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Dr. Shah:
We have a Dr. Daniel Gartenberg and he is a, uh, a doctor in cognitive psychology has also been featured on Ted, uh, which is a huge accomplishment and tells you about all the things you’ve done throughout your lifetime, uh, to get, uh, featured and focus. There has, uh, a professor at Penn state, uh, and is the CEO of, uh, one of the most forward-thinking companies in sleep, Sonic sleep, AI, um, which uses a smartphone internet of things, the technology to detect sleep and make it even more regenerative and how to improve our sleep and quality of sleep. Um, he’s currently, uh, studying, uh, using some grants to validate his technology from the national science foundation and NIH. Uh, so, um, welcome. Uh, do you prefer to be called Dr. Gartenberg or Dan? What do you prefer?
Dr. Gartenberg:
Tommy, Dan, whatever you want, you call me a Anil.
Dr. Shah:
It’s all good. We’re I guess we’re both using, taken off our, uh, official, uh, hats.
Dr. Gartenberg:
Yeah. We’ll keep it laid back and really thanks for that introduction. I appreciate it.
Dr. Shah:
And, um, so, uh, we’re, we’re going to talk about some interesting areas that maybe you haven’t talked about before and, um, in the realm of beauty and sleep and all that. And, but before I jump into that sleep, um, how did you become so interested in sleep and why is it so interesting?
Dr. Gartenberg:
Yeah, so it’s a good question. I mean, what really captivates me about this topic is that it’s, that B it’s a behavior that we literally do the most stuff. Um, and I didn’t necessarily have like a major sleep problem. Um, but I kind of come at it more from the biohacker side of things, like the optimizer side of things. Um, and my thought when I was in college was sort of, if I could improve this one behavior that I do the most of it could have a massive impact on myself and also, you know, global health wise. Um, so in a lot of ways, this technology that I’m building, I’m trying to build it almost for myself. Um, like I would love to go to bed every night and get more regenerative sleep. Um, but then when I started diving into this, you know, I took like a neuroscience of sleep course by this famous professor at university of Wisconsin.
Dr. Gartenberg:
Um, Giulio, Tononi, um, I saw how much sleep impacted basically every chronic health illness. Um, and that’s what then has driven me into focusing this on this for the last 10 years. Um, and I was being in a quantified self back in the day. Um, and sleep is one of those things that, you know, a lot of quantified selfers and bio-hackers are really interested in. And right now, um, you know, I actually got reinvigorated into this about two years ago when I saw the sensors in these new cheap consumer wearables could finally accurately measure people’s sleep. And that’s where, how I got to where I’m at right now. Cool.
Dr. Shah:
Uh, and I’m noticing your ring. I’m wondering if you’re wearing the same ring as me, is that Nora ring? Yes. Yes. Cool.
Dr. Gartenberg:
Um, we’re, we’re doing like the same thing here. We’ve got apple Jordan,
Dr. Shah:
We both wear it. And I think that, um, so that’s kind of one of those things that people probably ask you a lot. Is there a difference in if someone’s saying I want to try to biohack and I just, I get both, there’s actually another one I’m going to talk to you about and to see your thoughts on that, but, um, ordering an apple watch any differences for, for us at home, if we’re tracking our sleep with it and which one do you prefer and why, and
Dr. Gartenberg:
Yeah. Um, so, you know, we have some what I call truth data to answer this question, and as you’re aware, that’s, polysomnography in a sleep lab. Um, and so we can see explicitly how accurate or inaccurate these devices are. Um, one thing that, um, one thing that became pretty clear when we were like comparing EK, like clinical EKG to the sensors of these devices, is that almost all the devices have very high correlation to clinical EKG. So my general analysis of these sensors is that they have very similar accuracy, the sensors, um, what differs is the algorithms. Um, so how the companies are using the sensor data to predict people’s sleep and sleep stages. And when it comes to that, um, you know, they’re pretty good at predicting sleep wake like around 90% accurate, but then when it comes to actually predicting sleep stages, it can go down to like 70% accuracy. And one of the problems with this is that as far as I can tell all the algorithms are population-based algorithms. So they can be like very accurate for one person. Um, cause it’s based on like basically a healthy population, but then it can get very inaccurate for other people. Um, and there’s actually a new term in the, um, sleep literature. You might’ve seen this New York times article about this ortho Somnia, um, w are you familiar with this
Dr. Gartenberg:
New thing? It’s but it’s basically like, and I, I come across this with my clients sometimes is like, they’re like, oh my God, my aura ring. And my Fitbit told me that I got two minutes of deep sleep. Um, and sometimes who are trying to optimize and improve already are kind of anxious about their sleep and getting that feedback actually makes the problem worse. So like ortho, Sammy, it was his concept that, um, some there’s some articles about, you know, people overly fixating on the feedback from the devices and that’s actually making the sleep worse. So oftentimes I’ll tell people that, you know, the sleep wake is pretty accurate, but take the sleep staging stuff was sort of a grain of salt and think about it in terms of relative truth, not absolute truth. Um, so, you know, for me, one thing that I know that I’m a healthy sleeper and I get like a normal amount of deep sleep cause I’ve been to a sleep lab and I’ve seen my polysomnography output. Um, and so when the ordering for example tells me that I got like five minutes of deep sleep, I don’t really believe it, but it does provide a relative signal to like when I got five minutes of deep sleep, I think I had relatively worse sleep than if it told me I got like 20 minutes, if that makes sense. Oh yeah.
