What's the deal with sleep?

24:45Emily Oster:Before animals even existed, there's essentially sleep because plants will photosynthesize with oxygen, but then also fix nitrogen. And those two things are incompatible. They can't happen in the same cell at the same time. Those chemical reactions just won't work if you're doing both at the same time. So from the very first plants, they had to evolve this ability to turn on the oxygen, the photosynthesis thing, and then shut that down and then turn on the nitrogen fixation thing. And so it would do photosynthesis during the day and nitrogen fixation at night. And it's everywhere. It's everywhere.

25:24We are sort of slowly, I think, understanding a bit better, like what are we getting out of sleep? There's a sort of general idea that people will say, which is like, well, the brain cleans itself out. Like it's like your opportunity to clean things out of your brain. It's not very specific. There's actually some new evidence on mice from a couple of years ago where they looked at sort of the patterns of brainwaves and basically found that like during the night, the brainwaves lined up in a way that were moving like debris effectively out of the brain. And so their idea was you needed this period of sleep where the brainwaves lined up in this way to like flush the byproducts of being a functional thing out of your brain.

26:10And otherwise they just build up and build up and build up and then you die.

26:14Emily Oster:Yeah. These are, you can actually visualize, this was a very cool set of studies, like the cerebrospinal fluid, like the fluid that the brain sits in, this sort of salty, clear fluid that protects it somewhat. Yeah, just kind of like washing over the brain at night. That's, of course, not the only thing that's happening to your brain at night. Lots of stuff is going on. We'll need to get into some more detail as people start thinking about what's happening during sleep. But certainly for humans, it appears that memory consolidation between short-term and long-term memory is happening probably primarily during sleep.

26:53Emily Oster:I learned that from Inside Out. Did you see Inside Out? Oh, I have seen Inside Out, but I don't remember. Yeah, they're like, remember when she's asleep at night? Oh, they have the balls. They're like moving the balls from like the short-term memory, like to the memory storage area. That seems to happen at night. I learned that it's important to feel my feelings. Yeah. No, that's also true. I cried so much at that movie. Oh my gosh. That's a great movie. That's really good. People should watch that. Really good. Okay. Back to sleep. Okay. So people sleep, big picture, everybody sleeps, including potentially plants and certainly all, you know, living, all of the animal-like and animal organisms.

27:32Probably it has something to do with cleaning something out and your brain is doing something. We don't completely understand it. People talk a lot about the idea of circadian biology here. So do you want to, and I hesitate to ask this because of some earlier episodes where you got too involved, but do you want to do a little of the biology, Dr. Perry?

27:54Emily Oster:I think that people want to hear about the biology. People do. People do. Okay. Do it. Briefly. No, circadian biology is really cool. So circa around the day. So this is the day-night cycle, which everyone on the planet Earth has. I say everyone, including the plants and everything like that. We live on a planet that has a daytime and a nighttime, and it's no wonder that biology has sort of adapted to these different things. The way it works in humans is pretty cool. There's a specific part of your brain called the suprachiasmatic nucleus, which is the clock, like to the point that if people have a stroke or a tumor and that part of the brain needs to get removed, they no longer follow day night cycles.

28:42Emily Oster:They just like free run through their circadian rhythm. The suprachiasmatic nucleus is the clock in your brain. And it doesn't only tell you when you're tired and when to go to sleep, but all the other things that vary throughout the day, like your basal body temperature and your cortisol levels that spike in the morning. And all of those things are determined by the suprachiasmatic nucleus. That part of the brain has a direct neural pathway to your retinas. And on planet Earth, if you're human, the way the suprachiasmatic nucleus stays in sync with day and night is through light. It's very simple, and that's probably how you would design it anyway, right?

29:23Emily Oster:Like, it turns out that if you put someone in an isolated room, right? Just like no exposure to outside light whatsoever, you know, the lights on all the time or the lights off all the time. They have an inherent pace that their suprachiasmatic nucleus will follow. Some people have a slightly longer day than 24 hours, maybe 25, maybe even 26. And so if you just let them go, and they've done these experiments where they keep these poor, graduate students in a lab for weeks at a time while they write their theses or whatever. They pay them. And they'll basically go to sleep two hours later every night.

