To Dr. Tony Masri, neurologist and co-founder and CEO of Helyx Health, sleep is the bedrock of life, and the quantity of sleep — along with the quality — is intertwined with our longevity. During his presentation in the “Fueling Longevity: Nutrition and Sleep” session at DOC 2025 with Dr. Valter Longo, Dr. Masri asked who among the DOC community used an alarm to wake up in the morning That question was telling: Those who don’t wake up naturally are fighting their bodies — and potentially harming their longevity.
“If you’re using an alarm in the morning, you’re not getting enough sleep,” he says.
In addition, while we might think we’re helping ourselves by catching up on sleep during the weekends, it might not be sufficient. The data shows that sleep debt is like money debt: if you lose an hour of sleep each weekday, you need to pay off the full 5 hours on the weekend. Sleeping in an hour on the weekend days is not enough. Further, those clocking in fewer than seven hours a night see their long-term risk of mortality go up by 12 percent. (Sleeping more than 9 hours increases your risk increases further, to 30 percent). These poor-quality events, including insufficient REM cycles, can increase mortality risks such as cardiovascular events.
To Dr. Masri, optimal sleep operates like a metronome, where regular cycles — when we go to bed, and when we wake up — dictate our routine, and “ultimately will lead to the best sleep,” he says.
You can hear more from Dr. Masri’s talk in the video or read our lightly edited transcript below.
TRANSCRIPT:
Dr. Tony Masri
Sleep. The fountain of youth is in the bedroom. This is actually a quote from, Bill Damon at Stanford, who discovered REM sleep and started the first sleep clinic. Does anyone know this artist. No art history majors here? It’s kind of obscure. On the right, this is, William Blake, “Jacob’s Ladder.” from 1800s, depicting Jacob lying down, sleeping, and then the angels going up and down stairs. Then we go back to the other one on the left. This is very much the oldest, painting or the oldest cave art that we know from humans back 44,000 years ago in Indonesia. What it depicts is, depicts a creature that’s part human, part animal chasing wild pigs. What anthropologists tell us that the first time humans really started thinking or realizing that they can be outside of their body and look at themselves in a 3D fashion, was through dreams.
When we sleep, we discover things about ourselves. Sleep has been teaching us things about ourselves, from the spiritual to our physical well-being, to our mental health, etc. and the extent that sleep tells us about our state, our wellness, our disease process, what’s happening with us is the extent that we can measure it, and to the extent we can be curious about it and our tools and technology.
Over the years, we we’ve been observing people sleep ever since the dawn of humanity. We start out with observation. Clinically we know, for example, that, Cheyne-stokes, discovered by watching patients who have heart failure, in the middle of their sleep and seeing these agonal breathing. Then we fast forward after that in 1924, Hans Berger was a German psychiatrist, used the first EEG on humans and saw the squiggly lines and scribed them as alpha waves and beta waves. Interestingly was a psychiatrist. Then about ten years later, another researcher Nathaniel Kleitman, who was very influenced by the work of, Freud, decided to study sleep as a way of understanding human consciousness, and then came to New York and later on to the University of Chicago, and became the first full time researcher dedicated to the understanding of sleep, sleep, physiology, etc., and was very much into it.
He spent a month in a cave underground. He fasted for several days. He kept meticulous notes of his daughter from the time she was an infant until she was 20. He was super dedicated to that and he was using basically, he took that EEG from Hans Berger and then he would record patients’ EEG throughout the night. For every night, it would be about a half a mile of paper recording for all these squiggly lines, almost as long as a CVS receipt. So then came Bill Dement, who was one of his mentees, and they worked together and they discovered REM sleep. Bill Dement went on to Stanford to establish the first, sleep clinic. And then we start understanding sleep quality. We first start looking at sleep quantity, then sleep quality. That probably some engram showed up. Then we started looking at what happens when we sleep. We discovering diseases like sleep apnea. We understood the impact of sleep apnea and cardiac disease. And as our technology improved, then we started unraveling ideas and understanding the timing of sleep. We fast forward to data population in the last, 10, 20 years, which tells us a lot about timing.
First I’ll start with quantity of sleep. Everyone asks, What’s the exact time I need to sleep. What’s more important is are you sleep deprived? How many people here use an alarm to wake up in the morning? Less than I thought. If you’re using an alarm in the morning, you’re not getting enough sleep. That’s a better way to ask that question. If you’re sleeping in on the weekend for more than an hour, you’re not getting enough sleep. So what does the data show us? When we look at a meta analysis, for example, from 2010, they looked at 1.3 million people and looked at, longevity. If you sleep less than seven hours, your long term risk of mortality goes up by about 12%. If you sleep more than nine hours, then your, longevity is impacted by all risk mortality goes up by 30%. You know, I said 24% last, it was actually 30%. So sleep. As much as we want to sleep to be better and have better longevity sleep, it also can tell us as a sign about what’s happening.
