Dr. Matt Walker: Improve Sleep to Boost Mood & Emotional Regulation | Huberman Lab Guest Series

[Music]

welcome to the hubman lab guest Series

where I and an expert guest discuss

science and science-based tools for

everyday

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford school of

medicine today marks the fifth episode

in our sixth episode series all about

sleep with expert guest Dr Matthew

Walker today's episode focuses on the

inextricable link between sleep and our

mental health for instance a specific

stage of sleep called rapid eye movement

or REM sleep is critical for removing

the emotional content of our previous

days memories and in doing so provides a

sort of therapy within sleep that allows

us to feel emotionally restored when we

wake the next morning we discuss what

happens when you are deprived of REM

sleep to a small or greater degree and

we discuss how to improve the quality

and quantity of your REM sleep in order

to ensure mental health we also discuss

science-based protocols for reducing

rumination and negative thoughts before

sleep the information shared by Dr

Walker in today's episode is sure to be

critical for anyone that is either

struggling with mental health issues or

who simply wants to bolster their

overall mental health before we begin

I'd like to emphasize that this podcast

is separate from my teaching and

research roles at Stanford it is however

part of my desire and effort to bring

zero cost to Consumer information about

science and science related tools to the

general public in keeping with that

theme I'd like to thank the sponsors of

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huberman and now for my conversation

with Dr Matthew Walker Dr Matthew Walker

welcome back Dr Andrew huberman Delight

to be back during the course of this

series we've of course been talking

about sleep and you've talked about the

biology of sleep ways to improve maybe

even optimize sleep you defined what

optimizing one's sleep actually

is talked about learning and memory

creativity caffeine naps food exercise

and so much more

today I'm excited that you're going to

teach us about the relationship between

sleep and emotion regulation but also

mental health mental health challenges

but I sometimes like to remind people

that mental health includes the word

Health it's not all about mental illness

it's also about how to improve one's

Health as well as ways to combat certain

forms of mental illness or challenges so

to start things off maybe you could just

give us the basics of the relationship

between sleep and emotional states or

one's ability to regulate their own

emotions this is an area of work that

we've been uh interested in and doing a

lot of research on for about 20 or so

years

now and I would say that probably the

most striking statement I can offer

upfront is the following in that 20

years of research we have not been able

to discover a single psychiatric

condition in which sleep is

normal and to me it has taught me

everything that I need to know about

this very intimate bidirectional

relationship between your sleep health

and your mental health and you're right

to emphasize that notion of mental

health because we're not just going to

speak about some of the sort of

challenging aspects of sleep and

psychiatric disorders but we'll speak

about some of the benefits that sleep

can provide when you get it to turn the

tables and we move in the direction not

of Mental Illness but we move in the

direction of mental Wellness so I'm

excited sort of make sure that I I don't

fall prey to

that stepping back still though what

about this relationship between just

sleep and our basic emotional regulation

and our emotional

stability I'm sure everyone has seen the

example or had the example as a parent

of that parent holding a child and the

child is crying and they look at you and

they say well they just didn't sleep

well last night as if there's some

miraculous parental knowledge that bad

sleep the night before equals bad mood

and emotional reactivity and regulation

the next day and some years ago now we

were fascinated by this but we couldn't

really unearth basic science that would

help us explain what was going on and

why that was so clearly the case so we

did an initial study where we took a

group of healthy people no signs of

psychiatric illness or emotional

instability and we gave them a full

night of sleep or we sleep deprive them

and then the next day we put them inside

of a brain scanner and we showed them a

whole range of emotional visual images

is ranging from very neutral all the way

up to quite unpleasant and negative and

we were looking at how the brain was

reacting to those emotional experiences

with versus without sleep and the

structure that we'd initially focused on

was a structure that you've spoken about

before called the amydala and you

actually have one on the left and the

right side of your brain and the amydala

is the centerpiece region for the

generation of emotional reactions both

positive and negative but here we're

focusing on that aversive that negative

aspect and when we looked at that

structure in people who are sleep

deprived what we saw relative to the

people who'd had a full night of sleep

was a 60% 60 60% increase in amydala

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responsivity under conditions of sleep

