In this episode of the Flex Diet Podcast, I’m diving headfirst into the science of sleep with two heavy hitters—Dr. J Wiles and Dr. Jeff Dermer from Absolute Rest. We cover it all: why sleep is such a big deal from an evolutionary standpoint, how your modern lifestyle is probably trashing it, and what you can actually do to fix it. We dig into behavioral changes, the role of wearables versus legit lab sleep studies, and practical, no-BS strategies to get better shut-eye. Dr. Wiles and Dr. Dermer break down Absolute Rest’s comprehensive approach, examining the psychological, physiological, and environmental factors that influence sleep. Translation: it’s not just “buy a new pillow and call it good.” We also get into the fun stuff like caffeine, nicotine, and alcohol—how they mess with your recovery and performance—and why making small behavioral shifts and value-based choices can keep your sleep dialed in for the long haul. If you’ve ever wondered how to stop treating sleep like an optional side quest and instead make it one of your biggest performance enhancers, this one’s for you.
In this episode of the Flex Diet Podcast, I’m diving headfirst into the science of sleep with two heavy hitters—Dr. J Wiles and Dr. Jeff Dermer from Absolute Rest.
We cover it all: why sleep is such a big deal from an evolutionary standpoint, how your modern lifestyle is probably trashing it, and what you can actually do to fix it. We dig into behavioral changes, the role of wearables versus legit lab sleep studies, and practical, no-BS strategies to get better shut-eye.
Jay Wiles and Jeremy Durmer break down Absolute Rest’s comprehensive approach, examining the psychological, physiological, and environmental factors that influence sleep. Translation: it’s not just “buy a new pillow and call it good.”
We also get into the fun stuff like caffeine, nicotine, and alcohol—how they mess with your recovery and performance—and why making small behavioral shifts and value-based choices can keep your sleep dialed in for the long haul.
If you’ve ever wondered how to stop treating sleep like an optional side quest and instead make it one of your biggest performance enhancers, this one’s for you.
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Speaker: [00:00:00] Welcome back to the Flex Diet Podcast. I'm your host, Dr. Mike T. Nelson. On this podcast, we talk about all things to help with increasing muscle, increased performance, better body composition, and do all of it without destroying your health and the flexible framework. Today on the podcast, we're talking about a extremely deep dive into sleep.
We have Dr. J Wiles and Dr. Jeff Dermer of the company. Absolute rest. You might be familiar with absolute rest. I was put in touch with them. I'm a good buddy. Dr. Andy Galpin is one of the co-founders there at Absolute Rest, and we talk all about the weeds of sleep especially related to devices, behavioral changes, how you can maximize sleep.
What are some differences even in wearable devices [00:01:00] versus PSG, which is polys sonography? If you go in and get a formal sleep study done, again, the pros and cons of a formal sleep study versus getting some data in your home environment and really just a wide range of pretty much anything you could think of related to sleep and the intersection of technology.
And what's really great about both these guys is not only are they up to date on all of the research and what's going on, but they work with actionable humans. And so they're in the business of applying all of that research to get people better results. So even if you have been thinking about doing something through absolute rest, I would highly recommend it.
Or if you have no desire to do that yet, I think you'll still learn a ton. From this podcast and maybe whenever you're ready or you get to that point you can check them out. Full disclosure, I don't have any disclosures or anything with them to disclose. Andy's a [00:02:00] good buddy of mine I've known for many years, and he's like, Hey, you should have these guys on your podcast.
And I'll looked them up and said, yes, I would love to. I think it'd be a great conversation. So Dr. J Wiles is a leading expert in stress physiology, human performance resilience. He's an international recognized speaker, clinician. Scientist specializes in psychophysiology heart rate variability, biofeedback and nervous system resilience, holds board certifications in HRV and peripheral feedback and consults with elite athletes, executives, military personnel, and high performers looking to optimize performance, recovery and stress.
So over at Absolute Rest, he is the Director of Behavioral Medicine. And then we also have Dr. Jeff Dermer. He is a systems neuroscientist and sleep medicine physician only, both an MD and a PhD and Systems Neuroscience from University of Pennsylvania. He served as a director of Emory [00:03:00] University's Sleep Laboratory and Pediatric sleep Medicine program.
Also founded NOX, another health popular Sleep Company, and Knox, NOX medical, a sleep technology firm. So he is deeply involved with advancing sleep at all levels from serving on NAH advisory boards to many different roles and helping athletes all across the board. So currently Dr.
Jeff is the Chief Medical Officer at Absolute Rep. So I think you'll really enjoy this podcast here. And then for our sponsors check out some tasty electrolytes from our friends over at Element. I try to, in terms of recommendation, have one packet in about one liter of fluid. My goal for myself, my athletes, and the people I work with is to consume that before noon and then another one in the afternoon.
And I think that's a pretty darn good starting point for most people. Obviously you can get much [00:04:00] more in the depth weeds there if you need to. But I think that's a pretty good start. We'll have more info about Teton ketones coming up very soon. Hoping to have more from them any day now. I'm just waiting to hear back once everything is all good to go.
And then also if you want more information from me please check out all the great stuff I have. Today. You can hop on and get a special free report all about magnesium. This micronutrient is super important for sleep recovery, and odds are you're probably short in it, at least according to the current literature.
So check out the link down below. You'll be able to get that guide. It's pretty short. It's only about like six pages. I have all the references and everything there. The good part is magnesium is relatively inexpensive to purchase also. So for a lot of people it's been a pretty big easy game changer for sleep and recovery as a starting point and get it for free, [00:05:00] download it by going to the link down below.
It'll also put you onto the daily newsletter, so you'll be hearing more stuff from me. So without further ado, here is the podcast with the guys from Absolute Rest. Enjoy.
Dr. Mike T Nelson: Welcome to the podcast. How are you guys today?
Jay Wiles: Doing well, rock and rolling.
Dr. Mike T Nelson: Awesome. And since this is mostly on audio, if you wanna just say your name and give us a short intro so people listening by audio only can figure out who's who, otherwise I know that's my pet peeve on some podcast, they'll be like two or three guests and you're like, who the hell's talking?
Now it takes you half the podcast to figure out who's who.
Jay Wiles: Jeff, you're more important. So you should introduce yourself first. Oh,
Jeffrey Durmer: hey, you've just ruined my intro. No, all sure. I'll go first. So, I'm Jeff Dermer. I'm a neurologist and a neuroscientist. I focus in sleep and circadian rhythms and performance.
And I'm the Chief Medical Officer at Absolute Rest. So I'll hand it over to Jay, my colleague.
Jay Wiles: Yeah. Jay [00:06:00] Wiles. I am the Director of Behavioral Medicine at Absolute Rest. By background, I am a clinical health and performance psychologist with a background in psychophysiology and heart rate variability.
Dr. Mike T Nelson: Very cool. Very cool. I guess I'll start with a general question for you, Jeff. Like, why? I know this is really basic and everybody goes over it, but I think it's probably worth repeating. Like, do we have a good answer as to why we sleep? It just seems like this huge. Black box, obviously it's incredibly important for survival.
If we don't do it, people stay up for too long, they can actually die from lack of sleep. We spend a good portion of our life asleep, so it obviously is important, but it seems like we're just now trying to understand some of those mechanisms.
Jeffrey Durmer: Yeah. The y we sleep question is a question that I think people have been answering and asking each other since at least recorded history.
Yeah. As far as I can tell, it goes back to [00:07:00] the ancient Greek times. Most recently a colleague of mine, Matt Walker, has a book out that most people have read by this point. Yeah. Why we Sleep, and I think Matt gets to a lot of the basic concepts that are out there around why we sleep.
And, this is an evolving story constantly, but if you look back into the ancient world around what is sleep about, why do we sleep, the thought process was that really sleep was a period of complete detachment. It was almost like being dead. It was even considered the little death. That's one of the thoughts and one of the terms that was used for sleep.
So people thought nothing really was happening during sleep. In fact, that was maybe when the gods would talk to you and you communed with this, larger consciousness. So really was thought to have no major impact on daytime other than just not feeling good if you didn't sleep well. But fast forward to, the late 18 hundreds, a lot of neurophysiology kind of started and neuroanatomy started around the late 18 hundreds, early 19 hundreds with electrophysiology.
[00:08:00] So, this German neurophysiologist Berger actually developed a way to look at brainwave activity while you were awake and also while you're asleep, which is the electroencephalogram or EEG. And that led to a whole new window into what sleep was actually about. And we, lo and behold, found that what's happening at night.
Is not quiescence. There's a lot of activity in the brain and there's a lot of activity in the physiology of the autonomic nervous system as well. That changes and it follows certain patterns. And that pattern became recognizable through our electrophysiological recordings of not just brain activity, but also muscle activity, eye movements, breathing activities blood pressure eventually, and heart rate.
All of these systems seem to be very highly coordinated during sleep. And it under, under undercuts the concept that sleep itself is not an active process. It turns out it's a very active process. So now, in this last century, then in the 20th century, now in the 21st century, we're learning from [00:09:00] neuroscience and neurophysiology.
That what's happening in the brain and body is not just active, but it's incredibly important. In fact, it's necessary. It's essential for life. For us at least, and for all other beings. It turns out that not only do we sleep but also in all other animals that we know. But even plants have quiescent periods that mimic sleep, that look like sleep.
If you look at cave rolling animals or underwater creatures that live where there's no light, they have circadian rhythms that are actually mimic the wake and sleep cycles. So there is a number there are a number of studies that have eliminated the concept that sleep itself is ubiquitous.
It's something that happens across. All different life forms, not just humans and not just animals. Which is interesting 'cause you think about, we all live on a planet that has a 24 hour cycle. We spin around 24 hours or 24 point something and we go around the sun and have seasonality. We as organisms [00:10:00] have developed in that environment.
So what is a circadian rhythm and a sleep and wake rhythm that mimics our environment. And so we have adapted to that and so have all the other creatures out there. So if you look at it from the perspective of it's a requirement here on, on earth it first off, and then the second off what is it that it does well?
What we've learned is that it's not really about what it does, it's what happens if you don't have it. And we've seen a lot of studies around sleep deprivation, total subject, sleep deprivation, partial sleep deprivation, and it really demonstrates that what is happening on a night to night basis is reflective of recovery for brain and body systems that involve all of the activities of the cardiovascular system, the immune system keeping you healthy on a day-to-day pros in a day-to-day way.
So that you wake up every morning feeling refreshed. And that's largely because things like neurochemicals are repackaged at night. You have a number of things that are occurring through the glymphatic system of the brain that are clearing the brain from a number of [00:11:00] potential metabolites that could be even considered toxic.
Your body is doing the same thing now. You're resetting insulin receptor sensitivities. Your liver is actually recovering from the day. And, baking glycogen and a number of other things that are important for physiology. Muscles themselves repair, neuromuscular junctions repair themselves.
So you wake up in the morning after an injury, you feel a little better. The reason is that you're going through a huge amount of anti-inflammatory hormone release and growth hormone during the night, which is just definitely not something we do in the day. We do that at night. So, what we're finding is that sleep deprivation studies of the past have really informed us in terms of what it is sleep does for us when we don't have it.
In fact, we know from some animal models that if you don't get sleep, like, there's a rat study that was done by Resh and a number of folks back in the last century showing that if you sleep deprive a rat for up to 20 days, they die and they die of overwhelming sepsis. They have thermal regulatory abnormalities.
So you lose your defenses [00:12:00] against the environment, basically. And it's something we see in humans all the time. We see that people who don't sleep well end up with far more respiratory conditions and autoimmune diseases and inflammatory conditions. And they're far more ill, so. It's become far more of an interest just from that perspective because of what we know, what happens when you don't sleep.
