Episode 137: The Life-Sustaining Magic of Sleep

Carrie Dils guest hosts this episode of ZenFounder and interviews Dr. Jeffrey Clark, a psychiatrist and entrepreneur, who has developed an expertise on sleep. They talk about how to build better sleeping habits and its long term benefits.Office Hours PodcastSlumber CampSupport ZenFounder

Episode Transcript

Sherry Walling: Hey guys. Today's episode is hosted by my good friend Carrie Dils. Carrie Dils is a force within the WordPress community. She's also the host of TheOfficeHours.fm podcast, and she is an incredibly stellar human being. Anyone who's in a room with Carrie is laughing, is feeling listened to, is feeling cared about, and she's way smart. She today is going to interview Dr. Jeffrey Clark. Jeff is a psychiatrist and an entrepreneur. He's also someone who is developing this deep expertise in sleep, and anyone that I have talked to in the entrepreneurial community is struggling with this. Often, sleep is the first thing to go when we're busy, and when our families and businesses have demanded us.   Jeff has some awesome wisdom to throw down, and some great strategies, and I think this is going to be probably one of the most important episodes that we put out this year because of the importance of what Jeff has to share. Carrie is hosting today because Rob and I just had some things happening in our family that have made us say, "Wow, we need to slow things down and we need some help." I asked Carrie to help, and she did amazingly with two days notice. Took over this interview for me, and she'll be hosting the podcast this week, and then another one in the coming weeks, and I'm so grateful to her for stepping in and helping out, and Rob and I will be back on soon, and explaining a little bit of about some of the crazy and amazing things that are going on in our lives, and in the meantime I give you Carrie and Jeff. Carrie Dils: Jeff, it is really wonderful to have you on the show today. Thanks so much for agreeing to come on. Jeffrey Clark: Oh, my pleasure. Glad to be here. Carrie Dils: Yeah. One of the things that particularly excited to talk about, and when Sherry asked if I would be willing to do this interview I was like, "Heck yes," because this is a topic that is fascinating on multiple levels, and applies to absolutely everyone, and that is sleep. Maybe just kind of briefly share how did you ... You're a psychiatrist. How did the sleep component come to be something that you were particularly interested in? Jeffrey Clark: Oh, absolutely. I started learning about sleep all the way back in ... During my undergraduate degree. I was a neuroscience major, and so sleep is one of the most interesting physiological functions of the brain, and it turns out to be important for all sorts of diseases and illnesses, and in my roles as a psychiatrist I treat a lot of people who have sleep disorders on top of anxiety or depression or bipolar disorder. Also, I found that in a lot of my colleagues, sleep was a major challenge, and I just started to get more and more interested in it during my first year as a resident where I was working 80+ hour weeks most of the time.   I realized I was just totally burnt out, and tired, and frustrated. Sleep became a personal passion of mine. How to figure out how do I get better sleep? Even with limited time I can find a way to hit the sack and fall asleep when my head hits the pillow. Carrie Dils: Wow. That's an enviable quality. I know specifically for entrepreneurs, it's not like you punch the clock, and leave work, and you go home, and you think about anything but work. Work is with you wherever you go. Even when you lay down on the pillow, chance are high that you're still kind of mulling over a conversation from the day or thinking about maybe something that's going to take place tomorrow. How have you seen sort of the interaction specifically for entrepreneurs and sleep? Jeffrey Clark: I think a lot of us wish that we could just turn off our minds and go to sleep. The reality is that's not going to happen for most people. When you've got a project going that you're putting your heart and soul into, I am not convinced that you can just turn it off and go to bed. But there's a lot of things you can do to try to make that happen. Carrie Dils: Okay, well let's talk about some of those. Give me your secrets. Jeffrey Clark: A lot of people will be familiar with the idea of sleep hygiene. Usually, sleep hygiene is presented as a long list of ideas where you go down the list and you check the off, make sure you're going to sleep at about the same time every night, waking up at about the same time, making sure your room is comfortable, and these actually don't have a lot of evidence that they make a big difference to most people. They're good ideas. I don't think they all hurt to try them, but oftentimes we find that people who really struggle with sleep will look at a list of sleep hygiene items, and they'll go down the list, they'll start doing them, and they'll find that their sleep doesn't improve very much, and they get pretty frustrated.   