CIIS Public Programs Podcast

transcript

[Theme Music]

This is the CIIS Public Programs Podcast, featuring talks and conversations recorded live by the Public Programs department of California Institute of Integral Studies, a non-profit university located in San Francisco on unceded Ramaytush Ohlone Land. 

This week, we are revisiting an episode from our archives featuring a conversation with neuroscientist Matthew Walker about his groundbreaking exploration of sleep and its transformative power to change our lives for the better. This episode was originally recorded live with an in-person audience on October 9th, 2017. 

To find out more about CIIS and public programs like this one, visit our website ciis dot edu and connect with us on social media @ciispubprograms.

[Theme Music Concludes]

[Applause]

Rachael: Hello, so I confess, I'm a little tired. I didn't sleep too well last night. So perhaps I should…

Matthew: I have that effect on most people I have to say.

Rachael: Perhaps we'll start there. Can you tell us how much sleep should we be getting?

Matthew: So, the recommendation is that we need seven to nine hours of sleep and it's arranged a little bit like calories, you know, you could say for the average, you know, human adult male, it's... let's say 2000, but based on your physiology, your biology, what you've been doing... that could range from 1,800 to 3,000 and it's the same with sleep. There is a variable need. What we absolutely do know however in terms of science, is that once you get below seven hours of sleep you can measure objective impairment in the laboratory in almost everyone. And so the statistic would be based on thousands of studies. Now, the number of people who can survive on six hours of sleep or less without showing any impairment, rounded to a whole number and expressed as a percent of the population is zero.

Rachael: (laughs) So Margaret Thatcher and Ronald Reagan both apparently were great fans of less than four hours a night.

Matthew: They were. They were both very vocal about that. And I think it’s… part of it has to do... and we of course don't know if they truly were four-hour-sleepers. It's very unlikely that they were. Did they get insufficient sleep? I think that that's probably true. Were they proud of that? I think very much so. I think they used it as a public persona because we have this stigma that is associated with sufficient sleep which is laziness. And that does us a terrible disservice. Human beings are the only species that deliberately deprive themselves of sleep for no apparent reason and I should note by the way that we now have significant and causal links to insufficient sleep and Alzheimer's disease-

Rachael: which of course, they both got

Matthew: And I don't think it's coincidental though. It's just two samples. It's just two people so we actually don't, you know, we can't tell from their data alone, but it's often struck me as, I think not coincidental that they both went on to develop Alzheimer's disease. And insufficiency is perhaps one of the most significant lifestyle factors determining whether or not you will get Alzheimer’s.

Rachael: Gosh, so I have friends who are very keen to hack sleep and they talk about dividing it into two phases or sleeping six hours and then having a 2-hour nap. Can you do that? Can you split your sleep up or do you need to get it in one chunk? You look delighted by that question (laughs).

Matthew: Well, it's a lovely question because in some ways, you know, it challenges how we think human beings were designed to sleep. You know, most of us are programmed in this sort of day and age of modernity that we should be sleeping in one single bout throughout the night. That's how society is structured. That's how we're expected to sleep. Is that how we actually should be sleeping? And if you look back in sort of the historical record, there was a time just after the Medieval Era when people started to split the night and it was called the “first sleep” and “the second sleep.” The problem with that... it seems very clear that that was a practice and it went through sort of into the Dickensian era people were doing that. But it seems to be a social or a culturally transmitted practice. It's not a biological edict. There is nothing in your physiology that we can measure that suggests that you should split your night into two halves like that. That doesn't mean to suggest that we are sleeping the way we were designed which is in this single bout which is what we call monophasic sleep. If you actually look at hunter-gatherer tribes, nomadic tribes whose way of life really hasn't changed for thousands of years, they don't sleep the way that we sleep... in two ways. First, they have biphasic sleep, but they don't split the night into two. They sleep for about six, seven hours at night. And then in the afternoon, they have that siesta-like nap for an hour or so. And in fact, all of us are designed to do that. We have a genetically pre-programmed dip in our alertness in the middle of the afternoon and we all feel that you know around the boardroom table. You can probably see this, you know, after lunch, you know heads are starting to sort of nod like this. It's not people listening to good music... they're actually falling prey to this, sort of, you know, drop in alertness. That's the first way that sleep is different relative to those tribes. The second, is when they time that evening sleep... they don't go to bed at the same time we do. And have you ever wondered what the term midnight actually means?

Rachael: It's not in the middle of the night, is it?

Matthew: Right not for us now. You know, for many of us midnight usually means it's time to close the laptop or send that last email. For them, it is the middle of the night. They tend to go to bed somewhere between nine, ten o'clock in the evening and midnight starts to become the middle of the night and they actually wake a little before dawn as temperature starts to rise. It seems to be more temperature-dependent than it is light dependent for awakening and then they have the siesta-like afternoon nap. So I love your question and that's why... Because it challenges the very notion of how we are sleeping in the modern world.

Rachael: So it's so nice to know that we're allowed to have a nap then because they used to also tell us that we shouldn't nap... it would ruin your sleep if you took a nap.

Matthew: Well I'm going to have to tell you it's a double-edged sword. So napping is okay under two circumstances. Firstly, if you can nap regularly then napping is okay, but don't do it infrequently. That's a bad behavior to do. The second is, if you are struggling with sleep at night or struggling to stay asleep at night, the advice is don't nap during the day because as we're awake during the day, we build up a chemical pressure to sleep and we actually call it in the sleep field, “sleep pressure” and that chemical is called adenosine by the way. Yep, exactly. Longer that you're awake the more pressure that builds up, the sleepier you feel. When you fall asleep you actually dissipate that pressure. It's almost like a pressure valve on a cooker like pssshhhh. It just releases that. Now if you take a nap in the afternoon, what you will do is release some of that healthy sleepiness so that when it comes time to go to bed normally in the evening, you don't feel like sleeping. So sleep is difficult. And even if you fall asleep, you may not stay asleep because you don't have that heavy weight of sleepiness to keep you asleep.

