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Scot: We need a theme song. Do you know that?

Troy: I know. We do.

Scot: Maybe I could sing one for us?

Troy: Can you compose one?

Scot: Yeah, sure.

Troy: Yeah.

Scot: Men's health. Talking about men's health. Who wants to talk about men's health?

Troy: I can't take off on that.

Sleep Gadgets Are Not the Same as a Sleep Study

Scot: Troy, I've got a question for you. What was your sleep score last night?

Troy: You know, Scot, I did not calculate my sleep score. I know you're really into scores, but if a good score is 100, mine was probably about negative 10.

Scot: Oh, okay. I had an 83 according to my Oura Ring that I wear.

Troy: That's passing. That's something you should be proud of.

Scot: Yeah. So actually, I wanted to talk about sleep tech a little bit because a lot of these devices . . . I have a Fitbit that tells me what my sleep is like. I have this Oura Ring, which tells me what my sleep is like. And I was just curious, you know, is this information useful? I mean, am I any better off than you? You know, I've got this information you don't.

So to help sort that out, I brought in Dr. Kelly Baron. She's a clinical psychologist with specialty training in behavioral sleep medicine. She's also the Director of the Behavioral Sleep Medicine Training Program. Look at my pretty graph. How does that look? Does that look all right?

 

Dr. Baron: Well, help me understand what this graph is supposed to be telling me.

Scot: Okay, yeah.

Dr. Baron: Orient me here.

Scot: So the white . . . now, on the Fitbit it's red, but on this Oura Ring, it's white, is that the times I woke up during the night. This middle line where I tend to live here, this blue line, is light sleep, and I get mostly light sleep. REM sleep is these little guys towards . . . I think this was after I hit snooze. I finally had some dreams this morning. And then deep sleep is these deep ones here that go below the line.

Troy: So your graph here, it shows you, basically, in REM sleep almost all night.

Scot: No, light sleep.

Troy: Light sleep?

Scot: Yeah. Last night, I only got 34 minutes of REM and 41 minutes of deep, and that stresses me out a little bit.

Troy: See, that would just stress me out if I saw that. I'd look at that . . . I'd probably keep looking at it every time I woke up during the night and I would just think, "I am not getting deep sleep. I'm not getting REM sleep. I need to sleep. I need to sleep. I need to sleep." So I think it would just stress me out.

Scot: So, Dr. Baron, help me understand. Should I take this with a grain of salt or is this some good information for me or what?

Dr. Baron: Well, how do you feel when you look at this graph?

Scot: Well, the deep sleep thing stresses me out because it tells me that I'm getting below average, for somebody my age, deep sleep.

Dr. Baron: So your ring is measuring your sleep how? Do you think it's measuring the movements?

Scot: So it's measuring movement and it also measures body temperature, whereas the Fitbit is just movement, I think, and heart rate.

Dr. Baron: And heart rate.

Scot: For this as well, heart rate.

Dr. Baron: And then have you seen any validation of this sort of data?

Scot: That's why you're here. I'm looking for validation from you.

Troy: We need to validate you, Scot.

Use Your Gadgets as "Time in Bed Monitors"

 

Dr. Baron: Well, you know, there are so many tech sleep gadgets out there and there's not a lot of published evidence for most of them. And a lot of it is proprietary algorithms. So, you know, I wouldn't say that we know what these are actually measuring. I mean, I've had patients bringing graphs to me that aren't even labeled. And I'm like, "You're stressed out by this graph, but I can't even tell you what it's telling you."

So, you know, I like to think about these things as time in bed monitors, at least. I mean, they can really measure like when you laid down and when you got up for the most part, but can it tell sleep stages? I'm not sure we really can say that at this time.

Scot: So I'm looking at this light sleep, REM sleep, deep sleep, there's probably no way that that's accurate?

Dr. Baron: Hard to say. I mean, your graph right here doesn't look like a graph you'd see in a sleep study. So, in a sleep study we do in the lab, sleep is measured by EEG. That's how you define sleep stages, by the EEG signature.

Scot: And that's brain waves.

Dr. Baron: Brain waves, right. And, you know, there are several electrodes, you know, put on your scalp also measuring muscle tone and eye movement. And so what you're going to see across the night is alternating between REM and non-REM sleep. In the beginning of the night, you have a short period of light sleep and then you go into more deep sleep in the first third of the night. And then the amount of REM you have increases in each of these 90-minute periods over the night.

