118: Andrew Tubbs, MD/Ph.D. Candidate & Researcher: “Mind After Midnight”, How Your Mind Is Different At Night & How To Navigate It Powerfully

Welcome to the Sleep is a Skill podcast. My name is Mollie McGlocklin, and I own a company that optimizes sleep through technology, accountability and behavioral change. Each week I'll be interviewing world class experts, ranging from doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper.

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Let's jump into your dose of practical sleep training.

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And welcome to the Sleep is a Skill Podcast. My guest today is Andrew Tubbs. He is an MD PhD candidate and researcher in the Department of Psychiatry at the University of Arizona College of Medicine Tucson. His work really focuses on sleep and circadian rhythms and how they influenced. Suicidal thoughts and behaviors now, I think there's a huge kind of practical application from our conversation today because one of the studies that Andrew is a part of is really, really groundbreaking in starting to unpack how we can think about our.

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Mind as he calls it, our mind after midnight. Why is that important? Well, how many of us have woken up at some point throughout the course of the night or just didn't fall asleep throughout the course of the night, and you're thinking in a totally different way than the you of 8:00 AM might have been thinking?

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Well, it appears that there's some research to support the fact that we do think very differently in those evening hours and. Andrew helps us really unpack the why that this is, as well as some strategies of what we can do to kind of navigate this very real change in our brains at different parts throughout certainly the course of the day, but especially as the night progresses and late into the wee hours of the night and correlations between upticks in.

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Suicide rates, um, kind of depressive and anxious thoughts and some of the deleterious effects of, uh, this timeline for our brains and how we can help support ourselves by understanding that this is a real phenomenon, that there is some real science behind this, and then what we can do about it. So, without further ado, let's jump into the podcast.

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It is an honor to have Andrew Tubbs on the podcast. Andrew, thank you so much for taking the time to be here. Of course. Happy to chat. Oh, yes. This is gonna be really, really an important. Conversation, an exciting conversation for the research that you've really been behind that can make such a difference for the listener in understanding a whole other angle in at some of the impact that getting great sleep or, you know, really prioritizing sleep and the impact that this can have in many areas of life, including mental health and beyond.

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So, Really, really honored that you're here in the midst of all that you've got going on on your plate. So from that place, I wonder if you can just share a little bit of a background of how you even found yourself in this area of sleep and really pioneering some of this research as it relates to our understanding of the importance of sleep.

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Yeah. So I mean, I'll say off the bat, I, I got into sleep kind of as a, an accident really. Yeah. Uh, I was beginning my doctoral program, didn't really know what I wanna do. I, I actually was trying to work, uh, in a lab studying, uh, Neurophysiology and Rh acks. So monkey neurons, that was where I was gonna be and that didn't quite pan out.

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Okay. And so kind of at the last moment and I'm like, oh my gosh, I need a boss. I need someone who's gonna pay my graduate school time. Yes. You know, what am I gonna do? And I kind of fell into working with Michael Grander, who I think was previously on this podcast. Fantastic. A world round expert in, in sleep and cardiovascular health and so forth.

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And so he took me in, um, And from there it was just wow. Opening doors of possibility to all the things that I was interested in. Cuz my primary focus is in re and was at the time, uh, mental health. Yeah. So, you know, I'm completing my training to become a psychiatrist and I was like, okay, how, how does this sleep thing involve mental health?

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And it's more like, how does mental health not involve sleep? Yes. You know, it's like where, name? The ways that. Sleep isn't related to mental health. You can't name any. Yeah. So it was, the door was wide open for me to kind of explore that intersection between s sleep, mental health, uh, serious mental illness such as psychotic disorders and, and ultimately suicide, which is kind of where my research focus has, um, been the last couple of years.

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Wow. Well, Thank you for the work that you're doing. I shared with you before we hit record that a lot of my originating interest in sleep came from my own sleep breakdown and seeing really close family members go through their own mental health struggles and journeys as it related to sleep. So it's a personal mission that I have to share.

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Just the interconnectedness and the bidirectional relationship that we have here as it relates to really prioritizing this area and just. Beginning to understand and unpack our findings in the world of how much this is the place to begin. I would assert to really, really get up under any of those mental health concerns and prevent against any problems in that realm.

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So, Let's dive into some of what you've been discovering. You know, I've got to see lots of articles and things pop up. You've been trending in the world of sleep, so what have you been discovering that has been, you know, really noteworthy in this area of sleep and mental health? Yeah, so let me kind of give you the story as Sure.

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Please, of how this, this came to be. So, you know, I'm very interested in, in suicide as an outcome. Mm-hmm. It's like how do we prevent suicide? And that's a really tricky question. Um, because as much as it is a problem in our society, it's a small proportion, very, very rare behavior actually, compared to how many people there are, say, in the United States or in the West.

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So it's hard to track, you know, what are the common factors across this random group of people who seem to be committing suicide? And you have some very obvious ones, right? Um, mental illness that seems to be a, a, a pretty consistent factor. Um, but sleep is also a factor that plays in and, and poor sleep, disrupted sleep has been identified among a dozen other factors as one of these potential suicide risk factors.

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Now the way sleep, um, is usually thought of as contributing to suicide risk or rather bad sleep. Contributing to suicide risk is you don't sleep well and then your next day risk increases and that, and that kind of goes over a long period of time. So year after year after year after year, more poor sleep, more chronic insomnia, more nightmares, increases the risk cumulatively of committing suicide.

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But we also know now that suicide is kind of a. It's an acute phenomena by which I mean it, there's a lot of changes that happen very rapidly that lead someone to suicide. Most people don't spend a decade or even a couple of months writing out a plan and a note and organizing everything like some people do, but that's not the majority of suicides.

