Your Day, Your Way

6:30 AM—Wake up!

Unless you are one of those irritatingly peppy morning people, dragging yourself out of bed is often one of the hardest things you will do on any given day. But when, exactly, should we wake? Does the early bird really get the worm?

My father couldn’t stand the thought of his kids sleeping in. Even if there was no reason for me to get up—school, work, chores—he would burst into my room early in the morning and arhythmically tap his finger on my shoulder, declaring I was “wasting the best part of the day” or that I should “get up and do something useful” (or some other parental-advice cliché). Which only added aggravation to this morning ritual. To this day, I cringe when someone pokes me in that particular arhythmic manner.

Is there any evidence to support my father’s get-the-hell-up commandment?

“For me, when it comes to waking up, consistency is the most important thing,” Professor Satchidananda Panda told me. “In fact, your day really starts the night before with when you go to bed.”

Professor Panda is a researcher at the Salk Institute for Biological Studies in California and a renowned expert on the human circadian rhythm, which is the master biological clock that helps to regulate how our bodies function. He has studied the influence of these daily rhythms in cells, flies, mice, and humans. “We should try to go to bed as close to the same time every night,” he advised. “And we should also wake up around the same time.”

It was at night that he passed along this sleep advice to me. He had a glass of wine in his hand and a smile on his face, so there was a tinge of irony to the recommendation. We were both speaking at an academic conference in Santa Barbara and, at that moment, we were enjoying some post-event downtime. Earlier in the day Professor Panda had presented his compelling research on how ignoring our circadian clock can have a profound effect on our well-being. “Of course, being consistent can be very difficult,” he continued, raising his glass.

Numerous studies back up Professor Panda’s assessment of the value of a consistent sleep pattern. Much of this research has been done on university students, a cohort not known for adherence to a strict sleep schedule. One 2017 study of undergraduate students found that those with irregular sleep patterns had lower academic performance. Another 2017 study of more than 100 undergrads found that sleep regularity was associated with increased general well-being. Not surprisingly, being consistent with your turning-in schedule is also associated with sleeping longer and better, and not just for chronically exhausted students. A 2018 Australian study of over 300 elderly individuals—a demographic that often struggles to sleep well—determined that sleep regularity can help people get the recommended amount of sleep, which, for most adults, is around seven hours a night (though there is significant variation). An irregular sleep schedule has also been linked with poor dietary choices and weight gain.

So, was my father right? Was his exasperating finger-poking wake-up strategy doing me good by keeping me on a consistent sleep schedule?

Not exactly.

Studies have found that morningness is correlated with such things as greater life satisfaction, academic performance, and workplace productivity. Indeed, waking early is often seen as a successful approach to life. It is what winners do. It is what hard-driving executives do. Apple CEO Tim Cook reportedly wakes at 3:45 AM. When she was first lady, Michelle Obama woke at 4:30 AM. Quarterback Tom Brady is watching football film at 5:30 AM. And actor Dwayne “the Rock” Johnson is in the gym, lifting ridiculous amounts of weight, at 4 AM.

But from a health and productivity perspective, this is not, contrary to the pop culture push, a good way to organize your life—at least for a significant portion of the population. There is a remarkable disconnect between the accepted wisdom and what the research tells us about when to wake. Some researchers have even suggested that our entire society has set the work clock wrong. Dr. Paul Kelley, a researcher in sleep, circadian, and memory neuroscience at Open University in the U.K., argues that we should reconfigure when we start work and school, because our bodies have a natural biological rhythm that does not fit our current timetable. Given that some of us are morning people and some are night owls, Dr. Kelley believes that for a large hunk of the population, starting work at 10 AM, which is pretty darn late for many of us, would actually increase productivity. Getting up too early—a near-universal norm, Kelley argues—messes with our brain in a manner that reduces creativity and increases the risk of mistakes. It may also contribute to mood problems, weight gain, and a decrease in life satisfaction. In some jobs, it can create work site safety issues.

“I’m actually an extreme morning person,” Dr. Kelley told me. “I love the morning. The light. The quiet. And I’m a train wreck by 8 PM. Yes, I am fully aware of the paradox. I am advocating for social change, despite the fact that I benefit from the current situation. But given all the evidence, it is the right thing to do.”