So, you know, in that regard, your graph does show that you have your greatest amount of REM in the early morning hours. That's what we'd expect. But otherwise, it doesn't look like we'd expect to see in the lab.

For example, it shows that you didn't wake at all between 12:00 a.m. and 4:00 a.m. In a normal sleep period, you're going roll over. You know, most people would get up once or twice in the night, and it's not picking that up. So it's probably not sensitive. And if anything, it might even be overestimating your sleep. And I really wouldn't trust the staging of it.

But on the other hand, I always look at the staging and I think it makes a pretty picture. But then you're thinking like, "What am I going to do with this information?" So, you don't get as much deep sleep as what it says, so I don't have an intervention for deep sleep.

Scot: There's nothing you can do about it even if I came to you and said, "I need more deep sleep"?

Dr. Baron: Well, there's a lot of variation between how much . . . what percentage slow-wave sleep you're going to get per night. You know, on average, it's somewhere between 3% and 10% in adults. But there are some people, especially older men, who might get 0% of deep sleep, and that's just normal sleep in an older adult. So it really doesn't mean anything is wrong with your sleep if you're not getting what this says you should be getting for deep sleep.

Scot: All right. So you're saying this is probably not super accurate because it's not using brain waves. It's using movement, heart rate, temperature, and an algorithm then to take that information and try to guess what's going on.

Dr. Baron: Totally. And the bigger picture . . . I mean, I like sleep tech in that it gets people engaged in their sleep. They're interested in trying to sleep the right amount or trying to improve their sleep. I think that is good. But when people over-interpret these things and, you know, stress out about how much REM or how much deep sleep, that's really where they become problematic.

Troy: To me, this is like the equivalent in the ER someone coming in and saying, "Wow, my heart rate's going 150 beats a minute. I can see it on here," and really, really, really getting worked up about this. And then we do all this testing and it led to really an unnecessary emergency department visit, unnecessary stress. I don't know. For me, I think this would just stress me out. Like, I know I don't sleep well. There's no question in my mind. I don't know how that would help me.

Dr. Baron: And maybe like 1 out of 100 times somebody would have something wrong with them and this would sort of alert them. And the same thing happens with these monitors. I'll have patients come in and say, "I showed this data to my doctor. He sent me for a sleep study and it diagnosed my sleep apnea." You know, at this time, these devices are not able to diagnose sleep apnea.

Now, in the future, they are working on improvements in the oxygen sensors and that sort of thing, and it really possibly could diagnose sleep apnea in the population or, at least, diagnose these periods of low oxygen in the blood, which could signal sleep apnea. And so, that would be really awesome in terms of public health, but the tech is just not there yet. So I would really caution people in over-interpreting these.

On the other hand, you know, I use one. I track my sleep pretty . . . I've tracked it for pretty much maybe four years. As part of my research, I'm using these devices and I'm playing with them and trying to understand how people use the data. But I've learned a couple of things. I've learned if I don't go to bed before 10:30, I never get the seven hours of sleep that I'd like to have.

Scot: Yeah, just total time of sleep.

Dr. Baron: It's just obvious. But, you know, it's a good benchmark for me to say, "Oh, yeah. I didn't get enough sleep. Okay. I need to go to bed earlier," and that sort of thing. And sometimes I look at the data and say, "Wow, that was a little better than I thought. It's a little bit encouraging."

Troy: That's interesting because on the one hand, I'm kind of hearing you say that maybe there's not a whole lot of value in these, but you've been using it for years. And is it more just out of curiosity? You know, you said at least you're able to see how long you sleep. For someone like me or the average person out there, would you recommend they use this?

Dr. Baron: I don't think the average person needs one to improve their sleep, but for somebody who likes tech and gadgets, somebody who's interested in tracking things, it's not necessarily harmful. It could be helpful if it's motivating them.

We're using these in our research among short sleepers because we are trying to incentivize and encourage people to spend enough time in bed. I mean, basically, you know, like all of us, we're all just trying to do too many things and we're watching that one extra show on Netflix or that sort of thing. You just need to go to bed like 20 minutes earlier.

And actually, a small change in your sleep like that, even just 20 minutes, it could improve your health. It can lower your blood pressure. It improves your performance. And it feels like a very small amount, but unless you're tracking it, it's hard to really make yourself do that.

Scot: So what I'm hearing from you is the more specific information, probably not super valuable, but the more general information, much like my Fitbit tracks my steps as well, it gives me a picture of, "Oh, I'm getting to bed later than I should," or, "I'm getting up later than I should," or, "My sleep time is not consistent," some of those basic things you would want to watch out for.

