Friday, April 16, 2010

Getting Deeper about Sleep: Towards the Perfect Sleep Rep - even for parents and caffeine adicts

This is the second part of my interview with sleepologist Stephan Fabregas of Zeo, the folks who make the device that lets us visualize our sleep patterns. As we heard in part 1, good sleep has various stages from waking, to light, to REM to Deep - and that we cycle through these stages over the course of a night. How many and how well we achieve these states seems to have a lot to do with how well rested we feel. In this part we talk a bit more about the Zeo itself, about caffeine and its effects on Deep Sleep (not good), about sleep coordination with physical benefits and a wee jag about help for kids and parents in getting better zzz's.

Welcome back, Stephan. The zeo is a pretty unique device on the market. Some devices more or less just track movement in bed to get a sense of sleepfulness. The Zeo is going right for the action in the frontal lobe of the brain. It's also a very nice alarm clock, with a very pro web site, and associated coaching. None of that - especially getting hardware designed, produced and out the door, with all the TON of support material that's in the box and on the site, is a trivial undertaking. So someone believes in Zeo in a Big Way. What's the Zeo story?
Zeo, formerly Axon Labs, was founded by some sleep deprived Brown University students back in 2004 with the idea of helping people wake up at the right time to minimize the effects of sleep inertia (that grogginess you feel right when you wake up). However, when they built a technology that could help people track their sleep and unlock that mystery for the first time for the average person, they realized there was more power than just waking up a little easier. Bring in world-class Scientific and Executive Boards and Zeo has developed the first scientifically-based personalized sleep coaching system. I joined the company full time about 3 years ago after having helped out a bit in the past. I've known two of the co-founders, Jason Donahue and Eric Shashoua, since we were freshmen. In fact, Eric and I were roommates and lived right across the hall from Jason.
Seems to me there's a great business case study here. Very cool to get that the company has been working so long on this. Makes sense now that everything looks so well-considered in the package. I'll come back to that in a review of the myZeo experience. In the interim, let's come back to the ues of the Zeo to help with sleep.

The device tracks brain waves from the frontal lobe and translates these into representations of sleep state (nicely described in this blog post by Zeo scientist Ben Rubin) - very cool.

 Despite this rather amazing technology, a person might be tempted to ask, however,  why fork out $250 on a device rather than just follow some tips for getting a better sleep, and just sleep better?
Here goes: The first reaction tends to focus on the ability to track something that you've never really been able to track before. You have an idea of when you get to bed and when you wake up, but you never write it down. And even if you did... people's reports of how they sleep and how they actually sleep don't line up very well. Self-reports of sleep are very subjective - and tend to reflect how a person feels more than how they actually slept. Zeo provides an easy tool to give you accurate information, and allows you to aggregate that information and look back over time. How was your sleep affected by the daylight saving switch (for the sake of argument, since you didn't have to deal with that in the UK)? It's hard to remember what's happened with your sleep in the past without a reliable record. But that's not all...
Beyond being able to track your sleep, Zeo is about empowerment. Track your sleep, learn about your sleep, make changes in your lifestyle to find better ways to sleep. There's a lot of value in learning about the cause and effect patterns around sleep, and being able to actually connect those things to your daily life. Reading a book will provide a lot of good information, but behavior change is more likely when you can connect the science to your own life. I knew about sleep before I had a Zeo. Now I know about MY sleep, with a Zeo. It has made that daily connections relevant to me. I only drink caffeine when I need it - if I have to stay up late, if I have to be alert and ready for an early meeting.

 I think twice about doing a heavy meal before bed, even if I'm really hungry. I know that a nap is a great idea, but not too late and not too long. It's like there's now a level of accountability when it comes to my sleep, because I have to report to my Zeo every night. And that's produced good results for me.
Oh dear. You've mentioned caffeine. And not in a good way. And that's already distressing me. So before we get into that, you also talk about these kinds of habits you're developing around sleep behaviour. Is sleep a skill?
 I'm not sure it's about skill as much as control. One can't really become a marathon sleeper (sleep for 16 hours a night with 3 hours of deep sleep) with the right regimented training program, just through practice. But one can learn how to make sure their sleep is natural and under their control. The best thing about sleep is that once it's under your control, it can become very a very passive process. The body will dictate how much it needs and when. That's when sleep is a real pleasure and a relief.
Alright then, as part of getting sleep under control, what's the story with caffeine and sleep?
Caffeine can really muck with sleep. Taken too close to bedtime, it can make it more difficult to fall asleep. It's also been shown to affect deep sleep. As a matter of fact, some studies have shown that caffeine intake up to 16 hours in advance of going to bed can have an effect on deep sleep. And if you're tired at 3 in the afternoon, a 15min nap has been shown to get you going again better than a cup of coffee. I could dig up some of that research if you like.

That's a good segue to some Zeo research. One study that was just completed (by Chris Drake and co. at Henry Ford in Detroit) looked at the effects of different caffeine doses at different timings before bed. Another study (from the same folks) looked at the creative and cognitive benefits of sleep extension in people who habitually get little sleep (on purpose). We also did a study in the fall that looked at the habitual sleep of college students at Cornell. The short of that - they don't think they sleep very much, and they sleep less than they think. We also have a couple reports looking at the effects of daylight saving changes, weekend vs weekday sleep, and sleep across age and gender. Reports from all these studies have been accepted as abstracts at either/both of APSS 2010 (in June) and ESRS 2010 (in September). And I'm happy to provide more details once those reports are publically available. :) We also have preliminary validation results for Zeo's technology available on our website (abstracts presented at APSS and ESRS in the past).
[That said] caffeine's not all bad. It can be really handy in a pinch, because life happens and you just need to stay awake sometimes. (And I'm sure you're aware that caffeine increases physical ability in addition to just keeping you awake.) However, it's not all good, either, and getting more sleep is probably a much better idea in the long run.

