SPEAKER_00 0:00

Today, if you have ever struggled with sleep as I have, you know it has a profoundly negative effect on every aspect of your life. When I do get good sleep, after bouts of struggling with sleep, I am shocked how I'm just a completely different person and how much more sharp and how much I'm in a better mood after good sleep. There's been times I've wondered if perhaps I do have insomnia, but how do you really know when you actually have insomnia or when you're just going through a season of life where you're struggling with sleep? How is our mental health connected to sleep? And which comes first when trying to improve sleep, your mental health or the sleep aspect? What strategies can people utilize to relax to fall asleep? To help me unpack these topics and much more, I'm joined by Dr. Phil German, professor of psychology in the Department of Psychiatry of the University of Pennsylvania School of Medicine. He directs the sleep, neurobiology, and psychopathology lab at Penn, where he studies insomnia and links between sleep and mental health. Dr. German's clinical specialization is on the delivery of cognitive behavioral treatment for sleep disorders. I'm Jake Penisevich, and this is the Yoga with Jake podcast. Good, how about yourself? I'm doing well. Phil, it's it's really great to speak with you today. I um I was wondering if you could tell me just a little bit about yourself and your background to start.

SPEAKER_02 1:57

Sure. So um I'm a clinical psychologist, and my specialization is in uh what we call behavioral sleep medicine. So it's it's sleep medicine, but from kind of a psychological behavioral perspective. Um my background is I'm currently a professor at the University of Pennsylvania in the Department of Psychiatry. Uh, and this is actually where I did my undergraduate degree. So I went to college here at Penn, uh, worked in the sleep lab for a couple of years as a research assistant, and then moved to San Diego for graduate school uh at my uh at San Diego State University and the University of California, San Diego. Came back to Penn for my postdoc, and uh I've been around ever since.

SPEAKER_00 2:41

Beautiful. I um I was curious what uh made you decide to focus in on sleep for a career, studying sleep.

SPEAKER_02 2:52

So it was uh and it was actually a class my senior year of college. I uh saw a class when I was trying to, I was registering, and I saw a class being offered on sleep and circadian rhythms, and it didn't really wasn't a topic I had really thought about. And then I decided to sign up for the class, and I was just hooked on the topic. I found it just so interesting. Uh then when I was looking after graduation to stick around for a research position, I managed to get a job in the sleep lab. And so that kind of solidified my interest. And so, really, from the before I even went to graduate school, I knew this was the area I wanted to focus on.

SPEAKER_00 3:34

All right. And I have gone through bouts myself personally, struggling with sleep. And I know from previous guests um that sleep really affects everything. And yeah, for sure. For sure. And it's it's a really difficult, uh, miserable time if you're struggling with sleep. Um I'm curious, are we currently struggling with sleep more so now than ever? Or is this just more something we're we're more aware of?

SPEAKER_02 4:04

I think it's a combination. I think probably rates have gone up, but I'm kind of emphasizing probably because the field of sleep research is is is fairly new. That I mean, that it's really taken off and kind of kind of grown. So we don't have like the decades of studies that you have for obesity and other kind of areas of health, but it does seem like rates are are going up. But certainly we're paying a lot more attention to it. So uh so I often joke that when I was first in graduate school studying psychology with an emphasis on sleep, when I would tell people that's what I was doing, this was in the uh, I guess mid-late 1990s, sleep was not a popular topic back then. So when I would tell people what I was studying, they'd look at me funny and say, So, like you're interpreting people's dreams. And I said, No, no, no, that's not, that's not what I'm doing. And so, yeah, now these days, like sleep for the last what 15, 20 years or so, sleep has been such a hot topic that we are definitely paying a lot more attention to it than ever before.

SPEAKER_00 5:08

And you look at mental health and uh sleep, and I know there's a lot of um lot of numbers show that we are clearly struggling with our mental health. And are these two things correlated, uh mental health and sleep, and and how so? How are they uh related?

SPEAKER_02 5:30

Yeah, they're they're very intricately intertwined in in a number of ways. One kind of for a very long time, people have known that uh when people experience depression, anxiety, a wide range of mental health problems, that sleep is often negatively impacted. And at first it was for a long time it was thought that, well, it's just it's just a symptom of of depression, anxiety, things like that. But what we've learned is that when you're not sleeping well, it makes it difficult. It negatively impacts your mood, your anxiety, things like that. So it can what can happen is like people develop, let's say, significant anxiety, then they start to sleep worse, and then that worsens their anxiety, which makes their sleep worse, and it just becomes a cycle. And then on the flip side of that, what we've also learned is that for people with insomnia, but without anxiety, depression, things like that, that having the insomnia can actually make it more likely that they're gonna go on to develop other mental health problems. So it's it can be both a consequence of mental health problems, but also a risk factor.

