173: Dr. Jeffrey Durmer, USA Olympic Weightlifting Sleep Advisor & CMO at Absolute Rest: Revolutionizing Sleep Care for Peak Performance

  Welcome to the Sleep as a Skill podcast. My name is Mollie Eastman. I am the founder of Sleep as a Skill, a company that optimizes sleep through technology, accountability and behavioral change. As an ex sleep sufferer turned sleep course creator, I am on a mission to transform the way the world looks.

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sleep. Each week I'll be interviewing world class experts ranging from researchers, doctors, innovators and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness.

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And I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health and by extension, allowing you to sleep and live better than ever before. 

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Welcome to the sleep as a skill podcast. My guest today is a two time guest and among his many accolades, he currently stands as the sleep performance director for the United States Olympic weightlifting team. So yes, he is the sleep coach for the United States Olympic weightlifting team. No big deal.

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But let me just read to you some of his other accolades. Jeffrey Dermer is the Systems Neuroscientist, Neurologist, and Sleep Medicine Physician. He earned his MD and PhD in Systems Neuroscience from the University of Pennsylvania, is the past director of the Emory University Sleep Laboratory. and Pediatric Sleep Medicine Program and co founder of Knox Health, a population sleep health care company based in Atlanta, Georgia, and Knox Medical, a leading sleep technology firm based in Iceland.

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He is a member of the NIH Sleep Disorders Research Advisory Board, serves on the board of directors of the RLS Foundation, is chair of the American Academy of Sleep Medicine, Sleep Medicine Foundation Development Council and is, as I stated before, the Sleep Performance Director for the United States Olympic Weightlifting Team, along with many other professional and elite athletic organizations.

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Currently, he is the Chief Medical Advisor of Absolute Rest, a tech enabled, high performance sleep health and behavioral management company. We get into a lot of topics in today's podcast. We look at the current state of sleep care as it stands today and look at new possible ways of exploring this area of our health.

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Beyond that, we also go in more deeply on this topic of absolute rest, this tech enabled high performance sleep. sleep health and behavioral management company and look at new and innovative ways of using sleep for performance. And I think, you know, that over here at sleep is a skill that is our commitment is understanding and utilizing and harnessing the power of sleep optimization to get you your best life, the best version of yourself and using sleep.

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Sleep as a catalyst for that. And Jeffrey goes into that topic and so much more. I think you're going to really enjoy this conversation. Now let's jump into the podcast, but first a few words from our sponsors and please check them out. They are what keeps this podcast alive. So go to their website, check out their offerings.

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We only partner with companies that we truly believe in. So truly just take a second to look them over. It really helps out the podcast. If you're listening to this podcast, you're likely looking to improve your sleep. And one of the first places that many people begin when they talk to me about sleep is they want to know what's the supplement I can take.

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Well, I got to say, I honestly don't take that many supplements nowadays for my sleep. And I'm very grateful for that. A lot of things you can do for free. However, one of the supplements that I do consistently take and have taken for ages is magnesium, specifically magnesium breakthrough. It's an all natural supplement that helps you reduce fatigue and sleep more peacefully.

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com forward slash sleep is a skill. And I think you're going to be pleasantly surprised by the results. And welcome to the Sleep is a Skill podcast. I could not be more excited for this guest. He is two time guest on to Sleep is a Skill podcast, incredibly honored. Thank you so much for taking the time. 

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My pleasure, Molly. Great to be back.  Yes, thank you.  I know that your time is valuable. So I am just thrilled to have you here today. And we're just going to be tackling some big topics today. So just hitting the ground running. Well, maybe we can just take a little moment to share. Some of the things that you have coming up.

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I know that you're connected with the Olympics just for further context for who people are listening to this, you know, incredible expert in the area of sleep. So maybe just a little bit about what's coming as it relates to the Olympics and sleep and then we'll get into some of these big topics around this next chapter that we see for sleep care.

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Yeah, absolutely. So for the last, um, probably about six years or so, maybe seven or eight, um, I've worked with the U. S. Olympic team, especially the weightlifting team and a few of the other, um, small group teams, uh, as well in the national teams to help them, uh, plan for major, uh, competitions, but also how to, um, utilize sleep as a component of their training, um, and also utilize circadian rhythms as a way to, um, optimize.

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Their performances. And, um, so last time around the 2020 Olympics, which actually was 2021 because of the COVID pandemic, we established a, uh, a camp in Tokyo and actually in Honolulu, Hawaii for about three weeks before the games for all of the weightlifters to come in and actually adjust their time period so that they were actually weightlifting, eating, sleeping, living on Tokyo time.

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And then they flew to Tokyo, had their event, and then quickly left Tokyo because they weren't allowed to stay in country for very long after, uh, their events because of COVID. Um, and it, it seemed to be a really, first off, it was the first time that ever was done. Sort of an experiment of the coaching staff.

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They were like, yeah, Jeff. Go for it. Yeah.  And I think it actually worked out quite well. We did very well in our competitions. Again, it wasn't because of this, but I think this was another component of the optimization of performance. And a lot of the, um, lifters that I worked with directly had, um, significant changes in their sleep patterns that I think.

