196. Is Sleep the Ultimate Performance Enhancer? | Jade Wu, PhD

Welcome to Medicine Redefined. I'm Dr. Altamasharaja. And I'm Dr. Darsha. Let's put the help back in the healthcare. Today we're joined by a repeat guest and someone who has spent her career studying one of the most fundamental and most misunderstood pillars of human performance, sleep. Our guest is Jade Wu, a board certified behavioral sleep medicine psychologist who specializes in insomnia and the science of restorative sleep. She earned her PhD in clinical psychology from Boston University and completed her behavioral medicine residency and fellowship at Duke University School of Medicine, where she also conducted research on sleep and chronic illness. Dr. Wu is the author of the book Hello Sleep, The Science and Art of Overcoming Insomnia without medications and the founder of Thrive Behavioral Sleep Medicine, where she helps high performers rebuild a healthy relationship with sleep using evidence-based behavioral approaches. Her work has been featured in major outlets like NPR, ABC News, The New York Times, and Scientific American, and she's becoming a leading voice pushing back against the modern culture of sleep hacking and over optimization. In this conversation, we dive into a question that many ambitious people struggle with. Is sleep actually the ultimate performance enhancer? Or are we treating it like an obstacle to productivity? So in this episode, we talk about why high performers often have the worst relationship with sleep, the difference between neglecting sleep and over-optimizing it, how sleep affects creativity, resilience, and emotional regulation, why rest during the day may be just as important as sleep at night, and how to rethink sleep not as an engineering problem, but as a relationship. So if you've ever told yourself, I'll sleep when I'm dead, or if you've ever gone down the rabbit hole of sleep tractors, cold plunges, and optimization protocols, this episode may just completely change how you think about rest. If you're a high performer who wants a clear plan for longevity, performance, and staying active with fewer setbacks, I'm now seeing patients through my telemedicine practice refining health and performance. I'm opening a limited number of founding members spot refininghealthrx.com. Alright, let's jump in. Dr. Jade Wu, welcome back. Thanks so much for having me back. Exciting round three here, talking a lot about sleep and performance. Let's just cut right to the chase. Is sleep the ultimate performance enhancer? I think so. I know when you're a hammer, everything looks like a nail, but it would be hard to argue against that, because sleep is like nutrition, it's like breathing air, it's like drinking water. It is just so crucial. It's a non-negotiable. And so yes, I think if you get sleep right, everything else is easier to get right. So yeah, I will call it the ultimate performance enhancer. Yeah, it's a biological necessity, right? We've talked about this, and I think in one of our previous conversations, if it wasn't necessary, then evolution over the millions of years would have figured out how to phase it out. And we have talked about how, I guess historically, we would be incredibly vulnerable, technically we're still pretty vulnerable when you're sleeping in. If it didn't make sense, it didn't have an incredible purpose, it wouldn't be necessary. Yet people, particularly, I'll put all three of us, I would call them three of us high performance, or maybe you are high performer, Darshan are aspiring to be high performance. No, you're doing great. I think people often see it as a cost to be paid for performance. And that conversation in terms of understanding its role in performance is building up over the last couple of years, but I still think generally speaking, it's not well understood. Why is that the case? I think about these cultural moments that kind of bubble up to the surface and get a lot of media attention, like Elon Musk saying things like, oh, while my competitors are sleeping, I'm in beast mode, or whatever he calls it, hardcore mode. And so I think that just gives people the sense that I'm missing out if I'm sleeping, or I'm not performing as hardcore as I should be, I'm falling behind. And I think that sense of a FOMO is a really strong, not motivator is not the right word because it's not motivating towards anything good. But that FOMO is overriding people's deep-seated knowledge that they actually do need to sleep. Because anyone, if they were truly honest with themselves, knows that they need to sleep. Yeah, it's interesting you say that. And I've heard that too. But I've also heard him on multiple interviews talk about how sleep is important. Oh, I haven't heard that. Okay. Yeah, Darcer probably knows this because I know Dar's you've read his biographies or maybe you know all about it. You want to chime in here? I actually, I haven't heard that. I'm actually not sure if his sleep preferences. I hope somebody calm us and find out his sleep schedule. You know what's interesting is, yes, certainly as a saying goes, I'll sleep when I'm dead or sleep is for the week and all these things that you pointed out. And the reality is, again, realistically speaking, if you don't sleep, you will eventually die. And you will be weaker if you don't sleep. And we know that physiologically speaking, cognitively speaking, a lot of things that we're going to talk about. But yeah, it's just really interesting phenomenon. But as I mentioned, I think it's exciting that we're starting to have more conversations. That's one of the reasons this is a third conversation we're having on this podcast. I suppose you've been working with people, right? So for those who don't remember, you're a clinical psychologist. You spend a lot of time in academia. academia, you're still affiliated