Aric Prather

These are the things that you constantly hear about as sleep hygiene but are critical. The things that I mentioned in trying to regulate people's sleep don't tend to work unless you also have a really well-set-up bedroom. This is the things like keeping your bedroom dark,

These are the things that you constantly hear about as sleep hygiene but are critical. The things that I mentioned in trying to regulate people's sleep don't tend to work unless you also have a really well-set-up bedroom. This is the things like keeping your bedroom dark,

um keeping it quiet you know some people use eye masks some people use earplugs some people use noise machines white noise machines and then the other one is temperature temperature is you know our our core body temperature has to drop as we sleep And one of the things that facilitates that is keeping the room cool.

um keeping it quiet you know some people use eye masks some people use earplugs some people use noise machines white noise machines and then the other one is temperature temperature is you know our our core body temperature has to drop as we sleep And one of the things that facilitates that is keeping the room cool.

And so it seems like, you know, the sweet spot is somewhere between 60 and 67 degrees Fahrenheit. You know, certainly you want to ensure that you have, you know, that you're warm enough. And, you know, often layers are kind of the best way to go about this.

And so it seems like, you know, the sweet spot is somewhere between 60 and 67 degrees Fahrenheit. You know, certainly you want to ensure that you have, you know, that you're warm enough. And, you know, often layers are kind of the best way to go about this.

But those things combined with not getting into bed prematurely, making sure that you use the bed just for sleeping, and ensuring this transition put people in a pretty good position to sleep well. And then there are other things that happen that are not close to the bedtime window that seem to be really critical to help people sleep.

But those things combined with not getting into bed prematurely, making sure that you use the bed just for sleeping, and ensuring this transition put people in a pretty good position to sleep well. And then there are other things that happen that are not close to the bedtime window that seem to be really critical to help people sleep.

The one that I tell everyone, first off, if there's one thing that I could tell people to get their sleep back on track, it's actually to maintain a stable wake time seven days a week. That is really critical for setting your circadian rhythm and making things more predictable for your body.

The one that I tell everyone, first off, if there's one thing that I could tell people to get their sleep back on track, it's actually to maintain a stable wake time seven days a week. That is really critical for setting your circadian rhythm and making things more predictable for your body.

what else is it that people do maybe unknowingly unwittingly that actually sabotages their sleep you know one of the things that's critical and is really part of the the foundation of what feeds insomnia is people's tendency to spend

what else is it that people do maybe unknowingly unwittingly that actually sabotages their sleep you know one of the things that's critical and is really part of the the foundation of what feeds insomnia is people's tendency to spend

excessive amount of time in bed not sleeping and this is really hard right because you you want to be asleep you're like waiting for this to happen you're kind of like on the edge and you think that if i wait another 10 minutes i'm gonna fall asleep but what happens for a lot of people is you know 10 minutes turns into 20 turns into 40 turns into two hours and they're kind of you know trying to fight this um experience of their active mind

excessive amount of time in bed not sleeping and this is really hard right because you you want to be asleep you're like waiting for this to happen you're kind of like on the edge and you think that if i wait another 10 minutes i'm gonna fall asleep but what happens for a lot of people is you know 10 minutes turns into 20 turns into 40 turns into two hours and they're kind of you know trying to fight this um experience of their active mind

And what that does is it actually fractures the relationship your body has with the bed. Your body gets confused. And it actually develops into something called a conditioned arousal. So, you know, I hear so often in our clinic, patients say things like, you know, I was feeling really sleepy. And then I got in bed and my brain woke up. And that can happen both physically.

And what that does is it actually fractures the relationship your body has with the bed. Your body gets confused. And it actually develops into something called a conditioned arousal. So, you know, I hear so often in our clinic, patients say things like, you know, I was feeling really sleepy. And then I got in bed and my brain woke up. And that can happen both physically.

when you go to sleep but also in the middle of the night and it it changes the experience so what you need to do is actually get out of bed and it's it's challenging no one no one loves doing this but it's important because once you get out of bed you do something quiet relaxing and then you want to get back in bed

when you go to sleep but also in the middle of the night and it it changes the experience so what you need to do is actually get out of bed and it's it's challenging no one no one loves doing this but it's important because once you get out of bed you do something quiet relaxing and then you want to get back in bed

and and try to go to sleep again and what that will do is it will repair the relationship of kind of sleepiness and the bed and over time will will help you sleep more soundly how big a problem is it when you

and and try to go to sleep again and what that will do is it will repair the relationship of kind of sleepiness and the bed and over time will will help you sleep more soundly how big a problem is it when you

Yeah, that's I mean, that's a great question and that's a great point around placebo sleep. You know, certainly at kind of the extreme ends, the extreme end of sleep deprivation, there is it's clear that, you know, our faculties are damaged right now, you know, cognitively, our reaction time. All of those sorts of things, our mood is impaired.

