Factually! with Adam Conover - All Things Sleep, the Circadian Clock of Cells and Hormones of Darkness w/ Dr. Judith Owens

Episode Date: July 24, 2019

Dr. Judith Owens, the Director for the Center for Pediatric Sleep Disorders at Boston Children's Hospital, joins Adam this week to discuss sleep deprivation and mortality, the circadian clock of cells, jet lag tips and more. Plus, Judith answers burning sleep questions from the Factually! crew. Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way. I don't know what to think. I don't know what to say. Yeah, but that's alright. Yeah, that's okay. I don't know anything. Welcome to Factually, I am your host Adam Conover and when you think about it, sleep is a super dumb idea, isn't it? I mean like evolutionarily speaking. Like just imagine you live not in a nice safe house like you hopefully do now, but out in the wilderness like humans did for tens of thousands of years. And out there, there are monsters, predators that are trying to eat you, and it's your job to constantly avoid them or face certain death. Not only that, you have to use basically every hour of the day to collect meat, berries, and other edible lichens just to keep your enormous calorie-chugging body

running. It's a world of fear and struggle, and in that world, you have no choice but to lie down every night and sleep. I mean, forget being on your guard. You are biologically required to become inert and helpless while the sun is down. Just a little meat bar in a furry wrapper. It makes no sense. And that raises the question, why does pretty much every animal ever studied do it? Zebrafish sleep, weird microscopic nematode worm sleep, even cyanobacteria, the ocean algae that make oxygen, operate according to a circadian clock. Sleep is universal. If you sleep to private fruit fly or a middle schooler, the result is going to be the same. The next day, they'll be less effective, whether the job is puncturing the skin of a peach to lay eggs

or learning fractions. And you might think that you and cockroaches don't have that much in common, except for the fact that if you sleep-deprive either of you for long enough, you will die. And even animals who positively, absolutely cannot find the time to get a solid eight hours go to extreme evolutionary lengths just to get a little shut-eye. Dolphins, for instance, sleep with one half of their brain at a time in a process called unihemispheric sleep so they can stay somewhat alert in dangerous open water. So clearly, sleep must be incredibly important, right? I mean, if every animal goes to such great lengths to do it, risking life and limb just to lie like a log for a chunk every day,

there must be a good goddamn reason for it, right? Well, here's the really weird part. We actually don't know why we sleep. I mean, we know that if we don't do it, bad things happen. But scientists still don't know exactly why evolution chose eight hours of total body shutdown as a way to solve those problems, rather than just, you know, taking care of them while we're awake. And that's really weird, right? I mean, sleep's one of the necessities of life, like breathing and eating, but we know why we do those things. I mean, imagine a world where no one can explain why people pee. Like, we know that if you don't pee, it's painful and eventually fatal, but we don't know what the purpose is of excreting small amounts of liquid three or four times a day.

Okay, in my case, that's an underestimate. It's more like 20. I should see a doctor. Anyway, that would be strange, right? Well, that's the position we're in with sleep. And maybe the fact that we don't understand sleep nearly well enough is the cause for how little respect we give it. As a nation, we are chronically sleep deprived. More than one third of American adults don't get enough sleep. And that puts us at risk of heart disease, obesity, diabetes, not to mention the morning grumpies. Our health depends on it. Yet we as a nation don't do it nearly enough. Why? What exactly is causing this insomniac epidemic?

Well, to help us sort through these questions and more, our guest today is Dr. Judith Owens. She has been studying sleep for decades, and her work has shed light specifically on why school start times are bad for adolescent health. She's the director of sleep medicine at Harvard Medical School and a specialist in pediatric sleep disorders. Please welcome Dr. Judith Owens. Well, Judith, thank you so much for being on the show. My pleasure, Adam. So you are a sleep expert, correct? That is correct. Yes, I am. I am an MD and my specialty is sleep medicine. And how did you come to that particular field? Were you just like, you know, you sleep a lot

and then you were like, hey, I kind of like this. I want to know more about it. Let me look into it or what? Well, that played somewhat of a role. But, you know, I think the first thing that, pardon the pun, opened my eyes to sleep was I was actually driving home after my last night on call as a pediatric resident in Philadelphia, and I had a car accident. Totaled my car. It was a perfect day. You know, visibility was great. It wasn't my fault. Thank God no one was hurt. But I was absolutely convinced that if I had been awake and alert, was absolutely convinced that if I had been awake and alert, I could have avoided the accident. So that sort of personal experience with the consequences of not getting enough sleep, which of course I experienced all throughout my residency, but this was a particularly telling experience. And then, you know, I went on to do some work with children who had ADHD and autism and depression and anxiety during my subsequent training. And I pretty quickly

realized that about 80% or more of these kids had sleep problems. And at that time, you know, there wasn't really any such thing as pediatric sleep medicine. This was in the mid-80s. The field was just getting started. And so I kind of learned on the job, but was very motivated to do so because I saw these families that were really suffering and dealing with these problems really impacted mental health, physical health, quality of life. So here I am. Wow. And so I opened this show by talking about how mysterious sleep still is to us. We know that it's important, but we don't really know why this is the means for accomplishing all the things that sleep accomplishes. Can you just sort of summarize what our best understanding

of it as a biological process is and sort of some of the newest research that's been done? Sure. You know, I would just point out to your earlier point that up until the age of two, children spend more time asleep than they spend awake. So there's got to be something incredibly compelling about the sleep state so that our most vulnerable human being stage is spent in the most vulnerable possible situation. Right. That seems less than ideal from a protecting yourself from predators kind of standpoint. Exactly. But I think what that tells us is that sleep is incredibly important for brain function. important for brain function. And we know that sleep affects things like the brain's ability to recover from injury, something called neuroplasticity, which is the brain's ability to change its structure and function in response to environmental experiences. in response to environmental experiences.

