Ep 009 & Ep 010: Dr. Fiona Barwick-- Sleep Myth, What Makes Our Insomnia Worse? (part 1 & part 2)

 
deepintosleep.co

Dr. Fiona Barwick

with Dr. Yishan Xu

 

TODAY’S GUEST

Dr. Barwick is a Clinical Assistant Professor in Stanford's Department of Psychiatry and Behavioral Sciences who serves as Director of the Cognitive Behavioral Sleep Medicine Program at the Stanford Sleep Medicine Center.

Dr. Barwick and her team offer comprehensive evaluations of sleep problems and brief, evidence-based, non-drug treatments for insomnia, hypersomnia, circadian rhythm disorders, nightmares, and Positive Airway Pressure (PAP) adjustment. Treatment, provided in individual or group formats, emphasizes a collaborative approach and uses cognitive and behavioral techniques to help people fall and stay asleep more easily, feel less sleepy or fatigued during the day, manage misaligned sleep-wake patterns, and reduce the frequency and severity of nightmares.

WHAT WILL WE LEARN

Want to know what makes our sleep anxiety rocking up high, and stop us from enjoying a high quality of sleep? Let’s find out how our mind makes insomnia strong!

Myth 1: More deep sleep is better.

  • Our deep sleep only takes about 10-20% of our total sleep time, this is normal and healthy.

  • Too much deep sleep may actually be indicators of other sleep or health problems.

  • Sleep trackers are not accurate mostly and may cause more sleep problems for ppl having difficulties with sleep.

  • “Sleep trackers turn sleep into performance.” It pushes ppl to put unuseful efforts into sleep. Sleep is NOT a performance!

Myth 2: Good sleep means I don’t wake up and I don’t dream.

  • Average adults wake up around 10 to 12 times each night, we may or may not remember them, and it is normal. “Waking up is a normal part of adult sleep.“

  • We spend about 20% of our night in REM sleep and that is when we dream, and then the rest 80% is NREM sleep stages.

  • Some of us remember our dreams, some don’t, both are normal.

  • All sleep stages are necessary for a healthy night of sleep. The REM stage is important for us to regulate our emotions.

  • Worry and sleep are incompatible. The more worried about sleep we are, the worse our sleep gets. Remember, sleep is a self-correcting system and it can regulate itself biologically.

Myth 3: I should feel great when I wake up in the morning.

  • Sleep inertia is a transition state when we transit from sleep to awakeness, and it has nothing to do with our sleep quality.

  • Blue light awakes us, and social media messages, emails, increase our stress levels. All of these will stop us from falling asleep smoothly.

  • Check the time in the middle of the night is NOT helpful! Stop looking at the time!

  • Consider to take off the trackers at night if there are sleep difficulties.

Myth 4: I should go to bed EARLY.

  • The time to go to bed, actually differs between individuals, just like height and weight differs among us.

  • There are at least three different Chronotypes, and around 50% of these are decided by our genes:

    • Lark (early morning person)

    • Humming Bird (in the middle)

    • Night Owl (evening person)

  • Sleep closer to your biological clock is helpful with improving sleep quality.

  • Couples, communicate with each other about the variety of your chronotypes and respect that.

Myth 5: Using a pill will help me sleep.

  • It is not only NOT helping, but also hurting.

  • Sleeping pills sedate us and deprive us of our healthy normal sleep stages.

  • Evolutionarily, no pills are more powerful than our biology! And that is why CBT for Insomnia (CBTi) is the golden standard treatment of insomnia.

  • Remember, short-term gain, long-term pain.

Myth 6: Sleep will stay the same as we age.

  • When we get older, our sleep actually changes.

  • One tip to keep a good healthy sleep quality: accept that sleep changes, and work with it.

  • If you want to improve your sleep quality, matching your sleep opportunity to your sleep ability, even if that means reducing your time on bed.

RESOURCES

You can find Dr. Barwick on the Stanford website.

Thank You for Listening!

Newsletter and Download Free Sleep Guidence E-Book:

CBT-I Courses:

Podcast Links:

Transcript

Episode 9:

-   0:00  

Welcome, everyone. It's near the end of October now, and it's getting kind of cold temperature change a lot in the San Francisco Bay Area. I am catching a cold so I kind of lost my voice recently. Hopefully you can still hear me and understand me when I lost my voice. I realize how important taking care of ourselves means. So for whoever is listening, please take good care of yourself. If you hear my earlier podcast episodes, you may know that I was trained in the Stanford sleep center and I have a great mentor that is Dr. Filner Barwick. Dr. Barwick is the director of the cognitive behavioral sleep medicine program at Stanford Sleep Medicine Center, and she is a clinical assistant professor in Stanford's Department of Psychiatry and Behavioral Science. Such an honor today that I invited her to our show Share with us her expertise and knowledge about insomnia. And today she will share with us common myths about sleep. That what we are thinking wrong about sleep. And what makes us so anxious that we are not able to sleep well. Hi, Dr. Barrick, welcome to the show. I'm very happy to be able to talk to you outside of your office in Stanford.

-   1:30  

Thank you very much for inviting me, Sean. It was a pleasure to be chatting with you about sleep, one of my favorite topics.

-   1:37  

Great Look forward to it. So I know you work in Stanford Sleep Medicine Center. And I'm curious what are some common sleep problems you see day to day in your practice there?

