The Snooze Button

Dr. Mark Boulos and I sit down after my second night in the Sunnybrook sleep lab to find out what changed, including:

• what happened after treatment for the periodic limb movements found during my first sleep study;
• why my wife's description of my sleep changed almost immediately;
• what the second sleep study showed;
• how different the second night felt to me compared with what the laboratory actually recorded;
• CPAP and the decidedly strange experience of trying to sleep — and talk — while wearing the mask;
• why getting used to CPAP may take some experimentation;
• what changed in my deep sleep and REM sleep;
• why I had become slightly obsessed with increasing N3 sleep;
• whether continuing the same treatment could produce further changes over time;
• the danger of chasing unproven sleep remedies without knowing what problem you're actually trying to solve;
• melatonin and the limits of treating it like a universal sleep aid;
• what consumer sleep trackers are useful for — and why trends may matter more than precise-looking percentages;
• why even a laboratory sleep study varies from night to night;
• home sleep-apnea testing and a 2019 discussion about how Ontario was using — or not using — the technology;
• why some people still need a full laboratory polysomnogram rather than a simpler home test;
• medication side effects, including sleepiness and impulse-control problems;
• the strange gap between objective improvement and still not waking up refreshed;
• Adrian Owen's computerized cognitive tests as another possible way to look for long-term change;
• sleep debt;
• whether naps simply add to nighttime sleep;
• my slightly ridiculous collection of alarms;
• and whether the actual snooze button was helping or hurting.

The episode ends in a very different place from the first Boulos conversation. The first study was about finding problems. This one is about discovering that several of those problems may be moving in the right direction — and realizing that there is still more work to do.

Dr. Mark Boulos is a neurologist and sleep researcher at Sunnybrook Health Sciences Centre and the University of Toronto.

He is currently an Associate Professor and Clinician Scientist in Neurology at the University of Toronto, Medical Lead for the Sunnybrook Sleep Laboratory and Program Director for the university's Sleep Neurology Fellowship. His research includes sleep disorders, stroke, home sleep monitoring and new approaches to diagnosing and treating sleep disorders.

https://deptmedicine.utoronto.ca/faculty/mark-boulos

• PSG Norms — Boulos and his colleagues' tool for comparing polysomnography measurements with normative values based on factors including age, sex and whether the study occurred on the first or a subsequent night. The calculator remains online.
• https://omc.ohri.ca/psgnorms/
• Sunnybrook / Dr. Mark Boulos — current University of Toronto profile and information about his work in sleep neurology.
• https://deptmedicine.utoronto.ca/faculty/mark-boulos
• Home Sleep Apnea Testing — a major section of the conversation concerns the potential for home testing to reduce dependence on laboratory polysomnography. Current sleep-medicine guidance recognizes properly ordered and interpreted home sleep-apnea testing as an option for certain uncomplicated adults suspected of having obstructive sleep apnea.
• https://aasm.org/advocacy/position-statements/clinical-use-of-a-home-sleep-apnea-test-an-updated-american-academy-of-sleep-medicine-position-statement/
• Pramipexole / Mirapex — the medication discussed in connection with restless legs and periodic limb movements. Current prescribing information continues to warn about sleepiness and possible impulse-control or compulsive behaviours.
• https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=44c336d2-01d1-4f13-bad9-549cdc3505ec
• Adrian Owen's computerized cognitive testing — I refer back to the computerized cognitive assessments developed through Adrian Owen's work at Western University. The platform formerly known as Cambridge Brain Sciences is now called Creyos.
• https://owenlab.org/Research

Sleep is a mysterious thing, in terms of just what happens in your brain. How do you explain people who walk in their sleep? Talk in their sleep? Or ride motorcycles? Or worse?

Dr. Guy Leschziner's new book, "The Nocturnal Brain", shows just how much we still have to learn.