deprivation that is quite a striking

amplification in fact we to that date

with all of us that these on sleep and

sleep loss had not quite seen an effect

size within the brain that was that was

that big sorry to interrupt but just to

make sure that everyone's on the same

page so people are being shown images

with varying degrees of emotionality

including images that are known to evoke

negative averse emotions as we call them

in the laboratory um could be feelings

of fear anger disgust revulsion what

whatever negative

veilance was it the case that sleep

deprivation increased the activity in

the amydala to such images by 60% only

for the aversive images or for let's say

a neutral image um presented to somebody

who has had plenty of quality

sleep um let's say it is I'm making up

the units here gives us two out of 10

units of Amal activation this isn't the

way Neuroscience is done but for sake of

discussion is it the case then that that

neutral image would provide a you know a

six out of 10 a level of activation or

was it only for aversive images so the

way we did the analysis first was we

used almost a a correlation approach so

we sort of told the brain Imaging

analysis to say look here are the the

ratings of these pictures and they go

from very neutral to increasingly

negative and aversive and show me what

in the brain is reacting to that curve

that gradient curve and sure enough

you've got the magnitude overall was 60%

but it's a very interesting point that

you make because worthy amydala started

to respond and that res responsivity

started to hook up in the activation and

the sort of aggravation Direction was

much earlier in the curve of

emotionality in other words things that

previously when you've had a good night

of sleep do not feel particularly

emotional started to become rather

emotional when you were not getting

sufficient sleep

so it heightened the sensitivity of the

initial triggering of the emotional

response and then the more emotional it

became the more separate those two sort

of reactivity curves became from the

Amala when you had sleep versus when you

had not sleep or had not slept I should

say to us then the question became well

why why is the amydala so reactive and

controlled when you are absent sleep and

we did another analysis and what we

found was that there was a structure in

your frontal lobe and the frontal lobe

just sits directly sort of if you think

about your eyes and you go directly up

your in your frontal lobe and it was a

particular part of the frontal lobe the

middle part that sits right between your

eyes something that we call the medial

prefrontal cortex and what we found was

that with a night of sleep the med Al

prefrontal cortex was strongly connected

to the amydala why is that important

it's because that part of the your

frontal lobe is very good at acting like

a control rational mechanism on your

deep sort of you know it's not

Neanderthal but your deep emotional

brain centers but without sleep we found

that that connection had been

severed and so it was almost as though

without sleep you become all emotional

gas pedal and too little regulatory

control break and so you couldn't

modulate those emotions anywhere near as

effectively now some people may say well

hang on a second you that was a total

night of sleep deprivation and that's

not really relevant for me because I I

don't sleep enough I know that from all

of the previous episodes that uh I've

gone through here hopefully if you've

listened to them but I'm usually maybe

getting five or 6 hours of sleep is this

really relevant so we started doing that

study we wanted to say Let's do an what

we call an ecological study more of a

real world sleep restriction rather than

total

deprivation and we were about halfway

through that study when a wonderful

Japanese research group essentially

published the study that we were doing

and what was great is that they did it

even in a more rigorous way and

essentially what they were able to do is

replicate exactly what we'd found but

now by putting people on sort of less

than 6 hours of sleep for five nights

and sure enough you got the same

response so that was very clear to us

that there is some sensitivity there's a

reason why you become so

unbuckled emotionally when you are not

getting sufficient sleep it's the reason

that you have almost this sort of

erratic pendulum like sort of

responsivity when you're not getting

sufficient sleep that notion of I just

snap dot dot dot or you apologize and

you say look I am so sorry I just bit

your H off I just haven't been getting

enough sleep and so we could start to

understand what in the brain was

happening when you didn't get sleep it

such an important finding uh for a

couple of reasons that maybe we can

explore um previously on the podcast we

had a guest um doctor he's a

neurosurgeon Matt McDougall he's the

lead neurosurgeon at um neurolink yeah

he came up through Stanford works on

deep brain stimulation Etc and I love

his description of what the prefrontal

cortex does it jbes perfectly with the

way you describe it which is he said the

main function of the prefrontal cortex

is to

say to specific brain areas under

specific contexts so um the sh of course

is a you know his way of describing

neural inhibition so quieting of neural

activity in certain brain circuits under

certain conditions because there are

conditions under which you want your

amydala activation to be very robust you

know fast and um there's time for uh you

know protecting oneself maybe even

certain situations for Swift violent

action to protect your family Etc but

the prefrontal cortex seems to be able

to hold it in mind so to speak what the

context is under which that would be

appropriate versus when it would be

inappropriate a great example of that

people can think of if all of a sudden a

gun is pointed in your

face you would want your amydala to

react if it's in the real world but if

you're at the movie theaters and you see

a gun pointed in your face your igula

doesn't really react as much why because

you're prefontal cortex understood the

word that you describe which is

context but in some ways it seems as

though you

become almost regress to this more basic

fundament mental

Elemental you know emotional brain and

the Red Mist descends and you really

can't see much more because your

prefrontal cortex seems to be absent you

become very reflex driven and we don't

want to um go too uh far a tangent of on

prefrontal cortex but one of the most

beautiful descriptions of prefrontal

Cortex I ever heard was also from a

colleague Eric nudson at Stanford who's

now retired does beautiful work on

neuroplasticity and he described how

when people or animals have lesions to

certain regions of the prefrontal cortex

they become stimulus-driven machines

such that you know if you if you go like

this to a you know to a puppy or to Baby

they'll look to the snapping finger but

at some point you know we all learn that

you know there must be a reason for us

to follow the snapping of the fingers in

different locations in space but with a

prefrontal damage people and animals

just become like machines whatever

stimulus is there they Orient to and

this has implications for ADHD Etc one

of the things that I want to um ask

about to take us back to the specific

relationship between sleep reduced

medial prefrontal activity and

emotionality is this feeling when we're

sleep deprived that certain things just

great on us a bit more you know I had

this experience recently unfortunately

there was a night where I didn't get

much sleep at all and then the next day

I was on a phone call and the person I

was talking to I I I'm quite fond of but

they were they had a lot of energy and

they were talking they were kind of

coming at me with a bunch of stuff that

they wanted to and it just felt like you

know it was grading on my system and I

knew because I was sleep deprived that

you know they were entirely well-meaning

and so you just kind of resist but it's

incredible how cold water loud noises uh

requests of our time things like that

become very irritating and they grate on

us yeah when we're sleep deprived

whereas when we're rested it's like oh

yeah okay they're you know talking kind

of faster kind of loud okay somebody is

requesting something else I'll put it in

my list or maybe I'll the Ator or you

know the the uh cold shower that you

know feels like got to get over this

threshold to get into like when you're

rested you're like all right let's do

this right you know maybe even let's go

I I'm excited for it but when you're

tired o it is as if the um the brain is

fighting for any sense of Peace it can

possibly get and that peace is

interrupted by almost anything and

everything it is a grim situation and

we've certainly heard that from you know

patients and individuals it's almost as

though the world that they are

experiencing they look at and they say

you know what you're in an 11 and I need

you at a seven right now it is just too

much and this comes back to that result

that we described that when the amydala

crosses the threshold and says okay

things are getting emotional things are

getting unpleasant I'm going to be

responding

negatively in an angry way or a fearful

way that starts much earlier so the

threshold for triggering your emotional

aversive reaction is much lower and

that's why the person's voice when you

hear it first normally if you had a

great night of sleep you'd say gosh you

know what today I really love your

energy it's it's really it's so

infectious versus a day when you're not

sleeping you just think I just I'm

lifting my earbuds out of my ears I

don't know if I can take this much

longer and so that was where we were

able to manipulate sleep one way which

is to say I dial sleep down and then I

look at the emotional brain and you can

see this ramping up of the emotional

reactivity in these basic kind of gutur

all centers but then we wanted to do the

inverse we wanted to instead see if we

could insert sleep back in in other

words manipulate sleep and dial it back

up could you get a disapp ation in the

emotional

reaction and here we decided to throw a

second ingredient into the equation not

just simply looking at your emotional

reactivity but we wanted to look at

emotional memory now in a previous

episode we've spoken a lot about sleep

and memory but there we were speaking

about really quite neutral memory

textbook like memory fact-based memory

emotional memory is very different and

if I were to ask you you Andrew cast

your mind back to some of your earliest

childhood memories or your team memories

and if anyone listening were to do that

my guess is that almost all of the

memories that you recall are memories of

an emotional nature positive or

negative why is that it's because one of

the functions of emotions when it comes

to memory is to R flag and prioritize

that experience that memory as being

Salient because it's emotional and that

instructs the brain that this

information in particular is very

relevant to us as an organism why

because the rest of the brain is

shouting at me this is emotional so

there is something very privileged and

very special about an emotional memory

like a red flag that tags it for

priority in the brain but something I

started to notice when I would read the

data both the neural data and the

subjective data on emotional memory led

me to get very interested in what

happens with emotional memories over

time because what you will hear is that

if I were to ask you you know recall an

emotional memory just try to remember it

my guess is that now at the time of

recollection much later on you are not

having the same regurgitation of the

same visceral emotional reaction that

you had at the time of the experience

what that sort of turned a light bulb

moment on for me was that somewhere

between the initial experience and the

later recollection of that emotional

memory the brain has done a very clever

trick it has divorced the emotion from

the memory so now when you come to

recollect that emotional memory let's

say days later or even months later in

some ways it is a memory of an emotional

event but it is no longer as powerfully

emotional itself as it was at the time

of the experience right and I started to

wonder is that time or is that time

asleep so we did a study and we had

people experience these emotional

memories sort of essentially make

emotional memories and they were doing

it inside of a scanner and then we gave

them a night of sleep or even a nap and

then we brought them back or we just had

them learn those emotional memories in

the morning and then bring them back

after an identical amount of time to try

to soften those emotional memories but

without sleep and we put them back in

the scanner and we were able to look to

see when you come back later in that

second session is your emotional and you

recollect those experiences and you

relive them is the emotional reactivity

at that second session any different to

the first session and is that different

if that time elapse has contained a full

night of sleep versus you've just been

awake and what we found is that in those

people who remained awake across the day

having had those emotional memories

essentially implanted implanted sounds a

little bit sort of Big Brother I don't

mean it that way but they'd learned them

the amydala was just still as responsive

as they were recalling and reliving and

reexperiencing those emotional memories

but in those people who had the same

amount of time to process the memories

but had had a full night of sleep we saw

this incredible emotional amygdala dep

potentiation and what that taught me was

that the sleeping brain was able

to almost detox the emotional memory it

is think about it like um an

informational orange that the emotional

memory Has This Bitter emotional rind

around it and then you've got the

informational orange in the middle and

what sleep was doing was stripping the

bitter emotional rind off the

informational orange so that then when

you came back the next day again it is

now a memory of an emotional event but

it's no longer triggering that strong

visceral reaction in other words and we

describe this Theory as something called

overnight

forgetting which is that when it comes

to an emotional memory you both sleep to

forget and sleep to remember

respectively which is that you sleep to

remember the information the memory of

the experience but it is no longer

emotional

itself and from there we built a

biological model of exactly how this

works because when we looked at the

Sleep group who'd had that full 8-hour

opportunity we asked the question

because we'd measured their sleep what

is it about that sleep that seems to

provide this form of it's almost

overnight

therapy how is it doing that what stage

of sleep is doing that and sure enough

what we found was that it was REM sleep

rapid eye movement sleep associated with

dreaming and the greater the amount of

REM sleep the greater the amount of

emotional depotentiation the greater the

amount of sort of emotion detox that you

got the next

day and one of the fascinating things

that we didn't um quite mention in uh

the episode where we described what is

sleep and we described the different

stages including RAM and we spoke about

the brain

changes something utterly unique happens

during REM sleep levels of a brain

chemical called noradrenaline are

completely shut off it is the only time

during the 24-hour period when you see

the complete cessation of neur

adrenaline in the brain and of course

neur adrenaline is associated with many

different functions and you've elegantly

described them one of the functions is

that it's associated with emotional

responsivity and the focus and that sort

of strong um sort of emotional energy

and people will know we speak about it

has two names noradrenaline or

norepinephrine same thing us UK but

people of course are familiar with the

sister chemical in the body called

adrenaline upstairs in the brain we can

think about noradrenaline and during REM

sleep neur adrenaline is completely shut

off this stress Associated neurochemical

it's not only associated with stress but

it's associated with lots of things but

stress included is noradrenaline shut

off in the brain and body during uh

rapid eye movement sleep no it's not it

seems to be specifically within the

brain that there is this blockade of

noradrenaline and serot goes down too

whereas another chemical called atile

choline which is another

neurotransmitter that ramps up in the

brain so if there is a brain chemical

that seems to be underlying REM sleep or

dream sleep it seems to be acetycholine

and in fact in some parts of the brain

you can see almost a 30% greater amount

of acetel choline in some brain regions

than when we're awake yet on the other

hand when we think about noradrenaline

and serotonin they are both shut off so

the stress related chemical within the

brain is Switched Off during REM sleep

however if you look at other parts of

the brain the memory related centers of

the brain such as the hippocampus that

we've spoken about before and the

amydala that I just mentioned too those

are very active during REM sleep so we

laid out this biological model that is

almost beautiful that REM sleep is this

perfect condition for emotional

overnight therapy where you can re

activate and re sort of experience and

reprocess those emotional memories but

you're doing it in a neurochemically

quote unquote safe environment that

allows you to strip away the emotion

from the memory I'd like to take a brief

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huberman in some ways it does resemble

