December 16, 2020 • 42 mins
A good night's sleep is the foundation of a healthy mind and body. You compromise your sleep at your peril. But although we all know this, we live as if we have forgotten it. We have invited Vyga Kaufmann to this week's episode of What Monkeys Do, to remind us just how vital sleep is to our mental and physical health and to tell us how to get the best possible sleep.
Vyga Kaufmann is a clinical psychologist. She specialises in cognitive behavioural approaches to the treatment of sleep issues as well as anxiety, depression, and work stress. She believes sleep is the most critical measure in the treatment of those disorders. Nevertheless, all changes you want to make in life depends on mental health and flexibility. And good night's sleep is the foundation for both.
VYGA TALKS ABOUT
- 3 tips for you to sleep better tonight
- The 4 stages of sleep. They increase your health and productivity, and most importantly, boost your mood
- Disorders and sleep issues. If you suffer from a disorder, chances are that you have sleep issues too. Instead of only trying to treat the disorder, Vyga suggests fixing the sleep instead.
- Why the bed should only be a place for sleep and sex
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Morten Andersen (00:05):
Hello, and welcome to What Monkeys Do. My
name is Morten Kamp Andersen.
And this is a podcast about whatit takes to make a change and
make it stick.
It says on page one of mosthealth and wellness books and
psychology books that you need agood night's sleep to be in good
(00:26):
physical and mental health. Butwhat is sleep? And how do we get
that good night's sleep? Well,let's find out in this episodes
of What Monkeys Do. About 25years ago, I read a book about
sleep. I can't remember theexact title, but it could have
been called How to optimize yoursleep and be more productive and
have more fun. The idea of thebook was that we work eight
(00:50):
hours, we play eight hours, andwe sleep eight hours each day.
And the book suggested that wecould optimize our sleep. So we
only need to be in bed for sixhours and get the same amount of
quality sleep. And then we couldtake those two hours and spend
one extra hours on work. So bemore productive, and one extra
hour on play. So have more fun.
And I tried that for a week. ButI found that I had actually less
(01:12):
energy to work, and I was notmuch fun to be around. So I
stopped. My guest today will beable to tell me if I just didn't
follow the instructions well, orif it's not even possible to
optimize our sleep in that way.
She's a clinical psychologistspecializing in cognitive
behavioral approach to thetreatment of sleep issues. She's
(01:35):
earned her PhD from theUniversity of Colorado in
Boulder, where she's alsoteaching. She's the co founder
of summit behavioral SleepMedicine, a company that use an
evidence based approach toaddress overall sleep quality.
Welcome to you, Vika Kaufman.
Vyga Kaufmann (01:52):
Hello, thank you for having me today. I
appreciate the invitation.
Morten Andersen (01:55):
Absolutely. So this episode is about sleep. And
before we begin, I just want toknow a little bit about your
background, and how does onebecome interested in sleep. So
what did you do to make thatbecome your speciality?
Vyga Kaufmann (02:09):
Well, I am a clinical psychologist and my
licensed clinical psychologist,which means that in addition to
teaching, I maintain a privatepractice treating different
types of disorders such asanxiety disorders, such as
generalized anxiety disorder,phobias, panic disorder. And I
also treat things like mooddisorders, bipolar disorder,
(02:31):
major depressive disorder. Andwhat those disorders all have in
common is that behavioralelements play a big role in
managing the course of thedisorder. For some disorders
such as specific phobias, weknow that behavior therapy can
cure them. And for otherdisorders, such as bipolar
disorder, we know that the waypeople manage some of their
(02:53):
behaviors, especially as itrelates to sleep and wake cycles
can really influence the courseof mood episodes and even
predict whether or not anothermood episode is imminent. And
what was interesting to me isthat those were the first places
that I saw the power of behaviorchange. And over time, what was
discovered is that one thing incommon to a lot of mental health
(03:16):
issues is disturbed sleep. Andthe big question became, well,
if disturbed sleep is the commonthread for a lot of these
disorders. What happens if youfix the sleep? And for a long
time, insomnia and sleepdisorders were thought to be a
symptom of other types ofdisorders, what and it was
thought that if you fix thecardinal or the parent disorder,
(03:39):
that sleep would just kind offall into place. And over time,
I was really clear, that's notexactly how it works. Sometimes
sleep issues even persists evenwhen the parent disorder is
managed or cared. And what we'reseeing is that as I looked into,
well, then how do we fix thesleep, it became really obvious
that once again, behaviorchange, and a lot of the things
(04:00):
that I had learned in terms ofhuman cognition and human
behavior actually result inphysiological changes and
biological changes that candrive people into consistent and
better sleep. So that was reallyexciting. And once people start
learning about sleep, it getsreally exciting. And you can't
really stop so to say.
Morten Andersen (04:19):
So you, you see that people are depressed, and
they also suffer from sleep,they don't sleep very well. And
instead of treating thedepression by itself, and then
over time, they'll sleep better,you could actually treat sleep,
and then that will help not fixbut probably help go a long way
to help the depression as well.
Vyga Kaufmann (04:40):
That's right. I like to think of a lot of our
interventions as kind of actinglike a volume knob rather than,
you know, light switch. It's noteither that it helps or it
doesn't help is to what degreeso often, if somebody comes to
my clinic and they have a sleepissue, along with some other
mental health issue, I proposethat maybe let's see if we can
get some movement on the sleepand see how that influences
(05:01):
overall health, but also mentalhealth as well.
Morten Andersen (05:04):
Okay, let's look into sleep. I go to bed at
11 o'clock, and I wake up at sixnext day I've been asleep. But I
bet it contains a lot morenuances than that. So what is
sleep? And what different typesof sleep do we have?
Vyga Kaufmann (05:18):
Your right sleep is not one thing, sleep kind of
unfolds throughout the night intwo different stages, these
stages of sleep are bestmeasured by the electrical
activity of our brain. So whenyou hear about sleep stages, the
way that scientists think aboutthat is, what types of
brainwaves are being generated.
And what other types ofphysiological markers are there
(05:39):
that would suggest that somebodyis progressing through the
different stages of sleep. Sostage one sleep is a very, very
light sleep. In fact, I like tocall it beverage cart sleep,
have you ever been on anairplane and you know, the
beverage coming and yet you'revery relaxed, so you kind of
close your eyes. And you'relike, well, but I want to say
just alert enough so that whenthe beverage cart comes, the
(06:02):
person will know that I wouldvery much enjoy having a drink.
But that is actually a stage ofsleep, because you're not alert
as you might be now. And yet,you might self report that that
was a period of time when youwere awake, and not asleep.
Morten Andersen (06:19):
So you can actually sleep with your eyes
open in that sense. I mean,that's first stage, you, you
probably have your eyes open ina sense, and you would call it
sleep,
Vyga Kaufmann (06:28):
and your eyes would probably still be closed.
And yet you would be in betweenthe stage of being completely a
word alert and awake now, ratherthan maybe capitulating and
allowing yourself to fallasleep. So it's kind of like
teetering on that edge ofwakefulness and being completely
more asleep, which is whatpeople think of when they're
(06:50):
sleep. So when they're stage twosleep, now you wouldn't notice
maybe the beverage cart, yourability to detect external
stimuli is diminished. Butstill, it would be relatively
easy to wake you up. And whenwe're in stage two sleep, I
could get your attention easily.
And if I woke you up, you mighteven do a pretty good job
estimating about how long you'vebeen asleep. And then when we
(07:10):
advanced down into deeper stagesof sleep, when we think of deep
sleep, what we're reallythinking of is stage three, and
deep sleep is this deliciousrestorative sleep, that when
people are deprived of it, theymight feel that accident didn't
sleep very well. And that mightbe using experience, like I had
perceived that I was unconsciousfor seven hours, or asleep for
(07:31):
seven hours. And yet I don'tfeel quite rested. So there
might have been something thathad disturbed that that deep
stage of sleep, and if you wakeup in a deep stage of sleep,
usually we're a little bitdisoriented. So if you've ever
woken up in a hotel andwondered, you know, if you've
been kidnapped, where are you?
How did you get there, it isvery, very possible you actually
(07:53):
woke up from from deep, deepsleep. And then we go into what
most people are familiar with,which is REM sleep, which is
where most of our dream sleepoccurs, and the cycle begins. So
we we cycles from stage 123,down to REM sleep, and we spend
a different amount of time ineach stage of sleep as the night
unfolds.
Morten Andersen (08:13):
Okay, so would it be fair to say that the
better quality sleep if youspent more time in stage four,
or three and four, or is it justthat you cycle and and it's
actually all four parts that areequally important?
Vyga Kaufmann (08:29):
So what we know is that stage three sleep or
deep sleep is especiallyconserved so that what that
means is that if you getinsufficient sleep a few days in
a row, and then you have amplesleep opportunity that your body
by itself will actually spendmore time in stage three sleep
(08:51):
and deeper stages of sleep. Butthat's recovery or an attempt
for recovery. Really, we don'tknow enough about sleep to know
what happens when you spend lesstime in each stage of sleep in
favor of maybe more time andanother stage. We have some
clues, but for the most part,what it seems like is that
having an adequate sleepopportunity and cycling through
(09:13):
those stages, completely eachnight is certainly the
healthiest form of sleep.
Morten Andersen (09:18):
Okay, so there is something called a good
night's sleep and a poor night'ssleep. And a good night's sleep
is the more time we spend inprobably stage three, maybe even
stage four as well during anight.
