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

00:00:00.000 | - Welcome to the Huberman Lab Guest Series,

00:00:02.440 | where I and an expert guest discuss science

00:00:05.120 | and science-based tools for everyday life.

00:00:07.320 | I'm Andrew Huberman,

00:00:09.800 | and I'm a professor of neurobiology and ophthalmology

00:00:12.820 | at Stanford School of Medicine.

00:00:14.760 | Today marks the fifth episode

00:00:16.360 | in our six-episode series all about sleep

00:00:18.800 | with expert guest, Dr. Matthew Walker.

00:00:21.240 | Today's episode focuses on the inextricable link

00:00:24.080 | between sleep and our mental health.

00:00:26.280 | For instance, a specific stage of sleep

00:00:28.480 | called rapid eye movement, or REM sleep,

00:00:30.760 | is critical for removing the emotional content

00:00:33.480 | of our previous day's memories,

00:00:35.360 | and in doing so, provides a sort of therapy within sleep

00:00:38.500 | that allows us to feel emotionally restored

00:00:41.000 | when we wake the next morning.

00:00:42.640 | We discuss what happens when you are deprived of REM sleep

00:00:45.440 | to a small or greater degree,

00:00:47.560 | and we discuss how to improve the quality

00:00:49.400 | and quantity of your REM sleep

00:00:51.160 | in order to ensure mental health.

00:00:53.080 | We also discuss science-based protocols

00:00:55.120 | for reducing rumination and negative thoughts before sleep.

00:00:58.720 | The information shared by Dr. Walker in today's episode

00:01:01.720 | is sure to be critical for anyone

00:01:04.040 | that is either struggling with mental health issues

00:01:06.160 | or who simply wants to bolster their overall mental health.

00:01:09.440 | Before we begin, I'd like to emphasize that this podcast

00:01:12.080 | is separate from my teaching and research roles at Stanford.

00:01:14.760 | It is, however, part of my desire and effort

00:01:16.880 | to bring zero-cost to consumer information

00:01:18.840 | about science and science-related tools

00:01:20.840 | to the general public.

00:01:22.200 | In keeping with that theme,

00:01:23.440 | I'd like to thank the sponsors of today's podcast.

00:01:26.240 | Our first sponsor is Eight Sleep.

00:01:28.280 | Eight Sleep makes smart mattress covers

00:01:29.880 | with cooling, heating, and sleep tracking capacity.

00:01:32.340 | Many times on this podcast,

00:01:33.560 | we discuss how in order to fall and stay deeply asleep,

00:01:36.520 | your body temperature actually needs to drop

00:01:38.680 | by about one to three degrees.

00:01:40.440 | And in order to wake up feeling maximally refreshed

00:01:42.800 | and energized, your body temperature needs to heat up

00:01:45.560 | by about one to three degrees.

00:01:47.280 | Eight Sleep makes it very easy to control the temperature

00:01:49.560 | of your sleeping environment

00:01:50.680 | so that it's easy to fall and stay asleep

00:01:52.620 | and wake up feeling refreshed.

00:01:54.300 | I started sleeping on an Eight Sleep mattress cover

00:01:56.320 | several years ago,

00:01:57.300 | and it has completely and positively transformed my sleep.

00:02:00.580 | So much so that when I travel to hotels or Airbnbs,

00:02:03.360 | I really miss my Eight Sleep.

00:02:04.620 | I've even shipped my Eight Sleep out to hotels

00:02:06.700 | that I've been staying in

00:02:07.540 | because it improves my sleep that much.

00:02:09.480 | If you'd like to try Eight Sleep,

00:02:10.740 | you can go to eightsleep.com/huberman

00:02:13.760 | to save $150 off their Pod 3 cover.

00:02:16.640 | Eight Sleep currently ships to the USA, Canada, UK,

00:02:19.680 | select countries in the EU, and Australia.

00:02:22.100 | Again, that's eightsleep.com/huberman.

00:02:25.120 | Today's episode is also brought to us by Element.

00:02:27.800 | Element is an electrolyte drink

00:02:29.220 | that has everything you need and nothing you don't.

00:02:31.320 | That means plenty of the electrolytes,

00:02:32.840 | magnesium, potassium, and sodium, and no sugar.

00:02:35.780 | As I mentioned before on this podcast,

00:02:37.780 | I'm a big fan of salt.

00:02:39.120 | Now, I wanna be clear,

00:02:39.960 | people who already consume a lot of salt

00:02:42.240 | or who have high blood pressure

00:02:44.200 | or who happen to consume a lot of processed foods

00:02:46.520 | that typically contain salt

00:02:48.080 | need to control their salt intake.

00:02:49.680 | However, if you're somebody who eats pretty clean

00:02:51.520 | and you're somebody who exercises

00:02:52.960 | and you're drinking a lot of water,

00:02:54.520 | there's a decent chance that you could benefit

00:02:56.420 | from ingesting more electrolytes with your liquids.

00:02:59.040 | The reason for that is that all the cells in our body,

00:03:01.280 | including the nerve cells, the neurons,

00:03:03.040 | require the electrolytes in order to function properly.

00:03:05.920 | So we don't just wanna be hydrated,

00:03:07.300 | we want to be hydrated with proper electrolyte levels.

00:03:10.200 | With Element, that's very easy to do.

00:03:12.160 | What I do is when I wake up in the morning,

00:03:13.640 | I consume about 16 to 32 ounces of water,

00:03:16.040 | and I'll dissolve a packet of Element in that water.

00:03:18.880 | I'll also do the same when I exercise,

00:03:20.920 | especially if it's on a hot day and I'm sweating a lot.

00:03:23.320 | And sometimes I'll even have a third Element packet

00:03:25.600 | dissolved in water if I'm exercising really hard

00:03:28.260 | or sweating a lot, or if I just noticed

00:03:30.240 | that I'm not consuming enough salt with my food.

00:03:32.400 | If you'd like to try Element,

00:03:33.620 | you can go to drinkelement, spelled lmnt.com/huberman

00:03:38.040 | to claim a free Element sample pack with your purchase.

00:03:40.240 | Again, that's drinkelement, lmnt.com/huberman.

00:03:44.200 | Today's episode is also brought to us by BetterHelp.

00:03:47.320 | BetterHelp offers professional therapy

00:03:48.960 | with a licensed therapist carried out entirely online.

00:03:52.200 | I've been doing therapy for over 30 years.

00:03:54.300 | Initially, it was a requirement

00:03:55.640 | for being let back in school,

00:03:57.160 | but I decided to keep up with that therapy

00:03:59.240 | because provided the therapy has three essential components,

00:04:01.840 | which are excellent rapport with the therapist,

00:04:04.120 | support from the therapist,

00:04:05.720 | and valuable insights from the therapist

00:04:07.900 | that we wouldn't otherwise be able to arrive at,

00:04:10.600 | well, then it's a terrific way

00:04:12.160 | to improve our mental landscape,

00:04:13.840 | both our emotional state and our behaviors.

00:04:16.080 | BetterHelp allows you to find a therapist

00:04:17.720 | with whom you have those three key components,

00:04:19.740 | and it also makes it very easy to schedule.

00:04:22.000 | Again, the sessions are carried out entirely online,

00:04:24.760 | and even if you're extremely busy or traveling a lot

00:04:27.200 | or have a lot of family and business obligations,

00:04:29.560 | BetterHelp allows you

00:04:30.400 | to access those therapy sessions regularly

00:04:32.560 | so that you can constantly improve.

00:04:34.280 | There's just oh so much data supporting

00:04:36.140 | that quality therapy can improve our mental health

00:04:38.620 | and the overall landscape of our lives.

00:04:40.800 | In fact, I view quality therapy

00:04:42.280 | as important as physical exercise,

00:04:44.440 | and I know many others do as well.

00:04:46.000 | There certainly aren't a replacement for one another,

00:04:48.120 | but if you're doing physical exercise,

00:04:49.600 | meaning resistance training and cardiovascular training,

00:04:52.120 | and you're doing regular quality therapy

00:04:54.040 | of the sort that BetterHelp can provide,

00:04:56.000 | well, then you're essentially doing

00:04:57.200 | as much as anyone possibly can

00:04:59.120 | to improve your mental health and physical health.

00:05:01.400 | If you'd like to try BetterHelp,

00:05:02.800 | go to betterhelp.com/huberman

00:05:05.500 | to get 10% off your first month.

00:05:07.300 | Again, that's betterhelp.com/huberman.

00:05:10.820 | And now for my conversation with Dr. Matthew Walker.

00:05:14.120 | Dr. Matthew Walker, welcome back.

00:05:16.600 | - Dr. Andrew Huberman, delight to be back.

00:05:19.520 | - During the course of this series,

00:05:22.400 | we've of course been talking about sleep,

00:05:24.560 | and you've talked about the biology of sleep,

00:05:26.860 | ways to improve, maybe even optimize one's sleep.

00:05:30.320 | You defined what optimizing one's sleep actually is.

00:05:33.060 | Talked about learning and memory, creativity,

00:05:36.620 | caffeine, naps, food, exercise, and so much more.

00:05:41.840 | Today, I'm excited that you're going to teach us

00:05:45.160 | about the relationship between sleep and emotion regulation,

00:05:50.160 | but also mental health, mental health challenges.

00:05:53.200 | But I sometimes like to remind people

00:05:55.520 | that mental health includes the word health.

00:05:58.600 | It's not all about mental illness.

00:06:00.240 | It's also about how to improve one's health,

00:06:02.440 | as well as ways to combat certain forms

00:06:04.840 | of mental illness or challenges.

00:06:07.400 | So to start things off,

00:06:09.560 | maybe you could just give us the basics

00:06:11.040 | of the relationship between sleep and emotional states,

00:06:14.440 | or one's ability to regulate their own emotions.

00:06:17.900 | - This is an area of work that we've been interested in

00:06:21.440 | and doing a lot of research on for about 20 or so years now.

00:06:26.440 | And I would say that probably the most striking statement

00:06:32.280 | I can offer up front is the following.

00:06:34.600 | In that 20 years of research,

00:06:37.300 | we have not been able to discover

00:06:39.320 | a single psychiatric condition in which sleep is normal.

00:06:43.460 | And to me, it has taught me everything that I need to know

00:06:48.520 | about this very intimate bi-directional relationship

00:06:51.640 | between your sleep health and your mental health.

00:06:54.920 | And you're right to emphasize that notion of mental health,

00:06:58.320 | because we're not just going to speak

00:07:00.480 | about some of the sort of challenging aspects

00:07:03.980 | of sleep and psychiatric disorders,

00:07:06.280 | but we'll speak about some of the benefits

00:07:08.300 | that sleep can provide when you get it to turn the tables.

00:07:12.080 | And we move in the direction, not of mental illness,

00:07:15.680 | but we move in the direction of mental wellness.

00:07:18.600 | So I'm excited to sort of make sure

00:07:20.420 | that I don't fall prey to that.

00:07:22.640 | Stepping back still though,

00:07:25.980 | what about this relationship between just sleep

00:07:28.400 | and our basic emotional regulation

00:07:31.160 | and our emotional stability?

00:07:33.500 | I'm sure everyone has seen the example

00:07:35.880 | or had the example as a parent,

00:07:38.200 | of that parent holding a child and the child is crying

00:07:42.040 | and they look at you and they say,

00:07:43.680 | "Well, they just didn't sleep well last night."

00:07:46.340 | As if there's some miraculous parental knowledge

00:07:49.320 | that bad sleep the night before equals bad mood

00:07:53.060 | and emotional reactivity and regulation the next day.

00:07:56.960 | And some years ago now, we were fascinated by this,

00:08:01.060 | but we couldn't really unearth basic science

00:08:04.340 | that would help us explain what was going on

00:08:07.100 | and why that was so clearly the case.

00:08:10.540 | So we did an initial study

00:08:11.900 | where we took a group of healthy people,

00:08:14.100 | no signs of psychiatric illness or emotional instability,

00:08:18.300 | and we gave them a full night of sleep

00:08:20.320 | or we sleep deprived them.

00:08:22.060 | And then the next day we put them inside of a brain scanner

00:08:24.820 | and we showed them a whole range

00:08:26.860 | of emotional visual images ranging from very neutral

00:08:31.420 | all the way up to quite unpleasant and negative.

00:08:35.420 | And we were looking at how the brain was reacting

00:08:38.300 | to those emotional experiences with versus without sleep.

00:08:42.700 | And the structure that we'd initially focused on

00:08:46.260 | was a structure that you've spoken about before

00:08:48.260 | called the amygdala.

00:08:49.740 | And you actually have one on the left

00:08:51.100 | and the right side of your brain.

00:08:52.980 | And the amygdala is the centerpiece region

00:08:55.500 | for the generation of emotional reactions,

00:08:58.500 | both positive and negative.

00:09:00.100 | But here we're focusing on that aversive,

00:09:02.460 | that negative aspect.

00:09:04.340 | And when we looked at that structure

00:09:06.460 | in people who are sleep deprived,

00:09:08.580 | what we saw relative to the people

00:09:10.340 | who'd had a full night of sleep was a 60% sick zero,

00:09:14.980 | 60% increase in amygdala responsivity

00:09:19.980 | under conditions of sleep deprivation.

00:09:23.540 | That is quite a striking amplification.

00:09:25.940 | In fact, we to that date with all of our studies

00:09:28.860 | on sleep and sleep loss had not quite seen an effect size

00:09:32.820 | within the brain that was that big.

00:09:35.580 | - Sorry to interrupt, but just to make sure

00:09:37.100 | that everyone's on the same page.

00:09:38.180 | So people are being shown images

00:09:39.900 | with varying degrees of emotionality,

00:09:41.740 | including images that are known to evoke negative,

00:09:46.740 | averse emotions as we call them in the laboratory.

00:09:49.060 | - That's correct.

00:09:50.740 | - Could be feelings of fear, anger, disgust,

00:09:53.520 | revulsion, whatever, negative valence.

00:09:57.400 | Was it the case that sleep deprivation increased

00:10:00.240 | the activity in the amygdala to such images by 60%

00:10:04.840 | only for the aversive images or for,

00:10:08.000 | let's say a neutral image presented to somebody

00:10:10.960 | who has had plenty of quality sleep.

00:10:13.580 | Let's say it is, I'm making up the units here.

00:10:17.040 | It gives us two out of 10 units of amygdala activation.

00:10:19.520 | This isn't the way neuroscience is done,

00:10:20.720 | but for sake of discussion.

00:10:22.680 | Is it the case then that that neutral image

00:10:25.120 | would provide a six out of 10 level of activation

00:10:29.880 | or was it only for aversive images?

00:10:32.560 | - So the way we did the analysis first

00:10:34.320 | was we used almost a correlation approach.

00:10:37.520 | So we sort of told the brain imaging analysis to say,

00:10:42.320 | look, here are the ratings of these pictures.

00:10:45.680 | And they go from very neutral

00:10:47.080 | to increasingly negative and aversive.

00:10:50.560 | And show me what in the brain is reacting to that curve,

00:10:54.560 | that gradient curve.

00:10:56.400 | And sure enough, you've got the magnitude overall was 60%,

00:10:59.880 | but it's a very interesting point that you make

00:11:02.280 | because where the amygdala started to respond

00:11:05.880 | and that responsivity started to hook up

00:11:09.880 | in the activation and the sort of aggravation direction

00:11:14.080 | was much earlier in the curve of emotionality.

00:11:17.880 | In other words, things that previously

00:11:20.040 | when you've had a good night of sleep

00:11:22.080 | do not feel particularly emotional

00:11:24.640 | started to become rather emotional

00:11:27.360 | when you were not getting sufficient sleep.

00:11:29.920 | So it heightened the sensitivity

00:11:32.080 | of the initial triggering of the emotional response.

00:11:35.160 | And then the more emotional it became,

00:11:37.480 | the more separate those two sort of reactivity curves became

00:11:42.480 | from the amygdala when you had sleep

00:11:45.760 | versus when you had not sleep or had not slept, I should say.

00:11:51.440 | To us then the question became, well, why?

00:11:54.880 | Why is the amygdala so reactive and uncontrolled

00:11:59.880 | when you are absent sleep?

00:12:03.200 | And we did another analysis.

00:12:05.040 | And what we found was that there was a structure

00:12:07.440 | in your frontal lobe and the frontal lobe

00:12:10.240 | just sits directly sort of if you think about your eyes

00:12:13.400 | and you go directly up, you're in your frontal lobe.

00:12:16.240 | And it was a particular part of the frontal lobe,

00:12:18.400 | the middle part that sits right between your eyes

00:12:21.360 | something that we call the medial prefrontal cortex.

00:12:25.160 | And what we found was that with a night of sleep

00:12:28.680 | the medial prefrontal cortex

00:12:31.080 | was strongly connected to the amygdala.

00:12:33.800 | Why is that important?

00:12:35.480 | It's because that part of your frontal lobe

00:12:38.840 | is very good at acting like a control rational mechanism

00:12:43.840 | on your deep sort of, it's not Neanderthal

00:12:48.400 | but your deep emotional brain centers.

00:12:51.920 | But without sleep,

00:12:53.040 | we found that that connection had been severed.

00:12:56.560 | And so it was almost as though without sleep

00:12:58.480 | you become all emotional gas pedal

00:13:01.200 | and too little regulatory control break.

00:13:04.920 | And so you couldn't modulate those emotions

00:13:08.080 | anywhere near as effectively.

00:13:09.760 | Now, some people may say, well, hang on a second,

00:13:12.880 | you that was a total night of sleep deprivation.

00:13:15.200 | And that's not really relevant for me

00:13:16.960 | because I don't sleep enough.

00:13:20.040 | I know that from all of the previous episodes

00:13:22.400 | that I've gone through here,

00:13:24.080 | hopefully if you've listened to them,

00:13:26.440 | but I'm usually maybe getting five or six hours of sleep.

00:13:30.160 | Is this really relevant?

00:13:31.280 | So we started doing that study.

00:13:32.920 | We wanted to say, let's do what we call an ecological study

00:13:36.160 | and more of a real world sleep restriction

00:13:38.480 | rather than total deprivation.

00:13:40.160 | And we were about halfway through that study

00:13:43.320 | when a wonderful Japanese research group

00:13:46.040 | essentially published the study that we were doing.

00:13:49.120 | And what was great is that they did it

00:13:51.480 | even in a more rigorous way.

00:13:53.320 | And essentially what they were able to do

00:13:55.400 | is replicate exactly what we'd found,

00:13:58.520 | but now by putting people on sort of less than six hours

00:14:02.480 | of sleep for five nights,

00:14:04.640 | and sure enough, you got the same response.

00:14:07.400 | So that was very clear to us

00:14:11.680 | that there was some sensitivity.

00:14:13.440 | There's a reason why you become so unbuckled emotionally

00:14:18.440 | when you are not getting sufficient sleep.

00:14:21.040 | It's the reason that you have almost this

00:14:23.520 | sort of erratic pendulum-like sort of responsivity

00:14:28.280 | when you're not getting sufficient sleep,

00:14:29.680 | that notion of I just snap, dot, dot, dot,

00:14:32.920 | or you apologize and you say, look, I am so sorry.

00:14:35.640 | I just bit your head off.

00:14:37.240 | I just haven't been getting enough sleep.

00:14:39.600 | And so we could start to understand

00:14:41.200 | what in the brain was happening

00:14:42.400 | when you didn't get sleep.

00:14:44.800 | - It's such an important finding

00:14:46.960 | for a couple of reasons that maybe we can explore.

00:14:49.740 | Previously on the podcast,

00:14:52.240 | we had a guest doctor.

00:14:55.240 | He's a neurosurgeon, Matt McDougall.

00:14:57.200 | He's the lead neurosurgeon at Neuralink.

00:15:01.080 | He came up through Stanford,

00:15:02.080 | works on deep brain stimulation, et cetera.

00:15:04.560 | And I love his description

00:15:05.680 | of what the prefrontal cortex does.

00:15:07.880 | It jibes perfectly with the way you describe it,

00:15:10.640 | which is, he said,

00:15:11.480 | "The function of the prefrontal cortex

00:15:13.560 | is to say shh

00:15:16.720 | to specific brain areas under specific contexts."