30:03Emily Oster:And they'll just, by seven days later, they're all of a sudden 12 hours off. Some people have a shorter cycle, 23, 22 hours, and the reverse happens, right? They just kind of like every night they go to bed a little bit earlier than they would have the night before. So that's the biology, but we all fix that by seeing the day-night cycle. Let me tell you that when I was in graduate school, one of my professors told me that when he was in graduate school, he actually tried to put himself on a 26-hour cycle because he thought he could get more work done. And it turns out that putting yourself on a 26-hour cycle does not work, even if your natural cycle, say, was 26 hours because the light exposure means that your body is going to try to get back to the 24-hour cycle, so he really messed things up.

30:50Emily Oster:Yeah, it is super powerful. Going outside, seeing the sun really does entrain the suprachiasmatic nucleus. Just to close the loop on sleep, the suprachiasmatic nucleus has a neural connection to the pineal gland, and the pineal gland releases the hormone melatonin, which is one of the important hormones in making you sleep, and is obviously also a supplement that many people use for sleep. So just a bit of biology, Emma. Just that's only, that was so good. So if we have people who are just like sort of not exposed, we can talk about artificial light, but if you're like living in the general world, most people will fall asleep a couple hours after sunset and wake up around sunrise or a little bit after sunrise because of the light.

31:41I'm curious, given that, if we sort of step outside the artificial light, like sort of go back to a time we didn't have a lot of artificial light, if people are living in places where there's like sunlight all the time or darkness all the time, like the ends of the earth, do they sleep less in the summer and more in the winter? Is that a sort of standard adaptation? Do you know? I don't know.

32:04Emily Oster:But let's Google and find out because it's a good question. It is a good question. Sleep times at extreme latitudes. It's heavily disrupted by intense seasonal light variations, shorter fragmented sleep in summer, delayed often increased sleep durations during the dark winter. Neat. Yes. You know, humans evolved in sort of equatorial areas of Africa. So that's maybe our ideal environment in terms of how much we should be sleeping. But of course, in the modern era, we're exposed to a lot of light sources that aren't the sun, which is one of the major problems people have in terms of, you know, staying on a good sleep schedule.

32:37At these high latitudes, adapting your sleep in that way to the time of year is actually probably evolutionarily beneficial because in the summer, you need more hours to work. In the winter, you need fewer hours to work because it's too cold. So anyway, all right. So in this modern world, we need to sleep. We know why we sleep generally at night. People like to measure their sleep, like getting back into the kind of like influencer wellness space. People are really, really interested in measuring their sleep. It's one of the core things that all of these like trackers like to measure. and we tend to talk about three pieces of sleep.

33:22There is duration, which is how long we are sleeping. There is latency, which is how quickly we fall asleep. And there's efficiency, which is a metric of like how much of the time you are in bed that you are actually asleep. Are there other measures that you feel like you care about? Those are the ones that my tracker likes to tell me about.

33:47Emily Oster:I'm so curious how you do on your trackers because I have some theories. I suspect as an endurance athlete, I want you to have very good sleep parameters because I feel like that should be what you get for all the pain you're putting yourself through during the day is a good night's sleep at the end of it. In terms of other sleep metrics, I am interested in sleep stages. So we can talk in a minute after I hear your numbers about the different stages of sleep and what might be happening in them. And I think there's interesting, actually, pathology in each stage of sleep that is worth mentioning.

34:26Emily Oster:But talk to me about, like, as a real athlete, an endurance runner, I assume your sleep latency is 30 seconds, right? Head hits the pillow. You're out. You sleep a solid eight hours. And you're good to go. So I don't sleep as many hours as I should, but my sleep efficiency is very good. So my sleep efficiency is like 95%, which I think means basically I'm asleep all the time that I'm in the bed. But my tracker thinks that my duration sucks. It tells me every morning, hours versus needed, 73%. That's like a standard thing. It thinks I should be... Oh, wait, so how many hours are that? Yeah. Okay.