Development of brain cells, the way brain cells work, are all affected by sleep. And in particular, recently there's been discovery of what's called the glymphatic system, G-lymphatic system in the brain, which only operates during sleep. And essentially, it clears the brain of toxins that have accumulated from brain self-function during the course of the day to give you a clean slate to work from when you wake up in the morning. So that really underscores the point that there is no substitute for sleep, that there are processes that only occur during that particular stage of being. I would also point to some very important recent research that has been done on what's called the circadian system. So

that is a part of the brain. There's what we call a master clock in a particular area of the brain that really helps to determine when we sleep and when we're awake. But the Nobel Prize a couple years ago in medicine was won by a group of circadian biologists who discovered that not only was there this master clock in the brain, but that every cell in the body has circadian clocks. And those have to be synchronized with each other and also with the external environment. So an example of what can go awry with that is shift work. So as human beings, we're really hardwired to be awake during the day and to be asleep at night. And kind of violating that basic biological principle has pretty significant consequences, so that people who are shift workers are more likely to have type 2 diabetes. They're more likely to have cardiovascular problems like high blood pressure and strokes. They're more likely to have certain types of cancer because they're really fighting their own body's biological rhythms.

And that plays out in all these different organ systems in the body. So it's not just a particular process in the brain or in some other higher function organ. This is really embedded into our structure on a just basic cellular level. Absolutely. structure on a just basic cellular level. Absolutely. And that's really critical to the understanding that it's not only how much sleep you get, it's when you sleep and how that matches up or aligns with your own natural circadian rhythms. Well, before we get into that, I mean, what this makes me think of is, you know, I talked about in our intro about how, you know, creatures from not just humans all the

way down to, you know, nematode worms and, you know, some bacteria operate according to a circadian clock. So if I'm putting on my sort of, you know, dilettante, not quite a scientist, well, let me, well, actually not a scientist at all, let me say, but just sort of looking at that all together and what you just told me, if I'm trying to come up with a working theory of what sleep is, I might guess that it's that this rhythm of, you know, the day night clock is just embedded into life at every single level, like from the cells to all the way up to the processing of our brains, and that it's just some sort of rhythm that evolution, as far as it's existed on Earth, has sort of cleaved to. Does that make sense, or am I talking crazy here? No, no, I think that makes a lot of sense.

crazy here. No, no, I think that makes a lot of sense. I mean, a very intriguing example of that is, you know, certain animals like dolphins, for example, you know, imagine what would happen if they fell asleep. They would either be, you know, sought upon by predators or they might not be able or porpoises might not be able to surface to breathe. So some of these animals essentially sleep with half their brain, which really makes you think, wow, you know, sleep is so important that these creatures have evolved that they still can retain an ability to sleep but also remain vigilant with half their brain. Now, perhaps this would be a good skill for human beings to learn, but I'm not sure that's anywhere in the near future. But it's intriguing nonetheless. So I think you're right on the money in saying that circadian rhythms in all different life forms are really important, as is sleep. And that means that when we say we don't know why we sleep, I mean, that means that there's just, it sounds like there's this whole frontier of effects that sleep has on us in all different levels of the systems of our bodies.

And so many of them we're not even aware of yet, or we're discovering new ones every day. That's right. You know, a lot of this information is brand new. is brand new. You know, it's only been within the last several generations that we really have any understanding of what even happens during sleep. So that the delineation of different sleep stages, like deep sleep or like REM or rapid eye movement sleep, which are characterized by certain EEG patterns, really was only discovered, you know, in the last 75 years. So I think for many generations and millennia, human beings have had a sense that sleep was important, but didn't really understand what comprised sleep. And once we had a better sense of that, then we could start to look at, well, what happens when you don't get enough sleep?

And what are the other operations that are going on during sleep that are unique to that stage? Yeah. So let's talk about, I just want to get started by talking about one of the ways that sleep has impacted me the most recently. I recently went on a trip with my girlfriend to Hong Kong for our 10th anniversary. And the jet lag that I experienced upon coming back was such a blow to me physically. And it's the pattern that happens to me every time I travel that far. When I get there, when I get to the destination, it's not so bad. It takes me a day or two to adjust. And then, you know, I need a nap or I get kind of sleepy, but I'm mostly able to handle it. But then when I come back, what I experience is an honest to God, 10 days of experience is an honest to God, 10 days of insomnia. Like I am sick for a week. I cannot,

I cannot get myself back on track. And it's that thing of lit. I mean, literally I found myself lying awake in bed thinking I am so tired. I have barely slept in 48 hours and I cannot fall asleep. Um, and I'm doing everything I can. I'm, you know, doing all the tips, and it's just not happening. And it feels like my entire body is completely haywire. Why is that? Yeah, yeah. I mean, that's a perfect description. It's miserable, isn't it? Yes. Well, you know, and particularly with those kinds of time zone changes that are 12 hours or more, you know, really wreak havoc. are affected by this misalignment in the circadian clock with the environment because part of what gives us cues in the environment to help solidify our circadian system is light and darkness.

So, you know, if your body is living at, but it's absolutely pitch dark, you know, that presents a whole lot of confusion. And, you know, we believe that all of these different organ systems kind of adapt at different rates. So, that may be part of why you have some physical symptoms at the beginning, and then there's other kinds of symptoms in the middle and then towards the end. So you don't just feel sleepy. You also feel irritable, and you also feel confused and not like you're sinking at the top of your game because of this misalignment. But you may also have stomach complaints. You know, you may have skin breakouts, headaches. Check, check, check. Yeah. It's really fun stuff. And so, I think the difference that you experienced coming and going makes a lot of sense.

I mean, for one thing, there's the psychological piece of you're getting to a new fun place, you know, if you're going on vacation. And so you're sort of more motivated to move all your activities to where you're going to, you know, because you want to be up, you want to be able to sightsee, you want to, you know, do all these great things that you traveled for, which you don't have as much motivation when you're coming back. But probably more important than that is the direction that you're going. So it's always harder to travel across time zones in the eastward direction than in the westward direction. And that's... Yep. This is one of the worst things about moving to Los Angeles for me, from New York, because in entertainment, you have to fly from New York to Los Angeles. I have to do it maybe

half a dozen to a dozen times a year. And flying from New York to LA is much better if you have work to do over there because it's, you know, the, it's happening later in the day for you. So you have more time to adjust. But when I, now that I live in Los Angeles, I got to fly to New York. I got to do it much earlier in the day. And it, you know, I have to, if I have something at 9am, well,'s at 6 a.m. And on top of that, it just feels physically harder to go in that direction. Well, it is. And that's because the human circadian clock is actually a little bit longer than 24 hours. So we have to be what's called entrained or synchronized to the 24-hour day.

