The Peter Attia Drive - #233 - AMA #42： Optimizing sleep - bedtime routine, molecule regimen, sleep trackers, sauna, & more

00:00:00.000 hey everyone welcome to a sneak peek ask me anything or ama episode of the drive podcast

00:00:16.400 i'm your host peter atia at the end of this short episode i'll explain how you can access

00:00:20.840 the ama episodes in full along with a ton of other membership benefits we've created

00:00:25.460 or you can learn more now by going to peter atia md.com forward slash subscribe so without further

00:00:32.140 delay here's today's sneak peek of the ask me anything episode welcome to ask me anything

00:00:41.100 episode 42 i'm once again joined by nick stenson in today's episode we cover a bunch of questions

00:00:48.100 but all of them on one topic sleep sleep is something that we've talked a lot about on

00:00:53.100 past podcasts mainly with matt walker however we haven't done a sleep podcast in over two years

00:00:59.340 in that time we've collected a lot of questions around sleep and we cover those in today's episode

00:01:04.200 these include questions around my pre-bedtime routine as it relates to various behaviors that

00:01:10.220 i use to optimize my sleep we've got a lot of questions about my current molecule regimen so

00:01:16.880 what are the meds supplements etc that i use to help with sleep both for routine use and maybe

00:01:23.520 sometimes what i would describe as unusual circumstances such as great jet lag and things

00:01:27.940 like that talk about how i use sleep wearables including both the positives and potential negatives

00:01:33.560 of using such trackers for sleep now if you're a subscriber and you want to watch the full video of

00:01:38.720 this podcast you can find it on the show notes page and if you're not a subscriber you can watch the

00:01:43.420 sneak peek of the video on our youtube page so without further delay i hope you enjoy ama number 42

00:01:49.400 peter welcome to another ama how you doing doing well how are you i'm not too bad not too bad how's the

00:02:00.980 week going it's good we're still struggling with this decision about to read or not to read the books

00:02:06.200 i guess that's the thing that's on my mind today at least anyone listening if they have a strong

00:02:10.700 preference either way if peter should read it or not let us know and we'll tally up the votes

00:02:16.020 that's an uninformed vote because i think people would naturally tend to vote for the author to

00:02:22.220 read the book but i have information that they don't have which is i've already heard myself read

00:02:26.540 a sample of it and it's absolutely horrible so it's really just a question of can i be coached into

00:02:32.240 reading it better or is it just flogging a dead horse and is it better off to just have a

00:02:36.440 professional do it no i think there's anything about you it's that you're coachable so i think

00:02:42.620 you could get there it'll still be interesting to see what people think yeah all right so peter

00:02:47.100 today's ama not going to be about the book but what it is going to be about is sleep so sleep's a

00:02:53.500 subject that i mean we've had a lot of podcasts on especially with guest matt walker but it's been

00:02:58.940 about two years since we've had any type of content on it and it's a topic that we get so many

00:03:04.600 questions on and we continue to get so many questions on so what we did is kind of compiled

00:03:09.400 all those questions for today and we're going to kind of discuss all of that so that will include

00:03:16.560 questions around your pre-bedtime routine your behaviors as it relates to how you're currently

00:03:22.620 improving your sleep we'll talk about the molecules that you currently use pharma over-the-counter

00:03:28.560 supplements and how you think about that with not only you and your patients and then we'll also

00:03:33.120 talk about wearables what are some of the pros of them how can they be helpful and at the same time

00:03:38.260 what are some of the potential dangers of them in terms of what people think about so with that said

00:03:43.960 i think we'll just start jumping into it with question number one yep that sounds great perfect

00:03:50.200 so you shared a bit ago on instagram kind of your thoughts not only around sleep trackers but also some

00:03:56.380 changes you made to your pre-sleep routine which have been really effective and we received a lot of

00:04:01.620 follow-up questions from the audience where they just wanted to dive deeper into that and so

00:04:04.980 i think what maybe be helpful is just start with what is your current pre-bedtime routine look like

00:04:12.200 especially if you're really trying to optimize your sleep for that night you know this is kind of the