00:15:21.360 | So the shh, of course,

00:15:24.200 | is his way of describing neural inhibition,

00:15:27.200 | so quieting of neural activity

00:15:29.340 | in certain brain circuits under certain conditions,

00:15:31.480 | because there are conditions

00:15:32.300 | under which you want your amygdala activation

00:15:34.080 | to be very robust, fast,

00:15:36.640 | and there's time for protecting oneself,

00:15:40.280 | maybe even certain situations for swift, violent action

00:15:43.640 | to protect your family, et cetera.

00:15:45.640 | But the prefrontal cortex

00:15:47.200 | seems to be able to hold it in mind, so to speak,

00:15:50.280 | what the context is

00:15:51.520 | under which that would be appropriate

00:15:53.280 | versus when it would be inappropriate.

00:15:54.520 | - And a great example of that people can think of,

00:15:56.360 | if all of a sudden a gun is pointed in your face,

00:15:59.680 | you would want your amygdala to react

00:16:04.200 | if it's in the real world.

00:16:07.300 | But if you're at the movie theaters

00:16:09.240 | and you see a gun pointed in your face,

00:16:11.680 | your amygdala doesn't really react as much.

00:16:14.080 | Why?

00:16:14.920 | Because your prefrontal cortex

00:16:15.880 | understood the word that you described, which is context.

00:16:20.320 | But in some ways,

00:16:21.600 | it seems as though you become almost regressed

00:16:25.720 | to this more basic, fundamental,

00:16:29.440 | elemental, emotional brain,

00:16:33.040 | and the red mist descends

00:16:35.200 | and you really can't see much more

00:16:36.960 | because your prefrontal cortex seems to be absent.

00:16:40.320 | - You become very reflex-driven.

00:16:42.040 | And we don't wanna go too far a tangent

00:16:46.400 | of on prefrontal cortex,

00:16:47.960 | but one of the most beautiful descriptions

00:16:49.520 | of prefrontal cortex I ever heard

00:16:51.680 | was also from a colleague, Eric Knudsen at Stanford,

00:16:55.280 | who's now retired,

00:16:56.320 | does beautiful work on neuroplasticity.

00:16:58.620 | And he described how when people or animals

00:17:01.120 | have lesions to certain regions of the prefrontal cortex,

00:17:04.120 | they become stimulus-driven machines

00:17:06.280 | such that if you go like this to a puppy or to a baby,

00:17:10.480 | they'll look to the snapping finger.

00:17:11.760 | But at some point, we all learn

00:17:14.120 | that there must be a reason for us to follow

00:17:17.000 | the snapping of the fingers in different locations in space.

00:17:19.360 | But with prefrontal damage,

00:17:21.480 | people and animals just become like machines.

00:17:23.460 | Whatever stimulus is there, they orient to.

00:17:25.640 | And this has implications for ADHD, et cetera.

00:17:28.040 | One of the things that I wanted to ask about

00:17:30.240 | to take us back to the specific relationship

00:17:32.360 | between sleep, reduced medial prefrontal activity,

00:17:35.800 | and emotionality is this feeling

00:17:40.240 | when we're sleep-deprived

00:17:41.300 | that certain things just grate on us a bit more.

00:17:45.040 | You know, I had this experience recently.

00:17:46.360 | Unfortunately, there was a night

00:17:47.300 | where I didn't get much sleep at all.

00:17:49.080 | And then the next day I was on a phone call

00:17:50.480 | and the person I was talking to, I'm quite fond of,

00:17:52.920 | but they had a lot of energy and they were talking.

00:17:54.960 | They were kind of coming at me

00:17:55.960 | with a bunch of stuff that they wanted to.

00:17:57.680 | And it just felt like, you know,

00:18:00.520 | it was grating on my system.

00:18:02.120 | And I knew because I was sleep-deprived that, you know,

00:18:04.280 | they were entirely well-meaning.

00:18:05.840 | And so you just kind of resist.

00:18:07.560 | But it's incredible how cold water, loud noises,

00:18:12.560 | requests of our time, things like that

00:18:14.720 | become very irritating and they grate on us

00:18:19.440 | when we're sleep-deprived.

00:18:20.440 | Whereas when we're rested, it's like, oh yeah, okay.

00:18:22.920 | They're talking kind of fast or kind of loud.

00:18:25.840 | Okay, somebody is requesting something else.

00:18:27.400 | I'll put it in my list or maybe I'll defer to later.

00:18:29.660 | Or, you know, the cold shower that, you know,

00:18:32.920 | feels like, oh, got to get over this threshold to get into.

00:18:35.300 | Like when you're rested, you're like, all right,

00:18:36.600 | let's do this, right?

00:18:37.800 | You know, maybe even let's go.

00:18:39.600 | I'm excited for it.

00:18:40.800 | But when you're tired, ooh,

00:18:42.960 | it is as if the brain is fighting

00:18:47.180 | for any sense of peace it can possibly get.

00:18:49.880 | And that peace is interrupted

00:18:51.580 | by almost anything and everything.

00:18:53.840 | - It is a grim situation.

00:18:55.440 | And we've certainly heard that from, you know,

00:18:59.600 | patients and individuals.

00:19:01.580 | It's almost as though the world that they are experiencing,

00:19:06.580 | they look at and they say, you know what?

00:19:08.760 | You're in an 11 and I need you at a seven right now.

00:19:11.760 | It is just too much.

00:19:14.960 | And this comes back to that result that we described

00:19:17.320 | that when the amygdala crosses the threshold and says,

00:19:21.960 | okay, things are getting emotional,

00:19:23.840 | things are getting unpleasant.

00:19:25.480 | I'm gonna be responding negatively in an angry way

00:19:29.360 | or a fearful way.

00:19:30.800 | That starts much earlier.

00:19:32.780 | So the threshold for triggering

00:19:35.260 | your emotional aversive reaction is much lower.

00:19:40.260 | And that's why the person's voice, when you hear it,

00:19:43.540 | first, normally, if you had a great night of sleep,

00:19:45.720 | you'd say, gosh, you know what?

00:19:47.020 | Today, I really love your energy.

00:19:48.900 | It's really, it's so infectious.

00:19:52.020 | Versus a day when you're not sleeping,

00:19:53.940 | you just think, I just,

00:19:56.060 | I'm lifting my earbuds out of my ears

00:19:58.620 | 'cause I don't know if I can take this much longer.

00:20:01.200 | And so that was where we were able to manipulate sleep

00:20:06.160 | one way, which is to say, I dial sleep down.

00:20:09.440 | And then I look at the emotional brain

00:20:11.120 | and you can see this ramping up of the emotional reactivity

00:20:15.160 | in these basic kind of guttural centers.

00:20:18.160 | But then we wanted to do the inverse.

00:20:20.560 | We wanted to instead see if we could insert sleep back in,

00:20:24.440 | in other words, manipulate sleep and dial it back up.

00:20:27.440 | Could you get a dissipation in the emotional reaction?

00:20:31.040 | And here we decided to throw a second ingredient

00:20:35.560 | into the equation,

00:20:36.800 | not just simply looking at your emotional reactivity,

00:20:40.200 | but we wanted to look at emotional memory.

00:20:43.760 | Now, in a previous episode,

00:20:45.560 | we've spoken a lot about sleep and memory,

00:20:48.040 | but there we were speaking about

00:20:50.360 | really quite neutral memory,

00:20:52.520 | textbook-like memory, fact-based memory.

00:20:55.120 | Emotional memory is very different.

00:20:57.520 | And if I were to ask you, Andrew,

00:20:59.640 | cast your mind back to some of your earliest

00:21:02.000 | childhood memories or your team memories,

00:21:04.100 | and if anyone listening were to do that,

00:21:06.580 | my guess is that almost all of the memories that you recall

00:21:09.960 | are memories of an emotional nature, positive or negative.

00:21:14.960 | Why is that?

00:21:16.920 | It's because one of the functions of emotions

00:21:19.920 | when it comes to memory is to red flag

00:21:23.160 | and prioritize that experience,

00:21:25.200 | that memory as being salient because it's emotional.

00:21:29.800 | And that instructs the brain that this information

00:21:32.800 | in particular is very relevant to us as an organism.

00:21:37.480 | Why?

00:21:38.440 | Because the rest of the brain is shouting at me,

00:21:41.240 | this is emotional.

00:21:42.760 | So there is something very privileged

00:21:44.880 | and very special about an emotional memory,

00:21:47.900 | like a red flag that tags it for priority in the brain.

00:21:52.480 | But something I started to notice when I would read

00:21:55.600 | the data, both the neural data and the subjective data

00:21:58.720 | on emotional memory, led me to get very interested

00:22:02.880 | in what happens with emotional memories over time.

00:22:06.920 | Because what you will hear is that if I were to ask you,

00:22:10.520 | you know, recall an emotional memory,

00:22:12.640 | just try to remember it.

00:22:14.640 | My guess is that now at the time of recollection,

00:22:18.440 | much later on, you are not having the same regurgitation

00:22:23.440 | of the same visceral emotional reaction

00:22:26.600 | that you had at the time of the experience.

00:22:29.520 | What that sort of turned a light bulb moment on for me

00:22:34.240 | was that somewhere between the initial experience

00:22:37.160 | and the later recollection of that emotional memory,

00:22:41.400 | the brain has done a very clever trick.

00:22:44.600 | It has divorced the emotion from the memory.

00:22:49.040 | So now when you come to recollect that emotional memory,

00:22:53.320 | let's say days later, or even months later,

00:22:56.640 | in some ways it is a memory of an emotional event,

00:23:01.200 | but it is no longer as powerfully emotional itself

00:23:05.560 | as it was at the time of the experience.

00:23:07.800 | - Right.

00:23:09.120 | - And I started to wonder, is that time,

00:23:12.440 | or is that time asleep?

00:23:13.600 | So we did a study and we had people experience

00:23:17.680 | these emotional memories,

00:23:19.600 | sort of essentially make emotional memories,

00:23:22.120 | and they were doing it inside of a scanner.

00:23:24.600 | And then we gave them a night of sleep or even a nap,

00:23:29.600 | and then we brought them back,

00:23:31.080 | or we just had them learn those emotional memories

00:23:34.200 | in the morning and then bring them back

00:23:36.200 | after an identical amount of time

00:23:39.280 | to try to soften those emotional memories,

00:23:42.240 | but without sleep.

00:23:43.680 | And we put them back in the scanner,

00:23:45.720 | and we were able to look to see when you come back later

00:23:49.480 | in that second session, is your emotional,

00:23:52.400 | and you recollect those experiences and you relive them,

00:23:55.280 | is the emotional reactivity at that second session

00:23:58.720 | any different to the first session?

00:24:01.200 | And is that different if that time elapse

00:24:05.000 | has contained a full night of sleep

00:24:06.760 | versus you've just been awake?

00:24:08.920 | And what we found is that in those people

00:24:10.400 | who remained awake across the day,

00:24:12.320 | having had those emotional memories,

00:24:14.640 | essentially implanted, implanted sounds a little bit

00:24:17.320 | sort of big brother, I don't mean it that way,

00:24:19.000 | but they'd learned them.

00:24:20.800 | The amygdala was just still as responsive

00:24:23.520 | as they were recalling and reliving

00:24:25.440 | and re-experiencing those emotional memories.

00:24:27.960 | But in those people who had the same amount of time

00:24:30.720 | to process the memories,

00:24:32.320 | but had had a full night of sleep,

00:24:34.800 | we saw this incredible emotional amygdala depotentiation

00:24:40.720 | and what that taught me was that the sleeping brain

00:24:45.160 | was able to almost detox the emotional memory.

00:24:49.840 | It is, think about it like an informational orange,

00:24:53.840 | that the emotional memory has this bitter emotional rind

00:24:57.840 | around it and then you've got the informational orange

00:25:00.680 | in the middle.

00:25:01.640 | And what sleep was doing was stripping

00:25:04.040 | the bitter emotional rind off the informational orange

00:25:08.440 | so that then when you came back the next day,

00:25:11.200 | again, it is now a memory of an emotional event,

00:25:15.960 | but it's no longer triggering that strong visceral reaction.

00:25:20.480 | In other words, and we described this theory

00:25:23.840 | as something called overnight forgetting,

00:25:27.360 | which is that when it comes to an emotional memory,

00:25:31.600 | you both sleep to forget

00:25:34.200 | and sleep to remember respectively,

00:25:37.760 | which is that you sleep to remember the information,

00:25:40.920 | the memory of the experience,

00:25:43.800 | but it is no longer emotional itself.

00:25:47.160 | And from there, we built a biological model

00:25:51.520 | of exactly how this works.

00:25:53.360 | Because when we looked at the sleep group

00:25:55.360 | who'd had that full eight hour opportunity,

00:25:58.200 | we asked the question because we'd measured their sleep,

00:26:01.160 | what is it about that sleep

00:26:02.800 | that seems to provide this form of,

00:26:05.280 | it's almost overnight therapy.

00:26:07.480 | How is it doing that?

00:26:09.560 | What stage of sleep is doing that?

00:26:12.040 | And sure enough, what we found was that it was REM sleep,

00:26:15.480 | rapid eye movement sleep associated with dreaming.

00:26:18.800 | And the greater the amount of REM sleep,

00:26:21.400 | the greater the amount of emotional depotentiation,

00:26:25.880 | the greater the amount of sort of emotional detox

00:26:29.080 | that you got the next day.

00:26:31.760 | And one of the fascinating things

00:26:33.840 | that we didn't quite mention in the episode

00:26:38.200 | where we described what is sleep

00:26:40.320 | and we described the different stages,

00:26:41.760 | including REM and we spoke about the brain changes.

00:26:44.360 | Something utterly unique happens during REM sleep.

00:26:49.360 | Levels of a brain chemical called noradrenaline

00:26:53.480 | are completely shut off.

00:26:55.240 | It is the only time during the 24 hour period

00:26:58.200 | when you see the complete cessation

00:27:01.280 | of noradrenaline in the brain.

00:27:03.760 | And of course, noradrenaline is associated

00:27:05.880 | with many different functions

00:27:07.440 | and you've elegantly described them.

00:27:09.680 | One of the functions is that it's associated

00:27:12.160 | with emotional responsivity and the focus

00:27:15.800 | and that sort of strong sort of emotional energy.

00:27:19.320 | And people will know we speak about,

00:27:22.080 | it has two names, noradrenaline or norepinephrine,

00:27:24.880 | same thing, US, UK.

00:27:26.640 | But people of course are familiar

00:27:28.160 | with the sister chemical in the body called adrenaline.

00:27:31.640 | Upstairs in the brain, we can think about noradrenaline

00:27:34.840 | and during REM sleep, noradrenaline is completely shut off.

00:27:38.160 | This stress associated neurochemical,

00:27:41.160 | it's not only associated with stress,

00:27:42.920 | but it's associated with lots of things,

00:27:44.840 | but stress included.

00:27:46.000 | - Is noradrenaline shut off in the brain and body

00:27:48.840 | during rapid eye movement sleep?

00:27:51.280 | - No, it's not.

00:27:52.440 | It seems to be specifically within the brain

00:27:55.160 | that there is this blockade of noradrenaline

00:27:57.560 | and serotonin goes down too.

00:27:59.600 | Whereas another chemical called acetylcholine,

00:28:03.200 | which is another neurotransmitter,

00:28:05.080 | that ramps up in the brain.

00:28:07.080 | So if there is a brain chemical

00:28:08.880 | that seems to be underlying REM sleep or dream sleep,

00:28:11.880 | it seems to be acetylcholine.

00:28:13.240 | And in fact, in some parts of the brain,

00:28:15.480 | you can see almost a 30% greater amount of acetylcholine

00:28:19.480 | in some brain regions than when we're awake.

00:28:22.480 | Yet, on the other hand,

00:28:24.280 | when we think about noradrenaline and serotonin,

00:28:26.480 | they are both shut off.

00:28:28.440 | So the stress related chemical within the brain

00:28:31.720 | is switched off during REM sleep.

00:28:34.280 | However, if you look at other parts of the brain,

00:28:36.960 | the memory related centers of the brain,

00:28:39.320 | such as the hippocampus that we've spoken about before,

00:28:41.840 | and the amygdala that I just mentioned too,

00:28:44.520 | those are very active during REM sleep.

00:28:47.480 | So we laid out this biological model

00:28:49.840 | that is almost beautiful.

00:28:51.600 | That REM sleep is this perfect condition

00:28:54.680 | for emotional overnight therapy,

00:28:57.200 | where you can reactivate and sort of experience

00:29:00.600 | and reprocess those emotional memories,

00:29:03.760 | but you're doing it in a neurochemically,

00:29:05.960 | quote unquote, safe environment

00:29:08.840 | that allows you to strip away the emotion from the memory.

00:29:13.840 | - I'd like to take a brief break

00:29:15.120 | and acknowledge our sponsor, AG1.

00:29:17.480 | AG1 is a vitamin mineral probiotic drink

00:29:20.000 | that also contains adaptogens

00:29:21.640 | and is designed to meet

00:29:23.080 | all of your foundational nutritional needs.

00:29:25.280 | By now, I'm sure you've all heard me say

00:29:27.400 | that I've been taking AG1 since 2012,

00:29:29.640 | and indeed that is true.

00:29:31.440 | Now, of course, I do consume regular whole foods every day.

00:29:34.720 | I strive to get those foods mostly from unprocessed

00:29:37.560 | or minimally processed sources.

00:29:39.440 | However, I do find it hard to get enough servings

00:29:41.960 | of fruits and vegetables each day.

00:29:43.640 | So with AG1, I ensure that I get enough

00:29:46.000 | of the vitamins, minerals, prebiotic fiber,

00:29:48.360 | and other things typically found in fruits or vegetables,

00:29:50.720 | and of course, I still make sure

00:29:52.080 | to eat fruits and vegetables,

00:29:53.440 | and in that way provide a sort of insurance

00:29:55.600 | that I'm getting enough of what I need.

00:29:57.240 | In addition, the adaptogens and other micronutrients in AG1

00:30:00.720 | really help buffer against stress

00:30:02.240 | and ensure that the cells and organs and tissues of my body

00:30:05.160 | are getting the things they need.

00:30:06.800 | People often ask me that if they were gonna take

00:30:08.520 | just one supplement, what that supplement should be,

00:30:10.800 | and I always answer AG1.

00:30:12.920 | If you'd like to try AG1,

00:30:14.480 | you can go to drinkag1.com/huberman

00:30:17.440 | to claim a special offer.

00:30:18.840 | You'll get five free travel packs

00:30:20.520 | plus a year's supply of vitamin D3K2.

00:30:23.080 | Again, that's drinkag1.com/huberman.

00:30:27.080 | In some ways, it does resemble

00:30:29.760 | behavioral desensitization therapy,

00:30:32.360 | whereby under the care of a qualified psychiatrist

00:30:37.280 | or psychologist, somebody will be encouraged to recall

00:30:41.320 | in a great degree of detail some very difficult,

00:30:45.040 | maybe even traumatic event, and through repetition,

00:30:50.040 | and of course, through the knowledge

00:30:52.720 | that there's support in the immediate environment

00:30:54.800 | that will allow them to, you know,

00:30:58.520 | safely move through that experience.

00:31:00.440 | You know, should their heart rate go up,

00:31:02.260 | they're sweating profusely,

00:31:03.540 | having trouble getting the words out.

00:31:05.920 | You know, those are very, unfortunately,

00:31:07.640 | common features of trauma and negative memories.

00:31:11.240 | But the idea, as I understand,

00:31:13.000 | is to repeat the recall many times often

00:31:18.000 | in that safe environment,

00:31:20.480 | such that eventually what was initially

00:31:23.160 | a really terrible event remains a terrible event,

00:31:28.160 | but the emotional load of that event

00:31:31.660 | is removed from the person's sort of neural understanding

00:31:35.760 | of the event.

00:31:36.720 | The way I've heard it described is

00:31:38.360 | what starts as a tragic, traumatic story

00:31:41.440 | eventually becomes a kind of a sad, boring story,

00:31:46.440 | boring to the person who's saying it,

00:31:48.840 | meaning it doesn't evoke as much autonomic arousal.

00:31:52.360 | - Exactly, and in some ways,

00:31:53.680 | that's the perfect description

00:31:55.440 | of this overnight therapy process,

00:31:58.560 | that it becomes a memory that is no longer triggering

00:32:03.360 | an emotional reaction.

00:32:06.240 | And in some ways, that's what you want.

00:32:08.480 | If you go back to my description

00:32:10.360 | from an evolutionary perspective,

00:32:11.720 | I told you that one of the functions of emotions

00:32:14.200 | is to red flag and prioritize the memory

00:32:16.540 | at the time of learning to say that it's important.