with those as we were talking about earlier. You would save to say it worked with hundreds of thousands of people at this point, right? Oh, for sure. When it comes to high performers, all right? And we can talk about what that means exactly. How do you help them reframe their thought process? That this is not a cost to be paid. This is not something that's in their way to get to point B. But rather, this is how you will get to point B much faster and be better for it when you get there. Great question. When it comes to working with high performers, there's actually a double-edge sword. So when it comes to sleep, high performers are the ones that are the toughest work to work with in my opinion. And the most fun, that's why I do it. But yeah, there are two ways that high performers can fall off the wagon with their sleep. One, just like you said, they might be thinking sleep is costing me productivity. It's holding me back. I'm having this phomo because of sleep. Or on the other extreme, I've also had a lot of high performers try too hard. These are the people who are tracking their sleep every day. They're analyzing their sleep data. They're doing cold plunges at 5 a.m., and they're taking all these supplements and doing these things to force more sleep to happen. They're trying to optimize. It's really hard. So both of these extremes are not good for sleep. One, you're just totally neglecting something that is crucial for life and performance and well-being. And the other one is you're trying to force something that is not totally within your control. Either way, you're going to have a bad relationship with sleep, and that ends up turning into some sort of health problem, performance problem, functional problem. So for the folks who are neglecting sleep, I really draw the analogy with breathing air. Are you wasting time by breathing air? You do have to put effort into breathing more, especially if you're working hard. You have to slow down to catch a breath sometimes. And that's not a weakness. That's not something that is holding you back. It's something that allows you to be resilient for the long run. If you don't have oxygen in your body, you will die. If you don't sleep, you will die. Although I'll push back a tiny bit on what you said earlier about. If you don't sleep, eventually, you will die. That's true. If you're like a prisoner of war and some external force is preventing sleep. But if you just are trying to pull onators and work through sleepiness and tiredness and drinking coffee and whatnot, that's like trying to kill yourself by holding your breath. You can't do it. Your body will eventually rebel. You cannot hold your breath until you die. Just like you cannot sleep to pride yourself until you die, unless some other external force is doing it. Because sleep is such a foundational drive that you can't even prevent yourself from doing it, no matter how hard you try it. So that should tell us something, right, that it is so crucial, so non-negotiable, that how could it possibly be worth sacrificing for a little extra time when the quality of your work is so much better when you're actually well-rested? Yeah, I love reframing it with respect to, I guess, the most essential thing that it is we need for surviving. Now, all right. So let's just assume that somebody comes in. It's really easy. You tell them that, you're like, oh, you know what, you've sold me. I'm going to change my processes. And we're going to do this overhaul. Let's maybe take a step back and educate ourselves, Darshanai, as well as the listener in terms of, how is it that sleep does even help a buffer against... You didn't mention this, but in terms of stress and burnout and cognitive fatigue, because you did say the quality of your work is going to suffer. So how is it that it helps enhance your cognitive abilities, your performance, and so you become more efficient, you become more resilient? What is the specific process that's happening that's allowing for that to happen? Yeah, so the short answer is we don't even know all the answers for how that happens. Sleep is still a pretty mysterious phenomenon. We're getting closer to understanding X, Y, and Z aspects of it. But it's like the final frontier of the brain. There's so much that happens during sleep that we don't understand. But what we do know is, for one, during sleep, your body is able to physically repair damage. If you're an athlete or if you're just a normal couch potato like me, if you have any sort of illness or injury or you're working out and you're trying to build muscle, basically that's body tissue breaking down. And then during deep sleep, your brain is releasing growth hormone, repairing tissue, boosting your immune system, to allow you to allow the physical mechanics of your body to work. Now, if you're physically ill or injured or have high, excuse me, high levels of inflammation, you guys know this much better than I do, but if you're physically unwell, you're cognitively not doing your best work either, right? So that's just basic level 101, just physical repair of body tissue. And then, of course, there's memory consolidation. So much of our creativity comes actually from our memory. Because creativity is really just taking stuff that already exists, recombining it or repurposing it in a novel way that is helpful. So when we're being creative, we're almost never pulling something out of thin air. We're taking the vast knowledge and expertise that we've accumulated, and we're recombining and drawing new connections and drawing long distance connections between different parts of our brain to come up with something new and useful. Now, that only works if you remember a lot of stuff. If that long-term storage is holding true, if short-term storage is constantly getting renewed and passed on to long-term storage, if your