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underlie their, their performance across the entire period of time we were working together, not just the Olympic, uh, the Olympic trials and then also the Olympic Games. Um, and this year is now, as you know, in Paris, France. So a very different, uh, for U. S. uh, Olympic athletes, a very different venue because instead of flying from east, from, from where we are west to east, which, uh, it turns out to be an easier way to go because you're actually Um, we're sorry, we're going, we're flying to the west, but I'm going to the east.

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That sounds strange, right? So from the U. S. all the way to Tokyo, um, first you're traveling across dateline, so it's another day difference. But more importantly, we don't perceive day, we perceive time of day. And so that means that we had to delay all of our athletes so that they could be on a timeline that was.

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behind them in a sense, even though it was a day ahead. Um, biological time, it's a little bit behind. Versus when we go over across the Atlantic, now we're actually advancing. We're going forward in time. And it's much harder to go forward in time. So a lot of the recommendations this time around were Because we don't have COVID restrictions, which is nice to fly the team over there early.

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And  what we say is that every time zone you travel, the rule of thumb is you need about a day to adjust. And so if it's a seven hour time zone shift for some people in the United States versus six hours or five hours, depending on where you're coming from, we need to be over there at least a week. To two weeks early, and luckily, that's what we've been doing.

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So  just like, um, you know, the U. S. side, uh, the U. S. Sorry, the World Rowing Championship just happened in Lucerne, Switzerland last weekend. That means the rowing team is already in Europe. And so they're going to be rowing around Europe, uh, and trying to stay in the time zone as long as possible. Same thing's true with the weightlifters.

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Same thing's going to be true with, uh, multiple teams. The fencing team, for instance, is also going to be there.  So that's the big, the big difference this time around. The other part of what we do is we optimize their sleep itself. So sleep disorders, which is very common in our, in our patients. population is even not that uncommon within athletes.

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So young healthy athletes also suffer with sleep issues. Sometimes they're familial issues like restless leg syndrome. Others are kind of induced by their environment. Insomnia is different kinds of insomnia that can be performance based. So we work a lot with the sports psychologists to integrate care that way.

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But then also there are People who are just very much high strung and close to that insomnia line to begin with, and they have problems with insomnia routinely, even outside of their competition times. So, approaching those issues, and then finally, some of the bigger bodied individuals are like our football players.

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type size people, uh, NFL type football players. They tend to be, um, uh, more prone to things like sleep disorder, breathing or sleep apnea, just because of the bigger body making the work of breathing more difficult and sucking that airway closed, which we all do to some degree. So it just turns out to be much more of an issue with that population. 

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And, you know, treating some of the larger bodied athletes for their sleep apnea actually has been, I think, also revolutionary in some of their cases, um, and really changed just their perception of effort as well as their recovery periods. So, those are the big things that we really kind of take care of initially, um, which is kind of interesting because this is not something that Is integrated into regular health care, which is kind of the issue I wanted to bring up today.

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Absolutely.  Yes. Thank you. The perfect segue. Maybe we can begin with that point of what do you see is not working currently as we kind of embark on this conversation of current sleep care as it stands today? Well, it's, you know, unless you're an Olympic athlete and you have somebody like me working with you every day.

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Yes. You really, all you have access to is what's on the internet. Or what you have from your healthcare providers and your medical, your medical team. And, um, unfortunately that it's, it's not a very, um, integrated  system within our healthcare system to have sleep medicine or sleep healthcare as part of your routine healthcare.

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Typically, when you go to the doctor, they screen you for stuff, right? You go and make sure that you don't have, uh, signs of cancer. They check to see your blood pressure is under control. They ask you about your diet. They even ask you about exercise. But very often you don't get asked about sleep. And that's often because the doctors themselves don't know what to do with sleep.

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Because their training in medical school, in terms of prevention, um, is now starting to include sleep. But prior to the last few years. Literally the average medical student would get about two hours of training Yes. In their whole educational career on sleep medicine or on sleep itself. So yes, when I was, uh, uh, I was at, um, part of the neurology department at Emory University for a number of years, and also at University of, uh, Pennsylvania.

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We got, I mean, I got to teach the neuroanatomy or physiology of sleep and the sleep disorders section, and I get an hour for each. And that was all I had for the entire. You know, lifetime of those students, and then they wouldn't get that as a rotation unless they elected to do it as an elective, and many of them didn't have time to do that as an elective.

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And even when they went into their residency in medicine or whatever their sub specialty was, they'd have to find a sleep physician to do a rotation with or find a rotation that would that the residency director would allow them to take. So it was. really kind of like separated from the rest of training.

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And you had to go into sleep medicine and circadian neurobiology as a researcher or a scientist or a doctor like me, yourself. You had to go into it fully to learn it. So that's a problem. That's a problem. Yes, because we would imagine that if there were egregious red flags, many individuals listening right now would assume that they might have been caught by their GP or what have you.

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But sadly, at this current state that it stands systemically  from what we're dealing with, there's a high likelihood that things are going to go missed. Just a quick question for you. I have often said that I am a skeptic. I understand that we have a future that I would love to see a future where everyone is tested, not just once, but multiple times throughout their life for sleep disorders.

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Am I being too bullish on that? Is that too much? No, no, I, I don't think that's too bullish, especially, especially right now in an era where we're starting to, people are starting to recognize sleep as an issue for themselves. I think that COVID actually kind of accelerated that knowledge a little bit. Um, but the problem is sleep medicine as a part of medical care.

