197. Sleep for High Performers: Jet Lag, Naps, Wearables, and When Tech Helps (or Hurts) | 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. In this conversation we dive into a question that many ambitious people struggle with. What does it actually look like to apply good sleep principles in real life when your schedule isn't perfect? Joining us again is Dr. Jade Wu, a board certified behavioral sleep medicine psychologist, insomnia specialist, and one of the leading voices pushing for a more balanced evidence-based approach to sleep. In just our previous episode, 196, we explored the foundations, why sleep matters, the traps high performers fall into, and how over-optimization can actually backfire. In this episode, we take it a step further and make it practical. We talk about how to manage sleep when you're traveling across time zones, how to use light, meals, and activity to anchor your rhythm, and how to build flexibility without losing consistency. We also get into naps as a performance tool, how to recover from late nights without spiraling, and how to think about sleep tracking, wearables, and artificial intelligence. What's actually useful, and what's just noise. This is about moving from knowing sleep matters to actually living in a way that supports it. 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 spots at refininghealthrx.com. All right, let's jump in. Jay, welcome back. Thanks for having me back. So last time we talked a lot about, or we frame sleep as the ultimate performance enhancer, as you mentioned, and you laid out the traps for high performers. We talked about whether neglecting sleep or over-optimizing it and how that can be detrimental, and also covered the big buckets, physical repair, cognitive, memory processing, emotional regulation, and I think you emphasized why daytime rhythm is especially important in order to get a good night's rest and have the same response the following day. And inflexibility is another thing that you always talk about. And so today I'm interested in getting a little bit more practical. And I think the first place that I'd like to start is just talking about sleep and life architecture with respect to traveling. Now, it's not something I do a lot, but it is something that I struggle with, because as I mentioned, I know you're probably going to tell me that I have to approach it more like a friend, but when I get shaken off my routine a little bit, despite being a parent, it takes me a little while to settle. And I've figured out the recipe for me, but I'm curious in terms of how you counsel people. And I think you've been traveling quite a bit with a lot of Vermont's haven't you? I have. Yes, the past year or two, I've traveled quite a bit. So yeah, this is top of mind for me as well. And for a lot of high-performance, right? For sure. So for someone like crossing time zones, right, busy clinician, executive athletes yourself, what are your anchor habits to preserve rhythm? Or maybe even, let's take a step back as like, how do you approach this in terms of making sure that it's quote-unquote dialed in and you're not getting too far off, for rhythm, so to speak? Yeah, yeah. So the first thing to know is that people have different levels of tolerance for jet lag. So this is something that I think sounds like a myth, but it is actually true. So I think Taylor Swift famously said, while she was in the height of her arrest horror, she was like, jet lag is a choice. Just get over it or something along those lines. And so I think she's very lucky to have a high tolerance for jet lag, but some other people don't. Like I myself, when I guess we're off even a couple of hours, a couple of time zones, I'm like way off. So you and me, we might take the more time. So for those of us who do need a little bit more help to adjust, your best friend is going to be light. So wherever time zone you're in, you want to get bright light exposure in the morning of that zone. And very little light at night, not time zone. That's going to be your quickest and easiest way to set yourself to like, to align your biological clock to the actual clock of that time zone. Now it gets a little bit nuanced because it depends on how far you're going, how many time zones you're crossing over, how long you're going on that trip. If I'm going to the West Coast for a two day trip, I'm not even going to bother switching to West Coast time. I'm just going to try my best to stay on East Coast time. I'm wearing my blue light blocking glasses starting at five, six p.m., unless I'm going out and about. And then I wake up at like five a.m., four a.m., cover me a time because I don't want the bother of having to switch my clock back and forth. But if I'm going to the West Coast for a week long trip to week trip, then I want to get on West Coast time as soon as possible. So it's a little bit case by case. It's funny. And it's also a little counter-intuitive, right? Because a lot of times people think that, oh, if I'm only here for 48 hours, I got to maximize this time, right? So if you're going to the West Coast, you might even stay out later and truncate that sleep even in more. So I'm maybe taking a little too far, even if I'm out there for five days. My goal is to, I'm like, listen, we're going to bed at 7.30. It doesn't quite work out as well. If you're trying to assimilate into some social norms, maybe a family, they're like 7.30. That's dinner time or whatever, 6.30. And you're like, no, sorry, I'm so maybe people aren't as respectful as to your sleep. And aside from maybe getting that morning light and stuff, so let's just say you are going to adjust what are other things that you're going to do. So we'll maybe play this case in our area. I'm sure you've done some version of this where you may be arrived later in the afternoon. So we'll say late afternoon. And you know that you're going to be here for five days. And then you're coming back to the East Coast. We'll keep it there for three hours difference. And then I'm curious to see how you'd go about that. Yes. So another big biological signal that will set your circadian clock to the local time is your meal times. So if you eat your meals later, that will also push your clock later. So if you're traveling west, so the good news is if you live on the East Coast and you travel west, that's a pretty easy adjustment. Because our biological clocks tend to run a little bit longer than 24 hours anyways. So traveling west is almost like going with the flow of what your body is always going to do is like extending the day longer, basically. So if you just give yourself a little extra light in the evening and eat a later meal. And by later, I mean late for your usual biological East Coast time, but probably like socially conventional for west coast time, like a 7pm meal or something like that. It would be 10pm your regular time. That's going to push your clock later. So between the light and the meals and the timing of your physical and social activity, you can pretty easily adjust to that west coast time. And what about exercise? I know you mentioned physical activity, but will you do a later workout just to kind of keep yourself awake a little bit later and shift that part of it as well? I mean, personally, I don't just because I'm not really a gym rat anyway. He is a, but that is one strategy you can use. And it's debatable how effective that is. It's not as effective as light or meal times. But if you're bored anyway and you have nothing else to do, you might as well go to the gym at the hotel, right? So it might keep your body working harder a little bit later into the evening and hence help you push your clock back. But that's actually more effective the other way around. Like if you're going back home to the east coast, now you have a harder adjustment to make because you're going against what your body naturally wants to do, which is your body doesn't want to shorten the day, but you're essentially shortening the day. So to get back on east coast time, if you're anytime traveling east, working out in the morning of the time zone that you're landing in. So your east coast time zone, morning, do