Why You Can't Sleep: The Science of Insomnia, Hormones, and How to Fix Your Sleep for Good with Dr. Aric Prather

15:17The Body Pod Host:Like, I heard on the news that if I don't get X, Y and Z, I'm going to get Alzheimer's. And my ring is saying this, like, you know, what do I do? I haven't slept in weeks, you know, thinking about it, you know, and it's like, Oh, God, okay. So, but I mean, they are actually an aura included in aura, you know, is sort of more and more kind of gathering the market around around sleep tracking. they're all pretty great at estimating how much sleep people get, how fragmented their sleep is. I mean, in fact, these consumer devices are often as good as the research devices that we used to use. Now we kind of are relying more on consumer devices because people like wearing them.

16:06The Body Pod Host:I think where they're not quite all the way there is around what you're asking about, which is kind of the sleep architecture, right? So our sleep is not just one thing, it's stages. And so, you know, if you go to a sleep lab, it's like N1, N2, and N3 make up what's called non-REM sleep with the higher number meaning deeper sleep. So like slow wave sleep, this restorative sleep is in this N3 piece. And then there's REM sleep, so rapid eye movement sleep. That's, you know, synonymous with dreaming, but also has like lots of really important implications for learning and memory. And, you know, these devices have gotten really good at measuring that.

16:47The Body Pod Host:But, you know, it's not necessarily ground truth at this point. You know, obviously, you know, the gold standard is like from EEG waves on your, you know, to estimate this happening in your brain, which is where sleep is generated. And so it's no surprise that there might be like a little bit of error when you put something on someone's finger that isn't on their brain. But, you know, it is getting better. I will say the things that I think are really cool about these wearable devices is that, you know, maybe the like the absolute values aren't that aren't 100 % accurate. But because you wear the ring all the time and you gather the data over a long period, like percent changes are probably real.

17:29The Body Pod Host:Like, you know, a 10 % increase for you, even if the like the absolute values aren't accurate, like the change in those values might really tell you something. And I actually think that's where wearable devices are so helpful is that, you know, you can do these little experiments to see what impacts your sleep, right? Like if I do a meditation before bed, does that help with my sleep? If I do dry January, does that help with my sleep? You know, if I do the opposite in January and just drink a lot, like does that affect my sleep? You know, those kind of things. you can really see them immediately in the data and you can kind of make do these little experiments on yourself to get to know kind of how your body responds.

18:10The Body Pod Host:And I think that's true at any age, but certainly as we get older, when things just, you know, aren't as flexible, you know, it may be even more insightful for, for kind of understanding the relationship between your sleep and like all the other behaviors that you do in your life.

18:26Dr. Aric Prather:So is there, and this is probably individual, and this is where guidelines of exact numbers like kind of mess people up. I see it in the fitness world where people are, I need to have this many hours of interval training or this many minutes or this many. And I'm like, well, there's no one size fits all, but is there a certain amount of REM sleep and restorative sleep that you should aim for if you were tracking through a device?

18:55The Body Pod Host:Oh, you know, I mean, like, and that, that's where it gets down to like, if the device is, you know, completely accurate, right? Because I mean, you know, people, you will come in, and they'll say, you know, my aura rings, I got zero percent, I never get any deep sleep. And I'm like, I don't, you're alive. Like, that probably isn't right. Like, you know what I mean? Like, and so, you know, I mean, I think it definitely varies. I mean, population, you know, what we know from kind of just measuring in populations using kind of gold standards, things are, you know, it's, it's somewhere between like 10 and 20 % of your sleep is typically deep sleep or, and, and, or REM sleep, you know, on, on either end.

19:35The Body Pod Host:I mean, we get more, the majority of the deep sleep that we get is in the first half of the night. And then the majority of the REM sleep we get in the second half of the night. And there is like some circadian, you know, internal clock that, that helps regulate that. So like, it's, it also depends on like when you go to bed, like if you're someone that's supposed to go to bed at 10 and you go to bed at one, you might miss that deep sleep for that night, you know, but you'll make it up the next night. You know, your body is really good about trying to compensate for what you need. But you know, I think there's the other not deep sleep, not REM sleep, that's also just like critically important.

20:09And you know, it's kind of unfortunate things like, you know, certain device like aura

20:14The Body Pod Host:calls it light sleep. And people are like, what light sleep, I don't want light sleep. It's like what they mean is like, not deep sleep and not REM sleep. And it's like essential, you know, So, you know, Apple, as an example, changed it to core sleep. So that's what it calls it, where it feels like much, oh, core sleep. I got like a lot of good core sleep. Like, you know, and it's funny how language makes such a big difference in how people think about their needs and what they are. But yeah, I mean, I, you know, so that's typically what, you know, what, what people will have and it will fluctuate based on their, you know, how things change throughout the day.

