Any year the word “pandemic” is among the most popular search terms in Google, you know you’re in for a ride. If you’re like most people, the word itself is synonymous with some special challenge or circumstance you’ve had to endure. Many people have gotten sick. Many people have died. And an even great number have been compelled to make unwanted lifestyles changes. I have a few friends who entered the year physically and mentally unscathed, but they are the exception to the rule. The rule is that pandemics suck, and it takes special coping skills to make it out on top.

This week, I brought in my guy and newlywed, Chase Ridgway, to serenade us with his wisdom on the theme. Chase is the ultimate insider. He graduated from Capital University in Columbus, Ohio, with his Bachelor’s degree in Nursing. Chase worked in a pressure cooker environment for four years in the Cardiac Intensive Care Unit [ICU] at Ohio State Wexner. Chase also recently spent a few months on assignment to a unit that treated a number of Covid 19-positive patients. Due to his background and even-tempered personality, our interviewee is uniquely qualified to address the topic of stress management amidst a global pandemic. Never at a loss for words, I hope you find Chase’s experiences and reflections, taken from a 90-minute in-person interview, to be exquisitely practical, eye-opening, and down-to earth. FYI, I defined a few medical terms in brackets to save you time and give your thumb a break from all that scrolling.

Tell the people about yourself. 

My name is Chase Ridgway. I’ve been a nurse for five years. I spent my first four years in the ICU before transitioning over to endoscopy [procedures to look inside the body’s digestive system]. I am also currently taking classes to become a Family Nurse Practitioner.

As far as my personal life goes, I am recently married and the proud father of a black and white greyhound named Franny, and two black cats, Arnold and Mena. In my free time, I like woodworking, lifting weights, yoga, biking, boxing, and frequently hiking with my wife and family. I try to maintain an active lifestyle to stay healthy first and foremost, and to make sure what I preach and what I practice are one and the same.

What informed your interest in the medical field?

It was a family thing. My sister, my cousin, and my aunts were nurses. They liked their jobs. I’m also a people person. I knew I wanted to do something that involved people. Nursing is also a pretty steady occupation. You are never going to run out of people to treat. In fact, the healthcare profession is actually gaining patients.

I was also a heavy kid growing up. I had a really cool pediatrician, Dr. Heiny, who helped me get on the right path. Dr. Heiny didn’t ignore me and talk to my parents. He was very personable, very friendly, and talked to me on my level. He was also very upfront with me about losing weight, and told me very plainly in middle school that I was prediabetic, and without lifestyle changes, I could develop type-2 diabetes. To help combat this eventuality, Dr. Heiny made getting healthy into a point system and a game. He had me participate me in Weight Watchers and count the calories of everything that went into my body. He also suggested trying out sports to see what I liked. This led me to volunteer to play football in middle school, which along with many years of baseball, helped me trim down about 90 lbs from my freshman to senior year of high school. My background explains part of my interest in bariatric care [management of obesity] to this day.

How did you start out working in the Cardiac Intensive Care Unit? Was your temperament a factor in the decision?

I knew it is what I wanted to do straight out of college. I thought the intense stuff would be the most interesting, and I thought it would give me the opportunity to help the largest number of people. In reality, it was mostly about managing preventable conditions. A lot of people were chronically ill. Some had done permanent damage to their bodies. I watched the health of a lot of our patients deteriorate. This led me to want to shift to primary care to focus on the prevention side. People in hospitals often need band-aid care. We fix them up so they can return home and go about their lives. As a Nurse Practitioner, I want to help fight health issues before they develop and prevent these terrible conditions that people get admitted to the ICU for. It starts early, by being proactive and with the proper education.

I am generally a calm guy, but the stress of the ICU will take its toll on anyone. There were a lot of sad cases of drug abuse and overdose that were very difficult to manage. We also had cases where a single sick patient might have 10-12 different medications running through their IVs. Family members would often ask questions that nobody could be sure of. And about once a month, one of my patients would pass away. I was also working nights. I would typically work 7 PM to 7 AM, several days a week, and pick up a lot of overtime. On days I worked, I would sleep from 9 AM to 4 PM. I barely saw anyone, and when I did see someone, I would lose sleep. Whenever I had several days off in row, I would typically sacrifice two of them just flipping back to a normal sleep schedule.