00:32:19.240 | That's a very adaptive process.

00:32:21.200 | It helps us prioritize which things

00:32:23.400 | we really should be focusing on and remembering,

00:32:27.240 | but it's not adaptive for you to hold on

00:32:30.720 | to that emotion long-term once you've stored it.

00:32:34.480 | And there has been some suggestion in the literature

00:32:37.520 | before we were doing this work

00:32:39.080 | that maybe one thing you can do with trauma

00:32:42.400 | and trauma memories is sleep-deprived individuals

00:32:45.400 | the very first night after the trauma,

00:32:48.360 | because we knew at the time, sleep is important for memory.

00:32:51.680 | And what you would like to do,

00:32:53.440 | and it's very similar to that movie,

00:32:55.280 | "Sunshine Spotless Mind."

00:32:56.800 | I always forget the--

00:32:57.920 | - "Eternalist."

00:32:58.760 | - "Eternal Sunshine of the Spotless Mind."

00:33:01.240 | Thank you.

00:33:02.080 | - I didn't see the movie, but I hear it's good.

00:33:03.560 | - Yeah, and what they try to do is target in the brain

00:33:07.080 | these difficult, painful experiences

00:33:10.280 | and just excise them from the brain.

00:33:13.360 | And that was the suggestion.

00:33:15.960 | Could you pop those memories out of the biography

00:33:19.600 | of that individual and save them the trauma?

00:33:22.480 | I would argue that's not really what you want to do,

00:33:25.800 | because let's say that I have a trauma experience

00:33:29.960 | where I was walking home at night

00:33:31.960 | from the sleep laboratory late at night,

00:33:34.360 | and I was coming down kind of an alley to take a shortcut,

00:33:38.640 | and someone sticks me up with a gun, maybe some violence.

00:33:43.080 | I don't want to remove that memory.

00:33:46.440 | I would like to remove the trauma response

00:33:48.880 | associated with that memory.

00:33:50.560 | But I would argue for me as an organism,

00:33:52.960 | it's still very important for me to remember

00:33:55.400 | that that alley was associated with a bad experience,

00:33:59.720 | and I should forego going down that very same route again.

00:34:03.840 | I want to hold onto the memory, the information.

00:34:06.920 | I want to let go of the emotion.

00:34:09.680 | I want to sleep to remember, and I want to sleep to forget.

00:34:14.680 | And I'll come on to why I think that's relevant to PTSD

00:34:19.120 | when we perhaps speak about that condition,

00:34:21.040 | and it's very, very relevant.

00:34:22.600 | But coming back to REM sleep,

00:34:26.040 | we look back in the literature to see

00:34:27.880 | if we could find signs that REM sleep had this relationship

00:34:32.040 | with even just your basic emotional reactivity.

00:34:35.480 | And there was some wonderful work by a gentleman

00:34:37.800 | that you will know from Stanford,

00:34:40.000 | probably one of the founding fathers

00:34:42.120 | of modern day sleep research,

00:34:43.880 | a gentleman called William Dement.

00:34:45.800 | - Yeah, who passed away a few years ago.

00:34:48.080 | - He did.

00:34:49.240 | - Might've been one of the people

00:34:51.160 | who coined the term rapid eye movement sleep,

00:34:53.320 | but I don't think he was the one who discovered it, correct?

00:34:55.560 | - He was not, but he was well up there

00:34:58.160 | in terms of understanding both sort of what its term was

00:35:01.920 | and also what its function was.

00:35:03.560 | He, legend as he was, very early on,

00:35:08.360 | this was probably in the 60s,

00:35:10.400 | he would take individuals,

00:35:12.640 | because we didn't really have the first published report

00:35:16.240 | of these two types of sleep, of REM and non-REM,

00:35:19.760 | until they collected the data or found the data in 1953.

00:35:24.120 | It was published in 1954.

00:35:25.960 | So in other words, we discovered that even up to then,

00:35:30.120 | prior to then, we just thought sleep was sleep.

00:35:33.160 | We didn't have any knowledge that these different stages.

00:35:35.920 | So in the same year that Francis Crick unveiled

00:35:40.640 | this incredible helical structure

00:35:43.520 | that was called a DNA strand,

00:35:46.000 | we also discovered the different stages of sleep.

00:35:48.920 | But in the 60s then, William Dement,

00:35:51.280 | knowing that there were these two types of sleep

00:35:54.120 | and knowing that there was something that was going on

00:35:56.400 | with REM sleep where people were dreaming

00:35:58.680 | and he would be waking people up from these different stages

00:36:01.240 | and found that it's far more likely

00:36:03.600 | for people to report a dream.

00:36:05.240 | He wondered what the consequence would be

00:36:08.360 | if you selectively deprive people

00:36:11.040 | of this stage of sleep, of dream sleep.

00:36:13.360 | So he brought individuals into his laboratory

00:36:15.840 | and every time they would go into REM sleep,

00:36:19.520 | they would go into the room, they would wake them up,

00:36:21.640 | have them do some mathematical problems

00:36:23.800 | for two or three minutes and then put them back asleep

00:36:26.120 | and they go back into non-REM.

00:36:27.840 | And then as soon as they went back into REM,

00:36:30.000 | they would wake them up again.

00:36:31.320 | And the first night they would have to go into the room

00:36:33.240 | maybe six or seven times.

00:36:35.320 | - Still brutal for the person in the experiment.

00:36:38.920 | - It's not too much fun.

00:36:40.760 | But by the end of the five days or six days,

00:36:43.480 | I think they were going back into the room

00:36:45.000 | something like 17, 18 times, why?

00:36:47.840 | Because the people were building up

00:36:50.840 | this growing REM sleep debt

00:36:53.280 | and the brain had such a hunger for it

00:36:55.800 | that by night five of no REM sleep,

00:36:58.280 | all it wanted to do was rocket

00:37:01.120 | into this thing called REM sleep

00:37:02.760 | and start devouring it with high volume.

00:37:07.000 | But that wasn't the interesting part.

00:37:09.240 | The interesting part was the consequence to these subjects.

00:37:12.800 | They were all well-adjusted, perfectly normal individuals.

00:37:15.880 | By about day three of selective REM sleep deprivation,

00:37:20.160 | they started to show signs of paranoia.

00:37:22.920 | They started to believe people were out after them.

00:37:25.840 | They started to have hallucinations and delusions.

00:37:29.920 | And by day five, they were bordering on having

00:37:34.920 | aspects of quite severe psychosis.

00:37:39.520 | And so what all of this research has taught us in some ways

00:37:43.080 | is that it's almost as though REM sleep,

00:37:46.480 | and again, it's hyperbolic,

00:37:47.800 | is the difference between sanity versus insanity.

00:37:52.720 | It's the thing that separates those two.

00:37:55.360 | And there's a wonderful quote

00:37:56.960 | from an American entrepreneur called E. Joseph Kosman.

00:38:01.960 | And for all of the years of work

00:38:04.440 | that we've been doing in this field,

00:38:07.080 | and I've spilled so much ink over this,

00:38:09.320 | including in the book,

00:38:10.600 | he summarized it in a single sentence.

00:38:13.920 | The best bridge between despair and hope

00:38:18.040 | is a good night of sleep.

00:38:19.400 | And that's exactly what the data

00:38:21.840 | is demonstrating in terms of basic emotional brain function.

00:38:26.000 | - Such a powerful link there.

00:38:28.960 | And I think it's appropriate therefore,

00:38:32.640 | if we explore a little bit about

00:38:34.520 | what the link actually consists of

00:38:37.280 | in a way that will provide people a kind of a compass

00:38:42.280 | for when they're feeling a little bit

00:38:45.160 | less emotionally regulated,

00:38:46.720 | or if they would like to improve their levels

00:38:48.800 | of emotion regulation.

00:38:50.880 | This is going to be a little bit of an exploration,

00:38:52.880 | but you may recall,

00:38:54.000 | this is an exploration that you and I had some years ago

00:38:56.360 | when we were talking about the relationship

00:38:57.800 | between rapid eye movement, sleep, and emotionality.

00:39:00.860 | And here you've described

00:39:04.800 | that the medial prefrontal cortex

00:39:06.520 | normally plays this kind of role,

00:39:10.640 | this suppressive role over the amygdala under conditions

00:39:12.880 | where there is something to consider.

00:39:15.480 | Is it averse?

00:39:16.320 | Is it not averse?

00:39:17.140 | How averse is it?

00:39:19.760 | But in terms of what we know about stress and emotion,

00:39:23.680 | the autonomic nervous system,

00:39:25.000 | this incredible system that balances sympathetic,

00:39:28.280 | meaning alertness arousal,

00:39:30.120 | sometimes called the fight or flight system,

00:39:31.840 | and parasympathetic activation,

00:39:33.640 | sometimes called the rest and digest system.

00:39:35.360 | It's the balance of the two

00:39:37.360 | that dictates one's emotional state

00:39:40.400 | and alertness level of stress, et cetera.

00:39:43.340 | And I've always imagined the autonomic nervous system,

00:39:45.540 | the sympathetic and parasympathetic nervous system

00:39:47.440 | as sort of a seesaw.

00:39:49.320 | But on this seesaw sits us, right?

00:39:53.000 | And we can move back and forth across this seesaw,

00:39:56.600 | but there's a component of the seesaw

00:39:58.680 | that in my mental model, which is the hinge,

00:40:03.080 | how tight the seesaw is,

00:40:05.240 | meaning how easily or how challenging it is

00:40:09.780 | to tilt the seesaw to one or the other side.

00:40:13.060 | And I don't know if the mechanism has been discovered,

00:40:17.100 | but I feel like what happens under conditions

00:40:19.180 | of REM deprivation or sleep deprivation,

00:40:21.560 | that is sleep deprivation,

00:40:24.700 | but you've beautifully described

00:40:26.260 | how it's REM deprivation in particular that can do this,

00:40:29.860 | that the hinge becomes loose,

00:40:32.240 | but the hinge doesn't become loose

00:40:33.860 | toward us becoming more parasympathetic and relaxed.

00:40:36.940 | There's an asymmetry there.

00:40:38.140 | It's as if the seesaw now wants to flop

00:40:40.040 | to sympathetic activation until we're so exhausted

00:40:42.960 | that we just disappear into sleep.

00:40:45.300 | So the question is this,

00:40:47.460 | and maybe all we have here is opportunity for speculation,

00:40:51.560 | but is there any understanding of what the hinge might be

00:40:56.560 | and how sleep would adjust the tightness of that hinge?

00:41:00.080 | And if people are following this,

00:41:01.960 | what we're really trying to get to is,

00:41:04.560 | you described a neural circuit mechanism within the brain,

00:41:06.880 | but is this, for instance,

00:41:08.740 | the gating of the release of epinephrine,

00:41:11.320 | adrenaline, and cortisol?

00:41:12.780 | I mean, I could imagine that's regulated by the brain,

00:41:15.480 | but when we're deprived of REM sleep,

00:41:18.420 | that process becomes less poorly gated,

00:41:21.860 | and then we just will punch out a bunch of adrenaline

00:41:24.860 | in response to a phone call from a close friend

00:41:27.540 | that you adore, but is their voice is just a little bit loud

00:41:29.980 | and you're like, oh, this is rough, et cetera.

00:41:33.000 | Do we understand the nature of the hinge?

00:41:35.280 | - We do a little bit,

00:41:36.300 | and it's something that we started off trying to test

00:41:39.940 | with one specific belief,

00:41:43.120 | and then we were beautifully course-corrected by the data.

00:41:46.880 | We thought that the hinge was going to be,

00:41:48.880 | once you were sleep deprived and you started to slide down

00:41:51.880 | into that fight or flight branch,

00:41:53.440 | the more sympathetic and away from the parasympathetic,

00:41:58.120 | that the hinge would get ever tighter,

00:41:59.920 | the further into that sympathetic stress-related

00:42:03.840 | fight or flight dip that you had,

00:42:06.520 | and there you would stay.

00:42:08.600 | It wasn't quite that simple.

00:42:10.800 | What we found was that when I challenge you

00:42:13.000 | or put you either under a very simple

00:42:14.980 | cardiovascular challenge, let's say,

00:42:17.400 | I'm just having you grip a bar for a long period of time,

00:42:20.840 | or we have you under some other,

00:42:23.080 | maybe even if it's an exercise regimen,

00:42:26.940 | when you are in a sleep deprived state

00:42:30.400 | and you are largely inert

00:42:32.460 | and not interacting with the world,

00:42:35.040 | you actually are in a more strong parasympathetic state.

00:42:40.520 | It's almost as though you do not want to interact

00:42:44.080 | with the world per se, and this comes on to motivation.

00:42:48.800 | We and others have found that one of the earliest

00:42:52.000 | and strongest effects of a lack of sleep

00:42:55.840 | is just absence of motivation.

00:42:58.560 | I don't want to interact with the world.

00:43:00.600 | I don't want to be social.

00:43:02.320 | I don't want to learn.

00:43:03.640 | I don't want to exert effort.

00:43:05.360 | I don't want to exercise.

00:43:07.240 | I just don't want to do much of anything.

00:43:10.880 | However, when you provoke me and you force me to interact,

00:43:15.880 | or there is a very strong emotional event

00:43:18.400 | that I experience, I go all the way over

00:43:21.840 | into the strongly sympathetic.

00:43:24.460 | So it's almost as though we had the prediction

00:43:27.320 | that it was going to be a very tight hinge

00:43:29.280 | and the screw was tightening

00:43:30.880 | the more sympathetic you became.

00:43:33.080 | It was much more that you were

00:43:34.960 | in this sort of parasympathetic state,

00:43:38.640 | this sort of non-motivational state.

00:43:41.880 | And the hinge was so loose, however,

00:43:46.240 | that even just the tiniest flick of a challenge,

00:43:49.600 | whoosh, you went straight over to the sympathetic.

00:43:52.860 | There was no sweet spot of a tightening

00:43:56.520 | where you were nicely balancing between those two states.

00:44:01.280 | And this comes back to something else that we found.

00:44:03.840 | That's you switching, flip-flopping back and forth

00:44:07.280 | between parasympathetic and sympathetic.

00:44:09.420 | I spoke about the emotional reactivity

00:44:13.360 | to negative aversive events,

00:44:15.940 | but that's only one half of what we call

00:44:18.320 | the affective valence domain.

00:44:21.980 | It's not just that you can have

00:44:23.680 | negative emotional reactions.

00:44:25.220 | Of course, you can have positive emotional reactions.

00:44:29.960 | So we did a sister study to that amygdala study.

00:44:33.600 | And we asked, rather than showing you

00:44:35.760 | increasingly negative images

00:44:39.360 | and how your amygdala would respond

00:44:41.680 | much more strongly to those as we provoked it,

00:44:44.960 | we then started to show you

00:44:46.320 | much more positive rewarding images.

00:44:50.280 | And because one hypothesis would be that

00:44:52.880 | you just simply slide down the scale

00:44:56.000 | and you move towards more negative

00:44:58.480 | and away from more reward-based reactivity.

00:45:02.540 | Or you could imagine that it's both,

00:45:05.200 | that when you are sleep-deprived,

00:45:07.400 | you are equally excessively reactive

00:45:10.520 | to both of those domains.

00:45:12.520 | And what we found was that it was the latter,

00:45:15.440 | that you were very abnormally reactive,

00:45:19.040 | overreactive to negative events,

00:45:21.060 | but you were equally hypersensitive

00:45:24.000 | to very reward-based stimuli.

00:45:26.240 | And this fits beautifully with what we know

00:45:28.920 | from sleep deprivation.

00:45:30.560 | You are much more impulsive,

00:45:32.400 | you are much more reward-seeking,

00:45:35.120 | you are much greater in terms of your sensation-seeking,

00:45:38.920 | and your addiction potential,

00:45:40.960 | when you are not getting sufficient sleep,

00:45:42.900 | is significantly higher.

00:45:44.240 | And sure enough, when we looked in the brain,

00:45:46.360 | many of these dopamine-related circuits

00:45:49.000 | that you've described before

00:45:50.680 | were overactive when you were under-slapped.

00:45:55.280 | And so I bring this back

00:45:56.760 | because it relates to your seesaw sort of analogy.

00:46:00.520 | Yes, you can think about the seesaw with sleep deprivation

00:46:04.560 | from a sympathetic/parasympathetic.

00:46:06.600 | You can also think about it

00:46:08.040 | from a positive versus negative valence.

00:46:11.240 | And once again, our hypothesis was

00:46:13.400 | that you're just gonna slide down into the negative

00:46:15.760 | and you're just gonna be less responsive

00:46:17.600 | to the rewarding positive.

00:46:19.780 | It was the opposite.

00:46:22.080 | You were abnormally and excessively sensitive

00:46:26.140 | to both of those domains,

00:46:27.880 | which you could argue is perhaps

00:46:29.600 | the very worst of all adaptive responses as an organism.

00:46:34.600 | You don't want to be non-reactive.

00:46:36.640 | Emotions are powerful,

00:46:37.880 | and we've spoken about the benefits.

00:46:39.260 | You need to have emotions to be a functioning human being

00:46:44.000 | or organism in the world.

00:46:45.680 | They are designed to adaptively help us survive,

00:46:49.400 | but you can't go to the extremes.

00:46:51.420 | That's maladaptive rather than adaptive,

00:46:54.400 | but that's where you go when you are sleep deprived.

00:46:57.480 | It's this loose hinge and you become very, very erratically

00:47:02.320 | and extremely reactive from a neural perspective.

00:47:07.000 | - Yeah, my understanding is that, you know,

00:47:12.640 | sleep deprivation definitely increases impulsivity

00:47:16.040 | and addictive potential.

00:47:18.200 | It's, yeah, so best, worst of both worlds in this case.

00:47:21.740 | And given that, now would probably be an appropriate time

00:47:26.140 | to just cue people to some of the things

00:47:28.600 | that they can do to improve

00:47:30.180 | or maximize their rapid eye movement sleep.

00:47:32.060 | This was covered in detail in episodes one and two,

00:47:36.760 | and to some extent in episodes three and four as well,

00:47:40.500 | but they're in reference to other things,

00:47:43.980 | learning memory, creativity, the role of naps, et cetera.

00:47:47.740 | And I'll refer people back to this beautiful formula, QQRT,

00:47:52.740 | that it's not just about getting enough sleep,

00:47:55.000 | it's about the quantity indeed, but also the quality, QQ,

00:47:59.400 | regularity and timing of sleep and knowing one's chronotype,

00:48:04.040 | that is the best time to go to bed

00:48:07.000 | and the best time to wake up in the morning for them

00:48:10.040 | is going to be critical here.

00:48:11.240 | And I can raise my hand,

00:48:12.720 | I'll raise both hands in fact, metaphorically,

00:48:15.720 | and say that when I've gone to sleep early

00:48:20.060 | and woken up early, so for me, 8.30, 9 p.m.

00:48:22.900 | and then waking up at 4.30, 5 a.m.,

00:48:24.820 | which for me matches my chronotype,

00:48:27.640 | it has served as a powerful antidepressant effect.

00:48:31.020 | And when I've gotten an equal amount of sleep,

00:48:34.100 | but going to bed too late for me,

00:48:36.140 | that is, you know, midnight, 1 a.m.

00:48:38.580 | and sleeping in until eight or 9 a.m.,

00:48:41.260 | I always carry a low level depression.

00:48:44.980 | Fortunately, not something that needed to be medicated,

00:48:47.600 | but it's a striking effect in the positive direction

00:48:51.480 | when obeying QQRT and in the negative direction when not.

00:48:56.320 | So maybe just for, because we can provide some links

00:48:58.680 | to those segments in the show note captions,

00:49:01.060 | but maybe just for people that are here now,

00:49:05.160 | if we were going to list out, you know,

00:49:06.720 | two or three things that one can do to try and maximize

00:49:11.500 | the quality and quantity of REM sleep

00:49:14.680 | without going on too much of a tangent,

00:49:16.300 | but at the same time,

00:49:19.020 | we do want to highlight that addressing that QQRT formula

00:49:24.020 | for ourselves is going to be critical.

00:49:26.340 | So maybe, so for REM sleep, you know,

00:49:28.820 | in the domain of exercise, temperature, et cetera,

00:49:31.340 | are there any kind of quick bullet points

00:49:33.100 | that we can refer people to?