Yeah, that's I mean, that's a great question and that's a great point around placebo sleep. You know, certainly at kind of the extreme ends, the extreme end of sleep deprivation, there is it's clear that, you know, our faculties are damaged right now, you know, cognitively, our reaction time. All of those sorts of things, our mood is impaired.

But oftentimes, you know, people do better than they think. And that's a really important part of helping people with insomnia is kind of tracking the data on, you know, when you had a bad night of sleep, like, how'd you do during the day? And when you had a good night of sleep, how'd you do during the day? And it turns out if you track that over time, you know, our sleep doesn't

But oftentimes, you know, people do better than they think. And that's a really important part of helping people with insomnia is kind of tracking the data on, you know, when you had a bad night of sleep, like, how'd you do during the day? And when you had a good night of sleep, how'd you do during the day? And it turns out if you track that over time, you know, our sleep doesn't

necessarily play a huge role in our functioning during the day just in in kind of normal day-to-day things um so you know that that that can be really important evidence for people that they not they don't need to be so distressed about a bad night's sleep because they're common they happen to everybody and we're actually really resilient against it and that's just an important point to to have people understand

necessarily play a huge role in our functioning during the day just in in kind of normal day-to-day things um so you know that that that can be really important evidence for people that they not they don't need to be so distressed about a bad night's sleep because they're common they happen to everybody and we're actually really resilient against it and that's just an important point to to have people understand

Yeah, it's definitely the former. I mean, you know, our body is really good at compensating for lost sleep.

Yeah, it's definitely the former. I mean, you know, our body is really good at compensating for lost sleep.

So, for instance, if we deprive someone in the laboratory, which we do here, and they don't get to sleep, the next day when they sleep, when we allow that, their sleep, you know, they go into deep sleep much more rapidly, and their sleep is more consolidated because your body is trying to make up that lost amount.

So, for instance, if we deprive someone in the laboratory, which we do here, and they don't get to sleep, the next day when they sleep, when we allow that, their sleep, you know, they go into deep sleep much more rapidly, and their sleep is more consolidated because your body is trying to make up that lost amount.

I think the challenge is oftentimes that people are having bad nights of sleep consistently and then they are able to sleep the next night. They don't want to go to bed prematurely, right? You don't want to kind of like go to bed several hours earlier typically because you can only make so much sleep. And so if you go to bed too early, your sleep is likely to be fragmented.

I think the challenge is oftentimes that people are having bad nights of sleep consistently and then they are able to sleep the next night. They don't want to go to bed prematurely, right? You don't want to kind of like go to bed several hours earlier typically because you can only make so much sleep. And so if you go to bed too early, your sleep is likely to be fragmented.

Or you're going to, you know, you're going to wake up way earlier than you wanted to because when you lose sleep, you don't necessarily, your body doesn't make up the same amount the following night, right? Just the quality has changed.

Or you're going to, you know, you're going to wake up way earlier than you wanted to because when you lose sleep, you don't necessarily, your body doesn't make up the same amount the following night, right? Just the quality has changed.

Unfortunately, we don't have a lot of great data on that to understand how much of that is placebo. My guess is that there may be a little bit of an active ingredient, but just the rituals seem to be really important for people to let go and be able to sleep more soundly. Caffeine, however, we do know quite a bit about.

Unfortunately, we don't have a lot of great data on that to understand how much of that is placebo. My guess is that there may be a little bit of an active ingredient, but just the rituals seem to be really important for people to let go and be able to sleep more soundly. Caffeine, however, we do know quite a bit about.

