The Darya Rose Show
Feb. 1, 2022

Insomnia, anxiety, depression, sauna, cooking oils and more with Dr. Ashley Mason

Insomnia, anxiety, depression, sauna, cooking oils and more with Dr. Ashley Mason

Dr. Ashley Mason discusses the relationship between insomnia, anxiety, and depression, and how sauna use can help with treatment resistant depression. We also cover cooking oils, mindful eating and more.


Dr. Ashley Mason is an Associate Professor of Psychiatry at the UCSF Osher Center for Integrative Health. She directs the Sleep, Eating, and Affect, or “SEA” laboratory, is the co-director of the Center for Obesity Assessment, Study, and Treatment (COAST), and is core research faculty in the Osher Center research program. In her clinical role, she directs the Osher Center Sleep Group, wherein she provides cognitive behavioral therapy for insomnia for patients with tough to treat insomnia.

 

Lab Website:  Sealab.ucsf.edu

We will be looking for a volunteer and hiring in the coming year.

Instagram @ash_e_mason

Twitter @DrAshleyMason

 

Summer Tomato Farmers Market Updates:

Tucson

Mountain View

 

Fats:

AMA (with Kevin Rose) 

Paper that had me digging into cooking oils: https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-019-0383-2

On smoke point: https://www.aboutoliveoil.org/evoo-most-stable-cooking-oil

Grapeseed oil: https://www.nutritionadvance.com/grapeseed-oil/

Avocado oil: https://www.nutritionadvance.com/avocado-oil-nutrition/

Peanut oil: https://www.nutritionadvance.com/is-peanut-oil-healthy-for-frying/

Oxidative stability of selected edible oils: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6100155/

Evaluation of chemical and physical changes in different commercial oils during heating: https://actascientific.com/ASNH/pdf/ASNH-02-0083.pdf

How to make cauliflower taste as good as French fries

 

Mindful Eating:

Some of my earlier work on reward-driven eating / mindful eating:

https://pubmed.ncbi.nlm.nih.gov/26867697/

https://link.springer.com/content/pdf/10.1007/s10865-015-9692-8.pdf

Sandra Aamodt, Ph.D TED talk: Why dieting doesn't usually work

Mindful Meal Challenge

 

Insomnia:

Why We Sleep, by Matt Walker

Basic CBT book

Common cognitive distortions worth working with: https://arfamiliesfirst.com/wp-content/uploads/2013/05/Cognitive-Distortions.pdf

Nice review of CBT-I: https://www.acpjournals.org/doi/full/10.7326/M15-1782

Favorite CBT-I book (includes thought record)

Stimulus control instructions, original paper: https://link.springer.com/chapter/10.1007/978-1-4757-9586-8_2

Progressive Muscle Relaxation research: https://www.tandfonline.com/doi/abs/10.1300/J137v13n03_04

Progressive Muscle Relaxation (PMR) recordings https://students.dartmouth.edu/wellness-center/wellness-mindfulness/mindfulness-meditation/guided-audio-recordings/progressive-muscle-relaxation

Direct link to try PMR: https://students.dartmouth.edu/wellness-center/sites/students_wellness_center.prod/files/p_muscle_relax.mp3

Eight Sleep mattress cooler

 

Sauna:

2016 paper – Janssen et al. https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2521478

This is the medical hyperthermia device that I do NOT use: https://www.heckel-hyperthermia.com/index.php/wbhen01

This is the commercially available sauna dome that I DO use: https://infraredsauna.com/curve-sauna-dome/

2021 UCSF sauna paper: https://www.tandfonline.com/doi/full/10.1080/02656736.2021.1991010

2013 paper – Hanusch et al. (single arm, indwelling rectal probe): https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2013.12111395

Research on temperature elevations in depression: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0447.1999.tb10864.x

Temperature regularizes upon successful antidepressant treatment: https://www.sciencedirect.com/science/article/pii/S0006322397000462

Exercise works for depression: https://onlinelibrary.wiley.com/doi/full/10.1002/da.22842

Literally, I bought friends these thermomenters: https://www.walgreens.com/store/c/walgreens-30-second-digital-thermometer/ID=prod6367272-product

The rectal probe we use in the study: https://www.medwrench.com/equipment/2206/mindray-ipm-9800

Longer time to get to high temperature associated with larger antidepressant response: https://www.tandfonline.com/doi/10.1080/02656736.2019.1612103

Example of a possible sauna that people could use at home to extend treatment

Rhonda Patrick  on sauna use to extend healthspan: https://www.sciencedirect.com/science/article/pii/S0531556521002916

 

 

 

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Transcript

 

Darya Rose: [00:00:00] I am Dr. Darya Rose, and you're listening to The Darya Rose Show, where we bring a fact-based perspective to answer all those confounding questions that come up in our day-to-day lives. From achieving optimal health, to making conscious choices about your purchases, and raising kids that thrive. We are here to help you navigate your life, with confidence.

Hello, and welcome to the Darya Rose Show. Today's episode is one of my favorite yet. I speak to clinical psychiatrist, Dr. Ashley Mason, on so many interesting topics, that I think we may actually have been separated at birth [laughs] because our interests align so much.

Dr. Ashley Mason is an associate professor of psychiatry at the UCSF Osher Center for Integrative Health. She directs the Sleep, Eating, and Affect, or SEA, S-E-A, laboratory, is the co-director of the Center for Obesity Assessment, Study, and Treatment, COAST, and is core research faculty at the Osher [00:01:00] Center Research Program.

In her clinical role, she directs the Osher Center Sleep Group, wherein she provides cognitive behavioral therapy for insomnia, for patients with tough-to-treat insomnia.

In this conversation, we talk about how she became interested in healthy eating, and behavior change, mindful eating, and we correct the record on cooking oils, because, I had given some incorrect information in a previous episode, where it came up, and I definitely wanted to set the record straight on that.

We also go deep into insomnia, cognitive behavioral therapy for insomnia, anxiety, depression, and how those are all related, and, her latest research into how intense sauna sessions can reverse severe depression.

I learned so much from Ashley, and I hope you do as well. I also wanna let you know that this will be the last episode of season two. I'm going to take a break in February, and get back to you in the spring. In the meantime, if you have any topics you'd like me to dive into, feel free to shoot me a note on my contact form, over at DaryaRoseShow.com and I'll see what I can do to cover it.

Thank you [00:02:00] so much for listening today, and I hope you enjoy this conversation with Dr. Ashley Mason. Ashley! Welcome to the show.

Dr. Ashley Mason: Hello. It's a pleasure to be here.

Darya Rose: I'm so excited to talk to you. We have... so much in common, first of all... And... [laughs].

Dr. Ashley Mason: We certainly do.

Darya Rose: [laughs]. Yeah. And we've known each other for a long time now. You first reached out to me, I think back in, like, 2012, is that when it was?

Dr. Ashley Mason: Yep.

Darya Rose: About doing a farmer's market update for Summer Tomato, my website, that I haven't updated in forever. And, you did one in Tucson...

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: And then you did another one, a couple years later, from w- where was it again?

Dr. Ashley Mason: Mountain View.

Darya Rose: Mountain View.

Dr. Ashley Mason: Yeah. Yep. It was, honestly, I had just discovered farmer's markets in graduate school. And, was learning how to cook vegetables, for almost the first time, and, my husband, actually had found your website, and said, "Hey, you should check out this website. [00:03:00] It might help you figure out all this new farmer's market stuff you're trying to do." Lo and behold, [laughs]...

Darya Rose: [laughs].

Dr. Ashley Mason: I was totally, totally interested all the time, and ended up, yeah, wanting to do posts for your website. [laughs].

Darya Rose: That's so funny. So, tell everyone, uh, your connection to health eating, because... You have uh, a long history of it.

Dr. Ashley Mason: Yeah. Gosh. I'm not sure where to start. I grew up in Chicago, and did not grow up going to farmer's markets, or doing a whole lot of cooking with fresh vegetables and fruits. And I really started getting interested in this when I was in Arizona, and had this ability to go to farmer's markets, year round, it was just unbelievable.

And, there were vegetables that I'd never heard of. I remember the first time I ever read about a delicata squash. It was on your website, and you had this recipe posted.

Darya Rose: Hmm.

Dr. Ashley Mason: And I thought, my goodness, I need to go find this. It turns out they were in front of my eyes the whole time, but I thought they were gourds. [laughs].

Darya Rose: Uh-huh [affirmative].

Dr. Ashley Mason: So I never [00:04:00] bought them.

Darya Rose: [crosstalk 00:04:01] You thought, like, it was a decorative gourd?

Dr. Ashley Mason: Yeah. I thought it was something to decorate with.

Darya Rose: [laughs].

Dr. Ashley Mason: And I didn't know you could eat it. [laughs]. So, started getting into that...

Darya Rose: Oh, what a game changer.

Dr. Ashley Mason: [crosstalk 00:04:09] Yeah.

Darya Rose: 'Cause those are delicious.

Dr. Ashley Mason: Yeah. It, it was. And so, at the time, I was actually studying relationships at the University of Arizona, where I got my PhD. Specifically, I was, I was studying how relationships dissolve. So in my undergraduate, I was actually studying speed dating, and how relationships start. And then, graduate school, I went to go study their demise, and...

Darya Rose: [laughs].

Dr. Ashley Mason: Somewhere along the lines, I was [laughs] watching middle-aged men cry on Saturday mornings, as part of our research studies. And I thought, you know what, I'm not so sure, I'm not so sure this is for me. Meanwhile, I was doing clinical work, and a lot of it, in behavioral medicine, at a primary care clinic.

Darya Rose: Hmm.

Dr. Ashley Mason: And what I was seeing, every day, was starting to get repetitive. Type 2 Diabetes, people struggling with their weight, people struggling with their metabolic health, and my primary job there was to work with the primary care [00:05:00] physicians. They were residents at the time. And so, we would shadow them in their appointments, and try and help them work on behavior change in these 14 minute appointments.

Darya Rose: Mm [laughs].

Dr. Ashley Mason: And, so that's what we were charged with. And, I had a, a good friend at the time, there, who was rotating, and he said, "You know what? I'm not a primary care doc, I'm a diabetologist. That's all I do." And, he, a, ultimately he became an, disenchanted with the whole thing, and he went and he did, he re-did his residency in emergency medicine, but, that just k- solidified to me that there's a big problem, here. There's a gap between what people need, and what they're getting.

Darya Rose: Right.

Dr. Ashley Mason: In terms of their healthcare. And, so, when all these physicians were asking us what do we do to help our, help our patients change? It... It became so clear that not only was this an area that I found endlessly interesting, but that, there were opportunities that I could take advantage of, and, specifically go and continue my work in that direction during my clinical internship, [00:06:00] which is what we do after clinical psychology PhD's, we don't go to three, four year residencies, we go to a one year clinical internship.

Darya Rose: Hmm.

Dr. Ashley Mason: And so, I went on a clinical internship, and really focused on behavioral weight loss, and diabetes, and behavior change in those settings. And learned a whole lot, before going to UCSF, where then I continued on, focusing on this work. And, I think it was, gosh, I think I was a postdoc when I read your first book. I'm trying to remember exactly when that was. But I remember thinking, "Ah." And then I had met Sandra Umit, who, also was writing, I think she was writing her book at that time, or, was it, uh, timelines allude me.

Darya Rose: Yeah.

Dr. Ashley Mason: But I was starting to get really interested in this idea of food reward. And looking at, what is the behavior of eating doing for people? How it is serving you? And, really getting into the weeds with this idea of, oh, just tracking calories all the time, and measuring this all the time. And all of this is not a long term solution, and, I arrived at looking at a lot of mindful [00:07:00] eating practices, which, obviously, where we intersected again, at UCSF, and you were so kind to come and give a walk at the Osher Mini Med School about that.

And, ultimately, now I've done a number of trials, looking at mindful eating interventions. In the spaces of diabetes, and obesity overweight.

Darya Rose: So cool.

Dr. Ashley Mason: And, folks, folks really like it.

Darya Rose: Really?

Dr. Ashley Mason: They like it. Yeah. People really like doing these mindful eating activities, and exercises, far more than they like tracking their calories every day [laughs] with a calorie app, weighing their food on a scale, being crazy about, it, it's a lot of work to do those kinds of constant tracking.

Darya Rose: Also miserable.

Dr. Ashley Mason: And... Don't get me wrong.

Darya Rose: Yeah [laughs].

Dr. Ashley Mason: Like you've mentioned, a lot of times, mindfulness can be hard, too.

Darya Rose: Yeah.

Dr. Ashley Mason: We go to eat with other people, we do all kinds of behaviors while we eat, which is why I like the mindful meal challenge a lot. If you can do this one meal a day and kind of recalibrate yourself to getting in tune with, what does hungry feel like? What does full feel? Do [00:08:00] I really wanna eat this? What is the real reward of eating a second donut?

Darya Rose: Right.

Dr. Ashley Mason: Am I gonna be ex- happy for a minute, and then feel sick for an hour? It, really being able to clarify those rewards.

Darya Rose: Very cool.

Dr. Ashley Mason: It's like Santa Claus. Once you know he isn't real, you can't un-know that.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: So, once you realize what you can observe when you're eating, you can't really un-know that.

Darya Rose: So true. Picky eating is something that comes up in my [laughs] in my work a lot. And I, on one hand, get frustrated with people who are close-minded. Who won't try a category of food, because they had it once, and they didn't like it, or they don't like the idea of it. Or, I mean, just, like, to me, I'm just, like, "Come on, grow." [laughs], 'Cause, you can. You can train yourself to like anything.

But, I encourage being picky, in terms of having high standards about, especially things that are, like, not ideally healthy, being, desserts, processed foods. Not that you shouldn't ever eat them, but, get the best dang one you can find, because you [00:09:00] deserve it. And, why bother eating one that's mediocre, that's gonna make you feel like crap, when, you don't, it, it just doesn't do anything for you, es- and, and once you've had a Pastry in Paris, or a Tartine Bakery, or, y- some place that's like, mind-blowing, it's like, why would you ever eat the one from Costco?

