The Snooze Button

COVIDsomnia is its own special brand of sleep disorder, brought on in one way or another by COVID-19. Sleep experts say it’s not only the physical toll the virus is taking on the people who’ve been infected. It’s also keeping people awake at night with worry about whether they or their loved ones will get sick, too.

We cover COVIDsomnia this week with a couple of experts dealing with very different groups of patients. First, Neil talks with Dr. Lynelle Schneeberg. She’s an Assistant Professor at Yale School of Medicine and Director of the Behavioral Sleep Program at Connecticut Children’s Medical Center. She’s also the author of the terrific book for parents, Become Your Child’s Sleep Coach. (Affiliate link.)

Then, we look at COVIDsomnia with Dr. Seema Khosla from the North Dakota Centre for Sleep. You might also have seen her just recently as the sleep expert on Good Morning America. Seema talks about the eleven patients in her practice who’ve tested positive.

We cover a lot of ground in these two conversations. COVIDsomnia sparks discussion about everything from sleep apnea to delaying school start times.

LINKAPALOOZA

You’ve heard Dr. Schneeberg on the show before. She was first on with us last October to talk about her book, Become Your Child’s Sleep Coach. She also joined the show February 10 to talk about sleep crutches and how they affect kids and adults.

In addition to talking about COVIDsomnia this week, Dr. Khosla is a regular guest, too. Among Seema’s highlights: We discussed her podcast, Talking Sleep, on our episode from May 24, 2020. She came back in September to talk about wearable sleep trackers. And she was back again last week to talk about the crazy COVID dreams people have been having. That chat was an early intro to the COVIDsomnia conversation in this week’s episode.

This podcast uses the following third-party services for analysis:

Chartable - https://chartable.com/privacy

In this episode

• What “COVIDsomnia” meant in 2020 — and why it was never one formal new sleep disorder
• Lynelle Schneeberg’s three drivers of children’s pandemic sleep problems: schedules, physical activity and anxiety
• Why family activity sometimes had to replace recess and school-based exercise
• How bedtime can become accidentally associated with worry
• The “worry jar” and scheduled worry time
• Why taking a child’s concern seriously does not require solving it in bed at night
• Remote school, later wake times and adolescent circadian biology
• The case for later middle- and high-school start times
• What later research found about sleep duration, mood and academic performance after delayed school starts
• Seema Khosla’s firsthand observations of COVID in a sleep-medicine practice
• Changes in CPAP downloads and unusually long sleep during acute illness
• Stress-related insomnia versus sleep disturbance during and after COVID infection
• How persistent sleep disturbance became part of the long-COVID picture
• CBT-I, sleep medication and the importance of an exit strategy
• What the 2026 AASM insomnia guideline adds to that treatment discussion
• Remote work, telemedicine and the sleep gained by eliminating long commutes
• Which pandemic-era schedule changes were worth keeping

About Dr. Lynelle Schneeberg

Lynelle Schneeberg, PsyD, is a behavioral sleep psychologist, Associate Professor of Psychiatry at Yale School of Medicine and Director of the Behavioral Sleep Medicine Program at Connecticut Children’s Sleep Center. She treats sleep difficulties in children, adolescents and adults, with specialties including insomnia, circadian sleep disorders and pediatric sleep problems. She is the author of Become Your Child’s Sleep Coach: The Bedtime Doctor’s 5-Step Guide, Ages 3–10.

About Dr. Seema Khosla

Seema Khosla, MD, FCCP, FAASM, is board certified in internal medicine, pulmonary disease, critical care medicine and sleep medicine. She is Medical Director of the North Dakota Center for Sleep in Fargo and remains the host of the American Academy of Sleep Medicine podcast Talking Sleep, where she covers current clinical research, technology and treatment in sleep medicine.

MENTIONED

Lynelle Schneeberg at Yale School of Medicine

Current Yale profile and clinical/research roles.

Lynelle Schneeberg, PsyD

Lynelle Schneeberg at Connecticut Children’s

Her current pediatric sleep-medicine role and Behavioral Sleep Medicine Program.

Connecticut Children’s profile

Become Your Child’s Sleep Coach

Schneeberg’s 2019 guide for parents of children ages 3–10.