00:49:35.180 | - I would say just to keep it high level and brief,

00:49:41.060 | the single best way, cheapest non-pharmacological way

00:49:46.000 | that you can enhance your REM sleep

00:49:48.040 | is to just sleep an extra 15 or 20 minutes

00:49:52.160 | later into the morning.

00:49:54.720 | Don't try to put, if I tell you, this is about,

00:49:58.000 | by the way, this is about the quantity,

00:49:59.920 | that your sleep opportunity.

00:50:02.280 | Don't try to add that 30 minutes or 20 minutes

00:50:05.400 | if your goal is to increase REM sleep

00:50:07.400 | at the start of the night, at the front end.

00:50:09.560 | Instead, take that desire that I've offered you

00:50:13.580 | of adding just 20 minutes or 25 minutes of extra sleep.

00:50:18.240 | Now, to the last part of your night,

00:50:21.920 | wake up that sort of much later, 20, 25 minutes later.

00:50:26.500 | That's the REM sleep rich phase.

00:50:29.520 | So if people go back and listen to episode one,

00:50:32.280 | we'll describe to you exactly how the different stages

00:50:34.920 | of sleep unfold across the night.

00:50:37.120 | And they're not evenly distributed.

00:50:39.280 | It's not as though you get just as much REM sleep

00:50:41.920 | as well as deep non-REM sleep in the first half of the night

00:50:44.880 | as you do in the second.

00:50:46.120 | You get most of your deep sleep in the first half

00:50:48.800 | and you get most of your REM sleep in the second half,

00:50:51.840 | and particularly in the last quarter of the night.

00:50:54.480 | And this leads us to understand

00:50:57.040 | that the later into the morning hours that we go,

00:51:00.280 | the greater the hunger preference

00:51:02.520 | and the taste desire that is of your brain

00:51:06.240 | to start sampling from the finger buffet

00:51:08.560 | of all of those different stages,

00:51:10.320 | this thing called REM sleep.

00:51:12.800 | And the later that you sleep into the morning,

00:51:15.240 | the more of that REM sleep that you will have.

00:51:17.120 | And many people will have experienced this at the weekend

00:51:20.100 | where they have this pattern that we don't recommend

00:51:23.440 | based on the QQRT.

00:51:25.200 | QQR, regularity, goes a bit at the same time,

00:51:29.440 | wake up at the same time.

00:51:30.800 | What we see often in society

00:51:33.400 | is something that we call social jet lag,

00:51:35.880 | where you're short sleeping during the week

00:51:37.840 | and then at the weekend,

00:51:39.480 | you're out with friends or you're out sort of on the town,

00:51:43.160 | you go to bed late and you wake up late,

00:51:46.240 | and maybe you're doing that by two hours.

00:51:48.680 | Maybe you're normally in bed by 10 p.m. during the week,

00:51:51.800 | but now at the weekends,

00:51:53.000 | you're going to sleep maybe 12, 12.30

00:51:56.280 | and you're waking up two, three hours later

00:51:59.080 | on a Saturday and Sunday.

00:52:00.760 | And then the problem with that, parenthetically,

00:52:03.040 | is on Sunday evening,

00:52:05.640 | you've now got to go back to work the next day.

00:52:08.200 | So you have to push yourself back to 10.30 or 10 o'clock,

00:52:12.360 | whereas you were going to bed, let's say at 1 a.m.

00:52:15.480 | on Friday and Saturday night.

00:52:17.680 | That's a three-hour time shift.

00:52:19.800 | And people are doing that very frequently.

00:52:22.160 | That's the equivalent of you and I

00:52:24.360 | flying back and forth from Los Angeles to New York

00:52:27.600 | every single weekend in terms of our circadian rhythm.

00:52:30.800 | And it's brutal on it.

00:52:32.360 | But this is separate from this notion of your timing,

00:52:37.160 | the final part of the QQRT.

00:52:40.000 | And by pushing your timing a little bit later

00:52:43.440 | into the morning when you wake up,

00:52:45.320 | you will experience more REM sleep.

00:52:47.360 | And as I said, when people sleep later,

00:52:50.320 | they go to bed later at night

00:52:51.680 | and they wake up much later in the morning at the weekend,

00:52:54.760 | I strongly suspect that if they paid attention,

00:52:57.360 | they would say at weekends, I always dream more.

00:53:00.640 | I always can remember my dreams and they're more intense.

00:53:04.680 | It's not because there's something magical

00:53:06.640 | about how your memory recollection of dreams

00:53:09.120 | operates on Saturdays and Sundays.

00:53:11.240 | It's because you've slept in later.

00:53:12.880 | You've gone into that REM sleep rich preferential phase

00:53:16.440 | in the morning,

00:53:17.400 | and therefore you've increased your REM sleep.

00:53:19.680 | So I would say that that's probably the easiest way

00:53:21.920 | that you can start to modulate REM sleep.

00:53:23.920 | - So it's a terrific do.

00:53:25.680 | And I think we can probably summarize the top don't

00:53:29.760 | as don't drink alcohol, because it abolishes REM sleep.

00:53:33.360 | - Alcohol and THC are both very potent ways

00:53:37.240 | that will remove or obliterate your REM sleep.

00:53:42.240 | And we spoke about this in the episode on THC

00:53:46.640 | when we discussed this.

00:53:48.400 | I think just yesterday, I got a very long email

00:53:52.600 | and I'm sure you get lots of emails

00:53:54.640 | from delightful people in the public.

00:53:57.600 | And a gentleman just saying,

00:53:59.120 | I was using cannabis for probably about seven years.

00:54:03.160 | And then I watched or listened to some of your content

00:54:06.560 | and I stopped and I just had this explosion of dreams.

00:54:11.560 | And I was never recollecting any of my dreams before,

00:54:16.560 | but now they came back and goodness were they vivid,

00:54:19.520 | they were rich, they were, and I could not believe it.

00:54:22.920 | - And that's REM sleep.

00:54:24.000 | - And that's because during the cannabis use,

00:54:27.320 | by way of the THC, not the CBD,

00:54:29.520 | you've been blocking that REM sleep.

00:54:31.280 | You've built up that pressure

00:54:32.880 | just as we described in the dement studies.

00:54:35.160 | And then when you finally do take away the agent

00:54:38.360 | that is blocking the generation of REM sleep, the THC,

00:54:43.000 | all of a sudden your brain doesn't just go back

00:54:44.800 | to having its standard amount of REM sleep and dreaming.

00:54:47.880 | It has that, plus it tries to get back as much of it

00:54:51.720 | as it possibly can by having what we call

00:54:54.800 | a REM sleep rebound.

00:54:56.200 | And that's why people, when they stop using,

00:54:59.480 | they end up having this intense REM sleep.

00:55:01.440 | By the way, to your point about reward

00:55:03.240 | and addiction sensitivity with sleep deprivation,

00:55:08.000 | one of the things that we did in a collaboration,

00:55:11.720 | gosh, this was years ago when I was at Harvard

00:55:13.800 | with Carl Hart, who I think you, I don't know if you--

00:55:17.000 | - Columbia.

00:55:17.840 | - Yeah, Columbia, you know him.

00:55:19.000 | Yeah, he's a fantastic researcher,

00:55:20.760 | a very interesting man too.

00:55:23.360 | And what we found was that a lack of sleep

00:55:27.440 | was not only predictive of your addiction potential,

00:55:31.560 | but when you went into a clinic to abstain

00:55:35.000 | and trying to come off some of those,

00:55:36.960 | and here we were looking at cocaine addiction,

00:55:40.440 | a lack of sleep was a strong predictor of your abstinence

00:55:45.320 | and you falling off the wagon and going back to you.

00:55:47.960 | So sleep is so critical,

00:55:50.000 | not just for maintaining or pushing you away

00:55:54.320 | from that addiction potential,

00:55:56.080 | but once you are addicted and you're trying to abstain,

00:55:59.200 | it gives you that lift of altitude

00:56:01.960 | to try to resist falling off the wagon.

00:56:04.040 | And when sleep gets short,

00:56:05.640 | that's when you become vulnerable again,

00:56:07.680 | probably because your reward circuitry becomes enhanced

00:56:12.680 | and all of a sudden you just cannot resist

00:56:16.080 | the temptation anymore.

00:56:18.440 | I wanna take a brief break

00:56:19.520 | and acknowledge our sponsor InsideTracker.

00:56:21.920 | InsideTracker is a personalized nutrition platform

00:56:24.320 | that analyzes data from your blood and DNA

00:56:26.760 | to help you better understand your body

00:56:28.280 | and help you reach your health goals.

00:56:30.200 | I've long been a believer in getting regular blood work done

00:56:32.960 | for the simple reason that many of the factors

00:56:35.040 | that impact your immediate and long-term health

00:56:36.960 | can only be analyzed from a quality blood test.

00:56:39.560 | The problem with a lot of blood tests out there, however,

00:56:42.000 | is that you get information back

00:56:43.400 | about metabolic factors, hormones, et cetera,

00:56:45.620 | but you don't know what to do with that information.

00:56:47.800 | With InsideTracker, they make it very easy

00:56:49.580 | to understand your results

00:56:50.840 | and they also point you to specific directives

00:56:52.960 | that you can follow in the realm of nutrition,

00:56:55.120 | exercise, supplementation, even prescription drugs

00:56:57.820 | that can help bring the levels back into the ranges

00:56:59.880 | that are optimal for you.

00:57:01.200 | InsideTracker also offers InsideTracker Pro,

00:57:04.040 | which enables coaches and health professionals

00:57:06.080 | to provide premium and personalized services

00:57:08.320 | by leveraging InsideTracker's analysis

00:57:10.240 | and recommendations with their clients.

00:57:12.240 | If you'd like to try InsideTracker,

00:57:13.780 | you can go to insidetracker.com/huberman

00:57:17.180 | to get 20% off any of InsideTracker's plans.

00:57:19.540 | Again, that's insidetracker.com/huberman.

00:57:23.180 | I think the takeaway is very clear.

00:57:25.220 | In order to be your best emotional self,

00:57:28.420 | that is in order to be able to access positive emotions

00:57:31.660 | to their full amplitude, motivation,

00:57:35.100 | learning as we also covered in a previous episode,

00:57:37.500 | but also to stay out of those irritable,

00:57:40.140 | emotional traps of life and to be a regulated person,

00:57:44.620 | calm and joyful person, it stands to reason

00:57:48.940 | to minimize alcohol and cannabis use

00:57:52.680 | unless there's some medical reason

00:57:54.960 | why someone should do otherwise.

00:57:56.660 | But the real take home message here

00:57:58.540 | is get as much rapid eye movement sleep as possible

00:58:01.140 | and don't do anything to inhibit it.

00:58:03.020 | - Yeah, get as much sleep.

00:58:04.220 | So focus on all of those four macros of sleep,

00:58:07.580 | quantity, quality, regularity, and timing.

00:58:09.780 | And notice that if you want to try to optimize

00:58:13.540 | some of that emotional reactivity and balance,

00:58:16.740 | you may want to slightly over-index

00:58:20.180 | on your REM sleep in that regard

00:58:21.780 | and one easy, cheap way of doing that.

00:58:24.460 | If you can, lifestyle permitting.

00:58:26.100 | And again, of course I understand

00:58:28.140 | everyone has a life to live and pressures,

00:58:31.100 | but that's the way that if you were to ask me,

00:58:33.660 | can you do it and do it simply?

00:58:35.540 | Yes, you probably can.

00:58:37.340 | - Great.

00:58:38.780 | You touched on trauma a little bit already,

00:58:40.860 | but now would be the appropriate time, I think,

00:58:43.100 | to talk about PTSD, post-traumatic stress disorder,

00:58:45.900 | which I think we can use the definition of PTSD and trauma

00:58:50.900 | that the great Paul Conti,

00:58:53.180 | former guest on this podcast,

00:58:54.500 | who also did an expert series. - Wonderful, epic man.

00:58:56.460 | - Yeah, an incredible man.

00:58:57.660 | What a mind on him and what a generosity

00:59:00.780 | of sharing information in clear ways about mental health,

00:59:03.460 | as he did in the four episode series on mental health here,

00:59:06.340 | and he's been on other podcasts as well.

00:59:08.980 | Wrote a marvelous book on trauma.

00:59:12.060 | Paul defined trauma as some event that is aversive,

00:59:17.060 | that changes the way that our nervous system works,

00:59:20.900 | such that we function less well in the future.

00:59:23.900 | It's not that every negative event,

00:59:26.100 | every negative emotion associated memory is trauma.

00:59:31.100 | I think that's a misconception,

00:59:34.100 | but there are things that happen to people

00:59:36.700 | or that they observe happening to other people.

00:59:39.580 | So there's first person trauma,

00:59:41.140 | third person observational trauma, et cetera.

00:59:44.220 | And these can be single events, multiple events.

00:59:46.900 | Sadly, this stuff happens.

00:59:48.440 | It can be neglect.

00:59:50.300 | So sometimes it's the absence of an event,

00:59:52.700 | which becomes the traumatic event

00:59:53.980 | that fundamentally rewire some component of neural circuitry

00:59:58.060 | such that we don't function as well

01:00:01.340 | in terms of relationship to anything,

01:00:04.160 | work, food, sex, sleep, relationships,

01:00:07.140 | baseline levels of emotionality, and on and on.

01:00:10.740 | - So what is the relationship between sleep

01:00:14.220 | and post-traumatic stress disorder specifically?

01:00:17.180 | I think some of what we've covered already

01:00:19.060 | certainly touches on this,

01:00:20.580 | but PTSD seems to me that it might be its own unique case.

01:00:25.580 | - It is because if you look at the diagnostic criteria

01:00:30.500 | for PTSD, firstly, you see sleep disturbance.

01:00:35.340 | And as I said, right at the top of this episode,

01:00:37.800 | there is no major psychiatric disorder

01:00:40.220 | where there isn't some mention of sleep problems

01:00:43.020 | in its diagnostic criteria.

01:00:45.140 | But something else was intriguing about PTSD

01:00:47.820 | that compelled me to think about it

01:00:50.420 | and then create a theory around it.

01:00:52.880 | It's not just sleep problems,

01:00:55.960 | it's also nightmares and specifically repetitive nightmares.

01:01:00.860 | In fact, repetitive nightmares

01:01:02.820 | form part of the diagnostic criteria

01:01:05.380 | for you to receive a diagnosis of PTSD.

01:01:08.480 | That's how reliable they are.

01:01:10.820 | And as I thought more about this model of overnight therapy,

01:01:16.300 | this notion that sleep and particularly REM sleep

01:01:19.220 | provides a form of emotional first aid,

01:01:22.460 | PTSD stood out to me as something

01:01:26.140 | that I had to return to to explain.

01:01:28.860 | Why?

01:01:29.780 | Because if you think about PTSD and a veteran,

01:01:34.780 | it is the perfect example of the process that I described

01:01:39.780 | of emotional depotentiation failing.

01:01:43.760 | Because what I started to realize is that in PTSD,

01:01:48.160 | there is this trauma experience.

01:01:50.760 | And then perhaps what's happening is that sleep,

01:01:55.000 | the brain goes back to sleep that night and says,

01:01:57.440 | okay, please do your elegant trick

01:01:59.840 | of stripping away the emotion from the memory and it fails.

01:02:03.700 | So then what happens the next night?

01:02:05.120 | The brain comes back and says,

01:02:06.840 | I'm sorry, but I still got this

01:02:08.920 | very emotionally charged memory.

01:02:11.760 | Please do your elegant dissipation,

01:02:14.360 | depotentiation of the emotion from memory and it fails again

01:02:17.560 | almost like this broken record that was so indicative

01:02:21.040 | of these repetitive nightmares.

01:02:23.760 | And then when you looked at PTSD,

01:02:25.760 | I told you that REM sleep is a time

01:02:28.640 | of this remarkable decrease in noradrenaline.

01:02:33.340 | But if you look at PTSD patients,

01:02:35.720 | they actually have heightened levels of noradrenaline

01:02:40.080 | and also in the body adrenaline as well.

01:02:43.400 | - In sleep.

01:02:44.480 | - In sleep and also when you look

01:02:46.680 | just as a basal state as well.

01:02:49.560 | So there's something not quite right

01:02:51.640 | with the noradrenaline story in REM sleep in PTSD patients.

01:02:56.640 | So I had just published this paper

01:02:59.640 | and I was up at a conference in, I think it was Portland.

01:03:04.640 | And I presented the theory that both the data

01:03:07.180 | that we had on healthy people.

01:03:08.740 | And I put forward this theory of PTSD.

01:03:11.740 | And then later that afternoon,

01:03:16.460 | a psychiatrist came on the stage called Murray Raskin

01:03:20.220 | and he was working a lot with PTSD vets.

01:03:23.420 | And he described data, which I couldn't believe.

01:03:27.780 | It's one of those moments, Andrew,

01:03:29.020 | where you're at a scientific conference.

01:03:31.780 | And I think it happens maybe once in a career

01:03:34.620 | if you're lucky.

01:03:35.740 | All of the hers on the back of my neck stood on sharp end

01:03:40.740 | because he was saying, we've got this data

01:03:43.820 | and we don't quite understand it.

01:03:45.720 | We've been treating our veterans for blood pressure,

01:03:50.060 | for hypertension using a generic drug called prazosin.

01:03:54.380 | And prazosin blocks the adrenergic response in the body

01:03:59.380 | because you're trying to sort of tamp down

01:04:01.820 | that sympathetic activation in the body.

01:04:03.900 | - So it's a beta blocker.

01:04:05.100 | - So it's an alpha adrenergic antagonist.

01:04:09.900 | - Not a beta blocker.

01:04:10.740 | - So it's not a beta blocker,

01:04:11.660 | but it's blocking the adrenergic system.

01:04:14.080 | And so, and it's a generic, pretty cheap drug,

01:04:20.060 | but it turns out that it crosses the blood brain barrier.

01:04:23.440 | So it doesn't just stay within the body.

01:04:25.340 | It goes up into the brain.

01:04:27.380 | And he said, we don't really understand it

01:04:28.860 | because I've been giving patients this medication

01:04:31.660 | and it works to a degree, but something else happens.

01:04:34.500 | They come into the clinic and they say,

01:04:36.740 | doc, I'm not having those nightmares anymore.

01:04:40.980 | They seem to have gone away.

01:04:43.060 | And these patients seem to start to show signs of resolution.

01:04:48.700 | So all of a sudden I had had a model,

01:04:52.920 | a clinical model that was in search of data.

01:04:55.520 | And he had data that was in search of a theoretical model.

01:05:00.120 | I couldn't believe it

01:05:01.280 | because it's exactly what I would predict,

01:05:04.080 | which is that if noradrenaline is too high in PTSD,

01:05:07.400 | you're not processing and stripping the emotion

01:05:09.640 | from the memory.

01:05:10.640 | So it keeps coming back over and over

01:05:12.940 | like this repetitive nightmare.

01:05:15.100 | But then if you block and help bring back down

01:05:18.500 | that level of noradrenaline to that,

01:05:20.140 | which would be seen in a normal healthy person,

01:05:23.340 | in other words, completely blocking it,

01:05:25.500 | all of a sudden the emotional memory

01:05:27.340 | gets the chance to be processed

01:05:29.300 | and you finally start to get symptom resolution.

01:05:32.320 | So we couldn't believe it.

01:05:34.420 | He flew down to Berkeley.

01:05:35.980 | We spent several days together.

01:05:37.780 | We went out to dinner.

01:05:38.700 | We just could not stop talking.

01:05:40.780 | He subsequently did some incredible work in this area

01:05:44.500 | and prazacin went on to become

01:05:46.740 | an FDA approved medication for PTSD

01:05:51.020 | and repetitive nightmares

01:05:52.260 | that was approved by the Veterans Administration.

01:05:55.100 | - Bravo.

01:05:55.940 | - And so, no, it's not me.

01:05:56.860 | It's all of his work.

01:05:58.360 | - No, no, no, no, no, no, no, no, no, no.

01:05:59.300 | You can't, no, this to me is the scientific collaborative

01:06:03.420 | conceptual equivalent of the old Reese's

01:06:06.300 | peanut butter cup commercials.

01:06:07.820 | For those of us old enough to remember,

01:06:09.620 | it's two people running toward one another on the beach,

01:06:12.100 | one with a jar of peanut butter,

01:06:13.340 | one with a bar of chocolate,

01:06:15.700 | and then they crash into one another

01:06:17.060 | and then they both share in the delight

01:06:19.400 | of the chocolate peanut butter combination,

01:06:21.700 | which is an amazing combination.