My first few months in ICU were rough. I had a hard time going to sleep, thinking of everything that happened that day and playing out different scenarios in my head to make sure I was prepared. I got better at stress management over time, but it’s something you have to constantly stay on top of in that environment. ICU was intense, and it was fun. I liked it, and I learned a lot, but I knew it wasn’t something I could continue for life. Around year three, I could sense that it was time for a change.

What’s the most chaotic situation you’ve ever had to deal with? 

We once had a patient who had just suffered a heart attack. He was in cardiac arrest and came to our catheter lab to receive treatment. By that time, he had already been unresponsive for a couple hours. His blood pressure was very low and his organs were starting to shut down, and began doing CPR and giving meds. It was basically I and a few nurses running a code [trying to save a dying person], and we were fortunately able to get him back. The patient had a bunch of occlusions in his heart and was admitted from the cath lab to the ICU floor. He had like 20 family members with him, and they all wanted answers. They stayed up all night in the waiting room because they didn’t know if he would make it to the next morning.

The patient wasn’t showing any signs of life neurologically. His lab values from his blood showed massive organ breakdown and death. His family was camped out, praying, hoping for the best. They wanted to wait until his daughter could come see him before he passed. And so we spent the whole night trying to keep him alive long enough for his daughter to say goodbye. As for the doctor, he was sitting outside his room the entire time, ordering meds and directing us what to do. The patient’s electrolytes would get out of whack, and we’d have to correct it or he would go into cardiac arrest again. He needed blood drawn every hour and meds every 20 to 30 minutes. He had 5 or 6 IV drips going. Three of them are called vasopressors to help keep his blood pressure high enough.

It was a chaotic situation. I would go out and talk with the whole family as often as I could, every 2 or 3 hours, to give them updates. One thing they talk about is not giving false hope but remaining positive, which is not easy to do. It’s hard to tell the truth and be honest about his condition and not inspire false hope. “He’s still fighting, and he’s not doing any better.” You try to ride the line and be as respectful as you can.

The man wasn’t in good shape, but he made it through my shift. We stabilized him long enough so his daughter could some see him the next day. When I came back the next night, he was gone. The family decided to reverse his code to DNR [do not resuscitate], and turned off all the medication. It was a tough situation for everyone. I’ve had a lot of patients in critical care, but he was one of the most difficult to keep alive, and one of the most emotionally taxing to take care of.

How do you stay calm under pressure? Is there a special motto or breathing technique or prayer or meditation that you resort to?

I’ve always been a guy who doesn’t overreact to things. Some of it is built into my personality. I can’t say that I have a special secret or mantra, but I have learned from working in ICU that work stress isn’t worth bringing home. Don’t worry about anything you can’t control. I don’t think about it or dwell on it. At the end of the day, it’s a choice. I know it’s not always easy to do, but knowing that is what makes the difference for me.

My calmness also comes from being sure that I am in the right place doing the right thing with my life and that I have the right knowledge to help. I gave it my all in my schooling and in my training and I felt like as long as I kept learning and getting better, I could remain calm in every situation. Listen to those who know best in an area, and you can feel confident enough about what you’re doing to experience that same effect. Knowledge is key here, as is the ability to keep learning and listening.

I’ll add that physical activity is the number one way for me to de-stress in the moment. Early in my career, like I said, I was very stressed out. During the first few months, I’d be so keyed up from work that I would come home and work myself out to exhaustion and hope to be able to fall asleep after that. I would get home at 7 AM and wouldn’t go to bed until 1 PM, because I was so focused trying to remember everything and make sure I did the very best I could. I eventually got better at the work-life balance, but it wasn’t always easy.

Music is another big one. I rarely ever drive in complete silence. Music and comedy, but between the three, physical activity for me is king. They were also pretty big on deep breathing in my undergraduate program. Whenever you can, take a moment to deep breath, focus, and try to process as much stressful input as you can.

Based on your reflections, it sounds like there is a lot of grace built into our biology. In a word, physical and emotional health is capable of changing for the better.

