Better Sleep with Dr. Ashley Mason

Priyanka and Hari dive into the science of better sleep with expert Dr. Ashley Mason, unpacking what “healthy sleep” really means. From inconsistent schedules and late-night scrolling to alcohol, naps, and blue light, they explore what’s helping or hurting your rest.

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Episode Transcript

Speaker 1 (00:00):
This podcast is for information purposes only and should not
be considered professional medical advice.

Speaker 2 (00:08):
Healthy sleep looks like consistent sleep.

Speaker 3 (00:11):
Is a nap a bad thing.

Speaker 1 (00:12):
Then the first time I tried blue white blocking glasses,
I was asleep like in an hour.

Speaker 2 (00:20):
Should we should talk about alcohol and drugs?

Speaker 3 (00:23):
Yeah, yeah, of course we should. I'm hurry, condobolu, I'm
doctor pre uncle Wally, and this is health stuff.

Speaker 1 (00:37):
How how did you sleep last night?

Speaker 3 (00:39):
Terribly? Oh? Tell me, I do not sleep well. I
know I have sleep apnea, so that's a problem. And
I got the oral instruments that are supposed to help
you get more oxygen, but it hasn't really been effective.
I've been sleeping earlier and waking up like at the
same time, like I could get twelve hours of sleep,

(01:02):
and I'm still tired, and it doesn't make much sense
to me.

Speaker 1 (01:05):
That's a bummer that the oral appliance didn't make a difference.

Speaker 3 (01:09):
I'm going to try again. I don't want to give
up on it yet, just because a sea pat machine,
you know, we've talked about it before, give me cumbersome,
and I don't like the tracking elements of it.

Speaker 1 (01:19):
But plus you travel so much, so it would be
a lot to like take it around, right.

Speaker 3 (01:24):
I mean I probably wouldn't. I mean, you know, like
that which limits its use as well. So I'm just
kind of I don't know. I wish I could talk
to somebody about sleep. I don't know, I don't know
if we if we can arrange that somehow, but I
could I could really talk to somebody about sleep and
sleep hygiene.

Speaker 1 (01:45):
Well, I mean, boys, today you're a lucky day. What, yeah,
because today we're actually going to be talking with a
sleep expert. Because this is like some hardcore, deep diving
sleep knowledge with one of the coolest people that I know,
one of the coolest scientists that I know, doctor Ashley Mason.

(02:07):
She has taught me everything useful that I know about sleep.
So yeah, we'll definitely get into that. You know, It's
funny for me, I used to sleep really, really well,
and then the moment I had a baby, sleep is
now a distant concept. It's like a theoretical idea. So

(02:31):
I definitely miss those days. But in terms of sleep hygiene,
you know, there's so much to unpacked. So I'm really
excited to share with all the listeners today about everything
that is helpful to know about sleep hygiene, and hopefully
maybe after this episode you will realize that maybe there
are some areas that you can change upon that might
make a big difference.

Speaker 3 (02:52):
I would love that, My God, I would love that. Yeah,
I mean just I feel like this is a really
useful episode for basically everybody.

Speaker 2 (02:59):
Could.

Speaker 3 (02:59):
Sleep is an issue that we all have, Like, you know,
getting good sleep, not getting good sleep, Like that's something
that defines a day, you know it. It sets the
tone for what the day could look like, because if
you're exhausted, you're not going to be at your best.

Speaker 1 (03:14):
Yeah, and depending on your chronotype, Like, we spend a
third or a quarter of our lives asleep. I mean,
that's a huge chunk of time that we're alive offline.
And there are so many important health processes that happen
in our sleep that if we don't sleep well, get disrupted,

(03:36):
which can have lots of long term complications. Sleep is
one of the most sort of underrated important health things
that we don't really necessarily talk about. I mean, we
talk about how we look or how we feel. We
talk about like mental health or physical health, but we
don't isolate sleep as this whole other category of well being,

(03:58):
And honestly, I think it should be because we spend
so much time doing it.

Speaker 3 (04:03):
I mean, and it affects other organs and other processes, right,
I mean, like I'm assuming and maybe we talked about
this that that sleep has a link with heart disease?
Is that true?

Speaker 1 (04:15):
Like like oh totally yeah, so sleep? Yeah, bad sleep
can cause diabetes, it can cause high blood pressure, it
can cause all sorts of hormonal imbalances. So it's it's
really really important. So when you hear the word sleep hygiene,
har are you like what comes to mind? Like do

(04:36):
those combination of words sleep hygiene mean anything to you
when you think about that?

Speaker 3 (04:41):
They do to me. Now, if you asked me a
year ago, I would have assumed you meant like brushing
my teeth, But like now I think about, like, what
are the steps that I take before I go to bed?

Speaker 2 (04:52):
Am?

Speaker 3 (04:52):
I am I on my phone when I'm going right
before I go to bed? Am I playing music when
I'm going to bed?

Speaker 2 (04:57):
Am?

Speaker 3 (04:57):
I did I eat minutes before going to bed?

Speaker 2 (05:01):
Like?

Speaker 3 (05:02):
What are the things I did to set up my sleep?

Speaker 1 (05:05):
Yeah?

Speaker 3 (05:06):
That's what Yeah, that's why I assume it is.

Speaker 1 (05:08):
Yeah, I mean, that's really funny that you a year
ago thought it meant like brushing your teeth in bed sleep.

Speaker 3 (05:14):
No, of course, Like I mean, I think we'll obviously
doing this podcast, I've learned so much, but like, yeah,
I mean I thought of sleep, like we've talked about,
as this thing that can be broken down, studied, and
improved upon.

Speaker 1 (05:27):
Yes, yes, totally. It's very very helpful. Today we're talking
with sleep expert doctor Ashley Mason, and people, this is
not your everyday pillow talk. She is an integrative psychologist
and currently the director of the Sleep Eating and Affect
Laboratory also known as the C Lab Very Clever at

(05:50):
the UCSF Ocher Center for Integrative Medicine.

Speaker 3 (05:53):
People.

Speaker 1 (05:54):
She's also the kindest, smartest and most hard working scientist
I know, and she's personally taught me everything useful that
I know about sleep and sleep disorders, which is what
we're going to talk about today, specifically insomnia and sleep
related anxiety. Welcome to health stuff, doctor Mason.

Speaker 2 (06:14):
Well, thank you. I am thrilled to be here, especially
with you.

Speaker 1 (06:19):
So let's kind of get into the conversation first about
really basic just how to get better sleep and sleep hygiene.
But before we kind of talk about what keeps us
up at night, let's just talk about defining healthy sleep.
So what does healthy sleep typically look like.

Speaker 2 (06:39):
Healthy sleep looks like a person feels like they are
rested during the day, they feel like they have gotten
enough sleep, and that is going to look different for everybody.
There is an obsession with this number of eight, this
magical eight hour of sleep a night unicorn, And I

(07:00):
want to just give a quick backstory on why that
looks like that. We have people who sleep very short
six and a half hours, for example. We have people
who sleep very long twelve hours. Right. If you look
at these epidemiological studies and the headlines that say, hey,
people who sleep way too long are more likely to die,
people who sleep way too short are more likely to die,

(07:21):
the sweet spot is seven to nine hours. There's a
very good reason why that is. And that's because if
you look at all of the people who are sleeping,
for example, six hours, you're combining people who naturally healthfully
sleep six hours and also the people who are working
three jobs, trying to raise three kids, two pets, and
whatever else and only have time to sleep six hours,

(07:42):
but they actually need eight And when you put all
of those people in the same analytic bucket, it's going
to make that bucket look worse. Similarly, if you take
all people sleeping twelve hours now most almost nobody naturally
needs to sleep twelve hours, those people are likely already
ill receiving chemotherapy, forget having cancer for example, so they're

(08:03):
sleeping a lot of the day. They're also more likely
to die sooner. So we see this bell curve of
the healthiest people being around seven to nine hours. Well,
people who have the great good fortune of having time
to sleep seven to nine hours. That's really important, and
most adults on average aren't gonna need more than seven
to nine hours just biologically speaking. So these are the

(08:25):
people who have enough time to sleep as much as
their biology needs, and therefore they end up looking the
healthiest in all of these studies. That said, a healthful
night of sleep for almost everybody is going to involve
not waking up very much, not experiencing a lot of pain, right,
not experiencing other discomforts, not anxiety right, and sleeping enough

(08:50):
that you feel rested during the day. That's going to
be what healthy sleep looks like. Now. To achieve that
is we have a lot to unpack to get there.