So I, I think a lot of what Matt was tapping into is the understanding of the last century of understanding what it is when we don't have sleep, that sleep actually does for us. In fact I worked in laboratories back at Penn, university of Pennsylvania in Philadelphia, where I did my MD and my PhD in Dave Ding's lab, where we did serial sleep deprivation on a regular basis.
That was actually the research that we're doing. So we'd keep people in a laboratory for two weeks at a time and sleep deprived them in certain amounts. And show these changes in driving ability and mental tasks and mood alteration. And one of the things that Dr. Dinges and a number of his colleagues in our [00:13:00] colleagues in that field have actually recognized is that perhaps we shouldn't be doing those studies because those studies are actually putting people at more risk than we realized.
And so a lot of sleep deprivation laboratories, trucker's lab at Harvard as well have really refrain from doing a lot of these hardcore sleep deprivation studies. So it tells you that even the field in a short period of time has learned that maybe this is not as it's not just not bad not good for a short period of time.
It could have lasting effects.
Jay Wiles: Yeah. Mike, I add you add to that Jay. Yeah, the there's, that was great Jeff. There's one of the most convincing arguments that I've heard for why is sleep important comes from the evolutionary perspective. And I really love this example. If you think about sleep, it's a pretty inefficient process.
Think about it, right? Like we go to bed and we shut down in a vulnerable position where we are basically unconscious, free for anything to come and attack us. And we do so every single night, anywhere from generally six to eight hours or so, and [00:14:00] evolution throughout all of these millions of years has decided that it is a necessity in order to keep that and has not written it out of our actual code, our DNA code.
Like we, we have to have it. And if evolution continues to say, you need this you need this inefficient process, we should probably be listening to it. Because if it wasn't something that was a requirement, we probably would've written it out of our behavioral needs a very long time ago. So when I heard that, for me it was like the light bulb went off and like yeah, I think that's pretty, pretty convincing argument as to why sleep is a necessity.
Dr. Mike T Nelson: Yeah. I always think of even performance through the lens of survival. If you want better performance, like teach your body how to survive better. And along those lines, it's always been fascinating to me that out of all the changes over many years, like we're still sleeping. As far as I'm aware, the need for sleep is about the same.
So it must confer, like you said, some massive survival advantage [00:15:00] because it's a very vulnerable point, but yet it hasn't really changed that much, at least as I'm aware over time either. No, it definitely
Jeffrey Durmer: hasn't. There's been no major genetic changes in our in our genome that have precluded sleep at all.
As Jay was saying it's it's clearly an evolutionary benefit and that cycle continues. It's true for all species that have been studied. And there's some great neuro ethological studies of different species that show, the variable amount of sleep that different animals get, especially citations that live in the ocean and that float in a three-dimensional space.
It's just as important for those creatures that could be attacked from it any angle at any time to sleep at least one half of the brain at a time, which is typically how a lot of the cean sleep. And in fact, there are a number of other species that do the same thing. So it is evolutionary, evolutionarily very important.
Even if you're only sleeping half of the brain at a time or half the body at a.
Dr. Mike T Nelson: I think it's dolphins primarily. The first study I ever read on that [00:16:00] was dolphins with a uni hemispheric sleep where kind of half of the brain kind of, checks out into sleep and the other half is still working because like kind of what you said, they're maybe in a very vulnerable state, but they're may not appear like they're sleeping, but they're still getting a fair amount of sleep. Correct.
Jeffrey Durmer: Yes, absolutely. In fact, some of the species, like mallard ducks, for instance, that sleep on a lake, they sleep typically in a line.
The ducks on the end of the line will leave one o one eye open and one hemisphere asleep, one hemisphere awake. The other ducks are sleeping to are both hemispheres are sleeping, and then the ducks rotate all through the night so that there's always an on, on, on guard, a watch duck if that's such a thing.
Really interesting studies like that. So you gotta get,
you
believe that this is something that is very important, that if you put watch ducks on the end of the line, it's important for this whole species to get sleep.
Dr. Mike T Nelson: Do you think humans could do uni hemispheric sleep, and would there be any adva?
This [00:17:00] is one thing I've wondered like why. I understand why certain animals do it, but yet humans seem to be the most adaptable overall. Is there any reason that they could do it or I don't know, does any weird thoughts around that? Jay,
Jeffrey Durmer: do you have any
Dr. Mike T Nelson: weird
Jeffrey Durmer: thoughts on that? Because I
Jay Wiles: have, oh my goodness.
I can, I could make up something that is completely tangential here, but I feel like I have no intelligent response for this, Jeff, so feel free to, to go and I'll add color,
Jeffrey Durmer: please. Let's do color commentary. So a really interesting question, actually. It's and I, it goes back into my own personal history as a researcher.
When I was at patent, working with Dave J in the group there, and I unpack, there was a DARPA study that we actually sent in with we, so we were applying for DARPA funding and, darpa, like, not just like stepwise progress, progressive kind of research, but large leaps of. Research. So they're looking for outta the box thoughts.
And so we came up with this really great idea of like a functional magnetic resonance imaging study helmet that we could put on pilots. And it was actually [00:18:00] really cool 'cause then we could see small changes in the brain that would associate with like frontal lobes shutting down. And that would be a better and more sensitive way to look for sleepiness.
Well, we didn't get that award. We didn't get the DARPA grant. The grant that actually was received though was for teaching humans Uni here at Hemispheric sleep. Ah. And to this day I don't think it's worked. Because honestly, so there, there is some evidence though in the literature that and there's a lot of evidence around, localized sleep phenomenon within the brain. So like parts of the brain actually come online and offline all the time, even during wakefulness. And at night when we sleep, actually this is the, these areas of the brain do the same thing and it's around the thalamus, which is the little brain inside of your cortex that thalamus gates information.
So it's usually has a higher ga while you're sleeping so you don't act, activate the cortex and wake you up. But. Different parts of the cortex at different times [00:19:00] are more or less active or more or less asleep. So these local sleep phenomenon are noted in humans. How to actually capture an entire hemisphere so that you can see stay awake on one side and sleep on the other, I think is not something that's really our program.
If you look at all the other apes out there that are our family we all sleep in a similar way. We help create beds like the great apes create beds on the ground or some in the trees. And the efficiency of the sleep in the jungle is very different than our efficiency. In fact, there's some studies around that showing that there isn't any un hemispheric sleep, but there's.
Less intense deep sleep compared to what we get. So in our protected caves, we tend to get into these deeper stages more so, and our sleep is more efficient. It's shorter than great apes, which can be spend 10 hours sleeping versus our six to nine hours of sleeping, sleeping. So there are [00:20:00] differences, but I really doubt that we'll be seeing uni hemispheric sleep devices at Walmart anytime soon.
Jay Wiles: I'm sure the biohacking community is gonna be trying to crowdfund for something in I definitely in that field, yeah.
Jeffrey Durmer: Yeah, they're,
Jay Wiles: oh, for sure.
Dr. Mike T Nelson: It'll be on Instagram tomorrow and be like the new uni hemispheric sleep program in 17.5 days. Get it here now.
Jeffrey Durmer: That's right. Just as long as we don't get people trying to like shut off half their brain with electrical impulses.
That could be a real problem. I'm
Jay Wiles: Someone's doing it, Jeff. Someone's already asking. God. I said
Jeffrey Durmer: it out loud. Jay on a podcast. Oh no, this is not good. Get
Jay Wiles: the attorneys ready. Jeff get has
Jeffrey Durmer: nothing to do with this. We do not endorse you hemispheric sleep. We do not believe it should be possible.
No. Okay.
Dr. Mike T Nelson: Yeah. My last crazy thought on that was you think some of it might be related to eye position because I think almost all the animals that do uni hemispheric sleep have their eyes located basically on each side and don't really do 3D vision or like [00:21:00] apes and humans, and again, this isn't exclusive, but they tend to have their eyes more situated in front for more 3D vision.
I don't even know if that's related or not, or I don't know. Just something I wonder about. Well,
Jeffrey Durmer: your idea here is basically going to prey versus predator. Correct. So predators have eyes in the front of their head, prey on the side oftentimes, but that's also a very advantageous so that they can see a larger field.
Yeah. Versus see specifically something in front of them. I mean that there's some potential associations there. I don't know that there's any research associated with the actual sleep in like lions versus horses.
Dr. Mike T Nelson: Yeah. That would be interesting. Yeah,
Jeffrey Durmer: that would be interesting. Dolphins certainly and all the other citations have eyes that are clearly not focused straight ahead.
Yeah. You know that, that's an interesting concept. Mallard ducks is the same. But again, we should also like compare to eagles and owls. And other birds within the same species. And there's been a lot of neurology around owls in particular 'cause of their ability to echolocate and also [00:22:00] to move eye their eyes themselves can actually see so much more than most of us.
Yeah. Interesting question. Love to hear if there's any science out there that, that could support it.
Dr. Mike T Nelson: Yeah. If people get bored, just look up eye function and owls it's crazy. And how they can, or even hawks, like how they can stabilize their head as they're moving through complex environments, like their head doesn't really move hardly at all.
Some dogs and other animals are good at doing this too. It's just fascinating.
Jeffrey Durmer: Yeah.
Dr. Mike T Nelson: I was at a zoo recently and one of the, we went to the owl area. I was talking to one of the people there. I was telling him like oh, these are so cool. They can do all this stuff. And he is like. Man, owls are so stupid.
He like gave me this 20 minute lecture about how we thought owls were like the dumbest animal ever, which was shocking to me. So. Maybe he just hated owls. I don't know. But
Jay Wiles: the vendetta against owls, he probably got attacked when he was a kid. He's got some childhood trauma and now he's just he's laying it all out there for you.
Yeah. [00:23:00] Yeah.
Jeffrey Durmer: There I know that there, there are studies of owls that they do have unit hemispheric sleep. So owls do have un hemispheric sleep. Not all owls, but many owls have uni un hemispheric sleep. So it's hard to say that the eye position is related. Sure. Because owls are in the front.
Yeah. There are, and the thing is, the more we study different animal species, the more we find out that there are stuff we have no clue about. This is why basic science is so important. It's not just about us guys. It's about understanding the ver variety across different species. It leads to a whole bunch of other discoveries.
Like bats and echolocation is one of the things that I was most intrigued by when I was in neuroscience grad stu grad school. Just the amount of data that a bat can pick up from echolocation is, it had to have been something that DARPA picked up on. It, it had to have been utilized in some other fashion.
So it's not just high tech, it's also looking at other basic animal species that, that could really help inform us. [00:24:00]
Dr. Mike T Nelson: Yeah, and I don't know if this is true or not, but I heard a rumor from a military person that some of the early ideas for radar and sonar were actually from how animals are doing echo location, especially for subs back in the day when the technology just wasn't super advanced and they know that conduction of the water is, very high.
So like some of the early submarines got really good at just, echo location and sonar of trying to figure out where everybody was, which is fascinating.
Jeffrey Durmer: Yeah, I think dolphins have I think it was Flipper in the 1960s. That was the the model for training dolphins.
Maybe putting jet packs on them, making them faster and spies against the Russians or something.
Dr. Mike T Nelson: Yeah, they did all that stuff. And obviously, yeah, John Lily had all sorts of crazy stuff trying to train dolphins. I think his early work was it sponsored by darpa, I think. And he had some really interesting stuff and then, well boy, he went a little bit off the rail, starts towards the end, but
Jeffrey Durmer: yeah.
Dr. Mike T Nelson: [00:25:00] Awesome. Related to, you talked about doing sleep studies in the lab with keeping people up for a fair amount of time. Would you agree that most people now probably need more sleep than what they realize, but that the awareness of how much sleep we need tends to unfortunately get worse the more sleep deprived we are.