a good workout then and eat a good hearty breakfast. And that will go a long way to adjusting you back to the east coast. I want to double click on this light aspect a little bit. I know we've talked about the importance of getting early morning light. And I think this has just been talked a lot about, particularly Dr. Heberman seems like he's the champion for this talking a lot about that. And obviously there's a lot of literature. I've also heard some people talk about the importance of getting a different type of light later in the evening as well. Can you talk a little bit more? I mean, do you see that as an important aspect of your overall circadian clock through the day? And if so, are there any differences in the type of light that you're getting, in respect to wavelength? And does that influence how your sleep quality at nighttime? Yeah, that's a good question. Honestly, I think there is some research on this that I'm not super familiar with. So I think this is pretty cutting edge stuff that we're talking about. And I don't want to definitively say one way or the other before there's more data and before I'm more well-versed in it. But my general impression is that the morning, bright light and daytime broad spectrum light is going to be a much more impactful and important than whatever special wavelengths light you're getting at night. Basically, as long as the light exposure you're getting between day and night is very different. Like there's a big contrast in how much bright light you're getting, that could be good. And if you are going to have an evening light exposure, dimmer and warmer lights would be better. But there's probably, I'm guessing there's some nuance there with like sunset and seasonality and things like that. I don't know that it makes that big of a difference, but there's probably something that. Makes sense. You mentioned blue light blocking classes. Is there a type or a brand or something that you prefer? I don't have a particular brand. The only thing I would say is that some of the clear ones are not as good at filtering out blue lights. And if you basically, if they look good, then they're probably not super effective because they're open on the sides. There's light that's coming in from the sides. So the ones that I have are like really nerdy, like kind of wrap around, or like amber, like almost. Yeah, exactly. Like very much like bono, but not as cool. So yeah, so that's the only thing. And I would just say that blue light blocking classes, they have been sort of overhyped. They've been sort of put forth as if you do this, if you wear this in the evening, you'll be all set. If you use your screens and if you have other bad habits, no problem. And that's not really true. This is more like a marginal improvement. It's kind of like if you are already healthy and exercise and you add like a little bit more specialized training in a particular muscle group. Great, but that's not going to be the thing that makes or breaks your health. So same thing with the bright, the blue light blocking classes. I think there are good tools to use, especially when it comes to circadian stuff like jet lag, but I wouldn't hang my hat on it. I think I'm familiar with what you're talking about. I think the initial study maybe came out from Harvard when they're looking at that. And then the subsequent analysis where they talked about, actually it might be the stuff that's more stimulating, closer to bedtime, this disrupting. Is that a little bit what you're alluding to as well? Exactly. Yeah, it's like, is it really the light source or is it the content of what you're looking at on your phone? If you're scrolling TikTok for two hours, that's a lot of stimulation. It might feel like you're relaxing because you're laying down, your body's technically relaxed, but it's not even really technically relaxed that well, because how often have you been on your phone or on your iPad, and then you realize, oh, my shoulders have been clenched or been shallow breathing or holding my breath, we're not totally relaxed until we actually pay attention to our breathing and to our five senses. So I think the content of what we're looking at can be explicitly stressful, or even if it's not, even if it's just cute cat videos, it's still a constant stream of stimulation that our brains have to process to look out for. So I think that probably has a bigger effect than the blue light itself. Maybe cat videos where cats are only purring. Maybe that'll be allowed. It's sure that we can try that. So if those are some of the two dues, either East Coast, West Coast, whichever, what are some of the do-nots that we want to try to avoid here? I think excessively using alcohol or caffeine to switch yourself to one time zone or another is not really going to be effective and in fact it might backfire. So for example, if you are going east and you need to fall asleep sooner than you're used to because of your West Coast clock and you drink lots of alcohol to put yourself to sleep on East Coast time, that will not only confuse your circadian clock. It will also make your sleep lighter. It'll make your body temperature higher when you're trying to sleep, and that's going to do the opposite of cooling you down earlier to shift your circadian clock earlier. So you see how that might actually be more confusing for your circadian rhythm. And similarly with coffee, I mean, yes, it gives you like a boost in the moment, but the crash that you feel afterwards might actually be counterproductive. So I will say try to minimize or try not to do use a lot more caffeine or alcohol than you usually do in the service of shifting your clock. Yeah. Yes, sounds like really the only sensible place caffeine would have a role is if you're going west coast to east coast and you want to wake up on East Coast time. Let's just say six. Possibly because that's technically like 3 am your time trying to shift it. Yeah, yeah, because the other way. The caffeine could be useful. Yeah, what else could be even more useful is a light box. And I have no financial relationship with any light boxes, but the all of my patients and all my clients that have tried the light box have been just astounded by how much more effective it is I'm making you alert and awake compared to even caffeine because you get less of the jitteriness, your brain actually works faster and you know, you feel not just jazzed, but you feel actually able to process information. So that's something to try instead of caffeine. I think I have the same exact one that I used right now because I wake up. I mean, we're both on the East Coast during the same time zone and I'm waking up six o'clock when the sun doesn't come out till seven here. So that's what I'm using. Yeah, but I think I don't know. Is it 10 minus 10,000? Is that the number that works? 10,000 likes minimum. You do want that or more or is that kind of the magic number? I think 10,000 is what the research has looked at. More might be, you know, and just to drop a note of cautionary note here, folks who have a history of bipolar disorder or bipolar disorder in their families should see consultation before they use the light box on their own because that might trigger a manic episode. And also some people have had headaches and I strain using it. So definitely better to consult a medical professional before using it. But if you want to give it a little bit of a try, I would start with just, you know, five minutes and not more than 10,000 likes just to give it a try. And then it feels comfortable. No side effects. You know, like generally the prescription is like 20 minutes, but I will start with a shorter time than it. Love it. So let's talk a little bit about naps. Are you a napper? Do you like that? Yes. Love naps so much. Good. Who does it right now? We got to bring them up. So what role do naps play in your framework for high performers? No, I hear, I think, is it Google that has these little nap pods or something? I think a lot of Silicon Valley companies, a lot of Silicon Valley. So they've got to figure it out. We, I don't know anybody on the East Coast. And certainly nobody in medicine. We had