Like, that just, to me, that's like something, like, exactly like you said, I can't un-know how good this should be. And, and I know how crappy I'm gonna feel if I eat it, if I eat the low quality version of it. And it's just not even a hard choice at all. And people think I have, like, willpower, or people think I'm just a freak, [laughs] or something, but it's like, "No, I've just had these experiences, and thought about it."

Dr. Ashley Mason: You just have a lot of awareness.

Darya Rose: Yeah. I've just... I'm aware, and I thought about it, yeah.

Dr. Ashley Mason: You really know what you like.

Darya Rose: Yeah.

Dr. Ashley Mason: And that's why I scoff at these, like, food-free food products. So you've got sugar-free, fat-free, carb-free, everything free, ice cream.

Darya Rose: Yeah.

Dr. Ashley Mason: What's the [00:10:00] point?

Darya Rose: Right.

Dr. Ashley Mason: If you're gonna do the ice cream, do the ice cream. Do it.

Darya Rose: Yeah.

Dr. Ashley Mason: But you don't need to do the whole pint of it, is what you'll realize. But if it's food-free food ice cream, maybe you do need the whole pint, to get [laughs]...

Darya Rose: Right.

Dr. Ashley Mason: To get [crosstalk 00:10:11] enjoyment out of it. Exactly.

Darya Rose: It, yeah, it, until you're sick. [laughs].

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: I'm curious, what exercises do you give people, that they love so much more than tracking food?

Dr. Ashley Mason: Oh, so, asking people to do nothing, other than eat, while they eat, is really hard.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: But folks don't dislike this as much. And, one thing that I've also found that folks really like, is when I tell them, simply, "You don't have to obsess over carb grams, and fat grams, protein grams." What I really want you to do, is observe your own habits. Just be your own self-scientist. No one is as good of an expert about you, as you are.

Darya Rose: Yep.

Dr. Ashley Mason: So pay attention for a day, and that's your homework. Right? [00:11:00] I think one of the best examples, though, that I have, that's worth sharing, has to do more with smoking, actually.

Darya Rose: Hmm.

Dr. Ashley Mason: I once had a patient, and he gave me permission to tell his story, 'cause he's, he said, "As many people as you can tell, my story, the better." [laughs]. And what, what I did with him, was actually quite interesting. He presented to me when I was actually a, when I was at the VA [inaudible 00:11:22] to do my clintern- clinical internship.

And, he was a pretty big smoker. One and a half packs a day, or so. And, he had reached his limit, on a certain kind of medication and was dealing with peripheral neuropathy, which is a consequence of smoking. And, needed to decrease his smoking.

But the doctors wouldn't let him do some- something else, until he had least, done an appointment with someone like me. And so, he came in, and said, "Okay, I'm here not 'cause I wanna be, I love smoking, I'm not gonna quit smoking, I need to be here in order to get some other medication to deal with this issue."

Darya Rose: Hmm.

Dr. Ashley Mason: And I said, "Aw, that's cool. Tell me about [00:12:00] smoking." And he proceeded to tell me it's something everybody in his family does, has always done, he really enjoys it. And I said, "Oh, what do you enjoy about it?" He told me all the things he enjoyed about it, and I said, "That sounds really enjoyable."

Darya Rose: [laughs].

Dr. Ashley Mason: And, he was just perplexed at our conversation.

Darya Rose: 'Cause you weren't scolding him?

Dr. Ashley Mason: I wasn't, I wasn't lecturing him...

Darya Rose: Yeah.

Dr. Ashley Mason: I wasn't telling him to change anything. Right? I was just asking him about what he loves. And I said, "You know, can I give you one homework assignment before I sign all these papers? Would you be willing to come back and see me one more tame- time, after just trying one thing, for me?" He said, "Sure. I'll do, I'll do one thing. You're not gonna make me quit smoking." I said, "No. In fact, I'm gonna assign you homework, and I'm gonna tell you, you have to smoke. In fact, smoking is so important in your life, that, I want you to smoke, and I want you to actually prioritize it. When you're smoking, you can't be watching TV, drinking coffee, reading the paper, chatting on the phone. Smoking is really important, and you really enjoy it. So let's get [00:13:00] everything else out of the way. And just smoke."

And you know what? When he started doing that, he said, "This is, this is no problem, okay." At first, he found it, or, he said, "This is no problem," when he left my office that first day. He did find it pretty difficult.

Darya Rose: Hmm.

Dr. Ashley Mason: But what he ultimately found, was that, he does enjoy smoking, and it's much more enjoyable when he's not doing anything else with it. And so, did he fully quit smoking, when he left treatment with me? No. But he was down to five a day. From one and a half packs a day, down to five a day.

Darya Rose: Wow.

Dr. Ashley Mason: So that falls into the category- [crosstalk 00:13:36].

Darya Rose: [crosstalk 00:13:36] 20 cigarettes in a pack? Something like that?

Dr. Ashley Mason: Something like that.

Darya Rose: Yeah [laughs].

Dr. Ashley Mason: I don't know. But, it, it's a lot. And, that's in, you know, by some standards, that's a failure, right? He didn't quit smoking. By other standards, it's harm reduction. His, his peripheral neuropathy did get better, as a result of that much of a reduction over time.

Darya Rose: Wow.

Dr. Ashley Mason: And so, we can equate this over to eating, right? We're not telling people, don't ever eat chocolate cake again. We're [00:14:00] saying, "When you do eat it, enjoy the hell out of it. Don't make it something that you're doing while you're watching TV, checking your phone on the internet, on hold on a phone call, or, doing 10 things at once."

Darya Rose: Or secretly, like, doing it as fast as you can so you don't have to be ashamed of yourself, or [laughs].

Dr. Ashley Mason: Exactly.

Darya Rose: Yeah, like, sit at the best restaurant in town, and get the best chocolate cake you've ever had.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: Yeah. And, and enjoy the fuck out of it.

Dr. Ashley Mason: Yeah.

Darya Rose: [laughs].

Dr. Ashley Mason: And, some people, though, when you ask them to do mindful smoking, they'll actually realize they don't like it.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: "Actually, this tastes terrible. I don't like this." And they become disenchanted with their own behavior, and it's way easier then, for them to let go of the behavior.

Darya Rose: Wow.

Dr. Ashley Mason: When they zero-in on it.

Darya Rose: You just reminded me of this email I once got, from, a Mindful Meal Challenge student. And, he said, "I decided to do it with a banana." And he's like, "I hate bananas. I really hate bananas," He said, "I don't know why. I've hated them since I was kid." In my head I'm just like, "Why, why did you do this with a banana if you hate them so much?" [laughs]. I don't know, maybe it was all he had.

But he was like, [00:15:00] "You know what I found? I, I took some bites, and I, I was doing the ch- the challenge, and it was like, I realized, I love bananas." [laughs].

Dr. Ashley Mason: [laughs]. That's pretty good.

Darya Rose: [inaudible 00:15:09] Oh, you know, yeah, I just remembered, he said he ate bananas, 'cause he felt like he had to. So he would, like, eat a banana every morning. I'm like, "I've never heard anybody say they have to eat bananas," But...

Dr. Ashley Mason: [laughs.]

Darya Rose: Then he was like, "Anyway, I love bananas now. Thank you so much." And that was the email. And I was just like, "It's so crazy what happens when you just pay attention to what's going on in your body."

Dr. Ashley Mason: It really is. And doing that, is work. Don't get me wrong. But for some reason, people find it way less aversive, than the chaos of tracking every bite they're taking.

Darya Rose: Yeah.

Dr. Ashley Mason: Yeah.

Darya Rose: Thank you for that deep dive into mindful eating. That's so cool. The, one of the reasons that we're talking right now, is because I did a show with my husband Kevin, for New Year, oh no, it wasn't New Year, was it New Year's? No. [crosstalk 00:15:54].

Dr. Ashley Mason: Few months ago, I think.

Darya Rose: Yeah. Yeah. And, cooking oil came up, somebody, oh, somebody had [00:16:00] asked a question about cooking oils. And, I was, it's one of those things that I just haven't thought about that much, because I just, I, I use extra virgin olive oil, and it's, has a long history of being safe and healthy, and I just don't really understand why anybody would do anything else.

But, I do know that, that the chefs that I know, and work with sometimes, they, they usually use Grapeseed oil when they're doing higher stuff, higher temperature stuff. And, so, you know, we kind of threw around some cooking oil info like that, and I, apparently, totally missed a major point [laughs], which, thank you for emailing me, and telling me, and correcting the record.

So, I wanted to have you here to just chat, and correct the record on that really fast, because, I put my foot in my mouth, and [laughs] and people should know, they should not be using Grapeseed oil.

Dr. Ashley Mason: So, all good. And, actually, I am definitely a clinical psychologist. So this is not my area.

Darya Rose: [laughs].

Dr. Ashley Mason: The reason why this has come up for me, is because, when we've been analyzing our diabetes trial data, [00:17:00] one, I should back up. One of the major components of our interventions, is using a carbohydrate restricted diet, because we know that for folks with Type 2 Diabetes, they can lower their sugars, and their A1C by eating less carbohydrates.

One of the things that's often criticized about carbohydrate restricted diets, is that they increase cholesterol. Or they increase, uh, your consumption of quote, unquote, "bad fats."

Darya Rose: Right.

Dr. Ashley Mason: And so, one of the analysis I did, and we published this a few years ago in, in, I think in BMC Nutrition and Metabolism, showing the effects of our diet on all different types of LDL. And at that time, I ended up taking a deep dive into all of this oil literature.

Darya Rose: Hmm.

Dr. Ashley Mason: To try and figure out what's going on, here. And, one of the interesting things that I found out, in looking at polyunsaturated fats, versus saturated fats, has to do with their stability during cooking. And, it turns out, there's a difference between the point at which an oil [00:18:00] oxidizes, and the point at which it smokes.

Darya Rose: See, that is what I didn't know, for some reason I had gotten into my head, and I, I feel like I've read it, at some point, but, I got in my head that it was all about the smoke point, and that there wasn't, and that, and the oxidation happened at that point, and so, I was like, "It's easy to tell if it's nasty, 'cause it's nasty. It smells bad, it tastes bad." But that is no, not true.

Dr. Ashley Mason: Yeah. So it turns out, and I definitely would suggest that listeners go look up more extensive resources on this, 'cause I'm gonna give a very high level understanding.

Darya Rose: I'll link to 'em in the show notes.

Dr. Ashley Mason: [crosstalk 00:18:32] What I know. Yeah. Is that, polyunsaturated oils oxidize at much lower temperatures than oils that have more saturates, or, that have more mono-unsaturate. So for example, I think olive oil actually has quite a bit of saturates in it. And, so do things like avocado oil. But grapeseed-

Darya Rose: Those are high in mono-un-

Dr. Ashley Mason: [crosstalk 00:18:54] Mon, yeah, mono-unsaturated fat. And, but those, I think, also, are more stable in the face of heat. But [00:19:00] polyunsaturated fats, those are going to be less stable, and are going to oxidize at lower temperatures. [crosstalk 00:19:06].

Darya Rose: [crosstalk 00:19:06] Clini- clinically meaningful?

Dr. Ashley Mason: Gosh. What yardstick are we using for clinically meaningful? I mean, are you eating them every s- like if you're deep frying your breakfast, lunch, and dinner in these polyunsaturated fats, I would betcha that it could be clinically meaningful for your health.

Darya Rose: Sure.

Dr. Ashley Mason: If you're eating, you know, french fries deep fried, and grapeseed oil once a month, I don't know. There's much worse you could be doing. So, it's, it's really gonna be a, "What's your yardstick?" Question. But, when it comes to the smoke point of, for example, grapeseed oil, it's really nice that it has a s- high smoke point, because then it's easier to, to cook food at high temperatures without it, you know, getting [crosstalk 00:19:45]. Yeah. So chefs love it.

However, I'm, I'm with you, in terms of cooking, I'm generally using olive oil, avocado oil, or just plain old butter. And these are- [crosstalk 00:19:56].

Darya Rose: Butter burns, like, pretty fast, that's, that's...

Dr. Ashley Mason: Yeah.

Darya Rose: That's the issue, [00:20:00] right? And that's, actually, in my experience, coconut oil does, too. Like, it, like, I, it, I know, that's supposed to be one of the better choices, but, I find stuff burns really easily in it.

Dr. Ashley Mason: I think that, I don't know enough about the food science with it, it might depend on what you're, what you're actually cooking with it, too. When you heat coconut oil in a pan, and it melts, I haven't had experiences of it, like, scalding and burning, making a crust, and such, on the pan, like...

Darya Rose: Yeah, not on the pan. It's more like, the, the onions, or ginger, whatever.

Dr. Ashley Mason: Oh yeah.

Darya Rose: Will just cook f- faster than I, I don't know. I, I've, maybe I'm just not skilled at cooking [laughs] in cooking oil.

Dr. Ashley Mason: I [crosstalk 00:20:35] I don't have the foggiest, with that. I just know that, uh, when it comes to high-heat cooking, you're definitely gonna be better off using an olive oil, or, a monounsaturated fat, than you are a pily- polyunsaturated fat.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And, unfortunately, smoke point, and oxidation point, are not equivalent.

Darya Rose: And they're not even really, particularly correlated, is what I'm getting, because you can have a low oxidation [00:21:00] temperature, and, a high temperature smoke point, and that's when you get tricked.

Dr. Ashley Mason: Right, and that's why restaurants, they're out to serve you the most tasty food. Not necessarily the most healthy food.

Darya Rose: Right.

Dr. Ashley Mason: So, yeah.

Darya Rose: And I would say the TLDR is extra virgin olive oil is great for everything, as long as it's not over, what? Like, 450?

Dr. Ashley Mason: I think something like that.

Darya Rose: It's pretty high.

Dr. Ashley Mason: But you know what? I roast veggies above 450 in my oven to make that, that...

Darya Rose: With olive oil?

Dr. Ashley Mason: I think there's a cauliflower recipe that you and I both love...

Darya Rose: Yeah.