brain is getting rid of stuff that's unuseful, that's also a really important part of learning and memory. And also, you need to be able to retrieve those memories. Just because all that stuff is in there doesn't mean you can go through the files and find it easily, right? So sleep helps you with all four of those processes in order to give you the building blocks for innovation, for creativity. And then, of course, there's emotion regulation. So that's the third kind of big bucket. There's a physical healing. There's the cognitive memory processing, executive function. Didn't even scratch much of the surface on the cognitive bucket yet, but want to make sure I highlight the emotional bucket, because that's so underrated. As a higher performer, so much of what you do is just regulating your emotions so that you can do what you need to do, right? Make the hard decisions. Bulldoze through adversity. Be flexible during times of change. Or when you fail getting back up again or pivoting when things change. Like, all of that requires you to emotion regulate. And when we don't sleep well, we do not emotion regulate. Just like the three-year-old who didn't get a nap is like throwing a tantrum on the floor in the grocery store. That's basically us, but just we're just big two-year-olds when we don't sleep enough. Because we can't, our emotions bubble up faster. They get more intense quicker, and we're less able to bring it down into a manageable level when we don't sleep well. And that's because during REM sleep, the brain is literally sorting through our emotions, dissipating the emotional intensity built up that we've experienced throughout the day. And it's sorting through different memories and experiences and tagging some emotions as important, discarding others as unimportant. So you're not overwhelmed and overloaded with every emotion you felt during the day. So that when you start the next day, you have a relatively clean sleep and you're ready to face the new day. So anyway, physical, cognitive, emotional, those are the three buckets that your brain is working hard on when you sleep, and all of those are crucial for functioning. Wow, so much to follow up on here. Quick, one question though. In states of illness, do we have a sense that when the body is going through a fairly logical repair, whether it's like an actual physical injury or maybe somebody has an infectious process they're fighting, do we know if they spend more time in stage three sleep where you're getting more, is that true? They do, they do. Yeah, that's why one of the sort of biggest banks for your buck or like the easiest way to boost your deep sleep is just to do strength training. Because strength training is basically you're breaking down your muscle fibers so they can build back up, like bigger and stronger. Is that basically you guys know better than I do, but by my understanding that's what is happening. Interesting. Yeah, I'd really be curious to see if this all exercise or is just strength training. It's specifically strength training. Interesting. That makes sense. Yeah, it depends on your baseline. If you're a complete couch potato and you just don't do any exercise, then any exercise is going to be better than nothing. Walking, cardio, like dancing, rowing, all great. Like no exercise is going to be bad for sleep. But if you're like a moderately active-ish person running a 5K, probably won't do too much for your sleep. Whereas if you do a really good lifting session at the gym, then probably knock you out. Yeah, I imagine as you talked about the growth hormone response that has something to do with it. You're going to have a more amplified growth hormone response when you are strength training or doing any type of resistance training. That's right. As opposed to aerobic zone 2 training. Yeah, I'm thinking about so many different things, right? So if you want to make a web and you just have just the scatter plot all the way around, unless you go to sleep and you have all the data points, you're never going to make those connections like you talked about or the files. You've accumulated all the files, but to be able to help organize them in a nice filing cabinet, you mentioned is really important. So it's so funny that we're having this conversation about emotional regulation because not too long ago I was talking to my trainees where I had to emphasize the importance of when things seem hectic and I work in an outpatient setting now. And so this is well known when you're in the hospital and you walk into a code blue situation. It's pandemonium, it's chaos. You as a leader are responsible to take a step and sometimes take a step back because the instinct is and people watch these ER shows, the instinct is you come in and it's a code blue situation is life and death. You've got to jump in, right? You can't just sit there and pause. But sometimes that pause and not doing anything, right? Being very still and just processing is so important and then you can take action, especially when you are the leader and people are looking at you for action action now. And so I remember it's saying to my, some of the people who are working with, hey, that's important in the outpatient setting too because you're going to walk in. These patients, a patient might come in and they've seen seven or eight doctors before and you are there very last stop. They'll tell you this, we like you are my last hope doc. They expect me to be Dr. House. I'm not Dr. House and they'll say, look, here's the situation. Other family members are in there and you just have to take a step back and not bias. Like just say, hey, what are we missing here? I'm not necessarily smarter than all these other doctors. If the patient jumping down at you, your family jumping down at you, what are the answers? Don't tell me it's not going to be this. Don't