Speaker 3 (09:00):
I mean, I definitely felt like I slept the most
in my life when I was a teenager. I feel
like I I'm was sleeping twelve to fourteen hours because
I felt like it, because I needed it. It was
a Saturday, I could. Does the amount of sleep we
need change as we get older.

Speaker 2 (09:16):
Absolutely, so baby sleep the most, and it's downhill from there, folks,
it's downhill from there.

Speaker 3 (09:22):
Now.

Speaker 2 (09:22):
What's interesting about teenagers is they tend to sleep later.
So during the teenage years, people tend to want to
go to sleep later and sleep in later, which doesn't
line up great with our social worlds. Unfortunately, high school
seems to start very early. Now some schools are changing this,
and my hat's off to them, right, they're going to
get students that feel better and learn better. It's going

(09:42):
to be better for them. But what you see in
teenagers in particular is they're forced to wake up really
early during the week. They're staying up really late anyway
because they're talking with their friends. Right, the teenage years
is the time of intense socialization, and they're doing ketchup
sleep on the weekends. So no wonder they're sleeping in twelve,
you know, twelve forteen hours very late on the weekends,
they're also staying up quite late, so they're missing out

(10:04):
on sleep during the weekend and they're sleeping on the weekends.
And then as we age, we tend to do the opposite.
We start to go to bed earlier and earlier, and
we wake up earlier and earlier. So this whole idea
of senior hour at the restaurant actually comes from somewhere, Right,
Folks tend to just shift their whole pattern earlier and earlier,
and there's something wrong with us per se. I also
want to make a note on the diversity of phenotypes

(10:27):
in sleep. You may be an adult and you may
know people who are total night elves, and then you
know people who are morning larks, and you may wonder, well,
why does this exist? Well, evolutionarily, this is pretty adaptive.
Think back to where we adapt where we evolved on
the prairie, right, we needed people in the tribe who
were staying up late and making sure we weren't eaten
by lions. We needed people in the tribe who were

(10:49):
waking up early making sure the lions hadn't come around. Right,
It was actually advantageous to have this diversity in chronotypes.
So this whole idea that everyone should be a morning
person is very very unfortunate. There are some people who
are never going to be mourning people, and we can
move them maybe a little bit. But this goes back
to when we're talking about what healthy sleep looks like.

(11:10):
I'll add my favorite parameter now. From the start, healthy
sleep looks like consistencleep, meaning you're waking up at the
same time every day and you're going to bed around
the same time every night. So the same block of
hours in that twenty four hour period is when you're sleeping.
So short sleep during the week, long sleep during the

(11:32):
weekend not very healthy sleep. And in fact, some amazing
data have come out over the past couple of years
from very very large data sets, and when data on
sleep come out from very large data sets, we're much
more excited than when they come out from small data
sets of ten to twenty people. But there's this data
set called the UK Biobank, and this is the gift

(11:53):
that keeps giving because what these researchers did was they
had people in the UK where these risk watches very
ugly by the way, just they're called act to watch
type devices. All they do is measure your sleep. They
don't do anything fun, they don't go with any of
your outfits. Right. They had them wear it for a
week and then they measured these people for years afterward
to see what happened. And what they found was the

(12:16):
people with the most irregular sleep were more likely to
have a variety of health problems. They were more likely
to have heart attacks, type two diabetes, depression, anxiety, dementia.
And we're talking like nineteen percent increased risk of heart attack,
thirty percent for type two diabetes, forty eight percent for
depressive disorders, thirty five percent for anxiety, twenty percent or

(12:39):
more increased risk for dementia five to eight years later.
And it didn't matter how long they were sleeping. It
only mattered how regularly they were sleeping. So even if
they were sleeping eight hours, if it was irregular, they
had those increased risks. Wow. So a major focus in
sleep treatment is regularizing sleep and not hyper focusing on

(13:01):
the number of hours. We'll discover how many hours you
need to sleep, but first we have to get you
situated into when your biology wants to sleep.

Speaker 1 (13:11):
So how would you advise someone to help figure that
out how many hours do they need?

Speaker 2 (13:17):
So the first thing I have patients to do in
my clinics. So by the way, I direct a cognitive
behavioral Therapy for Insomnia clinic. CBTI is the treatment that
is the first line treatment for insomnia, as recommended by
the American College of Physicians in twenty sixteen. I am
not a physician. I cannot prescribe medications. I do not
work with medications. I collaborate with people's prescribers and providers

(13:41):
on making changes to their medications. But the first thing
that I work on in cognitive behavioral therapy for insomnia
is we find a wake up time to be consistent.
When you start waking up at the same time every day,
then you'll start getting sleepy around the same time every night.
And that's what's going to tell us. Okay, given a

(14:02):
wake time of for example, seven am, how much sleep
does your body produce? When do you start naturally going
to sleep? And I'll have people keep what's called a
sleep diary or a sleep log on pen and paper
the old fashioned way folks, where they write it down
every morning what time they woke up, what time they
went to but all that stuff from the previous night,

(14:24):
and we look at a seven day period and then
we compute on average how many hours they slept that night,
and we see, okay, that's how much sleep their body
is producing given this wake time, and then we go
from there. But if we don't have a consistent wake time,
we're not really going to be able to see what
your body can do consistently. So that's where we start.

(14:44):
And I always tell people, Look, I can wave a
magic wand and make you wake up at the same
time every day. I cannot wave a magic wand and
make you fall asleep at the same time every night.
That's the power of the alarm clock.

Speaker 3 (14:56):
I was about to ask that, Yeah, just because of
the wear soci structured most people do have in awake
time that they're going to have to get up. Yeah.

Speaker 2 (15:05):
But the key thing is I've had patients, By the way,
all of the patients stories that I will mention today,
I've been given explicit permission by the patients to share
these stories. But I've had patients who will wake up
every other day at four forty five am to get
to an exercise class that they really like. But then
on the other day, they'll sleep until seven thirty, which
is essentially flying to New York from California. Right, that's

(15:27):
giving yourself jet lag without the joys of travel. So
making sure that people actually wake up at the same
time every day, regardless of responsibilities. The responsibilities determine that
wake time. If you have to be up five days
a week at five am, folks, that's your wake time
on the weekends too. And when I tell people you
have to wake up at the same time every day,

(15:48):
I say every day that ends in day, so like Monday, Saturday, Sunday, like.
We go over this extensively to make sure there's no confusion,
because sometimes there is confusion. So that's that's the first
thing I do. And the other thing I do is
the thing everybody hates. Look, we have a rule nothing

(16:11):
in bed except for sleeper sex. And I tell people,
if you're not sure if something counts as sleeper sex,
send me a message. I will clarify it for you
day service and will make sure you know if it
counts as I do live in San Francisco, right, so
I've gotten some some that are like, well, just some
of it on the edge.

Speaker 1 (16:30):
Yeah, what's the weirdest question you've gotten about differentiating is
the sleeper sex?

Speaker 2 (16:35):
Well, I've gotten you know, there's there's different audiobook type
situations that people have written about and asked about, mostly
involving audio and visual materials in preparation for sex. I've
gotten a lot of these interesting, interesting ones.

Speaker 1 (16:55):
So you're talking about like jerking off before going to bed,
that could be it's good sleep, Hi, Jeep, I mean.

Speaker 2 (17:02):
That's technically in the category of sex. I have gotten
that question, so we put that let that we let
that one fly in bed. But you know what I'm
really talking about here, which is like I don't want
people scroll on TikTok. I don't want people I really
don't want people listening to podcasts and falling asleep while
they're listening to them, because we don't want to blur this.
People are trying to blur this line between being awake
and being asleep and just like like zoom over into sleep.

(17:25):
I actually want you to be really, really aware when
you're sitting on that couch. Wow, I'm feeling sleepy. I
could fall asleep right now. I'm going to get in
my bed. And there's a huge difference between feeling exhausted, tired, fatigued,
and feeling sleepy. Right, Sleepy means I feel like I
could fall asleep, Tired, fatigue, exhausted means you just can't

(17:46):
work anymore. You just can't wash those dishes. That report
is just not getting done, Your boss isn't getting the
email back enough. Right, very different, But I want your
body to learn what does it feel like to be sleepy?
And when you blur those lines by falling asleep while
doing stuff, you're not learning that, right. I dread the

(18:08):
day when I ask you preanca like, oh, do are
you hungry? You want to go get lunch? And you're
and someone not you wouldn't do this, but a lot
of people might might look at their app and say, oh,
you know, let me check, let me check see how
much I meeting today, and let me see if I'm hungry.

Speaker 1 (18:21):
Right.