behavioral desensitization therapy

whereby under the care of a qualified

you know psychiatrist or psychologist

somebody will um be encouraged to recall

in a great degree of detail some very

difficult maybe even traumatic event um

and through repetition and of course

through the knowledge that there's

support in the immediate environment

that will allow them to um you know

safely move through that experience you

know should their their heart rate go up

they're sweating profusely having

trouble getting the words out there very

unfortunately common features of trauma

and and negative memories but the idea

as I understand is to repeat the recall

many times often in that safe

environment such that eventually what

was initially a really

terrible event remains a terrible event

but the emotional load of that event is

removed from the person's sort of neural

understanding of the event is the way

I've heard it described is what starts

as a tragic traumatic story eventually

becomes a kind of a sad boring story

boring to the person who's saying it

meaning it doesn't evoke as much

autonomic arousal exactly and in some

ways that's the perfect description of

this overnight therapy process

that it becomes a memory that is no

longer triggering an emotional reaction

and in some ways that's what you want if

you go back to my description from an

evolutionary perspective I told you that

one of the functions of emotions is to

red flag and prioritize the memory at

the time of learning to say that it's

important that's a very adaptive process

it helps us prioritize which things we

really should be focusing on and

remembering but it's not not adaptive

for you to hold on to that emotion long

term once you've started and there has

been some suggestion in the literature

before we were doing this work that

maybe one thing you can do with trauma

and Trauma memories is sleep deprive

individuals the very first night after

the trauma because we knew at the time

sleep is important for memory and what

you would like to do and it's very

similar to that movie Sunshine Spotless

Mind I always forget the Eternal Eternal

Eternal Sunshine of the Spotless Mind

thank you I didn't see the movie but I

hear it's good yeah and what they try to

do is Target in the brain these you know

difficult painful experiences and just

excise them from the brain and that was

the suggestion could you pop those

memories out of the biography of that

individual and save them the trauma I

would argue that's not really what you

want to do because let's say that I am

um I have a trauma experience where I

was walking home at night from The Sleep

laboratory late at night and I was

coming down the kind of an alley to take

a shortcut and someone sticks me up with

a gun maybe some

violence I don't want to remove that

memory I would like to remove the trauma

response associated with that memory but

I would argue for me as an organism it's

still very important for me to remember

that that alley was associated with a

bad experience and I should forego going

down that very same route again I want

to hold on to the memory the information

I want to let go of the emotion I want

to sleep to remember and I want to sleep

to

forget and I'll come on to why I think

that's relevant to PTSD when we perhaps

speak about that condition and it's very

very relevant but coming back to REM

sleep we looked back in the literature

to see if we could find signs that REM

sleep had this relationship with even

just your basic emotional reactivity and

there was some wonderful work by a

gentleman that you will know from

Stanford probably one of the founding

fathers of modern day sleep research a

gentleman called William DeMent yeah who

passed away a few years ago he did um

might have been one of the people who

coined the term rapid eye movement sleep

but I don't think he was the one who

discovered it correct he was not but he

was well up there in terms of

understanding both sort of what its term

was and also what its function

was he Legend as he was very early on

this was probably in the 60s he would

take individuals because we didn't

really have the first published report

of these two types of sleep of REM and

non-rem until they collected the data or

found the data in 1953 it was published

in 1954 so in other words we discovered

that you know even up to then prior to

then we just thought sleep was sleep we

didn't have any knowledge that the these

different stages so in the same year

that um Francis Crick you know un

unveiled this incredible helical

structure that was called a DNA strand

we also discovered the different stages

of sleep but in the 60s then William

DeMent knowing that there were these two

types of sleep and knowing that there

was something that was going on with REM

sleep were people were dreaming and he

would be waking people up from these

different stages and found that it's far

more likely to for people to report a

dream he wondered what the consequence

would be if you selectively deprive

people of this stage of sleep of dream

sleep so he brought individuals into his

laboratory and every time they would go

into REM sleep they would go into the

room they would wake them up have them

do some mathematical problems for 2 or 3

minutes and then put them back asleep

and they go back into nonr and then as

soon as they went back into REM they

would wake them up again and the first

night they would have to go into the

room maybe six or seven times still

brutal for the uh for the person in the

experiment not not too much fun and but

by the end of the 5 days or six days I

think they were going back into the room

something like 17 18 times why because

the people were building up this growing

REM sleep debt and the Brain had such a

hunger for it that by Night five of no

sleep all it wanted to do was rock it

into this thing called REM sleep and

start devouring it with high volume but

that wasn't the interesting part the

interesting part was the consequence to

these subjects they were all well

adjusted perfectly normal individuals by

about day three of selective R sleep

deprivation they started to show signs

of paranoia they started to believe

people were out after them they started

to have hallucinate ations and delusions

and by day

five they were bordering on having you

know aspects of quite severe

psychosis and so what all of this

research has taught us in some ways is

that it's almost as though REM sleep and

again it's

hyperbolic is the difference between

sanity versus Insanity it's the thing

that separates those two and there's a

wonderful quote from an American uh

entrepreneur called e Joseph Cosman and

for all of the years of work that we've

been doing in this field and I I've

spilled so much ink over this including

in the the book he summarized it in a

single

sentence the best bridge between Despair

and hope is a good night of sleep and

that's exactly what the data is

demonstrating in terms of basic

emotional brain

function so a powerful link there and um

I think it's appropriate therefore if we

explore a little bit about what the link

actually consists of um in a way that

will provide people a a kind of a a

compass for when they're feeling a

little bit less emotionally regulated or

if they would like to improve their

levels of emotion regulation uh this is

going to be a little bit of an

exploration but uh you may recall this

is an exploration that you and I had

some years ago when we were talking

about the Rel relationship between rapid

eye movement sleep and

emotionality

and here you've described that the

medial prefrontal cortex normally plays

this kind of

sh role uh this suppressive role over

the amydala under conditions where there

is something to consider is it averse is

it not averse how averse is it right

um but in terms of what we know about

stress and emotion you the autonomic

nervous system this incredible system

that balances sympathetic meaning

alertness arousal sometimes called the

fight ORF flight system and

parasympathetic activation sometimes

called the rest and digest system it's

the balance of the two that dictates

one's emotional state and alertness um

level of stress Etc and I've always

imagined the autonomic nervous system

the sympathetic and parasympathetic

nervous system as sort of a seesaw yeah

but on this seesaw sits us right and we

can move back and forth across this

seesaw but there's an component of the

Seesaw that um in my mental model um

which is the hinge how tight the Seesaw

is meaning how easily or how challenging

it is to tilt the Seesaw to one or the

other side and I don't know if the

mechanism has been discovered but I feel

like what happens under conditions of

REM deprivation or sleep

deprivation that is sleep deprivation

but you've beautifully described how

it's REM deprivation in particular that

can do this that the hinge becomes loose

but the hinge doesn't become loose

toward us becoming more parasympathetic

and relax there's an asymmetry there

it's as if the Seesaw now wants to flop

to sympathetic activation until we're so

exhausted that we just disappear into

sleep so the question is this and maybe

all we have here is is uh opportunity

for speculation but is there any

understanding of what the hinge might be

and how sleep would adjust the tightness

of that hinge and if people are

following this what we're really trying

to get to is you know you described a

neural circuit mechanism within the

brain but is this for instance the

gating of the release of epinephrine

adrenaline and cortisol I mean is that I

could imagine that's regulated by the

brain but when we're deprived of REM

sleep that process becomes less poorly

gated and then we just will punch out a

bunch of adrenaline in response to you

know a phone call from a close friend

that you adore but is their voic is just

a little bit loud and like H this is

rough yeah Etc do we do we understand

the nature of the hinge we do a little

bit and it's something that we started

off trying to test with one specific um

belief and then we were beautifully

course corrected by the data we thought

that the hinge was going to be once you

were sleep deprived and you started to

slide down into that fight or flight

Branch the more sympathetic and away

from the the par sympathetic that the

hinge would get ever tighter the further

into that sympathetic stress related

fight ORF flight dip that you had and

there you would stay it wasn't quite

that simple what we found was that when

I challenge you or put you either under

a very simple cardiovascular challenge

let's say I'm just having you grip a bar

for a long period of time or we have you

under some other maybe even if it's a um

an exercise regiment

when you are in a sleep deprived State

and you are largely inert and not

interacting with the world you actually

are in a more strong parasympathetic

State it's almost as though you do not

want to interact with the world per se

and this comes on to

motivation we and others have found that

one of the earliest and strongest

effects of a lack of sleep is just

absence of motivation I don't want to

interact with the world I don't want to

be social I don't want to learn I don't

want to exert effort I don't want to

exercise I just don't want to do much of

anything however when you provoke me and

you force me to interact or there is a

very strong emotional event that I