Like, I've heard stories of friends of mine who were sleep researchers back in the day that they would run around trying to recruit people on campus and people would be like, oh, I'm not sleep deprived at all. And then we'd put 'em in this dark room and have 'em do like boring, repetitive tasks. And they would tell me like, how many of the people would just almost fall asleep during the test, even though they reported going before going in that, oh, I don't really have any sleep issues.
I'm just fine.
Jeffrey Durmer: Yeah, it's a huge issue. Jay, you wanna
Jay Wiles: Yeah. Jump on that. The there's a few schools of thought here. There is and this is probably more in, in line with myths that have been [00:26:00] perpetuated. I think you have a lot of the high chargers, high performers. Mostly business, high performers, entrepreneurs that historically were just like, I am one of those individuals who can get away with four and a half, five hours of sleep and I can perform and function really well.
And we found out that lo and behold, there are a lot of deleterious health effects that come with only sleeping four and a half, five hours a night. And also, and again, this is more of my lens from a mental performance perspective and mental acuity perspective, like brain health, cognitive functioning, mental performance with severely suffering.
And so now these individuals, a lot of the high performers have gotten interested in health and wellness. And so they've turned more towards strategies for improving sleep. And it's a lot of the people that Jeff and I and the team see at absolute rest who come from this background of like, we were the hard chargers for 25, 30 years.
We built this amazing company, sold this company, but I was really sleeping like four hours a night for that entire time. And now I have like this [00:27:00] conditioned response where I can still only sleep four hours a night. And it's been this inherently problematic thing. I think the great thing that has happened here within the last, I don't know, maybe decade or so, and I think a lot of it has been because there's just a lot more accessibility to information, health information out there.
Is that many of these high performers have come to the stark realization that sleep is a necessity and that this four and a half, five hour a night thing isn't going to cut it. And then you look on the other end of kind of the myth spectrum where there was this idea, it was perpetuated that it essentially you must get eight hours of sleep in order to function well.
And I think that by and large, I'd rather someone get eight hours than get four hours for sure. So I'll make that, that, that distinction. But also too, we know that based on a wide variety of factors, and I'm sure that we can talk about and get into is that eight may not necessarily be the sweet spot for everybody.
You may not actually require eight in order to function well to [00:28:00] recover, to be at the highest level of mental acuity and mental performance. And so that kind of begs the question and one of the things that we do kinda at absolute rest. Is we want to make the assessment for this individual of where that sweet spot is for them.
Because I think so many people, they come in and they're like, I've been the four hour a night for 30 year person, get me to eight. And we're like, eh, hold on. Not so fast. We don't know if that's actually realistic and that advantageous for you based on a wide variety of factors. And so for us, we take a much more nuanced and personalized and granular approach to determining what is the appropriate amount of hours.
Because maybe you are someone who, for whatever reason, like the six to seven hour range is really your sweet spot. We've identified that anything under six not good. Like there are no advantages to being under six going over eight. Not a ton of distinct advantages there as well, especially when you start to approach the nine or 10.
Unless, and again, this is the example. If you're a high performance elite athlete, you may need that extra [00:29:00] amount of sleep. So again, those are edge cases. And so a lot of it is just figuring out based on again, a personalized approach of sleep assessment, kinda where your sweet spot is.
And for many people, and again, I'm not, I don't wanna say this is the rule of thumb or a golden rule for sleep, but we find that for many people, a good starting point is seven. That's like a good midpoint between the six to eight hours is of course seven. So I think I don't know if that answered your question there, Mike, but I just wanted to dispel a little bit of the myths that yeah you can't function at the highest level of your overall performance if you're getting sub six.
But also if you're attempting to get eight and you are frustrated because you can't, whatever for whatever reason, get to eight, it may not mean necessarily that something is inherently wrong with your sleep. Because for me, I know as someone who's done a lot of sleep testing and done a lot of analysis of my sleep, is that when.
I rarely get eight hours. Seven is my sweet spot. That actually really is where I function at. My [00:30:00] highest, actually, I feel a little bit draggy and laggy if I go longer than that. So it's there again wide variety of factors that kind of play into that. I'm sure Jeff, you have some color to add?
Jeffrey Durmer: Yeah, well no, I also definitely a color there. One, one in particular is, it's really important to clarify what we talk about in terms of sleep time. It's the amount of time you're asleep, not the amount of time you're in bed, not the time you're in bed. Yeah, that's a really important distinction because a lot of people get those confused.
So when they hear Jay say, I sleep seven hours, they're like, he's only in bed for seven hours. He's like, no. He's probably in bed for nine hours or eight and a half hours because our efficiency, oh, come on, Jeff May sleep
Jay Wiles: efficiency's better than that. Oh true. No you're in bed for
Jeffrey Durmer: seven hours and three minutes.
I get it. Yes, you got it. Yeah. Yeah. So that brings up this really, this major issue, which is sleep efficiency, which is a very important concept to get across to people, that it's not about the amount of time in bed that's important. It's the amount of efficiency in the hours of actual sleep. So if you wake up in the morning and that, your Garmin, [00:31:00] whoop apple watch or a ring, whatever it is you're using, says seven hours and three minutes.
You're shooting at eight hours, but you felt good and that was where you feel you should be. That's really what we're talking about. It's the amount of sleep time. The amount of time in bed could have been eight hours and 51 minutes. It could have been nine hours. In fact, that becomes a problem over time.
Dedicating like 10 hours or 11 hours to a, to being in bed and only sleeping seven hours is very low efficiency and that actually can cut against the impact of good sleep. And so. That's something we often work together in especially Jay, working with people to actually reduce the amount of wake time in bed.
And there are many different ways that we actually work with clients to reduce that inefficiency so that we can get to sleep efficiencies that are typically 85% and above. So very important to understand that concept. And then secondarily, more of a, the color commentary around the idea of sleep hours.
If you just kinda [00:32:00] look back in time back in when we were doing surveys around sleep and diet and weight, and a number of things started in the 1950s post World War ii. C-D-C-N-I-H started funding these large public surveys. And these large public surveys have been going on for a while now, and the data associated with sleep time, actually average sleep time during the week for adults in the 1960s was a eight, 8.1 hours.
That was the amount of sleep people were reporting and then. As you get into the seventies and in later seventies, into the early eighties, the number of hours started to crash. It went down to like around seven hours on average. Now averages are a very big difference than an individual, right? So average seven is a big change of an hour over a course of like a decade and a half or so.
And then when we got into the eighties, it continued to go down into the six hours and nineties. And in around the 2000, say 8, 9, 10, around that era where we had the first [00:33:00] market crash in a while and recession, the average sleep time was around 6.1 hours for adults. So in the span of 40 years, we dropped two hours on average.
In terms of surveys that have been replicated across many years in the same population over that period of time, that's a significant change. That's not that's not because their physiology change. That's because our behaviors changed and the way we approach sleep changed. And I, as an example, I often cite this example in discussions and talks that, what happened from the sixties into the eighties?
Well, companies like seven 11 started and they became 24 7 eventually. So, I remember my grandmother in the sixties saying, seven 11, what? Who's gonna get up at seven o'clock in the morning? Go to go get food, and who's gonna stay up till 11 o'clock? Everybody goes to sleep at nine o'clock. This was the mentality.
So the idea of protecting sleep was something that was really well understood culturally, and then that was lost because of the convenience. And all of a sudden grocery stores were open [00:34:00] 24 7 and it just became. Part of the normal expectation. So we've lost our, we kinda lost our way there, but now with the advent of wearables, people are starting to take, their own health more seriously and actually use metrics in a way that could be advantageous to reduce the impact of poor sleep and sleep timing issues.
But again, like Jay was saying, it can also be a double-edged sword. If you're shooting for a number, that's not really what's important. It's not about a metric. It's actually using the metric in your context to make the recipe as a, like, Jay likes to use the word the recipe for our different clients.
We create their sleep recipe. We find out what is their duration requirements, what are their quality issues, and what are the timing components. And that's a whole nother area that's often missed, is the circadian timing of sleep. You have a natural circadian timing that is inherent to your brain and body, and it is something that you get oftentimes is genetically related to other people in your family.
It [00:35:00] can be out of sync with the environment, it can be outta sync with culture. It's a big issue for kids in high school and middle school. We can talk a whole bunch about that, but that's that's another aspect of building a program that is precision medicine based, if you will, to not use medicine as the, it's a bigger, the bigger concept of medicine, meaning everything that you can do for therapy.
That's really what we do. And that's a very different approach using data to create precision for the individual and not use population norms or bell-shaped curved outcomes and apply them to everybody. Like hammer and nail.
Dr. Mike T Nelson: Yeah, I think that's a good point about the individualization too, because.
I think people see a number and they can understand the average, but they're not sure of what the curve is. Like what is the low point, what is the high point? Because on individual basis, you may be someone who needs a little bit more, you may need someone who needs a little bit less. I feel like over the course of my life so far, I've tested [00:36:00] both ends of the spectrum.
Like doing my PhD, like if anyone does an advanced degree, it's probably the worst thing you can possibly do for your health. Like my sleep was four or five, six hours a night. Way too much caffeine. You're screwed when you open the lab at five in the morning and it's nine 30 and you're already taking a caffeine power nap in the back of your car just to make it to 10 o'clock in the morning.
Like that's not a good thing. And then now I feel like I probably, I dunno if I sleep too much, but what I've noticed with training, if I'm doing more. Higher volume, heavier weight training. It seems like my need for sleep goes up quite a bit. If I drop that and just do easier, moderate cardiovascular work and still get movement, still get some light movement, I feel like that is a big difference.
And my question then is, how do you figure out in an individual level what is best for a person? I'm assuming it's some type of functional test. Obviously you're gonna look at the sleep, you're gonna look at the quality, you're gonna look at the environment and everything else. But is [00:37:00] there any sort of, testing you would use to try to figure that out?
Anecdotally what I use is looking at my heart rate, looking at my performance in the gym, and then cognitively, especially on writing tasks, how I feel. And I feel like just roughly from those, I can get an idea of where I'm at. But is there any kind of functional tests you would use for people to try to figure out, are they, need a little less sleep or more sleep?
And then from there, what do you do to change it?
Jay Wiles: Yeah the one thing to point out here, because I think that the objective metrics that we can use for testing are valuable and they're important. However, they should not, we should not overlook their subjective experience. Oh, a hundred percent.
Yeah, and what I mean by that is that I would actually say that the largest source of truth is actually how they're feeling. If I've got somebody, or we've got somebody who's coming into our clinic and they're saying, like, I, for the last 10 years, I wake up every single morning and I feel completely groggy.
I'm not [00:38:00] motivated, I don't have a lot of energy. I woke up last night like 10 times, two of the times I was up for 30 minutes. Like we can, we're gaining a lot of data just simply from that. And so it's their level of dissatisfaction that they're voicing to us. That is a huge kind of, that, that provides huge insight into the quality of sleep.
Now we have a wide array of metrics that we can look at that's determining the quality of sleep. So if someone's coming into absolute rest, one thing that they're getting is they're getting the most comprehensive sleep assessment and battery like on the face of this planet. We, our kind of whole mantra is that we leave no stone unturned.
We are assess. Everything in regards to your sleep physiology. So assessing things like sleep disordered breathing, looking at autonomic sleep testing now, which is a very high fidelity mechanism of looking at how your body is responding to testing. I'll let Jeff open up that can of worms. Yeah.
Because it is immensely now valuable and important. It's a Pandora's
Jeffrey Durmer: box actually. Yes it is.
Jay Wiles: And I think that most people [00:39:00] aren't familiar with what autonomic sleep testing is true. So I think that Jeff explaining that it will be helpful. But then we're also taking into other considerations.
