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Scot: Troy, I've got a question for you. What was your sleep score last night?

Troy: You know, Scot, I did not calculate my sleep score. I know you're really into scores. But if a good score is 100, mine was probably about -10.

Scot: Okay. I had an 83 according to my Oura ring that I wear.

Troy: Well that's a good . . . That's passing. That's something you should be proud of.

Scot: Yeah. Last night, I only got 34 minutes of REM and 41 minutes of deep, and that stresses me out a little bit.

Troy: See that would just stress me out if I saw that. I'd look at that . . . I probably keep looking at it every time I woke up during the night, and I would just think I'm not getting deep sleep. I'm not getting REM sleep. I need to sleep. I need to sleep. I need to sleep. So I think it would just stress me out.

Mitch: It's so easy a baby can do it. But for those of us like Troy that may struggle with sleeping in one way or another, it can be stressful. Luckily, we've chatted with a sleep expert, and she's got plenty to talk about and, hopefully, it can help.

You're listening to "Who Cares About Men's Health," where we aim to give you some information, inspiration, and a different interpretation of your health. I'm producer Mitch. Scot, Troy, and I are taking a little bit of a summer break. So in the meantime, we've put together some best of episodes highlighting some of the very best moments over the past 145 episodes.

Today, we're talking about one of the core four that just never seems to get enough attention in the men's health world — sleep. Your body needs it just like air, water, food. But as guys, we may think it's something that we can skip over or ignore. I mean, you don't see many, like, cover stories on fitness magazines about, you know, 10 tips to get a better night's sleep. Instead, we say phrases like "I'll sleep when I'm dead," or be that guy on the job that brags about how little sleep he's had. I mean, I shouldn't talk. I have been that guy.

But sleep is vital to living your best life. And take it from me, someone who just a few months ago finally, finally went and had a sleep study, found out I had a disorder, got treatment for the disorder, and am finally getting a good night's rest in almost a decade. I cannot tell you how much easier things are in my life after a good night's sleep.

So to help us better understand sleep and how we can make some improvements, we spoke with Dr. Kelly Baron, a clinical psychologist who specializes in behavioral sleep medicine. She's one of my absolute favorite guests. And she has a knack for making a topic like sleep actually quite fascinating.

But enough of me. I'll let Dr. Baron explain to Scot and Troy the basics of good sleep from Episode 38, "The Four Rules of Rest."

Dr. Baron: Sleep is one of the most important things, well, important behaviors for both your mental and physical health. There isn't one system in the body that isn't affected by sleeping poorly. And that includes emotional health, like depression, things like reaction time, and cognitive ability, so that affects your safety in driving and safety at work. And then also things like the functioning of the cardiovascular system, risk for diabetes, for weight gain. It's a basic process like breathing, eating, that sort of thing.

Scot: All right. So how do you define a good night's sleep? First of all, how many hours generally do they say you should sleep to have a good night's sleep?

Dr. Baron: So the amount of sleep that's recommended by the National Sleep Foundation is between seven and nine hours of sleep per night. So when you hear eight hours, it's not really that everyone needs to get eight hours of sleep. In general, it seems that people need to be in bed to get at least seven hours of sleep. In a recent consensus panel, you know, they said that at least seven hours is really recommended for adults.

Troy: And that's crazy, Kelly, because you're saying, you know, seven to nine hours. And Scot, I think the statistic you read said 75% of people are getting less than six hours a night.

Scot: Yeah. According to a Harvard Medical School study, yep.

Troy: Yeah, that's . . . you know, obviously a lot of us are suffering from significant sleep deficits. And like you said Scot, I think for many of us, it really is sort of an ego thing or, you know, we just don't consider it part of our health.

Dr. Baron: I think what happens too is that people get used to feeling tired all the time. And they've shown that, over time, people's performance when they're sleep deprived continues to go down, but their perception of how sleep deprived they are stays the same. And so overall, people are just really terrible judges of how sleep deprived they are and how they perform under those conditions of sleep deprivation.

Scot: Are there other ways that you define a good night's sleep as a sleep expert?