Publisher information

Worry Jars and Worry Time

Connecticut Children’s current explanation of the bedtime tool discussed in this episode.

3 Bedtime Challenges Your Kids Might Be Having Now — and How to Solve Them

Children’s Sleep During COVID-19

A 2024 meta-analysis of 57 studies and 206,601 children and adolescents.

Prevalence of Sleep Disturbances in Children and Adolescents During COVID-19 Pandemic

School Start Times, Sleep and Youth Outcomes

The 2022 Pediatrics meta-analysis covering 28 studies and more than 1.7 million participants.

School Start Times, Sleep, and Youth Outcomes: A Meta-analysis

2026 Delayed School Start-Time Meta-analysis

A newer synthesis estimating roughly 69 additional minutes of sleep after delayed starts, with substantial heterogeneity.

Delayed School Start Times to Improve Sleep Duration and Mitigate Depression in Adolescents

Sleep Disturbance Across the COVID-19 Pandemic

A systematic review and meta-analysis of 250 studies and nearly half a million participants.

Sleep Disturbances During the COVID-19 Pandemic

Sleep and Long COVID

A meta-analysis of sleep disturbances in 13,935 patients with long COVID.

Prevalence of Sleep Disturbances in Patients With Long COVID

2026 AASM Insomnia Treatment Guideline

Current guidance on combining CBT-I with medication for chronic insomnia.

Combination Treatment for Chronic Insomnia Disorder in Adults

Talking Sleep

The American Academy of Sleep Medicine podcast hosted by Seema Khosla.

Talking Sleep

Okay, we all know that REM sleep is important, so maybe the headline is a little sensationalized; but the data don't lie. Dr. Eileen Leary joins the show this week to talk about a fascinating look at nearly ten thousand people, that points to a reduction in REM sleep as a risk factor for mortality.

One of the things that's fascinating about this data is that Eileen tried - repeatedly - to come up with another way to explain what she found. Instead, she can quantify the risk of all-cause mortality that you sign up for when you don't get enough REM sleep.

Couple that with the work Laura Bojarskaite is doing at The University of Oslo looking into the glymphatic system and REM sleep, and suddenly we see a picture starting to materialize where deep sleep isn't the holy grail after all. (We talked to Laura on the September 7 episode of The Snooze Button podcast.)

Additionally, Dr. Michael Grandner from The University of Arizona talks about amateur epidemiology, and Dr. Seema Khosla from The North Dakota Center for Sleep talks COVID nightmares. We also have an update for Seema about how in love we are with the new Dreem 2 headband (affliate link) that she sent our way, and the changes in REM sleep it's measuring compared to the Fitbit Versa 2.

 

Here's the link to Eileen's dissertation at Stanford.

Perhaps better suited to North American attention spans, here's the infographic version of Eileen's REM sleep study.

Note: As I'm writing my book and researching which "hacks" worked and which didn't, I'll be tracking my sleep with a Dreem 2 headband. The people at Dreem didn't give me a tracker to use; far from it, in fact. However, if you click this link or the one above and end up getting a Dreem 2 headband of your own, I get a tiny little "thank you" check from them.

This podcast uses the following third-party services for analysis:

Chartable - https://chartable.com/privacy

In this episode

• Eileen Leary’s Stanford dissertation on REM sleep and mortality
• The difference between association and causation
• The 13% higher all-cause mortality rate associated with each five-point reduction in REM percentage in MrOS
• Replication in the Wisconsin Sleep Cohort
• Why sleep apnea, depression, antidepressants and sleep duration did not explain away the central association
• The important nuance in the cause-specific mortality results
• The possible mortality threshold below about 15% REM sleep
• The third Sleep Heart Health Study cohort and the later 10,000-plus-participant meta-analysis
• A 2026 replication signal in coronary artery disease plus obstructive sleep apnea
• Why the evidence still does not prove that increasing REM will extend life
• Machine learning and the relative importance of REM among the measured sleep stages
• Why consumer wearable REM percentages are not interchangeable with polysomnography
• Eileen’s current work in orexin-agonist clinical development
• Michael Grandner on scientific literacy, animal models and amateur epidemiology
• Why access to a scientific paper is not the same thing as knowing how to interpret it
• The University of Helsinki pandemic-dream study
• What the Helsinki study actually found — and what the original on-air summary overstated
• Seema Khosla on ordinary bad dreams versus nightmare disorder
• Imagery rehearsal therapy and “rewriting” recurring nightmares
• How REM sleep behavior disorder differs from simply having nightmares
• Sleep testing and obstructive sleep apnea during COVID
• What later evidence found about OSA and COVID outcomes
• Neil’s first weeks sleeping with the Dreem 2 EEG headband
• Dreem versus Fitbit sleep-duration and staging discrepancies
• Why “the trend is your friend” remains useful wearable advice