So we're looking at the behavioral and psychological as well. And that's a key kind of differentiation between kind of the work we do in our clinic versus more of like a traditional academic clinic that's really just gonna maybe do like a polysomnography, do some sleep testing, looking at sleep physiology.
They say, yeah, yes or no, you do have sleep disorder breathing. And they give you the CPAP and say, good luck for us. Yes, we're doing that. We're doing in-home. Polysomnography and autonomic sleep testing. But we're also assessing things like someone's behavioral patterns. We're looking at kind of their psychological wellbeing.
We also assess environment. Are there aspects of the environment that may actually be lending itself to poor quality of sleep? So for us, it's a very integrative and holistic approach. And of course, we're utilizing multiple disciplines. You've got myself as a psychologist, you've got Jeff, who is a m md, PhD.
We've got other psychologists on the team and other disciplines as well. And so for us, we're really saying like, again, we want to [00:40:00] leave no stone unturned. So that's more of a broader view of how we look at things. I went more from the subjective is the starting place. But then also we have a lot of testing and I think that testing can be immensely enlightening.
So Jeff, I think maybe unless Mike you wanna lead this in another direction. I think Jeff speaking about like the autonomic testing and how that provides insight into someone's quality of sleep is probably another, a good place to go.
Dr. Mike T Nelson: Yeah. And if you can weave into that question, if it makes sense too where traditional PSG testing came from and that I'm guessing this is your opinion.
I might be putting words in your mouth that from my opinion, it's not as hard as black and white as what people think it is. Like I used, like with EKGs, so I worked in cardiac devices for many years and I stood there next to probably two of the top electrophysiologists in the world arguing about the same, 12 lead on this person.
Yeah. Both of 'em well respected. They're both looking at [00:41:00] the exact same data and they're arguing about, well, I think it's this. I think it's that. And it was interesting to me because I was always told in school that, well, this is exactly air quotes the way that it is, and you get into the real world and you realize with a lot of this testing, there's more variability in it than what you think there is or what there's perceived to be,
Jeffrey Durmer: yeah, I, you're absolutely right, Mike. And that is actually the reason we use autonomic testing as a component, as a major component within our programming. And if you step back and take a look at polysomnography itself, polysomnography. Was developed as a clinical tool that we could then utilize to support people with their sleep issues.
And the first sleep clinic was at Stanford back in the 1970s. Group of basic neuroscientists that came from the University of Chicago actually, and also internationally. All moved to Stanford. Things like REM sleep Aronofsky's and Kleitman and all the research that they did from the University of Chicago on circadian [00:42:00] rhythms and understanding what these signatures were in the burglary, EEG.
That's really the beginning of understanding sleep, but then making it a clinical discipline, not just a research based question. Is where Polysomnography came in, and that's where Stanford came in. And so what happened was the well understood Neurophysiologic tests of the day were combined, and that included EEG or a subset of EEG, not the full 16 array, eight leads or eight channels.
We used. Eye movements, so EOG or electro logography. Also utilizing EMG electromyography of the face as well as muscles of the body. EKG looking or ECG electrocardiograms looking at least single leads, if not. A few more. Also looking at pulse oximetry, which came into favor in the sixties and seventies through PPG analysis.
Body position using accelerometers and positional sense. Airflow, which was something that initially was using peasy [00:43:00] electric devices that looked at in thermistors that looked at airflow and temperature change and physis electric activity of the chest and abdomen movement, which then turned into respiratory inductance, plasm or rip belts that are currently used.
All of these. As well as many other things, like you could look at intercostal activation, you could look at manometers that go down into the upper airway so we can actually see pressure changes in the upper airway, nasal cannula, looking at airflow. All of these were combined into different channels.
So we used to have these big look like polygraph machines that were multiple channels, 32 64 channels of pens scribing as paper went through them. And every 30 seconds we called an epic just because we all agreed that 30 seconds is an epic, no, nothing special about that. There's a lot of things like that in medicine, as you guys probably know.
But that 32nd epic. Was then, a piece of paper that you would look at, and based on the e the EEG, [00:44:00] the EKG, all of these different channels, you would determine if the person was awake, electrophysiological, or asleep. And then if they're asleep, you would try to decide whether they're in stages of non REM sleep, which at initially were four different stages of non REM sleep, or were they in REM sleep.
And there are multiple phases of REM sleep, phasic and and quiescent REM sleep. That's what you do. And then using scoring rules that were agreed upon criteria from the American Academy of Sleep Medicine. Prior to that, the Sleep Research Society and the combined group called the the Physiology Societies of Sleep, they actually came up with, rules.
And those rules change every now and then. So we went from four stages of non-REM to three stages of non-REM. We have amplitude criteria for certain kinds of things that didn't meet criteria for delta waves. 10 years ago. Now [00:45:00] do meet delta Wave criteria. So these are the reasons that there is an agreement.
Often when people look at. A page because they're interpreting the physiology, they're interpreting electrophysiology. And it wasn't until, and I remember those year, actually I got tested. I'm not gonna give away age here on paper based PSG to get my boards right. So I'm sitting there flipping through stacks of paper every 30 seconds and giving them my opinion.
And if my opinion agreed with theirs, they gave me my board. So that was the way we did it. And that's why agreement is more the issue than actual physiology. So. That changed when we moved from paper into electrical systems. So once we started doing electrical recordings, so it's on the screen now, I don't have to look at paper, I can actually apply algorithms to that screen and determine, the size of the waves, the averages across the [00:46:00] night.
We can look at different components of waveforms and even look at like, even like less than one second activities within the EEG. Like a gamma level of of EEG activity waveforms. So it created more of a an easier way to measure activity during sleep. But still it's interpreted.
So even at the end of the day, our electrical signals that we can now analyze with auto scoring, which is what is used typically can be wildly different from person to person. In fact, the American Academy Sleep Medicine, when they approve a laboratory and they give them their credentials as a sleep lab, they look for.
85% or better agreement between interrater reliability scores. So that tells you that you could be 15% off and still be highly accurate. Yeah. In their eyes. So that's a, that's an issue with PSG, so that have all of these years, like 40, 50 years of PSG, clinical information research, [00:47:00] clinical articles.
So there's a lot of knowledge built around PSG. Still a very valuable instrument for that reason, because we can apply lots of different knowledge points from PSG. But it's one night of study. It could be an off night. It's in a lab. It is with a host of electrical connections that tether you to things.
So one of the things I did and in previous companies is developed some of the first home sleep testing devices. That was my old company. We developed the first FDA approved home sleep testing device that is also now the leading home sleep test in the world, but also developed polysomnographic testing devices that you can walk around with.
So we've reduced the burden. Oh, company's called Knox Medical. You can go check 'em out. They're from Iceland. That's where we started the company. But that's really still an issue because now you still have a lot of sensors on. You're still getting what we call first night effect, which is changes the sleep structure and architecture.
And that's why we don't rely on PSG other than as in a sense, [00:48:00] like a two night at home PSG, which we do in the absolute rest program to give us that baseline. It gives us where you are at that point. It's not meant to be something we go back and test against so much. It's what we use as like a starting block.
And then we use autonomic testing, which can be deduced from an ECG signal or a pulse from the photo mammography signal at the finger or the wrist or the forehead. We tend to use the finger. It's a little bit more comfortable. It's easier for people to do on a night to night basis throughout the entire program.
And what we're looking at with the pulse and deducing from this data is direct physiological outputs using something called the cardiopulmonary coupling algorithm. Developed first really at Harvard in the 1990s, and then utilized as a research tool. For many years. And also now a clinical tool that's FDA cleared.
And that's what we utilize in our program. And what it tells us is a direct gives us a spectrogram of parasympathetic relative to [00:49:00] sympathetic activity. It also shows us stable REM and or non REM and unstable non-REM sleep, as well as a number of other pathological components of sleep like fragmentation, which is sympathetic surges that occur through the night.
Now, normally that happens in REM sleep, we see sympathetic activation that's normal, so we can understand that. But when it happens in non-REM sleep and then you see oxygen desaturations and sleep disorder breathing, or movement act, acto graphic movement, and it could be things like periodic limb movements or restless sleep disorder or restless leg syndrome or a number of other things, pain for instance.
That's actually something that we can approach and actually build a program. This is where the subjective discussion that Jay brought up is so important that even though this is a far more sensitive tool than a PSG test, it's also not very specific. It tells us that there's a problem to raises the flag very high, but it doesn't say what it is.
So in our interactions with our clinical sleep specialists and our [00:50:00] PhD psychologists, we figure out what that problem is and we figure out that issue and then address it depending on what they need. And that's why we have such a wide variety of therapeutic approaches in our program that are not just medical or pharmaceutical or device driven, but also that are psychological programs that we utilize, like cognitive behavioral therapy and act therapy that Jake can definitely un open that Pandora's box.
But other activities that you wouldn't even think necessarily. Are sleep related, but they do have that relationship. So understanding like how anxiety during the day. Can cause sleep problems at night. It's not even like what happened right before bed. It could be happening all day long. And it just creates this sympathetic overdrive that you just can't shut down when you go to sleep at night.
And then lo and behold, insomnia. Same thing's true for things like A DHD. If you've not untreated A DHD in the daytime, it doesn't go away at night. It actually continues to cr create problems. So [00:51:00] we really have to unwind the issue using the most sensitive technology, which is utilizing autonomic nervous system testing versus polys sonographic testing, which.
For many years, it's called the Gold Standard. And I think we're now starting to recognize from the research perspective and also the clinical perspective, that it's the golden hammer, but it isn't the golden screwdriver. So we can't use it for the same outcome. It's not use, it's not the same tool. So now we're starting to take the PSG apart.
Actually you'll see that there are devices that show brain activity through EEG only, and they're using that specific component or act actigraphy, which we do with all wrist and, activity based bands and wrist watches. And then we add things like PPG. And so P PGS now being added in and some of the devices out there may even eventually get to the point of using cardiopulmonary coupling algorithms, as well as other more validated measures.
Other than things like heart rate variability, which can definitely be useful. But I [00:52:00] think are very misunderstood and not utilized properly. And I will definitely bump that over to Jay because that is his area of expertise. As an neurophysiologist, we often tease each other back and forth. 'cause I'm, I work with the night and he works with the day.
So he has all the happy sunshine and I have all the darkness. That's, we work with all with people at the different times of their circadian rhythm. So I'll let you talk JI versus cth.
Dr. Mike T Nelson: And quick question before we go into Jay on that. How is that marker different from HRV and how are they related?
Because it sounds like they're trying to get at the same thing, but they're doing it by a little bit different. And maybe that'll lead us into the HRV discussion. Yeah,
Jeffrey Durmer: for sure. I can give you a sense. So CPC or cardiopulmonary coupling itself for through that waveform is something that requires heart rate variability as part of the, for, as part of the calculation, but also respiratory rate variability.
Ah, okay. So what we deduce from the actual signal is like when you look at the pulse wave not only shows variation in heart rate, it also in frequency, but it also shows amplitude [00:53:00] changes. And so the pulse gets wider and smaller. And that's because respiratory function actually changes the cardiac output.
So when we take a breath and our heart and our lungs are together, we tend to see very high coupling. And that's driven by vagal dyssynchrony and vagal tone. And that's parasympathetic activity. That's what most of our sleep looks like. And then if you have a sleep disorder breathing event, all of a sudden the breathing stops and the heart starts to catch up.
You get desynchrony, and then that's sympathetically driven. So on a scale of zero, which is all sympathetic to one, which is all parasympathetic, we tend to move in that realm all night long depending on what's happening to us. And people who have a lot of high coupling, parasympathetic activity are getting the best, highest quality sleep that we can actually measure objectively.