The fact that morning people, including Dr. Kelley, seem more successful may simply be the result of our society’s being structured to benefit morningness. The alleged advantages of being an early bird are deeply ingrained. Rising early is almost always portrayed as a virtuous and noble act. If, on the other hand, you wake later than what is generally considered a reasonable time, you are viewed as lazy or unmotivated. (Studies have put the average wake time in the U.S. at 6:37 AM, though there is considerable country variation, with Slovenia waking at 6:02, Canada at 6:50, and Argentina at 8:44.) And think of all the famous quotes and aphorisms espousing the value of waking early. Thomas Jefferson said, “The sun has not caught me in bed in 50 years.” Aristotle advised, “It is well to be up before daybreak, for such habits contribute to health, wealth, and wisdom.” And Benjamin Franklin’s singsongy version of that same prescription is perhaps the most famous of all: “Early to bed and early to rise, makes a man healthy, wealthy, and wise.”

Can you think of a single saying promoting the idea of staying in bed a wee bit longer? Perhaps we should make up a few. How about, “Those who sleep in are destined to win!” Or, “Midmorning waking and a productive day you will be creating!” Maybe, “Ignore the clock and finish on top!”

During our discussion, Dr. Kelley suggested that in most of the world there is a systemic bias against eveningness. Some people are, through no fault of their own, at a distinct disadvantage because they aren’t wired to embrace the morning. “There has long been an assumption that everyone is good with an early start time,” he said, clearly frustrated by the situation. “This is simply not true! This bias can have real negative consequences.”

Your propensity to rise early or not—that is, your chronotype—is largely determined by genetics. A 2017 analysis of genetic data, including an analysis of twins, concluded that genetic factors explain up to 50 percent of your chronotype. Brain scans have also found structural differences in brains associated with different chronotypes. So it is safe to conclude that much of when you wake up comes down to born-with-it biology. This means changing it significantly—that is, forcing yourself to become a lover of the early AM—isn’t easy or even advisable. My friend and colleague Dr. Charles Samuels, the medical director of the Centre for Sleep and Human Performance at the University of Calgary, told me that it is possible to shift your chronotype slightly, perhaps an hour or so, if strategies are applied consistently—and the core strategy is, again, being consistent.

Although it isn’t a character flaw to not be a morning person, a 2018 study of more than 400,000 people did find that being a night owl “was associated with a small increased risk of all-cause mortality.” But, again, that may be because the schedules of modern societies are structured around the morning-works-for-everyone assumption. A 2018 study explored the relative contributions of hardwired biology and lifestyle factors to the health risks associated with being a late-night person. The researchers concluded that the health risks were caused, not by the biology that creates the propensity to stay up late, but by the behaviors associated with those late nights (such as late-night eating, poor sleep, and being sedentary). This is good news, as these are modifiable behaviors, especially if accompanied by social changes that allow for a bit of flexibility to accommodate different chronotypes.

Why and how chronotypes affect our health are a complex puzzle that researchers are still trying to figure out. For the purpose of our day-to-day decisions, the important point is that there is now a broad consensus that chronotype does matter to our health and well-being.

There is even more evidence to suggest that the biological clocks of teenagers are ill suited to the current daily schedule. A 2017 study followed over 30,000 students for two years and found that starting school later was associated with an increase in grades, more successful graduations, and, not surprisingly, better overall attendance. Dr. Kelley points to evidence that indicates that later start times could increase academic performance by as much as 10 percent. And allowing teenagers to sleep more can have other social benefits. Brain imaging research from 2013 concluded that when teenagers don’t sleep enough—which is the case for approximately 80 percent of them—their inhibitions are reduced even more than usual for teens, resulting in greater, and possibly dangerous, risk-taking behavior. This is why many scholars, including Professor Kelley, have been pushing for later start times for school. And as the evidence mounts to support his position, we are seeing jurisdictions throughout the world take this issue more seriously. A 2017 study from the RAND Corporation concluded that using later school start times would contribute $83 billion to the U.S. economy within a decade, primarily through better academic performance (which, they predict, will create more productive citizens) and reduced traffic accidents caused by sleepy adolescents and parents. I wish I could time travel this data back to the 1980s and hand it to my shoulder-tapping father.

While debates continue about moving school start times and reconfiguring our culture’s approach to work schedules, the takeaway from the research is pretty straightforward: get a sense of your own sleep rhythms (your chronotype), if possible adjust your schedule to fit that rhythm, and try to be consistent.

