30. Dr. Matt Walker: The Sleep Habit That's Secretly Aging You (and How to Fix It)

How many nights have you told yourself you'll catch up on sleep later? You push through exhaustion, thinking it's just part of life. But here's the truth: chronic sleep deprivation isn't just making you tired—it's rewiring your brain, disrupting your hormones, and holding you back from living your best life. In this episode of Extend, I sit down with sleep expert Dr. Matt Walker to dive into why sleep is the ultimate game changer for your health. We unpack how poor sleep impacts everything from your memory to your metabolism and share science-backed tips to improve your sleep quality without overhauling your entire routine. If you're ready to stop running on empty and start waking up energized and focused, this conversation is for you. It's not about perfection—it's about making small changes that lead to big transformations. Dr. Matt Walker is a renowned neuroscientist and sleep expert dedicated to unraveling the mysteries of sleep and its profound impact on mental and physical health. As a bestselling author and host of The Matt Walker Podcast, he's known for making complex science accessible and inspiring people to prioritize rest. We Also Discuss: (00:00) The Importance of Good Sleep (12:33) Optimizing Sleep With Technology (25:08) The Incredible Impact of Sleep (40:49) Understanding the Impact of Caffeine (45:32) The Truth About Coffee and Alcohol (57:21) CBD and THC for Sleep (01:09:04) Detecting and Treating Sleep Apnea (01:22:16) Improving Sleep Through Environment and Routine (01:36:15) Fostering Innovation in Sleep Science Thank You to Our Sponsors: TruNiagen: Whether you are looking to stay sharp, feel more energized or simple age better, go to https://www.truniagen.com/ IFit: If you are looking to elevate your home gym fitness experience with the best in fitness tech, choose IFIT. Go to https://www.ifit.com/ NextHealth: Your destination for cutting-edge health optimization—from IV therapy to hormone balancing. Explore at https://www.next-health.com/ Vitaboom: For supplements you can trust and wellness solutions tailored to your health, visit https://vitaboom.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/ Learn More about Matt Walker: Website: https://www.sleepdiplomat.com/ Instagram: https://www.instagram.com/drmattwalker

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  Have you ever struggled with sleep? Some studies show that almost 50% of people have a sleep disorder and don't even know it. In this episode, I'm going to sit down with Dr. Matt Walker, one of the world's top sleep experts. We're going to break down why sleep is your secret weapon for a longer, healthier, and happier life. We're not just going to talk about quick fixes or trendy hacks. You're actually going to learn some real, science-backed habits that can transform your sleep and boost your performance in ways you didn't even think were possible. We'll explore what makes up good sleep, how caffeine and alcohol affect your rest, and the surprising truth about popular sleep aids like CBD and THC.

• 1:33Dr. Darshan Shah?

  You'll also learn why consistency in your bedtime might matter more than the number of hours you sleep, and how modern tech can help diagnose and improve sleep issues like sleep apnea. Dr. Matt Walker is a globally recognized sleep scientist, bestselling author of Why We Sleep, and host of the Matt Walker Podcast. As a professor of neuroscience and psychology at UC Berkeley, his groundbreaking research has transformed the way we understand sleep and its impact on our mental and physical health. Dr. Walker has appeared on major platforms like TED, Joe Rogan, and now the Extend Podcast to bring actionable sleep science to the masses. His mission is to help all of us harness the power of sleep

• 2:18Dr. Darshan Shah?

  for a healthier, longer, and more vibrant life.

• 2:26Dr. Darshan Shah?

  Dr. Walker, I am so humbled that you came to join me on the Extend Podcast. This is just incredible. Ever since I've read your book, I've been a huge fan.

• 2:36Speaker 01

  Oh, my goodness. Well, I mean, just to have the privilege to be here and sit with you as a, as a medical mind to begin with is amazing. And also just to see what you're doing with Next Health. You know, I think you can look around and you can see some of the sort of, you know, imposter practices out there where people are selling the snake oil sort of charms. And, and as someone who understands medicine too, it's always painful to see that until you then come along and you see the real, genuine article. And I think that's why, you know, you and I have resonated offline so well. So congratulations on what you're doing here. I think it's really important to empower people with the ability to reclaim their right

• 3:20Speaker 01

  to health under their own conditions. Well done. Congratulations.

• 3:24Dr. Darshan Shah?

  Thank you so much. And, you know, it's always been a goal or a vision of mine for people to interact with healthcare differently. And, um, you know, this old system of doctors and clinics that are on the 20th floor of a building with bad parking and a glass wall between you and your, the receptionist and a three hour wait sometimes and 10 minute visits. It's just not a system focused on health. It's great for if you get hit by a bus or if you get diagnosed with cancer.

• 3:53Speaker 01

  Sure.

• 3:53Dr. Darshan Shah?

  But for people looking to optimize their health, it's not the right place to be. And, you know, I look back at my own journey, sleep was a huge part of it. And one of the things I did was go to a sleep clinic because I didn't, I knew I wasn't getting good sleep. I woke up tired every single day.

• 4:09Speaker 01

  Okay.

• 4:09Dr. Darshan Shah?

  And literally, I mean, the only option I was given was you need a sleep study and a sleep apnea machine. And I knew there was so much more.

• 4:19Speaker 01

  Yeah, that's that's essentially, you know, like saying you've got you've got some kind of pain in your stomach. Okay, well, you just need two Tylenol and, you know, take a hot drink.

• 4:30Dr. Darshan Shah?

  Right.

• 4:31Speaker 01

  No, I this this is the incredible high fidelity detail to what, you know, manifold number of reasons as to why that's happening. So to come back to your sleep, what is it about your absence of sleep quality, quantity, regularity, or timing that is predicting that sense of feeling unrefreshed, of unrestored?

• 4:51Dr. Darshan Shah?

  Right.

• 4:51Speaker 01

  And if anyone feels that way, where they're waking up consistently, they can't operate with effectiveness without caffeine, you know, at 11 o'clock in the morning, then if you are hitting the caffeine pretty hard, you may be self medicating both your state of insufficient sleep, but also an undiagnosed sleep issue. And what's interesting, when you look, it's not really doctors' faults, because we did a survey where we looked at about 11 different countries, and we looked at the medical curriculum, and we asked, how many hours of education do doctors get regarding sleep? And on average, it was about one hour and a quarter. So in medical school, four years

• 5:31Speaker 01

  of medical school, the doctor will get trained a little over 60 minutes on something that is one third of their patients' lives. So we can't even blame the doctors, because they aren't educated in this thing called sleep. So I think right now, we are, in the medical field, we think of sleep like a barometer, you know, how is your appetite? Are you going to the restroom? Fine. How is your sleep? As if sleep is this holy grail biomarker of health, but that's where it stops. And it shouldn't stop there. There's so many things that we need to ask. But to your point, yeah, I think it's it was a classic demonstration of how medicine has, and maybe even still,

• 6:13Speaker 01

  neglects this thing called sleep. It is the neglected stepsister in the health conversation of today.

• 6:19Dr. Darshan Shah?

  Absolutely. And I think, you know, the way I was taught in medical school was, poor sleep was a symptom of something else, not really the root. Cause of all of these other downstream problems. And so that one hour of sleep in our medical school was really, okay, what can we diagnose if someone has poor sleep? And how do we fix that with a pill versus, you know, let's get to the root cause of why this person is not sleeping in the first place. So that brings up my first question to you, which I think is foundational to the rest of this conversation. How do you, as a sleep scientist, define good sleep?

• 6:55Speaker 01

  Yeah, it's an interesting question because I think a lot of us, you know, in the morning you'll come down, if you have a significant other, you'll say to them, how did you sleep? Or they'll say, how did you sleep? And you'll say, I slept well or I didn't sleep well. So we all have some subjective sense of quote unquote, what good or bad sleep is. If you look at the science, though, it actually teaches us it's more complex. And in my mind, there are really four macros of good sleep, just like there are three macros of food, fat, protein, carbohydrate. Well, there are four and you can remember it by the acronym Q Q R T. And it stands for quantity, quality, regularity and timing. Q Q R T. So quantity, most people have heard of this. Somewhere between seven to nine is the average range.

• 7:40Speaker 01

  Once you get less than seven, we can start to measure imperiments in your brain and your body. So quantity is fairly obvious. Quality is interesting, though. Quality is really two different things. The first is the continuity of your sleep. Are you sleeping in nice, long bouts throughout the night? Or is your sleep highly fragmented and you're spending a lot of that time awake? The way that we measure quality in that sense is something called sleep efficiency. Sleep efficiency is of the time that you're in bed, what percent of that time are you asleep? And for people out there with sleep trackers, what we tend to like to see in medicine is somewhere about eighty five percent or above is a good quality of sleep. The second measure that you can't really get through these sleep trackers

• 8:25Speaker 01

  is the electrical quality of your sleep. So what do the big, powerful brainwaves look like during the deepest stages of deep, slow wave sleep? So that's the second measure, quality. The next two have come really late on the scene. So QQ, quantity, quality, then R, Q Q R T, R stands for regularity. And here it's going to bed at the same time and waking up at the same time, no matter whether it's the weekend or the weekday. And I was somewhat, as a sleep scientist, aware of some of this data, but there was a recent study that was published, I think it was a couple of hundred thousand individuals from something called the UK Biobank, which is an incredible data source. And they were looking at quantifying individuals in quartiles.

• 9:06Speaker 01

  The top quarter was the most regular, then sort of going down. So you had these quartiles and they compared the the top quartile to the lowest quartile, those who were most regular, those who were least regular. Those who are most regular staved off conditions, well firstly, all-cause mortality, I think it was an odds ratio of about 1.6, so non-trivial. Similar numbers for cancer mortality, cardiovascular mortality, as well as metabolic disease mortality. But what was also interesting is that in that study, they were also measuring quantity. So then they did something clever. They put quantity of sleep, seven to nine hours, together with regularity into the

• 9:47Speaker 01

  same statistical model to see which one won out in terms of predicting all-cause mortality. Both of them had a strong predictive signal. However, regularity beat out quantity. Interesting. And it stunned me. It suggests that regularity may be even more important than quantity. Now, you can't get away with absent quantity, you know, you can't get away with sleeping four hours, but highly regular, that's not what I'm saying. But still, nevertheless, it stunned me into being even more just vanilla, you know, constrained in terms of my onset and offset. The final one is T, Q Q R T. T stands for timing. And you may think, well, timing sounds very much like regularity, so what's the difference?

• 10:31Speaker 01

  Timing is about your chronotype. So are you a morning type, evening type, or somewhere in between? And it turns out that if you're an evening type, it's not your fault. It is genetically determined. There are, right now, best count 22 different genes that dictate your morningness or eveningness. Preference. So it's gifted to you at birth. And what's interesting is that if you are not sleeping in harmony with your chronotype, your sleep won't be as good. So let's say that I've got a morning type who likes to go to bed or a morning slash neutral type who likes to go to bed at ten P M and then wake up at six A M. So it's eight hour opportunity. And then I've got an evening type, an evening type, this person would like to go to bed at two P M

• 11:15Speaker 01

  and wake up at ten, sorry, two A M and wake up at ten A M. So they both have an eight hour opportunity. But let's say I then take the night owl who likes to go to bed at two A M, wake up at ten A M and drag them back and force them to sleep from ten P M to six A M. Well, that's the same quantity. They've both had the same opportunity, so they should just be fine. It's not because the night owl will not have good quality sleep. They will be in bed for probably the first two hours wide awake because their biology is not yet ready to sleep. And we get people coming to my center at U C Berkeley saying, look, I am, I've got terrible sleep onset insomnia. We do the chronotype testing, which I'll tell you how to do in a second. And what we realize is that you don't have insomnia.

• 12:00Speaker 01

  You just have a mismatch between your chronotype and when life is forcing you to try to sleep. And we find some type of middle ground and they start sleeping better. And by the way, if you want to figure out your chronotype, it is a genetic test that some people can do. However, there is a very simple questionnaire if you just go online and you type in M E Q and it stands for morningness eveningness questionnaire.

• 12:24Dr. Darshan Shah?

  Right.

• 12:25Speaker 01

  And it takes about three minutes to fill out. And what's nice is that the questionnaire will get you very close to your genetic sort of predilection. It's actually a good sort of biomarker of your genetics. So you'll figure out what type you are and then just try to align yourself to it. So long answer to your elegant, simple question. What is good sleep? For me, it's the four macros of good sleep. Quantity, quality, regularity and timing. Get those things straight. And if sleep is still not in place, then we can talk about what's going on with diet, mental health, blood biomarkers and yeah.

