The REM Sleep You're Not Getting Could Be Killing You with Dr. Eileen Leary

In this episode

• Eileen Leary’s Stanford dissertation on REM sleep and mortality
• The difference between association and causation
• The 13% higher all-cause mortality rate associated with each five-point reduction in REM percentage in MrOS
• Replication in the Wisconsin Sleep Cohort
• Why sleep apnea, depression, antidepressants and sleep duration did not explain away the central association
• The important nuance in the cause-specific mortality results
• The possible mortality threshold below about 15% REM sleep
• The third Sleep Heart Health Study cohort and the later 10,000-plus-participant meta-analysis
• A 2026 replication signal in coronary artery disease plus obstructive sleep apnea
• Why the evidence still does not prove that increasing REM will extend life
• Machine learning and the relative importance of REM among the measured sleep stages
• Why consumer wearable REM percentages are not interchangeable with polysomnography
• Eileen’s current work in orexin-agonist clinical development
• Michael Grandner on scientific literacy, animal models and amateur epidemiology
• Why access to a scientific paper is not the same thing as knowing how to interpret it
• The University of Helsinki pandemic-dream study
• What the Helsinki study actually found — and what the original on-air summary overstated
• Seema Khosla on ordinary bad dreams versus nightmare disorder
• Imagery rehearsal therapy and “rewriting” recurring nightmares
• How REM sleep behavior disorder differs from simply having nightmares
• Sleep testing and obstructive sleep apnea during COVID
• What later evidence found about OSA and COVID outcomes
• Neil’s first weeks sleeping with the Dreem 2 EEG headband
• Dreem versus Fitbit sleep-duration and staging discrepancies
• Why “the trend is your friend” remains useful wearable advice

About Dr. Eileen Leary

Eileen Leary, PhD, RPSGT, is an epidemiologist and sleep researcher with more than two decades of clinical-research experience. She earned her PhD in Epidemiology and Clinical Research from Stanford University, where her dissertation examined the relationship between REM sleep and mortality. She has worked across academic sleep research and biopharmaceutical development and is currently Senior Director of Clinical Development at Centessa Pharmaceuticals, with work that includes orexin-receptor agonist programs for disorders of excessive sleepiness.

About Dr. Michael Grandner

Michael Grandner, PhD, MTR, CBSM, FAASM, is a clinical psychologist and Professor of Psychiatry at the University of Arizona College of Medicine – Tucson. He directs the Sleep and Health Research Program and the Behavioral Sleep Medicine Clinic at Banner – University Medical Center, with research spanning sleep health, behavioral sleep medicine, circadian health and population-level sleep.

About Dr. Seema Khosla

Seema Khosla, MD, FCCP, FAASM, is a pulmonary, critical-care and sleep-medicine physician and medical director of the North Dakota Center for Sleep. She has held multiple leadership and technology roles with the American Academy of Sleep Medicine and is the longtime host of the AASM podcast Talking Sleep.

MENTIONED

Eileen Leary: REM Sleep and Mortality

The 2020 JAMA Neurology paper at the center of this episode.

Association of Rapid Eye Movement Sleep With Mortality in Middle-aged and Older Adults

Sleep and Death: Leary’s Stanford Dissertation Project

Eileen’s project page includes the three-cohort work, poster and dissertation material.

The Association Between REM Sleep and Mortality in Three Independent Cohorts

The Third REM-Mortality Cohort

The 2021 reply reporting the Sleep Heart Health Study replication and meta-analysis of more than 10,000 participants.

Living to Dream — Reply

2026 REM-Mortality Follow-Through

A later study in patients with coronary artery disease and obstructive sleep apnea that again found lower REM associated with greater mortality.

RICCADSA REM Sleep and Mortality Study

Eileen Leary

Current CV, publications and clinical-development work.

Eileen Leary’s CV

Michael Grandner

Current University of Arizona profile.

Michael Grandner at the University of Arizona

Pandemic Dreams

The University of Helsinki study discussed with Seema Khosla.

Pandemic Dreams: Network Analysis of Dream Content During the COVID-19 Lockdown

Imagery Rehearsal Therapy for Nightmares

The AASM position paper supporting the nightmare-rewriting treatment Seema describes.

AASM Position Paper for the Treatment of Nightmare Disorder in Adults

REM Sleep Behavior Disorder

The current AASM clinical-practice guideline for RBD.

Management of REM Sleep Behavior Disorder

Sleep Disturbances and COVID-19 Outcomes

A 2024 meta-analysis of 48 observational studies covering more than 8.6 million people.

Pre-existing Sleep Disturbances and Risk of COVID-19

Dementia and Sleep: It’s Not Just Deep Sleep That Counts

The earlier Snooze Button conversation with Laura Bojarskaite referenced during the REM discussion.

Listen to the Laura Bojarskaite episode

Tracking My Sleep: Forget Everything I’ve Ever Said

The immediately preceding Seema Khosla episode about consumer trackers and the Dreem 2 headband.

Listen to the sleep-tracker episode