And that involves the light and dark cues. So that's part of it. But it's also doing scheduled activities, you know, at the same time every day, eating breakfast, eating lunch, eating dinner, you know, kind of having a regular pattern of daily activities as well. But, you know, coming back. So, in general, it takes about one day per time zone crossed to adjust. But it is harder in the eastward direction because think about it. If you're traveling westward, you can make yourself stay up later than your sort of natural fall asleep time. But coming back in the eastward direction, it's really hard to force yourself to fall

asleep earlier than you're ready to. Very much so. It's basically impossible. Yeah. Well, and part of that is due to something called the forbidden zone or the second wind phenomenon. This is, I love that name, the forbidden zone. Doesn't that sound evil? And for some young children, they really do.

Their parents perceive them as being evil during that time. as being evil during that time. But it's this surge in alertness that is mediated by the circadian system that essentially allows you to stay up in that hour or so before your body is ready to fall asleep. Yes. So, yes, you know, trying to fall asleep during that forbidden zone, forget it. It's not going to happen. I used to experience that when I was in college and I would stay up all night to finish a paper, you'd get that sudden second wind circadian system is a relatively predictable series of peaks and troughs in terms of alertness. So, in the sort of mid to late morning, we feel pretty alert because our circadian system is kind of pushing us in that direction. Around three to five in the afternoon, siesta time in many cultures, we reach for a Starbucks or, you know, because we feel a little bit sleepy, tired. And that's because this is a relative trough of circadian alertness. And then we've

got this bump, this forbidden zone, just before we're ready to fall asleep. And then around three to five in the morning, there's another most profound trough. But most of us are asleep at that time, so we don't even notice it. I see. So I just want to return to something you said a few minutes ago. You said that our circadian clock is actually slightly longer than 24 hours. Now that is fascinating to me because we were just talking about how obviously the, you know, the earth's day night cycle influenced our evolution and, you know, created the need for sleep. Uh, or at least that's, that's our working theory, uh, or my working theory as I've come up with it. So why would our circadian cycle be longer than the amount of time it takes the Earth

to revolve around its axis? Yeah, well, that's a great question. And, you know, I don't think we really have the answer to that. Oh, I love that. What a great mystery. I know, I know. Are we from another planet? Is there some planet that goes around 25 hours and we are all transplanted from there or what?

Hey, you know, could be. But, you know, these experiments that really found this, they're called constant routine experiments. And essentially, they put people into an environment where there's no time cues. There's no clocks. There's no television programs. There's no light and dark changes. measured the sleep and wake patterns under these conditions, which also can be termed sort of free range or free reign conditions, the clock shifts to closer to 25 hours than 24. Why that happens, happens? We don't know. I think it really is an intriguing mystery. But human beings have adapted to that by exposing themselves to light exposure. So, if you avoid light in the evening and you

increase light exposure in the morning, light turns off your body's release, your brain's release of melatonin, the hormone of darkness, which is essentially the biomarker of the circadian system. I love it. The forbidden zone, the hormone of darkness. These are wonderful phrases. So how do we manage these changes? I mean, another one that this reminded me of in addition to jet lag was, for instance, when we're shooting Atom Ruins, everything occasionally we do night shoots. There was one episode where the location we were in, we had to shoot it overnight for three to four days. That means we were shooting from 9 p.m. to 9 a.m. for four days

in a row. So suddenly everybody's sleep schedule was flipped a hundred, you know, 180 degrees. And this is my first time ever doing that. And afterwards we all resolved we would never do it again because it was so difficult. People were nodding off on set. I remember driving home and, you know, I was driving down my own street in remember driving home and, you know, I was driving down my own street in my own neighborhood at, you know, just 15 miles an hour. And I started to nod off. Thank God I didn't hit anybody. And it was, you know, and then going to sleep in the intervening times was also extremely difficult, but it was mandatory for our jobs that week. It was, we had to give ourselves self-induced local jet lag. And so when people are in those conditions, I mean,

when I came back from Hong Kong, when I was coming back, I started looking up how, you know, jet lag tips. And honestly, they all seemed useless to me. They were like, oh, don't eat fatty foods and try to expose yourself to light if you can. I was like, well, I mean, I don't know how I'm going to expose myself to light other than going outside or whatever. So, you know, I'm on vacation. It doesn't like seem like, like I want to hang around in the dark, uh, in a dark hotel

room. So, uh, and then a lot of the other tips, oh, drink water or whatever. I was like, this just sounds like, uh, just sounds like regular travel tips and not get dehydrated. Right, right. So not the best advice. So what do you actually tell people who have to live under these sorts of circadian changes? Well, it depends on how long you're going to be at the new time zone. That's a little piece of it.

So if you're going on a business trip and you're only going to be at the new time zone. That's a little piece of it. So if you're going on a business trip and you're only going to be there for two or three days, really the best advice is to stay on the schedule, your home schedule, and not try to make those drastic changes. Now, obviously, if you have meetings and all that stuff, that can be somewhat limited. But if you're going to be there for a longer period of time, then you want to try to adapt to the new time zone as quickly

as you can. And that means that as soon as you get on the plane, for example, you set your watch to the new time. And the airlines are somewhat sensitive to that because they will start to feed you kind of on the schedule of your destination and dim the cabin lights when it's supposed to be dark, which does help quite a bit in terms of your adaptation. help quite a bit in terms of your adaptation. And, you know, some people adapt more quickly than others. There's some theories that people who are sort of natural night owls. So most of us are sort of in between being a morning lark and a night owl. We're kind of in the middle. But there are some people who... We're an afternoon hawk. Oh, I like that. That's good.

I mean, sticking with the bird, you know, analogy. It was the fastest I could go. We're an afternoon seagull or... Or chicken, maybe. I don't know. Duck. Duck. Oh, I like that.

Duck is good. Let's don't know. Duck. Oh, I like that. Duck is good. Let's go with duck. Duck. But there are people at either ends of the extreme. And people who are natural night owls, or what we call an evening chronotype, if you want to use a fancy word. I do. Just naturally go to bed later and wake up later. And if they can choose what kind of work they're going to do and when they work, then they're fine if that jives with their natural schedule. But when you talk about teenagers, for example, who around the time that they go through puberty start to become night owls, they have a real shift in their circadian rhythms. Yes.