• 12:58Dr. Darshan Shah?

  Absolutely. And you know, I what? A lot of different thoughts I have there when I see my patients that as you were talking, I remember these stories that come up when I see my patients. One particular story I remember that happens actually quite often is I ask my patients, how do you sleep? Almost always the answer is I sleep pretty good, pretty good.

• 13:19Speaker 01

  Okay.

• 13:19Dr. Darshan Shah?

  And then my next question is at what time do you go to sleep every night? Most people, they say somewhere between nine to 11 and some, and this is like the same individual.

• 13:31Speaker 01

  Yeah.

• 13:32Dr. Darshan Shah?

  Their sleep time is off by multiple hours depending on, you know, what their social engagements were for that night, whether it's a weekend or not. And what you're saying is that more important than the actual quantity, getting the seven or eight hours is making sure you go to bed every night at the same time.

• 13:51Speaker 01

  Yeah, and same time here, you know, with plus or minus sort of 20 minutes on either side. So a total wiggle room of let's say 40 minutes.

• 13:58Dr. Darshan Shah?

  Forty minutes.

• 13:58Speaker 01

  But nevertheless, now to your point, in listening to this interview with me, I'm going to talk about the ideal world for sleep.

• 14:05Dr. Darshan Shah?

  Right, yeah.

• 14:06Speaker 01

  And drumroll, none of us live in the ideal world. We live in this thing called the real world. And so, you know, I understand that every now and again, go out with friends, have a good time, joie de vivre, live a little for goodness sake. However, really be careful on the nights when you can gain regularity. And let's say try to do it, you know, at least five or six nights out of the week, you know, stay regular. That's the place where you've got opportunity on the table to invest in your sleep health and therefore your longevity and your lifespan and both your health span as well. And so it's so tempting, you know, to start, you know, just binging on Netflix, staying awake a little longer and thinking, oh, I'll just send that last email.

• 14:47Speaker 01

  And then I'll just sort of scroll on Amazon, I'll just do a bit more shopping. And I've got to send that text or maybe I'll add the calendar reminder, you know. And all of a sudden you look up and it's 40 minutes later and that's what we call sleep procrastination. So on those nights, what do you do? I would say just real world, set a to bed alarm. Most of us have a wake up alarm. Why don't we have a to bed alarm? And so I would say usually one hour before bed, that's the time when that goes off, you instigate several things. Firstly, you go and get changed, you brush your teeth, you take your makeup off, you do whatever you need to do, so that when it literally strikes the point of your bedtime, there's no more time that you need, you just go straight to bed.

• 15:30Speaker 01

  Also, when that alarm goes off one hour before bed, turn down half of the lights in your house, if not seventy five percent. We are a dark deprived society in this modern era, and we need darkness at night to release a hormone called melatonin. And that darkness that we're not getting normally because of this bright overhead light is creating what I would call junk light. You know, we've had this concept in biology of junk DNA. Well, I think this junk light and junk light happens at night. You will be surprised at how soporific that reduction in light ends up being. And if you you hear me saying this and you think, okay, wow, interesting idea.

• 16:10Speaker 01

  Just try this, people listening, tonight or whenever you can, when you have a one week stretch where everything is stable in life and you can do this experiment, just try it. And after one week, if you absolutely can say to me hand on heart that I didn't start sleeping better and I didn't feel more relaxed going into bed and I didn't fall asleep faster, then throw out the experiment, it was a failure and don't do it. But I suspect that for a large proportion of people, you may find it useful.

• 16:40Dr. Darshan Shah?

  Yeah, absolutely. And that brings up my next point, which is, I I really believe, and now I'm doing this with all of my patients, is every single one of them are tracking their sleep for at least six weeks. I find about seventy percent of people have never tracked their sleep, actually.

• 16:57Speaker 01

  Yeah.

• 16:57Dr. Darshan Shah?

  And, you know, once again, when I ask them the question, are you getting good sleep? And the answer is, yeah, I sleep pretty good. I know for a fact that half the time at least that answer is not true. When we actually track their sleep, you know? And so when doing these little experiments like you're talking about, to really have the data, you need to be doing some sort of sleep tracking, I think. Um, to understand how it's working for your individual biology. Because just like chronotype, everyone has a different biology. And so their biology will react differently to different interventions.

• 17:31Speaker 01

  So true.

• 17:32Dr. Darshan Shah?

  Right, right? And I think it's a good time to dive into sleep tracking right now.

• 17:36Speaker 01

  Yeah.

• 17:36Dr. Darshan Shah?

  And your perspectives around what are the best trackers to use? Uh, what are different types of trackers? How do you do it effectively? Uh, what are your thoughts around sleep tracking?

• 17:46Speaker 01

  Yeah, I think, you know, I, I've thought a great deal about sleep tracking and you can create, you know, the fanciest, most remarkable piece of technology that has, you know, almost a hundred percent accuracy relative to the gold standard sleep laboratory that I have at my center, where you look like a spaghetti monster with all this madness all over your head. And if people don't wear it, it's useless.

• 18:09Dr. Darshan Shah?

  Right.

• 18:09Speaker 01

  It could be so accurate, but so I say that because the first way, when people ask me what's the best sleep tracker? I think of it as two verticals. The first is accuracy, of course. The second is whether it's a low friction or no friction device, which is form factor. And that's why I think for the most part, I have a preference for not really sort of wristwatches or chest straps or headbands. It's when we go to sleep, we take things off.

• 18:37Dr. Darshan Shah?

  Yeah.

• 18:38Speaker 01

  We don't put things on. And so anything where you're asking a user to do something that violates first principles is usually not going to work. So that's why probably seven or eight years ago, I started wearing the Aura Ring. Full disclosure, I am a scientific advisor to the company now. So take what I say with a grain of salt about the Aura Ring. But I would say that I was using it for about three years beforehand. And it was just such a low friction, no friction device. We do go to bed with, you know, rings on our fingers. So it's not unheard of. I would also say right now, looking at the algorithm and its performance, it's probably best in class in terms of its accuracy. Now, what does that mean? It means that this device, this ring device, it's about in sort of high seventy percent accuracy

• 19:23Speaker 01

  for what we call a two-class algorithm, which is to say, can it classify wakefulness from sleep? So wake from sleep, that's a two. Two class algorithm and there it's up in the high seventies. If you look at what's called the four class algorithm, which is separating wake from light non REM, deep non REM and REM, that's actually a harder sort of algorithmic problem to solve. There you're looking in the sort of low seventies, high sixties. Now, you may say, well, okay, low seventies, high sixties, you mean it's sort of, it's got a thirty percent error rate. Well, keep in mind that I have fifty thousand dollars worth of equipment to be able to accurately stage your sleep and you do look like this bizarre sort of, you know, Frankenstein monster.

• 20:08Speaker 01

  And you're telling me within a form factor that is a ring, you can get seventy, seventy-five percent of the way there. That's bloody remarkable, you know, so I think, so the first thing I would say is it's form factor I very much like. And then I think the accuracy is excellent. The other thing I would say about sleep trackers in general, yes, their absolute accuracy on any one night may be in the mid to high seventies. But its relative accuracy is far better, meaning that don't look at necessarily nightly headlines. Follow weekly trend lines because if there is something that's starting to deviate and change, it's not the ring because it's consistently inaccurate every single night in the same way.

• 20:54Speaker 01

  So anything that's changing must be me, I'm the one that, so that's when I start to kind of look out to have a concern about my own sleep. So overall, I like sleep trackers because unlike diet and exercise, you can track your physical activity with all of the different gadgets and you can track your food with some new technologies. That's great, but for the most part, what's different about sleep is it's a non-conscious process. So if I were to say, okay, Doshin, you know, how have you been exercising for the past week? You can tell me, how have you been eating? Have you been eating clean? Yes, I've been eating clean. Okay. If I were to say, how much deep sleep did you get last Tuesday night? You know, if I don't have a sleep track, I've got no idea.

• 21:35Speaker 01

  So it's a non-conscious process, so I think it's especially amenable to tracking. The only caveat that some people have when it comes to sleep trackers, where you start to get a little bit anxious, where if your numbers are going down and you're someone who is already maybe a little bit sort of sleep nervous and you're starting to struggle with sleep, the last thing I need when I wake up in the morning is for it to tell me what I already know, which is, I just did not sleep well last night. And now I get reinforcement of that. It can then start to create this almost sort of inverse bedtime room sort of, it's like what we call an anxiogenic trigger, which means it starts to make me anxious about going into my bedroom and trying to get sleep even before I've done

• 22:20Speaker 01

  it. It's now got a name in sleep science and sleep medicine. It's called orthosomnia. So in medicine, ortho, we typically think of as straight, so orthopedics, orthodontics, you know, strengthening teeth, strengthening bone. This is about getting your sleep straight and perfect. And I would say if you're starting to experience that, do one of two things. First, take the ring off, put it away. Let's figure out what's causing you your problems. Get your sea legs back underneath you. When you've got confidence, let's go back to tracking. The second is halfway ground between those two. Don't take it off, but only check the data once a week, maybe on a Sunday afternoon, when you've sort of had, you've been playing with the kids, you're coming in. Okay, you've got 10 minutes to sit down and you're just

• 23:03Speaker 01

  going to relax, no stress. That's the time to do it. But I would say overall, I am very bullish on sleep trackers for the keep, for the accuracy, the capacity to do this and the ability to inform you about your sleep. I do think where we need to move though, right now with sleep tracking technology. And the other thing I should mention, by the way, and we can come back to it for technology, is the eight sleep bed. So I sleep on an eight sleep and have been for a couple of years now. And again, after just a couple of months ago, myself and two of my friends, Peter T. and Andrew Huberman, we all joined the scientific board to see if we can help them with their science and really try to improve it. But I really like that technology too. And we can sort of unpack why that's the

• 23:47Speaker 01

  case. But overall, I think what we're missing Right now in the sleep tracking field is we sense the data correctly. Fantastic. And then we show you the data. That's good through the UX through the app. But then the missing two pieces are, okay, that's my data. But what does that mean? What does that mean for a, you know, a man in, you know, male mid forties? Is that good? Is that bad? Am I in the upper 20th percentile for my deep sleep? Or am I in my lowest, you know, sort of 10 percentile for my REM sleep? I don't know. So tell me what it means. And then after I learn about what it means, well, tell me what to do about it.

• 24:26Dr. Darshan Shah?

  Exactly.

• 24:27Speaker 01

  Because that's what we're in the game for here. That's what you're doing, you know, this incredible service to humanity. That's what I'm trying to do with this sleep mission is we're trying to change people so that we reunite them with the health that they so deserve.

• 24:42Dr. Darshan Shah?

  Right.

• 24:43Speaker 01

  And if you don't tell them what to do about it, you can't change them. So I think those are the two sort of missing pieces right now.

• 24:51Dr. Darshan Shah?

  I agree. I agree. You know, I haven't ate sleep bed myself.

• 24:54Speaker 01

  You do? Okay.

• 24:55Dr. Darshan Shah?

  I absolutely love it. We'll talk about that a little bit later. But I wanted, I do want to talk about, you know, kind of the subject matter of your first book, Why We Sleep? And also how that relates to what you talked about is, you know, what do we do about our sleep? But why is that even important? Because I think I grew up in an era, and maybe you did as well, you're a lot younger than I am. But I grew up in an era where sleeping was considered something that if you were weak, you had to go to bed, you know? And the more you could stay awake and power through the night and stay up all night and pull all nighters, the more mental fortitude you had. And now we know the exact opposite is true, is that you're actually having majorly deleterious effects,

• 25:36Dr. Darshan Shah?

  not just to your brain health, but also to your physiological health as far as your metabolism goes, your heart health goes, have a higher rate of heart attacks, higher rate of cardiovascular disease, higher rate of diabetes in people that don't sleep.

• 25:49Speaker 01

  Yeah.

• 25:49Dr. Darshan Shah?

  So why did we evolve to sleep? And what are the reasons that we're trying to improve our sleep?

• 25:56Speaker 01

  Yeah, it's a very good question. I would say sort of to the first part of the question, you know, why sleep?

• 26:02Dr. Darshan Shah?

  Yeah.