I try to get away from the idea of sleep hygiene and focus on techniques that actually do work, and help people a lot. My orientation when it comes to sleep is using a treatment called cognitive behavioral therapy for insomnia. This is something that works well for people who don't have insomnia also. But the general idea is if you have trouble sleeping more than three days a week, and that troubled sleeping also gives you trouble during your daily life, so you feel fatigued during the day, you don't have a lot of energy, you feel like you can't focus because you haven't slept enough. Those are the kind of people that really benefit from these techniques, and they can be a little bit hard to learn. They're really intimidating for a lot of people, but they work really well. Carrie Dils: You said cognitive behavioral therapy for insomnia. Jeffrey Clark: Insomnia, yes. A lot of people think, "Well, I don't know if I have insomnia." I wouldn't want to apply a blanket term to everyone who has trouble sleeping because a lot of us have trouble sleeping, and maybe we have trouble sleep one or two nights a week. If that's the case, then it might be worth looking at a list of sleep hygiene recommendations, and seeing if there's something on there you could change. But if it doesn't get better or if it's more than a few nights a week, you really oughta think about trying out some of these CBTI techniques, so that's the shorthand for cognitive behavioral therapy for insomnia because it's just a mouthful to say. Carrie Dils: Alright. CBTI techniques. Is there one that stands out more than the others? Jeffrey Clark: Absolutely. There's two main techniques that really stand out. The first is that we think of sleep in terms of a Pavlovian response. If you remember Pavlov's dogs. Pavlov was a famous neurophysiologist near the turn of the 20th century, and he had dogs that he would ring a bell for, and of course they wouldn't salivate. But when he gave them meat, their taste buds just went wild, and they would produce saliva, and spit. He had this insight of what would happen if I started playing the bell, and giving them meat at the same time? When he did that, they again salivated, and so he decided to take away the meat. Realized that playing the bell alone was enough to produce a salivary response afterwards.   This idea is called Classical Conditioning. It turns out that a lot of us develop classical conditioning around our bed. Anytime you get into bed, and you don't fall asleep. Let's say you get into bed, and you're on your phone, you're answering a few emails for clients or communicating with your team, you're training your body the bed is a place where it's okay to be awake, and your body will develop this Pavlovian response even when you put away your phone. One of the techniques of CBTI is to train your body to only be asleep while you're in bed. We use the principal, "Use your bed only for sleep and sex," as the big basic idea, and we take it to the extreme.   That means, if you get into bed, and it's been about 20 minutes and you're still not asleep, you got to get out of bed and go find something comfortable to do, something relaxing, and when you feel sleepy again go back to bed. But if you stay in bed, lie awake thinking about something you need to get done at work the next day, you're really going to have trouble falling asleep. Then in the long run it's really going to hurt you. Carrie Dils: And it's frustrating too to lay there and know that you're not falling asleep even though you want to be falling asleep. Jeffrey Clark: Oh yeah. It's totally miserable. I think all of use have experienced at least one night were we just lie in bed, and we can't turn off our minds, and the thought itself of, "How do I turn down my mind?" is incredibly anxiety provoking, and it usually ramps me up. There's actually a nice technique we use in CBTI to get around that also, and it's called Paradoxical Intention. Let's say you're getting in bed, and you want to fall asleep, and you can't stop thinking about work or falling asleep. What I typically recommend is focus instead on staying awake. Get into bed, make sure you're all comfortable, all ready to fall asleep, and just think about staying awake. Do your very best to stay awake for about 20 minutes. If you're still awake by then you can get out of bed, you can do something relaxing.   