But they have to get up at, you know, 6 or 6.30 or earlier to get to school. Then you're going to run into some problems because they're constantly fighting their natural schedules. Now, as we age, we tend to go in the opposite direction. So older people are more likely to be sort of this morningness chronotype where they prefer to go to bed earlier and get up earlier in the morning. And sometimes that can become problematic if they're falling asleep at five or six in the evening and then waking up at three o'clock in the morning. So your circadian rhythms do normally change across the lifespan. Yeah, but it's so interesting how we have this understanding of circadian rhythms sort of in a folk way, you know, like we know old people go for early bird

specials. Yes, exactly. Yep. And grandma gets up really early. We know, we know this about them and we know that teenagers like to sleep late. But, and I experienced this myself, by the way, know that teenagers like to sleep late. Uh, but, and I experienced this myself, by the way, up until I was, you know, 27 or 28, I would, I kept a very late schedule. Part of that was cause I was, I was, uh, freelancing, uh, and I would, you know, I was doing comedy in the evening. So I would go do comedy shows. I would come home and, and do video editing or website design or whatever. And then I'd sleep in, I'd do that until 4am and then I'd, I'd sleep until noon. And now I couldn't even think of doing that now that I'm in my thirties. Uh, you know, I was working with some friends on a live show once and they wanted to stay up past one working on a show for the next day. And I was like, I'm not doing this. I'm going to bed. I

don't, I don't have that ability anymore. Um, and you know, when I was back in high school, I was just unable to go to sleep before midnight. But despite that, we have done a very bad job of arranging our society in accordance with those circadian rhythms, despite the fact that it's so important for our health. I mean, we've got the early bird specials. That's one nice concession to this biological change. But as you came on, Adam ruins everything to talk about. The fact that we have organized our school schedules largely in this country so that high school students have the earliest start times. They got to be at school at 7 a.m. sometimes. Yeah, that's right.

7 a.m. sometimes. Yeah, that's right. But they're the ones out of all the K through 12, they're the ones who are biologically hardwired to stay up later and sleep in later, means that as a result of our schedules not taking biology into account, we are chronically sleep depriving the entire population of American high school students

who live under this system, which is very bad for their health and their studies. Absolutely. And middle school students who live under this system, which is very bad for their health and their studies. Absolutely. And middle school students, too, because, you know, puberty these days, you know, starts a lot earlier than it did 100 years ago. And so, you know, most middle school students, especially girls, are pubertal. So they're going to be subject to the same kinds of problems if their school starts too early as well. But, you know, you're absolutely right that I think we're so enamored of this 24-7, you know, world that we live in, like you can go grocery shopping at three o'clock in the morning, you know,

that, you know, we fail to see the downside of that. And I hope that particularly some of these new scientific discoveries that really underscore the importance of sleep and the function of sleep will start to percolate into the consciousness of us all. You know, the average adult in the United States gets, you know, somewhat shy of seven hours of sleep a night. And we know that that seems to be sort of the critical point that if you chronically get less than seven hours, that really ratchets up your risk for things like cardiovascular disease and diabetes and even Alzheimer's disease. And if that's the average, that means that there's a huge number of people who are getting less than that. That's what an average is. Right. Absolutely. And, you know, and people brag about how little sleep they get, right?

You know, it's sort of a badge of honor. Yeah. I have friends that way who are, you know, oh, I grind all the time and, you know, every hour I'm sleeping is an hour that I never get back, you know, until I die. And so I'm going to try to, you know, maximize how little I sleep. Is that a misguided way to manage your sleep? Well, I guess in a way not because you're going to die sooner. So, you know, maybe. Really? It's actually going to cause them to die sooner? Well, what I will say is there is an association between short sleep and a whole host of health consequences like obesity, like cardiovascular risk, like these other things that I've mentioned that in turn affect mortality rates. So, yes, they've done very large epidemiological studies. And people who are at either end, so in other words, people who chronically sleep, you know, particularly less than five hours a night, and people who sleep 10 or more hours a night, are also more likely, both are more likely to die sooner than people who are sort of in that middle ground. But why do you think that we don't have an understanding of this culturally? I mean, we, you know, again, we've got a culture that, you know, prides ourselves on working really hard and, you know, I can sleep when I'm dead kind of culture. But also, you know, there are so many jobs where people are forced to

work night shifts or, you know, are sort of chronically unable to get sleep because they have such crazy work schedules, et cetera. And look, if we were talking about food or water, people would understand that this is a health hazard. No one's walking around going, yeah, I get by on no food or at least no one's loudly proclaiming it. Certainly there are folks who have very disordered eating, but no one's quite wearing it as a badge of honor. And God forbid if you had a job that didn't allow you, that chronically undernourished you, we would all see that as a problem. But with sleep, it's much more of an invisible issue for some reason. Do you have any theories about why that might be? There have been a number of sort of national or international disasters like the Challenger explosion and Three Mile Island and Chernobyl, which had a element of sleep deprivation. Really? I didn't know that a lot of things, but you weren't aware of that link.

Yeah. training, you know, working 80 to 100 hours a week, you know, used to be the norm. And it took what was called the Libby Zion case. This was a young woman who arrived within a day or so was dead. And it became clear that there were a series of medical mistakes that were made by trainees who were severely sleep deprived and just were making very poor decisions. And her father happened to be, I believe, an editor of the New York Times and really brought this case to light. And it consequently resulted in New York State changing work hour regulations for all medical trainees in that state. And then eventually it became a national thing because it became clear that, guess what, you know, doctors are not superhuman. They're vulnerable to the same kinds of negative effects of sleep deprivation as everyone else. And they make more mistakes, and their mistakes can kill people. So, you know, when you draw those kinds of analogies, hopefully that gets across.

But, you know, like with a lot of things, people shrug their shoulders and say, well, you know, I'm fine with six hours of sleep. I don't know, you know, I don't know about you't know about you, but it doesn't bother me. And human beings are terrible at judging how impaired they are by sleepiness. Yeah. Well, and let's talk about that because, say, drunk driving, we used to have that attitude of, oh, I can get home fine. It's not that big of a deal. That was our societal attitude. And through, you know, massive, you know, public service advertising campaigns and, you know, pressure on this issue, we now, you know, you'd be hard pressed to find someone who wouldn't agree that drunk driving impairs your performance and makes you more likely to cause a deadly accident.

Even if people do it, they probably know they shouldn't be doing it. Right, right. But I have to say, I mean, drowsy driving is, as I know you've spoken about on our show even, a huge problem that results in many deaths. Actually, a person close to me passed away that way. And so I personally know that that's an issue. But that's not something that people have an awareness of. People don't know that that is a risk factor in death.