• 26:03Speaker 01

  Simply put, sleep is the single most effective thing that you can do each and every day to reset your brain and body health. And I don't say that flippantly or lightly relative to diet or exercise. They are absolutely essential. But if I were to take you and deprive you of exercise for 24 hours, deprive you of food for 24 hours, deprive you of water for 24 hours, or deprive you of sleep for 24 hours, and then map the brain and body dysfunction, it's not even close. You know, sleep, hands down, will have far more of a blast rate. The only thing I lose out on is oxygen. You know, if I deprive you of oxygen, okay, fair enough. I'll give it up for oxygen.

• 26:38Dr. Darshan Shah?

  We'll talk about oxygen deprivation later.

• 26:40Speaker 01

  Yeah, absolutely. We should absolutely should do. But I think, so to me, that was in part the motivation to write the book. I could see the disease and sickness that was happening. And you're right that at the time and still now in this modern era, the sleep has an image problem.

• 26:57Dr. Darshan Shah?

  Yeah.

• 26:58Speaker 01

  That we still stigmatize people who get sufficient sleep as being slothful or lazy. And it stuns me for two reasons. First, human beings are the only species that appear to deliberately deprive themselves of sleep for no apparent good reason. And the second is, we don't always have this opinion. None of us look at an infant sleeping during the day and say, what a lazy baby, you know? We don't, because we know at that time of life, sleep is non-negotiable, absolutely necessary. But somewhere, if you look at the data now, between infancy, even childhood, we abandon the notion of sleep as a biological requirement. And then we chastise people. And we adopt this sort of sleep machismo

• 27:41Speaker 01

  attitude, where we start to go into competitive undersleeping with, you know, all of our colleagues. In terms of what it does to you in terms of a lack of sleep, certainly what we know is that upstairs in the brain, probably the strongest link that we have right now is sleep and Alzheimer's disease and dementia. We know that insufficient sleep across the lifespan is a strong predictor of how much of these sticky toxic proteins, beta amyloid and tau Protein will ultimately get deposited in your brain in later life. We also know that that's just associational evidence, that's epidemiological, doesn't prove causality. Then they went in search of causality. If you deprive animals of sleep or you deprive a human being selectively of just deep non-REM sleep,

• 28:26Speaker 01

  what you can see the next day is an immediate rise in blood circulating biomarkers of beta amyloidin tau protein. We've done spinal cord taps on individuals, looked at the cerebrospinal fluid, which is bathing the brain. And there too, you see an escalation of Alzheimer's protein the next day. So that's a causal manipulation. Then that causal manipulation went in search of a mechanism. Okay, so if you're not getting sleep, Alzheimer's pathology builds up in your brain. Why then, what is it about sleep when you do get it that de-escalates Alzheimer's risk? And this was a discovery, remarkable discovery made from the University of Rochester. And they showed that there's a pulsing cleansing system in the brain at night

• 29:06Speaker 01

  that uses the cerebrospinal fluid to wash through the brain and it removes all of the metabolic detritus.

• 29:12Dr. Darshan Shah?

  Lymphatic system.

• 29:13Speaker 01

  Lymphatic system. And we all know of the body having one called the lymphatic system. Well, the brain has one, but the brain only switches on that high flow volume of clearance during sleep and specifically during deep non-REM sleep. So I think that's, so that's upstairs in the brain is a demonstration. We also know that sleep is critical for learning and memory and cementing memories. We know that sleep is also essential for your emotional and mental health.

• 29:40Dr. Darshan Shah?

  Right.

• 29:41Speaker 01

  I would say we do a large research program on sleep and mental health and psychiatric disease. In the past, gosh, now 20 years of study, I have not been able to discover a single major psychiatric condition in which sleep is normal. And that tells me everything I need to know about this just profound, sensitive connection between your mental wellness and your sleep wellness. Downstairs in the body, sleep, gosh, it does so many different things. The first thing it does is restock all of the weaponry in your immune arsenal. The second thing that it does for your immune system, it not only increases. Sort of, you know, gives you this panoply of immune factors. Your body becomes more sensitized to those immune factors.

• 30:24Speaker 01

  So you wake up the next day and you're much more immune robust as an individual. And that's why we see very strong links between a lack of sleep and your COVID infection rates. Infection rates of the common cold, hepatitis B, we've seen. And also now, more recently, you look at the data with cancer. I think there's a very clear link there with some forms of cancer. There's a great study done here at UCLA by Michael Irwin. And he showed that if you deprive people of four hours of sleep for just one night. There was a 70% drop in natural killer cells, which are essentially the, almost the James Bond Secret Service agents of your immune system. And they will go after certain cell types, like cancers.

• 31:08Speaker 01

  And so I think from a downstairs body perspective, firstly, your immune system gets this overhaul and it's remarkable. That's why your mother would always say, if you're getting sick a lot at college, you know, are you sleeping enough? The intuition was right.

• 31:21Dr. Darshan Shah?

  Makes sense.

• 31:22Speaker 01

  Then we can speak about the cardiovascular system. And here what we've discovered is that a lack of sleep will start to shift you into what we call the fight or flight branch of the nervous system. What we call the sympathetic nervous system. Now, it's anything but sympathetic. It's agitating and very activating.

• 31:37Dr. Darshan Shah?

  Exactly.

• 31:38Speaker 01

  And that will start to put you, it's almost like a classic car engine. And you've just got it in neutral and you are just revving the living daylights out of the engine. That's what it means to be pushed over into this fight or flight branch. That, together with the fact that sleep or lack of sleep will increase the amount of stress related hormones, particularly things like cortisol. So you've got these two sort of sister systems that were going to drive you into a state of chronic, long term inflammation by way of the stress axis. So insufficient sleep is going to. Drive you into this sort of dominant sort of fight or flight system, which means

• 32:20Speaker 01

  blood pressure increases, that means increased vascular stress on the vessels, the walls of the vessels. That type of stress can lead to something called atherosclerosis. That's the furring up of your arteries. There's a great study from Harvard and they looked at a cohort of individuals who had no signs of coronary artery disease. They were perfectly healthy. And then they tracked them over a five year period. And then they retrospectively bucketed those individuals into those who were saying, I got five hours of sleep, six hours of sleep, seven hours, or eight hours or more across that five years. Those people who were sleeping five hours or less across that five year period had a 200% increased risk of developing calcification of the coronary artery, which are the major life corridors for the heart.

• 33:05Speaker 01

  Right. And that was a prospective longitudinal study where these people had no signs before, but insufficient sleep increased the likelihood. So cardiovascular system absolutely dependent on sleep. And when we go into sleep, sleep is the very best form of natural blood pressure medication that you could ever wish for. Your heart rate decelerates, the vessels relax, you know, your heart rate variability goes up. We can also then speak about the metabolic system. And here, this is absolutely essential. I think some of the strongest data is in metabolic regulation. When most people hear of metabolic regulation, you think my metabolism and how I'm burning calories. But, you know, in medicine, when we think about the metabolic system, it's that, but it's also how you regulate things like blood sugar.

• 33:48Speaker 01

  And here, what we've been able to discover is that if you put an individual who's got no signs of diabetes on a diet essentially of six hours of sleep for five nights, at the end of those five nights, their blood sugar control is so devastated, so poor, that a doctor would classify them as being prediabetic. So you can take a perfectly healthy individual and you could force them into a prediabetic state after just five days on limited sleep. So again, causal manipulation. There's probably also, the other aspect is hormonal health. Yes. And particularly reproductive health, what some, there was a great study from University of Chicago, and they put healthy young males, virile young males, on a diet of four hours

• 34:32Speaker 01

  of sleep for five nights. At the end of that week, they had a level of testosterone, which is that of someone 10 years their senior. So a lack of sleep could age a man by a decade. And we've seen similar impairments in female reproductive health, things like estrogen, luteinizing hormone, and progesterone as well. So I think all of which is to say that there is, there is no operation of the mind, and there is no major physiological system within the body that isn't wonderfully enhanced by sleep when we get it, or seemingly impaired when we don't get enough.

• 35:09Dr. Darshan Shah?

  Right.

• 35:09Speaker 01

  And it makes sense, because sleep, from an evolutionary perspective, is such a dumb idea. Because you are, you're not, you know, you're not finding food, you're not finding a mate, you're not reproducing, you're not caring for your young, and worse still, you're vulnerable to predation.

• 35:28Dr. Darshan Shah?

  Right.

• 35:28Speaker 01

  So on any one of those grounds, but especially all of them as a collective, sleep should have been strongly selected against in the course of evolution.

• 35:36Dr. Darshan Shah?

  Absolutely.

• 35:37Speaker 01

  But the fact that it's in every species that we've carefully studied to date, sleep is present. What that means is that sleep appears to have evolved with life itself on this planet. And despite being so evolutionary deleterious, it has fought its way through every step along the evolutionary path.

• 35:55Dr. Darshan Shah?

  Right.

• 35:55Speaker 01

  What that tells us, if it's conserved across phylogeny, is it's an essential process. And that's why I think sometimes when I, you know, hear people say, well, you know, is this sleep thing really important? Can't I just, you know, sleep six hours or five hours? You know, I, I'm, I'm pretty tough, you know, guy. Well, don't you think that after 3.5 million years of evolution, and it being such an idiotic thing, if Mother Nature could have found a way to shave off two hours? Absolutely, it would have. But no, it's there. And we think that we can come along with in the space of twenty or thirty years and say, I can get used to a lack of sleep. I can train myself out of it. You know, that's, it's just hubris and usually leads to unfortunately a shorter life.

• 36:40Dr. Darshan Shah?

  Yeah, absolutely. You know, if you go to the CDC's website, you can easily look up what are the top ten causes of death. Sleep is associated with every single one of these.

• 36:49Speaker 01

  Yes, yeah.

• 36:49Dr. Darshan Shah?

  You know, I'm in the longevity business and I show people this list to emphasize, these are the things that we want to try to eliminate from your biology. So you don't die of these ten things. This is what's going to lead to longevity for you. Number three in that list actually is unintentional injuries. Okay. And so that also has a lot to do with sleep because lack of sleep, I think, leads to a lot of the accidents that we see, both on the roadway and outside of the roadway. There's a statistic, isn't it four hours of sleep or less and is equivalent of a blood alcohol level of point eight?

• 37:24Speaker 01

  Yeah, if you are awake for twenty hours straight, essentially, which is what you're saying, then you are performing cognitively at the level of someone who is legally drunk.

• 37:34Dr. Darshan Shah?

  Right.

• 37:34Speaker 01

  And that's what also stuns me about the workplace, by the way, just to take a side tangent. You've, you know, you have got these business leaders who will say, you know, I've got this incredible team, you know, they are the on email at five thirty in the morning, I'll shoot them a text at, you know, ten, they've got the report there to me by two AM the following. Well, I've never heard of, you know, a CEO saying, I've got this fantastic team, they're drunk all the time.

• 38:01Dr. Darshan Shah?

  Right, right.

• 38:02Speaker 01

  But they would never say that. But essentially, that's what you're doing by co-opting that maybe. And the data is very clear in business, which is less sleep does not equal more productivity. It's the opposite. But I think, coming back to your point, the data on road traffic accidents is really quite compelling. The problem with insufficient sleep when you're driving, this is one way that a lack of sleep will pop you out of the gene pool very quickly, is that you start to have something called micro sleeps. And this is where your eyelid will just partially close over and certain parts of the brain essentially go into a sleeplike state. Now you as the driver, you have no perception of you having these lapses in your focus, these micro sleeps.

• 38:43Speaker 01

  The danger is that they only last for about, you know, maybe a second, a second and a half. But if you're traveling at sixty five miles an hour, within a second, you're in the next lane.

• 38:53Dr. Darshan Shah?

  Right.

• 38:54Speaker 01

  You know, within two seconds, you're in the ditch. And so that could be the last micro sleep that you ever have.

• 38:58Dr. Darshan Shah?

  Yeah.

• 38:59Speaker 01

  If, if you, so the other problem with, with drowsy related driving accidents is that, let's say that you are intoxicated, you're inebriated. Typically, the reason that you have a crash is because you react too late.

• 39:12Dr. Darshan Shah?

  Uh huh.

• 39:13Speaker 01

  But you still reacted.

• 39:14Dr. Darshan Shah?

  Right.

• 39:15Speaker 01

  When you fall asleep at the wheel, there is no reaction.

• 39:17Dr. Darshan Shah?

  It's your reaction.

• 39:18Speaker 01

  And at that point, there is a two ton missile traveling at sixty five miles an hour and no one's in control. And so that's why we typically see, you know, sleepy, drowsy related driving accidents as often having a higher mortality rate.

• 39:30Dr. Darshan Shah?