SPEAKER_00 6:39

Okay, interesting. And when does one know that they have insomnia for certain? I feel like there's certain seasons of life, thinking back to COVID, where we go through some really uh stressful times and our sleep is negatively impacted. But at what point is it a diagnosable problem, or what should one seek out some help for insomnia?

SPEAKER_02 7:06

Yes. I mean, so if you look at the diagnostic criteria, um, which of course always have a certain amount of kind of arbitrariness to them, but the according to the diagnostic criteria, he to get a diagnosis of insomnia, it has to be occurring for three or more nights per week for at least three months. And so anything less than that, it would not make a formal diagnosis. Um, but another way to look at it is just to think about to what extent is the insomnia causing significant distress or impacting an individual's ability to function during the day. So if someone's had insomnia for two months, but it's been really severe and it's really impacting them, I wouldn't tell them, well, wait another month and see before you seek help for it. And so I think it's a matter of when it's like persisting and it's not going away, and when it's really kind of having a negative when it's negatively impacting someone is when they should start to seek help for it.

SPEAKER_00 8:07

Okay. And are do we know are are men or women more affected by insomnia, or is it relatively balanced?

SPEAKER_02 8:18

It's about 50% higher in women. So for every in terms of the rates. So about for I would say for every two men with insomnia, there are three women with insomnia.

SPEAKER_00 8:28

Huh. Is you know, is that you think uh a relatively accurate number, or do you think it's one of these conditions where men are just reluctant to seek out help?

SPEAKER_02 8:39

Yeah, probably a bit of both. Um, I mean, we know that uh that depression and anxiety have higher rates in women, and insomnia often goes along with that. So those, so it's it's it's probably partly a consequence of that. But it you know, it does make me wonder if like yeah, women are more just more likely to seek help for it than men, but uh but that would be speculative.

SPEAKER_00 9:02

Okay. Do do we know what's going on there? If why women are more affected than than men?

SPEAKER_02 9:09

We know some of the reasons. Um I mean for some women uh they experience uh insomnia at certain points uh in their menstrual cycle. So there can be so hormonal fluctuations can cause insomnia. So that that's one thing unique to women, and also it's very common during menopause. Um, so those are a couple periods of uh a couple of factors that certainly are are part of the reason for higher rates in women. I'm sure there's many other factors involved, but uh but not a lot of research has tried to like a lot of studies have documented the differences, but not a lot of research has had to has tried to figure out the reasons behind it.

SPEAKER_00 9:50

Okay. So what uh what sort of strategies can people utilize to help themselves relax and and fall asleep? Do you have any suggestions?

SPEAKER_02 10:03

Yeah, a few things that I I like to recommend is one is, and and these may seem quite basic, but even though they're basic, a lot of us don't have this built into our routines. And so the first one is just the idea of a pre-bed winding down time. And so a lot of people are busy. A lot of times they're busy up until the time they want to go to bed and they're they might feel exhausted, but then they get into bed and they can't sleep because it takes our our body and our mind a good 30 to 60 minutes to kind of wind down and relax and be ready for bed. But a lot of people don't have that kind of winding down period built in. So so really making sure you're taking time for relaxing, calming activities before bed. And um, so for example, very common thing people do before bed is watch TV, which can be good, but uh I don't know how many people I've talked to that like to watch the news before bed, but not too many people feel more relaxed and calm after watching the news. And um, or people like to read before bed, but like you don't want to pick up a suspenseful murder novel that you're gonna get sucked into before bed. So, really just trying to choose those pre-bed activities wisely. Um, so so that's one thing. Another thing I'll suggest is um for people who have an active mind at night. So one of the most common things I hear from people is I could sleep much better if I could just shut my mind off at night. And um the one way to kind of help facilitate that is actually a writing exercise. And so uh I often use like a balloon analogy that when we're busy during the day, it's like our mind is like a balloon filling with air, you know, thinking about all the things that are going on that day, what you have to do tomorrow, things you're stressed out about. And that pressure kind of builds up. And then when you lay in bed with your it's dark, it's quiet, your eyes are closed, that air all starts coming up. And some people tell me, yeah, it's just like their mind just gets flooded with all these thoughts when they're in bed. So, what you can do is basically let those thoughts out, let the air out earlier in the night. So, not right before bed, but like a little while before bed, like at the beginning of the winding down routine. You can pull out a piece of paper and just start writing down all the things that are on your mind that day. Which again, you might be thinking about something that happened earlier in the day. You might be thinking about something you're worried about. Might be so for some people, this becomes their to-do list for the next day. It kind of doesn't matter what it is, but the writing down is really key for it. Give yourself 10 minutes to get all those thoughts down on paper, then you can put that paper aside and move into your winding down routine. And a lot of people find that that the doing they're doing this writing exercise as simple as it is, helps to kind of clear your mind so that you're less likely to have those thoughts keeping you awake at night.