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There's data that shows that a lot of. Um, suicides, the time between decision to kill and time of death is something like an hour or two. Mm-hmm. Um, very, very quick precipitating behavior and so, so much so now that, uh, We know there's something called the or there's something coined called the Suicide Crisis Syndrome.

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This idea that people have an acute change in their ability to think and their ability to problem solve and their emotional regulation, and that acute change is what leads people to end up attempting or dying by suicide. So with that in mind, right, how, when you know the usual frame sleep is chronically, slowly contributing to people's suicide risk, and that's probably true.

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You know, there's good data for that. But if we know that a suicide is a much more acute phenomena, the hack happens very quickly, the question is like, well, is there a way that sleep could affect that as well? And my colleagues and I was very fortunate to get involved with, um, some collaborators. Michael Grander, I already mentioned Michael Perlis at University of Pennsylvania, Dr.

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Fabian Fernandez here at University of Arizona. And we were all sitting here and we're like, okay. What happens if you're awake in the middle of the night? What happens when people commit suicide in the middle of the night? You know, roughly 20% of all suicides that happen happen in the middle of the night, you know, around one to three in the morning.

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You know, is sleep playing a role in that phenomena? Because that would be what that implies if you're committing suicide in the middle of the night, is that you're awake. Yes. Right? Is that you're not sleeping like you should be. And maybe that sort of acute. Nocturnal wakefulness contributes to your risk.

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So is that okay? What does nocturnal wakefulness mean? What is this involved? Uh, I mean, half of it is sleep loss, right? You, you haven't slept enough, you haven't recovered from the prior day. Um, so all the usual ways that we think about sleep being necessary for brain health are at risk because you've only maybe gotten 2, 3, 4 hours of sleep at most.

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But then there's this other part, which is the circadian rhythms, and for those who don't know, a circadian rhythm is really just. An approximately 24 hour cycle of how things happen in our, in our lives. You know, during the day we're supposed to be awake because as visually oriented animals, we're optimized to be awake when the sun is shining, and we can see very far.

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And so we also need recovery time. So best to put that at night when we can't see very well in our chances of getting murdered by a predator are a lot higher. So if you're awake when you're not supposed to be awake, you're awake during that circadian period that's driving you to be asleep. Because your physiology is set up to say, okay, be awake at night or be awake during the day, but be asleep at night.

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If you're awake at that time, you actually have brain processes that are driving against you that, so it's not just that you have insufficient sleep, you have circadian, sort of regulated brain mechanisms that are pushing you to be asleep by inhibiting your cognition, by making you not think as well by disentangling the regions of your brain because you wouldn't need any of those things if you were asleep.

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So the combination of those two factors, right? The what happened, the circadian changes at night in your brain, plus the fact that you haven't had good sleep at night creates this risk zone, and we call this the mind after midnight qsy term, but it reflects this idea that. People who are awake when they're not supposed to be acutely, not supposed to be, may be at risk for poor decision making, for impaired judgment, for, you know, negative emotions that they can't regulate and, and ultimately for being impulsive and trying suicide and even, and dying by suicide.

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So that's kind of the, the process, how the story came to be and kind of the way we're thinking at it. Um, I'll make a couple of additional points, please. We have, we have epidemiologic data looking at, oh, I dunno, 70,000 suicides over the past 15 years. Um, and when you look at most of the suicides, again, only 20% of them happen at, you know, at night.

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In the wee hours in the morning between 12 and six, something like that. Um, the, the peak and per hour suicides is noon, but that's really a reflection of fact that more people are awake at noon. Hmm. And when we plot the data, you can actually see like suicide, you know, deaths per hour kind of track, sort of when most people are awake and when most people are asleep.

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So when we do adjusted analyses, we say, okay, accounting for how many people are awake, what's the actual risk of dying by suicide? And, and a way of thinking of this is like, If we expect a certain number of people to commit suicide at night based on overall suicide rates and who's awake and who's asleep, and what we observe is actually higher at night than we would expect, so we see an increased risk in the middle of the night for suicide.

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If we were just going off of population wakefulness based on who's supposed to be awake and asleep. So we, we've replicated that data in suicides. We've seen similar patterns, and people with suicidal ideation, they tend to be awake more in the middle of the night. Um, and in some of that other data. So we, we have, um, good evidence that there is this middle of the night phenomenon.

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It's not just conceptual, it's also in evidence. The other point I'll make is this behavior isn't this phenomena, the might after midnight isn't purely limited to suicide. Um, because in theory, any sort of bad behavior could be at greater risk, right? It may not be suicide, it may be homicide. I. We have some evidence that that's true, that people are maybe more violent at night.

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Um, it could be substance use. Um, heck it could be food intake, right? Sure. Nobody gets up in the middle of the night and goes to the fridge and gets broccoli. They get an ice cream cone or something like that. You know, it's like people make terrible decisions now. Just the variant, the variant of those decisions may change.

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You know, not everyone makes the same bad decision. Um, but what we're arguing is that the decisions people are making in the middle of the night aren't great. So interesting. And just the depth or the breadth by which we see the impacts of kind of this deleterious effects of poor sleep, uh, particularly in these evening hours.

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So I'm wondering if you can peel back the layers a bit more for us of. Understanding. Is this something that we can begin to spot in advance or is this outside of the scope of what you've been looking at? So understanding this, what are some of like those warning signs that we might be going down this path?

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Does this happen weeks and months in advance? Anything that we can kind of be on the lookout for to help support kind of this shift in our sleep regulation and minimizing some of those that fragmentation or being awake at the wrong times, basically. Yeah. Um, a couple of thoughts there. Okay. So I think the thing that I would encourage people to think about is actually people are very bad at assessing how impaired they are by their sleep.