20:49The Body Pod Host:I mean, it's sort of like the idea that we have kind of an internal set point that we kind of vacillate around based on what changes in our environment and how we change our behavior. Like we have a bad night of sleep. You know, the next night's most likely going to be better, right? If we have a short night of sleep, we'll probably get more deep sleep the next night because your body will try to kind of make up whatever it needs first. You know, if you exercise a lot, you may get more deep sleep. You know, that's I mean, because and the thinking is that like maybe that one of the functions of that is kind of cellular restoration and recovery.

21:26The Body Pod Host:And so it would make sense that as people are more physically active, your body would do things to help support that. But, you know, I think on any given time that those are like the percentages that people tend to get. But there's error around that, that, you know, isn't should not be a source of anxiety. because one, you know, there aren't a lot of interventions to change these things at this point. And so, you know, it's like, it's almost like, I don't know what, if someone had what they felt like was insufficient deep sleep, we would like first try to understand, is there, you know, a medical problem that's happening?

22:02The Body Pod Host:Are they taking medications that might suppress it? Are there substances that might be impacting the brain that could be affecting it? But otherwise, It's like, you know, these are just, I think the idea is that for the vast majority of people, your body will take care of you. You know, like sleep is so fundamental and core to human existence. And every other organism that we've measured does something that looks like sleep. It's like conserved across species, across millennia. And it's like just built into our biology. and often the problem with sleep is that humans have this really big brain and we then like get in the way of it.

22:45Dr. Aric Prather:You say getting out of your own way so sleep can do its job. What does that mean in real everyday terms?

22:55The Body Pod Host:I always say that, you know, no one ever really wonders how sleep even works until it stops. And then you're like, Oh, like, I, I need to fix this. Like, I need to, I need to like, I need to make myself sleep. And you know, that's not that's not how sleep happens. Sleep is sleep is something that happens to you, not something you make happen. And it kind of washes over you. And when people have consistent sleep problems, they will, you know, understandably, make behavioral changes in the hope that that will bring them sleep, right? But it actually ends up undermining how sleep works naturally.

23:32The Body Pod Host:So a great example is, you know, people, when they have really unpredictable sleep, will do this thing where they will often go to bed early. And they'll like go to bed because they're like, God, I've been having such bad sleep. I really just need to get to bed because I don't, I'm only getting four hours of sleep, but I don't, I don't know when I'm going to get it. Like, I just need to be in bed because if it happens, I need to get it, need to catch it. And so they end up spending a lot of time in bed waiting, noticing that they're not falling asleep, being really anxious about it, which is making it harder to fall asleep.

24:07The Body Pod Host:And then they end up spending 10 hours in bed and it's like this really torturous experience. And what that does is both kind of, it doesn't work and it's a much bigger time than you would even, even in the best of circumstances, you would never sleep. Most people don't sleep 10 hours. If you're a seven hour sleeper and you get your bed for 10 hours, you're going to guarantee that that's three hours of like somewhere in there of like being awake. It also ends up making the bed a really scary place to be. Right? Like our brains are predicting machines and they're just trying to take in information as best they can to kind of figure out how to use metabolic resources to thrive, right?

24:54The Body Pod Host:And so we have all these environmental cues that kind of tell your body like what's going to happen next. And so the bed is one of those things, the bedroom and the bed is specifically and so you know, people who don't have sleep problems, they will, you know, they'll feel sleepy before they go to bed, but the bed itself is like a hammer coming down on them. And you know, like, you know, you probably know people like this, where they're like, They're like asleep before they hit the pillow. Oh, I'm so mad.

25:20Dr. Aric Prather:I hate it when I ask. Yeah, yeah, I know.

25:23The Body Pod Host:It's frustrating. But that's in part because the bed plays such an important trigger, environmental trigger to help you transition, to help you let go of the day and kind of move into this other part of your night. And when people spend a lot of time in bed, kind of angsty and frustrated about not sleeping, your body gets confused. And, you know, so often I'll meet people that'll say, you know, I was feeling really sleepy. Then I got in bed and my brain woke up. Right. And that's, that's like a very common experience for people. And that's what's called a conditioned arousal. And that is usually due to the fact that people have been spending a lot of time in bed, not sleeping.

26:10The Body Pod Host:And so now it's, it's actually a source of anxiety. Right. But in both those instances where like people are going to bed and they're staying in bed for a long time and they're just kind of waiting, those are completely reasonable when you're thinking about like, I just want sleep tonight so badly. But it actually, you're kind of creating a barrier for sleep happening naturally, right? And so that in our clinic and people who do CBTI, that's, I mean, that's what we often work on is like kind of helping people understand that and then putting up guardrails so that people don't have to put so much effort into like sleeping, you know, like, like when people have bad nights of sleep, they spend their whole day often thinking about like, God, I just hope tonight's okay.

26:55The Body Pod Host:Like, what do I need to do? You know, and that amount of effort is unfair. It's not necessary. And if, you know, if we can just kind of give them like, do this, this, and this, it's like, now it's off your plate. Just, just follow this. And, you know, oftentimes that will start getting people in the right direction and building some confidence that they don't need to worry about it. Like it, you know, sleep is in there. Okay.

