Ep 199 Sleep Part 2: Predictably unpredictable

Now that we know just how critical sleep is, we’re all making sure we get the amount we need, right? Unfortunately no. One-third to one-half of Americans are not getting enough sleep, according to public health guidelines. Why is that? Hypotheses abound, but many point the finger of blame at different aspects of modern society such as screen time, artificial light, a sedentary lifestyle. These narratives suggest that sleep in industrialized societies today is not just different but worse than in centuries past. Is that the truth? How did humans sleep in yesteryear, and what can that tell us about sleep today? In the conclusion to our sleep two-parter, we explore the many ways that humans sleep and the wide array of consequences when we don’t get enough (or too much) of it. Support this podcast by shopping our latest sponsor deals and promotions at this link: https://bit.ly/3WwtIAu See omnystudio.com/listener https://omnystudio.com/listener for privacy information.

• 0:01Speaker 00

  This is Exactly Right.

• 0:06Speaker 01

  Dry hands can be uncomfortable and frustrating, especially when frequent hand washing, changing weather, and everyday wear and tear take their toll. O'Keefe's Working Hands is here to help keep dry hands feeling hydrated and comfortable. O'Keefe's Working Hands creates a soothing barrier on the skin that locks in moisture and prevents further dryness. It's concentrated and non-gracey, and you start to feel relief in one use. Go to O'Keefe'sCompany.com to get yours today. That's O-K-E-E-F-F-E-S Company dot com for guaranteed relief. O'Keefe's Working Hands. Yeah, it works.

• 0:38Speaker 02

  Hey, I'm Niall Rogers. This fall, I'll be driving across the country, meeting some of today's coolest and most fascinating artists. We'll explore the stories before the moments that changed everything. Because every musician remembers the moment where it all began. Experience Before the Moment, a Lincoln Original Series, on the iHeart Radio app, YouTube, or wherever you get your podcasts.

• 1:10Speaker 03

  Hi, my name is Kelly. I'm a big fan of the podcast, so it's a real treat to be here sharing my story about sleep, or in my case, lack of it. I was nearing the end of my final quarter at college, and I'd spent my finals week living off caffeine pills and no sleep in an effort to cram for my tests. The day after my last presentation, I decided to go cold turkey on the caffeine, just spend a few hours at my internship, and then head home for some uninterrupted napping. My internship, I could feel the heaviness of my week of all-nighters pulling at me, so I asked to leave early and got in my car to battle the early developments of rush hour traffic. As I sat in my car, the stop-and-go movement slowly lulled me to sleep, and the next thing I knew, I was

• 1:54Speaker 03

  jolted awake by a thud as my car had rolled forward and struck the Jeep in front of me. Because we were going so slow, the only damage done to the Jeep was a cut in his wheel cover. The driver was so nice and checked on me to make sure I was okay and then drove off. Other than being incredibly embarrassed, I was fine, but my car, Betty, the cute little blue car I'd had since I was 16, had damage to her frame and was totaled. Now that I'm older, I'm incredibly cautious of driving fatigued. I was so lucky, my wake-up call didn't hurt anyone, except poor Betty.

• 3:12Speaker 04

  Wow. I mean, what a harrowing, what a harrowing, and also like relatable. I know. Who hasn't stayed up way too late, many nights at a row. Way too often. Yeah. I know. Terrifying. Glad you're okay. I'm sorry about your car. I know. I know. Kelly, thank you so much for sharing your story with us. We really appreciate it. We do. Thank you so much. Thank you. Hi, I'm Erin Welsh. And I'm Erin O'Malley Updike. And this is This Podcast Will Kill You. Welcome to Sleep Part Two. Sleep Part Two. If you didn't listen last week, or watch, you should, because it's really great. You know, there's a lot of cool stuff. Pretty proud of it. Absolutely. Last episode, we discussed sort of like, what is sleep? What are the

• 3:55Speaker 04

  different stages of sleep? A little bit about what sleep does for us. For us. And how we fall asleep, et cetera. We talked about sleep in animals. Very cute stuff. Human hemispheric sleep. And animal sleep. Yep. And this week, we're going to go in more into how humans have slept Yeah. over history, and also like, what sleep disruption means, what sleep quality means, and what are the consequences of not getting enough sleep? There's a lot of them.

• 4:23Speaker 01

  There's a lot.

• 4:24Speaker 04

  There's a lot.

• 4:24Speaker 01

  And we'll get into all of it.

• 4:25Speaker 04

  We will.

• 4:26Speaker 01

  But first, it's Quarantini Plessy Barita time.

• 4:29Speaker 04

  It is. What are we drinking this week?

• 4:32Speaker 01

  We're still drinking.

• 4:33Speaker 04

  We are.

• 4:34Speaker 01

  Pillow Talk.

• 4:35Speaker 04

  Pillow Talk. Should we do the whole episode in a whisper?

• 4:38Speaker 01

  Yeah, so that everyone can fall asleep.

• 4:41Speaker 04

  It's chamomile tea.

• 4:42Speaker 01

  Chamomile tea, ginger, ginger honey syrup.

• 4:45Speaker 04

  Honey syrup.

• 4:46Speaker 01

  And a lemon. I can't do it. I'm gonna lose it.

• 4:50Speaker 04

  That's enough for me. We will post the full recipe for Pillow Talk on our social media, at the very least, and maybe on our website, which is where you can also find...

• 5:04Speaker 01

  So many things that you really, really want, trust.

• 5:08Speaker 04

  Trust.

• 5:08Speaker 01

  Like merch.

• 5:10Speaker 04

  Yeah.

• 5:10Speaker 01

  We've got that. We've got transcripts from all of these episodes. We've got a Goodreads list, a bookshop.org affiliate account. We've got links to Blood Mobile, who does the music for every one of our episodes. We've got sources from them all. We have a Contact Us form and a Firsthand Account form, and much more.

• 5:27Speaker 04

  Much more. I don't even, I honestly don't even know, because I kind of zoned out when you were talking about the website.

• 5:34Speaker 01

  I do too.

• 5:34Speaker 04

  I know, while we're discussing it, yeah.

• 5:36Speaker 01

  ThisPodcastWillKillYou.com.

• 5:38Speaker 04

  Um, we're, this is a YouTube video that you are, like, we're filming this.

• 5:43Speaker 01

  We are.

• 5:43Speaker 04

  In the Exactly Right Studios. It's really cool.

• 5:45Speaker 01

  Thank you for having us.

• 5:47Speaker 04

  Yes, thank you. And so if you would like to watch the full thing, it is there. That is possible to do.

• 5:51Speaker 01

  Thank you if you are watching it.

• 5:53Speaker 04

  Yeah, and if you're not, you know, you can always rate, review, subscribe on various platforms.

• 5:58Speaker 01

  All the platforms.

• 5:59Speaker 04

  Yeah.

• 5:59Speaker 01

  That you like to use.

• 6:01Speaker 04

  God, it's like we, this is our first time doing this.

• 6:03Speaker 01

  Every single time.

• 6:04Speaker 04

  Every time.

• 6:05Speaker 01

  So, on that note.

• 6:07Speaker 04

  Break time?

• 6:09Speaker 01

  I need one already.

• 6:12Speaker 04

  Well, let's take a quick break, and when we get back, there is so much to discuss about sleep and humans.

• 6:17Speaker 01

  That was great.

• 6:18Speaker 04

  Thank you. I say it a lot for the book club.

• 6:19Speaker 01

  Oh. With that?

• 6:21Speaker 04

  Yeah.

• 6:22Speaker 01

  Really?

• 6:22Speaker 04

  Oh, no, not really.

• 6:23Speaker 01

  Okay.

• 6:23Speaker 04

  Okay. Okay, break time's starting now.

• 6:25Speaker 01

  Okay.

• 6:27Speaker 01

  Dry hands can be uncomfortable and frustrating, especially when frequent hand washing, changing weather, and everyday wear and tear take their toll. O'Keefe's Working Hands is here to help keep dry hands feeling hydrated and comfortable. O'Keefe's Working Hands creates a soothing barrier on the skin that locks in moisture and prevents further dryness. It's concentrated and non-greasy, and you start to feel relief in one use. Go to okeefescOMPANY.COM to get yours today. That's O-K-E-E-F-F-E-S-COMPANY.COM for guaranteed relief. O'Keefe's Working Hands. Yeah, it works.

• 7:00Speaker 02

  Hey, it's Niall Rogers, host of Before the Moment, a Lincoln original series. I'm driving across the country, meeting some of today's most fascinating artists. We're exploring the stories before the moment that changed everything. This week, I'm joined by Miguel.

• 7:18Speaker 05

  My small experience with the discrepancy in the business of music made me angry in the best way. And I wanted to, I wanted to finish. So I started really leaning into my therapy, trying to get down to like, what matters now? Somewhere, Miguelito felt like he didn't have a place to say how he felt. And music was the place that I went to to say how I felt.

• 7:40Speaker 02

  Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.

• 8:02Speaker 04

  Earlier this year, I bought myself a smartwatch. I know that. You do know that. And I started wearing it overnight. When I woke up in the morning, I would check out how my watch said I slept, right? How many hours did I get? How much deep sleep? What was my percentage? How many wake-ups? Oh, gosh, only six and a half hours of sleep? Only 5% deep sleep? Oh, yep, that's when I woke up because my dog was licking himself excessively. Always. No wonder I'm so tired today. And on the rare occasion that I hit my eight hour sleep goal, my phone would send a little congratulatory notification like, yay,

• 8:39Speaker 01

  Does it really?

• 8:39Speaker 04

  You did it. You hit your goal.

• 8:41Speaker 01

  Congrats.

• 8:42Speaker 04

  And I would be, I would like, I started to get really annoyed. I'd be like, I don't know why, but I was just like, yeah, I hit it today. Once every two months, thank you for reminding me what a failure I am when it comes to sleeping.

• 8:56Speaker 01

  Oh, my gosh.

• 8:56Speaker 04

  A little bit. Like, I'm exaggerating.

• 8:58Speaker 01

  I know, but still.

• 8:59Speaker 04

  But it would just be like, oh, you hit it today. And I was like, what about yesterday when I got seven hours? Like, was that okay?

• 9:05Speaker 01

  Was that decent?

• 9:06Speaker 04

  No, clearly not.

• 9:06Speaker 01

  Is that good enough?

• 9:07Speaker 04

  Right.

• 9:07Speaker 01

  Siri?

• 9:08Speaker 04

  And then I was like, okay, am I actually tired? Or was my, my watch sort of creating this self fulfilling prophecy where I convinced myself that I was more tired just because I had X number of wakeups, or I didn't hit eight hours or whatever?

• 9:22Speaker 01

  Yeah.

• 9:23Speaker 04

  And I kept wearing it, but then I was like, you know what? I'm not going to check what it recorded until later in the day.

• 9:28Speaker 01

  Okay.

• 9:28Speaker 04

  Just to see like, how tired am I today?

• 9:31Speaker 01

  How do I feel before I have the watch tell me how I should feel?

• 9:34Speaker 04

  A hundred percent. Right, right? And it didn't always align, of course. This is all anecdotal. This is an N of one.

• 9:40Speaker 01

  I love it.