SPEAKER_00 13:21

Excellent. It is it worth, I've always wondered, I've heard um journaling before bed, something similar to what you had brought up in writing things down um to help fall asleep. Is it worth having that close uh on hand for nights? I feel like there's instances where uh thought will come up or an idea, and I'm like, oh boy, don't forget that for tomorrow. Is it worth having something close by to literally write that idea down?

SPEAKER_02 13:53

I have had a lot of people say they like to keep a notebook next to the bed for that very reason. Because if you know if you don't write it down, there's part of you that wants to keep thinking about it because you're afraid you're gonna forget the next day. So absolutely, for some people, having some paper by the bed is a great idea.

SPEAKER_00 14:10

Okay. And what are your thoughts on things like I've I love certain meditations for sleep. Um, I do wonder and worry that I've gotten so I've used it as such a crutch that I almost rely on it uh for sleep. You know, um I've I love meditations. I don't know if you're familiar with Yoga Nidra, but folks like and and and Andrew Huberman have have made it very popular and mainstream. He's renamed it. I've got opinions about that, but but uh I was curious your your take on things like you know meditation and um specifically you know meditation while you're literally either preparing for sleep or or as you're literally lying down trying to sleep.

SPEAKER_02 15:02

Yeah, yeah, a couple of thoughts about that. I mean, anything that is gonna help your body and mind calm down and relax is gonna be helpful. And fortunately, we have a lot of tools to accomplish this, whether it's through forms of meditation or Yoga Nidra or deep breathing exercises or um muscle relaxation exercises, guided imagery. There's kind of a million things that people can do that can help with kind of the kind of winding down the de-arousal before bed. Um my just experience in working with people is that it seems like there's not one approach that works better than another. Because like you might, it's more like personal preference. Like you might like one and I might like a different one, but it's a matter of finding one that that you like that you feel like you can incorporate into your routine. Um, so uh um, so yeah, and and doing it before you making that part of your winding down routine can be good. Um I do have people practice these types of exercises in bed if they're doing it when they first get into bed. And what I mean by that is uh one of the things we often have people do is is part of treatment is when when we get into bed to fall asleep, usually we have maybe 15, 20 minutes or so that our body and our mind are relatively calm and relaxed. But if you haven't fallen asleep in that time, you start to reach a point where you start thinking about the fact that you haven't fallen asleep yet. Same thing in the middle of the night. You start thinking about the fact that you haven't gotten back to sleep. But once those thought processes kick in, it often starts this kind of spiral of thinking more and more about sleep, trying harder and harder to sleep. Sometimes people get frustrated or anxious about not being able to sleep. And so the longer we lie there, we actually become more and more awake rather than more likely to fall asleep. So for that reason, I always tell people whenever you're lying in bed and you're not sleeping and you're getting to that state where you're thinking about sleep, trying to sleep, the best thing at that point is to actually take a break, is to get up, do something relaxing, and then return to bed when you feel ready for to sleep again. So for that reason, what I don't want people to do is lie in bed if they don't fall asleep and now they're becoming awake to now start practicing meditation and or other exercises in bed. Like at that point, they should be getting up and going and doing it somewhere else. So if people are gonna use that in bed, use it like right away.

SPEAKER_00 17:50

Interesting. Okay, that's a really specific uh differentiate differentiation there. Um yeah, that's that's interesting. I um I'm curious, you know, what what effect does things like like exercise and and yoga have effect on uh on our sleep? Uh like the physical component. And how should one think about um maybe gearing their physical activity for sleep? Is it better to exercise in the morning, afternoon, or night? Is it based on the individual or how does that work?

SPEAKER_02 18:30

So a lot of it has to do with our body temperature. So our core body temperature, not our surface temperature, but our core body temperature is lowest in the morning. It increases over the course of the day and peaks in the late evening, early part of the night. And then our core temperature starts to cool. And that cooling of the core temperature helps to promote sleep. Any kind of exercise that really gets your heart rate going, cardiovascular exercise, raises your core temperature, but then it keeps it elevated for an hour or two afterwards. So for that reason, we generally recommend people avoid cardiovascular exercise for a couple of hours before bed, because it can end up making it harder to fall asleep because it's delaying that cooling of the body. Earlier in the day is is great. Just trying to avoid it when you get closer to bed. But things that are forms of exercise that are not really getting the heart rate pumping. So stretching, certain forms of yoga. Obviously, there's a range of kind of types of of yoga, like anything like that is going to be fine before bed. Um, and it's it's just not get really getting your heart rate going too much.

SPEAKER_00 19:44

Okay. And you brought up the importance of having a routine, getting to bed at the same time. Yeah. Is there a time that is optimal for folks? And is it reverse engineering basically that circadian rhythm of eating dinner earlier to wind down early to get into that relaxation uh mode routine to then hopefully fall asleep earlier?