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Has not grown. In fact, if you look at the number of physicians going into sleep medicine over the last 20 years, it had a peak in the early 2000s. Sure. And it's been going down ever since. And part of that is because of, um, it's the difficulty of being paid to do what you do in, in sleep medicine. It's been  totally  compressed by insurance companies.

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Yeah, the other problem is access so that most of the sleep physicians themselves, you can't get access to them. They're usually either an academic center where they only see patients once or twice a week, or if they're clinically practicing, they're doing sleep medicine. As a side gig to what they currently do, which is often pulmonary medicine, psychiatry, neurology, or even cardiology or medicine. 

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It's not a primary focus of those physicians. Um, they, they certainly do what they can. It's just not their primary focus. And  that sort of has led, I think, a lot of people to go from the healthcare system to the Google system of healthcare.  Um, is open season for everybody who's trying to sell you something that has the word sleep in it from pillows and mattresses to fans and mattress pads and, uh, books, um, coaching things that, you know, aren't well intended perhaps, but in a system where we're kind of driven by economic gain, it's not always above board.

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And so there's  There's a big problem in that, with that, in particular. Oh, so well said. Okay, so if that is part of the bucket of where we're at now and what's not working, painting a picture for a vision of a future that could really defy this, what are you seeing? And I know you're at the helm of certain things and initiatives to really dismantle some of this.

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So what might you see as a possible future of how this would look very different for people? Yeah, so I have a few different seats I sit in. One of the I work with the NIH on the Sleep Disorders Research Advisory Board and that board is part of the National Institutes of Health funding research for sleep and sleep disorders in the U.

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S. So this is sort of where the advisory board that helps the NIH to think about where to put money To do more research so that we can improve our health care system related to sleep. And one of the areas that we've been really focusing on is the ability to bring because there's very few sleep physicians to begin with to bring Um sleep medicine through more digital means and using more digital metrics and measurements that don't need you Necessitate that you go to a laboratory or to a hospital or a health care system But that could be done in your home and that are FDA cleared devices that are valid, uh, clinically, scientifically valid endpoints and therapeutic programs and intervention programs.

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Um, so that's one kind of seat I sit in, is try to stimulate more research in that realm so we can support Utilizing that and ensures potentially, uh, would potentially, um, pay for those, those care points, uh, which is always a challenge in a system that we have, um, the other seat I sit in is, uh, also looking at, um, how to encapsulate all the needs.

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of individuals in sort of the the health care system. So as a physician, when somebody comes to see a sleep physician currently, what are you, what are you getting from that sleep physician? So currently sleep physicians, as I said, are pulmonologists, neurologists, they have another, they often have another background.

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So I'm a neurologist background. I only do sleep medicine and circadian neurobiology. I don't You know, take care of migraine headaches and seizures and epilepsy and things like that. Like a lot of neurologists, I do handle those in coordination with sleep issues, but sleep is my main issue that I handle.

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So, um, in those contexts, when you see those doctors, um, especially like a pulmonologist and you have sleep apnea, you can get treatment from that doctor for your sleep apnea. You're just, your sleep sort of breathing. But what are you insomniac or restless leg syndrome or some other? Uh, genetic, uh, you know, familial disorder that's affected your sleep. 

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Is the pulmonologist the right one for you to see? And many times, you know, you need to see somebody else or somebody who can contextualize your problems. What if your issues are more psychological in nature? And you have PTSD and sleep problems. Or, um, you have anxiety or depression and sleep problems.

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Um, and what if you, you know, live in an environment, That's highly stressful. You live in an inner city. You don't have a, you know, a high socioeconomic status and light is coming through your, your windows all night or there's noise or gunshot or there's fear in your environment. Um, or there's lack of temperature control in your environment.

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That's an, I, I, as a physician, can I control that? That's very hard to do. Um, and then there are a number of other aspects besides, you know, your environment and your physiologic or medical issues. There's also, what are the behaviors that you personally have built up around your sleep? Or even your thoughts about what you think about your sleep.

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How do you approach sleep? And how does your culture approach sleep? There are a lot of studies showing that the anthropology of sleep as you look, you know, rural settings versus urban settings, there are belief systems where sleep is actually, um, thought of very differently. Like in some systems, sleep is thought of as, uh, I'll sleep when I'm dead.

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I'm just going to work as hard as I can. And that's the way people think often in Western urbanized cultures versus rural cultures where it's, you're connected to the sun and the moon and you're, you're fulfilling the cycles of life in a different way. But also, there's a different culture around sleep, um, compared to the urban setting.

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And that's just one division. So behavior is another major part of this that physicians often are not equipped to manage that cultural thought process or the behaviors behind it. So, when I look at sleep, um, problems that people have, They need to look, I think it kind of breaks down into four basic categories.

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One is, what is the physiologic problems you have with your sleep? Like sleep disorder, breathing, restless leg syndrome, insomnia.  Then the second one is the psychology you bring to it. Are you thinking about your sleep in a way that's going to help you to repair, recover, and replenish yourself for the next day?