-   1:52  

We see virtually all sleep disorders. Stanford Sleep Medicine Center is the oldest Sleep Medicine Center in the US and probably the world. And one of the largest, so we see hundreds of sleep patients a year. As a result, we see disorders ranging from insomnia to circadian rhythm disorders to parasomnia is like nightmares or sleepwalking or REM sleep behavior disorder to sleep disordered breathing like sleep apnea, narcolepsy, if it involves sleep, we will have seen it.

-   2:25  

Wow, that's a lot of different sleep topics.

-   2:30  

Yes, it is. It's one of the things that makes it so interesting. It's there's always something new that's coming into our clinic.

-   2:37  

So I know you are one of the experts treating insomnia. So regarding insomnia, I know a lot of audience are really curious. And or a lot of people have those kind of struggles. What are some common misperceptions people often carry with them when they see you? I'm

-   2:58  

so glad you asked me that question. To Nishan, because there's so many misperceptions about sleep. There's not a lot of accurate information available to the public, it's getting better. But there still is a lot of misinformation. So I'm happy to have the opportunity to correct some of those misperceptions. One of the first is more deep sleep is better. I've heard people saying this,

-   3:25  

definitely, it's a very popular thought about sleep among many Chinese I know,

-   3:30  

so to most Americans. So the idea of more deep sleep is better is incorrect. Because deep sleep is actually a small percentage of our sleep from 10 to 20% of our night. It usually happens in the first part of the night within the first three to four hours. After that, after our cycles of deep sleep are finished, we transition to lighter stages of sleep, to dream sleep. What's interesting to me is when are asleep physicians read an overnight sleep study. So when someone comes into our sleep center, and they stay in our lab overnight, we get a printout of what's happening in their brain while they sleep. And so we can see very easily when they're asleep when they're awake when they're in light sleep when they're in deep sleep. And what the sleep physicians who read these studies say is, when they see too much deep sleep, they think there's a disorder. Sometimes it's narcolepsy, sometimes other things, but too much deep sleep actually reflects a problem.

-   4:30  

Oh, wow, that's so interesting, because I keep on hearing the median. Talking about you want to try whatever you can to get more and more deep sleep. That means good, high quality of sleep. So that's totally not true, and maybe even the opposite.

-   4:49  

Yes, you want the right amount of this deep sleep along with all the other sleep stages that are so important. I think what amuses me is this This particular pattern of sleep the pattern for humans, which is very different than other animals, even though all animals as far as we know, all living organisms need to sleep, or to hibernate. We don't understand why they have different sleep patterns. So human, the human sleep pattern has evolved over 10s of thousands, if not hundreds of thousands of years. That's a lot of time in which to develop the sleep pattern that serves us best. So the idea that we can somehow hack our sleeper engineered in a way that is more effective for us over a couple of decades, I think is highly inaccurate and likely is going to have adverse effects in the long run.

-   5:43  

So regarding the deep sleep, I have a question. Sometime patients coming to me, especially people with the Apple Watch, they track their sleep, they would complain they say, Well, I only slept one hour deep sleep Last night, I slept poorly.

-   6:03  

Yes, unfortunately, the fitness trackers or the the wearables the wrist track trackers, which are so common nowadays can also cause problems. First of all, they're almost always not measuring sleep. The only way to truly measure sleep is if you attach a few electrodes to your head. So you can measure your brain activity when you're asleep at night, but something on your wrist is really measuring movement. What the correlation is making is if you are not moving, you are asleep. If you are moving, you are awake. It's pretty easy to see some problems with this. I imagine some people have been lying in bed watching a movie very still, well, that would be recorded asleep. Conversely, some people are quite restless sleeper so they're moving around a lot that could be recorded as wakefulness, the correlations between the wearables and sleep itself are okay if you're a quote unquote good sleeper, but they are not so good if you're someone who has more trouble sleeping. I think the other issue with the wearables is it turns sleep into a performance. And sleep is not a performance when sleep is working. Well, we don't think about it. It just happens. We go through our day we go through our evening, eventually we get ready for bed, we get into bed and at some point sleep unfolds. When you turn it into a performance, you actually start putting in effort to try to sleep and effort is directly opposed to sleep. It simply gets you more activated. I think that's probably my biggest complaint with the wearables you turn sleep into a performance.

-   7:43  

Hmm. So sleep is not a performance. I like that.

-   7:48  

We can put it on a T shirt.

-   7:51  

Maybe I should make one and wear it around. Wait for people to ask me questions. So I can use

-   7:58  

another one. is not as common but I think in some cultures I've heard this good sleep means I don't wake up at all and I don't dream, or at least I don't remember my dreams. definitely heard about that one. Okay. Normal adult sleep includes some awakenings, it is often surprising to people to hear that the average adult wakes up 10 to 12 times a night 10 to 12 times a night. Wow. Most people are very surprised when they hear that number. Now, if you are awake for less than three minutes, you likely won't remember it, which is why you can be awake in the middle of the night, have a conversation with someone and have no memory of it in the morning because if that conversation finished after two and a half minutes, you won't remember it. Similarly, we don't remember our awakenings at night or we might wake up get up to use the bathroom come back fall asleep quickly that is all normal. Now if you are waking up and spending a long period of time awake at night Okay, that's something we can help you with in our clinic, we can certainly reduce the time you spend awake at night. So it's very important for people to realize that waking up is a normal part of adult sleep. Now for dreaming, we were talking about these different stages of sleep deep sleep, the light sleep, they're really two states in sleep. One is called REM sleep, the rapid eye movement sleep, which is when we dream, and the other, ironically, is called non REM sleep. I say ironically, because REM sleep is a relatively small percentage of our night compared to non REM sleep, it's about 20% plus or minus two. Non REM sleep therefore is the remaining 80%. So non REM sleep up implies that it's so less significant than REM sleep. The only reason REM sleep has primacy is because it was discovered first. What's it called it the rapid eye movement sleep because of course when we dream our eyes move back and forth rapidly and that was the first time they indicated there was something else going on. asleep. So there are some people who believe Well, there's some people who believe that they don't dream at all. That's probably not true. It's very common for us not to remember our dreams even though we do dream at night. Other people think dreaming is bad. They want more deep sleep, less dream sleep. But in fact, as we were saying, all stages of sleep are important. So you want the right pattern which includes deep sleep, light sleep, mid stage, sleep, and REM sleep or dream sleep. I think what's especially interesting is we don't understand the purpose of these different stages of sleep. There's certainly some interesting research that indicates deep sleep is a sort of restorative sleep, it's when tissues are repaired. neurotoxins are cleared from the brain. REM sleep however, seems to be especially important for learning and memory and regulating our emotions. So if you are getting Not if you're not getting REM sleep, if you're not dreaming, then you might find that you're a little more easily overwhelmed during the day, you might be a little more irritable, or a little more down a little more anxious. And so REM sleep is really important. So that we can learn and remember what we might have encountered during the day. And also so we can regulate our emotions in an appropriate way.