call rooms. But yeah, where would you even nap if you wanted to? Like, that's just not a thing, yeah. How do people strategically use them as a performance tool and not let them become a sleep disruptor? Yes, I love that question. Naps are honestly one of my first go-to tools, especially for athletes, people who work high stakes, high stress jobs, people who travel a lot. It's like there's not much they can change about the nature of their job and travel such that they sometimes they just don't have enough time to sleep at night or they will have jet lag. It's just unavoidable. Then in that case, your nap is sort of your fallback. And so you can use naps to catch up on sleep that you haven't gotten or to prevent circadian shift that's too far in one direction or another. So for example, I would rather someone wake up at the same time every day, even if that means they have less opportunity to sleep at night on some of those nights, because I want them to stay on the same circadian rhythm. Because that is extremely important for performance and wellness and longevity and all of that. But then that comes at the cost of sometimes they just don't get enough sleep because maybe they had to work late one day or they traveled or whatever. That's where the naps come in. That's where the nap allows you to catch up on that last sleep without shifting your circadian rhythms by sleeping into much or going to bed too early or one way or another shifting the timing of your sleep. So generally speaking, half an hour, 45 minutes, the research has basically landed on half an hour as the magic duration of the nap. That's not going to disrupt your nighttime sleep. But it gives you a measurable boost in performance and emotion regulation and wellness and all of that energy and all of that. And we want it to be early afternoon relative to your home time zone. But for some people, I make an exception. So for young athletes, especially like college athletes, by all means sleep much more than half an hour during the day, if you can catch it because they're so sleep deprived that there's the number one priority for them is to just sleep as much as possible when they can. For pregnant people, also you can sleep longer naps, as long as that doesn't severely disrupt your nighttime sleep. That's just because circadian rhythms and sleep need changes quite a bit during pregnancy. So I allow longer naps for pregnant people. But people who really should stick to shorter naps are older folks. Because as we get older, our circadian rhythm tends to become less robust, which means that our days and nights are less contrasted and they're more mixed up. Like our nights are a little bit more awake and our days are a little bit more drowsy. So then older folks tend to take little micro naps throughout the day and then they wonder why they have insomnia and night, right? They're probably getting the exact same amount of sleep, but it's just more spread out and less good quality sleep, less consolidated. So I would rather someone like that take one good half hour nap in the middle of the day and do whatever it takes to stay awake the rest of the day and get that consolidate as sleep at night rather than take five mini naps spread out and have a bunch of insomnia. So naps generally let's say half an hour set your timer for 45 minutes ish, but even if you don't fall asleep, that's still very helpful for your brain and for your well-being and for your performance. But yeah, whoever can swing a half hour nap should do it, but especially if you're pregnant, especially if you're a high performer, especially if you're not a athlete. What's the physiological basis for older folks? We're not going to put it, mostly people in 60 and above where they can't get the consolidated as they through the night or through the day. What's happening there? Yeah. So it's a gradual change, but I would say it's more like 70 and above 75 and above. We're not just freshly retired, but well into retirement 10 of age. And the mechanism is a few things actually. So one thing is that the master clock part of the brain, it's called the super chismatic nucleus or the SCN. This part of the brain is like a tiny little thing, but it's the master clock that runs all the billions of clocks that are distributed through all your cells in your body, and all these cells and all your organ systems and hormones and all of that look to this master clock to keep on time. This master clock actually gets smaller as we get older. And also the way this master clock gets most of its input from the outside world to know what time it is through the eyes. So the light that comes in through the eyes, it hits the back of your retina and there's special cells that just detect how much light there is in the environment, tells the SCN almost directly. There's two synapses that is like a very direct route to the SCN to say, okay, it's daytime or it's nighttime. So those types of cells on the back of our eyeballs, they actually did heriary as we age. And also they're sligh more glaucoma, more eye problems that keep out light. So there's basically less signaling in terms of light. There's less strong signaling in times, in terms of physical activity as well because older folks tend to be more sedentary. So between all of these different changes and just the SCN shrinking in like literally shrinking in size, the circadian rhythm is less robust. So the highs are less high, the lows are less low and there's, it goes off track more easily. It makes sense. You earlier mentioned the importance of consistency wicking up same time. Is there a little window that you'll allow for like in terms of setting your time, if I'm setting an alarm and I know I'm going to bed a little bit later tonight. Yeah. Do a 30 minute later or 30, you know what I mean? Is that okay? Yeah. Sure. Uh, I always say an hour's wiggle room. So yeah, I mean, you're generous actually with this one. Yeah, I mean, we're adaptable. Leap and circadian rhythms are resilience were meant to adapt to different seasons and you know, all of that. So it's okay to lean on that leeway, um, as long as we're not exploiting that too much. And also there's always going to be exceptions. Like if you have to catch a really early flight, so be it, you know, or if you're, if you're at your best friends wedding, go wild, drink a lot, stay up all night. It's going to only happen once, hopefully, right? So have fun. It's okay. If just most of the time you stay within that one hour wiggle room for your rise time, you're good. Somebody who struggles within somebody, I think we talked about this in her first conversation. That's the person who probably shouldn't nap even if they're tired. What do you think? Yeah. So that's a conventional wisdom. And I would say probably half of my colleagues at least, maybe like two thirds of my colleagues would agree with that. Like if you're, if you haven't saw me, I just don't even nap at all ever. Over the years, I've really become more lenient about that. And in fact, I found that some for some people taking a nap, planning a nap can be good for their insomnia because for one, they're less anxious. If they're usually at night at 3 a.m., they're not sleeping well. They're like, I got a crap. I'm going to be totally useless tomorrow and be still tired. But if they know that they at least have that one nap to catch up a little bit and to look forward to, then it eases that anxiety. And that eased anxiety turns into falling asleep more easily. And also, the, you know, big part of CBTI cognitive behavioral therapy for insomnia is that you have to limit your your amount of time in bed. So you're supposed to stay up later and stay out of bed. And some people can't do that if they haven't had a nap. Like they are literally falling asleep on the couch. They're falling asleep at the dinner table. And that's not helpful for insomnia. So I would rather them take a half hour nap, like one p.m., but be able to stay awake the rest of the evening until their proper bedtime, rather than start falling, dosing off at like seven, eight, nothing p.m. So I've strategically used napping for my insomnia patients. Makes