Vyga Kaufmann (09:31):
I would say a good night's sleep would be
defined by smoothly sleptcycling through each stage
uninterrupted. Okay.
Morten Andersen (09:40):
That's the other piece is that we know that
consolidated sleep is not onlyhealthier for us, we're in a
better mood and better able toconcentrate so if you have seven
hours of fragmented sleep, youmight not feel as rested as
somebody who has had five or sixconsecutive hours of sleep and
this this the same folderPeople, so I'm just practically
(10:01):
thinking. So for instance,whenever there is a noise
outside of our house, I alwayswake up during the night, but my
wife never wakes up, she neverhear those noises. And I always
do. Is that because I'm in a,I'm in a lighter sleep? Or do we
just have different sleeppatterns? Or do we have that our
deep sleep level is differentlevels of deeper? Why would that
(10:22):
be?
Vyga Kaufmann (10:24):
What is most likely happening? I actually
have a theory, this is funnythat you just said that, because
I don't have any data to supportthis. But it seems to me, deep
sleepers are always paired withlight sleepers. That you've just
you've just added another datapoint to that observation. But I
think what it might not havesomething to do with what stage
of sleep that you're in, what itmight have to do with is your
(10:45):
proneness to hyper arousal, andhow, what you're physiologically
predisposed to noticing. Somaybe your arousal threshold is
simply lower in terms of beingable to respond to what's
happening externally from you,then your wives.
Morten Andersen (11:00):
Yes. And we know that that kind of alertness
is actually something which ishardwired in us as we're very
different from each other. Sowhat is the impacts and the
benefits of having a goodnight's sleep, what's the health
benefits other than if you'redepressed, and then that can
lead you out of a depression?
What, what else is there in agood night's sleep?
Vyga Kaufmann (11:19):
So we know that healthy sleep is extraordinarily
good for our cardiovascularhealth. As we descend into
different stages of sleep, andthroughout the night, our heart
muscle has an opportunity torest and something that
sometimes called the heart ratehammock where your your heart
rate descends ever. Sogradually, as you fall asleep,
it kind of stays at a lowerlevel throughout the night. And
(11:40):
then comes back up as ourcortisol awakening response or
and as our as our sleep drivediminishes. And we wake up, our
heart rate is back up to maybewhat our typical resting heart
rate is during the day. And itlooks like cardiovascular break
is very good for our hearts. Sopeople who have a lifetime of
sufficient sleep, tend to havebetter cardiovascular health. So
(12:02):
from a medical perspective,that's one piece. We also know
that sufficient sleep is goodfor our metabolic health. So in
are attempting to manage theirtheir body weight, in addition
to their cardiovascular health,we know that having well time
sufficient sleep can helpregulate our hunger and fullness
cues so that maybe we don't haveto rely on our own willpower as
(12:25):
much and can rely instead on ourbody's natural need for food and
satiety. So there's anotherthere's another piece there. And
also for our brain, we know thatone of the things that sleep is
really good for is removing someof the metabolic waste that has
accumulated throughout the day.
So it looks like for forcognitive purposes, especially
(12:46):
one devotee, and being able toremember things well and prevent
certain types of dementia, thatperhaps a lifetime of good sleep
is beneficial. And for our mood.
You know, I think a lot of timessome of these distant type of
health benefits are not quitemotivating for people to
(13:06):
prioritize sleep, when when wehave guests in our home. And in
the morning, when they wake up.
What's the first question we askhow did you sleep and and so and
we know that maybe we're askingthat perhaps out of tradition,
but also we know that getting agood night's sleep sets us up
for a much better day. So ithelps with our mood, it
diminishes irritability, it alsomakes us more patient. And I you
(13:29):
know, you mentioned you have youhave kids. And so patience,
being a big piece of parenting,and sleep sets up for that type
of success. It also helps uswith creativity, I think that
we're starting to see morebusinesses really prioritizing
well rested. Employees we knowthat increases productivity, we
(13:49):
know that sleep, insufficientsleep actually diminishes
productivity, and actually canbe very costly to companies. So
really prioritizing the thesleep of employees can increase
productivity, creativity, myfavorite measure of anything is
just quality of life. And weknow that sleep remarkably
increases just day to dayquality of life.
Morten Andersen (14:14):
This is a wonder drug, it really has a lot
of benefits. And I guess thedownside, the only downside of
it is that the investment is afairly big investment if the
investment is time. I am justanxious to hear about the book
that I read 25 years ago, whichwould said that I could cram in
eight hours of quality sleep insix hours if I just optimized
it. I just want to hear is thatpossible?
Vyga Kaufmann (14:35):
No. I think what's interesting is that sleep
is a really hot topic right now.
You are going to hear so muchabout lotions, potions,
tinctures, oils, technologies,things that can optimize your
sleep when even scientists don'teven know what that means. So
one example is I heard somebodysaying that this particular
medication increases the amountof time that people spend in
(14:56):
stage three or deep sleepHowever, that's at the expense
of other stages of sleep. Andthere's a reason that we go
through these different stagesof sleep. And humans aren't the
only ones that do it. This is ahighly conserved process across
species. If evolution hasconserved this particular
behavior, it must be incrediblyimportant. But what's
(15:20):
interesting is that you saidthis is a tremendous investment.
And yet, I do have to wonder ifthe return on investment is far
greater than what one mightimagine, you know, acutely that
loss of and in people often wantto go from eight hours to six
hours, what is it two hoursbuying you?
Morten Andersen (15:40):
Yes, yes, I actually fully agree. On one
hand, it is an investment islike going for a run, you know,
there is an upfront investment,so to speak, but the benefits is
so much better. And I'm not evencomfortable talking about
investments when we will betalking about this. But on the
other hand, I mean, people haveknown about the importance of
sleep for years. I mean, when weeven look at the ancient
scripts, you know, there isadvice about sleeping well, and
(16:02):
the importance of sleep. On theother hand, we now can, you
know, measure our brain in waysthat was completely impossible
just, you know, 50 years ago,what have we learned about sleep
the last 1015 years, that isnew.
Vyga Kaufmann (16:16):
When we sleep, there, space between our neurons
in our brains grows, so thatmeans our neurons have to shrink
in some way. Right. And what'scalled is that an increases
what's called these interstitialchannels, and cerebrospinal
fluid is shunted through thesechannels in our brain, and it
removes some of the metabolicwaste that's been accumulated
(16:38):
during the day. The good newsis, is that it seems like the
glymphatic system works kind ofovertime as we are sleeping, but
it also may work during the dayas well. But some of the
metabolic waste that it removesmight be familiar to some of
your listeners. So for example,beta amyloid plaque, we know
that the accumulation of betaamyloid plaque is one of the
(17:02):
markers of Alzheimer's typedementia. So it's the
relationship between chronicsleep loss and dementia is still
being elucidated. But it seemsthat when we think about what's
the mechanism by which sleepdeprivation might increase risk,
or vulnerability to certaintypes of dementia, they're going
fatik system and its ability tohave the time to remove some of
(17:25):
that metabolic waste might beone of those mechanisms. So the
discovery of that which is stilltremendous amount of data being
collected is I think, one majoradvance that gives us a better
understanding about sleep. Iknow, you know, in 2017, the
Nobel Prize was awarded toscientists who discovered some
of the genes that regulatecircadian rhythm. So I think a
(17:48):
lot of times, you know, we'retalking a lot about sleep, and
you know, the stages of sleep.
An important piece of that iseven the timing of our sleep and
how that fits in somebody's owncircadian rhythm. And then the
question was, well, how's thecircadian rhythm regulated?
Anyway, we know that light is amajor piece that in trains our
circadian rhythm, but from abiological process, how does
(18:10):
that happen? And so that wasdiscovered, which was really
exciting.
Morten Andersen (18:25):
You mentioned just before that there was there
was a whole industry that istargeting sleep, so you can get
medicine, as you said, you canget lamps that wake you up with
sunlight, you can geteverything. And one of the
things that is I think, verypopular is watches, wristbands,
or rings that can help youmonitor your sleep. And my wife
(18:46):
actually has one of those. Andevery morning, it tells her for
how long time she has beenasleep, how much of it was REM
and light sleep and deep sleep,and she gets a score. And that
score tells us overall score.
How useful are those? Thattechnology? Is it? is it
accurate? And can I can I usethat for anything? Would you
recommend things like that?
Vyga Kaufmann (19:08):
I think it depends on what you are doing
with that information. So welove data collection, right? And
we especially like to learnabout ourselves. So those sleep
devices, you know, they'reaccurate enough. I think that
you know, there there are somethere's some data that some of
them overestimate time inasleep. Some of them
underestimate but for the mostpart, it's good enough for what
(19:29):
people might be interested intracking. The the paradox here
is that when people becomepreoccupied with the data, they
actually can end up doing harmto their sleep. So there's a
term that's been coined by asleep researcher named Kelly
Baron and she calls it orthoSamia. So you know this strive
(19:53):
for perfection around sleepcould have the paradoxical
result of increasing anxietyabout sleep. And striving for
sleep perfection might actuallyimpede people's ability to
sleep. So one of the questionsI'm often asked is, well, what
do you think about these sleeptracking devices? And typically
my response, which is tongue incheek, but honestly, is why? Why
(20:15):
do you need it?
