>>> WE KNOW WE ALL NEED OUR BEAUTY HE SLEEP.

THERE IS NOTHING MORE FRUSTRATING THAN TOSSING AND TURNING IN BED, UNABLE TO DRIFT OFF.

MILLION OF AMERICANS SUFFER FROM INSOMNIA INCLUDING OUR NEXT GUEST, THE ATLANTIC'S STAFF WRITER JENNIFER SENIOR.

SHE JOINS THE SHOW TO DISCUSS HER RECENT PIECE ON THE STRUGGLE FOR SLEEP AND HOW IT IS BECOMING A PUBLIC HEALTH EMERGENCY THANK YOU FOR JOINING US.

YOU WROTE AN ARTICLE RECENTLY, WHY CAN'T AMERICANS SLEEP?

MY FIRST QUESTION IS HOW BIG OF A PROBLEM IS SLEEP THAT IT REQUIRES THIS MUCH ATTENTION?

>> I FEEL LIKE THAT STORY, THE NAME IS A LITTLE DECEPTIVE.

IT SHOULD HAVE BEEN CALLED DON'T FEEL BAD IF YOU CAN'T SLEEP.

I WAS TRYING VERY HARD NOT TO WRITE A SCARY SLEEP STORY BUT I DEFINITELY WANTED TO CONVEY THE SCOPE.

SO MANY PEOPLE HAVE TROUBLE.

THE ANSWER IS, 30 TO 35% OF AMERICANS REPORT AT LEAST TEMPORARILY SOME FORMS OF, SOME FORM OF INSOMNIA, WHICH IS TO SAY EITHER THEY CAN'T FALL ASLEEP, THEY CAN'T STAY ASLEEP, OR THEY WAKE UP FAR EARLIER THAN THEY WOULD LIKE.

12% OF AMERICANS REPORT IT AS AN ENDURING CONDITION.

THAT NUMBER BOMBS UP TO 15% IF YOU'RE A MILLENNIAL.

ANOTHER WAY TO THINK ABOUT THIS, WHICH I THINK IS VERY INTERESTING, IS THAT 18.4% OF AMERICANS TAKE SOME MEDICATION TO FALL ASLEEP, EITHER EVERY NIGHT OR SOME NIGHTS.

WHEN I MENTIONED THIS TO A GIANT IN THE FIELD, THIS WOMAN NAMED SUZANNE, SHE WROTE BACK TO ME, THAT'S IMPOSSIBLE.

THE NUMBER HAS TO BE MUCH HIGHER.

WHICH MAKES ME WONDER, ARE PEOPLE UNDERREPORTING?

LIKE THEY'RE ASHAMED?

DO THEY NOT CONSIDER MELATONIN A DRUG?

DO THEY NOT CONSIDER WEED A DRUG?

>> YOU SHARE A LOT ABOUT HOW THIS IS SUCH A PERSONAL STORY FOR YOU BECAUSE UP, THEN ONE NIGHT, MAYBE TWO MONTHS BEFORE I TURNED 29, THAT SENSE THAT NORMAL SLEEPERS HAVE.

THEIR MINDS LISTING TOWARD UNCONSCIOUSNESS, COMPLETELY DESERTED ME.

HOW BIZARRE, I THOUGHT.

I FELL ASLEEP AT 5:00 A.M. AND THIS WAS, DO YOU REMEMBER THAT KIND OF TRANSITION FROM A PERSON WHO GOT GREAT SLEEP TO JUST -- NO LONGER HAVING IT?

>> SUCH A GOOD QUESTION.

IT IS SO VISCERAL WHEN I THINK ABOUT IT.

I WAS JUST THINKING THE OTHER DAY THAT SENSATION THAT YOU HAVE, NOT JUST OF THE PIX LATING STUFF.

THAT YOU CANNOT STAY UP ANOTHER MINUTE.

YOU JUST HAVE TO ROLL OVER AND YOU'RE OUT.