-   11:24  

Those sounds like not only waking up in the middle of night is very normal. Also having dream is very normal phenomenon and which is also very important for our health.

-   11:39  

Yes, exactly. I would say getting the right amount of sleep, and getting the appropriate stages of sleep is crucial to both physical and mental health. Hmm, yeah. So regarding dream, I have a little bit more questions. I hear people and friends often ask me so When they wake up, they use whether they can remember their dream or not to judge how they slept the night before, including some of the myths that Oh, if I remember my dream, maybe I did not sleep well, I possibly have too many dreams. Well, unfortunately, we are not very reliable reporters of our own sleep. And this is especially true of dreaming. When you think about dreams. They often combine strange content, bizarre experiences, our sense of time is totally off it can feel like weeks are passing in a dream. And yet, it happens in the night. So if we wake up thinking we're remembering our dreams, thinking that they took up most of our night that is almost certainly not accurate. So I don't think people should get too caught up trying to figure out how they slept or what was going on when they slept or using their wearables to indicate what was happening because Because most of that is going to be misleading, and it has the potential to actually increase worry about sleep. I see. And I should mention something else for those with insomnia. The classic sign of insomnia is you're worrying about sleep, and worry and sleep are incompatible. So as long as you're worrying about sleep, you're not gonna be sleeping as well.

-   13:21  

Yeah, a lot of people I see this vicious cycle that they cannot sleep while one night start worrying about this so much end up not sleeping while the other night.

-   13:32  

Yes, that's a very, very common pattern. And part of the reason you see that pattern is because sleep is a self correcting system, biologically it it how it regulates itself. So if we have poor sleep one night, we usually get better sleep the next night. That's part of what the system is supposed to do. Now of course, if worry is what's disrupting your sleep, then you definitely want to address the worry and get a realistic perspective. On what adults looks like, in order to make sure that worry is not part of it, because worry is always going to interfere with sleep.

-   14:08  

Yes, definitely. I think I and I see that a lot not only from myself, people around me patients coming in. Yeah worries, often the one of the biggest complains.

-   14:23  

And I don't think people truly understand sleep is a system that's virtually unbreakable. When you understand the biology of it. As long as you are awake and active and doing things during the day, you're building up a biological pressure to sleep. Of course, the more physically active the more socially active you are, the higher that sleep pressure, the more daylight exposure, the higher the sleep pressure, but as long as you're doing that you're building up sleep pressure, and if you build up sleep pressure, at some point you'll sleep You can't break that system. The only thing that might break it is in our much later decades. If we do have too many Sure, that means there's some sort of neurodegenerative process going on. So our brain tissue is breaking down. And if the parts of the brain that regulate sleep and wake start to break down, then we might see some problems with sleep. Other than that, the system is virtually unbreakable.

-   15:18  

That's such an important key points for us all to understand. And remember, I think that our sleep system actually is not broken. If we don't sleep well, one night, that actually could be a good thing for the next night's sleep.

-   15:38  

Yes, and of course, again, evolutionary biology has something to do with this. You know, stress is an inevitable part of human life. None of us are going to go through life without being stressed at multiple points. And so of course, we have to have adapted to manage that stress. There are going to be times when we need to be up evolutionarily speaking, if we were Short on food, we couldn't find food or being hunted by a predator, we might need to stay awake longer. And if we weren't adapted to do that we would not have survived. So of course we're designed to manage after a night of poor sleep. The system again when we're able to sleep corrects for that. What you don't want happening in the past we might have shorted been shorted sleep because there was some sort of threat to our life. Nowadays, what happens more often is people it's almost a self perceived threats. We'll talk about this a little later with one or the other myths. That's great information. So now let's talk about the morning.

-   16:41  

Oh, there are morning myth,

-   16:43  

classic myth. I should feel refreshed when I wake up in the morning.

-   16:47  

Oh, yes, definitely. That's one even myself think about that all the time and people keep on talking about it. Oh, when I wake up I feel so bad or I slept so poorly, just because my eyes are not So open up immediately and shiny in the morning.