27:16Dr. Aric Prather:So what works? What have you seen in your patients? Well, I mean, so, you know, like, I think, I really think about improving people's sleep

27:28The Body Pod Host:in any age group is, is really not just about bedtime. It's about kind of structuring your day and your evening to just put yourself in the best possibility to improve your sleep. And it actually, ironically, I would say the number one thing that I always tell people that to start with is to set a standard wake up time seven days a week. And like, believe me, I get tons of pushback. No one wants that on the weekend. And if you don't want that, and you know, it's understandable. But like, if you're trying to work on your sleep, like this is like the best way. And the reason for that is, um, there are two things that regulate your sleep, uh, biological things.

28:13The Body Pod Host:The first one is your circadian rhythm or your internal clock, right? So, you know, we have a tendency to go to bed at a certain time and wake up at a certain time, but when people have really bad sleep, they'll often like make huge differences in what time they wake up. Like they have a bad night and they're like, I'm calling off work. I'm going to sleep in and try to make up on that sleep. Right. And that throws your clock off. Like the entrainment of that is actually really important kind of predictability of how the rest of the things move in your body. And so, you know, first we standardize that because of your internal clock.

28:42The Body Pod Host:The other reason is for the second process that regulates your sleep. And it's called your homeostatic sleep drive. And it's really a simple idea that like, the longer you're awake, the sleepier you get. And I think of it as kind of like a balloon. So you like wake up in the morning, your balloon is flat, go throughout the day, and it kind of fills up with the sleepiness. and then when it gets to like this optimal amount, you know, you feel these sleepy cues and you nod off and you go to sleep and then you go through the night and you kind of drain out all that sleepiness like you drain out of a balloon.

29:11The Body Pod Host:This is why when people are trying to work on their sleep, naps might be problematic because it kind of steals some of that sleepiness out of the balloon and then you have to wait longer for it to build up. But if you set a standard wake-up time, it both entrains your internal clock so that you're kind of getting up at the same time each time and it starts the same time in which that balloon begins to blow up. And so, you know, we can't control when we fall asleep, right? Like we can put ourselves in the best position, but, you know, sometimes things happen, you know, life takes hold and, you know, you may not fall asleep at the same time because of those things, but you can control what time you wake up, right?

29:45The Body Pod Host:And so like you do have a sense of control there and it sets in motion all of the things that can start kind of working for your sleep. But then, you know, in addition to that throughout the day, it's like, you know, making sure that you're kind of managing your stress, like trying to get in front of things that might get it crop up in the middle of the night, like, you know, so we have people do worry journals and, and other kind of strategies to help manage that so that they don't use that time in the middle of the night. You know, and then it's things like ensuring that you give yourself an adequate transition.

30:18The Body Pod Host:I mean, we're in all in like such busy lives, right? And it's often the case that, But man, if we could, we wish we were like a laptop that you could just close at the end of the night. Be like, okay, and I'm off. And now I'm moving to the next thing. My next thing is sleep. But like we didn't evolve as humans. Like technology has happened much more rapidly than we will change. And it was not developed that way, our brains, to just be able to turn off like that. So we actually need to build in time to ensure that we have this transition. So, you know, whether it's kind of cutting off work two hours before, dimming the lights, having these rituals.

30:53The Body Pod Host:like rituals are so fundamental to help making sleep predictable. And it doesn't even matter what it is. It's it these are all just cues for your body to know what's going to happen so that it can kind of begin to increase your kind of parasympathetic nervous system and, you know, start kind of calming down and being getting ready to transition. And the more you build those in ensuring that your bedroom is, you know, dark, cool, quiet, and safe, are all things that are necessary to allow you to kind of transition. And then, you know, not getting in bed early, like earlier than you would kind of making sure that you're sleepy, using the bed for sleep and sex, making it kind of a shrine to sleep.

31:38The Body Pod Host:All of those things are kind of when packaged together, you know, really give you all the tools that you might need to deal with the fluctuations of our stressful lives and help protect the sleep that we all really are searching for.

31:55Dr. Aric Prather:So is there a difference between someone that has a hard time falling asleep versus someone that has a hard time staying asleep? Different issues or same issues? You know, I mean, they definitely can happen in the same person.

32:11The Body Pod Host:They can happen separately like that. I mean, you know, I guess, I mean, I will say that more common these days is the kind of waking up in the middle of the night, you know, usually around the same time, you know, you look and it's like 2.30 or whatever, and you're, you know, pissed off again. And, you know, I mean, I think, but there are absolutely people that, you know, are anxious at night. They have a tendency to ruminate. Sometimes it's the case that, you know, people just don't have a time to process anything else going on in their lives until it's like bedtime. And now they have this time to themselves.

