[00:00:00] Welcome to the Health Policy Podcast. I'm Brian Hyde. Today I'm joined by Amy Saola. Amy is a contributing writer for the Maha Report. That's one of many hats that she wears though, Amy. Welcome to the program. Take a moment if you would tell us just a little bit about yourself and your background. Thank you so much. Thank you for having me. So I'm a clinical pharmacist. I specialize in women's health. Um, so I mostly work with women from basically fertility kind of related things through midlife. Um, and then later in life as well, I cover urology, urogynecology and OB GYN. Um, but I also am a very passionate, uh, home cook, uh, gardener, a mother of. Two children. Um, and I have an undergrad in nutrition and I've studied functional and integrative medicine. So I've worked in a number of roles, um, but am particularly, uh, excited about writing for Maha, uh, the MAHA Report and everything they're doing. We're gonna talk about [00:01:00] something today that I think a lot of people will be nodding their heads in agreement when we, when I mentioned. We talk about sleep in, in particular, you know, teenagers or adolescents and sleep, um, set the stage for us, if you will. Um, I don't know if any of us feel particularly like we're, we're getting all the sleep that we want, but, um, talk to me about Jeffrey Rose and the case for sleep as part of Make America Healthy again, policy. Yeah, so I was excited when I got this story assigned. Um, they told me Jeffrey Rose is, he is a, um, hypnotist and he's a coach and like he has, he wears a lot of hats too, but he's really passionate about sleep, but comes at it from a different perspective than I had seen before. And he's really involved with this organization called Start School Leader. And once I started looking into it, like you said, it makes a ton of sense and you're like, why isn't everyone doing this? But, um, essentially what it is, is they found that the circadian rhythm of teenagers shifts as they get older. So they tend to [00:02:00] stay up till about 11 o'clock, and when school starts prior to eight 30, they're not able to get the eight to 10 hours of sleep that they actually need for their brains to function for their immune systems. Like all of the things. And we build that into the system. So it becomes a structural problem where kids aren't able to get the sleep they need, and then downstream we see the consequences of that. So let's talk about some of the aggravating factors here and, and it's been a little while since I've been in school, but how many, for instance, public high schools in the US get underway before eight o'clock in the morning? Yeah, so right now the statistics are about 43% of high schools are starting prior to 8:00 AM And one of the things that I found shocking as I researched this was just starting, uh, I believe it was 8 55 in the morning, reduce the number of traffic accidents in teens by like 70% [00:03:00] for kids that were. 16 to 18 who are getting in cars and driving to school to reduce traffic accidents by that much is incredible. But still, 43% of high schools are starting prior to 8:00 AM And you know, I, I have to think back on this. Um, um, 'cause I think this, and I remember from high school, we, we tended to start closer to nine o'clock. I don't remember as many kids falling asleep in class. Now having said that, my wife is a public school teacher, and, uh, though she's teaching middle school, she says that's, that's a real challenge, kids. Fall asleep in school, it's just six R one in three children or adolescents, teens to me, report that they're falling asleep in school. So that's a really significant amount. 70% of kids report that they're not getting even eight hours of sleep. So what, where do we begin to approach a topic like this? And, and, um, I I'm gonna ask this from, from a health policy standpoint. Um, what kind of role should. You know, [00:04:00] the, the government at, at whatever level be, be playing to, to help start this. Does it, is it as simple as adjusting the start time of school? Yeah, I think that's the best place to start and the most logical place to start it. You know, one of the things that struck me about Jeffrey Rose is he said, you know, you wouldn't wake like, wake a newborn baby and call that discipline, right? Like when a baby's sleeping, you don't wake him and say like, oh, this is discipline. You gotta get up at this time. And same thing with kids during this really strong neuro development. Developmental period. We're whisking them up and being like, all right, gotta go. You know? And then we're surprised when maybe they don't perform as well. Academically. They have troubles focusing. They have a DHD, right? Like I think, um. We need to account for that. It's not just sleep hygiene. 'cause a lot of times people are like, well they're on screens or they're staying up too late and they should just go to bed earlier. Right? But sleep hygiene really is about sleep quality. [00:05:00] But if structurally, our system and our policies don't allow kids enough duration of sleep, that is where the problem lies. So let's, uh, let's go into some of the specifics of what happens when a person gets the necessary sleep, but more importantly, what happens when they don't? Yeah. Yeah. So we know that sleep deprivation really affects every part of the system. And I am biased because prior to this interview, I would tell you nutrition is fundamental to health, right? Like nutrition is the most important thing. But after talking with Jeffrey Rose, I've really changed my mind. And as long as you have nutritional adequacy, right, and you have access to food and aren't food insecure, I think that sleep is actually more important. And I'll tell you, I think it is really difficult to make good decisions regarding nutrition. Um, even just metabolically looking at insulin regulation and all those things, if you are not sleeping [00:06:00] enough, especially less than six hours, we know that it has an impact on metabolic health immune function, which is critical for kids in school with all the colds and flus and everything going around. Um. You know, if a child, if a teen is getting less than the recommended amount of sleep, they're four times more likely to get sick after