And this is probably the best metric that we have for understanding objective sleep quality, [00:54:00] other than asking people, how did you feel subjectively? So I'll leave that to, to Jay talk more about the H RV itself. Yeah. Yeah.
Jay Wiles: And as you could guess, Mike, most of the people who are coming into our clinic are individuals who do not have a lot of high frequency coupling.
So we don't see a ton of parasympathetic activity. And this can be a result of a multitude of things. This could be evidence of psychological stress, poor recovery, but also sleep disorder breathing. If someone is having APNIC events or NIC events all night, their sympathetic nervous system's gonna be revved up.
And so we won't see as much of that parasympathetic activity. So it gives us, again, just a lot more granular insight into their sleep quality as opposed to just looking at something like PSG. But we look at both in our.
Jeffrey Durmer: Yeah, for sure. It's also because we can actually look at it every night.
That's the big difference. The PSG can only do when people are willing to put all, put the kid on. So we do that in the beginning, but then from that point forward, they're wearing a ring on their finger and [00:55:00] that's far more tolerable and more acceptable and it gives us a really good under indication of their natural sleeping environment.
So they may be traveling and they'll take it with them. We see that oftentimes we have clients that have houses that are in the mountains here in Denver, that I live in Denver, and they go up to 11,000 feet and they had no sleep disorder breathing where they lived at sea level. And all of a sudden it's like, 40, 50 events an hour.
And it's not just obstructions, it's also central events. So we have to treat that issue in that environment, not just the person. So there's this combination of the environment and the physiology of the individual. We have to into account.
Dr. Mike T Nelson: And that may explain like one of the things I did, and I still do it, is looking at their heart rate variability and if it's very low, so that means they're very much on the sympathetic side.
Even for sleep, respiratory issues, pathologies side, let's just say assume they don't have a lot of those things going on. I've had pretty good luck with [00:56:00] anything to increase their parasympathetic tone seems to transfer to their sleep from both downregulation at night breath work. Maybe they've got some anxiety they need to deal with to even chronically doing more aerobic training, trying to get their VO two max up.
Things we know that are gonna increase that baseline of vagal tone. Would you agree that's a good idea or is that like, eh, maybe that's not really related, it just happens to transfer
Jay Wiles: it. It's a hundred percent related. I just may view it in a little bit of a different way. Yeah, so explain.
So I think that, yeah, so the. So for people who don't know about my background, so my background is in psychophysiology and heart rate variability, biofeedback, and then also heart rate variability as a recovery metric. And one of the I would say more perpetuated myths. And the thing that I get emailed about most and called about most and talk about on podcasts the most is just this idea of like good HRV versus bad HRV, high versus low.[00:57:00]
And think I would agree with that.
Dr. Mike T Nelson: I get way too many questions on that.
Jay Wiles: Yeah, it's all the time. Well, 'cause again, the advent of wearable technology, people get an aura ring or a whoop band and they look and they see what their HRV is over the course of a few weeks, and then they see some influencer health and wellness influencer posting their data on their Instagram page or whatever it may be, and they're like, oh my god, mine's one 50.
You suck. Exactly. They're like, I've got 150 milliseconds and mine is like 20. Am I gonna die Dr. J? That's like the email I get probably every other week. And I think that for the most part, what I always tell them is like, listen, this metric number one is not a vanity metric. It does not operate like other metrics do.
And that's because most other metrics that we have a normative base for comparison. Now we have enough population data to understand where people generally fall in terms of heart rate variability metrics, resting heart rate metrics, and that's great. But what we don't have is enough empirical evidence to suggest that if your heart rate variability falls [00:58:00] below the said average of let's say your age, gender, or any other type of demographic that.
Means you're either number one stressed out or in a poor cardiovascular health. We just don't have the evidence to suggest that. What I tell people is that a good HRV is not a high HRV it is not a low HRV, it is a stable HRV across time and the most underutilized HRV metric especially in the health and performance world that I do not see in any wearable right now, but I use on a day-to-day basis with all of my clients, is looking at the coefficient to variation of heart rate variability.
We call this H-R-V-C-V, which is looking at a seven day rolling window, and it is looking out the variability of HRV and we know that stability in terms of HRV is actually a good sign. That means adaptability, resilience and recovery. When HRV becomes more volatile, that's indicative of more of a more volatile nervous system, and that's where we may want to intervene.
So the reason I said, I may look at it a little bit differently. Is that my [00:59:00] intention is not to set out and say, Hey, we have an outcome marker of improving heart rate variability. I say that we have an outcome marker of improving psychological flexibility and also nervous system resilience. And this is where we introduce with every one of our clients and this is with an absolute rest, but also like if I'm working with my elite athletes or high performers.
For from a nervous system stability perspective, this is where we're gonna introduce any mechanism to help them better control their nervous system. This is typically gonna come from things like downregulation practices. Now my, again, I'm gonna be very open and say that my bias is towards heart rate variability.
Biofeedback, which is leveraging information and data about your nervous system in real time to offer as a guide. And then changing your breathing practices, typically to what we call your resonance frequency rate in order to align kind of your nervous system with your car, with your cardiovascular and respiratory system.
And we know from hundreds, if not at this point in time, thousands of studies that [01:00:00] have shown that this is an effective strategy for controlling the thermostat of your nervous system. How does this translate to sleep? If we have people doing this during the daytime, which we have them doing, everyone, every client that comes through our practice is doing this.
They're doing it as a part of their wind down or pres sleep. But many of them love it so much that they're actually introducing it into the middle of their day, let's say around lunchtime or mid-afternoon or whenever it may be. What we see is that the ability to downregulate the nervous system, reduce resting heart rate, increase heart rate variability, control the thermostat of the nervous system prior to sleep, it aids in a multitude of ways.
First thing is it improves things like sleep latency. So how long it takes you to fall asleep because you've now downregulated the nervous system, we can ease into sleep as opposed to, Hey, I'm running around the house trying to do everything, all the chores that I have to get done, preparing stuff for kids in school for the next day, whatever it may be.
If we don't take that opportunity to down regulate and we try to jump in bed and our heart rate's up at like [01:01:00] 80. Beats per minute, 90 beats per minute. How do we expect just to fall asleep? It's very difficult to do that. Eventually you will. But how about we prime that system so that we can get the extra quantity of sleep?
And that's where we'll introduce something like that. The other advantage that we have of this is that we see that metrics, like Jeff mentioned before, something called fragmentation, which is the short bursts. Or it can be long bursts of the sympathetic nervous system throughout the course of the night.
That can cause us to context switch in terms of sleep stage or also cause awakenings in the middle of the night. We see a reduction in that when people are teaching their nervous system. How to reflexively become more parasympathetic and to become more relaxed. So I mentioned biofeedback as one of them, but there are a multitude of things that we can utilize.
Things like autogenic training, even self-hypnosis. So we use mindfulness or meditation as a practice as well. Guided imagery, visualization. All these things can be immensely helpful and impactful for keeping people in the deeper stages of sleep [01:02:00] throughout the night, reducing those, that fragmentation, reducing latency and just improving overall quality of sleep.
And then I would say, as my final point here is that leveraging kind of those tools not only helps with the nighttime behavior, which is sleeping, but also too, we see this as a translative skill throughout the day. So what does this equate to Better mental performance, reduced emotional regulation or dysregulation.
So we become more emotionally regulated. We just find that people are more calm throughout the day, and I think most of us in this day and age could use a little bit more. Calm. So anything we can do to downregulate the nervous system is gonna be immensely impactful. And I just think that if we have that objective of those objective metrics like we have in like heart rate variability, biofeedback, it becomes more sticky for the user as opposed to just like doing a meditation and they're like, yeah, I think this is helping.
We can actually show them in real time like what their nervous system is doing.
Jeffrey Durmer: Yeah. Oh, that's awesome. And go ahead. Yeah, no, also, I was gonna just say this whole idea of having [01:03:00] metrics is so important in our program because the, we have people, don't believe it. Show me. That's a lot of people.
One of the things we can also do is show them how much worse it could be. Keep drinking that alcohol before bed. Yeah. Let's show what actually happens. And we do that part of, oh yeah. It was something we were just talking about before. We do a lot of empiric experimentation during our three month program.
So we have three months with these folks and. They could come in drinking like three drinks a day, or smoking cigarettes or vaping or using Xin or whatever they're using to stay awake in the daytime. And we're like, all right, keep doing that. Let's show you. And they'll come off of it and we'll see what the difference is between these two different functions.
And then you decide. Does this make sense for you? And it becomes a per, it really works into, and Jake can talk a lot more about this, their values and their value system. Like, what is it that's important to me? Is that what's important to me is the metrics gonna, are the metrics gonna drive my change in [01:04:00] behavior?
Because at the end of the day, all the precision that we bring to the table in terms of diagnostic abilities or figuring out the context of a problem using all of those data sources, if somebody's not actually, if we don't make the behavior change precise or precision based, they'll never change.
And it won't have any, it won't any kind of impact over time. So precision based, medical practice or precision based ca change, behavior change is a big part of our program. And it's actually something I think it's missing across the spectrum in the whole concept of precision medicine.
As I work at the NIH sleep sort of research advisory board and we set the tone in terms of what people are gonna, what are we gonna fund from the NIH for sleep. And we had this big discussion at our last big meeting a month ago in DC that this is a time where we are getting so much more information, but people are still not even changing like simple behaviors.
Yeah. Like setting bedtimes for their kids or little things [01:05:00] like when they eat. So how do we do that? And a big part of this comes from behavior change psychology, which is also Jay's area. And this idea of value-based change, I think is a big missing piece that that we've really found incredibly effective in our program.
Dr. Mike T Nelson: I feel like a lot of my job, I could just replace my job as, I'm just an awareness coach, but nobody understands what that means and they probably wouldn't pay me a lot of money for that. But a lot of it with the wearables, it's nice to be able to, and I've done this for years with HRV of Oh, okay.
Like you think, having two beverages at night doesn't affect your sleep or whatever. So, okay, great. Do that. We'll log it. We'll look at your HRV. You will have nights where you don't have that, or maybe one drink or however. We're gonna set the parameters and then we'll come back and we'll review the data.
And then I'm just gonna show you, oh look, two, because I can almost say you guys have probably seen the same thing, like right around especially two drinks and more. Almost everyone, their HRV will drop. Other metrics usually go to crap, and I [01:06:00] just ask them like, okay, is you have to now decide if this is worth it to you or not.
But I do not allow them to say. Well, I want really good HRV. I want my sleep to be amazing and I wanna drink three drinks a night. Okay. For your physiology, this is just not possible, right? Yeah. So you have to pick one or the other. If you tell me, Hey, I went out with some friends and haven't seen 'em in a while.
We had two drinks. I know my sleep wasn't good, but that's okay. That's a decision I actively made. Cool, man. We're fine with that, but I think a lot of times everybody, they wanna do both, but they don't realize the cost that they're actually paying to do that.
Jay Wiles: Everybody wants to have their cake and eat it too.
Oh, of course. It's totally understandable. Yeah. Yeah. It's totally underst human nature. Understandable. That's human nature. Exactly. The one thing that we always tie back to, and this is kind of Jeff's point in regards to the value system, is I always ask why until I can't ask why anymore. And so the first thing that we.
Do when they come in is they do what's called the VLQ, which is the valued living questionnaire. This is [01:07:00] developed by Dr. Steven Hayes, who is the creator of Acceptance and Commitment Therapy. So act, and essentially what it does is that it gives you this list of kinda like values. This may be physical health, intimate relationships, children on work, on and on.
