Meredith Arterburn

Chawkat
IR
19 February 2019
Interview Transcript and Reflection
Dr. Barger: This is Dr. Laura Barger and I’ve conferenced in Dr. Charles Czeisler.
Me: Oh wow!
Dr. Barger: Yeah, I said Chuck let me conference you in because this will be a big bonus. Dr.
Czeisler has worked with a lot of different athletes, so I think he’ll be able to add a lot to our
conversation.
Me: Yeah definitely. I read a bunch of the articles you sent and it was really cool to read about
the stuff that he did especially with the NBA.
Dr. Czeisler: Hi Meredith, how are you?
Me: Hi, I’m good, how bout you?
Dr. Czeisler: Good. So what’re you up to?
Me: so I’m in an independent research class at my high school where we get to choose what we
want to study. And this year I chose sleep in student athletes but more generally just sleep in
athletes just because I thought it was something that was really interesting in that apply to my
life and that affected me a lot but that I didn’t necessarily know that much about.
Dr. Barger: so what sports do you do?
Me: I do cross country, track and lacrosse.
Dr. Czeisler: excellent
Dr. Barger: ok, great.
Me: and I play basketball up until this year, but I switched to track.
Dr. Barger: right, you have to choose at some point.
Me: so we can just get started. In both of your experiences in the sleep studies field, what do you
think have been the main difficulties of sleep studies?
Dr. Barger: You mean in this population of athletes?
Me: yes.
Dr. Barger: I don’t know, chuck what do you think, that people are hesitant to try something
new?
Dr. Czeisler: yeah, and they don’t have a lot of time in the middle of the season, and they have to
maintain their focus on the sport. So, oftentimes it’s a bit of a distraction. And then some athletes
are like “well I’m already spending a lot of time on the sport and in my free time I don’t
necessarily want my coach to know what I’m doing,” so that’s another reason.
Dr. Barger: and i’m thinking of the basketball study that Mah did at Stanford, where you can’t
really randomize and say that I have a great new treatment that i think is going to help you so
we’re going to randomize and some of you don’t get to do it and the others do.
Dr. Czeisler: right, and that’s a huge problem because they don’t want to randomize the group
that they think is going to make them lose.
Me: how do researchers analyze trends in sleep when it varies so much between each person?
Dr. Czeisler: that’s a great question.
Dr. Barger: I mean, we collect sleep data in a number of different ways. We have an electronica
diary where we collect their subjective estimates of sleep and the timing of sleep every day. So
we just had college students do that for a whole semester. we also do it with acti graphy. I dont
know about trends, I mean we’ve done it over a number of years and compared data.
Dr. Czeisler: You say it varies a lot, and it does vary to a certain extent, but it’s kind of like
height. Some people are taller than others, but if you see someone who is 9 feet tall that’s way
out of the range and if you see someone who is 3 feet tall you know that is way out of the range.
So while there are differences in the amount of sleep that people need, as my colleague would
like to say, if you took the amount of people who needed five hours of sleep a night or less, made
that into a percent and rounded it to a whole number it would be zero.
Very few people need that little sleep, even though a lot of people only get that much sleep,
especially during competition season. And when you start talking about student age, like your
age, most of them need 8 to 10 or even 9 to 11 hours of sleep and they’re not getting that.
Me: in both of your research, have you found that it’s easy or difficult for athletes to alter their
circadian rhythms?
Dr. Barger: Well, i think they can if they’re committed to it, But if you’re going to alter your
circadian rhythm or you’re going to use light or counter measures like that, it would take a big
commitment on the part of the person to do that
Dr. Czeisler: you know, it’s like making a commitment to eating healthy: you can either eat fast
food or say you’re going to make a commitment to having a nutritious diet because you’re
preparing for the olympics or whatever. And it’s the same way with sleep. Tom Brady goes to
bed at 8:30 every night during the season. He doesn’t drink, he doesn’t do this, he doesn’t do
that, but he has to get up early for practice and he wants to be able to play until he’s 45. Many
elite athletes...
Dr. Barger: Yeah so I think that people that commit to it… that’s a good analogy about the
nutrition. If you prioritize sleep, then you’ll be able to make changes.
Dr. Czeisler: LeBron James checks into the hotel room at every city he plays in and makes sure
to get a two to three hour nap before every game. So, people can make it a priority so they
perform at their best. So they can make it happen no matter how bad things are but it takes a
commitment. It’s easy to say “oh, i don’t have time”
Me: and do you think it’s more of a lack of knowledge or ignorance about why a lot of athletes
don’t get enough sleep, especially professional athletes?
Dr. Czeisler: Well, we live in a sort of 24/7 society and there are a lot of pressures, and i think a
lot of it is structurally imposed sleep deprivation. Throughout the career of the athlete, say you
have a kid out of college, and they turn pro, and a lot of them burn out in the first year - even
people who are number one draft picks. And a lot of that may be related to suddenly being in the
situation where they have all these games in different cities and they’re flying all night, so the
league requires them to take overnight flights otherwise they get a million dollar fine. So there
are a lot of things that are imposed on the athletes. In baseball, in the minor leagues, they had me
giving sleep talks to them and one of the players came up to me and said, “do you understand
that after each game we have to get on a bus and then we drive overnight to the next city.” And
they’re these school buses for grade school kids, and they’re these big athletes that are like, “we
can’t even fit in these seats let alone sleep, and then we get to the next city.” And that’s all driven
by money; most of these things are, one way or another. So, you’re taking very talented people
and you’re subjecting them to conditions that they can’t really thrive in, which is kind of sad.
