ConnectSafely CEO Larry Magid speaks with Dr. Logan Schnieder, Clinical Lead for Sleep Health, Google Health. They talk about all things sleep for adults and children, including healthy sleep habits and helpful sleep technology.
Dr. Schneider specializes in the treatment of sleep disorders, which include things like sleep apnea, narcolepsy, insomnia, restless legs syndrome, sleepwalking, and REM-sleep behavior disorder. He has practiced Sleep Neurology for more than 5 years. Dr. Schneider has a special interest in REM-sleep behavior disorder and other parasomnias (such as sleepwalking)
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Listen to “The Science and Technology of Sleep with Dr. Logan Schneider” on Spreaker.
Transcript:
Larry: I’m Larry Magid, and this is Are We Doing Tech Right? A podcast from Connect Safely where we speak with experts from tech, education, government, and academia
It’s my great pleasure to speak with Dr. Logan Schneider, who is the clinical lead for sleep health at Google. Dr. Schneider specializes in the treatment of sleep disorders. which includes things like sleep apnea, insomnia, restless leg syndrome, sleepwalking, and REM sleep behavior disorder. And he’s practiced sleep neurology for more than five years.
Thank you so much for joining us, Dr. Schneider. Oh, thank you for having me. Now, I have to admit that this interview is more than just a journalistic exercise. I hope you don’t bill me for your time, but as someone who sleeps, not always perfectly. As someone who wears a Google, uh, Pixel watch that tracks my sleep and has a Nest device that tracks my sleep, and as a sleep apnea patient, I have a great deal of interest in this topic because I have to look at my watch to see how well I slept last night, but I’m sure it wasn’t perfect.
So, talk to us a little bit about the importance of sleep. the importance of understanding your sleep, both from the standpoint of adults, but also young people as well.
Logan: Yeah. So I think this is an excellent point. All of us do sleep. So every interview is somewhat personal as you highlighted. And that’s actually what got me into sleep in general was trying to figure out how to do it well.
And I think this highlights the fact that many of us just assume, particularly since we did it so well for much of our life, and it’s much easier to do well as a kid that we can sleep well. But I think this is one of the things that it’s, you don’t know what you had until you lose it. Aspects of preventive health, right?
This is the narrative that medicine is often putting forward to try and say that people should be focusing on improving their health by focusing on aspects about their health that are working well, as well as even just gaining insight into how to, how it’s doing itself, how it’s doing so well, so that when you get to the point of having a problem develop, you’ve already built in healthy practices that make you more resilient, as well as have insights into what was working versus what’s not working.
You know, you don’t want to just get to the point of, well, now something’s wrong and why. Okay. And be on, like, in the, in the woods or in the dark about how to actually fix those things. So this is why sleep health is a advocacy point, I think, that medicine looks at, broadly, to ensure that individuals understand their sleep and don’t just assume that one third of their day is done, spent doing some mystical type of thing where they log off into some magical world and then come back and are refreshed, but really getting a deliberate understanding of how to promote health.
Just like thinking about, well, when aerobic exercise came into the narrative, it’s like, well, What is exercise? What does health and fitness look like? We didn’t actually have a way of quantifying it, defining it until somebody started actually becoming expert in it and, and identifying it and then spreading that word.
And so this is where medicine is going in general is looking at health in many different domains from neurological and brain and body health to cardiovascular health to sleep health, and we’re just trying to make sure that people are aware of like, well, how do you define that? And once they have a way of defining it, they can look at their own life, reflect on whether or not they’re actually living a healthy life.
And then. being able to promote healthier practices in any regard.
Larry: You know, I think about monitoring sleep. I think about, historically, many of the technologies that Google has come up with and other companies have come up with are very new. But I’ve had a bathroom scale my entire life. That was probably the one health monitoring device that virtually everyone has in their home.
And I’m thinking about it because this last few days, a few weeks actually, I’ve been feeling a little bit, you know, a little pudgy lately. I’m just feeling like it’s not right. And sure enough, I finally got on the scale this morning and I said, Oh my God, I’ve put five pounds on in the last three months.
It’s time for me. to make some changes, because before it becomes a bigger problem than it is. Yet, most of us have not done that with sleep. We may have the sense that we’re not sleeping well. I certainly have had that for years. The sense that maybe something’s going on. I’m waking up in the middle of the night, I’m a little short of breath.