SPEAKER_02 20:10

Yeah.

unknown 20:11

Yeah.

SPEAKER_02 20:11

I mean, the circadian rhythms are a big part of the answer to that. And so because that we all have these daily rhythms in our body, but the timing can vary from or varies from person to person. So some people have later rhythms, they're more of a night owl, some people have early rhythms, they're more of kind of what we'll call a lark, and other people are in the middle. In an ideal world, people's sleep schedule would match their circadian rhythm. So if you're a night owl, ideally you would go to bed later and wake up later, and so on and so forth. Um, so and that then, yes, you would build these schedules in in relation to that. Of course, the reality is a lot of people, especially for extreme night owls, many of them can't sleep in in sync with their circadian rhythm because they have to be at work or school early. And so it's more challenging for it in that case. But ideally, you want to kind of follow your body's natural rhythm as much as possible and think about like, yeah, what's a bedtime that fits with when I just naturally feel sleepy at night? Um, because if you get into bed earlier than that, your body's just not going to be ready for sleep. But then, yeah, so so we're like, let's say someone says, well, 10:30 is a good time for for my body. Then counting backwards, that means like ideally by 9.30, you're starting your winding down routine. Uh yeah, work. And so that means maybe by 8 30, should be the latest, you're having kind of a heavy meal. And uh, so yeah, kind of building in your schedule relative to your bedtime. Um, although I always like to emphasize like, it's not that we have to be rigid and inflexible. About our routines and schedules because if we're too rigid with them, sometimes then they actually make us more anxious instead of feeling better. So it's like good having general routines and patterns, but not feeling like you need to follow them to the like to exactly the same way every night.

SPEAKER_00 22:17

Yeah, I was going to say there seems to be a trend in my wellness social media bubble of folks who are so seemingly dialed in and vigilant with their perfect routines, every day is perfect, kind of everything through a perfect uh lens of Instagram. But I think that's a a really important thing for folks to remember that sometimes it's it's helpful to not to um be so maybe uh obsessed or locked in on your routine that if something goes off or you have to do something with your kids that night, like don't beat yourself up because that only makes that cycle worse. Okay. Exactly. Exactly. Yeah. Do you think speaking of like popular trends on social media, there's a real push for folks? They love this idea of sunlight in your eyes in the morning. Like, very first thing, get sunlight in your eyes to to ramp up these mechanisms, these uh processes of circadian rhythm. Is how how important is that actually?

SPEAKER_02 23:27

Yeah. Generally, I agree with that. I mean, um, bright light is the strongest cue for regulating our circadian rhythms, and that morning bright light exposure can be very important. I I would not say it needs to be like the moment you wake up in the morning, but just generally trying to get some good uh light exposure within the first couple of hours of the day is is is good. Um I mean, the reason a lot of people advocate for sunlight is even uh even the brightest lamp that someone's gonna have is a fraction of the light outdoors on a sunny day. Even on a cloudy day, it's it's it's much brighter. So there's just no comparison to sunlight in terms of any kind of indoor lighting with the intensity that you're gonna get.

SPEAKER_00 24:18

Okay. And for folks who are waking up in the middle of the night, is there I've I've known a lot of folks now, like in their 40s and 50s, that are just saying, this is my regular sleep pattern, this is what's normal. Is it normal for that to happen? Or and what could someone do if they're trying not to break that habit of waking up middle of the night?

SPEAKER_02 24:45

Yeah. So I would say waking up two to three times a night is normal as long as people are not having trouble getting back to sleep. So people are waking up to use the bathroom or change position or whatever, but it's not hard for them to get back to sleep. Then I don't I don't that's just that's just normal. Every once in a while someone comes to me and they for treatment and they say, Well, I want to be able to fall asleep right away and not wake up at all in the middle of the night. And I usually tell them, Well, so would I. But I mean, but that's that's so that's normal. But if it's taking like 20, 30 minutes or more to get back to sleep each time, okay, now that's that's more problematic.

SPEAKER_00 25:31

Okay, and and what should someone do about that?

SPEAKER_02 25:36

Yeah, I think one is kind of getting back to what I was talking about earlier in terms of don't just linger in bed tossing and turning for for long periods of time. That actually tends to make the our awakenings longer. So if you've been, like I said earlier, if you've been lying there for a little while and you're just not getting back to sleep, get up, do something relaxing but not stimulating. And then when you feel ready for bed, get back to sleep. Even though you're getting out of bed, you're probably going to fall back to sleep faster than if you just toss and turn it in bed for a long time.