Me: I’ve read opinions both that exercise can be good and bad for sleep, which would you say is
the case more often?
Dr. Czeisler:
Dr. Barger: I would say good, if you’re not exercising too close to bedtime.
Dr. Czeisler: Yeah, I would agree. And Laura’s actually done a study on the impacts of exercise
on circadian rhythms.
Dr. Barger: Yeah, we found that exercise was able to help delay the circadian phase. We also did
a study showing that exercise can improve alertness for night shift workers. And I just saw a
review article talk about using exercise to help advance circadian phase in teenagers.
Dr. Czeisler: I didn’t see that, but I didn’t think you found any advances when you did the study.
Dr. Barger: Yeah, we didn’t look for advances but I actually just saw it, I haven’t read it yet but I
thought it was interesting. The timing of exercise can be important in that
Me: Right. ALthough most people say that athletes should get more sleep, do you think that this
is a feasible goal, especially in student athletes?
Dr. Barger: I do. I think that students in general, and student athletes… a couple questions back
you talked about what some barriers are and I think education is really important for students
especially in high school and college about how important sleep is to learning and memory and
their health and performance. I have teenagers and I watch that they say up late doing homework
and things like that but if you take away all of the distractions and improve time management,
then I think people are able to go to school, do their homework, go to practice, and still get 8
hours of sleep.
Me: I’ve read a lot about the short-term effects of a lack of sleep on athletes and I’m wondering
what you both think the most prominent short term effects are.
Dr. Czeisler: The first thing it does is it slows down reaction time. So, our studies have shown
that healthy 18 year olds should be able to respond to something that they see within a quarter of
a second, 250 milliseconds. And when you’re sleep deprived, the average response time triples.
So if you hear the starter pistol and you’re at a track meet, it’ll take you three times longer to get
off the block. In basketball, if somebody throws the basketball, you have to have a really quick
reaction time. And the probability of zoning out completely and having a lapse of attention is
much higher. So that’s what can happen if someone’s not covering the defense or not
recognizing that your buddy’s throwing you a pass. So that’s reaction time. Another thing, and
this is something that very few people realize, that balance and coordination are affected by
sleep. Scientists in Scandinavia were trying to develop using a Wii platform a test for sleep
deficiency, like a traffic stop, just by having you stand on a Wii platform. When you’re sleep
deprived, you can’t maintain your balance and you’re not as coordinated. So that’s obviously not
good for athletes that balance and coordination are impaired. And then, you’re more emotionally
volatile. That can get you technical fouls and your ability to work with your teammates is
degraded because you become more easily angered and your judgement is impaired, all of with
are crucial for sports.
Me: On the other hand, what do you think are the most prominent long term effects of a lack of
sleep on athletes?
Dr. Barger: Probably health related huh?
Me:
Dr. Czeisler: Yes, exactly. It’s during sleep that students release the hormones that make them
grow and that turns students from girls and boys into women and men. So, for example, the
chronic sleep deficiency lowers testosterone levels, and that’s going to interfere with strength
and conditioning and increased injuries. Also, the sex hormones are released during sleep and
that can have effects on the menstrual cycle and other things like that. It also increases the risk of
catching a cold, it degrades the immune system. You have an increased risk of getting the flu and
a decreased antibody response, higher blood pressure, cardiovascular issues.
Me: Why do you think it’s been difficult for researchers to discover more about sleep and its
purposes?
Dr. Barger: I’m not sure exactly what you mean.
Me: Just how sleep is still such a mystery to scientists and why you think it’s been so difficult to
find out more about it.
Dr. Barger: That’s a good question. I don’t know, Chuck maybe you know why we can’t figure it
all out. I mean we’ve come a long way.
Dr. Czeisler: There is a lot of information that is difficult to study. So as William Dement wrote,
a book that he wrote while i was a graduate student called “Some must watch while others
sleep.” So, ironically, to study sleep you also have to be sleep deprived yourself, which is tactic.
And the tools for studying sleep… I mean, the different stages of sleep were only recognized in
the 1950s, which is a relatively short time period. And why did it take until then? Largely
because it’s very hard to be able to track because everyone is asleep when it’s happening. If it
were happening during the daytime, it would be quite another matter, and I think many things
would’ve been noticed sooner. Also it’s set in people’s homes. One of the first people to set up a
sleep laboratory in his house was a very wealthy person in New York named Lewis [i think
that’s what he said] and the brainway recording had just been discovered. So he would have
people over for dinner parties and throw a lavish thing and the price of admission was that he
would record their sleep. Also the famous people would be like, “ok now it’s time for the sleep
recording.” Kind of an odd way to end the dinner party don’t you think? But he had a very fancy
facility that he set up there… but even there they didn’t discover Rapid Eye Movement because
they were too far away from the participants. So it’s also hard to do because you’re trying to
understand what’s happening in a state, and if you disturb the person then that state goes away.
