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Ted Audio Collective. Hi, everyone. Chris Duffy here. As you know, How to Be a Better Human is coming back at the end of June, and I'm so excited for our new season to premiere. I cannot wait for you to hear these amazing conversations we've been having with people like tech writer Kevin Roos and comedian Maeve Higgins and so many other brilliant, incredible people about how to be a better human and be a little less terrible in our everyday lives.
For now, though, today we have an episode from another TED Audio Collective podcast for you. This one is Body Stuff with Dr. Jen Gunter. I think that Jen is amazing.
able to, in a really scientifically accurate way, break down so much of what is going on in health and medicine and what's going on in the research around our bodies and what we should be worried about and what we shouldn't be worried about and what we need to pay more attention to. I just think she does it in an incredible way. And this episode is a perfect encapsulation of that. This is an episode for anyone who is stressed that they might not be getting enough sleep, which is literally every single person I've ever met. So enjoy it.
And to find more episodes like it, you can follow Body Stuff wherever you're listening to this. I'm looking at my bedside table and I have one, two, I have three eye masks. I have some melatonin. I have some zolpidem in case of emergencies. I have a bag full of earplugs. I fear to not be a great sleeper.
This is our editor, Sarah. Lately, I wake up in the middle of the night and I lie in my bed and I think, am I sleeping? Am I sleeping now? Should I be sleeping? I should be sleeping. Am I sleeping? The anxiety can absolutely take over and then it's like a rock rolling down a hill. So why did you start worrying about your sleep? You know what might have started me getting stressed out about sleep a little bit?
I had, like many people, a Fitbit some number of years ago, and it had a kind of sleep monitoring where it would tell you how you were sleeping and how you had slept. I do think sometimes I woke up and felt like I'd slept fine, and it said that I tossed and turned a lot. And then I think I started worrying, like, oh, am I not sleeping well when I think I am? It made me not trust my sleep. Why are you worried about how you sleep and not how you sweat?
Maybe because I'm not conscious for when it's happening. Like maybe because it is a mystery. Yeah, it's a mystery. Sleep's a mystery. Sleep is mysterious. It's also easy to worry about because it's so important. When we can't sleep, we feel awful and are desperate for help.
But lately, it feels like our fascination with sleep has gone too far. Do a quick internet search and you'll find a slew of articles about how to make your sleep perfect and productive. Even worse, you might find claims that if you're not sleeping right, you won't live as long. You'll get all kinds of diseases. So stay away from blue light. Don't
Don't drink caffeine in the afternoon. Buy this supplement. Get that fancy alarm clock. Try this pillow, this mattress. It goes on and on. And if you're already struggling with sleep, it's hard to get clear guidance on what will really help. Honestly, I'm a doctor and it's hard for me to sort through the noise. I'm Dr. Jen Gunter and from the TED Audio Collective, this is Body Stuff.
In this episode, we're getting to the bottom of sleep, from circadian rhythms to Puritan witches to the bat signal in your brain. It's all coming up after this.
I'm just going to confess, I'm a bit of a stalker of your research and your writings. I'm a stalker too. That's funny. I feel like I already know you because I feel like you're a Twitter friend. You're a feisty one too. Kindred spirit there. Dr. Colleen Carney is a psychologist and the director of the Sleep and Depression Lab at Ryerson University in Toronto.
Sleep medicine is a relatively new field, and studying sleep is kind of like peeling back the layers of an onion. There's always more to understand. Researchers like Dr. Carney are grappling with some really big puzzles, like what is sleep?
The nerd answer is that we don't really know what sleep is. And you can think of sleep as more of an idea that changes based on how you measure it. Is it your Fitbit telling you that you're asleep? Is it your experience? Because people with chronic pain will tell us they're awake when we think they're asleep. So is it the EEG telling us that they're asleep, their brainwaves? So the idea of sleep is actually this incredible idea
mystery in a way. We know that we need sleep, but we're still figuring out all the amazing things it does for us. We don't have a universally accepted explanation of what sleep really does. We know that it restores tissue, right? That's where we get most of our growth hormone released. So that makes good sense. And it helps us also when we're growing as kids. Our brains do lots of organizing and maintenance work while we're sleeping.