00:04:17.340 result of many years certainly of tinkering and also a luxury that i have today that i didn't have

00:04:24.120 pre-covid which is the luxury of not traveling at least not with any regularity i mean i used to

00:04:29.160 spend 150 to 180 days a year or a night a year in my own bed prior to covet and that's completely

00:04:37.180 changed now it might be 340 so i'm really able to kind of dial in what i do at home and it's also

00:04:44.860 something i just gravitate towards paying a lot of attention to so a lot of these insights are not

00:04:49.120 necessarily new but it's just a question of being diligent around putting them in place so one of

00:04:55.080 those of course is alcohol very difficult to have a good night's sleep if you have alcohol in the

00:05:02.760 proximity of bedtime or even if you have two or three drinks several hours removed from bedtime it still

00:05:09.560 will linger and that'll manifest itself in a number of ways but probably most notably is kind of a

00:05:16.040 reduction in the quality of sleep so you'll see you'll trade more deep sleep and REM sleep for

00:05:23.080 light sleep and then the other thing you'll see is much more frequent wake-ups if you're really trying

00:05:29.060 to dial in your sleep you're going to have to basically say i'm not going to drink in the evening

00:05:32.720 and for many people that just means not drinking period because most people are not drinking too much

00:05:36.740 in the daytime and then cutting it out in the evening the other thing that i think i learned a lot

00:05:42.160 when i was fasting like crazy is how much the low glucose empty stomach impacted sleep it was profound

00:05:49.440 i mean one of the things that amazed me when i was fasting was how my sleep quality improved in ways

00:05:54.720 that you know i'd never seen before frankly and so i generally eat dinner early ish and in large part

00:06:03.060 that's because we have kids so they're going to bed early so we're eating all kind of early but i noticed

00:06:07.660 that if i pay attention to it when i go to bed i'm a little bit hungry and i think in the past there

00:06:12.660 were times when i would have just had a little snack and now i don't now i just say i'm going to go to

00:06:16.760 bed with a little bit of a hunger pain that's also a very positive effect on sleep we've talked a lot

00:06:22.400 about sauna not to get too far into this rabbit hole but as you know i've kind of taken a 180 on sauna

00:06:29.240 so i would say six years ago seven years ago when we first really did our deep dives into this i came to

00:06:36.180 the conclusion that there was really no benefit to sauna that wasn't captured in a healthy user bias

00:06:40.700 meaning all of the epidemiologic benefits associated with sauna which are numerous let's be clear there

00:06:47.540 are immeasurable benefits that come from sauna if you buy the epidemiology in particular an enormous

00:06:54.360 reduction in cardiovascular mortality and mortality associated with dementia but i really felt that that

00:07:00.380 was mostly a healthy user bias and i think over the years and we do this every two or three years we

00:07:07.640 go back and internally revise our white papers on this and i think it was the 2019 late 2019 early 2020

00:07:15.320 revisit this literature when i kind of changed my mind a little bit and i started to say maybe the

00:07:23.620 magnitudes of the benefits associated with sauna are being amplified by these biases that can't be

00:07:30.620 controlled for but the direction of them the consistency of them across studies led me to

00:07:36.420 believe there's probably something there in addition to the plausibility of the mechanisms it's a long-winded

00:07:41.620 way of saying i've become a pretty diehard sauna convert over the last couple of years and we have one at

00:07:48.640 home now which you know i always get asked questions about sauna so i guess i'll give a bit of a digression

00:07:53.520 on what kind of sauna we have and does infrared does it have to be dry all those things let's park

00:07:59.040 that and we'll come back to it in a second but i do try to get into that sauna at least four nights a

00:08:05.680 week if not five or six i'm really only limited by how much work i need to get done but it's become a

00:08:12.540 great tool and i like it before bed so that i know that there are a lot of people who like to do their

00:08:17.440 sauna in the daytime they like to do it right after the exercise i think that's great but i've been

00:08:21.640 using it basically for two purposes one i do buy that there is some mortality benefit that comes from