Rachael:  Unless you're a habitual napper.

Matthew: That's right.

Rachael: And then you're allowed to… is anyone feeling relieved? They can tell their boss that they have to have a siesta every single afternoon and not mess around with it.

Matthew: Well some forward-looking companies are now actually doing this, you know, Google, Nike. They all have nap pods installed in their workplaces. At Google they are called “shhh” rooms and people are literally getting paid to sleep on the job because they understand them and these companies make no mistake about it. You know, they are about profit. They’re as ruthless as they come

Rachael: So that must boost productivity then if people can nap when they need to and then come back refreshed

Matthew: And those studies are very clear, that sleep can enhance creativity... almost a three-fold increase in creativity, and I should say by the way, Edison used that as a tool. He would actually nap at his desk. He called it the genius gap and he would take two steel ball bearings in his hand, rest them on the arm of the chair and put a pad of paper and a pencil next to him, and at some point, he would drift off into sleep. And then when he would go into deep sleep, so he didn't go too far, his muscle tone would release the steel ball bearings from the hand. They would crash on a metal saucepan that he placed underneath it, wake him up and then he would write down all of the ideas that he was having from sleep.

Rachael:  Fantastic. So I have read that creativity and being a night owl are linked and I've always felt a little sort of guilty around the morning people. They seem to have got the moral high ground somehow. [audience laughs] Ah, my people are with me in the audience here [Matthew laughs]. But you say that's genetic. I shouldn't be feeling guilty about liking to sleep in in the morning.

Matthew: Not at all. No, you shouldn't and society does chastise what we call the night owls, and it's not your fault, it's genetic. So it's called your chronotype and we know the genes that dictate and determine whether you're a morning person or an evening person now. Now about 30% of the population is owl-like meaning that they like to go to bed late. Wake up late. About 30% are larks. They like to wake up early and go to bed early and then the rest of society sits somewhere in the middle of that sort of bell curve. The problem is that in most first world nations, we have a heavy bias toward structuring both our professional lives… and also our status... our acceptable status on early morning rises. They're the people who get the praise. Whereas people who go to bed late and want to wake up late. We deem them as slothful and that's incorrect.

Rachael:  How long has that been going on? When did that start?

Matthew: It seems to have been present even back, if you look in hominid Evolution. In some of these cultures, it's certainly not morphed or distorted by modernity. It's very present in those individuals too... in those communities.

Rachael: Because even in the New Testament right isn't there something about sleeping. If you sleep then you lose out or you're not productive enough, or something?

Matthew: And that mentality… yeah, sorry... goes back there. But you know being genetic we can see it all of the time in all communities too and you could argue, by the way, why? Why do we sleep at different times in terms of our preference as a species? And the argument that I think is reasonable but is made in the book is that you as a species are offline for eight hours, desperately vulnerable, you know, and that is dangerous. It turns out when you look at these cultures untouched by electricity and modernity, they don't sleep by themselves, they sleep as a collective

Rachael: And I imagine someone's the night watchman and then someone has to take over in the middle of the night and do the second part of the night

Matthew: That’s the theory. So it's a beautiful design. You get a group of people, all of which you sleep eight hours. Each individual sleeps eight hours, but some of them are sleeping early in the night and ending early in the morning and some of them are going to bed much later and waking up much later. So in sum total you as a collective are only offline all together perhaps just three hours... yet each individual gets a full eight hours. So you can press your vulnerability window by way of this genetic variability in sleep taste preference on the clock face.

Rachael: So it's another case of where diversity actually increases our well-being as a group.

Matthew: Precisely

Rachael: Very nice. So you mentioned the adenosine builds up during the day, what are some of the other things that have to happen in our brains and our bodies for us to get sleepy and sleep healthily?

Matthew: Yeah, so I think there's probably three things: biological, psychological, and temporal. Next question. No, I'm kidding you [both laugh]. That's not obvious? And so biological... we've already spoken about building up enough of that sleep pressure and it usually takes about 16 hours of wakefulness to create enough sleep pressure to fall asleep. The next one is thermal and it's something that many of us under-appreciate. We often set our thermostats incorrectly to higher a temperature because your brain and your body need to drop the temperature by about 2 to 3 degrees Fahrenheit to initiate sleep and it's the reason it's always easier to fall asleep in a room that's too cold than too hot because the cold room is at least taking your body in the right direction that it needs to go to initiate sleep. So you need to drop your thermostat to somewhere around about 67, 68 degrees, which sounds very cold. But it turns out that that is optimal versus - there’s another biological way. A third biological way is actually light or the absence of light. We are a dark deprived society and Edison actually has a lot to answer for in this regard. He electrified the night for the masses, at least, arguably, not the inventor of the light bulb, but certainly he distributed electricity in the light bulb across a vast nation. And one of the problems is that for you to time your sleep effectively, a hormone has to rise within your brain called melatonin. It's also called the “hormone of darkness'' or “the vampire hormone.” Not because it makes you look longingly at people's necklines and you know, it's just because it comes out at night. It's now the way that melatonin works, it’s that it helps you time the beginning of sleep. It doesn't participate in the generation of sleep. So it's one of the most misunderstood sleep aids.

Rachael: So it's just about the timing of when you go to sleep?