Morten Andersen (20:16):
And I think for most people, it is just fun. It
is like tracking how many stepsyou're walking and things like
that. And you're right, for whatpurpose? And actually, we
discover sometimes that, youknow, she would wake up and she
said, Oh, I had a great night'ssleep, and then the score wasn't
as great. And then she didn'tfeel as good about as liebhard
as she otherwise would.
Vyga Kaufmann (20:33):
And, you know, there's there's some data to
support her experience is thatwhen you bring people into a
sleep lab, and measure theirsleep, and then in the morning,
if you ask them, you know, howdid you sleep if they slept?
Great? There have been studieswhere they say, Oh, really,
gosh, okay, well, good. Youknow, it seemed like through
your your polysomnography, orthe sleep measures that you
actually didn't sleep thatgreat, but good for you. And
(20:55):
does it even if they had a greatnight of sleep, just being told
that it was not a great nightasleep, we call that the CBOE
effect. Usually people know theplacebo effect, which is
thriving benefit from some sortof inner intervention, while the
nocebo effect is a close cousin,which is negative side effects
of an in art intervention. And Ithink sometimes sleep trackers
(21:16):
end up doing that.
Morten Andersen (21:17):
That's so funny. There are of course, some
people who really suffers frompoor sleep insomnia is is an
example where people are reallystruggling to sleep. What is
insomnia? And why do some peoplesuffer from that
Vyga Kaufmann (21:31):
the diagnosis of insomnia disorder has to do with
the frequency and duration ofsleep problems. And you can kind
of think of it as a rule ofthrees is that if for three
nights each week, you're notgetting restorative sleep, and
this is lasting, about threemonths, you might qualify for a
diagnosis of insomnia disorder,and the question of how this
(21:54):
happens, it just depends on theindividual. So the it's thought
that we all have some baselinevulnerability to developing
sleep problems. And thatvulnerability might be pretty
consistent throughout our lives.
So the question is, if we're alleach have different
vulnerabilities, most peopledon't report I've had insomnia
(22:14):
from birth, right. So there mustbe some sort of precipitating
event and the precipitatingevent can be virtually anything,
it could be a stressful lifeevent, like starting a new job
and having new responsibilities.
It could be you know, the lossof a relationship, and the birth
of a child. And there'ssomething that you know, might
(22:36):
provoke, you know, hyper arousalin some, and some of these
things also could be medical. Sofor example, a very common side
effect of chemotherapy forcancer is disrupted. But the
precipitating event isn't enoughto maintain insomnia, we know
that there are a lot ofperpetuating factors. And those
are things that keep insomniaalive. So let's take for
(22:58):
example, something that weconsider, you know, a biological
precipitating event, which issomebody who's having
chemotherapy, obviously, there'sanxiety and stress of cancer,
but also the effects of thedrug. They might finish
chemotherapy. And you know, fiveyears later say, this is weird,
like I've ever since I hadchemotherapy, I'm unable to
sleep. But if you were to lookto see what might have been
(23:20):
going on during that interval,you might see behaviors that
unfortunately, while intuitivelymight seem like good ideas and
up keeping insomnia live, andthose are the things are like
staying awake in bed, beingawake in bed, creating that that
learning experiences, repeatedassociations of bed being a
place of arousal bed being whereyou plan your day worry, or just
(23:46):
watch your mind race, you know,there's repeated associations
can be very strong. That'ssomething that perpetuates
insomnia. Another is anirregular sleep schedule. So
oftentimes people will say, youknow, they don't get much sleep
during the week, and then theysleep in on Saturday, and Sunday
ketchup. Yeah. Well, yeah, they,the perception is, is that sleep
hasn't caught up with. Andoftentimes people report that
(24:09):
Sunday night of sleep is theirworst night of sleep. And the
report would be well, I must bereally stressed about becoming
workweek and the things that Ihave to do, when really the
their sleep drive might bedisrupted from having slept in
that, you know, some of thecircadian rhythm might have been
disrupted from a sleep schedule.
So these are all things that canperpetuate insomnia that might
have absolutely nothing to dowith the initial cause.
Morten Andersen (24:33):
I heard a couple of advice there. One was
get a regular sleep schedule. Sogo to bed at the same time, get
up regular, you know, at thesame time, and also if you are
struggling to sleep, get out ofyour bed and go outside and and
take a break and then go back tobed again when you feel tired so
you don't stay in your bed andcreate a learning experience of
(24:54):
staying awake in your bed is ishow things are
Vyga Kaufmann (24:57):
correct. I think that not only is it that you're
not creating a learningexperience that the bed is where
other things happen that overtime, if people do this, they
actually become precipitouslymore tired, went into bed
because bed has been become acue for, oh, this is where sleep
happens and your body knows thatthat is a cue and it prepares
(25:18):
itself and is more apt to tofall asleep more smoothly when
you do that.
Morten Andersen (25:22):
So when people come to you, and they are
struggling with sleeping, you'reusing cognitive behavioral
therapy as your tool for helpingthem Can you just help our
listeners just a little bitabout what is cognitive
behavioral therapy and also how,why that is particularly helpful
for this.
Vyga Kaufmann (25:41):
When you say to a psychologist, well, I'm doing
cognitive behavioral therapy,the nerdy psychologist will
probably say, for what, becausethere are different types of
cognitive behavioral therapy. Sothere's a system, cognitive
behavioral therapy for majordepressive disorder, versus
panic disorder, or some specificphobia. So for sleep, we call it
cognitive behavioral therapy forinsomnia. And I think
(26:03):
psychologists need some advicefrom marketing and branding
people because we need to putour whole Methods section in the
title. But so so cognitivebehavioral therapy for insomnia
really leans on some very oldbehavioral theories. So one very
important one being classicalconditioning or Pavlovian
(26:24):
conditioning. And I often jokethat if people only use their
bed for sleep, that I might beout of work. So if you are only
using your bed for sleep, thenit's not necessarily a conscious
idea. Okay, I'm now going tosleep is that your body has
created that association. Sothere's something called
stimulus control. And the firstrule of stimulus control is to
(26:49):
use your bed for sleep and sexonly. And I like to think that
I've saved many marriages byremoving sex out of the bed. And
but creating, you know, the thebed being in the bedroom, really
being a place that sacred forfor sleep, and this takes
repetition. This is notsomething that you know, someone
will do for a week and say,well, it didn't work. Yeah. And
(27:09):
there are other elements. Soanother element is something
called sleep consolidation,which some people also call
sleep restriction, and otherpeople call it torture. So what
what that has to do with is alotting, the your sleep
opportunity to match what theamount of sleep you're already
getting. So somebody comes tothe clinic and they you know,
are tethering together or sixhours of sleep, but it's taking
(27:31):
them eight or nine hours toachieve that, then in
collaboration with that person,I would say, Well, what do you
think about creating a sleepschedule for the next week where
you don't go to bed untilmidnight, and you get out of bed
at six each morning. And thatrepetition also can increase
sleep propensity or their sleepdrive. But again, this is
(27:52):
something that takes somerepetition, but it's a it's a
biological intervention, andthat it increases what's called
the sleep homeostatic sleep,drive, I like to even think of
it as a sleeping pill, you know,is controlling that sleep in
that way. But often people willsay that they're grumpy. And
while that, you know, theirtheir sleep might be
consolidated, they're stillgetting enough of it. So there
(28:13):
are strategies to be able toincrease amount of time in bed
to be able to also betterreflect the amount of sleep
someone is actually producing orachieving. So there we have a
behavioral we have behavioralcomponents about when someone is
in bed or not. But then thereare also cognitive components.
So the cognitive events have todo with people's beliefs about
(28:33):
sleep, one of the first thingsthat we typically end up talking
about is how much sleep Doessomebody want? And why? Hmm, so
I think a lot of us grew up withthis idea that, you know, we
need eight hours of sleep. Andthat's true for some people.
Some people we actually know nowthat most adults, a healthy
sleep window would be betweenseven and nine hours. Those data
(28:56):
are from population basedstudies to see what happens for
adults who say they get lessthan fewer than seven hours
versus more than nine hours andoutcomes. So somebody might say
I want eight hours of sleep. Andwe just have to wait and see.
Because the best, the bestmeasure of how well you're
sleeping, is how you feel eachand every day.
Morten Andersen (29:15):
Okay, so I have a friend and he insists that he
only needs six hours. I've beentrying to say no, I don't think
that's right. But what you'resaying is that well, for most is
actually between seven and nine.
But there could be people whereit is 10 and some way it is six.
Vyga Kaufmann (29:31):
In short, yes, there could that type of
individual variation probablyexists. And and what I'm curious
about is if your friend uses analarm clock to wake up,
Morten Andersen (29:39):
okay. So if he does, then it's probably
Vyga Kaufmann (29:42):
that there's some debt being accumulated. But
sure, no, I think your overallpoint is a good one is that, you
know, there is some variationand maybe but for most people,
for the majority of adults,seven to nine hours seems to be
optimal.
Morten Andersen (29:56):
I just need to make sure it's so are you are
you suggesting that not havingan alarm clock is, is good,
Vyga Kaufmann (30:02):
correct? Yes, in fact, that's one of the was one
of the ways that you I mean,because think about it, if
you're using alarm clock to wakeup, that means your sleep is
being interrupted, and your bodyis not able to complete the
sleep cycles that it wants to gothrough. So there is a very good
chance that if you arehabitually using an alarm clock
that you are likely alsocarrying a sleep debt. And
Morten Andersen (30:24):
I've never heard that before that it's
actually really surprising tome, because I would not trust
myself to wake up. I probably dowake up at about the same time
every day, but I'm not sure Iwould trust myself to wake up.