Dr. Ashley Mason: That you posted once... I think that's at, like, 500 and I use olive oil for that. So.

Darya Rose: Yeah, so do I. And, and it does, it's, it's, and even, it doesn't smoke, right?

Dr. Ashley Mason: No.

Darya Rose: So... Um.

Dr. Ashley Mason: I don't worry about that stuff. I think...

Darya Rose: Yeah.

Dr. Ashley Mason: It's more-

Darya Rose: If you want a neutral tasting oil, I think, avocado oil's probably the best choice.

Dr. Ashley Mason: Yes.

Darya Rose: I did some reading on peanut oil, which is one that chefs also like, and, an- 'cause it has a, an interesting flavor. It's not terrible. [crosstalk 00:21:53] It's not the best, but it's not the worst. And, it depends on how refined it is, but that's anoth- and I'll, I'll link to uh, uh, a very good article that I found about peanut oil, so, I, I feel like those are, those are good places to start. And then, like you said, butter.

Dr. Ashley Mason: Yeah.

Darya Rose: Lard [laughs].

Dr. Ashley Mason: Yeah, yeah for sure. [crosstalk 00:22:09].

Darya Rose: And, uh, coconut oil. Yeah.

Dr. Ashley Mason: I just think that the ones that perplex me, I think are, is it, I think, rice bran oil, is pretty polyunsaturated?

Darya Rose: Oh, all the grains and seeds.

Dr. Ashley Mason: Yeah.

Darya Rose: You were saying, yeah.

Dr. Ashley Mason: So that's why-

Darya Rose: So, soy, canola...

Dr. Ashley Mason: It's [00:22:00] just confusing to me, why...

Darya Rose: You wanna avoid.

Dr. Ashley Mason: Some of those are the defaults for, some of these-

Darya Rose: They're cheap.

Dr. Ashley Mason: Quote, unquote, "healthier deep frying," methods.

Darya Rose: Sometimes, people, I swear, they just think if it's not from an animal, it's good for you.

Dr. Ashley Mason: Oh, right.

Darya Rose: It's just not true. [laughs].

Dr. Ashley Mason: That's, that's, definitely a common thing.

Darya Rose: I'll share those links for everyone if you have any extra curiosity, but, that, we just wanna, I just wanted to correct the record on, on that, since I didn't quite get it right the first time.

Dr. Ashley Mason: Yeah, I, it's, it's confusing stuff. I, I, I wish that there was a definitive guide that we could go to, like one on Rhonda's website, [laughs] or something like that.

Darya Rose: Yeah.

Dr. Ashley Mason: That just said, "Cooking oils. Here you go." [laughs].

Darya Rose: She probably has one.

Dr. Ashley Mason: [laughs]. [crosstalk 00:22:58] Could check.

Darya Rose: All right. So, what [00:23:00] I really, really wanted to talk to you about is, so we got, we got onto these topics, and, now you are working on insomnia, depression, and anxiety...

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: And, so, again, our paths have crossed, 'cause, since having children, and I've talked about this on the show a little bit in the past, I've h- struggled with insomnia, more than I ever have in my life. And, after a lot of troubleshooting, I realized that it was largely being induced by anxiety and depression. And the only reason I know that, is because I was so desperate, I finally went on medication. I went on, um, Lexapro, for those curious.

And it, not only did it solve my sleeping problems, like, in a week, which was, oh no, probably two weeks, which was magnificent, [laughs] that first, like, t- week, where I was sleeping, I was just, like, "Ah, this is amazing." But, there are side effects, and, I don't want to be on a drug for my [00:24:00] entire life.

But I also noticed that I had less anxi- I, I, I, like, once it was gone, once the depression and anxiety were gone, I realized that they had been there for years.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: S- you know, since about six months after I had my second, and, you know, so I'm like, "Post-partum depression?" I'm guessing this is linked to that. And also just being a mom of two kids under [laughs] under a year and a half [laughs] is, uh...

Dr. Ashley Mason: During a pandemic.

Darya Rose: During a pandemic was pretty, and during a Trump presidency was pretty intense.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: So, I, and then, I think my nervous system just got, like, way, way activated. And it would, I would just wake up in the middle of the night, and not be able to go back to sleep. And I've made a ton of progress on it, but, like I said, I do want to get off these drug- this drug.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: Um, on the sooner side if possible. And, you know, as, you know, not everybody necessarily needs to have that goal, but, your research that you're working on, is so interesting.

We've talked about sleep before on the show, but we haven't really spoken specifically about insomnia.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: But, it is really interesting. It is [00:25:00] impacting a ton of people. I know that I'm not alone, 'cause that was my mo- was one of my most...

 ...affecting a ton of people. I know that I'm not alone because that was my- was one of my most- every time I talk about sleep on this show, it's, like, one of my most popular episodes.

And- and I- and I- and you can correct me if I'm wrong, but I'm getting the impression that most people that are, like, newly having insomnia and, since the pandemic, it's related to anxiety and depression. They're really hard to separate. So, it's so cool that you're studying all of them at once.

Let's talk about it. [laughs]

Dr. Ashley Mason: [laughs] Yeah.

Darya Rose: How did you get- how did you get here? I just said how I got here.

Dr. Ashley Mason: Oh, gosh. So, I got here through a few different converging pathways. First, let me normalize this. The American Academy of Sleep Medicine says that 30-percent of people are going to have a sleep problem at some point. That's a lot of people.

Darya Rose: Big number, yeah.

Dr. Ashley Mason: That's one in three people are going to not be happy about their sleep at some point. And yet, there's a lot of shame attached to having a sleeping problem. If you come into your work one day and you tell your boss, "Oh, sorry. I need to head out to a doctor's appointment to get this mole removed at the dermatologist because it might be [00:26:00] pre-cancer," your doctor- your- your- your boss is going to say, "Oh, of course. Go. Please, go do it."

It takes a lot of a different orientation to say to your boss, "Hey, I really need to leave early to get to this therapy appointment for my sleep problem that I'm having," or, "Oh, I- I need to come into work at a little bit of a different time because I'm trying to fix my sleep."

Darya Rose: Yeah. It almost sounds like a weakness or something.

Dr. Ashley Mason: Right. Like, these seems like big asks and reflective of "Oh, maybe I'm deficient somehow or I'm defective somehow."

Sleep is a pretty big issue and, when I got to UCSF, this wasn't something I was specifically focusing on at the time. I've been trained in how to do cognitive behavioral therapy for insomnia by the person who actually invented it, Dick Bootzin, at the University of Arizona. And he invented it in the seventies, but I was at the University of Arizona where I learned it from him. And it's a really fun treatment to do because it's really, really effective.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And a lot of [00:27:00] folks are finally coming out of the woodwork and saying, "Oh, I want to find this treatment. I read about this in Matt Walker's book," or "I heard that the..." Less often that the people hear that the American College of Physicians actually said, "Hey, you should be getting this treatment before you get prescribed a sleep medication." This is supposed to be the first line of treatment. But, the problem is that it's pretty hard to find. So hard.

Darya Rose: So, when I was-

Dr. Ashley Mason: It's so hard.

Darya Rose: [laughs] Yeah.

Dr. Ashley Mason: So, when I was at UCSF, I'm still not sure how all of this happened. But, one day, I ended up getting an email saying, "Hey, we heard you know how to do this and there's a- a grant deadline in six days. Could you just put something together to get- to get some money to start this clinical service in six days?"

And I was in Florida-

Darya Rose: [laughs] Seriously?

Dr. Ashley Mason: Yeah, I was in Florida at the time and visiting my- my late grandmother, and thought, "Okay. This is interesting. I'll give this a shot."

Darya Rose: Wow.

Dr. Ashley Mason: So, it was an internal- it was an internal grant, right? It wasn't a- but, ultimately, got some seed money to start this clinical service. [00:28:00] And, years later now, I have a sleep clinical service at the Osher Center for Integrative Medicine, where I treat patients with tough-to-treat insomnia.

And it's overwhelming how many referrals I get. I- I did not ever expect that this many patients would be seeking treatment for this and-

Darya Rose: Has it increased with the pandemic?

Dr. Ashley Mason: It's- I can't keep track. I- it's so- it's- I'm embarrassed. My waiting lists are embarrassing. I'm not- I'm- I- I- probably, if I were doing all my scheduling right now, I'd be booking early 2023 because they're- they're so long and I can only run so many groups because I'm trying to a bunch of other things too.

But I do love doing cognitive behavioral therapy for insomnia. So, that kind of emerged separately from my work on depression. But, what I will say about cognitive behavioral therapy for insomnia is that [00:29:00] it's really a treatment for anxious people who can't sleep. You can do this treatment with people who aren't anxious too, but 75-percent of the people who are seeking treatment for insomnia, at least with me, they're anxious and they can't sleep. And those things just are inextricably linked for them.

Darya Rose: And they- and they feed each other.

Dr. Ashley Mason: They do.

Darya Rose: Yeah.

Dr. Ashley Mason: So, this treatment focuses on five major components. There's, of course, the cognitive therapy to deal with the anxious thoughts. There's sleep hygiene, which everybody here is about all the time. It says, "I've done that. It doesn't work." It has to be done with these other things. Then, there's stimulus control, which I can explain what that is. Sleep restriction, which is not the same thing as sleep deprivation. It's different. And then relaxation techniques.

So, these five pieces form the intervention package together and they have to be given together to work together. Doing any of them on their own, you get less benefits. So, I can talk more about what that treatment is.

Darya Rose: [00:30:00] Let's.

Dr. Ashley Mason: So, let's start with the cognitive piece. So, the cognitive piece is changing dysfunctional thought patterns. So, seeing, for example, the real rewards of your medication use or- because for many people, they're using sleep medications and that- and they come to get treatment from me and they don't want to be using those medications because they make them feel hungover in the morning, they don't make them sleep very- they don't feel like the sleep is very restorative. They don't like the feeling of knowing that they're dependent on something. There's all kinds of reasons people want to quit drugs.

Darya Rose: Wanna hear mine? [laughs] First, before I was taking Lexapro, I would take Xanax as a way to sleep. And it worked for me. That works amazing. If I could take that every day and not worry about everything else I know about it, it would be fantastic. But I know that, one, it doesn't give me the best quality sleep, even though I feel amazing afterwards. And two, I have a [inaudible 00:31:00] [00:31:00] four, one copy of [inaudible 00:31:01] four, and I know that there are some linkage, correlation, at least, between benzodiazepine use and dementia, and that scares the living crap out of me.

So, the main reason I went to get help is I don't want to be taking Xanax more than twice a week. That scares me. And if it was up to me, I would take it four or five days a week. So, help [laughs], so yeah.

Dr. Ashley Mason: Right, and I- I don't know how many people have come to me saying that exact thing.

Darya Rose: Yeah.

Dr. Ashley Mason: I- I took the 23andMe test. I've got some of these genes. I've been taking Ativan, Lorazepam, Klonopin. Name your pin or your pam, or your, you know, your pam or your pin, or whatever. And I wanna quit it because now I know all of this stuff.

The first thing that you can't un-know when I tell you this is that taking those medications actually isn't producing sleep. It's actually producing sedation and those are not the same. We don't know if getting more sedation is associated with less [00:32:00] risk for Alzheimer's. We know that more sleep is associated with less risk for future dementia. so, not sure that those benzos are actually achieving the- the goal that you're actually taking them for.

Now, when it comes to the cognitive components, one of the things we- we work on is thoughts and feelings about medications. But, also, the kinds of catastrophizing thoughts, the "should-ing" all over ourselves. "I should do this, I should do that, she should do this, she should that." When you get into a lot of the cognition affecting sleep, it turns out some of them have to do with sleep. But, a lot of them have to do with other stuff that's going on. And learning how to manage anxiety and dysfunctional thoughts about things happening at your work, in your family, with your friends, in your life circumstance, we do things called thought records. And I'll give you a link to a couple great books that you can put in the show notes for this for folks.

Darya Rose: Oh, great.

Dr. Ashley Mason: But, we work with thoughts by having people identify their feelings, rate their [00:33:00] feelings, then identify the thought they were thinking before they had those feelings. So, I'm feeling sad. What was I just thinking about? I was thinking, "Ugh, gosh. I'm sad. Why am I sad? Oh, I was thinking because if I don't get enough sleep tonight, I'm gonna just really let some people down tomorrow and that makes me sad."

And then we work with this thought: "If I don't get enough sleep tonight, I'm gonna let people down tomorrow." What evidence do we have that that's true? Well, maybe in the past, you've not slept well and you've dropped the ball before. Maybe it's happened before.

And then we have to look at evidence that it's not true. We don't actually know if you're going to sleep well or not tonight. We can't predict the future. We don't have a genie ball. Also, have there been times that you've slept poorly and then performed fine the next day? Got your kids to school, got your work done that you needed to get done, cooked meals, whatever you needed to do? Yes.

And then we develop a more balanced thought, which is along the lines of, "Although I may not get great sleep tonight, when this has happened before, I've been just fine the next day."

Darya Rose: You'll live.

Dr. Ashley Mason: You'll live. But, we're [00:34:00] developing these- what's key is that when we develop balanced thoughts, they're not just Pollyanna versions of the negative thought. "Oh, that's not gonna happen." Because it's like the Bob Newhart skit.

Darya Rose: You can't lie to yourself.

Dr. Ashley Mason: You can't lie to yourself. It's kind of like the Bob Newhart skit, you know, when- where he plays the psychiatrist and the- the patient comes in and I think this was on SNL. And the patient says, "I've got this problem. I've got this problem." And Bob Newhart just says, "Oh, no, no. I have your solution. Just sit down and I'll tell it to you. It's two words." And she gets out the notebook to take her notes and she says- he says, "No, you don't need a notebook. Most people can remember this." And she says, "Oh, okay. What is it?" He says, "Stop it!"

Darya Rose: [laughs]

Dr. Ashley Mason: And what we know is that telling people "Just stop it. Just think the opposite way!" That doesn't work. So, instead, we have to take that distressing thought and make it more realistic. It's not gonna be the happiest thought, but it's gonna be more realistic. And chances are, if it was unrealistic in the wrong direction, making a more realistic thought is going to make a thought that's less distressing.