Matthew: Yeah, correct. So the analogy would be melatonin is a little bit like the starting official in the hundred meter race at the Olympics. It organizes the sort of... all of the races, all of the different chemicals that are going to mechanisms that generate sleep itself... to the start of the race line and it begins the race, but the officials themselves, they do not participate in the great sleep race itself.

Rachael: So taking... Does that mean taking melatonin is not going to give me better sleep, for example?

Matthew: Well, yes and no. No, in the sense of clinically controlled placebo comparison trials. However, the Placebo Effect is the most reliable affect in all of pharmacology. So if you think that melatonin is working for you, I usually say “no harm no foul” and now... and I don't think we need to dismiss that by the way, I think that tells us something profound which is that the truth is mind over matter. I think the Placebo Effect in medicine has been dismissed for decades, and only now are we realizing that that tells us something incredible about the brain: that it can heal the body. You have to fool it to do so, but I'm drifting from the point. So, that's another biological factor that you need: darkness. Because darkness releases the brakes that are normally placed on melatonin. So when darkness ensues, melatonin starts to rise and your sleep is nicely timed. But now we have all of these electrical light bulbs and, worse still, we have these LED screens which are enriched with blue light. That's especially damaging, that blue wavelength light.

Rachael: So what about some of these technologies like FLUX, for example, that actually adjust the light on your iPhone or your max or your PC? Does that work for helping people to overcome-

Matthew: It is wise to try and do that and also Apple recently released something called Night Shift, which essentially does the same thing on phones and iPads and you can go into settings and find that. The advice though is perhaps a little bit more I think profound than that, which is you don't need all of the lights on in your house the last two hours. Switch half of them off. You know, close the laptop screen down an hour before bed. Studies done, if you read for an hour on an iPad... before bed versus just reading a book in dim light, the iPad will actually forward delay your melatonin by somewhere between two to three hours. So if I'm in California, it puts me almost in Hawaii in terms of my time zone. Plus it disrupts your sleep and it prevents your REM sleep from occurring and it has an after-effect so that when you wake up the next day you don't feel as refreshed by your sleep. So I would say abstain from caffeine... because that will actually block that adenosine. So get lots of wakefulness during the day. Lots of light during the day, but when it comes to night, dim the lights, drop the temperature, those are some biological ways. Psychological - much harder and it seems to be the principal cause of insomnia. This Rolodex anxiety mind that we have. Evermore present now, people worrying about their finances, about their professional lives, about their relationships. Those seem to be the three key things that instigate nighttime anxiety. There, people can actually use meditation. Meditation has been demonstrated to be quite effective in quieting the mind if you have that anxiety related insomnia too

Rachael: I would imagine people coming home and having either a joint or a glass of wine. That's also going to affect their sleep in adverse ways. Even though it feels like it's calming people down.

Matthew: Yeah, those are probably two of the other most misunderstood sleep aids, quote-unquote. And neither of them actually are a sleep aid. Alcohol… we often think you have a nightcap helps you fall asleep. It's not true. Alcohol is a class of drugs that we call the sedatives and sedation is not sleep. So what you're doing with alcohol is simply knocking your brain out, but you're not getting into naturalistic sleep. That's the first issue... the second is that alcohol will fragment your sleep. So you wake up many more times throughout the night. The problem is that they're so short you don't remember them but it has a marked impact on the quality of your sleep, such that you wake up the next morning feeling unrefreshed, but you don't remember waking up throughout the night so you don't put two and two together.

Rachael: Can I ask-

Matthew: And the final thing about alcohol…Sorry to interrupt… Is that it also blocks your dream sleep, as does marijuana too. And in fact alcohol is one of the best chemicals that we know to actually block and suppress your dream sleep. So you miss out on that and dream sleep is critical for a number of features. It's emotional first aid, its overnight therapy, and dream sleep is also essential for creativity.

Rachael: So let's go to that right now. Tell us what is a dream anyway. I mean, I have my opinions as to what a dream is because I work with dreams all the time, but what's your take on what a dream is?

Matthew: Well scientifically we've taken the stance that a dream is simply any report of mental activity upon awakening. So, if I wake you up and I say “what was going through your mind?” And you tell me something that was going through your mind before I woke you up whilst you were sleeping… Some people classify that as a dream and that's sort of the loosest broadest definition of dreaming. The most stringent version is that dreams have to be a narrative. They have to be hallucinogenic, auditory, or visual. They have to be emotional. They tend to have to be motoric, kinesthetic... and they have to have some aspect of memory. So those are sort of more of the full blown… and that's what most of us think of as dreams. And if you restrict dreaming to that definition then we tend to only dream during rapid eye movement sleep or REM sleep. The type of quote-unquote dreaming that we have from non-rapid eye movement sleep or non-rem sleep tends not to be so narrative, hallucinogenic, emotional as REM dreams. If I wake you up out of deep non-rem sleep, firstly, it's very unlikely, it’s only about 20% or less probably that you will report having any mental activity and if it is a report... it tends to be just sleep thinking, and what I mean by that is I'll wake you up and you say, “well, I was actually just thinking about the next time that you were going to come into the room and wake me up,” but it's not really visual. It's not a story. It's not emotional. So those are sort of the two extremes of it... of dream definition within sort of sleep sides.

Rachael:  So we were talking just before we came in about… about ducks. (Both laugh). And the way that three ducks on a log will sleep. The outside ducks will sleep with one half of their brain and one eye open, and then in the middle of the night they'll switch over. Why don't you talk a little bit about that because I have another question for you following that but tell them about the ducks first.