experience I go all the way over into

the strongly sympathetic so it's almost

as though we had the prediction that it

was going to be a very tight hinge and

the screw was tightening the more

sympathetic you became it was much more

that you were in this sort of

parasympathetic State this sort of

non-motivational state and the the hinge

was so loose however that even just the

tiniest flick of a challenge whoosh you

went straight over to the sympathetic

there was no sweet spot of a tightening

where you were nicely balancing between

those two states and this comes back to

something else that we found that's you

switching flip-flopping back and forth

between parasympathetic and

sympathetic I spoke about the emotional

reactivity to negative aversive events

but that's only one half of what we call

the affective veilance domain it's not

just that you can have negative

emotional reactions of course you can

have positive emotional

reactions so we did a sister study to

that amigdala study and we asked rather

than showing you increasingly negative

images and how your amigdala would

respond much more strongly to those as

we provoked it we then started to show

you much more positive rewarding images

and because one hypothesis would be that

you just simply slide down the scale and

you move towards more negative and away

from more reward-based

reactivity or you could imagine that

it's both that when you are sleep

deprived you are equally excessively

reactive to both of those domains and

what we found was that it was the latter

that you were very abnormally reactive

overreactive to negative events but you

were equally hyper sensitive to very

reward-based stimuli and this fits

beautifully with what we know from sleep

deprivation you are much more impulsive

you are much more reward seeking you are

much greater in terms of your sensation

seeking and your addiction potential

when you are not getting sufficient

sleep is significantly higher and sure

enough when we looked in the brain many

of these dopamine related circuits that

you've described before were

overactive when you were under slapped

and so I bring this back because it

relates to your seesaw sort of analogy

yes you can think about the Seesaw from

with sleep deprivation from a

sympathetic parasympathetic you can also

think about it from a positive versus

negative veilance and once again our

hypothesis was that you're just going to

slide down into the negative and you're

just going to be less responsive to the

rewarding positive it was the opposite

you were abnormally and excessively

sensitive to both of the those domains

which you could argue is perhaps the

very worst of all adaptive responses

absolutely as an organism you don't want

to be non-reactive emotions are powerful

and we've spoken about the benefits you

need to have emotions to be a

functioning human being or organism in

the world they are designed to

adaptively help us survive but you can't

go to the extremes that's maladaptive

rather than adaptive but that's where

you go when you are sleep to Pride

it's this loose hinge and you become

very very erratically and extremely

reactive from a neural

perspective yeah my understanding is

that um you know sleep deprivation

definitely increases impulsivity and

addictive potential it's um yes so best

worst of Both Worlds in this case and

and given that um now would probably be

an appropriate time to just um cue

people to some of the things that they

can do to improve or maximize their

rapid eye movement sleep this was

covered in detail in episodes one and

two um and to some extent in episodes uh

three and four as well but they're in

reference to um to other things um

learning memory creativity the role of

naps Etc and I'll refer people back to

this um beautiful formula uh q qrt that

it's not just about getting enough sleep

it's about the quantity indeed but also

the quality QQ regularity and timing of

sleep and knowing one's chronotype that

is the best time to go to bed and the

best time to wake up in the morning for

them is going to be critical here and

and I can raise my hand I'll raise both

hands in fact uh metaphorically and say

that when

I've gone to sleep early and woken up

early so for me 8:30 9 p.m. and then

waking up at 4:35 a.m. which for me

matches my chronotype

uh it has served as a powerful

anti-depressant effect and when I've

gotten an equal amount of sleep but

going to bed too late for me that is you

know midnight 1 a.m. and sleeping in

until 8: or 9:00 a.m. um I always carry

a low-level depression um fortunately

not something that needed to be uh

medicated but uh it's it's a striking

effect in the positive direction when

obeying qqr and in in the negative

Direction when not so maybe just for

because we can provide some links to um

those segments in the show note captions

but maybe just um for people that are

here now um if we were going to list out

you know two or three things that one

can do to try and maximize um the

quality and quantity of REM sleep uh

without going on too much of a tangent

but um at the same time we do want to

highlight that addressing that Q qrt

formula um for ourselves is going to be

critical so maybe so for REM sleep um

yeah you know in the domain of exercise

temperature Etc are there any kind of

quick quick bullet points that we can

refer people to I would say just to keep

it high level and and brief the single

best way

cheapest non-pharmacological way that

you can enhance your REM sleep is to

just sleep an extra 15 or 20 minutes

later into the morning don't try to put

if I tell you this is about by the way

this is about the the quantity the your

sleep

opportunity don't try to add that 30

minutes or 20 minutes if your goal is to

increase real sleep at the start of the

night at the front end instead take that

desire that I've offered you of adding

just 20 minutes or 25 minutes of extra

sleep now to the last part of your night

wake up that sort of much later 20 25

minutes later

that's the REM sleep Rich phase so if

people go back and listen to episode one

we'll describe to you exactly how the

different stages of sleep unfold across

the night and they're not evenly

distributed it's not as though you get

just as much REM sleep as well as deep

non-rem sleep in the first half of the

night as you do in the second you get

most of your deep sleep in the first

half and you get most of your REM sleep

in the second half and particularly in

the last quarter of the night and this

leads us to understand that the later

into the morning hours that we go the

greater the hunger preference and The

Taste desire there is of your brain to

start sampling from the finger Buffet of

all of those different stages this thing

called REM sleep and the later that you

sleep into the morning the more of that

REM sleep that you will have and many

people will have experienced this at the

weekend where they have this pattern

that we don't Rec recommend based on the

qqr T um QQ our regularity go to bed at

the same time wake up at the same time

what we see often in society is

something what we call social jetl where

you're short sleeping during the week

and then at the weekend you're out with

friends or you're out sort of on the

town you go to bed late and you wake up

late and maybe you're doing that by 2

hours maybe you're normally in bed by

10: p.m. during the week but now at the

weekends you're going to sleep maybe 12

12:30 and you're waking up 2 3 hours

later on a Saturday and Sunday and then

the problem with that parenthetically is

on Sunday evening you've now got to go

back to work the next day so you have to

push yourself back to 10:30 or 10:00

whereas you were going to bed let's say

at 1 a.m. on Friday and Saturday night

that's a 3-hour Time shift and people

are doing that very frequently that's

the equivalent of you and I flying back

and forth from Los Angeles to New York

every single weekend in terms of oaan

Rhythm and it's brutal on it but this is

separate from this notion of your timing

the final part of the Q qrt and by

pushing your timing a little bit later

into the morning when you wake up you

will experience more REM sleep and as I

said when people sleep later they go to

bed later at night and they wake up much

later in the morning at the weekend I

strongly suspect that if they paid

attention they would say at weekends I

always dream more I always can remember

my dreams and they're more intense it's

not because there's something magical

about how your memory recollection of

Dreams operates on Saturdays and Sundays

it's because you've slept in later

you've gone into that REM sleep Rich

preferential phase in the morning and

therefore you've increased your REM

sleep so I would say that that's

probably the easiest way that you can

start to modulate REM sleep so that's a

terrific do and um I think we can

probably summarize the the top don't as

uh don't drink alcohol because it

abolishes REM sleep alcohol and THC are

both very potent ways that will remove

or obliterate your REM sleep and we

spoke about this in the episode on um on

THC when we discussed this I think just

yesterday I got a very long email and

you know I'm sure you get lots of emails

from um from delightful people in the

public and a Gentleman just saying you

know I was using cannabis for probably

about 7 years and then I watched um or

listen to some of your content and I

stopped and I just had this

explosion of dreams and I was never

recollecting any of my dreams before but

now they came back and goodness were

they Vivid they were Rich they were and

I could not believe it and that's REM

sleep and that's because during the kind

use by way of the THC not the CBD you've

been blocking that REM sleep you've

built up that pressure just as we

described in the dementi these and then

when you finally do take away the agent

that is blocking the generation of REM

sleep the THC all of a sudden your brain

doesn't just go back to having its

standard amount of REM sleep and

dreaming it has that plus it tries to

get back as much of it as it possibly

can by having what we call a REM sleep

rebound and that's why people when they

they stop using they end up having this

intense real sleep by the way to your

point about reward and um addiction

sensitivity with sleep deprivation one

of the things that we um we did in a

collaboration gosh this was years ago

when I was at Harvard with Carl Hart who

I think you I don't know if you colia

yeah Colombia you know him yeah he's

fantastic researcher very interesting

man too um and what we found was that a

lack of sleep was not only predictive of

your addiction potential but when you

went into a clinic to abstain and trying

to come off some of those and here we

were looking at cocaine um addiction a

lack of sleep was a strong predictor of

your abstinence and you falling off the

wagon and going back to you so sleep is

so critical not just for um maintaining

or pushing you away from that addiction

potential but once you are addicted and

you're trying to abstain it gives you

that lift of altitude to try to resist

falling off the wagon and when sleep

gets short that's when you become

vulnerable again probably because your

reward circuitry becomes enhanced and

all of a sudden you just cannot resist

the temptation anymore I want to take a

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docomo I think the takeaway is very