sense. So to build off earlier what you were talking about every now and then, your best friend's wedding, I think I saw something that you posted in social maybe on LinkedIn a while back. You're talking about structure versus flexibility. So late night social life, you talked about being able to do something fun, like dancing, even it pushes you past bedtime. And so I think I have a sense of where you land on this with sleep being your friend. I do think it's important, particularly for your high-performance, to have some structure. It's important just to be high-functioning. You've got to have that, but also have spontaneity. And what I'm really interested in learning from you is if you do build that spontaneity, for somebody who is reluctant to do that, if they do take you up on that, is how do they do it? So they're not paying for it all week. So what's that recovery plan look like after that late night, where you've partied and did all the things. Next day, anchors, you're not like timing and basically just don't let one late night or quote unquote bad sleep night just turn into a spiral. Yes, that's a fabulous question. So I'll use myself as an example because I go salsa dancing every Friday night and the salsa scene runs. It's like my one thing that I get to do outside of having little kids is like Friday night, I ditch the kids, I ditch the husband, I go salsa dancing. I was in dance club in high school. Really? What kind of news? What kind of news out there are me doing salsa, like honor society stuff like that? No, you don't want to, you're not going to see them. If we ever see each other in person, we should have dance. Yeah, but I mean, it's a beautiful thing because it's like it's social, it's exercise, it's like mood boasting, it's all good things for my physical and mental health, right? It's like very well worth the sacrifice of maybe two fewer hours of sleep than usual, maybe three fewer hours of sleep. So that's the math in my head. It's like, first of all, is this worth it? And for me, it is. So I would start just by sort of, you know, evaluating your values of what is this event doing for you? Like, are you doing it just because of pure pressure? Are you doing it just because you've always done it? Or is this actually valuable for you? And if it is, go ahead and do it. And then the next day recovery plan is still try to wake up within an hour of when you usually wake up. So yes, your sleep opportunity is going to be cut short, but that's still important to do. So still, you know, hydrate, wake up at the about the same time, move your body, eat a healthy breakfast, you know, do all the things like double down on the healthy habits that are good for you. Anyways, like go outside, take your dog for a walk, all these things, and then use a nap to catch up on your sleep. But the nap is not going to be equal to the amount of sleep that you lost. So you're not going to take a three hour nap if you want to bed three hours later than usual. It doesn't really work like that. So still stick to your half hour nap or at most one hour, if you're the kind of person who can sleep an hour and not get into deep sleep and get all like funky about it. And then just like really double down on those nurturing activities for your body for the rest of the weekend. And also try not to push it that hard like two nights in a row, three nights in a row, then that becomes harder to recover from. What about the person who napping is just not for them? Like I'm thinking about my wife actually, but for as long as I've known her, when I tell her to take a nap, she almost, in very, she'll feel worse afterwards. She'll feel more groggy after nap. And it doesn't matter. The length of it doesn't matter. Only time in medical school, I think she was successful is she would drink coffee, she'll chuck coffee, and then go to sleep. Like 20, 30 minutes later, she'll wake up and she would avoid that groggyness that post almost like a hypnagogic. Yeah. I'm going to say that episode, but it would be a prolonged hypnopopic episode. What thoughts do you that like, what can that person do to turn it off a little bit and just recuperate? Yeah. Great question. I'm going to take a wild guess here that your wife was probably sleep deprived in general in medical school. It still is. Yeah. And maybe still is. I know you guys have a young child. Yeah. Yeah. Yeah. Oh my gosh. So she probably hasn't got enough sleep consistently for years at this point. And so that's important to know because the reason you wake up groggy from a nap and wake up feeling almost like worse or sometimes people even wake up in like a low mood kind of funk is because you've accidentally gone into deep sleep during that now. So if you're sleep deprived generally, any opportunity that your body has to sleep, it will quickly go into deep sleep to recover that really important deep sleep that it hasn't gotten. So if she were to overall become less sleep deprived, then when she goes to take a nap, she will only stay in light sleep for the nap as she will probably wake up feeling good. But if that's not an option right now, like it's just not possible to be overall, you know, overall less sleep deprived, I was still air on the side going to take a nap even if it's not like fully falling asleep. Like maybe she listened to a listen to a podcast during her 30-minute lie down time so that at least we're decreasing the stimulation level during that time. Like yes, she's listening to something to stay away. But there's no visual stimulation. There's no juggling whatever tasks that she has at home or at work. Just something to bring the stimulation down for half an hour, get into kind of a meditative state. That's still really, really beneficial even if it's not real sleep. But if she's doing that and accidentally falling asleep, that means she's just really sleep deprived. And the real solution is just really she has to sleep more at night. Yeah, yeah. Yeah, fix the root cause so to speak. Yeah, exactly. Hey, where's where do we land on sleep banking now? I remember I think the last time we had spoken or maybe a wall back conventional wisdom was like, that's not really a thing, right? You can't ahead. But then I do remember listening to Dr. Matthew Walker recently, maybe a couple of months ago talking about we actually might be able to some of the new emerging evidence. Are you familiar with anything like this? I'm not too familiar with that. It's possible. I think maybe what he's referring to is there is some pretty cutting edge research on sort of inducing sleep using brain stimulation, auditory stimulation, like conditioned sleepiness, condition responses and things like that. And those I believe are short term one off or two off laboratory conditions, kind of things. So I don't think there's a technology currently that you can continually, like consistently use every day to induce sleep when your body isn't ready to sleep. That's just not a thing that really exists. So yes, someone who's a particularly blessed sleeper who easily falls asleep and has really positive associations with their bed and all of that good stuff, they may be able to bank some sleep ahead. Like my husband will definitely be able to do that. Like he can fall asleep anywhere. Also, he has mild sleep apnea. He's always just a little bit sleep deprived. So then yeah, then he can lie down and take a three hour nap ahead of having a drive all night, for example. But you can't do that indefinitely. You can't do that every day and you can't bank too much sleep because your body just can't really sleep until you've actually earned that sleep. If you don't have that the amount of bit denocene floating around to tell your body that this is the amount of recovery that you need, then your body's not going to do that recovery. I guess we'll see. We'll see where the evidence goes. Yeah, let me set it for that one. All right, here's the big one that coming out. I don't think we can have a conversation about high performers without talking about measurement and feedback and optimization here. Sure. So I'm interested in talking about metrics now. And I think last time I had