35:02So to be fair, my whoop... I love whoop. I love you, whoop. My whoop thinks that last night I should have been sleeping for nine hours and 28 minutes. But as a person with a job, I was unable to achieve nine hours and 28 minutes of sleep. I managed to get six hours and 52 minutes of sleep, which I think was actually pretty good. That's not like, you know, that feels like a solid amount of time. But I, it's now it tells me my sleep debt is one hour and 18 minutes. And I feel like this is going to, you know, anyway.

35:35Emily Oster:Yeah, that's how sleep debt works. It just adds up until you're dead. I think WHOOP here is probably like looking at your activity during the day and extrapolating like how much sleep would be appropriate. And that probably isn't quite right. Full disclosure, we ran a study for WHOOP back here several years ago. So I've received research funding from WHOOP in the past. How many hours did you sleep last night, Perry? I slept seven hours, which is sort of the standard for me. I mean, my problem is - That sounds like a number that somebody reports if they just estimate it and don't have a tracker app on their phone.

36:13Emily Oster:I mean, I can get, if we pause the podcast and I can get my app out because I am wearing a Galaxy watch and I think I do have my sleep numbers, but I don't necessarily care that much. My problem with sleep is that I feel like I can't always sleep. I have to wake up because kids need breakfast and all that kind of stuff. And high school starts way too early before the sun even comes up, which is clearly bad for your suprachiasmatic nucleus. But then there's some days on the weekend where I'm like, oh, I can sleep in. But then I don't. I want to sleep until 8 or 9 a.m. And I still wake up at 6.15.

36:49And that bothers me.

36:51Emily Oster:That's my sleep problem. I think a lot of people have that sleep problem. OK. So it's not just how much time you're asleep. it is what you are doing when you are asleep. And there are different stages of sleep. There's deep sleep. There's REM sleep. There's light sleep. Should I care about which one I am in for how long? Yeah, I think so. I think so. So let's go through a couple of them. So REM sleep, which is rapid eye movement sleep, that is what's happening when you're dreaming. And the thinking from the neurologist is that this is where a lot of that memory consolidation is happening that we about from inside out.

37:25Emily Oster:So converting short-term to long-term memories. REM sleep is a fascinating physiologic state. You may know that you're paralyzed from the neck down during REM sleep to prevent you from acting out your dreams. When this goes wrong, people do act out their dreams to kind of disastrous effect, as you might imagine. Check out comedian Mike Birbiglia's Sleepwalk With Me, which is a hilarious retelling of him literally jumping out a hotel window to escape from a missile that was locked on him in a dream and waking up covered in glass in the hotel parking lot. This is very rare, fortunately. But what's not so rare is sleep paralysis.

38:11Emily Oster:And so you can actually regain consciousness during REM sleep. So you're sort of like, all of a sudden you're awake. REM is very close to being awake, actually, like in terms of brain waves. And so you can open your eyes and still your brain has that paralysis function turned on. And the experience is you're lying in bed and you cannot move your body at all. And it's very frightening. And a lot of people will talk about like alien experiences or feeling like, you know, there are like demons and things like that in the room. That can be really disturbing. REM sleep is inhibited by alcohol and benzodiazepines.

38:51Emily Oster:And so insofar as it's an important stage of sleep, that is something to be aware of if you're drinking at night. So that's REM. And then deep sleep is also important probably for that cleaning function that we talked about, the CSF sort of washing over the brain and getting rid of all the junk. There's weird pathology that can happen in deep sleep too. So that's the place where night terrors happen. This is distinct from nightmares, which is a REM sleep phenomenon. It's just a bad dream. Night terrors, if you've ever seen, are terrifying for people watching. It is people will just scream bloody murder in the middle of the night.

39:29So it's like, just to be clear, this is like very common in kids and it freaks out parents because there is sort of nothing you can do. Like your kid is sitting up in bed screaming. screaming and unlike with a nightmare where you know they they are kind of a conscious and they'll be like here's a bad dream there was a monster chasing me you can like okay they're just screaming and screaming and screaming and there's nothing you can do because they're not really awake they're just asleep and all you can do is kind of leave and then they just lay down and go back to sleep and they have no memory of it but it's horrible yeah really really bizarre as we said

40:02Emily Oster:if there's a theme of this episode, sleep is very strange. So weird. So weird. Again, clearly, you know, a physiologic state that leads you every once in a while, especially when you're a young child to scream as loud as possible in the middle of the night is not good if you're trying to hide from saber tooth tigers. So the benefit is clearly, clearly extreme. Let's talk about that benefit a little bit. So, you know, it's sleep is something where there is a fair amount of research on, you know, why it matters. And some of it's in this very extreme, like animal stuff. You know, if you keep the animal up for some amount of time, it just dies.