And we don't have that awareness of, oh, you know, someone died in that accident. You know, people want to know, oh, were they drunk? Or, okay, well, then now I know that. But no one asks, well, how much sleep did they get? Well, and that's a great point and a very important problem. And part of it has to do with, you know, law enforcement officials aren't necessarily trained to ask questions about how much sleep the driver involved in a crash has gotten.

There's no breathalyzer test, you know, to show that your blood sleep level is low. Unfortunately, a high percentage of drowsy driving-related crashes are fatal because the individual is asleep and they make no attempt to avoid the crash. individual is asleep and they make no attempt to avoid the crash. And that's why there's rumble strips, you know, on the right side of highways because, you know, we know that when people fall asleep at the wheel, they tend to veer off to the right and hopefully that rumble strip will wake them up enough so that they're able to avoid an accident. But it's a huge problem. We did a study a number of years ago now where we actually took a group of medical residents and we tested them on a variety of different things like reaction time,

but also a driving simulator when they were rested. And then we tested them when they were post being on call. So they were sleep deprived. And the third condition was we gave them enough vodka to raise their blood alcohol level to moderately intoxicated. was that they were equally or more impaired when they were post-call and sleep-deprived than they were when they were moderately intoxicated. And so, yeah, you can imagine this costs a fair amount of stir, but, you know, it makes the analogy that, you know, most of us can understand what it's like to feel impaired by alcohol. But we get used to the way that we feel when we're chronically sleep deprived.

Yeah. enough sleep or we treat our sleep disorder, then we're then able to say, wow, did I feel terrible, you know, for the last 10 years. And this is what it's like to feel awake all the time. It's as though you were drunk that entire time without realizing it. That's right. That's right. And you get sort of habituated to it. And you're not, I think people misinterpret that as, oh, well, I'm habituated to only getting six hours of sleep a night. That's not what happens. What happens is you're habituated to being, to living impaired. Yeah. And I really want to highlight how important this is for saving lives, especially when we're talking about driving. I mean, just to tell the

story I alluded to someone close to me, my cousin, when I was growing up, when he was in high school, died in a car crash. And they don't know the exact story, but he was a very dedicated student who was working very hard in those last couple of years of high school. And his car, when he was just routine drive at night, swerved into a median and hit a tree. And my feeling is that when I hear you tell this, I'm like, this is, it's that story to me. It's the student or the doctor or the other person who's like pushing, pushing, pushing, and is not able to give enough respect to this part

of their lives. And that can really have deadly results. And it's not an abstract issue. It really happens every day in America. Oh, absolutely. And I think it happens a lot more than we're aware of, because, you know, sleep deprivation, people make bad choices, you know, when they're not well rested. And so, they may drink as well as being exhausted. They may just make bad decisions about, you know, deciding to drive when they feel like they're too tired to do it. Oh, well, Deciding to drive when they feel like they're too tired to do it. Oh, well, you know, it's just five miles. I know the road.

You know, I can get there. And there was a really interesting study that was done by the Centers for Disease Control where they looked at over 50,000 students, high school students. And they compared students who got less than seven hours versus students who got nine or more hours of sleep a night during the week. And what they found was that the students who got less sleep were less likely to wear seatbelts, were less likely to wear bicycle helmets, were more likely to text while driving, were more likely to wear seatbelts. We're less likely to wear bicycle helmets. We're more likely to text while driving. We're more likely to drink and drive. We're more likely to ride with a driver who had consumed alcohol. So it's those kind of poor, impulsive decisions that people make when they're sleep deprived. Because one of the things we know

is that people who don't get enough sleep tend to take more risks because they perceive less in the way of negative consequences to these risks. So, there's a particular part of the brain called the striatum, which controls the sort of reward-related decision making. And decision making is altered in people who are chronically sleep deprived. And so, not only is their reaction time affected as they're driving in the car and they're falling asleep, but they may have made a whole host of bad choices on top of that. Right. Well, it just goes to show how important sleep is for our lives that, that it, it, you know, people so often see it as something

that, uh, you know, I'd rather I can sleep when I'm dead. It's taking away from my life, uh, this time that I'm spending, but really it enhances and can save your life. Uh, we have to take a quick break. We'll be right back and talk a little more about sleep. Okay. We're back with Judith Owens, director of sleep medicine at Harvard Medical School. And so look, Judith, as we were prepping for this episode, I was talking to our podcast staff about what questions we should ask. And they all had very personal, very specific questions. And so I thought it would be fun since everybody has questions about sleep. I want to open the floor to them and let them ask you their burning sleep questions.

Sure. Does that sound fun? That sounds great. Let's start with our engineer, Brett. Hey there, this is Brett. I was just wondering, I've read before that humans are tuned to sleep in two chunks, like two four-hour chunks. And this comes from, I guess, pre-elected.

Brett, you must not have seen the adam ruins everything episode on sleep or you did see it and you're half remembering it because yeah what we talked about in that segment is that before electric lights that's right uh people didn't have a way to sleep for a solid eight hours uh or actually uh like they were sort of more uh uh at the mercy of the sun going up and down. And specifically what happened is that, you know, for a lot of the year, the sun is down for more than eight hours. Uh, and so they would sleep for a while and they would naturally wake up and then they'd be like, Oh, I guess I'll, well, I'll have sex or I'll eat a little food

and I'll go back to sleep again. Um, and so their sleep schedules were really, there was such a thing as segmented sleep where, uh, they would naturally wake and I'll go back to sleep again. And so their sleep schedules were really, there was such a thing as segmented sleep where they would naturally wake up and then go back to sleep again. And Brett, what was your question? Did you want to know if it's true? I guess. I mean, it is true. Yeah. As far as we know, you know, when you look at historical records, but I think a factor in this to keep in mind is the relationship between the

time you spend in bed and the time you're actually asleep. So, before the advent of electric lights, you went to sleep at sunset, you know, or fairly close to it, and you got up with the sunrise. Well, if that happened to be, you know, 10 hours, but you really only need eight hours of sleep, well, what's going to happen? Either you're awake for two hours at the beginning of the night, you wake up two hours earlier than you should, or you're awake for two hours in the middle of the night. So that, it kind of makes sense. And the other piece of that is the first stage of sleep that your body goes into is deep sleep, or what's also called slow-wave sleep. And that's felt to be the