I USED TO HAVE THAT EVERY NIGHT AT 1:00 ON THE NOSE.

I HAVEN'T KNOWN THAT SENSATION FOR OVER 25 YEARS.

AND I STILL KNOW, I CAN STILL REMEMBER WHAT IT FELT LIKE, THE TUG INTO UNCONSCIOUSNESS.

THERE'S SUCH A GIANT DISCONTINUITY IN MY PERSONALITY OR MY BODY BETWEEN THEN AND NOW.

YEAH.

I DO REMEMBER THAT TRANSITION.

AND IT WAS ABRUPT.

IT WAS TERRIFYING.

AT FIRST IT WAS JUST WEIRD.

IN SHORT ORDER, YOU'RE THINKING, SOMETHING BROKE.

WAS I POISONED?

WHAT HAPPENED?

>> WHAT ARE SOME OF THE REASONS WE HAVEN'T BEEN ABLE TO GET A HAND ON THIS?

>> A LOT OF THEM ARE THINGS THAT ARE INTUITIVE.

A LOT OF THEM, THE NUMBERS ARE REALLY FASCINATING.

ELECTRICITY LAYS WASTE TO OUR CIRCADIAN RHYTHM.

MIDNIGHT WAS NO LONGER MIDNIGHT.

YOU KNOW?

SOMETHING A LOT OF US STAYED UP UNTIL.

BUT LET'S SEE, 16.4% OF AMERICANS WORK NONSTANDARD HOURS, WHICH IS TO SAY NIGHT SHIFT WORK.

SO THEY'RE DRIVING HOME DURING THE DAY WHICH IS CONFUSING THEIR INTERNAL CLOCK.

SO THAT'S PART OF IT.

PEOPLE WORK SECOND JOBS.

THAT'S PART OF IT.

IF YOU'RE WHITE COME ARGS YOU ARE GOING TO HAVE THE CONSTANT WOOD-PECKERING INCURSIONS FROM YOUR BOSSES AND YOUR COLLEAGUES AND EVERYONE ELSE ASKING BUT WORK.

THERE IS NO SUCH THING, YOU KNOW, THE BOUNDARY BETWEEN HOME AND WORK IS COMPLETELY DISSOLVED.

ADOLESCENTS SOCIALIZE ONLINE, THEY DO HOMEWORK ONLINE, THE BLUE LIGHT, IT'S HORRIBLE.

>> I WAS, MY FASCINATION WITH SLEEP IS PARTLY BECAUSE I DON'T GET GOOD SLEEP AND I'M SURE YOU AS A PERSON, YOU DESCRIBE YOURSELF AS SOMEONE WHO DOESN'T GET GOOD SLEEP.

YOU LOST THE ABILITY.

IT IS AMAZING HOW PEOPLE WHO GET GOOD SLEEP HAVE THE BEST ADVICE FOR PEOPLE LIKE US.

HAVE YOU TRIED, I DON'T KNOW, X, Y, Z, A -- YES.

I'VE GONE THROUGH ALL THOSE THINGS AND IT'S NOT SLEEPING.

>> I LOVE YOU FOR SAYING THAT.

THE.

A INSIPID TIPS.

ALL THE LISTS WE'RE GIVEN.

OH, I HADN'T THOUGHT OF THAT.

DON'T DRINK CAFFEINE AT 9:00 AT NIGHT.

CRAZY.

IF YOU SLEEP IN A ROOM THAT'S THE RIGHT TEMPERATURE.

AS IF WE DON'T INSTINCTIVELY THROW A BLANKET OFF IF WE'RE TOO HOT.

AND THE DOPEY STUFF LIKE SPRAY YOUR PILL THEY DO WITH ESSENTIAL OILS.

THESE ARE NOT, IF YOU REALLY HAVE TROUBLE SLEEPING, AND IT IS VERY INTERESTING.