Caffeine certainly can increase alertness, but it's in our system for a long time. And so caffeine has a half-life of about six hours. And so that means that after six hours, half of it is still in your system. So if you have a double espresso at 4 p.m., at 10 p.m., you still have a single espresso in your system. We know that that can keep people alert.

Caffeine certainly can increase alertness, but it's in our system for a long time. And so caffeine has a half-life of about six hours. And so that means that after six hours, half of it is still in your system. So if you have a double espresso at 4 p.m., at 10 p.m., you still have a single espresso in your system. We know that that can keep people alert.

It can make it difficult for them to fall asleep. And if they fall asleep, their sleep is often lighter or more fragmented. And so the quality seems to suffer as a consequence.

It can make it difficult for them to fall asleep. And if they fall asleep, their sleep is often lighter or more fragmented. And so the quality seems to suffer as a consequence.

I feel like, since I've been doing this type of work, you know, some of the collective consciousness around sleep and its importance for health and wellbeing has changed. There has been a shift. And I think a lot of it comes from kind of hearing it in the media and kind of what we're learning in sleep science.

I feel like, since I've been doing this type of work, you know, some of the collective consciousness around sleep and its importance for health and wellbeing has changed. There has been a shift. And I think a lot of it comes from kind of hearing it in the media and kind of what we're learning in sleep science.

But despite that, there's still a dramatically high number of individuals that are getting insufficient amounts of sleep and struggle with their sleep. And so it makes me think that maybe there are things that are getting in the way, barriers, or kind of the way that we live our lives.

But despite that, there's still a dramatically high number of individuals that are getting insufficient amounts of sleep and struggle with their sleep. And so it makes me think that maybe there are things that are getting in the way, barriers, or kind of the way that we live our lives.

But also, I think that there may be some gaps in our knowledge about what to do when we're not able to sleep well. That kind of perpetuates these chronic problems of insomnia or insufficient sleeping.

But also, I think that there may be some gaps in our knowledge about what to do when we're not able to sleep well. That kind of perpetuates these chronic problems of insomnia or insufficient sleeping.

Yeah, I mean, the literature certainly varies. But, you know, when we think about insomnia symptoms, so that's sleep disturbances, problems in falling asleep or staying asleep or waking up too early, you know, that seems to range, you know, a little bit above, you know, 30 to 40 percent of the population in the United States reports insomnia symptoms.

Yeah, I mean, the literature certainly varies. But, you know, when we think about insomnia symptoms, so that's sleep disturbances, problems in falling asleep or staying asleep or waking up too early, you know, that seems to range, you know, a little bit above, you know, 30 to 40 percent of the population in the United States reports insomnia symptoms.

And so, you know, that's nearly 100 million people in the U.S. When people have trouble sleeping,

And so, you know, that's nearly 100 million people in the U.S. When people have trouble sleeping,

Yeah, that's a really great question. The most common model for insomnia is called the 3P model. And so each P stands for a different part of the thing that leads to insomnia. And so there's the predisposition, right? There are some people that are kind of anxious folks and are more likely to have difficulty falling asleep.

Yeah, that's a really great question. The most common model for insomnia is called the 3P model. And so each P stands for a different part of the thing that leads to insomnia. And so there's the predisposition, right? There are some people that are kind of anxious folks and are more likely to have difficulty falling asleep.

These are the people that say, you know, my whole life I've been a bad sleeper. And then there is a precipitating factor. That's the second P. And usually that's some sort of stressor that happens out in the world and can make it difficult to fall asleep or stay asleep. And that's, of course, an adaptive response. I mean, we're built to kind of withstand lack of sleep to kind of get things done.

These are the people that say, you know, my whole life I've been a bad sleeper. And then there is a precipitating factor. That's the second P. And usually that's some sort of stressor that happens out in the world and can make it difficult to fall asleep or stay asleep. And that's, of course, an adaptive response. I mean, we're built to kind of withstand lack of sleep to kind of get things done.

I mean, talk to any parent of a young child and certainly we can survive that. But then the final P is the perpetuating factors. And that is what is really ironic in how insomnia develops. Because what happens is that people tend to make a lot of choices that in the moment make a lot of sense.

I mean, talk to any parent of a young child and certainly we can survive that. But then the final P is the perpetuating factors. And that is what is really ironic in how insomnia develops. Because what happens is that people tend to make a lot of choices that in the moment make a lot of sense.