Dr. Shah:
Yeah. I kind of fall victim to that myself where I’ve tried to track my sleep with multiple modalities. And I think sometimes I’ve sort of fell back to Morocco. Like I’ve, uh, probably over-analyzed my sleep to a point where I think that it’s something I shouldn’t look at it like second by second day by day and every statistic because I’m kind of a little bit type a and I think that’s a great rule of thumb, not just for it’s for most of us is saying, Hey, guess what? Let’s not get so fixated on a number here or there. Um, because I’ve fallen victim to that and saying, let’s focus on the general picture and all of that. Um, because,
Dr. Shah:
Um, and, uh, I think from again, from a non sleep experts that that’s mine, I put myself as a non sleep expert. I, again, I deal with more airway obstruction issues and less on kind of the science of sleep and that area. Um, I think the ordering is easier to follow, um, from that standpoint, because it kind of gives you a little bit more data as far as, um, dividing it up. And I like the sleep score. That’s what people think it’s a little hokey, but I kind of liked that sleep score. Um, I think the REM deep sleep aspect of it. And I think in the current iteration of apple watch it just because of battery issues and some of the apps that are out there for it. Um, again, it’s not really integrated quite yet. I think that we’ll, we’ll talk about where we’re Sonic sleep is going into that a little bit. It’s co it’s easier form function just to wear an apple, uh, for I’m sorry to wear an aura ring than an apple watch. Yeah.
Dr. Gartenberg:
So back to that, like I think theoretically, the ring has the most potential, um, in terms of the battery is a huge thing, especially when we’re trying to do like longterm measurements of people. Um, and so our whole thing is we’re just trying to integrate with the best devices. Um, apple watch is sort of first in our list, um, but like we’re, you know, going to integrate with every single wearable basically. And theoretically actually I think, um, the signal of your finger should theoretically be better than on your wrist. Um, but I haven’t seen that empirically yet.
Dr. Shah:
Um, and we’re talking about integrating and we’re talking about integrating for our listeners is with Sonic sleep and I use Sonic sleep. Um, and I can’t say I use it every night, but I use it actually probably about 50%, 60% of the nights and what I live in Chicago. And I think you live in, uh, normally you’re in New York city, correct? Yes, yes. Uh, and so there’s, I didn’t realize it until I kind of started, started diving into sleep, how much background noise there is. And again, I have a house with three kids. My wife stays up later than I do. Um, there’s always like someone’s turning on the faucet and they’re brushing their teeth. Do you hear a toilet flush all these little noises? They like, they can jar you and then you get off at your wife. You’re like, okay, she has to go to the bathroom, but I mean, you can’t tell her not to go to the bathroom because like, I need my, I need my sleep.
Dr. Shah:
So it’s, especially when I have a really important day in front of me. Like I have to have this up because it gives me, um, I think you refer to as like an acoustic Christian, is that right? Um, and it actually helps a lot because you kind of block out all that extraneous noise. You can actually hear sirens in the background over here. I’m not sure if you can hear it on your set, but, um, there’s always some bit of noise. So it helps with that. Um, and I try to correlate the deep wait. It seems like maybe my deep sleep is a little bit more intense when I put the deep wave modification on the Sonic sleep, uh, that maybe my numbers are usually around two hours and I might get like a two 20, um, you know, maybe a two third, something like that. So I might get that little extra boost with that. Um, so let’s talk about Sonic sleep. Um,
Dr. Gartenberg:
Yeah. And th and thanks for that. And that was one of the kind of surprising things. When I looked into, when we were studying this in the sleep lab, like we would literally see people’s brains turn on when, like your air, when the air conditioning in the lab turned on. So we actually had to go through all this effort to do like sound dampening in order to make sure that that wasn’t confound in our study. And that’s partly why the, um, acoustic cushion we’re actually calling it a sound mask now. So it’s a little bit more clear. Um, so that’s one of the reasons why that was one of the lowest hanging fruit things to implement in the software. And, you know, there’s a lot of like sound machines out there. I’m not going to claim that it’s like crazy innovative, but we have kind of, you know, we have like a, um, a guy in the team who’s a neuroscientist who’s specialist specializes in understanding acoustics.
Dr. Gartenberg:
And so we kind of made this specially designed, um, um, pink. You can think about it like white noise, but it’s like a special type of white noise to block out the noise pollution in your room. And so that’s sort of one of those low hanging fruit ways. I hate that expression, but I’m using it to improve people’s sleep quality. And then the other thing that you mentioned, um, the deep sleep stimulation is another aspect of the app. And that’s what we have our grant funding for, which is kind of this really interesting finding in the literature, showing that the brain essentially processes auditory information as electrical signals and that with different auditory cues, like you can play these special sounds at a certain time in people’s sleep. And it could actually prime more of these regenerative deep sleep brainwaves. And so when we bring people into our lab at Penn state, um, we have someone stay up all night and then systematically play these deep sleep stimulation sounds, and we’ll actually see their brains respond in a certain way.
Dr. Gartenberg:
Um, so we have it kind of based on, you can do it on an iPhone app, but we haven’t, um, we’ve only validated it when you integrate it with an apple watch. So we have like a little disclaimer on there that, you know, this really only works well when we can detect your sleep, um, stage, um, with an apple watch. And we have certain ways of being highly accurate for certain periods of time, um, using any sensor that has, you know, like the apple watch that has heart rate and motion data, um, to deliver this deep sleep stimulation. And basically in like two weeks from now, I’m excited for you to try this out. Um, we’re going to have the apple watch integration, so it’s gonna, it’s going to be much more effective.
Dr. Shah:
Wow. So that is awesome. Cause I’ve, I’ve been hearing about that, the integration and that is like the next step of like, cause people always want, um, quote unquote actionable events to happen with the devices. Cause like, what do I do with this data? And now you have a way to actually impact someone’s, uh, life.
Dr. Gartenberg:
Totally. And I mean, that’s the dream, right? Is that like, what do I do with this Fitbit data? That’s telling me X, Y, Z about my sleep. Like it’s hard to do anything because you’re unconscious. So the thought is what if we could actually use internet of things, devices, I E sound manipulating sound, and then also we’re going to get into lights and then temperature is a little bit down the line, um, to actually get more out of the sleep when you’re sleeping. So let’s talk about
Dr. Shah:
Some of these variables of light temperature sound, um, before we kind of jump into those, because I, I’m always obsessed with all these little details and like kind of creating a I sleep chamber and, um, you know, w so first talk about deep wave sounds. So the deep wave sounds, isn’t just kind of a random coincidence. There’s, there’s a, there’s a science behind these sounds correct. Um, there’s just specific amplitude and frequency and all that.