00:08:29.160 it but empirically the impact this has had on my sleep is insane so much so that i've often wondered

00:08:36.940 is the mortality benefit of sauna largely attributed to the sleep benefits that come from its use i don't

00:08:45.540 know the answer to that question of course these would all be very easy experiments to do if you lived

00:08:49.640 in a resource unconstrained world is there an ideal amount of time that you try and have between when

00:08:57.260 you last eight and when you go to sleep it's going to change for person to person but just a relative

00:09:02.280 rough number i think would be helpful for people i strive for about three hours okay between when i

00:09:08.720 finish dinner and when my head hits the pillow and again i just want to be clear on all this stuff

00:09:13.560 it's super important not to go psycho on this and i know that when i talk about it this way it sounds

00:09:20.060 like i'm going psycho i'm not i want to be really clear like last night my wife and i went out to

00:09:25.700 one of her friends was having a birthday party and we went out and truthfully i probably ate an hour

00:09:31.980 before going to bed it didn't phase me it's not like i was sitting there at the restaurant looking at

00:09:36.520 my watch going oh my god where is the food but no no no so you can do this most of the time and not

00:09:43.200 be a psycho and i think that's the broader lens you want to look at through this which is these are

00:09:48.840 general principles that are going to get violated quite often but you want to kind of revert back to

00:09:55.540 them whenever you can this weekend you're going to be in town lacy's in town i mean we got tons of

00:10:00.060 friends in town this is going to be a bananas weekend i promise you there will not be a night i'm

00:10:05.880 going to bed this week where i will have had three hours of rest between my last meal and there

00:10:13.140 probably won't be a night that i'm going to bed where i won't have had a drink but guess what we have

00:10:17.060 a bunch of friends in town and that's the way it's going to be but that's not the norm so i just

00:10:20.820 think with sleep in particular there's such a psychological component to this that you just

00:10:25.660 don't want to get too wrapped up in your head about this sort of stuff because i think that can

00:10:29.220 cause more harm than good so you need to be flexible in this regard as an individual and i think

00:10:33.960 and not terribly rigid i just hope people can interpret what i'm saying as guidelines that we

00:10:39.300 try to stick to but we have the flexibility to deviate i think that's really good and it kind

00:10:44.120 of fits back to what i believe is the last ama we did where we kind of talked about how you think

00:10:50.660 about doing everything together and how sometimes you have to make concessions to live your life and

00:10:55.860 so you don't have to be so robotic all the time and on that note we have a question coming a little

00:11:01.520 later on which is maybe some of the dangers of sleep trackers not dangers in the sense that

00:11:06.080 it causes physical harm but more so like the psychological piece so i'll save that for then

00:11:11.760 but the other question that i had is i know you like to think about things in a risk matrix a lot

00:11:18.040 like a two by two like are you picking up a gold coin are you picking up a penny are you picking it up

00:11:22.600 in front of a tricycle or a freight train and it kind of creates that two by two matrix that you like

00:11:26.980 to put in the boxes what's your current view on sauna use in terms of risk reward have you thought

00:11:33.740 about how you would quantify that based on that risk matrix yeah i mean it's going to depend on

00:11:39.260 the individual i do think that there are probably some people who would need to consult with their

00:11:44.040 doctors before getting into a sauna because to be clear when i get into a sauna it's hot i mean

00:11:49.100 our saunas we run it at about 198 degrees fahrenheit my typical routine is 15 minutes

00:11:56.760 and then a cold plunge and then 20 to 25 minutes by the end of that second stint you're really

00:12:03.700 sort of taxed there's clearly a subset of the population for whom that might be a little too

00:12:08.460 taxing outside of that i think look the biggest risk of sauna is there are other risks i've heard

00:12:14.760 horror stories of people that have had accidents in saunas and things like that so we'll bracket that

00:12:18.860 all those things are possible but like anything else it comes at an opportunity cost i think about

00:12:23.980 how much time i actually spend from the moment i decide to get in the sauna until i'm ready to go

00:12:30.220 to bed it's about an hour so then the question is what else could i be doing with that hour