But most of the time, people find that they just nod off while they're focused on being awake. That's the Paradoxical Intention technique. It really helps with performance anxiety, which is what's happening when these thoughts keep us awake. "I can't sleep. I need to sleep." If you just focus on staying awake, more often than not you'll fall right asleep. Carrie Dils: Is counting sheep a myth? Jeffrey Clark: There's not a lot of data on counting sheep. If it works for you, I think that's wonderful. But I haven't seen a scientific study saying, "If you count sheep you're going to fall asleep." That would be wonderful. Carrie Dils: Well, okay. We'll put that on the back burner. Entrepreneurs typically working longer hours than usual, which means ... I mean those hours have to come from somewhere, and I know a lot of times those hours are borrowed from sleeping hours. Have you seen a correlation between ... I mean is there kind of a typical curve of how much sleep the average person gets based on how much time they're working every week? Jeffrey Clark: There is. The traditional recommendation is for an adult aged say 18 to 65, you should be sleeping roughly seven to nine hours a week. Carrie Dils: A week? Jeffrey Clark: Oh. I'm so sorry. Carrie Dils: You said seven to nine hours a week. I think you meant day. Jeffrey Clark: I'm thinking of neurosurgeons here. But no, you should be sleeping seven to nine hours a night, and that number isn't magical. Some people do require less sleep than that. Five or six hours. Some people get along just fine. A lot more people think they get along just fine on five or six hours than for entrepreneurs. A lot of times it's their team that's cleaning up a lot of messes when they're going on five or six hours a night. The best studies of sleep or total work hours, and hours of sleep actually come from the medical literature.   We found that when you take medical residents who work really long hours, and you change the number of hours of work they do, if they're working about 60 hours a week, on average they'll get about six and a half hours a night, which frankly isn't enough. If you're working 80 hours a week, which a lot of entrepreneurs do, on average we expect to see about five and a half hours. Now, everybody is different. You might compensate in a different way, but the more hours you put in at work, it's got to come from somewhere, and a lot of times that comes from your social life, it might come from your time exercising, your time eating. But some of that is going to come from sleep too. You've got to be really careful to find a balance.   Now, I'm not saying that you can just turn it down and go from 80 hours a week to 40. It doesn't work quite that way. There's always going to be more work to do. But the quality of your sleep, and the amount of sleep you get can dramatically increase so many things in your life that it's worth thinking of way to systematize your business or to outsource a few hours so that you can find a way to sleep a little bit more. Maybe we can spend a minute talking about some of the benefits of sleep and why it might matter so much for an entrepreneur. Carrie Dils: Let's do that because I think that it's sort of one of those things that you it's good to eat your veggies, you know it's good exercise, you know it's good to get sleep. But the knowledge doesn't actually correlate to any particular benefit that I might see you say, "Tomorrow at work." Yeah, I would love to talk about those. Jeffrey Clark: Right. I'm always cautious to say that something will make a big change tomorrow or the next day. These are long term benefits that you're going to see as you persistently practice this. If you're hoping for a magic bullet, I don't know that sleep is going to get you there, but the overall benefit is pretty huge. The most important things about sleep is we know that people who have restricted sleep because of their jobs or otherwise have a reduction in executive function. This is your traditional frontal lobe activity. Your ability to make decisions, your ability to coordinate data, to work with people. This is a big deal, and to put it into entrepreneurial terms, I think of executive function as this is your ability to execute on your vision. As the founder, it is your responsibility to have the vision, to be creative, and to make things work.   A lot of times it's easy for us to get caught up in the little details of our businesses. The things that maybe we only see because we're at the top. Those little details are good, but they take up a lot of time, and if we can find a way to have somebody else help with those, so that we can stay focused on the big picture, we're going to get more sleep and we'll be able to do a better job at our role as in forming the vision, executing on that vision, and making things work.   