Speaker 2 (18:21):
I'm so worried about the state of people getting divorced
from their own bodies and needing to check external devices
to determine how they feel. I want you to learn
what does sleepy feel like to you so you can
act on it and go to sleep. So nothing in
bed except for sleeper sex and if you know I
tell doctors like, if your patients are sure, I have
the message you, it makes for some funny jokes. And

(18:43):
then and that means, don't go to bed until you're sleepy,
because you can't get in your bed and then scroll
for two hours because that doesn't count. So we're not
going to bed until we're actually feeling sleepy. And a
lot of people have this like automatic thing in their
head like, oh, it's nine thirty, I should go to bed,
but actually, no, you shouldn't, and you should stop shooting
all over yourself. You go to bed when you're actually sleepy,

(19:06):
and that might be later. So many patients who come
into my clinic have this idea that they should get
in bed at nine and get up at six. I
don't know where these numbers come from, maybe because they're
like inversions of each other, but there's something about these two.

Speaker 1 (19:19):
It's like capitalism and the whole system that tells us
they should be in bed by nine and up by six.

Speaker 2 (19:27):
It's yeah, it's it's the machine. And I tell and
so many people's problems are solved when I say, guess what,
just don't go to bed at nine. You can keep
your keep your alarm at six, stay up till you're sleeping.
I had one patient who discovered then instead of going
to bed at nine, he just need to stay up
till ten thirty. And let me tell you how much
joy this brought to his entire family because he got

(19:50):
an entire hour and a half extra in his day
at the end of the day to potter around, do
some little things, set the table for his kid's breakfast.
His wife was delight okay, delighted. He got his mee time,
turned on the sports stuff while he was doing stuff
in the kitchen or whatever else, did his scrolling, did
everything that, like, you know, she didn't really want to

(20:11):
be a part of, but he was also doing stuff
for the like. It was just this perfect, perfect situation.
And at the end of treatment he was like, my god,
all I had to do was go to bed an
hour and a half later. Who knew because he was
up for an hour and a half in the middle
of the night every night, between like one and three
am and couldn't figure it out. And here's why, by
going to bed too early, he was going to bed

(20:33):
before he had enough sleep pressure. We should probably define
what sleep pressure is during the day as you're awake.
In doing things, just like we're sitting here recording this podcast.
You build up sleep pressure. Maybe you go to a
yoga class, maybe you're taking your carried kid, maybe you're working,
maybe you're doing all kinds of things. You're building up
sleep pressure. By the end of the day you are sleepy.
You have enough pressure to fall asleep. And as we sleep,

(20:57):
we spend out that sleep pressure. And if you don't
build up enough, you're gonna wake up, and then you'll
build up more while you're awake and then get back
to sleep. So when people go to bed before they've
built up enough sleep pressure, I mean, we could get
into the biology of the adenizine receptors and everything else
about how that works. But when you go to bed
before you have enough sleep pressure, it's like popping the

(21:19):
balloon too soon.

Speaker 3 (21:21):
Is a nap a bad thing? Then let's talk about naps.

Speaker 2 (21:25):
So when people have no sleep problems and regularly nap,
I don't touch it. But I don't see those people.
The only people who I see are people who are
coming to my clinic saying, hey, I have a sleep problem,
help drowning, help right the normal napper, normal sleeper people
never come into my orbit. So what I'm going to

(21:45):
say only applies to people having problems asleep. Okay, when
someone comes to me and says, I can't fall asleep
at night, Oh yeah, and I take a two hour
nap between you know, noon and two every day. Well,
we know what's going on. They're actually using up sleep
pressure during the day and then they're not able to
sleep at night. And it's worth it's worth talking a

(22:05):
little bit about the different stages of sleep to describe
the answer to this problem. Sleep is not one uniform thing.
We don't lie down and experience one thing throughout the night.
We actually experience varying levels or stages of sleep. The
first stage is called stage one, non rapid eye movement sleep.
So you've heard of rem sleep, right, rapid eye movement sleep.

(22:28):
This is when we dream. I'll talk about that in
a moment. Stage one sleep is very light. If you
were asleep during stage one sleep and I came up
and poked you, you would say, hey, why'd you do that.
I wasn't asleep, and I'd say, yeah, you are. You
say no, I wouldn't. So when you're in stage one sleep,
you don't think you're asleep. Stage two sleep is the majority,
and that's like five percent of the night. By the way,
stage one sleep very very little bit. Stage two sleep

(22:50):
is the majority of your night. It's like fifty sixty
percent of your night, and it's what you think of
as like core sleep or base sleep. I don't like
calling it light sleep because it's actually very important and
a lot of important things happen during stage two sleep.
If I came and woke you up during stage too sleep,
you'd say, Hey, why'd you do that? That wasn't nice.
But then if I woke you up from stage three

(23:13):
n REM or non rapid movement sleep, you'd be annoyed
at me. You'd be like, why did you do that? Awful?
Because that is deep sleep. You'd wake up feeling groggy.
You'd be annoyed. And what a lot of people think
is like, oh, most of my night should be that
deep stuff. Yeah, that's that's what I'm no. No, Actually,
the average adult over forty is between five and twenty

(23:34):
percent of their night is deep sleep. Okay, it's not
that much, and we're cycling between these stages, and let's
talk about remsleep. Rem sleep actually is the time of
sleep when you dream. That's true, but also it's a
time when your body is paralyzed and that's biologically useful,
so that you're not acting out your dreams. Right, you're
very still. And a lot of people then conflate remsleep

(23:56):
with deep deep sleep. Rem sleep is not deep sleep.
Your brain waves during rem sleep actually look more like
your brain waves when you're awake than they do during
during deep sleep. That doesn't mean you're awake, it just
means your brain is very busy. And if you wake
up during rem sleep, that's when you remember your dreams.
A lot of people will say, oh, I don't do
remsleep because I don't have dreams, and it's like, well, no,

(24:18):
you just don't wake up during remsleep. That's what happens.
You're just not wake a nap. So let's circle back
to your nap question. Then. Now, when people want to
nap during the day, I say, okay, well, for trying
to fix your sleep at night, these are kind of incompatible.
But if you have to nap during the day, let's
say you've got to take a brief refresh before you
drive a car, or argue with a teenager, or do

(24:38):
something you know that requires mental effort, right. I tell
people you can have a twenty five minute opportunity, And
an opportunity means you set your alarm for twenty five minutes,
you go, get into your bed, you lay down, You
have a twenty five minute period before your alarm goes off.
I don't care how much you slept during that naptun

(25:00):
that was what you get. What you get, and you
don't get upset. By keeping it twenty five minutes, we're
making sure that you don't cycle into stage three sleep.
You're staying at stage one and stage two sleep, which
is going to deplete your sleep pressure the least for
that night. So I tell people that's the an opportunity
you can have, and I try to. I tell people, look,
try and do it before like three pm. Don't do

(25:21):
it too late, because later in the day you get,
the more likely you are to cycle down into deep
sleep because you have more sleep pressure built up. So
I try and keep that nap a little bit earlier.

Speaker 3 (25:31):
Well, it refresh you. If you end up having just
those twenty five minutes, like well, it's serve it's it
will okay, So.

Speaker 2 (25:38):
You're more likely to feel refreshed when you wake up
from stage two sleep than when you wake up from
stage three sleep. Now, if you do go up all
the way around from a cycle, you can feel more refreshed.
But it's a gamble. If you take a long nap,
you're always going to compromise your sleep. At night, you
may or may not feel better. So I don't know.
I like those odds.

Speaker 1 (25:58):
Yeah, we'll be back with more health stuff after this break.
So how do sleep medications or sleeping pills impact the
cycle that you're talking about. We know three percent of

(26:21):
the population uses prescription sleep meds, but things like melatonin
are over the counter. What is your stance on those items,
taking those items to help you sleep, and how does
it impact the cycle.

Speaker 2 (26:36):
There's a lot to unpack there. Let's start first with melatonin.
Melatonin is a hormone. It's the hormone of darkness, and
a lot of people think, well, it's going to make
me sleepy. No, melatonin tells your brain, hey, darkness coming.
Your brain associates darkness with sleep. If you slice open
a rat's brain in the middle of the night, their

(26:57):
melatonin level will be high because guess what, telling a
rat darkness is coming means it's time to get up
and eat right. So melotonin hormone of darkness, and when
you take it, you tell your brain, hey, darkness coming, sleep,
sleep time coming, all right. And the problem with this
is let's say you haven't built up enough sleep pressure
yet and you pop a melotonin pill which tells your body, hey,

(27:21):
do the sleep thing now, time to get unconscious darkness right,
and you go to bed too early. Then you're up
at one am thinking, well, wait a minute, it's going
on here. You might have caused yourself to go to
sleep too early and not had enough sleep pressure. So
the time your body is a gosh. We can put
people on the moon, but we cannot cure cancer.