About Dr. Eileen Leary

Eileen Leary, PhD, RPSGT, is an epidemiologist and sleep researcher with more than two decades of clinical-research experience. She earned her PhD in Epidemiology and Clinical Research from Stanford University, where her dissertation examined the relationship between REM sleep and mortality. She has worked across academic sleep research and biopharmaceutical development and is currently Senior Director of Clinical Development at Centessa Pharmaceuticals, with work that includes orexin-receptor agonist programs for disorders of excessive sleepiness.

About Dr. Michael Grandner

Michael Grandner, PhD, MTR, CBSM, FAASM, is a clinical psychologist and Professor of Psychiatry at the University of Arizona College of Medicine – Tucson. He directs the Sleep and Health Research Program and the Behavioral Sleep Medicine Clinic at Banner – University Medical Center, with research spanning sleep health, behavioral sleep medicine, circadian health and population-level sleep.

About Dr. Seema Khosla

Seema Khosla, MD, FCCP, FAASM, is a pulmonary, critical-care and sleep-medicine physician and medical director of the North Dakota Center for Sleep. She has held multiple leadership and technology roles with the American Academy of Sleep Medicine and is the longtime host of the AASM podcast Talking Sleep.

MENTIONED

Eileen Leary: REM Sleep and Mortality

The 2020 JAMA Neurology paper at the center of this episode.

Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults

Sleep and Death: Leary’s Stanford Dissertation Project

Eileen’s project page includes the three-cohort work, poster and dissertation material.

The Association Between REM Sleep and Mortality in Three Independent Cohorts

The Third REM-Mortality Cohort

The 2021 reply reporting the Sleep Heart Health Study replication and meta-analysis of more than 10,000 participants.

Living to Dream — Reply

2026 REM-Mortality Follow-Through

A later study in patients with coronary artery disease and obstructive sleep apnea that again found lower REM associated with greater mortality.

RICCADSA REM Sleep and Mortality Study

Eileen Leary

Current CV, publications and clinical-development work.

Eileen Leary’s CV

Michael Grandner

Current University of Arizona profile.

Michael Grandner at the University of Arizona

Pandemic Dreams

The University of Helsinki study discussed with Seema Khosla.

Pandemic Dreams: Network Analysis of Dream Content During the COVID-19 Lockdown

Imagery Rehearsal Therapy for Nightmares

The AASM position paper supporting the nightmare-rewriting treatment Seema describes.

AASM Position Paper for the Treatment of Nightmare Disorder in Adults

REM Sleep Behavior Disorder

The current AASM clinical-practice guideline for RBD.

Management of REM Sleep Behavior Disorder

Sleep Disturbances and COVID-19 Outcomes

A 2024 meta-analysis of 48 observational studies covering more than 8.6 million people.

Pre-existing Sleep Disturbances and Risk of COVID-19

Dementia and Sleep: It’s Not Just Deep Sleep That Counts

The earlier Snooze Button conversation with Laura Bojarskaite referenced during the REM discussion.

Listen to the Laura Bojarskaite episode

Tracking My Sleep: Forget Everything I’ve Ever Said

The immediately preceding Seema Khosla episode about consumer trackers and the Dreem 2 headband.

Listen to the sleep-tracker episode

The sleep tracker has become the latest must-have tech gadget. I’ve gone through at least half a dozen myself as my efforts in tracking my sleep have gone through a number of iterations.

The obsession with the data sleep trackers spit out can cause its own special brand of insomnia – orthosomnia, the sleep nerds call it. (We discussed orthosomnia a couple of times on the show before. We’ve talked to Dr. Seema Khosla about it, and Dr. Jade Wu, among others.)