01:06:23.560 | But here, a far more important example,

01:06:28.700 | because it's led to clinical relief in patients with PTSD.

01:06:33.200 | So I'm not making light of that at all,

01:06:35.620 | but this is one of the reasons to go to scientific meetings.

01:06:39.580 | Seriously, this is one of the reasons

01:06:41.020 | why scientists need to talk.

01:06:42.380 | This is one of the reasons to do podcasts

01:06:43.980 | is it fosters hybridization of ideas,

01:06:47.940 | which is central to new discoveries.

01:06:50.900 | And in this case, a clinical discovery.

01:06:53.060 | I have a question about this notion

01:06:56.220 | of blocking norepinephrine in the brain and body.

01:07:00.340 | On the one hand,

01:07:03.500 | it seems that during rapid eye movement sleep,

01:07:06.380 | we know we're paralyzed or we are paralyzed.

01:07:09.180 | That's a fact of rapid eye movement sleep.

01:07:11.460 | The brain is recalling memories often in great detail,

01:07:16.460 | sometimes through symbolic representation.

01:07:18.860 | Space-time is disrupted.

01:07:20.980 | It's either faster or slower because you're dreaming.

01:07:23.620 | And it seems that there's something powerful

01:07:28.360 | about being able to replay the memories

01:07:31.340 | and yet divorce them from certain neurochemical release

01:07:36.300 | in the brain and body to essentially uncouple them.

01:07:39.260 | And then to me, it makes perfect sense

01:07:40.980 | why taking a drug that would reduce

01:07:43.380 | the amount of sympathetic arousal in sleep would help,

01:07:45.960 | especially PTSD, because you said with PTSD,

01:07:49.460 | it's sort of an invasion of the noradrenaline response

01:07:52.640 | into rapid eye movement sleep that is inappropriate.

01:07:55.300 | So does that mean that rapid eye movement sleep

01:07:58.060 | in people with PTSD is not truly rapid eye movement sleep?

01:08:01.580 | It's as if it's been abolished and replaced

01:08:03.460 | with something that's kind of pseudo-waking,

01:08:05.620 | stress-invaded, you know, it's like a zombie REM.

01:08:11.380 | And it's not good.

01:08:12.940 | Is that correct?

01:08:13.780 | - It seems to be, and you can look at this

01:08:16.140 | in terms of the electrical activity of REM sleep,

01:08:19.220 | the electrical brainwaves of REM sleep in these patients.

01:08:22.540 | And you're right,

01:08:23.380 | it doesn't seem to be of the same electrical quality.

01:08:25.860 | But what was interesting in Murray Raskin's studies,

01:08:28.860 | when he started to treat patients with the prazosin

01:08:32.060 | and tamp down that noradrenaline,

01:08:35.300 | one of the other things that returned back to normality

01:08:38.380 | was not just that the symptoms dissipated,

01:08:41.380 | the REM sleep started to return with a greater amount.

01:08:46.380 | And so I think it fits very well with this notion

01:08:50.320 | that whatever REM sleep that was going on

01:08:53.140 | may not necessarily have been electrically

01:08:55.660 | or neurochemically identical to normative REM sleep.

01:09:00.140 | But when you assisted the system with a chemical

01:09:03.140 | to bring it back into normality,

01:09:05.660 | REM sleep was gifted back to the brain

01:09:08.700 | and emotional resolution started to unfold.

01:09:11.580 | Now I should note that there have been a number of studies

01:09:15.180 | that have replicated the finding.

01:09:16.720 | Some studies have not though.

01:09:17.940 | And so we still need to understand exactly

01:09:20.200 | why this is the case.

01:09:21.780 | And there are other therapies that we'll probably discuss

01:09:24.860 | in a later episode on dreaming

01:09:26.960 | that are as if not more effective than that drug therapy

01:09:30.740 | for repetitive nightmares.

01:09:33.220 | That is a psychological intervention

01:09:35.620 | rather than a pharmacological intervention.

01:09:38.020 | And that seems to be very effective too.

01:09:40.100 | - In 2017, as my laboratory was starting to explore

01:09:44.860 | some studies on humans on fear and trauma,

01:09:47.340 | I visited a trauma addiction center on the East coast.

01:09:52.020 | The guy who runs it will be a guest on this podcast

01:09:54.340 | in the future, an amazingly talented trauma

01:09:58.220 | and addiction therapist by the name of Ryan Suave.

01:10:01.100 | And there it was that I learned about Yoganidra,

01:10:05.420 | non-sleep deep rest.

01:10:06.620 | And here's why, they were taking heroin addicts,

01:10:09.340 | gambling addicts, sex addicts, alcoholics,

01:10:12.300 | people with what they call behavioral process addictions

01:10:14.580 | and substance abuse addictions.

01:10:16.340 | And every morning after they woke up,

01:10:20.500 | the first thing that they would do

01:10:23.220 | was one hour of non-sleep deep rest,

01:10:26.420 | you know, placing people into this liminal state.

01:10:28.260 | And I asked why, and Ryan said,

01:10:31.540 | this is especially important to do with addicts

01:10:34.060 | when they arrive in inpatient recovery in the first week,

01:10:37.340 | and even more so in the first three days,

01:10:40.020 | because typically they are badly sleep deprived.

01:10:43.420 | And in addition to that,

01:10:45.100 | many of them are just not good at getting

01:10:47.300 | and staying asleep at night without the use of pharmacology,

01:10:51.580 | or in some cases their behavioral addictions,

01:10:54.100 | depending on what it was.

01:10:55.900 | And so it was a kind of a self-directed relaxation training

01:10:59.660 | of sorts first thing in the morning that in addition,

01:11:03.900 | perhaps could compensate partially

01:11:06.140 | for some of the sleep deprivation

01:11:07.500 | that they no doubt were experiencing when they arrived.

01:11:09.660 | It's also a novel environment

01:11:11.020 | and sleeping in novel environments can be challenging.

01:11:14.140 | So there is, as far as I know,

01:11:17.540 | no randomized control trials of this practice yet,

01:11:22.380 | but there are a good number of clinics and treatment centers

01:11:25.620 | that are now employing non-sleep deep rest, aka Yoga Nidra,

01:11:30.540 | for 30 minutes to an hour first thing upon waking

01:11:34.420 | as one of the core components of treatment

01:11:38.020 | for helping people get and stay sober.

01:11:40.660 | - I think it's absolutely fascinating

01:11:42.580 | because that morning time period as well

01:11:46.300 | can be for those who are struggling with sleep,

01:11:48.700 | especially difficult.

01:11:49.820 | And you and I have spoken on this podcast series

01:11:52.660 | about sort of awakening at night or later in the morning

01:11:56.820 | when you really want to be asleep

01:11:58.460 | and it's just a struggle to get back.

01:12:00.820 | And as you noted that he was saying,

01:12:03.620 | they often come in underslept.

01:12:06.300 | And my suspicion is that they're probably getting sleep

01:12:08.780 | at the front end in part because they're heavily medicated,

01:12:12.300 | but self-medicating in terms of helping their sleep.

01:12:15.740 | But then of course, because they are asleep,

01:12:18.260 | they can't continue to medicate.

01:12:19.780 | So which part of sleep is fragile?

01:12:21.820 | It's those morning hours.

01:12:23.460 | And therefore, if you have something

01:12:25.140 | that is a compensatory tool

01:12:27.140 | that is not going to be the trigger of saying,

01:12:29.020 | just get back into bed, get under those sheets and sleep.

01:12:32.260 | Sleep doesn't work like that.

01:12:34.340 | Sleep is not something that we do.

01:12:36.660 | Sleep is something that arrives to us, with us.

01:12:41.220 | And if it's not, you can't force it.

01:12:44.260 | And it's a bit like someone's name, in fact,

01:12:46.940 | quite the opposite that the harder you try to remember,

01:12:49.300 | the further you push sleep away.

01:12:51.620 | And when you stop, it all of a sudden comes back.

01:12:54.500 | But I love this idea of inserting something like that

01:12:57.660 | as a compensatory tool.

01:13:00.060 | And that's why I think you and I have discussed openly here,

01:13:03.060 | in fact, on this series.

01:13:04.980 | At some point, we're going to collaborate

01:13:06.500 | and we're going to look to see exactly

01:13:08.740 | what is happening electrically

01:13:11.620 | at high fidelity mapping inside of the brain

01:13:15.180 | when we are going through these liminal states.

01:13:18.180 | And what is the benefit of that?

01:13:20.420 | Is it a very similar benefit for sleep?

01:13:23.340 | And it's fascinating because it's possible

01:13:25.460 | that what we find at the level of the brain

01:13:27.940 | is that it's not sleep-like, it's something else-like.

01:13:31.900 | Maybe it's just a liminal state-like.

01:13:35.180 | And what's also interesting is that it provides

01:13:37.500 | seemingly many of the benefits of sleep,

01:13:40.620 | but it's not sleep.

01:13:42.340 | In other words, you can arrive at the same destination

01:13:45.460 | of mental and physical health through two different routes.

01:13:49.700 | One thing called sleep, one thing called these liminal states

01:13:53.860 | or they both operate on the same highway

01:13:56.660 | in terms of mechanistic transaction benefits.

01:13:59.660 | So much that we need.

01:14:00.880 | We could stay here all night and all day,

01:14:04.080 | hopefully not all night.

01:14:05.140 | - Well, we will absolutely do those studies.

01:14:08.420 | And because I think that people are in desperate need

01:14:11.380 | of zero cost tools to try and access the replenishment

01:14:18.300 | and recovery that comes from sleep.

01:14:19.780 | And when sleep is available to us, when we can access it,

01:14:23.240 | that's going to be the best option.

01:14:24.580 | There's no question.

01:14:25.420 | But then some of these tools in theory and in practice

01:14:29.060 | provide a portal to get better at sleeping as well.

01:14:32.740 | - So yeah, I was going to say,

01:14:33.780 | one of the other things I'd be fascinated for us to do

01:14:36.180 | is not just look at that model

01:14:37.980 | of what happens in the morning,

01:14:40.060 | but can we use that for people

01:14:42.060 | who have the opposite insomnia problem,

01:14:43.940 | which is that I can't fall asleep.

01:14:45.900 | And we spoke about this in a previous episode

01:14:47.900 | of tools and techniques and methods

01:14:49.580 | to help you fall asleep.

01:14:51.640 | Could this be one of them?

01:14:53.380 | Where you just start to help move yourself

01:14:57.300 | into this liminal state, you take the stress off.

01:15:00.260 | One of the things I hear so much at the center

01:15:02.180 | when people come in and they say,

01:15:03.980 | I always struggle to sleep and you go into depth

01:15:07.020 | and it's because their mind starts to Rolodex

01:15:11.140 | through that anxiety of what I need to do

01:15:12.940 | and what I should do.

01:15:13.900 | But also then the later it gets

01:15:17.060 | and the absent the sleep becomes,

01:15:20.200 | the more stress they get, not just about the next day,

01:15:23.020 | the more stress that they get about this thing

01:15:25.060 | called not being able to fall asleep.

01:15:27.540 | And if there's something, a practice

01:15:29.100 | that you've taught someone that says, that's okay.

01:15:32.540 | I know this place and I know this situation

01:15:36.220 | and there's a tool I have and it's called

01:15:41.260 | this a liminal state.

01:15:43.140 | And if you were to train people on that sort of that method,

01:15:48.140 | is it a way that they finally can then cast themselves off?

01:15:54.300 | And it's the bridge, not necessarily just between despair

01:15:58.700 | and hope, but the bridge between wakefulness and sleep.

01:16:02.420 | So put it at the back end, at the end of the day,

01:16:05.140 | rather than the front end.

01:16:06.980 | - A lot for us to discover there.

01:16:08.460 | And at risk of being hyperbolic,

01:16:12.820 | I mean, what would be more useful

01:16:14.700 | than a zero cost non-pharmacologic tool

01:16:17.380 | for people to get the rest and restoration they need

01:16:21.420 | and to get better at getting the ultimate form

01:16:23.700 | of restoration, which is sleep.

01:16:26.160 | - Yeah, I love the paradox of it,

01:16:28.900 | that non-sleep deep rest allows you

01:16:32.360 | to go into sleep deep rest.

01:16:35.140 | - It is after all a transition or liminal state.

01:16:38.280 | Maybe this will become the stage

01:16:40.220 | before stage one of sleep, who knows?

01:16:42.460 | - We define our staging criteria.

01:16:44.460 | - That's right.

01:16:45.980 | Okay, so speaking of challenges,

01:16:48.060 | sleeping because of one's concern,

01:16:51.060 | aka anxiety about the importance of sleep.

01:16:54.980 | What about the relationship between sleep and anxiety?

01:16:57.540 | Meaning many people in the world

01:17:00.940 | experience low level anxiety or have a low threshold

01:17:04.660 | to what could be a full-blown anxiety or panic attack,

01:17:07.900 | but more often than not,

01:17:09.460 | is this feeling of being tired and wired

01:17:12.460 | or having a quick pre-pulse startle,

01:17:17.260 | as we call it in our business, a nerd speak

01:17:19.460 | for kind of a reactive to input, anxiety.

01:17:24.460 | And I don't think there's any clean definition

01:17:27.620 | between anxiety, stress, and PTSD.

01:17:31.100 | These run along a continuum and they braid together.

01:17:33.180 | - PTSD is an anxiety disorder, it's one of many.

01:17:35.900 | - Right, these things braid together

01:17:37.540 | in a way that it would be a waste of our time

01:17:39.500 | to try and disentangle those.

01:17:41.860 | But many people have anxiety that is anywhere

01:17:44.780 | from minor to debilitating,

01:17:47.020 | but that is separate from PTSD,

01:17:48.540 | although people with PTSD can have anxiety.

01:17:51.500 | So what do we know about the relationship

01:17:54.720 | between sleep and anxiety?

01:17:57.820 | And perhaps we could frame this in the context

01:18:00.500 | of the QQRT, you know, I'll just toss out a question

01:18:04.940 | that perhaps highlights what I mean.

01:18:07.160 | Is it possible that somebody is getting eight hours

01:18:09.020 | of sleep a night, which for them meets

01:18:11.540 | their quantity requirement in the,

01:18:13.980 | the quality is relatively high,

01:18:18.060 | but it's not as high as it could be

01:18:19.500 | because the regularity and timing of their sleep isn't great.

01:18:23.260 | Is that person going to be more prone to anxiety

01:18:25.560 | than somebody who's really matched to their chronotype

01:18:27.420 | and is still getting enough sleep?

01:18:29.620 | - No one's done the head to head comparison

01:18:32.340 | where you kind of do the, how I can do,

01:18:34.460 | the Coke, Pepsi, Dr. Pepper Sprite, QQRT challenge

01:18:39.460 | between all of those.

01:18:41.840 | What we do know is that if you look at each one

01:18:44.160 | independently, QQRT, quantity, quality, regularity, timing,

01:18:48.920 | if any one of those is off,

01:18:51.100 | it's very difficult not to see a coexisting anxiety disorder

01:18:55.640 | or increase in anxiety or a mood disorder.

01:18:59.360 | And I think to me, anxiety is part of that class

01:19:03.680 | of a broader class that I would call mood disorders.

01:19:06.760 | It's relevant that we make that distinction,

01:19:08.860 | at least in my eyes.

01:19:10.480 | And I know some people may disagree

01:19:12.500 | because mood and anxiety are different than emotions.

01:19:17.500 | And many of us clump them together.

01:19:19.960 | The way I think about the difference is the following.

01:19:23.120 | Timescale, emotions are short punctate events

01:19:27.800 | that usually last anywhere from seconds to many minutes.

01:19:32.680 | Mood states, however, like anxiety or depression,

01:19:37.680 | those operate on a slightly different timescale

01:19:41.360 | from minutes to hours, to months, to years.

01:19:45.160 | And so it's very unlikely

01:19:47.200 | that we can experience an emotional reaction

01:19:50.240 | that from a sort of a chronometry point of view

01:19:54.400 | lasts for two years.

01:19:56.960 | But you can certainly see someone

01:19:58.240 | who has a mood state abnormality of depression

01:20:01.400 | that lasts for several years

01:20:03.280 | or who has been chronically anxious for several years.

01:20:06.500 | And I'll come back to why I think that distinction

01:20:09.440 | is relevant for a second.

01:20:11.120 | To your point though, about the relationship with sleep,

01:20:14.440 | here again, it's a very strong bi-directional relationship.

01:20:18.120 | And I would say that probably in the last eight or nine years

01:20:22.440 | we've been doing a considerable amount of work

01:20:24.720 | in sleep and anxiety rather than just sleep

01:20:26.920 | and basic emotional reactivity.

01:20:30.200 | What we found is it's very strongly bi-directional

01:20:33.680 | that if you have anxiety, it's very difficult to sleep.

01:20:38.680 | And if you are having difficulty sleeping,

01:20:42.160 | it's very likely that you will increase your anxiety.

01:20:46.280 | But before we really unpacked that,

01:20:49.200 | we started with a very basic study,

01:20:51.680 | similar to those that we've described.

01:20:53.680 | We took a group of people and we were very careful

01:20:55.840 | to make sure that they had completely normative levels

01:20:59.840 | of anxiety, they showed no signs

01:21:01.560 | of an anxiety related disorder.

01:21:03.080 | And by the way, anxiety disorders are,

01:21:06.720 | it seems one of, if not the most common

01:21:09.440 | of all psychiatric conditions,

01:21:11.240 | just to put it in context for people listening.

01:21:14.120 | And these individuals, no signs of anxiety disorders

01:21:17.280 | whatsoever, they were normative.

01:21:19.000 | And then we had them go through a full night of sleep

01:21:22.780 | or we then sleep deprived them.

01:21:25.800 | And the next day we were measuring their anxiety

01:21:29.600 | and in those people who were sleep deprived,

01:21:32.280 | we were actually measuring the level of anxiety every hour.

01:21:36.280 | So we could almost get this time-lapse photography

01:21:39.320 | of what happened to their anxiety state

01:21:41.920 | as it unfolded across the sleep deprivation period.

01:21:45.440 | It wasn't a linear response, that the more and more hours

01:21:49.440 | that you were awake beyond 16, the more exponential

01:21:54.440 | that rise in anxiety became.

01:21:58.440 | So it wasn't simply a linear dose response curve,

01:22:01.120 | it was exponential, meaning that there was

01:22:02.920 | this hockey shape swing up.

01:22:05.600 | And in fact, by the next morning,

01:22:07.680 | compared to when you'd had a full night of sleep,

01:22:11.080 | those individuals were so anxious that almost 50%

01:22:15.840 | of the participants in that group who had no signs

01:22:18.560 | of anxiety before, had a level of anxiety

01:22:22.480 | that was so strong that they would reach

01:22:24.600 | the diagnostic threshold for having an anxiety disorder.

01:22:28.780 | And that was simply by way of the absence of sleep.

01:22:32.760 | But again, that brought me back to this notion

01:22:36.280 | of this is a good experimental tool for us scientists

01:22:41.200 | to understand what is the benefit of sleep

01:22:44.000 | when it's present and the absence of sleep when it's not

01:22:46.280 | by taking sleep completely out of the equation

01:22:48.400 | by way of total deprivation.

01:22:50.200 | But of course that's not real life.

01:22:52.420 | So we did a slightly different study.

01:22:54.380 | Here, what we did was we tracked individuals

01:22:58.000 | essentially in the wild as it were,

01:22:59.960 | just going about their daily lives.

01:23:01.880 | And we had different sleep tracking monitor,

01:23:04.320 | monitoring equipment on them.

01:23:06.000 | So we were tracking their sleep from one night

01:23:08.820 | to the next, to the next, to the next,

01:23:10.600 | and from one day to the next, to the next,

01:23:13.160 | we were tracking their level of anxiety.

01:23:16.160 | And what we found here was that even small perturbations

01:23:20.160 | in their sleep from one night to the next, to the next,

01:23:24.920 | accurately predicted that increase or decrease

01:23:28.880 | in their anxiety from one day to the next, to the next.

01:23:33.000 | What was the critical ingredient here?

01:23:34.960 | Well, in the first experiment,

01:23:36.960 | I'd essentially manipulated both quantity and quality,

01:23:40.560 | the two QQs of the QQRT.

01:23:43.160 | I'd removed the quantity of sleep.

01:23:45.920 | And also they had no quality of sleep, why?