Speaker 3 (27:42):
Right.

Speaker 2 (27:42):
The human body is a miracle. It's a miracle, okay.
Our pinio gwent actually secretes molton. We make our own.
We make our own, okay. And so I tell people,
look like, this is not a solution to your problems.
If melatonin iplementation was a solution for insomnia, we wouldn't

(28:03):
be talking today. My clinic wouldn't have a wait list
of I'm not even going to say it's bad. Okay.
But and in Europe, in many countries in Europe, if
you want melatonin, you need a prescription from a doctor
like you, Brianco. You can't just go buy it at
the store. But in the United States, I mean, go
to Walgreens, you could buy so much. I don't know why.

(28:24):
I mean, I guess it's really you can't really overdose
on melatonin and hurt yourself. It's really hard to do.
I don't think you can. I don't think you could
swallow enough. I don't know, not a doctor, but I'm
pretty sure it'd be really hard to overdose on melatonin.
So maybe that's why we don't regulate it here in
the same way as they do in many countries in Europe.
I don't know. But the other problem is that melatonin dosing.

(28:44):
If you go to Walgreens, you find a pill it
says ten milligrams. Guess what the appropriate dose of melatonin
for people who actually need it is somewhere around zero
point five to one milligram. So finding the appropriate dose
is really hard. And when I say people who actually
need it, I want to give one class of people
who actually need it. There are these medications that you

(29:06):
I'm sure have prescribed, called beta blockers, metopral aull per
panel all lots of things ending in a lull. They're
not the first line treatment for blood pressure currently, but
they are still used for a variety of conditions. And
these medications can inhibit our endogenous melatonin processes such that

(29:29):
when people start taking these medications they might find it
really hard to fall asleep at the start of the night.
I once had a patient who came in in his sixties,
and he was a professional singer, who said, look, this
is the only drug I can take because all these
other blood pressure medications impact the sound of my voice.
So I have to take this. And I've been taking
it since I was in my thirties, and that's when

(29:49):
I developed insomnia. And his reasoning was, well, I must
have been so stressed out about being diagnosed with blood
pressure that I have blood pressure that I developed in somnia.
And I said, really, okay, And so I asked him
to just try a half milligram of melotonin from a
liquid dropper bottle. At the time this was years ago,
that was the only way to get the small dose.

(30:11):
And I got a message for him the next day
he said, I feel like I was hit by a
truck last night. I actually slept was this and he
was so angry and so satisfied at the same time,
but so angry, like thirty something years he'd been dealing
with this and no one had told him so. The
dose of melatonin for folks like that is quite small,
and it's hard to find. There's only a few websites

(30:33):
now where you can find a dose that's small. But
the average person should not be using melatonin now. When
you travel and you're trying to adjust to a new
time zone, right, darkness is coming at a time your
body doesn't expect it. You can benefit from using it now.
Some people don't. They don't eat it. They can just
do the thing. Other people's bodies needs a little help.
But on the regular, melotonin is not just like part

(30:55):
of your that's not your multivitamin. Don't just be taking
that every day. For most people, they don't need that. Okay.
The next thing I want to have about is over
the counter sleep aids. A lot of over the counter
medications were developed for specific purposes. One of my favorites
is benadrill. If you're having an acute allergic reaction, my

(31:17):
understanding is that benadrill is an option for you. I mean,
obviously EpiPens et cetera, et cetera. But that's really what
benadrill is intended to be used for. It's not intended
to be a sleep aid. Right. Yet people use these
medications specific diffhenhydromene. Right, if we're going to talk about
the actual medication. They use these for sleep, either regularly

(31:43):
or irregularly, and there are times when it's appropriate. For example,
an extreme stressor happens, the loss of a loved one,
a car, accept like some of these major things that happen,
and you need help getting drowsy. That can be a
time where people take them. And it's appropriate because the

(32:05):
other thing I want to mention is the more stress
and anxiety and upset you have, the more sleep pressure
you actually need to sleep. If you've ever had a
time in your life when you've been really stressed and
anxious about something that's happening, the next day, you may
have noticed, wow, I'm having trouble falling asleep. Conversely, like
kids the night before like you know, I don't know, Easter, Christmas,

(32:26):
like some of these holidays. They're so excited because like
some animal is coming to visit or something their house
and going to leave presents. I mean, have miracles about
to happen. Right, they're so excited they can't fall asleep. Similar, same, same, Right.
So the more stress anxiety all these things, the more
sleep pressure you need to fall asleep. And when you
have an unexpected bowlnus of stress anxiety, it's from a

(32:47):
major event. Sometimes people will take these sleep baits and
it's useful for them. Now, that's a very special circumstance.
Other folks, going back to the sleep pressure thing, will
have a string of bad nights of sleep, and then
let's say they sleep poorly for three nights, and then
on the fourth night, they're like, you know what, I'm
gonna pop Ben and row. I'm gonna do it. I

(33:07):
really need to get some sleep. Well. Unfortunately, what they're
doing is they're kind of popping their sleep pressure balloon
because they've spent the last three days building up sleep pressure.
They probably would sleep well before, right, But then they
take a drug. And what drugs can do to our
sleep is menifold. They can't remember how I talked about
the different stages of sleep. Drugs can impact how we

(33:28):
cycle through those stages of sleep. It can mess up
how much time we spend in the different stages of sleep.
It can fragment our sleep, and we can get into
talking about you know, marijuana and alcohol too. Actually let's
in just a second, but these drugs can impact our sleep.
What our sleep architecture looks like is what that's called.
And I'm gonna go ahead and guess it's not always

(33:50):
in a good way. Most research shows that these drugs
are not intended to be used for a long time
and can have some negative long term effects. A lot
of patients come to my clinic on these medications saying
I want to get off, and they've tried to get
off before, but they're waking up at noon on the
weekends and seven am on the weekdays and they don't

(34:10):
have a stable situation. It's really hard to quit medications
when you don't have a stable sleep window. So I
always fix that first and then help people, in collaboration
with their prescribing physicians, taper down off of these medications.
Now you specifically asked about prescriptions sleep medications. Now there
are medications that are specifically prescribed for sleep, not used

(34:34):
off label like otcs, and many people find benefit from
these for periods of time. Many people take them and
then find they need more and then more, and then
another one, and then a few, and then we combine them,
and then we take them at different times during the night,
and it just spirals out of control. Right. A lot
of these drugs were not intended to be used for

(34:57):
a lifetime either. So we also know that benzodiazepines should
not be prescribed for sleep problems. They should not be
that's not we should be doing that. Unfortunately, it's still done.
This is my plea to providers. Please please don't do that.
There are other options to prescribe that are then easier
to help patients wean off of. But these medications can

(35:22):
increase different types of sleep. They can make you feel
feel they can make you go unconscious faster, or they
can help you fall sleep faster. They are not what
people should be trying to fix their sleep at first though.
They're more of a last resort option. Should we should

(35:42):
talk about like sex, drugs and rock ral like alcohol
and drugs?

Speaker 3 (35:46):
Yeah, yeah, of course we.

Speaker 2 (35:49):
Should, all right, So let's talk about alcohol first. There's
a lot of confusion about what alcohol does to your sleep.
It does make you fall asleep faster, and I've had
patients come in before, who I say oh, do you
drink alcohol And I say, well, yeah, I have to
take shots to go to sleep, but I don't like it.
And that's like, okay, we're going to fix that. It
does help people do that, but unfortunately it really fragments

(36:12):
your sleep during the night and it makes you wake
up too early. And the reason why waking up too
early is really bad is because it shortens your remsleep.
Remember we talked about deep sleep and REM sleep. It
turns out you get most of your deep sleep, that
stage three sleep in the first half of your night,
and most of your REMS sleep in the second half
of the night. Why, you need a lot of sleep

(36:33):
pressure in order to cycle down into deep sleep, but
then you run out and it's harder to cycle down
into deep sleep. Okay, So you're cycling more into the
REM sleep in the second half of the night, and
when you wake up too early, you're chopping off a
lot of that REM sleep. So people who are chronically
drinking alcohol they get less REM sleep, and remsleep is

(36:55):
also responsible for a good deal of consolidating what's called
procedural memory. Procedural memory is remembering how to ride a bike,
how to drive a car, these aren't things you like
get in your car and think, okay, now, what are
the instructions to do this? You just remember, right, So
when people chronically are drinking a lot of alcohol, they
may find that they're just a little clumsier, they're you know,

(37:17):
they how do I do that thing? Like, things don't
come as automatically to them. And at severe ends of
the pattern, people who are alcohol dependent, you know, there's
that alcohol walk, right, They're not They're not walking as well.
All these things that rely on our procedural memory one
foot in front of the other don't go as well.
So alcohol is not a great strategy for improving your

(37:42):
sleep or improving People will say, well, I really want
to drink, and I say, well, try and drink as
early as you can in the day is the first thing.
Just try. And a lot of my patients find that
if they drink on an empty stomach, everything's worse. And
I'm like, yeah, the buzz hits you harder, but worse
sleep effects. Right, So I try to tell people don't
drink on an empty stomach, and try and drink earlier
during the day.

