The Peter Attia Drive - #58 – AMA with sleep expert, Matthew Walker, Ph.D.: Strategies for sleeping more, sleeping better, and avoiding things that are disrupting sleep

Episode Date: June 17, 2019

In the first three parts of our series with sleep expert Matthew Walker, Matt revealed the many reasons why we need sleep as well as the many short- and long-term dangers of not sleeping enough. In this special AMA episode, Matt comes back to provide a dissertation on listener’s questions about HOW to sleep. He answers questions from subscribers that largely focus on the practical and tactical ways we can improve our sleep in terms of duration, quality, consistency, and avoidance of the common things that are standing in the way the best sleep possible.   We discuss: Matthew’s TED Talk, and his favorite public speakers [7:45];   How good are the current sleep trackers like Oura, Fitbit, etc.? [10:45]; Is it bad to eat food too close to bedtime? [15:30]; How does exercise impact sleep? [17:30]; How is appetite affected by our sleep quality? [21:30]; Anxiety, cortisol, and weight gain: An awful feedback loop of sleep deprivation [23:30]; How to optimize your wind down routine: lights, temperature, & relaxation [26:10]; How alcohol disrupts sleep (and contributes to Alzheimer’s disease) [46:00]; Sleep’s impact on sex hormones, and romantic relationships [50:00]; Performance, accuracy, and minimizing the damage of shift work [55:30]; Bed partners: How to sleep in separate beds and retain a good relationship [59:30]; Can we use sound machines and electrical stimulation to improve sleep? [1:02:40]; Will we ever be able to “supercharge” our sleep stages using technology? [1:08:30]; Why sleep is the best insurance policy for lifespan and healthspan [1:11:45]; Melatonin: How (and how not) to use it for sleep improvement [1:19:00]; The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:28:30]; Can CBD and THC be used for sleep? [1:43:30]; Why haven’t we been able to develop a really effective sleeping aid? [1:50:40]; Can you get too much sleep? [1:55:50]; What to do (and not do) immediately following a terrible night of sleep? [2:09:15]; Why a consistent wake up time is king [2:14:30]; Does poor sleep speed up the aging process? [2:16:00]; Can different people be more (or less) resilient to sleep deprivation? [2:22:50]; Finding your optimal sleep schedule and determining your sleep chronotype [2:27:45]; Defining sleep efficiency and how to improve it [2:33:25]; Correcting insomnia: A counterintuitive approach [2:35:45]; How can parents improve the sleep of their kids? [2:41:30]; and More. Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia. The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peteratia-md.com.

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I guess this week is Matthew Walker. Many of you are familiar with Matthew because in April of this year, we released a three-part series with him. The response to this was overwhelming. In fact, it was among our most popular podcasts to date. And as a result, we decided to do a special AMA with Matthew hosting and me asking the questions on behalf of our subscribers. So what you have here today is what I would describe as three hours of the best Q&A I've ever heard on sleep imaginable. I was super impressed with the questions that came in from people. I couldn't resist but sprinkling in a few of my own questions,

and many of my team did the same thing. And we had a hard stop imposed by his flight departure, and that forced us to just be ruthlessly efficient and accomplish a lot. We actually got through about 80% of what I thought would take probably six hours. So as a quick refresher at Matthew is a professor of neuroscience and psychology at Cal Berkeley. He's the founder and director of the Center of Human Sleep Science. He's earned his degree in neuroscience from Nottingham University in the UK, his PhD in London before becoming a professor at Harvard and ultimately moving to Berkeley. You may know him more from being the international best-selling author of the book Why We Sleep. He has also very recently given a TED Talk that was incredibly well received

this year at the conference and we will link to that, of course. As a reminder, of course, AMAs are for subscribers only. So if you're not a subscriber, you'll only be able to listen to a little bit of this episode, but hopefully episodes like this and all of the other AMAs and benefits will at least convince you of the benefits of supporting our work here in an ad-free environment. And you can do that at pdratia MD dot com forward slash subscribe. In this episode, we talk about a ton of stuff. So the questions dive in with how do we get the best amount of sleep? How do we specifically go about targeting different stages of sleep? We talk a lot about what it means to create the perfect sleep environment. So if the first

episodes that we did with Matt focused a lot on why you means to create the perfect sleep environment. So if the first episodes that we did with Matt focused a lot on why you want to sleep, this we focused much more today on how you want to sleep. Timing your sleep with respect to food, exercise, what does a wind down routine look like sound, temperature, light, all of these things. We got really deep on supplements, melatonin, CBD, we talked about GHB, THC, all of these things. We went into strategies for what to do when you blow it. We all do, we have a horrible night of sleep, what can you do

about that? This was something that actually I found very helpful personally. What can you do to help your kids? Unfortunately, kids are often in an environment educationally that is actually not in the best interest of their school. So, school. So one of the best takeaways from this entire episode was, what can you do as a parent to make it better for your kid if you don't have the luxury of simply moving them to a school that has a better sleep strategy? It would take me another 10 minutes to go into even at the topic level what we talked about. So you have to take my word for it.