And then you rate that on a scale of one to 10, one being, this is not important to me whatsoever, 10 being the most important to me. And you do that and then you do the questions over again. But this time, instead of rating, what is the level of importance you say, are my actions on one to 10 in line. With that value system, one being actions are not aligned with that value.
10 being my actions are, and what we're looking for here is where are the discrepancies? Where is somebody saying, well, my family is the highest value system for me at a 10, but my actions are at a three, oh. Huge discrepancy that we have here. Now. How does this rely relate and tie back into your overall health and wellness and what you're doing?
Well, then we continue to ask the question [01:08:00] of, well, why is that? What's getting in the way? Well, I'm going out and I'm drinking with, my buddies every night after work because we need to de-stress and, gripe about, everything that's going on in the law firm. Heard that one before.
Or, maybe some other story that somebody's giving. And the question has to be, well, okay, well how is this like, how is this impacting kind of your overall ability to connect with your kids? It's like, well, I'm getting home and actually the kids are already asleep by that time I get home, so I'm really not seeing them until the weekends.
And on the weekends I've got more work to do. And you're like, but you rated work at a seven and you rated your family at a 10. I was like there's this gap here that we need to address. And for us, the reason that it's so important is because we do not believe. That any type of behavior change is going to be sustainable unless it is tied directly to your value system.
If you are simply doing it just because you want some said metric outcome, I want to improve my sleep disorder breathing, I just want to have better sleep. Like that's great and it may be successful and because it's novel [01:09:00] within the first few weeks, but it's not gonna create this lifelong sustainable behavior pattern.
So for us, we want to tie kinda why improving your overall sleep and reducing alcohol use, improving your ability to downregulate, why is that, how is that tied to improving your value set or the behaviors around your value set and it just becomes immensely more sticky when people can link the behavior with why.
And so I think that kind of just to circle back to, to the point here is that if we really want to drive home someone's. Ability to execute sustainable behavior change in the long run. It's got to actually matter to them. And if it doesn't matter to them, why the hell are you here?
Why are you spending all this money to do this work? If this is actually just something where you're like, well, I just dipping my toes in it, you're not gonna be successful. Like, you just aren't. And we, unfortunately, we've seen this in our program but for [01:10:00] us, like we've doubled down on this idea of just linking it with the value set.
Jeffrey Durmer: Yeah. And I think that's the C and ACT is commitment for that very purpose. Yeah.
Dr. Mike T Nelson: Yeah, that's right. And I think that's where, having a program like what you guys do, just having coaching in general to interpret the data and to apply it to their values and to hold them accountable, to run those scenarios through with them.
I think there's a little bit of this myth that. Well, if I just had more data, I'll automatically make behavior change. And I rarely see that happen, like once in a blue moon. Like, eh, it'll happen. But I think that's still a myth that people think if I just, if I have five wearables, oh my God I'll be amazing.
It's like, no, you're gonna be so confused. You're probably get worse. Yeah. Without someone to walk you through. Okay. How does that go into behavior change? Or what are you actually gonna do with it? What does that look like? What are the behaviors? And then we can use the data, like you said, to to crosscheck and to see how are you doing on that path? And again, you're back [01:11:00] to, coaching and awareness and looking at the full picture of both the physiology and the psychology.
Jay Wiles: Well, because the data, when it's not understood, eventually leads to self-fulfilling prophecies. So somebody wakes up and they say that my sleep was actu absolute garbage.
My recovery is absolute garbage, so therefore I feel like garbage. So it's introducing how you feel based on objective data as opposed to checking in subjectively first. And we see this so often where people are like, well, I'm using your ring and it's telling me that my sleep is actually absolute crap.
So what did we do as a program? We said, okay, actually for the first few months, we're not gonna let them look at any data. Yeah. And we're gonna tell them, your aura sheath it your whoop sheath. It like, put it away. We don't want you spending too much time and obsessing over it. Because people who come into our program, one of the questions we ask them is, number one, are you wearing a wearable?
It's about a hundred percent of people who come in are wearing a wearable. And then the second question is more, most important is. Is this bothering you in the morning when you're looking at your data? And almost everybody says it at least either bothers me a little bit or it [01:12:00] bothers me a lot.
So for us it's like, actually for right now, until we learn, or until we teach you and you learn how to actually use this data, like just put it away for right now. Because what we don't want to have happen is for you to say, well, my sleep was bad, so therefore I feel bad, or My recovery was bad, and so therefore I get to take the day off.
Let me go sit on the couch, eat bon bons, right? And drink a couple beers. That is like the worst thing that we can have happen. And it sounds, silly and maybe facetious for me to say that, but it's actually something that we see far too often.
Jeffrey Durmer: Self-fulfilling prophecies and superstitions, they go together.
And that's actually something that we see, Jay and I both work with high level athletes and the superstitious athletes Oh yeah. Are the ones with these self-fulfilling prophecies and they can wind themselves into these vicious cycles which are not breakable until we get to the understanding of like, what's important here, what really is and the why, the breakdown is really how to start that process.
But yeah that's a, that's [01:13:00] definitely part of our program and something that we see way too often. And it doesn't even have to be a high level athlete. It could just be any of us that basically get into those cycles.
Dr. Mike T Nelson: Yeah. And that's, I've had clients, not so much now, but especially more in the past where I'll ask 'em like, okay, how was your sleep last night?
And I'm looking at their scores and they'll like, oh, my Garmin says it was horrible. Or My aura says, I'm like, I, no, I asked you, how did you feel in the morning? They're like, oh, well my scores were bad. I said, that's not the question I asked. Like, before you look at any data, I want an eval, a qualitative score, even a one through 10, a good thumbs up, thumbs down.
I don't care. Like, how did you feel when you got up before you looked at your data? Because so often they're like oh my gosh. Well, my, efficiency was only, 84%. And Bob next door, he is got 87% and I'm a worthless human being. Now I'm not sleeping well. And it's like, oh my gosh.
Like, just chill out. You made it this far in your life so far and you're still okay. So it, I've pitched to, I've given up this idea, [01:14:00] but someone will do it. I'm glad you guys are what I call like the coaching mode where you can black out data to the person on the other end. But I, as a coach, only get to see their data.
Now, potentially you may run into a compliance issue and how big is their buy-in and stuff like that, but I still think that would be a good idea and I'm glad you guys are doing something like that so you can then guide them to what's the most important. And they don't have these freakouts every time they get up and look at their device data.
Jay Wiles: Well, and what we do too here, Mike, is what we will initially not let them view the data now, because historically we did let them view the data and they just ran with it and they made up their own damn thing. Yeah. And we're like, isn't that what you paid us to do to give you some insight on this?
And you're just being your own interpreter. I'm not sure why you're paying us all this money. And so what we've done now though is we said, well actually we're gonna block it for the first, it's a three month program. So we normally will block it for like the first two months, and then in the last month we unlock it, but only at the discretion of like if we think they're ready.
But then also our [01:15:00] css, which is our clinical sleep specialists, take the time to then teach the person how to interpret the data because the data are complex. Like we're not, the data that we're using is. It's not very easy to understand, especially the a ST of the autonomic sleep testing. However, if we do teach them, then when they leave our program and we still give them access to that data, well now they can be their own sleep advocate.
They can continue to run these experiments both in what can we add into kind of our routine, but also what can we subtract? What are the main catalyst or levers that are actually pushing me in my sleep in the right direction? But we have to empower them first on how to use the data. 'cause otherwise they'll just run free with it.
Jeffrey Durmer: Yeah, it really is. And it's a very effective construct because the idea that they have something that they can control now and then you, and they're not it's like we look at it our program for three months is like a bootcamp. And that bootcamp we're going to, it's really intensely provide you with what you need to get started.
But sleep is forever. It's not just a three month [01:16:00] program. So we are gonna get you on the right road, give you the metrics that are important for you to measure, not what everybody else is measuring, what you need to measure. And then also we're here so that if you come back and have questions, Jay and Jeff are always here to ask, answer your questions.
Our CSS team, that, that CSS that PhD psychologist is your lifeline. So if there are issues, you can always ask questions, come back. We even have a continuum program where if you need a little bit more intense time at a month or two or six more months, you want to do that's fine. It, it really is made to.
Answer the individual's or cater to the individual's needs. It's not saying that everybody at the end of three months is gonna be out there perfectly sleeping. That's not the job. We're actually not interested in optimizing sleep. That's not our job. Our job is to create more resilient sleepers and give you the tools so that as you go through your life, you can respond in a way that you know it will be effective for [01:17:00] you.
If bombs are going off around you, we gotta help you figure out how to sleep in that environment. That's really the concept. It's about resilience, not optimization. 'cause we don't want people comparing and competing on some metrics that are meaningless to that person's physiology.
Dr. Mike T Nelson: Yeah. That's so key.
One side note question. I'll have you guys explain exactly everything you do at absolute rest and give us the full rundown. What have you seen with caffeine and especially now nicotine? Like I, it's a funny side story and this one was on me, this is my fault. I had a guy, we could not figure out his sleep stuff.
We tried everything and he was a, busy professional, had a, worked a later shift, et cetera, et cetera. Finally, I hired a buddy of mine to do a sleep consult PhD guy, and I said, Hey man I'll pay for his time. Just talk to this guy. I'm at my wits end. I can't figure out why I can't figure this out.
So he does the whole thing, did a great job and everything, and he gives me the rundown of the call. 'cause I said, just record it. You guys chat. My [01:18:00] client tells me, he is like, wait, I've been doing like, four Zens at night 'cause I've been busy doing work and stuff, and I'm like, son of a bitch.
I never asked him about nicotine. I asked him did he smoke? I asked about ca, I asked him all these, and I'm like hitting myself in the head going, I didn't ask about, any other form of nicotine. Obviously having a high amount of this, like an hour before you're going to bed is not gonna help your sleep, so.
Just side note, make sure you ask clients about it, but what have you guys seen,
Jay Wiles: Jeff? I don't think we've ever seen anybody who's no. What is this caffeine you speak of? Is it something that I know about? What are you talking about Nicko?
Jeffrey Durmer: What is this? Crazy? Yeah. Adenosine and nicotine, a nicotinic receptors and adenosine receptors are probably o other than gaba, are the three main receptors that we work with in terms of sleep and wake.
And so, yeah, it's a big part of our intake discussion around not just whe how much you take, but when you take it. What forms are you taking [01:19:00] it and also how long have you been taking it? And we even, as part of our program and we can talk more about the program itself. We're we do a lot of, we do serum testing, so we look at a number of values that are not just associated with normal metabolic function, but we're looking at things like you.
You're taking 27 supplements, not an unreasonable number for some people actually in our program, and your B12 level is 3000, so. B12. What ha Well, what do you give people when they're fatigued and a shot in the butt? B12, because it creates arousal and wakefulness. So basically they have got a shot in the butt of B12 every day, and they're having trouble going to sleep.
So we, we look for those sorts of components. And in terms of caffeine, like even the programming a around things like genetics and your predisposition to being a fast accelerator or a slow accelerator, these are all things that can, are useful tools that we utilize. And then building an entire genetics program, it's something that we're also working with right now to figure out what exactly would be useful [01:20:00] for people, because that's one of the problems with genetics and genomics.
And that was my own research area. It's it's really interesting, but is it useful? And there are a few things that can be useful, but is it worth the expense of actually utilizing a genetic test versus. Knowing what other values in the blood work. We look at testosterone levels, we look at a number of things that people are taking that affect wakeful, wake and sleep programming.
And then we also look at things like minerals, magnesium, the most common thing people take magnesium three N eight, and all these other magnesium based sprays that are putting on their bodies and in their bodies. Magnesium's really helpful for people who have hypomagnesemia, who have low magnesium levels or that use a lot of magnesium because they're athletes, but the vast majority of the rest of us don't need that.