Matthew: Yeah, it’s unihemispheric sleep. If that's not the best thing that you've heard of in the past year then I don't know what it is, and I'm so biased but it turns out that birds and all or for the most part, everyone that we've studied… aquatic mammals... have what we call unihemispheric sleep which simply means that you can sleep with half of your brain and the other half is wide awake. And you can actually see this in birds. You will see them, they will sort of be moving around often after a feeding, and then if you look one side the eye is completely closed which means that the opposite side of the brain is fast asleep. And if we've got electrodes on we can see these big beautiful deep slow brain waves. They're in a deep slow-wave state. You look at the other half of the head and that eye is wide open. And the other half of the brain, the opposite side, is in clear wakefulness, fast, frenetic brain activity. Birds do it. Aquatic mammals do it, for example dolphins sleep with half a brain. Otters also, half a brain… And with birds, they do it for different reasons it seems, but for birds there is this remarkable act where they all line up on a branch. Now all of the guys and gals that are not at the sentinel ends of the line, they all sleep bi-hemispherically, both halves sleep. The unfortunate folks on either end, they have to sleep with one half of the brain because it means that then one side of the flock gets a hundred and eighty degree panoramic safety from the guy at the end who's got this eye open… All the way at the other end they've got the other hundred and eighty degrees covered by the other guy who's got his eye open, and the inner side of the, sort of you know, of the eye... of the vision is closed, meaning the opposite side of the brain is asleep. Now you would think that there is equity in the avian world, which is that when they want to get up and maybe switch their brains to both sides or kind of get the other side, they would shuffle into the middle of the flock and everyone would take their turn, sort of like that penguin movie where they all kind of take turns and to go to the outside and get the cold… (audience laughs) No! What happens is that those guys at the end, those poor chaps and gals, they stand up, they rotate 80 degrees and sit back down and switch sides of their brain

Rachael: Those poor things. That is a prodigious achievement.

Matthew: Isn’t that remarkable? But that tells you something and it tells you this: that it would have been so much easier for mother nature to to have found a way to just do away with this thing called sleep, but it didn't, it has to go to such extremes to still get this thing called sleep and every species that we've studied to date sleeps.

Rachael:  Even snails and cockroaches and...

Matthew: Even snails! Even worms!

Rachael: Huh… So why?

Matthew: Even jellyfish recently and even, in fact, if you look at bacteria, as long as they survive more than 24 hours, they undergo active and passive phases that seem to be the precursors of what we call sleep. In other words, sleep emerged with life itself on this planet and from that point forward, it has fought its way through, heroically, every step along the evolutionary pathway, which must mean that sleep is essential at the most basic of biological levels.

Rachael: So is it about rest? Is it about keeping us out of danger for a certain number of hours a day? What is... what is it about?

Matthew: It’s… It’s not so much about rest because if you look at the caloric savings that you get from sleeping versus lying on the couch awake for eight hours, but completely immobile, it's only about the savings of calorically of a slice of brown bread. And it just doesn't make sense from that energy savings perspective. You just go out and club an extra baby seal at the end of the day, get that extra energy, and I say that as a vegetarian by the way, and… and forgo this thing called sleep because it's so disadvantageous. You're not finding a mate. You're not reproducing. You're not caring for your young. You’re not foraging for food, and worse still, you’re vulnerable to predation. On any one of those grounds, sleep should have been strongly selected against. On all of them together, if sleep does not serve a vital function, it's the biggest mistake of evolution ever made.

Rachael: So what's that vital function Matthew?

Matthew: Well, 20 years ago we couldn't answer the question on why we slept, and the crass and simple answer was that we sleep to cure sleepiness, which is the useless equivalent of saying you eat to cure hunger. Tells you nothing about the nutritional benefits of food. 20 years later with all of this sleep science, we've been forced to upend the question and invert it and say, “is there anything within the body or is there any process of the mind that isn't wonderfully enhanced by sleep when we get it, or demonstrable impaired when we don't get enough?” And the answer seems to be no. We cannot find anything that is invulnerable to a lack of sleep... even down to your genetic code. Study recently took a group of healthy people, gave them six hours of sleep for one week and looked at their genetic activity... that genetic profile. They found 711 genes were distorted by sleeping for six hours a night for one week relative to when those same individuals were getting eight hours of sleep. Now, I know for a fact from the statistics that almost one out of every two American adults is trying to survive on six hours of sleep or less during the week. So this is a highly relevant experiment. 700+ genes distorted by short sleeping to six hours. What was interesting, is that about half of them were increased in their activity in terms of genes, half of them were decreased. Those that were decreased were genes related to your immune system and we know the immune system implodes by way of a lack of sleep. Those genes that were increased in their activity were genes related to the promotion of tumors and cancer, genes that were related to stress and cardiovascular disease, and genes that were related to long-term chronic inflammation within the body. And I give that example just to say how little sleep loss it takes to create a marked deficit in your biology and that it's not about the whole-brain or even large organs... a lack of sleep will even erode the very DNA fabric of life itself.

Rachael: That's fascinating. You talk in the book about some of the health risks about not sleeping enough.

Matthew: Every disease that is killing us in the developed world has a significant and causal link to a lack of sleep. So from cardiovascular disease, to Alzheimer's disease, diabetes, obesity, cancer… all of them have links to insufficient sleep and it doesn't take much. So for example, if I were to take you and short sleep you for a week for five or six hours, your blood sugar would be so disrupted at the end of that week you would be classified as being pre-diabetic by a doctor. Secondly, your cardiovascular system, it just takes one hour because there is a global experiment that is performed on 1.6 billion people twice a year, and it's called daylight savings time. Now in the spring, when you lose an hour of sleep, we see a 24% increase in heart attacks the subsequent day.

Rachael: Good Lord

Matthew: In the fall when we gain an hour of sleep, we see a 21% decrease in heart attacks. That is how fragile your cardiovascular system is to even just the smallest perturbation of sleep.