I’m waking up a little not rested. And then I got some technology and said, Wow, I have not been getting enough REM sleep. I’m not getting enough deep sleep. It turns out that while sleep apnea is something that’s difficult to measure, From a consumer standpoint, you can measure proxies of it like snoring. And yeah, it turned out I had sleep apnea, which I had no idea.
But I did have a high snore rate and that correlated with sleep apnea. So talk to me a little bit about the tools that are now available from Google and other companies that can help us get a better handle on our sleep.
Logan: I think that’s a great point in the sense that many people have a good intuition, right?
We’ve all woken up from a good night’s sleep or we’ve all had a bad night here and there, but it’s hard to actually identify that as an unobserved phenomenon. From weight, yeah, I look in the mirror, I feel that there’s a little bit more jiggle to my jump or shake to my run. And so those are things that are much easier to quantify and much more natural to understand.
Like, we all understand weight. It’s a one to one connection to what, to what we felt. But sleep is often unobserved. And there are many factors that go into that, as you might see from an actual clinical evaluation, like a polysomnogram. And so I think that’s where sleep health technology or consumer based sleep technology really tried to fill a gap is that it was identifying an unobserved state that most people were not able to discern.
Sometimes they would get the rib and the elbow from their loved one who was sleeping in the same room, but most often they didn’t have any signals as to what was going on in their sleep. And so it was a chance to start getting data that identified patterns, aspects about the sleep, details about it that they couldn’t see, they couldn’t pick up on without this kind of sophisticated technology.
And then they could connect that to how they were feeling and say, Oh yeah, when this thing is there, I feel better. When this thing is absent, I feel worse. And it wasn’t just strictly the duration component. We realized it was this multidimensional construct. It was the quantity that you got. And was it adequate for meeting your needs?
It was the quality of the sleep itself, which means like of the sleep that you got, was it good? You can have a short sleep that is at least refreshing and serves your needs at least for the short term Versus a very bad quality short sleep, right? So those two things feel quite differently and then also even just the routine over time
Larry: One nice thing about what the bathroom scale told me today is that I know exactly what to do about it.
And what I have to do about it involves when I’m awake, I, while I’m awake, I will have to eat less or eat more healthfully and do more exercise. So the bad news from the scale, I clearly understand how to deal with it. The bad news from my sleep devices, it’s a little harder because I’m asleep while I’m asleep.
And. I’ve had a little bit of trouble translating the data that I’m getting from my Nest device, from my Google Watch. I actually have a Tempur Pedic bed that has its own sleep monitor built in, a ton of data. In fact, I will talk to you later about TMI, too much data. A ton of data. I’m asleep. I don’t know exactly what to do with that data.
Logan: Yeah, I think that’s one of the challenges that we face is much of the data and much of the way that these devices have been developed is looking retrospectively, like what has happened, but not looking forward to how to fix that and correct it. And that’s because there is a bit of a challenge there.
One, this data is not the same as what the clinical data is. It’s similar. And so in some ways it can be helpful in that regard, but it has different aspects. certain biases. What it’s measuring is not what’s going on in your brain. It’s measuring what your body’s doing. It also has some limitations. And sometimes these devices have funny behaviors that can make it difficult to interpret.
But I think that was the promise that everybody was hoping is first, look at and start to draw connections. If there’s something that you can meaningfully connect and that’s simple and straightforward, just like weight, how many calories I take in versus how many calories I burn. Same with sleep. Am I getting enough sleep or not getting enough sleep?
And does that affect how I feel? That’s the starting point. Once you get into the more sophisticated things, it takes a little bit more for people to be able to draw the connections, because good sleep starts the minute you wake up. And all of those habits that you’ve acted on throughout the day, all of these factors, the stress levels, all of the things that affect the underlying physiological processes of sleep, like the homeostatic drive, the circadian rhythm.
Your levels of psychophysiologic hyperarousal, both in how your body acts, as well as how your brain acts, as well as extrinsic factors, things that might interrupt your sleep that you’re not aware of. A dog barking. Well, that wasn’t obvious on the data itself, but you need to start being able to draw those connections.
And that’s difficult with sleep tracking technology because it’s looking at sleep primarily. It’s not able to look at all of those surrounding things. So as the capabilities of these platforms become better at picking up on what’s going on around, Sleep, that influences sleep, the actionability of sleep will become much more obvious.