Dr. Guy Leschziner joins me for a wide-ranging conversation about the strange territory between sleep and wakefulness, including:

• why even sleep specialists don't necessarily sleep perfectly themselves;
• the first-night effect and why sleeping somewhere unfamiliar can change what happens in the brain;
• why one night in a sleep laboratory may not perfectly represent somebody's usual sleep;
• how Oliver Sacks influenced Leschziner's approach to telling patients' stories;
• why sleep remained something of a neglected corner of neuroscience for so long;
• what unusual sleep disorders can teach us about normal sleep;
• whether sleep really behaves like a simple on/off switch;
• how apparently complex behaviour can occur while parts of the brain remain deeply asleep;
• sleepwalking and other parasomnias;
• paradoxical insomnia and the gap between feeling awake and actually being awake;
• lucid dreaming and what it may reveal about awareness during REM sleep;
• narcolepsy and unusually continuous dream experiences;
• why some patients featured in The Nocturnal Brain actively wanted their stories told;
• the damage that can come from years of delayed or incorrect diagnoses;
• how much sleep medicine the average physician actually learns;
• whether insomnia is truly becoming more common or we're simply paying more attention to it;
• orthosomnia — when the pursuit of perfect sleep data starts making sleep worse;
• why consumer sleep trackers can be useful for some people and deeply misleading for others;
• where Fitbit-style measurements stop being useful and proper sleep evaluation becomes more important;
• sleep disorders and some extraordinary legal cases involving behaviour during sleep;
• and the important difference between fascinating extreme cases and the far more common sleep disorders millions of people deal with every night.

Professor Guy Leschziner is a neurologist and sleep physician in London. He is currently a consultant neurologist and clinical lead for the Sleep Disorders Centre at Guy's and St Thomas' NHS Foundation Trust, where his specialist interests include parasomnias, narcolepsy, nocturnal seizures, restless legs syndrome and other neurological sleep disorders.

His work also includes research, teaching and extensive public communication about neuroscience and sleep. Since The Nocturnal Brain, he has gone on to publish The Man Who Tasted Words and Seven Deadly Sins.

https://www.guyleschziner.com/

https://www.guysandstthomas.nhs.uk/our-consultants/guy-leschziner

• The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep — the book at the heart of this conversation, using real patient stories to explore insomnia, narcolepsy, parasomnias, restless legs, sleep apnea and some much stranger neurological territory.
• https://us.macmillan.com/books/9781250202710/thenocturnalbrain/
• Mysteries of Sleep — Leschziner explains that the book grew partly out of a BBC radio series he had made about sleep disorders. His official site still lists the series among his broadcast work.
• https://www.guyleschziner.com/media
• Oliver Sacks — Leschziner credits Sacks' neurological case histories with helping inspire both his career and his approach to using unusual patients to illuminate how the human brain works.
• https://www.oliversacks.com/books-by-oliver-sacks/
• PSG Norms — the polysomnography reference tool that comes up again during the discussion of the first-night effect and differences between the first and subsequent nights in a sleep laboratory.
• https://omc.ohri.ca/psgnorms/
• R. v. Parks — Leschziner discusses the famous Canadian case involving Kenneth Parks and sleepwalking as a legal defence. The Supreme Court of Canada heard the case in 1992.
• https://decisions.scc-csc.ca/scc-csc/scc-csc/en/item/907/index.do

John Watson joins me from New Zealand to talk about the very personal origins of Sleep Radio, including:

• how depression and insomnia eventually led him toward relaxation music;
• why a handful of CDs quickly became inadequate;
• discovering internet relaxation stations — and discovering why commercials and DJs weren't particularly helpful at 3 a.m.;
• how an idea for a simple one-hour audio file grew into a 24-hour internet radio station;
• beginning with just a handful of listeners and watching the audience grow internationally;
• the surprisingly difficult job of deciding which music is actually appropriate for sleep;
• why Watson avoids vocals, obvious beats, drums and other potentially disruptive elements;
• the listener feedback that taught him that even birdsong and running water don't necessarily belong on a sleep station;
• why every submitted track has to be listened to all the way through;
• the unfortunate discovery that a perfectly relaxing piece of music can suddenly go thumpa-thumpa-thumpa several minutes in;
• why Sleep Radio works for Watson but doesn't work for his wife;
• what independent ambient and new-age musicians can submit to the station;
• how artist, track and sales information can be embedded so listeners can find music they like;
• running the station from a small home studio;
• why Watson has no particular ambition to turn it into conventional FM radio;
• the costs involved in keeping a worldwide stream running;
• and why he sees the whole operation less as a business than as a way of helping people who are dealing with the same problem he had.