You know, things like, you know, if I have a bad night of sleep, I'll try to make up for it by sleeping in a few extra hours in the morning, or I'll take a nap during the day, or I'll get in bed really early because I don't know when sleep's going to happen. And those types of things, though they make sense in the moment, actually undermine how sleep works naturally.

You know, things like, you know, if I have a bad night of sleep, I'll try to make up for it by sleeping in a few extra hours in the morning, or I'll take a nap during the day, or I'll get in bed really early because I don't know when sleep's going to happen. And those types of things, though they make sense in the moment, actually undermine how sleep works naturally.

There's one thing that I can tell people to get their sleep back on track. It's actually to maintain a stable wake time seven days a week. That is really critical for setting your circadian rhythm and making things more predictable for your body.

There's one thing that I can tell people to get their sleep back on track. It's actually to maintain a stable wake time seven days a week. That is really critical for setting your circadian rhythm and making things more predictable for your body.

And then it kind of feeds forward. to becoming what we know is kind of chronic insomnia or insomnia disorder. Well, it's weird when you think about it because not sleeping isn't doing something.

And then it kind of feeds forward. to becoming what we know is kind of chronic insomnia or insomnia disorder. Well, it's weird when you think about it because not sleeping isn't doing something.

Yeah. I mean, I think the unfortunate thing is like in the middle of the night when we're awake, it's not like our mind is filled with the best things happening in our life, right? It's not like, oh, how great is tomorrow going to be? Or this wonderful experience I've had. It's always these kind of negative things. It's things that like, you know, worries about what we're doing tomorrow.

Yeah. I mean, I think the unfortunate thing is like in the middle of the night when we're awake, it's not like our mind is filled with the best things happening in our life, right? It's not like, oh, how great is tomorrow going to be? Or this wonderful experience I've had. It's always these kind of negative things. It's things that like, you know, worries about what we're doing tomorrow.

you know, ruminations about things that you wish had gone differently. Or, you know, as you mentioned, worrying about the fact that you're not sleeping and like, what does that mean? What, you know, how are you going to feel tomorrow? What happens as the minutes tick by and you're still not asleep?

you know, ruminations about things that you wish had gone differently. Or, you know, as you mentioned, worrying about the fact that you're not sleeping and like, what does that mean? What, you know, how are you going to feel tomorrow? What happens as the minutes tick by and you're still not asleep?

That really ramps up that anxiety that ramps up our stress response, which is incompatible with sleeping. And so it's often kind of a mixture of those sorts of things that happen when people are kind of in the quiet of the night and your brain kind of fills that vacuum of space with just busy, often negatively valence thoughts.

That really ramps up that anxiety that ramps up our stress response, which is incompatible with sleeping. And so it's often kind of a mixture of those sorts of things that happen when people are kind of in the quiet of the night and your brain kind of fills that vacuum of space with just busy, often negatively valence thoughts.

absolutely so you know one of the key pieces of our sleep regulation is our circadian rhythm okay and when the sun goes down and it gets close to bedtime your brain starts releasing melatonin right like lots of people have heard of melatonin it you know it's often a supplement that people use uh but you know we make it and it's you know it's released from our pineal gland in our brain

absolutely so you know one of the key pieces of our sleep regulation is our circadian rhythm okay and when the sun goes down and it gets close to bedtime your brain starts releasing melatonin right like lots of people have heard of melatonin it you know it's often a supplement that people use uh but you know we make it and it's you know it's released from our pineal gland in our brain

One of the things that

One of the things that

happens when people are exposed to blue light that frequency of light is it can actually shut down the release of that hormone and so the thought is that you know when people are exposed to that it actually makes it difficulty difficult to fall asleep because you don't have this melatonin release and there's some some kind of compelling science to suggest that that can happen physiologically and some people might be more

happens when people are exposed to blue light that frequency of light is it can actually shut down the release of that hormone and so the thought is that you know when people are exposed to that it actually makes it difficulty difficult to fall asleep because you don't have this melatonin release and there's some some kind of compelling science to suggest that that can happen physiologically and some people might be more

sensitive to that than others. My concern is that there is a lot of focus on the blue light. Devices now have night shift filters where we can filter out that, or there are glasses that people can wear that will protect them from that. But when it comes to sleeping, it's often the content