Rachael: So we're running a huge experiment by depriving ourselves of sleep and lighting up the night and so on?

Matthew: The global sleep loss epidemic is perhaps the greatest latest public health challenge that we now face in the 21st century. It's the greatest, I think, disease that... curable... that we are not speaking about and we are not trying to change.

Rachael: You know, I've noticed that we've had the fires going on in California in the last 10 days and people have been in a state of fight-flight. If you smell smoke in the air, then you're in a... you're in a fight flight state and I noticed that when people get into clean air or now when the air quality is good again, I see people with your jaw cracking yawns feeling very sleepy because they've... their parasympathetic nervous system has switched on it's quite apparent right now

Matthew: And you've hit on what currently seems to be a leading model of insomnia, which is... it's what we call a hyper arousal disorder which isn't what you perhaps think it is. Actually what that describes physiologically is that a fight or flight branch of your nervous system, something that we call the sympathetic branch of your nervous system, is cranked in the on position. Now you hear “sympathetic nervous system,” you think ‘oh, it must be a lovely part of your nervous system... empathetic, calming.’ The exact opposite! It's the fight-or-flight activator. The parasympathetic is the calming kind one. Insomnia patients seem to have an abnormally high level of sympathetic... of fight or flight nervous system activity, which keeps your heart rate too high. It keeps your body temperature too high and it keeps the mental wheels of the mind spinning too much and that's why things like meditation for example, which try to dampen the sympathetic nervous system and bring on and to the surface the parasympathetic nervous system. That's why meditation, we believe, actually seems to be efficacious in the context of insomnia.

Rachael: So if somebody suffers from chronic insomnia are sleeping pills a friend or a foe?

Matthew: It would be lovely to say that they are a friend and let me go on record and be clear that I am not anti medication. I am all for medication if it is well designed and does what it says on the can. Sleeping pills, unfortunately are not the go-to choice and should not be the go-to choice first line treatment for insomnia. That's not my recommendation. That's not the recommendation in 2016 of the American College of Physicians. After a review of well over 60 placebo-controlled studies with sleeping pills, the conclusion was that those sleeping pills offer minimal advantage over placebo and should not actually be recommended because they come with dangers and here are the following three problems with sleeping pills. Firstly, they too are a class of drug that we call the sedative-hypnotics, and again sedation is not sleep. The electrical signature of your sleep when you're taking sleeping pills is not the same as natural healthy sleep. The second is that those sleeping pills have been associated with a significantly higher risk of death, and third they've been associated with a significantly higher risk of cancer. And this information is not actually been well communicated to the public and that's part of... another part of a whole chapter in the book and I wanted to convey that to people. Now hearing this it means that you don't have to buy the book and that's great. I don't actually care. My publisher will kill me, but it's about sleep here. That's the mission. It's not sales. Now, I want to be clear also about those findings. We do not yet know if that is simply an association or its causality. We don't yet know if sleeping pills are associated with those things rather than causing those things. It's possible that they could be associated, but it is equally possible at this stage that they are a causal ingredient. You need to, as the public, be at least aware of those facts and informed about them and then you get to make the choice on the basis of science informing you about the dangers

Rachael: And in comparison with the fact that if you don't sleep at all you're running a risk of ruining your immune system and upping your inflammation and your blood sugar and…

Matthew: That’s right!

Rachael: So-

Matthew: And people don't have to look to sleeping pills. And the reason that the American Association of Physicians made that recommendation is because there is an alternative it's called Cognitive-Behavioral Therapy for Insomnia, or CBT-I, and you work with a therapist. It is just as efficacious as a therapy as sleeping pills are in the short term. However, beneficially once you stop working with the therapist that good sleep continues unlike sleeping pills when you cease medication you not only go back to the bad sleep that you are having, often you have what's called rebound insomnia, which is where you back to even worse sleep.

Rachael: Right.

Matthew: So on every level right now, it seems to be that sleeping pills are not necessarily the thing that you should go for. But, to be clear, speak with your doctor about that. You know, I'm not trying to play doctor here.

Rachael: Absolutely. What about natural things like chamomile tea and the things your granny used to recommend? A cup of milk before for bed?

Matthew: Yeah, all of those things right now, there is not good scientific proof that they work. Again, however, I invoke, not my fifth amendment but I invoke the placebo benefit and if you do feel as though it's working for you, then I would say as long as it's not damaging and, you know, Google is there for you to check those things. Keep… keep doing it.

Rachael: So speaking of Granny, sleep changes over the life cycle. So can you talk a little bit about that? We were talking about teenagers, but I'm also thinking about babies whether they dream... talk about the whole human life.

Matthew: There is probably no more dramatic physiological change that we see across the lifespan other than sleep. I mean, you know, physically you change of course, but physiologically sleep is dramatically different across the lifespan. So for example in utero, you spend ninety to a hundred percent of your time in a sleep-like state and most of that is in dream sleep or REM sleep. Now at that stage is the fetus dreaming? Unlikely, but we don't know what it’s dreaming about and you should never tell any expectant parent and particularly mother that when they sing to their child or whether they should sort of speak to it that the kicks and the bumps and the jabs... They think that that's a response to all of these vocal things. It's actually not, it's dream sleep. Now when we all go into dream sleep, our brain is incredibly active. Part of our motor cortex and emotional sensors are up to 30% more active than when we're awake... and when we’re walking around and doing things in our dreams. However, our brain paralyzes our body. It sends a signal down your spinal cord, paralyzes you, so you're... you are imprisoned in your own body for a good reason, so that you can dream safely and not act out those dreams. But in utero that paralysis of dream sleep has not yet developed. So all of the kicks in the punches are just the brain in acting out these remarkable motor commands

Rachael: Like when you see your puppy dreaming and its legs are going like this...