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And there's a lot of good sleep study data looking at this. Particularly in driving, um, you can give caffeine, you can give all kinds of supplements or stimulants or whatever to rescue people who have been experimentally sleep deprived, and they'll tell you, oh, I, I actually feel pretty awake and alert.

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But you look at their objective performance, pretty garbage. Yeah. So, you know, if you're, if we're talking about acutely predicting, like, okay, am I slipping into the mind after midnight? Like, yes. Most people aren't gonna think that way. Sure. That's a level of metacognition that. Most people aren't in, myself included, aren't capable of even at the best of times.

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Yeah. And so you're asking people to do that at a higher risk level, the worst of times, but yeah. Yeah. So you kind of have to assume that this is a blind spot that okay. You know, if you're thinking to yourself, okay, I'm gonna be awake when I'm not supposed to be. The only way to defend against that really is to anticipate that you're not gonna be making good decisions, right?

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So if you're prone to binge shopping and you know you're gonna be on an overnight flight or some weird flight schedule, may maybe keep that credit card in your pocket. Uh, and don't pull it out for any reason until you've had a good night of sleep, cuz you just know you're not gonna make any good decisions.

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Sure. Whatever that thing you saw on, on Etsy is really, really enticing to you then. But just, just wait. Just get a good night's sleeps and then, and then try to buy it later. That's like, that's what I'm saying. It's like you just have to think about it in advance. I'm not gonna be making good decisions right now, so that'd be one thing.

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Um, as far as, I think another way that people can kind of. Worry about or integrate the mind after midnight into their, their lives is, is for shift workers. Really? Yes. Because I think the group of people who are pretty vulnerable to this kind of thinking are shift workers and you know, I'm in the medical field, residents, you know, go from day shift to night shifts over the weekend.

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So it's like two days and then you're gonna be flipping your entire circadian rhythm. Good luck with that. Yeah. Um, you know, so. Part of the anticipation there is going, okay, I need to be able to stabilize my circadian rhythm as quickly as possible so that it's helping me to be awake during the, the time that I need to be awake and asleep during the time that I need to be asleep.

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Um, melatonin is helpful for that. That's, that's just about the only thing melatonin is useful for is kind of adjusting your circadian rhythms. So I know when I was doing my overnight labor and delivery shifts, it was like, okay, ramp up the melatonin so that I can adjust so that I'm awake at night and asleep during the day.

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And then I did that continuously, whether I was, uh, working that day or not working that day. You know, if it was my off day, I was still awake at night and sleeping during the day to maintain that rhythm. So that when it was all over I could switch back to day shift and not be so disoriented going back and forth.

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And that helps minimize the risk of being awake at an inappropriate time when your brain's gonna make stupid decisions. I love that. Uh, I think everyone can kind of appreciate the sense of. There's likely a little light bulb, but that can go off of that fits. It just makes sense of, from a common sense perspective, but now to have more and more research mounting, to validate just how much we might not wanna believe the thoughts that are popping in our head in these certain hours that are occurring reliably.

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And it gives us a little bit more of a place to stand. To set us up powerfully so that we aren't getting swept away by the kind of poor thought patterning that might happen in those wee hours of the night and from that place. I love that you pointed to shift workers. We work with a lot of poker players in particular on optimizing their sleep, and certainly, you know, they've got sometimes for high stakes players, millions at stake, quite literally when at.

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The times of night that might not be so optimal for them to be making some of these decisions. And they're just a nice, you know, kind of group to look at of, uh, very on the ground effects of some of the importance of prioritizing our sleep at the right time and getting this workability even when it might not be the most optimal of times.

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And then we see that with shift workers, of course. So from that place, having been someone that has. Been in this world of looking at this research deeply, are there kind of takeaways that you're discovering or things in your own life that you are really extrapolating by, which it's shifted your own sleep behaviors or how you think about sleep and kind of this diurnal way of sectioning off our days by day and night and kind of behaviors that you might engage in?

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Have there been any kind of aha moments for you? Have there been aha moments? Well, I, I think all the research that I've done and, and I'll be the first to, to state that as a practitioner of these behaviors. I'm not very, you know, I study this stuff and that doesn't necessarily make me an expert at applying it, you know?

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I totally get that. Yep. Doctors are the worst patients, so it's like, you know, I know a lot about why I should get more sleep and that doesn't mean I actually get more sleep. Yeah. So for those of you in the audience struggling, you know, it's very normal. Yes. Um, I, I think what's been important to me is really just the emphasis on.

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Circadian regularity, which is a big word for being the same big Yeah. It was just really just routine. Routine is very important. You mentioned the, the poker players. Yeah. Um, very, very interesting phenomena. I think. I've only been to a casino once or twice in my life, and, and I don't know that poker's always played in casinos.

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Yeah. But what I noticed about casinos, if you ever walk in, there are no windows and there are no clocks, and the lighting is ambient constant. At all times of day, it's like a circadian prison. Mm-hmm. Um, nobody knows what time it is. And that's almost the goal Yes. For the by design casino manager. Right.

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It's like, sure. You don't wanna know how long you've been there because I want you to stay longer. Um, But the consequences that your brain can easily lose track of daytime, not just how long you've been there, but what time of day it is, and whether you're making good decisions or whatever. Yeah, I think may, you can fight that by using melatonin or bright light by maintaining consistent diet schedules.

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You know, eating regular meals at set times by socializing and then not socializing at times. Like those are very regulating processes that can help you to. To combat the untoward objectives of casino owners who want you to lose all your money at the tables. Um, the other population that occurs to me for this are patients with psychotic disorders.

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Yes. So for a couple of years, um, we have a first episode psychosis clinic in, in Tucson that I worked with, and essentially first episode is 15 to 35 people who are within five years of a, of an acute psychotic break. You know, the onset of schizophrenia, schizoaffective, bipolar with psychotic features. So, you know, I did therapy with that, that population for a time, doing cognitive behavioral therapy for insomnia.