Sleep helps us learn and form new memories. But what's really cool is we're also getting some pruning. The unimportant stuff's getting pruned away and forgotten. So we sleep to remember, but we sleep also to forget.
I like to joke that I've learned so much in medicine over the years that one day knowing how to tie my shoes will fall out of my brain. But sleep is making sure my brain keeps what I need and gets rid of what I don't. It's kind of like your internal Marie Kondo.
While we sleep, we cycle through different stages. Each one has its own patterns of brain activity. Stage one sleep is a stage of sleep in which you might tell me you're awake because you have a memory of that time. You have some awareness of what's going on in your surroundings.
One time I was in this half awake, half sleep state and talking with my son. And when he asked me a question, I responded, Franklin chicken sausage, which seemed to make perfect sense to my half sleep brain. So in my house, that's what we call the sleep stage. Stage two sleep is probably the stage we spend the most time in.
And you're going to be less aware of your surroundings during this one. But if you hear an alarm or your name or something meaningful, you can be roused out of it. In fact, we can actually see your brain responding to things in the environment, even if you don't wake up, which is really kind of cool. Stage three is deep sleep, sometimes called delta or slow wave sleep.
The majority of this stage is really this deep, non-responsive growth hormone recovery type sleep. It's going to be about 20% or less of your entire night, but it's really important when it happens. And it happens closer to the start of your sleep. So in the first half of your sleep period. And then you've got your wild REM sleep. It used to be called paradoxical sleep because it looks like wake.
And this is where most people are going to have an awareness of dreaming. And it's because there's all this transition sleep interspersed. So you see some REM activity and then you see stage one and two sandwiched all around it and throughout it. And that's actually how you know you're dreaming is that you have these awakenings either right after or throughout. So how does our body know when it's time to sleep?
There are two internal biological mechanisms that guide us. First, sleep drive. The longer we're awake, the more our sleep drive increases. Second, circadian rhythm, which is like a clock ticking inside us. I want you to imagine that you're going to have a dinner party and you're going to invite a friend over who has a toddler. And you say, you know, bring little Johnny dinners at 8 p.m.
And imagine what the mom's face would be like. It would be like, no, because you would disrupt when they are going to have their regular meal and their bedtime and little Johnny's going to be a monster and like ruin your dinner party. Right. So.
Why? Well, it's because we are clocks. So we have rhythms all throughout our body, in our gut, in our muscles, in our brain, our suprachiasmatic nucleus. It keeps time and it coordinates itself with the environment, with the sun. So when we travel and we feel jet lag, it's like we're little Johnny, right? Because it's like, basically there's a mismatch between the timing that's expected in our body and the timing in the environment.
What's most important to know about these clocks is that they crave regularity. We spend a lot of time creating routines for kids to keep their clocks happy. Little Johnny goes outside every day to play, eats his meals at a certain time, and has a regular bedtime and wake time.
But adults often don't know that they need a schedule too. And even the sleep problems that we experience are actually related to the fact that our clock is always trying to catch up to the environment because you're throwing like 10 p.m. at it certain days and then 2 a.m. certain days and then no meals, so nothing to regulate it. And I mean, COVID has been the worst for this because people have been inside. They don't have a regular schedule.
work schedule anymore. And just like the going out to the gym, going out to a job, having regular mealtimes, it's just all out of whack. So some of the fatigue that people are feeling is actually really just circadian rhythms. Oh, that is fascinating. So-
I have a question about people that live in the extreme north. What happens to your circadian rhythm where you have these days that become incredibly short and you even have, you know, a month with very little sunlight? What's happening to them? It's what we would call a social zeitgeber. So a zeitgeber is a cue giver to the clock. And the most powerful cue giver to the clock is absolutely light, right?