SPEAKER_00 26:12

Okay. Um, I'm assuming we didn't bring this up specifically, but you're talking about avoiding stimulating uh activities before bed and trying to fall asleep. Obviously, this this device is glued to us. It is like an appendage anymore. Uh do you have any suggestions for folks to uh maybe take the phone out of the bedroom? Or I'm assuming scrolling is one of the biggest um culprits for folks not uh following the the protocol of of winding down. So what could we do about the devices and and a lot of the tools to meditate and relax are on an app. And so how do you handle that?

SPEAKER_02 26:59

So I think when it comes to electronics close to the face, so phones, Kindles, laptops, you know, whatever, anything close to the face, um, there's two aspects of it. One is the light exposure, especially the blue light exposure we're getting. Now, I will say there there are some new data, newer data coming out suggesting because the concern has been that that light exposure can actually suppress production of a hormone called melatonin that our brain produces at night and make it harder to sleep. But there's there's some evidence suggesting that maybe the effects of melatonin are not as big as we thought they might be. So people, I think, are starting to question whether the light is as much of a problem as we previously thought. But the other piece is the content of what people are doing. So if people have their phone apps, uh phone out because they're listening to a meditation app, that that's probably not going to be an issue. But if you're doom scrolling, then that's probably gonna be too stimulating of an activity for you. So it's yeah, a lot of it is like, well, what are you doing on your phone? Um the my general recommendation, which a lot of people don't have to hear, is really try to minimize screen use for about an hour before bed. Like ideally not having that as part of your winding down time. Again, with exceptions where like you're listening to apps for relaxation or something like that.

SPEAKER_00 28:29

Okay. Do you is there anything to things like uh light sensitivity, noise sensitivity, uh temperature sensitivity when folks try to fall asleep? And is there anything there uh backed by science and and what is optimal if if that is uh something that is worth folks uh messing with to help sleep?

SPEAKER_02 28:54

Yeah. I mean, generally you want to have a bedroom environment that's conducive to sleep. And so uh I mean, if if someone has like a chronic insomnia probe problem, just fixing their bedroom environment is probably not gonna fix their insomnia, but this can be like a a part of the puzzle. Or but if someone has milder sleep problems, this might make more of a difference. So, in terms of the lighting, you don't want a lot of bright light in the bedroom. Um, so if people have a lot of like the street lights outside their bedroom that's coming in, or now that we're in the warmer months and the sun's up early in the morning, if they're waking up earlier than they would like because of of the sunlight, then it may be worth seeing can you get darker curtains or even if it's just like hanging a blanket over the window to minimize the light coming in. Doesn't need to be pitch black. And in fact, if it's pitch black, and then you need to use the bathroom in the mighty night, you might trip or fall. So, like necessary having a night light or something so that there's some light, but just trying to keep it low. Uh, in terms of temperature, we tend to get the most studies have shown we tend to get more deep sleep in a cool bedroom, not cold, but but cool. But of course, the problem is for people who have bed partners, what's cool to them might be warm to the bed partner, and but vice versa. So sometimes that's a little hard to navigate with two people, but um, but that can certainly make be a factor. Noise in the bedroom can be a factor. So, like some people will run a fan in the background or get a sound machine or something like that. I don't recommend the TV on or keeping the TV on to for background noise because it's not constant noise. It's it's the volume changes, the lighting changes. So you want something that's more even and constant. So uh so yeah, the bedroom environment can matter.

SPEAKER_00 30:58

Okay. And for folks to who do have a bed partner, um, do you find that folks, people who struggle with insomnia, it might be worth them experimenting having separate beds, bedrooms, and um having, you know, hopefully a uh civil conversation with their partner that it's about sleep, not the relationship.

SPEAKER_02 31:22

And I think that's really the key. It's a dialogue, you know, it uh uh between them and what's like thinking about like what's important to them. Like, you know, I work with plenty of people for whom like they and their bed partner, it's really important to them to be in the same bed. And so they want to do whatever they can to kind of make that possible. Other couples I talk to, it's like it's not gonna hurt their relationship at all if they're sleeping in separate beds. So I think I think it's a discussion to see kind of what's important to them as a couple and um what what uh kind of what's a setup that's gonna maximize their sleep and their the health of their relationship?

SPEAKER_00 32:06

Great. And um so we with mental health what is what are the steps when someone needs to seek out more help? What is treatment like? Is it uh medication or is there uh CBT for sleep specifically, or or what how does one approach treatment?