32:47The Body Pod Host:And, you know, once if that's the case, and it's, you know, it's really kind of, you know, maybe not negative, but activating, people can have a hard time getting to sleep. And, and, you know, then there's, you know, it's combined with this, this phenomenon of, you know, revenge, bedtime, procrastination, where, you know, people like have no time to themselves. And so they'll actually like, push way past their bedtime so that they can have kind of grab back some autonomy of their me time, you know, and so all of those things kind of like get mixed in with this like difficulty of falling asleep.

33:24The Body Pod Host:But you know, the waking up in the middle of the night, you know, it's, it's, it's, it's so common, and it can be so frustrating. And for some people, it's, it's they get up, go to the bathroom, they fall back asleep. Others, it's like they get back in bed and they're just mine is off to the races. Right. And so it's a lot of us trying to figure out like what what's going on? Why is there a way to try to create some strategies to help people fall asleep more naturally? Sometimes it's about that their sleep window is too big. It's like a natural wake up for people. I mean, there's been this historical idea that people used to sleep in like two bouts, right?

34:09The Body Pod Host:Like they'd go to bed, kind of late at night or when the sun went down, they'd sleep for a few hours, they'd be awake for a few hours and they'd sleep for a few hours. And it is interesting that people have still have this kind of a wake up that becomes so habitual. But I mean, that's all to say that it may, you know, waking up in the middle of night is normative, right? That like, you know, as I said, like 80%, as we get older, 80 % of people will end up getting up to go to the bathroom. And so like, there's no way to get around that. And so that's not problematic. It's really about like this difficulty getting back to sleep.

34:42The Body Pod Host:Yeah. So, I mean, but I don't know if they're necessarily different. I think the one thing that I would say is that in some cases, the waking up in the middle of the night can be driven by kind of undiagnosed sleep apnea, right? And so, you know, as people go towards the second half of the night and they're having more of that REM sleep that we talked about. People will also tend to have more kind of apnea events. And it's not just people that are overweight. I think that's one of the misconceptions. It's like, you know, it's, it can be about like just the structure of your draw and just aging generally as like our, our, you know, like our back of our throat gets kind of less taught, you know, those that can become a problematic.

35:26The Body Pod Host:And, and so, you know, sometimes it's the case that those people can be different because they're, it's like a pipes problem that is making them wake up. And then the kind of being awake at that time becomes like an insomnia because they're like, it's happening all the time. And, and they start to kind of worry about their sleep. And then we have to kind of intervene on multiple fronts.

35:47Dr. Aric Prather:It's so psychological sleep. I feel like people are so focused on it and getting good sleep that it's causing all of this stress. Yeah. And it's like they're overthinking it. Yes.

36:03The Body Pod Host:I mean, it's, yeah. Like, what do we do about that? Like, it's because, I mean, you know, we do shows like this, right? And it's like because people are interested in their sleep, right? And they're like, because they're thinking about it. And I love that. I love that people are prioritizing it. I wish there were more policies, like at the workplace, anywhere, that helps support people's sleep, right? But yeah, but then also it, you know, people can get really worked up about it, you know, and that can be challenging. I think some of it is that, you know, there's not always like education around what's normal, you know?

36:47The Body Pod Host:And so I, you know, I often, even with new patients, I always have like, you know, do you talk to your friends about their sleep? Like, you know, you, you know, like everyone has challenges with their sleep and that's not necessarily because everyone needs help with their sleep. It's just that like, it has changed and it's just, it's, it's, and it's okay. I mean, there are things that like, like, for instance, like I have like this shoulder pain, right? Like I'm like, I don't know, my family history of like shoulder pain and I'm like, maybe it's fixable, but it also is just like, it's something that's developed over time.

37:21And like, I try to think

37:23The Body Pod Host:like, oh gosh, like I'll just make adaptations to do the best I can. But like, I can't expect that I will, you know, be the same as I was when I was 20. And I didn't have to worry about those things. You know, it's just like, it's like being okay and accepting about some of these natural changes, even if it means that it's, it's suboptimal to what you used to have. You know what I mean? And I think that's true about lots of aging things. And we can continue to do like all these interventions and optimizations. And that's great. But, you know, I mean, it shouldn't be at the expense of people's kind of having the sleep that they can get because they're so stressed out about what they don't have.

38:05I've never heard anyone say that, too, that our sleep does change.

38:11Dr. Aric Prather:the quality and what was normal doesn't mean that that's what's normal now.

38:17The Body Pod Host:Yeah. I mean, I, you know, like I often, it often comes up like I'll, you know, gosh, I'll see people that they've had insomnia for like three decades, you know, and it's like, they're like desperate and they're like, it's never getting better. And then we work on it, but I always tell them like, you know, you're going to, you're thinking back to your sleep when you were like 25 as like, how do I get back to that? I'm like, you know, you're 55 now. Like this is, you know, we're going to look at what sleep looks like for like a regular 50-year-old, you know. And I think that's helpful because, you know, people get so frustrated because they're working so hard.