IF YOUR CASE, I WONDER WHETHER YOUR BODY LEARNED A NEW TRICK.

EVENTUALLY, NOT SLEEPING BECAUSE A REPETITIVE STIMULUS AND IT IS A NEGATIVE.

SO YOU HAVE TO RELEARN SLEEP TO SOME DEGREE.

AND COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA IS ONE OF THE BEST TOOLS OUT THERE.

AND ALMOST NO ONE KNOWS ABOUT IT BECAUSE GENERAL PRACTITIONERS DON'T HEAR ABOUT IT MUCH AND NOT ENOUGH PEOPLE ARE TRAINED IN IT.

THERE IS A SUBSTANTIAL NUMBER OF PEOPLE FOR WHOM IT DOESN'T WORK SO PEOPLE TAKE MEDICATION AND THEY DON'T WANT TO TALK ABOUT IT BECAUSE THERE'S SOMETHING SHAMEFUL ABOUT IT.

AND MY FAVORITE THING IS WHEN PEOPLE SAY, I COULD NEVER NOT SLEEP.

YOU LOVE SLEEP TOO MUCH.

WHO LOVES SLEEP MORE THAN INSOMNIAC!

>> YEAH.

AND THAT'S STRESSFUL.

>> YES.

>> I WONDER, YOU TALKED ABOUT COGNITIVE BEHAVIORAL THERAPY IN THIS ARTICLE AND THERE'S THIS IDEA OF SLEEP RESTRICTION.

EXPLAIN WHAT IS HAPPENING FOR OUR AUDIENCE.

>> I WILL.

IT IS REALLY ONE OF THE MAIN PILLARS OF COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA.

IT IS KIND OF THE PILLAR AND IT IS REALLY HARD.

I COULDN'T SWING IT.

I COULDN'T HACK IT.

IF PEOPLE CAN HACK IT, IT IS SUPPOSED TO WORK.

WHAT DO YOU DO?

YOU KEEP YOUR SLEEP DIARY.

YOU HAVE YOUR WEARABLE AND IT TELLS YOU HOW MUCH SLEEP.

AND YOU DISCOVER THAT YOU GO TO BED AT, LET'S SAY, 11:00, AND YOU WAKE UP AT 8:00, AND YOU'VE ONLY ELEMENTARY SCHOOL FIVE OUT OF THE NINE HOURS.

YOU CAN PRESS ALL OF THAT SLEEP INTO A FIVE-HOUR BLOCK.

THIS IS A DISCIPLINE YOU DO.

WHICH MEANS, LET'S SAY YOU WANT TO STILL CHOOSE EIGHT AS YOUR WAKE-UP TIME.

YOU HAVE TO GO TO BED AT 3:00.

YOU ARE ONLY ONLY THOSE FIVE HOURS IN BED.

THAT IS IT.

ONCE YOU'VE SLEPT THE MAJORITY OF THOSE HOURS, YOU HAVE TO DO IT TWO MORE NIGHTS.

AND ONLY AFTER YOU'VE DONE IT FOR THREE NIGHTS, THEN YOU CAN REWARD YOURSELF WITH 15 MORE MINUTES OF SLEEP.

AND YOU HAVE TO DO THAT FOR THREE NIGHTS.

THEN YOU ADD 15 MORE.

YOUR SLEEP DOESN'T JUST CONTRACT OBLIGINGLY INTO A CASE.

IT IS REALLY HARD TO DO.

AND IT MAKES YOU REALLY HYSTERICAL WITH EXHAUSTION IF YOU CAN'T PULL IT OFF.

>> AS YOU DESCRIBE THIS PROCESS, I CAN HEAR PEOPLE IN THE AUDIENCE WHO DON'T HAVE A PROBLEM SLEEPING SAY, THAT SOUNDS LIKE THE MOST XIETY.

WHEN PEOPLE DON'T FALL ASLEEP, THEY'RE THINKING ABOUT NOT FALLING A SLEEP.