Larry: The other thing about health, I think in general, as you point out, it’s never a one shot thing. Just like you can’t, you know, watch your diet for one day and lose weight, you might. lose a pound or two of water, but you’re not going to really deal with an issue of obesity or being overweight. You can’t have, you know, one night of good sleep and think you’ve solved the problem.
So from a longitudinal standpoint, what is an approach that you recommend for your patients and the world’s customers or anyone to try to, you know, develop good sleep habits?
Logan: So I think that’s a, that’s a very complex framework, which I don’t think anybody has fully mastered. Some people have mastered it in certain domains, like enduring change, hopefully through.
You know, dietary habits and exercise that promotes healthy weight. Similar type of philosophy applies here. I think what you have to do is you have to connect. What about your sleep affects something that you care about? Is that how you feel? Is that your mood? Is that your cognitive function? Is that your physical performance for young athletes?
And then look at the factors in your life that influence those aspects about your sleep. And then it’s about building a behavior change infrastructure. Behavior change is very difficult, particularly when it’s not necessarily immediate. Fortunately, sleep is often immediately gratifying, but sometimes the benefits accrue over time.
And so it’s really about building habit change progressively, saying these things influence this to the highest impact. In your cost benefit analysis, yeah, this is the greatest value I’m going to get to improve my sleep for the least cost that I have to put in. But sometimes you’ll have to, you know, build those things over time and eventually turn them into habits, creating healthy sleep routines that not so you don’t have to be overly rigid about adhering to them, but really build a scaffolding that makes you very resilient to changes in life so that you are getting the sleep that you need on a regular basis.
But again, that’s a behavior change infrastructure. That’s like an entire field of science on how to do that.
Larry: Well, let’s talk about teenagers because a lot of our listeners or parents of teens. And you mentioned, you know, when you’re a baby, you sleep pretty well. But teens sometimes have challenges. I mean, I remember as a teen, you know, not getting enough sleep or waking up groggy, you know, sort of dragging myself to school.
And I certainly saw that in my teens when they, when they were in high school.
Logan: Completely. Yeah. Well, I think this is a point that you’re raising that I think is actually circles us back to the initial point, which is promoting sleep health broadly. If you started at an early age, you create healthy sleep practices, you prioritize that, and even then recognizing that there are limitations to being able to get healthy sleep every single night.
But how do you, on the whole, make sure that you are adequately getting healthy sleep, understanding the importance of it, establishing healthy habits that promote healthy sleep? That starts at an early age, understanding how to get a healthy sleep within the time constraints that you have, setting a strong circadian rhythm, understanding the influences of what you’re doing during the day, like caffeine versus activity on how easy it is to sleep, and also making sure that you have balanced against those other things that are drawing your attention, right?
Oh, I just want to scroll a little bit more. Oh, I just want to do this thing. But if I do burn the midnight oil, I’ll actually do worse on that test than if I just got a little bit of sleep. I’ll actually do better than if I was reading and studying all night. So it’s really just making people aware at an early stage of the importance of sleep and how to get it through defining healthy sleep and defining the association between their habits and sleep itself, as well as the sleep and its outcomes that they want to achieve.
For example, good mental health, you know, emotional stability, cognitive performance, physical performance. So starting at an early age and modeling that behavior among parents, But also disseminating that news from, you know, health outlets, public health agencies like the CDC and what have you, and making sure it’s an important message that kids understand this is but one important dimension of their health. Then they’ll grow up into adults that are thinking about it well.
Larry: But isn’t it also a symptom of what we’re putting kids through in general? I mean, a lot of pressure from school, a lot of pressure to have extracurricular activities, to have sports. It seems to me, and again, I don’t want to sound like some kind of old fogey, but it does seem to me that kids are more heavily programmed these days and have a much bigger agenda to attend to than I remember having to do when I was a teen.
Logan: I completely agree. When I look at the resumes of people applying to any stage of career that I’m overseeing, be it college, medical school, residency. I look at this, I think, man, I never would have gotten in based on how these kids are being expected to perform. So you’re right, there are external impositions.
