Why sleep matters in having Good Energy

Casey Means, MD is a Stanford-trained physician and co-founder of Levels, a health technology company with the mission of reversing the world’s metabolic health crisis. Her book on metabolic health, Good Energy, comes out in May 2024 with Penguin Random House (pre-order here!). She received her BA with honors and MD from Stanford, was President of her Stanford class, and has served on Stanford faculty. She trained in Head & Neck Surgery before leaving traditional medicine to devote her life to tackling the root cause of why Americans are sick. She has been featured in The New York Times, The New Yorker, The Wall Street Journal, Forbes, Women’s Health, and more.

What’s your overall approach to sleep as a pillar of your health? How do you think about sleep?

Especially after diving even deeper into the research on sleep for my book,Good Energy, I can tell you sleep is one of the single most important investments we can make for our mental and physical health. The research is clear and overwhelming. And right now, we are not doing a good job at it. Compared to one hundred years ago, we are sleeping on average 25 percent less. That’s 25 percent less time for our bodies to do its critical processes of biological repair, recovery, and memory consolidation. Every time we skimp on the quantity, quality, or consistency of sleep, we inch toward the grave—and toward metabolic symptoms and diseases— by generating oxidative stress, mitochondrial dysfunction, chronic inflammation, plus a big helping of microbiome dysfunction. Lack of quality sleep is a profound “danger” signal to the body, throwing off proper metabolism and promoting fat storage. I think about sleep in three ways:

1. Sleep quantity: Getting 7-8 hours a night of good quality sleep.

   • Study highlight: One study found healthy, normal-weight individuals who slept fewer than 6.5 hours per night had to produce 50 percent more insulin than normal sleepers to achieve similar glucose results—placing the short sleepers at significant risk of developing insulin resistance in the long term. Remember, prediabetes and type 2 diabetes are insulin resistance—a root of nearly every other chronic symptom and disease.

2. Sleep quality: Getting minimally interrupted sleep.

   • Study highlight: One study followed over two thousand adult men for eight years and found that subjects who reported difficulty maintaining sleep had a two- fold to threefold higher risk of developing type 2 diabetes. And in the short term, studies showed a link between sleep quality and the immediate ability to manage blood sugar efficiently the next day

3. Sleep consistency: This is the hardest one for me, but keeping a consistent bedtime and wake time matters profoundly for our metabolic health. More on this in one of the later questions about “social jet lag”

Poor quality and quantity of sleep generate a wide array of downstream effects that damage the mitochondria. Lack of quality sleep leads to hormonal imbalances, including altered cortisol, insulin, growth hormone, and melatonin levels, all of which interact with the mitochondria. Additionally, sleep deprivation disrupts the expression of genes involved in the production of new mitochondria and replication of mitochondria. Sleep deprivation generates increased damaging free radicals, both by activating cellular machinery that makes free radicals and by inhibiting the production of antioxidants.

I mention Professor Matthew Walker in my book, Good Energy, because he notes that the Guinness Book of World Records still recognizes “Most Motorcycles Driven over the Body While Lying on a Bed of Nails” but has stopped recognizing attempts to break the sleep deprivation record because these attempts are just too dangerous. Lack of sleep is dangerous. Every person should prioritize the quantity, quality, and consistency of sleep like their life depends on it!

What tips do you have on going to sleep earlier, as well as getting up earlier?

Historically, my sleep issue is that I am a notorious night owl and go to bed at late times and my bedtime bounces around night to night. This is NOT good for your health, particularly because we tend to get more deep sleep earlier in the night. The research shows that "sleep consistency" -- meaning regular sleep and wake times — is really important for metabolic health, above and beyond sleep quantity and quality (which we all know are important!).

I have tried every sleep hack in the book to get to bed at a more consistent time, including having a sleep coach for a while (through the app Crescent Health, which was great!), texting my sleep data to my best friend every day (and having to literally Venmo her money if I don't go to bed at the goal time I'd set), and planning early workouts so I’d be forced to get up early (and hopefully then go to bed earlier). I believe in accountability and these strategies were helpful, but the honest truth is that the thing that has transformed my sleep more than anything is living with my partner who likes to go to bed at a more reasonable time than me!

