That's component number two, right? So I don't even really care about the numbers. If you're like, no, I wake up, feel phenomenal, I'm on point all day, blah, blah, blah, blah. Okay. So your subjective nature is number two. Number three is quality. And this is how long did it take you to fall asleep, your sleep onset? Did you wake up at all throughout the night?

9:32If so, why? How hard is it to go back to sleep? What's the, people will focus on sleep stages, deep sleep and REM, massively overrated. Like in general, throw those things entirely away. If you're getting those from a tracker, throw that entirely away. What you want to pay more attention to are things like your stability, fragmentation, positional awareness, how much movement are you having? Those things actually determine architecture, but like the sleep staging is like almost entirely nonsense at this point. So that's not the appropriate way to think about it. Quality is that other stuff. Then there's also regularity.

10:11The simple fact of like how consistent are you at going to bed and waking up at the same time. This can have as much or more of an impact than quality or duration can have. You also then have timing, which is what time of day are you waking up and what time of day are you going to sleep. Any of these independent factors can be your problem. So the person that wakes up at two or three in the morning, let's just assume, because there's so much to go over here, let's just assume they're not having changes in regularity and that their timing is normal so that they're going to bed at say 10 or 11 and waking up at six or seven in the morning.

10:50But two or three, they're still shooting awake. Okay, the walk into that time matters. So when I started this answer, I told you about that heart rate wind down, okay? Well, one thing that predicts this is, and I went immediately to wired and tired because a lot of times what happens at night is people are extremely tired, super fatigued, like a sleep pressure is really high. So they'll fall asleep pretty quickly or regularly, but they'll shoot up between two to three in the morning. Really common number, by the way, like almost always, because they've hit those first few hours of critical sleep window.

11:25They're not actually down regulated. And so they get too close to that sympathetic drive window and they get kicked into arousal. And now they don't have strategies and techniques to get back down into a parasympathetic drive. They don't recognize it. And so now they're up and up and up and up. Always happens at two to three because it is that three to four hours post-sleep where you've hit a critical threshold. Brain has done what it absolutely has to do. And now you hit that threshold of awakening. It can be some other things like blood glucose drive, cortisol, and so on and so forth. But for the most part, this is almost always driven by actually a poor down regulatory routine.

12:07We will see this in people's heart rate data. We actually just had this happen. Where was I just at? Costa Rica, just before this at the Four Seasons with some clients down there. Ran through all their data, really consistently see this. You will see a heart rate irregularity and their heart rate is being too high in the 90 minutes prior to sleep. Sleep onset is fast, five minutes, they fall right asleep. Sure. Exhausted, tired, but shoot awake at that time. The nights that they, that they had this happen versus the night that they don't happen were a hundred percent predicted by that pre-sleep heart rate.

12:42And that particular person, that's all we had to go solve. And so this is a classic example of, this is a extremely high level individual. Everyone would know this person, like very famous person. And we're like, hey, you have to do this downregulation routine. And this person was like, zero chance. I'm not doing yoga. I'm not doing breath work. Like could not be less interested in these things. Showed the data and said, I don't, it's not about the breath work of the yoga, whatever. Do whatever you want. Just make your heart rate go down prior to bed. Oh, I don't need that. I'm so tired tonight.

13:16I fall asleep easy. It has nothing to do with that. So people will conflate the exhaustion with downregulation. Sleeping and falling asleep is not downregulated per se. Those are different pieces. And so in this particular case, it is very often one of a few things. Let's assume also, by the way, it's not a menopause or perimenopause situation where it's getting hot. Those are different answers. But in that particular case was that issue. And so we actually have to have that person and go through a wind down thing. And again, that wind down thing can look different. It doesn't have to be breath work.

13:54It can be any number of things that are more aligned with your personality. If breath work is your thing, like great. But we gotta find a way for your heart rate to come down prior to sleep. And then you'll actually walk into sleep with a higher or lower, sorry, higher HRV, lower heart rate, more prepared for sleep. Your onset may or may not change, but that two to three a.m. waking up thing almost always goes away. Thanks so much for listening. To hear the full episode, there's a link in the description.