Sleep experts explain how to get better sleep

[iteles]

https://www.youtube.com/watch?v=Yl0C3Hv0Hxk

I've taken some notes on what was particularly interesting to me:

Sleep stages

• Stage 1: Transitionary state, just getting to sleep which is around 3-4% of the night
• Stage 2: 45% of the night
• Stage 3 and 4: Beginning of the night, physical restoration
• REM sleep: Happens at the end of the night and is brain restoration

Sleep is individual

Sleep schedule consistency is the most important thing and you certainly don't need 8 hours, you need the right amount of time for your chronotype.

To figure out your ideal times to go to sleep: Count back 7.5 hours from your wake-up time (when your whole house wakes up) and see when you wake up naturally without an alarm. Adjust the sleep time based on your natural wake-up time.

Your chronotype can change over time but usually stabilises for the time between 22 and 50 years of age.

Sleep Hygiene

• Taking sleeping tablets to 'sedate the brain' is the worst thing you can do to calm a racing mind because you're ignoring the problem and you get terrible sleep
• Benadryl based sleeping tablets almost obliterate stage 3 and 4 sleep where it cleans out your brain and body and are very linked to Alzheimers

Fix Your Sleep Naturally

• Cut off caffeine around 14h00 (although I've heard 12h00 from others)
• Try to 'switch off' after dinner
• Stop alcohol 3 hours before bed
• Exercise with your chronotype, preferably not just before bed
• Very consistent bedtime
• When you wake up in the morning, get 15 minutes of sunlight and drink a bottle of water
  • Sunlight, particularly blue light which is part of the spectrum of the sunlight, hits the melanopsin cells in your eye and that turns off the melatonin in your brain; so if you're feeling terrible in the morning get sunlight in your eyes

The biggest problem for sleep is people not being able to deal with the stress and not knowing how to slow down their brains

Cognitive behavioural therapy is therefore a great way to try treating this Psycho-physiological insomnia:

• Part 1 is a sleep schedule which restricts people's sleep, dictating the hours they go to bed and get up
  • Go to bed at the time you would normally fall asleep and not earlier
  • Build up the natural sleep deprivation
• Part 2 is the cognitive portion

www.thesleepdoctor.com

[nelsonic]

Most of the info in this video is good. ✅

But there are a few issues worth noting.

The notion of "Count back 7.5 hours from your wake-up time" assumes
a) people fall asleep instantly when their head hits the pillow. (this is false for 90% of people)
b) you don't wake up during the night (also false for 40%+ of people)
c) people get up when wake up and don't snooze ... most people snooze.

This overly simplistic advice is about as misleading and counterproductive as Arnold's "Sleep Faster" 🤦‍♂

Chronotypes are NOT Set in Stone!

Chronotypes are an excuse to ignore circadian rhythm and stay up way after sunset using artificial light.
I was a "night owl" when I didn't have a routine and spent all night "online" (not being particularly effective).
But when I discovered the super power of getting up "early" in the morning (5am) and reading and studying for the hours before anyone else in my family woke up, I unlocked a new level in my life!

I switched from being a "night owl" (going to bed after 1am) to being a "lark" (in bed by 21:00 and up by 05:00) by having a reason to get up early. I wasn't a "morning person" in fact much the opposite, I used to get up 10 minutes before I had to leave the house! I perfected the 90 second shower and got dressed faster than most firemen! I did everything I could to stay in bed as long as possible. If someone has told me about "chronotypes" when I was 17 I would have used it as an excuse to stay up even later!

People who are convinced by the Chronotype dogma are the same as those who are sold on the Myers-Briggs "personality test" ... Oh, I'm an "introverted intuitive" because I like to read a lot and draw my own conclusions ... but then I'm into public debating and so I'm an "extrovert sensing" ... i.e. two opposite sides of the spectrum. Not very scientific or reliable measure.

The test-retest reliability of the MBTI tends to be low. Large numbers of people (between 39% and 76% of respondents) obtain different type classifications when retaking the indicator after only five weeks.
https://en.wikipedia.org/wiki/Myers%E2%80%93Briggs_Type_Indicator#Reliability

Not saying that Chronotypes have been or will be debunked the way MBTI has been. Just that people need to understand one important thing: don't be defined by an arbitrary label and then use it as an excuse to underachieve because you are too undisciplined to have a bed time and wake up early.