tell me it's psychosomatic. And you just have to regulate yourself a little bit better. Take a big step back and be able to move forward. Yet we deprive residents, we deprive attendings, we deprive health care workers with a sleep and we expect them to be in these life and death situations to be regulated, to make really good life and death decisions. It's such an interesting thing that, yeah, I don't really know when we're going to tell them that. Darshan, did you have it seemed like you were going to jump in there? Oh, no, no, yeah, I totally agree with you. It is following up on that question is thinking about, I guess for me too, I'm interested in how you think about these high performers and you mentioned optimization, right? And initially Brian Johnson came straight to mind, don't die. And he said he had a hundred percent sleep score for the last six months. So he's somebody I guess, he's probably not one of the worried well. He's not somebody who's actually anxious about getting that sleep score. He's just living life so optimized that he's able to just achieve that sleep score. For me personally, I found that if I add a little bit more of something that I haven't incentive for, so I started playing tennis a lot more, started doing matches, started actually having something where, okay, now my nutrition matters, my sleep matters, my overall health matters for those things. Do you ever think about oftentimes, as ultimately I said, we can go towards the sleep hygiene route? Do you ever think about, or I'm sure you do, but can you take us through at least how you think about maybe the day-to-day activities, the work, the things on during the daytime that these high performers do, that will then correlate to getting better sleep. Absolutely, that's, yes, that totally makes sense. And I'm glad you asked about the daytime stuff because usually people come to me wondering, what should I do at 3am when I wake up and I can't get back to sleep? I'm like, that's already too late to be asking that question at 3am. Because what's really affecting your 3am wake up is probably more likely what you did earlier that day and what you did during the day for the past month, past year. So I actually focus mostly on daytime stuff with my clients, especially the high performers. So that means getting light exposure, that's number one. And this is something that a lot of my high performers don't get enough of because they're white collar workers. Maybe they work their way up to that beautiful bright corner office so they get a little bit more light exposure. But a lot of them don't really, they kind of live in a cave all day long. So they're not getting that much broad spectrum sunlight and they're getting too much light in the evening. So they're answering emails like right before bedtime, they're on their phone, they have their Kindle on the brightest setting, whatever it may be. So not only are there days dim, their evenings are bright. So that basically sets their circadian clock up for confusion. If your circadian clock barely knows when it's day versus night, then how is it supposed to give you clear signals for when to sleep? Not just when to sleep, but how deep your sleep gets, how consolidated your sleep is. So light strategic timing of light exposure. That's like number one and super underrated. And then of course there's movements. We know we just talked about strength training as really important. But it's not just about going to the gym for that 45 minute workout each day or every other day. It's about what's happening throughout the day. Are you getting up and walking around in between meetings or literally just sitting like this for eight hours straight? That makes a big difference too. And another thing that people don't realize, especially the high performers, is that daytime rest is actually super important for night time sleep. And that sounds counterintuitive because you would think the busier you are during the day, the more exhausted you make yourself during the day, the sleepier you are at night, right? You earn your sleep by being busy during the day. And to an extent, that's very true. However, if you're so busy and you're like one thing after another without break, then you're basically acting as if there's a saber suit tiger on your tail all day. Or like at the very least it's on the horizon and you need to keep moving to stay out of the way of that tiger. Otherwise, why wouldn't you sit down and breathe? Why wouldn't you sit down and just be for a moment? Right? And just hang out. So if you're sending body that message that there's a tiger, of course, it's not going to let you sleep at night. That would be completely ridiculous. Like, we all evolved this process so that we didn't all die at night while we were sleeping. So it's a very strong evolutionary drive that if we feel too on edge, like physiologically aroused, cognitively aroused, without a break, then we're not going to sleep all at night. You're getting into, so we talked about circadian drive, but there's the sympathetic drive as well. That's kind of what we're talking about right now. That's right, yeah, fight, flight, freeze. And these are the people who were go, right? This is the type A of type A. Yes. Right? Where it's finding it really difficult to actually wind down. Although interestingly, every time I get behind the wheel on a car, that's this happened, but that's a very scary thing. Interesting that I've started to appreciate for as long as I've been doing this. And my friend Dan Pope about this, about talking about the importance of seasons in life. So I think we're all in this same ballpark, both you and I have young kids. There's this idea that there are just sometimes in life where you just have to work your butt off. If you have a newborn, this is not the time to get, although you'll argue