However, trying to find just the right way to go about tracking my sleep served a specific purpose, in my case. I’m writing a book about my lifelong battle with insomnia, and I’m trying to help others by road-testing a number of things that claim to give you a good night’s sleep. (I leaked the first three chapters in audiobook form here.) The trouble is, if I don’t have a dependable sleep tracker, I have no real way of knowing what worked and what didn’t.

That’s where Dr. Seema Khosla comes in.

She’s the former chair of the Presidential Technology Committee of the American Academy of Sleep Medicine. As a result, she has seen every gadget and piece of gear that’s out there. She has also tried several of them herself.

It Was Like Christmas!

Last week, Seema sent me a large box, filled with sleep tracker after sleep tracker. I now have more of these gadgets myself than your average Best Buy.

However, my conversations – both on and off the air – with Seema have led me to make a change to my original plan for the book, which was to use a Fitbit Versa 2 as my go-to for tracking my sleep. Few people would take my amateur research project seriously, because the data was likely to be flawed right out of the gate.

We talk our way through an “unboxing” of the various devices she sent me, while we save for last the one I’m going to be using going forward. [SPOILER ALERT: I’m going to be tracking my sleep with a Dreem 2 headband. You’ll hear us discuss why in the episode. The people at Dreem didn’t give me a tracker to use; far from it, in fact. However, if you click this link and end up getting a Dreem 2 headband of your own, I get a tiny little “thank you” check from them.]

This podcast uses the following third-party services for analysis:

Chartable - https://chartable.com/privacy

In this episode

• Why Neil abandoned Fitbit as the primary measurement tool for his sleep-experiment project
• Seema Khosla’s box of sleep technology
• AYO blue-light glasses and circadian timing
• Why the timing of bright light matters as much as the light itself
• Ravi Allada’s Major League Baseball jet-lag study — and the corrected 20-season dataset
• Forehead oximetry and the arrival of blood oxygen on Apple Watch Series 6
• Why more sensors do not automatically mean better clinical information
• Apple’s original simpler sleep-tracking approach
• Orthosomnia and the danger of letting a sleep score decide how you feel
• Why Seema first asks patients what prompted them to start tracking
• Consumer tracker data as a reason to ask a clinician a better question
• The Dreem 2 EEG headband and why it changed Neil’s book plan
• What EEG adds that an ordinary wrist tracker does not directly measure
• How Dreem later performed in PSG validation studies
• Why a Dreem movement count cannot be compared directly with a laboratory PLMI
• The current Waveband descendant of Dreem technology
• CBT-I inside a consumer sleep device
• Why dose and timing matter when talking about melatonin
• Internet sleep advice, cannabis anecdotes and evidence
• Why the tracker should contribute information rather than dictate reality
• Seema’s continuing role as host of AASM’s Talking Sleep

About Dr. Seema Khosla

Seema Khosla, MD, FCCP, FAASM, is medical director of the North Dakota Center for Sleep in Fargo and a physician board certified in internal medicine, pulmonary medicine, critical care medicine and sleep medicine. She has served in multiple leadership and technology roles with the American Academy of Sleep Medicine, including chairing its Consumer and Clinical Technology Committee. She is the longtime host of the AASM podcast Talking Sleep.

MENTIONED

Dr. Seema Khosla

Current professional bio and sleep-medicine work.

Seema Khosla and Talking Sleep at the AASM

Consumer Sleep Technology: AASM Position Statement

The 2018 position statement led by Khosla on how consumer-generated sleep data can — and cannot — be used clinically.

Read the AASM statement

World Sleep Society Recommendations for Sleep Trackers

The 2025 recommendations on fundamental sleep measures, proprietary metrics, clinical use and device selection.

Read the recommendations

2025 Wrist-Worn Sleep Tracker Meta-Analysis

Twenty-four studies and 798 participants comparing consumer wrist devices with polysomnography.

Read the meta-analysis

Orthosomnia

The original 2017 clinical case series that introduced the term for unhealthy perfectionism around tracker-generated sleep data.

Read the paper

Dreem Headband vs. Polysomnography

The 2020 EEG and sleep-staging validation study discussed in the archive update.