Dr. Baron: Yeah, it's not just about the hours, but it's also about the quality of sleep, about the continuity of sleep, about the quality of how you feel during the day. So good sleep is not just one thing.

A framework that's been published by University of Pittsburgh, Dan Buysse's group there, they came up with this acronym called SATED that has to do with: Satisfaction, are you satisfied with your sleep; Alertness, do you stay awake all day without dozing; Timing, they have defined timing in sleep, good timing meaning are you asleep between 2:00 a.m. and 4:00 a.m., that your sleep period crosses those hours; the Efficiency of sleep, do you spend less than 30 minutes awake in the night; and then Duration and this one says, do you sleep between six and eight hours per night?

Scot: Is this a test that's available for anybody to take to just kind of get an idea of if they're getting a good night sleep?

Dr. Baron: Yes, it's available online.

Scot: Okay, great.

Troy: Yeah. I mean, it seems like that's something that is a little more comprehensive than just saying, "Hey, I was in bed for nine hours last night." And, you know, like you said, if you're tossing and turning and you're awake for two hours of that, and you're . . . it's interesting, too, that they include that crossing the hours of 2:00 to 4:00 a.m. as a piece of that. But I like that it is a lot more comprehensive than just saying, "Oh, well, I was in bed for nine hours. I must be getting a good night's sleep, but I just don't feel well rested."

Dr. Baron: But there are people who sleep a decent amount of hours, but if you still feel fatigued during the day, especially if you're having trouble staying awake without dozing off, there's something wrong there. That could be a sign that you're having sleep apnea or limb movements waking you up, you know, or something else happening that's affecting the quality of your sleep. But not just the amount of sleep, but it's the quality of the sleep that you're getting.

Scot: But what about people who say they do better on less sleep? Does that person really exist? You know, they're like, "Yeah, I only sleep four hours a night, and I actually get more done. If I sleep eight hours, I'm tired and slow." Like, is that really a thing?

Dr. Baron: Well, there are some case studies of, for example, some possible genetics that link some families that have this familial short sleep. But in general, the studies of short sleepers have not panned out.

For example, a study they did here at University of Utah that looked at short sleepers who said they felt fine, when they did fMRI scans, they fell asleep in the scanner. When they made them stop, they slept. Another study by Harvard, they had short sleepers spend more time in bed. They all slept longer, and their performance went up.

So I think really the difference is how you respond to sleep loss. Some people are more robust in the face of sleep loss than others. Some people are people who can continue to push on and that feel okay, but it doesn't mean that they don't need more sleep, it just means that they handle it better than others.

Mitch: So it sounds like sleep is pretty important even if you think you're someone who doesn't need a full night's sleep. So if you're having trouble getting a good quality seven to nine hours, what do you do?

Scot: Let's talk a little bit about somebody who doesn't feel like they're getting the quality of sleep that they need. Cognitive behavioral therapy, is that actually a good way to work on getting better sleep?

Dr. Baron: Cognitive behavioral therapy for insomnia or CBTI is the number one recommended treatment for chronic insomnia by the American College of Physicians. So it has a huge endorsement, as well as from American Psychological Association, etc.

The use of cognitive behavioral therapy, I said for chronic insomnia that means difficulty falling asleep, staying asleep, or waking up too early if it's happening more than three times a week, and that's going on for more than three months. And it's causing a negative impact on your life or functioning. That's what we define as chronic insomnia.

Scot: Okay. And what are some of the tenants of CBTI?

Dr. Baron: CBTI, it's abbreviated time-limited therapy. So it's typically around four to six sessions. It involves the combination of changing cognitions or thoughts about sleep and then changing behaviors. And that's using techniques to help regulate your sleep better, learning how to relax and fall asleep at night.

And I like to tell my patients, these are not rocket science. But when you put them together in a program, you can really see some substantial improvement in sleep. In fact, 75% or 80% of patients improve in their sleep. This includes improvement in people who have sleep problems along with other health problems, like chronic pain, or sleep apnea, or depression, or alcoholism. You know, other conditions that have sleep problems as part of them can even improve with these techniques.