• 9:41Speaker 04

  This is my personal introduction to the story, right? And, and I know that these watches, like you talked about last week, they are not substitutes for professional sleep devices and they can be very inaccurate. And what mine did for me was kind of in a way, increase my sleep anxiety. Or like the anxiety that I feel about not getting enough sleep or not getting quality sleep.

• 10:01Speaker 01

  Right.

• 10:01Speaker 04

  According to my watch, I was rarely getting quote unquote enough sleep. Like, what does enough mean?

• 10:07Speaker 01

  Right.

• 10:08Speaker 04

  It was from Public Health Guidelines, seven to nine hours. And also alarmist headlines also would talk about how much sleep you should be getting. And these headlines every day are always proclaiming some new connection between a lack of sleep and chronic disease, or mental health issues, or dementia, or poor life satisfaction, or just sudden death.

• 10:31Speaker 01

  Yeah, that's true.

• 10:31Speaker 04

  Yeah, I know. I know. Believe me.

• 10:35Speaker 01

  Yeah.

• 10:35Speaker 04

  And even when I try to go to bed early and practice good sleep hygiene, I rarely hit that solid eight.

• 10:41Speaker 01

  Yeah.

• 10:41Speaker 04

  What was wrong with me?

• 10:43Speaker 01

  Oh.

• 10:43Speaker 04

  I was sleeping myself into an early grave.

• 10:47Speaker 01

  Or not sleeping yourself.

• 10:48Speaker 04

  Or not sleeping, yeah. I was awaking myself into an early grave.

• 10:54Speaker 04

  But 1/3 to 1/2 of American adults aren't getting enough sleep, according to those guidelines.

• 10:59Speaker 01

  Okay.

• 10:59Speaker 04

  50 to 70 million Americans have a sleep disorder.

• 11:02Speaker 01

  Yeah, I have that same stat.

• 11:04Speaker 04

  And 1 in 5 Americans aged 19 to 30 use alcohol or cannabis as a sleep aid. 1 to 5.

• 11:10Speaker 01

  That's a problem.

• 11:11Speaker 04

  Or 1 in 5, yeah.

• 11:12Speaker 01

  This is not medical advice, but that's a problem.

• 11:15Speaker 04

  It's really, it's bad news.

• 11:16Speaker 01

  Yeah.

• 11:17Speaker 04

  We are struggling, though. Like, all of this speaks to a desire for sleep.

• 11:21Speaker 01

  Yeah.

• 11:22Speaker 04

  And not getting enough of it.

• 11:23Speaker 01

  Yeah.

• 11:23Speaker 04

  And so many aspects of our modern society are blamed for bad sleep.

• 11:28Speaker 01

  Yeah.

• 11:28Speaker 04

  Our screens, artificial lighting, stress, diet, lack of exercise. And bad sleep has been, in turn, blamed for everything.

• 11:37Speaker 01

  Mm-hmm.

• 11:38Speaker 04

  If only we could turn back time and sleep the deep, unbroken, restful sleep of our ancestors. They must have been so refreshed, just laying down to sleep when the sun dipped below the horizon and gently awakening as the first rays of light softly caressed their faces.

• 11:58Speaker 04

  If only that were true.

• 12:00Speaker 01

  If only.

• 12:00Speaker 04

  If only. But what do we actually know about how our ancestors slept?

• 12:06Speaker 01

  Yeah.

• 12:07Speaker 04

  Like, and what bearing might that have on our relationship with sleep today?

• 12:10Speaker 01

  Yeah.

• 12:12Speaker 04

  Sleep, since it's a behavior, unfortunately, does not leave behind a fossil trace.

• 12:16Speaker 01

  As we learned last week.

• 12:18Speaker 04

  I mean, even poop leaves behind a fossil trace.

• 12:21Speaker 01

  We love a coprolite.

• 12:22Speaker 04

  We do love a croprolite. Craprolite.

• 12:24Speaker 01

  Crap.

• 12:25Speaker 04

  Oh, my god. But there are a couple of ways that we can speculate about what sleep might have been or might have looked like for pre-industrial humans.

• 12:32Speaker 01

  Okay.

• 12:33Speaker 04

  One way is by asking how modern-day, pre-industrial humans sleep, like, certain hunter-gatherer groups.

• 12:38Speaker 01

  Right.

• 12:39Speaker 04

  And another is by searching historical writings for mentions of sleep or the nighttime experience.

• 12:45Speaker 01

  I love this so much.

• 12:46Speaker 04

  Okay. In 1878, a 27-year-old Robert Louis Stevenson, still a few years away from Treasure Island and fame.

• 12:54Speaker 01

  Okay.

• 12:55Speaker 04

  He was hiking through southern France with his donkey, Modeste, as his only companion.

• 13:00Speaker 01

  Oh, my gosh. Sorry, I love that.

• 13:02Speaker 04

  He was just like, I'm gonna take a gap year.

• 13:04Speaker 01

  I'm gonna take my donkey.

• 13:05Speaker 04

  Bring my donkey.

• 13:06Speaker 01

  How do you just have a donkey? I guess that's just a thing you had back then.

• 13:09Speaker 04

  You can buy a donkey today, even.

• 13:10Speaker 01

  Well, I know that, but like, I couldn't have a donkey.

• 13:13Speaker 04

  I really like donkeys.

• 13:14Speaker 01

  I don't think my landlord would allow it.

• 13:16Speaker 04

  We met a donkey recently.

• 13:17Speaker 01

  It was lovely.

• 13:18Speaker 04

  We have more to talk about with donkeys than I anticipated.

• 13:23Speaker 04

  So as Stevenson crossed the land with his donkey, he set up camp wherever he felt like, oh, I'm done for the day. I'll just camp here.

• 13:30Speaker 01

  Okay.

• 13:31Speaker 04

  And he noticed something unusual. Quote, "There is one stirring hour, unknown to those who dwell in houses, when a wakeful influence goes abroad over the sleeping hemisphere and all the outdoor world are on their feet. At what inaudible summons are all these sleepers thus recalled in the same hour to life? Even shepherds and old country folk, who are the deepest red in these arcana, have not a guess as to the means or purpose of this nightly resurrection. Towards 2:00 in the morning, they declare the thing takes place and neither know or inquire further." End quote.

• 14:05Speaker 01

  So he's like, everyone's awake at 2:00 AM, bro. Did you know that?

• 14:08Speaker 04

  Did you know that? No one knows why, but it happens only if you're sleeping in the country.

• 14:12Speaker 01

  Everyone in the country is doing it?

• 14:13Speaker 04

  Everyone is doing it. Everyone's doing it. But in fact, this midnight awakening, or 2:00 AM awakening, was only unusual to Stevenson and his contemporaries that were living in rapidly industrializing areas.

• 14:26Speaker 01

  Okay.

• 14:27Speaker 04

  For centuries before, many societies across the globe slept in two chunks, separated by about an hour or so, by phasic or segmented sleep.

• 14:37Speaker 01

  I learned that, Erin, in researching this.

• 14:40Speaker 04

  Yeah.

• 14:40Speaker 01

  And I want to know everything.

• 14:42Speaker 04

  I can tell you a lot.

• 14:44Speaker 01

  Give it to me.

• 14:44Speaker 04

  Not everything.

• 14:45Speaker 01

  Wow.

• 14:45Speaker 04

  I can tell you a lot.

• 14:46Speaker 01

  No one knows everything.

• 14:47Speaker 04

  No. So evidence for this segmented sleep comes from a huge variety of sources.

• 14:53Speaker 01

  Okay.

• 14:54Speaker 04

  And there's, of course, a bias towards English language sources, but there is evidence for this beyond just the British Isles, which is where most of the sources are concentrated. And many of these references are made in passing, right? Like, not about the sleep itself. They're not like, we sleep in this way.

• 15:10Speaker 01

  Right.

• 15:10Speaker 04

  Because who talks about that, right? Like, it's not a part of, it's just in passing.

• 15:15Speaker 01

  It's just what you do.

• 15:16Speaker 04

  Yeah.

• 15:16Speaker 01

  Okay.

• 15:16Speaker 04

  But there would be writings like, "After my second sleep."

• 15:20Speaker 01

  "After my second sleep."

• 15:21Speaker 04

  Or "After my first sleep." You know, things that showed that it wasn't particularly noteworthy or like, interesting. It wasn't like, oh, I need to highlight this.

• 15:29Speaker 01

  Right.

• 15:29Speaker 04

  It was like...

• 15:30Speaker 01

  Like, hey, guys, just so you know, I'm sleeping in two chunks. It was just like, like, first breakfast, second breakfast.

• 15:36Speaker 04

  Yes.

• 15:36Speaker 01

  11:00.

• 15:37Speaker 04

  "After my second breakfast."

• 15:38Speaker 01

  Yeah.

• 15:38Speaker 04

  "I went to Mordor."

• 15:40Speaker 01

  Yeah, exactly.

• 15:41Speaker 04

  Yeah.

• 15:42Speaker 01

  Thank you.

• 15:42Speaker 04

  You're welcome.

• 15:45Speaker 04

  The first sleep was often called something like first sleep, duh.

• 15:48Speaker 01

  Okay.

• 15:49Speaker 04

  Or dead sleep.

• 15:50Speaker 01

  Oh.

• 15:50Speaker 04

  While the second was second sleep or morning sleep.

• 15:54Speaker 01

  Oh, interesting.

• 15:55Speaker 04

  And they were split pretty evenly. But I think it's interesting, dead sleep, because that's when deep sleep.

• 15:59Speaker 01

  Deep sleep is happening. We learned last episode.

• 16:01Speaker 04

  We did.

• 16:01Speaker 01

  Check it out if you didn't listen.

• 16:02Speaker 04

  We did. And the intervening break was referred to as watch or watching.

• 16:07Speaker 01

  Hmm.

• 16:07Speaker 04

  In The Canterbury Tales, a character sleeps soon after evening fell and woke up in the early morning after her first sleep. And then there was a 16th century book called A Treatise of Ghosts, which like, why?

• 16:20Speaker 01

  I want to know more.

• 16:21Speaker 04

  Know more, yeah. That refers to, quote, "about midnight when a man wakes from his first sleep."

• 16:27Speaker 01

  Interesting.

• 16:28Speaker 04

  Yeah. Even medical books made reference to first and second sleeps. They recommended that on your first sleep, you lay on your right side, and on your second sleep, lay on your left side. I don't know why. I don't know why.

• 16:42Speaker 01

  That's just so typical of a medical textbook to be like, this is what must be done.

• 16:46Speaker 04

  You have to do this.

• 16:47Speaker 01

  Based on what?

• 16:47Speaker 04

  I know, I know.

• 16:48Speaker 01

  It's your feelings.

• 16:50Speaker 04

  Yeah.

• 16:51Speaker 01

  Sorry.

• 16:52Speaker 04

  I just, we know based on science.

• 16:54Speaker 01

  We know.

• 16:55Speaker 04

  Period.

• 16:55Speaker 01

  The end. Okay.

• 16:58Speaker 04

  But waking up in the middle of the night, it seems to have been like a routine thing.

• 17:02Speaker 01

  Interesting.

• 17:02Speaker 04

  I mean, if you woke up at 2:00 AM nowadays, would you be like, oh, okay, well, I've gotten my first sleep, might as well do some dusting and sock mending?