OH, NO, I ONLY HAVE THREE HOURS LEFT.

THEN THEY'RE THINKING ABOUT THE NEXT DAY AND HOW THEIR LIFE WILL BE A WRECK.

SO I WONDER HOW MUCH OF SLEEP IS OUR PHYSIOLOGICAL NEED TO REST, RIGHT?

AND THEN OUR SORT OF MANAGING ALL THE PSYCHOLOGY AROUND IT TO ALLOW OUR BRAIN TO RELAX.

>> YOU ARE EXACTLY RIGHT.

IN FACT, YOU HAVE ISOLATED WHAT BASICALLY KEEPS INSOMNIA AIRBORNE, IF THAT'S THE REAL WORD.

AT A CERTAIN POINT, WHATEVER THE PRECIPITATING FACTOR, IF YOU CAN EVEN FIGURE OUT WHAT IT IS, KIND OF BECOMES BESIDE THE POINT.

YOU START DOING INSOMNIA MATH.

NOW I HAVE FIVE HOURS, FOUR AND A HALF, NOW I HAVE THREE.

PART OF THE BEHAVIORAL COMPONENT OF COGNITIVE BEHAVIORAL THERAPY IS TO NOT LOOK AT YOUR WATCH.

WHAT THEY SOMETIMES SAY WHEN YOU'RE DOING SLEEP RESTRICTION IS, YOU TAKE A MEDICATION IN ORDER TO MAKE SURE THAT YOU DO FALL ASLEEP AT THE PRESCRIBED HOUR.

AND PEOPLE ARE OFTEN VERY RELUCTANT TO DO THAT.

IF YOU ONLY TAKE IT A SHORT PERIOD OF TIME, IT IS PRETTY EASY.

YOU CAN WEAN.

IN FACT, YOU CAN WEAN ANY TIME, REALLY.

JUST TAPER SLOWLY AND UNDER THE SUPERVISION OF A DOCTOR.

THE IDEA IS THAT YOU BUILD UP ENOUGH SLEEP PRESSURE IF YOU DO THIS.

I REFUSED TO TAKE SLEEP MEDICATION.

IT MADE IT WORSE.

YOU HAVE TO MANAGE YOUR ACTUAL ANXIETY ABOUT SLEEPING.

AND FACT-CHECK YOUR BELIEFS.

WILL YOU REALLY NOT FUNCTION THE NEXT DAY?

WILL YOU REALLY GET FIRED?

OR WILL YOU REALLY BE MAD AT YOUR JOB FOR A DAY OR TWO?

>> I ALSO WONDER WHETHER THERE IS THIS CONNECTION, WHICH WAY THE CONNECTION IS BETWEEN THE ANXIETY THAT THE LACK OF SLEEP IS GIVING YOU AND DEPRESSION.

THERE'S A LOT OF OVERLAP FOR PEOPLE WHO SEEM DEPRESSED.

WHICH WAY IS IT?

>> I'M SO GLAD YOU ASKED THAT.

THAT WAS ONE OF THE THINGS I FOUND MOST FASCINATING.

THE MOST RECENT WAVE OF STUDIES SUGGESTS, OF COURSE, THEY'RE BIDIRECTAL AS ANY ANALYST OR CLINICIAN WOULD SAY.

BUT IT USED TO BE, IF YOU FELL ASLEEP FOR SOME KIND OF MYSTERIOUS REASON, JUST THIS I HADDIO PATHIC ONSET OF SLEEPLESSNESS, THEY WOULD SAY IT'S PROBABLY DEPRESSION IN DISGUISE.

IT IS HOW IT IS MANIFESTING.

I WAS LOOKING AT PEOPLE SAYING, YOU DON'T UNDERSTAND.

APPLY WEEK IS NO DIFFERENT FROM THE WEEK, MONTH, TWO MONTHS I'VE HAD BEFORE.