  Yeah, I mean, it's, it's, it's really mind blowing to me that, I think about my own career in, in, I'm a surgeon and surgeons, during your residency training, you're not, you're expected to stay out for two or three nights in a row sometimes.

• 39:45Speaker 01

  Yeah.

• 39:46Dr. Darshan Shah?

  And you're operating on humans at two or three nights in a row with very little sleep. And, you know, thank God you're working on high levels of cortisol and caffeine to get through these surgeries.

• 39:55Speaker 01

  Yeah.

• 39:56Dr. Darshan Shah?

  But I remember very specifically, multiple times driving home from work, I only live like a mile away, I would fall asleep at the traffic light, the one traffic light that was there, cause I just could not stay awake. And it just, you know, you can force no sleep over and over again for multiple nights, but it is going to catch up to you.

• 40:14Speaker 01

  Yeah. And, you know, we've done a number of studies in this area and some folks at Harvard have done the studies. If you look, resident, young residents who have pulled a thirty hour shift will make four hundred and sixty percent more diagnostic errors in the intensive care unit.

• 40:27Dr. Darshan Shah?

  Yeah.

• 40:28Speaker 01

  Secondly, if your surgeon has not slept at least seven hours in the previous twenty four, they are a hundred and seventy percent more likely to cause a surgical error, to your point.

• 40:38Dr. Darshan Shah?

  Right.

• 40:39Speaker 01

  And then the irony of all of this, there's a study from Charles Sizer at Harvard Medical School, he demonstrated that a young medical resident. Who's worked a thirty hour shift, when they finish that shift and get back in the car and drive home, they're a hundred and sixty eight percent more likely to get into a car accident, ending up therefore back in the emergency room from where they've just come from. But now as a patient, not as a doctor, you're thinking, this is lunacy. What are we doing here? You know, and so I think this, and if you look at some of the medical boards, I know I've spoken to, to Charles Sizer a number of times, they petitioned, you know, the medical system to change resident hours. And the first time I think they did it, it was a very much a case of old boys network.

• 41:22Speaker 01

  And, you know, my mind's made up, don't confuse me with the data. Okay, then they went back and I think they appealed on the grounds of malpractice. And all of a sudden, when you started to talk money, then there was some shifting. And I do believe, and I'll have to check to see if this is correct. I do believe they changed the resident hours based on the strength of the data and they said, fair enough, we'll change them. And when they looked at the fine print, they'd only changed it for first year medical residents.

• 41:49Dr. Darshan Shah?

  Yes.

• 41:49Speaker 01

  So they said, well, why, why did you change it for just first year medical residents? And they said, well, your data was only in first year residents. So, sorry, there's something magical that happens when I make the transition from being a first year to a second year resident, that I don a Teflon coat of biological immunity to the effects of sleep deprivation and everything's just fine. I mean, it's just, yeah.

• 42:11Dr. Darshan Shah?

  It's lunacy, I know. You know, residency training is a hazing type of environment almost. And the, the lack of sleep or the push to lack of sleep, just like we were talking about earlier, is supposed to be a sign of strength.

• 42:23Speaker 01

  Yeah.

• 42:23Dr. Darshan Shah?

  And in reality, it does cause worse outcomes in the hospitals.

• 42:28Speaker 01

  It really does. And if that's, you know, if we're training our doctors to, you know, do exactly what their oath dictates.

• 42:35Dr. Darshan Shah?

  Right.

• 42:35Speaker 01

  Then a lack of sleep is counterfactual to that. And the, it's an interesting history, by the way, that the reason that there was a residency program of sleep deprivation, that the initial, the first residency program happened at Johns Hopkins University in Baltimore, here in the United States. And it was a surgeon called William Holstead, who created the. The first residency program and the residency program by its name meant that you as a doctor, you essentially are living in the hospital.

• 43:02Dr. Darshan Shah?

  Right.

• 43:02Speaker 01

  Now, he was well known for being able to perform these heroic stints of being able to go without sleep for three or four days straight. And it was just superhuman and he expected all of his residents to do that. It turns out that Holstead had a dirty secret that he was originally working in his research at with local anesthetics and he was specifically looking at cocaine, which is a local anesthetic. And it turns out that he started to use and he got addicted to cocaine. And so he was an accidental addict. And this is why he could pull these heroic stretches because he was high on cocaine for three or four days straight. Unfortunately, he recognized this after a while. He took himself to a rehab clinic under a different name and there they were actually

• 43:47Speaker 01

  giving them methadone to trying to get them off cocaine. And unfortunately, he came out of the rehab, both still with a cocaine habit, but now with a heroin addiction as well.

• 43:57Dr. Darshan Shah?

  Oh, wow.

• 43:58Speaker 01

  So, so that's the, uh, the, the tortured history.

• 44:01Dr. Darshan Shah?

  That's the story behind the story.

• 44:02Speaker 01

  Yeah.

• 44:03Dr. Darshan Shah?

  Yeah. I, we used to have procedures named after Holstead in textbooks that Holstead wrote chapters in as a surgical resident. I read that out of his work.

• 44:12Speaker 01

  Holstian method.

• 44:13Dr. Darshan Shah?

  Yeah, makes sense. Makes a lot of sense. My goodness. I, I had no idea that there was a cocaine addiction and a heroin addiction behind it too.

• 44:20Speaker 01

  Yeah, he would get his shirts apparently laundered, uh, in Paris and they would come back, not just with starchy white crispness, but a lot of other white material in the packages too, apparently. So.

• 44:30Dr. Darshan Shah?

  Wow, wow.

• 44:36Dr. Darshan Shah?

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• 45:14Dr. Darshan Shah?

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• 45:54Dr. Darshan Shah?

  Well, you know, on the topic of drugs and sleep, talk a little bit about the ultimate sleep drug, caffeine. How does one manage their relationship with caffeine? And do you have any tips around how to use caffeine in a positive way? And when is the most negative times to use caffeine?

• 46:12Speaker 01

  Yeah, I think this is a place where I've definitely changed my tune. I think when I first published the book, I came out at swinging, you know, and saying caffeine was really just to be avoided. There was nothing good about caffeine. And I think when it comes to caffeine now and sleep, I would say the dose and the timing make the poison. So with caffeine, caffeine has a half-life of about five to six hours for the average adult. That means it has a quarter-life of about 10 to 12 hours. So if you have a cup of coffee at noon, just rest assured that, on average, for the average adult, about a quarter of that caffeine is still in your brain at midnight if you've had a coffee at noon. And I don't think any of us would, you know, go to bed at midnight and drink a quarter of a cup of coffee

• 46:57Speaker 01

  and then think that that's going to give us good sleep. But in effect, that's what you're doing by having coffee at 12 noon, based on the pharmacodynamics of it. Now, different people have a different version of an enzyme that will speed up or slow down the metabolism. And everyone kind of knows what type they are, although you can do these genetic tests. So the timing, but also the dose, no matter sort of whether you're a fast or slow metabolizer. Once you get past about three cups of coffee, things start to go very south with your sleep. And the problem with sleep and caffeine is that some people will say, I just know it keeps me awake. Others will say, I can have two espressos after dinner and I fall asleep and I stay asleep. So no harm, no foul.

• 47:41Speaker 01

  Well, if we've done those studies where we'll give you a dose of about 200 milligrams of of caffeine in the evening, which is like a good cup and a half of strong brewed coffee. And some people with this certain enzyme, they will fall asleep fine and they'll stay asleep. Problem is they stay away from deep sleep. And in fact, it will remove somewhere between about 18 to 22% of your deep sleep. So and to do that, to remove 20% of your deep sleep, I'd have to age you by about 25 years. Or you can do it every night with two espressos.

• 48:11Dr. Darshan Shah?

  Yeah.

• 48:12Speaker 01

  So I think there's hidden dangers there. The reason I've changed my tune, though, is that if you look at the health data regarding drinking coffee, it's astronomically beneficial.

• 48:22Dr. Darshan Shah?

  Yeah.

• 48:23Speaker 01

  And what's paradoxical is that all all the conditions, all the diseases that drinking coffee de-risks and is helpful for are almost the same conditions that'll sleep is beneficial for. So people were saying, look, I'm sorry, Matt, how do you square that circle? Because this doesn't make sense. It turns out that the coffee bean contains a whopping dose of antioxidants. And because in this sort of western way of eating, we are so deficient in our antioxidant needs. The coffee bean has been asked to carry the Herculean weight of all of our antioxidant needs.

• 49:03Speaker 01

  And that's why drinking coffee looks like it creates this, that it looks like caffeine is really good for you. Case in point, if you look at the benefits of decaffeinated coffee, it's almost the same set of diseases that you de-risk. So it's not the caffeine, it's the antioxidants in the coffee bean itself. So again, I would say drink coffee, watch your timing, try to cut yourself off probably at least 12 hours before you expect to go to bed. At that point, you know, switch to decaf if you want to. There are some good brands out there. It's not that, that bad. And I would also say that the de-risking benefits for diseases for coffee, it starts to downturn, however, after about four cups.

• 49:48Speaker 01

  So upwards to sort of three cups a day, no problem at all. Cut yourself off 12 hours before. Try not to go over to four because at that point you start to go into the danger of actually increasing the risk. So again, I think it's the same thing with, you know, alcohol, which we can also talk about.

• 50:06Dr. Darshan Shah?

  Before you talk about alcohol, I just want to say one thing about the coffee studies. I believe most of those studies were based on questionnaires, recall questionnaires. And the, most of the people that were drinking the coffee that had lower risk of mortality from these diseases, they were drinking morning time coffee only. So it was not spread out throughout the day. So I think the dosing was mostly in the morning.

• 50:26Speaker 01

  That's right.

• 50:27Dr. Darshan Shah?

  Yeah.

• 50:27Speaker 01

  Yeah. So that's why I think the, you know, yes, the timing is important and the dosing is important. Get those two things straight. And I think, you know, and again, not to speak ill of longevity, but none of us want to be the healthiest person in the graveyard.

• 50:43Dr. Darshan Shah?

  Exactly.

• 50:45Speaker 01

  I, you know, live a little bit for goodness sake. But just keep in mind that what you're trying to promote and what I'm trying to promote specifically through sleep is a balanced life where I don't want to live with disease or sickness any longer than I have to. And I don't want to die any sooner than I have to. And all of the things that we're talking about here are just those first principles of trying to keep that, you know, I'm just trying to, you know, avoid death for as long as possible. And sleep is part of that.

• 51:18Dr. Darshan Shah?

  Back into those years, like you don't want to spend the last 10, 15 years with Alzheimer's, post-stroke, post-heart attack.

• 51:24Speaker 01

  Correct.

• 51:25Dr. Darshan Shah?

  So getting good sleep will add the health back into those years as well.

• 51:28Speaker 01

  Yeah, it really will. And I, you know, I, when people ask me, how much sleep do you get? I will usually say, you know, it's, I, I give myself about an eight and a quarter hour non-negotiable sleep opportunity. And, and yes, I'll go out with friends every now and again, I'll have a late night, of course, but. It's not because I want to be a poster child for good sleep or seem to practice what I preach in some kind of influencer way. It's not that. It's simply that if you knew everything that I do regarding the importance of sleep, you would do nothing other than invest in sleep. I am being thoroughly selfish with my sort of commitment to sleep.

• 52:07Speaker 01

  It is the most, I think, freely available, efficacious, largely democratic, mostly painless healthcare system that I know of that is available in repeat prescription every single night.

• 52:21Dr. Darshan Shah?

  Absolutely, absolutely. Let's talk about the other great sleep drug, which I'm saying facetiously, alcohol.

• 52:28Speaker 01

  Yeah.

• 52:29Dr. Darshan Shah?

  Right? I think so many of my friends, they go home, they have a nightcap to help them get better sleep. And when you look at what that does, friends who are slash patients, what it does to their deep sleep and just the order of their sleep and the amount of times they wake up at night is really a disaster for their sleep. Can you talk a little about why there's a misconception with alcohol as a release of sleep? And how we should handle alcohol in regards to our sleep cycles?

• 52:56Speaker 01

  Yeah, I think alcohol is probably one of the most misunderstood sleep aids that there is out there. And of course, it turns out not to be a sleep aid. The reason that people will use alcohol as probably one of the first line sort of defenses, it's almost the OG, over the counter sort of sleep medication originally, is because alcohol is in a class of drugs that we call the sedatives. And so when you will have a couple of glasses, a couple of nightcaps in the evening, what you're doing is simply sedating your brain. And if I were to show you the electrical signature of your brain with alcohol versus with not, it looks very different. And so what you're doing is you're mistaking sedation for sleep.