The other big things that we see with sleep is that impaired sleep really ruins communication. If you're sleeping five hours a night, it's really hard to feel empathy towards your customers, and if you can't do that it's hard to target them. It's hard to speak to them, and make sure that your marketing efforts are on point because if you can't understand their perspective it's really hard to know how to help them. The other thing that often happens when we have five hours of sleep a night is that we get more irritable, and sometimes having a little bit of edginess maybe a benefit, but overall it tends to cause problems. If you can make your team communicate in a way that you don't want to have happen, and it can really ruin relationships, and kind of put to bed a lot of the networking efforts that you make. I think the benefit is really, really big in the short term. Carrie Dils: Yeah, those are great points, and you said "Put to bed your marketing efforts," which it's ... That was punny. Well, let me ask you this. The idea of compounding sleep deprivation. Sleep deprivation not just one night, but over a period of time, and the idea that you can make up for loss sleep say by sleeping 12 hours on Saturday. Jeffrey Clark: Yeah, that's a really common behavior that a lot of us get into. It really is setting you up for problems. Something of the best studies we have on short term impaired sleep show that if you go a full 24 hours, so you pull an all-nighter, the next morning a lot of your motor functions, and your ability to coordinate movement, your ability to perform motion related tasks, and your ability to process information. Those efforts will be about the same as if you had a blood alcohol level of 0.10, which is above the legal limit for driving in most states.   An all-nighter, while it may be good for a sprint, the next morning you really will be in trouble. The problem with this is that we don't adequately make it up when we sleep for 12 hours on the weekend. Throughout the week you'll still have accumulated deficits of sleep, and you're going to have trouble executing in the way that you'd like to. The long term problem is that the more often you do that, the more likely you are to develop insomnia, burn out, depression, and anxiety with your business. I tend to think of these times when we sprint, and go without sleep as something that may be okay in the short term, but that really cannot become a long term patter. There are a very small percentage of people that have the right combination of genetics, and passion, and ability to function at a high level on a small amount of sleep, and I think it's safe to assume for the most part that you aren't one of those people.   That's what I assume about myself because I've made the opposite assumption at times, and it's been a disaster. Being a founder is a marathon. It's not a sprint, and you really need to invest in doing things that are sustainable so that when you do have a sprint, when you do have an emergency when your server goes down in the middle of the night, and you need to fix it you can do that. But if you add that onto an already strung out position, you're really going to be in trouble. Carrie Dils: Yeah, I think that plays into just the overall health in the idea that if you're not in a healthy place yourself, mentally, emotionally from a holistic perspective you're less effective and helpful to other people, and sleep certainly plays a role in that in my life. I'm one of those people that it's kind of embarrassing to say how much sleep I could sleep every day. But we're talking about that sleep deficit, and really it seems like it turns into just a bad cycle. For instance, somebody that lives in my house, it's not me and I won't name names, but there's only two humans in my house, he has trouble sleeping, and in our house we call it work brain. You go to bed, work is on the brain, it's hard to fall asleep, you finally do get to sleep, and then as we get older we may be up during the middle of the night to go to the bathroom or something.   You come back to bed and try to fall back asleep, and then all of a sudden you're wide awake, you're thinking about work again, you can't sleep, so you get out of bed, and it's 2:00 or 3:00 in the morning, and then by the time you feel sleepy again you're only 45 minutes away from your alarm clock going off. There's no point going back to sleep. You start your day at a deficit, and it's just ... I see the cycle repeating itself like you just sort of keep falling back into that, and I know we've talked about some specific techniques, but what would be your best piece of advice to someone who just was trying to break that cycle of sleep deprivation, and just turn the brain off? Jeffrey Clark: This is a complicated problem, and there's a few different approaches that may really help. In my line of work we call this Sleep Maintenance Insomnia. The in ability to maintain sleep despite falling asleep okay, and there's a few things that I think really work with this. I think the first part is finding adaptations to reduce stress, and deal with stress in your life. I tend to think that the hour before you go to bed is a great time to disconnect from your business, and try to find a moment of peace. There's some reasonable data that shows that if you can turn of screens during this period of time, that'll make a big difference too, and I think for entrepreneurs it's two-fold there.   