38:55The Body Pod Host:Everyone is doing their best, you know. And when you fall short, you feel like it's something that you're doing wrong. And in some cases, it's like, no, like, this is what it's like. And we can kind of work around the edges. And that's great. But, you know, like, you shouldn't carry that same kind of shame around, like, sleep, especially something that is the more you grab at it, the more you're like, push it away, you know, and that's, it's like, unlike any other behaviors that we have.

39:28Dr. Aric Prather:So if we were to say, okay, these are the things that we know aren't great for sleep,

39:33The Body Pod Host:Yeah.

39:34Dr. Aric Prather:Alcohol close to sleep. Yes. That is going to impair sleep. We know we want a dark room, preferably a little bit cooler. No working in the bed, taking your phone and your all of that, turning off screens. Anything else that goes along with that list?

39:53The Body Pod Host:I think you know absolutely you know making it quiet and comfortable you know um I think the other thing we worry about is is caffeine like that's another one that you know caffeine has a really long half-life so meaning you know uh how long it takes for half of it to just still be in your system and so it's about six hours and so for for the average person and so if You know, if you have a double espresso at 4 p.m., that means at 10 p.m. You have like a single espresso still in your system. And, you know, that's that's that's things. And yeah, I mean, any other kind of substance that might get in the way.

40:36The Body Pod Host:I mean, we worry about when people eat like heavy foods or spicy foods too close to bedtime, you know, that that can cause some indigestion and impact people's sleep. But yeah, I mean, those are those are like the main sleep hygiene things for sure.

40:50Dr. Aric Prather:How important is the mattress?

40:53The Body Pod Host:You know, I mean, it's such a great question. You know, it is definitely one of those things that is kind of preference based, right? I mean, you know, like whether it's firm or what it's made of and those sorts of things. I think the place where I'm most interested in has been around heat and its ability to cool. You know, this has been, you know, since we began this conversation, you know, thinking about kind of the menopausal transition and hot flashes. And to the extent that, you know, as kind of women go through that transition, you know, the loss of estrogen does have an impact on thermoregulation.

41:35The Body Pod Host:And, you know, what do we do about that? And one of the things that you can do is potentially invest in mattresses that help support that, that allow like better heat, you know, transfer so that it can provide a little bit more comfort. But, you know, I don't know. And then like, you know, like majority of people, you know, sleep partnered. And so, you know, identify, you know, in some cases that can be.

42:06Dr. Aric Prather:Touch me while I'm sleeping.

42:08The Body Pod Host:Yeah, you can do kind of the, you know, whatever the Swedish sleeping where it's like separate duvet covers, but also, you know, in the firmness and things like that. I mean, it is interesting because it's so common for someone that has like very serious insomnia to be partnered with someone who like falls asleep like immediately, right? Right. And and and I always say that, you know, thankfully, they, you know, they presumably didn't kind of find each other and couple up based on sleeping preferences. But but, you know, then you have to manage it. And I was just the point was that like these new newer mattresses are like technological mattresses might help kind of deal with some of those, you know, slight conflict conflicts a little bit within couples.

43:00The Body Pod Host:And so that's also another reason that that might be helpful.

43:03Dr. Aric Prather:Laura, you got lied to about that$200 ,000 mattress that makes it different. Yeah, there's some expensive mattresses out there.

43:15The Body Pod Host:I'm always open for them sending me one. I'm still not going to buy one.

43:21Dr. Aric Prather:Who's spending$200 ,000 on a mattress? No. How does sex affect sleep? Isn't that positive?

43:31The Body Pod Host:I mean, there is some research around it, but I feel like it's due for a comeback to study this. I mean, we've done a couple of different projects on this. And we did a large study where we worked with Samsung, where they used to have an app on their phone where you could kind of measure people's blood pressure on the back of the phone. And it was with my colleague, Wendy Berry-Mendez, who's at Yale now. And she created an app where, you know, you answered all these questions in the morning, but you also had measures about your sleep. And over like the last, I don't know, like 10 years, we've been in our sleep diaries, we've been adding in, like, did you have sex?

44:11The Body Pod Host:And it's like told us so many interesting things. And in this particular study, we found that, you know, compared to people's days and nights when they didn't have sex, when they did report having sex, they slept better, their blood pressure in the morning was lower, their mood was better, and they reported less stress. and so you know it it does suggest that like maybe it is beneficial and at least in that sample you know the questions you know we've not done a great job of like really digging down into it right like we don't ask we don't even know if people are partnered we don't know what they mean by sex like we don't know any of that stuff but and you know there has been this like mechanistic question about like whether it's about orgasm and that like that might be the really what it is, you know, that that matters.

45:01The Body Pod Host:But I actually think we had a postdoctoral fellow here who wrote a grant who she was going to do a randomized experiment to figure this out where she was going to randomize couples to have sex or not, so that we could track their sleep and all these things. But we have not found the funding yet.

45:17Dr. Aric Prather:But all the dudes are signing up for that one or just saying that it exists.