Troy: That's great to hear. I was actually wondering that, you know, as you were talking like, well, you know, it sounds like it's a great technique, but you're saying 75% to 80% of people actually do report significant improvement with this. And it sounds like it's also maybe even potentially translating into some of these other issues as well, and maybe helping in other health issues or other things that have come up as a result of their lack of sleep.

Dr. Baron: It's a really wonderful treatment. That's one thing that led me to go into this field is that a couple of sessions and people are so happy. When you can finally sleep, you feel like life is better.

And so I've worked in populations, such as, you know, people who are undergoing cancer treatment or people who have some really severe developmental problems, also, you know, people with schizophrenia and some really severe problems, and they can still improve their sleep and feel better. And that is so important to improve someone's life.

But the biggest problem in CBTI is that there are only a couple hundred of us that are certified to do this type of treatment. So we're lucky at University of Utah. There's a couple of us here, myself and Dr. Czajkowski at the Sleep Wake Center. We're bringing in a new post-doc to work with us next year, who's going to expand our services.

And then at IHC, as well, there are people doing this treatment. So we're lucky to have a couple of us, but even there's like maybe four or five of us in the whole valley. You know, as a healthcare system, we have a couple of different ways to go through this. But, you know, for other people, especially people in rural areas, it can be really challenging.

There are some books. There are some insomnia workbook. There's CBTI apps that do offer this treatment. Interestingly, they've shown that this treatment, even delivered through a digital platform, not having a therapist attached to it can improve sleep significantly. It was shown to be not different than face-to-face CBTI in an equivalency trial, which is really cool.

Mitch: Cognitive Behavioral Therapy for Insomnia, CBTI is one of the most effective ways to improve your sleep. And there are books and apps that can help walk you through it. And if you want to dive deeper, we'll throw a link to a couple in the show notes. But Dr. Baron shared a condensed version, called the Four Rules of Rest. And let me tell you, I use these every night I'm having trouble sleeping.

Dr. Baron: So the group at Pittsburgh has titrated down CBTI to a version they called BBTI, Brief Behavioral Therapy for Insomnia. In that treatment, they had one session and one telephone follow-up, and this was conducted by a nurse practitioner. And what they taught people was they had them do a log of their sleep. And then they told people these four rules.

They said spend only the number of hours in bed that you sleep. So look at your log, how many hours you're sleeping, spend only those hours in bed. Number two, don't stay in bed unless you're sleeping. Three, don't go to bed unless you're feeling sleepy. And then the fourth rule is get up at the same time each morning.

You know, so when I have people that are, for example, coming in from Montana, or, you know, they're not able to come every other week or even once a month, these are the things that we talk about different ways to regulate your sleep. The reason that we do this is when people are having trouble sleeping, they feel tired all the time, but they're oftentimes getting into bed far too early. And so what we're trying to do is increase their hunger to sleep. It's this thing called sleep pressure. So when they do go to sleep, they're more tired, they're more hungry for sleep. And then by getting up at the same time each day, you're regulating your circadian rhythm or your body's clock.

Scot: So the challenge is going to be to kind of do that for the first few times, getting up super early in the morning, and then not, you know, taking a nap in between then and bedtime I would imagine.

Dr. Baron: I think that's definitely the challenge is. Most of the time we have people go to bed a little bit later. When people have insomnia, they get into bed earlier and earlier trying to get more sleep. And we actually say forget about that. Wait till you're sleepy, and then get up at the same time no matter what. And that's really hard. I mean, have you heard that don't stay in bed unless you're sleeping? Like who wants to get out of bed in the middle of night?

Troy: That to me is the hardest thing. I've heard that before that you shouldn't just lie in bed. But I feel like anytime I get up and I'm like, well, I'm up and I'm not going to fall back asleep. But it sounds like you're saying that's a better technique than what I typically do, which is just lie there, and I'm just going to lie there and just wait to fall asleep. And then sometimes I'm lying there for two hours.