Read the Dreem validation study

Dreem in Older Adults and Alzheimer’s Disease

A 2025 independent evaluation showing both useful accuracy and important stage- and signal-specific limitations.

Read the 2025 evaluation

Beacon Biosignals / Waveband

The current descendant of Dreem’s clinical EEG-headband technology.

Beacon’s Dreem acquisition and Waveband

Apple Watch Series 6 and Blood Oxygen

Apple’s September 2020 announcement that had just happened when this conversation was recorded.

Apple’s 2020 announcement

Apple Watch Sleep Apnea Notifications

The 2024 regulatory milestone showing how consumer sensors later moved toward a specific validated clinical screening use.

FDA clearance notice

Ravi Allada: Jet Lag and Major League Baseball

The 20-season, 46,535-game study discussed during the light-therapy segment.

Read the baseball study

Personal Light Treatment Devices

Newer work on wearable blue-light and blue-blocking devices for circadian alignment in an operational setting.

Read the study

Talking Sleep: Wearable Sleep Tech

Seema’s 2026 follow-through with members of the World Sleep Society tracker task force.

Listen at the AASM

Julie Flygare on Narcolepsy

The earlier Snooze Button episode highlighted here for World Narcolepsy Day.

Listen to Julie Flygare on The Snooze Button

In this episode

• Beth Wyatt’s “rest instead of sleep” approach when sleep will not come
• Breath awareness, racing thoughts and reducing pressure at bedtime
• Why chronic insomnia is rarely solved by another generic sleep-hygiene tip
• How Beth ended up with a mild sleep-apnea diagnosis when she expected narcolepsy or hypersomnia
• The first-night effect in polysomnography
• Neil’s repeat sleep-lab experience and the modern correction on pramipexole for RLS
• Short naps, comfort and feeling safe enough to sleep
• How COVID-19 changed Beth’s coaching work and her clients’ sleep
• Listener Amy’s questions about upper airway resistance syndrome
• Why UARS is now considered part of the OSA spectrum rather than a separate disease
• RERAs, arousal-based scoring and why AHI can miss part of the clinical story
• Whether cone-beam CT can diagnose an airway-related sleep problem
• Small or recessed jaws, anatomy, loop gain, airway muscles and arousal threshold
• Why permanent dental or surgical intervention deserves caution when the diagnosis is uncertain
• What to do when an airway-focused treatment has not worked
• Why the patient’s own symptoms and treatment response belong in the decision
• The 936-million global OSA estimate
• The 2020 open-source framework for validating consumer sleep trackers
• Michael Grandner’s argument that sleep stages are useful human categories, not perfect boundaries in nature
• How hypnodensity and multisensor wearables later followed the direction Michael predicted
• The prediction that Alzheimer biomarker testing would become easier — and the 2025 blood-test milestone
• The 2020 white-noise systematic review and what newer evidence says now

About Beth Wyatt

Beth Wyatt is a sleep coach, author, podcaster and meditation teacher. She is the author of The Calm & Cozy Book of Sleep: Rest + Dream + Live and host of the archive of The Calm & Cozy Podcast. Her current coaching work focuses particularly on sleep in midlife, including stress and hormonal change.

About Dr. Atul Malhotra

Atul Malhotra, MD, is a professor of medicine and sleep-medicine specialist at UC San Diego Health whose research focuses on obstructive sleep apnea, respiratory physiology, OSA endotypes, treatment adherence and personalized approaches to sleep-disordered breathing.

About Dr. Michael Grandner

Michael Grandner, PhD, is a clinical psychologist and behavioral sleep-medicine specialist at the University of Arizona, where he directs the Sleep and Health Research Program and the Behavioral Sleep and Circadian Medicine Clinic. He later served as president of the Society of Behavioral Sleep Medicine and is now a past president of the organization.

MENTIONED

Sleep Coach Beth

Beth Wyatt’s current sleep-coaching work and resources.

Sleep Coach Beth

The Calm & Cozy Book of Sleep

Beth’s 2020 book from Rock Point/Quarto.

Book details from Quarto

Behavioral Treatment of Chronic Insomnia

The AASM clinical guideline supporting multicomponent CBT-I and advising against sleep hygiene as a stand-alone treatment.

Read the guideline

2025 VA/DoD Insomnia and OSA Guideline

Current evidence-based guidance for chronic insomnia and obstructive sleep apnea.