45:23The Body Pod Host:I know, I know, I know. I mean, I think the other thing that's been interesting about these studies is like it had nothing to do with kind of the relationship quality it was like it was just like the act you know but i mean i think there is something there and i think i think it's uh you know i i think it's well worth investing to try to understand these like very basic kind of human experiences and how they may play an important role in um both our sleep health, but also just like our physiologic and psychological health for sure.

45:59Dr. Aric Prather:Okay. So what about eating? You talked about eating and digestion if you have spicy foods, but what about just eating in general? So the experts that I've worked with, not sleep experts, but just kind of give the midlife women the range of saying, don't eat close to bedtime so that your stomach isn't digesting. Is there something to that? Or what would you say to that? Yeah.

46:28The Body Pod Host:I mean, you know, they're like, I have to say I've been pretty impressed by like, like the intermittent fasting data, you know, and kind of having like a very defined period of, of when you can eat. And, you know, so then ultimately it's ends up being like, not later than 7pm or 4pm or, you know, whatever the model is. But in all those instances, it's often around like people's circadian function and kind of their, you know, metabolism. But I think there are some data that suggests that it also supports better sleep. I mean, I think like so many areas of science, there's really a scarcity of like really rigorous nutritional information that I think is absolutely something that we should invest our research dollars in trying to understand.

47:17The Body Pod Host:um i mean i think in general uh there you know there seems to be some evidence that you know more like like a whole food diet is better but it's like better for everything but like so no no no surprise it's like also better for sleep you know it also means like not drinking alcohol you know i mean like it's like okay not not a big surprise but and that like ultra processed foods probably do have a negative impact on people's sleep but also potentially on their well-being anyway. And so it's, it's, it's not so surprising, but I mean, I, I, I'm not personally aware of like a lot of like rigorous, like randomized controlled trials to help like understand kind of the causal path, but you know, certainly observationally it does seem to seem to matter.

48:00The Body Pod Host:And so, you know, probably whatever the recommendations are that are consistent for, you know, people, women over 40 for nutritional also would be likely supportive for their sleep health.

48:13Dr. Aric Prather:So is there sex differences in more women or male, like at the same age group, let's just say midlife, because that's what we're working with, that have a harder time with sleep or present and come in to your clinic that have a harder time just overall with good quality sleep at this stage of life? Yeah.

48:37The Body Pod Host:So there, I mean, there are kind of like sort of well-documented sex differences in sleep. You know, it is true that men on average, and I guess I'm not remembering if exactly if it's like midlife, but it probably is, might get a little less sleep. but women tend to report kind of poor sleep quality overall. And that can be for a whole lot, lot range of reasons, right? Like it can be like difficulties and kind of maintaining sleep or just kind of not feeling as refreshed as they maybe did previously. But it does seem that women do have a bit harder time with sleep, at least by their report. And, you know, and, and so that's not so surprising.

49:24The Body Pod Host:I mean, it's, it's striking to me how challenging sleep can be in this stage of life for like lots of reasons for women. You know, I mean, it's, there's like hormonal changes. It's like peak career stress. It's like caregiving stress, like sandwiched. It's like, I mean, there's so many things that can, you know, easily on their own impact someone's sleep. And so, you know, and it's all just like out of out of their control. Right. Like, so it's it's it's it's a it's a tough spot to be in. And I do think the other thing that I also imagine for like in the next five years, there's going to be kind of this increasing investment in how to better, more effectively treat sleep problems for women in that that time of life.

50:15The Body Pod Host:days yeah oh my god like you know i mean it's i it's it's so interesting that you know like women going through kind of the menopausal transition even if they don't have hot flashes their sleep is all messed up you know and it's like to me and it's like it's totally anecdotal and you know and like my like this seems different than other people you know like there's like something going on hormonally and I'll, you know, I'll have, or I have women that either like, yeah, just like two days out of the month, every month I like don't sleep, you know? That's me. Yeah. And it's like, oh my God, like that's, that's horrible.

50:55The Body Pod Host:What a horrible thing to have to manage. And I, you know, and, and like, clearly it's not about, you know, going to bed at the wrong time. There's like something happening hormonally that like, you know, and, and, and I just, I think there has to be like a more comprehensive way to manage that. I mean, and improve it, right? Like not just, I guess it's like not just manage it, right? But also be very understanding that like, it's not in your head. Like that's, that's like, that's really happening. And like that sucks. And so, you know, my hope is that as as this, I mean, menopause just in general is, you know, having a moment, which is amazing.

51:40The Body Pod Host:I love I love like how much people are kind of talking about it more and more. And there's more money being invested in it in that research. But I really hope that that also translates in the arena of sleep, because there's a lot of God, you know, half the whatever gazillion people, women dealing with this and and having to just take Unisom or whatever.