Speaker 1 (38:00):
Day, so day drinking, so you're like four day drinking basically, look,
you want to.

Speaker 2 (38:08):
Doctors are if you're going to drink on the weekend,
like please have wine with lunch? Like why not noon?
Why why not?

Speaker 1 (38:14):
Tell me there's a good reason, So do what the
Spaniards do, basically the Spanish.

Speaker 2 (38:20):
I don't want that. I don't want people eating so
late at night though, that's right, right, I will, Yeah,
I really would like you to stop eating three hours
before bed. But so the other alcohol thing to remember
is that alcohol has the potential to mess up not
just one night of sleep, but two. Because if you
have a if you go on a bender and you
really screw up your sleep one night, what do you
think is happening the next night? Your body is getting organized,

(38:42):
It's like, well, okay, we really missed out on this
sleep last night, so we're going to have a rem rebound.
We're going to have a rebound. We're going to change
our change up the architecture and try and make up
for what we missed out on. So you're really biasing
potentially two nights of sleep. And so when people tell
me they drink every other night, I'm like, well, function
only alcohols messing up all your sleep then, right? And

(39:04):
you know, that's not a very popular, fun opinion. And
we can't really test that easily in the lab because
there have been studies though, where they've gotten people in
the lab and they just get them rip and drunk
to see what happens. I mean, God bless those people,
Like those are great, great studies, but I don't I'm
not aware of an every other night alcohol study. This
is from my clinical practice. So that's that's one thing.

(39:24):
And then if we talk about marijuana, which is also
you know, a fan favorite, people are starting to treat
marijuana like a supplement. Yeah, this is good for me.
I'm like, oh, who told you that? What do you
do know? And then they're like, well, it's less bad
than alcohol. I'm like, are we trying to is this
a competition? We don't have as much data on marijuana.

(39:47):
Remember it has only been legal in some areas of
the country for a short, relatively short period of time.
But what we're starting to see with first of all,
we also have to separate out THHC and CBD. And
don't get me started on the cbn CB insert the
letter here. It's getting a little bit, a little bit,
a little bit hairy. But let's just keep these categories

(40:09):
for now. CBD. The jury's out. You know, we don't
really know if it helps sleep. But my theory is
if it really helped sleep, I still I wouldn't have
this long clinic waiting list. Everybody on my clinic waiting
list has tried it. They're like, yeah, I tried that,
got it. I saw the thing on Instagram. I bought it. TikTok,
so oh I tried that too. Like they've tried everything.

Speaker 1 (40:27):
Yeah, they sell even like a CBD with melowtonin combined gummy,
but yeah, good.

Speaker 2 (40:34):
But my favorite story, my patients have tried a lot
of things by the time they get to me. My
favorite story was the woman who tried a Jamaican sleep cruise.
She's like, yeah, I spent like ten grand. It was
like this huge cruise in Jamaica supposedly to reset my sleep.
Didn't work. So I know, it's like, wow, insurance didn't
pay for that, did it. Shoot. So people have tried

(40:55):
all these things by the time they get to me,
which is why I'm like, well, this isn't working. But
unfortunately THHC. If you use it sporadically, and by sporadically,
I mean like a couple times in a month. Yeah,
it'll help you fall asleep. But the problem is people
use it and then after a couple weeks of using
it every night, it starts to do things. It starts

(41:17):
to change your sleep architecture big time, and not in
a good way. You start getting less deep sleep. It
really starts fragmenting your sleep. And the big problem is
then when you go to get off of it, you
get this crazy insomnia rebound and everything gets way worse
and it's really hard to quit. If you say, Ashley,
what would you rather help a patient get off of

(41:37):
ambient or marijuana? I'll take the ambient every day much easier.
I know what the dose is. I can have patients
by a drug scale. Oh it's so funny. So there's
these gem scales on the internet on Amazon. They're marketed
as gem scales. But you and I both know that
anybody who's rich enough to have gems worth measuring on
a scale isn't buying a twenty dollars scale on Amazon
to weigh them. We know what this is. This is

(41:59):
a drug dealer scale. Drug dealer scale, that's what it is.
And there are people I tell my patience to buy
them like, look, by this, weigh your pill. And I
have them weigh their they're ambient pill, and they some
of them freak out because they don't remember that I
told them that your pill might weigh thirteen milligrams even
though it's a ten milligram pill, because there's binders and
fillers and die and everything else in it. Right, And
then I work with their doctor and I have them

(42:19):
shave off a little bit. They get a razor and
a mirror. I tell them to get a bandana. You
could do dress up, you know, like breaking bad. Like
I tell them to really ham it up. Right, We
make it fun, and we shave off a little bit
of that pill, and then we shave it up and
we just change it every few weeks, a little bit more,
a little bit more, I saw you were going to say.

Speaker 1 (42:35):
Then we roll up a dollar and I tell them.

Speaker 2 (42:40):
So, no, ambient is really not a snortable one, so
we we we mostly keep it under the tongue. But
the the thing with marijuana is like I have no
idea what I'm what we have no idea like what
is it this week? What is it last week? What
is in that supplement? This way could change who knows like,

(43:00):
it's very hard, like when it's dispersed in a gummy like,
is it evenly dispersed? It's actually maybe not. Like there's
all kinds of issues with getting people off of marijuana
that make it much harder. A lot of people are
baking their own cookies. By the time they're seeing me,
They've got all these creative things they're doing. I'm like,
oh lord, how we gonna how are we going to
reduce this dose? So it's much easier, in my opinion,

(43:21):
to get people off of pharmaceuticals than off of marijuana.
And I tell people, do not start trying marijuana for sleep.

Speaker 3 (43:25):
Don't do it.

Speaker 2 (43:26):
Just don't do it. And people like, oh, but I
like smoking marijuana. You know. My answer is gonna be
the same weekends. That's an eleven am activity. Okay, if
you're gonna really let's let's we're adults now. It's nobody
told people like, when you're an adult, you can actually
have dessert before lunch if you want to, you can
you can have your you know. I once had a

(43:47):
patient who's like, yeah, I have chocolate after dinner for
my dessert. And I'm like, that's fine. And a couple
of weeks later, we couldn'tigure out what was going on.
Turns out it was chocolate full of like espresso nib things.
And I was like, oh, no, we can't have that
after dinner. You can have that in the morning. She's like,
chocolate in the morning. I'm like, yes, you are now
above the age of fifty. You can do whatever you want.

(44:08):
You can have your chocolate bar for breakfast. I don't care.
And she was just like wrapping her head around this idea, like, no,
it's you have to eat your dinner first. No, you
really don't. But we should talk about caffeine too, because
that's a drug. I mean, that's the most widely used
drug in the world actually, and there's nothing wrong with it.
I tell people, look, you can keep your coffee, you
can keep your teeth. I don't love these energy drinks.

(44:31):
They freak me out a little bit, and there's just
too much caffeine. There's also all kinds of weird vitamin,
weird stuff in them that you're not supposed to have
in those quantities that doesn't exist in nature like that.
But the coffee, beans, tea leaves all right, okay. And
when I tell people, look, your caffeine is fine, but
don't be using caffeine as a crutch. If you didn't

(44:52):
sleep well, don't have extra caffeine. Just just live with
the fact you didn't sleep well, because then you're going
to sleep better the next night. Right, sleep pressure the
body score if you're going to have caffeine. I give
people the standard cut off time of eleven o'clock, but
it really depends on your day. And I tell people,
keep your caffeine consistent and have a cut off time.