Matthew: And it’s twitching. Yeah. Yep, now... so enormous amounts of REM sleep during the third trimester and then in the first year. Why? Because dream sleep at that stage acts as a remarkable neural fertilizer for your brain and your nervous system. It stimulates flourishing tracts of neural connectivity in the brain, and I guess dreaming would be... or REM sleep at that stage would be a little bit like an internet service provider, I guess, you know, it goes into a new neighborhood and it lays down this wonderful fiber-optic, you know connectivity and then activates it, that's dream sleep. It constructs the neural architecture. We go through remarkable changes during adolescence and it's about the opposite. Now deep non-rem sleep actually increases in its amount and there the idea is sculpting down the number of connections. It's about pruning. It's about making your brain lean and efficient. And so you actually take synapses away and that's the act of deep non-REM sleep at that time in life. Then, from that point forward sadly comes the great sleep depression. I'm sorry, bad news coming here, and it starts early. I can already start to measure the decline of your deep sleep in your 30s. By age 50, you've lost almost 50% of the deep sleep that you are having as a teenager. By 70, you've lost almost 90% of your deep sleep and by 80 we almost can't measure those deep sleep brain waves.

Rachael: Gosh.

Matthew: And I think we've been doing a lot of this work on sleep aging and Alzheimer’s disease… insufficient sleep and sleep disruption is perhaps one of the most underappreciated factors that is contributing to what we call cognitive decline and age-related ill health and disease, and medicine has not woken up to this fact, and we have a myth which is that older adults need less sleep. Not true! Older adults need just as much sleep as they did in their 40s or 50s when they are in the 70s or 80s, but the problem is that the brain simply cannot generate physically the sleep that it needs because unfortunately the brain, just like the body, deteriorates with age, but some parts of the brain deteriorate faster and earlier than others. The parts of the brain that deteriorate fast and early are of the same regions that generate deep sleep.

Rachael: This is miserable. What a prognosis.

Matthew: Well, it's miserable, but since I'm a rational optimist I'm going to give you a glass half-full scenario. There's a silver lining. Unlike many of the other factors that we know are associated with aging, for example changes in the vasculature of the brain or the blood flow, those are fiendishly difficult things to treat and medicine has no good approaches right now. Sleep is a missing piece in the exponent 3 puzzle of ageing and Alzheimer's which is what we've discovered is exciting because we may be able to do something about that and here again I'm not talking about sleeping pills. What we are trying to develop is electrical brain stimulation technology to see if we can actually sing in time with those weak deep sleep brain waves in aging and Alzheimer's patients.

Rachael: To increase the amplitude of...

Matthew: Increase the amplitude. So we're trying to act like a supporting choir to a flagging lead vocalist and we're trying to actually give back and restore some health equality of deep sleep. And in doing so, I'm trying to salvage aspects of learning and memory function. That is one of my real hope... that goals now... that's one of our moonshot projects at my sleep center.

Rachael: That’s very interesting. There's a center up at... near Petaluma near Ions where they're doing research in reversing or at least arresting Alzheimer's and they have very very small data right now, very small studies. But one of the things that they do I believe is around sleep and meditation as well as diet exercise and other things.

Matthew: It is… They've Incorporated… They've... they've... see only... this... this sleep aging and Alzheimer's link has really only come onto the scene in about the past five years. We've been very fortunate to be a part of that scientific conversation instead of discoveries, but the evidence now is very strong. Yeah.

Rachael: Very interesting. So the second part of my ducks question…

Matthew: So sorry, go on now then

Rachael: [laughs] That’s alright. So you said that humans also have like a proto-mechanism for keeping part of their brain awake to look out for monsters, and that explains why it's your first night in the new hotel, you don't sleep so well, for example. So how do you control for that in your sleep lab? Are people sleeping less well because they're covered in electrodes with little things going beep beep beep?

Matthew: Spaghetti monster all over the head. That's what it looks like. So we did used to think that unihemispheric sleep was limited to birds and Aquatic mammals, not entirely true. About seven or eight months ago… there's a great paper. Not my own. It's one of those papers where you look at it and I knew it's a great paper because I was deeply jealous whatever...  I wasn't oh no! I wish I thought of that but it’s a great paper. And what they found was that when you sleep the first night in a novel location like a hotel, it's not as though one half of your brain stays awake and the other half sleeps, it’s not so extreme like it is in in birds, but one half of your brain does not go into as deep of a sleep as the other as if it's standing guard in a lighter shallower sleep. That's why you will often feel as though you've had a rough night in the hotel, and gradually over time the second night, it's better third night. It's better still. And we've actually known this for a while in the sleep field and we build this into our experimental paradigms. We call it an adaptation night. So the night when we do our experiments is never the first night that we record your sleep. You usually come in for a first night and then maybe a second night just to get used to the environment and then the third night is when we do our real science and studies to get rid of that and we also now do a lot more at home recording. So we've got technology now, which is ambulatory so we can wire you up, send you home with a little box. And as long as you don't mind walking through the street looking a little strange, you go home. Yeah, exactly... and... and then sleep at home and it's much more naturalistic. So we're doing a lot more of that work too.

Rachael: Uh huh. So if I don't get so much sleep because you've got me the first two nights or whatever, can I catch up on that sleep later?

Matthew: No...

Rachael: Tell us about that. Give us more bad news.

