Disclaimer: This podcast is for informational purposes only and is not intended to be used as personalized medical advice.

Joey Wahler (Host): It's an important part of maintaining good health. So, we're discussing unplugging from technology. Our guest is Natalie Hoyte. She's a family medicine physician assistant. This is Be Well with Skagit Regional Health. Thanks for joining us. I'm Joey Wahler. Hi there, Natalie. Welcome.

Natalie Hoyte: Thank you so much. Thanks for having me on.

Host: Yeah. Great to have you aboard. We appreciate the time. So first, in a nutshell, what do we mean exactly by unplugging or doing a "digital detox"? And why is this a necessary conversation for good health?

Natalie Hoyte: Yeah, absolutely. So, when we say unplugging or digital detox, really, we're just talking about setting intentional limits around our screen time use. It doesn't have to mean anything dramatic. It doesn't mean going off grid. It could just be setting some boundaries around when you choose to have access to your phone or perhaps leaving the house and deciding to leave your phone at home or putting it away when you're at dinner with family.

I think it's a really important conversation for health, in large part because we're all constantly bombarded by digital stimulation all day long throughout our days. And if we're not collectively aware of the health impacts and we're not intentional about creating some boundaries, I think we'll continue to see some negative impacts on our mental health, our nervous systems especially

Host: And I'm going to ask you more about that in further detail in just a moment. But first, is there a general thumbnail guideline for the amount of recommended screen time for adults and maybe separately for children as well?

Natalie Hoyte: That's an excellent question. I'm sure that there are guidelines. I know there are guidelines for children. We definitely don't recommend any screen time below a certain age, and we try to keep it below two hours in general. I don't know specifics for adults. I think the gray area is there's a difference between we're on our screens at work, does that count as screen time? Students are now on screens at school as well, and it's not necessarily, you know, mindless scrolling, but it's still time in front of a digital device and not looking out at a natural environment. So, there seems to be a lot of overlap.

Host: Yeah. So, speaking of which, you make a good point there. Do we need then to differentiate between what we might call necessary screen time and unnecessary?

Natalie Hoyte: I don't know how much of a difference it makes. Because regardless, we ultimately didn't evolve to be looking at an object that's up close throughout the day. I think one really interesting piece of research that I've seen is that we actually are meant to be out in the natural environment. And when we're outside looking off into the distance and scanning the horizon with our panoramic vision, we activate our rest and digest nervous system. So, that helps us to feel calm versus when we're looking with a narrow focus at something that's up close, that actually keeps us more in that fight or flight state.

Host: Interesting. So, there really is a difference there. It's not just mental. There are physical changes taking place, you say, when you're looking at nature compared with looking at a screen. I think it's also funny that you said we didn't evolve to be on screens. I guess that's true, right? Cavemen weren't walking around with clubs in one hand and tablets in the other, right?

So, all of that being said, what are the most common physical symptoms you see in patients suffering from excessive screen time? How can you tell?

Natalie Hoyte: I think that it can range quite a bit. Sometimes we'll see people coming in with eye symptoms, maybe some digital eye strain, dry eye. But I think with that, that can lead to complaints of headaches. I think the posture of sitting at a desk, if you don't have a good setup or if you're looking down at your computer or looking down at your phone, that can cause a lot of neck, upper back and shoulder strain. We can also see issues at the elbow or the wrist and nerve compression, kind of overuse injuries, depending on how you're holding your phone. So, those are some of the overall physical things we can see. But I think more insidiously, we might see people who are experiencing chronic fatigue, maybe burnout.

One of the reasons I think that comes into play is because constant digital stimulation all day long prevents us from allowing our nervous system to get into a state of true rest. And if we're not truly resting and resetting our nervous system, that's going to lead to a place of burnout.

Host: Gotcha. So, how does constant digital stimulation affect the brain's stress response system?

Natalie Hoyte: Yeah, it's huge. So, our brains are designed to pay attention to things that are novel. So, every time that we're opening an email, opening up Instagram, reading a text message, refreshing a news feed, our brain receives a little signal saying, "Hey, there might be something important here. Pay attention." And so, we do.

And that low-level stimulation, that need to be on to pay attention and focus at a low level, keeps our nervous system in a state of just low-level hypervigilance. We're always scanning for new information or something important. And this can lead to our sympathetic nervous system, our kind of our fight or flight system to be constantly on at a low level. And it also prevents us from getting into it's called the default mode network. It's regions of the brain that get activated when we're not focused on an external task. So, the default mode network might get activated when we are daydreaming, walking, looking out at a horizon, sitting by the water, waiting in line, showering, even driving. Any kind of activity that's just kind of slow, rhythmic, you don't have to pay attention. And it's in the default mode network that our nervous system actually can relax; our brain can rest. It's when new thoughts might start bubbling up to the surface, new ideas, solutions to old problems. It's also where we process emotional experiences and meaning in life.