Health outcomes can always be improved with diet, exercise, and stress management. Even in cases where permanent damage has taken place, lifestyle changes can help prevent the situation from getting worse. Take diabetes, for example. The pancreas is no longer able to secrete its own insulin after irreversible damage has occurred. However, diabetics who make lifestyle changes will likely need less insulin, lose weight, and generally feel better. Immune function may go up. Fatigue may go down. It’s not a cure all, but it makes a huge difference. And that is a kind of grace.

Hypertension [high blood pressure] is another example. Depending on the cause, hypertension can be reversible. Salt intake. Fat intake. Caffein intake. Weight. Stress. And some people also have other conditions that influence it and need managed. You should always first develop a plan of treatment with your doctor, but generally anyone can improve their health at least a small amount with lifestyle changes. The goal is to get your body working better, feeling better, and hopefully living longer.

The sicker and more out of shape you get, the harder it becomes to reverse health outcomes. If you’re immobile, for example, or if you’re very old. It is always best to make lifestyle changes as soon as you can wherever you are.    

How has the pandemic influenced the healthcare industry, in general, and your occupation, in particular? 

Healthcare has become a lot more careful about what visitors they let in and who is being treated where. They’re a lot more careful about making sure employees call off when they’re sick. I know a lot of nurses who are workaholics and would come in no matter what. With Covid, they realize their health can deteriorate if they put extra stress on themselves, and they also run the risk of getting their coworkers and patients sick.

I also see a lot more people doing touch point cleaning in and around our work stations. As a nurse, we wear a lot more PPE [personal protective equipment]. Masks. Gloves. Eye shields. For example, we all wear N-95s or respirators whenever administering an upper endoscopy to patients. These tests look for infections, inflammation, ulcers, genetic diseases, things like that. And we have all our patients get tested for Covid before entering our unit.

You recently got assigned to a unit that saw a number of Covid-19 patients. What was it like working in that environment?

It was an in-patient Covid overflow unit. About fourteen of us from endoscopy received this assignment. The unit was created because Covid cases were rising and they were trying to isolate Covid patients on the units these people came from. It was difficult for everyone. I was gone from in-patient nursing [overnight care] for about a year, and some had been gone even longer. And so we were all worried about patient safety and making sure we were back to being competent and patients were getting appropriate care. It was dicey at first. I oriented for about two weeks, and there was the option to orient for even longer for those who needed it.

We took care of patients who had tested negative and others who ended up testing positive. It was a brain and spinal hospital, so a lot of people had neurological issues. Some patients had liver disease and some were there for surgeries. Time management was the biggest thing. It’s a skill that often gets lost in the moment. In endoscopy, we would hyper focus on one patient whereas on this unit were taking care of 3 or 4 patients at a time and needed to divide that time adequately to care for each patient. In this way, it resembled the ICU.

A few weeks ago you received a vaccine. How did that go?

Healthcare workers were one of the first populations to get offered the vaccine. It wasn’t required, and some were hesitant, but most went ahead and got it. A few weeks ago, I got my second dose of the Moderna vaccine, which consisted of two shots four weeks apart from each other. My only symptom after the first shot was a sore arm. It felt just like a flu shot. People who had got it before me said the second one was pretty rough, at least rougher than the first. After my second shot, I felt very fatigued. I had body aches and nausea. Not everyone experiences these symptoms. They say two thirds of all people don’t feel anything beyond a sore arm.

To my mind, it’s well worth it. If you do contract the virus, there’s a less likelihood of developing severe symptoms. However, it’s still unclear if you can spread it after you get the vaccine. People still need to be careful, wear masks, and take all the other precautions.

What’s the most challenging part of working in healthcare? 

It’s very physically exhausting. You’re constantly in motion, gathering resources, going from room to room to take care of different patients. It’s not an easy job. Some patients are less appreciative of your help than others, which can be frustrating.

What about the most rewarding? 

Making a positive impact in the lives of others. Helping people get home and live healthier lives and hopefully not have to come see us again. The job can be demanding, the job can be stressful, but I know the work we do is meaningful. And, in spite of everything, there have been very few days where I didn’t feel like going in.

How does your current job in endoscopy compare to working in the ICU and the Covid Unit?