This is a sleep wake cycle. This is what we call that a hypnogram. Before anyone pulls their, wearables starts comparing, no one looks exactly like that, the same way no one is exactly at 120 over 70 pressure all the time. So there are variations, that are normal variations. But what that tells us is primarily that you get more deep sleep the first half of the night, you get more REM sleep the second half of the night. We used to think that you only dream during REM, but you also dream during deep sleep.Instead of having vivid, colorful video like dreams, you know it’s black and white and pictures.
What happens when we have poor quality sleep? Looking at a large data set of about 300,000 people, with a group of 150,000 of them where we were able to match, primary care data, whether there are other diagnoses, patients who reported poor quality sleep, they just felt that they’re not refreshed, they scored high on sleepiness scale, they were had two years less of cardiovascular free years. Some of these cardiovascular events, about 20% of them, led to death. Those who had sleep apnea had about seven years less of cardiovascular disease free years. So it’s not just a matter of mortality. It’s a quality of life and complications. For insomnia, four years. The data was mostly consistent between men and women. So it’s very important.
The other data set is from Emmanuel Mignot, he looked at probably one of the largest data sets of patients who come in, get a blood lab, does a detailed questionnaire. He shows that about 5% reduction of REM sleep increases, mortality by about 13%.
This is one of my favorite, slides here, and it shows I know if you have the last slide said, but this is from, Brian Murray in Toronto, where they did something interesting. They went and looked at normal controls. We used to think that when patients get older, basically, you start having poorer sleep, you wake up more often, your sleep actually is reduced. But in reality, what they did in this interesting study, they went and looked at all the normal controls from various studies, They were able to pull 5000 normal PSGs (polysomnography), which are actually rare to find. They said, how does our sleep change? What I love about this study is it changed our thinking in the last ten years. We actually found out that on average, we sleep about ten minutes less every decade, starting from our 20s. So when you’re when you’re 40, sleepy about 20 minutes less. When you’re 60, it’s about 40 minutes less. However, at the same time, you’re amount of deep sleep and REM sleep as a percentage, which is usually about 20 to 25%, does not change very much.
As physicians, it’s important for us to ask the question if our patient is sleeping, or not sleeping as well as they get older, it doesn’t mean that they’re just older and we ignore it. We need to look for underlying causes that can cause them to have less sleep. We really pay attention. Where I look first is I look for typically sleep related diseases like sleep apnea, periodic movement, restless legs, insomnia, etc. The next thing we look at in non-directly sleep related conditions like depression, mental health, chronic pain for example, hormone changes in women. Then you look after that for wellness. Is your patient exercising enough? Are they eating well? Is their sleep wake cycle consistent?
The next study here. So I told the importance of quantity, qualities. Even more important than quality. This is a very interesting study looking at, about 60,000 patients or 10 hypnographies. Now we’ve gone from observations and not population data, and they looked on average about a week. Regularity, having a regular sleep wake cycle is actually just important, not just as important, more important than getting enough sleep. If you look here, the white the three white boxes, if you are the most, if you have the most irregular sleep wake cycle. Now you can actually look at your wearables. So at the bottom of the X axis is the timing in each of these black bars is this day. If you’re going about a different times at different days, the more irregular that is you can increase all-risk mortality can go up by as much as 40%.
Speaking of AI, I asked AI to make a basically an art piece. Summary slides. I took the slide from the previous study, fed it in it, and I was like, make me a slide. You can see the art here. I actually tried several of them. Not exactly the best art. So can AI really tell the story?
Take homes. We cannot achieve optimal, health span in lifespan. Obviously, without optimal sleep. Problems are common. Universal, more or less. But the solutions are unique and tailored. You can have apnea, insomnia, you can have disrupted sleep like everyone else. But the solutions should be individual and personalized for every for every patient. And then best sleep is organic. Your bedroom should look the same as it looked hundreds of years ago, and then you have to be very deliberate about what you bring back in, whether it’s technology, TVs, obviously we’ve determined that’s not good in the bedroom. Having, natural fabrics, seeing the temperature change naturally, that ultimately will lead to best sleep.