-   17:05  

Yes. So this is not true. It is not always the case that we will wake up feeling refreshed because then part of this sleep inertia sleep inertia is a transition state between sleep and wakefulness during which we often feel groggy, heavy limited. Hired, I'd like maybe we could roll over and go back to sleep. It actually doesn't mean anything about our sleep or the quality of our sleep it passes once you get up. It can take anywhere from 30 minutes up to two hours and that is for normal sleepers. And sleep inertia is prolonged if you lie in bed. So the best thing to do in the morning regardless of how you feel is get up the sleep inertia will pass more quickly. You will feel better more quickly alert more quickly. The worst thing to do is hit the snooze button because that's just going to prolong for won't be unpleasantness. Oops, I think I've been doing the wrong thing. A lot.

-   18:02  

I think you're far from the only person who's guilty of that.

-   18:08  

You know, another big myth. And this is ubiquitous nowadays.

-   18:14  

If I check my phone and use my laptop before bedtime, that's not going to really affect my sleep. I don't have any trouble falling asleep, so it's fine. In fact, it's not for a variety of reasons. First, the light from your device, I think a lot of people nowadays are becoming more aware of this blue light. So screens emit blue light. And blue light is the particular frequency of light that gets transmitted through our eye and our retina to our master pacemaker, what's called a super charismatic nucleus. And that blue light tells that pacemaker it's time for us to be awake. And so the pacemakers then going to communicate Okay, let's suppress melatonin. Let's wake this person up. That's what happens when you are hitting your eyeballs with a lot of blue light at that time. And the filters that people use are not they don't filter out all the blue light. So blue light can actually suppress and delay melatonin, which is our main sleep inducing hormone. This is compounded by the fact that we actually don't get a lot of daylight exposure anymore. You know, a lot of us are in office, not necessarily near window on our screens all day not getting outside. And then of course, coming home and spending more time on screens, whether it's phone or tablet or laptop or TV. If you Yeah, if you think about it. We evolved in an environment where we got lots of light during the day and virtually no at night. And now, we're in an environment we get we get virtually no light during the day and then lots of light at night. So we are in what I call a state of evolutionary mismatch. This is not healthy. We need in order to maintain our Sleep, what we need to do is try as much as we can to recreate the environment in which we evolved. So daylight exposure, and then limit screen time at night. If you do get more daylight exposure, interestingly, the screen light may have less of an impact on your circadian system, that pacemaker that I mentioned. So, so the light is the first problem. The second problem is the content, the content that comes to through our devices is both a reward. So you get a dopamine hit when you get that tweets or that email or that Facebook posting. But they're also a threat, because the messages that come through our social media and our devices are not always positive. And of course, when we're threatened, there's a cortisol spike. So both the dopamine and the cortisol actually wake us up. They help us feel more alert, which is not what you want to be doing right before you're heading to bed. So you really want to be careful about when you use your devices. Because if you do use them too close to bedtime that can interfere with sleep. And even if you don't have trouble falling asleep, if you happen to wake up at night, which is of course not uncommon for adults, and you haven't allowed yourself to de stress and disengage from your day, you might be awake for a while at night as a result.

-   21:21  

Wow, hold on that part I haven't thought about so I always think you know, if you have insomnia, sure you want try whatever you can have good sleep habits. So try to block all the blue lights a while before bedtime, or at night in general. But I always think if people's sleep is normal, totally okay. No complains, see, can use blue light as much as they want to however they want. Sounds like it's not true.

-   21:55  

No, it's really not true. And of course when we're younger

-   21:59  

we probably Probably are able to overcome that the effects of the blue light a little more easily just as we're able to overcome a lot of things more easily when we're younger, we're just generally more resilient to things. But it is not a good habit to get into. And I'm really struck when I see patients, we always recommend that people put away their devices in the hour before bedtime, because an hour or two before bedtime is when your melatonin levels start to rise naturally. And so you don't want to inadvertently inhibit the the increase in melatonin because that's what helps you feel sleepy. So we always tell people put away your devices an hour before bedtime. You've been using them the entire day, most of the evening. So an hour is not going to kill you. But I cannot tell you how many people will look at me

-   22:41  

confusion or concern and say, but what am I going to do?

-   22:47  

Exactly. I see people coming to me for treatment for insomnia, they would say, Well, I'm waiting for you to tell me stop using my phone my computer I plan to tell you no, absolutely not.

-   23:01  

Now having said that, there are some situations you know, someone is not watching a lot of TV not spending a lot of time and devices and they have this these favorite sitcoms or sort of light funny shows that really help them relax, okay. But you certainly don't want to be on your screens doing work related activities, productive activities, Bill paying, that's just going to stress you out, the light will alert you and then you're not going to have a restful night.

-   23:30  

Yeah, and I think talking about that reminds me I think figuring out your own stressors is quite important, right, because I know some people get even triggered or get more stressed out when they read a political news at night.

-   23:49  

Exactly. Again, I unfortunately, we're going through a particularly challenging time politically in the US and I cannot tell you how many patients come And they are watching the news and night and getting activated. And so literally we have to establish a news free zone. So in our to before bedtime, you will not watch the news, I will tell people that. Wow. You and I think you put your finger on a key point here, which is you have to know what stresses you out because we're all individual. So what stresses you out might not stress me out or vice versa. So you have to know yourself and what gets you worried or anxious. And that's what you want to avoid an hour or two before bedtime.

-   24:31  

Right? That's so true. Totally agree.

-   24:35  

Now there is a another activity that can make us feel anxious at night.

-   24:43  

Almost always when we see people for sleep problems they are if they happen to be awake at night, they are checking the time. Oh,

-   24:50  

yes.

-   24:53  

Are you guilty of that too.