Endoscopy is all out-patient, so people generally go home the same day. There are 30-40 employees on any given day, and we see anywhere from 60-80 patients in a day. It’s a very high-functioning environment, and we get each patient in and out of the hospital within a couple hours. Each procedure lasts anywhere from 15 minutes to an hour or more, and they take place in any one of 9 procedure rooms. I prefer endoscopy not because it’s low pressure but because we deal with one patient at a time. This allows us to get know that individual a little bit and fully focus on what we’re doing. We also have a good camaraderie among the staff, as we take care of the same patient in different phases. There are also fewer life or death situations, and so that helps with the stress. The biggest difference I find is I’m physically but not mentally exhausted at the end of the day.

The flexibility is one of the things I appreciate the most about nursing. There’s opportunity to try something new if you get bored or unhappy where you’re at, no matter where that may be.

You’re currently in school. Tell us more about the endgame you have in mind.    

My end goal is to become a Family Nurse Practitioner. FNPs can prescribe medication, examine patients, diagnose and treat conditions, whether that be with medication or other kinds of interventions. A typical visit covers a lot of what you would have done during a normal doctor’s appointment. Eventually I’d like to specialize in bariatric care, preferably with kids, or diabetes, or maybe become a general practitioner who sees patients of all different kinds in an out-patient setting. I’ve got about a year and a couple months left of the 3-year program. OSU Wexner has a full-time work, part-time study program where they offer tuition assistance.

I’m currently taking around 9 credits. We’re learning assessment techniques and pharmacology, where you learn about all the different drugs to prescribe and their various contraindications [reasons not to prescribe a medication]. It can be stressful to work full time and do school, but I feel like with the time management and study skills I’ve acquired, it hasn’t been as bad as I thought it would be.

Your wife is also a nurse. How has being married to someone in the same field influenced your life? 

I think being married to someone in the same field makes it easier to destress, especially for people with stressful occupations. Megan works with cardiac patients at Nationwide in the ICU, and I’ve already said a lot about the challenges of working in that environment. It helps to connect with someone of similar interests or work because you have shared experiences, and communication become that much easier.

Healthcare, in general, is a specialized thing where there is a lot of intimacy between patients and coworkers and everyone involved because it’s the work of improving lives and providing the best possible care. Healthcare is a lot different from other fields. There’s a very real healthcare community, and it helps to have someone who is a part of that and can relate to that. When my wife and I first met, we were both on the night shift, which helped us connect and made it a lot easier on our relationship. Megan is currently studying to be a CRNA [certified registered nurse anesthetist], and so were both doing the work-study thing and can relate to each other’s experiences in a big way.

What advice would you give someone who came to you for help with stress management and emotional control?

The key is to take a minute and think about all the resources you have, whether that’s knowledge, giftings, skills, or people. My ability to stay calm and in control, in my relationships, work, and the goals I’m working toward, is about having confidence in those resources. It’s also important to have good coping skills to destress, and to find activities or hobbies that have a relaxing effect on the mind. Stress management, like good health, is all about prevention. You don’t want to wait until you’re in an emotional crisis to act. You want to take steps now to set yourself up for success in the future.

Boundaries are also important. Don’t pull yourself in too many directions. Don’t get too emotionally involved with your work. Don’t take things personally. And don’t dwell on negative experiences. I know that’s easier said than done, but it’s a skill that can be developed. I made the choice to sacrifice social time, and time spent on hobbies, to dedicate to being a full-time nurse and student. My lifestyle works for me, but everyone should weigh their emotional health and well-being before taking on any new commitments. Think about the sacrifice that will be involved and whether you will be able to follow through. And remember, you can still be happy while you make sacrifices to pursue your goals and ambitions.

They say success in nursing is as much about taking care of yourself as it is taking care of patients. The same applies to other areas of life. Self-care is important because it affects your outlook on life, how others see you, how you see yourself, and how you interact with the people around you. If you’re not allowing yourself time and space to decompress and relax, whatever that looks like for you, then you’re setting yourself up for failure.

You have the last word. 

Wear your masks. Stay away from people when you can, and be safe when you can’t. Also, maintain communication with the ones you love. Don’t take for granted the time you get to spend with them because tomorrow’s not promised.