Simply living with someone I deeply respect and love who has a healthier habit than me (consistent sleep!) rubbed off on me almost instantly. This isn't to say that you should pick a partner just based on their bedtimes! What it did solidify to me, though, and is the takeaway, is that having support for health goals from the people closest in your life can be transformational for success, and we should aim to surround ourselves with healthy people if being healthy is our goal!

Research has shown that who you surround yourself with directly impacts your health. For instance, if one spouse becomes obese, it almost doubles the risk of their partner becoming obese. What a mother eats before conception, during pregnancy, and even after a child is born is an extremely strong factor in the child’s health outcomes. What’s more, social support and a sense of community are known to help a person do better in the face of many different diagnoses, from cancer.) to heart disease. Fast food consumption “clusters” into groups – a science-y way of saying that if some people in a community have a particular behavior, it’s more likely that others will. Health behaviors seem to be contagious. This is supported in the research for sleep! One study from Communications Biology showed that “an individual’s sleep may impact that of their partner, promoting opportunities for sleep interventions at the family-level.”This is not a hack, it’s a long-term solution!

What are some strategies to try and get quality sleep - and STAY asleep during the night?

This was one of the most frequently asked questions, because nothing feels better than going to sleep and not waking up until your alarm goes off, or the sun comes up!

The first thing to know is that everything is connected - which means our diet, exercise and stress management all impact our ability to get quality sleep.

Below are 5 Good Energy habits to consider here that can help with sleep:

1. Stop ultra-processed foods: A high intake of ultra-processed foods confers fourfold higher odds of having insomnia! Cut the ultra-processed food in favor of real, unprocessed, organic food to create the foundation of biology for good sleep. You can literally EAT your way to better sleep!
2. Stress management: This one is so important! When it comes to Good Energy and the brain, it’s a vicious cycle: lack of healthy habits weaken the brain’s defenses to chronic stress, and chronic stress and fear can directly cause more metabolic dysfunction that worsens mood and resilience. Consider that 75 to 90 percent of human diseases are related to activation of the stress-related biology, and much evidence points to the common pathway between psychological stressors and metabolic dysfunction. Your cells “listen” to all your thoughts through biochemical signals, and the message they are getting from chronic stress is to halt the production of Good Energy. Actively employ stress management techniques like breath work, meditation, coaching or therapy, positive self talk, and spending time in nature during the day to improve stress levels and support sleep.
3. Set sleep boundaries: To establish a consistent sleep schedule, you may have to set some serious boundaries in your household, like going to bed earlier than other people or sleeping in longer. It might require keeping pets out of the bedroom or sleeping in a different bedroom from your partner for a period of time if they tend to wake you up! We need to be ruthless in getting our sleep so we can show up best for ourselves and everyone around us.
4. Maximize sunlight exposure in the daytime, and minimize artificial light at night: Spend at least fifteen minutes outdoors without sunglasses on during the first hour after waking every day. After the sun goes down, turn off any unnecessary lights and dim necessary lights to a low level or wear blue light blocking glasses. Add dimmers to your home lights if you can. Red lights in the home can work great, too. We have red lights sprinkled throughout our home that we can turn on from our phone in the hours before bed, which have been great because they are inexpensive and don’t require changing out bulbs on your regular lights.
5. Pick a cutoff time for “Last Call” on daily eating: In the US, 35 percent of food intake still occurs after 6:00 p.m, which can impact our sleep. Set a reasonable goal for when your last bite of food will be to give your body time to digest before trying to sleep. This can help with sleep quality.

For me, the biggest game changers in my sleep quality have been using my Eight Sleep mattress cover for tracking and temperature control, having a consistent bedtime and wake time, avoiding artificial light at night, and turning my phone to minimal brightness and red tint in the hours before bedtime. I take magnesium L-threonate every night before bed (I take Momentous or Now brand), and when I need an extra sleep aid, I take valerian root, L-theanine (from Mary Ruth’s or Momentous), and GABA (from Thorne).

What about strategies to increase deep sleep?