You get rid of the light, which produces wakefulness in your brain, and you also get rid of some of the anxious thoughts about dealing with problems that maybe aren't solved very well at 11 PM at night or at 3 in the morning. Being able to sit with the discomfort of knowing that you can't fix your business at that moment is an important skill to learn. Some people use mindfulness meditation as a way to try to reduce stress there also where they'll take a few moments to meditate and allow themselves to experience what they're experiencing in a non-judgemental way, and to focus on their breath, or to focus on their body in a guided way. There's a lot of good evidence that in itself can reduce the overall tone in your body that produces wakefulness, and there's good evidence that'll help you fall asleep and stay asleep a little bit better.   The other thing that can be done is a technique we call sleep restriction, and this sounds terrifying to anyone who has had trouble sleeping, but it's the single most effective technique for sleep maintenance insomnia. It works for all insomnia, but especially to the type where you wake up during the night and can't fall back asleep. How this works is you take a sheet of paper, and every night you write down exactly how many hours you sleep, and exactly how many hours you're in bed. Over the course of a week, you take this information and you tally it up. You decide how much you're sleeping on average, how much time you're spending in bed, and then there's a standardized protocol you can use to adjust it over the week so that it averages out, and you get the same amount of sleep each night so that you don't have these ups and downs.   This is a big part of why I've created my current product Slumber Camp, which is a way to systematize sleep restriction and make it available to everyone. The other part that I think is important is recognizing that some sleep disturbance is normal and healthy, that we will have nights that are bad, and when that happens it's okay to reflect on it, and realize that tomorrow night will probably be better because you're a little more tired. You will sleep more soundly, and to let yourself be a little more comfortable with a bad night of sleep because when you can do that you suddenly break the cycle and realize, "Hey, this was just one night. Tomorrow will probably be better." But when you get anxious about it and think, "Oh no, I didn't sleep well, but I'm not going to sleep well tomorrow night." It can really cause a lot of problems. Carrie Dils: Yeah, a lot of anxiety. You mentioned keeping a log. What are your thoughts on a Fit Bit or Apple watch or things like that, that kind of monitor sleep? Do you find those to be I don't know very helpful in terms of the data they produce? Jeffrey Clark: I would say that the jury is still out on whether those are helpful. Most of the evidence we have on sleep comes from self-reported diaries. Fit Bits and Apple watches, they can produce some good data, but it's not as well validated whether it correlates with how much you're actually sleeping or if it's just a good ballpark figure. To be fair, keeping a sleep log is also a good ballpark figure. I think the danger that you can often get into is if you focus so much on sleep and measuring every little detail of it, it can make you more anxious about it. It's really a balance of choosing, "Do I ignore this part and focus on this part?" For any individual I can't say, but I don't know that measuring every little thing about your sleep is going to make it better. Carrie Dils: Gotcha. Awareness not obsession. It's kind of like Google Analytics. Jeffrey Clark: Exactly. Yeah. Carrie Dils: It's good to have the data, but not all data should be actionable. Jeffrey Clark: Right. Carrie Dils: One thing ... There's a couple of things that I'd like to keep track with you about. One that's probably very specific to entrepreneurs is travel. You mentioned earlier the sleep hygiene. One of those recommendations that's the jury is out is creating a comfortable same sleep routine or whatnot. But when you travel, that's pretty much out the window. I mean you're going out on client dinners or you're ... Even if you get to bed at a reasonable time. The bed ... It feels like you're sleeping on a piece of plywood. Any tips for traveling and getting better rest when you're on the road? Jeffrey Clark: There's a few things you can do. I think it's always going to be a struggle to sleep in a bed that's not yours. I wish I had a way around that. Some people find a certain hotel chain that has beds they like, but if you're crashing on someone's couch you may not have that luxury. Yeah, do spend a few minutes trying to make the room as comfortable as you can. A couple other travel tips are that when you're traveling, expect to sleep a few hours less a night when you get there, and expect your body to catch up as you go along. It maybe uncomfortable for a few days, but it will get better.   