most restorative form of sleep. If, for example, if you don't get enough sleep chronically, your body tends to try to compensate for that by increasing the amount of deep sleep. And you also go, the more sleep deprived you are, the faster you go into deep sleep, because it's almost like your brain says, well, I got to hold on to as much deep sleep as I can, because I don't know how much sleep I'm going to get. So, you know, I think what used to happen is people would not only spend more time in bed than they necessarily needed to, but they got their first sort of blush of deep sleep at the beginning of the night. And then they woke up for a couple of hours and did whatever and then went back to sleep and they might have had some deep sleep then, but more REM, a rapid eye movement or dream sleep, because that's

concentrated in the last third of the night. So they were getting their full sleep stages, but it was just in chunks. Now, let me ask, a lot of times when we learn that, hey, humans way back in prehistory used to live in way X or way Y, we then conclude, oh, well, that's how we should live today because that's the natural thing to do because that's what we were doing before the advent of modern technology. And so we should try to emulate that. Do you feel that this is an example of that? Should people be trying to do this sort of segmented sleep in their own lives? Or is that a silly idea? Well, I mean, if I suppose if you have the luxury of spending 10 or 11 hours in bed every night, you know, maybe that makes some sense. But I, but I, you know, I, I, I, your point is that, you know, to try to equate that with what is best for human beings to do is we realize are not in the best interest or just really simply are incompatible

with the way that we live our lives now. Right. I mean, you know, we also didn't have dentistry or medicine back then, and we do today. And one of the hallmarks of humans is that we've been able to improve our lives through technology and through understanding our bodies better. So, okay. Producer Dana, do you have a question? I do have a question. Okay. I know you kind of brought this up earlier, but just wanted to get, like, some clarification around it.

I was curious about, I know, you know, obviously getting, like, seven, eight hours of sleep is kind of the average amount that's healthy and good. But I'm wondering if it matters when you go to bed. I know you talked about, you know, people that have night shifts, how it's horrible if like they're going to bed, let's say in the morning versus going to bed at night. But what if you're getting eight hours starting at say 2 a.m. and waking up at, you know, 10 or whatever versus going to bed at say like 10, 30 or 11 and getting the eight hours starting then? Well, you know, if in the best of all possible situations, if you could engineer the rest of your life to revolve around that 2 to 10 a.m. schedule, that would probably work. But the

reality is, and a good example of this is shift workers, is, you know, most of the rest of the world is operating largely during the day. And first of all, it's light out, so it's harder to stay in the dark, which is what the environment needs to be when you're actually sleeping. And you're much more likely to get interrupted. You know, people call you on the phone or they, you know, there's all kinds of things going on around you which make it more challenging for shift workers to try to sleep during the day. So, on average, they get significantly less sleep than the rest of us, and then the rest of us aren't getting enough to begin with, in addition to this idea of they're sort of fighting their natural circadian rhythm. So, they've got this double whammy going on, which is what makes that hard. But, you know,

if in theory, you can sleep in the dark uninterrupted from 2 a.m. to 10 a.m. and you can get done what you need to get done the rest of the day and into the night, then, you know, that probably is okay as long as you're getting enough sleep. Producer John, do you have a question? I do. enough sleep. Producer John, do you have a question? I do. I've been hearing a lot recently about the difference between breathing through your nose and breathing through your mouth while you're sleeping. I've heard

this as well. Breathing through your nose. I even have one friend who tapes his mouth shut when he goes to bed at night. Oh, duct tape! I'm not sure what he's using, but I just wanted to know if there's any evidence that leads to believe that breathing through your nose is that much more important. Should John's friend be taping his mouth shut?

I would say that seems a little extreme. is validity to that argument because air is more efficiently filtered and warmed through your nose than it is through your mouth. And in fact, you know, one of the signs of obstructive sleep apnea is not only snoring, but also mouth breathing. And many people who have obstructive sleep apnea are primarily mouth breathers, and that is a less efficient way to breathe. I would not recommend the duct tape method, but certainly, you know, trying to, and there are actually, there's a field called myofunctional therapy, which works on training people to use their oral muscles and their tongues to more efficiently breathe, but also to learn how to breathe through your nose primarily, because there is good evidence to suggest that that's better. It's not that

necessarily being a chronic mouth breather is a terrible thing, but it could be an indication that you have some degree of blockage. And so you're not breathing as efficiently as you might. So let's move from that to a discussion of other sleep disorders. When I was confronting that insomnia after my jet lag, you know, insomnia is the most frustrating thing. And I can imagine there are people listening to this thinking, okay, they're talking so much about how important sleep is, how I need to get more sleep, but I just have trouble sleeping. Um, it's difficult actually. And I've, I've had this at earlier times in my life, you know, when I was a younger, younger man, I, uh, took Adderall to treat ADHD. You're talking about sleep disorders in, in kids with, uh, ADHD,

uh, you know, Adderall is, uh, amphetamines. And so I had a lot of trouble sleeping at that time. And, you know, I had a whole, I would drink a lot in order to help myself go to sleep, which also was not good for me. But it can be so frustrating when you're, I need to go to sleep, but I can't, it can't make it happen. What do you recommend people do in that circumstance? Well, that's a great question. You know, we know that chronic insomnia is a huge problem and really a public health problem in the United States as well as elsewhere. And I would first talk a little bit about what we call the three Ps of insomnia. And I didn't develop this, so I don't take any credit for it, but I think it's brilliant because it helps us sort of understand what the different components are. But there's sort of predisposing factors. So, that might be genetics. You know, we're beginning to think that

there may be some people who, for genetic reasons, may be more prone to develop insomnia. But for whatever reason, there are folks who, particularly if they're stressed or there's something going on in their lives, some changes, their manifestation of that is to develop insomnia. And then there are precipitating factors. So that might be a stressor. It might be something as major a life change as a divorce, or it could be, you know, going to a new school or a new job that sort of sets you up to develop problems, either falling asleep or staying asleep. But what we focus on are the perpetuating factors.