Benjamin Franklin famously quipped, “In this world nothing can be said to be certain, except death and taxes.” People think a lot about taxes. Knowing that tax season is around the corner may inspire us to work more or spend less. And if we qualify for a generous tax return, it may have the exact opposite effect. It goes without saying that taxes have an effect on the emotions and lifestyle of almost every adult American. It is generally true that what we expect to happen tomorrow influences our behavior today. Since death is a certainty, and not merely an expectation, how should knowledge of death impact the way we live today? A lot of times we postpone this uncomfortable question until the very last minute. People on their deathbed, however, don’t have that luxury.

Bronnie Ware is an Australian nurse who spent several years in palliative care (care for terminally ill patients). She regularly got to converse with people on the brink of death, and what she learned from those conversations is as fascinating as it is thought-provoking. Ware’s experience inspired her to author The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing.

The top 5 regrets she discovered are: 1) I wish I’d had the courage to live a life true to myself, not the life others expected of me; 2) I wish I didn’t work so hard; 3) I wish I had the courage to express my feelings; 4) I wish I had stayed in touch with my friends; 5) I wish I had let myself be happy.

I’ve transcribed a YouTube clip in which a famous vlogger and psychologist, Ralph Smart, succinctly outlines each regret.

Transcript:

Nurse reveals the top 5 regrets people make on their deathbed. This is a new series. Well, we’re going to talk about the greatest, most inspirational, life-changing articles and stories on the whole internet before we’ve had breakfast. . . This one really caught my eye. This actually went viral a while ago, and a nurse–Bronnie Ware–who was working in palliative care, looking after the elderly. She noted down that they shared similar regrets, things they wish they could have done. So I’m here to tell you you have got an opportunity right now.

The first wish was I wish I’d had the courage to live a life true to myself, not the life others expected of me. Now this really hit home for me because let’s face it. A lot of us we get caught up in a massive spider web of trying to live up to expectations from family and friends. You know they’re not your friends right? You’ve got to have the courage to really stay true to yourself. You’re entire life–can you do it? Because if you don’t that’s probably going to be your biggest regret ever.

The second wish she noticed was I wish I didn’t work so hard. Well, that’s why we’re nature, baby, right? Because a lot of us–let’s face it–if you are working solely for money and you’re not getting any joy of it, you really got to start scratching your head to ask yourself, “Is it worth it?” Because many of them said that their health was far more important than their earnings. And a lot of us we just don’t do that. We’re going to break our back just for a check and then use the check to pay for our back. We’re real smart.

And the third wish was I wish I had the courage to express my feelings. She saw how so many elderly people regretted suppressing emotions. Because a lot of us we do that, we suppress our emotions. We suppress our emotions–things we want to say. Sometimes you want to say yes. Say yes. Sometimes you want to say no. Say no. But don’t say no if you want to say yes, and yes if you want to say no. That can be a little rap right there. “Express yourself”–that will be the next song I release.

Number four was I wish I had stayed in touch with my friends. Now I will admit it I’m bad sometimes at keeping in contact, but this one, once again, hit home because I took out my phone and I started to call people. If you got a call from me, that’s the reason why. Thank me later. So take out your address book, probably go on page 88–that number, yeah it looks foreign right now–call that friend because you need to call them right now.

And the fifth regret was I wish that I had let myself be happy. . . A lot of us we deny ourselves of happiness. We deny ourselves to have a moment of clarity where we can move toward what most moves us.

I’m learning from that list, and that’s why it’s so inspirational, so once again there you have it. Have a beautiful day.

Our culture is littered with misconceptions about sleep. I often hear things like “If you want to be successful, then you have to sleep less than everybody else” or “I’ll sleep when I’m dead”–as if sleep wasn’t vital to life itself. You probably already sense how important sleep is based solely on how miserable you feel when you don’t get enough. Sleep-deprived individuals are notorious for performing poorly at mental and physical challenges. It is in the immediate and long-term interest of every human being to get adequate sleep on a regular basis. Of all things we should sacrifice to be successful, sleep is not one of them.

Matt Walker knows just how important getting a good night’s sleep is. He’s human, for one, but he’s also a brain scientist and has dedicated his life to the field of sleep research. Dr. Walker is the author of Why We Sleep: Unlocking the Power of Sleep and Dreams. He recently gave a Ted Talk in which he talked about how crucial sleep is to human health and well-being–and all the things that go wrong in sleep-deprived individuals. Sleep deprivation damages male and female reproductive health; impairs learning and memory; accelerates aging and dementia; weakens the immune system; and is a risk factor of heart attacks, car accidents, and even suicide. Let alone the damage it can do to personal relationships.