Dr. Baron: I think that's totally right. I mean, even in these clinical sleep studies, we look at the sleep architecture of how much percentage of this or that and we comment on it. But there's actually very little that you can do about it if somebody is not getting any REM sleep. And even there are some drugs, for example, that inhibit read REM sleep, like SSRIs or, you know, a lot of the common antidepressants. And so, that's just a normal change that happens with these drugs. That's not necessarily a bad thing.

The Gadgets Can Still Be Good and Are Getting Better

 

Troy: So a lot of our listeners work in tech and it sounds like there's an opportunity here to really develop a good app and it's not there. If you were to develop the ideal sleep app, what would it do?

Dr. Baron: Wow. I mean, I think that, in the future, getting these devices to be more accurate, you know, using multiple sources of data, and this is where the field is moving, including using GPS and heart rate and temperature and other sensors, they can become more accurate.

But also, involving some psychology of behavior change, you know? Getting people the type of intervention they need and when they need it. You know, as a therapist, I could see people once a week at most, but these sort of interventions could be giving people prompts and types of incentives during the week in between sessions, for example, or even helping figure out what their sleep problem is.

Scot: Very cool.

Troy: Maybe something beyond just the data, like you said, maybe more intervention and feedback and "This is what you can do differently," which seems like a great idea.

Dr. Baron: You know, we're really thinking about sleep optimization. A lot of the sleep field has been working in like insomnia and sleep apnea, but there are a lot of people who don't have those disorders, who are just regular folks who need to improve the pattern of their sleep, the timing, the duration, that sort of thing. And the possibility is that this could improve their productivity, how they feel, or reduced the number of sick days, improve athletic performance, things like that.

Scot: All right. So that doesn't concern you? My sleep graph doesn't concern you? Like, if I was to come into your clinic and say, "Ahh," you'd be like, "You're fine. Don't worry about it."

Dr. Baron: I would say, "Well, how do you feel when you look at that graph?"

Troy: She's not going to just say you're fine. It's the equivalent of me seeing that same person in the ER. I would be like, "Okay. Let's do some testing."

Dr. Baron: Let me see that again.

Scot: So you do want to take a second look at it.

Dr. Baron: I just wanted to see what it said.

Troy: "We need to set you up for a sleep study, Scot. Put some electrodes on your brain."

Dr. Baron: I mean, honestly, so much of sleep, especially insomnia, it's about how you feel about your sleep. And we do these studies and call in healthy sleepers and we look at their data, and actually their sleep looks so bad objectively. And the opposite, there are people who come in and say, "I'm not sleeping at all," and their sleep data looks so good. It's just amazing that there is a lot of interpretation.

Scot: I would love to someday compare that to the actual gold standard of brainwaves to see how, you know, that matches up. Have there been any research studies that actually do that?

Dr. Baron: There have been plenty.

Scot: Yeah?

Dr. Baron: And, basically, they show that these devices . . .

Scot: Are useless.

Dr. Baron: . . . are often calling segments that you're asleep, calling you awake, and vice versa. You know, it depends on the settings. If it's sensitive, it tends to overestimate your wake, and then if it's regular setting, it tends to overestimate your sleep. I mean, haven't you ever had it like you know you were awake and reading on your phone and it said you were sleeping?

Scot: Yeah, that's happened a few times.

Dr. Baron: So, I mean, I like to tell my patients that, honestly, it isn't very good at telling whether you're awake or asleep.

Troy: It doesn't sound super helpful. I'm not going to download the app.

Scot: All right. Maybe I'll take the ring off and just go back to sleeping without data.

Troy: Take the ring off. Get rid of the ring.

Dr. Baron: I mean, I really want to get out there the idea that these things can be a tool. Just don't over-interpret them. I think that it's really exciting that people want to measure their sleep and that they want to improve it. I think that's a really good thing, and that's why I use them in the research, because, basically, if we're going make sleeping fun, this is one of the ways to do it, to gamify it, to understand the tech, to look at your patterns. I think that's really fun.

Scot: Okay.

Troy: It sounds like there's at least value in paying attention to your sleep, but don't read too much into it.

Dr. Baron: Exactly.

Scot: All right. Well, thank you very much. I'm a little disillusioned, but I'll probably sleep better at night now.

Troy: Not stressing about your sleep. Nice.