Dr. Baron: All of these techniques will make your sleep feel worse before it feels better. And that's why it is better to do this as part of a program because, you know, I look at their log, and I'm saying you're on the right track or you're not on the right track. Here's what you need to do. Because it actually feels worse to get out of bed, you're more tired. You would feel better if you laid there tossing and turning for a couple more hours, but that's not helping you break the pattern of insomnia.

Troy: That's actually great advice because I think my approach has been to like try this stuff, and I'm like, "Well, that didn't help." But just recognizing that it's going to be probably a few weeks of this before you really see the improvement.

Dr. Baron: I can't tell you how many patients have said, "Well, Doctor, I've already tried that once. It didn't work."

Troy: Yep, there you go. You can add me to your list.

Dr. Baron: I like to tell them that . . . you know, it's like you don't say like, "Here's one blood pressure pill. Did it work?" You know?

Troy: Yeah, I'm kind of the type where like I've got to have immediate results. But you're exactly right. If I'm telling someone, you know, weight loss program or blood sugar reduction or something like that, I don't want them to do something for two days and come back and say it didn't work. You've got to give it a month or two at least.

Dr. Baron: I see this all the time. They come in, they're waking up at 3:00 a.m. In fact, this has even happened to me. Waking up at 3:00 a.m., thinking about the next grant or that sort of thing, and it just becomes a habit. So what I do is I get up and I read "The New Yorker." My dad gave me a subscription that came along with his. And there are these, like, wonderfully long, interesting, but not too interesting articles. It's really the perfect thing, in my opinion. I like podcasts too. So not to say that a podcast is boring, but, you know, it's kind of soothing.

Troy: So you're recommending that our podcast is potentially a cure for insomnia. That's kind of what I'm getting from this.

Dr. Baron: Possibly.

Scot: No, not ours.

Troy: Well, you know.

Scot: No, no. Not this one.

Troy: It's all right. If that's how we help people's health, then we've done something good.

Scot: That's other guy's podcast Troy, not this one.

Troy: Not this one. Okay.

Scot: Not this one.

Mitch: So four simple rules to follow. Sometimes easier said than done, especially the wake up at the same time, regardless if you couldn't fall asleep, and it's like 3:00 a.m., right? But hey, it's a great place to start. And if you see some improvement, I highly suggest checking out a full CBTI app or workbook. They really help me figure out a few things about my sleep schedule.

Now on the who cares crew, we each have our own struggles. And for Troy, sleep has been one of his biggest health challenges, especially with his type of work in the ER. And if you're chronically not sleeping well or having trouble falling asleep, it may be insomnia.

Next up, let's look at the sleep disorder of insomnia, what causes it, how you can tell if you have it, and some more strategies about how to treat it, from Episode 11, "How To Beat Insomnia."

Scot: Insomnia, how is that different from just not getting a good night's sleep?

Dr. Baron: So insomnia is defined as difficulty falling asleep, staying asleep, or waking up too early if it's happening at least three times a week. And if it's happening for at least three months, it's considered chronic insomnia. And insomnia also has to cause some sort of negative effect on your life or even just frustration over poor sleep. But, you know, if you're having awakenings and you feel fine, then that's not insomnia.

Scot: So insomnia is just an inability to fall asleep. You really want to, but you can't, and it happens two to three times a week?

Dr. Baron: At least three times a week to be considered diagnosable. Certainly, there's more mild forums or that sort of thing. You know, lots of people have a couple of nights a month that they have trouble sleeping. But if it's happening at least three times a week, then that's where we would flag it as a disorder.

You know, some people have insomnia that's just situational and it'll improve, like, you know, the first night before starting school, or that sort of thing, or going through a stressful time. But what we think happens is that, you know, people start with a predisposition toward having disrupted sleep with stress, and then usually something kicks it off, a precipitating event. And then what happens is insomnia gets a life of its own.

So it's like the stress over not being able to sleep, people become physiologically stressed out when they go to bed. If you've ever had that feeling where your heart starts pounding when you get into bed or you start to worry,

Scot: Yeah and you lay down, and you're like, oh, man, I just dread this because I'm not going to fall asleep. I'm just going to be laying here all night. There's just no . . . I don't even know why I'm doing this, that sort of thing.