At the same time, especially ifI have a meeting the next day is
something interesting.
(30:49):
So obviously, most of us are notsuffering from insomnia. But we
are interested in having a goodnight's sleep. And I have to
admit that I usually go to bedaround the same time and I
usually get up around the sametime I feel I have a good sleep.
But I'm not equally rested.
Every time that I wake up.
Sometimes I feel very rested.
Very happy wellness is high. Andother times I feel that I
(31:12):
haven't quite slept enough eventhough that I know I have been
asleep for seven and a halfhours. Why is there difference
in that and, and in thissection, I would like to just
know some good advice for aperson who doesn't have what I
would call sleep problems. But Iwould still like to know how to
get a good night's sleep. Whatadvice can you give me?
Vyga Kaufmann (31:35):
Okay, the quality of your sleep vary from night to
night people really tend tofocus on, you know, I want the
eight hours. But what isimportant as well is, you know,
cycling through the sleep stageswell, and you said that you are
easily easy to wake up. So maybethere were some awakenings that
you didn't even register thatwere different night tonight so
(31:56):
that your seven and a half hoursfeels great most of the time,
but then from time to time, itjust doesn't feel the
restorative.
Morten Andersen (32:03):
So if I'm asleep for seven and a half
hours, the quality may be verydifferent. What can I do to
improve the quality of my sleep?
Vyga Kaufmann (32:12):
You mentioned that you go to bed around the
same time each night and youwake up around the same time
each morning so you are anoverachiever. The piece that
that we should mostly focus onis that your wake time is
consistent. And the reason thatthe wake time seems to be the
key is that and which is a topicfor an entire other podcast is
(32:36):
our circadian rhythm is best intrained with consistency, our
bodies love consistency. And ourcircadian rhythm doesn't just
govern what time we fall asleepand what time we wake up. it
governs how the timing of ourdigestion it governs the speed
of wound healing, we know thatwe wounds heal far faster if
(32:57):
they happen during the day thanif they happen at night. So our
eating rhythm is very complex.
And one of the things we can doto make it happy and to make us
healthier is to actually have aconsistent wake time which also
includes exposure to morninglight.
Morten Andersen (33:13):
Yes,
Vyga Kaufmann (33:14):
when you you know we don't go overboard and go
outside and go for a run or walkalthough Bonus points if you do
but just simply you know openingthe drapes and in the bedroom in
the house and bringing light inso a consistent wake time is the
first piece that I think is veryimportant. The other piece I
alluded to earlier which is useyour bed for sleep only. And if
(33:36):
you find that at the end of youknow when you get into bed, you
are planning your day around fortomorrow, just take that
activity outside of that maybethat should be part of your
nighttime ritual where you knowbefore getting into bed, you
know maybe a few hours beforegetting into bed you write down
what are the types of thingsthat I'm going to be doing
tomorrow so that your braindoesn't have to do that work
(33:57):
while you're luxuriating andappreciating being in bed and
the feel of your sheets and themattress and the pillow.
Morten Andersen (34:04):
And I think that's probably one thing that
that would be a new thing for mebecause I like to read before I
go to bed and I do that in bed.
I suspect many of my listenerswould be watching a Netflix
series in bed as well and you'resuggesting all of that out of
the bedroom.
Vyga Kaufmann (34:20):
If you sleep well and you are reading in bed that
seems like you know don't don'tchange a winning game. That's
great. However, if you do havesleep problems and there are
things that you are doing in bedthat are not sleep, I would take
those out of bed, watchingNetflix and doing those types of
things. anything involving youdon't want to blast light on a
(34:41):
sleepy brain. We know that lightinhibits melatonin production
and melatonin influences thetiming of our sleep. Some people
are very sensitive to that whereonce again if there is a problem
and you have sleep difficulty Iwould I would take that out of
out of bed.
Morten Andersen (34:56):
So bedroom only for sleep wake time. consistent,
Vyga Kaufmann (35:01):
I would add adding a buffer zone, and I
would add sleep rituals that arevery mobile. Hmm. So for people
who have kids, we know that kidslove ritual, they brush their
teeth, put on their pajamas, getinto bed, hear a story, and
lights out. And that rhythmicityis really advantageous to kids,
(35:25):
but also to adults. So whatparents are doing by creating
that sleep ritual is they'realso conditioning their child,
that child's body that you know,prepare for sleep, do the things
that the body needs to do, tofall off to sleep and adults
benefit the exact same way. It'sinteresting, I'll have clients
come in who described their day,and they work Work, work, work,
(35:46):
work, work, work, notice thetime brush their teeth, get into
bed, pull up the sheets, andthen you know, close our eyes
and hope that sleep will sooncome. That's not the way our
bodies work. bodies need just alittle bit of a buffer zone. So
I usually suggest creating aritual, you can take anywhere,
maybe 2030 minutes. And that caninclude, you know, brushing your
teeth, and reading a book for awhile. But you know, helping
(36:07):
bring down that hyper arousal.
When we fall asleep, our bloodpressure goes down or heart rate
goes down, our respiration rategoes down. So maybe having some
of those things that increasethe probability that will happen
starting it outside of bed.
Morten Andersen (36:21):
Okay, what about room temperature? Does
that impact our quality of sleepin any way?
Vyga Kaufmann (36:27):
Sure, yeah, we that we, our bodies like to have
cool air in the room while weare asleep. So the typical
recommendation is to bring thetemperature down as cool as you
are comfortable. And also tokeep your room as dark as
possible. So that's not possiblebecause you know, your your bed
partner doesn't want to getlight blocking drapes in the
(36:50):
room, then you could eyemask weall have different sensitivities
to light. So So having a verydark room, and a very cool room
is advantageous for promotinghealthy sleep.
Morten Andersen (37:02):
So sleep is, is a fascinating topic. And it's
actually one of those thingsthat if I meet a colleague at
work, you know, he might want toexcuse for being in a in a poor
mood, he would say I didn'tsleep very well. And sleep is a
topic that we talk about, not asmuch as the weather, but it's
probably quite close to that.
And you're also suggesting thatthere are so many health
benefits. For a regular person.
(37:25):
like myself, you know, there area lot of benefits. But also, if
you are suffering from a mentalillness, or depression or things
like that, it can actually helpyou get back on track if you
work on your sleep. And thereare some really good sound
advice here in terms of doingthat. I have a feeling that
people are not always followingthem, because they're trying to
(37:46):
cram in other things during theday, they're not respecting the
time, and the things that youneed to do in order to get a
quality sleep. Whatmisconceptions do most often
hear about sleep? So what dopeople most often think is right
about sleep, which isn't true atall.
Vyga Kaufmann (38:02):
A lot of people think that they are doing just
fine getting by on less sleepthan is recommended. Hmm. And a
lot of the referrals to myclinic have to do with people's
partners saying, You're not thesame. Your presence isn't the
same. You are not as happyyou're you tend to you're
(38:24):
trending towards irritability.
I've observed this long enough.
I think it's your sleep. And sosome people arrive and say, you
know, I'm only here because mywife sent me. And what's my
favorite quote from somebody is,I was doing great. I am the CEO
of my company, and I am a highachiever. And what I what has
happened now that I'veprioritized sleep is I've found
(38:45):
a new gear, I realize thatthings are much more effortless
now that I have sufficientsleep, I'm far more efficient,
and getting things done duringthe day. And apparently I'm more
fun to be around. So I thinkthat a common misconception is,
well, I'm doing great. I'm ahigh achiever. I'm doing well in
my profession. I think I'm oneof the outliers. I don't need a
(39:07):
lot of sleep. And I would likepeople to kind of tinker with
that and collect your own dataand prioritize sleep for a few
weeks and see see how that thatchanges your mood, productivity
and patience.
Morten Andersen (39:19):
Fantastic. I always finish a podcast with
three do's and don'ts and inthis case do so we have already
talked about but maybe just saythem again. So what what advice
would you give our listeners toget a great night's sleep?
Vyga Kaufmann (39:36):
three pieces of advice. Okay, number one, use
your bed for sleep only. Hmm.
Number two, no matter thequality of your sleep the night
before, get up at the same timeevery day and try to get some
light exposure as well. Thethird piece of advice is
creating a buffer zone beforebedtime. Create a routine that
(39:57):
is sustainable and that you'rewilling to engage in night after
night. And that will also helpimprove the physiological
process of falling asleep andstaying asleep.
Morten Andersen (40:11):
Fantastic.
Thanks a lot for those pieces ofadvice. And thanks a lot for
this conversation we got thatwas really interesting. Thanks
for your work, I think it's veryimportant that we get to
understand the field a lotbetter. So thanks a lot.
Vyga Kaufmann (40:25):
No, thank you. I really enjoyed talking with you.
This was really nice. Thank you.
Morten Andersen (40:29):
Thank you. What a great conversation with the
guy, I took three things. One,sleep really is important. The
conversation with viga remindedme of a thing I knew, but I
needed reminding off. And thatis that sleep is probably the
(40:49):
most essential part of a healthymind. And it can help you if
you're suffering from depressionor anxiety. But as we also said,
The health benefits are enormousand really are there for all of
us to benefit to you can improvethe quality of your sleep with
three simple advice. A, only useyour bedroom for sleep, be get
(41:13):
up at the same time each day.