40:40But we can also sort of think about at smaller scales, what is the impact of sleep deprivation, either a single night of missleep or a long period of time of more limited sleep. The best studied parts of this, in my view, are cognitive. So not sleeping enough, either skipping an entire night of sleep or sleeping less than you should in a kind of consistent way really impacts your ability to basically, if people's executive function, short-term memory, any kind of cognitive performance, it also impacts mental health, it impacts depression, impacts all kinds of stuff like that.

41:24Emily Oster:Absolutely. Everything gets worse when you don't sleep. And a lot of these things can contribute to something of a vicious cycle. So sleep deprivation can worsen depression symptoms. Depression can manifest as increased sleepiness, but also decreased sleepiness. It can go both ways. The same thing, anxiety symptoms can worsen with lack of sleep, and then being more anxious can worsen your ability to fall asleep. So yeah, you can definitely get yourself into quite a bit of trouble here. The place that I worry about this a lot, I mean, I worry about adults, but having a teenager, actually having two teenagers in my home are the kids.

42:05So Emily,

42:07Emily Oster:are you as concerned as I am about our kids not getting enough sleep? One of my major concerns as a person is that kids are not getting enough sleep. And let me say more about this because I care so much about it. And I think this is adults' fault. So generally kids who are, you know, elementary school, middle school, high school, they need a lot of sleep. You know, high school kids need, you know, nine to 10 hours of sleep, ideally a night. They just they need a lot of sleep. And we are getting in the way of that in two ways. So one is with school start times. So high school tends to start early in the morning.

42:45It actually tends to start earlier than elementary school in many school districts. This is stupid because high school students are on a kind of delayed circadian rhythm relative to most people. So actually their ideal is to go to sleep later and wake up later. And we have seen when school districts move back the school start time so kids can sleep more. We see that kids do better in school and we see like things like less car accidents because they're just like a bunch of less tired teenagers driving around. So we're having a problem with school and the school start times.

43:18Emily Oster:Yeah. Why is this? Like, I've got an elementary school kid and a middle school kid and a high school kid, and they wake up in the opposite order, like my elementary school kids up first. Yeah. So like, what is it? I think it is. So I've talked to many school districts about this. And the answer I often get is something about bus schedules, but it's hard for them to be specific about exactly what that means. I think there's also an issue with high school sports. At the end of the day, kids need to go to a game. And so if school starts later and ends later, you're less time for sports. This relates to my second feeling about how adults are getting in the way of our children's sleep, which is putting them into many activities.

43:58And actually, I think that hits even as early as middle school. People are like, okay, my kid's got to go to like six hockey practices and, you know, Russian math school. And so then they're not going to get home till nine o 'clock at night. And then they still have to do their homework. Like, no, no, we need to actually treat sleep as a priority for our children and understand that means they may not be able to do some of those other things. And that's okay because sleep is important, not just like a nice to have. It's a nice to have. It's like a need to have, otherwise you die.

44:28Emily Oster:Oh my gosh. I want, there needs to be like a stop oversubscribing your kids movement because there's so much social pressure here. Like all the other parents signed their kids up for 30 things. And like, if I don't sign my kid up for 30 things, then I clearly am not, you know, they're like, how will they learn Mandarin? But I think we also have an opportunity with our older kids to enroll them a bit in the sort of need for sleep and in actually thinking this is important and helping understand, like helping them prioritize this too. Because of course, some of the things that get in the way of sleep are like, I'm texting my friends.

45:04Emily Oster:Sleep's clearly important. Let's get to brass tacks here. Like, how much am I supposed to be sleeping? Is the best thing for me to do to strap something on my wrist and trust what it tells me? Can I like, should I base this on how I feel? Is it just eight hours full stop? Like what's your thinking in terms of just the amount? Generally, my sense is that adults need about seven hours of sleep a night. If you are doing a high level of activity, you probably need more. There's a small share of the population that need less, but most people need about seven hours at night. Of course, there is variation in this.