Dr. Baron: Yeah.

Troy: That's the worst feeling.

Dr. Baron: And that's terrible for sleeping. You can't try to sleep. Sleep just has to happen. And so what happens is it gets a life of its own. And then people do things that make sense in the short term, like try to nap or have a little more caffeine. And then what happens is it makes your sleep worse, and it develops this pattern of chronic insomnia. And that's what our treatment addresses actually is the stuff that happens once you started sleeping poorly, basically.

Troy: And as you're looking at treatment, if someone comes in, like myself, you know, or someone who is not a shift worker, who has a regular schedule, and they tell you, "Hey, it's three nights a week at least I just cannot sleep. I lie there staring at the ceiling, counting sheep, counting numbers," whatever it is to try and fall asleep, what's your first step? Are you looking at medication with these patients or other interventions?

Dr. Baron: Well, I'm a clinical psychologist, so I can't prescribe medication. And actually, I end up working with physicians a lot to taper people off of their medication. So the main treatment that we offer for insomnia is called cognitive behavioral therapy for insomnia CBTI. And in the last couple of years, it's gotten a lot of press for how effective it is. And it's recognized by the American College of Physicians as the number one treatment for chronic insomnia. It should be a first line.

Scot: Really?

Troy: Before medication, don't even think about medication, try CBTI first.

Dr. Baron: Before medication. Now, I'm not totally anti-medication. You know, there are some people that have tried the CBTI, that didn't improve, or some people that prefer that route. And that should be a conversation with their physician about the pros and cons. But, you know, these medications, they've got side effects. They're not as effective for all patients. And then not only that, is a lot of people would prefer a non-drug treatment, if they could.

Scot: Is this a form of mindfulness then?

Dr. Baron: Not exactly.

Scot: Okay.

Dr. Baron: So it's a form of cognitive and behavioral treatments. So the main components are sleep restriction, stimulus control, cognitive intervention, so sleep-related worry, and some relaxation training. And so basically, we're trying to get people on the right schedule for their sleep need. And so we start by changing their schedule and then teaching them some techniques to relax and fall asleep.

We start by reducing the amount of time they're spending in bed. So it's not helping anybody to spend 9 or 10 hours or even 12 hours in bed and only sleeping 6 hours. That's just giving them all this time to worry and stress. So we reduce that time in bed and help them really feel that drive to sleep. It's kind of like the opposite of what they're trying to do, and it's very effective.

Scot: Because you can't force yourself to sleep. It just has to happen as you've told us before?

Dr. Baron: Right.

Troy: So let's say I'm someone who I'm hesitant to admit maybe I've got a problem here, but I think maybe I do, and I'm having some struggle with sleep. But it's tough for me to get that motivation to go into a clinic and meet with someone like yourself and go through CBTI.

Dr. Baron: So there are plenty of books and online resources. We frequently use some books like "The Insomnia Workbook." There's a book called "Quiet Your Mind and Get to Sleep." It's really rather well named. And then there's several different online versions. I'm not sure if all of them are available commercially, right now. But there's some online apps. There's CBT-i Coach. There's Sleepbo and ShutEye.

I think the benefit of meeting with somebody is that you can get a more thorough screen for other sleep disorders. So certainly, these online programs and the books, I've had a handful of patients pick them up before they came in to see me, and every once in a while they're cured before they even get in the door if my waitlist is long enough.

But, you know, these also, they take a lot of commitment. And like actually doing these techniques, like making yourself stay up later and get up earlier is really hard. And oftentimes, you have to do them for a couple of weeks before you see the benefit. And a lot of people give up on them before they've actually had enough time to get better. And so by the time they come to see me, they say, "I've already tried that." Like the whole getting out of bed when you can't sleep, have you guys tried that one?

Scot: Uh-huh. Yeah.

Dr. Baron: And nobody likes doing that. And so . . .

Scot: No, it's terrible. It's cold out there . . .

Dr. Baron: Right.

Scot: . . . when you're not under the covers.

Troy: Not good.