Read the guideline resources

First-Night Effect in Polysomnography

A 2024 review of how the first night of sleep monitoring can alter sleep architecture.

Read the review

AASM Restless Legs Syndrome Guideline

The modern guideline that conditionally recommends against standard pramipexole use because of augmentation risk.

RLS and PLMD treatment guideline

Dr. Atul Malhotra

UC San Diego Health profile and current clinical work.

Atul Malhotra at UC San Diego Health

Upper Airway Resistance Syndrome and OSA

The 2023 international consensus statement explains why UARS is no longer treated as a separate diagnostic entity and why RERAs still matter.

International Consensus Statement on OSA

Arousal-Based Scoring in OSA

The AASM position statement on hypopneas, RERAs and respiratory disturbance index.

AASM position statement

Global Prevalence of Obstructive Sleep Apnea

The 2019 analysis, coauthored by Malhotra, estimating 936 million adults aged 30–69 with mild-to-severe OSA.

Read the global prevalence study

OSA Endotypes and Phenotypes

Malhotra and colleagues on airway anatomy, muscle responsiveness, ventilatory control and arousal threshold.

Read the review

Standardized Framework for Testing Sleep Trackers

The open-source validation framework Michael was excited about in this episode.

Read the paper

Hypnodensity and Probabilistic Sleep Staging

A modern approach to representing stage ambiguity rather than forcing every epoch into one perfectly clean box.

Read the hypnodensity review

World Sleep Society Recommendations for Consumer Sleep Trackers

The 2025 recommendations on fundamental sleep measures, proprietary metrics and responsible tracker use.

Read the recommendations

Noise as a Sleep Aid

The 2020 systematic review of white and continuous broadband noise discussed with Michael.

Read the systematic review

2025 White-Noise Meta-Analysis

Newer randomized-trial evidence showing benefits in some populations while retaining substantial heterogeneity.

Read the meta-analysis

FDA-Cleared Alzheimer’s Blood Test

The 2025 milestone that followed Grandner’s prediction that Alzheimer biomarker testing would become easier and less invasive.

FDA announcement

Deep sleep has traditionally been the focus of any conversation about dementia and sleep. But that's about to change, if Laura Bojarskaite has anything to say about it. Laura is working on her PhD in Oslo, Norway, with a focus on "brainwashing", or the removal of harmful waste products that accumulate in the brain. (Maybe "brain washing" is a more accurate way to write it.)

Dementia is at the heart of Neil's journey into the sleep world to begin with. Similarly, cognition has come up on the show multiple times, too, most notably with Dr. Adrian Owen OBE, in a discussion about cognitive decline associated with sleep deprivation. Equally important, REM sleep removes these waste products as well, according to Laura's research. As a result, people who worry about getting enough deep sleep might be able to breathe a little easier.

So if you're obsessing over your tracker data because it says you're not getting enough deep sleep and you're convinced you're headed for a date with Alzheimer's... relax. REM sleep matters in a conversation about dementia, too. As a matter of fact, over and over again we see that all the sleep stages play important roles in all aspects of health, not just cognition.

We'd say, "take a deep breath", but Laura gets into that subject, too.

More of Laura's work here:

Astrocytic Ca2+ signaling is reduced during sleep and is involved in the regulation of slow wave sleep

Astrocytes Play an Important Role in Maintaining Slow Wave Sleep

From Laura's own bio:

Laura is a neuroscientist and a yogi from Lithuania, currently living in Norway. Laura is finishing up her PhD degree at the GliaLab at Letten Center at the University of Oslo. Her field of research is astrocytes, sleep and “brainwashing” – clearance of toxins and waste products from the brain.