sensitive to that than others. My concern is that there is a lot of focus on the blue light. Devices now have night shift filters where we can filter out that, or there are glasses that people can wear that will protect them from that. But when it comes to sleeping, it's often the content

that people are consuming that is actually engaging their brain and keeping them from falling asleep so even when the blue light is taken out of the equation people have difficulty falling asleep when they're on social media when they're on their computer working when they're

that people are consuming that is actually engaging their brain and keeping them from falling asleep so even when the blue light is taken out of the equation people have difficulty falling asleep when they're on social media when they're on their computer working when they're

watching engaging shows i mean i i certainly um have engaged in those sorts of things and you know it can be difficult to fall asleep and and part of it is or a big piece of it is that you know particularly when it comes to the internet and social media it's developed and designed to keep you engaged. It activates that reward system in your brain that keeps you coming back.

watching engaging shows i mean i i certainly um have engaged in those sorts of things and you know it can be difficult to fall asleep and and part of it is or a big piece of it is that you know particularly when it comes to the internet and social media it's developed and designed to keep you engaged. It activates that reward system in your brain that keeps you coming back.

And that experience is the enemy of sleep. Sleep is something about kind of letting go

And that experience is the enemy of sleep. Sleep is something about kind of letting go

and and not engaging in those sorts of activities and so it's not just about blue light you know there is certainly some evidence to suggest that it can get in the way and it certainly can uh down regulate your melatonin release but you know if I had to put my money on a on a thing to to work on when it comes to those types of activities it would be around the content

and and not engaging in those sorts of activities and so it's not just about blue light you know there is certainly some evidence to suggest that it can get in the way and it certainly can uh down regulate your melatonin release but you know if I had to put my money on a on a thing to to work on when it comes to those types of activities it would be around the content

So what are they? I think the really important things that in kind of shifting how people think about their sleep is that sleep isn't something that you make happen, right? Sleep is something that happens to you. It kind of washes over you. And so oftentimes the effort that people put in

So what are they? I think the really important things that in kind of shifting how people think about their sleep is that sleep isn't something that you make happen, right? Sleep is something that happens to you. It kind of washes over you. And so oftentimes the effort that people put in

and the angst that they experience to try to make it happen actually really gets in the way of it happening naturally but you know on any given night there are obviously things that you can do to kind of put yourself in the best position to have a restful night's sleep the first is

and the angst that they experience to try to make it happen actually really gets in the way of it happening naturally but you know on any given night there are obviously things that you can do to kind of put yourself in the best position to have a restful night's sleep the first is

you know ensuring that you have an ample transition right we need to demarcate the the time from the day to when you're kind of winding down for for for bed um and you know one of the things that i see so regularly is that you know people treat their brains as if they're their laptop computers where you can just kind of shut the lid and it turns off and then you go to sleep

you know ensuring that you have an ample transition right we need to demarcate the the time from the day to when you're kind of winding down for for for bed um and you know one of the things that i see so regularly is that you know people treat their brains as if they're their laptop computers where you can just kind of shut the lid and it turns off and then you go to sleep

And it turns out that's just not how it works. And so I really suggest that people carve out a good transition time, and this is range an hour, maybe two hours, where you can really relax and do something kind for yourself, things that are positive and kind of low arousal, kind of relaxation type activities. And those can be personal, but it's really important to have those in place

And it turns out that's just not how it works. And so I really suggest that people carve out a good transition time, and this is range an hour, maybe two hours, where you can really relax and do something kind for yourself, things that are positive and kind of low arousal, kind of relaxation type activities. And those can be personal, but it's really important to have those in place

as it will cue your body that it's time for rest and you can get the restorative sleep you need. The second thing is that you don't want to go to bed unless you're sleepy.

as it will cue your body that it's time for rest and you can get the restorative sleep you need. The second thing is that you don't want to go to bed unless you're sleepy.

And so it turns out in cognitive behavioral therapy for insomnia, which is what we do in our clinic here at UCSF, we often end up pushing people's bedtimes back later as a way of trying to increase their sleep drive, the second thing that is really important for regulating our sleep. So I mentioned the circadian rhythm, but our sleep drive is the second one.