(45:13):
Have the same amount every day, have the same cutoff time.
And if you wake up earlier than your wake time,
like let's say you're alarm time at seven am, and
for some reason one day you wake up at six,
don't have your caffeine before your wake up time because
you don't want to teach your body to wake up earlier.
So that's the caffeine rules that I tell people, and
then people will I should also qualify that people will say, well,

(45:35):
marijuana is a plant. It's natural, and I'm just like, yeah,
so is tobacco. We know where that went, right, So
the whole natural thing is not an argument for coffee
and tea. The real argument for coffee and tea is
just that it's not a crazy energy drink. It doesn't
have obscene amounts of coffee of caffeine in it. But
just be reasonable. Most people know what reasonable means. I

(45:57):
do have people who come in and they're like, yeah,
I have eight shots of espresso, and I'm like, all right,
well don't. I always tell people, don't change how much
you have. You have to move it all earlier because
I don't want people to go into caffeine withdrawal. And
what my eight shots of espresso people find is like, wow,
that's really hard to get all those in. And I'm like, yeah, okay,
well you have to do it, and then we'll slowly
decrease you to seven and a half and we'll see

(46:18):
if that's easier, then we'll go to seven. We go
very very slowly because caffeine withdrawal is not fun and
I never want to induce it while I'm treating sleep.
It's the worst. So don't quit caffeine as a way
to improve your sleep, just move it earlier.

Speaker 3 (46:33):
More to come on health stuff. Is there any research
regarding sugar specifically in sleep.

Speaker 2 (46:44):
I think that it's in the bucket of calories and
sleep Okay, it's not good to eat a lot of
calories right before sleep, because the whole idea, like, when
you eat sugar, lots of things are happening that are
different than when you eat protein, but there's also a
lot that is similar. Your liver recognizes calories are coming in.

(47:07):
I must do work right now. Digestion must happen right
Your organs are doing all of this stuff. And during
sleep you really want to be giving your organs a break.
You don't want them doing that. And when your organs
are receiving calories, they're also getting the message, oh, I'm
getting calories because we're going to do stuff. We need
these calories to do stuff. But during sleep, the whole

(47:29):
idea is to not do stuff. So it's best to
not eat three hours before bed. And I do tell
people who are sensitive to sugar. Some people experience a
sugar high when they eat a lot of sugar. Right,
They get some heart, they get a little sweaty heart, palpitation,
need they get a little like whoa sugar high? Right?
That comes from somewhere. If that's you, be really careful
and again insert my you're an adult chorus earlier in

(47:51):
the day.

Speaker 1 (47:53):
So when a person's actually sleeping in a room. I
would love to hear from you about your what is
like your ideal fantasy best sleep environment situation? Like how
hot should it be? How dark should it be? How
noisy should it be?

Speaker 3 (48:13):
Like?

Speaker 1 (48:13):
What is the ideal sleep environment?

Speaker 2 (48:16):
Love this question. The ideal sleep environment is very dark
and very quiet because your eyeballs are very important. When
you see light, that suppresses melotone and secretion in your body.
So we want to see dark to be able to
be secreting melatonin, which reminds us dark sleep time. Now, okay, Now,
if you go to the bathroom and you see some light,

(48:39):
your melatonin production will resume itself when you go back
to your dark bed area. Right, that's not a big
problem per se. But the ideal environment is very dark,
is very quiet. You might have a white noise machine.
Those are fine, totally fine. And also it is very cool.
Sixty eight degrees or cooler to be exact, is going

(49:00):
to be a sweet spot. And I also tell people, look,
we have to talk about bedding. Down belongs in your
ski jacket, not in your bed. I take away down comfort.
If I had a nickel for every time I took
away down comforter from patient and their sleep got better.
I'd have like in the order of sixteen dollars, like
a lot of money, A lot at this point, okay,

(49:21):
because our body. If everybody's heard of this phrase circadian
rhythm before, right, you can actually think about this as
circadian temperature rhythm. You're the warmest during the day and
coolest tonight, and warmest during the day and coolest tonight.
And when you're getting ready to fall asleep, your core
body temperature is actually cool and your body's cooling down, right,
And so if you get under a whole bunch of

(49:42):
ski clothes aka comforter, duvet, whatever, and your body gets
and you get warm and you wake up, you think,
why am I waking up right now? Well, you send
a message to your body, Hey, we're getting warm. It's
time to wake up. So if you are someone who's
waking up in the middle of the night, a lot
switch out your bedding for cotton blankets. I tell everybody,
I make everybody in my clinic do this, anyway, And

(50:04):
a similar situation with the definition of a cotton blanket.
Cotton blankets are not coverlets, they're not down alternatives they're
not quilts. If those words, if the word coverlet comforter
duvet quilt is involved, it's wrong. A cotton blanket is
a very boring, ugly blanket. Some of them are better looking.

Speaker 1 (50:25):
Now.

Speaker 2 (50:25):
I have like a list that I send out to patients,
and I have nothing to do with the money of
any of them. But there's a lot of options. And
I once had a patient who was an interior decorator
and she said, this is so ugly, and I said,
good news. It's really dark in your room when you're sleeping.
No one's going to know. And then during the day
you can put that duvet coverlet chaos back on your

(50:48):
bed with all thousands of those pillows. No one has
to know. No one has to know. So cotton blankets
are key. Another thing that is really important for a
lot of people is an mask or a sleep hat.
I have a sleep hat that I pull down over
my eyes because I can't handle a lot of imasks.
But if you close your eyes right now, if we
all do, we'll be able to tell that it's actually

(51:10):
light out in this room. Our eyelets are not perfect,
and a lot of people find that, especially in the
early morning hours when they're running out of sleep pressure,
it's easier to wake up. But if they use an
eye mask, it can really help because light's going to
get in in the corner of those windows and such, right,
And so that's my shpiel I think on a sleep

(51:31):
environment that I think is really important. The other thing
to keep in mind is a lot of people find
that you wearing socks helps them fall asleep easier. And
that's because when your hands and your feet are warm,
it's easier for you to dump heat from your core
because your vasculature in your hands and your feet opens
up when your hands and your feet are warm, and
then the warm blood circulates to your hands and your

(51:55):
feet and dumps the heat through your hands and your feet,
and it's easier for you to fall asleep. And one
of my research studies actually right now, we're randomizing people
to either do a digital version of cognitive behavioral therapy
for insomnia by itself or with a heating protocol before
bedtime to see if that helps them fall asleep faster.
And research shows, you know, in many cases so far

(52:18):
that before bedtime heating like taking a hot shower before
bed can actually help people fall asleep. Faster because ultimately
cools them down opens the vasculature they done. Pete. Now
I'm not talking about getting in a shower for like
half an hour and getting sweaty. If you're sweating the
jigs up got you've gone too far. But just gentle
skin warming can really help with that.

Speaker 3 (52:37):
What's the difference between insomnia and other sleep difficulties, Because
I feel like people use insomnia very loosely when they
struggle to sleep. Yeah, they do.

Speaker 2 (52:47):
When people have insomnia, they have been having trouble sleeping
for at least three months, at least three nights a week.
They're having trouble falling asleep, staying asleep, waking up too early.
Their sleep problem is really upsetting to them, and it's
causing distress in their life, like it's causing things to

(53:10):
not go so well. It's also not due to another problem.
For example, if you have an extreme back pain problem
that's causing you to not sleep, you don't have insomnia.
You have a back pain problem that's interfering with your sleep.
People with insomnia, it's just about sleep, and these people

(53:31):
should seek out cognitive behavioral therapy for insomnia. The common
complaint is that this is hard to find. And it's true,
it is hard to find clinicians who are trained in this,
who are to take your insurance and all of that jazz.
There's a lot of private pay clinicians who can't afford

(53:53):
to operate and take insurance and provide this treatment. It's
out there. There's a website that I can get you
all to put somewhere to help people find clinicians. But
there's also an amazing treasure trove now of data showing
that digital cognitive behavioral therapy for insomnia works. This has
been tested in very large clinical trials, and there's a

(54:13):
variety of these platforms. Unfortunately, a lot of the platforms
that have been tested in these trials aren't available to
the public, which drives me bananas. They sold out to
insurance companies and now they're just not available. There's one
that I've actually advised, so full disclosure, I've advised them.
They asked me like, what do you think what should
we do? And I said, you should do CBTI this

(54:33):
way And that app is called rest and they're still
direct to customer, and customers can go and buy this
app and it will guide them through CBTI. You know so,
but there's there's these these apps now that actually, you know,
they actually work, and I'm thrilled. I'm thrilled about it.
But people with sleep problems need to seek out some

(54:56):
form of cognitive behavioral therapy for insomnia. What is that?
It's the first line treatment.