45:44And I think the sort of standard diagnostic, actually not so different from a diagnostic with kids, is if you are sufficiently rested, you should not weekend oversleep. So you shouldn't be tired during the day. But then also, if given an opportunity, you should basically get up at about the same time. Like not exactly, you know, if you generally get up at six, like you. If you generally get up at six and like, you know, then on the weekend you get up at 630, like that's fine. But if like you're generally getting up at six and then you give yourself an opportunity and you sleep until noon, like you are not sufficiently rested.

46:17And I think that that can also work with kids. Like if you sort of see, you know, my kids sleeping till three o 'clock in the afternoon, that does suggest that they are not getting enough sleep in general. So looking for that kind of signal for people can help titrate a little bit. Like do I, does it kind of seem like I'm hitting about the right amount.

46:37Emily Oster:Fair enough. Plug for familial natural short sleep, a rare genetic mutation, which has people sleeping about five to six hours a night and being completely fine with it. You don't have this if you are listening to this podcast. That's just the chances are, but you might come across it because it's very cool. As we were doing this episode, I even looked into it in a little more detail and it is an evolutionary mystery. One of the things that we're talking about that the people who study this syndrome, it's not really a syndrome because it doesn't cause any problems, but one of the questions they continually ask is like, wait, why hasn't this spread through the population?

47:12Emily Oster:It's so clearly evolutionarily advantageous. So it may be that we're still missing something. We're not measuring something that is beneficial from sleep that even these miracle people who apparently don't need sleep might actually not be getting and it's hurting their reproductive chances in some way. Hear me out. Hear me out. It may be that from an evolutionary standpoint, being awake while it's dark is actually not that helpful because you can't really do that much. There's like no light. It's not like you're getting stuff done. And so there's not that much advantage. And more time in bed is more time for sex.

47:47And so then you like maybe by like being in bed for less time, you have less sex. Okay. Okay. Okay.

47:55Emily Oster:So this is the thing where it's like when you're married and one partner goes to bed earlier than the other and the other is like, no, no, no, I'm going to like stay downstairs and play this video game or finish watching this movie. Like that's not great for the old marital relations. Yeah. I'm sold. Sold. Okay. There you go. We solved that problem. Solved that controversy. Speaking of short sleep, I think it's worth talking a little bit. You know, if we sort of know how much sleep people should get. We know that one of the things gets in the way of people's sleep is just I don't have time to sleep.

48:29And I often tell people like, but it is important. Like even for adults, I think we can treat sleep like it's a spa day or something, but it's actually a biological necessity. So like one of the, you know, trying to figure out your life so you can get more sleep is good. But the thing that is really frustrating to people is when you try to go to sleep and you can't or when there's some sort of biological thing. So the two big things here. So one of them is insomnia, and the first one is sleep apnea. So there's a lot. So sleep apnea gets in the way of sleep for a large number of people in ways that they may actually be unaware of.

49:07So this is when we think this is going to affect the quality of your sleep less so than the sort of duration. It's like the realized duration.

49:14Emily Oster:Let me, I'm going to sidebar sleep apnea. So full disclosure, sleep apnea sufferer here. Really? I use a CPAP machine at night. And so a couple of things. So massively underdiagnosed. It is a huge problem. Some symptoms of sleep apnea, what you'll see on the sleep apnea scoring scales is how tired you are during the day. The classic symptoms of sleep apnea is like, oh, I'm falling asleep at my desk. I'm falling asleep at a traffic light in that kind of severe daytime sleepiness. There's a lot of other more subtle things, migraine headaches or recurrent headaches, hypertension, can even be caused by sleep apnea.

49:53Emily Oster:And there's a host of downstream cardiovascular problems. I was diagnosed, as many people were initially, by my wife who sleeps in bed with me and heard me snoring a lot and occasionally sort of stopping to breathe. If you do sleep in a bed with someone else, ask them about this. I think it's important to realize if you're just listening that's on the podcast, you can't see me, but there's a misapprehension, I think, that sleep apnea is exclusively reserved for people who might be overweight or obese. That is not true. There is increased risk in those populations, but it also has a lot to do with the structure of your soft palate and the way your nose and your mouth and your jaw is put together.