Dr. Baron: You'd rather just stay in bed and try to sleep. But actually, that's one of the most effective treatment techniques is if you're not sleeping, don't stay in bed, get up, watch something, you know, read a book, don't work, you know, don't check your emails. Do something else. Listen to a podcast, not this one, because this one is very interesting.

Troy: This one will not put you to sleep.

Dr. Baron: And then, you know, they come in they say they've tried this, and it turns out they tried it for a night or two. You know, you have to do this consistently. You've got to get up in the night if you can't sleep, and then get up at the same time, no matter what. And if you do that for a couple of weeks, you'll see an improvement. But if you do it for two nights, you'll just feel tired for those two days.

Scot: And I keep drawing this parallel between just health health. Like I can't go to the gym and expect that, one workout, I'm going to all of a sudden feel better, be stronger. And it sounds like sleep is the same thing. I can't expect that I get out of bed and try some of these things once and it's going to be better. It's going to take a few weeks. It's going to take some time.

Dr. Baron: I really like that. You know, sleep is really all about the pattern. And just because even you have one bad night, just like if you skip a workout or that sort of thing, you just have to get back on track. It's not about perfection. It's about trying to establish these good patterns.

And I think the most interesting thing is that I see people who are trying to do everything right, all the sleep hygiene things, no TV, blah, blah, blah, and they still can't sleep. And they're like, "Why can't I hack this problem?" And it's because it's not all within your control.

Scot: And I think another health analogy, tell me if this is right or wrong, is like sometimes you might need a personal trainer or a health coach to help you through some of these things. It sounds like you're my sleep health coach. Like you can make it a little bit easier. I could read the books and try to do it on my own, and some people are successful. But it's going to be a little bit of an easier path maybe with a professional to help me through it.

Dr. Baron: I think probably if you have a more severe sleep problem as well, that's really time to go and talk with a professional. So maybe it can be somebody who has diabetes and other health conditions and doesn't know what they're doing in exercise and really needs to go meet with a trainer to get on the right path.

Troy: So my take home from this is I need help. I've admitted it. I recognize my problems.

Mitch: And what about those sleep trackers, those wristbands or rings, or bed sheets, or whatever, these tech that we wear that gives us graphs about how well we've slept. Longtime listeners know that Scot loves numbers, especially when it comes to health. And his fancy tech ring tells him a whole lot of data about his sleep. But can those results be trusted? Dr. Kelly Baron shares some of the pros and cons about sleep tech on Episode 6, "Sleep Trackers."

Scot: So Dr. Baron help me understand. Should I take this with a grain of salt, or is this some good information for me? Or what?

Dr. Baron: Well, how do you feel when you look at this graph?

Scot: Well, the deep sleep thing stresses me out because it tells me that I'm getting below average for somebody my age deep sleep.

Dr. Baron: And then have you seen any validation of this sort of data? You know?

Scot: Well, that's why you're here. I'm looking for validation from you.

Troy: We need to validate you, Scot.

Dr. Baron: Well, there are so many tech sleep gadgets out there And there's not a lot of published evidence for most of them, and a lot of it is proprietary algorithms. So, you know, I wouldn't say that we know what these are actually measuring. I mean, I've had patients bring in graphs to me that aren't even labeled, and I'm like, "You're stressed out by this graph, but I can't even tell you what it's telling you."

So, you know, I like to think about these things as time in bed monitors at least. I mean, they can really measure like when you laid down or when you got up for the most part. But can it tell sleep stages? I'm not sure we really can say that at this time.

Scot: So I'm looking at this light sleep, REM sleep, deep sleep. There's probably no way that that's accurate.

Dr. Baron: Hard to say. I mean, it doesn't . . . Your graph right here doesn't look like a graph you'd see in a sleep study. So in a sleep study, we do in a lab, sleep is measured by EEG. That's how you define sleep stages by the EEG signature.

Scot: And that's the brainwaves.

Dr. Baron: Brainwaves, right. You know, there are several electrodes put on your scalp. Also measuring muscle tone and eye movement. And so what you're going to see across the night is alternating between REM and non-REM sleep. In the beginning of the night, you have a short period of light sleep, and then you go into more deep sleep in the first third in the night. And then the amount of REM you have increases in each of these 90-minute periods over the night.