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And almost universally, all of those patients have real difficulties with maintaining routine and consistency. Mm-hmm. Part of that's because of their medication regimen and I'm, I'm 100% in favor of antipsychotics for this population, so don't mistake my point. Sure. Yeah. But they're very sedating. Yeah.

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And so I'll have patients who will wake up and they'll be too tired to get out of the bed and they just lay there. And they can't maintain a rhythm because their medication timing is off. And so one of the simplest things I would do with people is let's adjust your medication timing. You know, let's move it up, move it back, let's change it around.

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Let's try it in the morning, in the evening. You know, something to make it workable. I. Socialization regularly. It's like, well, do you ever leave your house? No. Mm-hmm. Okay. Well maybe it's time to go outside in the sun. Turns out the sun's a really good way to know if it's daytime or nighttime, you know, and, and just basic stuff like that where it's like, let's wake up at the same time every day.

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Go to bed at the same time every day. Doesn't matter if you have a bad night to sleep. Don't compensate. And, you know, just roll out of the bed onto the floor. Even still better than laying there in the bed. You know, use bright lights, use food, use socialization, use melatonin to cue yourself to that regular time.

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And over time, that rhythm can help you engage with the world. And in, in, in my argument, you know, for the mind after midnight is it can also protect you against making terrible decisions and, you know, not thinking clearly and all the rest of it. Oh, absolutely. And thank you so much for bringing in that angle in our understanding of psychotic breaks and really some of our real fears that can come about from disrupted sleep over our extended period of time.

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So it's so important. Uh, I'm curious if you have any, uh, thoughts from, as it really, cause I know you mentioned antipsychotics and some of the importance that they can play any call outs around. Particular types of medications and how that might play a role in the mind after midnight piece, or do we need more research for that?

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I ask because we do a lot of people that reach out particularly about benzos and sleep, um, or Z drugs and you know, so if if it's something that needs more research, let me know. But just curious if you have any thoughts there. Yeah, so I mean, If, if we're thinking about the mind after midnight as an acute limited phenomenon, uh, sure thing that happens briefly in the middle of the night, couple of hours or whatever, taking a medication to treat that would not be my first approach.

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Yeah. So it's like, okay, I'm, I, I woke up at 1:00 AM I didn't need to be awake at 1:00 AM and now I'm really mad at the world cause my brain's not working. Right. Um, My best solution for that would be get back to sleep. Yeah. You know, it's like the first intervention would be just help people to sleep through the night.

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So cognitive behavioral therapy remains my, my primary approach. Yes. Um, now that's not always feasible. Um, and obviously if it worked for everybody or everyone could get access to it, we wouldn't really be talking about this. Yeah. Um, I don't like Z drugs. I'll just explicitly restate my bias here. I don't like benzodiazepines and I don't like Z drugs.

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Yeah. Um, I don't think that they're terribly efficacious. They are statistically effective, meaning compared this group to that group, you get a P-value and you're successful and you sleep better, and you look at the effect sizes and it's like 20 more minutes a night. Yes. I don't know that that's helpful for people and I don't know that it's worth the side effects.

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So, yeah. You know, there's some other more complicated metrics. We have newer medications now. These dual orexin receptor antagonists, I think they have greater promise for being useful. Um, they don't have the sedate the. Sedation kind of side effects of the Z drugs or benzodiazepines cuz they work by a different mechanism.

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I, I worry about people, this is usually a question more for older people who wake up in the middle of the night and they're still halfway through the halflife of their Z drug and they're kind of out of it and they go to pee cuz every old person goes to be in the middle of course night and they trip over the rug and they fall and they break their hip.

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Right? Very un. Desirable outcome. Yeah. I think like that kind of cognitive impairment from Z Drugs wouldn't help the mind after midnight and might make it worse. I don't have evidence for that. Sure. But conceptually it makes sense. I think the Doras, these dual orexin agents will. We'll be less prone to that.

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Um, but I think there's an even simpler, uh, intervention, if I'm being perfectly honest. Yeah. There was a very interesting study out of Japan some years ago. Uh, Japan is a huge suicide problem. Mm-hmm. Uh, I, I won't comment on why I think that is, it's kind of a pointless exercise cuz it's a very different culture than the one we live in.

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Sure. Um, but they have a huge problem and, and in Japan they don't have guns, they have trains. So people jump in front of trains. Yes. Um, So a public health intervention was launched. They put a bunch of blue lights out on the train platforms. Now their reasoning for this was that blue light would engage positive mood and that it would somehow improve people's mood.

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And so you see the blue light and you're like, ah, I don't wanna die anymore. Um, I maybe not that acutely, but yeah. Well, the funny thing about blue light is it's also the primary light wave that affects circadian rhythms. So yes, um, but turns out the sky is blue and, uh, when you, when it's blue outside, you know that it's the day.

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And what we know about blue light is it tends to activate the. Daytime circadian pathways that tells you that it's day out and you get that response. And I would be very curious to know if the effectiveness of this intervention, because when they did this, I'll back, I forgot to mention this. They saw a drop off in suicide rates by train after they, at the train stations where they put these blue lights.

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So they were actually helpful. And then they did a follow up study where they said, well, did people just go to different train stations and jump off of there? And, and that was not the case. So the people who. I guess war jumping off the train platforms did seem to get stopped by the blue light. I don't know that it's because their mood improved because they saw a soothing blue light, or if it's because they engaged a circadian process that woke them up.

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That's an experimental test that I would be very interested in conducting. But just that, that idea that like even if you can't go back to sleep, if you're really distressed, here's, here's my, my takeaway point about this whole Yeah, please. If you're really distressed in the middle of the night, right. And, and you're upset.