But behaviors like eating, these things can actually help with free running circadian rhythms. So when you're up north, they have ways of adapting to that and they maintain a routine despite. So we have this biological system, this clock telling us when it's time to sleep and time to wake up. One of the biggest worries we have about sleep is that we're not getting enough.
We've all heard about the magical eight hours, but there's a range of how much sleep we need. We would want adults to sleep somewhere between six and nine hours in terms of norms. But there are a few people who we call short sleepers who are actually short sleepers. They're not deluded or not deluding themselves. If in their heart of hearts, they actually do feel good and they don't fall asleep ever during the day,
then they probably the exception to that health rule.
Not getting enough sleep is associated with serious health problems like high blood pressure, cardiovascular disease, diabetes, and depression. But Dr. Carney says the aggressive messaging about getting eight hours or it's certain doom is not exactly true and can be really counterproductive. One of the things I love to say to people with insomnia is it is true that we have to sleep to live, but we don't want to live to sleep.
We've got people on the other end of the spectrum too. All of the myths about you have to sleep eight hours, you have to sleep eight hours, we do that because we have to reach people from a public health perspective who are not prioritizing sleep, right? But then we're throwing people under the bus who over-prioritize sleep because they're the ones listening to that message and they're the ones getting anxious. Figuring out if you're getting enough sleep is pretty straightforward.
Do you feel reasonably well rested? Well, then Dr. Carney says you're probably getting enough. Do you fall asleep involuntarily during the day? Then you probably need more sleep. But lately we've started worrying about our sleep a lot. It's sort of the weirdo who says, I don't know, I sleep like a baby. People look at them like, what is wrong? You must be shallow or you must be, something's off there. We get here.
Dr. Ben Reiss is an English professor at Emory University and the author of Wild Nights, How Taming Sleep Created Our Restless World. He says we've been fascinated by sleep for millennia, but the way we manage it has changed a lot over time. For most of human history, sleep was a religious matter, not a medical one.
We can see that very clearly through ideas about dreaming, you know, dreaming as being prophecy and so on. But even the idea of being able to manage sleep, to stay asleep, to sleep at the right time was often interpreted in religious terms.
You do your prayers at a certain time, and if you don't do it the kind of the right way, maybe you're susceptible to the snares of the devil. Puritans were really focused on this kind of thing. And the witch trials, that was women getting out of bed at night and going and meeting when they're supposed to be sleeping.
So going out at night to meet with your gal pals was a sign you were a witch because you were up at night? Oh, yeah. I mean, there's no good reason for women to be getting up and doing much of anything outside of the home. And so that itself became evidence that, you know, the devil was after you because why would you be up at night if you weren't a witch?
In the 1800s, sleep started going through a big shift. It wasn't about sins and witches and visions anymore. It became a medical problem. Dr. Rees looked closely at the story of one woman, Jane Ryder, who experienced this change firsthand. Jane worked for a wealthy family in Massachusetts. Strange things were happening, and so they started to observe her and saw that she was rising from her bed and seemed to be in some kind of trance.
So there was a local physician who was interested in kind of curious psychological behaviors who started to interview her and follow her.
Eventually, poor Jane was sent to a state asylum. They subjected her to a kind of dizzying array of drugs and, you know, leeches and blistering her scalp. I mean, it's a really extreme case, but about like just the magnitude of the shift from thinking about sleep as a spiritual phenomenon to thinking about it as a medical phenomenon. You would think that doing it the latter way would be an improvement. Not always.
Dr. Reese says the people who ran asylums, like the one Jane was sent to, were obsessed with their patients' sleep. They would write things like saying, you know, there is no form of madness that can be cured without getting good sleep. And so they had patients in these separate rooms with very thick walls and put them on a very strict regimen and order, often keeping track of exactly when they went to bed and when they got up. And there were
Sometimes fairly severe punishments for people who would try to wander out or who would call out in the night. But it wasn't just these asylum physicians who became fixated with sleep. Through the Industrial Revolution, industrialists and factory owners wanted to figure out how to control the sleep of workers. During this era, people worked long shifts with small chunks of time left over for sleep.