• 53:39Speaker 01

  But the truth of the matter is that when you have a couple of glasses in the evening and you say, I fall asleep quicker when I've had a nightcap, not quite true. You're losing consciousness more quickly. You're not really going into natural sleep. So I think that's the first thing just. To keep in mind. The second is that alcohol is very good at fragmenting your sleep, particularly in the first half of the night. The reason is because the alcohol will overstimulate the fight or flight branch of the nervous system again that we were talking about. And that leads to a number of chemicals like cortisol, which should normally be going down at its fastest rate in the first half of the night when the alcohol is potent there in the system.

• 54:22Speaker 01

  That's where cortisol starts to rise back up with alcohol. It starts to speed the rate, the contracting rate of the heart. Yes. And all of a sudden, that's where you get a lack of deep sleep because your nervous system, which should be shifting over to what we call the parasympathetic branch, which is the sort of rest and digest branch. That is switched off and you're forced back over to the activated fight or flight branch. That's why people will say, gosh, my deep sleep just got decimated. Right. When we had that bottle of wine with friends and my heart rate variability just went down and it didn't come back. Again, because it's a cardiovascular effect. So that's the first issue. It fragments your sleep and will keep you out of deep sleep.

• 55:05Speaker 01

  The second problem is that alcohol is very good at blocking your rapid eye movement sleep as well, your REM sleep. And technically, it's actually not the alcohol itself. It's the metabolic byproducts of alcohol, particularly the aldehydes that will will wash away your REM sleep. And so that usually then leads you to waking up the next morning feeling unrefreshed and unrestored. But you, because of the sedation, you typically don't remember waking up. Now, your sleep will be very fragmented with lots of these micro awakenings, but they're so short, you don't commit them to memory. So you think, well, I think I slept like a log last night, but you just don't feel good. And then what happens, and we actually published a study very recently in Wall Street traders, who I think are the extreme of this.

• 55:48Speaker 01

  They will be, you know, going out in the evening with clients, having, you know, a lot of alcohol, who knows what else. And then the, so they will sort of sedate themselves in the evening. And then their sleep is so unrestorative, then they are just hammering the caffeine the next day, they're drinking. So much caffeine that then the subsequent night, they have to self medicate with alcohol to sedate. And it's this real sort of, you know, I've got my go pills and I've got my stop pills. It's this real sort of classic. And and so I think we also see that in just the general public where people are having a couple of drinks at night. They don't feel good in the morning, so they're now increasing the caffeine intake, which means that then they're too, they're tired in the evening.

• 56:33Speaker 01

  But they're so wired that they can't fall asleep. So now I have to go to the bottle again. It's a real tough situation.

• 56:38Dr. Darshan Shah?

  Yeah. Is there an optimal amount of time between your like your last drink and what your traditional bedtime is? How much should someone separated to not have so much negative effect? Because, I mean, like you're saying, you have to live a little bit. You have a glass of wine with dinner.

• 56:50Speaker 01

  Absolutely.

• 56:51Dr. Darshan Shah?

  So how much time should you try to separate between the two?

• 56:54Speaker 01

  There is a time sort of dose dependent relationship, meaning if you give people a glass of wine in the afternoon versus in the early evening versus late in the evening, there is this decay function, meaning the earlier you onboard the alcohol, the less the blast radius going into sleep at night. Which would lead me to then say the politically incorrect thing of go to the pub in the morning. That way the alcohol is out your system in the by the evening and no harm, no foul. But I would never say that on on a podcast such as this regarding health and wellness. But um, but yeah, I would say that there is, I can't be untrue untrue, sorry, in terms of the data and say having a glass of wine in the evening won't hurt your sleep. It it will.

• 57:37Speaker 01

  But again, if it's just every now and again, that's fine. It's gonna be okay. You know, having a bad night of sleep or having a bad night because you took some alcohol on board and you lost some of your deep sleep. It's not the end of the world. You're not gonna wake up with Alzheimer's disease the next day or have a massive coronary. Don't worry about that. But if you're doing it consistently. You're doing yourself a disservice.

• 57:59Dr. Darshan Shah?

  Yeah, absolutely. I have a question about another drug in sleep, CBD THC. I get a lot of questions about this from my patients. What are your, what is your advice around CBD for sleep and THC?

• 58:10Speaker 01

  Yeah, I think it's interesting. I keep going back and forth based on new studies that come out. And I know that's usually not very helpful, but I think as scientists and doctors, that's what we, we're not politicians. We don't have to be wedded to, you know, a stance and then live it for the rest of our careers. I think the data is fairly clear on THC, tetrahydrocannabinol, which is the psychoactive component of marijuana. The THC does help you fall asleep faster, very much so. In fact, that's the reason that people start using it for sleep. The problem is that it will also decrease the amount of rapid eye movement sleep that you get. Now, it does it through a different mechanism to alcohol, but it will still fleece you of your REM sleep, which is critical for sort of emotional regulation, learning and memory.

• 58:54Speaker 01

  It's important downstairs in the body. We release our peak levels of testosterone, both men and women, during REM sleep. So it's essential for brain and body. And in fact, when you speak with people who have just been using marijuana for a long time, they will often say, I don't remember my dreams, in part because they're not having REM sleep to have their dreams. And then when they stop, they will say, I just had this period where I had crazy amounts of dreams, intense dreaming. The reason is because your brain has been so starved of REM sleep. It's built up what we've called a REM sleep debt. And then finally, when it's out your system, when you've stopped smoking or taking your edibles, all of a sudden REM sleep comes back with a vengeance.

• 59:36Speaker 01

  Now, you never get back all that you've lost, but goodness does your brain try. And that's why you'll have these really intense REM sleep periods. So I think for THC, the final problem is your dependency, which is you start to really require THC to sleep. And without it, you can't. And if you look at the data, the number one reason why people fail in their abstinence to stop smoking weed or taking gummies is because they can't deal with the rebound insomnia, which is when you finally stop using it for sleep, you go back to not only your bad sleep that you were having before, but it's even worse and you just can't take it, so you relapse. So I would say for THC right now, the data is probably not favorable.

• 1:00:21Speaker 01

  CBD is very interesting, though. I don't think there's enough data yet for me to feel confident to say CBD could be one of the new sleep aids. But so far, the data is, I would say, somewhat promising, but with a caveat, which is it's dose sensitive, meaning if you have lower doses of CBD, if anything, it's wake promoting. Higher doses, and again, what does higher dose mean? If you squint your eyes and look at the data and kind of, you know, spin around five times, it's probably going to be about 50 milligrams and above is sleep promoting. 25 milligrams or less is wake promoting.

• 1:01:03Speaker 01

  The danger is, at least here in the United States, it's not regulated by the FDA. So it could say it's 50 milligrams, and this is why I think we get such heterogeneous reports from people to say, I tried CBD and it didn't do anything for me, or in fact, it actually kept me awake. It may be that you just had, it said 50 milligrams, but it was maybe 10, and so you just don't know. So I would say CBD right now, it's a Goldilocks sort of phenomenon, not too little, not too much, just that right amount. If we come back in five years' time, we have the conversation where there is good data now for CBD, going back, casting our minds back to five years here and now, what could we have estimated was the reason that CBD has a benefit? Let's just sort of do a think tank experiment. You know, why would it benefit?

• 1:01:47Speaker 01

  I think there's probably at least two very viable mechanisms right now. The first is that CBD is an anxiolytic, meaning that it lowers down your anxiety, and there's really good brain imaging studies to show that these emotional senses of the brain ramp down when CBD is given. So I think it's a very good tool for reducing your anxiety. One of, outside of physical pain, the principal reason that most people in society are not being able to sleep is stress and anxiety. So it's not that CBD is directly influencing the sleep mechanistic process itself. It's not. It's simply removing the roadblock that is otherwise preventing you from going into sleep. So it's an indirect method. It may have a direct method, though, and this is number two.

• 1:02:32Speaker 01

  If you All of us, we have to drop our core and brain and body temperature by about one degree Celsius or about two to three degrees Fahrenheit to fall asleep and stay asleep. And it's the reason that you'll always find it easier to fall asleep in a room that is at least too cold than too hot, because too hot is taking you in the wrong temperature direction for good sleep. When you dose animals with CBD, sort of at equivalence of humans, sort of fifty milligrams, a hundred milligrams, it starts to drop their core body temperature a little bit. Now, not profoundly, it's not that they go into a hypothermic shock, but it does move them on the path towards a cooler body temperature. So I think if it has a second direct benefit, it's that it's moving you in a thermal direction

• 1:03:17Speaker 01

  that co-ops good sleep. So right now, I would say for CBD, jury is out. I would say, though, that there is some data in pediatric populations, which I think is very controversial, but I was speaking with a medical doctor in the Dallas area the other week, and he's had exceptional results with children who have some aspects of either ADHD or aspects of autism spectrum disorder, where sleep is hugely problematic in those pediatric populations. And what he was finding was a mixture, a low-dose mixture of THC and CBD, I think it was around about two point five milligrams for each one of those.

• 1:03:59Speaker 01

  And I think, and again, this is data that's not published, people should not just start racing out there and doing any of this, but it's something that I think these are grounds for good clinical trials next step. And I think it was maybe morning and evening, but in the morning, the THC was, I think it was sativa, and then in the evening, I think it was, gosh, I'm blanking. It will come back to me as I'm thinking about it, but I think even different strains of sort of THC can have a different impact on the sleep process. So one may be more sort of alerting and activating, one may be more sort of sedating and sort of induced quiescence.

• 1:04:44Speaker 01

  So I think there's some really interesting potential in the pediatric realm.

• 1:04:48Dr. Darshan Shah?

  Right.

• 1:04:49Speaker 01

  Because those conditions, we have constantly faced with sleep challenges and we have constantly not had great solutions.

• 1:04:56Dr. Darshan Shah?

  Yeah.

• 1:04:56Speaker 01

  Especially because we don't want to start, you know, using any heavy medications, any of the classic sedative sleeping medications in those populations because they're developing brains. Now, is THC or CBD, you know, to be thoughtful of? Very much so. So I think the jury is is out right now.

• 1:05:13Dr. Darshan Shah?

  A lot of research should be done with good clinical studies, especially when you're talking about the children. You know, I always think about with all of these different interventions, like different dosages of THC, CBD, every human is an N of one, right?

• 1:05:25Speaker 01

  Yeah.

• 1:05:25Dr. Darshan Shah?

  So how this is going to affect you is going to be very different than how it affects me. And that's why it's so important to get a tracker. And like you said, try something for a week and see what it does to your trend line without changing too many other things.

• 1:05:38Speaker 01

  Correct.

• 1:05:39Dr. Darshan Shah?

  And I think this is where the real magic happens with some of these interventions, is seeing how it works for you, right?

• 1:05:45Speaker 01

  Yes.

• 1:05:46Dr. Darshan Shah?

  And what I've found is certain things absolutely don't work for me. But when I recommend them to my patients, they do seem to work. And so I'm never discounting something just because it doesn't work for me.

• 1:05:57Speaker 01

  You see, that now that's the genius of a good doctor versus, I think, a doctor who you would probably be less excited to have at your side, which is it's so powerful to have a personal experience.

• 1:06:10Dr. Darshan Shah?

  Right.

• 1:06:11Speaker 01

  Influence and taint your belief that it must therefore be the same thing that is going to work for everyone else. And as a doctor, what you have to do is disabuse yourself of the hubris that what works for me is what will work for you is what will work for everyone. Even disabuse yourself of the fact that, yes, the medical literature says that on average, you will get X outcome. But as you well know from being boots in the trenches, it is so idiosyncratic from one patient to the next. And I think that's why, you know, offering, you know, offering a suite of services like you do here at X, you you are thoughtful about what the person is trying to solve for, and you are thoughtful about trying to understand.

• 1:06:53Speaker 01

  That unique snowflake that is the person that walks through your door. I I can't see a version of sort of medicine three point O. That takes this classic one size fits all approach anymore. It's just not the case, you know. And it's the same with, you know, if look at something as basic as blood sugar. You can have someone who will eat exactly, you both given exactly the same blueberry muffin.

• 1:07:16Dr. Darshan Shah?

  Yeah.

• 1:07:16Speaker 01

  And one person will have a grotesque sugar spike. You know, I maybe I'm terrible at my sugar regulation. But, you know, you being fit and healthy, you know, you may just deal with that perfectly well. No problem at all.

• 1:07:28Dr. Darshan Shah?