clear in order to be your best Emotional

Self that is in order to be able to

access positive emotions to their full

amplitude uh motivation um learning as

we also covered in a previous episode

but also to stay out of those um

irritable emotional traps of life um and

to be a regulated person calm and and

joyful person um it stands to reason to

uh minimize alcohol and cannabis use

unless there's some I don't know medical

reason why uh someone should otherwise

but the the real take-home message here

is get as much rapid eye movement sleep

as possible and don't do anything to

inhibit it yeah get as much sleep so

focus on all of those four uh macros of

sleep quantity quality regularity and

timing and notice that if you want to

try to optimize some of those that

emotional reactivity and balance you may

want to slightly over index on your REM

sleep in that regard and one easy cheap

way of doing that if you can lifestyle

permitting an and again of course I

understand everyone is has a life to

live and pressures but that's the way

that if you were to ask me can you do it

and do it simply yes you probably can

great but you touched on trauma a little

bit already but um now would be the

appropriate time I think to talk about

PTSD post-traumatic stress disorder

which um I think we can use the

definition of PTSD and Trauma that the

great Paul kti a former guest on this

podcast who also did series

yeah an incredible man what a what a

what a mind on him and what a generosity

of of sharing information in clear ways

about mental health as he did in the

four episode series on Mental Health

here and he's been on other podcasts as

well wrote A M marvelous book on trauma

Paul defined trauma as some event that

is aversive that changes the way that

our nervous system works such that we

function less well in the future it's

not that every negative event

every uh negative emotion Associated

memory is trauma I think that's a a

misconception um but there are things

that happen to people um or that they

observe happening to other people so

there's you know first person trauma

third person observational trauma Etc

and these can be single events multiple

events you know sadly this stuff happens

um it can be neglect so sometimes it's

the absence of an event right which

becomes the traumatic event that

fundamentally rewire some component of

neur neural circuitry such that we don't

function as well in terms of

relationship to anything work food sex

sleep relationships uh Baseline levels

of emotionality and on and on so what is

the relationship between sleep and

post-traumatic stress disorder

specifically I think some of what we've

covered already certainly touches on

this but PTSD seems to me that it it

might be its own unique case

it is because if you look at the

diagnostic criteria for

PTSD firstly you see sleep disturbance

and as I said right at the top of this

episode there is no major psychiatric

disorder where there isn't some mention

of sleep problems in its diagnostic

criteria but something else was

intriguing about PTSD that compelled me

to think about it and then create a

theory around it it's not just sleep

problems it's also

nightmares and specifically repetitive

nightmares in fact repetitive nightmares

form part of the diagnostic criteria for

you to receive a diagnosis of PTSD

that's how reliable they

are and as I thought more about this

model of overnight therapy this notion

that sleep and particularly REM sleep

provides a form of emotional first

aid PTSD stood out to me as something

think that I had to return to to explain

why because if you think about PTSD and

a veteran it is the perfect example of

the process that I described of

emotional deep potentiation

failing because what I started to

realize is that in PTSD there is this

trauma

experience and then perhaps what's

happening is that sleep the brain goes

back to sleep that night and says okay

please do your elegant trick of

stripping away the emotion from the

memory and it fails so then what happens

the next night the brain comes back and

says I'm sorry but I still got this very

emotionally charged memory please do

your elegant dissipation depotentiation

of the emotion from memory and it fails

again almost like this broken record

that was so indicative of these

repetitive

nightmares and then when you looked at

PTSD I told you that REM sleep is a time

of this remarkable decrease in

noradrenaline but if you look at PTSD

patients they actually have heightened

levels of neur adrenaline and also in

the body adrenaline as well in sleep in

sleep and also when you look just as a

basil State as well so there's something

not quite right with the noradrenaline

story in REM sleep in PTSD patients so I

had just published this paper and I was

up um at a conference in I think it was

Portland and I presented the theory that

or the data that we had on healthy

people and I put forward this theory of

um of PTSD and then later that afternoon

a psychiatrist came on uh the stage

called Murray Raskin and he was working

a lot with PTSD

vets and he describe data which I

couldn't believe it's one of those

moments Andrew where you're at a

scientific

conference and I think it happens maybe

once in a career if you're lucky all of

the hers on the back of my neck stood on

Sharp end because he was saying we've

got this data and we don't quite

understand it we've been treating our

veterans for blood pressure for

hypertension using a generic drug called

prasin and prasin blocked

the um adrenergic response in the body

because you're trying to sort of Tamp

down that sympathetic activation in the

body beta blocker so it's an it's an

alpha

adrenergic antagonist not a beta blocker

so it's not a beta blocker but it's

blocking the adrenergic

system and so and it's a you know it's a

generic pretty cheap drug but it turns

out that it crosses the blood brain

barrier so it doesn't just stay within

the body it goes up into the brain and

he said we don't really understand it

because I've been giving patients this

medication and it works to a degree but

something else happens they come into

the clinic and they say Doc I'm not

having those nightmares anymore they

seem to have gone away and these

patients seem to start to show signs of

resolution so all of a sudden I had had

a model a clinical model that was in

search of data and he had data that was

in search of a theoretical

model I couldn't believe it because it's

exactly what I would predict which is

that if neur adrenaline is too high in

PTSD you're not processing and stripping

the emotion from the memory so it keeps

coming back over and over like this

repetitive nightmare but then if you

block and help bring back down that

level of neur adrenaline to that which

would be seen in a normal healthy person

in other words completely blocking it or

all of a sudden the emotional memory

gets the chance to be processed and you

finally start to get symptom resolution

so we couldn't believe it he flew down

to Berkeley we spent several days

together we went out to dinner we just

could not stop talking he subsequently

did some incredible work in this area

and presin went on to become the um an

FDA approved medication for PTSD and

repetitive nightmares that was approved

by the Veterans Administration Bravo and

so no it's not me it's all all of his

work no you can't no this to me is the

uh scientific collaborative um

conceptual equivalent of the old rees's

um peanut butter cup commercials for

those of us old enough to remember it's

two people running toward one another on

the beach one with a jar of peanut

butter one with a with a piece with a

bar of chocolate and then they crash

into one another and then they both you

know share in the Delight of the the

chocolate peanut butter combination

which is an amazing combination um but

here a far more um important example uh

because it's led to a clinical relief in

in patients with PTSD um so I'm not

making light of that at all but um this

is one of the reasons to go to

Scientific meetings seriously this is

one of the reasons why scientists need

to talk this is one of the reasons to do

podcasts is it is it uh Fosters

hybridization of ideas which um is

Central to to new discoveries um and in

this case a clinical Discovery I I have

a question about um this notion of

blocking norepinephrine um in the brain

and body um you know on the one hand it

seems that during rapid eye movement

sleep we know we're paralyzed um or we

are paralyzed that's a fact of rapid eye

movement sleep the um the brain is

recalling memories often in in great

detail sometimes through symbolic

representation SpaceTime is disrupted

it's either faster or slower so because

you're dreaming um and

it seems that there's something powerful

about being able to replay the

memories and yet divorce them from

certain

neurochemical uh release in the brain

and body to essentially uncouple them

and then to me it makes perfect sense

why taking a a drug that would reduce

the amount of sympathetic arousal in

sleep would help especially PTSD because

you said with

PTSD sort of an invasion of the

noradrenaline response into rapid ey

Moon sleep that is inappropriate so does

that mean that rapid eye movement sleep

in people with PTSD is not truly rapid

eye movement sleep it's as if it's been

abolished and replaced with something

that's kind of pseudo waking stress

invaded you know it's like a zombie REM

um and it's not good is that is that is

that correct it seems to be an and you

can look at this in terms of the

electrical activity of REM sleep the

electrical brain waves of R sleep in

these patients and you're right it

doesn't seem to be of the same

electrical quality but what was

interesting in Marie Raskin studies when

he started to treat patients with the

pricin and Tamp down that

noradrenaline one of the other things

that returned back to normality was not

just that the symptoms dissipated their

REM sleep started to return with a

greater amount and so I think it fits

very well with this notion that whatever

REM sleep that was going on may not

necessarily have been electrical or

neurochemically identical to normative

REM sleep but when you assisted the

system with a chemical to bring it back

into normality REM sleep was gifted back

to the brain and emotional resolution

started to unfold now I should note that

there have been um a number of studies

that have replicated the finding some

Studies have not though and so we still

need to understand exactly why this is

the case and there are other therapies

that we'll probably discuss in a later

episode on dreaming that are as if not

more effective than that drug therapy

for repetitive nightmares that is a

psychological intervention rather than a

pharmacological intervention and that

seems to be very effective too in 2017

as my laboratory was starting to explore

some studies on humans on fear and

Trauma I visited a a trauma Addiction

Center on the East Coast um the guy who

runs it will be a guest on this podcast

in the future

an amazingly talented uh trauma and

addiction therapist by the name of Ryan

Suave and there it

was that I learned about Yoga Nidra

non-sleep deep rest and here's why they

were taking heroin addicts gambling

addicts sex addicts alcoholics people

with what they're call behavioral

process addictions and substance abuse

addictions um and every morning after

they woke up the first thing that they

would do was 1 hour of non-sleep deep

bre you know placing people into this

linal state and I asked why and um and

Ryan said this is especially important

to do with um addicts when they arrive

in inpatient recovery in the first week

and um even more so in the first three