In 1890, by some estimates, the average work week for manufacturing workers was 100 hours. Industrialists used the strategies of enslavers to make sure no one fell asleep on the job. Enslaved people were deliberately worked to the point of and beyond the point of exhaustion as a way to ensure that when they were off labor, they didn't have a lot of energy left over.
And then they were punished very severely if they overslept in the morning. And so one of the things that was developed under the system of slavery became a favorite technique of industrialists, which was the kind of random surveillance, the spot check.
A few decades after slavery was abolished, many descendants of people who were enslaved worked in the railroad industry, often as porters. And they had horrible sleeping conditions, too. You could be doing, you know, 10, 12, 14, 20 days in a row where you're only catching a little bit of sleep at a time because you could be thrown off if the train jolts. And so one of the really powerful union organizing activities
campaigns from that period was the Pullman car workers who were organized and testified about the health detriments of being, you know, forced to work and sleep under these kinds of conditions for extended periods. Sleep even became part of the labor campaign for an eight-hour workday.
It was eight hours for work, eight hours for rest, eight hours for what you will. So, you know, the model that we think of as sort of natural and normal, it's really tied to some of these industrial developments and struggles around them.
While sleep used to be treated as mysterious, even divine, when it became part of the industrial world, it turned into something to be managed, tinkered with, made more productive. And that's grown into our current obsession with optimizing our sleep. After the break, how to figure out if you actually have a sleep issue, and if so, what you can do about it.
Everyone has trouble sleeping sometimes, but if you struggle at least three times a week for at least three months, and if this leads to difficulty functioning, you have insomnia. It's really common. 33% of adults in the United States suffer from insomnia sometimes. So do 20 to 40% of kids and teenagers. Dr. Carney says insomnia builds on itself. It's a cascade of damage to your sleep.
It could start out with one night of bad sleep, which you might make up for by napping the next day. But your body actually has a way of compensating for lost sleep by producing more deep restorative sleep. Most people don't know that. Then if you have trouble sleeping the next night, maybe you panic. You start canceling activities and plans all to create more time during the day for sleep.
and that throws your whole system off balance. Our time in bed tends to go up, our activity level tends to go down, and it moves that sort of homeostatic system, the set point about how much deep sleep you're going to get, it kind of moves it down and down and down unintentionally. Over time, this also creates low sleep drive, which means it's harder and harder to fall asleep at night.
The other thing that's happening is they are laying awake in bed, frustrated. And so it's kind of like their bed becomes paired with wakefulness. So where the bed used to be the place where you slept, now the bed is the place where I don't sleep. So conditioned arousal happens. And you know if you have this, if you're sitting downstairs and you're like kind of nodding off, you feel ready to go, you get into bed and a switch goes off and you're wide awake,
you have conditioned arousal. And eventually, some people with insomnia stop going to bed and waking up at their usual times. Because although we normally would get up, we'd set our alarm at six and get up, when you feel exhausted,
you're not going to do that, right? So you'll try and hit the alarm a couple times, you'll call in sick maybe. So the timing of when you get into bed and out of bed, we often will find like hours of difference between the earliest and the latest within one week. That's really the equivalent of what you would feel if you traveled that many time zones and you would have that much sleep disruption.
To treat insomnia, doctors like Dr. Carney try to break this downward spiral. They try to address the root causes of insomnia by getting your clock back on track and reassociating your bed with sleep. And the best way to do that is cognitive behavioral therapy, or CBT.
People track their behaviors and their experience for two weeks on a sleep diary so that we can come up with a schedule that is going to be right for their particular body. And then a set of rules called stimulus control. So essentially, we ask people to wait until they are showing the behavioral signs of sleepiness. Sleepiness for us is not feeling tired. It's when you're literally falling asleep or nodding off.