  Yeah, it's such an important, important point to make is look at everything as how it affects you, not what you're seeing. Not what you're seeing in a friend or even sometimes what major studies show. Because we know with every major study, there's really a bell shaped distribution curve.

• 1:07:44Speaker 01

  Yeah.

• 1:07:44Dr. Darshan Shah?

  Of how people get affected, right?

• 1:07:46Speaker 01

  Yeah, that's the dirty secret of science and medicine is that, you know, there is this huge variance.

• 1:07:51Dr. Darshan Shah?

  Right.

• 1:07:51Speaker 01

  In the data. And if you're on either side of the the bell curve distribution, you could have radically different outcomes.

• 1:07:59Dr. Darshan Shah?

  Absolutely. No one's going to care more than you than to look at your own data to see how this particular intervention applies to you.

• 1:08:05Speaker 01

  Right.

• 1:08:06Dr. Darshan Shah?

  It's really important to kind of understand the data that your body is producing. And not just wearable data, also, how do you feel, right? You can, maybe your wearable says you got better sleep, but you feel terrible in the morning.

• 1:08:18Speaker 01

  Yeah.

• 1:08:18Dr. Darshan Shah?

  There's might be other effects that you're seeing from utilizing a sativa CBD intervention, you know.

• 1:08:24Speaker 01

  Yeah, and I think that's, you know, I've I've listened to many of your podcasts. And I think that's what I really appeals about the way that you think about medicine. Which is, it's also about how the patient feels.

• 1:08:37Dr. Darshan Shah?

  Right.

• 1:08:37Speaker 01

  You you seem to have had this really, you know, you've got all of the medical background and training, the discipline of hardcore biology, physiology, biochemistry. But you've also tried to be sensitive to how someone feels because ultimately, you know, that's what a patient will come back for. And to begin with, that's what a patient will be coming in to see you for initially, which is, I don't, there's something that does not feel right. And so I think that's having a sensitivity to that and designing a medical care practice that is inclusory of that, rather than, you know, I don't really want to hear about your feelings. I'm just going to do up my blood assay and I'll, you know, just be quiet. I'll take care of it. No, you are appreciative of that.

• 1:09:22Dr. Darshan Shah?

  Yeah. I would say it's just an important of a biomarker as a blood test is how do you feel? That question is just as important to me.

• 1:09:33Speaker 01

  The number of doctors that I've heard say that are few and far between.

• 1:09:38Dr. Darshan Shah?

  Well, hopefully with this new type of medicine.

• 1:09:40Speaker 01

  Incredibly rare.

• 1:09:41Dr. Darshan Shah?

  We get more of that.

• 1:09:48Dr. Darshan Shah?

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• 1:10:29Dr. Darshan Shah?

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• 1:10:47Dr. Darshan Shah?

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• 1:11:28Dr. Darshan Shah?

  and just open up a daily pack for every day that I'm taking my vitamins and supplements. Go to Vitaboom.com and check it out.

• 1:11:40Dr. Darshan Shah?

  You know, I wanted to circle back a little bit and talk about something very important and near and dear to my heart is sleep apnea. Right? Because I suffered from sleep apnea for many, many years myself. And I feel like it was both my fault and the fault of my doctor just ignored. There's something that, you know, the answer was if you lose weight or, you know, sleep on one more pillow, it'll get better. And that led to five years of suffering with sleep apnea. And for the audience, you know, sleep apnea is literally when your brain is being deprived of oxygen. Well, every organ in your body is being deprived of oxygen for multiple seconds every few minutes, which adds up to minutes a night, right?

• 1:12:21Dr. Darshan Shah?

  And hopeful that the wearables now will get better at detecting sleep apnea because I think it's much, much more prevalent than we think it is.

• 1:12:31Speaker 01

  So I think the estimate right now is that 80% of people who have sleep apnea are undiagnosed, which is tragic to begin with. And you're right, you know, the word apnea, you know, is often a medicine. And I think with an A before it is the, you know, the absence of something. So arrhythmia, the absence of normal sinus arrhythmia. So here, apnea, panea is, you know, a Latin derivative for breath. So it's the absence of breath. And you're right that you have these, what happens with sleep apnea is that the airway will start to collapse. Usually because if you're sleeping on your back, you're giving way to gravity and the airway will collapse. So think of a straw and if it starts to sort of partially collapse, you'll get the fluttering of the airway and that's where you get the snoring sound of.

• 1:13:17Speaker 01

  And then when it completely collapses, when the straw collapses shut, then you stop breathing entirely. Now, we have a. Index of this, what's called the apnea hypopnea index or the AHI score. And a mild version of sleep apnea would be, let's say, having, you know, five to 10 of these apnea events every hour. So that's very mild. Let's say it's 10 and you sleep for eight hours. Imagine if I were to say to an apnea patient, tonight, I'm going to come into your room. And about 10 times per hour, I'm just going to throttle you to the point where your blood oxygen saturation starts to decrease. In fact, I'm going to do that every single hour. So we're going to do this 80 times. I'm going to throttle you tonight.

• 1:13:59Dr. Darshan Shah?

  Throttle mean choke you.

• 1:14:01Speaker 01

  And, and yeah, yeah, exactly. Choking you to the point where your oxygen starts to plummet and we can measure that oxygen desaturation. In fact, at times I may even do it to the point where you stop breathing. Do you think you'll feel rested and well tomorrow? And of course, the answer is no, but that's, you know, and also that has a stigma with that. We joke that, you know, oh, he snores like, you know, the next door neighbors can hear it, or it's like a chainsaw or, but it's a very serious condition and it will take years off your life untreated. And I think the rise of the quantified self movement is going to give us some semblance of that now. Whether or not these companies, these sleep tracking companies ultimately want to take the

• 1:14:42Speaker 01

  the tough financial decision to get it FDA approved is, you know, I, I think right now many of them have stayed away from that because it's either too costly and they don't want it to be medicalized. But I think even just having the awareness of that by way of these sleep tracking devices. I know that Eight Sleep, for example, will show you the quantity of snoring throughout the night. They've now got a very clever bed system, which actually articulates up it. The sensors on the bed will notice when you're getting these breathing sort of fluttering senses. They will recognize it as snoring and then they will articulate the upper part of the bed just a few degrees. But enough that you come back and you get out of gravitational force pulling the airway down.

• 1:15:26Speaker 01

  And you stop snoring and then it will gradually lower you back. A very clever, smart piece of technology. I think the Ouring has oxygen saturation, so it can look. To see whether you had regular breathing or not. Again, no FDA indication clinically yet, but I think we're going together. So I think we will start to have a greater awareness of sleep apnea and its deleterious effects. Then I think we need to make inroads in terms of treatment.

• 1:15:49Dr. Darshan Shah?

  Right.

• 1:15:50Speaker 01

  Now, I think, you know, the main company out there that's based in San Diego is ResMed. I actually think that they've been doing an incredible job at refining their technology. You know, 10 years ago, 15 years ago, you look like sort of Tom Cruise fight a plier with a mask on and it was very cumbersome. Now they've got these little nasal pillows and I think it's much better too. I think there's been great advances in what we call mandibular augmenting devices, these sort of gum guards that articulate the jaw a little bit forward, which can really help with snoring if it's mild. We're now starting to look at different sort of implanted devices, just very superficial, that will stimulate the airway open. I think there's a lot of, you know, novel territory to go.

• 1:16:29Dr. Darshan Shah?

  Yeah.

• 1:16:29Speaker 01

  Oddly enough, that's one of the other areas that if you, and I did this when you asked me the question about THC. You know, I I tried to read all the papers and you, this is a good reason. Don't just scan the abstract because sometimes there's really good stuff in the paper itself. And I was reading a lot of the papers with THC. And what they were showing was that the number of sleep apnea events and respiratory disturbances actually started to decrease.

• 1:16:56Dr. Darshan Shah?

  Interesting.

• 1:16:57Speaker 01

  So I don't know, can we find analogues of THC where we dial up the volume on whatever it's doing to the respiratory system? And the structural integrity of the airway and presumably the autonomic modulation of the airway. What is it doing that we could dial up? And then can we, from a sort of a novel analog of THC, can we dial down the components? That leads to perhaps the sleep fragmentation or the REM sleep sort of suppression. So how can we get what is good about THC perhaps for apnea and dial down what we don't want? Because the trade off is probably not going to be worth it. So I, you know, there's so much, I think, on the event horizon with apnea.

• 1:17:40Speaker 01

  First port of call, though, get diagnosis solved.

• 1:17:43Dr. Darshan Shah?

  Yeah, absolutely. You know, I think just looking at the last 10 years of diagnostics around this has become so much better. You can just go home with a sleep device now that can help you. elucidate whether or not you have sleep apnea events at night.

• 1:17:56Speaker 01

  Yeah.

• 1:17:56Dr. Darshan Shah?

  It's called a watch pad device that we use.

• 1:17:58Speaker 01

  That's right. Yeah, it's great. It's non intrusive.

• 1:18:00Dr. Darshan Shah?

  Yeah.

• 1:18:01Speaker 01

  You get good data, highly diagnostic. Yeah.

• 1:18:04Dr. Darshan Shah?

  Did you hear the withings their pad just got FDA approved for sleep apnea as well?

• 1:18:08Speaker 01

  It did.

• 1:18:09Dr. Darshan Shah?

  You did hear that too. So that's, that's interesting that these, you know, consumer device companies are getting FDA indication for this particular issue.

• 1:18:17Speaker 01

  Yeah, I think it's going to, once you get a few of them going in that direction, then a lot of the others will just have no choice. You know, I think probably the Apple Watch will be the next one that tries to go after that. I think it's trying to, you know, get ever closer to clinical, you know, AFib detection. It's probably going to maybe do something along the lines of, I don't know, in the future, maybe glucose monitoring. I think that would be a game changer if we have truly non invasive glucose. Monitoring, um, blood pressure monitoring, I think has been fiendishly difficult from these devices, together with sleep apnea. Inextrably, it's all going down the path of FDA regulated.

• 1:18:54Dr. Darshan Shah?

  Absolutely, absolutely. And getting your sleep apnea treated will lower your blood pressure, lower your risk for Alzheimer's disease, lower your risk for metabolic disease, all of it, just like getting better.

• 1:19:04Speaker 01

  Weight will change dramatically, usually because for several reasons. First, you, your appetite hormones will not be just all over the place.

• 1:19:12Dr. Darshan Shah?

  Exactly.

• 1:19:13Speaker 01

  Because when you're not sleeping well, by way of things like sleep apnea or sleep deprivation, you ultimately start increasing the hormone that makes you want to eat, which is ghrelin. And it decreases the hormone that usually says, no, you're full, you're satiated, you don't want to eat anymore. So no wonder when you are suffering from undiagnosed sleep apnea, you're constantly in a state of hunger and you're not satisfied. So you're eating more. You also change what it is that you want to eat. You go for the heavy hitting carbohydrates, simple sugars, which are obesogenic foods. And then finally, what we also see with that underslept signature is that the endocannabinoids.

• 1:19:51Speaker 01

  So we've spoken about the cannabinoids that you take exogenously like THC, but we actually all have inside of us naturally occurring cannabinoids called endocannabinoids. And as you've probably. You know, lots of people have heard when people sort of smoke marijuana, they'll say I get the munchies. I get really hungry because endocannabinoids can be appetite increasing. And sure enough, when you are underslept, these naturally occurring endocannabinoids that increase your appetite swell in terms of their concentration. So the deck is stacked so strongly against you in terms of healthy eating and versus, you know, overeating and having that obesity genetic trajectory. That no wonder patients with sleep apnea, you know, come in already being obese and it's a cause and consequence.

• 1:20:35Speaker 01

  You know, the obesity can be a cause of their sleep apnea and also the sleep apnea is only perpetuating the continuation of that obesity profile. But the nice thing is, once you start getting treated, you start to reduce your appetite, you start to lose weight, you want to be more physically active. The more physically active you are, then all of a sudden, the more weight that comes off. And all of this leads to a lowering and lowering of your sleep apnea. So I remember a patient that I I saw once. And after being treated with sleep apnea, he said, I just thought that this was me at fifty seven years old. That I I just, it was just age regression and boy, did I just regress and I regress so quickly. And what I realized with sleep apnea treatment is that I'm not the fifty seven year old I thought I was.