spoken, I know we gave a disclaimer because this is something particularly within summary access, not something we want to focus on. But now we're taking that out of the equation here. So you're at 2026 take on sleep metrics that matter most for performance and what's noise? Are there any wearables, any sleep tech that interest you that you use personally? So I'll say that I personally don't use any wearable or any nearable that type of sleep tech. I don't have a smart mattress. I don't track my sleep. I don't do any of that personally. But it's because I don't feel a need. Like I have a good relationship with sleep. I feel like I'm getting enough. I take a vantage on Friday nights, but I make up for it. It's fine. Like I feel okay. But for people who are maybe having some concerns about their sleep or just have a longstanding feeling that they should be or could be doing better with sleep. I think there is a place for sleep tracking and sleep metrics. And so first I'll say that a lot of these trackers are getting very good. So it's still proprietary black box algorithms, how they come up with their sleep staging and sleep scores and writing a score. So I can't comment on exactly how accurate or how they do those calculations. If we compare those trackers to the gold standard in lab, the PSG measures, they're pretty darn good. Even the sleep staging at this point, some better than others. I think whoop and aura are traditional. Like not. Sorry. I think whoop and aura have the best data. James, I'm going to jump in there. So I've had both the home sleep study and an formal PSG where I had to go in. And not only did I have the overnight, I think I had the many multiple sleep latency test as well. That experience is a horrific experience. Like you have 50 leads on you. I cannot imagine anybody, even if somebody was a bad sleeper with that type of stuff on you, you're come a worse sleeper. So almost like after going through that experience, I went through a couple of years ago and was like, this can't possibly be the best thing that we have. Have you ever done that? Have you ever done that? Not personally. I've done that. He has not had an in lab study. Actually, both done an at home study. And obviously, I know a lot of people who have had in lab studies and MSLTs, like you mentioned, my father, and this is off topic, but he has a startup company that has a wearable PSG device so that you know, you can do the gold standard full like multiple eG leads and all of that stuff with one headband at home. So what's the name of the company? It's it's a Chinese company. Okay. So and they don't have a product in the US as a yet. I'll update you if that changes. But yeah, people are working on the solution, right? Like how do we take the lab into the home and make it way less invasive, intrusive and make it more ecologically valid and more comfortable, obviously, and more accurate. But yeah, that's being worked on, but those are not commercially available. The commercially available sleep trappers measure heart rate variability and movement. And they use those and possibly I think body positioning maybe blood pressure to and sometimes sound to triangulate triangulate on whether someone is sleeping or awake at what stage of sleep they're in. And honestly, they're they're pretty good. You don't have to be 100% accurate to get a big picture of what's going on with your sleep. But the caveat is that still most of these devices, their algorithms are based on data from healthy young men mostly and women, but more more so men. So we don't have a lot of algorithms specifically for people with insomnia or other sleep disorders. We don't know for people with fibromyalgia, for example, or people with PTSD. Nightmare disorders is like if you have some sort of mental health or physical health issue, we just don't know how accurate these trackers are for you. So that's my main concern on just the measurement side. In terms of the metrics, I think sometimes it's information overload to see all of the metrics like sometimes you have to scroll like multiple times just to see all your different last night. And how much of that is actually useful? How much of it is actionable? You know, how much of that can be interpreted in a way that's actually accurate and helpful because sometimes like we think more data is better. But that's not always true. Sometimes more data gives you a sense of confidence in the data, but just leaves you astray. It gives you a sense that every single data point is important. But if you can't knit all of those together and put it in a holistic context to interpret, then it's worse than having few data points. So if someone were to use a sleep tracker like for my insomnia patients, for example, and they really want to use a tracker, I have them look at the consistency of their sleep timing and their sleep efficiency. And those are the two metrics I have them look at. I do not have them look at the readiness score because what does that even mean and where does that come from? And also, is it going to be a self-fulfilling prophecy? If I wake up and see a terrible readiness score, then I'm like, oh crap, my day is shot. And then I end up not having confidence in myself or not doing the things I should do to like get myself comfortable the game or the competition. Exactly. Yeah, yeah. Exactly. Imagine someone who's like playing in the Olympics, or like, you know, like someone who's about to do a figure skating performance at the Olympics. It's like they wake up and see that their readiness score is super low. They're like, oh crap. And when they get on the ice, are they going to be thinking about that? Like, oh, am I ready for this? Am I going to let myself and my country down? You know, that's a lot of pressure. There's already so much psychology. So why give yourself that pressure? When all you really need to know is, did I have good sleep efficiency? Did I sleep most of the time that I was in bed? And have I been doing a good job staying consistent with my sleep timing? That's pretty much it. Yeah, I think the if somebody is economically fortunate, like they would have a coach or something with somebody in the Olympics. Maybe your coach has access to the data and you don't. I think a lot of high level coaches, that's how they're going to operate. They're not going to let see the athlete that type of data. That's pretty good. With heart rate and stuff. Are you under recover, over recovered? You know, we heard a million stories of people where they've slept poorly, but then they come in and they PR in the gym or they PR with their event and whatnot. And so for me, what I'm interested in is because I know you do a lot of sleep coaching and you work with patients in very stages of their lives. Is that do you ever use the data and the objectives? You mentioned sleep timing. So you're actually looking to see when the wearables says they actually fell. They've not when they went to bed, correct? So you use it in your coaching and your interactions with your patients and give them feedback and I'm curious about how you tinker with your sleep with that. Yeah. So the main way that I've actually used sleep tracker data with my patients, most of whom are insomnia patients, is actually using the data to give them reassurance. Because often, so what I'll do is have people write down track their own sleep in a sleep log, legacy diary, and I help them fill out that diary every day before they look at their sleep tracker data. So they're not biased or swayed by it. And then we'll compare the data, their subjective data and their more objective data and almost invariably insomnia patients underestimate how much they slept. So when they see their objective data, they see that, oh, I thought I only slept three hours last night, but my track is telling me I actually got six hours of sleep. So like that whole two hour chunk in the middle, I thought I was awake the whole time. Turns out I was asleep for at least some of that time, but I wasn't aware of it. And so that decreases the anxiety. And that gives people like so much of insomnia therapy and coaching is just having people realize that they're