And that if you get into that bed and that switch goes off and you're wide awake, then to say, well, I'm not falling asleep anytime soon right now. So I'm going to go do something enjoyable until that feeling comes back. While you're out of the bed, it actually, you're building drive for deep sleep. It's going to create some sleep deprivation, almost like what we're doing for Europe when we're trying to adjust to local time. We're going to use that to our advantage, right?
CBT can help people in just two sessions and is very effective. To give you an example, I'm having trouble right now because I wanted to study relapse after CBT. So I treated 300 people, or my students did, 300 people, and we tracked them over a year.
And no one relapsed. Oh, wow. So we were like, well, that is a weird problem to have because I said that I was going to study what is the characteristics of those relapse and no one did. That's remarkable. I wish more patients and doctors knew about CBT.
Dr. Carney says CBT is recommended over sleeping pills because it's safer and so long-lasting. But she says sleeping pills can provide relief and shouldn't be as villainized as they are. They certainly have a place in treating insomnia. There are a few big things we hear about as treatments for insomnia that are not effective. First up, melatonin.
Melatonin supplements are touted everywhere from the wellness industry to physicians, but these supplements are marketed based on a complete misunderstanding of how melatonin works. Melatonin is a hormone secreted by the pineal gland in your brain.
It's released when the sun goes down. And it's kind of a signal that many hours later, you're going to be ready for sleep. I mean, that's kind of, that's basically it. Taking more melatonin when it's already circulating through your brain will not help you sleep. It's kind of like the bat signal, right? You know, Commissioner Gordon like flashes up the bat signal for Batman to come and
and Batman's on his way. And then he's like flashes it again. It's like, well, it's, he's already on his way. Like that the signal has already been thrown. He knows to come. It's not, he's going to like extra come. Right. And there's no melatonin problem in insomnia either. Some people really feel that melatonin supplements help them. And that's likely a placebo effect. These,
These supplements can also be contaminated. In one study, researchers tested what was actually in them and found the neurochemical serotonin in more than a quarter of the samples. That can be dangerous. So when you take melatonin, you don't even know what you're putting in your body. How about melatonin for jet lag? Well, here's a joke for you. A group of sleep researchers flies from North America to Rome for a conference. What do they pack?
We all have the same plan and not a one is going to take melatonin. Oh, okay. I love this. So all the sleep researchers are traveling internationally and not one of them is going to take melatonin. Of course not. Why would we do that? I mean, the best thing to do to adjust to jet lag is to use sleep deprivation. So we fly all night, you get off the plane in the morning, and then we spend all day, we've booked all kinds of tours, whatever, in the sunlight.
So we will build a strong sleep drive by staying up all night and being awake all day. And we have very clear input into the clock from the daylight. And then that night when we go to bed, the last time we did it, we were in Spain and we were only like 90 minutes off the cycle the next day. That is fascinating. Except we were a little naughty on the plane. The deal is you shouldn't really drink on the plane because it does thwart your sleep.
It does thwart your attempts to stay awake. There was some poor adherence there that was alcohol related. The study subjects did not adhere strictly to the trial. No, no, there was, I mean, it was French wine. It was free. Whether you struggle with insomnia or not, there's another piece of advice you've probably seen all over the internet. Maybe you've even heard it from your own doctor. Sleep hygiene. I even badgered my own son about sleep hygiene when he started struggling with insomnia.
But the American Academy of Sleep Medicine recommends against using sleep hygiene as a standalone treatment. Dr. Carney says she even uses it as a placebo control in studies because she knows it won't work, but people believe that it will. When researchers like Dr. Carney say sleep hygiene, they mean focusing on how substances and the environment affect our sleep.
Might include advice like don't drink alcohol before bed. Exercise, but not in the evening. Set your room to a particular temperature. Block out blue light. Not one of those recommendations were ever developed clinically. And Dr. Carney says blue light is actually important for your sleep cycle.
Sunlight and light from screens are both forms of blue light, and they keep you alert and awake during the day. By the evening, melatonin has been released and your body knows it's time to sleep, so it's not likely that blue light can cause insomnia. That means you can skip all the blue light filters people are selling and the other products marketed to optimize your sleep.