SPEAKER_02 32:32

Yeah, the the two treatment approaches for insomnia that have the most evidence behind them are medications and as you mentioned, cognitive behavioral therapy for insomnia, or what we just call CBTI for short. Um the I would say each approach has pros and cons. The for the medications, the pros are when they work well, they work quickly. Like you take the medication and that night you sleep, and they're widely available. You can go to your primary care provider, you don't have to go to a sleep clinic to get sleep medications. The psychiatrist could prescribe them, nurse practitioner. The disadvantages of the medication are they often don't work as well as we would like. So a lot of times people will say, Well, I sleep better with the medication, but I'm still not sleeping great. Uh, they can become less effective over time. Uh, they can there can be side effects to them, and and ultimately they're not really, most of the time, not solving the underlying problem. So you have to keep taking them. The cognitive behavioral approach, on the other hand, has the advantage of uh the research consistently shows it has much better long-term improvements than medication does. Um, because it's really designed to try to break the underlying cycle of insomnia. So it's kind of getting more at the source of the problem instead of just covering it up. But the disadvantage of CBT are that it's a lot more work. You have to kind of invest the work and energy into it, whereas it's simple to just pop a pill. Um and it's not as it's not always as easily accessible. Um, so you know, there are a number of providers of mental health providers who do offer CBT for insomnia, uh, but it's there's it's not as there's not as many providers as who could write you a prescription, for example. So and and if you're especially if you're in an area where there's a low concentration of mental health providers, it might be harder to find someone who offers it.

SPEAKER_00 34:43

Okay. Is there any common threads that you see with folks in mental health and sleep? Like, is there a common uh issue or problem that folks are up against uh that you've noticed that is linked to sleep? Yeah. Anxiety is probably number one.

SPEAKER_02 35:00

Uh sometimes I say, like, what we need to do is find the people who can be really anxious and yet sleep well and study them. Like, what's different for them? Because most people, if you're anxious or I'll even say anxious or stressed, sleep's like one of the first things that goes out the window. And so uh, and then what can happen is then people become anxious about their sleep. And so now they can't sleep because they're worried about being able to sleep at night. So it kind of becomes a cycle people get stuck into. So that's that's probably like the strongest link is between kind of insomnia and anxiety. Probably right behind it would be kind of low mood or depression. So the rates of insomnia are quite high in people with depression. And uh, and like with the anxiety, they can just kind of feed into each other.

SPEAKER_00 35:54

Yeah, I um I'm definitely one of those people who when I've struggled with sleep, that anxiety about trying to fall asleep kept me up for sure. Um it is it is really brutal when you can't sleep. I think when you you notice when you do get even one night's good sleep that you're like a different person entirely.

SPEAKER_02 36:17

Yeah, I've had a lot of people tell me that. Absolutely.

SPEAKER_00 36:20

Yeah, and for what are your opinions on wearables? Everyone's got a watch, a Fitbit. Now, the aura ring specifically has uh niched itself for sleep. Uh, those are supposedly the most accurate in getting numbers about your sleep. For someone like myself, again, who's struggled with sleep and then obsessed over sleep and that affected my sleep. What do you do you think the wearable is there any value in um the wearables? And um when are they appropriate and when are they maybe maybe take off the watch or the ring if you're thinking too much about it? What's what's your sense?

SPEAKER_02 37:04

Yeah, I'd say um they for they can usually be helpful to get a general sense of what your sleep and wake patterns are like, but they always have to be taken with a grain of salt because they're not perfectly accurate. And sometimes people will say to me, you know, I thought I slept really well last night, but my watch told me I didn't. And so therefore I didn't. Well, maybe you're right and your watch is wrong in that in that case. So I think if you're if people are using it for like a general sense of their patterns, that can be they can be very useful for that. But don't assume it's always accurate. Um, in terms of when it can be maybe doing more harm than good, I think you kind of hit the nail on the head earlier. We were talking about like how much are you focusing on that number, those numbers. Uh and this one sleep researcher in Utah has has coined the term orthosomnia, which is when people are good sleepers, but then they start focusing so much on tracking their sleep and paying attention to their sleep that they actually sleep worse because they're focusing too much on it. And so I think when people start getting to that point, I'm like, stop wearing the wearables.

unknown 38:16

Yeah.

SPEAKER_00 38:17

Okay, interesting. Um, I had a a really great friend when I uh confided in them about sleep, say, you know, you're doing all the work. Um, you gotta believe that you're gonna, I'm gonna sleep great tonight. It was almost became like a mantra, like, man, I'm gonna sleep so well. I'm I'm gonna fall asleep. I like it almost like I don't want to say it's a fake it till you make it kind of thing, but I it is there anything to just like mentally believing that I'm gonna fall asleep, I'm going to have a good sleep.

SPEAKER_02 38:50

Yeah. It certainly is in the extent that it means you're not worrying about your ability to sleep. And it kind of type with what I was saying earlier, that a very common cycle people get stuck into is they start having trouble sleeping. Now at night, because they lack confidence in their ability to sleep, they start becoming anxious about falling asleep. And because they're feeling anxious about it, that makes it hard to sleep. So if people can kind of talk them into being more confident and therefore less at less anxious about being able to sleep, then you know anything that's going to reduce that sleep-related anxiety is can be helpful.