Dr. Gartenberg:
Yeah. So basically the idea is, and like, we’re not the first lab that showed this, there’s actually this lab out of Germany. Um, I can never pronounce the name. It’s NGO, um, is the author from 2013. And this actually started with zapping people’s brains with electricity in the frequency of Delta waves. And so Delta waves are the brain waves associated with deep sleep, um, which plays a role in like cell recovery, human growth, hormone, memory consolidation. Um, and so at first they were, while people were in a certain stage of sleep, I E deep sleep, they would basically zap the brain. And then they eventually showed that you didn’t have to zap, which is a little bit invasive. Um, you could actually play sounds at that same pulse rate. So I could actually like simulate it with my voice right now, but it’s all about the pace of the sound. Um, and so it’s actually pink noise at like 0.8 Hertz. And, um, when you’re in Delta sleep your brain, your whole brain oscillates between 0.8 Hertz and like two Hertz. And so we’ll put it in like, that’s like a little less than once a second, basically. Uh,
Dr. Shah:
So if you were to use your own voice, it wouldn’t be [inaudible] because that puts me into a deep drooling sleep of all.
Dr. Gartenberg:
Oh yeah. I mean, the sleep stories is another whole conversation. Um, but it it’s kind of like click, click, click, click. Yeah. And so it’s all about the, the, um, we call that burst, burst frequency, um, and actually the contents of the sounds, what we’ve seen in our study don’t matter that much. It’s all about the on-off at that rate, basically.
Dr. Shah:
Can you, um, thought process here is, do you think if you, if you gave someone messages during sleep, like if there’s subliminal messages during sleep and said, Hey, guess what, you’re a wonderful person you’re going to heal great. Or you’re some area you wanted to work on them. And so theoretically someone comes in and said, you know what? I have a fear of public speaking. Um, and then for a month or so you gave them messaging, would it work, not work?
Dr. Gartenberg:
So that’s the other cool side of this. And, um, maybe some of your listeners are familiar with the movie, uh, or with the concept of lucid dreaming. Um, and I was really obsessed with this movie in college called waking life. That was kind of all about that. It’s a, um, Linklater movie, the guy that wrote dazed and confused really cool movie. Um,
Dr. Gartenberg:
It’s really cool. You should check it out. But I mean, there is science showing that like lucid dreaming is a real thing. Basically people can be aware of the fact that they’re dreaming and then manipulate, um, what they’re dreaming about. And we just submitted this patent. That’s kind of getting at exactly what you were just talking about. Like, theoretically, we understand the science of how to play set, and this is like a tight rope walk, because if you play a sound too loud, it’s going to wake the person up that’s bad. Um, and so first and foremost, we want to make sure we’re not doing that. Um, and so, but we also, with the wearable know how to play the sound, so the brain responds, but it doesn’t wake you up. Um, so theoretically, and we haven’t scientifically validated this. So I’m being a little bit presumptuous and talking about this, but it’s really interesting.
Dr. Gartenberg:
And maybe other companies can, you know, explore this too, like all the power to them, but like, theoretically, you could play certain sounds while you’re in a dream state that would prime certain types of cognitive processes, whether it’s getting over fear of public speaking, you know, we’re thinking about it in the context of PTSD, um, um, and identifying, identifying these night terrors. Um, but there is this really cool scientific study getting at exactly this concept where basically you expose someone to a task while they’re smelling like bananas or something like this. And then you’ll replay that banana smell when they’re in a dream state and through Pavlovian classical conditioning. Um, it basically primes the minds to, um, recall that this is like not very strong science, but like there’s evidence that this can work and then they’ll do better in that memory task the next day, which is captivating. Yeah.
Dr. Shah:
Um, so that’s, that’s a whole nother area where that can, uh, expand and positivity and changing behaviors and some of the aspects and even learning. I mean, who knows if, uh, that’s even, that’s even possible to that aspect, but that’s just all, um, you know, fascinating and that’s, um, where we see the future of health is just kind of not just getting better, but getting, you know, you know, better in so many other areas and things that hold us back.
Dr. Gartenberg:
Yeah. Yeah. I mean, the wellness thing is like one of those big topics that, that, that got me interested in this space coming from a kid whose father told, was a doctor and told him never to be a doctor, like just seeing that medicine model of illness and kind of how dysfunctional it is. Um, so whenever we start getting into wellness, that really excites me.
Dr. Shah:
Um, is there a certain volume? You, you want people to put this Sonic sleep, we’re still on that kind of the audio aspect of it. Is there a amount of volume you like that, um, that to be at? Do you like it to be, you can barely hear it or do you like it to have it a little bit louder than not, or TV listing
Dr. Gartenberg:
Something? We just did a bunch of user does a good quick, thank you for this question. Um, we just did a bunch of user testing and on this, and that’s something that came out was people weren’t clear on what the right volume is to adjust the pink noise, the acoustic cushion. And so we are going to make it more clear in the next software update, but basically
Dr. Shah:
Whatever you find comfortable. Um, so like in my bedroom environment, I live in a noisy, lower east side, uh, apartment, um, for a reason, like I want to see if I can solve this problem with my technology. Um, and so I have like FA like one of my kids too, if you want to make it even more real.