• 17:10Speaker 01

  Sock mending. No.

• 17:12Speaker 04

  As one does.

• 17:13Speaker 01

  Wouldn't know where to begin.

• 17:14Speaker 04

  I doubt it. Yeah, I don't know how to sock mend. But that is exactly what it seems like many people used to do. Maybe they would lay in quiet reflection, they would get up to use the bathroom, they would smoke a pipe, they would start some bread dough, do the washing, even visit neighbors.

• 17:27Speaker 01

  I'm sorry, the idea of starting bread dough is genius.

• 17:29Speaker 04

  I know, right?

• 17:30Speaker 01

  Like, I could have biscuits every morning if I just had a double two-sleep regimen.

• 17:35Speaker 04

  Yep.

• 17:36Speaker 01

  I might be changing my life after this episode.

• 17:37Speaker 04

  I think you could. I think you are entitled to do that.

• 17:40Speaker 01

  Okay.

• 17:42Speaker 04

  A text from the 1700s says that students should study after their first sleep so they're more refreshed, which sounds like a literal nightmare.

• 17:51Speaker 01

  Yeah.

• 17:52Speaker 04

  It's not happening.

• 17:52Speaker 01

  Sorry, but no.

• 17:53Speaker 04

  No, no. So, side note, though, segmented sleep might help explain why today many people have sleep maintenance insomnia, where you wake up in the middle of the night and you're like, I can't fall back asleep.

• 18:04Speaker 01

  I can't go back to sleep.

• 18:04Speaker 04

  It's like, might be a remnant. People think it's a remnant of segmented sleep.

• 18:08Speaker 01

  I love this.

• 18:09Speaker 04

  I know.

• 18:10Speaker 01

  I'm gonna have so much more to say about this.

• 18:11Speaker 04

  Evolutionary origins of sleep disorders. Okay, so these biphasic sleepers, were they going to bed super early in order to get all the sleep? It doesn't seem like it.

• 18:21Speaker 01

  Okay.

• 18:22Speaker 04

  I think there's this idea that like, oh, sun's down, nothing to do but sleep.

• 18:26Speaker 01

  Right.

• 18:26Speaker 04

  For in the olden days. And it's possible that some people could not afford the same amount of candles or oil lamps as the wealthier classes. But like you, most people had a hearth to provide light.

• 18:36Speaker 01

  You had some kind of fire.

• 18:37Speaker 04

  And so you could like read, you could, you had to take care of your entire home, mending, spinning, read, praying, other activities by the fireplace. We humans, we are a social species. And so there was also socializing at taverns or gathering halls or just at your neighbor's house. So this is a painting from the 1800s called Evening in the Village. And it's like, it shows kind of like, this is what evening was like. There was, it was a boisterous time often. It wasn't just like, oh, the sun's down, time to turn in.

• 19:08Speaker 01

  Time to turn out the lights.

• 19:10Speaker 04

  But it's not like people stayed up all hours of the night.

• 19:12Speaker 01

  Okay.

• 19:12Speaker 04

  They valued their sleep very much. Sleep was written about as like a peaceful respite from the worries and the pain of waking life.

• 19:21Speaker 01

  Huh.

• 19:22Speaker 04

  A diary entry from Sarah Cowper in the late 17th century said that with few exceptions, quote, "This family goes to bed between nine and 10." Yeah.

• 19:32Speaker 01

  Okay.

• 19:32Speaker 04

  And then this, I'm gonna get this and hang this in my house. There was an inscription over the parlor of a Danish pastor's, like in, yeah, over his parlor in his room.

• 19:41Speaker 01

  Okay.

• 19:42Speaker 04

  From in the house of a Danish pastor. And from around the same time, late 17th century, that said, "Stay till nine, you are my friend. Till 10, that is all right. But if you stay till 11, you are my enemy."

• 19:58Speaker 01

  I love that so much.

• 19:59Speaker 04

  You too.

• 20:00Speaker 01

  Like, you gotta go.

• 20:01Speaker 04

  Please, like, you, you don't know how quickly.

• 20:03Speaker 01

  Yes.

• 20:03Speaker 04

  This could turn.

• 20:07Speaker 04

  There is an Italian proverb, bed is a medicine. And another proverb that was one hour's sleep before midnight is worth three after.

• 20:16Speaker 01

  Fascinating.

• 20:18Speaker 04

  And there's a Welsh saying that men thrive by sleep, not long, but deep. What is long? Like recommendations on how much sleep to get back then, you know, historically varied, but echo a lot of what we hear today.

• 20:32Speaker 01

  Okay.

• 20:32Speaker 04

  Six to eight hours.

• 20:33Speaker 01

  Okay.

• 20:34Speaker 04

  Is usually what I've seen. Eight during the summer and nine during the winter. One guy recommended a mere three. And you can always, you can already see them moralizing. And another guy's belief that, quote, "Nature requires five. Custom takes seven. Laziness nine and wickedness 11."

• 20:51Speaker 01

  OMG.

• 20:53Speaker 04

  Like, calm down.

• 20:54Speaker 01

  Like, dude.

• 20:55Speaker 04

  It's sleep, bro. It's okay.

• 20:59Speaker 04

  But it seems clear that unless you were in the wealthier classes, you were lucky to get seven hours of sleep.

• 21:03Speaker 01

  Okay.

• 21:04Speaker 04

  That was like a pretty, like a norm.

• 21:06Speaker 01

  Okay.

• 21:07Speaker 04

  And everyone seemed to do the most that they could to make their sleep as restful as possible. By the 16th century, the bed became the most expensive piece of furniture in the home.

• 21:17Speaker 01

  Oh, wow.

• 21:19Speaker 04

  Yep. Ornate, softer, ornamented with pillows, the first thing that newlyweds bought and the most desirable item in a will. Like, if you were left the bed, you were...

• 21:30Speaker 01

  You were the favorite child.

• 21:31Speaker 04

  You were the favorite child.

• 21:31Speaker 01

  Or niece or nephew.

• 21:33Speaker 04

  Yep.

• 21:33Speaker 01

  Oh, wow, that's fun.

• 21:34Speaker 04

  Oh, yeah.

• 21:35Speaker 01

  Who's gonna get the bed?

• 21:36Speaker 04

  Who's gonna get the bed? Bedtime ritual was also a big deal. It might involve removing flies or lice or bedbugs from bedding and clothes. Like, there's another painting that I didn't put in here, but it's, I'll show you. It's very cute. It has like, they're hunting for either fleas or bedbugs or whatever.

• 21:53Speaker 01

  Around the bed.

• 21:54Speaker 04

  Around the bed.

• 21:55Speaker 01

  Yuck.

• 21:59Speaker 04

  The beds were warmed with hot coals or stones wrapped in rags. Windows were shuttered and curtains were drawn. You washed your feet, you combed your hair, you set out or had your servant set out your chamber pot. You donned your nightgown and nightcap, if you could afford one, to avoid catching your death from the cold. And maybe you had a little dram of whiskey or a few drops of laudanum to help you sleep.

• 22:23Speaker 01

  All the way back then.

• 22:24Speaker 04

  All the way back then. And finally, the head of the household would lead everyone in nighttime prayers. It seems like a recipe for a really wonderful, restful sleep, right? Like, everyone was gonna get really great sleep.

• 22:38Speaker 04

  I'm obviously leading you to say no.

• 22:40Speaker 01

  I can guess, no.

• 22:42Speaker 04

  I mean, like, they must have slept so much better than today with, like, our screens and our stressful jobs.

• 22:48Speaker 01

  Yeah, but also they're picking lice out of their bed, bro.

• 22:51Speaker 04

  Exactly.

• 22:52Speaker 01

  Yeah.

• 22:52Speaker 04

  Exactly.

• 22:53Speaker 01

  And their beds are made of what, like, hay?

• 22:56Speaker 04

  If you even had that, yeah. Many descriptions of sleep from this era use words like restless or troubled. People across the board were less healthy than we are today, trying to get a good night's sleep when you're sick or you're injured or you have a chronic disease. It can be really challenging. There's a painting by the artist William Hogarth from 1750 called Francis Matthew Shuts in His Bed. It features a man sitting up in his bed, vomiting into a chamber pot. Like, was he commissioned to paint this? Like, I love that he... Like, Francis Matthew Shuts was like, "Please paint a painting of me. I'm gonna paint..."

• 23:35Speaker 01

  Barfing?

• 23:35Speaker 04

  Yeah.

• 23:36Speaker 01

  Yeah. I mean, we had a barf bowl growing up next to the bed.

• 23:39Speaker 04

  We had a barf bucket, yeah. I hated it, even the sight of it. It was a popcorn bowl? That's...

• 23:46Speaker 01

  After being clean.

• 23:47Speaker 04

  No, I don't like that very much. No, thank you.

• 23:51Speaker 01

  Oh, maybe I shouldn't mention that.

• 23:53Speaker 04

  It's in there. We are not cutting that.

• 23:57Speaker 01

  Sorry, Mom.

• 23:57Speaker 04

  But Francis here, he was lucky to have his own bed.

• 24:01Speaker 01

  Yeah.

• 24:01Speaker 04

  Many, many, it was a rare luxury. Many of the poorer classes couldn't afford good blankets or comfortable beds, and so the whole family would sleep in one bed, sometimes with animals. Not a great way to get sound sleep. I mean, my dog sleeps in my bed, and he's sometimes really a lot.

• 24:17Speaker 01

  Yeah. Oh, my gosh. If the cat or the dog gets in there, it's a disaster, though the toddler is the worst, I will say. I love him.

• 24:24Speaker 04

  I believe that, yeah. Yeah, yeah.

• 24:28Speaker 04

  And this is also evident, like the fact that people did not get great sleep is evidenced by frequent references to daytime napping. Ah. Mm-hmm. And I think that people did probably get restful sleep from time to time, but I think that, you know, like we've talked about with the food of yesteryear. Oh, yeah. People tend to romanticize sleep in the past. Oh, would have been so great. Like, oh, before screens, before social media, before this and that, there must have been such unbroken, you just had so many hours a night to sleep. What else were you gonna do? Right. And it says that's not the case. But with the Industrial Revolution and the introduction of artificial light, shift work, well-lit streets, and the growth of cities and nighttime entertainment and socializing, segmented sleep began to fade from memory. Interesting.

• 25:12Speaker 04

  And by the turn of the 20th century, it was a relic of the past. Like Stevenson was like, I've never heard of this. Yeah. But it's common in the countryside. And then that just started to slowly fade more and more and more. How interesting. Mm-hmm. And this 8-8-8 rule became dominant. Eight hours for work, eight for sleep, eight for yourself. Like, that was after shifts kind of shrank from like 12 to 8. To 12 to 8, okay. And it was like, I honestly, I tried to find like more of an origin than that. Like, was there a scientific guidance that led with this 8-8-8? And I don't, I don't think that there was. Okay. I think it was just like, this is, seems like a nice, easy division. Okay. Yeah. And so it was really only much later, like, we forgot about segmented sleep.