SPEAKER_00 39:32

Okay, then it's with the rise of popularity of sleep also comes the rise of a very uh strong market for different tools to sleep. Some of them, I think, if they help, wonderful. Um, but is are is this also as a as a doctor, as a as someone who's made this their entire career, do you notice that instances like this, do a lot of folks tend to try to DIY their uh sleep hygiene to the point where they're saying, you know, I'm I don't need to go to therapy because that's the hard thing. I've got this, you know, app. I don't need to go to therapy, I'll try this melatonin uh over the counter. I don't need therapy, I'll try, you know, adjusting and keep adjusting and adjust for years. And um is this just something that's in my that I've created in my own mind, or is this something you is there a trend or something you see in science that uh this is allows people to kick the can down the road with this DIY kind of uh sleep hygiene?

SPEAKER_02 40:44

Yeah. So I think I think it's perfectly reasonable for people to try to find solutions to their sleep problems on their own for a little while. But what can happen is, and I've seen this in so many patients who come to me, is they'll say, like, they try one thing and that doesn't work, and they try another thing, and maybe it works for a little while, but then it stops working. And they've tried so many things that have not solved the problem that by the time they come to me, they're hopeless. Like they've just kind of they say nothing's going to work at this point. So I think it's and that then makes it harder for like the treatments that I offer to make a big difference if they're already so hopeless about their sleep. So I think it's I don't think it's unreasonable to try because fixing the problem on your own for a little while, but if you find yourself like trying one thing and another thing and another thing and another thing, okay, now maybe it's time to seek some professional help.

SPEAKER_00 41:45

Okay, and this is maybe a broader question, but with do you think there's just a lack of purpose in our lives? Like, do you think folks come to you um with you know, there's a lot of talk with mental health about failure to launch for boys, like finding work currently in our culture, finding uh mission? Uh religion is seemingly now on the more upswing, apparently, if from some folks I've heard, because I think people are longing for meaning in their life.

unknown 42:19

Yeah.

SPEAKER_00 42:20

Do you have an opinion on that and our culture in general? Like, do you think this this is all tied in?

SPEAKER_02 42:25

Yeah. I mean, I think certainly the frenzied pace of our culture um and the constant influx of information and stimulation has made it harder for our nervous systems to calm down at night. And so I think that's and I think a sense of kind of like so one of the things that sometimes when you if you take people, say, for example, who um have insomnia, but they also worry a lot, studies have shown that sometimes treating insomnia can reduce their anxiety because when you're lying in bed unable to sleep in the middle of the night, we we always we say it gives you a lot of time to practice worrying. And that's usually like we don't normally lie in bed in the middle of the night thinking how wonderful our lives are. We tend to be anxious and depressed or irritable or angry, like we tend to experience that have a lot of negative emotions at night, and not put on that list like when it's quiet and it's dark, and like sometimes that's a sense when time when you can kind of feel that existential kind of angst. And um, so um the I it that's probably not the best time of day to be kind of dwelling on those things. I'm not saying I think we should ignore them, but I think those are things best considered in the light of day when we can kind of give ourselves some time in our day to kind of think about you know, what am I you know, what's do I have purpose in my life? What am I striving for? You know, what how How are things going in my life? And certainly when people feel like things are not going well, that can just contribute to the to the insomnia.

SPEAKER_00 44:11

Is there benefit in finding a community, like a third place uh social connection, those sort of things to um find uh folks to just talk to or be happy around or or feel emotions around? I feel like we don't gather too much anymore.

SPEAKER_02 44:31

Yeah, I I'd say I don't know that too many people have specifically like studied how that affects sleep, but we know that having being part of a community, having social and a regular social interaction is so good for our mental health in so many ways that it's hard to imagine that would not also be good for our sleep.

SPEAKER_00 44:54

Okay. And is there any other suggestions for folks? I'm sure obviously we could spend a long time on this topic, but I was curious, is there anything in particular that you wanted to make sure that we put out there for folks to uh strategies to help relax and fall asleep, or or anything else that you wanted to make sure that we touched on?

SPEAKER_02 45:17

Oh, I mean, I think you really hit on the key stuff. Um I mean, I the balance I always want people striking is I want people taking their sleep seriously and making a priority, but not obsessing over it to the extent that now their obsession is actually making their sleep worse. So it's like finding that balance is really the key.

unknown 45:39

Okay.

SPEAKER_00 45:39

And it's is there any um any trends that you will find out there that are particularly not accurate that you'd like to put out clarification on?