that you certainly can improve your sleep quality in the perinatal burden. We talked about that last time, but this might not be the time where again, you ate an hour's good quality uninterrupted sleep distance. How are going to happen? Right. Where it might be a deadline approaching work when you're studying for your board examinations, when you're maybe hustling and starting a new business. Maybe you made that change like you did in terms of moving. So high-star seasons, project deadlines, traveling, moon lighting, if you need to for some additional money as a physician. What might be for one, what's that communication like? Like how are you transmitting that message to these high performers? Because you've just got them to buy in that, hey, I need you to dial it down. And then you've got to come back to like, okay, maybe dial right back up and it's okay. Like how do you have that conversation? And the second part of my question would be, are there tactical things that you could talk about in that temporary dial-up period that you might help them with to employ during that time? I love that you framed it as seasons of busyness, seasons of life. Because it's true, it's unavoidable. In some ways, we talk about these ideal scenarios like in a vacuum. This is what you do for sleep, but it's not always possible. And that's okay. So first I reassure people, sleep is resilient. If sleep was not resilient and we needed to sleep the same way or the same amount or the same pattern all the time to be healthy, none of us would be alive. Our species would have died out like diversity and resilience. That's what allowed us to be so successful as a species. So it's okay to study for that word exam. It's okay to focus on your newborn. But let's be very intentional about how back to back these seasons are stacking up. And in addition to thinking temporally in terms of seasons, let's also think in terms of values. Because I mean, I don't know about you, but I'm going to take a wild guess that probably you were raised pretty goal oriented. Get good grades. So you get into good college and get good grades there and apply for internships and etc. Everything you're always working on the next milestone, right? So this is like when you're paddling in a boat and you're just trying to get to that next island. If I could just paddle hard enough to get to that island, I'll be fine. But then as soon as you get to that island, you're like, crap, there's another island I need to get to and the paddle paddle. This whole time your head is down, you're just paddling. And you don't even know why really maybe like at the end of your life, you're like, okay, I've island hopped all these islands and then I'm really tired. And so what? Whereas if you're paddling your boat on the ocean and you look up to where your north star is, that's your value in life, whether that's mastery, whether that's compassion, whether that's creativity. There are no wrong answers here. It could be wealth and beauty too. All of that is fine. Just decide what your value is. That's your north star. So you're not just putting your head down and paddling to each goal in your life in succession. You can take a detour sometimes. You can take longer to get to that next island sometimes, as long as you're headed in the general right direction by looking up at that north star. Then you feel less burnt out. You're more resilient. You do better quality work, better quality parenting, whatever it is that you do value in life, you do better of. And guess what you sleep better too? Because you're not feeling as much of a sense of foam or stress or burnout or like, where's my life going? And if you go to bed feeling contented, yeah, I've been a good parent today and that's what matters right now, then you sleep better. Even with your kids calling you from the other room occasionally. I love that and honestly it's a concept that I've known about like slow living and how a lot of these philosophers talk about the pleasure of doing nothing. And within that there is also this inner ambition and then you start to seek out these intrinsic motivations and how they work with the external and people actually start to reach their goals a little bit better actually just by calming down and slowing down. What you were also talking about how we need us needing rest in order to let our body know that, hey, everything's okay. We don't need to be on high alert. That's something that's actually like a newer concept for me. Because I think about my patients all the time. And as an inpatient rehab doctor, our patients are doing intensive therapy, right? Three hours a day, physical therapy, occupational therapy, speech therapy, people are always coming in and out. And what are the most common things we tell them, especially whether a circadian rhythm is off and being napped during the day and then they complain the next morning about not getting great sleep is, hey, make sure you stay up. Let's make sure we don't get them snacks in. Keep trying to stay up and do as much as you can. But now it's alerting me that, oh, me, maybe we're actually just telling these patients that they should be on high alert. And maybe that's why so that rest is important. So brings us to the next topic, which is, how do we allow our biological individualization to work with us? So you did mention morning light. But when we talk about cronetypes and obviously I know, when we talk about hyperformers and this topic, we're talking about adults and I know there's variation between tumors and teenagers and they've become adults. How do you assess people's biological differences and how do you help them to be more attuned to it? Yes, I love that question because so often people are coming to me for the perfect formula for sleep. And that depends on who you are. And we need to figure out what your perfect