Speaker 1 (55:01):
But what if a person, you know, I just had
this experience actually with the patient they had some sleep issues,
they actually had insomnia. I suggested CBTI and their response
was like, oh, but that's therapy. I've spoken to a therapist.
I therapy doesn't work. I don't want someone just talking

(55:22):
to me. How would you talk to someone who maybe
has some you know, skepticism towards CBTI.

Speaker 2 (55:29):
I tell them, look, this is not therapy. Don't tell
me about your mom. We're not talking about any of that, right,
this is like physical therapy for your sleep, okay. And
I do group medical visits now because I don't have
time to see individual patients. I see eight patients at
a time, and I go around my zoom room and
I tell them what they each have to do. And
it's all a variation of the same thing. You're waking

(55:49):
up at this time. You're waking up at this time,
you're waking up at that time, right, And they all
have the same rules applied. They all learn all the principles.
And I say, look, there's no disclosure here, right, but
there's the only things you're going to do are about
what time you're sleeping, drugs, alcohol, because everybody in my
clinic has tried all of the drugs and all of
the alcohol and everything to make their sleep better. But
I tell people, look, this is not therapy. I wish

(56:10):
we could take the word therapy out of it. This
is more of a set of instructions. It's more like
sleep physical therapy. And I also tell people, look, give
me five weeks. If you hate you've been struggling with
insomnia for decades, what's five weeks? Give me five weeks.
And if you want to go back to your old
way afterward, be my guess. Nobody ever does. I also

(56:31):
have the luxury of people waiting for years on my
sleep waitlist, and by the time it's their turn, they're
just like, oh my god, I'll do anything you say.
I'm like, yes, great. And I also tell people you're
gonna hate me. I tell them, look, you're gonna hate me.
I'm gonna tell you to wake up. You're gonna you're
gonna want to put it. You're gonna want to put
my face on a dartboard and play darts with it,
and you can. And I tell people, look, I'll smile
on zoom, take a picture, print it out, put it
on the wall, darts. Okay, it's fine, I can take it.

(56:55):
But my retort is just look, it's not therapy. It's
got a bad name. This is physical therapy. That's also
an interesting name, physical therapy for your sleep. And we're
going to fix it, and we're not. We could just
totally not talk about your feelings at all if we want.
But for the people who are anxious, we can, and

(57:16):
we do, and I give them lots of tools for
how to work with their anxiety and their worry, because
half of my patients are in fact professional worriers who
need some tools to worry more professionally. And we can
go over a couple of my favorite ones. If you
guys are.

Speaker 1 (57:30):
Game, yeah, yeah, yeah, let's do it.

Speaker 2 (57:32):
One of my favorites. If you have a patient who
comes in and says, look, I'm really worried about X
y Z all day, every day. Da da da, I said, Okay,
here's what we're going to do. I'm not going to
tell you to stop it, because if I told you
to stop it, I'd actually be a bad psychologist, right
if that works. If just telling patients, oh, I've got
your solution, just stop that, they would never come back.
What I tell them is, look, it's so important. Your

(57:54):
anxiety and worry are so important that we're going to
get out of calendar and we are going to schedule
an hour every day for the next seven days for
you to worry. You're going to worry between four and
five pm every single day. And if you start worrying
at nine am, you're gonna jot down what that thing was,

(58:14):
and you're gonna save it for four pm because you
don't want to be bored at four pm. So at
nine am, when you start getting worried about whatever the
thing is, I got to fix my car, you say, oh,
fix car, you'd be like, I don't have to worry
about that now, because I have time scheduled to worry
about that later. And what this functionally does is cleans
up the rest of the day and consolidates the worry.
And then what I do is I give people discrete

(58:36):
tools like the thought record to work linearly with their worries,
so instead of spinning in circles, they're actually coming up
with solutions, working with their thoughts, adjusting their feelings, doing
these tools during that one hour time or half an
hour time or whatever it is. And a lot of
people really like this. The other thing that people often
really like is what I call the brain dump, and

(58:58):
every night before I tell people you need to land
the plane. Humans are not toasters. When you unplug a toaster,
it's immediately going to not work. Right. We can't just
get in bed and go like from like typing, typing, typing,
working that doesn't work. We were much more like airplanes.
If you ever been on an airplane, that's like coming
to the runway and you're about to land, and all
of a sudden, the pilot goes and then you go

(59:20):
way back up into the air, and everybody on the
flight goes no, and no one knows what's going on,
and people freak out. And then fifteen minutes later the
pilot gets back on and says, well, folks, you know,
we had some wind cheer on the left wing, and
we're just gonna approach from the West angle or whatever
the thing is, right, and he's going to redo it.
That's like going to bed at night. You need like

(59:40):
a one hour routine that you kick off so your
body knows, oh, we're starting to do these things. We're
getting ready for that unconscious thing, right, And that might involve,
you know, brushing your teeth, doing a face mask, reading
a magazine, like doing calm things. I always tell people
we don't read about global warming, global politics, wars, you know,

(01:00:00):
these kinds of things. Horror before bed. That's eleven am, right,
So I tell people you might want to kick off
your one hour routine by making a brain dump list,
because if you've ever gone to bed and you're circling
a list in your head of all these things you
need to remember tomorrow, it's like exhausting. And we often
do that the night before travel. We're like, oh, I
need to turn off the air conditioning, shut the garage,

(01:00:21):
get the mail, and blah blah blah. But if you
get in bed, just remember, oh, I need to look
at the list. I just need to look at the list.
It stops really fast. So these are the kinds of tools,
and again those aren't really very therapy like, right, they
arguably we could couch them in therapy, and the scheduled
worry time thing is part of treatment for generalized anxiety disorder.
But I think when people think about therapy and think

(01:00:42):
I don't want to do therapy, they're thinking about disclosure
and you know, disclosing a lot of information that they
feel like has nothing to do with sleep, which they
don't have to do. So those are I think that's
my final favorite or tool that I tell people is
tracking your degree of belief in something you worry about,

(01:01:04):
so at two am. I once had a patient who
would wake up at like two am and he would
be convinced that we were about to be bombed by
North Korea, and he'd be like, Wow, we're going to
be bombed right now? Is coming? I could feel it
like it's awful. But then the next day, at like
two pm, while he's walking his dog in the park, like,
how worried are you about that bombing? I'd be like, Ah,
it's a nice day, I'm not really worried about it
right now. But if you're certain that something's happening at

(01:01:26):
two am, and you're not certain at two pm, how
true can this thing be? If something's true, it shouldn't
change and how true it is across the twenty four
hour period. So if a patient learns like, oh, I'm
having this thought because it's two am, not because it's true,
it can take away a lot of the power from
the thought. So I'll have people track their degree of

(01:01:47):
belief in a given thought, and often they'll make this
discovery like oh, this is this I think this because
it's this time, not because it's true.

Speaker 1 (01:01:58):
We're going to take a short break. Stay with us.

Speaker 3 (01:02:05):
What is We talked about this in bits and pieces
a little bit, but what is sleep hygiene? And one
of the biggest mistakes people make in terms of their
sleep hygiene.

Speaker 2 (01:02:16):
Yeah, a lot of things are starting to roll into
sleep hygiene. If you go, I get sent the patients
off and will send me these videos of people doing
their sleep hygiene routine, and I'm like, oh, that's fascinating, right.
I actually blend a lot of things into sleep hygiene
that probably shouldn't be there. Like I consider a stimulus control,

(01:02:36):
which is a fancy way of saying nothing in bed
except for sleep or sex. I end up throwing that
in sleep hygiene. A lot of the time, even though
it's technically its own thing, And I tell people reserve
the bed for just sleep. You know, don't be eating
a huge meal, like if we're going to do classic
sleep hygiene, don't be eating a huge meal right before bed.
Don't be drinking caffeine late in the day, don't be

(01:03:01):
taking lots of long naps during the day. All the
stuff that we all talked about, A lot of that
that really is a lot of sleep hygiene. Don't commit
like cardinal sins like eating in bed, Oh my god,
don't do that right, Like these kinds of things. I
also tell people, don't cancel your plans, Like if you
have a bad night of sleep, don't cancel your whole

(01:03:21):
next day. Do the whole next day and build up
that sleep pressure for the next day. You know, we
can get into really granularish stuff like see bright light
in the morning. That's great. I love that people should
do that. But the thing about fixing sleep is that
there's so many different recommendations I can give to people,
but I don't want to overwhelm people, so at the

(01:03:42):
beginning I really focus on the most important stuff.

Speaker 1 (01:03:45):
Well, so what do you think about blue light blocking glasses?
Those bright orange glasses that.

Speaker 2 (01:03:51):
Block me, and I thought you might have a question
about these.