This was a great episode, totally worth your while. And without further delay, I'd love to welcome you to my discussion as a follow-up with Professor Matthew Walker. Hey, Matt. Thank you so much for coming all the way down to San Diego to answer everybody's questions on sleep. I'll say pleasure. For the sake of time, because we're going to try to do this in under three hours, I won't get to ask you how much fun you had last night in the simulator, but I think in a word, it looked like it was pretty fun. Extra ordinary.

Maybe we can convince you to do monthly AMAs if we throw in the simulator. I mean, either, or I'll come down for simulator or AMA or both. But it's a pleasure to be back and thank you again for having me and hosting me here at your home. This is kind of a first. I know we have never done it where we've taken someone who's been on before as a guest and then brought them back specifically to AMA. And Tim has done stuff like this in the past.

It's been quite popular. I think it's safe to say that your three episodes probably generated more questions than any other topic we've covered. And I think that's why we realized this was an important thing to do. And I know how passionate you are about this. In fact, in the interim, since we did our first interview, and this one you've given a TED Talk, and I think it just came out, right? Yeah, it just came out.

Yeah. We'll be sure to link to that. That's a tough talk to give, huh? That's pretty intimidating. It was a lot of fun, but it was work to being a professor, you know, lecture most weeks. So you think that you know what you're doing. Ted is different.

It has a special aura around it, and then they have a particular sort of style that they would like. So it was something different, but I like that because it stretches you. Just when you think you're starting to perfect a craft, you realize that there's something else left. And to me, it's the difference between being an exceptional public speaker and then being a speaker who has a wonderment. And I would rank people like Carl Sagan, Richard Feynman,

and then probably Sir Ken Robinson, who's done some fantastic TED talks, they transcend being an exquisite public speaker into being someone who is just so compelling because they add this sprinkle layer on top called wonderment. And I've yet to ascend that pinnacle of wonderment in my public speaking capacity. I'm getting a little better, but I'll never hit that perfection. Yeah, that's an interesting way to put it. I've heard all of them speak, of course. In fact, Robinson's talk on education

is probably the second or third, at least at the last time I ever looked was probably one of the five most viewed TED talks, that's right. And we're both from Liverpool, actually. Yeah, yeah. I gotta watch it over and over again. I think you guys have the accent advantage, by the way.

I just think, like, I can list me the accent all day long. So we've got questions, some of them that are kind of high level, some of them that are super nerdy, and we're going to get through, I think, all of these. And you've, I know we have an imposed hard stop, so you can get a flight back home. Otherwise, I realize this would take easily six hours. So we'll get through what we can and whatever we can't get through.

Maybe, you know, as you offered to graciously just take a microphone and start recording stuff, which I think people will lap up. I will keep being a repeat offender on the show for as long as you and the listeners have me. Yeah. So let's start with some of the sort of high-level questions, right? So this was posed by a reader. So for a healthy adult who wants to optimize their sleep and is willing to do everything they can to get the A plus effort, gone to the head, pick a flawless sleep setup for an unknown healthy adult using the intuition you have built. And so we've talked about some of these things, but how much time should they be sleeping? How consistently do you want to see them hitting deep sleep or sleep? And you know, now that I think about

it before we ask this question, many of these questions come through the lens of people using devices like Aura, Woop, Fitbit, probably the Apple Watch has something comparable. What I heard you say in our last discussion was those devices are probably pretty good at estimating duration of sleep, probably less good at estimating stage of sleep. Is that a fair assessment? Yeah, I think it is right now, and especially the segregation between sort of rapid eye movement and non-repeat eye movement. You can think of it as a sort of like a three-step level. Total sleep time, are you awake, are you awake? Essentially, that's kind of like a two-class algorithm, wake sleep, and they're

pretty good at that. Step down, then you can do a three-class algorithm. Are you awake? Are you in non-rem sleep? Or are you in REM sleep? And they're pretty good at that. Four class model is, are you awake? Are you on light non-rem sleep? Are you in deep non-rem sleep? Or are you in REM sleep?