So those are things that people do that they think will help their insomnia, but actually may make it worse. So that would include something like napping during the day. So, you know, oh, well- Does that make it worse? It tends to make it worse because then, you know,

it's sort of perpetuating the cycle of, well, I, you know, nap for two or three hours, but then I can't fall asleep again because I haven't been awake long enough, you know, to feel sleepy. Or people lie in bed thinking, oh, I can't sleep, I can't sleep, I can't sleep, getting more and more agitated. And of course, that kind of stress, fight or flight response, adrenaline rush, makes it even harder to fall asleep. computer, which if you're a good sleeper, probably isn't a big deal. But if you have insomnia, starts to confuse your brain, like, what am I supposed to be doing when I'm in bed? Am I supposed to be doing awake things? Or am I supposed to be doing asleep things? The other one other thing that that people start to do is they catastrophize. So, you know, if I can't fall asleep, I'm not gonna be able to get up in the morning, and I'm going to be really tired, and I'm going to be late for work, and if I'm late for work again, I'm going to be in real trouble with the boss, and then I might get fired. And, you

know, and of course, that creates even more anxiety and arousal and difficulty falling asleep. So the answer here is what's called cognitive behavioral therapy for insomnia. The cognitive part addresses those thoughts that people have. And, you know, you started out this segment by saying, you know, we're telling people how important sleep is. You know, what we do with the cognitive piece is to actually ask people to step back a little bit and say, well, you know what? If I don't sleep as well tonight, it's not the end of the world. So that, you know, starts to reduce your anxiety. A lot of people think that good sleep means that you fall asleep and you don't wake up, you know, if there's a bomb in the house until seven o'clock the next morning.

And we all wake up four or five times a night, but we may just roll over and go back to sleep and not even remember that we awakened. Yeah, because at the end of a sleep cycle, which is about 90 minutes in adults, we have a little arousal or awakening, you know, like a mini wake, and then, boop, then you go right back to sleep. But people with insomnia oftentimes don't recognize that, and so they have an unrealistic expectation of perfect sleep. So when you wake up and say, you wake up, oh no, it's two in the morning. I woke up and I should be asleep right now and I'm not going to be able to fall back asleep. That can actually perpetuate

the problem. Oh, absolutely. Absolutely. Maybe it's better just to say, okay, I'm up for a little bit. Maybe I'll go get a snack from the fridge, read a couple of pages of my novel and then lie back in bed. This is fine. Yeah. I mean, one of the things that we teach people to do is that if you're awake for longer than 20 minutes or so, but we don't want you to watch the clock. But that's about the time when people start getting frustrated. Like, you know, if you're up for that long, then it's like, oh, you know. So get up out of bed.

Read a boring book. You don't want to read, you know, whatever Tom Clancy novel that you're going to get all jazzed up about. Yeah, read the boring nonfiction book you checked out of the library and haven't been able to get to yet yes, and we tell teenagers to read their algebra textbook until, you know this is terrible advice unless they're doing really badly in algebra then that might make them even more anxious

unless that's what they're stressed about but then once you start doing one of these head nod things Algebra, then that might make them even more anxious. Yeah, unless that's what they're stressed about. That's keeping them up. Right, exactly. But then once you start doing one of these head nod things, you know, you're drowsy. Then you get back in bed and you try to sleep. So you don't want to be in bed when you're awake. And you don't want to be out of bed when you're asleep. don't want to be out of bed when you're asleep. So, you want to associate being in bed with sleep or sex. We don't mention the latter to our teenage patients, but, you know, and that helps that association or conditioning of associating the bed with sleeping. And so those are sort of the pieces of

cognitive behavioral therapy. And at the end of the day, it's really more effective than taking sleeping medications because all those medications have side effects. And I mean, there are situations where we do recommend them, but they're kind of Band-Aids in the sense that if you don't address the underlying issues with this sort of behavioral cognitive program, if you stop the sleeping medications, your insomnia is going to come roaring back. Right. And let's talk about those medications for a little bit, because it's something else we covered in the Adam Ruins Everything episode about sleep is how pervasively prescribed those have been. And I remember when, again, when I was in college, I had a prescription for Adderall for ADHD, and it did help me quite a bit. But it was also a benefit to my life when I finally quit it a few years later, because it was amphetamines.

It was leading to other unhealthy habits. It was causing me to drink too much. It was making me smoke and stuff like that. But I had trouble going to sleep. And I went to a doctor and I told them. I was a senior in college. And I said, I'm really having trouble falling asleep. And they gave me a prescription for what I later found out was Ambien.

And so I took the Ambien. out was Ambien. And so I took the Ambien, but the thing was, because I was sort of, this is a very specific story from my youth, but because I was on the stimulant, the Ambien actually didn't help me fall asleep. All I got was the really trippy side effects where I would just sort of like stay up and hallucinate for hours. And I was like, they didn't even, they didn't tell me that. I was like, they didn't warn me that they were giving me what seems to be like a low dose of acid where I'm just like staying up and talking to the walls for a couple hours. I had a good time, but then I was like, I'm not getting another prescription for this. This stuff is, this stuff is insanity in a bottle. And that was just me. And then later, now that we know

the sort of really wild side effects that Ambien can have, that made me think back on that time. I saw the FDA is just now saying it's going to start requiring much stronger warning labels on these drugs. But at the same time, so many people are relying on them. And that's just that's just ambient. We're not even talking about the other ones yet. How should we be thinking about sleep aids like these? I mean, some people clearly need them. I'm sure there's some people who are listening who rely on them in order to

fall asleep. Yeah, well, you know, I think that those drugs like Ambien and Sonata and Lunesta, to use the trade names, you know, when they came along, they supplanted an older category of drugs called benzodiazepines, like Halcyon. You may have heard of that, which were highly addictive, you know, had all kinds of side effects. And so, you know, this represented a class of drugs that was free of a lot of the side effects of the benzodiazepines. And I think initially were perceived as being safe. And I think, you know, there are people who take them safely, but there are also people who take them and then get in the car and drive and have a car accident.

take them and then get in the car and drive and have a car accident. So, you know, I think that armed with the knowledge that we have now about these medications, I think in general, you know, they're probably most useful for in the short term. You know, if someone's going through a bad period after a divorce or after the death of a family member and, you know, is really struggling with sleep, that may be a situation where these shorter acting, and that's the other thing about most of these newer drugs is they're a lot shorter acting, so you don't have as much morning hangover as you did with the older benzodiazepines. But, you know, in general, medications, if they're going to be used, should always be used in conjunction with the behavioral methods of addressing insomnia. And in fact, you know, most of the time when we refer patients to a behavioral sleep medicine provider who can do the CBTI, the first thing they'll do is talk to the patient about weaning them off of their sleep medication because, again, it's more of a Band-Aid.