being exposed to the cold virus. So immune health is huge. Cardiovascular health, and you know, I think that, um, also really. Goes to then mental health. So we look at depression, anxiety, ability to focus, academic performance. Of course, all of those suffer greatly. So I'm curious if, if there's an added factor of challenge here in that, uh, energy drinks are readily available and actually quite in fashion. Um, I mean, it seems like a quick, easy fix. What are some of the things we need to know for, for those who. You know, would say, well, I'll just, you know, I'll grab a, a, you know, [00:07:00] a Red Bull or whatever and, and, and that's how I'll get past that sleep deficit. Yeah, and Jeffrey Rose talked about this a lot, and I actually found it really interesting. He drew a parallel between addiction, like addiction later in life to drugs or other substances and sleep deprivation. And what he said is that oftentimes we're training kids to use substances to feel normal from this sleep deficit by depending on caffeine or other, you know, energy drinks, whatever it is to just get to. Perform right? And day in and day out, it's like they're waking up with a hangover, right? So they're waking up, they're tired, they're sleep deprived. So they are then becoming dependent on substances like energy drinks or things of that nature. We know those are not helpful, um, for metabolic health. They're not helpful for cardiovascular health. Are certainly not helpful for sleep hygiene, especially later in the day. You know, if kids are struggling and drinking those drinks [00:08:00] later. The half life of caffeine is quite long depending on how you metabolize it. So it can really then cause troubles with getting to bed even later. Um, so definitely can be problematic. And I, I'd also love to have you comment on. The, the role of personal responsibility? I mean, um, from a policy standpoint, I know it's easy to say, well, let's, you know, let's have them start school later and we can have, you know, this or that health policy. But ultimately it seems like to make this work, people are going to have to take that responsibility for making sure that their adolescents are getting the necessary sleep, starting with their own household. Um, do you have some thoughts on, on what they could be doing to, to take control in so far as they can of the situation? Yeah. You know, the first thing is really the structural issue. So first of all, school, you know, if school is starting later, what we know from the research is that if school starts at eight 30, on average, students were getting 30 to 60 more minutes of sleep without even intentionally trying to change [00:09:00] anything else. So without working on sleep hygiene or any of the things, they were just getting more sleep by having school start leaders. So that's the number one. Step number two though, is certainly looking at screen time, um, looking at energy drinks like you mentioned, or caffeine consumption. Um, trying to turn down those lights around dusks, so thinking about circadian rhythm and blue light exposure. So we know blue light from electronics. Definitely disrupts our own melatonin production. So if your teen is on screens or if you are on screens, you know, once it's dark out, that's disrupting your own melatonin. Also, getting some bright light in the morning helps you wake up and again, helps set that circadian rhythm. So those would be kind of the top things. How does, uh, personal fitness play into the this sleep equation? Yeah, absolutely. So, you know, I think staying active is incredibly important and we know teams now. There's, you know, not recess anymore at most [00:10:00] high schools. So once you get to that age, so you know, unless they're active after school. Prior to school, sometimes they aren't getting nearly as much activity and we know that activity can be really helpful again for sleep regulation and metabolic health. Um, so regular physical activity is extremely important. Okay. Um, as far as, uh, other nutritional things that, that people need to keep in mind, I, I'm glad you talked about the, uh, the energy drinks. Um, and I'm, again, if memory serves, it seems like as, as adolescents, we didn't care quite so much about, you know, how healthy a particular food was. It was, is it convenient? Is it tasty? Yes. Well then, you know, it's, it's game. Um, talk to me about the effect of what kids are eating and, and what Yeah. What that does to their sleep cycle. Question. So typically we know more highly processed foods certainly can affect. Just metabolic health in general. Um, also [00:11:00] heavy meals late at night tend to disrupt sleep. So, you know, with sports or other afterschool activities, sometimes families do end up eating later at night and that can be definitely difficult to go to bed, um, if you're really full or had a heavy meal. So, thinking about that as well as again, timing of caffeine. Um. Extremely important. So focusing on foods, you know, even with my patients, um, thinking of, one thing I always talk about is like blood sugar regulation, right? So if your blood sugar is on a rollercoaster all day long, you're gonna be tired. You're gonna be, you know, up and down, up and down. And I feel like a lot of times with teens, especially as we're looking at sodas, energy drinks. You know, processed food, their blood sugar can be all over the place. Um, and so thinking about how do we balance blood sugar through the day, how do we provide like whole nourishing foods, um, that will provide the fiber and protein and things [00:12:00] they need to be healthy, um, and have healthy, uh. Metabolic regulation. You mentioned early on in our conversation, Jeffrey Rose and, uh, and you know, what, what he, the writing he has done on, uh, sleep as Maha policy, um, could you spell out for me what are some of the things that, that are being looked at, you know, starting at, at the national level that that could help, you know, influence or nudge things in the right direction as far as health policy? Uh, one exciting things is in the 25 20 25 Maha Commission report. Um, they actually labeled, um, sleep as a National Crisis for Children and Teens, and he was part of getting that in there. So I think it is been