days because typically they are badly

sleep

deprived and in addition to that many of

them are just not good at getting and

staying asleep at night without the use

of pharmacology or in some cases their

behavioral addictions depending on what

it what it was

and so it was a a kind of a

self-directed relaxation training of

sorts uh first thing in the morning that

in addition um perhaps could compensate

partially for some of the sleep

deprivation that they no doubt were

experiencing when they arrived it's also

novel environment and sleeping novel

environments can be challenging so uh

there is as far as I know no uh

randomized control Trials of of this

practice uh yet but there are a good

number of um clinics and treatment

centers that are now employing non-sleep

deep breast AKA Yoga Nidra um for 30

minutes to an hour first thing upon

waking um as one of the you know core

components of treatment for helping

people get and stay sober I think it's

absolutely fascinating because that

morning time period as well can be for

those who are struggling with sleep

especially difficult and you and I have

spoken on this podcast series about sort

of Awakening at night or later in the

morning when you really want to be

asleep and it's just a struggle to get

back and as you noted there he was

saying they often come in underslept and

my suspicion is that they're probably

getting sleep at the front end in part

because they're heavily medicated but

self-medicating in terms of helping

their sleep but then of course because

they are asleep they can't continue to

medicate so which part of sleep is

fragile it's those morning hours and

therefore if you have something that is

a compensatory tool that is not going to

be the trigger of saying just get back

into bed get under those sheets and

sleep you know sleep doesn't work like

that sleep is not something that we do

sleep is something that arrives to us

with us and if it's not you can't force

it and it's not it's a little bit like

someone's name in fact quite the

opposite that the harder you try to

remember the further you push sleep away

and when you stop it all of a sudden

comes back but I love this idea of

inserting something like that as a

compensatory tool and that's why I think

you and I have discussed um openly here

in fact on this series at some point

we're going to collaborate and we're

going to look to see exactly what is

happening electrically at High Fidelity

mapping inside of the brain when we are

going through these linal states and

what is the benefit of that is it a very

similar benefit for sleep and it's

fascinating because it's Poss possible

that what we find at the level of the

brain is that it's not sleep like it's

something else like maybe it's just a

Lial State like and what's also

interesting is that it provides

seemingly many of the benefits of sleep

but it's not sleep in other words you

can arrive at the same destination of

mental and physical health through two

different routs one thing called Sleep

one thing called these lional states or

they both op operate on the same Highway

in terms of mechanistic transaction

benefits there's so much that we

need we could stay here all all night

and all day hopefully not all night well

well we will absolutely do those studies

and um because I think that people are

in desperate need of zero cost tools to

try and um access the the the

replenishment and Recovery that comes

from sleep and when sleep is available

to us when we can access it that's going

to be the best option there's no

question but then some of these tools um

in theory and in practice provide a a

portal to get better at sleeping as well

so I was going to say one of the other

things I I'd be fascinated for us to do

is not just look at that model of what

happens in the morning but can we use

that for people who have the opposite

insomnia problem which is that I can't

fall asleep and we spoke about this in a

previous episode of tools and techniques

and methods to help you fall asleep

could this be one of them where you just

start to help move yourself into this

Lial State you take the stress off one

of the things I hear so much at the

center when people come in and they say

I've just I always struggle to sleep and

you go into depth and it's because they

their mind starts to roll it X through

that anxiety of what I need to do and

what I should do but also then the the

later it gets and the the absent the

Sleep becomes the more stress they get

not just about the next day The more

stress that they get about this thing

called not being able to fall asleep and

if there's something a practice that

you've taught someone that says that's

okay I know this place and I know this

situation and there's a tool I have and

it's

called this ainal state and if you were

to train people on that sort of that

method is it a way that they finally can

then cast themselves

off and it's the it's the bridge not

necessarily just between Despair and

hope but the bridge between wakefulness

and sleep so put it at the back end at

the end of the day rather than the front

end a lot for us to discover there and

um you know at risk of of uh being

hyperbolic I mean what what would be

more useful than a zeroc cost

non-pharmacologic tool for people to get

um the rest and restoration they need

and to get better at getting the

ultimate form of rest and restoration

which is sleep yeah and it you know I

love the Paradox of it that non-sleep

deep rest allows you to go into sleep

deep rest right it is after all a

transition or Lial State maybe this will

become the the stage before stage one of

sleep who knows who knows we Define off

stage in criteria that's right okay so

speaking of challenges sleeping because

of one's concern AKA anxiety about the

importance of sleep what about the

relationship between sleep and anxiety

meaning many people in the world

experience low-level anxiety or have a

low threshold to what could be a

full-blown anxiety or panic attack but

more often than not is this feeling of

being tired and wired or um having a a

quick uh you know prepulse startle as we

call it in our business a nerd speak for

um you know kind of a reactive um to

input anxiety and I don't think there's

any clean definition between anxiety

stress um and PTSD these run along a

Continuum and they PSD is an anxiety

disorder it's one of many right they

these things braid together in a way

that it would be a waste of our time to

try and disentangle those um but many

people have anxiety that is anywhere

from minor to debilitating um but that

is separate from PTSD although people

with PTSD can have

anxiety so what do we know about the

relationship between

sleep and anxiety and perhaps we could

frame this in the context of the

qqr you know um I'll just toss out a

question that perhaps highlights what I

mean is it possible that somebody's

getting eight hours of sleep a night

which for them meets their quantity

requirement in the um the quality

is relatively high but it's not as high

as it could be because the regularity

and timing of their sleep isn't great is

that person going to be more prone to

anxiety than somebody who's really

matched to their chronotype and is still

getting enough sleep no one's done the

head-to-head comparison where you kind

of do the how I going do the Coke Pepsi

Dr Pepper Sprite QQ RT challenge between

all of those what we do know is that if

you look at each one independently qqr T

quantity quality regularity timing if

any one of those is off it's very

difficult not to see a coexisting anxiet

disorder or increase in anxiety or a

mood disorder and I think to me anxiety

is part of that class of a broader class

that I would call mood

disorders it's relevant that we make

that distinction at least in my eyes and

I know some people may disagree because

mood and anxiety are different than

emotions and many of us Clump them

together the way I think about the

difference is the following time scale

emot ions are short punctate events that

usually last anywhere from seconds to

too many minutes mood States however

like anxiety or depression those operate

on a slightly different time scale from

minutes to hours to months to years and

so it's very unlikely that we can

experience an emotional reaction that

from a sort of a chronometry point of

view lack lasts for 2 years but you can

certainly see someone who has a mood

State abnormality of depression that

lasts for several years or who has been

chronically anxious for several years

and I'll come back to why I think that

distinction is is relevant for a second

to your point though about the

relationship with sleep here again it's

a very strong bidirectional relationship

and I would say that probably in the

last eight or nine years we've been

doing a considerable amount of work can

sleep in anxiety rather than just sleep

in basic emotional

reactivity what we found is it's very

strongly

bidirectional that if you have anxiety

it's very difficult to sleep and if you

are having difficulty sleeping it's very

likely that you will increase your

anxiety but before we really unpacked

that we started with a a very basic

study similar to those we've described

we took a group of people and we were

very careful to make sure that they had

um completely normative levels of

anxiety they showed no signs of an

anxiety related disorder and by the way

anxiety disorders are it seems one of if

not the most common of all psychiatric

conditions just to put it in context for

people listening and these individuals

no signs of anxiety disorders whatsoever

they were normative and then we had them

go through a full night of sleep or we

then sleep deprived them and the next

day we were measuring their anxiety and

in those people who were sleep deprived

we were actually measuring the level of

anxiety every hour so we could almost

get this timelapse photography of what

happened to the anxiety state as it

unfolded across the sleep deprivation

period it wasn't a linear response that

the more and more hours that you were

awake Beyond

16 the more exponential

that rise in anxiety became so it wasn't

simply a linear dose response curve it

was an exponential meaning that there

was this hockey shaped swing up and in

fact by the next morning compared to

when you'd had a full night of sleep

those individuals were so anxious that

almost 50% of the participants in that

group who had no signs of anxiety before

had a level of anxiety that was so

strong that they would reach the

diagnostic threshold for having an

anxiety disorder and that was simply by

way of the absence of

sleep but again that brought me back to

this notion of this is a good

experimental tool for us scientists to

understand what is the benefit of sleep

when it's present and the absence of

sleep when it's not by taking sleep

completely out of the equation by way of

total deprivation but of course that's

not real life so we did a slightly

different study

here what we did was we tracked

individuals essentially in the wild as

it were just going about their daily

lives and we had different sleep

tracking monitor uh monitoring equipment

on them so we were tracking their sleep

from one night to the next to the next

to the next and from one day to the next

to the next we were tracking their level

of anxiety and what we found here was

that even small perturbations in their

sleep from one night to the next to the

next

accurately predicted the increase or

decrease in their anxiety from one day

to the next to the next what was the

critical ingredient here well in the

first experiment I'd essentially

manipulated both quantity and quality

the two qqs of the qqr had removed the

quantity of sleep and also they had no