52:06Dr. Aric Prather:like yeah i'm gonna tell you my observational data um that i have no research on but just i've never met a single male that is like my sleep sucks all the time yet very few females i would say five percent and i've worked with thousands and thousands that are like my sleep rushes. I nail it. I never have a problem sleeping. Oh, like I would pay any amount to get that every night. And I know some of mine is psychological for sure. I mean, I've just, but I never want to lay, I have, I have no problem falling asleep. But then in the middle of the night when I get up and I, or I just wake up, I'm counting down.

52:56Dr. Aric Prather:Why is it going to take me 10 minutes to go back to sleep? Is it going to take me an hour and a half? Sometimes it's two. It's terrible. I'm going to the sleep clinic. That's it.

53:06The Body Pod Host:Totally. I mean, that is terrible, for sure. And I mean, I think it's, you know, it's because you've just had, like, I kind of think of like, when people have like a lot of sleep problems, it's like kind of like carrying around a trauma, right? It's like, like, you're kind of like, for sure, where people, you know, they've had this like really terrible experience. And there's like, usually like some most standouts. and they carried around. They're like, it's like a source of fear. Like, oh my God, I hope that doesn't happen again. And that, you know, just that, just that beginning of that is like, you know, gets under your skin.

53:36The Body Pod Host:Gets, gets, so I will say that like, one thing I've been telling people that I've found has been like modestly effective, but it's like a great way to start because I've noticed that people always come and tell me that like, you're like, you know, three o 'clock, three o 'clock is when I wake up every day, three o 'clock around this time. And I always say like, How do you know that? I'm like, oh, well, I look at the clock and then I'm like, damn it, it's three o 'clock again. I'm like, do you think that helps? Do you think that feeling, that frustration, that confirming how bad your sleep is, is supporting your sleep?

54:13The Body Pod Host:And of course, they're like, oh, no, I see what you're saying. But I'm like, how about just an experiment for a week? Turn your clock around. Don't look at your phone. Don't look at the clock and see if you have the same experience. My guess is that it will maybe produce at least a 25 % improvement in people's sleep. Because I think that that kind of immediate reaction is certainly kind of setting on a path of anxiety that then maybe doesn't stay on that, but turns to just alertness and thinking about tomorrow or thinking about the last day or whatever. whatever. But I know that it doesn't hurt and could be a way to kind of start chipping away at it.

54:57Dr. Aric Prather:Yeah, I need all the help I can get. Same. I'll take anything at this point. Is it normal? So it is normal to wake up. How many times a night would be considered normal?

55:09The Body Pod Host:Oh, it definitely ranges. I mean, it's it's normal to wake up. You know, people definitely wake up a few times per night, like a couple, like, I don't know if there's like a clear number. I mean, it's real. And in fact, people wake up what would be considered wake ups many more times, they just don't have conscious awareness of it. And so it's, you know, for me, it's like less about the waking up, it's more about how quickly you're able to get back to sleep. And and what are the causes of the wake up, right? Like there could be people waking up a bunch of times, but for like, reasons that are addressable.

55:47The Body Pod Host:And for others, it's like, you know, our sleep is cyclical. And so, you know, and in like 90 minute, maybe 120 minute bouts, and they usually end with like a wake up. So it's like, it's, you know, depending on how many, how, how many cycles you have, that could contribute to like, how many wake ups you could potentially have, though, you maybe you You won't actually imagine you experience those. But I will say that like, you know, I do work sometimes with like kids in their 20s. And like, it doesn't seem like they wake up at all. And I'm like, I like can't even like every time I was like, that's insane.

56:26The Body Pod Host:Like, I can't even believe that that exists. I don't remember that existing, but maybe it did. But, you know, as we get even into your 30s, like wake ups are very normative. and we do know that like as we move into like the fifth sixth seventh decade of life the amount of time awake in the middle of the night increases and it's completely normal okay

56:49Dr. Aric Prather:good to know what about dreams do dreams play into good sleep bad sleep or it's just individual

56:56The Body Pod Host:I mean dreams are really important for sleep uh and you know and it's synonymous typically with REM sleep. And, but I think the important thing that I want to point out is you don't have to remember your dreams to have dreamt, right? Some people are like, I don't dream. It's like, no, you just, I mean, you don't, you don't come out, you don't wake up out of a dream. And so you don't, it's like, doesn't get logged the same way for whatever reason that can be for like medications that can just be like normal differences between humans. But I mean, no REM sleep specifically is important for kind of learning and memory and things like that.

57:36The Body Pod Host:And then the experience of dreaming, gosh, I mean, that's like a whole other, you know, episode or podcast altogether about dreams.

57:44Dr. Aric Prather:Oh, I'm fascinated with that. Great.

57:47The Body Pod Host:I mean, people invest a lot of time trying to understand dreams. And I was on a I was on a podcast, I was on like the radio one time with like, as a as like a sleep expert, but it was about a dream thing. And I was like, so hooked, because they were talking about all these dreams that I had had that, you know, that like are just like universal across people.

