[Matt]: Well, firstly, I think it's good to recognize the sort of those four pillars of
sleep that, you know, depth, duration, continuity, regularity, but I think there are five actionable
things that people could do tonight to start getting better sleep.
And we've mentioned many of them.
The first is darkness.
You really do need some degree of darkness at night to release that hormone melatonin,
which helps trigger the timing of the healthy onset of sleep.
[Rhonda]: And you would say about maybe four hours before your bedtime, or what would you
say...?
[Matt]: Yeah, I would say three to four hours is the time to start thinking about your light
saturation exposure, certainly in the last hour before bed.
And there are ways that you can do that you can install software on your computer if you
really have to look at it, but I would advise against that because I think computers cause
and trigger anxiety.
I think, in fact, if anything, my estimation right now is that the blue light from those
screens is detrimental.
I think the evidence is favoring a blockade of melatonin and a reduction in REM sleep.
They did this great study.
They took people with an iPad, one hour of iPad reading versus one hour of book reading.
iPad reading dropped or blunted melatonin by over 20%.
The peak of melatonin didn't arrive until three hours later.
This is one hour of iPad reading.
They had less REM sleep, and they...
[Rhonda]: They were reading, like...?
[Matt]: They were reading just a book under dim light versus reading the same book on
an iPad.
When they woke up the next morning, the people who read the iPad felt more unrefreshed.
They subjectively knew that they had not slept as well.
What was interesting is that when they stopped the iPad reading, there was a washout effect
that was a blast radius of reading the iPad.
And it's continued into subsequent nights even though they'd stopped reading the iPad.
So I think light is a feature, but I also think part of the problem with computers and
iPads and iPhones...and I don't mean to sound like a prude about this, but they do trigger
anxiety.
They are what I would describe as anxiogenic pieces of hardware.
Unless you are, and if you can do this, please write to me and tell me how you do this, but
most people get a lot of their anxiety infusion in part through these devices.
A recent study in teenagers are actually demonstrated that part of the reason that they were having
sleep disruption by using phones was not necessarily about the light but was because of FOMO, fear
of missing out, that if you weren't online, you would miss out on some key social communication.
And they were suffering because of that, too.
But I digress.
My first recommendation is watch the light saturation, watch the light pollution.
And you can think about it like that in the evening.
So an hour before bed, certainly, close computers down, try not to stare at phones, and dim
half the lights down in the house.
It really is powerful.
The second is temperature.
Try to set your bedroom temperature to somewhere between about 63 to 66 degrees for most people
is optimal, colder than most people think.
[Rhonda]: Yeah, that is definitely colder than...
[Matt]: Yeah.
And if you get cold feet, it's okay to wear socks, but cold it must be.
The third thing is what I would suggest is walk it out, which is don't stay in bed awake.
This is one of the mistakes that a lot of people make.
In this era, I think most people, because of anxiety, were wired and tired.
And one of the problems when you are lying in bed awake for a period of time, and I think
more than 20 minutes is not great, because what happens is that your brain very quickly
starts to learn the association between being in bed is about being awake rather than your
bed being the place of sleep.
And so it learns this association.
And so many of the patients that speak to, they'll say, "Look, you know, I'm falling
asleep on the couch watching television, and then I get into bed and I'm wide awake, and
I don't know why."
And the answer is because you've made the association between your bed is the place
of wakefulness, not your place of sleep.
So the answer is you need to break that association.
Get out of bed, go to another room, in dim light, just read a book, no computers, and
only return to bed when you feel very sleepy.
And the first night this may mean that you're awake for two or three hours.
And it sounds bad, and it sounds strange coming from someone like me, but that's better than
staying in bed awake for those two or three hours.
And over time, gradually, by only returning bed when you're sleepy, your brain will relearn
the association that it once had when you're a child, and you can relearn it, which is
that your bed is a place of deep sleep and sound sleep.
So that's the next thing.
I think the final two things we've touched upon a little bit, which is alcohol and caffeine.
Caffeine, many people know, keeps them awake.
It's a stimulant.
It's what we call psychoactive stimulant.
It's the only psychoactive stimulant, by the way, that we readily give to our children
in an unregularized free way, which I think is a problem.
Caffeine has several problems with it.
Firstly, because of it being a stimulant, it can keep you awake and it makes it harder
for you to fall asleep.
A lot of people, though, will say to me, "Look, I'm one of those people who can have a cup
of coffee with dinner and I fall asleep and I stay asleep, and I'm just fine."