And so it turns out in cognitive behavioral therapy for insomnia, which is what we do in our clinic here at UCSF, we often end up pushing people's bedtimes back later as a way of trying to increase their sleep drive, the second thing that is really important for regulating our sleep. So I mentioned the circadian rhythm, but our sleep drive is the second one.

And so by pushing your bedtime later, it ensures that you have that sleepiness on board so that you can fall asleep quickly and often kind of experience more restorative, consolidated sleep. And so you want to have the transition and you just don't want to get in bed prematurely.

And so by pushing your bedtime later, it ensures that you have that sleepiness on board so that you can fall asleep quickly and often kind of experience more restorative, consolidated sleep. And so you want to have the transition and you just don't want to get in bed prematurely.

uh when you're not sleepy and and related to that is you know the bed is kind of a shrine to sleep it's not a workstation it's not a place where you watch television we always say in our clinic you know the bed is for sleep and sex and otherwise everything stays outside of it And that's important for kind of cuing your body that this is what happens here, that I fall asleep here.

uh when you're not sleepy and and related to that is you know the bed is kind of a shrine to sleep it's not a workstation it's not a place where you watch television we always say in our clinic you know the bed is for sleep and sex and otherwise everything stays outside of it And that's important for kind of cuing your body that this is what happens here, that I fall asleep here.

And we have lots of environmental triggers in our lives that tell our brains and bodies what to do. And the bed is certainly one of them.

And we have lots of environmental triggers in our lives that tell our brains and bodies what to do. And the bed is certainly one of them.

These are the things that you constantly hear about as sleep hygiene but are critical. The things that I mentioned in trying to regulate people's sleep don't tend to work unless you also have a really well-set-up bedroom. This is the things like keeping your bedroom dark,

um keeping it quiet you know some people use eye masks some people use earplugs some people use noise machines white noise machines and then the other one is temperature temperature is you know our our core body temperature has to drop as we sleep And one of the things that facilitates that is keeping the room cool.

And so it seems like, you know, the sweet spot is somewhere between 60 and 67 degrees Fahrenheit. You know, certainly you want to ensure that you have, you know, that you're warm enough. And, you know, often layers are kind of the best way to go about this.

But those things combined with not getting into bed prematurely, making sure that you use the bed just for sleeping, and ensuring this transition put people in a pretty good position to sleep well. And then there are other things that happen that are not close to the bedtime window that seem to be really critical to help people sleep.

The one that I tell everyone, first off, if there's one thing that I could tell people to get their sleep back on track, it's actually to maintain a stable wake time seven days a week. That is really critical for setting your circadian rhythm and making things more predictable for your body.

what else is it that people do maybe unknowingly unwittingly that actually sabotages their sleep you know one of the things that's critical and is really part of the the foundation of what feeds insomnia is people's tendency to spend

excessive amount of time in bed not sleeping and this is really hard right because you you want to be asleep you're like waiting for this to happen you're kind of like on the edge and you think that if i wait another 10 minutes i'm gonna fall asleep but what happens for a lot of people is you know 10 minutes turns into 20 turns into 40 turns into two hours and they're kind of you know trying to fight this um experience of their active mind

And what that does is it actually fractures the relationship your body has with the bed. Your body gets confused. And it actually develops into something called a conditioned arousal. So, you know, I hear so often in our clinic, patients say things like, you know, I was feeling really sleepy. And then I got in bed and my brain woke up. And that can happen both physically.

when you go to sleep but also in the middle of the night and it it changes the experience so what you need to do is actually get out of bed and it's it's challenging no one no one loves doing this but it's important because once you get out of bed you do something quiet relaxing and then you want to get back in bed

and and try to go to sleep again and what that will do is it will repair the relationship of kind of sleepiness and the bed and over time will will help you sleep more soundly how big a problem is it when you

Yeah, that's I mean, that's a great question and that's a great point around placebo sleep. You know, certainly at kind of the extreme ends, the extreme end of sleep deprivation, there is it's clear that, you know, our faculties are damaged right now, you know, cognitively, our reaction time. All of those sorts of things, our mood is impaired.