50:39Emily Oster:One of the first treatments I tried was actually this like mouth prosthesis that like juts your lower jaw forward, which actually works for my type of sleep apnea. But like I woke up in incredible jaw pain every morning, so that didn't seem good. And then I just like buckled in and got the little CPAP machine. And it's just like, it's a little thing that goes in, it like goes in my nose only. It's not like a full mask and it's super quiet and I don't snore anymore. And my wife is happier. we were like talking about, have you heard of sleep divorce? If you were going to have a sleep divorce. Sleep divorce is when spouses who still love each other very much sleep in separate rooms because of like sleep issues.

51:23Emily Oster:And oftentimes it's snoring. So, all right. That's probably enough on sleep apnea. But like do get yourself checked out if you think this could remotely be a possibility. The other thing is insomnia. So insomnia is pretty common. Of course, everyone experiences some kinds of insomnia, you know, like I had a stressful day, I can't turn my brain off, but kind of chronic insomnia, which typically means, you know, a consistent disruption of sleep, inability to get quality sleep over a period of at least three months for at least three nights a week, that's about 10 % of the population. And insomnia can be really debilitating.

52:01People get very, very tired. It's also very, very frustrating. and often people will respond by trying to like go to bed earlier, but then you're like laying in bed for more hours. And then, you know, at the end of it, you're tired, which is affecting your mental health. Like this is really bad, like all kinds of sleep problems. So there is one really, really good treatment for insomnia, which is cognitive behavioral therapy for insomnia, which is like a standard package of interventions that, you know, for a very large share of people who do them improve people's sleep. And it's kind of a set of things like don't actually lie in your bed when you are not able to fall asleep.

52:44So, and, you know, reframe some of your thoughts around not panicking. There's a bunch of pieces of this that are popular, but this is a very, very effective technique that not as many people know about as should.

52:59Emily Oster:Yeah, totally. And apologies as a doctor here who has given the wrong answer to this question more times than I can count. So we have, when people ask us about sleep problems, docs will go straight to sleep hygiene. And it's like, oh, okay, no screens before bed. Like, don't lie in your bed unless you're there to sleep or have sex and like sleep in a dark, quiet room and keep the temperature cool. cool. And it's like these parameters around sleep that are kind of easy to say and make sense, and they might offer some benefit. But actually looking into it, the randomized trial data about sleep hygiene exclusively for insomnia is pretty poor.

53:39Emily Oster:It doesn't really work. So it's like, oh, put that phone away. Like actually, it doesn't, it's not that - There's something wrong with putting your phone away, but it's not really going to work. It doesn't really work. Whereas this cognitive behavioral therapy, and there's interesting elements of it. One of the ones that I hadn't thought of because it's somewhat counterintuitive, but seems to work quite well. And by the way, this is delivered as a package. So don't, you know, look into this in a little bit more detail if you're suffering from insomnia. But one thing that came out was, you know, if you are normally falling asleep at midnight, instead of, as you say, like getting in bed at eight and lying there for four hours, not able to fall asleep, get in bed at midnight so that your body and your brain, more importantly is like, oh yeah, I get in bed and I fall asleep.

54:24Emily Oster:And then you can kind of move that time back. So there are solutions, but we should talk probably about, you said not enough people get access to cognitive behavioral therapy. And there are plenty of ways to access CBT. This is not just necessarily through a psychiatrist or a psychologist. There's even apps that provide some of this support and information. But most people who are suffering from insomnia are going to turn to other things like drugs, supplements, medications, et cetera. Emily, what's your thoughts on this area? So I think that there are two categories of how we think about substances and sleep.

55:06So there's one set of substances that are sort of category of substances that interfere with people's sleep, alcohol being probably the most commonly consumed. And for most people, alcohol, particularly close to bedtime, interferes with sleep. This is also true of benzos. So there's sort of that category of like, don't do that if you are struggling with sleep or at least recognize the impacts. And then there are these sort of sets of drugs that people take to improve their sleep, like melatonin or, you know, Ambien in more extreme cases. and those, you know, those can be effective. You know, melatonin is very effective for jet lag and in particular, you know, for most people, I think that they would like to not be dependent on medications for sleep ideally, which is where I think, you know, going into something that actually fixes some of the sleep architecture in the first place is a, you know, a sort of first best option.