Dr. Gartenberg:
Oh yeah. That’s that, that would be a good fidelity experiment there, um, crying kid and, you know, the sleep partner and like the dogs and the kids is oftentimes one of the, uh, major factors for why people are having problems. But, um, sometimes it’s hard to address or address that, but th there are solutions sometimes. Um, so anyway, you know, I have a fan going and so it’s already kind of a mask. And then I crank up the sound above the fan sound. Um, that’s just how I do it. And that’s how I feel comfortable with it. But the, to the easy, the simple answer is whatever you feel comfortable with in terms of perceiving the sound. I
Dr. Shah:
That’s less than TV, volume listening level, because I don’t want it to be like, I put it poppy, like if my normal TV is that like a volume of four or five, um, I like it at like three or two and a half. So it’s enough where I can hear it, but not so loud that it’s like overpowering things. So just enough to kind of get those low kind of sounds that’s right. I typically like it at,
Dr. Gartenberg:
Yeah. And that’s why one of the things that we see in the lab is that people have very different, um, threat arousal thresholds. And that’s not what it sounds like, but in sleep science, that means like the, um, basically people are sometimes very sensitive to things, waking them up, like sounds. Um, whereas other people like you can really blast a sound and a won’t wake them up. It actually has to do with something in sleep science called sleep spindles. Um, and the more of those you have the harder it is to wake you up from a stimulus, a stimulus. So there’s a lot of individual differences in this, and that’s why I suggest whatever you feel comfortable with
Dr. Shah:
Crying kid. My sleep sandals are like off the chart. I don’t know, like up, but I don’t wake up. My wife wakes up. She’s always thinks I’m just faking, but, uh, I’ll tell her it’s my sleep spindles are just like, uh, but she wakes up easier. Um, with that she can hear like a little whimper and she’s like wide awake.
Dr. Gartenberg:
Well, I mean, what happens sometimes with parents and I’ve talked to a few parents about this is you’re kind of in fight or flight response mode for a period of time when your kid is really young. Um, and then actually negatively impacts your sleep. Like if you’re in a high stress environment, your sleep quality goes down. Sometimes what happens is even after the kid can make it through the night and everything, you’re still kind of behaviorally
Dr. Shah:
In that place. Um, and sometimes you have to work on ways to try to deactivate that fight or flight and, you know, associate your bedroom with sleeping again. And that’s a major aspect of cognitive behavioral therapy for insomnia. This comes something called stimulus control. Um, so making sure that your bedroom is that relaxing environment that is conducive for sleeping. Great. And we’ll definitely want to dive into cognitive behavior therapy a little bit later. Um, but I want to kind of go through all these little variables. I have four. So anything else that’s that? I think that sound for me, it’s about having, especially if you’re a noisier environment, you definitely have to have it acoustic cushion, um, definitely have to, um, kind of control those aspects of it, put it at a volume that you’re comfortable with and then, um, uh, jumping over into light.
Dr. Shah:
Um, so people talk about, you know, blacking out lights, putting tape over things, getting rid of blue lights, all those aspects on it. Um, should you have the room totally dark? Um, what about having like light natural sunlight coming in in the morning to wake you up versus some people talk about having red light around? So any thoughts on light, w where do you want light to go? And I think one of the challenges I have is that I, if I have it completely blacked out what happens is in the morning, I don’t get that sunlight kind of like waking me up. Uh, my wife gets upset. She wants just a little bit of baseline light, um, so back and forth on light. So what are your thoughts on late?
Dr. Gartenberg:
Yeah, so basically what, like asleep first off, I’m not asleep clinician. I’ll just make it clear that I’m not a clinical doctor, but what a sleep clinician might say about this and what my professor would probably say is you want dark quiet. Cool. Um, in terms of the bedroom environment, the darker, the better, the quieter, the better, you know, and by quiet, we mean not like abrupt sounds cause the abruptness of the sound is actually the disruption part of it. Um, now it’s interesting, there’s some nuance to this. Um, and the professor I work with and his wife have done these crazy light studies, um, uh, Anne Marie Chang, and, uh, or fail Buxton, um, where they’ll like bring someone into a sleep lab, give them no light cues for like a two week period and then systematically manipulate light to shift their circadian rhythm. Um, because, you know, and I tell this to people in my sleep consultations, a really trying to convey how important light is.
Dr. Gartenberg:
It’s almost like the first drug that are any organism ever experienced. Like we evolved from bacteria in the ocean that could distinguish sunlight from darkness. Um, and that’s why like every organism has a circadian rhythm. Um, and so for humans, that rhythm is basically, um, 24 hours. It’s a little bit less than that actually, but you can shift it, um, with different light exposures at different times of the day. So you can literally, if someone’s a morning owl, you can shift them to be a night. Uh, if someone’s a morning Lark, you can shift them to be a night owl by exposing them to a lot of sunlight in the nighttime. All right, I’m getting on a garden path here, but, um, basically to answer your question, um, we have these receptors in our eyes that control melatonin, um, by sending a signal to a partner brain called the suprachiasmatic nucleus.
Dr. Gartenberg:
And that’s why it’s good to, uh, get that sunlight exposure in the morning. So it is a little tricky though, because you want the dark, but then you also want to wake up, um, with sunlight basically. That’s why we think that the solution is integrating with the smart light environment, um, Phillips you life ex bulbs. And so that’s another aspect of what we’re doing is so we have this really gradual alarm wake up, which is another thing that I think is, uh, it’s the right way to wake up. I’m a hundred percent sure of this. Like, you don’t want to wake up with that jarring feeling. Um, you want to wake up very gradually because that’s going to let you basically get a little bit more sleep that you probably need. Um, theoretically you should have no alarm clock at all. Right. You know, obviously that’s not always practical.
Dr. Gartenberg:
Um, but if you do have an alarm clock, at least use one that wakes you up gradually like in Sonic. Um, and so the right thing to do here for you, I think would be blackout blinds, but then integrate with the smart light to give yourself that cue to wake up. So it’s kind of like having your cake and eating it too. Um, and then the other thing that I think they’ve asked free really hit the nail on the head with this is the red light at night. Um, and there’s new science coming out. Um, basically showing that if you’re going to be exposed to any light at night, it’s better for it to be red and even some evidence showing that red primes fatigue. Um, so, you know, when I go into my sleep environment, um, I say, you know, Hey Siri, I’m going to bed all my lights turn red. And that happens 30 minutes before sleep. Um, and that’s also the kind of
Dr. Shah:
Turn red.
Dr. Gartenberg:
I use life X, but Phillips you, you can do the exact same thing. Um, and so our thought is we’re going to integrate with both of those eventually. Um, but next on our roadmap is the life X,
Dr. Shah:
You know, the other thing, um, some of these smart shades that go up and down, um, cause I don’t know that much about it. I haven’t gone invested in that aspect of it, uh, whether to put that my house is that that’s pretty complicated though. Right?