Even if that's true, we and others have done these studies, if you give someone a standard
dose of one cup of coffee in the evening, 200 milligrams of caffeine, the amount of
deep sleep that they have is reduced by 20%.
You would normally have to age an individual by 10 or 15 years to drop your deep sleep
quality by 20%, or you can do it simply by having a cup of caffeinated drink or coffee
in the evening.
So caffeine is a problem.
The other problem with caffeine is its duration of action.
Caffeine has a half-life of about six or seven hours.
And a half-life simply means the amount of time it takes for a 50% of the drug to still
be in your system or 50% of it to be cleared.
Caffeine has a quarter life of about 12 hours.
In other words, if you have a cup of coffee at noon, a quarter of that caffeine is still
circulating in your brain at midnight.
So if you have a cup of coffee at noon, it's the equivalent of getting into bed at midnight.
And just before you turn out the lights, you snick a quarter of a cup of Starbucks, and
you hope for a good night of sleep, you know, it's probably not gonna happen.
So the advice would be try to cut caffeine off around about midday if you can.
And even if you're someone who, you know, can fall asleep fine, stay asleep, you should
just know that caffeine can still impact your sleep.
It's what usually creates the vicious cycle, by the way, that those people will wake up
the next day, they feel unrefreshed and unrestored by their sleep, they don't remember waking
up, so they don't think it's the cup of coffee, but now they start reaching for two cups of
coffee in the morning rather than one.
They've got now more caffeine in the system.
The next night, they have even less deep sleep.
The next morning, they wake up even less refreshed.
And now they drink more caffeine.
Self-fulfilling prophecy.
Final one is alcohol.
Alcohol is probably the most misunderstood sleep aid or sleep drug.
It's what most people usually reach for when over-the-counter medications have failed.
Alcohol is a sedative.
It's a class of drugs that we call the sedatives.
And sedation is not sleep.
So when you drink alcohol, what you're doing is sedating your cortex.
You're just knocking yourself out.
And that's why you think that you fall asleep faster.
There are two other problems with alcohol.
Firstly, alcohol will litter your sleep with many more awakenings throughout the night.
And in fact, some people can even see this on their sleep trackers even though they're
not necessarily as accurate as my sleep laboratory would be.
Even with that less accurate measure, you can still see the impact of alcohol in sleep.
So it litters your sleep with awakenings, fragmenting your sleep.
So this comes back to the third of the four pillars of good sleep, which is continuity.
It takes away your continuous asleep, and it makes it fragmented.
The final part of alcohol is that it's one of the best chemicals that we know for suppressing
REM sleep alongside marijuana.
Now, by the way, I should say that's THC-specific.
If you look at CBD, the evidence seems to be less clear.
CBD actually doesn't seem to be as detrimental to your sleep as THC.
If anything...
[Rhonda]: Yeah, because a lot of people, I mean, again, this is just anecdotal, talk
about how marijuana improve their sleep.
[Matt]: Yes, yeah.
So marijuana...We have two separate sort of the active from the inactive component.
THC, tetrahydrocannabinol, is the active component.
And CBD is the sort of the non-hallucinogenic component of that.
[Rhonda]: They're both in if people are taking a whole plant here.
[Matt]: Typically, yeah.
Yeah, exactly.
Now with strains and drops that you can buy, you can separate those out, you can play around
with the ratios, and you can get very low THC to very high CBD.
THC does tend to decrease the time it takes you to fall asleep, but it tends to make you
sometimes wake up more throughout the night, but it certainly does seem to block REM sleep.
One of the other problems with THC dosing of sleep is that you become dependent on that
for sleep.
And when you stop using THC for sleep, you have quite bad rebound insomnia, which leads
to then a perpetuating cycle of dependency.
And I think, you know, I'm never keen for dependency on anything, be it dependency on,
you know, any, you know, food substance or anything.
I think you should, you know, be able to generate all of the physiological pathways and processes
that you need, you know, naturally without dependency.
CBD is interesting, though.
There is nowhere near enough data for someone like me to make any recommendation.
So all I can do is tell you the very limited data that there is right now.
CBD does not seem to produce the degree of REM sleep impairment that we've seen with
THC.
What's interesting is that low-dose CBD actually seems to be wake-promoting.
So you actually are sort of forcing yourself more awake.
High-dose CBD seems to help people sleep more consistently.