actually doing better than they thought they were. And that decreases the anxiety, and that decreased anxiety turns into actual better sleep. So it's a bit of a dance. It's a bit of an art rather than a science, but I have definitely successfully used sleep tracker data in those ways. Now I love that. The cart is definitely the key word there more so than the science. At least from a practical application standpoint, I'll share this story with you because I think that you'll find it interesting. I think I had mentioned to you that I had, or I've had it for several years, like actually probably haven't used in the last two to three years because I found myself getting up in the morning, looking at the score and making a sense of that score. Of course, it wouldn't necessarily affect what I could do during that day because things were already planned out. However, I did find myself having anxiety through that. And so I don't use it for that. But here's where I came down to be really helpful. I'm somebody who's a hot sleeper. And so I had an Euler no affiliation, chilly technology. I had that for a while. But what I found myself was like in the middle of the night, always waking up freezing. And I didn't recognize like what that was about. And I liked it to be really cold when I'm going to bed, like 63 degrees on the Euler setting. Yeah. And because my wife, generally, we talked about this before. My wife likes to warm the room and not like cold. And so what I noticed that it would I would consistently be getting up somewhere between one 30 and three in the morning is a point. And it would always coincide with sometime when I looked at my Euler data that I would be in REM sleep when I'm happy. And turns out that we are not good at thermal regulation during REM sleep. That's a complete turned off. And so because my Euler was so cold consistent throughout the night, it doesn't work that way. So likely that system you can adjust the temperature. So around 1 a.m. it would go up to 67 or 68. Once I made that jump, it was amazing. And then you got the warming feature and going on stuff like that. So yeah, I felt that was really cool. And that's where it was like super actionable for me and actually improve my sleep quality. That's a really good example. I think that's exactly a zooming out and looking at patterns. It's like if you always wake up around this time or if if there's like a discernible shift in your falling sleep time over the week, like I've I've had a client where he was like, I don't know what's going on. Like I I'm so erratic. I can never predict when I fall asleep or not. But then when we looked at his data, it was almost like a perfect linear slope. And we're like, Oh, you're falling asleep half an hour later every day. You have a delayed sleep phase and you or you have like non 24 hours for getting rhythms. But that would have been impossible to tell just zooming in on daily, nightly data. But when you zoom out, you see a bigger pattern. So yeah, absolutely stuff like that. And I've had people say like, Oh, I realized the days when I drink alcohol, it affects my sleep way more than I thought it did. So then they cut back on the drinking. So yeah, stuff like that definitely very actionable on that note. I'm interested in learning about your assessment slash diagnostic process. There are so many things that can go on and it's such a subjective thing because a lot of it's symptom based how they feel the next day and a lot of these symptoms can span a variety of or can have a variety of causes that's actually manifesting into whatever that they're telling you. So I guess the question would be how do you diagnose what's quote unquote broken as a sleep onset? Is it that delayed sleep phase that you're talking about early awake names? Acnea maybe is there some hints for that? And it would also be the second part of that question would be interested in understanding your rules for experimentation. Typically, we'd like to say one variable at a time, but how long do test that for? What does success mean to you if you do implement something? That's a loaded question there. Yeah, I love that. Okay, let me take it in turn. So the first question was about how do we diagnose sleep problems or assess? Yeah, that is tricky because like you said, it's so subjective. And in fact, if you look at the diagnostic criteria for insomnia, it's all subjective. You can diagnose it based on just a clinical interview. You don't need any almost any data to really diagnose insomnia because it's really in the eye of the beholder. It doesn't matter how long the person sleeps or how long they're awake for. If they feel like they're having a problem with sleep at night where they're having a hard time falling or staying asleep, they have insomnia. So then it's tricky though because a lot of things can masquerade as insomnia. Like sleep apnea also shows up as a lot of awakening at night and sleepiness and tiredness during the day. PTSD can show up as very much having trouble sleeping and like heightened alertness during the day, but also very tired, depression, chronic fatigue syndrome, all sorts of things can show up as insomnia. So I like to rule out, basically, I establish, is there insomnia at night, yes or no? And then after that, I rule out what I call the obvious, which are factors that better account for poor sleep at night. Like, are you in the middle of a hypersonic episode? Are you drinking too much coffee? Are you using drugs or alcohol that's affecting your sleep? Are you jet lag? Do you do shift work? You know, these obvious sort of environmental external factors. And then I assess for the sleepy. And the sleepy is like, if you are sleepy during the day, that's a real biological problem. That indicates either you're not getting enough sleep. You have something that severely alters your nervousness on like PTSD or you have sleep apnea or another type of hypersomnia-related sleep disorder. For people who have insomnia, they're hardly ever sleepy during the day. So that's a main differentiator. It's they're tired during the day, but they're hardly ever sleepy. So if someone was sleepy during the day, that is a big clue for what's actually going on. And what's the distinction? Tired versus sleepy. Yeah, it's very simple. Like, can you fall asleep? So sometimes like so often my insomnia patients will say, like I'm so exhausted during the day, I'm like groggy, I'm drowsy, I'm like, okay, if you go to lie down to take a nap, would you be able to fall asleep? And they're like, no, that's the thing. I can't even fall asleep during a nap, even if I want to. I'm like, okay, that's more like insomnia. But if someone's like, yeah, I'm falling asleep left and right. Like in the in the waiting room, like, you know, while driving my car, I'm dosing up. Then no, that is not insomnia. That is something else. Yeah. Makes sense. I will say, though, I think as you better remember, with these high performers, they're going to have a high sympathetic drive. More likely than not. Yeah. And again, that we talked, maybe we talked about this when I came to learn, is yeah, you have the circadian drive, but you also, of course, the autonomic driver, somebody who has a high sympathetic drive, and there you go. And if your body's constantly perceiving stress and fight or flight, it's not interested in sleeping. Even that person, though, and I came to learn this the hard way, there are certain situations where that's something that I drive will tone down. For me, it turned out to be when I'm behind the wheel driving. Yeah. Bad way to learn that situation. Yeah. Thankfully, nothing bad ever happened. But that's actually what warranted my first study where I was driving home from work. And so I think that's something that I've heard and I've had a conversation with people and that's a question that I've asked. And I was like, are there any situations where you end up falling asleep? Like, yeah, in this specific context only. And I found that the person that they end up putting their guard down, so to speak in that time, because something about that situation allows them to do that. And that's where they end up