-   24:55  

We all have phones around us right and sometime we were tracking kurz when you get up in the middle of the night or you somehow cannot sleep very habitually. You just turn on your light or your your phone and check the time. It's very I don't think I even think about that sometime. It's automatic. You're exactly right. Yes. And I think because it's automatic. That's where people get in trouble, because oftentimes they'll think, Oh, well, that, you know, if I check the time, I feel less anxious. It's reassuring. In fact, it's not

-   25:29  

the reason why it's twofold. Number one, when you wake up and check the time, first of all, if you set your alarm, you don't need to know the time. The only reason to know the time is just so you can start doing the math. How long have I been asleep? How much more time do I have to sleep? What do I have to do tomorrow? And at some point that arithmetic can really trigger worry, especially Oh, I better get back to sleep soon. Have a busy day tomorrow. I want to be on top of my game. So Checking the time of night, at a minimum wakes you up at a maximum, it actually makes you lose sleep. Because what people will say is Oh, but if I wake up and I see the time, and it's only two o'clock in the morning, I'm relieved because I have all this time to sleep. And then I'll ask them, well, what happens if you wake up and it's 530 in the morning, and you have to be up at 630? they'll usually say, Oh, well, well, you know, I'll get up and start my day. Yes, that's exactly right. Because you just psyched yourself out of a potential extra 45 minutes of sleep. If you did not know what time it was, you might be able to go back to sleep more easily. So checking the time at night is not helpful for sleep. We always tell people just set your alarm for the time you need to get up in the morning, even if you don't have to be up for something. And don't check the time. If you're awake at night if you're if you're really struggling with it and people really do. For some people. It's very easy not to check the time but for a lot of people it is not easy. So we tell people if you're really struggling then put the clock or your phone in a drawer Under the bed across the room or outside the wall.

-   27:06  

People nowadays really need to do so much to avoid using the for tracking the time, huh?

-   27:12  

Yes. As you said, it is so automatic. You don't even think about it. It just happens.

-   27:18  

Right? It's so interesting. Sometimes we do certain things without talking about that being aware of it. We just not realizing we're doing that actually we are doing that impact ourselves back in a way. Mm hmm.

-   27:34  

Yes. Yes, exactly. We're not helping ourselves, we're actually hurting ourselves. And we don't even know it.

-   27:39  

How about those people where it rains or trackers Do you just let them take it off?

-   27:45  

We usually encourage people to take off their sleep tracker. Again, because it can promote sleep is performance which actually hurts sleep and also because you know, I think I mentioned that pacemaker, that super charismatic nucleus that's like our own internal clock, we actually have a sense of what time it is. We don't necessarily need a tracker to tell us. And so people are using the trackers or tell them what's going on with their sleep. Not only is that not necessarily an accurate picture, but they don't even really need it to know the time.

-   28:24  

Frame feels like when people have the tracker, they not only ignore their own biological signal, they also miss interpret the data from the tracker.

-   28:38  

Yes, yes, exactly. Right. And that's what gets people in trouble. Because the tracker again, as we talked earlier about earlier, is not measuring sleep, it's measuring movement or the absence of movement, which is not the best correlation with sleep. And so it can really give them an inaccurate picture. And once again, my concern is either it's going to promote sleep performance for it's going to increase worry about sleep.

-   29:03  

Yeah. And also, for example, if people read from the tracker, first the tracker already not accurate. And then when they read it, they say, Well, I only had like one hour or one half hour deep sleep and that amount of REM sleep. What that means. What, what, what? But based on what you talked about if the deep sleep is those many percentage, and 10 to 20%, or REM sleep 20% ish, then actually, that data may look normal to experts like you.

-   29:40  

Yes, yes, I would look perfectly normal that if I saw that it'd be like, Okay, well, if you don't sleep, it's fine.

-   29:46  

Huh? Wow. Because I could not even remember how many people has come to me, including friends and family, showing me that data, trying to figure out whether it's bad sleep.

-   30:01  

Yes, that is just not something you want to get caught up in. It's not a helpful habit to have. So I encourage everyone who's listening to your podcast to give it up.

-   30:12  

Well, this company is gonna be very unhappy with it.

-   30:15  

That's true for me. I'm not getting paid by any of these companies.

-   30:20  

But yeah, if you're using a tracker for increasing your level of physical activity or other things great, but for tracking sleep, and telling you in the morning, how you slept, not a good idea. Also think of what happens when you wake up. You're you have that sleep inertia, so you're feeling a little groggy, you check your sleep tracker, and it looks like you didn't sleep so well. Last night. What are you gonna think about your day? The day ahead. Are you gonna feel alert, excited, ready to greet today? No, you'd be like, oh boy, I didn't sleep well today is gonna be so hard. Oh. So you have just given yourself created a self fulfilling prophecy. Where because of how you think about what happened. Your day is now not gonna be as good as if you did not have that early morning experience of sleep inertia sleep tracking, and oh my goodness, my sleep is not

-   31:12  

wasn't good. Yeah, exactly. Hmm. So this is the first part of my conversation with Dr. Barwick. She shared a lot of great information about deep sleep, Dream sleep, and how to use sleep trackers correctly, how to deal with our anxieties. Hopefully you're inspired and learn something from this episode. A summary of this episode will be on our website deepintosleep.co/episode/009. Please feel free to leave us comments if you like our show or if you have any questions. I would always love to hear from you. The second part will be released next Tuesday. We'll see you next week.

Episode 10:

-   0:01  

Oh no. Look at my sleep tracker. I only got 10% of deep sleep last night. That's awful. Have you ever had this conversations with yourself in the morning? Don't worry about that your sleep actually could be really normal. And that's what we talked about with Dr. Fiona Barwick last week. She is from Stanford Sleep Medicine Center and she talked with us about some common sleep myth. And today she will continue with this conversation and share more with us.