01:23:47.920 | Because they had no quantity of sleep.

01:23:50.640 | But when we looked at that day-to-day-to-day,

01:23:53.640 | night-to-night-to-night study,

01:23:55.680 | it wasn't quantity that was the best predictor.

01:23:59.200 | It wasn't shortening of quantity

01:24:01.760 | that determined next day increases in anxiety.

01:24:04.720 | It was quality.

01:24:06.200 | The worse the quality was, night-to-night-to-night,

01:24:09.000 | the worse their anxiety became.

01:24:10.860 | So that started to lead us to think a lot more

01:24:14.880 | about what is it regarding the quality of sleep

01:24:18.360 | that seemed to offer when it was present,

01:24:22.280 | what I would describe as an anxiolytic benefit.

01:24:25.520 | In other words, it's lessening anxiety.

01:24:27.560 | A lack of sleep is an anxiogenic.

01:24:30.160 | It's going to produce anxiety.

01:24:32.240 | What in sleep is anxiolytic?

01:24:35.720 | We started off with a hypothesis

01:24:37.360 | that was profoundly incorrect.

01:24:39.800 | We thought, well, for emotions,

01:24:41.840 | which are these short bursts of affective state,

01:24:46.600 | it was REM sleep that seemed to be the principal ingredient.

01:24:50.120 | Well, wouldn't that be the case for mood states?

01:24:53.480 | Well, here with anxiety, it wasn't.

01:24:55.400 | It was deep non-REM sleep, and we couldn't get away from it.

01:24:59.080 | And so what we found was that when we looked

01:25:01.000 | at their sleep in the laboratory and asked,

01:25:03.800 | what was predictive from the night before?

01:25:06.800 | So you measure your anxiety the night before,

01:25:09.120 | and then we measure it the next morning.

01:25:10.720 | And basically we calculate a change score.

01:25:13.560 | Has your anxiety the next morning increased,

01:25:15.640 | stayed the same, or decreased?

01:25:17.280 | And then we correlate that with the different stages.

01:25:20.000 | And what we found was that the electrical quality

01:25:24.720 | of your deep non-REM sleep was very much predictive

01:25:29.720 | of your dissipation of anxiety overnight.

01:25:35.520 | And this helped me realize, gosh, it's much more complex.

01:25:38.560 | These are beautiful surprises you get from research

01:25:40.880 | when you have this hypothesis and you see REM sleep,

01:25:45.800 | no signal of predictive relationship with anxiety.

01:25:49.080 | And I say, of course, 'cause I'm idiotic,

01:25:52.360 | rerun the analysis, just go back to raw data.

01:25:55.680 | And the REM sleep signal was so strong.

01:25:58.800 | Rerun the analysis and you get exactly the same result.

01:26:02.880 | It's deep non-REM sleep.

01:26:03.960 | Great, okay.

01:26:04.920 | Then what is that deep non-REM sleep doing

01:26:08.080 | to help dissipate the anxiety?

01:26:11.280 | But here again was a commonality with emotion.

01:26:14.200 | What we found is that the greater the amount

01:26:16.000 | of deep non-REM sleep, the greater the re-engagement

01:26:20.400 | of your frontal lobe was the next day.

01:26:23.440 | And that was predicting the dissipation

01:26:26.000 | of your anxiety the next morning.

01:26:29.880 | So we really started to understand

01:26:31.760 | this sort of critical bi-directional relationship,

01:26:34.680 | but it was a very complex one.

01:26:36.680 | That yes, anxiety can disrupt your sleep.

01:26:40.320 | And yes, disrupted sleep can predict your next day anxiety,

01:26:45.080 | but it wasn't the same stage of sleep

01:26:47.360 | that we thought before.

01:26:49.160 | It was the opposite.

01:26:50.680 | It was deep non-REM sleep.

01:26:52.720 | What we've come to realize is that deep non-REM sleep

01:26:55.440 | in part seems to be almost shifting you

01:26:59.080 | from that sympathetic state

01:27:01.960 | over to the parasympathetic state.

01:27:04.880 | It seems to engage that nice rest and digest.

01:27:08.600 | It seems to reduce your heart rate.

01:27:11.560 | It seems to drop levels of cortisol.

01:27:14.760 | And we think that perhaps is a resetting brain body,

01:27:18.680 | literally an embodied mechanism

01:27:21.360 | by way of deep non-REM sleep,

01:27:23.600 | helping you just relieve that anxiety pressure.

01:27:27.880 | So it does come back to your question,

01:27:30.240 | which is yes, quantity if I manipulated,

01:27:32.640 | quality if I manipulated,

01:27:35.240 | regularity or timing,

01:27:36.560 | manipulate any one of those, I can change your anxiety.

01:27:39.520 | But the story coming through here, if anything,

01:27:41.680 | was that it wasn't quantity, it was quality.

01:27:44.640 | I told you that from one night to the next to the next,

01:27:48.160 | the quality of your sleep that we were measuring

01:27:51.400 | was predictive of your anxiety.

01:27:53.600 | And then when we bring you into the laboratory

01:27:55.160 | and we look at the electrical activity of your brain.

01:27:59.080 | I also mentioned in that episode on the first episode,

01:28:02.680 | another way we measure quality

01:28:04.160 | is not just subjectively what's going on

01:28:06.440 | or objectively what is the efficiency of your sleep?

01:28:09.400 | Is it filled with lots of awakenings,

01:28:11.120 | which was the measure that we used in the day-to-day study

01:28:13.520 | and night-to-night study.

01:28:15.080 | But we looked at the electrical quality of your sleep.

01:28:17.600 | Once again, it was quality that was predicting it.

01:28:20.440 | It's something about getting good continuous sleep

01:28:24.480 | that is replete with this deep

01:28:27.320 | non-REM electrical brain activity

01:28:29.480 | that provides an anxiolytic benefit

01:28:32.760 | to your brain the next day.

01:28:34.680 | And I think it's strategic

01:28:35.760 | 'cause so many of us deal with anxiety.

01:28:38.560 | And some of us would prefer

01:28:41.280 | not to necessarily be on medication or even look to that.

01:28:44.400 | Well, here again is a strategic tool.

01:28:46.560 | Think about your sleep.

01:28:48.240 | It really does seem to be a buffer for anxiety.

01:28:51.920 | - Along those lines,

01:28:53.000 | maybe you can just recap a few of the things

01:28:55.480 | covered in previous episodes

01:28:56.960 | that are known to improve the quality

01:29:00.240 | and quantity of deep non-REM sleep.

01:29:03.080 | I can think of a couple, but you're the expert here.

01:29:09.280 | - Let's not rush to judgment on that one.

01:29:11.280 | - I think it's an established fact,

01:29:12.920 | which is why you're here.

01:29:14.640 | So let's perhaps list a few of those off

01:29:18.880 | in the domains of exercise, temperature, et cetera.

01:29:22.080 | What would you place in that?

01:29:23.880 | Is there a top three, like three greatest hits

01:29:26.240 | for improving deep non-REM sleep

01:29:30.720 | because of its important relationship

01:29:33.280 | to anxiety management or reducing anxiety?

01:29:36.800 | - I think there are.

01:29:37.640 | The first thing I would tell you

01:29:39.360 | is that regularity is going to be key here.

01:29:43.480 | When you are giving your brain the signals of regularity,

01:29:46.080 | it understands exactly how to instigate that deep sleep.

01:29:52.520 | And that's one of the two qualitative measures

01:29:55.640 | of sleep that I spoke about.

01:29:57.560 | So QQ, the quality, the second Q I spoke about,

01:30:01.360 | it's regarding the continuity of your sleep

01:30:04.080 | and the actual quality of your sleep.

01:30:06.000 | Regularity is probably best for the continuity of your sleep.

01:30:11.000 | If you're very irregular with the timing of your sleep,

01:30:14.760 | your brain almost doesn't know,

01:30:16.920 | are we on, are we off, are we on, are we off?

01:30:19.120 | And your sleep can become quite fragmented

01:30:21.520 | because it's confused based on regularity.

01:30:24.200 | When you give it regularity,

01:30:25.840 | sleep starts to become more stable.

01:30:28.320 | More stable means that it's less likely

01:30:30.960 | to be littered with awakenings,

01:30:32.640 | meaning that it's better quality of sleep.

01:30:35.840 | In terms of electrical quality of sleep,

01:30:38.400 | we did mention this in a prior episode

01:30:41.120 | when we spoke about sort of food and exercise.

01:30:44.320 | Exercise seems to be one of those things

01:30:46.400 | that's very good at improving the quality

01:30:49.000 | of your deep sleep.

01:30:50.200 | And here I'm talking about the electrical quality

01:30:53.920 | of your deep sleep.

01:30:55.680 | Try to make sure that you're physically active to a degree.

01:30:59.640 | And I think this is a protocol

01:31:01.680 | and I think it's a meaningful protocol,

01:31:02.960 | but to go so to the extreme where I were to say,

01:31:06.360 | you need to do at least 32 and a half minutes

01:31:09.800 | on a spin bike at this wattage or, you know,

01:31:12.600 | we can't prescribe quite at that point,

01:31:15.160 | you know, scientific prescription, not medical.

01:31:17.200 | And so I would say exercise is one.

01:31:19.480 | Then we spoke about another, which was temperature.

01:31:22.480 | And we said that getting your bedroom cool

01:31:25.520 | seems to be a way to promote the increase in deep sleep.

01:31:29.800 | So these are two dos, which is get regular, get cool.

01:31:34.800 | The don'ts, we've already spoken a little bit about too.

01:31:39.200 | One of the things that I probably didn't mention enough

01:31:41.400 | with alcohol, not only does it seem to compromise

01:31:46.040 | your rapid eye movement sleep,

01:31:48.200 | but it will fragment your sleep.

01:31:50.040 | It will make your sleep more unstable.

01:31:52.120 | And an indirect consequence of that is alcohol

01:31:55.920 | is going to be in highest concentrations in your system

01:31:59.200 | after drinking in the evening with sleep

01:32:01.600 | in the first four to five hours.

01:32:03.400 | Now that depends on how quickly you metabolize it

01:32:05.520 | and how much you've had,

01:32:06.400 | but let's assume some degree of standardization.

01:32:09.240 | In other words, I said that alcohol

01:32:11.280 | will not just block your REM sleep,

01:32:12.800 | it will fragment your sleep,

01:32:14.160 | makes your sleep more vulnerable to you waking up.

01:32:17.280 | Well, you're especially vulnerable

01:32:19.000 | in the first four or so hours

01:32:21.160 | because that's when alcohol concentration

01:32:23.000 | is highest in your system.

01:32:24.800 | And therefore the first four hours can also fall prey

01:32:28.080 | to the greatest culling of your sleep quality.

01:32:32.080 | And if you're removing or restricting some of that quality

01:32:35.800 | in the first four hours,

01:32:36.880 | what type of sleep are you principally restricting?

01:32:39.600 | You're restricting deep sleep

01:32:40.960 | because we've said deep sleep comes in the first half,

01:32:43.400 | dream sleep, REM sleep in the second half.

01:32:45.960 | So don'ts would be try to stay away

01:32:49.160 | from excessive alcohol in the evening.

01:32:52.880 | We also know that alcohol is associated

01:32:55.200 | with longer term chronic anxiety.

01:32:59.360 | And the tragedy is that it's often used

01:33:02.120 | as a way to blunt the anxiety

01:33:04.400 | because alcohol is a sedative

01:33:07.240 | and it can help just alleviate, take the edge off,

01:33:11.560 | but it's a short term "win" for a long-term loss

01:33:15.320 | 'cause overall it will increase anxiety levels.

01:33:18.040 | So I would say those are some dos and perhaps a don't

01:33:21.680 | if you want to try to optimize your sleep quality,

01:33:24.160 | including the integrity of your sleep

01:33:26.640 | and also the electrical quality of your sleep.

01:33:29.960 | - Terrific.

01:33:30.800 | I think because so many people struggle with anxiety

01:33:33.760 | ranging from mild to severe anxiety,

01:33:35.960 | the tips you just provided

01:33:37.400 | are gonna be immensely beneficial.

01:33:40.400 | And in addition to that,

01:33:41.520 | the previous four episodes

01:33:44.040 | that we've recorded for this series,

01:33:45.520 | each and all include tools that is protocols

01:33:49.440 | for improving the QQRT aspects of sleep.

01:33:53.560 | So all the more reason for people to dig into those

01:33:57.520 | and to glean the gems that you've laid out for people

01:34:00.880 | because they really are very actionable.

01:34:03.680 | And most all, perhaps even all of the tools

01:34:07.480 | that we've discussed in those episodes are zero cost.

01:34:10.320 | They require a little bit of time investment,

01:34:12.120 | some thought and consideration,

01:34:15.080 | but they're not really that difficult to implement.

01:34:17.720 | They just require a little bit

01:34:18.960 | of being one's own scientist of self.

01:34:23.000 | - And be in your own corner when it comes to sleep.

01:34:25.400 | And I love the low cost method that we mentioned

01:34:28.640 | was not just temperature

01:34:30.320 | in terms of keeping your room cool,

01:34:32.480 | but warm bath or shower before bed.

01:34:36.280 | I mentioned improved sleep,

01:34:37.800 | but one of the things that improves most

01:34:39.720 | is deep non-REM sleep.

01:34:41.160 | So there's another technique,

01:34:42.840 | get your room cool to go into,

01:34:44.880 | but warm up to cool down to fall asleep,

01:34:48.240 | which then keeps you cool so that you stay asleep

01:34:51.400 | and you'll get more deep sleep.

01:34:53.520 | - Fantastic.

01:34:54.480 | Although it's a terribly unhappy topic,

01:35:01.720 | suicide is an important topic for us to cover here.

01:35:07.200 | I can think of few things more tragic than suicide.

01:35:10.800 | And yet sadly, it accompanies

01:35:15.040 | certain psychiatric conditions.

01:35:17.120 | I think people with menopipolar have a 20 to 30

01:35:21.480 | times greater probability of suicide than others,

01:35:25.360 | but suicide accompanies major depression, anxiety, PTSD.

01:35:30.360 | Again, it's a tough topic to get into,

01:35:34.760 | but an important one to get into.

01:35:36.520 | What is the relationship between suicidality and sleep?

01:35:41.520 | And then I suppose we could look at this

01:35:43.840 | from the perspective of to what degree

01:35:46.480 | does sleep deprivation correlate with suicide

01:35:50.200 | or attempted suicides?

01:35:51.920 | And what sort of inoculatory effects

01:35:54.920 | does sleep provide towards suicide?

01:35:57.240 | - Unfortunately, we don't know much

01:35:59.760 | about the second part of the question,

01:36:01.280 | which is how can sleep be used

01:36:03.440 | as a risk mitigating tool when you know

01:36:07.840 | that there is the risk of suicide in place?

01:36:10.440 | There's been a number of people who are doing this work,

01:36:13.400 | including my colleague, Alison Harvey,

01:36:14.880 | again at the University of California, Berkeley,

01:36:18.640 | and Sherry Johnson, who's also there too.

01:36:21.280 | I would say though that the first question

01:36:23.400 | is quite answerable, which is what do we know firstly

01:36:26.680 | about how a lack of sleep can impact suicide?

01:36:30.560 | Some of the earliest data that we found

01:36:32.480 | were associational relationships.

01:36:35.000 | What we found is that short sleep

01:36:37.240 | or poor quality of sleep predicted three things.

01:36:41.440 | It predicted suicidal ideation,

01:36:45.480 | meaning that you had thoughts of suicide.

01:36:48.760 | Bad sleep seemed to predict suicide attempts.

01:36:53.040 | And then tragically more recent data,

01:36:55.760 | a lack of sleep predicts suicide completion.

01:37:00.920 | And what makes me think more causally about it,

01:37:02.880 | and we've been trying to get some grants

01:37:04.800 | and we failed to do so so far to do more of this work

01:37:07.680 | because I'm just so compelled by it.

01:37:09.760 | And you're right, it's one of the most tragic situations.

01:37:13.240 | Those sleep relationships aren't simply happening

01:37:19.080 | at the same moment in time.

01:37:20.480 | What I mean is that the sleep disturbance

01:37:23.160 | that we see precedes the onset of having suicidal thoughts.

01:37:29.680 | It precedes the onset of suicide attempt

01:37:32.960 | and it precedes the suicide completion.

01:37:37.080 | So what this has been teaching me

01:37:39.280 | is I've been looking at the data

01:37:40.400 | and we've looked at a little bit of our own data.

01:37:42.600 | Sleep disruption when it comes to suicide

01:37:45.400 | is almost the canary in the coal mine.

01:37:48.360 | It's almost like a tragic crystal ball

01:37:51.160 | that when you see that sleep starting to dismantle,

01:37:55.920 | it is a foreshadowing sign

01:37:58.880 | of a very dark series of events that will unfold.

01:38:02.400 | In other words, could we now start to think,

01:38:06.640 | and this is one of the things that we want to do,

01:38:08.800 | is sleep a biomarker, is sleep disruption, I should say,

01:38:13.160 | a biomarker for upcoming suicide risk before it begins?

01:38:18.160 | The idea of finding a biomarker

01:38:21.080 | or collection of biomarkers for suicide,

01:38:23.800 | I think is one of the more important missions

01:38:25.840 | of neuroscience, AI, and mental health generally.

01:38:29.480 | There's a brilliant young researcher

01:38:31.360 | up at the University of Washington named Sam Golden.

01:38:34.400 | He's spent a lot of his career studying animal models

01:38:38.000 | of aggression and rage.

01:38:42.440 | And of course, some forms of suicide

01:38:46.120 | are thought to be forms of self-directed aggression

01:38:49.160 | and rage, if it makes sense.

01:38:51.160 | Some forms of suicide perhaps are different.

01:38:53.640 | I don't think we quite understand

01:38:56.080 | what suicide represents in the brain just yet.

01:38:59.240 | And I think having spoken to Paul Conti

01:39:02.080 | and others about suicide,

01:39:04.000 | it's clear that there are unfortunately many paths to suicide

01:39:09.640 | and there isn't one brain state.

01:39:11.240 | Nonetheless, Sam's laboratory has been developing tools

01:39:15.520 | that help people with suicidal tendencies

01:39:20.200 | or people who have had suicidal ideation

01:39:23.680 | or plans in the past

01:39:24.960 | with these AI-based tools where it detects changes

01:39:29.480 | in their voice, in their sleep patterns,

01:39:33.600 | and in a few other metrics that I don't recall

01:39:37.040 | that together become very good predictors

01:39:39.680 | of later suicidal ideation.

01:39:42.480 | So the idea here is that people who are prone to suicide

01:39:47.800 | often don't realize that they're drifting that way

01:39:50.200 | until it can sadly be too late.

01:39:52.680 | So the point here is, A, biomarkers are key.

01:39:57.680 | B, these biomarkers are being developed.

01:40:00.200 | C, AI is critical, but that according to Sam,

01:40:03.920 | changes in sleep patterns is absolutely central

01:40:07.880 | to these algorithms for allowing people

01:40:10.480 | to detect their own potential for suicide.

01:40:13.760 | - I think it's critical, and we thought about this

01:40:15.800 | when we started to see these sleep signals

01:40:18.000 | that were preemptive, that were almost precognitive

01:40:20.960 | in the sense of prediction,

01:40:23.120 | occurred to me that we're at the stage

01:40:26.720 | of technological evolution,

01:40:29.400 | that if we get consent of many individuals

01:40:32.800 | who become suicidal,

01:40:35.120 | they are interested in some degree of support.

01:40:40.680 | And we often, but of course, some people will just recoil

01:40:45.360 | and go into themselves,

01:40:46.560 | and that's when things can get very problematic as well.

01:40:50.320 | But it would require some degree of consenting

01:40:53.200 | that if you have a history of suicide ideation in the past,

01:40:58.200 | what if you were to be able to consent and say,

01:41:01.400 | "I would like to risk mitigate,"

01:41:03.240 | and you have a wearable, like a watch,

01:41:06.160 | and that watch is connected to your phone,

01:41:09.880 | and there is a signal that can come from your watch

01:41:12.720 | that dials a series of phone numbers

01:41:15.320 | in order of preference.

01:41:17.520 | And when your watch starts to detect

01:41:20.000 | that your sleep has this,

01:41:23.040 | and one of the things we really want to understand

01:41:24.720 | is what is the specific signature of sleep abnormalities?