So that’s somewhat an advocacy point that requires legislative intervention. This is like the start school times later process that’s saying, you know, it’s not reasonable to have kids who have a natural phase delay, you waking up earlier than the sun and not getting any sort of entertainment. And so making them better sleepers, despite the social imposition, is another important factor.
That’s what I was doing when I was in residency. I was like, I’m getting four and a half hours. How am I able to optimize my function despite the fact that I have to be in the hospital all these times and I’m not allowed enough time to sleep? So, how do I safely function both for my safety and the safety of my patients with this limited constraint of sleep?
And so, I realized like, well, you know, appropriate dosing of caffeine, optimized nap timing, as well as making sure that I’m overall getting enough sleep, you know, even if I can’t get it on a day to day basis, I have to figure that out. So, to some degree, this is empowering people with tools to not be just subject to the systems that they’re placed in, but also make them like healthy sleepers within those structures as best they can.
So that is part of that sleep education narrative is, look, school is going to happen. If you want to do this sport, you’re going to be traveling or you’re going to be waking up for early morning water polo practice or what have you. So how do we help you sleep well within that state is an important part of that education that we’re talking about.
Larry: It’s funny when you talk about what they put interns and residents through. I think of the term physician heal thyself, the fact that here you are learning to be a great sleep doctor and doing all the wrong things that you don’t want your patients to be doing. Yeah, it’s ironic. I know. Let’s talk about demographics and democratizing sleep health.
Are certain communities more vulnerable than others and what’s being done to try to provide advice and support for people of all groups?
Logan: Yeah, I think that’s a really important point that we’ve recognized that for various factors and reasons that clearly imply undesirable health outcomes in various populations, those factors also imply or cause unhealthy sleep patterns.
And those sleep patterns also are partially contributory to inequitable outcomes when it comes to health care, but as well as to just overall social function, right? We understand the importance of getting good quality sleep in a secure and safe environment. It should be like some, many people think sleep is a human right that we should be prioritizing, particularly in the international domain, where it’s not a guaranteed thing.
Unsafety and security while sleeping is not there. So there are researchers who are exploring this specifically from both a disease standpoint as well as a sleep health standpoint in prevention of other diseases. Like folks at New York University who are doing this type of health equity research. It’s a small but growing body of researchers as well as public health advocacy.
That’s working on that. And I think this is also where technology enables people to get a more democratized access and awareness to the sleep health principles that they should be aware of, right? It’s information. Literacy can be, you know, tailored to the population and their needs. It can be contextually.
Uh, appropriate for their culture and their expectations, it can reach them in ways that they may not have been able to get this messaging in other forms or formats, like everyone has a phone, like if sleep health and sleep tracking can be shared with people via their phone, they might be able to actually understand what sleep health is and actually prioritize it in their life when it may not have been considered a high priority.
It can maybe help educate them as well as help motivate them or even help them make changes that get them to healthier sleep. So, you know, not everybody has access to a sleep doctor, and disease is not the only dimension here. But certainly, even just focusing on sleep health, technology is a way to have many people access the expertise of, or even just knowledge of what I should be doing.
So I think this is an opportunity to reach, you know, billions of people and meet them at their specific needs. understanding sleep and then making changes to improve it.
Larry: Well, how would the average person, the average parent know, for example, if they need to send their teen to a sleep doctor or if they need to see a sleep doctor versus just saying, ah, you know, I had too much caffeine yesterday, or I stayed up too late.
You know, how do you know when it’s time to get medical intervention?
Logan: So for some people, they’re attuned to that and they’ll just say, hey, there’s something wrong and they start seeking help, right? When you’re talking about the normal lived experience, most people don’t have that answer. They don’t have a context for is this normal or abnormal?
They’ve only lived their one experience. Sometimes parents look at their kids and they think that’s unusual. Is it truly unusual? So they’ll often benchmark against other people. to get anecdotal evidence or suss out if this seems abnormal or not. And sometimes people don’t have that external reference.
They live alone. They don’t feel comfortable raising these kind of like personal questions. And this is where, again, sleep technology can provide useful context. You’re sleeping much shorter than most people your age, or your REM sleep is higher than most people your age for our data set. If that’s something that you think is associated with how you’re feeling, you can go ahead and discuss sleep with your physician.
It’s up to you. We can’t be diagnosticians with these devices, but we can give you milestones or benchmarks to say this is not like most people like you. And if you feel that that’s relevant, go ahead and explore further. Sometimes it’s a pretty clear indication, snoring, right? Maybe that’s not something you should be doing.