• 25:55Speaker 04

  And it was only in the 90s and 2000s that people kind of rediscovered it. Do we know if when people were getting segmented sleep, how many total hours they were getting? Well, that's what I think. I think it was around, um, six to, like, seven, six to seven, six to eight. Okay. Roughly. Okay. Yeah, yeah, yeah. But it was just like broken up? It was broken up. Right. Yeah, yeah. But yeah, so in the 90s and 2000s is when this idea of segmented sleep kind of returned or resurfaced. Okay, okay. With work especially by Roger E. Kirsch, uh, 2005 book, At Day's Close. And there's like an earlier paper too. Okay. Sleep We Have Lost, I think. Yeah, okay. And so then these, this research led a lot of people to wonder, you know, is segmented

• 26:39Speaker 04

  sleep the true ideal for humans? Has it just been stolen from us by industry and artificial light? Yeah. Should we be sleeping in chunks? Should we? Should we? Should we? The answer is yes, and the answer is no.

• 26:55Speaker 04

  I mean, it seems clear, based on a wealth of historical evidence, that segmented sleep and daytime napping was commonplace throughout much of pre-industrial Europe. And in the 1990s, research psychiatrist Thomas Weir conducted an experiment where he deprived people of artificial light at night for a few weeks, over which time their sleep did become segmented. Segmented, I saw that, I saw that paper. Lay in bed for a bit, sleep for four hours, wake for a couple, and sleep for another four. Yeah. But is it universal, segmented sleep? Right. What about- Like, among humans. Among humans, yeah. What about, quote, you know, pre-industrial societies today? Like, certain hunter-gatherer or hunter-horticulturalist groups? Okay. Do they have biphasic sleep? Do they? Research is mixed. Mm-hmm. Some groups do seem to have segmented sleep.

• 27:40Speaker 04

  Okay. While others, so the ones that were studied in this one paper that I read, were living in Namibia, Tanzania, and Bolivia, so, like, quite distributed globally. Varied, yeah. Yep. They don't show any segmented sleep- Okay. -or frequent napping. Okay, so they're just sleeping in one chunk? One chunk. How many hours we talking? Okay, okay. So, there was a study in 2015 by Yedish et al., and it was published, that upset this assumption that everyone used to sleep in segmented chunks. Okay. They found that the three groups that they observed slept, on average, 5.7 to 7.1 hours of sleep a night. Interesting, okay. People went to bed at varying hours, but woke up roughly the same time. Interesting. That they slept an hour longer in the winter than in summer.

• 28:25Speaker 04

  Oh, wow. And that they stayed up about three hours after the sunset. Okay, so that's why they're getting a little more in winter, because the sun's going down a little earlier. Sun's going down a little earlier. Okay, yeah. Much of those evening hours were spent socializing. And people stayed up as long as they found something interesting going on, or they wanted to participate in, like, storytelling, or singing, or whatever it was. If they went to bed and something caught their attention, they would get back up. Okay. Like, they, you know, "Oh, I'm gonna, I'm not gonna sleep yet." Okay. There was no enforced bedtime for children. Ooh, interesting. Nor was there shushing if people were loud while others slept. Like, there was no anxiety about, like, you're gonna wake them up. You're gonna wake them up. They're sleeping, it's their sleep time now. Interesting, okay. And it's important to remember that these, you know, small-scale subsistence societies, they're not living history.

• 29:09Speaker 01

  Right.

• 29:10Speaker 04

  But they, along with these historical sleep analyses, can provide some interesting insights into the effects of industrialization on sleep. Insights which I think force us to question some of our current assumptions, like artificial light negatively affecting sleep duration. If pre-industrial societies, living without artificial light, are sleeping 5.7 to 7 hours a night, what does that mean for artificial light?

• 29:35Speaker 01

  Right.

• 29:35Speaker 04

  Like, is that the problem?

• 29:36Speaker 01

  Right.

• 29:36Speaker 04

  Is it a contributing problem? Is it a problem in some situations and not others? But there's these like blanket statements that like, it is evil.

• 29:44Speaker 01

  Yeah.

• 29:45Speaker 04

  And it's just really-

• 29:45Speaker 01

  Your screens are destroying your sleep.

• 29:47Speaker 04

  Your screens are destroying your sleep.

• 29:48Speaker 01

  Yeah.

• 29:48Speaker 04

  Maybe they are.

• 29:49Speaker 01

  Yeah.

• 29:50Speaker 04

  Is it the screens or is it the content that you're-

• 29:52Speaker 01

  What we're doing on screen. We talked about that in our circadian rhythm episode.

• 29:56Speaker 04

  Yeah. But if we are sleeping similar amounts as pre-industrial societies, both historical and modern, what's the issue? Like, are we all sleep deprived? Have we as a species been sleep deprived for millennia?

• 30:12Speaker 04

  But like, really?

• 30:13Speaker 01

  Yeah.

• 30:13Speaker 04

  Maybe. I mean, when you consider what we know about sleep in humans, segmented, non-segmented, go to bed soon after sunset or later in the evening, there's one thing, there's one rule that comes out. We are predictably unpredictable sleepers.

• 30:29Speaker 01

  Hmm.

• 30:30Speaker 04

  That's it. Flexibility is built into our sleep, especially when it comes to sleep timing.

• 30:36Speaker 01

  Okay.

• 30:36Speaker 04

  And that is key to what makes us human.

• 30:39Speaker 01

  Oh.

• 30:40Speaker 04

  Yes.

• 30:41Speaker 01

  Okay.

• 30:42Speaker 04

  Over our species' evolutionary history, we spent those evening hours socializing, storytelling, exchanging ideas, building relationships, philosophizing, becoming more human. Research has shown that the topics of nighttime conversations tend to be more abstract and creative.

• 30:59Speaker 01

  Oh, that's so weird and interesting.

• 31:01Speaker 04

  Using things like storytelling. I mean, like, think about when you're like, sitting around a fire.

• 31:05Speaker 01

  Right.

• 31:06Speaker 04

  Yeah.

• 31:06Speaker 01

  The weirder things get. No longer you're awake.

• 31:08Speaker 04

  Uh huh, uh huh.

• 31:09Speaker 01

  Even when there's not alcohol involved.

• 31:11Speaker 04

  Even, even. But during the day, the topics are more, you know, they're, they're more like practical, immediate concerns. How do we solve this problem right now?

• 31:20Speaker 01

  What are we gonna eat for dinner?

• 31:22Speaker 04

  Exactly. Not like, what does dinner mean?

• 31:25Speaker 01

  What is the meaning of life?

• 31:27Speaker 04

  Yeah.

• 31:30Speaker 04

  And maybe in the winter months, we wanted to turn in early and in the cool summer evenings, we huddle around a fire, we stay up late one night and squeeze in a nap the next day. We have different chronotypes. We have day larks and night owls. This is probably a part of this. It was beneficial to have people sleeping and awake at times offset from one another.

• 31:50Speaker 01

  Interesting.

• 31:51Speaker 04

  Continuous predator watch, childcare, things like that. As a species, as individuals, we are flexible sleepers. But that flexibility is no longer serving us well because we live in an inflexible society.

• 32:06Speaker 01

  You have to be at school at 7:20 a.m. or you're getting a tardy slip.

• 32:10Speaker 04

  Yep. And this, in this society, we are also constantly told and constantly feel that we are not getting enough sleep, that it is the source of all of our mental and physical health issues and we need to prioritize sleep. Even though many of us work eight to five or longer and need to commute and need to find time for family and friends and self-care and healthy home cooking and exercise and taxes and home maintenance and a second job. Sleep is often the first thing to go.

• 32:38Speaker 01

  Yeah.

• 32:38Speaker 04

  Especially since sleeping long hours is seen as such a moral failing.

• 32:42Speaker 01

  It is, yeah.

• 32:44Speaker 04

  So echoing the tech bros of today was Thomas Edison, who wrote at the turn of the 20th century, quote, "Most people oversleep 100% because they like it." That extra...

• 32:56Speaker 04

  Yeah.

• 32:57Speaker 01

  How dare you like to sleep?

• 33:00Speaker 04

  Oh my god. "That extra 100% makes them unhealthy and inefficient. For myself, I never found need of more than four or five hours sleep in the 24. I never dream. It's real sleep."

• 33:15Speaker 01

  Like, oh my god, Edison.

• 33:17Speaker 04

  I know, I know. We are always hearing people talk about loss of sleep as a calamity. They better call it loss of time, vitality, and opportunities.

• 33:26Speaker 01

  Oh my god.

• 33:27Speaker 04

  End quote, yeah.

• 33:28Speaker 01

  I'm so over him.

• 33:29Speaker 04

  Okay, but the thing is, he had cots in every room of his office building.

• 33:35Speaker 01

  So he could do little naps? Are you serious?

• 33:37Speaker 04

  Hundred percent.

• 33:38Speaker 01

  Because he was only sleeping four or five hours a night, bro?

• 33:40Speaker 04

  Right, and he was getting the other four or five around his office. Ah, yeah. But it's, it is like, that sentiment is such an American business industrial sentiment with Protestant roots. Like, if you aren't working or praying, you're commuting with the devil, for sure.

• 33:56Speaker 01

  What are you doing?

• 33:57Speaker 04

  There is so much toxicity surrounding competitive sleeplessness. Like, oh, I only need to get this many hours. And I think that sacrificing sleep has not only become normalized but idealized. Like, we can function on this. But this, what is the truth is that we are set to fail right from the beginning. Who genuinely feels most days that they are getting enough sleep and have enough time to do everything that they want and need to do, all while not feeling utterly exhausted? No one.

• 34:28Speaker 01

  Not me.

• 34:29Speaker 04

  Does anyone feel that way?

• 34:30Speaker 01

  Someone might.

• 34:32Speaker 04

  The medicalization of sleep, where sleep became an object to be managed or optimized or treated, rather than the restorative process it once was. This happened over the course of the Industrial Revolution. And it is in full swing today. During the 1800s, sleep grew more interesting to those titans of industry who wanted to maximize worker productivity. And sleep, capitalism, labor, and medicine all became intertwined. Medical discussions of sleep took on a more industrial tone. So it would be like, the more active the mind, the greater the necessity for sleep. Just as with a steamer, the greater the number of revolutions the engine makes, the more imperative is the demand for fuel.

• 35:12Speaker 01

  Okay.

• 35:12Speaker 04

  It's like, let's talk about it. Trains, steamers, whatever.

• 35:17Speaker 01

  Because that's what we are.

• 35:18Speaker 04

  We are machines.

• 35:19Speaker 01

  Yeah.

• 35:19Speaker 04

  Yeah.

• 35:19Speaker 01

  Yeah.

• 35:20Speaker 04

  Sleep transformed from a personal issue to a matter of public health. Something unruly to be brought to heel.

• 35:27Speaker 01

  Interesting.

• 35:27Speaker 04

  You're staying up too late. You're sleeping in too long. You are going to bed too early.

• 35:33Speaker 01

  It's the video games.

• 35:34Speaker 04

  It's the video games. It's the cell phones. It's the, you know, the books.

• 35:38Speaker 01

  Oh.

• 35:39Speaker 04

  The books. Yeah, yeah. Although I do, I have stayed up way too late, reading books.

• 35:43Speaker 01

  Okay, but when they're really good, you have to.

• 35:45Speaker 04

  Hundred percent. And then with the development of the EEG in the 1930s, it became something that you could objectively measure. You could assess sleep duration before, of course. But like, this was a whole new dimension.

• 35:58Speaker 01

  Yeah.