I would have thought it would it be the opposite, that low-dose would have been better than
high-dose, but the opposite seems to be true.
Now we don't know about the dependency.
We don't know about the long-term effects.
So I am not going to sit here and give any recommendations regarding THC use or CBD use.
If you're using any compound, be it alcohol, be it a sleeping pill, which are...sleeping
pills, by the way, come with deathly consequences and higher risk of cancer.
Or you're using...
[Rhonda]: Really?
[Matt]: Yeah, markedly increased risk.
[Rhonda]: Is that because there's something directly the sleeping pills are doing, or
because the way it affects your...?
What does it do to your sleep, sleeping pills?
A lot of people take Ambien.
[Matt]: So in the past month, 10 million Americans have swallowed some kind of sleeping aid,
either a prescription or over-the-counter, monumental amounts.
You know, I often joke that I think, it's not really a joking topic, but, you know,
it took George Lucas about 40 years to amass $4 billion in profit from the Star Wars franchise.
It took Ambien less than 20 months to amass $4 billion in profit.
That tells me everything about the insufficiency of sleep and the desperate need for sleep
in this modern 21st-century era.
But the problem is Ambien isn't part of that same class of drugs that alcohol is.
It's what we call a sedative hypnotic.
It works on the same receptor, which is the GABA receptor.
Now it tickles the GABA receptor in a different way to that which alcohol does.
But what we found is that sleeping pills, and I won't name any names but including the
one that you described, they are sedating the brain.
You're not going into naturalistic sleep.
If I look at the electrical signature of your sleep when you're on a sleeping pill versus
natural sleep, it's not the same.
Secondly, what we found is that those sleeping pills can often come with a grogginess in
the morning and some forgetfulness.
Third, what we've found is that in animal models, and this is work that was done by
Markus Frank, who's a wonderful friend and colleague, he was looking at how the brain
rewires itself during sleep.
And the brain does, particularly during the development.
And he has a model in animals, where, if you sort of put a patch on one of the eyes when
the visual cortex is developing, the visual cortex shifts over to developing more wiring
to the eye that remains open.
And it's called the monocular deprivation paradigm of brain plasticity, and it's a very
well worked out model of brain plasticity.
If you give those animals some exposure once you patch the eye to the eye that remains,
you drive learning and plasticity, and then you allow it to sleep, sleep will strengthen
the synaptic connections that have been made during the day by about 100%.
[Rhonda]: Wow.
[Matt]: So sleep is almost as powerful as experience during the day.
That's how sort of strong and powerful it is.
But what he then did was a study where he dosed those animals with Ambien.
Now it turns out that those animals slept even longer, if you look at the data, than
the animals who weren't dosed on Ambien.
And the prediction would be, surely, they would have as much if not more of that wonderful
brain plasticity.
The opposite was true.
Ambien-induced sleep resulted in a 50% unwiring of the connections that have been made during
day rather than potentiating them.
That frightens me.
Because if you look at the prescription age of sleeping medications over the past decade,
it's coming down and down.
I don't know how long it's going to be before prescription medication comes in to a pediatric
realm.
And if those data hold up, it makes me worried.
So I'm coming off topic a little bit, but we know that sleeping pills are associated
with a markedly higher risk of death, as well as cancer, as well as your susceptibility
to infection, particularly in pneumonia.
But returning to alcohol, it is definitely one of the most, I think, misunderstood drugs.
But what I was saying regarding THC, alcohol, sleeping pills, if you are using anything
to help you sleep, I think you have to ask yourself, are you just really treating, you
know, an open wound and not really actually trying to stitch it up?
Because what that is simply doing is masking a problem that you're not dealing with, you
know.
Why is it, like...?
And this is not a criticism, I'm sorry if my voice sounds like that, and it's not, you
know, I'm so sympathetic to people who have sleep problems.
We see them all of the time here.
But you have to ask why.
Why is it that you're struggling with sleep?
Is it because you're of a certain chronotype and you don't understand your chronotype and
you're sleeping at the wrong phase of the 24-hour period and it's masquerading as insomnia.
Or do you have too much anxiety in your life and you're blunting that anxiety with things
like alcohol or THC or sleeping pills?
You know, you're just kicking the can down the road.
You're just hitting the mute button.
But the movie is still playing of damage.
Whatever is causing that sleep disruption, you know, is still there.
You're just sedating your brain and trying to mask it.