And see, find your sleep ritual.
So the things that you do eachevening before you go to bed,
and then follow that ritual.
Three, all of the changes thatyou want to make in your life
depends on mental health andmental flexibility. And a good
sleep is the foundation for bothof them. So sleep really a
(41:35):
simple because made a great TEDxwhere she talks about how to
treat insomnia, and what thebasis is for a good night's
sleep. And even if you now knowthe answer to both of those, I
will encourage you to check thatvideo out. It really is good.
Enjoy. Until next time, takecare
Hello, and welcome to What Monkeys Do. My
name is Morten Kamp Andersen.
And this is a podcast about whatit takes to make a change and
make it stick.
It says on page one of mosthealth and wellness books and
psychology books that you need agood night's sleep to be in good
(00:26):
physical and mental health. Butwhat is sleep? And how do we get
that good night's sleep? Well,let's find out in this episodes
of What Monkeys Do. About 25years ago, I read a book about
sleep. I can't remember theexact title, but it could have
been called How to optimize yoursleep and be more productive and
have more fun. The idea of thebook was that we work eight
(00:50):
hours, we play eight hours, andwe sleep eight hours each day.
And the book suggested that wecould optimize our sleep. So we
only need to be in bed for sixhours and get the same amount of
quality sleep. And then we couldtake those two hours and spend
one extra hours on work. So bemore productive, and one extra
hour on play. So have more fun.
And I tried that for a week. ButI found that I had actually less
(01:12):
energy to work, and I was notmuch fun to be around. So I
stopped. My guest today will beable to tell me if I just didn't
follow the instructions well, orif it's not even possible to
optimize our sleep in that way.
She's a clinical psychologistspecializing in cognitive
behavioral approach to thetreatment of sleep issues. She's
(01:35):
earned her PhD from theUniversity of Colorado in
Boulder, where she's alsoteaching. She's the co founder
of summit behavioral SleepMedicine, a company that use an
evidence based approach toaddress overall sleep quality.
Welcome to you, Vika Kaufman.
Vyga Kaufmann (01:52):
Hello, thank you for having me today. I
appreciate the invitation.
Morten Andersen (01:55):
Absolutely. So this episode is about sleep. And
before we begin, I just want toknow a little bit about your
background, and how does onebecome interested in sleep. So
what did you do to make thatbecome your speciality?
Vyga Kaufmann (02:09):
Well, I am a clinical psychologist and my
licensed clinical psychologist,which means that in addition to
teaching, I maintain a privatepractice treating different
types of disorders such asanxiety disorders, such as
generalized anxiety disorder,phobias, panic disorder. And I
also treat things like mooddisorders, bipolar disorder,
(02:31):
major depressive disorder. Andwhat those disorders all have in
common is that behavioralelements play a big role in
managing the course of thedisorder. For some disorders
such as specific phobias, weknow that behavior therapy can
cure them. And for otherdisorders, such as bipolar
disorder, we know that the waypeople manage some of their
(02:53):
behaviors, especially as itrelates to sleep and wake cycles
can really influence the courseof mood episodes and even
predict whether or not anothermood episode is imminent. And
what was interesting to me isthat those were the first places
that I saw the power of behaviorchange. And over time, what was
discovered is that one thing incommon to a lot of mental health
(03:16):
issues is disturbed sleep. Andthe big question became, well,
if disturbed sleep is the commonthread for a lot of these
disorders. What happens if youfix the sleep? And for a long
time, insomnia and sleepdisorders were thought to be a
symptom of other types ofdisorders, what and it was
thought that if you fix thecardinal or the parent disorder,
(03:39):
that sleep would just kind offall into place. And over time,
I was really clear, that's notexactly how it works. Sometimes
sleep issues even persists evenwhen the parent disorder is
managed or cared. And what we'reseeing is that as I looked into,
well, then how do we fix thesleep, it became really obvious
that once again, behaviorchange, and a lot of the things
(04:00):
that I had learned in terms ofhuman cognition and human
behavior actually result inphysiological changes and
biological changes that candrive people into consistent and
better sleep. So that was reallyexciting. And once people start
learning about sleep, it getsreally exciting. And you can't
really stop so to say.
Morten Andersen (04:19):
So you, you see that people are depressed, and
they also suffer from sleep,they don't sleep very well. And
instead of treating thedepression by itself, and then
over time, they'll sleep better,you could actually treat sleep,
and then that will help not fixbut probably help go a long way
to help the depression as well.
Vyga Kaufmann (04:40):
That's right. I like to think of a lot of our
interventions as kind of actinglike a volume knob rather than,
you know, light switch. It's noteither that it helps or it
doesn't help is to what degreeso often, if somebody comes to
my clinic and they have a sleepissue, along with some other
mental health issue, I proposethat maybe let's see if we can
get some movement on the sleepand see how that influences
(05:01):
overall health, but also mentalhealth as well.
Morten Andersen (05:04):
Okay, let's look into sleep. I go to bed at
11 o'clock, and I wake up at sixnext day I've been asleep. But I
bet it contains a lot morenuances than that. So what is
sleep? And what different typesof sleep do we have?
Vyga Kaufmann (05:18):
Your right sleep is not one thing, sleep kind of
unfolds throughout the night intwo different stages, these
stages of sleep are bestmeasured by the electrical
activity of our brain. So whenyou hear about sleep stages, the
way that scientists think aboutthat is, what types of
brainwaves are being generated.
And what other types ofphysiological markers are there
(05:39):
that would suggest that somebodyis progressing through the
different stages of sleep. Sostage one sleep is a very, very
light sleep. In fact, I like tocall it beverage cart sleep,
have you ever been on anairplane and you know, the
beverage coming and yet you'revery relaxed, so you kind of
close your eyes. And you'relike, well, but I want to say
just alert enough so that whenthe beverage cart comes, the
(06:02):
person will know that I wouldvery much enjoy having a drink.
But that is actually a stage ofsleep, because you're not alert
as you might be now. And yet,you might self report that that
was a period of time when youwere awake, and not asleep.
Morten Andersen (06:19):
So you can actually sleep with your eyes
open in that sense. I mean,that's first stage, you, you
probably have your eyes open ina sense, and you would call it
sleep,
Vyga Kaufmann (06:28):
and your eyes would probably still be closed.
And yet you would be in betweenthe stage of being completely a
word alert and awake now, ratherthan maybe capitulating and
allowing yourself to fallasleep. So it's kind of like
teetering on that edge ofwakefulness and being completely
more asleep, which is whatpeople think of when they're
(06:50):
sleep. So when they're stage twosleep, now you wouldn't notice
maybe the beverage cart, yourability to detect external
stimuli is diminished. Butstill, it would be relatively
easy to wake you up. And whenwe're in stage two sleep, I
could get your attention easily.
And if I woke you up, you mighteven do a pretty good job
estimating about how long you'vebeen asleep. And then when we
(07:10):
advanced down into deeper stagesof sleep, when we think of deep
sleep, what we're reallythinking of is stage three, and
deep sleep is this deliciousrestorative sleep, that when
people are deprived of it, theymight feel that accident didn't
sleep very well. And that mightbe using experience, like I had
perceived that I was unconsciousfor seven hours, or asleep for
(07:31):
seven hours. And yet I don'tfeel quite rested. So there
might have been something thathad disturbed that that deep
stage of sleep, and if you wakeup in a deep stage of sleep,
usually we're a little bitdisoriented. So if you've ever
woken up in a hotel andwondered, you know, if you've
been kidnapped, where are you?
How did you get there, it isvery, very possible you actually
(07:53):
woke up from from deep, deepsleep. And then we go into what
most people are familiar with,which is REM sleep, which is
where most of our dream sleepoccurs, and the cycle begins. So
we we cycles from stage 123,down to REM sleep, and we spend
a different amount of time ineach stage of sleep as the night
unfolds.
Morten Andersen (08:13):
Okay, so would it be fair to say that the
better quality sleep if youspent more time in stage four,
or three and four, or is it justthat you cycle and and it's
actually all four parts that areequally important?
Vyga Kaufmann (08:29):
So what we know is that stage three sleep or
deep sleep is especiallyconserved so that what that
means is that if you getinsufficient sleep a few days in
a row, and then you have amplesleep opportunity that your body
by itself will actually spendmore time in stage three sleep
(08:51):
and deeper stages of sleep. Butthat's recovery or an attempt
for recovery. Really, we don'tknow enough about sleep to know
what happens when you spend lesstime in each stage of sleep in
favor of maybe more time andanother stage. We have some
clues, but for the most part,what it seems like is that
having an adequate sleepopportunity and cycling through
(09:13):
those stages, completely eachnight is certainly the
healthiest form of sleep.
Morten Andersen (09:18):
Okay, so there is something called a good
night's sleep and a poor night'ssleep. And a good night's sleep
is the more time we spend inprobably stage three, maybe even
stage four as well during anight.
Vyga Kaufmann (09:31):
I would say a good night's sleep would be
defined by smoothly sleptcycling through each stage
uninterrupted. Okay.
Morten Andersen (09:40):
That's the other piece is that we know that
consolidated sleep is not onlyhealthier for us, we're in a
better mood and better able toconcentrate so if you have seven
hours of fragmented sleep, youmight not feel as rested as
somebody who has had five or sixconsecutive hours of sleep and
this this the same folderPeople, so I'm just practically
(10:01):
thinking. So for instance,whenever there is a noise
outside of our house, I alwayswake up during the night, but my
wife never wakes up, she neverhear those noises. And I always
do. Is that because I'm in a,I'm in a lighter sleep? Or do we
just have different sleeppatterns? Or do we have that our
deep sleep level is differentlevels of deeper? Why would that
(10:22):
be?