• 1:21:19Speaker 01

  I feel ten years younger and it was had a lovely phrase. He said, in terms of my mental functioning. It's as though someone just wiped a fogged glass clear and finally I could see again. And that was their experience with sleep apnea. So please, if anyone is undiagnosed out there, you can use all of these gadgets. You can download and there's a great app that you can download. I have no affiliation with them. It's called Snore Lab. I recommend that to all my patients.

• 1:21:44Speaker 01

  You do? Yeah. Love it. Yeah. Snore Lab. So Snore L A B. You get a couple of nights of recording, you place the phone flat next to you, it listens to you and records your snoring. But the frightening part is that you then look at your night and your night is essentially represented on a graph. That looks like a Richter shocks. Yes. And it goes from being quiet, mild, moderate and epic.

• 1:22:11Speaker 01

  And if that wasn't bad. Enough, you can then do the dignity stripping component of it where you tap into the night. And you can hear yourself snoring. Goodness, is it a frightening thing to hear yourself choking in the middle of the night?

• 1:22:25Dr. Darshan Shah?

  Right.

• 1:22:25Speaker 01

  You've never heard yourself choke because you were fast asleep.

• 1:22:28Dr. Darshan Shah?

  Absolutely.

• 1:22:28Speaker 01

  Yeah, if just please go and get diagnosed and get treated if you have apnea.

• 1:22:32Dr. Darshan Shah?

  And I could tell you from treating hundreds of people now with sleep apnea. Universally, the patients will say, my life has completely changed once I got treated for sleep apnea.

• 1:22:42Speaker 01

  Yeah.

• 1:22:43Dr. Darshan Shah?

  Best thing I've ever done. I hear this over and over and over again.

• 1:22:46Speaker 01

  Yeah, it is a game changer. And I think once again, to me, it reinforces the fact that you can have something as seemingly benign as changes in your breathing during this essential thing called sleep. And your wellness can fall apart so quickly. It's yet another demonstration to me of just how, you know, non-negotiable sleep is. And here is the second of those four macros, quality of sleep.

• 1:23:13Dr. Darshan Shah?

  Exactly.

• 1:23:13Speaker 01

  And here's quality of your breathing.

• 1:23:15Dr. Darshan Shah?

  Right. The other thing that is important about this is quality versus quantity. Most people with sleep apnea, they are in bed eight, nine hours sometimes.

• 1:23:24Speaker 01

  Yeah.

• 1:23:24Dr. Darshan Shah?

  And it's really not the number of hours, it's really what happened while you were asleep that makes all the difference. On the subject of weight and sleep, have you heard about the studies around GLP one in sleep apnea?

• 1:23:35Speaker 01

  Very interesting.

• 1:23:36Dr. Darshan Shah?

  Very interesting, isn't it?

• 1:23:37Speaker 01

  Yeah. So I think if you look at these GLP one drugs, why is it helping with apnea? I think some of it is simply because, as we mentioned, when you are obese or when you are of weight that is non-normative, when you when you are of excessive body weight, it does seem to be a predisposing factor for increasing the likelihood of being of suffering from sleep apnea and the severity of that sleep apnea. So I think right now it's unclear whether those GLP one medications are having a direct effect on sleep and changing something about the respiratory dynamics of sleep. Or they are simply saying, when you shed weight, you will also decrease your severity of sleep apnea. I think.

• 1:24:23Speaker 01

  In some ways, you almost don't care. As long as it's working, then I think it's a really fascinating opportunity, which is you're not just going to have the health benefits of, you know, nor a more normative body weight profile and all of the good things that come with that. You may also be starting to downscale your apnea severity or even your propensity for apnea, which if you are on an obesogenic profile, you will absolutely be heading towards, if not already in the midst of.

• 1:24:50Dr. Darshan Shah?

  Right.

• 1:24:51Speaker 01

  So are they going to get the FDA indication for, you know, sleep apnea? I suspect if the data keeps looking as strong as it is right now, they probably will.

• 1:25:00Dr. Darshan Shah?

  Yeah, it'll be really interesting to even see people that are not necessarily obese, people that are maybe skinny fat, you know, they're

• 1:25:08Speaker 01

  Yeah.

• 1:25:09Dr. Darshan Shah?

  They're they're thin, but they have low muscle and they have high amounts of metabolic disease. Giving them GLP ones and seeing how that affects their sleep apnea as well.

• 1:25:19Speaker 01

  Because it's not only overweight people that I should probably say too, it's not only overweight people who have sleep apnea. People who are of normative weight can have sleep apnea. It's, is it more prevalent in males? Yes, it is. Does it mean females don't have sleep apnea? Absolutely not. There's lots of women who will suffer from sleep apnea. Lots of men and women of normative weight will suffer from sleep apnea. So therein lies the test, which is let's give those medications. Let's see if weight remains the same, but apnea changes, then it must be a central respiratory mechanism that is changing, not simply the weight.

• 1:25:51Dr. Darshan Shah?

  Yeah, which is really interesting to think about, you know, maybe it's affecting something centrally. And that could potentially lead to improvement because then it could potentially help even more hundreds of thousands of people with their sleep apnea.

• 1:26:03Speaker 01

  Correct, and that would actually tell you something novel about the way that the drug is working too, that we've previously not considered.

• 1:26:09Dr. Darshan Shah?

  Yeah.

• 1:26:09Speaker 01

  Which is something in the, you know, the respiratory.

• 1:26:13Dr. Darshan Shah?

  Centers of the brain.

• 1:26:14Speaker 01

  Yeah.

• 1:26:14Dr. Darshan Shah?

  Right, because there are GLP receptors in neurons, there are GLP receptors in our immune cells, there are GLP receptors throughout many different cell types in our body. We just don't know.

• 1:26:23Speaker 01

  Yeah.

• 1:26:23Dr. Darshan Shah?

  Yeah, it's very interesting. So when I go, when I see a patient, when we get to this section where we're discovering about their sleep, we talk about all the things that we talked about, we use the different questions around sleep, we rule out sleep apnea or rule in sleep apnea. We get them on a tracker, we try to identify how do we improve your sleep. Fifty percent of the time, people that tell me they have good sleep actually have very poor sleep when we start tracking them.

• 1:26:47Speaker 01

  Yeah.

• 1:26:48Dr. Darshan Shah?

  And then the question always comes up, okay, so now how do I improve my sleep? And I break these up into sleep environment and sleep routine, right?

• 1:26:58Speaker 01

  And so. Nice. Yeah, yeah. Tell me more about that. What?

• 1:27:00Dr. Darshan Shah?

  So I think we're gonna do two, we're gonna focus on two different aspects of your sleep to help improve your sleep. What is your sleep environment? That's your bedroom. What are you exposing yourself to in your bedroom that's either gonna help or hurt, harm your sleep? And what is your routine around sleep? Because as you mentioned, getting to bed at the same time is extremely important. Turning the colors of your light from white to yellow and dimming your light is extremely important. Honestly, the one thing I find that affects sleep the most is the exposure to their phone and how close that is before they go to bed. One of the biggest game changers I make in most people's lives is I have them move their phone charger first to their bathroom, then to their coffee machine.

• 1:27:41Dr. Darshan Shah?

  And then I tell people, leave your phone in your car at night before.

• 1:27:46Speaker 01

  Oh, that's it. I've never heard of that. I love that idea.

• 1:27:49Dr. Darshan Shah?

  If you get home late at night, try this, leave your phone inside your car and then pick it up the next morning in your car when you're ready to go back to work. That puts more and more space, space, time.

• 1:28:01Speaker 01

  Genius idea, because right now I stop at the kitchen.

• 1:28:03Dr. Darshan Shah?

  Right.

• 1:28:04Speaker 01

  Oh, I like this. I'm gonna have to steal this. This is fantastic. I would say the digital detox.

• 1:28:10Dr. Darshan Shah?

  Yeah, it's massively important.

• 1:28:12Speaker 01

  Massive for sleep, is absolutely huge. I would say the overhead lighting, so dimming down the lights in the last hour before bed and the digital detox, that's where I see, I think, some of the greatest traction, certainly. And then, you know, having some kind of a wind down routine.

• 1:28:28Dr. Darshan Shah?

  Right.

• 1:28:28Speaker 01

  Is, we think of sleep like a light switch that we just dive into bed and we. Just like the light, we should be able to just go to sleep. Sleep is much more like landing a plane. It takes time to gradually bring down your physiology and biology onto the terra firma of good sleep at night, you know. We wouldn't, you know, be driving our car on the freeway and then, you know, come home and go straight into the garage at the same speed in seventh gear. You know, what we do is we gradually, you know, ratchet down the gears and we gradually bring it down into the into the garage. So that's what sleep is. Now, any parent will tell you, if you don't get the bedroom bedtime routine straight, then it's not going to be a good situation. It's a bad, but we forget that as adults. We also need a bedtime routine.

• 1:29:13Speaker 01

  Now, that can be listening to a sleep story. It can be doing a meditation. It can do breath work. You can take a hot bath or a shower. You can do gentle stretching. You can listen to an audiobook. I don't mind whatever it is, but the goal is to try to disengage you and bring you back down. In the modern world, we are constantly on reception and very rarely do we do reflection. And the only time we do reflection in the modern era is when our head hits the pillow and that's the worst time. Because when we start to reflect then, the Rolodex of Anxiety begins. We start to ruminate. When we ruminate, we catastrophize. And when we catastrophize, we're dead in the water for the next two hours.

• 1:29:54Speaker 01

  Because to me at least, everything seems twice as bad in the dark of night than it does in the light of day. And so I think you've got to, when people say I struggle with sleep and it's not to do with pain or a principal sleep disorder. The reason that they're struggling with sleep is that they can't get their mind off itself. And almost every one of those things, breath work, meditation, sleep stories, listening to, you know, a podcast. Almost all of them are about getting your mind off itself. And when you start listening to a meditation or you even take yourself on a mental walk, just close your eyes and think about a mental walk and take yourself on it in hyper detail. Sleep at that time of night is like trying to remember someone's name.

• 1:30:39Speaker 01

  The harder you try, the further you push it away. And as soon as you stop trying, then it comes to you. And so usually I'll say, just, you know, listen to a sleep story or do one of these things. And then the next thing you typically remember is the alarm going off in the morning. Because finally you were able to get your mind off itself. So that's why I like this idea of, you know, having some kind of a wind down routine. And there's nothing worse in terms of triggering that rolodex of anxiety than this thing called your phone.

• 1:31:08Dr. Darshan Shah?

  Yeah.

• 1:31:09Speaker 01

  Because what we found is that it's not necessarily the blue light from them that's harmful. It's that these devices are attention capture devices.

• 1:31:17Dr. Darshan Shah?

  Yes.

• 1:31:18Speaker 01

  They are designed to fleece you of your attention economy. And they have spent hundreds of millions of dollars and they do it ruthlessly and very well. And so you've got to try to resist that if at all you want some kind of sense of, you know, a normative night of sleep. Also, keeping it in the bedroom to wake up to is a terrible thing. I think we've all had that sort of sensation of thinking, okay, I've got to get that early morning flight because I've got a job interview or it's a critical business meeting. And we all know that we are not going to sleep well that night before. Because we are anticipating something the next day.

• 1:31:54Dr. Darshan Shah?

  Yes.

• 1:31:54Speaker 01

  It's called anticipatory anxiety and it will reduce the amount of deep sleep that you get. But what we do with our phones is a kind of a L I T, like a diet version of that.

• 1:32:06Dr. Darshan Shah?

  Yes, so true.

• 1:32:07Speaker 01

  The anxiety light version of that, which is most people, if we're keeping our phones in our bedrooms, the moment we wake up, what's the first thing that we do? We swipe or we unlock it and that tsunami of anxiety just floods into our brain. So what you're doing there is training your brain to say every time I go to bed at night, I should expect this wave of anxiety the next morning. So we're constantly in this state of chronic low level anticipatory anxiety. So no wonder our sleep each and every night is not good. And if you look at the surveys of the number of times that people, if they keep their phone in their bedroom, will wake up in the middle of the night and check their phone.

• 1:32:48Speaker 01

  It's quite stunning. That number, I think, almost triples in teenagers, if you look at them, because it's this just this incredible rash of FOMO.

• 1:32:59Dr. Darshan Shah?

  Yeah.

• 1:32:59Speaker 01

  That so much is still going on at night and people get so anxious that they're missing out on something that they're constantly setting alarms to wake themselves up to check their phones.

• 1:33:08Dr. Darshan Shah?

  Hmm. That's terrible. That's terrible. Yeah. And just not physically having the phone there first thing in the morning just puts a little bit of time between the anxiety rush and you're waking up. And the more time you can put in between, the better.