And it's a very temporal, a temporizing effect. It doesn't last, it's not a lasting benefit. So we wanna get people away from these exogenous substances and actually get them to be more reliant on their natural sleep and wake systems. And then [01:21:00] if they need occasional help from a little ashwagandha or occasional help from MEG three and eight, fine.
This is not something you're gonna sustain as like, seven different sleep supplements to counteract the 20 other daytime supplements you took to stay awake. It's just the same issue with sleep and with caffeine and alcohol. We know the people who drink the most coffee also drink the most alcohol,
Dr. Mike T Nelson: so, yeah.
Yeah. And my, you want the hard transition from like, I want to be completely on all day and then. My head is a pillow and I wanna be out. It's like, that's not quite how physiology works.
Jeffrey Durmer: You're not a machine, you're, yeah, exactly. That's right.
Jay Wiles: That's right. And one of the things that we do practically with every one of our clients is that we actually titrate almost everybody off any type of Yep.
Supplementation nicotine use, caffeine use B12, another big one which I mentioned supplements anyway, and that's a really difficult behavioral thing for most people. Very difficult. [01:22:00] However, what we see is, and this is what we tell people, is that we are doing this as a short term. Experiment. It isn't to say you can never have ni nicotine for the rest of your life.
You can never have caffeine for the rest of your life. But let's just run the experiment just like, Hey, we'll say hey, yeah, go drink some alcohol. Like that's another experiment. We're letting you, giving you the privilege to go do it. What we're saying here is that we just want to see the effects.
And until we, have better, a better understanding of the genetic propensities and we're doing that type of testing, for us, it's just a matter of is it there and present versus is it not? And then looking to see what are the subjective benefits or lack thereof, and then what are the objective benefits or lack thereof.
And running that as a systemized experiment. And for us, we have seen that there are just so many people who do not realize that even that caffeine that they're drinking pre 12. 'cause a lot of people go, like by the pre 12:00 PM rule. They're drinking at 11:00 PM it's still. Affecting their system at 7, 8, 9 pm [01:23:00] And when we remove it and we say, Hey, like, yeah, have a cup, but have it at 6:00 AM when you wake up, as opposed to like a one at 11 or one post-lunch.
A lot of people do the post-lunch coffee. It's like the, they go eat at 12 and then 1230 they do it. And when they make these changes, we see a significant improvement. Like again, obviously to protect patient health information. I won't say any names. So we had a client of ours who was in our program who was using well over 60 milligrams a day of nicotine.
So a fair amount of nicotine day. Whoa. Over
Dr. Mike T Nelson: 60 MIGS per day of Nick, whoa. 60 mg
Jay Wiles: a day. Nick. What? And he said, I'm just gonna eliminate this stuff, which is a very, obviously as most people know with nicotine, very difficult, especially when you're on that high dose of 60 mig. It's a lot. And he said, I thought I was gonna crash and burn and have no energy.
Well, no, actually, what did it do? He improved his sleep, which therefore gave him more energy and he didn't feel like he was reliant on nicotine. Now that first week or so was pretty [01:24:00] freaking hard for him. It's rough. However, he noticed like, I don't need this stuff. I don't need to be relying on this stuff to give me that energy and motivation.
I can get it if I get really good sleep. And that was impairing my sleep. And so a lot of it is just running these experiments over and over again.
Jeffrey Durmer: Yeah. And getting people back to their natural sleep behaviors is really what is why we're we exist. Because people don't understand that their natural sleep and wake behaviors.
It's all they need. That's really what they need. And so part of, like, even with the nicotine example and also people coming off of caffeine, which is another drag for often for people, we substitute natural light therapies like in the middle of the day, instead of reaching for the caffeine or reaching for the pact, go out and walk for 30 minutes in the sunshine.
Get light you. If we live in Minnesota and it's December, we'll get you a light box. But the idea is we can use natural activation of circadian rhythm to not only enhance [01:25:00] daytime function, but it turns out that also accentuates sleep drive. So your natural circadian rhythm, something that we can definitely talk a lot more about.
Our program we'd we don't look at like what time you go to bed as that important. What time you go to bed is predicated on what time you wake up. Waking up is the most important part of our schedule and when we look at our sleep and wake schedule, so setting that up early on. And then looking at their natural cycle, like where do they see the lulls?
Where are they activated? Where are they? We do a circadian inventory when they first come in using the morning this evening as questionnaire, a number of other metrics that give us a sense of their morning, this, or eveningness or in the middle somewhere. Then their programming is designed around matching that with their lifestyle, which is difficult in many cases, but at the same time we can set up a wake time that now we can eliminate a lot of the things that we're getting in the way with this variability.
And all of a sudden, lo and behold, their sleep time [01:26:00] starts to become more regular. It's regularizing the morning creates the regularization of the night, and we're okay with a little bit of, play here in the evening, but not really so much play weekend to weekday either in the mornings if we really want to get you onto your natural sleep cycle.
And that's a big part of our program that I think a lot of even academic programs that I've run at Emory and at Penn, where I had, I worked with people who were cross disciplinary, we still didn't have that component. And there was no real way to follow up with our recommendations like using the autonomic testing device.
It's a big, it's a big missed opportunity across the sphere and medical care.
Dr. Mike T Nelson: Yeah, that's a big thing I look at for, so I do some sleep analysis for the guys over at Aura, or not Aura, but we use Aura over at rapid Health. And a lot of what I'm looking at is just regularity, right? How, what time do you go to bed?
What time do you get up? Does your body tend vary? And like you were saying, [01:27:00] Jay, like the variability in HRV, like your HRV looks like a stock market on a bad week where it's like up, down, up, down, up, down. It's like, I'm not so concerned about what your value is, but you've got some stuff, you got some stuff going on there.
'cause your coefficient of variation is just across the way. And I try to explain to clients that. Your body's just having a really hard time adapting to these stressors. It's overshooting, undershooting, overshooting, undershooting. So just trying to get any regularity I find makes like a huge difference for like a lot of people.
Yeah. So tell us about the program you guys got. Like, I know you send a whole bunch of sensors, you're even looking at like CO2 in the room and all sorts of stuff. So tell us all about it.
Jay Wiles: Jeff, you wanna talk about all the physiological stuff and then I'll talk about all the sure.
The other stuff.
Jeffrey Durmer: Sure. Absolutely. And, and before we jump into that too Yeah. I also wanted to double click on your thought process around regularity because there are a number of really valid metrics, like one called the Sleep Regularity [01:28:00] Index that has been used in many studies.
And a good friend of mine Eric Herzog at was St. Lou. He's not a sleep researcher. He's a physiologist that looks at he looks at circadian rhythm and he is looking at the regularity in mice models associated with pregnancies that actually are carried to term versus those that are not. And he's found that if there's a dyssynchrony in the circadian rhythm.
They almost always end up with spontaneous fetal loss.
And he's taken this work and translated into humans and it's the exact same outcome. Oh, wow. So regularity has such an important, and circadian rhythms have such an important part to play in just our general health and also in our activities outside of sleep that we're just starting to get to the, just the tip of the iceberg on that.
But it's a lot coming in that realm. I think it's gonna be really interesting. So. What do we do in our program? So we do a lot of data collection upfront. In the very beginning when we work with a client [01:29:00] oftentimes they'll find out about us through a podcast like this or through another person that has been through our program or even through functional medicine clinics that send us their clients or medical clinics that, that people come to us from.
And also people who have just had difficulty getting medical care for sleep issues in the medical system. We'll have them fill out a series of questionnaires that are validated clinical inventories that span a number of different really good clinical research trials, looking at sleep indices like sleep health indices.
Also looking at things like sleepiness in the daytime, things like upward sleepiness scale. Look at their mornings and eness circadian rhythms, their psychological batteries that we look at for stress, anxiety, depression. And not necessarily to diagnose anything, but to give us a qualitative metric for this individual across time.
All of those data points give us a significant amount of information about the thought process and also the behaviors. We also do a number of [01:30:00] other inventories like the VLQ that Jay mentioned earlier the values life questionnaire and the tippy, looking at the 10 item personality inventory, so we understand who we're working with and how they approach life.
Then we do an entire intake that includes polysomnographic testing in the home for two nights. At the same time we do audit, we do metrics around the house, the rooms. We look at air quality. We look at light sensors. We look at noise. We look at temperature, humidity, a number of things that we know can affect sleep and that are often missed by people.
So it gives us that metric. And then we get the autonomic testing device, so they start using it right away, and they continue to use that through the entire program. Then we all get together as a team and we talk about that data after our clinical psychologist who's assigned to that individual has an intake interview.
And that intake interview includes medical history, and they do a lot of this online beforehand, medical histories, their sleep issues, their medications surgical procedures. [01:31:00] They've had everything about them, their social situation, their lifestyle habits. Where they live is, do they live at altitude?
A lot of things that can affect sleep. And then we anal analyze that as a team. So we have a, an entire team of folks. It's led by Jay and myself and our clinical psychologists. But we also at that point, design this three month program for the individual based on that information, which then is utilized for the three months what by our clinical psychologists or clinical sleep specialists.
And they dynamically make changes to it. And every week we meet to talk about those changes. And they ask us questions. They ask, they're with their CSS the entire time, but we go back and forth. We use slack as a main act activity, so we can actually talk with them on a regular basis and then implement a series of different interventions across the, that three month period.
We also do pre and post outcome measures. So we use things like promise scores to look at the input and output from [01:32:00] somebody coming into our program with sleep issues. And then afterward they're done. We look at changes in things like sleep disorder, breathing that are objective. But there's a host of other outcome metrics that we utilize to understand the effect of the program in association with subjective outcomes.
Then at the end of three months, they can transition out into sort of their own use of the device. They keep the ring, it's theirs. They have the data, they have our app, which actually they learn to use, which is something we talked about earlier. And they can continue to their own programming from that point forward.
Or they can stay in the program for month after month, depending on what their needs are. So that, that's really a big picture of the program and the physiology is what I focus on and the medical aspects, but also the psychological associations that Jay and the clinical psychologists come up with.
So I'll let him talk a lot more about that and how we inventory that and use it.
Jay Wiles: Jeff really covered the program as a whole. So I'll speak more to like the dynamic nature of the clinical sleep [01:33:00] specialist who is a psychologist and kinda what they're doing that is a bit different than other sleep clinics because again, we do incorporate more of a behavioral and psychological approach compared to other, let's say, academic clinics a lot more than what they do.
Yeah. If what I like to think about is. How this person relates to sleep. Because when someone has battled with something, let's say like clinical insomnia for 10, 15, 20, 30 plus years, they typically have a very poor view of sleep. They have a lot of un they have an unhealthy relationship. I always tell 'em, I, I tell a lot of our clients, it's like, if you could have gotten a divorce with your sleep, you would've gotten a divorce with it a long time ago.
And they're like, yes, you're right. I would have so they have a lot of these kind of like dysfunctional, unhelpful. Beliefs about sleep, and a lot of the research has indicated that we can actually utilize cognitive approaches to change the way that we interact with sleep and not view this as this enemy that we're always going into [01:34:00] battle with every single night.
Because if you're having to go and rest with your enemy every single night, it's probably not gonna go very well. You're gonna be on high alert, you're really not going to be able to allow the nervous system to down regulate. So a lot of what our psychologist's job is to integrate different psychotherapeutic techniques, and this is why strategically we have put psychologists in these clinical sleep specialists roles is because they have the background in changing, not only in behavior change, but also in the psychotherapeutic techniques that are evidence-based for sleep and insomnia.