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You, you logged on to the, to the Facebook or the Instagram and you saw something that truly upset you. Some ex did something or whatever. Yeah. Right? Very common. Social media in the middle of the night never helped anyone. Yeah. Um, you see something upsetting? Maybe it's time to just fully wake up. Mm-hmm.

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Cause you're still in this twilight zone of not thinking clearly and not making good decisions, and you're too emotionally engaged to go back to sleep now. Mm-hmm. Like, maybe that blue light is the time that's like, okay, let's wake up, let's turn on, let's, let's get engaged. So I can think about this a little more clearly, or obviously step away, uh, you know, yeah.

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From poking yourself with the social media stick, but, That ki that might be the appropriate response too, where it's like, okay, time to engage. Don't let my emotional brain just run everything. Let's, let's wake up and think about this a little bit. And maybe that's what the blue light is doing in these suicide examples.

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Wow, that's so interesting cuz it's so flies in the face of what we might normally think about from a, you know, cognitive behavioral therapy for insomnia perspective, or just generalize. Oh, we wanna get our, we're trying to force ourselves back to sleep, which often doesn't work so great anyway. Mm-hmm.

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And we might think of, then we wanna be really, really mindful of our light environment. And yet, I like what you're saying in that perspective, do you think for someone, it's like you wouldn't necessarily be training to do that on the regular necessarily, but in an acute situation, you've had a hard breakup, a you know, lost a loved one, something very, very.

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Egregious is going on in your life that that might be a kind of out of the box strategy that we see could have some real evidence behind it to explore. Yeah, I definitely think if this is a scenario where every night you're triggered and you know we have issue, yeah, you know, you're gonna, we're gonna need to do something else.

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But it's like in those one-off moments where you're really upset, like you're just not gonna go back to sleep. And maybe that's okay. Right. And I actually think you're saying this is different from the normal C B T I mantra. I, I think it's kind of, I. I think it actually fits in, cuz usually with C B T I, the argument is get out of bed and stay outta bed.

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Bed until you're ready to go back to sleep. Yeah. And don't compensate for a bad night of sleep. Sure. So it's like you wake up in the night. And you find, you check your phone and it's like, oh, my wife just died. Right. You know, it was a car accident, freak accident. Some, some disaster happened. Yeah. You're probably not going back to sleep.

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Just engaged. It's time to wake, wake up and feel alert, you know? Yeah. And, and kind of work on that. And, and even if it's not that distressing, right. Even if it's not all that way to some mortal event, you know, sometimes it's better to just wake up and stay up and then stay up the whole day. Because you know you're gonna get a better night of sleep the next night.

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Yes. Right. Always, always the the mantra, don't compensate. Wait for next night you'll get a better night that night. And if not, na that night, then the next night, then the next. Yeah, absolutely. So, you know, I, I think it would be very interesting to see if the kind of poor thinking that we think happens in the middle of the night can be mitigated by acute blue light.

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That would be very interesting to try. Um, so, but my, my recommendation here, I guess is, is conceptual. That I think if you're really that distressed and you think you're gonna be in a bad decision, don't try to go back to sleep. Now's not the time. Distract with other work. Go engage. Try to wake up the rest of your brain so that you're not operating on two cylinders, thinking about suicide or whatever.

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Right. Yeah, no, that makes a lot of sense. And so I think that's the importance too. Cause sometimes we'll have people that get really locked into the rules that they need to be following as they're trying to get theirselves back to sleep. And then they'll say, oh, I know it needs to be dark and quiet and cold like a cave.

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And you know, then, They might be like kind of walking around their, their house and trying to force sleep to come and they've got all these rules up in there. Mm-hmm. And I love that you're kind of providing a framework that there are these times and it makes a lot of sense to really just accept what is there and really shift the viewpoint by which we're trying to force sleep to cut.

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So having said this, in the research that you've done, are there things that you're excited about going forward that you want to explore next? Or is that still kind of a, a question for you of what's ahead for next areas to research? No, I, I think there are a lot of opportunities. Yeah. You know, looking at the mind after midnight, there's a lot of ways that we can sort of investigate how true is this phenomena, how widespread.

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So I'll give a couple of examples. Like I said, I'm very interested in psychotic disorders. Yeah. And, and schizophrenia and so forth. And I have a sneaking suspicion that psychotic symptoms. Accrue more acutely in the middle of the ninth. Um, obviously it's not an issue if you're asleep, but if you're awake, you may be more prone to a psychotic experience.

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Um, this is even I think, kind of known with non psychotic disorders. If you just take a bunch of people in sleep, deprive them, they'll all start hearing voices and seeing things and, you know, having weird experiences. So, you know, I would be very interested in studying whether. Um, improving sleep and sleep regularity and continuity through the night.

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Not being awake in the middle of the night would improve overall mental health control and symptom control for patients with psychotic disorders. Um, cuz that might be a way to actually wean people down on some of the high levels of antipsychotics that they're on if they're being. You know, if they're having breakthrough episodes in the middle of the night, maybe they don't need a higher dose of their antipsychotic.

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Maybe they need better sleep control, something like that. Mm-hmm. So that would be one thing. Um, I think substance use is a huge, uh, opportunity. Um, not just because I think the national institutes of, uh, drug abuse have been a little, an ida, I think that's what it stands for. It's been a little more open to the idea that middle of the night is not helpful for, for drug use.

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Yeah. Um, we have some preliminary evidence that people might overdose more in the middle of the night. There's sort of a. Uh, problem with calculating how much drug you need and how, how good it feels. And so maybe you take two hits of, uh, fentanyl instead of one. I don't know how fentanyl works, but Yes.