is for this particular moment in life. And so the easiest and lowest tech way to figure out your cronetype is just to ask yourself, if I were on vacation for a whole month straight with no obligations at any time of day in particular, no one to judge me, including myself, when would I naturally sleep and when would I naturally wake up? And usually people have a pretty good idea of like ballpark, at least they know, yeah, it's going to be later than I usually do or it's going to be about the same as I usually do. And so then you start to get a sense of, are they circadian misaligned? Another complimentary low tech method is to look at their sleep timing on weekdays versus weekends or days on versus days off. Do they take the advantage of weekends to sleep in by a lot? If yes, then they probably have a later cronetype than what their lifestyle allows. So the body, I always just default to this. The body is very wise. Your brain knows exactly what you need. You just got to let it tell you. So there's no fancy equipment that's going to tell you better than your brain can in terms of cronetype and how much sleep you need. Just need to listen. The weekend thing though, people have to be really careful, because social jet lag is a real problem. So if you decide to party in the weekends, even as an adult, say adult, I guess technically over 18-year adult, we talked about college last time where we were going out at 10 o'clock and that's the reason that you're sleeping in. I'm not really sure if that's going to be a good brometer in terms of where your sleep timing will be cronetype-wise. So would you consider yourself a morning person? Night out, you're a night out. Sadly, yes. Yeah, it's cruel that society really bices against night elves. I think I had shared the story of my med school roommate who his optimal study time would be 10-2, and then exams would be at 7-30, which would be a nightmare for him. Although I have noticed over the last couple of years that more and more schools, like even the elementary schools are starting to push time. They're starting at 9-30 a.m., which is amazing. And some of the high schoolers are starting. But I think further on the west coast, that's becoming even more prevalent than it is. But I love that individualizing, identifying, putting context to advice and making sure it applies to you. Let's come back to that person, right? High sympathetic drive, they're wired. Perhaps they're a light sleeper, because they're never actually getting to that deep sleep. They're spending a lot of time in stage one. Stage two, we know that you spend a lot of time in there, but maybe they're even stage one sleep, which isn't like actual restful sleep at all. It's because they're high stress in a reactivity. How will you help them tailor some strategies to be able to wind down? You had mentioned that earlier. What can they do? Yes, where to start? A bunch of different things. But my favorite place to start with these high performers is to get out of your head and into your body in the evening, leading up to bedtime. So usually they're so busy during the day or early evening. There's not too much we can intervene on there. They got to do what they got to do. But then in the hour or so leading up to bedtime, can we protect that hour? Can we not answer emails during that hour? And then if we're not answering emails, can we not doom scroll? Can we not watch the news? Can we not catch up on podcasts? Or in some way, or maybe not even plan your next vacation? Whatever takes a lot of cognitive work, let's not do that. Instead, let's get down into... Yes. I'm going to jump in right there. Uh-huh. When you say that to me, I'm going to say this to you. I'm the mom, and I've got two kids, and I think you have two kids or three. I have two. Yeah. You have two kids, and they're two young kids. Yeah. You'll say, but after I put the kids to bed, this is my time. This is the only time that I have to watch Netflix to decompress me. Use that word. Yeah. And I say to her, amen, sister, same way for me, that is my time. That's why I protect the shit out of that time. That's why, instead of watching, let's be honest, I watch Netflix sometimes. Okay. I'm not saying anyone has to be screened celibate or never be on TikTok. I'm not saying that. But if you're serious about treating yourself, taking care of yourself, and actually enjoying your me time, then what you're going to want to do is get out of your head and into your body. So that means doing things through your five senses. So that'll be like stretching, light stretching, taking a nice warm bath. Put it on your favorite scented candle while you're taking that warm bath. Listening to some music, like actual music, not a podcast that gets you worried about the state of AI or whatever. Something that's artistic, aesthetically pleasing. Give yourself a head massage and cuddle with your partner, or cuddle with your dog. Do it all a little bit. Do something that requires tactile stimulation, something that stimulates your sense of smell, and taste, and sound. Because then you're going to be in your body, and your body is actually a very lovely place to be. We forget about that. We forget about that because we're up in our heads so much that we don't even think about our body until something's wrong with it. Have you ever stubbed a toe and realized you didn't even remember that toe existed until it hurt? It's like we do not even pay attention to our bodies until something's wrong, and that is not a good relationship to have with your body. That is not fair, right? Your body is actually really good to you. It takes really good care of you, and it's time that we actually pay a little attention and ask, hey, what's up with you? How are you feeling? What do you need? And without, and when I do like meditations, for example, with people, I