Dr. Gartenberg:
So yeah, I looked into it. It was just, if I had, if I was like a very successful startup, I’d probably buy it, but, uh, they were just kind of expensive. Um, but kind of down the, down the line, we’re, we’re, I’m going to think about that also. Cause it’s interesting. You, you could put them on a timer. I haven’t gotten into the nuance of how it could actually work.
Dr. Shah:
Uh, yeah. So that would theoretically with your Alexa set up like a scene or not, and then set that up to Sonic sleep say here’s like, here’s that? Um, but, um, because it’s the quandary, I think a lot of people are having, because you want this, the light, I guess you’re solving it with the Phillips you, cause now you’re getting, or the life X you’re getting the red light then dark and then that will wake you up in the morning as well.
Dr. Gartenberg:
Yes. That’s the thought. And then
Dr. Shah:
What do you wake up with? What kind of light do you like to wake up with? Is that where you go with just regular light or do you go with a different color?
Dr. Gartenberg:
Um, well in basically what I suggest to people is it’s not necessarily, you don’t need it right when you wake up. I mean, I think it’s good to get that light because it primes you to wake up basically. Um, but the big thing is to get enough sunlight during it.
Dr. Shah:
Okay.
Dr. Gartenberg:
Yeah. So it’s not, you don’t have to be like crazy vigilant about cause you want to give a spike to your circadian rhythm. So what I have and I make sure that everyone that I work with does this too, is we set up these 10,000 Lux because we work in a place that doesn’t get any sunlight basically. Um, so to counteract that we set up these 10,000 Lux lamps all around the office, um, to make sure that you get your dosage of sunlight during the day. Cause one thing I’ve noticed in the media, there’s been so much talk about, you know, th th the devices emanating light, which is hurting people’s ability to sleep, which is totally valid and true. But the other side of the coin is getting that sunlight during the day. And now that we’re like indoor computer animals now, um, it’s important that we are getting that sunlight dosage during the day and the happy lamps, if you just Google 10,000 Lux lamp, um, is a solution for that.
Dr. Shah:
Oh, great. Um, now with the temperature aspect, um, I actually think that’s harder to control than, um, some people give a credit for the things I’ve looked at, um, and interesting are like, like a chilly pad or a bed yet. Um, there’s also an Ember, uh, that’s out there and, um, you know, it gets kind of hot, you know, sometimes I think that the beds yet theoretically blows air on you, and sometimes that’s theoretically the weakness and that is getting you cool enough. Although the, just mixed on that, uh, I don’t, I don’t have any of these, so, um, chilly pad directly uses water and some of these can be somewhat integrated Volvo, not really, um, you know, with, um, they have like a thing you can kind of design yourself, which seems like that might make it more complicated for people. Um, so your thoughts on any of these devices and what’s the temperature, what should it be at the beginning? What should it be in the middle of the night and when you wake up?
Dr. Gartenberg:
Yeah. So the temperature actually. So when I think about the space, I think about when we think about like the actuators for temperature are a little bit earlier in the market than like speakers, you know, like every major hardware manufacturer has nailed the speaker form factor. And also the light is pretty like, well, treasure territory. Um, and those devices that you mentioned are the state of the art in temperature right now, the only one that I would add is, um, the eight mattress, um, which I’ve also tried out and I was pretty impressed by it. Um, very similar concept to the, uh, bed jet and chili pad, except it’s, uh, embedded it’s in the bed actually instead of a top instead of a topper. Nice. But, um, with the, uh, Ember is actually a risk-based one that is mainly used for hot flashes. Um, and there’s some efficacy in, I haven’t actually tried that one out.
Dr. Gartenberg:
Um, but it does seem like that that’s another option when it comes to the science of sleep here, here it is. So basically there’s, um, FDA approved devices that can cool your body temperature at nights that are shown to address insomnia. Um, so basically when you’re gone, when you’re falling asleep, your body temperature naturally falls. Um, so you can prime falling asleep with a colder environment. Um, and then the other part of temperature is that when you’re in REM sleep, you actually lose Thermo regulation. Meaning if it’s hot in your environment, your body gets hot and sweaty. If it’s cold, um, you know, you get cold. And a lot of times, if it’s not, if you’re in, if you’re either too hot or too cold, you’ll pop out of REM and that’s bad. Um, if someone wakes up in the middle of the night sweating, um, usually it’s in the second half of your sleep because that’s when REM occurs more, um, it’s probably, there’s something in your bedroom environment that you can do to optimize your sleep.
Dr. Gartenberg:
That’s a cue that I have, that there’s something that can be done in your environment to help you. Um, and so I’ve a black post, a simple solution is, um, when you’re having a sleep partner just to have multiple blankets. So I have this post called split blankets, not beds, all, uh, you know, Americans have this conception that we need to sleep in the same comforter together as a sleep partner, but like, that’s not the case in the Netherlands and other countries. So just having people have naturally different body temperatures. And just respecting that with different blankets is like a no brainer, simple solution. Um, when we’re getting into this deeper, theoretically, you could basically extend REM, which is a good thing, um, by delivering optimum temperature at certain times and sleep, but that’s very speculative and we have to do the science. They’re still,
Dr. Shah:
What would you want that temperature where you’d want it to be kind of in that 68 to 71, or it can be vary from person to person on that REM area?
Dr. Gartenberg:
Yeah, frankly, I’m not totally sure. Um, I think it’s going to be, have a lot of individual differences to it. I mean, like men naturally run a little warmer than woman and that’s probably going to be a factor like this is why sleep is interesting, but why it’s also such a hard problem is that the individual differences between people are massive. Like if you looked at like your sleep stages throughout the night, there’s similar from night to night to yourself, but very different from my sleep from night tonight. So it’s probably going to be like, you ha each person probably has their ideal REM temperature, um, where you could extend REM by priming that temperature basically.
Dr. Shah:
Um, it’s awful on my aura. So I, uh, I have to adjust, I have to get another blanket. I’m gonna tell my one. Um, uh, but it’s, yeah, my REM is awful. I have good deep sleep, but my REM is, uh, not good.