-   0:41  

Another sleep myth I should go to bed early. If I need good sleep, I should go to bed early.

-   0:46  

Yes, especially in China we say you have to go to bed like before 11pm ideally 10pm is healthy. Yes. And I understand

-   0:55  

why because you know the idea is if you go to bed at 10 the body goes through certain cycles during sleep, in which different organ systems are sort of replenished or regenerate, not regenerate, but restored. And so you need to make sure you're in bed by 10 because otherwise you'll miss that cycle. This is the the cycle of sort of restoration repair might well be true, but the timing of it is not correct. Because there is what I described is normal variability in sleep. It differs, the amount of sleep we need, the time that we need to sleep differs between individuals, just as height and weight and intelligence also differ between individuals. So this normal variability in sleep include sleep timing, there are what I typically think of as larks. And hummingbirds and owls larks tend to feel sleepy very early, seven, eight in the evening and then a wide awake at three to four in the morning. hummingbirds are asleep a little later. That's probably the most common sleep phase or what we call chronotype. The timing of your Sleep, so hummingbirds feel sleepy a little later 10 to 11 in the evening, and then they're awake at six or seven in the morning. But night owls usually feel sleepy sometime after midnight. I think the window we see most commonly here at the sleep center is sort of one to 2am bed time, and maybe a nine to 10am rise time. Now, the important thing to understand here is this variability in sleep timing is 50%. Genetic, it often runs in families, and they've identified genes associated with the larks in the night owls. So because it is 50% genetic, a night owl whose natural bedtime is to and can't fall asleep at 10pm. It's not going to work. It doesn't mean they won't go through this cycle of restorative sleep. But that cycle is going to happen later for them. So from two to three is when the first organ system won't be replenished from three to four, whatever it is, I don't know the exact timing. So you have to be very This is one of the biggest things Missed that people have that somehow they should be able or those they, they love should be able to go to sleep whenever they want. You can see how with a couple this could cause problems. Because if you have a larger Hummingbird whose natural bedtime is 10pm and you have a night owl whose natural bedtime is 1am they're not going to be able to fall asleep if the logon Hummingbird is gonna have a hard time staying awake until 1am. The Night Owl is gonna have hard time falling asleep at 10pm. And there could be a lot of tension or conflict around this. Whereas if you understand the normal variability in sleep and the fact that it is at least partly genetic, you're more willing to allow your partner to sleep in the window that works best with their biology because the reality is we will always get our best sleep and our biologically appropriate window.

-   3:50  

Wow looks like there's one more thing married couples can communicate with each other.

-   3:56  

Yes, we we definitely see couples where One partner is a night owl and other partners The larger the hummingbird and the larger the hummingbird is usually the one who wants the night out Come to bed with them. And when the night owl doesn't want to or hesitates because they know they're just gonna lie there for three hours waiting to fall asleep. The alarm and a hummingbird takes very personally it feels like they don't you know you don't love me, honey, why don't you want to go to sleep with me? Why don't you want to come to bed with me? But it's not that it's that they literally can't fall asleep at the same time you do. And so it's very important people understand is normal variability and sleep because just because I sleep one way does not mean you or others are going to sleep the same way. And I need to respect that.

-   4:40  

Yes, exactly. I think that's very important for the couples for everyone to keep in mind. And regarding the 50% genetic that's a great data actually the company in history and me. I think the published some of the data they have collected over the year which provides added more evidence supporting that.

-   5:03  

Yes, yes, that's exactly right. I think they even have a line item in there indicating a delayed sleep phase. So that's more of a night owl type. They have a line in there indicating advanced sleep phase, which be more than morning work because they literally have identified genes associated with these.

-   5:18  

Yeah, I think I remember someone mentioned, they were so happy when I talk to them about this data. They were so happy to get the permission to either get up early or go to bed late. That means a lot to them.

-   5:34  

Yes, we see a lot of night out here in Silicon Valley. And there's a lot of social pressure or social stigma attached to getting up later, which is truly unfair. I, I believe that we discriminate against night owls in the same way we used to discriminate against people who are left handed. We used to believe that people who are left handed were actually influenced by the devil. We would beat them if they With their left hand, so obviously, we did not understand the neurology, biology of handedness. And the same is true for the timing of sleep. We don't understand that there's this normal variability. And so we think everyone should be awakened to learn at 7am, which is profoundly unfair to the ninth house. And so I've had the same experiences up Sean where when I tell people I will prescribe that they literally go to bed at 2am. And they look at me like really, I can go to bed at two, they're actually excited about it. They can't believe someone has given them permission to do this. And someone is normalizing their sleep because when night owls are allowed to sleep in their biologically appropriate window, their sleep is fine.

-   6:45  

I really like that. I like how you prescribe sleep time to the patient.

-   6:54  

And sometimes I actually have to write a prescription so they can show their partner

-   6:58  

to make it affordable.

-   7:00  

That's exactly

-   7:04  

so another sleep myth is using a pill will help me sleep. Unfortunately, what the pills are doing whether they are prescription pills or over the counter pills or non prescription substances like alcohol, which is the most commonly used sleep aids, sleep aid, these things are not helping you sleep what they are doing is sedating you, they are rendering you unconscious. If you are unconscious, if you are hit on the head with a baseball bat knocked unconscious, would you actually be asleep? No You would not. You would simply be unconscious. You would not be going through these different stages of sleep that are so important the deep sleep light sleep, the mid sleep the dreams this would not be happening. So you are simply sedated And oftentimes, sleeping pills will take away the sleep stages that seemed very important like the deep sleep Sleep but the dream sleep. So there is no pill that recreates normal human sleep. So when you use a pill to sleep, you're not actually sleeping, you're sedating yourself for the night.