00:12:35.080 that would be potentially better for me and in my case i don't think there's much because my wife and

00:12:41.880 i do it together every night it's actually a way to spend time together and talk and so we get that

00:12:47.040 basically that hour to talk when we probably wouldn't have otherwise i probably would have

00:12:50.580 been glued to my computer working and she would have been reading or something like that but i

00:12:54.740 think for some people that might not be the case for some people that opportunity cost might be too

00:12:58.600 high maybe it's taking them away from an hour of sleep that they otherwise need whereas i'm still

00:13:03.520 able to structure it in a way that i'm still going to get eight hours in bed that's where i think each

00:13:08.360 person needs to figure out what they're giving up for that amount of time now of course it could be

00:13:13.280 less you could spend half an hour in a sauna all told if you want to spend 20 minutes in

00:13:16.760 call it a half an hour but at least in my world i think every minute counts i think that's probably

00:13:21.280 true for most people so i would say time is a big opportunity cost of course there's a financial

00:13:26.280 cost i think to easily utilize sauna in one form or another whether it's dry or infrared or whatever

00:13:33.680 there's a financial investment in putting one of these things in your home or your apartment

00:13:37.360 so that also needs to be weighed into it and again i don't know that that's so much a risk

00:13:41.700 in the way that we think of a drug or something like that but it's certainly a cost and then as

00:13:46.700 far as the benefits go i think there are benefits some of them are kind of soft benefits so again

00:13:52.000 not to harp on this idea but spending more time with your spouse if that's something that you guys

00:13:57.340 can do together there's no biomarker that's going to tell you that that's a good thing

00:14:01.340 improvement of sleep i think is a tangible way to assess benefit if you fall in the camp of people

00:14:07.580 whose sleep is improved by that as far as the hard numbers that we've covered before in other

00:14:13.200 podcasts around the reduction in mortality i'd be hard pressed to believe that they are as strong

00:14:19.120 as they are demonstrated in the finished data sets but if they're half that they're still pretty good

00:14:25.140 so it's harder for me to kind of quantify those benefits that's where i would sort of put sauna so

00:14:31.140 let me give you another example nick i wouldn't put sauna as valuable as exercise when i start to think

00:14:35.700 about what are the levers an hour of exercise i think is better for you than an hour of sauna if

00:14:41.140 you're really playing the game of of inches and then the other follow-up i had written down is you

00:14:47.060 kind of mentioned a little bit but your view on dry infrared temperature you like to keep it at that

00:14:54.240 kind of stuff where do you kind of end up on there well i get asked this question a lot and my answer

00:15:00.640 is i don't think we know if infrared and dry have the same benefits they're a very different mechanism

00:15:07.780 they produce a very different feeling if you're in them and the literature is mostly on dry saunas

00:15:13.960 so for that reason and just for the fact that i wanted to have a pretty large sauna and i like

00:15:19.780 the experience the cedar the rocks the dumping water on it that whole thing that's just why we went

00:15:25.040 with a dry sauna but not everybody has the space for one and the infrared devices they sell devices

00:15:33.820 that are relatively inexpensive relatively small such that if you live in a tiny apartment you could

00:15:39.220 still have one you might only be able to seat yourself in it and nobody else but i still think

00:15:44.200 there is a benefit there though it's going to be much more difficult to quantify by attribution to the

00:15:49.900 literature i also heard matt walker talk about this which is even though as it relates to sleep

00:15:55.620 benefits of a sauna can be there but for those people who don't have access can't get access

00:16:01.800 even a warm bath or even a hot shower can still have some of those sleep benefits that it's worth people

00:16:09.640 testing before they go to bed those types of activities correct absolutely and i think that's just

00:16:14.780 kind of the broader theme around sleep is you have to kind of try things several times and realize if

00:16:21.960 they work for you or not i think there are probably some people who if they do sauna before bed it would

00:16:27.300 probably have a negative impact on their sleep whereas if they did it earlier in the day it might

00:16:31.500 produce a better outcome so i think you just have to again it comes back to flexibility and