Then Dr. Guy Leschziner joins us briefly to consider the science.

Rather than arguing that relaxation music contains some magical sleep-inducing property, Leschziner points toward something more interesting: concentrating on breathing, music or another neutral stimulus may help by taking attention away from the act of trying to fall asleep. He uses the light-guided breathing device Dodow as another example of the same basic idea.

John Watson is the founder of Sleep Radio, an internet radio station he created in New Zealand after his own experience with depression, anxiety and insomnia.

In the 2019 conversation, Watson describes running the station with his wife from their home studio, personally reviewing music and largely paying its operating costs themselves.

And this is one of those restoration stories with a particularly satisfying present-day footnote:

Sleep Radio is still there.

Watson's current site still identifies him as founder and manager, broadcasting from Te Aroha on New Zealand's North Island. The station continues to describe its core purpose as uninterrupted music for relaxation and sleep.

Listen to Sleep Radio

About John Watson and Sleep Radio

Professor Guy Leschziner is a neurologist and sleep physician. At the time this episode was recorded, he was preparing to appear on the following week's Snooze Button to discuss his 2019 book The Nocturnal Brain.

He is currently Professor of Neurology and Sleep Medicine at King's College London and works as a consultant neurologist in the Sleep Disorders Centre at Guy's and St Thomas' Hospitals. His work encompasses insomnia, parasomnias, narcolepsy, restless legs syndrome, sleep apnea and other neurological sleep disorders.

Guy Leschziner — official website

• Sleep Radio — Watson's 24/7 internet station remains active. Its current site still emphasizes uninterrupted music without conventional radio chatter or advertising.
• https://www.sleepradio.co.nz/
• Sleep Radio — Artists and Promoters — Watson discusses musicians submitting suitable ambient and new-age tracks. The station still accepts submissions and publishes its requirements.
• https://www.sleepradio.co.nz/artists-and-promoters
• Supporting Sleep Radio — in the episode, Watson explains that he and his wife fund much of the project themselves. The current station continues to operate as a volunteer, not-for-profit project supported partly through listener donations.
• https://www.sleepradio.co.nz/helpus
• Dodow — the light-guided breathing device Dr. Leschziner uses as an example when discussing attention, breathing and falling asleep. The product is still available from its manufacturer.
• https://livlab.care/en-ca/products/dodow-us
• The Nocturnal Brain: Nightmares, Neuroscience and the Secret World of Sleep — Guy Leschziner's 2019 book, which becomes the subject of the next chronological episode.
• https://us.macmillan.com/books/9781250202710/thenocturnalbrain/
• Audacity — Watson mentions using the free, open-source audio editor in the Sleep Radio production setup.
• https://www.audacityteam.org/

Rather than ask somebody that runs a mattress shop for advice about the best mattress to get, we thought we'd get a different opinion.  What about a chiropractor?

Meet Dr. Jon Saunders - he's Neil's chiropractor - who gets complaints and questions all day long from patients who are looking for better answers about sleep as it relates to things like back and neck pain.

So Jon and Neil cover a little of everything in this episode, from sleeping positions, to what to look for when it comes to pillows and mattresses, too.

LINKAPALOOZA:

Dr. Jon on Twitter

Website for Dr. Jon's practice

Dr. Jon's Instagram

Dr. Jon's Facebook page

And here's the link to the video about sleeping posture that Jon refers to in this episode:

https://www.youtube.com/watch?v=15DBe9XrgF4

Dr. Jon Saunders joins me for a conversation about what happens to the neck, back and rest of the body while we sleep, including:

• why this episode generated objections before it was even released;
• where a chiropractor’s perspective on sleep begins — and where it ends;
• why sleep position and posture are closely related;
• the competing considerations involved in choosing a sleep position;
• what happens when advice intended to help one problem conflicts with advice intended to help another;
• the structural differences between sleeping on your back, side and stomach;
• why one of my basic assumptions about pillows gets challenged;
• what a pillow is actually trying to accomplish from Saunders’ perspective;
• why pillow size may matter more than whether it’s soft, firm, expensive or cheap;
• the extra complication for people who change positions during the night;
• body pillows and what putting something between your knees is intended to accomplish;
• why Saunders is reluctant to recommend one particular pillow to everybody;
• allergies and pillow materials;
• what to look for when shopping for a mattress;
• memory foam — including why Saunders thinks it can be perfectly reasonable even though he personally hates it;
• why the price of a mattress doesn’t necessarily tell you whether it’s appropriate for you;
• how often Saunders thinks pillows and mattresses should be reconsidered;
• whether sleep-position needs change as we get older;
• and the larger tradeoff between ideal body mechanics and actually being comfortable enough to sleep.