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Or is your psychology fighting with you? Depression, anxiety, stress, those things in particular. The third one is behaviors. What behaviors have you already built around your sleep that are making it difficult for you to sleep or that could be optimized and make you a better sleeper? And then the fourth one is environment.

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And it's often the one that's least thought of actually medicine is what is your sleeping environment? Like, like I often test people. Um, so tell me about where you sleep. And the first thing everybody says, well, there's a bed in my bedroom.  All right. Well, first off, why do you call it a bedroom? Because there's a bed in it. 

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Think about it. You don't call it the kitchen, your stove room. You know, you know what I mean?  that your kitchen is one of the most important places in your house. Yeah. Because that's where everybody goes. In fact, if you're going to sell your house, make the kitchen look great, right? Everybody knows. Yes. So, bedroom's actually probably the worst term I could think of because what it really is about Is  it's an environment for sleep.

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It's a sleep sanctuary, and I've been calling it that for at least a decade to this point, but the idea of your bedroom should be considered a sleep sanctuary. And if we can come up with a better, I don't know, German term like kitchen and for that, we could do that. But the sleep sanctuary environment. If you think that way, all of a sudden you realize, Oh, I've got electronics in there.

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I've got, I've got windows that overlook, you know, the sunrise every morning. And there's no, I have no, or, or streetlights and I don't have any shades. Um, aperture is not well controlled. I don't know, you know, the noise next to the street is pretty loud. Um, I don't, yeah, there's a lot of little components and conditions in your environment.

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That actually are a major predictor of your sleep and your sleep problems. So those are the things that, uh, I look for. And I, and I think our biggest, our biggest problem is that our sleep health care system  even is struggling to handle the physiology properly. Yes. Not even equipped to handle the behavior, the psychology, and also the environment.

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So, that's where, That's where the future lies. In my mind, the future lies in getting, you know, helping the healthcare system to integrate this larger picture. The American Academy of Sleep Medicine certainly, I think, understands this from the scientific and clinical practice side. It's just very difficult to integrate this because there's so few sleep physicians actually working.

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Right now, I think in pediatric sleep in particular, The number I was talking to Steve Sheldon the other day, who's a very famous, uh, pediatric sleep doc in Chicago and, um, he's publishing his next, uh, you know, uh, the principles of practice of pediatric sleep medicine, which I write a chapter in every, every time I'm the RLS guy for this.

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So, um, he was saying, you know, we did a census to see how many pediatric sleep, uh, practitioners there are in the country. There's only 600.  In the whole country. Oh, it was that low  for kids. And there were over a half a million. Kids that need sleep healthcare like right now that we know about so the numbers are sort of ridiculous like one out of this is one  Sleep physician for every hundred thousand kids or something.

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It's ridiculous  That's the other nature. So the ASM  actually sees this as an issue and they're integrating sleep into primary care The problem is primary care doesn't have time or the education to handle sleep. So that's the problem of our healthcare system right now. And I'm talking about paying for care, paying for psychological care, paying for dental therapies, paying for all of it.

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That's a whole other issue, but that is a problem. It's really about accessing care and then getting the right components put together in a holistic approach to improve your sleep. Because otherwise, you're going to go on the internet and buy books and products that really are not helpful or that even are worse, could set you up for failure and make it worse.

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You're investing in your health, well being and quality of life. So again, go to you. Block out spelled the letter you block out. And use code SLEEPASASKILL for a discount. Okay, so we've painted this picture of both what's not working, some of the things that we need to actually consider these buckets to be mindful of, and then the current problem of just the lack of resources, and we haven't quite met that Venn diagram integration.

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We've got the lofty plans to start bringing this into our standard of care, but it's not there yet. So in the meantime, What are you starting to see? And I know you're a part of different initiatives to be able to provide this to people that are struggling and want support. What are some of those initiatives looking like?

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Yeah, so I mentioned earlier that, you know, the Sleep Disorder Research Advisory Board, we're pushing for a lot more telehealth and a lot more access to that. That's one thing we can do from that perspective. From my own perspective, having worked with professional athletes and elite athletes of all stripes and number, I found that to sort of be a very open and progressive group to work with.

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First of all, they want to accelerate their performance. That's their ultimate goal. So, you know, going there and improving their sleep environment, improving their physiology, their psychology, and their behavior, is acceptable and actually, um, we actually developed a program directly for athletes called the elite program at a company we started called Absolute Rust.

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And what we do is we utilize all that science that's sort of stuck back in the research realm. And bring it forward over medicine directly to  these individuals. And for the last two and a half years, we've been doing this with hundreds of clients, uh, that are all either elite professional athletes or that are also elite, um, let's call, call them, um, uh, biohackers, uh, people who, you know, CEOs of companies who want to live forever. 

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And so. They've helped us, in a sense, fund a, an approach that we, um, put together from the science side, saying if we could just develop the best scientific approach to improving sleep or detecting sleep issues and then improving, how would we do that? And that's where we developed the four bucket concept, the environment, the physiology, the be, the behavior, and the psychology.

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And so when we work with folks, we do this all through tele. That's the first thing. 'cause it, you can't do this any other way. And we've marked outside of the country in Canada with a number of of folks too.  Um, we do an intake that includes understanding personality traits, psychological traits, uh, understanding if you're actually suffering with things like anxiety, stress, PTSD, uh, but also looking at what are your current behavioral protocols.