This podcast uses the following third-party services for analysis:

Chartable - https://chartable.com/privacy

In this episode

• What the glymphatic system is — and why “brainwashing” is a surprisingly useful metaphor
• Astrocytes and their role in sleep and brain-fluid biology
• Why amyloid-beta, tau and other proteins matter in neurodegenerative disease research
• Why the connection between poor sleep and dementia is more complicated than a straight line
• Laura’s 2020 hypothesis that REM sleep and sleep-stage cycling might matter for brain-fluid transport
• What Laura’s 2023 Nature Communications paper later found
• Why the old claim that “REM sleep clears waste too” was too strong
• The current scientific argument over whether sleep increases or decreases brain clearance
• Human evidence from sleep-deprivation and biomarker studies
• Neil’s fear that low deep sleep had put him on a collision course with Alzheimer’s
• Why there is no universal perfect percentage of deep or REM sleep to chase
• Laura’s warning that worrying too much about sleep can itself become a sleep problem
• Mouse studies of exercise and glymphatic function
• How breathing changes cerebrospinal-fluid movement in humans
• Why greater CSF motion does not automatically prove greater waste clearance
• The notorious low-dose-alcohol mouse study — and what it actually showed
• How brain waste connects with meningeal and cervical lymphatic drainage
• Why Alzheimer blood testing has changed dramatically since this interview

About Dr. Laura Bojarskaitė

Laura Bojarskaitė, PhD, is a neuroscientist and sleep researcher whose work focuses on astrocytes, sleep, cerebrospinal-fluid dynamics and brain clearance. She completed her PhD in neuroscience at the University of Oslo and has continued as a postdoctoral researcher associated with the University of Oslo and Oslo University Hospital. She is also a science communicator, speaker, radio host and author of 300 Questions and Answers About Sleep.

MENTIONED

Dr. Laura Bojarskaitė

Laura’s current work in neuroscience, sleep research and science communication.

Laura Bojarskaitė

Astrocytic Ca²⁺ Signaling and Slow-Wave Sleep

Laura’s 2020 Nature Communications paper on astrocyte calcium signaling across sleep and wake.

Read the 2020 paper

Sleep Cycle-Dependent Vascular Dynamics

The 2023 paper that followed the unpublished REM/NREM research Laura discusses in this episode.

Read the 2023 paper

Aquaporin-4 and Extracellular Solute Clearance

Laura and colleagues’ 2024 study examining the role of aquaporin-4 polarization in brain solute clearance.

Read the 2024 paper

Sleep Deprivation and Human Brain Clearance

A 2021 human MRI study reporting impaired molecular clearance after one night of total sleep deprivation.

Read the human study

Human Brain Solute Transport During Sleep and Sleep Deprivation

A 2023 MRI-informed modeling study of brain-wide solute transport in humans.

Read the 2023 human study

Brain Clearance Is Reduced During Sleep and Anesthesia

The controversial 2024 mouse paper challenging a central glymphatic claim.

Read the 2024 paper

A Curious Concept of CNS Clearance

The 2025 response from Maiken Nedergaard and colleagues disputing the interpretation of the 2024 clearance study.

Read the response

Sleep, Amyloid-Beta and Tau Clearance in Humans

A 2026 randomized crossover study reporting sleep-associated movement of Alzheimer-related biomarkers from brain toward plasma.

Read the 2026 study

Breathing and Cerebrospinal-Fluid Flow

A foundational human MRI study showing strong respiratory regulation of CSF flow.

Read the MRI study

Yogic Breathing and CSF Dynamics

A 2022 human MRI study examining immediate changes in pulsatile CSF movement during different breathing patterns.

Read the breathing study

Exercise and Glymphatic Function in Mice

A voluntary-running study examining glymphatic tracer influx in awake mice.

Read the exercise study

Alcohol and Glymphatic Function in Mice

The 2018 study behind the episode’s heavily qualified discussion of low-dose alcohol.

Read the alcohol study

FDA-Cleared Alzheimer’s Blood Test

The FDA’s 2025 announcement of the first blood test cleared to aid Alzheimer’s diagnosis.