There’s also an important limitation running throughout the conversation: Saunders is speaking specifically from his perspective as someone who works with necks, backs and musculoskeletal problems. The episode explicitly warns listeners more than once against treating the discussion as individualized medical advice.

Dr. Jon Saunders is a chiropractor in Newmarket, Ontario. At the time of this conversation, he had also been my chiropractor for roughly a year and a half, which is how a conversation in his office about sleep eventually became this episode.

Saunders continues to practice at Chiropractic on Eagle in Newmarket and produces educational material about posture, neck and back problems and spinal health.

Dr. Jon Saunders — current profile

Chiropractic on Eagle

• Dr. Jon Saunders’ sleeping-posture video — Saunders specifically mentions an existing video demonstrating sleep positions and pillow use. The original 2019 Snooze Button Express listing preserved the exact video link.
• Watch the original sleeping-posture video
• Best Sleeping Position — Chiropractic on Eagle — Saunders’ practice also maintains a current resource page collecting his material on sleep posture, pillows and related spinal issues.
• View the current resource
• Chiropractic on Eagle — the practice website listeners were directed to for Saunders’ information and contact details. The original Express listing specifically included his practice site among its resources.
• Visit Chiropractic on Eagle

Dr. Conor Heneghan is the Lead Sleep Researcher with Fitbit, and joins Neil for a conversation about sleep trackers that includes everything from Best Practices to the roadmap ahead for Fitbit, and exactly how their new 'Sleep Score' feature is calculated.  Plus, we dive into the data as Dr. Heneghan talks about what he saw in analyzing five months of Neil's sleep tracker data.

Dr. Conor Heneghan joins me to talk about sleep tracking from inside Fitbit, including:

• why Fitbit created a single-number Sleep Score in the first place;
• what sleep duration, sleep stages and “restoration” contribute to the picture;
• why a good night's sleep isn't an exam you're supposed to score 100% on;
• experimenting with your own habits instead of obsessing over somebody else's “perfect” number;
• the difference between how you slept and how you think you slept;
• whether seeing disappointing tracker data can actually change how you feel the next morning;
• why subjective and objective sleep can sometimes disagree;
• the limits of what a wrist-worn tracker can know compared with a sleep laboratory;
• wearing a Fitbit on your dominant versus non-dominant wrist — and the people experimenting with wearing one on an ankle;
• what additional sensors could theoretically tell us, including Heneghan's decidedly unenthusiastic response to my idea of wearing electrodes to bed;
• where a consumer wearable should stop and a medical professional should take over;
• what long-term tracking can reveal that a single night in a sleep lab cannot;
• and what Heneghan found when Fitbit analyzed several months of my own sleep data.

This episode also marked the launch of the original Snooze Button Express — a roughly nine-minute highlights version of the show.

At the time of this conversation, Dr. Conor Heneghan was Fitbit's lead sleep researcher, working on the technology and algorithms used to turn signals from a wrist-worn device into information about sleep duration, stages and quality.

His sleep and wearable research continued after Fitbit became part of Google. Google has described Heneghan as a senior staff research scientist on its consumer health research team, and he remains an author on Google sleep-tracking research published through 2026.