• 35:59Speaker 04

  And with that came conflict. How do you determine sleep quality? Is it based on the EEG or how well rested someone feels? Is it based on their duration? Or whether they feel like they got enough sleep? How do you define insomnia? Sleeping less than the recommended amount? Or wanting to sleep more, but not being able to? The medicalization of sleep, which continued over the 20th century, it led to this very narrow picture of normal sleep. And with that in place, medicine could now, number one, identify pathological deviations from that norm. And two, develop treatments or therapies with the aim

• 36:41Speaker 04

  of returning someone to quote unquote, "normal" sleep. At the same time, the EEG had shown a sleeping person to be really a world unto themselves, not influenced by environmental stimuli, meaning that interventions needed to be at the personal level. They were someone's personal responsibility.

• 37:01Speaker 01

  Ah, this is a you problem.

• 37:03Speaker 04

  This is a you problem.

• 37:03Speaker 01

  It's not an us problem.

• 37:05Speaker 04

  Forget the inflexible eight to five. Forget capitalism wanting to extract every drop of productivity out of their workers. Forget the moralizing over too much sleep. Forget the extremely narrow definition of what ordered sleep feels like. If you don't fit that picture, you either need to change something about yourself or get a special lamp or take meds or something.

• 37:24Speaker 01

  Yeah.

• 37:24Speaker 04

  But it is you. It is on you. Yeah. And the sad reality is that society is unlikely to change to accommodate human sleep flexibility, the non-pathogenic variation within our species. We have variation. It does not mean that you are wrong

• 37:40Speaker 01

  A problem.

• 37:40Speaker 04

  or broken or disordered. Yes. And there is disordered sleep.

• 37:43Speaker 01

  Oh, definitely.

• 37:44Speaker 04

  I'm not saying that there isn't.

• 37:45Speaker 01

  Yeah.

• 37:46Speaker 04

  But what I'm saying is that like, we have, do we feel like we have to fit ourselves into that rigid structure of going to bed at 10, waking up at 6, feeling super well rested, not having any naps, because who needs naps? Naps are for the lazy, right?

• 37:59Speaker 01

  I can't wait to talk more about naps.

• 38:01Speaker 04

  I mean, there are also, like, I didn't get into this, but there are like, there was a big push for certain companies to adopt, like, napping flexibility to increase productivity, of course.

• 38:11Speaker 01

  It's always about productivity.

• 38:12Speaker 04

  Always about productivity. Yeah. But, but also, I think it did have a relationship.

• 38:17Speaker 01

  There's so much good data that allowing naps increases productivity.

• 38:21Speaker 04

  Yes. Yes. Just like working from home. Yeah.

• 38:26Speaker 04

  But when we, when we fail to get that solid eight hours uninterrupted beauty sleep, when we feel tired, when we struggle to fall asleep, we might feel like a failure. And the medicalization of sleep has been a great thing, right? It has helped us to diagnose and treat people who are suffering from disordered sleep. It's allowed us to define what disordered sleep is, and it gives people solutions when they are especially desperate to actually get some sort of rest. It's been a real lifesaver when it comes to sleep apnea, for example, huge. It has helped us to better understand the negative consequences of sleep deprivation, which are very real and serious, and the importance of getting adequate sleep. But it has also given us this very narrow definition of normal sleep,

• 39:11Speaker 04

  leading us to over-pathologize and over-treat, especially with the direct-to-consumer marketing of sleep medications that convince us that we're all overtired or not getting enough sleep. What even is excessive daytime sleepiness, anyway?

• 39:26Speaker 01

  It's got actual definitions.

• 39:27Speaker 04

  I know that it does, but it's like, the commercials don't say what it is. They're just like, are you tired?

• 39:32Speaker 01

  Yeah.

• 39:33Speaker 04

  Buy this medication.

• 39:34Speaker 01

  I am.

• 39:34Speaker 04

  Ask your doctor about.

• 39:36Speaker 01

  I'm always tired.

• 39:36Speaker 04

  Yeah, exactly.

• 39:37Speaker 01

  Yeah, I know.

• 39:37Speaker 04

  Exactly.

• 39:38Speaker 01

  I know.

• 39:39Speaker 04

  And we start our obsession with sleep from a very young age. Like, what proportion of kids' books are about sleep and needing to sleep?

• 39:45Speaker 01

  I've read so many of them.

• 39:47Speaker 04

  So many.

• 39:47Speaker 01

  Hello, I was tracking my child's sleep.

• 39:49Speaker 04

  Yep, yeah.

• 39:50Speaker 01

  Yeah.

• 39:51Speaker 04

  And so.

• 39:51Speaker 01

  It consumes.

• 39:53Speaker 04

  It's consuming.

• 39:54Speaker 01

  The parents of newborns, especially right now.

• 39:56Speaker 04

  Sleep schedules.

• 39:57Speaker 01

  Because there's such a market for it.

• 39:58Speaker 04

  There's so, there's such a market.

• 39:59Speaker 01

  What is your baby's wake window, etc. Woah! It makes me, like, viscerally upset.

• 40:04Speaker 04

  Well, I think because sleep is and should be a restful thing. It's a restorative process. But now it has become a stressor rather than a stress reliever. And it creates the cycle where the more that we worry about sleep, the worse sleep we get.

• 40:20Speaker 01

  Yep.

• 40:20Speaker 04

  And it's clear that many people around the world struggle with sleep, myself included. And maybe those issues are the result of our genetics, our individual choices, our life stage, our stress levels, our inflexible society, or all of the above.

• 40:33Speaker 01

  All of the above.

• 40:34Speaker 04

  But I feel like one thing that I really took away from this and found helpful is that achieving society's definition of "ideal" sleep, quote unquote.

• 40:42Speaker 01

  We'll get into it.

• 40:43Speaker 04

  Night after night after night, it's probably a losing battle. And variation is normal. It is the norm. The average is not necessarily the ideal. Just like how few people actually have 28-day menstrual cycles? Who actually gets eight hours of sleep on average a night with this much deep sleep and this much REM?

• 41:04Speaker 01

  Yeah.

• 41:05Speaker 04

  And so on and so forth. Erin, maybe you'll tell me the answer.

• 41:08Speaker 01

  Well, no.

• 41:12Speaker 04

  Well, tell me some things, anyway.

• 41:13Speaker 01

  I can't wait to. Especially to get more into naps and split sleep and how we define good, what is quality sleep?

• 41:21Speaker 04

  What is it?

• 41:23Speaker 01

  Let me tell you.

• 41:24Speaker 04

  Who gets to say that?

• 41:25Speaker 01

  Let me tell you. Okay.

• 41:29Speaker 01

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• 42:14Speaker 01

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• 42:27Speaker 02

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• 42:46Speaker 05

  Man, I'm a Black and Mexican kid from San Pedro, and I grew up in Inglewood as well. I never liked to be boxed in. Both of my parents colored outside of the line. I mean, even them being together at the time in L.A. was just not typical. And so I think that has always been a part of my DNA. There's a defiant something in me that feels like what we get to do with what we're given that's greater than us is to maybe connect people to ideas that they wouldn't naturally, you know, connect to. That's really me. I'm just kind of defiant with love, though.

• 43:22Speaker 02

  Experience Before the Moment, a Lincoln original series on the iHeartRadio app, YouTube, or wherever you get your podcasts.

• 43:46Speaker 01

  Since the 1980s, it's estimated that on average in the US, sleep duration has declined from closer to an average of seven and a half hours per night to just over seven hours. So we've lost a half an hour of sleep. In that same time period, the prevalence of adults who report sleeping less than six hours per night has increased from 22% to 32% between 1985 and 2017. So more people are sleeping less than six hours a night, and on average, we're sleeping 30 minutes less than we used to.

• 44:23Speaker 04

  Mm-hmm.

• 44:24Speaker 01

  And like you mentioned at the top, as of 2012 at least, it's estimated that between 50 and 70 million Americans, which if you extrapolate that out globally is billions of people worldwide, are estimated to have some type of chronic sleep disorder. But is that true globally? I don't know.

• 44:43Speaker 04

  Yeah.

• 44:44Speaker 01

  Because there was a paper from the UK that actually suggested that we haven't changed, or at least there, they haven't really changed much in their sleep duration. Between the 1970s and now, if anything, sleep duration maybe increased by a few minutes on average.

• 45:00Speaker 04

  So what is that sleep duration?

• 45:01Speaker 01

  Around that seven and a half hour mark.

• 45:02Speaker 04

  Seven and a half hours.

• 45:03Speaker 01

  Still around that seven and a half hour mark.

• 45:04Speaker 04

  Okay.

• 45:05Speaker 01

  But studies out of Finland and Sweden are slightly more in line with US numbers, that maybe over the last 30, 40 years, we've lost a few minutes of sleep on average per night. Sleep duration is getting quote unquote "worse" rather than quote unquote "better."

• 45:17Speaker 04

  Yeah.

• 45:18Speaker 01

  Now, there is no doubt, and I don't want to underemphasize this, that there are substantial individual and public health consequences of a lack of sleep.

• 45:27Speaker 04

  Absolutely.

• 45:28Speaker 01

  So you were asking, like, what do we, like, why is this eight hours, why is this a magic number? It's really, I think, it mostly comes from the data that we have, that when people get consistently less than seven hours of sleep per night...

• 45:44Speaker 01

  They have some negative consequences in both the short term and the long term. But this is a U-shaped curve. So we see that people who are consistently sleeping less than seven hours or more than eight or nine hours all have long-term health consequences.

• 46:02Speaker 04

  Ah, but Erin, like, what about, what is normal for one person? You know what I mean?

• 46:08Speaker 01

  Right, it's going to depend.

• 46:09Speaker 04

  Exactly.

• 46:10Speaker 01

  And that's why it's always also a range. Like, it is, all of the literature is like, it is a range.

• 46:13Speaker 04

  No, I know.

• 46:14Speaker 01

  And it's, a lot of the data on like, people who are getting short-duration sleep, the people who are getting short sleep are actually usually getting less than five hours. Even though they then lump them with people who are getting less than seven hours. If that makes sense.

• 46:28Speaker 04

  Yes.

• 46:29Speaker 01

  So they get lumped together as this less than seven hours, but most of them are actually getting less than five.

• 46:35Speaker 04

  I mean, I, okay, I, I understand all that, but it like, it, again, we are, like, in last episode, you talked about how, how much sleep one individual person needs is highly variable and is very individual.

• 46:48Speaker 01

  And throughout their lifetime as well.

• 46:49Speaker 04

  Throughout their lifetime and blah, blah, blah. But we're still making as like, these public health guidelines that are like, if you are getting more than eight or nine hours of sleep, that's bad for you. But what if someone, like, there are people who, is that what they need?

• 47:01Speaker 01

  Well, and-

• 47:02Speaker 04

  As an individual level or in their life stage?

• 47:04Speaker 01

  That's also, that also is, we think that a lot of that, especially when it comes to long sleep, like, people who are sleeping longer than nine hours on average, is that actually reverse causation? Is there something going on that is a health consequence?

• 47:18Speaker 04

  Yes.

• 47:18Speaker 01

  And the sleep is a consequence of that health, like, problem or whatever?

• 47:22Speaker 04

  Right.