Dr. Gartenberg:
I wouldn’t necessarily, um, believe it a hundred percent. So keep that in mind.
Dr. Shah:
Okay. That’s one thing to know. Okay. Um, uh, we talked about temperatures, sleep exercise. Some of the other things that people talk about with sleep habits is, um, uh, besides temperature, bed angle, any issues with that, or is that going to vary from person to person? Do you notice that some people, is that gonna be more in the airway obstruction issue than actual sleep? Um, you know, kind of aspects in that?
Dr. Gartenberg:
Yeah. I mean, when it comes to like positioning and bed, a lot of this has to do with apnea and back issues. Um, you know, so when you have apnea, as you’re familiar with the soft palate, you know, blocks the airway, um, and, um, I don’t know what you recommend to your patients.
Dr. Shah:
So for me, I actually, I don’t, I don’t know if the answers are as straightforward as possible because, um, so there’s a, there’s another device that’s out right now called better. I’m not sure if you’re familiar with it. It’s called B E D D R. Um, and uh, the reason I looked at that device too, and actually I have that and I’ve been using it on myself is because I liked the ordering and I liked the apple watch, um, aspect of it. But sometimes, um, and there, it’s not supposed to be an everyday, um, device. It actually measures your pulse-ox and you’re like more like a sleep lab, like an RDI. And so for me, that’s kind of something I’m more familiar with than some of these other aspects of it. And, um, so you wouldn’t want to use it like every day, but sort of, uh, the first question I always ask, is it like truly apnea or is it like, um, cognitive behavioral?
Dr. Shah:
Is it, you know, temperature? Is it reg I mean this whole other category. And I think people probably fall a little bit into some of these categories and if they’re an apnea person, um, you know, if it’s a 300 pound person who has apnea is at night, well, their problems might be more, um, you know, physical. Uh, but if they’re a healthy person and they’re not sleeping, or they’re a person who’s maybe even five, 10 pounds and they’re, they’re, they’re noisy, there’s, there’s lots of different crossover and sleep is so complicated and every person is so different. So I measured myself with that better app a little bit, and I actually kinda like it because, um, you get a pulse Sox reading with it and you get, um, it’s not good for sleep stages and it’s kind of chunky, it’s kind of in their interest, but I think it would probably get better with time.
Dr. Shah:
And I, but kind of measuring that. Um, uh, so I, I put my bed at like a 15 degree angle, which my wife hated and I was getting more apneas than when I was at a flat level. Cause I think I was putting my head. So I, I think it’s such a variable thing. Is your head going to curl down? Is this going to happen? So I think that the airway obstruction aspect of it is I probably was doing a little of that, uh, um, psychosomatic sleep issues where I was kind of inducing myself to not sleep as well.
Dr. Gartenberg:
Well, I mean, what I’ve seen in the literature from this is you want to sleep laterally. I mean, like on your side basically is that,
Dr. Shah:
Uh, theoretically that’s better cause you have less, uh, less tongue retreats choosing things, going back left soft palette. As we get older, our tissues tend to distend more a little bit. So I think that aspect of it makes sense versus bad sleeping. Theoretically, it can be worse for sleeping. Um, uh, but, uh, uh, yeah, so that, that’s kind of that aspect with it. So I think that, um, that angle I think is gonna vary from person to person, um, uh,
Dr. Gartenberg:
The sleep apnea thing. Like you probably, you know, more about it than me, honestly. I mean, w w one of the things that, you know, the pulse-ox is definitely a SIG, like when we do our sleep labs, we screen, we have sleep studies, we screen for sleep apnea using a, uh, pulse pulse-ox I’m sometimes that people aren’t more familiar with these devices. I mean, it seems like such a first line of defense against this stuff. And if anyone does think that they might have sleep apnea, like it’s so noninvasive just to go to your general practitioner and get a pulse-ox right. Like,
Dr. Shah:
But the only problem with the regular pulse socks is typically they don’t measure it during the night. So, um, that’s why I think that app, cause usually I don’t think there’s a smart pulse-ox that kind of records it, maybe there is Michigan.
Dr. Gartenberg:
We, we use a known in device, it costs like 800 bucks. Um, that’ll say, yeah, you’re right. Like the cheap ones, you can’t do it throughout the night, but this saves the recording and then we’d go get a score where you want to be like above 90 oxygenation or whatever throughout the entire night.
Dr. Shah:
One is actually pretty cost-effective. I think it’s like $150. Um, they can go home with it. Uh, it syncs to your apple watch. It brings the data over there. And then, um, I’m not like investor or anything. I just literally just bought it online. Um, and then, um, it, it does, uh, it gives you an oxygen score, gives you an RTI score. And then, um, I try to correlate the ordering and the better together. And, um, you know, it, my thoughts are for patients who are pre-surgery versus post-surgery versus they clearly have, but the problem with this is it’s sleep is such a complicated issue that if it’s not an obstruction issue and they still have issues with sleeping so many times it falls into this huge other category of like, okay, well now what do I do? Um, and kind of some of the things that patients will try, I’ll kind of mention some things that I don’t think really work for sleep. Um, so one of the things they’ll try is like melatonin. Um, I think it’s good for resetting circadian maybe for jet lag, but does it actually do that or work with sleep? Your thoughts on that?
Dr. Gartenberg:
I mean, one thing that I came across is when I did a lot of research on this, um, there’s never been any scientific evidence that more than three milligrams is good. And a lot of times when you buy these things in the store, it’s like five to 20 milligrams, which is just not right. And that’s gonna make you feel groggy the next day. Um, you know, a lot of this is so individualistic and you’re kind of hitting on this a little bit, that it’s hard to give generic feedback. Right. Um, so I think you’re right for like jet lag. It can make sense in certain situations. Um, sometimes it’s just kind of like, since it’s the neg, the downsides of it are pretty small. Um, and I almost don’t want to say this because, um, it could hinder the effect, but I’m kind of a proponent in rubbing off of the placebo effect.