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You know, whatever the, whatever the way it is, people might accidentally overdose more at night than they intend to because their brain's not firing all cylinder. So that could be an opportunity for an intervention. Hmm. Um, and, and really just understanding the brain mechanisms. I watch this works too.

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You know, one of my hesitancies to say, we can do this treatment or that treatment, we can do Doras or blue light, is because we don't really understand all the mechanisms at play. Yeah. We have hypothetical mechanisms. We have good circumstantial evidence that these are involved. But until someone recruits a a thousand people and runs them through a protocol where they wake up in the middle of the night, test their neurocognitive function.

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Yeah. Put 'em back to sleep. We don't know. And that's a very difficult study to run. Yes. So it's like we really need more evidence from scientists saying, we woke people up in the middle of the night and they were really stupid, and then we put 'em back to sleep and they were normal intelligence during the day.

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It was an extreme example. Yes. That would be a way of helping us understand, okay, here's what's going on and how can we. How can we treat it? Wow, so exciting. I can't wait for more to come out from what you're delving into. Really, really fascinating stuff. And from that place, I know people listening are gonna wanna know from someone like yourself that has put so much time, energy, and effort into this world of sleep.

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Uh, they're gonna wanna know how are you managing your own sleep? So we always ask four questions for people. Around the management of their sleep now. And so our first question is, what is your nightly sleep routine looking like at the moment? Well, right now, uh, usually involves I crawl into bed with my wife and we watch, I don't know, 30 minutes of TV or so, and then, uh, we turn out the light and go to sleep.

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Simple. Yeah, I like it. Just keep it simple, you know, kiss, you know, little stupid, don't overthink it. And that usually works pretty well. And, and to be clear on the numbers, you know, we usually go to bed by nine at the latest, usually a little bit earlier cuz we're early birds. I wake up at five. Um, I like the peace and quiet of the morning.

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Mm. Um, so it, it helps when you wake up super early to be able to go to bed that early. Sure, a hundred percent. Are there things that you're mindful of that you are watching when you're watching the tv, or does it feel like it's just, it's not impacting your sleep results? Uh, If my wife and I watch, so, so I'll make a comment about that.

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Yeah. The TV that we have in our bedroom is up at, on the far wall. I'd say it's 10 feet from where the bed is or where we're at. Okay. Um, so for people who are worried about, oh my gosh, there's blue light coming from the tv. Yeah. Uh, the blue light is a high frequency wavelength that dissipates rapidly.

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Yes. So at a distance to about six feet or more, you're probably safe. You're probably not really getting that much blue light. The blue light we're concerned about is, is from your phone, which which is in your face. Yeah. You know, right into your face, uh, with all the power of the sun. So I don't worry too much about the blue light.

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If we've watched something particularly engaging, uh, a horror movie or something, yeah. We might switch to something fairly benign. Uh, it's usually an alternate between the office and Parks and Rec, which we've seen a dozen times now. That's what my husband and I do too. Yep. Yeah, so it's like very familiar, you know?

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Yeah. Okay. Don't have to think too much about this. Um, so, but we don't leave it running after I go back to sleep. I love that. That's fantastic. We always call it, we have to wash off, we watch. That was particularly intense with often the office. Sometimes parks and rec for sure is just that lack of novelty.

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You know how that's gonna go. Mm-hmm. Feel good. Fantastic. And I love that you called out the distance by which we're exposed to that light. So I think that's a really important part that's often lost in some of the conversation of that proximity equaling the poison, if you will, to be dramatic. So really great.

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So the second question would be, what does your morning sleep routine look like with the argument that how we're starting our day could impact the, our sleep results later on in the night? Sure. I try to wake up by five, I think. I'm imagine that. Yep. And that's because I, I need the quiet time to myself.

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Sure. Uh, before my son wakes up, he's almost three. Okay. So you, you know, he's, he's in the portrait behind me here. Um, so, uh, you know, it's like I need that hour or so to just kind of have quiet time to myself. Yeah. And you know, I'll, I'll wake up and I'll stumble into the kitchen and I'll make myself a cup of coffee and then sit and have my quiet time.

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Mm-hmm. I think that, you know, people will debate, oh my gosh, you shouldn't have coffee so quickly. You know? Yeah. Uh, because, because, you know, maybe wait until you're actually tired to have coffee or whatever. Sometimes I do t decafs, sometimes I do regular. I can't. It doesn't seem to matter for me, so I don't spend too much time thinking about it.

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And I just have to say, I don't know what the magical bean water has done to me, but it's such a cozy, lovely experience in my morning. I get it. It's not gonna give it up. Yep. So, so you know, if there's some magical rule about. Drinking caffeinated beverages first thing in the day is not good for you. Oh, well.

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Yeah. You know, can't optimize every part of my life. Yeah, and that's a good one. I totally understand that feel good response that comes from just that warm cup. It's just great in your own time. I love that. And are you mindful too, when then the sun does rise and certainly you're in Arizona, lots of. Of sunlight opportunities.

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Um, is that something that you work into your morning when the sun does come up to be exposed to that? Or is it, uh, intermittent? How do you relate to that? Yeah. Um, so, so you mentioned that you're right. I'm in Arizona. So here the sun will get to you in every room of your house, even though it's a windowless interior room with the door closed.

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Uh, you just can't escape it. Can't escape it. Uh, I, I don't normally do anything about it cuz the sun makes its presence known so strongly. But, Uh, when I was on hospital shifts this last month, you know, we did 6:00 AM to 6:00 PM um, and I was getting to the hospital before the sun was, was getting up. Uh, I made it a point to sit, uh, for morning, you know, reviewing patient hearts and stuff to sit in a room that did have a window so I could watch the sun coming up over the horizon.