00:16:36.760 being kind of experimental in how you think about stuff

00:16:39.800 and then the last follow-up question i had wasn't planning on asking it but it's kind of come up a

00:16:48.460 few times from various episodes i mean mainly like strong convictions loosely held and where it's kind

00:16:54.440 of like where has your opinion changed and in one of the recent amas you talked a little bit about

00:16:59.480 time-restricted feeding and how your opinions change and the importance of protein and even in this

00:17:04.300 episode you know you're talking about your view on sauna has kind of changed over time as new

00:17:09.200 information becomes available and as truthfully what you see with your patients in practice a lot

00:17:14.580 of times you're taking what the literature says and seeing how it applies to people and there's always

00:17:19.640 going to be that small group of people who are like why is your opinion change how can you change

00:17:24.520 your opinion how can you speak about something now in this way and then change it how do you think

00:17:29.700 about that in terms of your journey and how you work with patients to tie back in a previous ama you

00:17:36.740 talked a lot about how the biology of aging so confusing and so complex that there's always going

00:17:42.300 to be changes any advice you would have for people who are maybe a little more rigid and not open to

00:17:50.080 that change in their opinions or their ideals i don't think it's anything i haven't said before i

00:17:55.500 think it just comes down to what you anchor to if you anchor to being right or if you anchor to

00:18:01.900 knowing the truth if you can be more in the camp of the latter it's easier for you to accept change

00:18:11.460 if you anchor to being right you can sometimes get the right answer but if that answer changes

00:18:17.220 it becomes difficult to change i think part of it is also understanding the nature of science

00:18:23.720 and the scientific process which is that even the best experiments don't produce certainty they just

00:18:30.500 increase the probability of one idea being more likely than another and in that sense there really

00:18:39.260 isn't much that's black and white in science most things are shades of gray now some things are really

00:18:45.160 really dark shades of gray i mean it's really clear that we code from dna to rna to protein

00:18:51.760 it's called the central dogma but turns out there are a couple of little exceptions with viruses that go

00:18:59.200 the other way around so on the edges there's always going to be exceptions potentially for

00:19:04.420 things that are even sort of ironclad and very few things are that ironclad again we could go down

00:19:09.500 the rabbit hole of the whole debacle of covet how many things were deemed absolute certainties when

00:19:16.060 they had no business being deemed certainties so if there was a little bit just more acceptance of

00:19:22.120 how uncertain things are and operating in a world of probabilities it would just be a lot easier for

00:19:27.440 people to kind of navigate the changes that are coming and i will say this i don't find at the

00:19:32.660 level of interacting with my patients that this poses a problem i have a hard time thinking of an

00:19:37.180 example where a patient was frustrated or disappointed that we were changing our point of

00:19:42.340 view on something in the face of new information i think they appreciate that definitely anything else

00:19:48.080 you want to touch on regarding your behavioral pre-sleep routine before we move to your current

00:19:54.220 sleep molecule regimen yeah i think the last thing i'd say is really trying to be as unstimulated as

00:20:01.880 possible before i go into bed so i even like floss and brush my teeth before doing the sauna so that

00:20:09.260 once i'm done with that sauna it's dark i basically just go to bed i'm not even going into the bathroom

00:20:15.780 turning the lights on i'm certainly not looking at my computer or my phone or anything like that

00:20:20.600 that's probably another part of why the sauna is beneficial to sleep there's so many reasons here

00:20:26.260 and one of them could simply be that it's a forced hour of bringing myself down as opposed to

00:20:34.100 working right up until the last minute brushing teeth flossing teeth jumping in bed i think that's

00:20:40.300 also a big part of this is just dialing down the rheostat of stimulation before bed no i mean that

00:20:46.520 makes a ton of sense so what about the molecules then what is your current sleep molecule regimen

00:20:52.940 thank you for listening to today's sneak peek ama episode of the drive if you're interested in

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The Peter Attia Drive - December 05, 2022

#233 - AMA #42： Optimizing sleep - bedtime routine, molecule regimen, sleep trackers, sauna, & more

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