Vyga Kaufmann (10:24):
What is most likely happening? I actually
have a theory, this is funnythat you just said that, because
I don't have any data to supportthis. But it seems to me, deep
sleepers are always paired withlight sleepers. That you've just
you've just added another datapoint to that observation. But I
think what it might not havesomething to do with what stage
of sleep that you're in, what itmight have to do with is your
(10:45):
proneness to hyper arousal, andhow, what you're physiologically
predisposed to noticing. Somaybe your arousal threshold is
simply lower in terms of beingable to respond to what's
happening externally from you,then your wives.
Morten Andersen (11:00):
Yes. And we know that that kind of alertness
is actually something which ishardwired in us as we're very
different from each other. Sowhat is the impacts and the
benefits of having a goodnight's sleep, what's the health
benefits other than if you'redepressed, and then that can
lead you out of a depression?
What, what else is there in agood night's sleep?
Vyga Kaufmann (11:19):
So we know that healthy sleep is extraordinarily
good for our cardiovascularhealth. As we descend into
different stages of sleep, andthroughout the night, our heart
muscle has an opportunity torest and something that
sometimes called the heart ratehammock where your your heart
rate descends ever. Sogradually, as you fall asleep,
it kind of stays at a lowerlevel throughout the night. And
(11:40):
then comes back up as ourcortisol awakening response or
and as our as our sleep drivediminishes. And we wake up, our
heart rate is back up to maybewhat our typical resting heart
rate is during the day. And itlooks like cardiovascular break
is very good for our hearts. Sopeople who have a lifetime of
sufficient sleep, tend to havebetter cardiovascular health. So
(12:02):
from a medical perspective,that's one piece. We also know
that sufficient sleep is goodfor our metabolic health. So in
are attempting to manage theirtheir body weight, in addition
to their cardiovascular health,we know that having well time
sufficient sleep can helpregulate our hunger and fullness
cues so that maybe we don't haveto rely on our own willpower as
(12:25):
much and can rely instead on ourbody's natural need for food and
satiety. So there's anotherthere's another piece there. And
also for our brain, we know thatone of the things that sleep is
really good for is removing someof the metabolic waste that has
accumulated throughout the day.
So it looks like for forcognitive purposes, especially
(12:46):
one devotee, and being able toremember things well and prevent
certain types of dementia, thatperhaps a lifetime of good sleep
is beneficial. And for our mood.
You know, I think a lot of timessome of these distant type of
health benefits are not quitemotivating for people to
(13:06):
prioritize sleep, when when wehave guests in our home. And in
the morning, when they wake up.
What's the first question we askhow did you sleep and and so and
we know that maybe we're askingthat perhaps out of tradition,
but also we know that getting agood night's sleep sets us up
for a much better day. So ithelps with our mood, it
diminishes irritability, it alsomakes us more patient. And I you
(13:29):
know, you mentioned you have youhave kids. And so patience,
being a big piece of parenting,and sleep sets up for that type
of success. It also helps uswith creativity, I think that
we're starting to see morebusinesses really prioritizing
well rested. Employees we knowthat increases productivity, we
(13:49):
know that sleep, insufficientsleep actually diminishes
productivity, and actually canbe very costly to companies. So
really prioritizing the thesleep of employees can increase
productivity, creativity, myfavorite measure of anything is
just quality of life. And weknow that sleep remarkably
increases just day to dayquality of life.
Morten Andersen (14:14):
This is a wonder drug, it really has a lot
of benefits. And I guess thedownside, the only downside of
it is that the investment is afairly big investment if the
investment is time. I am justanxious to hear about the book
that I read 25 years ago, whichwould said that I could cram in
eight hours of quality sleep insix hours if I just optimized
it. I just want to hear is thatpossible?
Vyga Kaufmann (14:35):
No. I think what's interesting is that sleep
is a really hot topic right now.
You are going to hear so muchabout lotions, potions,
tinctures, oils, technologies,things that can optimize your
sleep when even scientists don'teven know what that means. So
one example is I heard somebodysaying that this particular
medication increases the amountof time that people spend in
(14:56):
stage three or deep sleepHowever, that's at the expense
of other stages of sleep. Andthere's a reason that we go
through these different stagesof sleep. And humans aren't the
only ones that do it. This is ahighly conserved process across
species. If evolution hasconserved this particular
behavior, it must be incrediblyimportant. But what's
(15:20):
interesting is that you saidthis is a tremendous investment.
And yet, I do have to wonder ifthe return on investment is far
greater than what one mightimagine, you know, acutely that
loss of and in people often wantto go from eight hours to six
hours, what is it two hoursbuying you?
Morten Andersen (15:40):
Yes, yes, I actually fully agree. On one
hand, it is an investment islike going for a run, you know,
there is an upfront investment,so to speak, but the benefits is
so much better. And I'm not evencomfortable talking about
investments when we will betalking about this. But on the
other hand, I mean, people haveknown about the importance of
sleep for years. I mean, when weeven look at the ancient
scripts, you know, there isadvice about sleeping well, and
(16:02):
the importance of sleep. On theother hand, we now can, you
know, measure our brain in waysthat was completely impossible
just, you know, 50 years ago,what have we learned about sleep
the last 1015 years, that isnew.
Vyga Kaufmann (16:16):
When we sleep, there, space between our neurons
in our brains grows, so thatmeans our neurons have to shrink
in some way. Right. And what'scalled is that an increases
what's called these interstitialchannels, and cerebrospinal
fluid is shunted through thesechannels in our brain, and it
removes some of the metabolicwaste that's been accumulated
(16:38):
during the day. The good newsis, is that it seems like the
glymphatic system works kind ofovertime as we are sleeping, but
it also may work during the dayas well. But some of the
metabolic waste that it removesmight be familiar to some of
your listeners. So for example,beta amyloid plaque, we know
that the accumulation of betaamyloid plaque is one of the
(17:02):
markers of Alzheimer's typedementia. So it's the
relationship between chronicsleep loss and dementia is still
being elucidated. But it seemsthat when we think about what's
the mechanism by which sleepdeprivation might increase risk,
or vulnerability to certaintypes of dementia, they're going
fatik system and its ability tohave the time to remove some of
(17:25):
that metabolic waste might beone of those mechanisms. So the
discovery of that which is stilltremendous amount of data being
collected is I think, one majoradvance that gives us a better
understanding about sleep. Iknow, you know, in 2017, the
Nobel Prize was awarded toscientists who discovered some
of the genes that regulatecircadian rhythm. So I think a
(17:48):
lot of times, you know, we'retalking a lot about sleep, and
you know, the stages of sleep.
An important piece of that iseven the timing of our sleep and
how that fits in somebody's owncircadian rhythm. And then the
question was, well, how's thecircadian rhythm regulated?
Anyway, we know that light is amajor piece that in trains our
circadian rhythm, but from abiological process, how does
(18:10):
that happen? And so that wasdiscovered, which was really
exciting.
Morten Andersen (18:25):
You mentioned just before that there was there
was a whole industry that istargeting sleep, so you can get
medicine, as you said, you canget lamps that wake you up with
sunlight, you can geteverything. And one of the
things that is I think, verypopular is watches, wristbands,
or rings that can help youmonitor your sleep. And my wife
(18:46):
actually has one of those. Andevery morning, it tells her for
how long time she has beenasleep, how much of it was REM
and light sleep and deep sleep,and she gets a score. And that
score tells us overall score.
How useful are those? Thattechnology? Is it? is it
accurate? And can I can I usethat for anything? Would you
recommend things like that?
Vyga Kaufmann (19:08):
I think it depends on what you are doing
with that information. So welove data collection, right? And
we especially like to learnabout ourselves. So those sleep
devices, you know, they'reaccurate enough. I think that
you know, there there are somethere's some data that some of
them overestimate time inasleep. Some of them
underestimate but for the mostpart, it's good enough for what
(19:29):
people might be interested intracking. The the paradox here
is that when people becomepreoccupied with the data, they
actually can end up doing harmto their sleep. So there's a
term that's been coined by asleep researcher named Kelly
Baron and she calls it orthoSamia. So you know this strive
(19:53):
for perfection around sleepcould have the paradoxical
result of increasing anxietyabout sleep. And striving for
sleep perfection might actuallyimpede people's ability to
sleep. So one of the questionsI'm often asked is, well, what
do you think about these sleeptracking devices? And typically
my response, which is tongue incheek, but honestly, is why? Why
(20:15):
do you need it?
Morten Andersen (20:16):
And I think for most people, it is just fun. It
is like tracking how many stepsyou're walking and things like
that. And you're right, for whatpurpose? And actually, we
discover sometimes that, youknow, she would wake up and she
said, Oh, I had a great night'ssleep, and then the score wasn't
as great. And then she didn'tfeel as good about as liebhard
as she otherwise would.
Vyga Kaufmann (20:33):
And, you know, there's there's some data to
support her experience is thatwhen you bring people into a
sleep lab, and measure theirsleep, and then in the morning,
if you ask them, you know, howdid you sleep if they slept?