That's where they sort of fail, and that's where something like my sleep laboratory continues to be the gold standard. So somewhere between sort of a two model and a three-class model, that's where those devices right now are rated limited. So I wouldn't get too nervous about some of your deep sleep versus light sleep numbers. Some of them could be accurate within an individual, but for others, it can be more tricky because of the physiology that's not giving the right signals for class accuracy.

Yeah. And what about the relative changes? I mean, this is sort of the way I explain things to my patients, which is probably there's no question I get asked more than Peter, why is my deep sleep only 17 minutes a night? It should be an hour and a half to which I don't have a great answer other than let's not assume that that's necessarily the case. It may be it might not be and unless we did a polysum, I don't think we can know. But what about relative changes? So the most obvious example is alcohol, which we've talked about. There is no doubt that alcohol impacts the model. That's right. In the wrong direction,

which gives you some confidence that the model is at least picking up a signal that makes sense. This is a great point, which is overall from one individual to the next. It may be somewhat inaccurate for that real deep classification of varied stages of sleep, but within an individual from one night to the next, it may be routinely inaccurate, meaning that once you establish some kind of baseline and you see a deviation from that baseline, it's more than likely that that deviation is a real deviation rather than a problem of the technology. Because the technology, even though it's errorful, is consistently errorful night after night after night. And so any variance from that, you're absolutely right. That's probably where you want to focus

more of your attention. Yeah, so what I try and again, please tell me if you disagree. What I try to get people to think about is once you've had these rings or whatever for a few months, you pretty much have a sense of what your baseline is on deep sleep, light sleep, REM, time and bed, et cetera. Don't judge those numbers. Now judge yourself against relative changes from those numbers. Absolutely. So the way I think about this is, don't follow headlines, follow weekly trend lines. That's the way that you should really sort of think about this type of

data set. Now, I can follow headlines in my sleep laboratory because we have that degree of precision and accuracy. But when it comes to these trackers, and I were them too, and I'd love the API, as I just data hungry downloaded. I will plot all sorts of those trends, but it's the trends to follow, not those sort of daily headlines, try not to be too worried, except when you see a marked deviation away from the trend line, and you think that you can pinpoint the cause, alcohol, great demonstration jet lag, perfect demonstration, etc, etc. So that's how you can see it. Yeah.

I also tell patients, they're much better at measuring the raw inputs, because at least for ORA, which is the one that I can speak to because I know the most about it. I mean, they're very good at measuring heart rate, heart rate variability, temperature, movement. And those things matter when you're resting heart rate is up seven beats per minute and your heart rate variability is down 20%. Yeah, that's going to impact the algorithm negatively and whether or not the fidelity with which its prediction is perfect, we don't know, but those are bad things. Your heart rate shouldn't be up 10 beats. Your heart rate variability shouldn't get crushed.

And as you said, I don't think I've ever seen those things where I couldn't point to the why. The room was boiling hot. Eight a monster meal, 10 minutes before bed. I had two drinks or more. Those are the things that sort of consistently do it, which actually now brings us back to our questions. What is the optimal time to stop eating before bed? So I would say probably about three hours before bed is where I would really cut it off.

And the principle reason is just because when you lie down, more likely to get acid reflux, more likely to have digestive issues. That's the first principal reason. A lot of people will just get reflux if they eat too much closer to bedtime. The other reason, however, is to be mindful of core body temperature.

So the advice generally is, don't go to bed too full, don't go to bed too hungry. And if you do feel as though you ate earlier in the evening and you just need something to take the edge off, try to stay away from simple carbs. The reason being is that those will actually just get translated more quickly into a sort of an energy and ultimately a heat index. And when you need to fall asleep, you need to drop your core body temperature.

So if you're fueling yourself with simple carbs right before bed, let's say that you just have a nice big bowl of cereal, sugary sort of nonsense, you will actually see a slight increase in core body temperature because of that sort of sugar caloric burning. That raises core body temperature, that makes it harder for you to fall asleep. Why? Because you need to drop your core body temperature by about 2-3 degrees Fahrenheit to initiate sleep and then to stay asleep. And that's the reason

you'll always find it easier to fall asleep in that room. That's too cold and too hard. So that's the second reason that I would say try to back away from food. If you do need to eat, try to maybe lean more towards protein, if you can, and away from simple sugars just before bed. But for the most part, cut off about three hours. Okay. And I want to come back to temperature in a moment with sleep environment. But let's go to another question, which is the same question, but with respect to exercise. We certainly learned in our first discussion that exercise has many benefits, but these of the sleep, it generates more adenosine. And adenosine is one of these three pillars that creates this drive for sleep.