never tell them, oh, breathe in for a count of five, breathe out for a count of whatever, or try to breathe down into your belly. I don't give any specific instruction on what to do with their breath. All I say is just pay attention to your breath. Let go of the other stuff for a moment. Pay attention to your breath, and everybody unanimously knows how to breathe once they start paying attention. They naturally breathe through their nose, they naturally breathe deeper and slower into their diaphragm. So the body is very wise. We don't need to do anything super fancy. Literally just get out of your head and into your body, and your body will take care of the rest. Love that. Yeah. The five senses approach is really awesome. Okay. So, and it's interesting, because I was thinking about the very first conversation we had, where you had also talked about people within Somnia, necessarily. Now that's a completely different ball game, because those people you would say, listen to any horror story, whatever it is, on audio that you want, because you're just trying to gauge how much sleep they're actually and trying to prove to them that they're getting more sleep than they think, because it's their anxiety that's affecting it. Some of the things that you're talking about, people will think, this is good sleep hygiene, and put that in quotes. And I know that, and these are the classic things when you start googling, and maybe now you're talking to that GPT or perplexity or whatever. Dark in the room, take the bath, like you mentioned, cool temperature, et cetera, eight sleep if you're darshed, do all those things. So they're familiar. And of course, the high performers are going to be, I'll say they're probably going to be optimizers as well. They're going to recognize, and this person who's been talking to you has recognized that this is important. Their schedules can be disrupted, whether it's because they're apparent, whether it's because they're traveling, and maybe they do struggle winding down, and maybe they think they have sleep onset insomnia. Because the idea is that, when you have difficulty because of anxiety, to sleep, you have a hard time sleeping, and this is vicious cycle, and now they have a hard time sleeping, you're getting stressed out about the fact that you're not getting good quality to sleep, and you're not going to be your best version tomorrow, or next week, or so on and so forth. How do you challenge that beast? What guardrails do you help these people put in so that they don't start over-optimizing? They don't start chasing hacks. One thing that comes to mind, because I think earlier in the conversation, you mentioned daytime rest is important, and I'm thinking about Heberman. He talks about non-sleep deep rest a lot. I'd be curious to get your thoughts on that, and protocols like that is, oh, now I got to do NSDR 15 minutes. I don't even know how to do it actually, but whatever it is, what are your thoughts there? First of all, non-sleep deep rest is just meditation. It's just mindfulness. It's just a, I don't know, like a Western repackaging, or something of that. So, I agree with it, because mindfulness is great, and NSDR is mindfulness. And, okay, so, if we're going to call this sleep hygiene, I think what we need to do is also talk about the intentionality behind the activities of sleep hygiene, because it's not just the motions of what you do, it's why you're doing it, and what your intention is with doing it. For example, if someone is meditating, because it's, it's just a good practice for them. They find that it's relaxing, and they enjoy it, and they feel very grounded in their body, and they like it. Great, that'll probably help them sleep. If someone is meditating to fall asleep, like to knock themselves out, that's probably just going to make it worse, and they're not going to fall asleep. Same activity, two different intentions, two different outcomes. So, when it comes to sleep hygiene, it's not just about a checklist of things that you do or don't do, or a list of gadgets you use or don't use. It's about how you're approaching sleep overall. Are you approaching it rigidly or flexibly? If you're approaching it rigidly, and saying, if I'm optimizing, I'm going to do it 100% perfect all the time, and it has to be exactly like this, that's a bad recipe, because nobody's sleep is exactly the same from night to night, week to week, year to year, because your body is doing different things, day to day, month to month, year to year, so it's going to need different things. So, if you're rigid, you're going to be the oak that snaps in the storm. If you're flexible, you're going to be the bamboo that bends, and then bounces back. So, flexibility is really important when it comes to implementing any sort of system or sleep hygiene routine. And it's also about how you're approaching sleep, almost like philosophically, I think. If you're approaching sleep as a friend, let's say, oh, I enjoy sleep, enjoys me. We have this longstanding relationship. I appreciate this relationship, and it's okay if it's not perfect all the time, and I trust that sleep will always be here for me, even if it's sometimes not showing up exactly the way I want. If that's your philosophical approach to sleep, you're probably going to be able to weather some storms. If you have surgery or get stressed or go through a divorce or go through stressors in life, sleep is going to get temporarily disrupted, but it will bounce back. But if you approach sleep like, either like a resource to be extracted, like a non-renewable resource that you extract from the ground, and you're like, you know what, if I get enough sleep tonight, I'm going to be able to power through tomorrow and crush my presentation or like close X number of deals or do this X number of hours of work. Then you're approaching