The other tendency that we often fall into when we travel is we maybe more tempted to use sleeping pills or alcohol to help us fall asleep or marijuana, and I would caution against that. A sleeping pill occasionally is probably alright. I mean talk with your doctor, make sure that it works for you. But getting into the habit is always going to be a problem, and although alcohol is the most commonly used sleep aid in the world, it tends not to be very good. It usually helps us fall asleep, and then as it metabolizes from our bodies it increases wakefulness, and often causes early morning awakenings, less restful sleep, and just be careful when you're traveling that you're not drinking more to try to compensate for timezone or having an uncomfortable bed.   At the same time though, I also think that caffeine can be a great tool in the mornings. If you have trouble getting up using a modern amount of caffeine can be a reasonable thing. If it's getting late in the evening, you should be careful. Try to avoid increasing that when you're traveling. But a little bit extra in the morning, yeah it might not be a problem. It might be a really helpful thing to keep you going. Carrie Dils: Okay. Don't pound the Red Bulls after ... And especially the Red Bulls and vodka late in the evening. Bad for sleep. Jeffrey Clark: Yeah, that's a good rule of thumb. Carrie Dils: Bad for sleep. Okay, well the alcohol and pills were one I specifically wanted to address because those are like, "Ah, okay. This helps me fall asleep faster." But you're saying that science shows that can actually decrease the quality of sleep over the course of the night? Jeffrey Clark: Yes. Certainly with alcohol. We know that for sure. Sleeping pills are a bit of a different story because in some people they really do improve quality of sleep. There's nothing that comes free. You're usually trading one phase of sleep for another when you take a sleeping pill, and there's really no data that long term use of sleeping pills is good for you. In terms of overall medications that cause problems, sleeping pills can be some of the most harmful and addictive medications especially in people who are prone to addiction, people who are prone to falls or dizziness, and all older adults especially. If you're getting past 60, I'd really be cautious about using a sleeping medication, and again it's something that should only be used as needed. I think the ideal ... For my patients is the people who feel, "If I just have a sleeping pill in my bag, I know I'll be okay, and then I can fall asleep because I've got a back up plan."   That's perfect. That's what I want to work with because in reality the best treatment for trouble sleeping is with cognitive behavioral therapy. It works just as well as sleeping pills, it works for a lot longer, and the side effects are a lot safer, and a lot better, which is why we try to focus on therapy when we can. Changing behavior is the most important thing for sleep, and it really works. Carrie Dils: Well, that sounds like a good note to end on. I still have more questions to ask, but we are actually coming up on probably the closeout point here. I don't want to hijack Dr. Walling's podcast, and then she'll never invite me back. Thank you so much Jeff for sharing your insights on sleep, and I'm sold. I was already sold, but I think really I want to sell some other people in my life of the benefits of sleep, and I think you mentioned the word discomfort a couple of times, and that's okay to experience a little bit of that discomfort while you're changing a habit, know that in a long term you're going to sleep better, you're going to rest better, which translates to working better more effectively. That's all related. Great stuff.   Jeff, where can people find you online to either say hello or learn more about Slumber Camp? Jeffrey Clark: Yeah. I'd love to have you come and check out SlumberCamp.co. It's a fully featured cognitive behavioral therapy for insomnia course, and my goal is to get as many people as possible using these techniques. Even if you can't afford it, I've got scholarships to make it free. Please come. Make your sleep better. Your life will be better for you. Your business will be better for you. Your customers will be better for it. This is an important thing to invest in. Carrie Dils: Awesome. Well, thank you so much Jeff, and for all you folks tuning. I appreciate your time today. If you head over to ZenFounder.com you can find notes for this episode along with other episodes of the show. Until next week, we'll see you then. Thanks.