But can it backfire if you exercise too close to bed? We think it can. I mean, the evidence, I would say, is moderate to strong and the following reasons. Firstly, you actually get an increase in corpore temperature, of course. And then you get this nice sort of down-s, sort of later on, and that's good. But if you're exercising, let's say, in the last two hours before bed, your core body temperature, depending on what you've done, may still be too high and working against what it would normally like to do from a circadian perspective, which is start to drop down

and low you into sleep by sort of evacuating the core temperature from your body. So be a little bit careful with exercise, too close to bed, I would say a cut off of about two hours. The other reason is not just temperature though, but also a whole cascade of hormones. You can typically get epinephrine, nor epinephrine, or adrenaline, nor adrenaline. The cortisol as well. Cortisol usually has a time decay of exercise, and again, it depends on what you're doing, of course,

but sort of somewhere between 90 to 120 minutes. So those things can actually work against you in terms of sleep, but for the most part, exercise, anything that is before two hours of sleep is a fantastic tool in terms of sleep promotion. What I would say though is that the data in the opposite direction is even more powerful, and I think we chatted a little bit about this. It's not just that exercise helps sleep. Sleep profoundly helps exercise. In fact, that is a two-way street, but if the traffic is flowing more dominantly, I would argue the evidence is that sleep is better for exercise and they're both reciprocally beneficial.

And what we know is that when you're sleeping well, firstly, just your motivation to do anything and especially exercise is increased dramatically. So forget anything thereafter, the likelihood that you're going to get into the gym, get out on the bike, get out on the road and start pounding the pavement far higher when you've slept well. Thereafter, it's great peak muscle strength increases. Your ability to respire and expel carbon dioxide is improved the more sleep that you're getting. Likelihood of injury risk, markedly decreased. Your ability to even sweat and perspire is determined by how much sleep that you get.

We sometimes forget how critical perspiration is for optimal exercise. So, as it's a peak muscle strength, all of those things, it's just this cascade of benefit that you get from sleep, from the point of getting out of bed, getting started, and then once you get started, exactly what your performance will be, including time to physical exhaustion, which we mentioned last time too. Beautiful relationship between those two. Yeah, two nights ago, I flew back from New York, and I almost always take the morning flight back because one, you're more productive on the airplane, it's just the morning.

There's a far less chance of delay on the first flight out of New York than the last flight out, but occasionally, you just, whatever, this schedule on. So I had to do what I hate doing, which is take the 8 p.m. flight from JFK back. And as is the case, at least 50% of the time, crew shows up late, but time the crew gets there an hour and a half later, your number 317 on the runway. I mean, we didn't get back until like two and a half hours later than planned. So, and I have a pretty fixed wake up time just both because of the jet lag coming back, but also the kids. So, I woke up yesterday morning only having five hours of sleep,

which was, I think, good all things considered, but it's less than what I've now become accustomed to. And it's interesting you say this because I worked out in the morning and my wife asked me later in the day, she's like, how was your work at? I was like, I gotta tell you, it was miserable. Not for any other reason that I didn't want to even be in the gym. It was like two hours of how quickly can I be done with this? I just don't want to be here.

For what it's worth, I didn't perform well either. But what caught my attention was how little I want it to be in the gym. If that's not bad enough, what you also do is get a compounding set of problems atop of that, which is your appetite. And I think there was a question that maybe I can try to weave in here, which is when you are sleep deprived, essentially what the brain receives is a signal that is not dissimilar to starvation. And it releases a cascade of hormones

that change your appetite profile. You want to eat more and you're less satisfied with your food. Why is this? The reason is the following. And we've mentioned it before, I think briefly. Human beings seem to be the only species that will deliberately deprive themselves

of sleep for no apparent reason. Only of the time that we see this in the wild where it does seem to have an impact is when animals are under conditions of starvation. When you get a starvation signal, it usually is sort of the cause of saying, you need to forage in a larger perimeter area for you to survive. And the way that you're going to do that is probably to stay awake for longer hours so you can forage further. So what happens when the body undergoes sleep deprivation? Is that the brain thinks, oh, I must be under conditions of starvation from an evolutionary

perspective, the only time I'm ever sleep deprived is when I'm starving, when I'm under conditions of starvation. Now human beings, when they sleep deprived themselves, they're not under conditions of starvation. So it's a fake starvation signal. So when you're deprived, your brain thinks, oh my goodness, I must be under starvation. It increases a hormone called growling, which makes you want to eat more.

