Overcoming insomnia: improving sleep hygiene and treating disordered sleep with cognitive behavioral therapy for insomnia | Ashley Mason, Ph.D.

**Peter Attia** (0:11)
Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. My guest this week is Ashley Mason. Ashley is an associate professor at UCSF, where she leads the Sleep, Eating, and Affect Laboratory. Her research focuses on non-pharmacological interventions for mental health, particularly exploring how treatments like whole body, hyperthermia, mindfulness-based approaches can improve mood disorders, sleep, and eating behaviors. She's also the director of UCSF's Center for Obesity Assessment, Study, and Treatment, known as COAST. Her work integrates clinical psychology with integrative medicine, aiming to develop accessible treatments that address the biological and behavioral aspects of health. In this episode, we focus almost entirely around one area of her expertise, which is cognitive behavioral therapy for insomnia or CBTI. Ashley gives us a master class exploration of CBTI, including various methods, including time in bed restriction, stimulus control, and cognitive restructuring to combat insomnia. We speak about how to manage racing thoughts and anxiety, and Ashley shares techniques like scheduled worry time to address stress during the day and prevent sleep disruption at night. We talk about the impact of temperature regulation and the role of warming extremities and optimizing sleep environments for effective sleep onset. We discuss behavioral and cognitive interventions and the impact of leveraging small actionable changes in thoughts, feelings, and behaviors to overcome patterns of insomnia and other mental health challenges. Ashley shares some sleep hygiene fundamentals, addressing blue light exposure, food, and alcohol intake, and creating bedtime routines for better sleep. She provides practical tools for tracking progress, like using sleep diaries and A-B testing to identify and refine effective interventions. Then we explore the potential for AI and digital tools to democratize access to CBTI and address the growing demand for sleep therapy. So without further delay, please enjoy my conversation with Dr. Ashley Mason.
Hey, Ashley. Thank you so much for coming to Austin to talk about a lot of interesting things. Let's start with the one that I think everybody listening can probably relate to at least once, which is insomnia. Where did your interest in insomnia arise?

**Ashley Mason** (3:20)
Well, I've been interested in sleep for a long time. I was fortunate to go to the University of Arizona for my doctoral work. When I was there, the late Dick Bootson was also there, and he's one of the co-inventors of cognitive behavioral therapy for insomnia.
I think I found it particularly interesting because it works so well. We have so many different psychological treatments, and they all have varying degrees of efficacy and effectiveness. The thing about cognitive behavioral therapy for insomnia is that it's like a recipe. If you do it, it works. This was always just so interesting to me because it was so different than so many other psychotherapies out there that had just so much more unpredictable outcomes. I would say that I became much more interested in it after my post-doctoral work. When I had gotten to UCSF, I was a post-doc at UCSF, but I started my assistant professorship at UCSF, and there was this gaping hole in treatment availabilities for people with insomnia. And I thought, oh, this might be a good way for me to get back into some clinical work. I was doing just research at the time. I fell back in love with it because there's almost nothing as rewarding as being able to see a patient seven times, and that seventh time have them say something to you along the lines of, I have my life back. I'm going to go get my driver's license back. I'm not afraid to drive with my kids in the car anymore. I'm going to go back to work. I have my life back. Not much better than that. And so I grew the clinic that I do CBTI in, and now I just love it so much that I do it on top of my job. Like I do it at night with patients after hours because it's the most rewarding thing and you can have such a big impact and people need it.