Matthew: So unfortunately, this is another one of those myths that you can sleep off what you lost in the past and most people do this during the weekend. They try and sleep off the debt that they've created during the week and I've often termed it “sleep bulimia,” which is where you should have binge at the weekend and then you sort of have this binge-purge relationship during the week versus the weekend. It's also known as social jetlag during the weekend. And the problem is this let's say I take you and I deprive you of an entire night of sleep eight hours. And then in the subsequent nights, I give you all of the sleep that you want as much as you can take ad-lib. I won't wake you up. Sleep all you want. Will you sleep more that following night, that recovery night? Yes you will, but you will never get back all of the sleep that you lost because the brain we have learned is incapable of getting back the sleep that it has missed. In other words, sleep is not like the bank.

Rachael: It's not a battery.

Matthew: No, you cannot accumulate a debt and then hope to pay it off at a later point in time or recharge it at the weekend in the context of a battery. It's an all-or-nothing event. Now you could ask yourself. Why not? Why hasn't Mother Nature figured that one out because that sounds to me like a really clever idea, because we also have a precedent in our bodies for that, which is called fat cells. So you have a credit system for calories and it's called adipose tissue. And the reason is because in your evolutionary past as a species and as life itself, we have faced the challenge of caloric deprivation. We have faced famine. We have faced feast and we've designed a system to take advantage of the feast so that we can face the time of famine. Where is that for sleep? The reason is because, again, human beings are the only species that deliberately deprive themselves of sleep for no good reason. In other words Mother Nature has never yet had to face the challenge of insufficient sleep. So Mother Nature has never had to create a safety net a banking system for sleep. So there isn't one.

Rachael: And we've only had lights at night for what a hundred and thirty years? A hundred and forty years?

Matthew: Yeah we've had fire which has a dim light effect on it too. But we haven't faced constant ambient temperature in our environment. For you know, for a long time. So all of this invasion of modernity, into our sleep has a damaging effect

Rachael: Complete wild card question. Does it change when astronauts sleep in space?

Matthew: It does. Radically so and it's been one of the biggest problems for NASA. So I did some work with NASA and some years ago and it is a major issue because if you make a problem... if you... if you make a mistake and have a problem down here on Earth because you're under slept at your desk, maybe no harm. No foul. If you're in a large metal cigar in a vacuum in space and you make a mistake, it could be really bad.

Rachael: So they can't mess with their sleep?

Matthew: So you have to be... but the problem is when you're rotating in some of these orbits, you will see somewhere between 20 to 30 sunrises every 24 hours which sounds beautiful. Doesn't it? Except that it plays havoc with your 24 hour we call circadian rhythm and their sleep is miserable. So you have to be... so you have to come up with strategic plans and they work with Philips to create a light bulb. It's now getting commercialized but to begin with, each light bulb was about $300,000. Minus shipping which by the way, up in space is kind of a Custer in and of itself. But so that is a big... It's been a big problem. The other... one of the other things by the way, that's Interesting that we had to face was suffocation. So when you are in space, obviously, you're just floating around and if you just start falling asleep, you stop bouncing off everything. So you put yourself in a hammock and you connect that to the side of the space capsule. Now the problem is if you're not actually creating a flow of air with 0g what builds up as you sleep is a cloud of carbon dioxide, so you slowly asphyxiate.

Rachael: Because it stays around you

Matthew: It stays around you. Who knew? Yeah things you have to figure out when you go into space and sleep there.

Rachael: So do they use CPAP machines, which is the machine…

Matthew: Ventilation.

Rachael: Uh huh. Do you want to talk a little bit about sleep apnea since it's a big sleep hygiene issue?

Matthew: Sleep apnea and insomnia are the two biggest sleep disorders. Sleep apnea is a major killer and a lot of people go unnoticed, so sleep apnea... apnea the term simply means an absence of breath, and most people think of apnea as heavy snoring. So if you have a partner who snores or you know that you snore yourself, if you find yourself waking up throughout the night gasping for breath, you are more than likely suffering from sleep apnea and it is a major problem for the following reasons. Firstly, you're a far higher risk for dementia. You're at a far higher risk for cardiovascular disease. Far higher risk for developing diabetes.

Rachael: Far higher risk for your spouse bashing you in the night and hurting you.

Matthew: That’s one way that it can hurt you acutely. The other is car crashes. You are up to four times more likely to die behind the wheel of a car with undiagnosed sleep apnea. It is a killer, chronically or acutely.

Rachael: And in general, right if you're short on sleep or jet-lagged your… you're advised not to be driving? You might as well be drunk.

Matthew: So if I would take you and put you on let's say seven hours of sleep for 20 days... and I'm talking here about... that is sleep deprivation. Most of you think that sounds luxurious your… you can be as impaired as you would be after one night of total sleep deprivation. Now you think well, what does that translate to give me something meaningful. It means that you're about half a second slower in your reaction time. You, think half a second? That's not much. That's quite a lot travelling at 40 miles an hour half a second in terms of slowed reaction time is the difference between you staying in lane and drifting into oncoming traffic.

Rachael: Right. Yeah.

Matthew: So what you're having there are what we call microsleeps, which is where your brain just for half a second or a second just falls asleep and then wakes back up. Now, you don't perceive that as you falling asleep. You think you're constantly awake. Your eyelid will undergo what we call a partial closure.

Rachael: So you're basically doing one of those kind of fall asleep things but a tiny one.

Matthew: Yeah but I even... sometimes you don't even see the head on, it's just the eye would just gently close. Now. If you have one of those at 60 miles an hour on the freeway, firstly at that point, there is a one-ton missile traveling at 65 miles an hour and no one is in control. And secondly, it could be the very last microsleep that you ever have. The reason by the way, and the statistics are striking, drowsy driving seems to kill more people on all roads, than drink or alcohol. Sorry, more than alcohol or drugs combined but there's no public health message out there for it, and you could ask yourself, “why? Why is drowsy driving so deadly?” And the reason is this. If you have one of these microsleeps or if you fall asleep entirely, you stop reacting entirely whereas with drugs or alcohol, bad as they are and they are desperately bad and I'm not saying that they should be be advocated at all, but you tend to be slower in your reaction, but you still react. When you fall asleep, no reaction at all.