But oftentimes, you know, people do better than they think. And that's a really important part of helping people with insomnia is kind of tracking the data on, you know, when you had a bad night of sleep, like, how'd you do during the day? And when you had a good night of sleep, how'd you do during the day? And it turns out if you track that over time, you know, our sleep doesn't

necessarily play a huge role in our functioning during the day just in in kind of normal day-to-day things um so you know that that that can be really important evidence for people that they not they don't need to be so distressed about a bad night's sleep because they're common they happen to everybody and we're actually really resilient against it and that's just an important point to to have people understand

Yeah, it's definitely the former. I mean, you know, our body is really good at compensating for lost sleep.

So, for instance, if we deprive someone in the laboratory, which we do here, and they don't get to sleep, the next day when they sleep, when we allow that, their sleep, you know, they go into deep sleep much more rapidly, and their sleep is more consolidated because your body is trying to make up that lost amount.

I think the challenge is oftentimes that people are having bad nights of sleep consistently and then they are able to sleep the next night. They don't want to go to bed prematurely, right? You don't want to kind of like go to bed several hours earlier typically because you can only make so much sleep. And so if you go to bed too early, your sleep is likely to be fragmented.

Or you're going to, you know, you're going to wake up way earlier than you wanted to because when you lose sleep, you don't necessarily, your body doesn't make up the same amount the following night, right? Just the quality has changed.

Unfortunately, we don't have a lot of great data on that to understand how much of that is placebo. My guess is that there may be a little bit of an active ingredient, but just the rituals seem to be really important for people to let go and be able to sleep more soundly. Caffeine, however, we do know quite a bit about.

Caffeine certainly can increase alertness, but it's in our system for a long time. And so caffeine has a half-life of about six hours. And so that means that after six hours, half of it is still in your system. So if you have a double espresso at 4 p.m., at 10 p.m., you still have a single espresso in your system. We know that that can keep people alert.

It can make it difficult for them to fall asleep. And if they fall asleep, their sleep is often lighter or more fragmented. And so the quality seems to suffer as a consequence.

I feel like, since I've been doing this type of work, you know, some of the collective consciousness around sleep and its importance for health and wellbeing has changed. There has been a shift. And I think a lot of it comes from kind of hearing it in the media and kind of what we're learning in sleep science.

But despite that, there's still a dramatically high number of individuals that are getting insufficient amounts of sleep and struggle with their sleep. And so it makes me think that maybe there are things that are getting in the way, barriers, or kind of the way that we live our lives.

But also, I think that there may be some gaps in our knowledge about what to do when we're not able to sleep well. That kind of perpetuates these chronic problems of insomnia or insufficient sleeping.

Yeah, I mean, the literature certainly varies. But, you know, when we think about insomnia symptoms, so that's sleep disturbances, problems in falling asleep or staying asleep or waking up too early, you know, that seems to range, you know, a little bit above, you know, 30 to 40 percent of the population in the United States reports insomnia symptoms.

And so, you know, that's nearly 100 million people in the U.S. When people have trouble sleeping,

Yeah, that's a really great question. The most common model for insomnia is called the 3P model. And so each P stands for a different part of the thing that leads to insomnia. And so there's the predisposition, right? There are some people that are kind of anxious folks and are more likely to have difficulty falling asleep.

These are the people that say, you know, my whole life I've been a bad sleeper. And then there is a precipitating factor. That's the second P. And usually that's some sort of stressor that happens out in the world and can make it difficult to fall asleep or stay asleep. And that's, of course, an adaptive response. I mean, we're built to kind of withstand lack of sleep to kind of get things done.

I mean, talk to any parent of a young child and certainly we can survive that. But then the final P is the perpetuating factors. And that is what is really ironic in how insomnia develops. Because what happens is that people tend to make a lot of choices that in the moment make a lot of sense.

You know, things like, you know, if I have a bad night of sleep, I'll try to make up for it by sleeping in a few extra hours in the morning, or I'll take a nap during the day, or I'll get in bed really early because I don't know when sleep's going to happen. And those types of things, though they make sense in the moment, actually undermine how sleep works naturally.

There's one thing that I can tell people to get their sleep back on track. It's actually to maintain a stable wake time seven days a week. That is really critical for setting your circadian rhythm and making things more predictable for your body.

And then it kind of feeds forward. to becoming what we know is kind of chronic insomnia or insomnia disorder. Well, it's weird when you think about it because not sleeping isn't doing something.