ER or Not: Stepped on a Rusty Nail

Scot: ER or Not. It's a little game where you get to play along. I'm going to throw out a scenario to Dr. Madsen here. He's going to tell us if it's something that you should go to the ER or not. Of course, it's fun to play along, but it's also educational too. It might save you a little bit of money or a trip to the ER if you don't have to take one or let you know definitively that, yep, you better go.

Today's ER or Not, stepped on a rusty nail, or this could even be maybe scratched myself with a rusty nail doing some spring cleaning, you know, or out hiking sometimes that could possibly happen. Is that a reason to go to the ER? Rusty nail, ER or not?

Troy: Well, rusty nails are something I, unfortunately, personally have a lot of experience with. I have stepped on a rusty nail more than once. The big things you have to think about here are, number one, tetanus. That is the number one you think about. Tetanus is some body that lives in the soil. There are spores there. If you get a dirty wound, particularly a dirty nail in your foot or your hand, number one, is your tetanus booster up to date? You probably had one at some point, but if you're thinking back and you say to yourself, "I don't know if I've had one in the last five years" . . .

Scot: Oh, five? I thought it was 10. It's five.

Troy: It is 10. But our rule of thumb in the ER is five.

Scot: Oh, so if I come in there, you're going to have a different standard.

Troy: Yeah.

Scot: Okay.

Troy: And that's more because of, you know, maybe you're not quite sure when it was and you think, "Oh, it's been within 10 years," and it's been 12 to 15 years. So we kind of just say five years. I mean, if you've got exact dates, yeah, that's going to be good for 10 years. But if you don't know when you had your last tetanus shot, go to the ER.

Scot: Okay.

Troy: They could probably do that at an urgent care as well, but that's the number one thing to go to an ER for, would be to get a tetanus booster.

The other thing to think about is infection. And the big thing we think about with infection is if the nail goes through the sole of your shoe, and this is kind of a weird one, but there is a certain type of bacteria called Pseudomonas that can live in the sole of the shoe. It's kind of a moist environment. And so, the concern is if it goes through the sole of the shoe, it pushes that bacteria into your skin.

So sort of the dogma for those of us who work in the ER, if someone comes in with a nail through the shoe, we put you on an antibiotic. I mean, otherwise, it's probably something you could just wash out really well. Probably don't need to be on an antibiotic. Watch for signs of infection. If it gets red and draining, then absolutely get into an ER or, you know, an urgent care to get on an antibiotic for that.

Scot: Let me clarify again. So if I can't remember the last time I had a tetanus shot or think it was outside the past 10 years, ER or urgent care for that?

Troy: I'll say urgent care because they should be able to give you a tetanus booster there. It's more convenient. It's cheaper, easier to get into. If you can . . .

Scot: Is this something I can wait 12 hours before I go do if the urgent care's closed?

Troy: Yes, absolutely.

Scot: Okay. All right.

Troy: It's not a super time sensitive thing. Get in within 24 hours.

Study Shows ÑÇÖÞ×ÔοÊÓƵ Begins to Decline at Age 27. Really.

Scot: So when does a health decline begin? I mean, there are a lot of times you'll hear, "As soon as you hit your 40s, that's when it all starts going downhill," which, you know, I've heard there's some truth to that. But there is a study. Blue Cross Blue Shield did a report on the health of people between 21 to 36 years old, focused on the 55 million people in that age group that are commercially insured. So, I mean, it's an interesting grouping of people. But in that report, they said the major decline in health begins at age 27.

Troy: That really jumped out at me. Twenty-seven? I mean, I'm thinking back to 27, I thought I was pretty healthy then. But this article shows a graph when all of these health conditions really start to become more prevalent and more of an issue, and it really drops off right at 27.

Scot: Knowing that is important because, you know, the things that you're doing right now contribute to your future health down the road. And if it's starting to happen at 27, well, first of all, what's the reason behind that? We've talked to some people and I think life starts changing. You start having kids, more responsibilities, so perhaps you're not focusing on your health as much. My guess.

Troy: Hard to say. You know, I also wondered if maybe some of these conditions were present and then at 27 people woke up to some of these other things and decided to get some medical help. And maybe that's why it's showing up in this report. Hard to say, for sure.

But for whatever reason when they're looking at their numbers, they're finding at age 27 is when people really start to have more of these health conditions listed going through a full range of heart disease and diabetes and psychiatric issues. All of these kinds of things really start to pop up in the late 20s.