So, collecting blood samples from people while they’re sleeping is an elaborate set of procedures
so that we can get blood samples from the next group without disturbing their sleep. We have
tubes and everything going on, but in and of itself, that’s the project. Everything that you do can
interrupt sleep or make it different than it would’ve been if you weren’t disturbed. I am shocked
myself that some sleep disorders were not discovered earlier. For example, sleep apnea, which is
a particularly lethal sleep disorder, it will kill 40% of people within 15-20 years if they’re not
treated. You would think something like that would’ve been discovered centuries ago. And it’s
astounding to me. But instead, because it’s associated with snoring, people think snoring is kind
of funny. They make fun of it and talk aout it. One of the best case descriptions is in literature
rather than in medicine, which is really odd that you have these descriptions could be in
literature. Then, we see a video of someone with sleep apnea and it’s hard to think that nobody
noticed that this person was choking to death. But in any case, he describes this whole situation
in the New England Journal of Medicine article that considers your sleepiness and some of your
medical complications, but they did not connect the dots between these things, even with those
descriptions. So they’re asking why he’s sleeping during the daytime… unknown… but if
anyone watched him sleep at night, they would’ve seen that he’s choking and gasping, but
they’re not there at night and they come in the next day and ask how the patient is doing… he
turned blue a couple of times during the night or he had this problem or that problem...
Dr. Barger: Sleep apnea is a problem with a lot of football players, especially the linemen that
have such large necks, in the NFL and college and even the big high schools where the linemen
are really big.
Dr. Czeisler: Yeah, I remember I was speaking to an NFL team and one of the linemen came up
to me and said “I wake up in the morning and the sheets are just soaked with sweat, what’s
happening?” I didn’t actually realize that that was a common symptom of sleep apnea but people
are working so hard to try to breathe that it can be more exhausting and create more perspiration
than even in the daytime, and particularly in really big athletes. But the NFL essentially blocked
us from studying it on any of the teams because they have so much bad publicity about
concussions and other health problems. Those people are actively trying to prevent progress. It’s
weird to me that he really had no idea what was going on. We have all these fancy instruments,
but really if anybody just stayed up and watched the person they would see that there’s
something radically wrong going on. A funny thing happened… there was somebody fixing our
furnace and he asked what I did and I said i worked with sleep and he said oh well my brother in
law came over and i’ve been trying to convince him to go to a doctor because he’s up all night
snoring. He fell asleep on the couch in the middle of the daytime and he was snoring up a storm,
choking, and couldn’t breathe and so on… and he whipped out his phone and videoed him. And
when he saw the video of how he was choking and gasping for breath, then immediately went to
the doctor and got treated. So part of the slow progress is that sleep takes place while people are
unconscious, so they don’t know it’s happening. And their friends are unconscious so nobody
knows
Dr. Barger: Nobody is reporting on what’s really going on.
Me: where do you see the next advancements being in the study of sleep in athletes?
Dr. Barger: I would like to see a randomized clinical trial to show improvement in performance
when the timing and duration of sleep are controlled, with consistent sleep timing and longer
sleep duration. I think if you could do a controlled study and show meaningful improvements,
it’d go a long way towards convincing athletes how important it is.
Dr. Czeisler: I agree.
Dr. Barger: Another struggle in this area is that we get funding to do research from, say, the
National Institute of Health, and so when you write a grant proposal, you have to have a
convincing argument of why it should be funded. So you’re competing against researchers who
are looking at curing diseases and important things like that. So some people see improving
athletic performance as perhaps not on the same par.
Me: Well, thank you both so much. That’s all the questions I had, but it’s been very very helpful
for my research.
Dr. Czeisler:
Dr. Barger: I’m glad we could get Dr. Czeisler as a bonus contributor to your project.
Me: Yeah, definitely. It was really cool to read all the articles on him.
*closings*

At the end of the interview, type a short paragraph discussing your opinion on 1. How the
interview went—2. What you would change for your next interview—3. What was easy/difficult
about the interview and/or preparation process?

Reflection
I think that the interview went really well. It was such a surprise that she conferenced in Dr.
Czeisler because he is known in major league sports teams as the Sleep Doctor! He obviously
knew a ton about the topic and helped a lot in my research. Both of them answered all of my
questions with a lot of detail. For my next interview, I would want to focus a little more on
student athletes, but I understand that that is neither of my interviewees main specialty. Also, if I
would've known that Dr. Czeisler was going to be on the call, I would have prepared a couple
more questions specific to his experiences. Once I really contemplated my interview questions
and got the ball rolling, it wasn’t too hard to think of them all. The most difficult part of the
interview process was probably just finding someone to interview, because there are a limited
number of people who focus on sleep in athletes. I’m glad that I was able to find someone and
get the bonus of two of them on my interview call though.