We’ve noticed you snore. No one else snores. Maybe talk to somebody about your snoring, and that can be a starting point to have a discussion that then lends itself to putting that in the hands of both the individual, and if they feel like, you know, clinical care is appropriate, then they can actually start to say, this is why I think I’m feeling this way.
Maybe we should go into that.
Larry: Another question I want to bring you is the TMI, too much information. I was actually talking, and interviewed a sleep doctor for a story I wrote on a O2 monitor that, you know, oxygen monitor that you can wear all night. which can also be a proxy for sleep apnea and other issues.
And, you know, we were talking about how often I was using my monitor and he mentioned the term orthosomnia, which he defined as poor sleep induced by the quest for perfect sleep. So, and I’ve thought about this a lot, you know, where you’re so stressed out about your stress, that you’re creating stress in your effort to diminish stress.
So, how do we balance, especially with all this technology, I mean, I’ve got my watch, I’ve got my Nest, I’ve got all these devices, and sometimes I think that I pay too much attention to the devices and not enough attention to just however I’m feeling.
Logan: Yeah, this is a finely thread needle, I have to say, right?
By providing people information that helps give them insight into how sleep health is affecting their life and whether or not their sleep is healthy, because Each person, you might be the short family sleeper in San Francisco, it’s like five and a half hours, and if I’m telling you to get seven, you’re gonna have a sleep disorder, and that’s, we’ve called that orthosomnia,.
And some people index onto these sleep scores to try and, oh my gosh, my sleep score isn’t high enough, or I’m not getting enough deep sleep, and so we see a lot of these individuals come into our clinic, and we have to provide them reassurance and counseling on how to appropriately use that type of sleep information and data.
And I don’t think you’ll find a one size fits all perfect solution that allays everyone’s concerns and fears. But I think this is again where it helps make people citizen scientists themselves, right? For you, it might be the snoring factor that was like, oh yeah, this really was the linchpin on my sleep health being poor.
For somebody else, it might be, well, I’m not getting enough deep sleep and why is that? Maybe I’m not active enough during the day. If I could drive that up through my activity levels, maybe that could help. And so this is really saying this data is here as a measure, but it’s not the answer. The answer is sleep is a means to an end in your circumstance.
So how do we actually help people understand that? Connect the dots. is really the way I think to avoid orthosomnia, it might say, well, even though your score is a 79 on our sleep score, that’s the best score for you. And in fact, that looks like healthy sleep for you and it helps you achieve your outcomes.
How do we get you to gain that insight to say, I just want to be a 79, not a 72? In contrast to somebody else who a 79 might be the bottom of their range, how do we get them to their best sleep? Like, this is good sleep for me. How do I then identify the things that promote good sleep for me and maintain those habits?
Larry: So another issue, and this is really beyond sleep, it has to do with all aspects. I mentioned that I got on the scale today and I noticed I had gained five pounds. Well, the fact is I had not been on the scale for like three months. Mm hmm. I fell off the wagon, so to speak, and people have a tendency to do that.
I mean, I, I’m not going to beat myself up for it because it’s, I’m a human being, but how do you develop healthy habits that you really, you know, I don’t want to say enforce it. You just practice. How do you, and I know it’s a hard question to answer, but, but you know, these ideas that many of us know what we’re supposed to do.
Are there any tricks to helping people create a regime that they can stick with?
Logan: I think there are many tricks, so to speak. Is nudge logic the answer for you? Making things undesirable and getting them out of your environment if they’re not healthy? Setting yourself up for success? Or is it actually a motivational coach that somebody needs a lot of contact?
It’s a very personalized way of getting people to make the behavior change, and sustaining that is also, as you highlighted, hard, right? It’s an ongoing, diligent experience, and some people are just like, Man, I just want a break, or I’m really drawn to scrolling social media right now, so we have competing forces also that we have to contend with.
So really, mastering behavior change science is really a big challenge, but I think making sure that you’re transparent with people, empowering them with choice, giving them a opportunity through transparency to understand like the reasons that We’re suggesting this thing and how it’s based on their data and also giving them the option to turn it off at times and say, Hey, look, I need a break.