So, we work with tools like that. We also do things like scheduled worry time. I'm a huge fan of this. If you [00:35:00] find-

Darya Rose: [laughs] It's a great idea.

Dr. Ashley Mason: -you are worrying all the time, this is along the lines of the smoking intervention that I talked about that I did with that guy. I never would say, "Just don't smoke at all." Just like someone who's a compulsive worrier, I would not say, "Hey, give that up." I would say, "Hey, this is important." And so, it's so important that we are going to get out your calendar and we're going to schedule your worrying for the next week. And during those times, you are going to sit down and, by golly, you're gonna get worried.

Darya Rose: [laughs] Worry your face off.

Dr. Ashley Mason: You are. And if you find that, at other times of the day, you're thinking of things that are worrying, jot them down so that you remember them, so that you can worry about them later because we don't wanna forget those things to worry about. So, we're consolidating this worry time.

And during that worry time, I'm having people use these different types of cognitive tools to actually worry effectively.

Darya Rose: Yeah.

Dr. Ashley Mason: And it's amazing what you can learn by writing some stuff down on paper. Doing this in your head doesn't work. You have to write it down, or your brain's gonna outsmart you and trick you.

Darya Rose: Right. Otherwise, it'll keep you still in the loop.

Dr. Ashley Mason: Exactly. So, I'll- I'll give you some links to some books with some great-some great tools that folks [00:36:00] might be interested in. And-

Darya Rose: I found that that did really- I did do that. I would just- even if it was in the middle of the night sometimes and a thing would come up, I would just rehash the same thing over and over again. And it was something- if I would- I would just get up and write it down, then I could stop.

Dr. Ashley Mason: Mm-hmm [affirmative], yeah. For some people, just dumping their to do list on a piece of paper before they go to bed is so magical because they're not trying to circle and remember everything in their head before they fall asleep. So, I have plenty of patients who I've had do that. Other folks, they use these thought records whenever these troublesome thoughts come up. They do some cognitive corrections. They adopt the new thought. I've had patients who make binders out of these thought records that they can refer back to them when they have that thought from before and think, "Oh, I think I developed a more true thought. Let me go and find what that was," to insert it in its place.

And then another really powerful cognitive tool that I tell folks to try, if they find they've got a thought that is really upsetting at two in the morning, but it's really not upsetting at two in the afternoon. For example, you- I don't have kids, so I don't have [00:37:00] the example of that. But, let's say you wake up in the middle of the night at 2 AM and you think, "My dog- my dog is not well. I just- I think something's wrong with my dog. I'm really upset about this. I love my dog. Gosh, and I can't sleep because I'm thinking about what I should be doing. Should I get him different supplements? Should I go to different vet? What should I do?" You know, spinning around about your dog at two in the morning. But then the next day, at two in the afternoon, you're out in the park with the dog who's thrilled, playing catch with him. He's fine, right? Running around. You're not worried about it at all. That's interesting.

So, what I have patients do is I have them track their degree of belief in a thought. I give them a piece of paper with the 12 times of the day written down and they write the thought at the top. And then they set an alarm on their phone to go off every two-ish hours or something during the daylight hours. We're not having people wake up in the middle of the night to report on this. And having them rate how much they believe that thought. Zero percent, 20-percent, 80-percent, 100-percent, whatever.

And, at the end of this period, people will often see, [00:38:00] "Oh, I'm pretty sure of that at two in the morning. But I definitely don't believe that anymore at two in the afternoon every day." So, once you see that your belief in a thought varies that much, how true can the thought be, right? And it de-clause your thoughts. You can start to realize, "Oh, you know what? I'm worried about this because it's 2 AM and that's when I worry about this."

Darya Rose: [inaudible 00:38:23] mode.

Dr. Ashley Mason: And once you realize that, you can't un-know that. It's like Santa Claus, right? So, we do a lot of these kinds of tools in the cognitive components of working with anxiety around sleep. So, that's just a tasting platter-

Darya Rose: Yeah, that's super interesting.

Dr. Ashley Mason: -of what we might do.

Darya Rose: Wanna hear how crazy my brain is?

Dr. Ashley Mason: Yeah. [laughs]

Darya Rose: [laughs] So, I was- I was- for awhile, I was definitely worrying. One of the things I worry about, like, a lot was childcare. I would just be like, "This is not happening the way that I want. Like, how do I talk to this person about that? That's- without upsetting her. Blah, blah, blah."

But then, eventually, I, like, wrote it all. I started writing it down and they would get out of my head. Then, my brain would just get on a song and it would [00:39:00] just stick to a song. Like, stupid songs, like, from "Frozen" or- or whatever. And I- I don't like that music. But I would just- or, like, some, like, hip hop song from 1992. Like, Salt-n-Pepa. Like, and my- my brain would just sing the damn song over and over again. I'm like, "You really just wanna attach to something." Crazy. Just let it go. Let it go. Don't hold it back anymore.

Dr. Ashley Mason: [laughs] As the song would say.

Darya Rose: Anyway, I just- as the song would say, you know? I just realized, I was like, "Oh, my brain just wants something to hold onto." Like, it doesn't- like, it will find something worrying if there is something worrying. But, also, it just doesn't wanna relax.

Dr. Ashley Mason: Yeah. I- it's funny. I've only had a couple patients present with a presenting problem of "I can't sleep because I'm playing music in my head." I've actually had two patients, they say that's their primary sleep problem. They just hear music when it's not playing. Fascinating. Don't totally know what to do with that.

But what you just described is interesting because what it's suggesting is that your brain is busy grasping.

Darya Rose: Right.

Dr. Ashley Mason: [00:40:00] And that's exactly the time that you should go cash in with Kevin and say, "Kevin, I need my 30 minutes of meditation now. Not when it was scheduled. Now."

Darya Rose: [laughs] Yeah.

Dr. Ashley Mason: And that's the time to go sit and notice, "Wow, my brain really wants to- wants to be busy."

Darya Rose: Yeah.

Dr. Ashley Mason: "Why doesn't it want to be here right now? Is there something uncomfortable going on in my body? Is there something- is there an uncomfortable emotion that is trying to come up?" Right? And really, really pay attention and figure out "What do I want right now?" I think is really important because otherwise we'll just grasp onto the easiest thing, which might be the "Frozen" song we just heard five minutes ago in the living room, right?

Of those five motives, we just talked about the cognitive pieces. And, again, there's many. That was just a sampling menu. Then, the sleep hygiene, which is the more typical stuff people will get in the form of a handout at their doctor's office that will say things like "Don't drink too much nitro, cold brew, caffeine-crazy coffee in the evening after dinner," right? That- that- [00:41:00] some of the stuff that you might expect.

Have a cool room. At- things like eye mask and ear plugs are good. Cotton bedding. I can't emphasize this enough. If I had a nickel for every time I took away a down comforter or even a cotton comforter for a woman between the ages of 40 and 60, and their sleep got better, I'd have $5 bucks. Okay? It's incredible. Even people who tell me, "Oh no, my temperature's fine at night." I say, "Fine. Get some cotton blankets, let's see." And then, all of a sudden, folks will say, "You know what? I'm waking up less." I say, "Oh, I wonder why?" You were probably waking up because you were- your temperature was dysregulated, even though you didn't necessarily know it, because your body temperature's actually supposed to be the coolest in its 24-hour cycle, two to three hours before you wake up in the morning. So, you're supposed to be cooling down and those down comforters were designed to trap heat magnificently, right?

Darya Rose: Right.

Dr. Ashley Mason: So, things like that go into the sleep hygiene bucket. Also, caffeine. And then people will give me- there's a whole song and dance out there. People will talk a lot about, "Well, oh, I can take caffeine in the evening. It doesn't help- it doesn't make it harder for me to fall [00:42:00] asleep."

Darya Rose: Bullshit.

Dr. Ashley Mason: And sure, that's fine. Maybe that's true. Maybe you're a fast metabolizer, or we can get into the weeds about the genotype that you might have and all of that. But, more high level, what we can look at it is when you use caffeine close to bedtime, we know that the half life of caffeine can be quite a while. There's gonna be some left in your system and it's gonna disrupt your deep sleep.

Darya Rose: Right.

Dr. Ashley Mason: So, even if you can fall asleep, it's gonna mess with the architecture of your sleep.

Darya Rose: Right.

Dr. Ashley Mason: So, I tell people, "Really try to be done with caffeine in the morning. Just really try for that and try not to do anything too crazy." When people come to me, they're always afraid I'm gonna take away their coffee. I say, "Don't worry. You can have the same exact amount. You just need to move it two hours earlier." So, that's really important.

And then the incident stimulants, ugh, I'll never forget. I made this awful mistake with a patient [inaudible 00:42:47]. She was telling me she had chocolate for dessert every night, a square of chocolate, and I said, "That's fine. Chocolate, a square of chocolate. It's your thing. Great." Three weeks later, I found out that it had ground up espresso beans in it.

Darya Rose: Oh my gosh.

Dr. Ashley Mason: And I was just like, "Oh, how did I [00:43:00] not ask if there was anything in the chocolate?" So, now I'm very careful about that whenever I'm doing intakes with folks. "Is anything in that chocolate?"

Darya Rose: Wow. You know what's so crazy is- I- first of all, I used to be one of those people who said, "Oh, I can drink." Well, I could. I could drink coffee after dinner, like, they do in Europe, and I could fall asleep. But, yeah, it was not good. And now I'm so sensitive that I can do either decaf in the morning at, like, you know, before 8 AM. Or a half a cup of real coffee, and I'm talking, like, a normal cup at, like, [inaudible 00:43:29] coffee, 23 grams of beans. I can do 13. That's it.

And- but, even if I- if I have a square of chocolate after 2 PM-

Dr. Ashley Mason: Wow, wow.

Darya Rose: -I notice. Just from plain, just straight chocolate without espresso beans in it because there's caffeine in there.

Dr. Ashley Mason: Different levels- different chocolate's gonna have different levels of caffeine.

Darya Rose: It's so crazy.

Dr. Ashley Mason: There's- it is crazy. There's a chocolate bar I'm trying to remember. It's at Whole Foods. I'm sure the name of it will come to me. But there's one kind that I know, it's, like, an [00:44:00] 88-percent super dark- oh, Endangered Species chocolate.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: That one will keep me awake, hands down, just definitely.

Darya Rose: Wow.

Dr. Ashley Mason: But then a Dick Taylor chocolate bar, not at all. Not at all.

Darya Rose: They're good.

Dr. Ashley Mason: I know. They are so good. But I think- I think there's big differences in the caffeine content of chocolate and I tell people, "Really-"

Darya Rose: Time for breakfast, guys.

Dr. Ashley Mason: That's what I tell people. I say, "Look, I'm telling you that what you wanted to hear as a child. Have your chocolate after breakfast. Have it as your morning snack. Really enjoy it then." Um, because, yeah, it can be part of your health style. It just doesn't need to be 9 PM at night.

Darya Rose: No, I do that. Like, I- that'll- I seriously do that. I'll sometimes have a piece of chocolate after breakfast just because I know that if I really wanna try it, this is the only time I can and still sleep at night.

Dr. Ashley Mason: Yep, 100-percent. So, other things in the sleep hygiene world, I don't have them. Here I am looking around for them. But I'll tell folks wear the orange glasses if you're going to do lots of screen stuff at night. And by orange glasses, I mean those blue blocking [00:45:00] glasses. People always ask me, "What kind? What brands?" But these- the brands and the kinds change so much that I tell people, "Just look for the really ugliest ones with orange lenses." The beautiful ones with clear lenses, I don't know. Orange lesses is always what I tell folks to look out for.

And then, um, something that isn't super obvious to a lot of folks, especially if they're eating a lot of fruits and veggies and foods with lots of water in them, is to try and limit water and fluid intake close to bedtime. Because the fewer times you wake up to pee, the fewer changes you have to wake up and be unable to fall back asleep. And what I find is people will often think, "Oh my gosh, I didn't hydrate enough during the day. I need to drink all this water," right before they go to bed because they're trying to make up for a whole day or something. And that's just a recipe for, ugh, not a good idea. So, I really try and get people to move their fluid intake to the morning, and then try and eat dinner as early as they're willing to.

Darya Rose: Yeah, that is a huge difference.

Dr. Ashley Mason: Huge.

Darya Rose: If I go out at night and I- [00:46:00] normally I eat dinner at 7:00, like clockwork every night, as soon as my kids go to bed, but if I go out and we don't get a reservation til 8:30, we sit down, we eat at 9, 9:30, it's a nightmare. It's a nightmare. And- and God forbid I eat something heavy.

Dr. Ashley Mason: Yeah.

Darya Rose: I mean, it's, like-

Dr. Ashley Mason: And it's a restaurant where you're supposed to go eat something a little bit indulgent.

Darya Rose: Right, right. Oh God, it's so bad.

Dr. Ashley Mason: It's- it's tough. So, sleep hygiene- it's easier printed on a handout sometimes than actually done. But it is a big part of this treatment. It's one of those five big pieces.

And then comes stimulus control, which is a fancy sounding term, but it's actually very simple. The instruction is simply the following: only do sleep and sex in bed. Nothing in bed, unless it's sleep or sex. What does that mean? No checking your phone. No listening to podcasts. No watching TV. No fighting with your spouse. No wondering where your kids are gonna go to preschool or kindergarten or grade school or high school or college because, here in the Bay area, it seems like [00:47:00] everything's an application, right?

So, no worrying about all that stuff in bed. If you're gonna be worried, if you wanna have those emotional conversations, whatever, you have to get out of bed? Why? We really wanna associate your bed with sleeping. We don't wanna associate it with all those other things. And one question I always ask people is, "Hey, do you sleep better on vacation? Or when you're traveling for work?" People often will say, "Oh yeah, I sleep great in hotels." Guess what? You don't have any associations between that hotel bed and not sleeping. You do with your bed at home.