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What do you use, even if you don't have one, what we call them protocols. What is your behavior? What are your thoughts around sleep? So we use well known clinically validated inventories that tell us about the way people think about sleep as well as how they behave around sleep. And then we send out devices that are FDA cleared medical devices.

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We do home polysomnography over the course of at least two nights because of the variation that can be seen.  More importantly, we utilize autonomic nervous system testing. So we use devices that you wear on your fingers. Sometimes you can wear them on your wrist or your chest, but they give us your pulse and also EKG patterns from the chest, but they allow us to look at your autonomic nervous system.

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And we use a well known algorithm developed at Harvard back in the 90s called the Cardiopulmonary Coupling Algorithm. And it takes a fast Fourier transform look at the spectrum of cardiac or heart rate variability and respiratory rate variability, combines it with PO2  levels from  the digital sensor.

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And we can actually tell if you're in sympathetic or parasympathetic. dominance. And we can see that fluctuating throughout the night. There's a very classic approach to looking at stability of sleep versus the polysonographic approach, which is just staging sleep. And staging is an artificial human.

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Humans made that up in the seventies, and we've been making it up ever since for the last 50 years. It was started at Stanford. It's great because we use it as a standard therapeutic or diagnostic as the therapeutic test for people with sleep apnea in laboratories and for other conditions like narcolepsy.

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But when we're looking at day to day variation, polysomnography doesn't help us because you can only do it one or two nights. It's in the way of test. It gets in the way of your sleep because you're wearing a lot of sensors versus using just a device on your finger that can actually see into your autonomic nervous system and give us a night to night stability metric, even quality metric that's FDA cleared as well as a tool.

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So that when we intervene, either in your environment or your psychology or physiology or your behaviors, we see the change in your autonomic nervous system, which ultimately is what underlies the state of being so your state is predicated on autonomic nervous system changes in the morning, corticosteroids go up, sympathetic nervous system surges.

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Throughout the day that ebbs and flows depending on circadian rhythm and also activity and then at night Sympathetics reduce parasympathetics increase Autonomic nervous system switches gears and you go into predominantly Parasympathetic activity that can be interrupted by environment Psychological problems behavior and we can see that and it's very sensitive  That's the personalization of how to get to the core root cause of an issue is having a tool that you can actually use to unwind  the problem over the course of time.

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It doesn't happen with just a single diagnosis in a laboratory. It takes time to unravel those issues, especially the psychological and behavioral issues.  We can certainly change temperature in an environment just by switching something on the HVAC system or particulate matter by changing filters and CO2 levels by opening ventilation, but we really can't do psychology and we can't do behavior change quickly.

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And even You know, people who have used CPAP for obstructive sleep apnea. It's not a one night, it changes everything. It takes time to adjust. And there are other therapies like oral appliances. There are devices that can stimulate the tongue that actually some somewhat support. Um, and then there's a bunch of conservative metrics that we use, like increasing nasal airflow.

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Everybody's probably read, uh, James Nestor's Breathe book by now. That one is, has spawned a little bit of a, of a revolution within the sleep field because now we're starting to pay much more attention to nasal airflow as a predictor of sleep disorder breathing, which we kind of always knew. And I've been talking about as well for many years, but you never really had, um, a, a sort of.

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Baseline common. Everyone understands this at a higher level, which I think is now the case with that. Um, so exciting. Yeah, we're doing now. And, you know, the real exciting part of this is that we've kind of cut our teeth on this whole, um, you know, elite population to really understand how to do this right.

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And over the course of the last couple of years made this much more efficient and much more streamlined so that we have a medical team that handles your medical issues, a psychology team that handles your psychological issues, and then an advocacy group, which is our our care team, if you will, that you have an advocate that handles your behavioral change.

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And also your environmental changes. So now everybody has a role rather than being a doctor. You know, I run, I'm the chief medical officer of absolute rest. So I oversee the whole thing, but that's not my job. My job is to make sure that all of the pieces are working together. Um, including, you know, oral appliance therapy with dentists across the country.

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We do that as well. And psychology therapy, CBTI and act therapy for, uh, for insomnia that has to be coordinated by the absolute rest team. But it's all kind of provided by the advocate. So we make it very easy for that population to interact with all of these components that are in our current system, completely separate.

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They live in different realms. They don't talk to each other.  I mean, it's impossible sometimes just to get. To these people that need this care from, um, but we've actually found a way to coordinate it all and have a central point of contact. Um, the exciting thing is that because we did this with this elite group population that would help us fund to do it.

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We've actually come up with a much more technologically sophisticated way and you can talk to my Uh, my CEO, uh, Josh Rubin, about that a little bit more, he's, he's the, the, he's the tech bro side of our company. He really is amazing at what he does, you know, from his last company where he sold to NASA with beautiful, incredible, uh, eye movement potential, uh, software.

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I think that's he's he's actually with the team figured out how to take what we've done in this very hand to hand way and make it technology enabled so that we can actually lower the price of the program and open it to everybody because we have 10, 000 people waiting on the elite list to come onto the program.