Dr. Gartenberg:
Like sometimes I’ll, I think that it’s kind of like people think that it might be helpful and then it becomes helpful. And I think there is something to that. So sometimes I, in certain situations, um, I might think that it’s okay for that, but I think you’re right. That generally a lot of times it’s not getting at the root of the issue. It can get at the root of the issue if you, you know, are really anxious about it and you feel like you need some external thing to help you. And at least it’s not causing that much negative side effects. If you kind of understand what I’m saying,
Dr. Shah:
I think kind of going into that aspect, almost all of the sleep medicine, like I’m an antique, even in my position, I’m kind of an, I don’t like to put substances in my body, um, unless they’re kind of in that natural element. Uh, and so even melatonin, I don’t like, like I’ll use it rarely when I’m traveling in jet lag, but other than that, I don’t want to be on it for more than like one or two doses. Um, a lot of the sleep medications that people thought were helping in the past, they find they’re just disastrous for sleep. Um, from seeing people on all sorts of sleep medications, like what, what kind of stuff does it do to their deep sleep, their REM sleep? They’re kind of like, is it actually, I mean, it’s sleeping eight hours with a sleep aid, worse, like asleep, they’d be in a medication then just getting four or five hours without one. What are your thoughts on that?
Dr. Gartenberg:
Yeah. I mean, unequivocally it’s worse. Right? Um, and there’s never been a study showing that sleep aids help in the long-term there’s only been, um, they’ve gotten FDA approval because they’re meant to be, to function in short-term situations. I E jet lag. And if you’re, you know, really stressed out and you know, you’re going to have a bout of insomnia or something like this. Um, and so
Dr. Shah:
Isn’t it worse? Isn’t it better just to get your, let’s say you’re stressed out to get the four or five hours then to take the sleep aid and probably not function the next day, your thoughts on that too, because that comes, it comes up to,
Dr. Gartenberg:
I think there could be instances where it’s better to take the sleep aids, the sleep aid. Um, but I got a certain, like there’s a certain point where, you know, if it’s, if you’re sleeping so much less, your sleep quality is going to be worse with the sleep aid. Um, but if you’re really sleeping so much less because of the insomnia, maybe in a very small window of scenarios, it could make sense to take the sleep aid periodically. And that’s the only way it’s ever been scientifically validated, but it’s not meant to be taken more than like a couple times a week. And there’s a really strong dose response to it and you get addicted to it. Um, and then also get all these doctors prescribe it off label for prolonged periods of times, which is not right.
Dr. Shah:
It’s a duty to the deep sleep and REM sleep on someone when you study them in a lab,
Dr. Gartenberg:
It hurts your, I mean, it’s just straight, it hurts your sleep quality. It hurts deep sleep and around,
Dr. Shah:
Uh, I, I can, sometimes we think of sleep as being this like, it’s, did I get seven hours? Did I get eight hours? Um, but it’s not just a quantity thing. Um, it’s definitely like, it’s a quality thing as well. And I imagine that you’re not going to get the same sort of qualitative benefits from this, right? Yeah,
Dr. Gartenberg:
Yeah. You’re a hundred percent. Right. And also like alcohol falls into this category too. Part of what’s happening is, um, it’s, it’s basically just like knocking you out. Um, so you have the perception that you’re unconscious, but your brain isn’t like fully unconscious, like it should be during sleep is a simple way that I think about it
Dr. Shah:
Versus sleep. They’re two different things.
Dr. Gartenberg:
Exactly. Exactly.
Dr. Shah:
You’re not really refreshed afterwards, but if you have good sleep, it’s a whole different story. You’re
Dr. Gartenberg:
Exactly.
Dr. Shah:
Um, so talking about, um, that, so I think the only thing that’s been proven to work is cognitive behavioral therapy is my understanding is that, so if you don’t have OSA, if you don’t have obstructive sleep apnea, um, and someone comes in and says, I can’t sleep. This is where this becomes such a hard thing to treat because now someone comes in and says, well, how do I treat it? There’s not a magic pill. We have established that. Um, there’s not. Um, um, so then it kind of falls into your lap and says, Hey, I can’t sleep. What do I do? And that’s it. Yeah.
Dr. Gartenberg:
Yeah. And it’s a hard problem. And when I talk about this with my professor, he, and he knows way more about this than I do even. Um, and he likes to speak about different sleep phenotypes. Like there’s probably, and the reason why cognitive behavioral therapy works is it’s designed to be a multimodal intervention that addresses the different phenotypes. Like if you have insomnia, it’s pro you know, it could be like five causal, different causal things that are making you have insomnia, whether it’s a circadian issue may because you’re older and your rhythm becomes less entrenched. Um, and now I would have a different set of solutions for that. Um, whether it’s, um, you know, a stress thing and then, you know, you start having insomnia and then you start associating. And so then there’s the stress causal factor. And then you, because you’re awake in bed so much, you start associating the bed with, um, being awake.
Dr. Gartenberg:
And so that’s why stimulus control works. Um, and the, so basically if we want to just talk broadly about what cognitive behavioral therapy for insomnia, is there stimulus control, associating your bed with sleep relaxation, um, you know, meditations, we have like progressive muscle relaxation in our app where you tend to different muscles in your body. And that’s been scientifically shown like learning how to not have an overactive fight or flight response, um, sleep hygiene, which is kind of, you know, the things that everyone talks about it almost everyone knows, you know, don’t drink, coffee goes to bed, don’t eat too close to bed. Um, that’s actually one of the, we usually use that in studies as a placebo cause it’s sort of the, um, lesser of an effect. Um, and actually the thing, and then cognitive training sort of getting over those maladaptive thoughts that can be, that can form around sleep.
Dr. Gartenberg:
Um, you know, like for example, like, you know, people’s stress like trying to address people’s thought processes of like, if I don’t get this much sleep, I’m gonna, you know, totally not be able to function the next day, like trying to get them to back off of that way of thinking, like the difference between sleep and lots of other things in Americans lifestyle is that like the harder you try to fall asleep, the harder it is to fall asleep, which is the opposite of almost every other thing. You know, the more I try to exercise the more effective it is. Um, so kind of shifting people into thinking about it like that. And sometimes I’ll have clients who like will meditate, do like three or four meditations. And they’re like, why can’t I fall asleep? And I’m like, you’re trying too hard. Um, you know, meditating is good and everything, but, you know, sleeping is about letting go.