• 47:22Speaker 01

  Rather than the sleep being the cause of any of these health problems.

• 47:26Speaker 04

  Yeah.

• 47:27Speaker 01

  We, so we don't really know. But there has even been studies that have shown just an increased risk of all-cause mortality with sleep less than five hours and with sleep more than nine hours.

• 47:37Speaker 04

  I mean, less than five is very short.

• 47:39Speaker 01

  It's very short, exactly. But again, they often lump, it is less than seven or less than five. So it, they, like, in these studies, they kind of group them in that way.

• 47:47Speaker 04

  These are big boxes.

• 47:48Speaker 01

  Big boxes. Acutely, we know that 24 hours of sleep deprivation is equivalent to a blood alcohol level of like 100 milligrams per deciliter, which is like a 0.1 on a breathalyzer. Yeah. A reminder that legal limit in the US is 0.08 and you are impaired at like 0.05 for the most part. But the long-term effects are also very serious. So I want to kind of get into a little bit of what we see, these like, what are these? Okay, I said there's negative health effects of short sleep. Yeah. What are they really? We, we definitely see increases in fatal accidents, especially car accidents, but also workplace accidents, whether that's like making mistakes at work that put other people

• 48:29Speaker 01

  at risk or getting like, getting your arm cut or like having an accident in your workplace. Right. And these are largely driven by impairment in performance and awareness that comes with this sleep deprivation, right? We talked about how it affects your ability to like react to things. Reaction time and yeah. And all of that. Attentiveness. Attentiveness, exactly. But we also see big increases in risks of cardiovascular disease. So that's heart attacks, stroke, heart failure. We see increases in high blood pressure. We see increases in diabetes. We don't know the exact mechanisms of this, but we think that it's related to effects on our metabolism as well as insulin resistance. And then maybe something about like variations in blood pressure and things that happen

• 49:14Speaker 01

  with sleep. So if we're getting short sleep, again, that less than five-ish, five to seven hours of sleep per night, we see increases in risk of all of these diseases. We talked in our circadian rhythm episode about the very strong associations between shift work, which tends to result in sleep deprivation. Yep. And increased risk of cancers. Yeah. And we don't really know the mechanisms there, but we also see, we know that sleep has a huge effect on our immune system. And so a lack of sleep can increase inflammatory markers and things like that. And we see sleep affected in a variety of ways, in a variety of psychiatric and neuropsychiatric disorders. Right. Including depression, bipolar, anxiety, and dementia.

• 49:59Speaker 01

  Sleep architecture is huge. Usually affected in dementia, is it causal?

• 50:03Speaker 04

  Is it cause?

• 50:03Speaker 01

  Is it consequence?

• 50:04Speaker 04

  Exactly.

• 50:05Speaker 01

  We have no idea.

• 50:06Speaker 04

  Right.

• 50:06Speaker 01

  But we know that it's like very involved.

• 50:08Speaker 04

  That's like, and that's what, yeah, there's like, ah, this is where the headlines, I feel like, are really frustrating because it's like, we know, for instance, in Parkinson's disease, that sleep disruption is one of the earliest symptoms. And it's usually something that you only look back on and go, oh, yeah.

• 50:23Speaker 01

  Yep. Just like constipation, actually.

• 50:26Speaker 04

  Just like constipation. But I feel like there are headlines that then suggest that like, if you aren't, if you are not getting sleep, you are...

• 50:34Speaker 01

  You're at risk of these disorders.

• 50:36Speaker 04

  Right. And it's like, is that, is that true?

• 50:38Speaker 01

  We don't know.

• 50:39Speaker 04

  What role does it play?

• 50:39Speaker 01

  Right.

• 50:40Speaker 04

  Yeah.

• 50:40Speaker 01

  Yes, you're right. Like, we, we don't really know, especially when it comes to like causal versus consequence and things like that. I also do want to just point out that there's also a lot of data that shows, especially in the US, that there's huge socioeconomic and racial disparities in who is getting quote unquote enough sleep.

• 50:57Speaker 04

  Right. Who's having to work two jobs, three jobs,

• 51:00Speaker 01

  Exactly.

• 51:00Speaker 04

  and have to do childcare. It's like, yeah.

• 51:02Speaker 01

  Right. So who is at risk for sleep deprivation or having short sleep? And because we know that short sleep is associated with a lot of the same health outcomes that we see huge disparities in terms of race and socioeconomic when it comes to things like heart disease, diabetes, blood pressure, these things that are also related to sleep. Like, you can't really disentangle those things very easily. But there's a few big caveats, I feel like, to all of this. And you pointed out so many of them already in what you were talking about. First is that whether we have this number of seven to eight hours. Because again, that is what this, like, kind of large scale data all converges on,

• 51:44Speaker 01

  that less than seven-ish hours, more than eight-ish hours, we see more negative health consequences. So that means that the ideal for adults is seven, eight-ish hours. Does it have to happen all at once? Or can a split sleep schedule?

• 51:59Speaker 04

  Yeah.

• 51:59Speaker 01

  Can siestas or naps or repouses, can that count? And there's not a ton of data on this, but the data that... Has actually looked at it, studies that have looked at like a split sleep schedule or looking at naps. They absolutely count.

• 52:14Speaker 04

  Yeah.

• 52:15Speaker 01

  So it is not about getting seven uninterrupted hours of sleep. It is seven total hours of sleep in a 24 hour period. And we know that especially in the cases of things like shift work where you can't avoid the fact that you only have this number of hours between work or whatever. That having naps can have a huge increase in performance, decrease in accidents, like it really improves outcomes. But the other thing is that if we need seven to eight hours. It needs to be good quality sleep too.

• 52:51Speaker 01

  But all of the data that we have on the negative effects of sleep really rely largely with a few exceptions on total duration of sleep. It's all about sleep deprivation, right? Where it's like, we know that if you're not getting enough hours of sleep. You're having these negative health income outcomes. We don't have nearly as much data on what makes good sleep, good sleep.

• 53:16Speaker 04

  Okay, but I have, I have like just a question or a thought to, because we're talking about how sleep deprivation, duration, et cetera. And I think that there's, and you pointed this out, that there are people who are at risk of sleep deprivation because of life circumstances, because of jobs, because of et cetera. Like all these different aspects, so they are not able to achieve eight hours of sleep.

• 53:40Speaker 01

  At least not eight hours continuously.

• 53:41Speaker 04

  Right, they like, let's say those eight hours are not available to them. But there's a difference between that person who's sleeping six hours, or is there a difference, I guess is my question, between that person who can only sleep six hours because of external life circumstances. Versus someone who can only sleep six hours even though they want to and have the space to sleep eight.

• 54:00Speaker 01

  That's a great question, Erin. I don't, we don't have that level as far. As I found in the literature, we don't have that level of disentanglement.

• 54:07Speaker 04

  Because I feel like this is where some of it comes into play, where is it like not being able to achieve those eight hours. Is it?

• 54:13Speaker 01

  Right. Why?

• 54:14Speaker 04

  Right.

• 54:15Speaker 01

  Is it because you are dealing with insomnia and you are trying to fall asleep, but you cannot?

• 54:19Speaker 04

  Right.

• 54:19Speaker 01

  Or is it because you get home at 10:00 PM and your next shift starts at 5:00 AM?

• 54:24Speaker 04

  Yeah.

• 54:24Speaker 01

  Right. I don't know. We don't have.

• 54:27Speaker 04

  Okay.

• 54:27Speaker 01

  Because again, these are like, yeah, it's a really good question.

• 54:30Speaker 04

  Ah, yeah, there's just so much. Okay.

• 54:32Speaker 01

  Because those are two different, that is two different issues that we're dealing with.

• 54:35Speaker 04

  Yeah.

• 54:35Speaker 01

  And yet the outcome is the same. You are getting less hours of sleep.

• 54:38Speaker 04

  You're getting less hours, but is the consequence of that outcome, like, does that, does that have the same effect?

• 54:43Speaker 01

  As far, as far as we know, on the big scale data, yes.

• 54:46Speaker 04

  Just period. It's like you're not getting enough sleep.

• 54:48Speaker 01

  You're not getting enough hours.

• 54:48Speaker 04

  Okay. Well, let's talk about quality then.

• 54:50Speaker 01

  So how do we define quality sleep? According to Big Sleep, just kidding. I just wanted to call that, that's the National Sleep Foundation. But you know, everyone's into big so and so.

• 55:00Speaker 04

  Yeah, yeah.

• 55:00Speaker 01

  So according to the National Sleep Foundation, uh, there was a paper, I think it was from 2017. I'll have to check my notes, but they came out with this big guideline, basically on like, how are we going to define quality sleep? How, how do, how do we actually do this? What, what counts as quality, good quality sleep? Um, and I'm not going to go nitty gritty in the details, but you, you can read the exact paper to really, because they go line by line on like, what do you need to have for this to be good sleep? Or what metric would qualify as poor quality sleep? The gist of it is, like, big scale, we should be falling asleep relatively quickly, which means within 15 to 20 minutes. Not too quickly. Like if you're falling asleep within two to five minutes, less than eight minutes, that might be a sign that you had sleep deprivation.

• 55:45Speaker 01

  And so your sleep drive is too strong. So you're falling asleep too fast. I'm sorry.

• 55:49Speaker 04

  I know. It's just like, I don't know. I just, I'm still on the whole like should, should, should. Here's the ideal.

• 55:56Speaker 01

  It gets better.

• 55:56Speaker 04

  You are wrong if you don't do this.

• 55:58Speaker 01

  Like, can we keep going? Because it's going to get even better.

• 56:00Speaker 04

  Please.

• 56:01Speaker 01

  Meaning you're going to get even more mad.

• 56:02Speaker 04

  I'm annoyed. Yeah.

• 56:05Speaker 01

  We, we should be falling asleep relatively quickly. We should not be waking up more than once per night. Certainly, we should not be awake for more than 20 minutes total after we fall asleep. Just let me finish and then we'll get into it. Our REM sleep, this gets a little more into sleep architecture and who's able to measure this. Our REM sleep should be about 20 to 30% of our total sleep duration and our deep sleep should be about 15 to 20%.

• 56:33Speaker 01

  Okay.

• 56:33Speaker 04

  Fifteen to twenty?

• 56:35Speaker 01

  Fifteen to twenty percent. Now, these are the consensus guidelines. This is the consensus. These are the averages that they came to. Even in this document, they have these like graphs for each of these and they have dotted, like, it's like a bar graph where it's like filled in versus dotted versus blank. And the dotted area is the quote unquote disagreement. And that's like most of these graphs, meaning that even among the experts, they could not agree on like, should it be twenty percent or should it be thirty percent? Should it be fifteen minutes or should it be twenty minutes? Like, we really don't know. And yet, they're trying to come up with these guidelines on how, what counts as good quality sleep? How are we going to measure this in like clinical studies? Not, how should you be measuring it on your rings and things?

• 57:18Speaker 04

  Right. Okay. Okay.

• 57:19Speaker 01

  Can I? There's one more.

• 57:20Speaker 04

  Yes, please, please.

• 57:21Speaker 01

  There's one more. Because this, I think, is so important in the context of everything that you're talking about.

• 57:25Speaker 04

  Uh huh.