• 1:33:22Speaker 01

  Yeah. And I would ask people, you know, and I would have this fear myself if I didn't know about sleep. But when was the last time, so in the past, let's say, two years, when was the last time that you received something the very next morning on your phone that was so mission critical that you absolutely had to have your phone next to you? Now, there are going to be some people with certain professions where, yes, that's the case. I would say, though, that probably ninety nine percent of the public, if you're being honest, you probably can't remember in the last two years when there was something so absolutely critical that within that moment of waking up versus fifteen minutes later, it made the world of difference.

• 1:34:00Dr. Darshan Shah?

  Exactly.

• 1:34:01Speaker 01

  And that fifteen minutes that will of sort of digital abstinence is an outsized difference in terms of your mental health to wake up in the morning. Goodness, does it make. So that's why I would say, you know, just ask yourself the honest question. Do you really, really need to? And I can hear the voices and I would myself, you know, I'm not trying to be puritanical and dictatorial or, but honestly, the feeling of being able to literally breathe easy when you wake up. And I'm, I suspect there are some people who don't recall what it's like to wake up without checking your phone. And if that's you listening to this right now, then say this next seven days,

• 1:34:44Speaker 01

  I'm fairly sure that something life, you know, just absolutely mission critical is not going to happen. If that's the case, do the experiment again. Just do it for five mornings in a row. And be honest. With me and yourself, if you don't feel better, if you don't feel a sense of equanimity when you first wake up, and it's a beautiful thing to wake up with acquiescence in your mind and your body without that anxiety trigger, then keep using your phone. But my suspicion is that most of you who try it, it will probably feel bloody amazing.

• 1:35:21Dr. Darshan Shah?

  Well, exactly. And I think that's a good point to end on because I think getting good sleep is more than just the data. It's more than just the number of minutes you spent in deep sleep versus REM sleep. It's more than just, you know, not getting into chronic disease or avoiding Alzheimer's. It's really about feeling comfortable in your mind and in your soul. And I think we've forgotten what that's like in this modern environment with alarm clocks and cell phones, you know? I remember being a kid and just waking up whenever I woke up with nothing to do except get my day started. And it was such a beautiful feeling, you know, waking up with a sense of quiet and peace in your head

• 1:36:05Dr. Darshan Shah?

  and not having to really, you know, get into a stressful situation literally seconds after you wake up like we do right now. And I think sleep is so much more than just avoiding disease. It's really about feeling good every day and feeling like you have your energy, your vibrancy, your mental peace, your quiet in your brain. And I think that's what it's all about. And, you know, your book, Why We Sleep, was the beginning of my journey into having good sleep. So I really want to thank you for that.

• 1:36:34Speaker 01

  My goodness.

• 1:36:35Dr. Darshan Shah?

  And the messaging that you're putting out there.

• 1:36:36Speaker 01

  Very kind of you to say, but I agree with you. I think we think of sleep, yes, in this disease deterrent mode, and it's very good at doing that. But we forget everything that comes before, which is sleep as a preventative tool, not a late-stage therapy sort of tool. And what a travesty it would be to look back on life and think that, you know, the that you were always looking through that fogged glass all of the time. And there's a life that you can have when you're sleeping well. I often think of sleep, it is the tide that rises all other wellness and vitality boats.

• 1:37:15Speaker 01

  And it's almost to me, in terms of my day and how I feel mentally and physically, if you go into one of those fancy music studios and as I say this, looking with a bad hairdo, looking all like a terrible eighties rock idiot, but anyway, you've got this music deck and all of these different dials do different things, but then there's that one dial all the way to the left side, that if you move that up, all of the other dials move with it. To me, that's sleep.

• 1:37:44Dr. Darshan Shah?

  Right.

• 1:37:44Speaker 01

  And I haven't seen yet a better invention by Mother Nature that is as close as we're going to get to immortality than this thing called a full night of sleep.

• 1:37:55Dr. Darshan Shah?

  Right. No, no, I absolutely agree with you and I thank you so much for being on the podcast and talking to us.

• 1:38:01Speaker 01

  Thank you for having me and giving me the opportunity to speak to your audience and again, for what you're doing in the world. And I think with this now, this new movement that you're pioneering and you really are a pioneer.

• 1:38:14Dr. Darshan Shah?

  Thank you.

• 1:38:14Speaker 01

  I mean, this is that, you know, it's a 10 year overnight success, you know, but you've been in this game for a long time. You had the vision, you saw what was needed. It's very rare to see people, visionaries who go through the, and you've had a tumultuous, you know, it's been hard these past years, as we were speaking about with the pandemic too, to have people who can pioneer a new vision for an industry that previously was so stuck in its ways. And goodness has medicine been stuck in its ways. You've, you're gonna have to have thick skin, sharp teeth and a motivation that exceeds just about everyone else's. You are that person. So it's me who thanks you for, for doing what you're doing.

• 1:38:56Dr. Darshan Shah?

  Thank you.

• 1:38:57Speaker 01

  Just remain brilliant in all things.

• 1:39:00Dr. Darshan Shah?

  I appreciate that. I will take that advice to heart. Thank you. How can people find you and learn more about you and what's next for you?

• 1:39:07Speaker 01

  Yeah. So if you want to find me or learn more about sleep, probably the easiest thing to do is come on over to my podcast. The podcast is wonderfully and ingeniously called, creatively called, in fact.

• 1:39:20Speaker 01

  The Matt Walker Podcast. Yeah, I know, wasn't my favorite, but the team went with it. And it is unlike this, I am nowhere near as skilled as you are in the didactic sort of ability to interview people, but my podcast is really, it's a short form podcast. They are short form monologues from yours truly. They last somewhere between 20 to 40 minutes. And it is a little bite of sleep goodness to accompany your waking day. And that we now have over, I think about 90 episodes so far. So whatever you're sleep curious about, I more than guarantee there's probably an episode for you in there. If you want to follow me, I am on Twitter at Sleep Diplomat.

• 1:40:02Speaker 01

  And if you want to follow me on Instagram, I am there at Dr. Matt Walker, so D R M A T T W A L K E R. But you can just Google me and unfortunately you'll probably find me.

• 1:40:15Dr. Darshan Shah?

  And if you type your name into the podcast search bar, there's, you've been on so many beautiful podcasts that you've done.

• 1:40:22Speaker 01

  Thank you. Yeah, I've been, yeah, somewhat around the block on the podcast things, but these, you know, just having people like you who give me the opportunity to speak the silent voice of sleep is an immense, I mean, it's an immense responsibility. And I take it very seriously and I just hope I do a good job for sleep in that regard to be an ambassador.

• 1:40:42Dr. Darshan Shah?

  I love it. I also love what you're developing as far as the technology goes around sleep. And I'm looking forward to bringing that technology to next health. And hopefully our patients can benefit more from deeper interaction with you and your thoughts around sleep.

• 1:40:57Speaker 01

  Yeah, I am so excited. I, I, I think, you know, to, to build an allegiance between the two brands. And I think what's great about the people that are already walking through your doors here is that they are health and bio and physio curious.

• 1:41:13Dr. Darshan Shah?

  Exactly.

• 1:41:14Speaker 01

  And that's exactly the population that I want to try to meet as a first pass principle to get sleep excited. But right now, we're just, you know, people know about this thing called sleep, but to try to dissect it, there's so much, I think, you know, snake oil and bad advice out there that I would love to cut through that. So I think trying to, you know, partner with an integrity brand such as yourself, I think there's a lot that is going to be happening between those that we're going to be able to bring to the customers of Next Health. So I am very, very excited for those next steps.

• 1:41:48Dr. Darshan Shah?

  I look forward to it.

• 1:41:48Speaker 01

  Stay tuned, folks.

• 1:41:49Dr. Darshan Shah?

  Look forward to all of it. Thank you.

• 1:41:51Speaker 01

  Thank you.

• 1:41:51Dr. Darshan Shah?

  All right. Thank you so much.

• 1:41:53Speaker 01

  Thanks again.

• 1:41:58Dr. Darshan Shah?

  I learned a lot of new things about sleep by talking to Dr. Matt Walker. Here are 10 of my top findings from this episode that I found to really be useful and new information for me. Sleep regularity beats sleep quantity for longevity. Research shows that going to bed and waking up at the same time every day is much more important for longevity than the total hours of sleep you get. A study of 200,000 individuals revealed that irregular sleepers had significantly higher risk of all-cause mortality, including heart disease and cancer. While you can't skimp on sleep entirely, maintaining a consistent sleep schedule and getting to bed at the same time every night, even if it's on the weekends, can be a game changer for your health.

• 1:42:44Dr. Darshan Shah?

  Number two, doctors get only one hour of sleep education in medical school, and I can attest to this. Across the 11-country survey, the average medical student receives just 60 minutes of sleep-related education over the entire four years of our medical training. This is an alarming gap that leaves many doctors ill-equipped to diagnose or treat sleep disorders, and even to just know how important sleep can affect our overall health. Sleep, which accounts for one-third of a person's life, is still treated as a secondary concern in mainstream medicine. Number three, caffeine can steal up to 20% of your deep sleep, even if you fall asleep after consuming Caffeine, it can reduce deep sleep by up to 20%,

• 1:43:28Dr. Darshan Shah?

  equivalent to aging your brain and body by 25 years. Caffeine has a half-life of five to six hours, meaning a quarter of that afternoon coffee is still in your system at midnight. For optimal sleep, cut caffeine intake at least 12 hours before bedtime. Number four, 80% of sleep apnea cases are undiagnosed. Sleep apnea, a condition where breathing stops repeatedly while you're sleeping, goes unnoticed and it affects millions. This disorder significantly increases the risk of heart disease. And I can tell you in our practice, we see this all the time where people are just living with sleep apnea. This can lead to cognitive decline and even Alzheimer's disease.

• 1:44:11Dr. Darshan Shah?

  Many people unfortunately ignore sleep apnea and attribute their morning fatigue just to getting old. They're unaware that this is a treatable condition that's robbing them of longevity. Number five, alcohol is not a sleep aid. Alcohol is a sedative and it actually fragments your sleep. It overactivates the fight or flight sympathetic response. It blocks REM sleep and it leaves you feeling unrested in the morning. While it helps people pass out quickly, the sedation that you get from alcohol is really not true effective sleep. And the effects of chronic alcohol use are devastating on the quality of our rest. Number six, sleep deprivation mimics drunkenness.

• 1:44:54Dr. Darshan Shah?

  Being awake for 20 hours straight has the same effect of on your cognition as having a blood alcohol level of 0.08, which is a legal limit for driving in most places. Drowsy driving leads to micro sleeps, brief lapses in awareness, where you lose control of your vehicle. Shockingly, sleep-related crashes often have a higher fatality rate than drunk driving accidents. Number seven, sleep loss decreases natural killer cells in your immune system by up to 70%. Just one night of losing four hours of sleep causes a 70% drop in natural killer cells, the very important cells on the front line of defense against viruses and cancer.

• 1:45:38Dr. Darshan Shah?

  This immune suppression is linked to higher rates of infections like COVID and diseases like cancer and heart disease and many more. Sleep is not just a recovery tool, it's essential for having a robust immune system. Number eight, REM sleep debt builds up over time. Using alcohol or even marijuana for sleep reduces REM sleep, which is critical for emotional regulation, memory, and physical recovery. Chronic suppression of REM sleep leads to what's called REM sleep rebound, where vivid and intense dreams occur once those substances are removed. Unfortunately, you can never really regain lost REM sleep,

• 1:46:20Dr. Darshan Shah?

  and that impacts your long-term mental and physical health. Number nine, sleep apnea can actually shorten your life by many years. Untreated sleep apnea can reduce your life expectancy by several years, with each night of disrupted breathing wreaking havoc on your heart and vascular system. Finally, number 10, skipping sleep for 24 hours wrecks your body more than skipping food or exercise. Depriving yourself of sleep by pulling an all-nighter and going the following day has a greater negative impact on your brain and body than going without food or exercise for the same duration of time. Sleep is the only biological process that, when neglected, affects every single organ and function in the human body simultaneously.

• 1:47:04Dr. Darshan Shah?

  Its immediate effects include hormonal imbalance, inflammation, impaired cognition, and physical performance. I hope you learned as much as I did from this episode, and if you found it useful, please forward it on to any one of your friends or family that needs evidence and reasons for why they need to be getting better sleep. Thank you.

• 1:47:27Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode, and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best, and it's always important to seek their guidance.