01:41:28.560 | It's not just that your sleep gets short,

01:41:31.080 | but is it that your sleep gets long and then short,

01:41:34.560 | and then long and then short,

01:41:35.760 | but it constantly has poor quality of sleep,

01:41:38.840 | and the regularity is all over the place,

01:41:41.040 | but the chronotype timing is still in place.

01:41:43.480 | What sort of specific pattern of those things

01:41:48.480 | is the hallmark that is most predictive of suicide?

01:41:52.520 | Let's say that I can come up with that algorithm finally,

01:41:55.440 | and then we can implement it into a watch

01:41:58.640 | or a tracking device of some sort.

01:42:01.040 | And when it starts to see that pattern,

01:42:03.440 | it's constantly pattern matching,

01:42:05.760 | and it starts to see that

01:42:07.160 | across whatever number of days we say,

01:42:09.440 | if you see this across six nights or across 13 nights,

01:42:14.440 | this is serious.

01:42:16.120 | It then triggers that phone

01:42:19.920 | to send a message to those individuals

01:42:23.000 | who are the designated support carers.

01:42:25.680 | And those people then reach out and start to say,

01:42:29.400 | how are you doing?

01:42:30.360 | Would you like to have a phone call?

01:42:32.960 | Can I come over?

01:42:34.280 | Can I make you some food?

01:42:36.040 | And I'd love to have a chat with you.

01:42:38.600 | Can you find a way to bootstrap a condition

01:42:41.520 | where you constantly then otherwise become asocial

01:42:44.760 | or antisocial and lose all support network?

01:42:48.160 | So that would be the sort of the grandiose idea.

01:42:52.440 | The other thing that's very interesting

01:42:54.360 | is that we could measure the activity

01:42:56.720 | and their wakefulness at night.

01:42:59.320 | And the reason I bring this up is some great work

01:43:01.480 | by Michael Perlis and Michael Grandner,

01:43:05.160 | who've looked at suicide,

01:43:07.480 | both attempts and suicide completion

01:43:10.920 | across the 24 hour period.

01:43:13.360 | It's not constant.

01:43:15.160 | It's not that you see suicide ideation

01:43:17.680 | and suicide attempts and completion

01:43:20.600 | in a distributed manner equally across the 24 hour period.

01:43:24.880 | When do they principally occur?

01:43:26.960 | They occur in the late middle of the night.

01:43:31.000 | And there's this almost four to five hour period,

01:43:34.600 | somewhere on average, and again, it's just an average,

01:43:37.560 | somewhere between let's say 1 a.m. and 4 a.m.,

01:43:41.360 | which turns out to be right at the lowest dip

01:43:44.360 | of your circadian rhythm, and it could be circadian rhythm.

01:43:47.040 | But I also think that there is something about,

01:43:49.920 | of course, the nighttime-ness when no one else is around

01:43:53.520 | and it is just you, bad point number one.

01:43:57.280 | Second, as we've spoken about before on this episode,

01:44:00.920 | negative thoughts are 10 times worse

01:44:05.680 | in the darkness of night than they are in the light of day.

01:44:10.680 | And third, at that point, if you're awake,

01:44:16.160 | you're not asleep.

01:44:17.760 | And we know sleep is providing this ballast

01:44:20.720 | to your mental health.

01:44:22.160 | So on all three of those counts,

01:44:24.960 | you see this very strong spike in suicide ideation,

01:44:29.800 | suicide attempt, and also suicide completion

01:44:32.920 | in this bewitching hour in the middle of the night.

01:44:36.160 | There is a final piece in the suicide story, though,

01:44:38.760 | that is only just emerging.

01:44:41.240 | If you are not getting sufficient sleep,

01:44:43.520 | you are somewhere between two to three times more likely

01:44:47.920 | to go into that suicidal state,

01:44:50.960 | which is a very significant number.

01:44:53.840 | However, when people started to measure another factor

01:44:58.960 | of sleep and particularly dream sleep,

01:45:01.720 | which was the dream content itself,

01:45:05.600 | it became even more predictive.

01:45:06.880 | And we've not really seen this very much

01:45:08.880 | in psychiatric conditions.

01:45:10.880 | But what they found was that instead of using

01:45:13.040 | your sleep disruption or your lack of sleep

01:45:15.720 | as a predictor of your suicide risk,

01:45:18.400 | we use nightmares as a predictor of your suicide risk.

01:45:22.880 | That predictive value, that risk,

01:45:25.280 | went from about two to three times more likely

01:45:28.200 | to somewhere between five to eight times more likely.

01:45:33.200 | There is something special going on with bad dreams

01:45:37.960 | and specifically nightmares that is even more predictive

01:45:42.880 | than this physiological thing that we call sleep itself.

01:45:47.280 | And we'll probably come on to maybe some of the reasons

01:45:49.360 | why dreaming and particularly nightmares

01:45:51.600 | in the next episode on dreaming

01:45:54.360 | could explain exactly why that is.

01:45:57.080 | But it's a new finding.

01:45:58.560 | I don't think we can say much more about it now,

01:46:01.240 | but it is one of the most, I think, novel findings

01:46:04.240 | in the psychiatric sleep story

01:46:06.840 | that now dreams have come above and beyond

01:46:10.840 | simply sleep itself as a predictor of mental illness

01:46:15.080 | and specifically a form that will take your life

01:46:18.320 | tragically very quickly.

01:46:19.920 | - When I think about depression,

01:46:23.560 | I immediately associate that

01:46:25.960 | with excessive amounts of sleep.

01:46:27.880 | After all, it's called depression.

01:46:31.600 | But what is the real link between major depression,

01:46:35.400 | which is the classical signs of malaise,

01:46:40.400 | one of the hallmark features also being

01:46:44.000 | a lack of optimism about the future

01:46:48.240 | or and/or ability to sense into the future.

01:46:52.640 | That's what, it's not the only criteria.

01:46:55.040 | When Dr. Karl Deisseroth,

01:46:57.040 | the great neuroscientist that he is,

01:46:58.960 | was on this podcast.

01:47:00.440 | And of course, he's also a practicing clinical psychiatrist.

01:47:04.640 | When we were talking about depression,

01:47:06.020 | he mentioned that another hallmark of major depression

01:47:09.400 | is people waking up at two or 3 a.m.

01:47:12.040 | and not being able to fall back asleep.

01:47:14.480 | This just seems like a recipe for disaster all around

01:47:17.480 | that the very condition that you're trying to

01:47:21.220 | perhaps ameliorate with additional sleep

01:47:24.640 | is preventing you from sleeping.

01:47:26.200 | It's like the, can't imagine.

01:47:27.880 | - It's very cruel, isn't it?

01:47:28.720 | - A whole lot of things more diabolical

01:47:30.920 | in terms of the sleep science.

01:47:34.000 | So what's the relationship between sleep and depression

01:47:36.100 | and how should one untangle that

01:47:38.680 | like seemingly Gordian knot?

01:47:40.960 | - It is like the other conditions,

01:47:45.760 | bidirectional, that depression can disrupt sleep very much.

01:47:51.340 | And disrupted sleep can trigger depression.

01:47:53.940 | Depression is interesting, by the way.

01:47:55.580 | Some people have conceptualized it

01:47:57.320 | as being different to anxiety based in some ways on memory,

01:48:02.320 | which is that when you think about anxiety,

01:48:05.180 | people consider anxiety a disorder of the future,

01:48:09.380 | that you are constantly worried

01:48:11.220 | about what's coming up in the future.

01:48:13.820 | I didn't do this today, so I need to do that tomorrow.

01:48:16.600 | And then I've got that other thing next week,

01:48:19.220 | or I'm fearful of going out to see them tomorrow.

01:48:22.460 | I just, I'm fearful of taking that flight tomorrow.

01:48:25.900 | It seems to be so much about prospective future.

01:48:30.300 | Whereas other people have suggested

01:48:32.300 | depression is the opposite.

01:48:34.180 | It's about rumination of the past.

01:48:36.940 | I went through this event, I had this bereavement,

01:48:39.900 | I had this painful divorce.

01:48:42.100 | I just can't get over my past.

01:48:46.180 | Now, I don't necessarily know if that's entirely true,

01:48:49.900 | but it is interesting in the sense that both of those,

01:48:54.580 | abnormal prospection, worry of the future,

01:48:58.580 | and abnormal retrospection, sort of ruminating on the past,

01:49:03.580 | seem to disrupt sleep.

01:49:06.900 | - Before you continue,

01:49:08.340 | I just wanted to drill into that idea just a little bit,

01:49:11.220 | 'cause I think it's a really interesting one

01:49:13.240 | worth exploring.

01:49:14.460 | Again, I'm no psychiatrist,

01:49:15.860 | but I have heard, and I've experienced,

01:49:19.300 | I've had a depression.

01:49:20.580 | I think it's, my understanding is it's normal

01:49:22.660 | for people to experience a major depressive episode

01:49:26.260 | at some point in their lives.

01:49:27.820 | Could be situationally triggered or not.

01:49:30.180 | But that for others, unfortunately,

01:49:34.620 | they have repeating major depressive episodes.

01:49:37.940 | And hopefully some people go through life

01:49:39.780 | never having had a depressive episode.

01:49:41.700 | But as I recall, one of the more salient

01:49:45.460 | thought patterns was that I used to have something

01:49:49.180 | that somehow was lost,

01:49:50.260 | and I couldn't quite figure out what it was.

01:49:52.060 | It was this recurring feeling of, right,

01:49:55.140 | like things were on track, and then they got off track,

01:49:57.580 | but not being able to tack the progression

01:50:00.900 | from on track to off track to one particular event.

01:50:03.300 | It was this sort of sense that like,

01:50:04.860 | I had something that then was lost.

01:50:06.340 | Now, fortunately for me, it eventually lifted,

01:50:08.860 | and it didn't get dangerously bad.

01:50:13.020 | But I've had some close friends

01:50:14.420 | who've gone through individual or several major depressions.

01:50:18.740 | And I hear this, like this idea that they had it,

01:50:22.100 | or they think something was there that then they lost.

01:50:24.380 | So I think I agree with your assessment.

01:50:25.940 | - It fits very well.

01:50:26.780 | If you think about the word that you just used,

01:50:28.340 | had is about, it's the past.

01:50:33.340 | It's past tense.

01:50:34.860 | - Right, and then if we apply the criteria

01:50:37.660 | that is indeed part of the criteria

01:50:40.100 | for determining if somebody has major depression,

01:50:42.140 | which is a lack of optimistic outlook on the future,

01:50:45.220 | one can see how one could be very much stuck in the present

01:50:47.660 | and focused on the past,

01:50:48.700 | and just stuck in that spin cycle.

01:50:51.820 | Anyway, we're not here to decide

01:50:55.100 | what depression is or isn't in every case,

01:50:57.540 | but given that-

01:50:58.380 | - Yeah, I'm not a psychiatrist either.

01:51:00.740 | - Right, but I think this distinction

01:51:02.380 | between anxiety being about the future

01:51:04.740 | in a way that disrupts one's present,

01:51:06.420 | and depression being about often the past

01:51:09.420 | in a way that disrupts one's sense of the present

01:51:12.380 | and the future, makes a lot of sense.

01:51:14.540 | It's just a nice, not nice, it's unfortunate,

01:51:17.820 | but it's a useful contextualization, yeah.

01:51:22.820 | Thank you.

01:51:24.180 | - And to your question though about sleep,

01:51:27.780 | it's been a little bit interesting with depression.

01:51:32.060 | Firstly, what we know is that depression

01:51:34.500 | will disrupt your sleep and make your sleep shorter.

01:51:37.420 | And it comes back to your comment from Karl,

01:51:41.620 | from Karl Deisseroth.

01:51:43.060 | We often see that patients will have problems

01:51:46.140 | staying asleep.

01:51:47.140 | They wake up in the middle of the night,

01:51:48.620 | they can't get back to sleep.

01:51:50.380 | It's problematic.

01:51:51.660 | And therefore their sleep duration

01:51:54.500 | and their sleep quality decrease.

01:51:56.980 | However, on the other hand,

01:51:58.740 | there is an interesting question by the way of,

01:52:00.860 | can you get too much sleep?

01:52:02.660 | Which I should probably come back

01:52:04.260 | 'cause there's a whole episode to do on that probably.

01:52:06.540 | But one of the places where we see quote unquote,

01:52:10.300 | too much sleep is in the depression literature.

01:52:14.140 | And it's a condition that we call hypersomnia.

01:52:17.180 | In other words, increased or excessive degrees of sleep,

01:52:21.620 | hypersomnia.

01:52:23.500 | But a great PhD students at Berkeley looked at the data.

01:52:28.500 | Kate Kaplan is a fantastic cognitive behavioral therapist

01:52:33.100 | now and a clinical psychologist,

01:52:35.260 | looked a little bit at the data

01:52:36.900 | and others have looked at this too.

01:52:38.900 | When you examine what people were asking those patients

01:52:44.540 | where there is this conclusion

01:52:46.100 | that patients with depression can sleep too long.

01:52:49.740 | Really what they were asking in those studies

01:52:51.660 | was what time do you go to bed?

01:52:53.660 | And what time do you wake up?

01:52:56.580 | And there, what you clearly find

01:52:58.220 | is that people with depression will be in bed

01:53:01.300 | for significantly longer periods of time.

01:53:04.220 | And the inference there,

01:53:06.380 | and you could argue almost the conflation

01:53:08.540 | is that if you're in bed for longer,

01:53:11.140 | then you're sleeping for longer.

01:53:12.500 | And therefore depression is a condition of hypersomnia.

01:53:17.220 | But when people looked at this a little bit more

01:53:19.220 | in a nuanced way and asked a different question,

01:53:21.780 | what time did you go to sleep?

01:53:23.580 | And what time did you wake up?

01:53:25.660 | That hypersomnia phenomenon is nowhere near as strong

01:53:29.380 | as you would have been led to believe otherwise

01:53:32.500 | from the, what time did you go to bed?

01:53:34.500 | And what time did you wake up?

01:53:36.860 | And I think part of the reason comes back

01:53:38.740 | to depression as a condition.

01:53:41.380 | When you think about depression,

01:53:42.660 | one of the aspects, one of the features

01:53:45.220 | is that you're depressed to the point

01:53:47.540 | where you just don't want to interact with the world.

01:53:50.500 | And what better place to spend if that's your mentality

01:53:55.460 | than this thing called bed?

01:53:57.060 | I just don't want to get out of bed.

01:53:59.660 | I'm just going to stay here and lie in bed.

01:54:01.180 | I'm awake, I'm not asleep.

01:54:03.100 | And so we don't quite know yet if depression

01:54:06.020 | is a condition that is associated with long sleep.

01:54:09.740 | We certainly know it's associated with short sleep

01:54:11.700 | and disrupted sleep, or that is masquerading

01:54:15.660 | as this thing called hypersomnia.

01:54:17.180 | But when you really look at the data,

01:54:19.060 | it's not quite so clear.

01:54:21.260 | That was the first peculiarity in depression

01:54:27.340 | that there could be this paradox of yes, long sleep,

01:54:30.380 | but also not enough sleep, too short sleep.

01:54:33.220 | One of the earliest findings in depression and sleep

01:54:35.980 | and has been quite well replicated

01:54:38.220 | is a change in REM sleep.

01:54:40.460 | But now it wasn't necessarily that individuals

01:54:43.820 | who had depression slept

01:54:46.700 | or had excessive amounts of REM sleep.

01:54:49.780 | They had a little bit more.

01:54:51.940 | What was interesting is that when that REM sleep emerged

01:54:55.740 | during the night was much earlier.

01:54:58.660 | And in the first episode, I was telling you that

01:55:00.860 | when your head hits the pillow,

01:55:02.500 | you go down to the light stages of non-REM,

01:55:04.420 | then into the deeper stages.

01:55:06.300 | And then maybe after about 50, 60, 70, 80 minutes,

01:55:09.420 | you'll pop up and you'll have your short REM sleep period.

01:55:12.220 | But that first REM sleep period in people with depression

01:55:16.740 | seemed to have been called up by the brain

01:55:20.620 | abnormally or not much earlier.

01:55:24.020 | So it's what we call REM sleep latency.

01:55:27.300 | From the moment that you fell asleep,

01:55:29.620 | what is the time, what is the latency

01:55:32.180 | of the first arrival of REM sleep?

01:55:35.100 | And that REM sleep latency was significantly shorter

01:55:39.020 | in those people with depression.

01:55:41.220 | REM sleep was arriving earlier.

01:55:43.780 | Now it's hard because you can argue,

01:55:46.180 | and these are the most dangerous hypotheses,

01:55:48.340 | you can argue both sides of it.

01:55:49.900 | You can say, well, perhaps that's because,

01:55:52.580 | Matt, you also spoke to me that REM sleep may be important

01:55:55.820 | for some aspects of the emotional brain.

01:55:58.700 | And when you are depressed,

01:56:00.020 | the brain knows that REM sleep is required

01:56:02.540 | and it calls it up on the menu of the series of dishes

01:56:07.380 | that you're going to be served earlier on in the night

01:56:10.620 | because it's needed more significantly.

01:56:14.180 | The other, and that's the adaptive theory,

01:56:17.860 | the other is the maladaptive theory,

01:56:19.860 | which is that arriving with your REM sleep too early

01:56:24.700 | does not do your brain good things,

01:56:27.540 | and therefore it's some abnormality of emotional processing.

01:56:32.540 | The data that's interesting there

01:56:35.380 | is that if you look at some antidepressants,

01:56:37.980 | many of them will either delay the onset of REM sleep

01:56:41.900 | or they will reduce it significantly.

01:56:44.460 | Now there's a huge debate about the efficacy

01:56:47.220 | and the utility of antidepressants,

01:56:49.620 | and I don't have a horse in that race

01:56:51.700 | and I don't know enough about that literature to comment.

01:56:54.180 | I would simply say though that it's at least intriguing to me

01:56:57.980 | that some medications that are commonly prescribed

01:57:02.100 | as antidepressants will alter specifically REM sleep

01:57:06.460 | and push it later or try to reduce it down.

01:57:10.980 | And that would fit with the maladaptive hypothesis

01:57:14.260 | that this arrival of REM sleep so early in depression

01:57:17.900 | and perhaps having a little too much REM sleep isn't optimal.

01:57:21.300 | And when you push back against that with pharmacology,

01:57:23.940 | i.e. antidepressants,

01:57:25.620 | you seem to get some degree of resolution

01:57:28.900 | or reduction in the depression symptomatology.

01:57:32.540 | Again, I don't think we clearly understand that.

01:57:35.780 | Another strange thing that has been often cited to me

01:57:42.100 | many times about sleep and depression

01:57:46.220 | is a literature that suggests

01:57:48.260 | that if you deprive people of sleep,

01:57:50.620 | which time and again in this episode we've said

01:57:53.300 | leads to bad outcomes for mental health,

01:57:56.180 | it does exactly the opposite in depression.

01:57:59.540 | That if you sleep deprive a depressed patient,

01:58:03.620 | you get a resolution of the depression.

01:58:07.260 | And that is the claim that's often made to me.

01:58:09.140 | Now, it is a very clear set of data in the literature,

01:58:13.740 | but there are two potential concerns with it.

01:58:17.020 | The first concern is that

01:58:18.660 | not all patients respond to sleep deprivation.

01:58:22.340 | In fact, if you look at the data,

01:58:23.620 | it's somewhere between 30 to 55% of patients

01:58:27.980 | will be responders to sleep deprivation.

01:58:31.060 | The other proportion of those patients don't respond

01:58:34.300 | or if anything, get worse when you sleep deprive them.

01:58:37.820 | And then the question is, well, how would you know?

01:58:40.740 | And right now, and there've been some brain imaging studies,

01:58:43.420 | some PET studies done way back at UC Irvine

01:58:46.820 | and other locations where they were trying to say,

01:58:49.340 | is there something about the metabolic activity

01:58:51.380 | of your brain that can predict

01:58:52.900 | if you're a responder or not to sleep deprivation?

01:58:55.620 | 'Cause at least then we would know

01:58:58.100 | who should we push through this "treatment"

01:59:01.660 | and who should we not because it's going to be bad for them.

01:59:04.780 | That's the first issue.

01:59:06.300 | And we don't have a clear understanding.

01:59:08.180 | The second issue is that as soon as those patients

01:59:11.580 | with depression sleep after the deprivation,

01:59:14.980 | the antidepressant benefit goes away

01:59:17.180 | and they go right back to being depressed again.