• 57:26Speaker 01

  According to these guidelines, if you are napping during the day and you're not a baby, that is an indicator of poor sleep quality, especially if you're napping for more than like ninety to a hundred minutes, AKA one full sleep cycle.

• 57:39Speaker 04

  Ah.

• 57:42Speaker 04

  Okay.

• 57:43Speaker 01

  Okay. Go ahead.

• 57:43Speaker 04

  So, here's the thing.

• 57:45Speaker 01

  Uh huh.

• 57:49Speaker 04

  Where do I begin?

• 57:50Speaker 01

  Where do you begin?

• 57:51Speaker 04

  They have different, all of these different metrics.

• 57:54Speaker 01

  Uh huh.

• 57:54Speaker 04

  And this is what you should do and this is what you shouldn't do.

• 57:57Speaker 01

  Yes.

• 57:59Speaker 04

  And why shouldn't you do those things?

• 58:00Speaker 01

  Mm hmm.

• 58:01Speaker 04

  That means that you get bad sleep? What does bad sleep mean? How is this measured? What about the piece? What about the picture of all of these things together?

• 58:09Speaker 01

  Correct.

• 58:09Speaker 04

  Why is napping bad? That feels very like industrial revolution.

• 58:14Speaker 01

  Doesn't it?

• 58:15Speaker 04

  More moralizing.

• 58:16Speaker 01

  And you should not be awake for more than twenty minutes at night. So that means that a split sleep schedule, a biphasic sleep schedule, would be an indicator of poor quality sleep, according to these guidelines.

• 58:26Speaker 04

  I don't, it's just, there's something about sleep that makes me feel so, I think maybe because like I feel such anxiety about sleep, that I am, because all of these things, like, I'm not getting good quality sleep on this or that.

• 58:37Speaker 01

  According to these metrics.

• 58:38Speaker 04

  But there are days when I feel great and I feel super well rested. But I'm like, but is this going to make me more vulnerable to infections? Or am I going to get dementia or whatever? All these different things. And it just feels like so much pressure.

• 58:51Speaker 01

  Yes.

• 58:51Speaker 04

  To do the right thing.

• 58:52Speaker 01

  Yes.

• 58:52Speaker 04

  And there's no... There's no salute, there's like very few solutions.

• 58:57Speaker 01

  Yes.

• 58:57Speaker 04

  Or there's solutions in the forms of pharmaceuticals, which like work for some people, don't work for others.

• 59:02Speaker 01

  And most of them are highly addictive, where you cannot then sleep without it. They're also altering our sleep architecture.

• 59:09Speaker 04

  Yep.

• 59:09Speaker 01

  Um, like there's a lot of downsides of a lot of the medicines that we use to help people sleep. And most of them are not indicated to be used in the long term.

• 59:18Speaker 04

  At the same time, like there is, okay. At the same time, many people aren't getting the sleep that they should be getting.

• 59:28Speaker 01

  Mm hmm.

• 59:29Speaker 04

  And part of that is maybe it's individual choices, but part of it is also because of the, how the way that society is functioning.

• 59:34Speaker 01

  Yep, yep.

• 59:35Speaker 04

  And so there's, there is no solution.

• 59:38Speaker 04

  Right?

• 59:39Speaker 01

  But it's so, I just think that these guidelines in particular are so interesting. If we really pull back and look at this like big picture evolutionary context. And they still largely are driven based on data about sleep deprivation and things. Because we see that like if people are sleep deprived, or they're not getting a lot of deep sleep or things like that during a sleep, then they're going to have, say, an increased, or rather, a decreased sleep latency. So like the next night, they're going to fall asleep a lot quicker, right? And so that is where, it's not like this data comes out of nowhere. They're not making it up.

• 1:00:12Speaker 04

  No.

• 1:00:13Speaker 01

  But it, it is, it's all very messy. And it's all based on how we live today. And I read one paper that was like, honestly, to, to look at how humans sleep today is like looking at lab rats in a lab. It's not like looking at natural rats in their habitat, because we live in labs, basically. Which I thought was so interesting.

• 1:00:32Speaker 04

  Well, and so much of the sleep treatments, or how sleep disorder is, is defined, or characterized, or how people feel like they're not getting enough sleep, is because I can't fall asleep at this time, the way that I, that everyone else is.

• 1:00:44Speaker 01

  I think I should.

• 1:00:45Speaker 04

  Yes.

• 1:00:45Speaker 01

  Right.

• 1:00:46Speaker 04

  And a lot of the treatments then, like I was, I didn't talk about any of this, but there was a book that I read that discussed this and did a lot of case studies. And kids who like, there were a few kids that were like, I can't, they could not stay awake during the day. And their tactic was to make them go exercise during that time. It would be like, you have to. Walk on this treadmill, you have to get on this exercise bike instead of like letting this kid nap.

• 1:01:08Speaker 01

  Take a nap?

• 1:01:08Speaker 04

  Yeah.

• 1:01:09Speaker 01

  Oh my gosh.

• 1:01:10Speaker 04

  And same thing, like somebody was like, I had to quit my job and find a more flexible job because I could not wake up or I could not sleep at whatever it is.

• 1:01:17Speaker 01

  Right.

• 1:01:18Speaker 04

  And but it's like in those situations or like I was on this medication that allowed me to sleep during these times when society was telling me to sleep.

• 1:01:26Speaker 01

  Yeah, that I had to sleep then.

• 1:01:28Speaker 04

  But it's just like, it shows such a bias towards what we define as ideal sleep.

• 1:01:34Speaker 01

  Right.

• 1:01:34Speaker 04

  And the way that medicine and and capitalism are

• 1:01:37Speaker 01

  Yeah.

• 1:01:38Speaker 04

  Hand in hand in this.

• 1:01:39Speaker 01

  Oh, 100%.

• 1:01:40Speaker 04

  Yeah.

• 1:01:41Speaker 01

  It's so, it's so, so, so interesting. Like, I, I, I feel like this has changed the way that I think about sleep.

• 1:01:48Speaker 04

  Totally.

• 1:01:48Speaker 01

  Um, it's really interesting, but at the same time, at the same time, there are quite a lot of sleep disorders.

• 1:01:55Speaker 04

  Yes.

• 1:01:56Speaker 01

  Um, and again, we do need sleep and it seems that on average, on average, we need somewhere between seven and eight hours as adults. You could maybe say six to eight hours.

• 1:02:06Speaker 04

  I just find that so interesting. Yes, six to eight. But like historically and then, you know, pre-industrial societies today, getting, getting five to seven or five point seven to seven.

• 1:02:17Speaker 01

  Yeah, so that's pretty close to six to seven.

• 1:02:19Speaker 04

  But like six to seven today is like, that would be low.

• 1:02:23Speaker 01

  I think in medicine, no, in medicine, that's usually considered pretty.

• 1:02:27Speaker 04

  But you were talking about short sleep being less than seven.

• 1:02:29Speaker 01

  Well, again, because they lump, most of them are getting less than five. I feel like seven is the number that is most common. So you're right, six would be probably considered not enough today.

• 1:02:38Speaker 04

  Right.

• 1:02:39Speaker 01

  Yeah, but it's all on average too, right?

• 1:02:43Speaker 04

  I know.

• 1:02:43Speaker 01

  And if they're getting more in the winter, but we're not because why is it the fluorescent lights? I don't know. It's a little bit of a mess, but there are a lot of sleep disorders and they're all really important and they all deserve their own episode, which we're not doing today.

• 1:02:56Speaker 04

  We will be doing narcolepsy, we will be doing insomnia, we will be doing.

• 1:02:59Speaker 01

  Sleep apnea.

• 1:02:59Speaker 04

  Sleep apnea, we should do that one soon.

• 1:03:02Speaker 01

  We should because we can, like you're saying, kind of group those, those are three of the big categories really, or they fit into three categories of sleep disorders. So I'll mention a few of the biggest ones just so that people know like how we define these big scale. Insomnia is probably the first one that people think of if we think of like sleep disorder. Maybe, I don't know, a lot of people. And there's different ways to define it if you're dealing with, you know, a little bit of insomnia, meaning like acute insomnia, jet lag versus chronic insomnia. But usually it's either not being able to fall asleep or not being able to stay asleep once you're asleep, which again is so interesting in the context of this idea of biphasic sleep.

• 1:03:40Speaker 04

  Insomnia, yeah, yeah.

• 1:03:41Speaker 01

  And it's estimated that at least in the US, anywhere from 10 to 20% of adults have either chronic insomnia or intermittent issues with insomnia.

• 1:03:49Speaker 04

  So many.

• 1:03:50Speaker 01

  10% chronic, 20% intermittent. We talked again in our circadian rhythm episode about circadian rhythm sleep disorders, which is, you know, whether you, whether it's just a mismatch between what your job or your environment requires, or because you have to do shift work, whatever it is.

• 1:04:07Speaker 04

  Yeah.

• 1:04:07Speaker 01

  Whether you're a teenager and your school starts at 7:00 AM, but you have shifted to be a night owl. So that's a whole nother set of sleep disorders. Then there are sleep-related breathing disorders like obstructive sleep apnea, which, and this is where I think we can get a lot of data about sleep quality, because sleep apnea is not necessarily changing your sleep duration at all, but it results in fragmented sleep because you are frequently arousing during sleep.

• 1:04:33Speaker 04

  Yep.

• 1:04:33Speaker 01

  And you're basically going from non-REM sleep to awake for very short periods. You might not even ever be aware that you're doing it, but your brain is doing it on top of the fact that you are not breathing, so your body and brain are not getting oxygen.

• 1:04:48Speaker 04

  Yes, alert, alert.

• 1:04:50Speaker 01

  That's why you wake up.

• 1:04:52Speaker 04

  Yes.

• 1:04:53Speaker 01

  And so that has huge consequences, especially on things like cardiovascular disease, high blood pressure, diabetes, metabolic syndrome, all those things. So obstructive sleep apnea is a very serious disorder, and it's estimated to affect close to 15% of adults in the US, 15%.

• 1:05:09Speaker 04

  Such a high number.

• 1:05:11Speaker 01

  And then there's the opposite end of the spectrum, which are disorders of central hypersomnia like narcolepsy, which is the most well-known. And that results in sleep attacks during the day and this interrupted, more fragmented and less consolidated sleep at night. We also see, especially with narcolepsy, we see what's called cataplexy, where you have the muscle atonia that we usually associate with REM sleep.

• 1:05:35Speaker 04

  Yep.

• 1:05:35Speaker 01

  That is associated by emotional arousal, or sometimes just happens randomly.

• 1:05:39Speaker 04

  Yes, okay.

• 1:05:40Speaker 01

  Inappropriate times, meaning not while you are asleep.

• 1:05:43Speaker 04

  Right.

• 1:05:44Speaker 01

  And then we have, there's other hypersomnes as well. And then there's things like parasomnes, which we see with things like Parkinson's. Or we have sleep-related movement disorders like restless leg. Like, there are a lot of sleep disorders that are affecting people's duration and quality of sleep, even though we don't have great metrics to kind of look at all of that.

• 1:06:03Speaker 04

  Yeah.

• 1:06:04Speaker 01

  And then what I think is interesting is part of what you were saying, Erin, is that there's often a disconnect between what our watch says

• 1:06:12Speaker 04

  Yeah.