58:06Dr. Aric Prather:Like your teeth falling out. Exactly. Your teeth falling out and not graduating from high school. Like, I don't know why it's high school. I'm like, I got a degree, a university. Like, I don't understand why it's high school.

58:21The Body Pod Host:I know. I know. It's really.

58:23Dr. Aric Prather:The teeth falling out drives me crazy. I'm like, it's so scary. Yeah.

58:28The Body Pod Host:But like, Why would we all like what? What's happening? I don't know. I think it's so I think it's so interesting. I think you guys should do a separate one on that. I would listen to it. I certainly can't comment. OK, good to know.

58:39Dr. Aric Prather:If we as we're wrapping this up. Yeah. For women. That are struggling with sleep, if you had just a few takeaways. Yeah. Shoot. Give them to it.

58:49The Body Pod Host:I mean, so I would say that, one, you should talk to your doctor about it. Don't try a medication, first thing, if you don't have to. I think it's important that women don't just kind of suffer with it and think that there's nothing that can be done. I think that is often, you know, the same happens during pregnancy. You know, they were just like, oh, well, that's just part of being pregnant. Sorry. But that's not true. And there are things that can be done. things like cognitive behavioral therapy for insomnia have been shown to be effective across the life course, including during menopausal transition, including during pregnancy, postpartum, all of those things.

59:30The Body Pod Host:People, things that they can do right now. I mean, again, you could start stabilizing your wake up time, start making your bedroom a shrine to sleep, try to manage your stress, try to move that kind of worrying stuff outside of that window So in earlier in the day, that can really make a big difference. And then I think like as hard as it is, you know, not spending a lot of time in bed awake, it can be really helpful. And it's hard to get people to do it, but it really helps, you know, reestablish your bed as a place of kind of slumber and safety and restoration. And so I always suggest that if like, one, people shouldn't go to bed unless they're sleepy.

1:00:22The Body Pod Host:And then if they're in bed for like more than 20 minutes or 30 minutes awake, they should actually kind of get out of bed and go somewhere quiet and just kind of do things relaxing. That doesn't mean like fire the computer back up and knock out those emails. It's like do things that are calming for you that can help you get to sleep. and then when you begin to feel sleepy again, kind of return to bed. And it does take time. I mean, you have to kind of reestablish this relationship with the bed. And definitely kind of reach out to your support community if you're struggling for sleep. I mean, I think it can feel pretty isolating at times in the middle of the night, just laying there and worrying about the next day.

1:01:06The Body Pod Host:But we're kind of all dealing with these things And there are kind of very clear behavioral strategies that can be helpful when implemented.

1:01:14Dr. Aric Prather:Well, we announced your book in the intro, but we didn't even get to that specifically. I'm guessing all of this is in the sleep prescription, which is your book. What else will women learn in there?

1:01:25The Body Pod Host:I mean, I like I think we covered a lot of it. I you know, the the sleep prescription was like such a awesome opportunity for me because, you know, like us as sleep medicine providers, we you know, we kind of see people one off. or one at a time. And, you know, it's like a fire hose, though. And but I do think like the principles that I outlined in that are, you know, our distillations of kind of our, our protocols, or what all of us sleep medicine folks do. But I think they're just really relatable and actionable to improve anybody's sleep. And, and I urge people if they're struggling to take a look, I think of it more as a recipe than a menu.

1:02:08The Body Pod Host:Like everyone can like stop drinking caffeine late. But like, if you know, if you start doing all of these things together, and you let it bake, you know, you can get a better, more delicious night of sleep. And so, you know, I just feel so grateful to even be able to kind of, you know, go on, you know, podcasts like this, or, you know, whatever to try to kind of spread kind of hope around people's sleep. Because as you said in the beginning, I mean, we all kind of we all deserve the opportunity to get our best rest.

1:02:38Dr. Aric Prather:Yes, I agree. Where can women find you?

1:02:42The Body Pod Host:You know, I mean, you search me up on the Internet. I'm usually pretty easy to find. You know, I'm based in San Francisco. I'm always just an email away. I have a website, but it's pretty pitiful. But, you know, whatever. But if anybody's interested, you know, I hope it became clear that I like love, love talking about sleep and trying to get people to sleep they need. And so if, you know, if anybody has questions or concerns, they can always reach out.

1:03:09Dr. Aric Prather:Do you have an Instagram handle?

1:03:11The Body Pod Host:I do. I do. I think it's Dr. Eric Prather.

1:03:15Dr. Aric Prather:Okay, perfect. Well, thank you so much, Eric, for coming on and sharing your expertise with us today. Obviously, this is a massive subject and that a lot of women are interested in. So we appreciate your time and sharing all of your knowledge with us today.

1:03:33The Body Pod Host:Absolutely. It was my pleasure. Sleep well.

1:03:35Dr. Aric Prather:Thanks for listening, everyone. If you enjoyed this episode, please consider giving us a five-star rating and sharing the BodyPod with your friends.