THERE IS NOTHING DIFFERENT.

AND EVERYONE SAID I WAS DEPRESSED.

NOW THE THOUGHT IS ACTUALLY THAT SLEEPLESSNESS MORE OFTEN CAUSES DEPRESSION THAN VICE VERSA.

DEPRESSION CAN CERTAINLY CAUSE SLEEPLESSNESS.

BUT THERE IS A THOUGHT THAT MORE OFTEN IS THE REVERSE.

IT CERTAINLY PREDICTS DEPRESSION IN A WAY THAT DEPRESSION IS NOT QUITE PREDICT SLEEPLESSNESS AS CONSISTENTLY.

>> MAYBE IN AMERICA WE'RE IN A PLACE WHERE THERE'S A LARGER CONVERSATION ABOUT MENTAL HEALTH.

MAYBE A LITTLE LESS STIGMA AROUND TAKING ANTI-DEPRESSANTS.

HAVE WE BEEN SCARED AWAY FROM PHARMACOLOGICAL SOLUTIONS TO NOT SLEEPING?

>> PEOPLE ARE VERY FREE WITH SAYING THEY'RE ON THEIR PROZAC OR WHATEVER BUT PEOPLE DON'T LIKE TO TALK ABOUT WHETHER THEY TAKE THING FOR SLEEP.

AND A LOT OF PEOPLE DO.

AND THE QUESTION IS WHY THERE'S SO MANY SHAME AROUND IT.

AS YOU SAID, WITH SOME LIFESTYLE CHANGES, MAYBE PEOPLE WOULDN'T NEED STATINS OR OZEMPIC.

THEY WOULDN'T NEED THEIR HYPERTENSION DRUGS.

NO ONE SAYS THEY'RE ADDICTED TO THEM.

BUT PEOPLE SAY THEY'RE ADDICTED TO THEIR SLEEPING PILLS, AND THEY CALL THEM DRUGS AS OPPOSED TO MEDICATION.

THERE IS A STENCH OF STIGMA SURROUNDING IT.

AND I THINK SOME OF IT IS CULTURAL.

AND THERE'S A DIFFERENCE BETWEEN DEPENDENCE AND ADDICTION.

PEOPLE ARE TAKING IT BECAUSE THEY'RE SEEKING RELIEF AND CONTRARY TO WHAT MOST PEOPLE THINK, MOST PEOPLE DON'T KNOW BEYOND THEIR AMOUNTS.

MELATONIN IN THE HIGH DOSES WE HAVE IN THE UNITED STATES.

THREE MILLIGRAMS, FIVE MILLIGRANS, EVEN TWO.

YOU CAN ONLY GET IT BY PRESCRIPTION IN MANY EUROPEAN COUNTRIES.

PEOPLE TAKE IT WITHOUT REALIZING, IT IS A CIRCADIAN SIGNALING HORMONE.

IT'S GOOD FOR JET LAG.

PROBABLY GOOD FOR SHIFT WORKERS.

IT TELLS PEOPLE WHEN TO GO TO BED.

>> WE HAVE HEARD FOR SO LONG, YOU NEED EIGHT HOURS OF SLEEP.

RIGHT?

AS YOU WENT AND TALKED TO ALL THESE DIFFERENT RESEARCHERS, WHAT WERE THE THINGS THEY SAID, YEAH, YOU DON'T HAVE TO WORRY ABOUT THAT.

THAT THING THAT YOU'VE HEARD FOR 20 YEARS, THAT'S NOT SUPPORTED BY THE SCIENCE THAT I'M DOING OR MAYBE YOU SHOULD THINK ABOUT THIS OR THAT MORE.

>> RIGHT.

SO I ASKED EVERY RESEARCHER I INTERVIEWED, TELL ME THE DOGMA ABOUT SLEEP THAT YOU THINK OUGHT TO BE DEBUNKED OR YOU THINK IS TOTALLY WRONG AND EIGHT HOURS CAME UP THE MOST.