Rachael: Hmm. Well in a second we'll get to the public health message. But first of all, is it possible for us to be getting too much sleep if we sleep as much as we want to sleep.

Matthew: Is there such a thing as too much sleep. Well, there is something called hypersomnia reported in the literature and it's often associated with the disorder depression. The problem is if you actually look at those studies carefully, it's actually very difficult to tell if people are sleeping longer rather than simply reporting being in bed longer.

Rachael: Yeah, comatose for longer, yeah.

Matthew: Yeah, and it's just that they seemed to be unmotivated to get out of bed and being unmotivated is unfortunately one of the aspects of depression. So it's unclear right now if that's true, but let's take it to a theoretical extreme. Could there be something that is too much sleep? I actually think yes. You know, is 18 hours 16 hours, as a human too much sleep? It's possible. Why do I suggest that? Well firstly there's no evidence, but I suggest it because all of the three other major life support systems, and sleep is the fourth, the three others are oxygen, water and food... can excesses of all three of those things kill you? Yes, they can of course. We know an excess of food can kill you. Excess of oxygen can kill you. Free radicals. Hyperoxia. We also know that if you drink to an extreme, and this happened in the ecstasy craze back in the 1990's, people were drinking too much water because there was such a fear that they would dehydrate. Their over-hydrated blood pressure increases vasculature... gets under too much pressure and the heart gives out because it's under too much load. So is there such a thing as too much sleep? Well, if those three other critical life support systems suggest that it's a bell curve, that it's not linear, that the more you get the better things are, that it's a u shape function; then maybe there is such a thing as too much sleep.

Rachael: So while we were talking earlier you were saying that the next thing for you is going to be addressing this public health announcement that you want to make so why don't you tell us a little bit about what you’re envisaging?

Matthew: Yeah, I mean the book... The motivation for the book was that I just could not recommend... when I give public lectures or talk to people and they say, “have you written a book?” And I'd say, “no,” and they say, “could you recommend one?” And I would say “it's just not... there's not a really great book out there.” I thought after a while, ‘suck it up a few. Write the book.’ And it took me four and a half years to do it, but I wanted to give the public a blueprint, a Manifesto of all of the science of sleep because sleep has been the missing piece in the health conversation of today. Diet and exercise we speak about a lot today but sleep is actually, it's not the third pillar of good health. It's the foundation on which those two other things sit but that information wasn't out there. So I wanted to write the book to start a conversation for the individual and empower them with the knowledge of sleep, but that was only a stepping stone in sort of the bigger picture of what I felt I had to do and I hope many more people join me. I don't want to be an army of one. Many other sleep scientists join me. Anyone else join me, but the next step after the book is to actually create a public health movement. Ignite a conversation that causes radical change to combat this global sleepless epidemic and it has to happen at all levels. I'm going to start at government. When was the last time that you saw any first world nation have a public health campaign around sleep?

Rachael: I don't think I…

Matthew: I haven't seen one. I've seen one about the dangers of drink, about drugs, about smoking, about diet, exercise. Sleep is not there. It needs to change and I want to lobby governments, not just here. Everywhere. It needs to happen in healthcare. When was the last time that you walked into a hospital and one of those billboards demonstrating, you know how you need to exercise and how it's good for you, had anything to do with sleep? When was the last time that your doctor prescribed a good night of sleep to you? Or asked about your sleep? It's not their fault because they get almost no education in their medical curriculum. That has to change too. It has to change in education. When I was at school, I had people come in and give me lectures on the dangers of risky behavior, sensation-seeking, drug-taking, drink and alcohol. No one ever told me about sleep. Why aren’t we educating our children about sleep?

Rachael: Particularly as teenagers need more sleep, right? Their sleep phase is later. They need to sleep in in the morning and we have him getting up at 6:00 to go to school.

Matthew: Right which means buses start at five o'clock, which means goodness knows what time they're waking up. If we as educators, as our goal as educators... is to educate and not risk lives in the process, then we are failing our children in the most spectacular manner with this model of early school start times. That has to stop too. Then I want to speak about the family in the home because there is a parent to child transmission of sleep neglect. We pull the covers off our teenagers at weekends. We say you're wasting the day, it's daylight outside and it's wrong for two reasons. First, as you describe, their biological clock moves forward in time. It's not their fault at that time of life. That's how they are wired to sleep. And secondly, they're trying to sleep off the debt that we've saddled them with during the week because of early school start times.

Rachael: Right.

Matthew: So we have to change this parental, sort of, you know stigma that we have associated with sufficient sleep, which is that it's equivalent to laziness. It has to chill... change in the workplace too. We lured the airport worker who's traveled between five different time zones in the past two days and is on email till two o'clock and back in the office at six. So, I'm sorry. It's rather a soapbox rant, isn't it? But this is the next step for me now. I want to start a public campaign. Something has to change.

Rachael: Thank you very much Matthew.

Matthew: Thank you. Thank you so much for coming out. Thanks very much. Thank you.

[Applause]

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Thank you for listening to the CIIS Public Programs Podcast. Our talks and conversations are presented live in San Francisco, California. We recognize that our university’s building in San Francisco occupies traditional, unceded Ramaytush Ohlone lands. If you are interested in learning more about native lands, languages, and territories, the website native-land.ca is a helpful resource for you to learn about and acknowledge the Indigenous land where you live.

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