FDA announcement

In this episode

• Why Evo Terra’s “40th podcast” claim is really a Podcast Alley historical marker
• Evo’s 15-year experience with sleep-maintenance insomnia
• How a 20-minute workplace nap became part of his routine
• What short naps can — and cannot — reliably do
• Evo’s near-nightly cannabis use for sleep onset
• Why anecdotal benefit is not the same thing as evidence of a treatment
• What newer cannabis-and-sleep research says about sleep architecture
• Spencer Dawson’s own middle-of-the-night strategy
• Stimulus control and getting out of bed when sleep is not happening
• Neil’s first sleep-lab mismatch between remembered sleep and measured sleep
• Sleep-state misperception, paradoxical insomnia and sleep discrepancy
• Why newer research questions whether PSG captures everything about feeling awake
• How CBT-I can reduce subjective-objective sleep discrepancy
• Why a consumer tracker should not be treated as the final judge of whether you slept
• How periodic limb movements can complicate movement-based sleep estimates
• Why insomnia and obstructive sleep apnea can coexist
• Dawson’s later MATRICS trial of CBT-I plus PAP
• Why “heard through a closed door” appears in real sleep-apnea screening
• Snoring, choking, gasping and resistant high blood pressure as reasons to investigate
• The diagnostic value of a bed partner
• Neil’s 2020 “sleep divorce” problem
• Why narcolepsy and hypersomnia can take years to diagnose
• Behavioral treatment as an adjunct to medical care for hypersomnia

About Evo Terra

Evo Terra is a podcast strategist, producer, author and one of the medium’s earliest practitioners. According to Podcast Alley, he began as its 40th listed podcaster in October 2004. He co-authored multiple editions of Podcasting For Dummies, founded Podiobooks, hosted Podcast Pontifications and was inducted into the Podcast Hall of Fame in 2022.

About Dr. Spencer Dawson

Spencer Dawson, PhD, is a clinical psychologist specializing in behavioral sleep medicine. He is currently an Assistant Clinical Professor and Associate Director of Clinical Training in Psychological and Brain Sciences at Indiana University Bloomington and continues to provide behavioral sleep services through Better Sleep Bloomington. His work has included insomnia, sleep discrepancy, comorbid insomnia and sleep apnea, narcolepsy and idiopathic hypersomnia.

MENTIONED

Evo Terra / Simpler Media

Terra’s current podcast strategy and production company.

Simpler Media

Podcast Hall of Fame — Evo Terra

Terra was inducted as part of the Hall of Fame’s 2022 class.

Podcast Hall of Fame

Podcasting For Dummies, 5th Edition

The 2024 edition co-authored by Tee Morris, Chuck Tomasi and Evo Terra.

Podcasting For Dummies, 5th Edition

Dr. Spencer Dawson — Indiana University

Dawson’s current university profile and behavioral sleep medicine roles.

Spencer Dawson — Indiana University

Dr. Spencer Dawson — Better Sleep Bloomington

Dawson’s behavioral sleep medicine practice.

Better Sleep Bloomington

Reconsidering Sleep Perception in Insomnia

A 2023 review asking whether “misperception” can partly reflect limitations in how standard sleep measurements define sleep and wake.

Read the review

Neurobiological Mechanisms of Sleep-State Misperception

A 2025 review of hyperarousal, sensory gating and other candidate mechanisms.

Read the 2025 review

CBT-I and Subjective-Objective Sleep Discrepancy

A later treatment study showing reduced discrepancy between actigraphy and self-reported sleep after CBT-I.

Read the CBT-I study

MATRICS: CBT-I and PAP for Comorbid Insomnia and Sleep Apnea

The randomized trial co-authored by Dawson that followed the COMISA discussion in this episode.

Read the MATRICS trial

STOP-Bang Sleep Apnea Questionnaire

The validated screening tool that includes loud snoring heard through a closed door among its questions.

STOP-Bang screening questionnaire

Cognitive Behavioral Therapy for Hypersomnia

The 2020 telehealth feasibility study by Jason Ong, Spencer Dawson and colleagues for narcolepsy and idiopathic hypersomnia.

Read the CBT-H study

Mindfulness-Based Intervention for Narcolepsy

A 2024 feasibility study co-authored by Dawson examining an intervention adapted for people with narcolepsy.

Read the study

Diagnostic Delays in Narcolepsy and Idiopathic Hypersomnia

A 2025 study documenting continued multi-year diagnostic delays across central disorders of hypersomnolence.

Read the diagnostic-delay study

Cannabis and Sleep Architecture

A 2025 systematic review and meta-analysis finding inconsistent objective effects of cannabis administration on sleep architecture, with more consistent sleep disruption during withdrawal.

Read the systematic review

Short Naps and Sleep Inertia

A review of naps of 30 minutes or less and why nap length alone does not determine whether sleep inertia occurs.

Read the nap review