56:08Doesn't mean there's not a place for some of these other, some of these other things in the short term.

56:13Emily Oster:Yeah, I think the dependency issue is a real one. Almost all of these substances, potentially with the exception of melatonin, do have some physiologic dependency. So Ambien and things like that, certainly Benadryl, the benzodiazepines, even alcohol, you become habituated to it. And once you stop, it's just harder to fall asleep. If you've been taking Ambien and you stop Ambien, it's harder to fall asleep for a few days when you're off of Ambien. It's not the end of the world. There's little with melatonin in the data, although probably melatonin, at least in adults for sleeping, is not as effective.

56:51Emily Oster:It does seem to be effective for jet lag to kind of reset that circadian clock, go back to the pineal gland there. Maybe not so great in adults, and maybe that's why we don't see too much rebound when you're off melatonin. People will have heard of kind of an alarming study suggesting that the chronic use of melatonin in adults increases the risk of heart failure. I don't buy this one. No, this is ridiculous. It's ridiculous because it is reverse causality. Okay. So let me explain what is happening there. Like people who have a lot of trouble sleeping are at risk for cardiovascular issues, you know, because there's other things that are driving that because potentially the lack of sleep puts you at risk for some of these issues because sleep is so important.

57:36And so what's going on here is that people are having a lot of trouble sleeping. To address their sleep issues, they take melatonin. And then there are negative cardiovascular issues, which have to do with the lack of sleep. So it's like the lack of sleep is causing you to take the melatonin and causing you to have heart issues. It is not that the melatonin is causing the heart issue. This is like a standard reverse causality, omitted variable bias, something else going on. It is not a causal relationship and should not be treated as such. Yeah.

58:09Emily Oster:Yeah. Don't freak out. But no, I love it. And I agree, you know, bottom line, sleep is a thing that happens in the brain to the extent that you can retrain your brain. That's probably the best way to get better sleep. Agreed. Last thing I want to say is, do you think there's a space for these sleep trackers? Do you think that they help people? I'm not sure we know. Like, this is really just a generic question. I don't think we know much from the data. It's hard to study that. It depends on the person. There's a condition called orthosomnia, I think is what they're calling it now, which are people who get anxious about their sleep score, right?

58:47Emily Oster:So they actually paradoxically have worse sleep because they're like, oh, shit, I've got to have my sleep latency below, like fall asleep, fall asleep, fall asleep. If you are that type of person who's trying to optimize, don't do it. Take it off. For many people, though, who aren't quite that obsessed with what the final score is, I think they can be useful in particular because some of those metrics, if you pay attention, really will show you how much alcohol in particular adversely affects sleep. I've had multiple patients who have used these things. I wasn't putting it together until my watch pointed out that my sleep score is 10 points lower and it's on nights that I drink, it's 10 points lower.

59:29Emily Oster:And on nights that I don't drink, it's 10 points higher. And something about that biofeedback can change the underlying behavior. So if you think that's for you, go ahead and do it. I wear mine at night, but I actually don't really know what – I don't pay attention to it. Yeah. I think this is an example where I would always ask people, like, you know, what are you going to do – like, what's the information that you want and what are you going to do with it, right? So if you're going to – like, if you're just going to, like, look at your sleep score and feel good or bad or whatever, like, that's not really very helpful.

59:56I just want to compete with others.

59:58Emily Oster:I want to – Yeah, if you want to win. My superiority. Yeah. So I will tell you that my husband has an aura ring and I have a whoop. And because he doesn't want to see his sleep score, I have the aura app on my phone. So every morning I can see both my score and his score. And that's marriage for you. But I think for some people, the kind of feedback of like a little bit of sort of data collection, largely around alcohol, there's a few other things that are kind of common to people. You can sort of see, okay, this is kind of affecting me in a way that maybe would cause me to want to change my behavior.