Darya Rose: That's interesting.

Dr. Ashley Mason: So-

Darya Rose: I love my bed so much. I hate sleeping in hotel beds.

Dr. Ashley Mason: That's good. That's a good thing. But, a lot of people can figure out very quickly if they have negative associations with their bed by answering the question of "Do you sleep better everywhere but your bed?"

Darya Rose: Yeah. You know, it's funny, the reason I love my bed so much is because of my Eight Sleep because I get hot in every other bed and my bed is perfectly calibrated to my body temperature.

Dr. Ashley Mason: Those things are very interesting. I- I confess, I've never tried one. I have never tried any of, um, any of those things, but I- I do know that when I've slept on beds that aren't mine [00:48:00] and I think- I don't know some of the brands, but there are some brands of mattress that are just hot.

Darya Rose: Yeah, the memory foam ones.

Dr. Ashley Mason: It just kills your sleep quality. I- I don't have one of those. I have a- I think, I'm trying to remember the name of it. Oh, Purple Mattresses is what we have, and they're perfectly cool and wonderful. And when I go somewhere else to sleep and it's a hot mattress, it's just awful. But I have yet to try these kind of cooling and heating mattress toppers. I do get antsy when patients come in and say, "Oh, I- I like to really turn my mattress setting up to really hot." And that's concerning because nighttime is supposed to be a time when you actually get cool. And then patients will say, "But then I have it set so that it gets really cold." And then my slight concern is, well, the way that your body temperature works at night, is that your skin- your skin temperature, all that actually gets quite warm while your center, while your core body temperature cools. Right? Your body is cooling itself by [00:49:00] having- having more of the blood circulate to your extremities and you're releasing more heat.

So, if you're then turning- trying to make your outer body feel extra cold with a machine, I don't know what that's necessarily going to do to your core body temperature body process. But, I think we're at the very beginning of science of mattress toppers.

Darya Rose: [laughs]

Dr. Ashley Mason: But those people- there are people like you who swear by them and I'm- and- and have really piqued my curiosity so I- I have a feeling I'll be trying one in the near future.

Darya Rose: Yeah. You know what's funny is you're right. I- well, I change mine in the summer and winter, and in the summer? No, in the winter, I do start noticing it will be too cold and that wakes me up, like, just as bad as too hot. So, it does have to be- I'm like minus one. And then in the summer, I'm like minus two degrees. And that just slight difference is so epic for me. But- but, yeah, more than that, less than that, doesn't work at all.

Dr. Ashley Mason: Yeah, really figuring out what works [00:50:00] for you is super, super key when it comes to bedding. The right pillow...

 ... for you is super, super key when it comes to betting. The right pillow, the wrong pillow, the right pajamas, all these things can make-

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: ... big differences for people. And folks will constantly ask me for my recommendations and for brands and I just, I just don't really have great ones, especially for when it comes to cotton blankets, it's your favorite cotton blanket. Every, every brand is making their own cotton blanket, as long as it's a blanket and not a woven quilt or a woven comforter type thing. If the word comforter in it, no, word duvet is in it, no, word quilt is in it, no. So that's how I tell people what to do in those terms. But when it comes, let's go, circle back to stimulus control, only sleeping and having sex in your bed and that's it it's helping people re-associate their bed with sleep. By the time folks will get to me for treatment sometimes they will have moved their whole lives into bed.

I'll ask them for what their routines are and they'll say, "Oh, okay. So I, I get in bed with my laptop and I do my emails. And then I go get my coffee. And I have this little table topper in my bed that I put my coffee on. And [00:51:00] then I do my conferences and then I'll have a snack." There are people who live in their beds and a lot of folks will live in their beds because that way their, their thought pattern is, oh, I'm already here in case I get sleepy I ca- so there's this fear of not being in the bed when they might actually be able to sleep 'cause they're so eager to get that sleep.

So in effect, they're trying to solve their problem in a way that's really, really backfiring. So stimulus control and people say, "Oh, does that mean then in the middle of the night, if I wake up, I have to get outta bed?" Yes it does. And that's why I tell everybody in my clinic, "Hey, guess what? You can get a dark board. Let me give you a picture of my face you can put it in the middle if you want. But you're [laughs] gonna hear my voice telling you, if you cannot sleep, get out of bed, go do something else that is fun or pleasant for 20 minutes." People will not wanna get out of bed 'cause then they're gonna go and do chores.

And I say, no, no, no, you have to get out of bed and go do something that you would get in trouble for doing at work, like [laughs] reading trashy magazine, like whatever the thing is, go do that. And then once you're sleepy again, then you can go back to your bed. And people don't like doing this, so we take all kinds of steps to try [00:52:00] and make it as, as like not uncomfortable as possible. For example, if I took away their duvet, they're gonna go put it on their couch, they can use it in the middle of the night when they're awake, then go back to bed. [laughs] These kinds of things. So that is what stimulus control is. People don't like it, but it starts to work really fast when people actually do it.

Darya Rose: Interesting.

Dr. Ashley Mason: Yeah.

Darya Rose: I love how so many of your interventions are permission based. Giving people permission to do what they like-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... and how that alone just-

Dr. Ashley Mason: It's huge.

Darya Rose: ... takes off so much of the anxiety.

Dr. Ashley Mason: Telling people they can do what they like as long as they pay attention. That's really the mantra. Because it turns out telling people not to do things just doesn't not work.

Darya Rose: [laughs] Does not work. Doesn't work on my kids, it doesn't work on my husband, doesn't work on my dog, [laughing] doesn't work on myself. [laughing] It doesn't work on anyone.

Dr. Ashley Mason: No, it really doesn't. But this, this is one of those unfortunate situations where I tell people you have to get outta bed and no, you can't stay in bed. But what I really tell folks is, hey, look, you're in an [00:53:00] intense treatment with me for five weeks. You've been sleeping poorly for 50 something weeks or 500 something weeks or however long some people can say, "Oh, I've been sleeping bad for decades." I'm like, "So what's five more weeks? How much worse can it get? If you don't try this full stop, you're never gonna know if it works." So [crosstalk 00:53:15] right, I'm like, "Just give me five weeks to show you what we can do with your sleep. You won't regret it." And people, people don't regret it. So then let's get to the other two things. Actually though, before I get to sleep restriction and relaxation techniques, I wanna double back over to sleep hygiene with alcohol really quick.

Darya Rose: Hmm.

Dr. Ashley Mason: 'Cause this is one I get a lot too. Um-

Darya Rose: Especially during the pandemic, I'm sure. [laughs].

Dr. Ashley Mason: You hit the nail on the head. Especially during the pandemic. So alcohol, people will feel that alcohol helps them fall asleep faster, but much like benzodiazepines what alcohol does is it puts you into a state of sedation faster. You're not actually sleeping, you are sedated. But your subjective of, experience of it is that you're sleeping. But what alcohol really does is it [00:54:00] makes you wake up early. Remember that experience that where you wake up too early and that cuts short your REM sleep because we get more deep sleep at the beginning of the night and more REM sleep at the end of the night.

Darya Rose: It makes me hot. I wake up hot and yeah, and then it's demolishes my REM sleep.

Dr. Ashley Mason: Yeah.

Darya Rose: It's insane.

Dr. Ashley Mason: Exactly. And plenties of ways to know this, we know from the literature, I don't know, you can try with some of the sleep trackers now I know that we both use the aura ring and full disclosure, I, I advise the company too, but you, you can see I've done some experiments with this with myself even and it's, it is dramatic. So-

Darya Rose: Yeah.

Dr. Ashley Mason: ... not only do I see this in the literature, I see it in myself and because I'm in the bay area and we live near some of arguably the best wine places.

Darya Rose: It's so goddamn hard. [laughs].

Dr. Ashley Mason: It's so hard for folks.

Darya Rose: And those red California wines are the worst. [laughs]. Like those ones more than any other will destroy my sleep. Like I can drink a couple [00:55:00] glass of champagne, like, I'll still have a good night's sleep ish, but two glasses of Cabernet from Rutherford or somewhere in the Napa Valley, like St. Helena and I'm, I am just done, tomorrow's over. [laughs]. Like-

Dr. Ashley Mason: What's been really interesting is I've had patients who work at wineries at this point now, because now that I do all my treatment virtually, I have patients from many, many hours away who are able to come and get treatment. And they'll say, "You know, I've been drinking two glasses of wine a night for years, and it's never had a problem for my sleep. And now I have a sleep problem. So why do I need to change my alcohol use during treatment?" And so I give people a really hard sell. I say, "Look, if you're a person who's been drinking every night, I want you to cut it down to two ounces of wine at night. All right. And after you've drank those two ounces, guess what? I want you to put some really overpriced, bubbly water or other nonsense right into that wine glass. You're still drinking out of the wine glass for just as long as you normally would be."

Darya Rose: That's smart.

Dr. Ashley Mason: "But you're drinking [00:56:00] something else." And you know-

Darya Rose: Like this trick Ashley.

Dr. Ashley Mason: Yeah. [laughs] But folks fall at me a lot. I get a lot of, I mean, I even recently-

Darya Rose: 'Cause I wanna keep drinking, that's a big part. I just want to keep drinking something. It doesn't need to be something that makes me feel like shit.

Dr. Ashley Mason: Exactly, exactly. So I tell folks, get some really delicious overpriced, special bubbly water or something and keep that for only after don't drink that during the day. Right? That's the special drink that you get when you're done with your wine and it goes into your wine glass. And I, I tell, I I'm like, you need to use a Pyrex measuring cup to measure these two ounces people, this is not an estimate this is not what you think might be two ounces. For all the examples that I'm giving, I have permission from these patients to share their stories, but I've had physicians in my clinic or the patients and they even will say, "No, I'm, I'm not gonna quit my, my two glasses of wine." And I say, "Well, you know, give me five weeks." Can you do five wee- you can do anything for five weeks. [crosstalk 00:56:56].

Darya Rose: Yeah.

Dr. Ashley Mason: And so it's, it's incredible once folks [00:57:00] remove the alcohol they'll sometimes they'll notice that it takes them a little longer to get to sleep. But actually it's really because they're skipping the sedation part and they're going straight to sleep now without the sedation part.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And they'll notice that their sleep improves dramatically. And then, you know what I do, I say, "Guess what? You're gonna drink again. I'm, we're gonna schedule it, you're gonna have a night out. Let's see how that goes.".

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And once you go from a period of not drinking every night to then having drinks, you get to see what the true cost of drinking is.

Darya Rose: Yeah.

Dr. Ashley Mason: And then you get to decide if it, if it's worth it. And then we come back to our mantra, which is, it's not really worth it to drink Two Buck Chuck every night. It's just not worth it. But you know what? Those two glasses of Silver Oak at that dinner at some at Bartartine or some fancy restaurant or whatever that might be worth it.

Darya Rose: Right.

Dr. Ashley Mason: So figuring out when it's worth it and when it's not. But the only way to know that and to know the true cost of what you're buying is for me to get a period with patients where they're not drinking that much every night. And I cap it at [00:58:00] two ounces of alcohol or two ounces of beer, or I really try not to let them have spirits because that's, it's more. So that's-

Darya Rose: Oh, two ounces of spirits, you mean that because it's-

Dr. Ashley Mason: Right. You can't do that. That's like, that's way more. [laughs]. So-

Darya Rose: I think that's a martini. [laughs].

Dr. Ashley Mason: Right. Exactly. That's enough. So in sleep hygiene, that's a major part of what I do with folks here. And I can't even begin to tell you, I get emails from patients years later saying, "Hey, I'm still doing this. It still works. I've actually lost 10 pounds now 'cause I'm drinking less IPA every day." and all these other good health benefits that happen from that happen from-

Darya Rose: Yeah.

Dr. Ashley Mason: ... that come with drinking less. And yet they're still able to go out and really deeply enjoy it when they do.

Darya Rose: Right.

Dr. Ashley Mason: Right.

Darya Rose: Amazing.

Dr. Ashley Mason: Yeah. Okay. That's sleep hygiene. [laughs]. Now we can move to sleep restriction, which is one of the scariest things. When people hear this, they think "What? I'm not here to restrict my sleep. I am here to increase my sleep lady." And [laughs] so what sleep restriction is, is it's [00:59:00] actually just restricting the amount of time that you're in bed to match how much sleep you're actually producing. So I have people do, what's called a sleep diary for a week and you'll have the link to a book with one of these, uh, for the note.

Darya Rose: Okay.

Dr. Ashley Mason: And I have them do this for a week. And then they calculate how much sleep on average per night are they actually sleeping? Let's say they're actually sleeping seven hours a night. And they're they, they are going to wake up at the same time every day, which is a major component of how we do this treatment. We ha- we set awake time and you get up at the same time every day. And that's actually more important than going to bed at the same time every night. The first thing that we do is we say, look, wake time every day. I don't care what time you go to bed, go to bed whatever time you want but you're waking up at the same time every day with an alarm and getting outta bed right at that time.

And so we take that time, let's say that time for this person is 7:00 AM. And this person's body is producing, actually let's, let's make it worse. Let's make it more representative of a patient of mine. So let's say someone on average is getting six hours of [01:00:00] sleep and we set their big wake time to be 7:00 AM. What we'll then do is we'll figure out what their bedtime should be based on the fact that they're sleeping six hours a night. So we go backwards from 7:00 AM to 1:00 AM. And then I add half an hour of grace because I'm nice and also [laughs] this is, this is, what's done in a lot of CBTI administrations.

Darya Rose: Let's just stick with you're nice.

Dr. Ashley Mason: Yeah, I'm nice. So this person's bedtime would be 12:30, but the catch is it's the bedtime of their childhood sleepover dreams. They cannot go to bed before 12:30. They can go to bed-

Darya Rose: I see why this is hard.

Dr. Ashley Mason: Anyt- yes, anytime after 12:30 they can go to bed and they have to wake up and get up at 7:00 AM. Now, after a week of this, their sleep efficiency is generally much improved. What a sleep efficiency? Sleep efficiency is the amount of time that you are asleep, divided by the total amount of time that you're in bed. So you want that to be super high right? 'Cause you wanna be sleeping at least 85% of the time that you're in the bed.