Speaker 1 (01:04:00):
I sent Harry a pair of blue light blockers early
when we started the show, and you own a pair, obviously,
as I own many many pairs. What if you could
just explain to our listeners that don't know anything about
blue light, like, what are your thoughts on that blue.

Speaker 2 (01:04:20):
Light is very effective at inhibit inhibiting melatonin related processes
in our bodies. And because we have invented lights and
we have changed our exposure to light altogether as a
result of inventing light bulbs, all these things, we've introduced
new problems into our health. And the purpose of these

(01:04:44):
ugly orange glasses is to block this type of light,
which is the blue light, which is it's not like
appearing blue right now to your eye, right it's just
everything is what the color it is that we see.
But during the day, exposed to a lot of blue light,
and it's suppressing our melatonin production and we're awake. But
then when the sun goes down, our melotonin processes are

(01:05:07):
supposed to start up. But if we keep all these
lights on around us that are emitting blue light, we're
messing with that and so some people find they're very
sensitive to that blue light, other people less so. But
I tell people who have difficulty falling asleep in particular,
you may benefit from wearing these for a couple hours
before going to bed in addition to having dim lighting

(01:05:28):
in your house. That's another sleep hygiene thing, right, like
dim the lights at night. Great, okay, good. But people
have differential experiences with these orange glasses. I had one
patient once who'd been on ambien for as long as
she could remember and only for the purpose of falling asleep.
I had her start using the glasses and she was

(01:05:48):
like doubled over. She's like, I could barely stay awake.
We were able to cut her ambient dose in half
in a week, and then she was able to get
off really quickly. But then she went on a trip
and she forgot to bring her orange glasses and was like,
oh my gosh, back to square one. So it turns
out she's one of those like super sensitive people. So
she bought like ten pairs. She says she puts them
like every perse Now, like every she just has them

(01:06:10):
because if she's out or somewhere in the two hours
before going to bed, she sticks them on now, people
should not be wearing these in the morning. You don't
wear these during the day. That's not a thing. Don't
do that. This is just in the couple of hours
before bed, particularly if you're you know, I don't know,
looking at a computer screen writing up your patient notes,
like doing you know, bad behavior at night that you
shouldn't do, like working late at night, another sleep hygiene thing. Right,

(01:06:33):
don't work in the couple hours before bed. You know,
it's so hard to do, but I still tell people
try try hard. So the other thing about these glasses is,
you know, there's so many on the market now, and
people will email me and they'll say, what about this brand?
What about that brand? And it's like, oh gosh, I
don't know. I tell people just look for the dark

(01:06:55):
orange lenses, like make sure they appear dark orange, and
when you look through them, the colors of things around
you should be hued orangish reddish. Right, I don't know
what to think about. You know, some of these new
glasses with the clear lenses that don't actually change the
color of anything you're seeing. I don't know. I don't know,

(01:07:18):
So I just stick with the darker colored lenses.

Speaker 1 (01:07:25):
The craziest looking ones.

Speaker 2 (01:07:27):
Yeah, the worst, uglier they are the probably the better
there if you want to save a lot of money.
And if you have glasses, because I see have glasses,
you can actually buy something called a dental curing light.
This is what dentists buy. It has to block that
really intense play because they're using that light to cure
your cavities big time, and they don't want to damage
their eyes. And they're putting those those dental curing glasses

(01:07:48):
on over their glasses while they're working on their patient.
And they're so cheap on the internet. They're ugly. They
win the prize for like least attractive, right, But you
can buy those to go over your glasses.

Speaker 1 (01:08:00):
They also sell the orange glasses that you can go
over your glasses. That's the one I sent Harry. Yeah, yeah,
they go over Yeah. No, they're totally attractive. Well, we
gotta start wrapping up. But I want to ask you, Ashley,
So what is your personally favorite like your personal favorite

(01:08:24):
sleep habit.

Speaker 2 (01:08:26):
Waking up at the same time every day boom, don't
change it. I don't change it. And people ask me, well,
what if you're sick, I say, if I'm sick. Then
if you're sick, you can nap during day and go
to bed early. But I tell people, really try and
defend that wake time. I'm a broken record on this.
Get up at the same time every day, literally every day.

(01:08:48):
Set an alarm, don't use your like internal magic alarm.
Set in alarm, and have it be at a reasonable
time that you can actually sleep until at least four
days of the week. If you say, O, I'm going
to wake up every at nine am, but then everybody
you actually wake up at eight thirty, you've chosen the
wrong time. Choose a time you can make it to
it the majority of the days of the week. And
then really really do your best to build a wind

(01:09:10):
down routine in the hour before bedtime that doesn't involve
scrolling on your phone, work stressful things. Build a build
a wind down routine that is portable that you can
take with you anywhere you go to tell your body, hey,
we're getting ready to sleep.

Speaker 3 (01:09:29):
And no more podcasts before you go to bed.

Speaker 2 (01:09:31):
Oh yeah, do not do not fall asleep listening to nonsense.

Speaker 1 (01:09:35):
Like except for this one, this well, this one is
this one.

Speaker 2 (01:09:39):
Is so riveting that nobody's going to fall asleep during this.

Speaker 3 (01:09:42):
That's a good point. That's a very fair point.

Speaker 2 (01:09:44):
No one's going to use this for sleep, for falling asleep.
There's other podcasts and we're going to shall remain nameless
that people use to fall asleep.

Speaker 1 (01:09:52):
Uh, Doctor Ashley Mason, everyone, thank you so much Ashley
for coming on the show. We've learned so much and
know we're all going to sleep better tonight thanks to you.
I will will be dreaming of you.

Speaker 2 (01:10:06):
Thanks for having me.

Speaker 3 (01:10:07):
Thank you.

Speaker 1 (01:10:12):
Okay, So, Harry, I gotta know what you think, like,
do you feel like you gained some new info or
what what are you feeling?

Speaker 3 (01:10:23):
Tell me? Well, I think the you know, keep your
bed focused on sleeper sex was definitely a big takeaway.

Speaker 2 (01:10:31):
Okay.

Speaker 3 (01:10:32):
I think also, you know, I tend to to listen
to podcasts before I go to bit. I'm definitely on
my phone way too much. So I think my sleep
hygiene is not good and it's never really been good
as far as I can remember. So that was that
was a big one, just really treating that bed space.
There is a mixing of worlds between like like bed

(01:10:56):
and rest of my life and trying to keep it
separate as much as possible and say like, this is
where sleep or sex happens, I think is important versus
this is where I look at my phone, and this
is where I write my book, and this is where
I do X Y Z. No, this is where you sleep.
And keeping it to that seems like a big one. Yeah,
you know.

Speaker 1 (01:11:16):
I actually I used to be the same way, and
then I met Ashley learned about all this, and I
changed that and it made a huge difference for me.
So now the bedroom is just for sleep and sex.
That's that's the only thing that's going on. So yeah,
I think it's It's incredible how little little things can

(01:11:38):
make a huge difference. And sleep is something that affects
all of us. So I'm glad. And one of these
days you got to tell me what you think of
the blue light blockers. At some point, you don't have
to wear them in public, like just go to sleep, yeah,
and just see, like if if you notice anything. I

(01:12:00):
swear the first time I tried blue light blocking glasses,
I was asleep like in an hour. They it was
so strong. I was like, WHOA, this is crazy, So yeah,
it was. It was really interesting. So I'd be curious
about your experience but.

Speaker 3 (01:12:16):
I could definitely, I could use different strategies. So that
sounds great. I'll give it a try.

Speaker 1 (01:12:21):
Well, I think I'll go take a nap.

Speaker 3 (01:12:23):
Now wait, we're not supposed.

Speaker 2 (01:12:26):
To, but for twenty five minutes, we can't.

Speaker 3 (01:12:29):
Five minutes, Okay, if we have to, we can.

Speaker 1 (01:12:32):
Thanks everyone for listening. If you're enjoying the show, please like, subscribe,
or give us five stars on whatever platform you listen to.

Speaker 3 (01:12:39):
Take care everybody. Sweet Dreams, Sweet Dreams.

Speaker 1 (01:12:48):
How Stuff is a production of iHeart Podcasts. The show
is hosted by Me, doctor preancle Wally, and Harrie Konnebolu.
Producers are Rebecca Eisenberg, Jenna Cagel, Christina Loranger, Maya Howard,
and Katrina Norvel. Our researcher is Maria Tremarchi and our
intern is Katia Zobel Leayala. To send us a question,

(01:13:09):
you can email us a voice memo at Healthstuff podcast
at gmail dot com. Thanks so much for listening.