Deep sleep is a stage of sleep marked by slow brain waves (delta waves) and is characterized by minimal responsiveness to external stimuli. This is a critical sleep stage - it is when the body is thought to increase repair of tissues, consolidate memories, and regulate hormones effectively. When people get more deep sleep, they have better memory recall - this is huge!

The thing about sleep - is that sleep quality, quantity and consistency are all connected. So the strategies listed above, will also help with getting deep, quality sleep. It’s important to remember that sleep is closely tied to metabolic health - in both cause and effect. If you start taking care of metabolic health and generating Good Energy (i.e., eating real food and avoiding processed foods, sugars seed oils, consistently moving throughout the day, lifting weights, managing stress, etc.), it isn’t going to be difficult to get good, consistent, quality sleep. By doing all these things, you’ll start to notice that you’re naturally sleeping longer, getting better quality sleep, and doing it consistently.

Evidence suggests that we can improve our deep sleep amount through the following factors:

• Regular exercise

• Consistent sleep schedules

• Going to bed earlier (because we get more deep sleep earlier in the night)

• Stress management techniques

• Avoiding caffeine later in the day

• Avoiding alcohol

• Avoiding hot bedroom environment

How significant is the role of sleep in managing metabolic health issues common among women?

Interestingly, women may require more sleep than men, and it may be because of unique differences in how women and men use their brains during the day. Sleep researcher Jim Horne, the former director of the Sleep Research Centre at Loughborough University, says that “during deep sleep, the cortex — the part of the brain responsible for thought memory, language and so on – disengages from the senses and goes into recovery mode."

Additional research says that sleep disturbances may impact women uniquely worse than men. One study of subjective sleep quality showed that women with poorer sleep had greater psychosocial distress, worse metabolic health, and more inflammation than as compared to men with poor sleep. Astonishingly, women are 40% more at risk to develop insomnia. Women’s hormones and sleep are intimately tied, as well. It’s been shown that fluctuations in women’s hormones, like those that occur during the menstrual cycle (especially late luteal phase just before menstruation), perimenopause, and pregnancy all represent increased challenges for sleep.

Women need to prioritize sleep aggressively for mental and physical health. This might mean asking for more support from people around you, setting more boundaries, and doing less. We do the most for the world when we are energetic and resourced! This means investing in sleep.

What is your favorite thing about Eight Sleep and how do you use it?

My favorite thing about Eight Sleep is that I can get my sleep data passively if I’m not feeling like wearing a wearable. While I love wrist and ring based wearables (like Oura, Fitbit, and Whoop), sometimes I like to just be free of things on my body. In this situation, having the Pod still give me sleep data just by me laying there is magical!

The second thing I love about 8 sleep is the temperature control and how easy it is to use. It is one of my most favorite moments of the day to slip into a warm bed on a cold day, or a cool bed on a hot day. I also love being able to set the temperature to change throughout the night, because I tend to feel hotter as the night goes on, so I have the temperature get cooler throughout the night. Currently it’s winter, so I tend to have my bed at +3 at bedtime, +2 and +1 later in the evening, and I wake up at 0. It’s perfect! (And also saves money on the heating bill, since I turn our heat off at night and let 8 sleep do the temp control).

What’s something surprising you learned about sleep when writing Good Energy?

I think something that will surprise people who first read the book is a concept I share called “social jet lag”, which is the measure of sleep consistency looking at the difference in bedtime and wake time between work days and days off as measured by the “midpoint” of sleep. To understand “midpoint” of sleep, here is an example: if you sleep from 12am to 8am, the midpoint is 4am. We often have to sleep earlier to wake up earlier during our workdays, and sleep later since we may have the luxury to wake up later during our days off. If, for example, there is a three-hour difference between the “midpoints'' of your different sleep schedules, you have three hours worth of social jet lag. Anything more than 2 hours of social jetlag doubles your risk of metabolic disease. Unfortunately, almost half of U.S. adults report at least one hour of social jet lag! This motivated me to keep my sleep schedule on track, and keep it consistent!

For more sleep and health tips from Dr. Casey Means, order her book, Good Energy, and subscribe to her newsletter, Good Energy Living.