1:00:35Emily Oster:Sounds good. Perry, let's do the smash or pass. Smash or pass on sleep. I'm smashing it. I love it. Let's do more of it. Sleep is good. Emily, smash or pass? I'm smashing it, and I'm going to aim to get my Whoop recommended nine hours and 28 minutes of sleep tonight, and we'll see. I'm going to be in such good shape tomorrow. I'll see if I can email one of them about that algorithm. Yeah, tell them the algorithm. Maybe a little aggressive. All right. When we come back, we'll do your question of the week.

1:01:12Emily Oster:Zach, nice vacation spot, but without T-Mobile 5G home internet, I feel so cut off. It's scary. Relax. Just breathe in the woodsy woodsy-ness. Zach! Don't open it. It's a monster. I just know it. Buddy, it's just our DoorDash driver delivering our T-Mobile 5G home internet. Here you go, guys. Thanks. Look, Donald, now you can get the fastest 5G home internet with same-day delivery powered by DoorDash. And it's easy to set up. See? Nothing to be afraid of. We're saved! It's scary how easy it is. Get T-Mobile 5G home internet delivered the same day, powered by DoorDash. Just$35 a month with auto pay and a voice line.

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1:03:09Let's talk about modern home shopping. It's sort of become a fun side hobby, right? Scrolling listings at night, dreaming about kitchens you've never seen, or backyards you haven't even stepped foot in. All from the comfort of pretty much anywhere. Redfin knows a lot of people like you want to own, but are stuck in this browsing, mode loop. That's where Redfin flips the script. With listings that update within minutes and tours you can book right from the Redfin app, you can see your dream home the moment it appears. Now, liking a listing is easy, but actually landing it, that's where Redfin comes in.

1:03:45Redfin has over 2 ,200 agents with local expertise. And Redfin agents close twice as many deals as other agents. That means they want to help you win, not just window shop. Redfin is built to help you go from just looking to wait. This could actually be home. So become the newest neighbor on the block. Visit redfin.com to start finding and start owning. That's redfin.com. Hi, Emily and Perry. This is Lucy from Virginia. I'm curious about any possible benefits of eating your placenta. Is this something we should all be doing or is it just kind of gross? Thank you.

1:04:26Emily Oster:Okay. We've been asked. It was only a matter of time, Emily. Should we eat our placentas? No, you should not. So actually, some mammals do eat their placentas. And that's because there's not a lot of other food available. And if you have just, say, given birth out in some area where it's hard to access food, And again, you're not a person, you're a different kind of mammal. Like this may be a good source of, you know, some nutrients. But people, unfortunately, have access generally to other food. And you should not eat your placenta because it's a medical product. And there is no evidence that eating your placenta improves postpartum depression or does anything else positive for you.

1:05:21And again, it's a medical product. You shouldn't eat it fresh. You shouldn't eat it frozen. You shouldn't eat it put in pills. There's just like no reason to do anything with your placenta except say thank you very much for being an incredibly cool, interesting organ that allowed me to create a person. And in the words of Marie Kondo, you'll thank it for its service and just like let it go.

1:05:43Emily Oster:I love that. What about burying it in your yard under a tree or something? Look, I mean, I wouldn't do that personally, but I think if you want to do that, that's fine. It's not going to make the tree any nicer, but if you have a feeling like this is an important, I have a sentimental attachment to this and I would like to remember it, and you want to bury it in your backyard, like, yeah, sure. But I think you should be prepared. Like a coyote could dig that shit up and like then there'll be like placenta all over. So you want to bury it pretty deep. okay with that um image uh we can we can end um stick with us next week when we will ask what's the deal with full body scans wellness actually is produced in association with iheart media our senior producer is tamar avishai our executive producer at iheart is jennifer bassett Our theme music is by Eric Deutsch, and our content is for educational purposes only.

1:06:49Emily Oster:If you like the show, help other people find us. Leave a rating and review on Apple Podcasts or your podcatcher of choice. And help us spread the word about the show. You can follow us on Instagram at wellnessactuallypod. And don't forget, we want to hear from you. Head over to wellnessactually.fm and leave us a question for our mailbag or suggest a topic for a future show. We'll let the influencers have the last word. Kill them, sleeping beauty Sleep on

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