Yeah. I mean, I think the unfortunate thing is like in the middle of the night when we're awake, it's not like our mind is filled with the best things happening in our life, right? It's not like, oh, how great is tomorrow going to be? Or this wonderful experience I've had. It's always these kind of negative things. It's things that like, you know, worries about what we're doing tomorrow.

you know, ruminations about things that you wish had gone differently. Or, you know, as you mentioned, worrying about the fact that you're not sleeping and like, what does that mean? What, you know, how are you going to feel tomorrow? What happens as the minutes tick by and you're still not asleep?

That really ramps up that anxiety that ramps up our stress response, which is incompatible with sleeping. And so it's often kind of a mixture of those sorts of things that happen when people are kind of in the quiet of the night and your brain kind of fills that vacuum of space with just busy, often negatively valence thoughts.

absolutely so you know one of the key pieces of our sleep regulation is our circadian rhythm okay and when the sun goes down and it gets close to bedtime your brain starts releasing melatonin right like lots of people have heard of melatonin it you know it's often a supplement that people use uh but you know we make it and it's you know it's released from our pineal gland in our brain

One of the things that

happens when people are exposed to blue light that frequency of light is it can actually shut down the release of that hormone and so the thought is that you know when people are exposed to that it actually makes it difficulty difficult to fall asleep because you don't have this melatonin release and there's some some kind of compelling science to suggest that that can happen physiologically and some people might be more

sensitive to that than others. My concern is that there is a lot of focus on the blue light. Devices now have night shift filters where we can filter out that, or there are glasses that people can wear that will protect them from that. But when it comes to sleeping, it's often the content

that people are consuming that is actually engaging their brain and keeping them from falling asleep so even when the blue light is taken out of the equation people have difficulty falling asleep when they're on social media when they're on their computer working when they're

watching engaging shows i mean i i certainly um have engaged in those sorts of things and you know it can be difficult to fall asleep and and part of it is or a big piece of it is that you know particularly when it comes to the internet and social media it's developed and designed to keep you engaged. It activates that reward system in your brain that keeps you coming back.

And that experience is the enemy of sleep. Sleep is something about kind of letting go

and and not engaging in those sorts of activities and so it's not just about blue light you know there is certainly some evidence to suggest that it can get in the way and it certainly can uh down regulate your melatonin release but you know if I had to put my money on a on a thing to to work on when it comes to those types of activities it would be around the content

So what are they? I think the really important things that in kind of shifting how people think about their sleep is that sleep isn't something that you make happen, right? Sleep is something that happens to you. It kind of washes over you. And so oftentimes the effort that people put in

and the angst that they experience to try to make it happen actually really gets in the way of it happening naturally but you know on any given night there are obviously things that you can do to kind of put yourself in the best position to have a restful night's sleep the first is

you know ensuring that you have an ample transition right we need to demarcate the the time from the day to when you're kind of winding down for for for bed um and you know one of the things that i see so regularly is that you know people treat their brains as if they're their laptop computers where you can just kind of shut the lid and it turns off and then you go to sleep

And it turns out that's just not how it works. And so I really suggest that people carve out a good transition time, and this is range an hour, maybe two hours, where you can really relax and do something kind for yourself, things that are positive and kind of low arousal, kind of relaxation type activities. And those can be personal, but it's really important to have those in place

as it will cue your body that it's time for rest and you can get the restorative sleep you need. The second thing is that you don't want to go to bed unless you're sleepy.

And so it turns out in cognitive behavioral therapy for insomnia, which is what we do in our clinic here at UCSF, we often end up pushing people's bedtimes back later as a way of trying to increase their sleep drive, the second thing that is really important for regulating our sleep. So I mentioned the circadian rhythm, but our sleep drive is the second one.

And so by pushing your bedtime later, it ensures that you have that sleepiness on board so that you can fall asleep quickly and often kind of experience more restorative, consolidated sleep. And so you want to have the transition and you just don't want to get in bed prematurely.

uh when you're not sleepy and and related to that is you know the bed is kind of a shrine to sleep it's not a workstation it's not a place where you watch television we always say in our clinic you know the bed is for sleep and sex and otherwise everything stays outside of it And that's important for kind of cuing your body that this is what happens here, that I fall asleep here.

And we have lots of environmental triggers in our lives that tell our brains and bodies what to do. And the bed is certainly one of them.