Great? There have been studieswhere they say, Oh, really,
gosh, okay, well, good. Youknow, it seemed like through
your your polysomnography, orthe sleep measures that you
actually didn't sleep thatgreat, but good for you. And
(20:55):
does it even if they had a greatnight of sleep, just being told
that it was not a great nightasleep, we call that the CBOE
effect. Usually people know theplacebo effect, which is
thriving benefit from some sortof inner intervention, while the
nocebo effect is a close cousin,which is negative side effects
of an in art intervention. And Ithink sometimes sleep trackers
(21:16):
end up doing that.
Morten Andersen (21:17):
That's so funny. There are of course, some
people who really suffers frompoor sleep insomnia is is an
example where people are reallystruggling to sleep. What is
insomnia? And why do some peoplesuffer from that
Vyga Kaufmann (21:31):
the diagnosis of insomnia disorder has to do with
the frequency and duration ofsleep problems. And you can kind
of think of it as a rule ofthrees is that if for three
nights each week, you're notgetting restorative sleep, and
this is lasting, about threemonths, you might qualify for a
diagnosis of insomnia disorder,and the question of how this
(21:54):
happens, it just depends on theindividual. So the it's thought
that we all have some baselinevulnerability to developing
sleep problems. And thatvulnerability might be pretty
consistent throughout our lives.
So the question is, if we're alleach have different
vulnerabilities, most peopledon't report I've had insomnia
(22:14):
from birth, right. So there mustbe some sort of precipitating
event and the precipitatingevent can be virtually anything,
it could be a stressful lifeevent, like starting a new job
and having new responsibilities.
It could be you know, the lossof a relationship, and the birth
of a child. And there'ssomething that you know, might
(22:36):
provoke, you know, hyper arousalin some, and some of these
things also could be medical. Sofor example, a very common side
effect of chemotherapy forcancer is disrupted. But the
precipitating event isn't enoughto maintain insomnia, we know
that there are a lot ofperpetuating factors. And those
are things that keep insomniaalive. So let's take for
(22:58):
example, something that weconsider, you know, a biological
precipitating event, which issomebody who's having
chemotherapy, obviously, there'sanxiety and stress of cancer,
but also the effects of thedrug. They might finish
chemotherapy. And you know, fiveyears later say, this is weird,
like I've ever since I hadchemotherapy, I'm unable to
sleep. But if you were to lookto see what might have been
(23:20):
going on during that interval,you might see behaviors that
unfortunately, while intuitivelymight seem like good ideas and
up keeping insomnia live, andthose are the things are like
staying awake in bed, beingawake in bed, creating that that
learning experiences, repeatedassociations of bed being a
place of arousal bed being whereyou plan your day worry, or just
(23:46):
watch your mind race, you know,there's repeated associations
can be very strong. That'ssomething that perpetuates
insomnia. Another is anirregular sleep schedule. So
oftentimes people will say, youknow, they don't get much sleep
during the week, and then theysleep in on Saturday, and Sunday
ketchup. Yeah. Well, yeah, they,the perception is, is that sleep
hasn't caught up with. Andoftentimes people report that
(24:09):
Sunday night of sleep is theirworst night of sleep. And the
report would be well, I must bereally stressed about becoming
workweek and the things that Ihave to do, when really the
their sleep drive might bedisrupted from having slept in
that, you know, some of thecircadian rhythm might have been
disrupted from a sleep schedule.
So these are all things that canperpetuate insomnia that might
have absolutely nothing to dowith the initial cause.
Morten Andersen (24:33):
I heard a couple of advice there. One was
get a regular sleep schedule. Sogo to bed at the same time, get
up regular, you know, at thesame time, and also if you are
struggling to sleep, get out ofyour bed and go outside and and
take a break and then go back tobed again when you feel tired so
you don't stay in your bed andcreate a learning experience of
(24:54):
staying awake in your bed is ishow things are
Vyga Kaufmann (24:57):
correct. I think that not only is it that you're
not creating a learningexperience that the bed is where
other things happen that overtime, if people do this, they
actually become precipitouslymore tired, went into bed
because bed has been become acue for, oh, this is where sleep
happens and your body knows thatthat is a cue and it prepares
(25:18):
itself and is more apt to tofall asleep more smoothly when
you do that.
Morten Andersen (25:22):
So when people come to you, and they are
struggling with sleeping, you'reusing cognitive behavioral
therapy as your tool for helpingthem Can you just help our
listeners just a little bitabout what is cognitive
behavioral therapy and also how,why that is particularly helpful
for this.
Vyga Kaufmann (25:41):
When you say to a psychologist, well, I'm doing
cognitive behavioral therapy,the nerdy psychologist will
probably say, for what, becausethere are different types of
cognitive behavioral therapy. Sothere's a system, cognitive
behavioral therapy for majordepressive disorder, versus
panic disorder, or some specificphobia. So for sleep, we call it
cognitive behavioral therapy forinsomnia. And I think
(26:03):
psychologists need some advicefrom marketing and branding
people because we need to putour whole Methods section in the
title. But so so cognitivebehavioral therapy for insomnia
really leans on some very oldbehavioral theories. So one very
important one being classicalconditioning or Pavlovian
(26:24):
conditioning. And I often jokethat if people only use their
bed for sleep, that I might beout of work. So if you are only
using your bed for sleep, thenit's not necessarily a conscious
idea. Okay, I'm now going tosleep is that your body has
created that association. Sothere's something called
stimulus control. And the firstrule of stimulus control is to
(26:49):
use your bed for sleep and sexonly. And I like to think that
I've saved many marriages byremoving sex out of the bed. And
but creating, you know, the thebed being in the bedroom, really
being a place that sacred forfor sleep, and this takes
repetition. This is notsomething that you know, someone
will do for a week and say,well, it didn't work. Yeah. And
(27:09):
there are other elements. Soanother element is something
called sleep consolidation,which some people also call
sleep restriction, and otherpeople call it torture. So what
what that has to do with is alotting, the your sleep
opportunity to match what theamount of sleep you're already
getting. So somebody comes tothe clinic and they you know,
are tethering together or sixhours of sleep, but it's taking
(27:31):
them eight or nine hours toachieve that, then in
collaboration with that person,I would say, Well, what do you
think about creating a sleepschedule for the next week where
you don't go to bed untilmidnight, and you get out of bed
at six each morning. And thatrepetition also can increase
sleep propensity or their sleepdrive. But again, this is
(27:52):
something that takes somerepetition, but it's a it's a
biological intervention, andthat it increases what's called
the sleep homeostatic sleep,drive, I like to even think of
it as a sleeping pill, you know,is controlling that sleep in
that way. But often people willsay that they're grumpy. And
while that, you know, theirtheir sleep might be
consolidated, they're stillgetting enough of it. So there
(28:13):
are strategies to be able toincrease amount of time in bed
to be able to also betterreflect the amount of sleep
someone is actually producing orachieving. So there we have a
behavioral we have behavioralcomponents about when someone is
in bed or not. But then thereare also cognitive components.
So the cognitive events have todo with people's beliefs about
(28:33):
sleep, one of the first thingsthat we typically end up talking
about is how much sleep Doessomebody want? And why? Hmm, so
I think a lot of us grew up withthis idea that, you know, we
need eight hours of sleep. Andthat's true for some people.
Some people we actually know nowthat most adults, a healthy
sleep window would be betweenseven and nine hours. Those data
(28:56):
are from population basedstudies to see what happens for
adults who say they get lessthan fewer than seven hours
versus more than nine hours andoutcomes. So somebody might say
I want eight hours of sleep. Andwe just have to wait and see.
Because the best, the bestmeasure of how well you're
sleeping, is how you feel eachand every day.
Morten Andersen (29:15):
Okay, so I have a friend and he insists that he
only needs six hours. I've beentrying to say no, I don't think
that's right. But what you'resaying is that well, for most is
actually between seven and nine.
But there could be people whereit is 10 and some way it is six.
Vyga Kaufmann (29:31):
In short, yes, there could that type of
individual variation probablyexists. And and what I'm curious
about is if your friend uses analarm clock to wake up,
Morten Andersen (29:39):
okay. So if he does, then it's probably
Vyga Kaufmann (29:42):
that there's some debt being accumulated. But
sure, no, I think your overallpoint is a good one is that, you
know, there is some variationand maybe but for most people,
for the majority of adults,seven to nine hours seems to be
optimal.
Morten Andersen (29:56):
I just need to make sure it's so are you are
you suggesting that not havingan alarm clock is, is good,
Vyga Kaufmann (30:02):
correct? Yes, in fact, that's one of the was one
of the ways that you I mean,because think about it, if
you're using alarm clock to wakeup, that means your sleep is
being interrupted, and your bodyis not able to complete the
sleep cycles that it wants to gothrough. So there is a very good
chance that if you arehabitually using an alarm clock
that you are likely alsocarrying a sleep debt. And
Morten Andersen (30:24):
I've never heard that before that it's
actually really surprising tome, because I would not trust
myself to wake up. I probably dowake up at about the same time
every day, but I'm not sure Iwould trust myself to wake up.
At the same time, especially ifI have a meeting the next day is
something interesting.
(30:49):
So obviously, most of us are notsuffering from insomnia. But we
are interested in having a goodnight's sleep. And I have to
admit that I usually go to bedaround the same time and I
usually get up around the sametime I feel I have a good sleep.
But I'm not equally rested.
Every time that I wake up.
Sometimes I feel very rested.