Darya Rose: I feel like [01:01:00] you're peering into my soul and it's scary.

Dr. Ashley Mason: [laughs] Mm-hmm [affirmative]. Uh, yeah, that's what the, people say that sometimes. So after a week, folks will come back and we will compute their sleep efficiency. If their sleep efficiency is above 85% then they get a present, they get 15 more minutes in bed. They get to go to bed-

Darya Rose: 15?

Dr. Ashley Mason: 15. But think, but hear me out, they get to go to bed at 12:15 instead of 12:30. But guess what? If you do that for four weeks in a row, that's an extra hour in bed. Right? And you've been sleeping poorly for a long time, what's one month, right?

Darya Rose: Yeah.

Dr. Ashley Mason: So we're slowly extending this period of time in bed without extending the amount of time that people are awake at night. So what restricting the amount of time in bed does is it pitches out all those long nighttime awakenings mm. And causes people sleep to get much more consolidated.

Darya Rose: Hmm.

Dr. Ashley Mason: And if you pressed me, what are the two most effective ingredients in this treatment? They are sleep restriction and stimulus control hands down. Cannot, you cannot do this treatment without those. [01:02:00] You can do it with varying amounts of cognitive components, 'cause some people with insomnia don't have anxious anxiety issues. There are some of those people-

Darya Rose: They just sing music in their heads?

Dr. Ashley Mason: I, I, [laughs] they do all kinds of stuff, right? They're just different. And then there sleep hygiene there's different components of sleep hygiene. Some people need others more than others. So that's what sleep restriction really is. And I, I made it sound pretty simple there. There's a bunch of nuances when it comes to how we do this in practice, but that's the overall like, overall hammer of how we do it. And then there's the relaxation techniques, this part is short. So the major relaxation technique that's used in cognitive behavioral therapy for insomnia is something called progressive muscle relaxation.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And I can give you a link for the show notes too, for a good, uh, resource for this. But progressive muscle relaxation involves really tuning into your body, and for example, if I were doing this now I might start with my hands and I would squeeze my hands and then [01:03:00] let them go and squeeze them and let them go. And then I would move to my forearms, I would squeeze them and let them go and squeeze them and let them go. And it's this process of getting out of your head and into your body in a more active way than say a body scan where you're just noticing your hands, noticing your arms, noticing your shoulders. This is a more active process.

And what's always interesting to folks is that sometimes they'll get to their shoulders and they'll go to squeeze them and they'll have the realization, oh, they're already squeezed, [crosstalk 01:03:21]. And so this is a technique that I tell folks to use when they're feeling tense, when they're feeling anxious. I often will advise people to do this as part of their bedtime routine. So in that hour, before going to bed, trying to get a consistent routine is helpful. It's part of, part of sleep hygiene and integrating this into that is helpful.

Darya Rose: Yeah. I was gonna ask this sounds like something that would be good to do in bed or is it something you're allowed to do in bed?

Dr. Ashley Mason: Aha, good question. So I tell folks when you wake up in the middle of the night and you have the thought, oh, I think I can just fall back asleep and you start to notice yourself going into the thinking brain, you can do this activity in bed to help you fall back asleep, if it's brief. However, if you're lying [01:04:00] there for more than 20 minutes, it's time to get outta bed.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And if you have the thought, I think I'm gonna fall back asleep. I think I'm gonna fall back asleep, at least three times, you're probably not about to fall back asleep and it's time to get back out of bed. Because what we're trying to retrain your body is knowing when you're actually sleepy and able to fall asleep, versus when you're exhausted, fatigued and annoyed. Because exhausted, [laughs] fatigued and annoyed you're not gonna fall back asleep and that's different than sleepy.

Darya Rose: Yeah.

Dr. Ashley Mason: But for people with sleep problems, those things often get all bundled up into one and we need to separate them out.

Darya Rose: Yeah.

Dr. Ashley Mason: So this was a very long winded explanation of the, the skeleton of this treatment. [laughs].

Darya Rose: Yeah. One of the things that I've used, haven't been doing your full thing I should say upfront, but, um, one of the things I've used too that is 'cause when I, when I decided I didn't wanna use Xanax, I would do yoga nidra which is similar to that. Is I would, and I did it in bed I won't lie. But I'd put in my headphones and I would, it's basically the same type of thing, it's like some deep breathing and then some body [01:05:00] relaxation stuff, 95% of the time I'll fall back asleep.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: And I can even know it's over, take my headphones out, put 'em away and still fall back asleep, like it doesn't wake me back up 'cause I'm so-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... relaxed. So I, but I would love your, your protocol for that. 'Cause the yo- the yoga nidra is like long. It's like almost 40 minutes.

Dr. Ashley Mason: The great thing about progressive muscle relaxation is that you can do a guided version. There's-

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: ... umpteen versions on YouTube and at university college counseling websites, et cetera. But you can also do it in your head 'cause you can start to decide which body parts are the easiest for you to scan through. And if you just start from your feet all the way up, it's hard to skip anything. [laughs]. So it's, it's, it's one of those nice ones that doesn't really require much for equipment and folks like it. So-

Darya Rose: Amazing.

Dr. Ashley Mason: ... that's that's cognitive behavioral therapy for insomnia in a nutshell. And there's a great book and there are, there is a website that I can give you too where folks can go and find providers in their state who actually [01:06:00] are, are part of groups that know how to do this treatment.

Darya Rose: Yeah.

Dr. Ashley Mason: So you can know, go find a provider who knows how to do this. And there's there's I, I do this in groups because I, if I saw patients individually and did this, I would see far few were patients. So I see eight patients at a time-

Darya Rose: Yeah.

Dr. Ashley Mason: ... in groups to do it. And it totally works that way too. So don't be shy if you find a group, just know it can be just as effective as individual treatment for this.

Darya Rose: Fantastic.

Dr. Ashley Mason: Yeah.

Darya Rose: So you've mentioned earlier that it was primarily anxiety and insomnia related. Is, is depression linked to insomnia as well?

Dr. Ashley Mason: Mm-hmm [affirmative]. Yeah. Great question. So my depression work actually is not clinical it's in the realm of my research. So I'm studying whole body hyperthermia as a non-pharmacologic treatment for depression. That's a really fancy way of saying I'm studying infrared saunas as a non-drug treatment for depression.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: An-

Darya Rose: Which is so interesting. So I hope you have another like two hours everyone. [laughing].

Dr. Ashley Mason: I'm it's, it's, [01:07:00] it's I'm so passionate about it, it is just so exciting. And right now we're actually running a trial, looking at a, at a combination of cognitive behavioral therapy for depression plus, sauna use for depression. And, and that's a package intervention right now for depression. So patients get CBT visits with a therapist and they also get the sauna session visits with, with the sauna staff essentially in the lab. So they're getting both of those things. But your question, let me back up is to depression and insomnia and yes, there's, there's a lot of research on this. There's there's chicken and egg argue to be made.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: For many people disruptions in sleep precede an onset of depression, for other people, an onset of depression can mean hypersomnia meaning way too much sleep. They're spending all their time in bed sleeping. And for other folks, it can lead to total insomnia and inability to sleep. And this just speaks to the diversity of presentations in depression, right? There's nine criteria for depression in the DSM and you [01:08:00] can have different combinations of those criteria and still meet criteria for depression. So your depression can look very different from someone else's depression.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: So it's, it's, it's tricky. But the, the short answer to your question? Yes. Can our sleep and depression related? Yes. What causes what? More complicated.

Darya Rose: I was curious is there, this might not be, there might not be data on this, but I'm just curious 'cause when I think about anxiety and depression they're different but similar and then sleep and I'm wondering if there's any hallmarks, is anxiety more can't fall asleep, can't wake up in the morning versus depression more like wake up in the middle of the night, like, or is, is there stages of sleep that are disrupted, like with alcohol and caffeine, how one more impacts deep sleep and one more impacts REM sleep? Or is it just like you there's so much variety in depression that you can't really lock in on anything like that?

Dr. Ashley Mason: There is, there's so much diversity, but there is a known effect in [01:09:00] depression of waking up too early and not being able to get back to sleep.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: That is gonna be common in depression. With anxiety, you're gonna have a lot of difficulty falling asleep in the first place and waking up in the middle of the night and having difficulty falling back asleep. With depression, we just do seem to see this more common effect of people just waking up way too early and not being able to get back to sleep. But again, huge individual variability there.

Darya Rose: That might be related to body temperature.

Dr. Ashley Mason: Yes. So it very much might. And that's what we're really looking at in the sauna work. So what happened to me was I was in the middle of doing all this eating behavior research, and I think you and I had been, we were emailing and you had come and given a talk at UCSF and there was just a bunch of things going on. And then this major paper came out in 2016 that totally captured my imagination. It was this paper where they recruited people with pretty severe depression and they assigned half of [01:10:00] them to get a pretty intense sauna session. And by intense, they were put into an infrared sauna tent, a medical hyperthermia device that heated them up to a core body temperature of 101.3 degrees. And by core body temperature, you better believe I meant rectal, okay, so-

Darya Rose: Oh yeah.

Dr. Ashley Mason: ... yeah. It's in there. And then, [laughing] and then half of the other half of the participants, they were only heated up to 99.5 degrees Fahrenheit.

Darya Rose: Which is still pretty warm.

Dr. Ashley Mason: Which is warm. Right. They were put in the same exact machine and the people who were sitting around the machine didn't know who was getting heated up to which temperature, et cetera.

Darya Rose: Okay.

Dr. Ashley Mason: So it, it was very, everything was blinded. In fact, 70 something percent of the participants who got the sham treatment, they thought they got the real deal treatment.

Darya Rose: Yeah. 'Cause it's hot, like that's hot.

Dr. Ashley Mason: 'Cause it was hot. But when you looked at the, between group differences in depression, they were striking. The group that got the, the treatment that heated them up to a 101.3 degrees had a [01:11:00] rapid and sustained reduction in depression symptoms that was noticeable within a week and then sticked like stuck around six weeks later. Now the-

Darya Rose: With severe depression?

Dr. Ashley Mason: This is pretty severe depression. And these people only got one sauna session.

Darya Rose: What paper is this? What's who, who wrote the-

Dr. Ashley Mason: This is the Jansen and Colleagues 2016. I'll give you a link for the notes. And the, they only followed the participants out through six weeks, then they let them go. And they only gave them one sauna session. And Chuck-

Darya Rose: That's insane.

Dr. Ashley Mason: I know, I know.

Darya Rose: One?

Dr. Ashley Mason: And Chuck, yeah, the senior author on the paper was actually one of my, uh, core mentors from my, my thesis and 'cause he, long story, but ultimately he was doing some other work involved in sauna and we were doing some other work, totally different area. But he, he was involved in this work and what he told me was that patients at the end of this treatment were coming back and saying, "Hey, this is the only thing that has ever worked for my depression. Can you just cook me one more time? Just in case it's gonna wear off. I don't know where else I can get this treatment." Like people were pretty desperate. And so [01:12:00] this trial totally picked my interest. And now I wanna back up and get a little bit more into the biology of what, what might be going on here. So you never, first of all, it's really hard to see effects this big in depression research.

Darya Rose: Yeah.

Dr. Ashley Mason: This is a pretty big effect for a pretty small study. I think there were 30 something people in it, 34 people in it.

Darya Rose: Wow. That's so intractable.

Dr. Ashley Mason: It is. It is. And, and it was such, such a rapid, rapid improvement. And when you take antidepressants, they take quite a while to start working. A lot of these other interventions take a lot of time. This was within days, these people were feeling completely different. I actually interviewed one of the participants like a, probably a year ago too 'cause I really wanted to understand. And she said, "Oh yeah, next day, totally different. Couldn't can't describe it." She did say that it, it wore off about in the order of a few months later after the follow up period ended and everything. So I wanna come back to that. But-

Darya Rose: Okay.

Dr. Ashley Mason: ... anyway, so why might this all be working? It turns out that at least a subset of people with depression tend to run hot. What does that mean? That means that their [01:13:00] body temperature, their core body temperature is just a little bit warmer than everyone else's. Why is that? They're not as good at thermo regulation, AKA, they're not very good at sweating.

Darya Rose: Hmm.

Dr. Ashley Mason: And some of these studies, these basic science studies from the 80's and the 90's have actually shown that people with depression have higher nocturnal body temperatures than people without depression. And what they have shown is that when the depression goes away, the body temperatures decrease.

Darya Rose: Hmm.

Dr. Ashley Mason: Which is fascinating. And-

Darya Rose: Fascinating.

Dr. Ashley Mason: ... what are we doing in the sauna? We are cooking people real hot. We're, we're getting them real hot. And we are turning on that sweating mechanism, we're forcing their body to turn it on their cooling system.

Darya Rose: Hmm.

Dr. Ashley Mason: And so that they have to be sweating and they have to be cooling themselves down. And the thought is we might be flipping a switch and consistent with this, that the person who I interviewed said, "Oh yeah, the next day I went to an exercise gathering like outside and I was sweating like a dog. I've never been able to sweat like that." And so it's, it's really interesting that that's my, what we might be doing. And in the other, there's [01:14:00] another trial that I wanna ra- mention to make this point. Uh, a 2013 trial I'll give you a, that link too. It was a single arm study where they had people go into the same exact hyperthermia device and they heated them to 101.3 and then in the days afterward they had them wear an indwelling rectal probe.

Darya Rose: Mm-hmm [affirmative]. Indwelling?

Dr. Ashley Mason: Indwelling.

Darya Rose: Should I ask?

Dr. Ashley Mason: Uh, no. [laughs]. And so that is not something I'm gonna try and get participants to do. So I found a work around and I, I'll say something about that in a minute. [laughs] But what they found in that study was that the reductions in core body temperature measured by that indwelling rectal probe correlated with the reductions in depression.

Darya Rose: Wow.

Dr. Ashley Mason: So the more people cooled off, the less depressed they got.

Darya Rose: Wow.