Scot: All right. So between the ages 21 to 36, the other thing that jumped out at me that you just mentioned is behavioral health conditions explained about 40% of adverse health issues. I feel like we're doing a better job talking about behavioral health issues, but, I mean, you tend to think of health in terms of physical health issues, but almost half are behavioral.

Troy: They are. That's a large number. But it's also good for me to see this because I think what it's showing is that people are getting help for behavioral health conditions. And if people weren't getting helped, it would not show up in this report.

Scot: Yeah, because it's an insurance company that did it.

Troy: It's an insurance company. Exactly.

Scot: And the way they get their data is . . .

Troy: Yeah, they're pulling it from medical records, from medications prescribed, and diagnoses that are listed on the chart as people are seeing their doctor or going to the emergency department, seeing specialists, whatever it is.

Scot: All right. The other interesting tidbit out of this for me was 83% of people between the ages of 21 and 36 consider themselves in good or excellent health, but yet we are seeing increases in health issues in this age group.

Troy: That's interesting too.

Scot: So the perception and the reality aren't quite the same, which is something that we've talked about on this podcast and have talked about with other people on this podcast. Perception versus reality, that was something I struggled with and didn't realize until I got my wake-up call.

Troy: Yeah, exactly. I kind of consider myself the same. I look at 27 and, you know, I think everything's going great and everything's going smoothly. There was a lot going on that I wasn't aware of. And, like you said, sometimes the perception does not match the reality. So, that's probably what some of these numbers are showing as well.

Scot: One last thing. The increase in these conditions between 2014 and 2017, is that what we're looking at?

Troy: Yes.

Scot: Please come with us to Exhibit 2 in this report. What did you take away from that?

Troy: So it's interesting. They compared people under the age of 36 and they looked at their health of this group in 2014 and 2017. And in that comparison, the big thing that stood out to me was the increase in type two diabetes. So that increased fairly significantly over that time at 22% increase . . .

Scot: Twenty-two percent.

Troy: Yeah, in the prevalence of type two diabetes in these individuals. A big increase in major depression as well, 31% increase. Also, heart disease, things related to heart disease, hypertension, high cholesterol, that was increasing by around 15%.

So, again, this type two diabetes increase really jumped out because that's often . . . not always, but it's often a consequence of, you know, being overweight, maybe not exercising enough. That can set you up to develop type two diabetes. And it's possible that what we're seeing is, you know, maybe a consequence of earlier years not exercising enough, not staying in shape like they should as kids, or teens, or whatever it is, and really seeing an increase there.

Scot: So that's when we come back to the core, the core of the show. How's your activity, your nutrition, your stress, your sleep, those nagging health issues? How are you doing with smoking and drinking? And you just got done saying, again, activity and nutrition would contribute to a lot of those things, and it's not hard to get the amount of activity. Again, we've got to hammer this message home. Thirty minutes a day makes a huge difference.

Troy: It really does. And that's another piece of this as well. People are being diagnosed at an increased rate with high blood pressure or high cholesterol or diabetes. If you are diagnosed with these things, you can reverse these things with exercise. It doesn't mean, you know, the 34-year-old who is diagnosed with type two diabetes is destined to be a type two diabetic the rest of their life.

Some cases maybe so, but oftentimes with exercise, weight loss, you can reverse these things and . . . particularly, high blood pressure or high cholesterol, all of these things have answers that are beyond just medication and feeling like this is what you're destined to have.

Scot: So get those tests results. Get your cholesterol tested, your . . . what is it? I always want to call it the A1A, but that's a . . .

Troy: A1C.

Scot: . . . highway in California.

Troy: Yeah, California.

Scot: Get your A1C checked. Get you, I think, BMI checked.

Troy: Get your BMI checked. You can do body fat composition testing. I know you're a fan of that and have done that.

Scot: I am.

Troy: I have not yet done it, but . . .

Scot: You should. I mean, you'd excel at it.

Troy: Yeah, that's true.

Scot: We were having so much fun and now we've got to wrap it up. What's the wrap-up? Oh, I think the wrap-up is take a look at your mental health as well.

Troy: Yeah.

Scot: You know, don't be embarrassed about it if you're experiencing any of these types of issues, especially major depression or even if you have an inkling something's wrong. A lot of times where you work will offer a certain number of free counseling sessions throughout the year. Get in and talk to somebody about it. They can provide you with some tools to perhaps, you know, get through whatever it is you happen to be going through right now.