We have a whole group of people who are biohacking right now with their fitness trackers, and they're getting stressed out about their sleep because...
Their wrist is telling them that they're moving in a particular way that would suggest that they're sleeping poorly or well, or that they're getting this stage of sleep or that stage of sleep. And they're adjusting their lifestyles around it. They're deciding whether or not they feel good during the day because of it. And in fact, it creates a problem we call ortho insomnia, this sort of preoccupation with the measured self and somebody telling us what our sleep is.
That's right. All this tracking and optimizing, like what our editor Sarah was doing, can actually cause insomnia. So can an overinvestment in rituals. I spent all day with a group teaching them how to treat insomnia. And I said, you know, where are my good sleepers on this call? And so they raised their hand. I said, could you teach eight hours like I just did on how to sleep well? And he kind of laughs and he said, I don't like it.
I closed my eyes and I was like, yeah. I mean, I said, you know, the thing is, is that if the stage is set, that's really what we need for sleeping. But when we make it complicated, when we decide I'm going to have this tea, I'm going to have this supplement, I'm going to smoke up, I'm going to get blackout blinds, I'm going to have whales singing to each other, I'm going to, I'm going to, I'm going to, I'm going to, I'm going to. It is the effort. It's all of the sort of rituals that actually make insomnia worse, right?
Because then you require all kinds of things in order to sleep poorly. All of these monetized ways of trying to make sleep more difficult really get people out of touch with how amazing their body is. She says not to buy into messaging about needing a particular product for a good night's sleep. Don't get me wrong. I love...
a high thread count of my sheets, right? Like there's not a, it's not like you can't create a beautiful sanctuary in your room to sleep, right? No problem. But I'm not doing it to sleep better. I'm doing it because it makes me feel better.
And I think there's a difference. Right. So if you get pleasure from something, that's fine. Like life is about enjoying it. And I think that, yeah, I think, you know, like I like wearing jammies. I love jammies. I just love putting my jammies on. It just makes me happy. Yeah. You know, and. But if you are wearing a copper lined jammy that reeked of lavender to sleep better, then I suddenly don't love your jammies anymore. Yeah.
And Dr. Carney's advice for all of us is to act like toddlers, go outside every day, have a routine and have a wind down period before bed. Like I put away my phone in the hour before bed. And the reason why it's not blue light, it's because I'm going to be tempted. I'll be tempted to answer an email and who I am the hour before bed. I want to just be Colleen. I don't want to be Dr. Carney. And so I'm going to,
watch trashy TV or whatever it is I'm going to do, play video games, I'm not afraid of blue light because melatonin has already been released in the hour before bed. So I'm fine. I'm going to unwind and set the stage. And we all have different things that make us unwind, right? That's... Exactly, exactly. Exactly.
From my wind down, I put on my favorite jammies. I call it jammy time. And I go over the New York Times spelling bee with my partner to see if we made genius or not. And if together we can get the queen bee. Next time on Body Stuff. Should you worry about yeast? The vagina is not a sterile environment. And yeast is part of the environment of different organisms that can be in the vagina.
From hygiene wipes to boric acid to probiotics, we take on the biggest myths about yeast.
Body Stuff is brought to you by the TED Audio Collective. It's hosted and developed by me, Dr. Jen Gunter. The show is produced by TED with Transmitter Media. Our team includes Mitchell Johnson, Poncy Rutsch, Greta Cohn, Michelle Quint, Ban Ban Chang, Sammy Case, and Roxanne Heilash. Phoebe Wang is our sound designer and mix engineer. Thank you for watching.
This episode was written and produced by Camille Peterson and edited by Sarah Nix. Fact-checking by the TED Fact-Checking Team. We're back next week with more Body Stuff. Make sure you're following Body Stuff in your favorite podcast app so you get every episode delivered straight to your device. And leave us a review. We love hearing from our listeners. See you next week. PR.