Dr. Ashley Mason: And, and they cooled off in the days after the sauna session markedly-

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: ... because it had turned on the sweating mechanism for them. So right now what we're trying to figure out, one of the things that we're trying to figure out is what's the optimal dosing. How, how, how many sauna sessions do people need? [01:15:00] How frequently do they need them? We, we don't even know some of-

 ... how frequently do they need them? We, we don't even know some of the most basic stuff about this treatment, but we really need to figure out is how many sessions do we need to do to get a sustained reduction in depression over what period of time.

Darya Rose: Yeah.

Dr. Ashley Mason: And also, one of the very fascinating things that happened in the 2016 study was Chuck was telling me that people just started getting chatty when they were in the sauna. They just started wanting to chat. And the research assistants would-

Darya Rose: Depressed people?

Dr. Ashley Mason: Yeah. The research assistants would come out and say, "What do we, what do we do? They wanna talk to us. Should, should we talk?" And, and-

Darya Rose: [laughs]

Dr. Ashley Mason: ... they weren't really sure what to do. But this got me thinking, wait, one of the major issues with depression is that people don't wanna talk.

Darya Rose: Right, yeah.

Dr. Ashley Mason: They're feeling depressed. So what if we were able to get people to a state where they're more interested in talking and then give them a therapy that we know works, like CBT, which is what's been used to compare in, in a lot of the drug studies with Lexapro and other SSRIs.

Darya Rose: Right.

Dr. Ashley Mason: They've compared CBT to the ... right? And they found that they're roughly equivalent in many, many studies. So if we [01:16:00] can just get patients to actually engage with CBT by getting their physiology into a different place, wouldn't that be great? So the National Institutes of Health is currently funding a study that I'm leading to test exactly that. And what's fun is that Rhonda's also, Rhonda Patrick's also a collaborator on that, and she is helping with the curation and assessment of biomarkers that we're studying too, because we're gonna study a bunch of those biomarkers that we would expect to see change in, with.

We know that exercise actually can be pretty helpful for people with depression. But getting people with depression to exercise is actually very difficult. Now, I know you love, you love exercise. That's just-

Darya Rose: Yeah, I know I'm weirdo. Yeah.

Dr. Ashley Mason: ... unfathomable to you. But there's a lot of folks-

Darya Rose: [laughs] Yeah.

Dr. Ashley Mason: ... who it's very, it's really hard for me to convince them with depression to go out on a run.

Darya Rose: Yeah, of course, yeah.

Dr. Ashley Mason: But it might be easier for me to convince them to go into a sauna.

Darya Rose: Yeah.

Dr. Ashley Mason: And then back to the indwelling [inaudible 01:16:50] question, I definitely am not having participants do that. We do that for during the sauna session.

Darya Rose: Hm.

Dr. Ashley Mason: But before and after the sauna session, we're having them wear the, the Oura Ring-

Darya Rose: Hm.

Dr. Ashley Mason: ... which does measure [01:17:00] ambulatory body temperature.

Darya Rose: Right.

Dr. Ashley Mason: So that, and, and participants aren't complaining about that one bit [laughs]. So that's been very easy. But the sauna studies are really, really focused on depression right now and are not, we're not specifically measuring much about sleep other than what we're capturing from the Oura Ring, so we are getting that. But we're not-

Darya Rose: Oh, yeah.

Dr. Ashley Mason: ... a whole slew of self-report measures about sleep, because you can only spam people with so many self-report measures in a study.

Darya Rose: Yeah, yeah.

Dr. Ashley Mason: And we're really focused on depression there. But we're very, very excited.

Darya Rose: That's so cool you will have the Oura Ring data though, even if-

Dr. Ashley Mason: Oh-

Darya Rose: ... it's not the best data in the world, it's still here, it's interesting.

Dr. Ashley Mason: It's, it's amazing. And it's, the temperature data from the Oura Ring are, it, uh, they're just, they're just incredible. Uh, during, when I was doing the first study ... So I have published one sauna study so far. We did a safety trial with 25 people showing that the device that we're actually using, we're using, in, in, in my studies, we're using an, a commercially available sauna. It's the-

Darya Rose: Hm.

Dr. Ashley Mason: ... [01:18:00] Clearlight, uh, Clearlight Sauna Dome. And anybody can buy it for about $2,000.

Darya Rose: Hm.

Dr. Ashley Mason: But that medical hypothermia device that was in the studies that I just described, that's like a $50,000, uh, medical device machine-

Darya Rose: Right.

Dr. Ashley Mason: ... made in Germany. And you can't just buy one. And you could burn yourself with it too. There's actual-

Darya Rose: Right.

Dr. Ashley Mason: ... bulbs there. Uh, it'd be pretty hard to hurt yourself with the one that we're using, I think. And so we're using this commercially available device and we already did a safety trial with it, and we've published that paper. And then right now, we're about to publish our second, from that trial, we're about to submit it. And we're gonna show that the Oura temperature data actually tracked pretty interestingly with the rectal probe data-

Darya Rose: Hm.

Dr. Ashley Mason: ... during, while you're in the sauna. So we had people wearing the rings in the sauna-

Darya Rose: Yeah.

Dr. Ashley Mason: ... which was kind of nuts. And it, it turns out that it does, it does pretty well under pressure in the, in the heat. And I-

Darya Rose: Wow.

Dr. Ashley Mason: ... wouldn't necessarily have expected that. But I guess since it's a Finnish company and the Fin- Finnish people really love saunas, I should have expected that.

Darya Rose: [laughs]

Dr. Ashley Mason: But, and it was during that study we sto- we were suppose to have [01:19:00] 30 people in that trial. We only ended up with 25, because we had to stop early due to COVID, and then we pivoted very quickly to doing COVID research because the, the temperature data was so good from the Oura Ring for that that we ended up using temperature data from the Oura Ring for COVID research to see if we could, you know, predict COVID type stuff. And, and then-

Darya Rose: Right.

Dr. Ashley Mason: ... now that a lot of that has died down, we're really diving back into the sauna work. That's my long lo- that's my longish spiel about this. And we're super excited about it. And I'll, I can give you my, my lab website where folks can go and see if, if they wanna participate. There's a, a way to click to see if you're eligible. And we're also about to be hiring for another lab member to join the lab, actually, to work on this study, if anybody's interested.

Darya Rose: Oh, how fun.

Dr. Ashley Mason: Yeah.

Darya Rose: That's sounds so amazing.

Dr. Ashley Mason: Yeah.

Darya Rose: I wish I wasn't so busy [laughs].

Dr. Ashley Mason: I mean, anyone wanna come try our protocol down in San Francisco, [laughs] just let me know.

Darya Rose: I, I have a couple questions about the protocol.

Dr. Ashley Mason: Yeah.

Darya Rose: So why IR? Like, why infrared sauna as opposed to a traditional sauna?

Dr. Ashley Mason: That is an excellent question. So a traditional sauna, your, your whole person is going in, [01:20:00] right, your head, your body. And when I was first ... after I read that paper in 2016 and I decided I was desperate to get involved in this research, I started finding out about all the red tape to use the medical device. And I thought, oh my gosh, there's gotta be another way. I, I can't-

Darya Rose: Hm.

Dr. Ashley Mason: ... I can't surpass all that red tape. And so I [laughs] went to Walgreens, bought a whole bunch of thermometers and gave them to my friends and said, "Hey guys, let's go on a sauna tour of the Bay Area [laughs], because there's a bunch."

Darya Rose: [laughs]

Dr. Ashley Mason: "And let's see if we can find a sauna where we can actually get our core body temperature hot enough."

Darya Rose: Hm.

Dr. Ashley Mason: But it turns out, nobody could stay in a sau-

Darya Rose: You can't stand it, yeah.

Dr. Ashley Mason: ... you can't stay in one long enough to get to that high of a core body temperature.

Darya Rose: And so not good for your brain [laughs].

Dr. Ashley Mason: Oh, you, you just would fry and roast.

Darya Rose: Yeah.

Dr. Ashley Mason: We went to some of the, there's, like, banyas, there's all kinds of places in San Francisco to try this stuff.

Darya Rose: Yeah.

Dr. Ashley Mason: So we tried and we tried. And we even tried in- infrared saunas where your head is in the sauna. But ultimately, [01:21:00] it turns out it's wildly important for your head to not be in the sauna during this treatment.

Darya Rose: Interesting. That's why you wear those hats, right, to, to, like, keep your-

Dr. Ashley Mason: Yes.

Darya Rose: ... to-

Dr. Ashley Mason: Keep your ears and your head and your hair from burning.

Darya Rose: ... the head and temperature down so you can stay in longer.

Dr. Ashley Mason: Yeah, yeah.

Darya Rose: Yeah.

Dr. Ashley Mason: And-

Darya Rose: And [laughs], and keep your hair from burning too.

Dr. Ashley Mason: Right. And, and the tops of your ears, it turns out, get super sensitive in that heat.

Darya Rose: Oh, interesting.

Dr. Ashley Mason: But for the, for the infrared protocol that we're using, using a sauna dome and having your head out is key because there's a person sitting at your head putting icy cloths and cold cloths all over your head and face the whole time.

Darya Rose: So you can do it.

Dr. Ashley Mason: So you can do it. Because you know what?

Darya Rose: Wow.

Dr. Ashley Mason: We are heating you for about 80 minutes.

Darya Rose: Whoa.

Dr. Ashley Mason: And that's a long time. And after that, we're taking you out of the dome and we're covering you with warm towels and blankets to keep your temperature up there, because what the data had started to show from these trials looking at different types of heat treatments, whether it's a hot tub, a hot bath, hot showers, whatever, the longer you are [01:22:00] warmer, the better the antidepressant effect. So we want it to be slower. We don't want you to necessarily get up to temperature super, super fast.

Darya Rose: Wow.

Dr. Ashley Mason: And so there's something to that, because once we've got you at that temperature and we turn off the sauna and we cover you in the hot blankets, you actually stay pretty warm for a longer period of time. You don't start to cool off very quickly. And so you're getting some sort of biological effect during that time.

Darya Rose: That is so crazy.

Dr. Ashley Mason: Yeah. And so there's really no way [crosstalk 01:22:29] to do that with a non-infrared sauna.

Darya Rose: Because a typical sauna session, it, it, once ... you have to adapt, but you can adapt to 20 minutes-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... which is where I am right now.

Dr. Ashley Mason: But you're sauna's pretty hot, right? That's a Finnish sauna?

Darya Rose: Yeah, I have a, I have a crazy sauna. But, but, yeah, no, I can't ... There's no way. So 80 minutes, like, that's bonkers.

Dr. Ashley Mason: Yeah. It's, it's a long time. But don't underestimate the effect of the set and the setting.

Darya Rose: Yeah.

Dr. Ashley Mason: So I know you hear that in a lot of other types of psychedelic world lately.

Darya Rose: Yeah.

Dr. Ashley Mason: They use those phrases a lot. But it [01:23:00] actually matters a lot for this sauna treatment too.

Darya Rose: Hm. Hm.

Dr. Ashley Mason: We have a very calm room with special lighting, and we have special music. And there's a very, very skilled a trained person sitting at your head knowing exactly where to put the ice and the cold cloths and how to make sure that you don't ... People can't start to panic, right? Make sure you, you stay calm. There's someone sitting there monitoring your temperature minute by minute. It's a very special setting. It's not-

Darya Rose: Yeah.

Dr. Ashley Mason: ... something that's easy to just replicate at home. We're also, we're also forcing you-

Darya Rose: Yeah, and you have a thermometer in your butt.

Dr. Ashley Mason: Right.

Darya Rose: [laughs]

Dr. Ashley Mason: I mean, it's silicone. It's like this-

Darya Rose: I'm just saying.

Dr. Ashley Mason: No, but anybody who's had a baby looks at that and they're like, "That's not a big deal." The other thing is we're also making sure that you're drinking. We provide a beverage with-

Darya Rose: Hm.

Dr. Ashley Mason: ... electrolytes, water. Some people like to suck on gummy bears. You know, we're, we're really-

Darya Rose: It sounds like a s- spa treatment-

Dr. Ashley Mason: It, it kind of is, except it gets intense.

Darya Rose: [laughs] Yeah.

Dr. Ashley Mason: It gets intense.

Darya Rose: I believe you.

Dr. Ashley Mason: So, but we're really, we're really excited to be running the study now. There's been some slowdowns with COVID restrictions. And we have a whole protocol in place, so every par- [01:24:00] whenever a person comes in, we, we give them a COVID test, the whole nine before the sauna sessions, because people, one of the most common questions people ask me right now is, "Are people wearing masks during sauna sessions?" And I'm like, "Absolutely not. That's-

Darya Rose: Yeah.

Dr. Ashley Mason: ... "that's [laughs] impossible." The staff is wearing N95s, but, but not you. And so we've got a bunch of protocols in place, and we're, we're rolling now. So if folks are interested in participating, they should definitely click the link.

Darya Rose: One of the things that was really intriguing about the first study that you mentioned was that obviously it would be cool to have answers is the duration and how to prolong this effect for people with these, these issues. I'm curious, are, are you expanding on that? Are you doing multiple treatments? Just one? How many, how long are you following these patients?

Dr. Ashley Mason: Great question. So believe it or not, right now we are trying a very, very intense approach. We are doing eight weekly treatments right now and-

Darya Rose: So one a week for-

Dr. Ashley Mason: One a week for eight weeks.

Darya Rose: ... two months? Okay.

Dr. Ashley Mason: Yep.

Darya Rose: Okay.

Dr. Ashley Mason: And each week, patients are also getting, uh, cognitive behavioral therapy sessions with a psychologist, with a PhD [01:25:00] psychologist who, who delivers that treatment on a different day, generally in, hopefully, we try to schedule them such that you get the sauna session one day and you get the CBT session the next day.

Darya Rose: Yeah, and they're still chatty.

Dr. Ashley Mason: So that hopefully you're still having some of those effects.

Darya Rose: Yeah [laughs].