quality of sleep why because they had no

quantity of sleep but when we looked at

that day to day to day night to night

toight study it wasn't quantity that was

the best predictor it wasn't shortening

of quantity that determined next day

increases in anxiety it was quality the

worse the quality was night to night to

night the worse their anxiety

became so that started to lead us to

think a lot more about what is it

regarding the quality of sleep that

seemed to offer when it was present what

I would describe as an angio itic

benefit in other words it's lessening

anxiety a lack of sleep is an anxiogenic

it's going to produce anxiety what in

sleep is

anxiolytic we started off with a

hypothesis that was profoundly incorrect

we thought well for emotions which are

these short bursts of um of affective

state it was REM sleep that seemed to be

the Principal ingredient well wouldn't

that be the case for mood States well

here with anxi it wasn't it was deep

non-rm sleep and we couldn't get away

from it and so what we found was that

when we looked at the sleep in the

laboratory and asked what was predictive

from the night before so you measure

your anxiety the night before and then

we measure it the next morning and

basically we calculate a change score

has your anxiety the next morning

increased stayed the same or decreased

and then we correlate that with the

different stages and what we found was

that the electrical quality of your deep

nonrem sleep was very much

predictive of your dissipation of

anxiety

overnight and this helped me realize

gosh it's much more complex these are

beautiful surprises you get from

research when you you have like you have

this hypothesis and you look at you see

REM sleep no signal of predictive

relationship with anxiety and I say of

course because I'm idiotic rerun the

analysis just go back to Raw data and

you know the r sleep signal was so

strong rerun the analysis and you get

exactly the same result it's deep non-rm

sleep great okay then what is that deep

non-rm sleep doing to help dissipate the

anxiety but here again was a commonality

with emotion what we found is that the

greater the amount of Deep non-rm Sleep

the greater the re-engagement of your

frontal lobe was the next day and that

was predicting the dissipation of your

anxiety the next morning so we really

started to understand this sort of

critical bidirectional relationship but

it was a very complex one that yes

anxiety can disrupt your sleep and yes

disrupted sleep can predict your next

day anxiety but it wasn't the same stage

of sleep that we thought before it was

the the opposite it was deep non-rm

sleep what we've come to realize is that

deep nonr sleep in part seems to be

almost shifting you from that

sympathetic State over to the

parasympathetic state it seems to engage

that nice rest and digest it seems to

reduce your heart rate it seems to drop

levels of cortisol and we think that

perhaps is a resetting brain body

literally an embodied mechanism by way

of Deep non-r Sleep helping you just

relieve that anxiety pressure so it does

come back to your question which is yes

quantity if I manipulated quality if I

manipulate regularity or timing

manipulate any one of those I can change

your anxiety but the story coming

through here if anything was that it

wasn't quantity it was quality I told

you that from one night to the next to

the next the quality of your sleep that

we were measuring was predictive of your

anxiety and then when we bring you into

the laboratory and we look at the

electrical activity of your brain I also

mentioned in that episode on the first

episode another way we measure quality

is not just subjectively what's going on

or objectively what is the efficiency of

your sleep is it filled with lots of

Awakenings which was the measure that we

used in the day-to-day study and night

to night study but we looked at the

electrical quality of your sleep once

again it was quality that was predicting

it it's something about getting good

continuous sleep that is replete with

this deep non-rem electrical brain

activity that provides an angiolytic

benefit to your brain the next day and I

think it's strategic CU so many of us

deal with

anxiety and some of us would prefer not

to necessarily be on medication or even

look to that well here again is a

strategic tool think about your sleep it

really does seem to be a buffer for

anxiety along those lines maybe you can

just recap a few of the things covered

in previous episodes that are known to

improve the quality and quantity of Deep

nonm Sleep

um I can think of a couple but I'm

you're the expert here um not rush to

judgment on that one well I think it's

an established fact uh which is why

you're here um so let's

um perhaps list a few of those off in

the domains of you know exercise

temperature Etc what what what would you

place in that you know is there top

three like three greatest hits for uh

for improving deep non-rem sleep for uh

because of its important relationship to

anxiety management or reducing anxiety I

think there are the first thing I would

tell you is that regularity is going to

be key here when you are giving your

brain the signals of regularity it

understands exactly how to instigate

that that deep sleep and that's one of

the two qualitative measures of sleep

that I spoke about so QQ the quality the

second Q I spoke about it's regarding

the continuity of your sleep and the

electrical quality of your sleep

regularity is probably best for the

continuity of your sleep if you're very

irregular with the timing of your sleep

your brain almost doesn't know you know

are we on are We off are we on and we

off and your sleep can become quite

fragmented because it's confused based

on regularity when you give it

regularity sleep starts to become more

stable more stable means that it's less

likely to be littered with Awakenings

meaning that it's better quality of

sleep in terms of electrical quality of

sleep we did mention this um in a prior

episode when we spoke about sort of food

and exercise exercise seems to be one of

those things that's very good at

improving the quality of your deep sleep

and here I'm talking about the

electrical quality of your deep sleep

try to make sure that you're physically

active to a degree and and I think this

is a protocol and I think it's a

meaningful protocol but to go so to the

extreme where I would to say you need to

do at least 32 and a half minutes on a

spin bike at this wattage or you know we

can't prescribe quite at that point you

know scientific prescription not MediCal

and so I would say exercise is one then

we spoke about another which was

temperature and we said that getting

your bedroom cool seems to be a way to

promote the increase in deep sleep so

these are two dos which is get regular

get cool the don'ts we've already spoken

a little bit about too one of the things

that I probably didn't mention enough

with alcohol not only does it seem to

compromise your rapid eye movement sleep

but it will fragment your sleep it will

make your sleep more unstable and an

indirect consequence of that is alcohol

is going to be in highest concentrations

in your system after drinking in the

evening with sleep in the first four to

5 hours now that depends on how quickly

you metabolize it and how much you've

had but let's assume some degree of

standardization in other words I said

that alcohol will not just block your M

sleep it will fragment your sleep makes

your sleep more vulnerable to you waking

up well you're especially vulnerable in

the first four or so hours because

that's when alcohol concentration is

highest in your system and therefore the

first 4 hours can also fall prey to the

greatest culling of your sleep quality

and if you're removing or restricting

some of that quality in the first four

hours what type of sleep are you

principally restricting you're

restricting deep sleep because we've

said deep sleep comes in the first half

dream sleep REM sleep in the second half

so don'ts would be try to stay away from

you know excessive alcohol in the

evening we also know that Al alcohol is

associated

with longer term chronic anxiety and the

tragedy is that it's often used as a way

to blunt the anxiety because alcohol is

a sedative and it can help just

alleviate take you know take the edge

off but it's a short-term quote unquote

win for a long-term loss because overall

it will increase anxiety levels so I

would say those are some dos and perhaps

a don't if you want to try to optimize

your sleep quality quality including the

Integrity of your sleep and also the

electrical quality of your sleep

terrific I think um because so many

people struggle with anxiety ranging

from mild to severe anxiety the tips you

just provided are going to be immensely

beneficial and in addition to that the

previous four episodes that we've

recorded for this series each and all

include tools that is protocols for

improving the Q qrt aspects of sleep so

um all the more reason for people to uh

dig into those and and to glean the the

gems that you've laid out for people

because they're they really are very

actionable and um you know most all

perhaps even all of the tools that we've

discussed in those episodes are zero

cost they require a little bit of time

investment some um thought and

consideration but they're not really

that difficult to implement they just

require a little bit of um being one's

own scientist of self and being your own

own Corner when it comes to sleep and

another lowcost method that we um

mentioned was not just temperature in

terms of keeping your room cool but warm

bath or shower before bed I mentioned

improved sleep but one of the things

that improves most is deep non-r sleep

so there's another technique get your

room cool to go into but warm up to cool

down to fall asleep which then keeps you

cool so that you stay asleep and you'll

get more deep sleep very

fantastic although it's a terribly um uh

unhappy

topic suicide is a is an important topic

for us to to cover here um you know I

can think of few things more tragic than

suicide um and yet sadly it U it

accompanies certain uh psychiatric

conditions I think um people with manic

bipolar have a 20 to 30 times greater um

probability of suicide than others but

you know suicide accompanies major

depression anxiety PTSD you know again

it's it's um a tough topic to to get

into um but an important one to get into

what is the relationship between

suicidality and sleep um and I suppose

we could look at this from the

perspective of to what degree does sleep

deprivation um correlate with suicide or

attempted suicides and what sort of inoc

ulatory effects does um sleep provide

towards

suicide unfortunately we don't know much

about the second part of the question

which is how can sleep be used as a risk

mitigating tool when you know that there

is the risk of suicide in place um

there's been a number of people who are

doing this work including my colleague

Allison Harvey again at uh the

University of uh of California Berkeley

and Sher Johnson who's also there too I

would say though that the first question

is is quite answerable which is what do

we know firstly about how a lack of

sleep can impact suicide some of the

earliest data that we found were

associational relationships what we

found is that short sleep or poor

quality of sleep predicted three things

it

predicted suicidal ideation meaning that

you had thoughts of

suicide bad sleep seemed to predict

suicide attempts and then tragically

more recent data a lack of sleep

predicts suicide

completion and what makes me think more

causely about it and we've been trying

to get some grants and we've failed to