-   8:12  

A lot of people actually always trying to go to pills very quickly when they cannot sleep or when they wake up in the middle of night cannot go back to sleep. But you are saying actually, that is not really helping.

-   8:31  

No, not only is it not really helping, it's actually hurting. So it's depriving you of natural sleep. There are certainly short term consequences. People will often feel sedated during the day, foggy, more likely to make mistakes, the risk of accidents, car accidents and other kinds of accidents is increased. People can feel more easily confused. So there are certainly short term effects and long term effects as well. I think one of the growing concerns among people who prescribe these medications, is there seems to be an association between longer term use of these medications and dementia. So we're certainly seeing prescribers who are no longer willing to prescribe for four years these if someone uses a sedative hypnotic medications or prescription medication or an over the counter sleep aid. It's only supposed to be for the short term, you're not supposed to be using it for months or years. So yes, you can definitely do your self harm by relying on sleeping pills to help you sleep. Now, having said that, for certain disorders, like restless legs, medications are very appropriate narcolepsy. Again, medications very appropriate for for insomnia or circadian rhythm disorders, no, no, the most effective treatment or the cognitive behavioral techniques, changing your behaviors and changing your thinking, the behaviors and thoughts that are interfering with your sleep. And I always tell people, it's the same sort of thing. evolutionary argument. Our there's no pill is going to be more powerful than our biology when it comes to helping us sleep. We were talking about that sleep pressure that builds as we're waking active. So activity. There's a particular molecule called adenosine that builds up as we're waking, active and then comes down as we sleep. You can think of it as sort of a asleep molecule. It's obviously more complicated than that. But simplistically, adenosine is a sleep molecule. adenosine is the byproduct of energy expenditure. So if you're expending energy, you're building adenosine. If you build adenosine, you will build sleep pressure. If you build sleep pressure, at some point, you fall asleep. There is no medication that produces adenosine. The only thing that does it is activity. So you your biology is far more powerful when it comes to helping you sleep than any medication. And that is why the cognitive behavioral therapy for insomnia is the gold standard treatment the recommended treatment from pretty much every major method Medical Association both nationally and internationally.

-   11:05  

Wow. Yeah, so that's good to know. So medication, it's not as magic. As we imagined. We always think medicine actually help us with our sleep. But in reality, it's actually hurt our sleep.

-   11:22  

Yes, yes, very much so. So we're big advocates of people using natural means the behaviors, the thoughts to help improve their sleep. I think the drawback or what makes it hard for people is, you know, changing your behaviors is not necessarily an easy thing to do. It takes conservatively three months to change a behavior. And so, whereas a pill seems to help overnight. Now, the advantage to the cognitive behavioral therapy for insomnia is when you change your behaviors in a rigorous way, you actually can see improvements in sleep within two to three weeks. And then if you continue to use these other things, strategies sleep will continue to improve. Whereas with the pill, you take the pill you stay yourself, you deprive yourself of normal human sleep. And then when you go off the pill, you're right back where you started, you actually haven't addressed the underlying problem. So we are big proponents of people using their biology to help establish and maintain healthy sleep rather than relying on sleeping pills.

-   12:21  

Yeah, I think many of us just want easy way out. We don't want to put effort in we want to rely on something and get all our problem solved.

-   12:31  

Yes. And what people don't realize is

-   12:35  

short term gain long term pain. So yes, in the short term, it might seem quicker and easier to take a pill. But the long term, not only is it not a sustainable strategy, you can actually incur negative effects over the longer term because of the strategy. Whereas if you change your behaviors to more healthy behaviors, if you change your thoughts to more helpful thoughts, these things are cumulative, the benefits continue to build as you use them, and these You're totally sustainable across your lifespan. So even though it takes a little longer to implement these strategies, these in the end are far more powerful than the medications. And that's actually what the research shows over and over again.

-   13:13  

Hmm. Wow. That's a very good way of understanding that. Yeah,

-   13:20  

yes. Yes. It's it's I'm a big believer in using our biology activity and nutrition and

-   13:30  

stress management as a way to improve not only sleep, but but other things. Mm hmm.

-   13:36  

Totally. We have that with us all the time. That's the most reliable method.

-   13:42  

Yes. Now finally, we might be running out of time here. I don't know. But But my my final myth that I want to discuss. I always tell people give up the fantasy. When we hit adulthood. We know We expect even except that most things are going to change as we get older, but for some reason we think sleep is exempt. We think we should be sleeping exactly the same as we did when we were eight years old. And we will never get better sleep than we did when we were eight years old. Because when we're eight years old, we we don't have a mortgage to worry about or a family to take care of or job to go to every day. We don't have to worry about homework for the most part that probably is there might be some cultural differences, I don't know. But in the States, the real homework doesn't start until probably seventh or eighth grade elementary school so we don't have a lot of homework. We can get home from school, we can play with our friends. We've got a great life. Our relationship with our parents is still pretty good. It's all good. So our sleep is fantastic. We're getting lots of deep sleep, we're really waking up. We do feel refreshed in the morning. Those days are gone. Sleep changes as we get older and you have to change along with it. If you don't change along with it, ultimately your sleep quality is going to get worse. And so understanding how sleep changes as we get older and adapting to that is a very important part of maintaining healthy sleep well into your later decades.