Troy: That's right. Lots of resources out there. And the big takeaway from this as well is recognize you're not alone. A lot of people in this study are showing increased rates of depression. It's something we all need to deal with and need to address. And, like you said, Scot, lots of great resources out there to get help.

Just Going to Leave This Here

Scot: Just Going to Leave This Here. I need somebody to explain something to me. Maybe you can explain it to me.

Troy: Okay.

Scot: Why are men's bathrooms so quiet?

Troy: Oh, yeah.

Scot: I mean, seriously, you go into a restaurant, you can go into, I don't know, a coffee shop, grocery store . . .

Troy: Right.

Interviewer: Music is blaring everywhere in the place and then you go in the bathroom and it is just the quietest. The place where I want noise . . .

Troy: Right.

Scot: . . . is so quiet. Why?

Troy: It's so quiet. Why can't they play some ambient music or something in there? Sometimes you're just like, "Why? Will someone just please flush a toilet or turn on the sink or something?"

Scot: One time, it was so bad and there were so many guys in the stalls that I started playing a song on my iPod. I just hit play.

Troy: Oh, that's awesome.

Scot: You want to know what song it was?

Troy: "Raindrops Keep Falling on My Head"? I don't know.

Scot: It was an old song called "It's Your Thing." "Do what you want to do."

Troy: Nice.

Scot: Which was almost appropriate.

Troy: And I bet you did not get a reaction. I bet no one looked at you. No one made eye contact, because no one makes eye contact in a men's restroom.

Scot: No. By the way, I looked up just after this . . . this was a rabbit hole I went down when I thought about my "I'm Just Going to Leave This Here." I typed into Google "songs to play while pooping."

Troy: Oh, wow. And these are like motivational or relaxing, or what are we talking about?

Scot: The very first thing that comes up is, "Songs to poop to" on Spotify.

Troy: Nice.

Scot: Reddit has a whole thread, "What's the best song to take a . . . to?"

Troy: Yeah.

Scot: And you can see here a list of songs to poop to.

Troy: Wow. I didn't know it was such a popular topic. I haven't given this a lot of thought.

Scot: Fifty-four million results.

Troy: Fifty-four million results. Nice.

Scot: This is apparently a thing.

Troy: This is a thing. And apparently, they are playlists for this as well. So I would encourage any restaurant owners, any airport administrators out there, consider this for the men's restroom. Like, just some ambient noise, please.

Scot: And the playlists are made for you.

Troy: Yeah, I love it. I'm Just Going to Leave This Here. The World ÑÇÖÞ×ÔοÊÓƵ Organization has actually created a new diagnosis for gaming disorder. So they're classifying this as people who are so into gaming, spend so much time playing video games, that they find that it really affects their ability to complete daily tasks, affects family relationships, school, work, sleep, all of these sorts of things. And they say this has to have gone on for at least a year to be classified as gaming disorder.

So I thought it was interesting. First of all, they recognize that this is a serious issue. The World ÑÇÖÞ×ÔοÊÓƵ Organization is not the final word on these sorts of things. This hasn't been classified in the major psychiatric textbooks or anything like that, but it may be that this gets the ball rolling to recognize that this could be an issue.

Scot: Yeah. This falls into that addictive behavior category we talk about sometimes. And I can relate to this because as a kid I was addicted to video games. I don't know that it affected my performance and things, but I definitely would go towards video games.

And even as an adult, like "Batman: Arkham Asylum," when that came out, I'd stay up till 3:00, 4:00 in the morning and not even realize it. And then it was weird because I would be like . . . when my wife would leave the house, I'd look forward to it because then I could go play my game or I'd try to sneak down and try to play a little bit. I mean, it definitely can be a very manipulative, scary thing at times.

Troy: Yeah. And even if, you know, you're not really into gaming, I think you can relate to that in one way or the other. Like you said, being awake until 3:00 a.m. and you just keep going and going, and then you're thinking . . .

Scot: Yeah, "One more time, one more time. I'm going to just try it one more time."

Troy: Yeah. And you're thinking, "I've got to be up at 6:00 or 7:00 to go to work, but I just can't pull myself away from it." So it's interesting that this is out there now. My guess is that this will continue to receive more attention and, you know, potentially, be something that we look at and look at treating and some sort of intervention.

Scot: Yeah. And I think it's something that would be easy for people to laugh at, but really, it's just like any other addictive behavior. Probably not something you should laugh at. And if it's something you're struggling with, go get help.