Dr. Ashley Mason: That's what we want, that's what we want to carry over. But we're gonna, we're gonna be experimenting with this. So we have, um, the grant I have from NIH is an R34, it's an intervention development grant. So one of the great things about this grant is that in the first year, we have licensed to do some modifications to the intervention to see what's tolerable, what's feasible, what's practical. Because if we, even if we designed the best treatment, if it's not practically doable by people in the real world-

Darya Rose: Right.

Dr. Ashley Mason: ... it doesn't matter.

Darya Rose: Right. Right.

Dr. Ashley Mason: So we're trying to find this happy medium. And originally, I did propose to NIH to do what's called a dose escalation study to try and figure out how much do we need. But they said, "Skip that. Start with this. Try this one a week-

Darya Rose: Yeah.

Dr. Ashley Mason: ... "for eight weeks thing and see if it works." I won't be surprised if ultimately we end up modifying the schedule so that it's every other week, for example.

Darya Rose: Yeah.

Dr. Ashley Mason: And then in, in a future trial, the next [01:26:00] trial basically, a multi-site RO1 trial, my hope would be that we would be doing longer term followup with folks after they have stopped the sauna sessions to see, all right, where's the drop off.

Darya Rose: Yeah.

Dr. Ashley Mason: And in my perfect world, we'd be developing a method where you come in for these kinds of hyperthermia sessions, but also you might be able to do some homework, so in a sauna tent or something that you can, that, in an affordable type of heat treatment that you might be able to do at home in-between these kinds of-

Darya Rose: Like, without somebody doing your face and, yeah.

Dr. Ashley Mason: ... that, that keeps ... It's almost like a little bit of a boost between those sessions to prolong the effects and, and figure out if we might be able to make a combination treatment. It, but you know what it might be the case, that people need a certain level of treatment in the style that we're doing with the really intense sauna, but then they're able to maintain it by doing a less intense sauna at home.

Darya Rose: Yeah.

Dr. Ashley Mason: We just don't know yet.

Darya Rose: Right.

Dr. Ashley Mason: The science is not there.

Darya Rose: Wow.

Dr. Ashley Mason: Yeah.

Darya Rose: That's so crazy. You know, you're making me think. So I had a very crazy experience in the last few you, weeks.

Dr. Ashley Mason: Hm.

Darya Rose: And this is totally anecdotal [01:27:00] and people can ignore me if they want.

Dr. Ashley Mason: [laughs]

Darya Rose: But, so I got COVID [laughs], as you know, as many people know.

Dr. Ashley Mason: Hm.

Darya Rose: And I had to isolate, right, from my family. And the, it was very stressful at first. Like, the first few days, I actually was, did have symptoms and I didn't feel well, and I, like, couldn't look at my computer for a day and a half. And then I started to feel better. But I had, was still testing positive, so I stayed isolated from my family. And around day three or four of isolation, I felt unbelievable.

Dr. Ashley Mason: Hm.

Darya Rose: I had no anxiety. I had no depression. I felt, I felt, like, almost like a kid again. You know, I just was like fresh, new eyes on the world. And in my, you know ... So I'm like, I'm like, this is interesting. Like, I mean, I'm still ta- I'm still taking my Lexapro, but like, you know, I've been tapering. And i- i- it, this was just nothing like [01:28:00] I'd experienced before.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: And I've been thinking about this, obviously.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: And so I had two hypothesis about why, what was going on. One, I wasn't parenting for the first time in over four years.

Two, I didn't have any alcohol for four days, which is, I've done that, I've done that before.

Dr. Ashley Mason: [laughs]

Darya Rose: So I'm like, I was like less inclined to think it was that. But I'm throwing that in there just because normally I do drink pretty regularly, like five, six days a week. And, but now you're making me think.

Dr. Ashley Mason: Hm.

Darya Rose: So one other thing that I did that I hadn't even thought of until today, or just now, is because I, I listen to Rhonda Patrick as well and she's big into sauna and sh- [laughs] sh- she told me, I was like chatting with her about my COVID, she was like, "Yeah, I," when she had COVID, she was still saunaing. So and into my brain, I'm like, that makes so much sense. But normally I, I would do my home sauna around, like, 180 or [01:29:00] less temperature. But for this, I cranked it up as high as it would go.

Dr. Ashley Mason: Hm.

Darya Rose: So it's at like 195, which is really freaking hot.

Dr. Ashley Mason: That's hot.

Darya Rose: And the first day, and I did this every day that I was sick. I, I was like [laughs], I'm not gonna give anybody COVID in the sauna. It's a million degrees in there. It won't live. So I would go upstairs and I would do ... And the first day it was so hard, but I was like, "I'm gonna fry this virus." [laughs] I'm gonna-

Dr. Ashley Mason: How long did you stay in?

Darya Rose: ... cook it out. 20 minutes.

Dr. Ashley Mason: Oh.

Darya Rose: And, and I did it every day. And I, and it's crazy, because now I am acclimated to that temperature. I can do it no problem, and it's been two, three weeks. And, but I'm wondering if that was maybe one of the factors as well in my, in my, like, magic where ... And I'm, I'm, like, very curious to see how this is gonna go with ... I still feel pretty damn good just ... I don't know if I was, it was just, like, the prolonged break from parenting, the medium break from alcohol or the super hot sauna. This is so interesting.

Dr. Ashley Mason: It could, it could be-

Darya Rose: [laughs] I'm like, I want you to do an experiment.

Dr. Ashley Mason: ... a combination of both. [01:30:00] It could be.

Darya Rose: Yeah, it could be a combination. Um-

Dr. Ashley Mason: But there's something that struck me in what you said, which is that you said you felt like a kid again.

Darya Rose: Yeah.

Dr. Ashley Mason: And kids don't have adult responsibilities.

Darya Rose: Yeah.

Dr. Ashley Mason: So it sounds like this might have been-

Darya Rose: Yeah.

Dr. Ashley Mason: ... one of the first times for a, in a long time that you didn't really have any responsibilities other than taking care of yourself.

Darya Rose: Yeah, that was my first though, the obviously-

Dr. Ashley Mason: Yeah.

Darya Rose: [laughs] Yeah.

Dr. Ashley Mason: That's, that's huge. And I think ... we [laughs], we don't emphasize that enough as a culture-

Darya Rose: Yeah.

Dr. Ashley Mason: ... because we're always taking care of things and other people and situations no matter-

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: ... pretty much what we're doing. There's very few times when we can have the luxury of being entirely self-focused. Right?

Darya Rose: Mm-hmm [affirmative]. Yeah, it was magic.

Dr. Ashley Mason: Especially those of you who are parents.

Darya Rose: Yeah. And it's like even if ... You know, I've taken a couple of vacations without my kids, but never more than three or four days. And yeah, I think part of it was [01:31:00] just like this was ... Oh, and, uh, the re- I got COVID on a trip, so I'd already been away from my-

Dr. Ashley Mason: [laughs]

Darya Rose: ... [laughs] kids for a few days. So, I mean, I, you know, I'm, I'm looking like looking at like a week-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... with zero parenting.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: And, yeah, and it could just be it, like, like you said, like flipping a switch. Like, it could just be I just hadn't had a break that long ever-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... and I needed it.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: [laughs] And maybe now that ... My kids are easier now, but I think my nervous system was just, like, so tense, like a really tight rubber band for so long. It's crazy.

Dr. Ashley Mason: Wouldn't shock me.

Darya Rose: It's really crazy. Yeah.

Dr. Ashley Mason: But also, and I also wouldn't be surprised if, uh, I don't know, um ... Going in the sauna that, that is that hot and shocking your system like that, it reminds me of how a lot of people feel after they can finally get a good workout again after they've-

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: ... been sick. They get, they haven't had a runner's high in three weeks because they had a chest cold, chest cold. Then they go out on their six mile loop and they finally really get one in, and it feels just freaking great. [01:32:00] Right?

Darya Rose: I had that experience too [laughs].

Dr. Ashley Mason: Yeah.

Darya Rose: Right? After not working out for a week and a half or whatever.

Dr. Ashley Mason: Yeah. And-

Darya Rose: Yeah.

Dr. Ashley Mason: ... as, as we talk a, Rhonda and I have talked about this a lot and, uh, talked about the sauna world, sauna is in many ways an exercise memetic. Right?

Darya Rose: Hm, right.

Dr. Ashley Mason: You were mimicking a very intense workout by going in there-

Darya Rose: Yeah.

Dr. Ashley Mason: ... for 20 minutes. And the positive emotional and psychological and stress reducing effects of exercise are pretty lasting after a high intensity interval type workout. And if you-

Darya Rose: Yeah.

Dr. Ashley Mason: ... were doing that every day, it wouldn't shock me that you'd be feeling pretty great. There's folks who they like to do the whole cold contrast with it too and they swear by that, and some day in my-

Darya Rose: Yeah.

Dr. Ashley Mason: ... in my future life, I will have, have one of those to use-

Darya Rose: I don't have the constitution for it. Yeah [laughs].

Dr. Ashley Mason: Oh, I would lo- I've tried it at a few places, and it's, it's pretty incredible. It's not something that I think I could regularly do, but it's-

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: You, you get a really [01:33:00] big mood boost, even from 10 seconds in that cold water.

Darya Rose: Interesting.

Dr. Ashley Mason: I tried one of those-

Darya Rose: Kevin, Kevin bought a cold plunge for awhile, but we-

Dr. Ashley Mason: [laughs]

Darya Rose: ... we got rid of it. We couldn't ... No- nobody was using it.

Dr. Ashley Mason: It's the kind of thing where I'm probably more likely to just want to find one I can reliably visit rather than have my own.

Darya Rose: Yeah, yeah.

Dr. Ashley Mason: But long story, I mean, that constitution effect ... But also, alcohol is a downer. It, we, we forget that. Like, it's-

Darya Rose: Yeah, yeah.

Dr. Ashley Mason: ... it's pretty, you know, it is. And so I can see why taking a brea- that combination of things was a great recipe for feeling great.

Darya Rose: Oh, it was so magic. Yeah. Is there data on sauna and sleep? O- obviously I know if you sauna closer to bedtime and get your body temperature to start cooling itself-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... get your body to start cooling itself before bed-

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: ... I know that can help. But is there more just overall sauna use in insomnia data?

Dr. Ashley Mason: Yeah. Great question. First of all, we know that using sauna too close to bedtime though, not a great idea-

Darya Rose: Hm.

Dr. Ashley Mason: ... because it increases your heart rate.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: And when you're sleeping, we want your heart rate to be [01:34:00] decreasing.

Darya Rose: [laughs]

Dr. Ashley Mason: So I would say a few hours before bed time is good, not just immediately before.

Darya Rose: Mm-hmm [affirmative].

Dr. Ashley Mason: If you wanted to do something warm before, I'd say a hot shower within an hour of bed is fine.

Darya Rose: Okay.

Dr. Ashley Mason: But I'd prefer, reserve the sauna for a little bit longer before that. But to your question, [laughs] this is one of the 50 million things I wanna study.

Darya Rose: [laughs]

Dr. Ashley Mason: We know that in ... There's a, there was a paper published on people's motivations for using the sauna, and they surveyed a whole bunch of people. This was in 2019. I can get you the link to this one too. And one of the major reasons why people said they used the sauna is for sleep benefits. So there are people out there who are saying, "Look, sauna definitely helps with my sleep." But have we ever measured it in terms of randomizing people to use the sauna or not and then-

Darya Rose: Yeah.

Dr. Ashley Mason: ... look specifically at their sleep? I'm not aware of a really well controlled study that's done that. And there's gonna be a whole bunch of different ways also that you can cross-cut this literature. There's [01:35:00] hyperthermic baths, hot tubs, hot showers, waon therapy. There's all, there's so many different types. In fact, there's ... And Rhonda wrote a nice review paper recently that we should link too in, in the notes for people who wanna read more about all the different types of benefits of sauna on, on your health span. But there's, there's definitely interest there, and I think there's a lot of people who wanna know the answer to that question. Hopefully I'm lucky enough to do some research on that too, because I would love to figure out a way to take the depression, the anxiety and the sleep stuff that I've, I'm working on and, and figure out some-

Darya Rose: Crack that nut [laughs].

Dr. Ashley Mason: ... s- synergy. Yeah, some researched synergy there. For sure.

Darya Rose: Very, very cool.

Dr. Ashley Mason: Mm-hmm [affirmative].

Darya Rose: Well Ashley, this was so informative and so interesting. And I'm so excited for your work. I just cannot wait to see your data.

Dr. Ashley Mason: Thank you. You and me both [laughs].

Darya Rose: [laughs] I bet.

Dr. Ashley Mason: It's very exciting for me, so thank you so much for having me. This was, this was-

Darya Rose: Yeah, I-

Dr. Ashley Mason: ... really fun.

Darya Rose: Yeah, you're so busy. And I, I really, really thank, appreciate you coming on and, and sharing your wisdom with us. And where can, uh, people [01:36:00] find you? Where should they go to learn more?

Dr. Ashley Mason: Yeah. So the lab website is the best place to find out what we're doing. And that's just sealab.ucsf.edu. I'm getting, I'm gonna hopefully at some point get better at social media. I have the accounts-

Darya Rose: [laughs]

Dr. Ashley Mason: ... and they are on Instagram and Twitter. And I can leave those for you so folks can find them. It's just Ash_E_Mason for Instagram, and then Twitter it's just DoctorAshleyMason.

Darya Rose: Fantastic. Thank you so much.

Dr. Ashley Mason: Thank you.

Darya Rose: Thank you so much for listening today. And I hope you've learned a ton from Ashley. I just thought that was such an awesome conversation. If you liked it as well, please consider sharing it with a friend. That really helps spread the word so that we can continue to get amazing guests like Ashley. Also, if you have some time in the break, if you could go to Apple and leave a review or Spotify and leave a review of the show, that would really help us a lot. Those reviews, five-star reviews, is how we get great guests and convince them that this a show they wanna be on. So please leave a [01:37:00] review. Please share with your friends. And I will bring you many more amazing episodes in season three. Thank you so much, and I'll see you next time.