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That was important to me, not just because I enjoy the rising of the sun, but because it helps. You know, wake me up. Yeah. It's difficult when you're waking up at four to get to the hospital by six. Sure. Um, you know, and so it's like I, I made a point to be near a window so that I could kind of get that benefit of that light.

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And the third question would be, what might we visually see in your sleep environment on your nightstand, or if you're traveling, maybe via apps or ambience, s gadgets, supplements, anything in your space. Let's see. I, I, I guess the biggest one would be, uh, we have a white noise fan. Mm, like a literal fan machine thing.

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Yeah. Um, designed for the, I forget the name of the company, but, uh, yeah, part of that is I think, good practice. I think having a constant noise that filters out intermittent low noises, um, is good because. Uh, briefly, your thalamus, which is the gateway to your brain, filters out things and it's very good at filtering out things that are constant and don't change, but it pays attention to things that change.

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So, uh, when I hear people saying, oh, I leave the TV on and fall asleep at that, well, the tones in the TV change constantly. So even if you don't notice it, your, your thalamus is tracking it constantly. Um, and that's tiring. The white noise machine sort of subsumes the little creeks and groans of the house and all the rest of it, and is a constant noise that my thalamus can just filter out.

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And so I never think about it. That's really the most consistent thing that I have. I have a lamp so I can read the book. Yeah. Um, I, I, I have a smart watch, but it was cuz I was in a research study and they gave it to me for free. So I, I don't have any reason to keep wearing it or not wear it. I just like, oh, whatever.

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I like knowing the time. Yeah. Allegedly it. It can track my sleep. I never look at it. Um, I don't find it terribly more useful than my subjective experience of my sleep, which is usually fine. Sure. Yeah. And for, and to that point are for you with sleep fragmentation, is that something that doesn't happen often?

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I'm just curious if you, and if it. Does happen or if you have certain flare-ups of wake-ups. Is there anything that you go to in your environment that you utilize, given your research? I'm just curious if you have particular outof the box things, you know, a lot of people we speak with might have, you know, notebooks in a pen to write out their stressful thoughts or they have a spot that they go to in their, in their home or what have you.

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Is there a strategy that you have in particular? Yeah. So, so you're talking about just when people wake up in the middle of the night, they're like, yeah, given what you, your, your can't go back of knowledge there. Yeah, I'd say three things. Waking up in the night is actually normal, so normalize the experience.

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Um, everybody wakes up at night, just not everybody remembers it. This is a fundamental part of sleep is that we actually have to cycle through. So if you've awoken, that doesn't mean something bad is happening or the insomnia is impending. You, you've experienced what everyone experiences night after night.

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You just happen to be remembering it this time. Uh, I used to encourage patients to go to what I call the cozy corner, you know, and this was usually because they couldn't leave their bedroom or whatever. It's like make a cozy corner for you that you can leave the bed and be in and be comfortable. Um, For me, I, I'll come into my, my office where I'm sitting right now, and I'll sit in that green chair, you know, and like, just kind of fiddle around.

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You read a book or something, you know, that's a different, it's a different location, it's a different environment. I have a nice low light lamp, and so then I can kind of let myself get tired again. Um, I, for patients who have a lot of, or people who have a lot of, um, worry or anxiety Hmm. I, I actually would try to encourage, The strategy I would use for this is, uh, um, a scheduled worry time.

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I dunno if anyone's ever mentioned this before, or you, where you actually plan a time that you sit down and, and you, you think about all the things that stress you out and you, you write 'em out. And there's kind of a, a scheme to this, but it's like, I don't encourage people to engage with their fears in the middle of the night cuz they're not gonna feel like they're getting more control over them usually.

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Sure. They're gonna feel more out of control because you can't do anything about them in the middle of the night. Yeah. Yeah. It's like, must, must write that, you know, 30th letter of recommendation for whoever, well, I'm not gonna get going on that two in the morning. You know, it's, don't think about all the things you have to do.

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So schedule the worry time for the day. Um, and then I usually paired that with. What I called a mental vacation, which is a practiced exercise of going on a five minute mental vacation to wherever you want to go. You just sit and close your eyes and you're imagined, you know, you're in the beach. Mm.

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You're in the forest, and the focus is on the sensations there and Right. You know, it's like I hear and I see, and I smell and I taste. I suppose if you're out the ocean, you can taste the air. Um, you know, and so you practice that during the day so that scale is ready to you. And then at night, if you wake up and you're stressed, Deploy your pre-prepared mental vacation, and that can help reduce some tension too.

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I love that. Fantastic. That's very helpful. And then from that place, clearly, again, it's just, you just exhibit how much deep thought and practice has gone into this area of sleep. So I'm curious your answer on this last question, which is in your life currently, and you know this answer might change down the road, but what would you say has made the biggest change to your sleep game?

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Or said another way, maybe biggest aha moment in managing your sleep. I think it would really have to be, um, the biggest aha moment. It's really just that like, If you look at people who have difficulty sleeping, what are they doing? Well, they have this routine and that routine and this thing and that thing, and they have these elaborate rituals and all the rest of it.

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And you look at people who sleep really well. You go, you ask a couple, this is very classic. You ask a husband and a wife. Wife, what do you do to sleep? Well, you know, I do these 13 different things and I wrote chocolate crystals in my head and, and then you ask the husband and you're like, how do you sleep?

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And he goes, I just put my head on the pillow and I close my eyes. Yes. Right. I'm being a little bit of a stereotype, but like Right. That's usually how it goes. Good sleepers. Don't do anything to sleep. They just sleep. People who have poor sleep have usually overthought it. Mm-hmm. And they have all these excessive things.