01:59:19.860 | So yes, it's a mechanistically interesting process.

01:59:23.660 | What is it about sleep deprivation

01:59:25.500 | that could alleviate depression?

01:59:27.660 | And I'll explain why I think it can.

01:59:29.580 | But it's not a sustainable one.

01:59:32.740 | It's not a clinically viable one.

01:59:34.940 | Why would it have that effect if it does?

01:59:39.980 | Well, you and I discussed earlier in this episode

01:59:43.060 | that when you are sleep deprived,

01:59:44.740 | not only does your emotional brain

01:59:46.420 | become much more responsive to negative things,

01:59:49.420 | it also becomes much more responsive

01:59:51.420 | to rewarding positive things.

01:59:53.940 | And one of the interesting things

01:59:55.100 | that I think people mistake about depression,

01:59:57.820 | they just think that when I'm depressed, I have sad mood,

02:00:01.900 | I have negative mood.

02:00:03.540 | That's not entirely true.

02:00:05.540 | One of the principal features of depression

02:00:07.820 | is something that we call anhedonia,

02:00:10.500 | which is an absence of having the ability

02:00:13.420 | to have hedonic responses.

02:00:15.660 | In other words, you can't get pleasure

02:00:18.580 | from normally pleasurable things.

02:00:20.980 | It's not an issue about sliding down to the negative.

02:00:24.380 | It's the absence of being able to experience the positive

02:00:29.180 | that puts you on a track towards depression.

02:00:32.300 | And what you and I discussed earlier in this episode

02:00:34.660 | is some of the work that we've been doing,

02:00:36.580 | where when you sleep deprive individuals,

02:00:38.740 | but you show them very rewarding based stimuli,

02:00:40.860 | they become much more reward sensitive.

02:00:44.060 | And perhaps this is why patients will respond

02:00:48.260 | to sleep deprivation with depression,

02:00:50.180 | because they're too far away

02:00:51.940 | from that positive end of the spectrum.

02:00:53.980 | They're not reward sensitive enough.

02:00:55.820 | They don't get a positive, good feeling.

02:00:58.900 | Now, if you're someone who is healthy

02:01:01.180 | and you're sleep deprived,

02:01:02.140 | you go too far in the reward direction

02:01:04.860 | and you become vulnerable to reward and sensation seeking.

02:01:07.860 | But if you're depressed and you're shifted

02:01:10.620 | to sort of away from that,

02:01:13.220 | and sleep deprivation brings you back closer

02:01:15.620 | to a normative reward based reactivity,

02:01:19.340 | maybe that's the reason why you get

02:01:21.140 | this antidepressant benefit

02:01:22.980 | and why when you start sleeping again,

02:01:25.860 | you take away that enhanced reward sensitivity

02:01:29.700 | and you lose the antidepressant benefit.

02:01:33.780 | So I think we still don't know enough

02:01:36.220 | about depression and sleep yet.

02:01:40.140 | If you were to ask me of the four,

02:01:41.980 | quantity, quality, regularity, and timing,

02:01:45.300 | which would be ideal,

02:01:47.020 | I would say all four are definitely players,

02:01:51.420 | but timing may have some of the best evidence

02:01:54.460 | because it's not just about sleep

02:01:57.100 | when it comes to depression,

02:01:58.300 | it's also about your circadian rhythm.

02:02:00.860 | That if you are not aligned with your natural chronotype,

02:02:04.580 | your natural 24 hour rhythm, circadian misalignment,

02:02:09.580 | when you fall out of synchrony

02:02:11.460 | with your natural chronotype

02:02:13.740 | is a strong predictor of depression.

02:02:17.300 | So if there is an actionable item,

02:02:19.780 | first, it would be to say

02:02:21.420 | from a big picture perspective,

02:02:23.300 | understand that sleep is one of the

02:02:26.940 | least painful available options for you

02:02:33.860 | as a no cost to try to stabilize your mental health.

02:02:37.980 | Now, I'm not suggesting that all psychiatric conditions

02:02:41.420 | are sleep disorders, that's not true.

02:02:44.180 | And I'm not suggesting that you should stop

02:02:46.900 | simply at the place of getting your sleep straight

02:02:50.100 | to help with your mental conditions, not at all.

02:02:54.140 | I am saying, however,

02:02:55.220 | that if you do get your sleep straight,

02:02:57.900 | it's only going to help and may help

02:03:00.260 | quite a significant amount based on the data.

02:03:04.100 | But when it comes to depression,

02:03:05.540 | I would say of those four, QQRT,

02:03:08.580 | there's a very strong emerging data

02:03:10.540 | that circadian misalignment,

02:03:12.420 | not matching your chronotype to the time

02:03:14.580 | when you are sleeping and the time you are awake

02:03:17.260 | is one of the strongest factors.

02:03:19.740 | So if you want to say, I can't do all of them, Matt,

02:03:22.700 | I can't do all of this QQRT nonsense,

02:03:25.300 | just tell me one of them to start with.

02:03:27.740 | I would say, don't worry, we'll get to the three others.

02:03:29.940 | Let's just start with getting your timing right.

02:03:32.340 | Let's understand what type you are.

02:03:34.380 | Take the, go online, you can take one of these tests,

02:03:37.660 | the MEQ, the Morningness Eveningness Questionnaire.

02:03:41.340 | You can just Google it, it's free, you can do it.

02:03:43.300 | - We'll write a link to it in the show note caption.

02:03:44.900 | - That's great.

02:03:46.140 | Understand what type you are,

02:03:47.660 | and then try to understand based on what time

02:03:50.620 | I'm currently awake and asleep,

02:03:52.420 | is it matched, is it mismatched?

02:03:53.940 | And if it's mismatched,

02:03:55.260 | try to see what you can do

02:03:56.740 | with your lifestyle accommodating, of course,

02:03:59.140 | to match that.

02:04:00.300 | Things will more than likely start there getting better.

02:04:04.220 | - Along those lines, and if I may,

02:04:08.300 | I'd like to just mention a recent study

02:04:11.140 | that I think dovetails with what you just said beautifully,

02:04:14.300 | and seems highly actionable to me.

02:04:16.900 | This was a study published in Nature Mental Health,

02:04:21.300 | which is a relatively new journal,

02:04:23.100 | but it involved exploring the light exposure

02:04:29.220 | and dark exposure patterns of,

02:04:31.140 | I believe it was more than 80,000 individuals.

02:04:33.760 | I'll have to go back and check that.

02:04:35.440 | But what was interesting is that

02:04:37.140 | when they looked at light exposure,

02:04:40.940 | in particular sunlight exposure,

02:04:42.940 | and they looked at darkness exposure

02:04:44.700 | across the 24-hour schedule,

02:04:47.180 | what they concluded was that

02:04:50.260 | there was a near linear relationship

02:04:52.420 | between the amount of light that one gets in the morning

02:04:55.580 | and throughout the day,

02:04:57.740 | and reduction in mental health challenges

02:05:01.380 | in terms of depression, PTSD.

02:05:04.140 | There were a few others.

02:05:05.020 | Some of the effects were less robust

02:05:08.180 | for certain psychiatric conditions

02:05:09.900 | than they were for, say, depression.

02:05:11.780 | What was equally interesting is that darkness,

02:05:13.660 | the absence of light,

02:05:15.060 | turned out to be as important a variable

02:05:18.140 | as light during the day.

02:05:20.460 | Made simple, if people tended to be in dim

02:05:24.480 | or dark light at night,

02:05:26.660 | they experienced reductions in their suicidal,

02:05:30.540 | depressive, anxiety, and PTSD symptoms,

02:05:33.780 | independent of how much light

02:05:35.020 | they were getting during the day.

02:05:36.420 | So what this says is get as much light

02:05:38.580 | as one can possibly and safely get in their eyes,

02:05:42.180 | by the way, in the morning and throughout the day,

02:05:44.220 | and then do one's very best to be in very dim

02:05:47.500 | or dark environments at night.

02:05:49.700 | Even goes so far as to say that

02:05:53.540 | if you didn't get sunlight during the day,

02:05:56.100 | then you would be especially well off

02:05:59.220 | being in a very dark environment at night.

02:06:01.140 | - And it's independent, so don't worry.

02:06:03.300 | Yes, it's always good to get that daylight,

02:06:05.540 | but what that paper also teaches us

02:06:08.340 | is that because those things can be independent,

02:06:11.460 | you can still get some benefit,

02:06:13.980 | even if though you've not made a good on your daylight

02:06:17.380 | during the day, getting that darkness at night

02:06:20.060 | is still going to be beneficial.

02:06:21.900 | And I should probably resolve

02:06:23.220 | what some people may think of as confusing.

02:06:25.460 | We spoke about, for example, suicide risk

02:06:27.540 | and it being highest in the depths

02:06:31.020 | of the darkness at night.

02:06:32.700 | I think what's clear from that paper

02:06:34.620 | comes on to one of the fundamental conventional tips

02:06:39.180 | that we spoke about in how to optimize your sleep,

02:06:42.100 | not just an unconventional, but the conventional,

02:06:44.260 | which was, I told you, we are a dark deprived society

02:06:48.060 | and we need darkness at night to help keep our sleep regular.

02:06:53.460 | So the sort of the R in the QQRT.

02:06:57.340 | And I think there in that paper, the inference of course,

02:07:00.460 | is that if you're getting dark at night,

02:07:02.820 | it's going to give you a nice sleep onset signal

02:07:07.060 | so that you are asleep at night in the darkness.

02:07:11.100 | And that sleep at night in the darkness

02:07:13.740 | provides this beneficial, you know,

02:07:16.660 | sort of not immunization, but at least palliative help

02:07:21.540 | to certain psychiatric conditions.

02:07:23.420 | We're not suggesting that darkness at night,

02:07:26.420 | if you're awake at night, however, is beneficial.

02:07:29.940 | That seems to be not beneficial,

02:07:32.900 | but it was such a great paper and very elegant

02:07:36.460 | in how it dissected the independent nature of these things,

02:07:40.540 | which fits very well with, I think,

02:07:42.020 | your mission in part in life,

02:07:43.940 | both as a scientist and as an educator,

02:07:46.060 | which is how can I curate information, gather it together,

02:07:50.460 | and give you some type of actionable boots on the ground,

02:07:54.540 | feet in the trenches advice as to what to do.

02:07:57.580 | It was a great paper.

02:07:59.100 | So thank you for bringing it up.

02:08:00.460 | - Yeah, I only wish I'd done that study,

02:08:02.180 | but I'm so glad that others did.

02:08:04.660 | One thing that's been helpful to me

02:08:06.100 | to encourage more darkness and dim light at night

02:08:11.100 | for myself in my home environment

02:08:12.900 | is to think about artificial photons

02:08:17.180 | coming from artificial sources

02:08:18.460 | as sort of empty calories at night

02:08:21.980 | and how sunlight provided one isn't getting a burn.

02:08:24.980 | And people debate how best to do that.

02:08:27.700 | Physical barrier, everyone agrees on,

02:08:29.420 | certain sunscreens are safer than others.

02:08:31.620 | Some are very safe, some are perhaps less safe.

02:08:34.240 | In any event, the point is that

02:08:36.180 | trying to make one's home environment dark at night

02:08:40.060 | is in my mind now akin to trying to avoid eating sugary,

02:08:46.880 | non-nutritious calories at night as well.

02:08:49.260 | It just lends itself to just overall feelings of wellbeing,

02:08:53.840 | improved sleep, and of course, improved daytime wakefulness.

02:08:56.660 | And then getting sunlight even through cloud cover

02:09:01.100 | in one's eyes early in the day,

02:09:02.980 | and as much as safely possible throughout the day.

02:09:06.820 | And if one can't get sunlight,

02:09:08.100 | getting light from bright artificial sources

02:09:11.060 | seems to be the best alternative.

02:09:12.700 | But I think there's this asymmetry

02:09:15.540 | of light-dark requirement in the same way

02:09:17.440 | that I think most everyone agrees

02:09:19.060 | that eating during one's active hours of the day

02:09:21.620 | is going to be the best way to go,

02:09:23.060 | as opposed to eating during the less active hours

02:09:26.140 | of the late night and certainly prior to sleep.

02:09:29.700 | - Such a good point.

02:09:31.020 | And since it's only you and I here

02:09:32.940 | and no one else watching and witnessing this,

02:09:35.660 | I am thoroughly going to steal that phrase of junk light

02:09:39.660 | and help educate people,

02:09:40.940 | because that's a perfect description.

02:09:42.740 | - It's like empty photons.

02:09:44.220 | - Yeah, you've all heard of junk food.

02:09:45.980 | Well, there's something called junk light.

02:09:48.120 | And if you get your whole foods during the day,

02:09:52.420 | just like you get your whole kind of encompassed light

02:09:56.060 | during the day, that's great.

02:09:57.900 | But then if you start binging on junk light at night,

02:10:02.900 | it's profoundly deleterious to your sleep

02:10:05.980 | and everything that sleep depends on.

02:10:08.980 | It's lovely.

02:10:10.100 | So when people hear me in future public spheres

02:10:13.780 | talking about junk light, you know where it came from.

02:10:16.620 | I will give you full credit.

02:10:17.980 | It's a delightful statement.

02:10:19.500 | - 'Cause I may have lifted it

02:10:21.380 | from somebody else inadvertently.

02:10:23.340 | - We all stand on the shoulders of other giants.

02:10:25.580 | - That's right.

02:10:26.400 | Or other Twitter accounts or something like that.

02:10:28.180 | - Well, I place myself firmly underneath a pedestal,

02:10:31.180 | but yes, we all try to stand on the shoulders of giants.

02:10:34.300 | - Well, wherever you place yourself,

02:10:36.100 | the information that emerges from you

02:10:39.220 | and that emerged today is absolutely spectacular.

02:10:42.460 | You know, I can't think of topics more interesting

02:10:45.220 | and important than emotion regulation, anxiety, PTSD,

02:10:49.820 | suicide, sadly, depression.

02:10:51.500 | All of these things are tragic challenges,

02:10:55.900 | but they are a real part of life.

02:10:58.900 | Some argue even more so nowadays,

02:11:01.300 | perhaps even because of the advent

02:11:04.060 | of so much artificial light and smartphone use

02:11:06.080 | in the middle of the night.

02:11:06.920 | Who knows?

02:11:08.260 | I think it's reasonable to assume

02:11:09.700 | it's at least one variable.

02:11:11.560 | Today, you've provided a ton of depth of understanding

02:11:16.560 | about why sleep and these mental health

02:11:20.700 | and emotional states are linked.

02:11:22.140 | It's just a really clear logical framework

02:11:24.740 | for both the non-REM sleep and REM sleep

02:11:28.220 | and how it impacts mood and reactivity during the daytime.

02:11:32.020 | And also some really actionable tools

02:11:34.660 | to improve one's mental health and emotionality, excuse me.

02:11:40.180 | And in addition to that, we'll refer people back

02:11:42.560 | to episodes one, two, three, and four,

02:11:44.840 | all of which include tools to improve every aspect of sleep

02:11:48.920 | and to really nail down the QQRT, that quality.

02:11:53.360 | Do you put quality first or quantity?

02:11:54.840 | - Quantity. - Quantity.

02:11:55.680 | I'm just making sure.

02:11:56.500 | That QQRT to really nail down the quantity,

02:11:59.240 | quality, regularity, and timing of sleep.

02:12:01.880 | We can no longer consider sleep just six to eight hours

02:12:05.400 | or get your nine hours or get your seven hours.

02:12:08.920 | Clearly there are other variables involved

02:12:11.720 | and you've made those variables very clear to us.

02:12:14.080 | And you've given us the roadmap

02:12:16.120 | to plug in the best variables for ourselves.

02:12:18.880 | So thank you, Matt, ever so much.

02:12:21.400 | - Thank you for allowing me to both voice

02:12:24.660 | and narrate the important story of sleep and mental health.

02:12:27.840 | It's something I'm immensely passionate about,

02:12:30.360 | both from a personal perspective,

02:12:31.920 | but also from a professional research perspective.

02:12:35.560 | Thank you for this opportunity.

02:12:37.120 | - Well, again, thank you, Matt.

02:12:38.640 | And I'm very much looking forward

02:12:40.840 | to the sixth installment in this series on sleep,

02:12:44.960 | which is about a topic that everybody is fascinated with,

02:12:49.160 | which is dreaming.

02:12:50.760 | I know you're gonna tell us about dreams and what they mean,

02:12:53.760 | perhaps what they don't mean.

02:12:55.760 | We'll get into dream interpretation of all things,

02:12:58.600 | lucid dreaming, and much, much more.

02:13:01.440 | So I really look forward to that discussion in episode six.

02:13:04.920 | Thank you for joining me for today's episode

02:13:06.780 | with Dr. Matthew Walker.

02:13:08.320 | To learn more about Dr. Walker's research

02:13:10.520 | and to learn more about his book

02:13:12.140 | and his social media handles,

02:13:13.440 | please see the links in our show note captions.

02:13:15.800 | If you're learning from and/or enjoying this podcast,

02:13:18.380 | please subscribe to our YouTube channel.

02:13:20.280 | That's a terrific zero-cost way to support us.

02:13:22.660 | In addition, please subscribe to the podcast

02:13:24.920 | on both Spotify and Apple.

02:13:26.640 | And on both Spotify and Apple,

02:13:28.040 | you can leave us up to a five-star review.

02:13:30.440 | Please also check out the sponsors at the beginning

02:13:32.440 | and throughout today's episode.

02:13:33.960 | That's the best way to support this podcast.

02:13:36.400 | If you have any questions for me

02:13:37.680 | or comments about the podcast

02:13:39.320 | or topics or guests that you'd like me to feature

02:13:41.200 | on the Huberman Lab Podcast,

02:13:42.720 | please put those in the comment section on YouTube.

02:13:45.200 | I do read all the comments.

02:13:47.120 | On many episodes of the Huberman Lab Podcast,

02:13:49.120 | we discuss supplements.

02:13:50.620 | While supplements aren't necessary for everybody,

02:13:52.760 | many people derive tremendous benefit from them

02:13:54.800 | for things like improving sleep,

02:13:56.160 | for hormone support, and for focus.

02:13:58.160 | To learn more about the supplements discussed

02:13:59.680 | on the Huberman Lab Podcast,

02:14:00.940 | go to livemomentous, spelled O-U-S.

02:14:03.500 | That's livemomentous.com/huberman.

02:14:06.360 | If you're not already following me on social media,

02:14:08.600 | I'm Huberman Lab on all social media platforms.

02:14:11.340 | So that's Instagram, X, LinkedIn, Facebook, and Threads.

02:14:14.820 | And on all those platforms,

02:14:16.320 | I discuss science and science-related tools,

02:14:18.620 | some of which overlaps with the content

02:14:20.120 | of the Huberman Lab Podcast,

02:14:21.580 | but much of which is distinct from the content

02:14:23.420 | covered on the Huberman Lab Podcast.

02:14:24.920 | So again, it's Huberman Lab on all social media platforms.

02:14:28.220 | If you haven't already subscribed

02:14:29.380 | to our Neural Network newsletter,

02:14:31.120 | our Neural Network newsletter is a zero-cost newsletter

02:14:34.000 | that provides podcast summaries,

02:14:35.720 | as well as protocols in the form

02:14:37.280 | of brief one-to-three-page PDFs

02:14:39.340 | that cover everything from neuroplasticity and learning,

02:14:41.960 | to sleep, to deliberate cold exposure,

02:14:44.040 | and deliberate heat exposure.

02:14:45.460 | We have a foundational fitness protocol, and much more,

02:14:48.480 | all of which, again, is completely zero cost.

02:14:50.480 | You simply go to HubermanLab.com, go to the Menu tab,

02:14:53.520 | scroll down to Newsletter,

02:14:54.760 | and by supplying your email, you can subscribe.

02:14:57.180 | I want to point out

02:14:58.020 | that we do not share your email with anybody.

02:15:00.300 | Thank you once again for joining me

02:15:01.640 | for today's discussion all about sleep

02:15:03.760 | with Dr. Matthew Walker.

02:15:05.360 | And last, but certainly not least,

02:15:07.400 | thank you for your interest in science.

02:15:09.440 | (upbeat music)

02:15:12.020 | (upbeat music)

Dr. Matt Walker: Improve Sleep to Boost Mood & Emotional Regulation | Huberman Lab Guest Series

Chapters