do so so far to do more of this work

because I'm I'm just so compelled by it

and you're right it's one of the most

tragic

situations those sleep relationships

aren't simply happening at the same

moment in time what I mean is that the

sleep disturbance that we see

precedes the onset of having suicidal

thoughts it precedes the onset of

suicide attempt and it precedes the

suicide completion so what this has been

teaching me is I've been looking at the

data and we've looked at a little bit of

our own data sleep disruption when it

comes to suicide is almost the canary in

the coal mine it's almost like a tragic

crystal ball that when you see that

sleep start starting to

dismantle it is a foreshadowing sign of

a very dark series of events that will

unfold in other words could we now start

to think and this is one of the things

that we want to do is sleep a biomarker

is sleep disruption I should say a

biomarker for upcoming suicide risk

before it begins the idea of finding a

biomarker or collection of biomarkers

for SU side I think is one of the more

important missions of Neuroscience Ai

and mental health uh generally there's a

brilliant young researcher up at the

University of Washington named Sam

golden he's um spent a lot of his career

studying animal models of um aggression

um and rage um and of course some forms

of suicide are thought to be forms of

self-directed aggression and rage it

makes sense um some forms of suicide

perhaps are different I don't think we

quite understand what suicide represents

in the brain just yet and I think

they're having spoken to Paul kti and

and others about suicide um it's clear

that there are unfortunately many paths

to Suicide there's in one brain State

nonetheless um Sam's laboratory has been

developing tools that help people with

Suicidal Tendencies or people who have

had suicidal ideation or plans in the

past um with these AI based tools where

it detects changes in their

voice in their sleep patterns and in a

few other metrics that I don't recall

that together become very good

predictors of um later suicidal ideation

so the idea here is that um people who

are prone to Suicide um often don't

realize that they're drifting that way

until it can sadly be too late so um

the point here is uh a biomarkers are

key B these biomarkers are being

developed uh C AI is critical but that

according to Sam um changes in sleep

patterns is absolutely Central to these

algorithms for allowing people to detect

their own um potential for suicide I

think it's it's critical and we've

thought about this when we started to

see these sleep signals that were

preemptive that were almost precognitive

in the sense of of prediction

occurred to me that we're at the stage

of

technological

Evolution that if we get consent to many

individuals who become

suicidal are they are interested in some

degree of

support and we often but of course some

people will just recoil and go into

themselves and that's that's when things

can get very problematic as well but it

would require some degree of consenting

that if you have a history of suicide

adiation in the past what if you were to

be able to consent and say I would like

to risk mitigate and you have a wearable

like a watch and that watch is connected

to your phone and there is a signal that

can come from your watch that dials a

series of phone numbers in order of

preference and when your watch starts to

detect that your sleep has this one the

things we really want to understand is

what is the specific signature of sleep

abnormalities it's not just that your

sleep gets short but is it that your

sleep gets long and then short and then

long and then short but it constantly

has poor quality of sleep and the

regularity is all over the place but the

chronotype timing is still in place what

sort of specific pattern of those things

is the Hallmark that is most predictive

of suicide let's say that I can come up

with that algorithm finally and then we

can implement it into a watch or a

tracking device of some sort and when it

starts to see that pattern it's

constantly pattern matching and it

starts to see that across whatever

number of days we say if you see this

across six nights or across 13 nights

this is serious it then triggers that

phone to send a message to those

individuals who the designated support

carers and those people then reach out

and start to say how are you doing would

you like to have a phone call can I come

over can I make you some food and I'd

love to have a chat with you can you

find a way to bootstrap a condition

where you constantly then otherwise

become asocial or antisocial and lose

all support network so that would be the

the sort of the grandiose idea the other

thing that's very interesting is that we

could measure their activity and their

wakefulness at night and the reason I

bring this up is some great work by

Michael peus and U Michael grandner

who've looked at

suicide um both attempts and suicide

completion across the 24-hour period

it's not constant it's not that you see

suicide ideation and suicide attempts

and completion in a distributed manner

equally across the 24-hour period when

do they principally occur they occur in

the late middle of the night and there's

this almost a four to five hour period

you know somewhere on average and again

it's just an average somewhere between

let's say 1 a.m. and 4 a.m. which it

turns out to be right at the lowest dip

of your Cadian Rhythm and it could be

Cadian Rhythm but I also think that

there's something about of course the

night ESS when no one else is around

around and it is just you bad point

number one second as we've spoken about

before on this episode negative thoughts

are 10 times worse in the darkness of

night than they are in the light of

day and third at that point if you're

awake you're not asleep and we know

sleep is providing this balast to your

mental health so on all three of those

counts you see this very strong spike in

suicide ideation suicide attempt and

also suicide completion in this

bewitching hour in the middle of the

night there's a final piece in the

suicide story though that is only just

emerging if you are not getting

sufficient sleep you are somewhere

between two to three times more likely

to go into that suicidal state which is

a very significant number however when

people started to measure another factor

of sleep and particularly dream sleep

which was the dream content itself it

became even more predictive and we've

not really seen this very much in

psychiatric conditions but what they

found was that instead of using your

sleep disruption or your lack of sleep

as a predictor of your suicide risk we

use nightmares as a predictor of your

suicide risk that predictive value that

risk went from about two to three times

more likely to somewhere between 5 to8

times more likely there is something

special going on with bad dreams and

specifically nightmares that is even

more predictive than this physiological

thing that we call Sleep itself and

we'll probably come on to maybe some of

the reasons why dreaming and

particularly nightmares in the next

episode on dreaming could explain

exactly why that is but it's a new

finding I don't think we can say much

more about it now but it is one of the

most I think novel findings in the

psychiatric sleep story that now dreams

have come above and beyond simply sleep

itself as a predictor of mental illness

and specifically a form that will take

your life tragically very

quickly when I think about depression

I immediately associate that with

excessive amounts of

sleep after all it's called depression

but what is the real link between major

depression which is you know the

classical um you know signs of you know

mala's um one of the Hallmark features

also being a uh a lack of optimism about

the future or Andor ability to sense

into the future that's what it's not the

only criteria um when Dr Carl daero the

great neuroscientist that he is was on

this podcast and of course he's also a

practicing clinical psychiatrist I when

we were talking about depression he

mentioned that another Hallmark of major

depression is people waking up at 2: or

3:00 a.m. and not being able to fall

back asleep um this just seems like a

recipe for disaster all around um that

the very condition that you're trying to

perhaps amarate with additional sleep is

preventing you from sleeping it's like I

couldn't imagine very cruel is a whole a

whole lot of things more diabolical um

in terms of the sleep sleep science so

what's the relationship between sleep

and depression and how how should one um

untangle that like seemingly gordi and

not it

is like the other conditions

bidirectional that depression can

disrupt sleep very much and disrupted

sleep can trigger depression depression

is interesting by the way some people

have conceptualized it as being

different to anxiety based in some ways

on memory which is that when you think

about anxiety people consider anxiety a

disorder of the future that you are

constantly worried about what's coming

up in the future I I didn't do this

today so I need to do that tomorrow and

then I've got that other thing next week

or I'm fearful of going out to see them

tomorrow I just I'm fearful of taking

that flight tomorrow it seems to be so

much about prospective future whereas

other people have suggested depression

is the opposite it's about rumination of

the past I went through this event I had

this bereavement I had this painful

divorce I just can't get over my past

now I don't necessarily know if that's

entirely true but it it is interesting

in the sense that both of those abnormal

prospection worry of the future and

abnormal

retrospection sort of ruminating on the

past seem to disrupt sleep before um you

continue I just wanted to drill into

that that idea just a little bit because

I think it's a really interesting one

worth exploring again I'm no

psychiatrist but I have heard and I've

experienced the I've had a depression I

think it's my understanding is it's

normal for um people to experience a

major depressive episode at some point

in their lives could be situationally

triggered or not but that um for others

Unfortunately they have repeating major

depressive episodes and hopefully some

people go through life never having had

a depressive episode but as I recall

that one of the more Salient um thought

patterns was that I used to have

something that somehow was lost and I

couldn't quite figure out what it was it

was this curring feeling of right like

things were on track and then they got

off track but not being able to to tack

the uh progression from on track to off

track to one particular event it was

this sort of sense that like I had

something that them was lost now

fortunately for me it eventually lifted

uh and you know it didn't get um

dangerously bad um but I I've had some

close friends who've gone through

individual or several major depressions

and I I hear this like this idea that

they had they had it or they think

something was there that then they lost

so I think I I agree with well if you

think about the word that you just used

had is about right it's it's about it's

the past right right it's past tense

right and then if if we apply the

criteria that is is indeed part of the

criteria for determining if somebody has

major depression which is a lack of

optimistic outlook on the future one can

see how one could be very much stuck in

the present and focused on the past and

you know just stuck in that spin cycle

um anyway we're not here to um to uh

decide what depression is or isn't in

every case but I I'm I'm not a

psychiatrist either right but but I

think this distinction between anxiety