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That's something that. I think when we open up the next version, uh, probably by the end of this year, uh, which will be technology enabled, you'll have everything done at home, you'll be using your phone and the app we've created to actually follow all of your information data and communicate with your advocate, that's gonna, I think, revolutionize the way that even sleep healthcare sees sleep, um, and how to integrate this into primary care, uh, in a way that's, that's not, uh, Just going to Google, but actually going to a scientific approach that utilizes medicine, utilizes psychology, dental care, all these components that we need.

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To improve sleep health. Oh, fantastic. And I love how you also hit on the the price point side of this and the excitement ahead of the ability to democratize this. So being able to bring this outside of these silos and bring it to the masses. It's so exciting. Well, given that you have been devoted your life to this topic and you're looking at some of the sleep from such a kind of performance enhanced level and optimization stance.

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Very excited to find out how you're managing your own sleep. But before we get there, is there anything on this huge topic that we left out that you want to, as a kind of parting words or thoughts on this topic, or did we do a decent job hitting on everything? I think we hit on a lot of things. The one thing I would like to, I may have even said this last time I was here. 

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The one population we really are not paying, or here's the thing, it's not we're not paying attention to them. It's just that we don't quite as a culture clearly understand the incredible impact that sleep and sleep deprivation is having on kids.  And I, I want to make that point to parents, to kids themselves, to college sports, uh, um, coaches to, to, you know, uh, little league coaches, um,  it's really important that the kids sleep.

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And so that means in teachers, you're in this too. That means that homework and all that stuff that you're trying to stuff into the whole day, it bleeds into the night and it causes kids  first anxiety. They get incredibly anxious about like not keeping up with the Jones's concept, but at the same time, they're not getting sleep.

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They're, they're, they're staying up doing other stuff. I mean, they're doing some digital stuff with their phones, probably a lot. And so for me. But that the kids who are really working hard, who are taking multiple AP courses, they're not sleeping and that is causing significant trauma down the road. It's like, oh yeah, I'll sleep when I'm dead concept again, that when you go through this and you learn that behavior at a young age, you do it.

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So it's your success from that point forward. The problem is when you hit 35 or 40 years old and you feel burned out, you have, you have pre diabetes hypertension. You're not happy because you're feeling depressed and anxious and you made all the money you needed to, but you just don't feel right. That's, that's the wrong time to fix it. 

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It should be fixed earlier on, and I tell parents this all the time because I get a lot of questions because I did pediatric sleep for my whole career. Sure. What's the one thing that we should do with our children? And my point to them is, treat your children, treat, treat your kids. Like they need  double the sleep that you think they need. 

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Something like nine to 10 hours on average, that's an average. So put them to bed near sunset  and allow them to wake up on their natural circadian rhythm. In other words, wake up time is not the most important  time. I mean, uh, sleep time is not the most important time. It's wake up time. Wake up time needs to be the same every single day.

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And I think that you have to understand that nine to ten hours go backwards from that. That's bedtime.  It's not, you know, homework.  It, it has to be done at other times. You can't do homework when you're supposed to be sleeping. You can't do sports when you're supposed to be sleeping. Now yes are times when things change a little here and there is fine, but if that becomes the routine, it throws kids off, uh, moving forward.

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And I think parents need to see that as their job. is to make sure that sleep is just as an important component of their life as their diet. Yes! Preach! Maybe we'll see absolute for families, for kids in the future.  Absolute rest for families.  That's, that's an ultimate goal. Absolutely. Yes, totally.

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Fantastic. Well, I love that point. And it's a beautiful kind of a bow on that conversation of what we could see painting this vision for the future. So having said that, I know everyone is going to want to know how the heck are you managing your own sleep given that you are in these conversations with the top of the top athletes and this, that and the other.

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So our first question that we ask everyone is what does your nightly sleep routine look like right now? Nightly sleep routine. The first thing that's a part of my nightly sleep routine is cutting off the television. And making sure I'm not on a computer for at least an hour to two hours before I intend to go to sleep.

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Yes. That's really what it is. That's the hardest thing for most of us to do. But it's one of the most important things to do. So wild and I'm curious within the sleep world, you know, it's such a interesting space where there has been a bit of this kind of pushback around blue light and stimulus and the thinking that, oh, well, maybe we can have the TV and the bedroom and this, that, the other for you and what you've seen in the research.

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It's just not there, right? No, no, not at all. In fact, the more we see about the blue blocking glasses and even like some of the iPhone apps you could put on to like cause a yellow screen or an orange screen. Yeah. These have no impact, literally. There's, there's just, I mean, yeah, there's some attenuation of, of light.

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The problem is it's not just that there's light. That's one component. The more important component is the novelty of the actual thing you're watching. Yes.  If you were, you know, I tell my patients who have insomnia, they do something, it has to be boring. It has to be something that's going to, you weren't doing it.

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Anyway, you should be sleeping. So the last time, the last thing you should be doing at night is worrying about your taxes and sitting down and looking at those. Well, doc, I, you told me to read. So I read my tax accountant's line. Like, no, that's, that has a huge impact on you. Your heart rate probably went up.

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So. Watching television, you know, watching Game of Thrones on Sunday night has got to be one of the worst things if you do it late at night. Yes! You've got to go to sleep after that. Hang on to that. Watch it later. But, or record it. We have DVR, right? So, the whole idea of reducing novelty is really the key.