A 47 Minute Sales Pitch for Modius Sleep

I'm quite disappointed with this talk because Tom is on the Board of Neurovalens (Jason McKeown's company) makers of the Modius Sleep. They both have a vested (cash) interest in pushing this product to their audience. They are using a few facts in the talk as the build-up to entice people to buy. This is a well-known sales technique.

The Indiegogo campaign:
https://www.indiegogo.com/projects/modius-sleep-sleep-better-without-medication

Links to the following BMJ abstract: https://bmjopenrespres.bmj.com/content/6/Suppl_1/A31.2

In case it mysteriously disappears, this is the abstract: A31.2.full.pdf https://bmjopenrespres.bmj.com/content/bmjresp/6/Suppl_1/A31.2.full.pdf
The study in question is P050 - Modulation of sleep using electrical vestibular nerve stimulation prior to sleep onset.

There are so many issues with this "study" it's comical!

• 20 adult participants - not exactly a large cohort
  • daily sessions of 30 minutes electrical vestibular stimulation for a period of 14 days. These sessions were delivered approximately 1-hour prior to sleep onset. Baseline ISI was established prior to the study, with repeat ISI scores measured on day 14. - 14 days ...
• No control placebo or otherwise - why not create a device that looks identical to the "Modius Sleep" but emits no electrical signal and test if the mere presence of an "insomnia reduction" device is the trigger for people to sleep better?
• No null hypothesis - they weren't searching for cases to disprove their theory. They were hoping to confirm the theory so that they could sell more units of their sleep device. confirmation bias
• They literally went searching for data that would support their Hypothesis: "that repeated electrical vestibular stimulation, when delivered prior to sleep onset, will improve ISI scores."
• "delivered approximately 1-hour prior to sleep onset" - is it possible that this "1-hour prior to sleep onset" was part of a bed-time routine i.e. "stimulus control" and "sleep hygiene" which are well researched elements of Cognitive behavioral therapy for insomnia (CBT-I) which has several peer-reviewed, highly cited and replicated randomized controlled trials and is widely known to be more effective than any other sleep therapy/aid. i.e. using the device 1h before sleep was the signal to the participant's brain that it was time to "shut down" and giving themselves that hour to wind down is what lead to their better sleep quality and reduced insomnia?! -> How did their "study" control for this?!
• "This result was statistically significant (p-value is <0.00001)." 🙄
  • a) the insomnia severity index (ISI) score/results were self reported by the study participants, they aren't measured objectively using sleep data. See: Hawthorne effect below!

  More on why this p-value is meaningless: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191982

  • b) with a sample of 20 in a population of millions of insomnia sufferers, how did they determine that the sample was even representative? Surely there is selection bias in the people who are willing to undergo a trial for an unproven insomnia treatment? With people who are desperate enough to undergo experimental treatment, surely they have optimism bias "guided" by the conductors of the "study"?
• Observer Effects:
  • Hawthorne effect, a form of reactivity in which subjects modify an aspect of their behaviour, in response to their knowing that they are being studied - i.e. people who know they are having their insomnia studied (by the fact that they were asked to rate their insomnia severity before and after the "study") are more likely to report an improvement.
  • Observer-expectancy effect, a form of reactivity in which a researcher's cognitive bias causes them to unconsciously influence the participants of an experiment
• Published in the online version of BMJ Open Respiratory Research ... Publication bias ?

  Why not Sleep, Sleep Medicine or the Journal of Sleep Research ? Could it be that BMJ Respiratory Research was easier to sneak this shockingly unrigorous excuse for "research" past the editors?

• How do we know that the study did not start out with 50 subjects and the data was overwhelmingly negative with their prototype device and they simply weeded out the negative results?

Anyone who is naively convinced by this "study" should watch the following video:

https://youtu.be/42QuXLucH3Q

And read:
https://journals.plos.org/plosmedicine/article/file?type=printable&id=10.1371/journal.pmed.0020124

https://bigthink.com/neurobonkers/believe-it-or-not-most-published-research-findings-are-probably-false

The major problem with people having a vested financial interest in publishing their "study" results in a prestigious medical journal like BMJ is that there is a high incentive to fabricate favourable data.
Note: I'm NOT saying that the authors in question have done anything wrong. Just that when this much cash is on the line (millions if they can sell a few thousands units of these devices at $299) there is a certain motivation to get the right results.

• https://en.wikipedia.org/wiki/List_of_scientific_misconduct_incidents
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4340084/

I could go into a lot more detail about everything that is wrong with this video and Tom selling this untested device but I have to get back to my work ... ⏳