• 1:06:13Speaker 01

  and what we feel.

• 1:06:14Speaker 04

  What feels normal.

• 1:06:15Speaker 01

  Right.

• 1:06:16Speaker 04

  And how we can, I feel like that is something that I struggle with sometimes. Like, is the tiredness I'm feeling excessive daytime sleepiness?

• 1:06:22Speaker 01

  Is it excessive daytime sleepiness?

• 1:06:23Speaker 04

  Or am I just like-

• 1:06:24Speaker 01

  Is it fatigue, which is different than sleepiness?

• 1:06:27Speaker 04

  Different. Yep. Or am I just like, you know, it's a down period or whatever?

• 1:06:32Speaker 01

  Yeah.

• 1:06:33Speaker 04

  Like, there's so many things.

• 1:06:34Speaker 01

  There's so many things.

• 1:06:35Speaker 04

  And am I just sitting at my desk for 12 hours a day?

• 1:06:36Speaker 01

  Right. And we can often see big, like, disconnects in terms of how much sleep someone is getting, if we're measuring it, and how much sleep they feel like they're getting, how rested they feel in the morning. So, like, all of that is hugely important. And the less sleep that we get, actually, especially acutely, we know this more from acute data, we are less good at recognizing our own deficits, much like with alcohol, right? Once you're drunk, you don't realize how drunk you are. Once you are sleep deprived, you don't necessarily realize how sleep deprived you are.

• 1:07:13Speaker 04

  Interesting.

• 1:07:14Speaker 01

  Yes. Especially, we have a lot of data on that in the acute term.

• 1:07:17Speaker 04

  Can you say more about that?

• 1:07:18Speaker 01

  Yeah, so like, someone who has been sleep deprived for, let's say, 24 hours or something like that, we know that they're like, blood, it's like they are drunk, right?

• 1:07:27Speaker 04

  Yes.

• 1:07:28Speaker 01

  But they think, often, that they are perfectly capable of making sound and rational decisions, and that there is no impairment in their decision-making. And it's not because they don't logically know that it, that sleep deprivation affects them, it's because in that moment, there's like a disconnect. You're not recognizing your own impairments. Probably because of those impairments, right? Like, that's why you have to hide the bowl of keys so that you, even though you know you shouldn't drink and drive, someone is going to grab those keys because once they are drunk, they're impaired in their decision making.

• 1:07:59Speaker 04

  Rational decision making.

• 1:08:00Speaker 01

  Right.

• 1:08:01Speaker 04

  Okay, so I have a question about sleep deprivation and trends. So like, one night is not sleep deprivation if you can get sleep the following. Like, it is, it's acute sleep deprivation, but like, I guess I'm wondering about like, what is chronic sleep deprivation? When we talk about, oh, you should be getting this many hours of sleep a night.

• 1:08:19Speaker 01

  Yeah.

• 1:08:19Speaker 04

  Is that average over months, over, you know?

• 1:08:21Speaker 01

  Yeah, it's a good question.

• 1:08:22Speaker 04

  Your whole life?

• 1:08:23Speaker 01

  I don't have a perfect answer for that. We have, I think, more strict definitions on that if we're talking like insomnia, right? So like, chronic insomnia would be like three months. There's like certain thresholds and like, they're kind of arbitrary, but like, someone had to make a threshold, I guess. But yeah, I don't, I don't have as much of like a, on average, it's just on average. Sorry.

• 1:08:45Speaker 04

  I know, average is not ideal, blah, blah, blah.

• 1:08:48Speaker 01

  Yeah. So it is, it's all, I mean, I, I think, what is my conclusion, Erin? I don't know. Sleep, I think, I think we learned from last week's episode that sleep is quite essential.

• 1:09:06Speaker 04

  Yeah.

• 1:09:07Speaker 01

  And we know from sleep deprivation and short sleep and these and these, that sleep is essential. And maybe many of us aren't getting enough of it. Maybe on average, we're doing okay. But a lot of this is probably not down to individual stuff.

• 1:09:25Speaker 04

  I know. It's, is, I, I, I wish that I had like spent more time trying to articulate this because there are many different components. Question though, what is excessive daytime sleepiness? What's the threshold?

• 1:09:36Speaker 01

  Yeah, so there's like different scales that you can use to kind of define it. So there's like, the one that I use most often in clinic is called the Epworth Sleepiness Scale. And so it's like a set of questions that you ask on like, how likely would you fall asleep in these scenarios? And if you score, I think it's like a 10 or greater, that's like, that would be considered excessive compared to, like, there are some scenarios, like, if you lay down in the afternoon to take a nap and you are able to fall asleep, that's not necessarily excessive sleepiness, if that's the only thing. But if you are, like, falling asleep while you're stuck in traffic, and you could fall asleep while you're reading a book, and you're gonna fall asleep no matter what if you sit down to watch a movie, or you're a passenger in a car, like, those are the kinds of things. And I think there's other, like, thresholds

• 1:10:20Speaker 01

  and other ways to kind of define it, too. Then there's other tests that you can use, like, the multiple sleep latency test, how quickly do you fall asleep? Or the, I forget the name of it now, but it's like, you sit in a quiet room, and how long can you stay awake for?

• 1:10:34Speaker 04

  Just by yourself?

• 1:10:35Speaker 01

  Yeah.

• 1:10:36Speaker 04

  Oh, boy. No, thank you.

• 1:10:38Speaker 01

  And so, based on, like, you know, there's, like, averages of what is typical versus what would be disordered. So that's, like, kind of how you make those distinctions.

• 1:10:46Speaker 04

  I just find that, there's so much, like, ugh, there's so much.

• 1:10:50Speaker 01

  I know.

• 1:10:51Speaker 04

  Also, John falls asleep in literally under 10 seconds.

• 1:10:53Speaker 01

  I mean, I do, too.

• 1:10:54Speaker 04

  Under 10 seconds.

• 1:10:55Speaker 01

  Maybe not 10 seconds, but I am very fast.

• 1:10:57Speaker 04

  Yeah. And it takes me a long time. I wish I could nap. I can't. What does that mean?

• 1:11:01Speaker 01

  What does that mean?

• 1:11:02Speaker 04

  What does that mean? But, I mean, I think that it's all, like, ah, I don't know.

• 1:11:06Speaker 01

  And so much, too, goes into it, right? Like, there's, I didn't even get into this, but there's, like, data on, like, what you eat for dinner, what time you eat dinner, the concentration of glucose versus fats versus this in your food, how much caffeine you're drinking, what time you're drinking that caffeine, how your individual body metabolizes that caffeine, are you drinking alcohol? Did you drink alcohol yesterday? There is so much that goes into this.

• 1:11:27Speaker 04

  Are you stressed? Do you have kids?

• 1:11:29Speaker 01

  I'm stressed now.

• 1:11:29Speaker 04

  Do you live next to traffic? Like, there are so many things that are working against us. And at the same time, it's also, like, I think part of what's working against us is this emphasis on, like, the right sleep.

• 1:11:42Speaker 01

  The right, the quote-unquote right. And I think that that really does, I think that you're very right, that, like, when we blanket statement anything, which, like, in some regards, we have to, from a public health perspective.

• 1:11:52Speaker 04

  Absolutely.

• 1:11:53Speaker 01

  Give this guidance.

• 1:11:54Speaker 04

  Sleep is a public health issue.

• 1:11:55Speaker 01

  It is. But does that mean that every single person needs to be getting exactly seven hours every night? No, that's not. Not what that means, right?

• 1:12:03Speaker 04

  Right.

• 1:12:03Speaker 01

  But it's very hard because then that's an individual level communication of like, how rested do you feel in the morning? Are you having sleepiness? Are you having issues at work? Like, how do you feel? Like, and that's not something that you can do in a set of public health guidance.

• 1:12:16Speaker 04

  Right. I think it just, it makes a, it further creates this disconnect between being able to ask yourself how you feel about the sleep that you're getting and what you are comfortable with. And then also like, what is the ideal? Are you achieving that? You don't look like this picture of normalcy. And it's this non-pathogenic variation.

• 1:12:34Speaker 01

  Yes.

• 1:12:34Speaker 04

  In the human species.

• 1:12:35Speaker 01

  Yes.

• 1:12:35Speaker 04

  That is, that does exist. And that also exists to our detriment because of the way that that society functions.

• 1:12:42Speaker 01

  Right.

• 1:12:44Speaker 01

  Drop that mic. Tell them where they can learn more.

• 1:12:48Speaker 04

  Many places. Okay. Actually, really, I, there were some very interesting parts of the book that I read called "The Slumbering Masses: Sleep Medicine and Modern American Life."

• 1:12:58Speaker 01

  Love it.

• 1:12:59Speaker 04

  By Matthew Wolfmeyer. And then by, that at day's close, "Night in Times Past," by Roger E. Kirch. And then that paper by Yedish et al. from 2015, "Natural Sleep and Its Seasonal Variations in Three Pre-Industrial Societies." And then there's a paper by Schultz and Salzerulo, 2016, "The Development of Sleep Medicine: A Historical Sketch." And many more on the website. Actually, not that many more for this one.

• 1:13:26Speaker 01

  I had a number of papers. One that I really liked was from 2007 from Cellular and Molecular Life Sciences. That was titled "Sleep and Sleep Disturbance: Biological Basis and Clinical Implications." There was one from Sleep Medicine Clinics from 2024 that was titled "Sleep Deficiency: Epidemiology and Effects." There's another one that I actually really enjoyed from 2024, "Nature: Human Behavior." That was titled "Individual Sleep Need is Flexible and Dynamically Related to Cognitive Function."

• 1:13:52Speaker 04

  How about that?

• 1:13:53Speaker 01

  How about that? But we have a lot more on our website. This podcast was killyou.com under the Episodes tab.

• 1:13:58Speaker 04

  We do. A big thank you to Kelly again for taking the time to share your story with us. We really appreciate it.

• 1:14:03Speaker 01

  Yeah, we do. We really do. Thank you.

• 1:14:05Speaker 04

  Yeah. Thank you to Blood Mobile for providing the music for this episode and all of our episodes.

• 1:14:10Speaker 01

  Yes. Thank you so much.

• 1:14:13Speaker 04

  So much.

• 1:14:14Speaker 01

  To Boomer and Sabrina and Tom and Leanna and Brent and Pete and everyone.

• 1:14:19Speaker 04

  Everyone.

• 1:14:19Speaker 01

  At Exactly Right. Corey, Jessica, Christina. There's too many.

• 1:14:23Speaker 04

  There's too, honestly, everyone.

• 1:14:26Speaker 04

  Thank you, thank you, thank you. And a big thank you, of course, to our listeners, to our watchers, to anyone who enjoys this podcast in any way or doesn't enjoy it and just has to watch it for a class. Thank you for watching or listening.

• 1:14:36Speaker 01

  Thank you for watching it.

• 1:14:38Speaker 04

  We really appreciate it. And a big thank you also to our patrons. Your support really does mean the world to us.

• 1:14:44Speaker 01

  It does. Thank you.

• 1:14:45Speaker 04

  Well, until next time, wash your hands.

• 1:14:47Speaker 01

  You filthy animals.

• 1:14:49Speaker 04

  And get some sleep.

• 1:14:50Speaker 01

  Get some sleep.

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