identified as a really important policy issue. Again, I think the biggest thing is school start time. Um, but you know, I think it's really getting everybody on board, um, with understanding the value of [00:13:00] sleep and also how that has downstream impacts on school performance. Um, we talked a little bit about like A DHD and the diagnosis rates are just skyrocketing and, you know, not that we think that the only reason is sleep deprivation, but. One of the things he talked about was like, before starting a medication, could we look at the, the basis like, is the child sleeping eight to 10 hours? And if not, could we improve that first? And so I think some of it is just this structural. Kind of like, or basic policy. And then looking at kind of the consequences of that downstream and how do we ensure that the foundation is there before we're kind of doing other interventions. You know, you mentioned eight to 10 hours of sleep and, and you know, as a grownup I'm like, holy cow, if only, but, but now I, I recall that, uh, you know, we don't all operate on the same, you know, sleep clock, [00:14:00] those, those circadian rhythms that you referenced, um, they're gonna be different. For a young person than they are for someone who, who is older. Um, I, I'm, I know I'm kind of asking you this off the top of your head, but, um, what are some of the differences we see? Why can't we approach sleep as a one size fits all, you know, policy for, for the household? Yeah. Yeah. And you know, in some ways it is. So for adults, I think sometimes our bad habits carry over, right? So I always say like, what are we modeling to our children, but also our children? These teens are going to go to college and they're gonna be adults. And if they're like used to not getting enough sleep, when does that stop? Right? And so. Generally the sleep recommendation, even for adults, is typically around seven to eight hours, so it's not drastically less. We know that across the board. Basically health suffers less than six hours. And I would tell you just from my own clinical experience, [00:15:00] many of the patients I'm talking with are getting far less than six hours. Um, and so, you know, I think, um, although you may be able to survive with less than six hours, when we look at optimizing health and how do we thrive and, you know, live a vital life and feel good. That really comes with prioritizing sleep and trying to get at least probably that seven to nine hours even as an adult. Okay. And this is, this is just one of those weird aspects of psychology. Um, I have six kids and I have learned when I tell 'em, Hey, this is good for you, that's akin to saying You're gonna hate it and you're gonna fight me every step of the way. Um, what are some thoughts about, uh, about helping them become informed so that they can understand this is not about, you know, you're little and you have to go to bed and, you know, we're gonna stay up and watch mash or whatever, but, uh, how do we help them understand that? This is in their best interest to, to learn and understand this and to implement these changes.[00:16:00] Yeah. One of the things I think about is, you know, because this affects almost every aspect of health, like what is important to them, right? Is it sports performance? Is it academic performance? Is it being able to hang out with friends, right? And speaking to 'em from that perspective. So if it's athletic performance, right? We know that if you're sleeping eight to 10 hours, you're going to perform better athletically, or is it doing great on a test? Or, you know, getting higher grades, like I think there's a way to make this important to them or tie it to something that's important to them, because really sleep impacts every aspect of kind of their day to day. And let's, uh, let's take just a moment here. We're down to our last few minutes, but, uh, talk to me a little bit about how Maha Make America healthy again. Is, is playing out. Um, you know, there, there are a lot of different things going on in the world and it's easy to get lost in all the different headlines, but, uh, this was one of the, the really, I [00:17:00] thought, uh, worthwhile initiatives that, that President Trump undertook in his second term. Um, how is. You know, Senator, uh, rather, uh, secretary Kennedy's efforts. How are they going? And is, is there momentum building? So, right. I hadn't heard anything lately. As far as sleep policy goes, I've been watching very closely. Um, I think they have a lot of irons in the fire as far as, uh, where they're making policy decisions right now. But I do know, because this was part of the Maha Commissioner report that it is on the radar. And I do hope to see more impactful policy changes coming around sleep. Absolutely. It seems to be, in many ways, less controversial than, than other policy initiatives. Yes. But at the same time, you know, it's, it's an easy one to overlook probably because it's, it's, it's not as polarizing. We want people to be healthy. It's just a, a question of, uh, you know, how do we go about it? Yes, exactly. And that's what [00:18:00] sometimes I feel like. Sleep is something that is overlooked because it is so basic, right? It's foundational. Sometimes I think adults too, like obviously aren't always the best at it, so it's often hard to recommend more sleep or change sleep policy when maybe as a society we aren't necessarily sleeping great ourselves. So I think finding, how do we prioritize that? How do we make, uh, policy decisions like we've been talking about. So that we can actually, you know, focus on the health benefits of sleep as foundational for all human health. Um, and I think that is one of the foundations to making America healthy again. And for people who wish to follow your work, tell me a little bit about the MAHA Report and, and where people can find that. Yeah, so we're on Substack. There are articles published almost daily. Um, so you can find us on the substack under Maha Report. Um, and you can [00:19:00] find me just amy saola.com. Again, we are visiting with Amy Saola. She's a clinical pharmacist as well as a contributing writer for the MAHA Report. Amy, thank you so much for joining us today on the Health Policy Podcast. Thank you for having me.