I'M GLAD YOU MENTIONED IT BECAUSE THERE IS ACTUALLY.

MANY THAT SAY THE RIGHT AMOUNT IS 6.5 TO 7.4.

IT IS TRICKY.

THOSE NUMBERS ARE ASSOCIATED WITH THE BEST HEALTH OUTCOMES.

WHAT THAT MEANS, YOU DON'T KNOW WHY PEOPLE ARE SLEEPING MORE.

YOU CAN'T, YOU CAN ONLY CONTROL THE THINGS YOU CAN CONTROL FOR.

YOU CAN CONTROL FOR AGE, FOR WEIGHT, FOR, I'M TRYING TO THINK, AND SEX.

DO YOU SMOKE?

THE PRE-EXISTING CONDITIONS THAT YOU MIGHT KNOW OF, IT'S HARD TO CONTROL FOR ALL OF THEM.

BUT THERE ARE MANY STUDIES THAT SAY SEVEN.

MANY THAT SAY SEVEN.

ALSO, THIS WILL CHANGE OVER THE COURSE OF A LIFETIME.

OLDER PEOPLE DON'T SLEEP AS WELL AS YOUNGER PEOPLE.

THEY JUST DON'T.

SO WHEN PEOPLE WHO ARE 75 COME INTO A SLEEP CLINIC AND SAY I'M NOT SLEEPING EIGHT HOURS, THE CLINICIANS HAVE TO LOOK AT THEM AND SAY, I HATE TO BREAK IT TO YOU.

AT THIS AGE, YOU'RE PROBABLY NOT GOING TO.

>> HERE YOU ARE, 25 YEARS LATER.

YOU HAVE LITERALLY THROWN THE KITCHEN SINK AT THIS.

ACUPUNCTURE AND DRUGS AND EVERYTHING ELSE.

WHAT IS YOUR SUGGESTION FOR WHO TO REACH OUT TO?

THE INFRASTRUCTURE IS UNEVEN.

THE EXPERTS MIGHT DIFFER IN THEIR OPINION.

>> MAYBE SOME HAVE APNEA, ALL SORTS OF THINGS.

I WOULD SAY TO PEOPLE, NUMBER ONE, IF IT'S BEEN A PERSISTENT CONDITION, GET YOURSELF INTO A SLEEP CLINIC TO SEE, YES, IF THEY CAN GIVE YOU COGNITIVE BEHAVIORAL THERAPY.

IF YOU FEEL LIKE YOU'RE TAKING MEDS AND THEY'RE RAGING OUT OF CONTROL, THEY MAY BE ABLE TO HELP YOU MANAGE THEM, REASSESS WHAT YOU'RE TAKING.

THERE ARE APPS, TWO DEVELOPED BY THE DOD AND THE VA. ONE DOESN'T INCLUDE A SLEEP RESTRICTION AND ONE DOES.

I CAN'T REMEMBER THE NAMES.

IF YOU JUST TYPE IN COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA ON GOOLG AND YOU WRITE.

YOU CAN SEE VERY QUICKLY WHICH HAS THE DRACONIAN SLEEP RESTRICTION AND IT IS THE ONE YOU WANT AND THAT WILL BE AVAILABLE TO YOU IMMEDIATELY.

ACTION PRESSURE IS GREAT.

IT JUST RELAXES YOU.

I WOULD SAY THAT MEDITATION DOES HELP.

IT DOES.

>> JENNIFER SENIOR, THIS HAS BEEN A FASCINATING CONVERSATION.

THANK YOU SO MUCH.

ONE, FOR TURNING YOUR PERSONAL NIGHTMARE INTO SOMETHING THAT PEOPLE CAN LEARN FROM AND WRITING ABOUT THIS.

THANKS SO MUCH FOR YOUR TIME.

>> THANK YOU.

THANK YOU FOR THE GREAT QUESTIONS.