I’ve reposted the transcript of the talk–entitled “Sleep is your Superpower”–with permission from Ted. You can find the complete video embedded below. I now leave you with the sobering conclusion arrived at by Dr. Walker. I hope you all sleep well tonight.

Sleep, unfortunately, is not an optional lifestyle luxury. Sleep is a nonnegotiable biological necessity. It is your life-support system, and it is Mother Nature’s best effort yet at immortality. And the decimation of sleep throughout industrialized nations is having a catastrophic impact on our health, our wellness, even the safety and the education of our children. It’s a silent sleep loss epidemic, and it’s fast becoming one of the greatest public health challenges that we face in the 21st century.

Dr. Walker

Transcript:

Thank you very much. Well, I would like to start with testicles.

(Laughter)

Men who sleep five hours a night have significantly smaller testicles than those who sleep seven hours or more.

(Laughter)

In addition, men who routinely sleep just four to five hours a night will have a level of testosterone which is that of someone 10 years their senior. So a lack of sleep will age a man by a decade in terms of that critical aspect of wellness. And we see equivalent impairments in female reproductive health caused by a lack of sleep.

This is the best news that I have for you today.

(Laughter)

From this point, it may only get worse. Not only will I tell you about the wonderfully good things that happen when you get sleep, but the alarmingly bad things that happen when you don’t get enough, both for your brain and for your body.

Let me start with the brain and the functions of learning and memory, because what we’ve discovered over the past 10 or so years is that you need sleep after learning to essentially hit the save button on those new memories so that you don’t forget. But recently, we discovered that you also need sleep before learning to actually prepare your brain, almost like a dry sponge ready to initially soak up new information. And without sleep, the memory circuits of the brain essentially become waterlogged, as it were, and you can’t absorb new memories.

So let me show you the data. Here in this study, we decided to test the hypothesis that pulling the all-nighter was a good idea. So we took a group of individuals and we assigned them to one of two experimental groups: a sleep group and a sleep deprivation group. Now the sleep group, they’re going to get a full eight hours of slumber, but the deprivation group, we’re going to keep them awake in the laboratory, under full supervision. There’s no naps or caffeine, by the way, so it’s miserable for everyone involved. And then the next day, we’re going to place those participants inside an MRI scanner and we’re going to have them try and learn a whole list of new facts as we’re taking snapshots of brain activity. And then we’re going to test them to see how effective that learning has been. And that’s what you’re looking at here on the vertical axis. And when you put those two groups head to head, what you find is a quite significant, 40-percent deficit in the ability of the brain to make new memories without sleep.

I think this should be concerning, considering what we know is happening to sleep in our education populations right now. In fact, to put that in context, it would be the difference in a child acing an exam versus failing it miserably — 40 percent. And we’ve gone on to discover what goes wrong within your brain to produce these types of learning disabilities. And there’s a structure that sits on the left and the right side of your brain, called the hippocampus. And you can think of the hippocampus almost like the informational inbox of your brain. It’s very good at receiving new memory files and then holding on to them. And when you look at this structure in those people who’d had a full night of sleep, we saw lots of healthy learning-related activity. Yet in those people who were sleep-deprived, we actually couldn’t find any significant signal whatsoever. So it’s almost as though sleep deprivation had shut down your memory inbox, and any new incoming files — they were just being bounced. You couldn’t effectively commit new experiences to memory.

So that’s the bad that can happen if I were to take sleep away from you, but let me just come back to that control group for a second. Do you remember those folks that got a full eight hours of sleep? Well, we can ask a very different question: What is it about the physiological quality of your sleep when you do get it that restores and enhances your memory and learning ability each and every day? And by placing electrodes all over the head, what we’ve discovered is that there are big, powerful brainwaves that happen during the very deepest stages of sleep that have riding on top of them these spectacular bursts of electrical activity that we call sleep spindles. And it’s the combined quality of these deep-sleep brainwaves that acts like a file-transfer mechanism at night, shifting memories from a short-term vulnerable reservoir to a more permanent long-term storage site within the brain, and therefore protecting them, making them safe. And it is important that we understand what during sleep actually transacts these memory benefits, because there are real medical and societal implications.