And so, I think the biggest harm of always having a phone in our pocket where we can reach for it when we're bored, is that it prevents us from getting into a state of boredom. And boredom is actually really important for a healthy emotional state, a healthy nervous system. That's what our brains want to do. And in our modern world, we've eliminated the need for boredom.

Host: Certainly, makes sense to me. How about specific neurological or hormonal changes linked to digital overload?

Natalie Hoyte: I think one of the things that people have maybe heard the most about is the impact on our dopamine system. Dopamine is a neurotransmitter that regulates our motivation and our learning. And it helps us want to pursue rewarding information or activities. Now, naturally, we are wired to get reward from fundamental effortful activities. So, things like foraging and then finding a ripe berry or physical effort, exploring and learning something new.

Now, in the modern world, we've kind of replaced that with the junk food equivalent. We don't have to do anything. We just open up our phone, and we see an alert or we see a like on social media, and that gives us that dopamine response. So, it has rewired our reward pathway, which can make it more difficult for us to engage in activities that are slower paced, like reading a book. We can see increased distractibility, difficulty with those low-stimulation activities, feeling restless during quiet moments. Those are some big ones.

So, that's one of the big ways that it can influence us. There's also impacts potentially on our circadian rhythm and our melatonin production, depending on when we're looking at screens and the bright light and the impact that that has on our eyes, which stimulate the hormones involved in our circadian rhythm and sleep cycle.

Host: Couple other questions for you. How about the early warning signs people should look for indicating that they need that digital break when someone should contact their provider? How do you know where the line is?

Natalie Hoyte: I think this can easily go unnoticed. But if somebody's starting to feel overwhelmed by their day-to-day life, if they're noticing that they're feeling more of a negative mood about things, or they're feeling stuck, burned out, maybe kind of a lack of purpose, I think that's a warning sign to reevaluate how are you spending your time, and are you taking care of your nervous system and allowing your body to actually have true rest?

And that's maybe a conversation that gets missed a lot in primary care because we're so focused on trying to find what's the underlying cause of your fatigue or these mental health changes. But I think it can be due to just that low-level stimulation throughout our days.

Another one that I think is really important is just being aware that teenagers and younger kids are really susceptible to the negative impacts from digital use and social media. So, if you are a teen or if you have, family members who are experiencing increased anxiety, feelings of depression, thoughts of self-harm, like those are some really serious things that can be a consequence of social media use in adolescence. And I think that's a really, really important thing for everybody to be aware of.

Host: Absolutely. So, speaking of which, in summary here, whether it's for an adult joining us or a way for them to advise their kids, what's a great tip or two that you have to set those healthy boundaries with devices without feeling cut off from the world? Because that's always the rationale or the excuse typically, right? "Well, I have to be on this or that device for this reason or that reason. I have to be in contact with my kids. I have to talk to my friends about the game. I have to make plans," whatever. What's the best place to try to put that all aside, at least temporarily, and have a good starting point for moving forward better with all this?

Natalie Hoyte: It's hard in the modern world, just like you said. We have things where we need to be in touch. We need to be able to access work email for various reasons. So, it's not about completely eliminating access to our phones or connection. But the important piece here is about being intentional rather than just mindlessly getting sucked into time spent on phones or screens.

So, I think perhaps one of the more important ways or impactful ways would be to make some guidelines around how you access your phone in the morning. Instead of having it as your alarm clock, just setting some boundaries around, you know, the maybe that first hour of your day, where you can allow some time for quiet, reflection, getting ready in a quiet space. So, just putting some boundaries around, when you use your phone.

One thing that I heard that I liked was this idea of parenting your phone, meaning you give it a bedtime, you put it to bed, you put it in the drawer. Other ideas are I've heard people where they treat their cell phone like a landline, meaning they keep it plugged in, they keep it in a certain spot in the house. If you need to go on it and use it, you go to that spot. And it's as if you were using the old phones that were connected to the wall.

There are some other simple things that you could do to make it maybe less engaging or less stimulating. Some people put their phones on gray mode. You can put timers or locks that will keep you out from accessing certain things at certain times or for more than a certain amount of time. And there are really great new phones that are coming out that are paying a little bit more attention to the way that smartphones seem to hijack our attention.

And I found some devices that are more intentional. They're maybe just a black and white E Ink screen that has the basics and doesn't have access to social media or the internet. So, if you wanted to be really radical for yourself or for your children, I think there are options to choose something that has basic capabilities but limit some of that excessive things that we don't necessarily need.

Host: Absolutely. Well, folks, we trust you are now more familiar with unplugging from technology for better health. Natalie, great advice indeed that I think we all can certainly use. Keep up all your great work, and thanks so much again.

Natalie Hoyte: Yeah. Thank you so much.

Host: Certainly, a pleasure. And for more information, please visit skagitregionalhealth.org. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of Be Well with Skagit Regional Health.