Read a more recent Google article featuring Conor Heneghan

• Fitbit Sleep Score — the feature at the center of this conversation. Important: the algorithm Heneghan describes is the 2019 version; Google has since redesigned how Sleep Score is calculated.
• Current Google/Fitbit Sleep Score documentation
• Fitbit Versa 2 — the device Fitbit provided for the project and the product whose 2019 launch coincided with the wider rollout of Sleep Score.
• Fitbit's original Versa 2 launch announcement
• Fitbit Premium and the original Sleep Score breakdown — Fitbit's contemporary 2019 explanation of time asleep, deep/REM sleep and restoration.
• Read the original Fitbit announcement
• PSG Norms — the age- and sex-based polysomnography reference tool mentioned while discussing sleep-stage results. The calculator remains online through the Ottawa Hospital Research Institute.
• PSG Norms Calculator
• Poor sleep in middle age and Alzheimer's-related brain changes — this appears to be the National Institute on Aging item referenced in the closing minutes of the episode. Published September 12, 2019, it reported an association between changes in middle-age sleep and later Alzheimer's-related biomarkers; it did not establish that poor sleep causes dementia.
• Read the National Institute on Aging summary

Dr. Michael Grandner joins me to talk about consumer sleep trackers and what we should — and shouldn’t — expect from them, including:

• why “Are sleep trackers accurate?” may be the wrong question;
• the two extreme ways people tend to interpret wearable data;
• why some consumer devices have been rigorously tested and others haven’t;
• movement, heart rate and the signals a wrist-worn device uses to make educated guesses about sleep;
• what happens when a tracker encounters insomnia, sleep apnea, restless legs or other sleep that doesn’t fit its assumptions;
• the important difference between restless legs syndrome and periodic limb movements;
• why your tracker may report awakenings you have absolutely no memory of;
• subjective sleep versus device-measured sleep;
• why those two measurements don’t necessarily have to agree;
• what “light,” “deep” and REM sleep on a commercial tracker actually represent;
• why Grandner is much less interested in obsessing over exact sleep-stage percentages than many consumers are;
• the “first-night effect” in a sleep laboratory;
• whether consumer sleep technology is deliberately gamifying sleep;
• why a tracker that measures sleep isn't necessarily a device that helps you sleep;
• the difference between precision and accuracy;
• why patterns and trends can matter much more than individual minutes;
• whether a Fitbit is useful for testing changes in sleep over several weeks;
• and why Grandner thinks a simple morning sleep diary belongs beside the wearable data.

We also talk about Grandner's own strategy when sleep doesn't come easily, why simply lying in bed trying harder can become counterproductive, and the difference between relaxation and distraction.

At the time of this conversation, Dr. Michael Grandner was Director of the Sleep and Health Research Program at the University of Arizona and a specialist in behavioral sleep medicine.

He remains at the University of Arizona, where he is Professor of Psychiatry, Director of the Sleep and Health Research Program and Director of the Behavioral Sleep Medicine Clinic at Banner – University Medical Center. His research focuses on sleep health, behavioral sleep medicine and translating sleep science into real-world health interventions.

Dr. Michael Grandner — University of Arizona

• PSG Norms — the reference tool I mention while discussing the “first-night effect” and how sleep-study results vary by age, sex and whether someone is spending their first or second night in the lab.
• PSG Norms Calculator
• The Consensus Sleep Diary — Grandner recommends pairing wearable measurements with a simple morning sleep diary. The standardized Consensus Sleep Diary was developed specifically for prospective self-monitoring of sleep.
• Consensus Sleep Diary — PubMed
• Fitbit Versa — the tracker I was using as the measurement tool for the Snooze Button experiment. Fitbit's original Versa included automatic sleep-stage tracking.
• Original Fitbit Versa announcement
• Consumer Sleep Technology — American Academy of Sleep Medicine — this 2018 position statement provides useful contemporary context for the conversation: consumer devices could contribute useful information, but were not substitutes for validated clinical diagnosis or treatment.
• AASM position statement — PubMed

Dr. Ravi Allada, Professor at Northwestern University, has combed through the statistics from decades of Major League Baseball games, and has discovered one specific statistic that is profoundly impacted by jet lag.

As we begin the 2019 PostSeason in MLB, Neil talks to Dr. Allada about the role circadian rhythms play in America's national pastime, and in other sports as well.

In Part 2, we meet up with Dan Shulman from ESPN (or as Neil prefers to call him, The Voice of Major League Baseball) and talk about what it's like traveling to a different city every night to cover the games and what impact that has on his own sleep, and we get his thoughts on Dr. Allada's study and others like it.

LINKAPALOOZA:

Dr. Ravi Allada on Twitter

How Jet Lag Impairs MLB Performance (Study)

Dan Shulman on Twitter