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And that's kind of my aha moment for me, where it's like, if I'm thinking too much about this, it's now counterproductive. Mm-hmm. Because nobody actually goes to sleep by thinking more about sleep. You, you just let it happen. Never. Yeah. Uh, and so, you know, I obviously anxiety is a difficult beast to control.

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You know, how do you, how do you become unanxious? Right. You know? Yeah. Just don't worry about it. Has never worked for every anyone. Yeah. Um, but really that aha moment is like, okay, if I'm having difficulty sleeping, I'm trying too hard. Mm-hmm. And maybe it's just time to let it go. Yes. Oh, that's so wise to point to.

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Then Certainly it seems that there is argument that to be made or an assertion that there's that tendency for perfectionistic tendencies for people that are consistently dealing with sleep difficulties and the meaning that they're making out of these nights. So that's very, very freeing to remind just mm-hmm.

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To let it go. To accept how it is and notice what is it that great sleepers do. And they actually just let it be when it goes the way it goes. So important. And is there anything we left out in this conversation, anything that we didn't touch on that you want to underscore or as it relates to mind, the mind after midnight concept or sleep and mental health?

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Anything that we didn't. Discuss. I think that the, the big takeaway again is just if you can sleep through the night, great. Yeah. If you're not, be aware of your decision making, just know, know that you're not gonna be at your best game, even if you feel like it. You were mentioning earlier on about how the, this idea had kind of caught on a little bit.

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I'll just share a humorous anecdote. Yeah, please. Um, for some reason on Twitter there was this meme floating around of a golden sonic the hedgehog. Uh, with the quote you, like, none of your best thoughts happen after 10:00 PM or don't do any good thinking after 10:00 PM And it was as right as this meme was going around when we published our paper on this.

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So suddenly my inbox on Twitter is flooded by people with Sonic Avatars telling me that I've proven them right, and that science has come to their defense. Um, And I was like, this is a new experience for me. Okay. I'm glad I'm, I'm glad I'm here. Prove a meme. Correct. Yeah. Yep. Yep. So on the one hand, um, that, that carries that implicit knowledge that we all have.

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They're like, yeah, this kind of feels right. Yeah. One of those things where science proves that everyone already knows, but I'll say there's another part to this. Mm. Because some people were like, actually my best thinking happens in the middle of the night. I don't know what you're talking about. Sure.

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And I actually think this fits into the framework too, just briefly. Hmm. The Mind after midnight is about, um, Increased impulsivity, kind of disinhibiting that frontal cortex that controls all of your thoughts all the time. And for some people, when you disinhibit the frontal cortex, you get a layer of creativity that comes out.

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So as long as you're not distressed and you're not upset, and you're not overwhelmed, Some people may have really great thinking in the middle of the night. Very creative works of painting or writing happen at weird times because the brain isn't there to like filter out all of the creativity. So, It fits within the framework.

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And if you're one of those people who's super creative at two in the morning, good on you. Yeah, I think it still makes sense. And just be aware that your rational decision making isn't necessarily at its best. Hmm. That's such an important distinction too. So would you, for those people, would you have them experiment or.

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See what could be possible if they were to bring about a consistent schedule to their sleep. Maybe if they're dealing with kind of the rollercoaster, you know, letting, oh, I'm, I'm in a creative flow, so I'm gonna stay up late. I'm gonna write or paint, or whatever they do. Would you make the argument for them that there still might be benefit for them?

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Establishing a, a structure around their sleep and that they could still be without stunting their creativity, or do you think it's something for them just to be mindful of that they might not have all their faculties about them in a particular way? Is there any call out for them as they navigate that?

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I think it would just be to be mindful. Um, yeah, I, you know, if people are having a great time in the middle of the night, I'm, who am I to say, you know, go to sleep? Right. Uh, you know, I, I think it only really matters if it's causing a significant disruption. You know, this is the DSM escape line, right? You know, it's only a disorder if it causes a significant disturbance in your cognition and your life and your interpersonal relationship.

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So if you're, if you're fine with it, have at it. So good, so wise. Well, thank you so much. And where can people find you and follow this upcoming research that is to come and to explore the research that you've done thus far and just stay abreast of what you're diving into. Sure. Uh, you can always find me on Twitter at a tubs underscore sleep.

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Uh, I don't post there terribly often, but I do try to keep all the publications, uh, up to date on that point. And one day when I have time, I will actually put my website up and, uh, my goal for that would be to try to. Go through in a lay terms, explain what each paper says, and, and the code that I use. I'm very into statistics, so Ooh.

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I try to explain the actual code that I use to analyze my data. Oh my gosh. When do we think that might be coming? That sounds amazing. Don't wanna lock you into, it's probably be a while, but it'll be a, did anyone who's listening or watching this and, and sees a paper and they're like, how did he analyze that?

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Just reach out to me. I always share my code. I never, oh, that's, I'm always open source here. That's so generous. Ugh. Well, thank you so much for just your openness and your passion and commitment in this area. I've shared with you that I have my own personal connections, and I just know for listeners that all of us at some point experience some of these difficulties.

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To a greater or lesser degree with our sleep and experiencing just how that can impact our mental health. And it's just so, so important, the work that you're doing, and really all of us have, it's in some ways been touched by real severe mental health issues in some ways, shape or form, suicide. You mentioned bipolar, schizophrenia, oa, schizoaffective, psychotic instances.

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There's so much there. And so just the work that you're doing is so, so important. So really, really appreciate it. Of course. Thanks for having me, Molly. I appreciate you giving me the time to talk about it. Aw, thank you. You've been listening to The Sleep Is A Skill Podcast, the number one podcast for people who wanna take their sleep skills to the next level.

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Every Monday, I send out something that I call Molly's Monday Obsessions containing everything that I'm obsessing over in the world of sleep. Head on over to sleep as a skill.com to sign up.

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