It's not really fixing the problem. And people clearly become, if not addicted, psychologically dependent on these medications in order to fall asleep. And in the long run, that's a bad thing. Absolutely. And that psychological dependence can be really powerful. I mean, I quit drinking about a year ago, but I really thought of drinking, I was a nightcap drinker, which is how my parents were as well. I sort of picked it up from them. Hey, just have a glass of whiskey before bed. And I really thought of it as something

that I needed to help me fall asleep. And then it wasn't until I quit that I was, you know, realized, oh, wait, I didn't. I actually immediately started sleeping better. I woke up feeling more well-rested. I stopped waking up in the middle of the night as often worrying about work. I slept through the night, or at least I experienced the feeling of sleeping through the night more often. But if you had asked me 18 months ago,

I would have told you, I got to have it or I'm not going to be able to sleep. And I was wrong about that. Yeah. Well, you know, that's a very important point. And alcohol clearly does have a sedating effect. There's no question about it. But the problem is that as your blood alcohol levels drop during the night, your sleep then becomes more fragmented as you experience. And alcohol is also a suppressant of REM sleep, rapid eye movement or dream sleep. And so you tend to have, at the end of the night, you tend to have a real rebound in REM sleep. And so one of the things people can experience if they're using alcohol to fall asleep is really vivid and sometimes very disturbing dreams. And so that adds to your perception that you're not sleeping well. So

it's very short-term gain and that it helps you to fall asleep. But, you know, certainly the negative effects far outweigh that. And as you say, you probably don't need it anyway. Well, I'd like to end on this topic. I think one of the reasons that we do over-rely on these prescriptions and on drinking and other things like this, or the reason that people don't get enough sleep is that our lives don't allow for it. You spoke earlier, you mentioned, hey, if you have the luxury to get 10 or 11 hours of sleep, that might be great. For a lot of people, eight hours of sleep is a luxury.

Either they do shift work or they work long hours and then they also have kids to take care of or they have new children or even your average CEO or lawyer, uh, is under such immense pressure to spend time at the office that, uh, they may not have enough time to sleep. Um, in, uh, heck in television writing, I know, uh, writers who, you know, have to work until 2 AM their showrunner keeps them in the room coming up with new story ideas. Yeah. Um, I, I need to sleep too much, so I can't do that. And I want my staff to be able to sleep as well,

but I know people who work under those conditions. I know people who work in late night television, for instance, who have trouble getting enough sleep. Right. So how do we reconcile that? We can give people sleep tips all day long, but when our society isn't organized in such a way that allows us to get enough sleep, that's a real problem, isn't it? And what do we do about it? what we as sleep medicine experts try to do is kind of chip away at some of those perceptions. And I use the example, again, of the medical profession. You know, looking back, I'm still astounded that work hour regulations actually went into place for medical trainees. I mean, that was a huge paradigm shift, right? Because, you know, it used to be, well, if you're a truly dedicated doctor and you really care about your patients, then you're going to stay up all night and take care of them.

And so it took this huge seismic cultural shift to realize that, no, actually staying up all night might harm my patients directly because I'm not making the right decisions. So, I don't know what, you know, analogous has to happen in our society. I don't think it's going to be in one fell swoop. But I do look at the Mothers Against Drunk Driving, you know, the MADD organization as being a perfect example of, you know, really persuading people to think differently about their behavior. And, you know, it has to start early, right? We can't, you know, it's hard as adults. It's even hard as teenagers to start learning this stuff. We need to, you know, we talk to young kids about good nutrition and getting plenty of exercise and using sunscreen and, you know, all these kinds of important health habits. But we need to start very early in introducing this idea that sleep is just as much of a pillar of health as exercise and nutrition and all the other good things that we do. having a chance in hopefully starting to raise generations who, when they become decision makers, will consider sleep in the equation, which so many times we don't do when we're thinking about

structuring, you know, work environments or anything else in our society. And that seems to be, that brings us back to what you talk about on Adam Ruins Everything, that if we care about that first generation respecting be, that brings us back to what you talk about at Adam Ruins Everything, that if we care about that first generation respecting sleep, that next generation, we need to adjust when we send them to school so they're able to get enough sleep. You got that one right. Absolutely. I've been working on that really hard for the last 10 years. And, you know, again, I've seen a real shift in, you know, people no longer say to me, oh, I don't believe any of that scientific hocus pocus, as one parent actually stated. A parent called it scientific hocus pocus?

Yes, yes. Yeah, unfortunately, well, anyway, you get a thick skin when you go out and give these talks. But I don't hear that anymore. What I hear is, oh, yeah, the evidence is there. You know, I believe it. The science is good. But it's going to cost too much to, you know, buy more buses or it's going to be too disruptive to our teacher schedules. Or, you know, there's all kinds of logistical issues which are very real and need to be taken into account. But at least we've made the leap to saying, okay, we really should do this. Now we just need to find the will

to do it. And have you seen progress with some schools? Have some schools made the change? Oh, definitely. And what results do they see? Well, so our team recently worked with Fairfax County, Virginia, which is around the 12th or 13th largest school district in the country. It's 183,000 students and 27 high schools. So it's a behemoth. And they changed their start time from 720.20 to 8.10 a couple of years ago. Our research team was involved in looking at changes before and after. We found that kids definitely got more sleep. They were less sleepy during the day. They didn't have to sleep in as late on weekends. They were less depressed. And one of the things that we looked at was

car accident rates among teenagers in Fairfax County two years before and after the change versus the rest of the state of Virginia. And we found that, you know, the car accidents went down in Fairfax County and that we can't necessarily attribute cause and effect. But certainly there is a correlational relationship there, whereas they did not go down in the rest of the state. So we have mounting evidence to go back to school districts and say, look, these are the consequences of doing nothing. and say, look, these are the consequences of doing nothing. Yeah. I mean, that this not only affects these kids' quality of life,

it can literally save their lives. That's right. Well, thank you so much for doing that work. And thank you so much for coming on the show and helping us unpack the mysteries of sleep. I really appreciate it. It was a lot of fun, Adam. Thank you, too. Well, thank you once again to Dr. Judith Owens

from coming on the show, and thank you folks for listening to Factually. Please make sure you rate, review, and subscribe on Apple Podcasts, Stitcher, or wherever you get your podcasts. It helps us out quite a lot. Thank you to our producer, Dana Wickens, our engineer, Brett Morris, and don't forget, you can check out my tour dates and sign up for my super special personalized mailing list at adamconover.net, and follow me on Twitter at Adamconover.net and follow me on twitter at adam conover until then we'll see you next week with more factually bye that was a hate gum podcast