sleep in a non-sustainable way. If you treat it like a non-renewable resource, it will be a non-renewable resource. It will run out. It will stop responding to you. And it will fail you sometimes. And if you treat it like an engineering problem or you're going to try to over optimize and you're going to be looking for that magic algorithm that you're just not going to find because we don't have the science to understand every single variable that goes into sleep. And even if we did, most of those variables are not going to be controllable. So if you approach it as an engineering problem, that's also probably not going to work. Approach sleep like a friend. And probably the wisdom of your brain and body will allow you to respond to disruptions and stressors and your relationship with sleep will survive and thrive in the long run. Talking about the long run, do you find, and I'm not sure if you worked with retirees that were once high performers? I do. A concept that I've been thinking a lot more about lately too is the monster we create and what that monster becomes later on in life. So for example, if you're someone who is very type A, just cares about grinding, making money for an eventual future where you don't think that's going to happen. Sorry, but you've already created that person. The future is just a series of present events that happen and then you carry that person into that future. Do you find the same with sleep where obviously people say, I'll sleep when I die? I'll sleep when I retire. Are they still having that poor relationship? How do you see that? Oh, yeah. I'm so glad you brought that up because one of the most common inflection points for insomnia and other sleep problems to develop is retirement. Someone comes into my office about that age or I have some background information on them and they say, I just suddenly stopped sleeping six months ago. I could bet money that they retired seven months ago. It's like clockwork because it's not just the identity that they had before, the level of performance that they had before that they no longer have. It's that the relationship with sleep that they had built, it is not what it is. That's their relationship with sleep now. So unless they really intentionally work on it to change it, that's going to carry over that deprioritizing sleep or using sleep like a non-renewable, extractable resource from the ground. That doesn't tend to just automatically change just because you retire. In fact, it often can get worse because you're like, oh, now I actually have all this time to relax and enjoy my retirement. I should be sleeping so I can enjoy my days better but then you're trying so hard to sleep at night. You're trying so hard that you're pushing sleep further away and then you're feeling cranky during the day and you feel lost because you don't have a sense of purpose. It's like a whole thing. So when I work with these folks, it's like sleep therapy but also a lot of like identity reformation like values rest of my life planning kind of work. Yeah, it's really interesting. Now Jade, is that similar to CBT or is it really more of a psychological just like you said, reframing the identity or doing this? Yeah, they go hand in hand. It's like CBT for insomnia, CBT for just anxiety, depression, and also a lot of act. Are you all familiar with act acceptance and commitment therapy? Yeah, so I do a lot of that within sleep and outside of sleep. So acceptance and commitment therapy is basically, it's awesome. It's like a gentle, practical compassionate approach to a person who feels stuck or lost in life. And they've been working so hard at trying to change that in all these ways but they're working in the wrong directions. And act is here to help you. Okay, let's take a moment to actually figure out, what do you actually value in life? What are you all about? Are you living in the moment? Just like you said, in the future, it's a series of present moments. The past is a series of present moments too. Who are you? Who have you been? Who do you want to be? So it's almost like a full-scale, like spiritual, psychological realignment and it's awesome. Yeah. Yeah. I highly recommend for those individuals who spend a lot of time reading these self-help books, us included, Darsh. But to look into that, I think it's something that if you can start adapting into life, can help you level up a little bit? Jay, I think this is a good place to park it. Certainly, so you have some time before your next meeting too. Thank you. You got to do. So what we'll do is, I think the next time we'll talk about life architecture, daily rhythms, traveling between zones, you're really curious to get to your day. Yeah, great. We're going to bring up metrics again. Let's see if your thoughts have changed in three years on a measurement tools and that kind of stuff. Yeah. And then just like tech and feature stuff, if that's cool with you. Yeah, absolutely. Sounds great. Thanks so much. Yes, always great. Bye. Thanks for listening to the other episode of Medicine Redefined. If you enjoyed this episode, please be sure to check out some of the additional resources in the show notes. Please also check out our social media platforms, where you can find more content like this. You can follow us on Instagram, Twitter, and TikTok at Med Redefined. We also want to thank our team for the production of this podcast, specifically Ethan Jewel in Video, Harita Yeporian Social Media, Zanablegmani on Research, and Sarah Hahn for Newsletter. Oh, and if you want to get similar bite-sized information delivered to your inbox every Sunday, please be sure to sign up for our newsletter. Also, if you enjoyed this show, please be sure to subscribe, review, and share with anyone who you think will gain value from this as well. 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