How do you figure out your chronotype? You probably already know what it is. Simply ask yourself, “Am I a morning person?” Of course, scientists have a more systematic approach. A 2018 study from the U.K. examined the chronotypes of almost a half a million people. It found that 27 percent of the population are definite morning types, 35.5 percent are moderate morning types, 28.5 percent are moderate evening types, and 9 percent are definite evening types. This was determined by using the well-known Morningness-Eveningness Questionnaire. The survey, which anyone can take (it’s easy to find online), was developed in 1976 to get a sense of where people sit on the chronotype continuum. Its questions seek to discover when you are at your “feeling best” peak. (The test categorized me as a “moderately morning type,” which seems exactly right.)

I know, I know. “Live to your chronotype” is the ultimate “easier said than done” advice. Many people do shift work, and many others have to be at work at 7 or 8 AM. Others need to get up early because they have young kids who require the presence of a semiconscious adult. But while we can’t all craft our wake-up time to exactly fit our chronotype, the advice still has relevance.

Do not feel compelled to conform to the “early is always better” stereotype. You are not the Rock (unless you are, in which case, I loved Furious 7!). Everyone is different. Do your best, within the constraints imposed by the realities of your life, to find a rhythm that works for you. Second, and perhaps most important, be consistent. Find a groove you can maintain.

But don’t let the drive for consistency get too regimented. Relax, dammit! “Yes, it is better to be consistent with sleep and wake times,” Dr. Panda told me. “At the same time it is also important to get enough sleep.” If you are tired, sleep in a bit. Give yourself about an hour or so wiggle room. In fact, there is evidence that, if done only occasionally and only for a short time, a good weekend sleep-in can help a tired body recover. Consistency is key, for maintaining both health and a restorative sleep schedule. You shouldn’t use the weekend sleep-in as a long-term sleep strategy.

But, as Dr. Samuels emphasized, it is all about finding your particular rhythm. When I asked him about all the sleep advice floating around, he said, “Don’t be a fool. Don’t apply someone else’s routine to yourself. Don’t adopt a pattern that is Tom Brady’s. That may be completely contrary to what will work for you. There is no magic routine!”

So for now, relax about that wake time. You don’t need to get up with Tim Cook at 3:45 AM.

6:31 AM—Check phone

Don’t.

A 2015 study found that for most people in the U.S., their smartphone was the most important thing on their minds when they woke—not coffee, dressing, or even their significant other. It is no surprise, then, that 61 percent of us check our smartphones within five minutes of waking. About half of us check the moment we wake. For millennials, that number is 66 percent. There are two problems with this behavior.

First, you may end up texting or emailing or tweeting or Facebooking something you will deeply regret. When you first wake up, you are consumed by what is known as sleep inertia, a state of decreased cognitive function. Your brain is just getting warmed up and isn’t yet working at full capacity. And it is the higher brain functions, the ones that will stop you from writing a cringeworthy text, that are the last to come online.

Second, checking your phone immediately may not be a great way to start your day. Compulsive phone checking is associated with anxiety and stress. Give yourself a bit of time before you dive into the sea of emails, direct messages, Facebook posts, and text messages.

In fact, make the decision the night before to place your phone in another room before you go to bed. This is probably the best way to avoid starting your day with an email kerfuffle or creating your own “covfefe” Twitter catastrophe.

6:35 AM—Brush teeth

The Egyptians first used toothpaste, likely applying it with a twig or finger, around 5000 BC. Toothbrushes have been around since roughly 3000 BC. The first bristled brushes—with bristles from the necks of pigs—emerged in China around AD 1600. Brushes looking somewhat similar to the ones we use today have been mass-produced since 1780. And while most North Americans didn’t start brushing regularly until after WWII, spurred on by soldiers who brought the habit back from Europe, oral health is now a multibillion-dollar industry involving high-tech toothbrushes, a dizzying array of toothpastes, flosses, mouthwashes, and whitening products, and a host of fancy cleaning contraptions. But despite this long history and strong social commitment to our teeth, the evidence surrounding the benefits of many of our oral health practices is remarkably equivocal. Indeed, there is surprisingly little good research to support much of what we do to our mouth and teeth. Morning breath can no doubt have a serious impact on our personal interactions. But what should we really worry about when it comes to our morning routine?

I will tackle some of the science surrounding oral health at the end of the day, because that is when most experts agree you should do the bulk of your teeth maintenance. But the morning bathroom stop is the perfect time to consider the growing concern about fluoride and the fluoridation of our water.