In sum, what is the effect of caffeine on sleep?

It reduces the sleep drive, making it harder to fall asleep, and reducing the depth and amount of deep sleep:
1. Landolt, H., Rétey, J. V., Tönz, K., Gottselig, J. M., Khatami, R., Buckelmüller, I., et al. (2004). Caffeine attenuates waking and sleep electroencephalographic markers of sleep homeostasis in humans. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 29(10), 1933-9.

It also has an effect on deep sleep well after you'd expect it to be out of the blood stream:
2. Landolt, H., Werth, E., Borbély, A. a., & Dijk, D. (1995). Caffeine intake (200 mg) in the morning affects human sleep and EEG power spectra at night. Brain research, 675(1-2), 67-74.

And a quick insight into how caffeine and alcohol combined can really make sleep tough:
3. Stradling, J. R. (1993). Recreational Drugs and Sleep. BMJ, 306, 573-575.

There is also that study I mentioned coming out of Henry Ford in Michigan. Those data have not been published yet, so I can't go into specifics, but I can say they definitely confirm previous work that has shown caffeine to affect sleep.

Well that's i guess great news: a potentially way to improve sleep is to cut out caffeine. Great. Dandy. Let's shift gears a bit. Since discussing sleep with some colleagues, i've had a few questions.
Here goes. Mike T Nelson asks:
1) what phase of sleep is most beneficial for what type of training.  I believe there are some data to show that REM is best for motor acquisition of new tasks.  What is best for tissue recovery, etc
2) Can we push our body into one of these phases for a longer period of time?
 Different sleep phases have been indeed associated with different kinds of functioning. For instance, REM sleep is associated with procedural and motor memory tasks. Deep sleep has been associated with declarative memory tasks and is the phase of sleep when the most Human Growth Hormone is released into the body. A lot of cognitive tasks, however, are very specific, and these associations are tougher to solidify in more real-world scenarios.
 As for "pushing" the body into these phases. I don't know of any meaningful, natural way to do so (other than what appear to be purely homeostatic responses - doing a very difficult and new-to-you fine-motor task for hours a day may boost the amount of REM sleep you get, but that may not be providing overall general benefits, it could just be a response to the hours you spent doing that task). And I'm not sure what the costs/benefits of such an effect would be, were you to artificially boost one phase or another.

 Interesting. Many of us are so keen on tweaking parameters of this that or the other thing, that we might miss simply achieving these sleep states well and naturally, never mind pushin them, may be the best thing we can do for ourselves. Cool. I do not think i have optimize normal good sleep yet. That caffeine thing will be a bear.

And with respect to optimization, here's perhaps one of the most popular push backs and questions around sleep, and it's about kids and parents - at least one of whom has expressed to me that the vision of being able to get a great sleep - to plan for such a thing - with children in the picture is "ridiculous." Any thoughts for the sleep-deprived parents in the house?

Sleeping Through the Night, Revised Edition: How Infants, Toddlers, and Their Parents Can Get a Good Night's SleepTake Charge of Your Child's Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and TeensParenting is certainly tough on sleep - but it's not the end of sleep. There are some things that might help. First, for the very young, it's going to be a struggle to get solid sleep. However, working out a system with a partner to take shifts could help distribute the effort. As kids get older and they're sleep consolidates (they're sleeping through the night) it can also help a lot to set a very specific schedule regarding sleep and waking (this is bedtime, and this is when's it's okay to leave your room in the morning, etc). That kind of consistency can be helpful to everyone. Also, communicate with children to set ground rules.

I'm not saying it's easy, but it's not impossible. For more info on dealing with children and sleep, sleep scientists Jodi Mindell and Judy Owens have put together a couple books on the topic. "Take Charge of Your Child's Sleep: The All-in-One Resource for Solving Sleep Problems in Kids and Teens", by Judy and Jodi, and "Sleeping Through the Night, Revised Edition: How Infants, Toddlers, and Their Parents Can Get a Good Night's Sleep" by Jodi.

Excellent. Thank you for the references Stephan. Will look forward to the comments on this post.

Learn about Zeo, a new home sleep monitor

Part III of this sleep discussion will be a review of the zeo/myzeo sleep coach in use. That's about a month away.  

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Samball said...

I got to know about this devise from your first post and today I ordered one. Only a little trouble to get it to Sweden :) Hopefully I will get som insight in my sleep cycles because I think they are pretty wierd and doctors wont send me to some sleep lab.

Piers McCarney said...

Did you ever have any other thoughts on your experience with the Zeo? Did its usefulness play out how you hoped?
Has it changed your habits much? Do you track consistently?

I have always considered getting one of these, but it is more difficult as a non-US resident, as they won't post to me. So I am interested in info before the hassle.

dr. m.c. said...

Piers, there are definitely distributore in the uk/eu for zeo now

here's my link for amazon uk

Personally, i have been using it pretty much non-stop since before this article came out.



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