It suppresses a hormone called leptin, which says, you're satisfied with your food, don't eat more. So overall, hunger levels go up, you start to eat more. Now we combine that with this lack of motivation of exercise in all sorts of obesity genic, directive territory. Eating more, wanting to exercise less, you're burning fewer calories. That usually is why I was starting to understand part of the sleep dependent obesity genetic equation.

And the other hormone that plays, I think at least for me, an increasingly greater and greater role in that cascade is cortisol. Because of its role directly on the adipocyte, it is a very anabolic hormone to adipose tissue and a very catabolic hormone to muscle tissue, but also it's effect on the liver and glycogen stores via hepatic glucose output. So it's raising glucose, which in turn is raising insulin, which is now acting alongside cortisol.

I mean, it seems intuitive to me, but I don't know what the evidence is that sleep deprivation would tend to also run with hypercortisolemia. We can see why hypercordisolemia would drive sleep deprivation. Do we think that there's a feedback loop that is in the wrong direction? I.e. the more sleep deprivation you have, the more cortisol that the animal or human tends to produce? That's exactly what we see, typically. Yeah. And if you can go into that state chronically, which is what most of society is not pulling all night as, most of society is chronically under-slept.

So what you end up doing is having this kind of chronic, mid-to-high level of hypercortisolemia. And that is leading to all of this cascade of biology that is non-optimal, part of which is a collection of changes not just in the brain but also in the body too. That cortisol spike can actually lead to things like anxiety and what you should not have if you're looking for good sleep is a high level of cortisol. And so it's by directional that the less that you're sleeping, the higher that cortisol level. If that cortisol level stays high at night, it's pretty difficult to get the good sleep that you need and so on and so forth. And that might also be evolutionary, right?

It might be that when the animal is sleep deprived, the evolutionary trigger is, there's a reason you're sleep deprived. You will need more cortisol. That's right. I had this discussion with Robert Sapolsky where we went into great detail about the role of cortisol in the subacute level of stress, which is actually for many people not the stress we're under, but evolution doesn't know the difference. Right.

Yeah. We've imposed sort of the mental saboteuth tiger, which is called a society-tricket anxiety. I should put fangs on my phone. Yeah. You know, it's nothing more than a collection of electronics and yet it induces in me the same feeling as a saber-toothed tiger wood if it were just growling around me from a hundred yards away in perpetuity. Yeah, and just like that you have night shift on your iPhone, those fangs during the day

should switch to a sign with lots of Zs and then a big strike against them over the because that's essentially what it's going to do to your sleep as well. Well, let's talk a little bit about the wind down routine, then that's a nice foray into that. I think anybody listening to this, as obviously so curious about sleep, has thought about this idea of, okay, you've made a very compelling case in our first discussion that if you want to sit there on your phone,

glued to your phone, in bed, until you put it down, that's just a recipe for a disaster. So we accept the fact that we've got to get the electronics out of the way because of two reasons at least, right? The blue light itself is damaging and it prevents the pineal gland from getting ready to give us that surge of melatonin. But also there's kind of an emotional piece of that as well. So if you were giving somebody advice on the perfect, wind down routine, and this is a

real person. So this isn't someone who has the luxury of being on a meditation retreat their whole life. This is someone who has a job. This is someone who has a boss. This is someone who is still accountable and lives in a world that unfortunately demands paying attention to their phone. But they're committed to getting the

best sleep they can. How would you counsel them at 6 p.m. they just finished dinner or 6.30 whatever. What should they be doing between now and say 9.30? Hey everyone hope you enjoyed a sneak peek with this AMA. AMA is along with extensive show notes and member-only discounts on products that I think are awesome are available to subscribers on. So if you're interested in hearing a remainder of this AMA or want to access any other benefits that come with being a subscriber, please head over to peteratiamd.com forward slash subscribe to learn more in sign up. You can find all of this information and more at peteratiamd.com forward slash podcast. There you'll find the show notes, readings and links related to this episode. You can also find my blog at peteratiamd.com. Maybe the simplest thing to do

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