So, you know, in that regard, your graph does show that you have your greatest amount of REM in the early morning hours. That's what we'd expect. But otherwise, it doesn't look like we'd expect to see in the lab. For example, it shows that you didn't wake at all between 12:00 a.m. and 4:00 a.m. In a normal sleep period, you're going to roll over. You know, most people get up once or twice in the night. And it's not picking that up. So it's probably not sensitive. And if anything, it might even be overestimating your sleep. And I really wouldn't trust the staging of it.

But on the other hand, I always look at the staging, and I think it makes a pretty picture. But then you're thinking like, "What am I going to do with this information?" So you don't get as much deep sleep as what it says. So I don't have an intervention for deep sleep.

Scot: Oh, there's nothing you can do about it even if I came to you and say, "I need more deep sleep"?

Dr. Baron: Well, there's a lot of variation between what percentage slow-wave sleep you're going to get per night. On average, somewhere between 3% and 10% in adults. But there are some people, especially older men, who might get 0% of deep sleep. And that's just normal sleep in an older adult. So it really doesn't mean anything is wrong with your sleep if you're not getting what this says you should be getting for deep sleep.

Scot: All right. So you're saying it's probably not super accurate because it's not using brainwaves, it's using movement, heart rate, temperature?

Dr. Baron: Totally.

Scot: Yeah, I mean . . .

Dr. Baron: And the bigger picture, I mean, I like sleep tech and that it gets people engaged in their sleep. They're interested in trying to sleep the right amount or trying to improve their sleep. I think that's good. But when people over-interpret these things and, you know, stress out about how much REM or how much deep sleep, that's really where they become problematic.

Troy: See, to me, this is like the equivalent in the ER of someone coming in and saying, "Wow, my heart rate is going 150 beats a minute. I can see it on here." And, you know, really, really, really getting worked up about this. And then we do all this testing, and it led to really an unnecessary emergency department visit, unnecessary stress. I don't know. For me, I think this would just stress me out. Like I know I don't sleep well. There's no question in my mind. I don't know how that would help me.

Dr. Baron: And maybe like 1 out of 100 times somebody would have something wrong with them, and this would sort of alert them.

Troy: Right.

Dr. Baron: And the same thing happens with these monitors. I'll have patients come in and say, "I showed this data to my doctor. He sent me for a sleep study, and it diagnosed my sleep apnea."

You know, at this time, these devices are not able to diagnose sleep apnea. Now, in the future, they are working on improvements in the oxygen sensors and that sort of thing. And it really possibly could diagnose sleep apnea in the population, or at least diagnose these periods of low oxygen in the blood, which could signal sleep apnea. And so that would be really awesome in terms of public health. But the tech is just not there yet. So I would really caution people in over-interpreting these.

On the other hand, you know, I use one. I track my sleep for . . . I've tracked it for pretty much maybe four years. As part of my research, I'm using these devices, and I'm playing with them and trying to understand how people use the data. But I've learned a couple things. I've learned if I don't go to bed before 10:30, I never get the seven hours of sleep that I'd like to have.

Scot: Yeah, just total time of sleep.

Dr. Baron: It's just, like, obvious. You know, it's a good benchmark for me to say, "Oh, yeah, right. I didn't get enough sleep. Okay, I need to go to bed earlier," and that sort of thing. Sometimes I look at the data and say, "Wow, that was a little better than I thought."

Mitch: So it sounds like there are some pros and cons to these devices. But would Dr. Baron suggests that the average person get one, someone like you or me?

Dr. Baron: I don't think the average person needs one to improve their sleep. But somebody who likes tech and gadgets, somebody who's interested in tracking things, it's not necessarily harmful. It could be helpful if it's motivating them.

We're using these in our research among short sleepers because we're trying to incentivize and encourage people to spend enough time in bed. I mean, basically, you know, like all of us, we're all just trying to do too many things. And we're watching that one extra show on Netflix or that sort of thing. You just need to go to bed like 20 minutes earlier.