SPEAKER_02 45:50

Or I guess I'll say one of the ones that that's has been popular for a little while goes by different names, but I think my favorite name for it is a Nappuccino, and which is when people have like a cup of coffee or an energy drink or something, and then they lay down to take a nap. And it's based on the fact that um more and more research is showing that like if you're gonna take a nap, keeping it to 30 minutes or less seems to be optimal for being able to fully wake up afterwards, but kind of get benefit from it. It also takes about 30 minutes for caffeine to hit peak potency in in your brain. So the thinking is that, well, you have the caffeine, you go to sleep, and the caffeine is going to wake you up after about a half hour, so you don't sleep too long. Um, I'm not aware of any study that I've have actually looked at the efficacy of this, but I I generally don't recommend it. So I'd say that's one trend I've heard of that uh I like I like the name of it, the Nappuccino, but I don't recommend it.

SPEAKER_00 46:54

Yeah, I I love my caffeine, I gotta say, and that might be part of the sleep problem um for me at least. Even I've been told uh caffeine in the morning cut off at a certain time could even potentially be problematic. Do you do we know um what's optimal, or is that just kind of based on one's individual makeup?

SPEAKER_02 47:16

For the it seems like for the majority of people, kind of really limiting caffeine after lunchtime is sufficient. There are some people who are just super sensitive to caffeine. So even caffeine in the morning can affect their ability to sleep that night. And but for most people, like morning caffeine is okay. It's just kind of being cautious after lunchtime.

SPEAKER_00 47:37

And there's is there an optimal amount or is there um a limit?

SPEAKER_02 47:43

The the general recommendation is kind of the equivalent of like two, maybe three cups of coffee max. And so like a few hundred milligrams of caffeine, um, which is like one to one and a half energy drinks for for a lot of them uh teas tend to have less caffeine in them. Um but sometimes people are drinking like tea or iced tea late in the day, and they're not thinking about the fact that, well, this this might have caffeine in it.

SPEAKER_00 48:13

Okay. And is there anything you would do personally that whether it's you could kind of uh whether it's backed by research or not, but just anything that you find personally helpful um as someone who's uh you know made this their entire livelihood?

SPEAKER_02 48:30

Yeah. I mean, a lot of the things we we've talked about are are part of my nighttime routine. So I uh I make sure I try to have keep a regular regular schedule, uh, keep my circadian rhythm nice and kind of strong. Um I do take time usually to wind down before bed. I try to limit the use of screens close to bedtime. Um I like to take a hot shower at night. That's kind of part of my winding down routine that I that I find helpful. Um, but otherwise, just all the stuff that we've been talking about. I I I'm pretty good about about practicing what I preach.

SPEAKER_00 49:08

Wonderful. Um, the Zed Heat, I I love hot yoga and saunas, but they've gotten a lot of negative press of uh we've been embellishing the benefits, supposedly. But do uh the cold plunges and heat, those sort of things, when you talk about thermal regulatory effects, do you do you have any uh opinion on those?

SPEAKER_02 49:30

I mean, the main thing is it gets back to like the core temperature relationship that I was talking about earlier, is that a shower and in particular like a hot bath at night can it like temporarily elevate your core temperature. But then when you get out and your your core temperature rapidly cools, that can uh lead to some increase in sleepiness close to bedtime. And so so that part I think is is pretty conclusive from the science. Uh all the other aspects, like the cold plunge and things like that, yeah. I don't I don't know what those do to sleep.

SPEAKER_00 50:06

Okay, okay. Um, well, you've answered all of my questions. I really appreciate your time. I've uh before I let you go, I know you're at Penn and uh I've I lived in Philly for 18 years. I still have a house in South Philly. Um how do you like how do you like Philadelphia? And uh are you a Philly sports fan?

SPEAKER_02 50:27

I am a Philly sports fan. I was very excited to see the Flyers uh uh win last night and move to the next round of the of the playoffs. And uh I would say Philly's it's a big enough city to have a lot to offer, but it's a small enough city to be manageable and a lot of it's very walkable. Uh a lot of great food in the city. Um, my family, a lot of my family is also from South Philadelphia, a great great part of the city. And so uh yeah, I think it's a good place to live.

SPEAKER_00 50:53

Wonderful. Yeah, I was very excited to see that game, very stressful, but they pulled it off. Yeah. So go flyers, and uh and Phil, this has been real a real pleasure. Thanks for um answering the questions in a way that I could easily understand and and and listeners could uh get a lot of value out of. It's uh I know it's a skill to communicate this stuff in a way that uh is you can disseminate it and understand it. So I really appreciate that.

SPEAKER_02 51:26

You're welcome.

SPEAKER_00 51:26

I hope it was helpful. Absolutely. I'd love to chat again sometime.

SPEAKER_02 51:31

Okay, I'll be here.

SPEAKER_00 51:33

All right. Thanks a lot. Take care, Phil. You too. Bye. All right, bye. Thanks for tuning in. If you found my conversation with Dr. Phil German to be helpful, informative, if you learned something, please give the podcast a like, a five-star review, write a review, and subscribe. And please share it with everyone you know. You can find me on all social media platforms, especially Instagram at yoga with jake, and on my website, yogawithjake.com. Until next time, take care of the