You know, I’m going on vacation. I want to sleep however I want. And I want to eat cookies in the middle of the night in my bed while watching Netflix for whatever amount of time. You have to allow people to also have that kind of autonomy in making these decisions, but also then being there to support them when they need it.
Uh, with the best science that you can. And I think that’s the challenge. We don’t, nobody has a perfect answer for that.
Larry: It’s funny you mentioned Netflix because my Fitbit has suggested a particular bedtime for me, which I try to stick with, but Netflix and its competitors are really good at getting you to watch the next episode of a program.
And so I’ll be watching some show and then at the end, they get a cliffhanger and of course another hour of TV. television watching right before. And by the way, speaking of which, what about that whole issue about screens before bedtime, are they harmful? I always wonder how much of an issue that really is, whether it’s your phone or TV or computer screen.
Logan: Yeah. I think there are many ways in which they’re perceived to be harmful to sleep. There are ways that they can be healthy to sleep too. There is healthy tech and there is harmful tech, right? So if you’re watching something that revs you up, makes you anxious or stressed, either obviously or indirectly.
That’s probably not something that you want to be doing before bed. We know that social media and that type of engagement is very activating to the cortex. In fact, social engagement is one of the influences on circadian rhythm. So effectively, if you’re promoting arousal, hyper arousal, like cognitively, even sometimes physically, it’s going to be harder to fall asleep.
There’s like that inherent aspect of many aspects of technology that are Harmful to sleep. In addition, there is the fact that your circadian rhythm is dictated by this hormone called melatonin in your brain and most screens to be visually pleasing to the eye tend to have a, an enrichment of blue light at the wavelength that suppresses melatonin and melatonin tells your body when to sleep.
So the way it does that is actually starts preparing you for sleep about two hours before desired bedtime. If you’re using media that suppresses the melatonin signal all the way up until bedtime or even past, You’re not going to get the signal your body needs to say, Hey, this is the timing of our body clocks.
Let’s get ready for bed and be ready to sleep at the right time. So both is it, it’s not only physiologically like foundational to suppress your natural signals to tell you to sleep and therefore can make it hard to sleep that night, but also subsequent days. But it also then has this psychologically activating component that can be harmful to getting the sleep or like inhibitory to getting the sleep you need.
Conversely, some people can use it to say, Hey, I just set my bedside device to help me with meditation. Some people need to listen to something passively to help them fall asleep. So in those cases, you can turn technology into a helpful resource. It’s just a matter of helping people gain insight into how to use it.
Larry: Yeah, I use my smart speaker to play ocean sounds at night sometimes. Yeah, exactly. It’s a great way to do it. Yeah. And then of course I have fallen asleep in front of the television, I have to admit it. And I suppose it, I don’t know whether the blue light is, uh, countering it or I’m just so exhausted it doesn’t matter, but that happens as well.
But I don’t know whether that leads to a good night’s sleep when you finally get up from the TV that you fell asleep in front of and go to bed. Is that going to help hurt? What do you think?
Logan: Disrupting sleep, not having it be continuous is one of the problems. That’s why we treat sleep apnea.
It’s the constant suffocation and arousal of the brain and deoxygenation or drops of oxygen levels in the blood. That interrupts sleep and we call it fragmentation. And either long period fragmentation or even intermittent short fragmentation all leads to poor quality sleep the next day. So it’s certainly not healthy to sleep in front of the TV, the noise, the light, all of those things could be disrupted.
Having said, putting tech at the right time. So if you want to watch those things, put them in the morning. That’s when they’re going to reinforce your circadian rhythm. That’s when they’re going to activate you, motivate you to get up. Just do it at a different time. That’s why I tell the kids who have delayed sleep phase, It’s other parents.
Hey, video games in the morning. Up they get.
Larry: Okay, so I have to change my work schedule. I’m going to watch Netflix in the morning and, uh, do my work at night.
Logan: Don’t put the work at night, too. You don’t want to stress yourself out by going to bed.
Larry: Okay, go, go, go to bed. Okay, Dr. Logan Schneider from Google, a sleep doctor and sleep specialist at Google.
Thank you so much for taking the time.
Logan: Yeah, thank you for inviting me. It was great talking about sleep health.
Larry: Are We Doing Tech Right is produced by Christopher Le. Maureen Kochan is the executive producer. Theme music by Will Magid. I’m Larry Magid