And so we see this as being a big distinctive advantage because these psychologists in this role help these individuals to grapple with some of these dysfunctional and unhelpful beliefs while also changing behavior and behavior change is a key component, right? 'cause we can, as. Educate people, until the cows come home, if you will.
And education is great, it's needed, but also we need accountability. And this is where the coaching and the therapeutic side of things are, is immensely valuable [01:35:00] because behavior change is just immensely difficult. It's really hard. Like you ask anybody who's battled with, let's say like, yo-yo dieting or weight loss throughout their life, they'll tell you like, yeah, I can get onto, I can get on the horse and I can ride it for, a good solid month.
And then something hits, and then things just get, become disheveled and I'm back to square one. The same thing happens with our sleep or any other health behavior for that matter. It's not just, weight loss or dieting. Like there's exercise disheveled and there's sleep and it just always happens.
And so having that extra layer of accountability there and a team that's got your back, like we're really gonna be the ones to advocate and teach you how to advocate for your sleep. I think that's the big differentiator. So for us. It's very, what I would say is that it's very objective heavy and appraisal heavy in the beginning, and then as things go throughout the rest of the program, it's very behavioral and psychologically focused.
And so, and that's the part that I think most of our clients would say like, yeah, we found the most value, not just in receiving [01:36:00] a really good comprehensive report on the data that you guys found, but also like I had someone there who gave me that white glove like handholding approach that was there for me when I inevitably hit barriers.
Jeffrey Durmer: That's awesome.
It wasn't explicit about this before, one of the things that also we're bringing directly to the individual is everything they need. So, the medical care that they may need. So if they need therapy for sleep, disordered breathing, we don't just start with, here's a pap therapy we act, or a positive airway pressure device, which can be very effective.
But we start off with understanding how they breathe that night. We have such a unique opportunity to look on a night to night basis in terms of the variability of their breathing, to look at the impact of specific positions in their breathing, the different stages of their sleep and their breathing altitude, a number of other factors, their behaviors in the day, their alcohol use, their caffeine consumption.
And all of those kind of play a factor into the designing of the design [01:37:00] of the therapeutic approach. So we typically don't just jump to a standard therapy, we work with the individual's needs. So if it's nasal air flowed issues, we work with an ENT to actually improve that, that airflow. If it's body position and obesity for instance, we work with metabolic training and we actually even bring nutritionists in as well as physical therapists if you're having pain.
And we even have an exercise physiologist that will work with you to start a, an exercise program. So there are a number of other adjunctive components. That we often just say to patients, oh, we'll go find a nutritionist, but if they're not on the team, what is the nutritionist really gonna do?
So how are they gonna be connected? So we bring all of these elements in, and then if they do need A-C-P-A-P device or they need an oral appliance, for instance, from a dentist, we work with the oral appliance professionals. We work with the best people in the country that do this and they become part of their program.
Or we work with the best places for, [01:38:00] or for starting a pap therapy. We even have people who have to go to a laboratory for specialized initiation of different kinds of pap therapies, like adaptive servo ventilators or using intelligent volume assist pressure or IAPs therapies. We can't do those remotely.
So we work with a SM accredited centers. Where they can do that and they're back in our program. So we create the integration that's missing and the navigation through our clinical psychology team that really is second to none. There's nothing like this that we could, I could have created in my academic programs in the past.
And that I know Jay working in the VA system in particular, and the vets with the DOD, you get a lot of support around issues, but not a team like this. It's quite a different environment from our perspective.
Dr. Mike T Nelson: I love that it's a whole system approach. Even though you're working on the system of sleep, like you guys were saying, there's so many components to it.
There's the physiology, the [01:39:00] psychology, and the sub components of each one from Autonomics to breathing to everything else. So it's cool that you have the ability to look at all those areas and figure out what it is, because not a knock against specialist. There's a time and a place to see a specialist, but only when you.
Know exactly. Oh yeah, my ACL is missing. Okay, yeah. Go to a good orthopedic to get your ACL replaced. But if it's something like, eh, I'm just not sleeping well at night. Oh my gosh, that could be a bazillion, different things going on. And it's not just one thing all the time. So it's cool that you can look at all those and actually figure out the root cause of what's going on, and then have the behavioral change on the backend to make sure that it's actually sticking and people are following up and it becomes more of a habit and a lifelong thing.
Jeffrey Durmer: You got it. It's awesome. It's not it's a, it sounds easy in in words, but it's really difficult in practice. So, I think if we're easy, a lot of other groups would be doing it. We've, we're just creating a new scenario and [01:40:00] then building outcomes around it so that we can demonstrate it.
Dr. Mike T Nelson: Awesome. If you wanna learn more or sign up or get information, where do they go?
Jeffrey Durmer: You can go to absolute rests.com. That's our website. It is under construction. Okay, so you can join our wait list, which is actually, we've had over 10,000 people on the wait list for about a year. But that's not to say that you won't be brought into the program sooner than that.
'cause many people put their names on the list and we find out that, they moved on or did something different for themselves. But please join the wait list. We also have a group that is gonna be working to make that a little bit more streamlined. But absolute rests.com is is the website and you can connect to us through that.
Also, you can email j and r and I with questions that you might have associated with this, as well as our absolute rest program, email as well, which we can provide as well.
Dr. Mike T Nelson: Awesome. That's great. Anything else you guys want to add? I really appreciate all your time. It has been super fascinating.
Jeffrey Durmer: [01:41:00] I, one more thing I just throw out there.
Jay Wiles: Oh, just
Jeffrey Durmer: got one more thing, of course. One more thing I always wanna throw out because this is I was a big pediatric researcher in my day and we always forget about kids sleep and the impact that kids have on parents. And vice versa. And even in our program, we don't have a program for kids, but we do have a program for adults who have kids.
So if you're managing through a difficult period with a crying infant or not understanding how to manage three kids like Jade is, and like I had four. So, we have a lot of personal knowledge, but really understanding what is the psychological cognitive approach and physiology of those children.
We actually can help a lot with that as well. And it's really important to understand that a lot of the behaviors that children learn around sleep come from their parents. And so if you want to coach your children in the proper sleep techniques and sleep and proper, what we call sleep hygiene, but really building for the future, it's now's the time to do that.
You don't wanna [01:42:00] wait until they have problems with sleep or, all of a sudden they have a DHD tendencies, which is really probably sleep deprivation more than a DHD. That's something we definitely can help out with as part of your program as well.
Dr. Mike T Nelson: Yeah. And a quick side note on that, I'm sure you've seen this, like a buddy of mine years and years ago, he was a dentist and he, I asked him, just met him at a conference for the first time.
I said, Hey man, what do you do? He is like, I work with kids who have a DHD. And then I started talking to him and I said, he is, an oral surgeon. I'm like, oh, hold on a second. Wait a minute. You're an oral surgeon. Oh yeah. And you're working with kids with a DHD. Yeah, we image their airway and a lot of times they have airway restrictions, which is causing their brain to not see enough oxygen, which is then presenting like they have a DHD symptoms.
We go in, we make some airway adjustments if needed. And the kids go on to not having A-D-H-D-I was like, holy crap. I never thought of that. Yeah.
Jeffrey Durmer: It's actually a really good area. My old research area was a, is a [01:43:00] DHD overlap with RLS and iron deficiency in kids. Oh. And it's a very well understood scientifically it's, there's a lot of knowledge, but it's not clinically understood.
So it's another area that you know it's not just one disorder, sleep disorder, like sleep disorder, breathing that can cause a DH ADHD symptoms. It's sleep deprivation period. Sure. And also some of the neurochemicals involved in RLS, dopamine in particular. Is actually implicated in RLS and A DHD.
So the overlaps are often even endotype based overlaps, not just phenotypes. They're actually cause and effect. So when you have dopaminergic systems in the frontal paral lobes that don't work as well, you get a DHD symptoms. If you get the same issue within the A 11 cell group of the hypothalamus in the spinal cord, you get RLS.
So oftentimes they coexist within the same, and if you treat one of the issues, the other tends to get better. So we often give kids, stimulants helps with the A DHD symptoms. It doesn't make the RLS better. So we [01:44:00] have to work with kids in RLS separately in a different way, but then it makes the A DHD therapies more effective.
Dr. Mike T Nelson: Oh, and is RLS, I assume restless leg syndrome.
Jeffrey Durmer: Restless leg syndrome you got, okay. Exactly. Which is an unfortunate name, but it is accurate in terms of how most people experience it, because it can happen anywhere in the body. I've had people with restless tongue, restless chest, restless arms. Yeah.
It's it's a, it can be very devastating, but with ane moniker, that doesn't sound so bad. Yeah.
But it is, it can be a pretty tough disorder and it's very common, 10% of the population, so. Wow. Huh. Yeah, much, much more common. I, that's a whole nother podcast though.
Dr. Mike T Nelson: Yeah. No, that's definitely good to know because if people are having some of those things, then that gives them an avenue to follow up and to see what's actually going on too.
Absolutely.
Jeffrey Durmer: Yep.
Dr. Mike T Nelson: Awesome. I highly recommend everyone check you guys out. Go to the website and thank you so much for all your time and sharing all your information here. I really appreciate it.
Jay Wiles: Yeah, thanks for having us. You bet.
Dr. Mike T Nelson: Thank you. Thanks so much, Mike.
[01:45:00]
Speaker 2: Thank you so much for listening to the podcast today with Dr. Jeff Dermer and Dr. J Wiles from Absolute Rest. I hope you've learned a ton of stuff about rest and how you can apply the science of sleep, but your body composition, performance and just more energy day to day, so huge thanks to those guys.
If you are interested in them. Full disclosure, I don't have any disclosures. They're doing really great work. My buddy Dr. Andy Galpin said I should have them on the podcast and I said yes, and it was a fun conversation. So you can definitely check them out on their social media and all of their information below.
If you do end up working with them please tell them I sent you, even though I don't make any money off of it, but they're doing cool stuff and so I want to support them. And thank you for listening. I really appreciate it. If you want to download my free report on. Missing micronutrient magnesium, which can help with recovery and [01:46:00] sleep.
Download it below for free. Just pop in your email address and we'll send it over to you directly. Also puts you on the daily newsletter list. So thank you so much for listening to this podcast. I wanna also let you know the Physiologic Flexibility certification opens again October 13th. So if you want to be a lot more resilient, increase your body's ability to recover, be more anti-fragile.
This is the certification for you talk about everything from temperature pH changes. So pH changes would be certain breath techniques like WIM h or Turo. Also super high intensity interval training to expanded fuels. Talk a ton about ketones and lactate and then also how your body is regulating oxygen and CO2, and we tell you all about the high level ones.
We also include some stuff on temperature. So including sauna and coal plunge. So you learn the high level reason for this, why I think it is [01:47:00] beneficial. And then we've got a primer that's only about one hour on each area. So what does the current literature say about each one of these? So a lot of stuff on social media is not correct.
Shocker. And then we've got five explicit action items for each one. So you'll know the big picture about the concept of this. You'll learn all about each intervention based on the science. And we translate it into explicit action steps for you and your clients to apply. So the best place is to hop onto the newsletter.
You get the magnesium report and you'll get all the information there on the physical exert, which will open for one week starting October 13th, 2025. So newsletter's the best place for that. So thank you so much for listening. Really appreciate it. Big thanks to the guys at Absolute Rest. If you could.
Download this or subscribe or hit the like buttons. All that wonderful stuff really does help us get amazing guests like this and get better distribution of the podcast. So better distribution allows us to get [01:48:00] more bigger guests for you. So thank you so much. Really appreciate it. We'll talk to all of you next week.
Speaker 3: Well, that's talent. An opera singer who tap dances and sings cowboy songs. I wonder if there's anything she isn't good at. Yes. Choosing what shoe to be on.
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