Very happy wellness is high. Andother times I feel that I
(31:12):
haven't quite slept enough eventhough that I know I have been
asleep for seven and a halfhours. Why is there difference
in that and, and in thissection, I would like to just
know some good advice for aperson who doesn't have what I
would call sleep problems. But Iwould still like to know how to
get a good night's sleep. Whatadvice can you give me?
Vyga Kaufmann (31:35):
Okay, the quality of your sleep vary from night to
night people really tend tofocus on, you know, I want the
eight hours. But what isimportant as well is, you know,
cycling through the sleep stageswell, and you said that you are
easily easy to wake up. So maybethere were some awakenings that
you didn't even register thatwere different night tonight so
(31:56):
that your seven and a half hoursfeels great most of the time,
but then from time to time, itjust doesn't feel the
restorative.
Morten Andersen (32:03):
So if I'm asleep for seven and a half
hours, the quality may be verydifferent. What can I do to
improve the quality of my sleep?
Vyga Kaufmann (32:12):
You mentioned that you go to bed around the
same time each night and youwake up around the same time
each morning so you are anoverachiever. The piece that
that we should mostly focus onis that your wake time is
consistent. And the reason thatthe wake time seems to be the
key is that and which is a topicfor an entire other podcast is
(32:36):
our circadian rhythm is best intrained with consistency, our
bodies love consistency. And ourcircadian rhythm doesn't just
govern what time we fall asleepand what time we wake up. it
governs how the timing of ourdigestion it governs the speed
of wound healing, we know thatwe wounds heal far faster if
(32:57):
they happen during the day thanif they happen at night. So our
eating rhythm is very complex.
And one of the things we can doto make it happy and to make us
healthier is to actually have aconsistent wake time which also
includes exposure to morninglight.
Morten Andersen (33:13):
Yes,
Vyga Kaufmann (33:14):
when you you know we don't go overboard and go
outside and go for a run or walkalthough Bonus points if you do
but just simply you know openingthe drapes and in the bedroom in
the house and bringing light inso a consistent wake time is the
first piece that I think is veryimportant. The other piece I
alluded to earlier which is useyour bed for sleep only. And if
(33:36):
you find that at the end of youknow when you get into bed, you
are planning your day around fortomorrow, just take that
activity outside of that maybethat should be part of your
nighttime ritual where you knowbefore getting into bed, you
know maybe a few hours beforegetting into bed you write down
what are the types of thingsthat I'm going to be doing
tomorrow so that your braindoesn't have to do that work
(33:57):
while you're luxuriating andappreciating being in bed and
the feel of your sheets and themattress and the pillow.
Morten Andersen (34:04):
And I think that's probably one thing that
that would be a new thing for mebecause I like to read before I
go to bed and I do that in bed.
I suspect many of my listenerswould be watching a Netflix
series in bed as well and you'resuggesting all of that out of
the bedroom.
Vyga Kaufmann (34:20):
If you sleep well and you are reading in bed that
seems like you know don't don'tchange a winning game. That's
great. However, if you do havesleep problems and there are
things that you are doing in bedthat are not sleep, I would take
those out of bed, watchingNetflix and doing those types of
things. anything involving youdon't want to blast light on a
(34:41):
sleepy brain. We know that lightinhibits melatonin production
and melatonin influences thetiming of our sleep. Some people
are very sensitive to that whereonce again if there is a problem
and you have sleep difficulty Iwould I would take that out of
out of bed.
Morten Andersen (34:56):
So bedroom only for sleep wake time. consistent,
Vyga Kaufmann (35:01):
I would add adding a buffer zone, and I
would add sleep rituals that arevery mobile. Hmm. So for people
who have kids, we know that kidslove ritual, they brush their
teeth, put on their pajamas, getinto bed, hear a story, and
lights out. And that rhythmicityis really advantageous to kids,
(35:25):
but also to adults. So whatparents are doing by creating
that sleep ritual is they'realso conditioning their child,
that child's body that you know,prepare for sleep, do the things
that the body needs to do, tofall off to sleep and adults
benefit the exact same way. It'sinteresting, I'll have clients
come in who described their day,and they work Work, work, work,
(35:46):
work, work, work, notice thetime brush their teeth, get into
bed, pull up the sheets, andthen you know, close our eyes
and hope that sleep will sooncome. That's not the way our
bodies work. bodies need just alittle bit of a buffer zone. So
I usually suggest creating aritual, you can take anywhere,
maybe 2030 minutes. And that caninclude, you know, brushing your
teeth, and reading a book for awhile. But you know, helping
(36:07):
bring down that hyper arousal.
When we fall asleep, our bloodpressure goes down or heart rate
goes down, our respiration rategoes down. So maybe having some
of those things that increasethe probability that will happen
starting it outside of bed.
Morten Andersen (36:21):
Okay, what about room temperature? Does
that impact our quality of sleepin any way?
Vyga Kaufmann (36:27):
Sure, yeah, we that we, our bodies like to have
cool air in the room while weare asleep. So the typical
recommendation is to bring thetemperature down as cool as you
are comfortable. And also tokeep your room as dark as
possible. So that's not possiblebecause you know, your your bed
partner doesn't want to getlight blocking drapes in the
(36:50):
room, then you could eyemask weall have different sensitivities
to light. So So having a verydark room, and a very cool room
is advantageous for promotinghealthy sleep.
Morten Andersen (37:02):
So sleep is, is a fascinating topic. And it's
actually one of those thingsthat if I meet a colleague at
work, you know, he might want toexcuse for being in a in a poor
mood, he would say I didn'tsleep very well. And sleep is a
topic that we talk about, not asmuch as the weather, but it's
probably quite close to that.
And you're also suggesting thatthere are so many health
benefits. For a regular person.
(37:25):
like myself, you know, there area lot of benefits. But also, if
you are suffering from a mentalillness, or depression or things
like that, it can actually helpyou get back on track if you
work on your sleep. And thereare some really good sound
advice here in terms of doingthat. I have a feeling that
people are not always followingthem, because they're trying to
(37:46):
cram in other things during theday, they're not respecting the
time, and the things that youneed to do in order to get a
quality sleep. Whatmisconceptions do most often
hear about sleep? So what dopeople most often think is right
about sleep, which isn't true atall.
Vyga Kaufmann (38:02):
A lot of people think that they are doing just
fine getting by on less sleepthan is recommended. Hmm. And a
lot of the referrals to myclinic have to do with people's
partners saying, You're not thesame. Your presence isn't the
same. You are not as happyyou're you tend to you're
(38:24):
trending towards irritability.
I've observed this long enough.
I think it's your sleep. And sosome people arrive and say, you
know, I'm only here because mywife sent me. And what's my
favorite quote from somebody is,I was doing great. I am the CEO
of my company, and I am a highachiever. And what I what has
happened now that I'veprioritized sleep is I've found
(38:45):
a new gear, I realize thatthings are much more effortless
now that I have sufficientsleep, I'm far more efficient,
and getting things done duringthe day. And apparently I'm more
fun to be around. So I thinkthat a common misconception is,
well, I'm doing great. I'm ahigh achiever. I'm doing well in
my profession. I think I'm oneof the outliers. I don't need a
(39:07):
lot of sleep. And I would likepeople to kind of tinker with
that and collect your own dataand prioritize sleep for a few
weeks and see see how that thatchanges your mood, productivity
and patience.
Morten Andersen (39:19):
Fantastic. I always finish a podcast with
three do's and don'ts and inthis case do so we have already
talked about but maybe just saythem again. So what what advice
would you give our listeners toget a great night's sleep?
Vyga Kaufmann (39:36):
three pieces of advice. Okay, number one, use
your bed for sleep only. Hmm.
Number two, no matter thequality of your sleep the night
before, get up at the same timeevery day and try to get some
light exposure as well. Thethird piece of advice is
creating a buffer zone beforebedtime. Create a routine that
(39:57):
is sustainable and that you'rewilling to engage in night after
night. And that will also helpimprove the physiological
process of falling asleep andstaying asleep.
Morten Andersen (40:11):
Fantastic.
Thanks a lot for those pieces ofadvice. And thanks a lot for
this conversation we got thatwas really interesting. Thanks
for your work, I think it's veryimportant that we get to
understand the field a lotbetter. So thanks a lot.
Vyga Kaufmann (40:25):
No, thank you. I really enjoyed talking with you.
This was really nice. Thank you.
Morten Andersen (40:29):
Thank you. What a great conversation with the
guy, I took three things. One,sleep really is important. The
conversation with viga remindedme of a thing I knew, but I
needed reminding off. And thatis that sleep is probably the
(40:49):
most essential part of a healthymind. And it can help you if
you're suffering from depressionor anxiety. But as we also said,
The health benefits are enormousand really are there for all of
us to benefit to you can improvethe quality of your sleep with
three simple advice. A, only useyour bedroom for sleep, be get
(41:13):
up at the same time each day.
And see, find your sleep ritual.
So the things that you do eachevening before you go to bed,
and then follow that ritual.
Three, all of the changes thatyou want to make in your life
depends on mental health andmental flexibility. And a good
sleep is the foundation for bothof them. So sleep really a
(41:35):
simple because made a great TEDxwhere she talks about how to
treat insomnia, and what thebasis is for a good night's
sleep. And even if you now knowthe answer to both of those, I
will encourage you to check thatvideo out. It really is good.
Enjoy. Until next time, takecare
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