Dr. Gartenberg:
And so that’s kind of what the cognitive training is about. And the thing that actually has the biggest effect size in the scientific literature, um, is something called sleep restriction. Um, and there’s also now sleep compression, which is a less severe form of it where say you haven’t Somnia, you’re sleeping. If you do this, you should really do it with a trained clinician. Um, you know, you’re only in bed for you’re in bed for eight hours, but you’re only sleeping five. Um, and by the way, what defines insomnia is spending less than 85% of the time in bed asleep is kind of the clinical definition. And if you’re doing that repeatedly throughout the week. And so what sleep restriction says is, okay, you’re only sleeping five hours anyway, let’s either move your bedtime really weight or move your wake time really early, you will be tired.
Dr. Gartenberg:
Um, and, but what will happen is we’ll consolidate your sleep. And the other part of this is no naps. Um, whereas if you were like an optimizer, I might suggest naps. Um, whereas if you’re an insomniac, um, or if you’re sorry, if you’re someone with a sleep problems falling asleep and staying asleep, you might suggest to them no naps. Um, and then once their sleep is consolidated, I E more than 90% of the time spent in bed asleep, you slowly move the bedtime back over like a two week period. And you do this with a slang, a trained, a sleep clinician, basically
Dr. Shah:
How many sessions does. So someone says, you know what, um, cause it sounds like a lot of people are going to fall into the second category of just, um, and having, um, CBD, uh, CBT, um, uh, how many sessions do you think most people require coming into each generic? I’m just hard to tell with every person, but, um, are most people going to be after three sessions, five sessions, and then when did they see improvement? You know, when they, when they become a, um, you know, kind of client, is it like after session two session one session five, or is this kind of one of those things that it’s, they’re going to probably need some follow-ups like a year or two years for, it’s probably just to kind of make sure everything’s kind of doing what it’s doing.
Dr. Gartenberg:
So all the signs, I mean, people will have different times where they respond, but all the science, usually all the publications that show that this works it’s over like a five week period. Um, so they’ll start out and, and each week the doctor would do different aspects of the cognitive behavioral therapy. So you might start out with doing like relaxation, um, and then you’ll introduce like, um, sleep restriction or sleep compression. And you’re rolling that out over like a five week period. What we’re trying to do is basically, um, you know, usually when you’re doing this, it’s only like our sessions with a doctor we’re trying to collect all this data in a way that a doctor, you know, we’re trying to build a software where someone, uh, maybe like you, um, or, you know, even someone that is in your office, um, could administer cognitive behavioral therapy for insomnia through getting the data from these devices. And it could actually
Dr. Shah:
Behavioral therapy. So I’ll raise my hand. I would refer them to you. So I would say, Hey, um, and then you could, you can do that to any person kind of anywhere in the world, correct?
Dr. Gartenberg:
Yes. Yes. So that’s the idea and there’s another software called Sleepio that is doing a digital thing. That’s similar. Um, but it’s not available to the general population where we don’t have this yet, but we’re going to try to make it available to everyone basically.
Dr. Shah:
So for our patients that kind of fall into that category where we ruled them out for a kind of an ed apnea aspect of it, the next thing is they need to see someone who’s an expert in sleep. Um, and so, and then the cool thing about this is if you’re doing kind of like we’re talking now, you can remotely look at someone’s place and you can see probably instantly, okay, this is a disaster and no one can fall asleep in this and then kind of saints that assessment. So cool. Um, so for some of our patients, um, with sleep, um, do you think you can actually become a more youthful with sleep aspect of it that can anti-aging aspect with it? Because a lot of our patients are looking for looking their best and they’ll try all sorts of things and medications and all that aspect. If you said to them, Hey, guess what I want you to, to age less, um, what impact do you think sleep would have on them?
Dr. Gartenberg:
I mean, it’s almost like common sense, right? Like haven’t you noticed when you’re sleep deprived, you have bags under your eyes. And like, people were thinking about this, like I’ve talked to L’Oreal about this too, and you know, other wings of venture companies and stuff like sleep is a way to look better and feel younger. Um, it’s responsible for self recovery. Like, um, you’re gonna look better if you sleep better. It’s not like a controversial statement, I think. Yeah.
Dr. Shah:
Yeah. And I think that, um, they have that aspect of, you know, snoring itself. There was like an age differential at some places I’ve looked at that for like, um, life expectancy. And I think there’s some correlation between sleep and, um, an age. And, uh, so it’s interesting that, um, uh, you know, kind of the aspect of it is it’s probably underappreciated if you’re, I think living longer with sleep, uh, that, um, I think, I don’t know how many years at the real scale, like if you don’t flush your teeth, you lose like six years of life. And I think if you snore, I think you lose, I think it’s eight to 10 years. So something of that nature,
Dr. Gartenberg:
The studies were untreated sleep apnea will take off five years on your life on average. Um, but, and another aspect of this is as you get older, um, you get less deep sleep. They don’t know exactly what’s causing what, but so theoretically, and that’s also associated with Alzheimer’s disease, lots of other things. Um, so one thing that we’re trying to do work towards in our next line of research is actually studying a 65 plus population seeing if by making them sleep more regenerative early, we can reduce their conversion to cognitive decline basically. Um,
Dr. Shah:
I’m not going to take any chances. So I’m going to try to get as much deep sleep as I can, whether it’s a, uh, natural or more than likely it’s going to be Sonic sleep induced with deep, uh, sleep. And, uh, having that integrated. I’m excited about that because, uh, it seems that, um, all these factors in regenerative and youth and having more deep sleep and keeping my, um, you know, my deep sleep, at least at two hours, even though it may or may not be as accurate. Um, so super, super, um, helpful information for me and for all of our patients. And, um, yeah. So, uh, thank you so much for joining us today and, uh, I mean, amazing, amazing information.
Dr. Gartenberg:
Thank you. My pleasure.