This is a good example of the influence of fear and even misinformation. Some jurisdictions in the developed world, such as Calgary, Alberta, have decided to stop fluoridating their water supply. A 2015 study in the Canadian Journal of Public Health notes that “opposition to water fluoridation is witnessing a vigorous comeback.” Celebrities such as Dr. Oz have given the anti-fluoridation advocates a voice. And it is a common theme on fake news websites. NaturalNews, one of the most notorious purveyors of health nonsense, featured an absurd article with the false headline “Hundreds of Brave Dentists Speak Out Against Water Fluoridation.” And there has been a growth in anti-fluoridation advocacy groups that have pushed the circulation of theories—not supported by convincing evidence—that fluoride in water has lowered the IQs of children and caused various kinds of cancer.

As is so often the case, much of the public’s angst associated with the fluoridation of our water supply seems to have started with bizarre conspiracy theories. Do a quick web search for “fluoridation” and you will find people suggesting that it is associated with communists, Nazis, and/or the Illuminati. One common theory is that governments put fluoride in the water to tranquilize the population. It is, the theory goes, a way for governments to produce a more subservient citizenry. A farfetched idea, you might say, but a 2013 study found that 9 percent of Americans believe this to be true and another 17 percent are not sure. Those are pretty shocking numbers. Over a quarter of the population is open to the idea that their government has been systematically sedating the entire population for decades.

Another anti-fluoride meme declares that fluoridation started with Hitler and Stalin as a way to sedate the inmates of concentration camps. This stuff is patently absurd, both historically and scientifically, and is likely believed by only a small number of those concerned about fluoride in our water. Still, studies have shown that the mere exposure to conspiracy theories, even utterly bizarre ones, can distort public perceptions.

Conspiracy theories can serve as the original source of a health concern—in effect, giving life to a false claim that fluoridation is harmful. After the concern takes root, it can become associated with more mainstream and intuitively appealing ideas. In the case of fluoridation, these may include the belief that industry has had an inappropriate influence on the research or that, regardless of how efficacious fluoridation of the water is, it is an infringement of individual rights. Those are both ideas worth considering, but they are grounded more in ideology and personal branding than in evidence-informed decision-making.

And because the conspiracy theories about fluoridation are so bizarre and extreme—Hitler, mind control drugs, and a massive government cover-up are all involved—they are memorable. Even if you don’t believe the core ideas, their existence helps to keep the general concern about fluoride in circulation and easy to recall. And, as we’ve noted, a significant body of research shows that the easier something is to recall and the more often you hear it, the more plausible it feels. Perhaps only a few believe the Hitler or mind control myths, but all the “noise” about fluoridation may nudge people to choose, for example, a fluoride-free toothpaste. And it appears that all the noise influences perceptions of benefit and safety. A 2015 survey of Americans done by the Centers for Disease Control and Prevention (CDC) found that a relatively large minority, 27 percent, believed that community water fluoridation had no health benefit, and only 55 percent believed it was safe.

But should we worry about fluoridation? Is there a vast conspiracy to use fluoride to anesthetize the population? Though research continues and we should regularly revisit the science, when it comes to an assessment of benefit and safety, the research is pretty darn consistent. As noted in the government of Canada’s 2016 position statement on fluoride, “Community water fluoridation remains a safe, cost effective, and equitable public health practice and an important tool in protecting and maintaining the health and well-being of Canadians.”

A 2018 study funded by the U.S.’s National Institutes of Health, involving 7,000 children aged two to eight and more than 12,000 older children and adults, also confirmed the substantial health benefit of community water fluoridation, particularly for children. While too much fluoride can have adverse effects, such as causing white specks on teeth, the amount added to drinking water for public health reasons is well within safe limits. But the adverse impact of stopping a fluoridation policy is greater. Indeed, in jurisdictions where fluoride has been removed, such as Calgary, the rate of tooth decay has increased significantly. Given this kind of data, it is no surprise that the CDC has declared community water fluoridation to be one of the top 10 most successful public health interventions in history.

When it comes to fluoridated water, the bottom line is clear: the evidence of benefit is solid and the evidence for harm is weak. If your community embraces fluoridation, be thankful and relax.

But let’s bring it back to your morning brush. Should you use fluoride toothpaste? Here again the answer is clear: yes. A comprehensive review of more than 70 clinical trials involving over 70,000 kids confirmed the “benefits of using fluoride toothpaste in preventing cavities in children and adolescents.”