falling asleep. And so that's a little bit of a technical nuance there, I suppose. And that's a really, really good point is every person is different. And you can't just ask, do you fall asleep driving? Because a lot of people don't fall asleep driving, but they'll fall asleep watching TV or they'll fall asleep making coffee standing at their counter. Like, then like scenarios where they really should not be falling sleep or vice versa. Some people like, like you, you only fall asleep if you're behind the wheel. So it can be unique to each person. But basically, if you're able to fall asleep during the day when you didn't mean to, then there's something wrong. So yeah, I got another, I find that a pretty universally good test. And this is not like any like validated scientifically like validated test is if you put someone in a comfortable, like kind of dark quiet room with a podcast or an audio book on, do they fall asleep? Because that's like enough stimulation that they're not bored. But enough like taking them off their guard because they're paying attention to something that's like kind of relaxing. That it will basically put them to sleep if their body wants to. Yeah, hopefully not our podcast, hopefully our podcast. Definitely. I want to look at the future now a little bit. A lot has happened in trends and sleep science. Actually, full disclosures. And so the last time we spoke, I pulled a plug, got myself an eight sleep. I just had it for a long time. I don't know if I love it for $3,000 to be honest with you, and I can't turn it into anymore. So whatever I digress. But there has been progress and it had not been a linear increase. It's been an exponential rise in things. And like you mentioned that they're getting better and better. And I do think that tech at the rate, especially with a lens and AI, it's going to only become better from an interpretation standpoint, but also from an application standpoint and new tech coming out. So where do you see sleep science and tech going in the next five years? And is there something about it that really excites you? Actually, I'd be interesting to see what excites you and what you think is hype and it's not really going to be anything meaningful five years from now. Yeah, I have very conflicted feelings in this realm. As I always have when it comes to sleep related tech, because on the one hand, the tech is always getting better at exponential paces. And honestly, I think leap in AI, it's just like an obvious marriage, right? Like within the next year, a couple years, I think so much sleep coaching will be done by LLMs or specialized AI agents or whatever. And I think so much so many hardware devices for sleep will incorporate AI. I think that's unavoidable. And I think probably a lot of these systems will do a really good job noticing patterns, diagnosing issues, assessing issues and providing coaching on that sort of technical level. On the other hand, what I have some concern about is as a culture, as a species, are increasing reliance on outsourcing our understanding of our own sleep. It's like once upon a time, not that long ago, our sleep tech was just am I sleepy? Okay, then I'll go to bed. Am I not sleepy? Then I won't go to bed. It was in our own brain, honed by millions of years of evolution, very wise, very adaptable, very precise, very intuitive. And now I so often hear people say, yeah, but my readiness score was not good or yeah, but I didn't actually get enough sleep last night because my tracker told me or I must be fine because my tracker said I'm good, but yeah, I don't know. I'm still tired, though. What is that all about? So people are going to technology first to understand their sleep instead of trusting their own bodies or like honing their own perceptiveness of their own physical needs. So I'm caught in between like on the one hand, we could increase access to sleep coaching, asleep care to exponentially more people through tech and through AI and probably get more accurate, get people diagnosed sooner earlier, more accurately, we can screen, leave the apnea more accurately and so many more people in a way that's not a dramatic experience in the sleep lab overnight. That's great. But are we going to lose our ability to feel sleepy for ourselves and be able to just let go and fall asleep? Is that in danger? And funny story about eight sleep, just because you brought them up. So first of all, did you know that they reached $260 million raised in VC funds? Doesn't surprise me. Yeah, it's an incredible amount of money for beds, right? And during this power outage, it's sometime in 2025, was it in the summer? I think their servers lost power temporarily during the night. And because of that, like all their beds kind of like freaked out and just started like heating up really, really hot or like going really, really cold, or they like raise up or go down and raise up and go down. Basically, the beds lost their like contact with the algorithm in the mothership or whatever. And so they all freaked out and people could not change this and like their night of sleep was ruined. I mean, that's like a funny one off thing that happened is not a big deal. But I think it's just so symbolic for our collective relationship with sleep that we outsource our sleep to a machine that's supposed to do it to optimize it for us when evolution has already optimized it for us for millions of years. I don't know. How do I really feel about it? I'm still working on that and still figuring it out. But my gut, my intuition says that we're over relying on tech. And this might become a problem in the future. But I'm also excited to see where the tech goes that allows us to do better, faster, you know, more impactful research. You know, the clinician in me versus the scientist in me, they're kind of like two minds. What would the AI driven coaching look like? Am I going to be sitting there talking to a robot instead of you here about? I think you can probably already do that. Like if you, well, so first of all, my colleagues and I every couple weeks will just ask chat GPT for insomnia advice. We kind of make up this insomnia problem or whatever other sleep problem and see how they deal with it. And it's answers are improving. Like it's becoming more and more evidence based, more and more accurate. And it's like more and more actionable and helpful. Yeah, I think you can already talk to an unofficial AI sleep coach just by telling chat GPT to be your sleep coach for the day. On the other hand, it's there's a limited set of clinical experience that any of these AI systems have. So for example, they don't have as much of the hard learned stuff that I have from like 10 plus years of realizing that actually in these circumstances, if you fit a nap in strategically here, it actually improves your insomnia outcomes rather than hinders it. Whereas I think the AI right now is still practicing kind of gold standard CBTI and saying don't nap. So probably pretty soon, it'll become more nuanced. So I don't think I'm going to have a job as a sleep coach, two, three, four years route, certainly not. Or maybe me specifically, people will just be nostalgic for like my book or whatever and pay me. But I think most sleep coaching will be outsourced to AI's. And is that a good or bad thing? I don't know. I have mixed feelings about that. Yeah. The AI piece, I know this is we could talk about this for days. It excites me and scares me at the same time. Yeah. A lot of people talk about, well, AI replaced doctors and this and that. And Darshan, I've done a whole episode on this because it's getting good enough where a lot of times it'll provide better medical advice and a lot of clinicians. I've done studies on this. There's paper came out in 2025 about this looking at this and it was in JAMA. And to challenge it, some people will say, you still want a human being to connect. And I feel like with coaching and anything, especially with your background, with psychology, that connection piece is really important because anytime you're vulnerable, I don't know. As I say, there's some also thinking about the other, because a lot of people are using chat