And let me just tell you about one area that we’ve moved this work out into, clinically, which is the context of aging and dementia. Because it’s of course no secret that, as we get older, our learning and memory abilities begin to fade and decline. But what we’ve also discovered is that a physiological signature of aging is that your sleep gets worse, especially that deep quality of sleep that I was just discussing. And only last year, we finally published evidence that these two things, they’re not simply co-occurring, they are significantly interrelated. And it suggests that the disruption of deep sleep is an underappreciated factor that is contributing to cognitive decline or memory decline in aging, and most recently we’ve discovered, in Alzheimer’s disease as well.

Now, I know this is remarkably depressing news. It’s in the mail. It’s coming at you. But there’s a potential silver lining here. Unlike many of the other factors that we know are associated with aging, for example changes in the physical structure of the brain, that’s fiendishly difficult to treat. But that sleep is a missing piece in the explanatory puzzle of aging and Alzheimer’s is exciting because we may be able to do something about it.

And one way that we are approaching this at my sleep center is not by using sleeping pills, by the way. Unfortunately, they are blunt instruments that do not produce naturalistic sleep. Instead, we’re actually developing a method based on this. It’s called direct current brain stimulation. You insert a small amount of voltage into the brain, so small you typically don’t feel it, but it has a measurable impact. Now if you apply this stimulation during sleep in young, healthy adults, as if you’re sort of singing in time with those deep-sleep brainwaves, not only can you amplify the size of those deep-sleep brainwaves, but in doing so, we can almost double the amount of memory benefit that you get from sleep. The question now is whether we can translate this same affordable, potentially portable piece of technology into older adults and those with dementia. Can we restore back some healthy quality of deep sleep, and in doing so, can we salvage aspects of their learning and memory function? That is my real hope now. That’s one of our moon-shot goals, as it were.

So that’s an example of sleep for your brain, but sleep is just as essential for your body. We’ve already spoken about sleep loss and your reproductive system. Or I could tell you about sleep loss and your cardiovascular system, and that all it takes is one hour. Because there is a global experiment performed on 1.6 billion people across 70 countries twice a year, and it’s called daylight saving time. Now, in the spring, when we lose one hour of sleep, we see a subsequent 24-percent increase in heart attacks that following day. In the autumn, when we gain an hour of sleep, we see a 21-percent reduction in heart attacks. Isn’t that incredible? And you see exactly the same profile for car crashes, road traffic accidents, even suicide rates.

But as a deeper dive, I want to focus on this: sleep loss and your immune system. And here, I’ll introduce these delightful blue elements in the image. They are called natural killer cells, and you can think of natural killer cells almost like the secret service agents of your immune system. They are very good at identifying dangerous, unwanted elements and eliminating them. In fact, what they’re doing here is destroying a cancerous tumor mass. So what you wish for is a virile set of these immune assassins at all times, and tragically, that’s what you don’t have if you’re not sleeping enough.

So here in this experiment, you’re not going to have your sleep deprived for an entire night, you’re simply going to have your sleep restricted to four hours for one single night, and then we’re going to look to see what’s the percent reduction in immune cell activity that you suffer. And it’s not small — it’s not 10 percent, it’s not 20 percent. There was a 70-percent drop in natural killer cell activity. That’s a concerning state of immune deficiency, and you can perhaps understand why we’re now finding significant links between short sleep duration and your risk for the development of numerous forms of cancer. Currently, that list includes cancer of the bowel, cancer of the prostate and cancer of the breast. In fact, the link between a lack of sleep and cancer is now so strong that the World Health Organization has classified any form of nighttime shift work as a probable carcinogen, because of a disruption of your sleep-wake rhythms.

So you may have heard of that old maxim that you can sleep when you’re dead. Well, I’m being quite serious now — it is mortally unwise advice. We know this from epidemiological studies across millions of individuals. There’s a simple truth: the shorter your sleep, the shorter your life. Short sleep predicts all-cause mortality.