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And novelty includes light. It includes noise. It includes eating. It includes all those things that are daytime. All those things you hear about in what's called sleep hygiene. Yes. It's all about novelty. It's about reducing your central nervous system's activation.  Food in your gut, it activates your central nervous system.

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You put light in your eyes, same thing. You put sounds in your ears, does the same thing. It doesn't matter which sensory system we're talking about here. Even temperature. Too high, it's too much input.  Cool, dark, quiet, boring. Yes, lower that novelty. So well said. Quick tangent. I know when I got to chat with you briefly at Sleep 2024, you were mentioning your excitement around meal timing, some of the research on meal timing and jet lag.

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Any call outs there around management? There's some great research, uh, coming out of multiple institutions. I spoke with one of the Harvard researchers who's doing this and, um,  Sure. And his, his work, it's really clear that when you look at all the elements that we utilize, and I do this with the athletes, to help Crono,  uh, Change or try to move somebody from one one phase to another phase for like things like jet lag.

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Um, we've always used light. We've always used sleep and wake as our major arbiters. We sometimes also use, you know, exercise and diet. So he did experiments and others have done experiments showing that. Um, if you make these shifts, these individual shifts like eating, sleep, exercise, play, the biggest effect on your circadian neurobiology seems to be When you eat and  when your timing of of eating actually occurs as well as the the amplitude of the size of the meal or type of meal, but the timing alone has more of a predictive outcome for whether or not you're going to switch into a new time zone or change your keep your circadian rhythm the same than any other component, which is kind of flies in the face.

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of all the people who thought of light as the only zeitgeiber there, but it definitely is working, I think, together with light as some of the largest, this research has been around for many years. I mean, I can't tell you for the last 25 years, I've been going to the sleep meeting. I go to the circadian meeting, the circadian talks all the time.

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And some original circadian researchers that basically were saying, Eat in the morning like, eat like a king in the morning, a prince in the afternoon, and a pauper in the evening. Their whole point was that that's something came out of their data. It's not something they believe in, it's just their data that was showing them this.

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Yes, oh my gosh, I couldn't agree more. We have a large database of Oura Ring users and we've religiously and continuously seen the that we can see changes in heart rate and H. R. V. consistently by just playing around quite dramatically with that meal timing and an average number that we've seen hit consistently is around 10 beats per minute.

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The raise up in heart rate when people start moving that meal timing markedly later, and that's the you know, going to impact how you're feeling, but certainly from a, a cue of the time. Couldn't agree more. Love that. Okay, and your morning sleep routine, with the argument that how we start our day could impact our sleep.

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Yeah, morning routines, I think a lot of us have them already. We have routines that we've learned to get ourselves ready for the day. One of the things that I think that we are missing, and I, this is one of the areas that I, I personally try to spend more time in, is. When you come out of the state of sleep, you're usually coming out of REM sleep in the early mornings or, or not too far from REM sleep.

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So there's a lot of dream mentation. There's a lot of potentially like thoughts that are emerging. Um, one of the things that often people ignore is your psychological wellbeing. While you're making that transition into the day, so I think it's a perfect time before you get up, go, go to the bathroom, do that first because you get that may be an urgency for some of us.

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Yes. Other than that, take your time to do something psychological versus physical. Which in my mind is create an intent for the day, meditate for just a few minutes on what the days to bring or what you where you are right now, try to stay present in the moment because sometimes people wake up with trauma memories and it's good to remember that you're good right here and you're right here right now, you're fine.

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And it's good to reset yourself for the day. Um, also, I think it's a period of time  people have heard of this, the quantum physics approach to life, the idea that we are energy and particles. And the idea that we are basically always energy and fighting with our inner art. Sorry. We're always fighting with our particles, our matter, and we're trying to force things.

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And the morning's a really good time in this quiescent period, you're just sort of waking up from something that's a little different than the regular day, where you can start to think of yourself more as energy and less as particle. And there are a number of books out there and interesting ideas about this that, yeah, I don't know, a lot of people have sold books on these things, but the idea that you can actually sort of affect your world just by the way you think and the way you approach it.

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And the energy you put into the world. And I think that's the, people call it manifesting. There's a lot of different ways you can think about that, but I think the morning's a perfect time for that kind of activity before you get in the shower, before you start your day, try to do a little psychological self care, uh, in the mornings.

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Oh, I love that so much. So well said. And what might we physically see in your environment on your nightstand or maybe if you're traveling, maybe proverbial nightstand or environment? Proverbial nightstand or environment? Well, I, unfortunately, my job as the chief medical officer of a very technology enabled company and also working in digital healthcare, I tend to have a bunch of gadgets on my, my bedside table.

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I've either worn to compare the data or Uh, yeah, that's kind of what you see on my bedside. Now, I don't recommend that. That's just a hazard of my job.  Litter your bedside table with electronics or any of that kind of stuff. I tend to take my phone, turn it off, flip it over, and that's it. If I have to get up in the morning, I set the alarm, but it's, it's off.

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There's nobody getting me after that at that time period. Um, and then, um, you know, I, I tend to have, uh, a very small light. That's the only light in my room that I allow to go on and off at night. I try to keep everything dark even as the sun sets. I darken the house. And, uh, that's, that's an important cue. 