GPT, you know, psychotherapy at this point. Absolutely. Chat GPT is the biggest provider of mental health, like talk therapy of any institution. It's already happening. Yeah. So yeah, maybe you're right. I guess maybe then if we can make it actionable, if somebody is using clot or chat GPT or whoever, Gemini, as a sleep coach, any guardrails that they should be aware of, because here's what I came to learn. And I'll use that a lot for things that I actually have domain expertise in. And I remember, so I coach one selling me, you have to understand all the rules intimately before you can break any of the rules. Yes. And that's where it doesn't, right? So the reasoning and the context dependent situation, all the kind of stuff that you're talking about, that's where it's not so good at. And sometimes, I'll ask a question about maybe training or biomechanics or something like that. And it'll answer something that would be like, this is such a newbie question, like, how would you get this wrong? And it's really fascinating. And then I made me wonder, it was like, maybe I shouldn't trust it when I asked about my taxes so much, because I don't know what I don't know. And it can be given your horrible advice. So what are some guardrails there? Yeah. You're exactly right. My biggest concern about this is people don't know what they don't know. So I think my sort of go to would be don't pre-AI as a doctor and treat it as a coach. So go to a real doctor for the diagnosis of what sleep problem you have. And the ones that doctor prescribes you a pathway for your treatment, then you can use the AI to hold you accountable to help you problem solve to, problem solve to make the treatment go better. But I would not necessarily go to AI for diagnosis because 80% of my job as a diagnostician is knowing what questions to ask that the patient would never have thought was relevant. So like, I will ask about their health history in ways that they're like, oh, I don't know, I haven't had my ferritin check in years. Is that relevant? That's just like my blood iron level, right? First of all, is your iron stores? And that does matter because it sounds like you might have restless legs. And if you have restless legs, you're going to have insomnia. And especially that's especially prone if you are on your third pregnancy. So there's new us. It's like that somebody who's on their third pregnancy who hasn't had a ferritin test would never have known to ask about. But they probably come in with assumptions of what sleep problems they have. And so often I find people that when they go to AI for answers, their questions are leading questions. They have assumptions baked into their questions. And AI being very psychophantic will take your question seriously and answer you on the sort of based like on the premise that you're presenting it. Instead of questioning the premise entirely and saying that's not even the right question to ask, you should be asking this instead or have you considered that entirely other possibility instead. And I think when it comes to sleep, there are just so many misconceptions and myths that I'm sure people are bringing the wrong questions to AI. And AI is treating those questions as if they were the right ones. I can't. I hate it. At this point, it's so annoying when I ask a question. And he's telling me, you're thinking about it the right way or this is exactly the thought process you want. And my immediate thought is if I was thinking about the right way, I wouldn't need to ask exactly. That can always be true. Yeah. So I love it. Jay, this is amazing. Is there anything that we should talk about that we should have talked about that we haven't talked about you think when it comes to just this topic in general? I want to maybe end on a bit of a philosophical note. And as cheesy as I may sound, like let's have these try to trust her intuitions a little bit. Let's hold that skill because intuition isn't just like a magical thing that defaults you. What it really is is your brain and body using the vast amounts of data it has collected through every second that you've been alive. And doing behind the scenes calculations and algorithms to come up with a gut feeling that's really from like a cajillion data points that you would not be able to pinpoint. Right. So like your brain is so smart and so wise. Your body is so knowledgeable about who you are. Like let's try to trust that first and like really learn to actually listen to our bodies and know what our bodies are trying to tell us because usually it's right. Usually it's right. And so I always just say you know at least practice getting out of your head and into your body for like half an hour a day. So just like don't be on your phone or like don't be like talking to Alexa or like chat GPT or whoever. And just get a little bored. Stretch a little bit. Take a long bath and just see what comes up. And when I've tried this with clients and patients of mine, they're like I took a shower without listening to a podcast at the same time for the first time in like a couple years. And I just immediately started crying and I had no idea why. And I'm like that's your body trying to tell you something like something really important. So like next step, let's continue to pay more attention and get into your body out of your head and into your body and your body will tell you more specifics of what you need. I love that slow living, I think as yes. Analog is what people are calling it nowadays. Analog. So Jade, you've been doing some amazing things. A little fun anecdote I'll share with you. I think I saw you I was again recently looking because it was time to upgrade mattress. We moved one here and I needed to get another mattress. And I saw you doing something for mattress firm. And I was like, oh, Jade's gonna she's gonna recommend a mattress. I need to go look at this. And that's of course not what it was about at all. But Tim is either here nor there. Where can people connect with you? You are on the East Coast. You are doing your private practice consulting and that kind of stuff. So if people want to reach out to you, what's the best way to do that? My website is doctor is drjwoo.com the doctor being dr and I'm on LinkedIn. Also dr underscore underscore woo if you just google me, you'll find me. And you know, funny thing you mentioned mattress firm. I love mattress firm. I've had a great collaboration with them for years and they're like so excited to learn evidence-based sleep and incorporate that into their their team like internal work and they're advertising and their message. But you know what's funny is literally in my contract with them, I have written it in like black and white that I will not recommend a specific mattress ever. Because that's like antithetical to my whole thing. That would be amazing. Yeah. Yeah. So you know, like they're doing great work, but they know that I'm never going to say by this specific mattress. Good. Yeah. Awesome. I love it. Jade, last question. You might remember this. We're all about putting the health and care actually back in health care. And you've been doing that. You did an incredible job at that for years. Thank you. I'm hopeful people will walk away from that feeling that you've done that here again. But when you hear that phrase again, two sentences will come to your mind. Putting health and care back into health care. Yeah, we'd definitely say put in the health back in health care, but either one. Yeah. I probably said this last time too. But I mean, an Elsa prevention is worth a pound of cure. I think when it comes to sleep, it's just even more true than for maybe anything else. Maybe that's my bias. But truly treating a sleep disorder should be a small percentage of what we sleep health professionals are working on. We should really be out there just spreading the good word of sleep before it goes wrong. So that's what really matters to me is like real health is not getting sick in the first place. So. I love it. Thank you, Jade. Thank you so much, Althamashed. Thanks for listening to the other episode of Medicine Redefined. 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