And if increasing your risk for the development of cancer or even Alzheimer’s disease were not sufficiently disquieting, we have since discovered that a lack of sleep will even erode the very fabric of biological life itself, your DNA genetic code. So here in this study, they took a group of healthy adults and they limited them to six hours of sleep a night for one week, and then they measured the change in their gene activity profile relative to when those same individuals were getting a full eight hours of sleep a night. And there were two critical findings. First, a sizable and significant 711 genes were distorted in their activity, caused by a lack of sleep. The second result was that about half of those genes were actually increased in their activity. The other half were decreased.

Now those genes that were switched off by a lack of sleep were genes associated with your immune system, so once again, you can see that immune deficiency. In contrast, those genes that were actually upregulated or increased by way of a lack of sleep, were genes associated with the promotion of tumors, genes associated with long-term chronic inflammation within the body, and genes associated with stress, and, as a consequence, cardiovascular disease. There is simply no aspect of your wellness that can retreat at the sign of sleep deprivation and get away unscathed. It’s rather like a broken water pipe in your home. Sleep loss will leak down into every nook and cranny of your physiology, even tampering with the very DNA nucleic alphabet that spells out your daily health narrative.

And at this point, you may be thinking, “Oh my goodness, how do I start to get better sleep? What are you tips for good sleep?” Well, beyond avoiding the damaging and harmful impact of alcohol and caffeine on sleep, and if you’re struggling with sleep at night, avoiding naps during the day, I have two pieces of advice for you.

The first is regularity. Go to bed at the same time, wake up at the same time, no matter whether it’s the weekday or the weekend. Regularity is king, and it will anchor your sleep and improve the quantity and the quality of that sleep. The second is keep it cool. Your body needs to drop its core temperature by about two to three degrees Fahrenheit to initiate sleep and then to stay asleep, and it’s the reason you will always find it easier to fall asleep in a room that’s too cold than too hot. So aim for a bedroom temperature of around 65 degrees, or about 18 degrees Celsius. That’s going to be optimal for the sleep of most people.

And then finally, in taking a step back, then, what is the mission-critical statement here? Well, I think it may be this: sleep, unfortunately, is not an optional lifestyle luxury. Sleep is a nonnegotiable biological necessity. It is your life-support system, and it is Mother Nature’s best effort yet at immortality. And the decimation of sleep throughout industrialized nations is having a catastrophic impact on our health, our wellness, even the safety and the education of our children. It’s a silent sleep loss epidemic, and it’s fast becoming one of the greatest public health challenges that we face in the 21st century.

I believe it is now time for us to reclaim our right to a full night of sleep, and without embarrassment or that unfortunate stigma of laziness. And in doing so, we can be reunited with the most powerful elixir of life, the Swiss Army knife of health, as it were.

And with that soapbox rant over, I will simply say, good night, good luck, and above all … I do hope you sleep well.

Thank you very much indeed.

(Applause)

Thank you.

(Applause)

Thank you so much.

David Biello: No, no, no. Stay there for a second. Good job not running away, though. I appreciate that. So that was terrifying.

Matt Walker: You’re welcome. DB: Yes, thank you, thank you. Since we can’t catch up on sleep, what are we supposed to do? What do we do when we’re, like, tossing and turning in bed late at night or doing shift work or whatever else?

MW: So you’re right, we can’t catch up on sleep. Sleep is not like the bank. You can’t accumulate a debt and then hope to pay it off at a later point in time. I should also note the reason that it’s so catastrophic and that our health deteriorates so quickly, first, it’s because human beings are the only species that deliberately deprive themselves of sleep for no apparent reason.

DB: Because we’re smart.

MW: And I make that point because it means that Mother Nature, throughout the course of evolution, has never had to face the challenge of this thing called sleep deprivation. So she’s never developed a safety net, and that’s why when you undersleep, things just sort of implode so quickly, both within the brain and the body. So you just have to prioritize.

DB: OK, but tossing and turning in bed, what do I do?

MW: So if you are staying in bed awake for too long, you should get out of bed and go to a different room and do something different. The reason is because your brain will very quickly associate your bedroom with the place of wakefulness, and you need to break that association. So only return to bed when you are sleepy, and that way you will relearn the association that you once had, which is your bed is the place of sleep. So the analogy would be, you’d never sit at the dinner table, waiting to get hungry, so why would you lie in bed, waiting to get sleepy?

DB: Well, thank you for that wake-up call. Great job, Matt.

MW: You’re very welcome. Thank you very much.