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Of all those gadgets, are there any that are worth noting for people that are, you know, hungry for the gadgets or, you know, transcranial electric stimulation and all these different things?  No, no. So most of the stuff that I'm testing is, it's not as much about consumer based wearables as using algorithms that are, um, like, like utilizing cardiovascular algorithms or cardiorespiratory algorithms, but also looking at, um, heart rate, respiratory rate.

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Um, even looking at temperature regulation and a number of other autonomic factors that, um, may help us to better predict, um, sleep quality. Cause right now we do have a sleep quality metric that comes from the cardiopulmonary coupling algorithm that can be useful, but it's, it's not foolproof and there are, you know, we have high level athletes with some of the lowest heart rates you've ever seen.

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And their sleep quality indices are low, which is not right. Okay. It's because the algorithm is not made to, there's a certain limit at which at the upper end and the lower end where it, it doesn't function as well. So  my job is to look for better endpoints for higher performing, you know, the, the small, like 1 percent on the top and bottom of the, of the typical range  with these devices.

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Some of these aren't even FDA cleared. They're just devices. Somebody's give me to try. So thanks for taking one for the team with that.  I appreciate that. And then the last question would be today. What would you say has made the biggest change the management of your own sleep or said another way, maybe biggest aha moment in the management of your sleep.

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Well, I have to say, um, so my, my dad and my brother both suffered with sleep apnea. So it's in my family to have sleep apnea. I test myself all the time. Um, I'm pretty healthy, but I do have some sleep disorder breathing. That's a little higher than others. So I started, um, I started to actually my own conservative management program, which we now use in absolute rest, uh, was dilators, um, and also, uh, mouth taping and therapy.

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And  In particular, the mouth tape has completely revolutionized my breathing and my sleep. Wild, right? So, I've seen changes in my autonomic nervous system just from that, just from that, the use of that. Now, you have to know how to use it and you have to be able to use it in conjunction with other components.

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So, I don't want people walking away from this discussion saying, I'm going to get a mouth tape, I'm going to get one of those hostage tapes. Don't, don't just jump into that. Understand that what we're trying to do is improve nasal breathing, and to do that, there are a number of components to improving nasal breathing.

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Mouth tape alone is just stopping air from going in your mouth. It doesn't improve nasal breathing, it just stops air from going in your mouth. it just inhibits the part that we don't want. So you got to improve the nasal airflow with other things. And those things can be also medical. You can get things like nasal inhalers, things like that will also improve.

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And it depends on your condition, your specific issue. So if you have, you know, a deviated septum,  mouth tape is probably a disaster. If you have large turbinates because of allergies and you're not treating that, mouth tape is sort of like going underwater without oxygen. Exactly. Be careful with what you do.

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It's not going to kill you. You can pull it off. But the idea is that it's not going to solve your problems by itself. For me, it was pretty, uh, remarkable. So. Oh, I love that. And the nuance to that, too, versus just like, Oh, it's mouth shape or bust. There's a lot to consider there. That's beautifully said.

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And I'm sure people listening, given this future that you've painted of what's possible and what you're, you know, at the helm of creating with absolute rest and beyond, it's People are going to want to know how can they work with you? How can they work with Absolute Rest, etc? What are the best ways to do that?

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Well, you can go to the Absolute Rest website, it's absoluterest. com. On our website, we're accepting people who want to go into the Elite program. As I said, we have thousands of people sort of waiting to go into the program right now. We're going to increase the speed at which that occurs by adding a lot more advocates and people to, to increase the flow through.

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Um, but I think it's also important to know that we're starting that other program that we call Lens probably by the end of the year, you can go on the website and sign up as a To be a pre, uh, pre sale member of that group and it's much, much more affordable. Um, it, it's different, but it's also same kinds of data that we're collecting.

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Um, so that would be my recommendation to work with Absolute Rest and to work with us as a team. Um, if you want to work with me specifically, sort of like the Olympic team does, you can always get me, um, go to my, uh, my own little consulting page. Limboco Health.  Com. L-I-M-B-I-C-O. Okay.  Health com or limbo.

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Um, and you can also just send me a message on LinkedIn, uh, or email me at, um, my email address, which is j Dermer at uh, uh, limbo health.com. Uh, hard to spell, spell limbic, but li it's, it's basically, I'm a neurologist. What a nerd. I'm also a nerd. The limbic lobe. In your brain. So limbic code. That's the company's name.

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Yeah, fantastic. That's amazing. And we will also put that in the show notes just for ease. That is fantastic. Oh, well, I'm so so grateful for the work that you're doing the difference that you're making in people's lives. It's just cannot be overstated how important this is. And I really, really just appreciate you taking the time and more to come.

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Hopefully, I know this was session two, but who knows what's ahead. Things keep evolving and we keep evolving with them. So yeah, there'll be more, I'm sure. But so much, Molly. Thanks for having me on again. Real pleasure. Thank you. Absolutely.  You've been listening to the Sleep as a Skill podcast, the top podcast for people who want to take their sleep skills to the next level.

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Every Monday, I send out the Sleep Obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet. Fun fact, I've never missed a Monday for over five years and counting. And it contains everything that you need to know in the fascinating world of sleep. Head on over to sleepisaskill. 

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