In fact, from a health perspective, the presence of fluoride is really the only reason to use toothpaste. This point was made to me by Dr. Grant Ritchie, a dentist, writer, and vocal advocate for science-based approaches to oral health. He is, no surprise, a fan of brushing. “It is the mechanical action of the bristles removing the plaque that confers most of the benefit,” Dr. Ritchie told me. “The main benefit of toothpaste is as a fluoride delivery system.”

Despite this, many “natural” and “organic” fluoride-free toothpastes are on the market. Beyond possibly helping your breath smell organic-y, these products are likely totally useless. Indeed, I could not find a single study to support their use. One study, on charcoal toothpaste, noted a complete lack of good research. Dr. Robert Weyant, a professor of dental public health at the University of Pittsburgh, agrees with my assessment. “Don’t fall for the naturalistic fallacy,” he said. “These ‘natural’ products—and, by the way, ‘natural’ is never defined—are an example of marketing trumping science. There is no evidence they are effective. I would completely discount their value.”

Dr. Weyant believes the public is subjected to a huge amount of misinformation about dental care. Taking care of your teeth is important, but, as is so often the case, it really comes down to focusing on the basics. “Eat a healthy diet, don’t smoke, and brush your teeth twice a day with a fluoride toothpaste,” he told me. “After that, everything else is secondary. If you live in a town with fluoride in the water, that is an added bonus.”

(If you are wondering about what type of toothbrush to use, soft bristles appear to be somewhat safer—that is, they are less likely to cause injury—and there is some evidence electronic toothbrushes might be better for avoiding gum disease. But there isn’t a ton of good evidence. A 2014 study found that “bristle design has little impact on plaque removal capacity of a toothbrush.”)

It is worth noting that there is, in fact, no magic to brushing in the morning. The evidence tells us that you get the most benefit from brushing twice a day—again, primarily because of the delivery of fluoride—but no added benefit by brushing more often. And most experts agree on the importance of brushing at night, right before bed. “This is primarily because it allows fluoride to hang in your mouth, doing its job all night long,” Dr. Weyant explained. So you don’t have to brush in the morning, though there is an obvious morning-breath mitigation benefit associated with an AM scrub. So if you work with me, please brush!

6:40 AM—Check phone, again

Don’t. You probably will. But you shouldn’t.

It is remarkable how quickly smartphones have altered the human experience. Apple’s iPhone was released in 2007, and since that date, smartphones have resulted in a staggering change in how we engage with the world. Some estimates suggest that the average person checks their phone over 100 times a day, looking at the device every 10 minutes or so. And we “touch” our phone—that is, perform some kind of function on it—in excess of 2,500 times a day. Crazy! A 2018 study found that people check their phones 80 times a day while on vacation. On average, we spend over four hours a day staring at these devices. That’s 120 hours a month, equivalent to a pretty serious part-time job. About half of us check our phones—usually email first—before we even get out of bed.

So, for sure, most of you will check your phone at least twice (or maybe 10 times) between waking and breakfast. My guess is you are doing it on the toilet. If you believe 2016 market research, 75 percent of people check their phone while sitting on the toilet and about 40 percent read and send emails on the toilet. (Think about that the next time your coworker sends you an early-AM message.) This might explain why 19 percent of us have dropped our devices in the loo. It is also one reason, according to a 2009 study, that 95 percent of smartphones are contaminated with various forms of bacteria. (Think about that the next time someone asks you to take a picture for them!)

Despite the ubiquity of the early-AM phone check, there are good reasons why you shouldn’t check your phone so frequently. I will tackle these later in our hypothetical day. For now, put down the damn phone.

6:45 AM—Step on the bathroom scale

People are stressed about their weight. A lot. One 2014 poll found that 21 percent of women worry about their weight all the time and 34 percent worry about it some of the time. Another 2014 survey of 2,000 Americans found that three in four adults “feel like they could always lose some weight.” And this isn’t just a North American phenomenon. A study from France found that about 45 percent of all Europeans are concerned about their waistline.

All this stress about our mass has led to a serious amount of (largely futile) dieting—and an enormous $220 billion weight loss industry. One estimate suggests that the average woman will go on 61 diets before age 45. And the number for men is increasing. The 2014 survey noted above found that 63 percent of American guys “always feel like [they] could lose weight.” It is not surprising, then, that the weight loss industry is increasingly targeting men (and doing their best to stoke weight-loss anxiety). Companies like Weight Watchers have turned to male spokespeople, including retired football stars, to push their products on the segment of the population that has been, until recently, largely ignored by the dieting industry.