And actually, a small change in your sleep like that, even just 20 minutes could improve your health. It can lower your blood pressure. It improves your performance. And it feels like a very small amount, but unless you're tracking it, it's hard to really make yourself do that.

Scot: So what I'm hearing from you is like the more specific information, probably not super valuable, but the more general information, much like, you know, my Fitbit tracks my steps as well, it gives me a picture of, oh, I'm getting to bed later than I should. Or I'm getting up later than I should, or my sleep time is not consistent, some of those basic things you would want to watch out for.

Dr. Baron: I think that's totally right. I mean, even in these clinical sleep studies, we look at the sleep architecture of how much percentage of this or that, and we comment on it. But there's actually very little that you can do about it if somebody is not getting any REM sleep. And even there's some drugs, for example, that inhibit REM sleep, like SSRIs or, you know, a lot of the common antidepressants. And so that's just a normal change that happens with these drugs. It's not necessarily a bad thing.

Scot: So that doesn't concern you. My sleep graph doesn't concern you. Like if I was come into your clinic and say, "Oh," you'd be like, "You're fine. Don't worry about it."

Dr. Baron: I would say, "Well, how do you feel when you look at that graph?"

Troy: She's not going to just say you're fine. It's like me seeing that same person in the ER. I would be like, "Okay, let's do some testing."

Dr. Baron: Let me see that again.

Scot: So you do want to take a second look at it. All right.

Dr. Baron: I just wanted to see what it said.

Troy: Yeah, we need to set you up for a sleep study, Scot.

Dr. Baron: Yeah.

Troy: Puts electrodes on your brain.

Dr. Baron: I mean, honestly, you know, so much of sleep, especially insomnia, it's about how you feel about your sleep. And we do these studies and call in healthy sleepers, and we look at their data, and actually their sleep looks so bad objectively. And the opposite, there's people who come in and say, "I'm not sleeping at all," and their sleep data looks so good. It's just amazing that there's a lot of interpretation.

Scot: Yeah. I would love to someday compare that to the actual gold standard of brainwaves to see, you know, how that matches up. Have there been any research studies that actually do that?

Dr. Baron: There's been plenty. And basically, they show that these devices . . .

Troy: Are useless.

Dr. Baron: . . . are often calling segments that you're asleep, they're calling you awake and vice versa. It depends on the settings. If it's sensitive, it tends to overestimate you're awake. And then if it's regular setting, it tends to overestimate you're asleep. I mean, haven't you ever had it like you know you're awake and reading on your phone, and it said you were sleeping?

Scot: Yeah. Yeah, that's happened a few times. All right.

Dr. Baron: I guess . . . I like to tell my patients that, honestly, it isn't very good at telling whether you're awake or asleep. So keep that in mind.

Troy: Doesn't sound super helpful. I'm not going to download the app.

Scot: Maybe I'll take the ring off and just go back . . .

Troy: Take the ring off.

Dr. Baron: . . . to sleeping without data.

Troy: Get rid of the ring.

Dr. Baron: I mean, I really want to get out there the idea that these things can be a tool. Just don't over-interpret them. I think that it's really exciting that people want to measure their sleep and that they want to improve it. I think that's a really good thing. And that's why I use them in the research because basically if we're going to make sleeping fun, this is one of the ways to do it, to gamify it. To understand the tech, to look at your patterns, I think that's really fun.

Scot: Okay.

Troy: It sounds like there's at least value in paying attention to your sleep, but don't read too much into it.

Mitch: Well, that's about all the time we have for today. Hopefully, you have some new information and tools to help you get a better night's sleep. And if you're interested in a more unique sleep story, I suggest you check out Episode 119, "Mitch's Sleep Troubles," where I share my experience of getting a sleep study and find out why Dr. Baron responded to my test results with an exclamation of "Holy moly."

If you liked anything you heard on today's best of episode and want to hear more, a list of episodes featured in this episode is in the show notes. And if you have any questions for our specialists or have a story to share, don't hesitate to message us through email at hello@thescoperadio.com. Thanks for listening and thanks for caring about men's health.