-   15:19  

Hmm, I like that. So as we growing up, we need a cept or realize that our sleep actually is changing.

-   15:30  

Yes, yes. When as we get older, deep sleep decreases. Waking up at night increases a bit more total sleep time declines a bit. So if you recognize this reality, accept it and work with it. That's how you can maintain healthy good quality sleep as you get older.

-   15:49  

What is the most difficult change that really throws people off when we age?

-   15:57  

I think the biggest problem I see is people Usually spending as much or sometimes more time in bed in their later decades as they did when they were younger. Because total sleep time has decreased a bit, inevitably, some of that time is spent awake, and what are they doing when they're awake at night, they're worrying about their sleep. So that's probably the biggest problem. I see. as people get older, they continue to spend the same amount of time in bed, and that fragments their sleep quality, whereas if they spent a little less time in bed match their what we call sleep opportunity to their sleep ability to match the time they spend in bed to the amount of sleep they think they're producing every night, they would actually get better sleep quality and better sleep quality does leave people feeling better during the day.

-   16:40  

So sounds like we really the forks on the quality of our sleep.

-   16:47  

I think focusing on quality is very important because you can't if you focus on quantity you get into trouble. Focusing on quantity is how people get into the situation where they're spending much longer in bed making film asleep and again as a result, they sleep quality versus they get lighter Sleep Sleep is more fragmented. So focusing on the quantity is a problem, which is unfortunately exacerbated by a lot of these myths. I'm sure you've heard the the big one out there. Everyone needs eight hours of sleep.

-   17:16  

Oh yeah. All the time. Every time I try to search for some materials, especially in Chinese, that always jump up all the time from so called experts.

-   17:28  

Yes, this is not accurate and not helpful. Remember, we talked about normal variability in sleep timing? Well, there's normal variability in sleep need. So you want to understand what your particular sleep need and sleep timing are the optimal amount of sleep for any individual is the amount that individual needs to feel alert and well rested during the day and evening so they can do the things they want to do apart from a normal dip in the afternoon. That's how you know your optimal amount of sleep and the rain can be six to 10 hours.

-   18:02  

So even six hours could be normal.

-   18:05  

Yes, absolutely. It differs between individuals. So people should not get hung up on the eight hours because that's just going to get them in trouble. If you're someone who actually needs, let's say, seven hours of sleep to feel fine during the day, do everything you need to do. You think you need a so now you're going to be in bed for eight and a half or nine hours to make sure you get that eight hours, you're going to spend an hour and a half for two hours awake at night, and you don't need to and then what are you doing when you're awake at night? You're worrying about your sleep. So it's very important people have a clear understanding of this normal variability and sleep need and sleep timing and try to figure out for them what what windows should they be sleeping in, where should that window be placed? How long should it be?

-   18:43  

Wow, yes, definitely. Feels like that's a lot people possibly never even thought about.

-   18:52  

No, I don't think we have thought about it because I think we've gone and I suspect the countries around the world are probably pretty similar. But in the US, we've gone from totally disparaging, dismissing, ignoring sleep, it's not important. I don't need to sleep, I can get four hours, I'm fine. So we've gone from that which really characterized our culture for probably, since this country was founded 150 200 years, we've gone from that to this sort of belief that we all need to get this amount of sleep. So we were really lacking nuance here, the pendulum has swung from one extreme to the other. And I'm hoping I'm sure it will happen. But I'm hoping that the pendulum will swing back to the middle, and people will begin to understand some of the nuances of sleep, some of this variability that we've been talking about, and people will start to think about sleep, their own sleep, the sleep of others in a more sophisticated way than they are now.

-   19:59  

Yeah, I really like all this information you shared. I hope all this more science based understanding about sleep myths can help a lot of people can help a lot of our audience to clarify the picture to reduce their worries about sleep, to really be able to accept ourselves accept our sleep that is maybe unique, but normal.

-   20:27  

Yes, yes, I think that's very well said. And that certainly is one of my goals as well to try to help educate people and give them an understanding of the complexities and complexities of sleep, the variability in sleep, so that they can realize that their sleep might well be normal. I really appreciate what you're doing for your audience, your listeners, because I think that some of the information you presented on your podcasts does get at this more nuanced understanding of sleep. I'd be very curious to hear what if any questions your listeners have after hearing this episode.

-   21:06  

I will definitely let you know. I will post all the information on the show note and hopefully we get some good questions, feedbacks, then I will be able to invite you back to the show again talk even deeper about sleep.

-   21:23  

That would be wonderful shot. I would love that.

-   21:26  

Great. Thank you very much. Dr. Barwick. This is great.

-   21:31  

You are welcome. It was my pleasure shot.

-   21:33  

What great information here. So just like Dr. Barwick said, we want to trust our body, listen to our body and accept changes of our sleep as we get older. So just go with the flow and follow the signals of our body then we will be able to improve our sleep quality and we also One forks on the quality over quantity. Thank you for listening today. And hopefully you enjoy today's show. Again, all the show notes will be combined with last episode, and you can find it in deepintosleep.co/episode/009. Also, this is the 10th episode of the show. Thank you so much for all your support and your time listening. Hopefully you learn something from each hour episode. Again, if you have any questions or comments, I would love to hear from you. Please feel free to either leave a comment or email me. It will be Halloween tomorrow. Wish you all happy Halloween and I will see you next week.

www.deepintosleep.co
Dr. Yishan Xusleep quality, insomnia, sleep trackers, sleep inertia, dream, deep sleep, sleep stages, REM, NREMComment