The Peter Attia Drive - #347 – Peter's takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma ｜ Quarterly Podcast Summary #5

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:15.580 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can access

00:00:20.040 the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:24.660 or you can learn more now by going to peteratiyahmd.com forward slash subscribe. So without

00:00:31.020 further delay, here's today's sneak peek of the ask me anything episode.

00:00:38.700 Welcome to another quarterly podcast summary episode of the drive. In today's quarterly podcast

00:00:44.980 summary, I'll discuss what I learned from some of the recent episodes of the drive, focusing on what

00:00:50.200 I think were the most important insights, as well as any changes in my behaviors as a result.

00:00:55.660 This shouldn't be seen as a replacement for listening to or watching any of the original

00:00:59.800 episodes, but this may be a great way to reinforce things that you already saw, or at least point

00:01:04.600 you back to an episode you missed. In today's episode, we cover interviews that I did with

00:01:08.740 Jeff English, Ashley Mason, Sanjay Mehta, Sean Mackey, and Sue Desmond-Hellman. We revisit topics

00:01:16.440 around trauma, therapy, mental and emotional health, insomnia, cognitive behavioral therapy

00:01:21.980 for insomnia and improving sleep, radiology, radiophobia, common misconceptions around it,

00:01:29.780 how radiation is used in not just cancer therapy, but also for treating inflammatory conditions such

00:01:35.860 as arthritis and tendonitis, pain, chronic pain, and how to treat them, and finally, discussions

00:01:42.640 around oncology, cancer drug development, and how AI is impacting medicine now and possibly

00:01:48.660 in the future. If you're a subscriber and you want to watch the full video of this podcast,

00:01:52.940 you can find it on our show notes page. If you're not a subscriber, you can watch the sneak peek

00:01:57.880 of the video on our YouTube page. So without further delay, I hope you enjoy this special quarterly

00:02:02.800 podcast summary AMA of The Drive. Peter, welcome to another quarterly podcast summary Ask Me Anything

00:02:16.240 episode with Peter Attia. How are you doing? Very well. You excited to be here? I am. No place you'd

00:02:22.920 rather be? No place I'd rather be. Nothing I'd rather be talking about. Even a race car? Maybe.

00:02:29.300 Okay. Well, it's good to know you're still being honest. So today, we're going to cover looking

00:02:35.660 back at recent episodes on the podcast. As a reminder for people, these quarterly podcast

00:02:40.060 summaries, they are a way for us to talk about and gather insights from you on what you learned

00:02:46.220 from previous episodes, where your behavior changed, where you're thinking about things differently,

00:02:50.840 but they're not necessarily a replacement for these episodes. What we often find is people kind

00:02:56.800 of use this accompanying listening to the episode or even going back and listening to some sections

00:03:01.720 again based on these insights. And so for today's episode, we're going to look back at previous ones

00:03:07.500 with Jeff English on all things mental, emotional health, trauma, therapy, Ashley Mason, all things

00:03:15.120 related to getting better sleep, insomnia, CBTI as it relates to improving sleep. We have Sanjay

00:03:21.600 Meta, looking at radiology, radiation, different ways to look at how that can be used to cure cancer,

00:03:28.400 and also interestingly, arthritis. We have Sean Mackey, all things related to pain, chronic pain,

00:03:34.820 and getting over pain. And then Sue Desmond Hellman, which was an interesting episode,

00:03:39.400 kind of looking at her career, but ultimately looking at cancer oncology, drug development,

00:03:44.020 and even an interesting segment on AI and medicine. So a lot to talk about,

00:03:50.480 a lot of different topics, which I think speaks to who we have on the podcast, which is a variety of

00:03:56.980 people, variety of angles. So I think it should be a good one. A lot of different things to chat

00:04:01.960 through. Anything you want to say before we get started? No, let's dive in. Perfect. First one,

00:04:08.100 Jeff English, all things trauma, mental health, therapy, et cetera. Do you kind of want to walk

00:04:15.040 through your insights from that episode? This was an episode I was really looking forward to doing

00:04:21.420 as we discuss in the episode. I've obviously known Jeff for many years. I owe him a great debt of

00:04:27.360 gratitude. And this is one of those episodes where between the time we recorded it and the time it came

00:04:33.500 out is probably eight to 10 weeks. During that period of time, I sent the unedited, just straight

00:04:41.360 audio file of it to no fewer than 15 to 20 people. Meaning I couldn't even wait for this episode to

00:04:49.220 come out to be sharing it with people. So I think that probably tells you something. I will be

00:04:55.940 completely comfortable stating that that will be a record that will last for some time. There's no

00:05:01.060 scenario I can think of where I've taken a podcast before it comes out and shared it with so many

00:05:06.100 people. I would say that most of the people I shared it with not only found it to be incredibly

00:05:12.100 valuable, but actually wanted to sort of engage with Jeff on a professional level after that. So

00:05:17.400 it's one of those podcasts where if it resonates with you, it's really important. You're going to

00:05:21.200 share it a lot. Okay. So what was this episode about? I mean, it really was a great episode about

00:05:26.020 understanding trauma. And it's such a loaded word that I think it's understandable why people might

00:05:31.120 have some skepticism around that. I think the word does get used a little bit too much,

00:05:35.000 but Jeff has a great definition for it. And I jotted it down, right? Which is that

00:05:38.560 trauma is a moment of perceived helplessness that activates the limbic system. This can be

00:05:44.780 a wounding event, a major event, or maybe a series of smaller events. And those typically get referred

00:05:50.680 to as big tree and little T traumas. So a big T trauma is something really obvious being the victim

00:05:56.700 of a violent crime, for example, and little T traumas are like a thousand paper cuts. A parent that was

00:06:02.780 there, but just really wasn't paying attention to their kid. And those can be damaging in different

00:06:06.880 ways. So what Jeff talked about was that in trauma, too often people focus on the what happened

00:06:13.160 part of the equation, but he thinks that it's more important to focus on the how did I adapt

00:06:18.560 part of the equation. And as he talked about it, the sin qua non of trauma is that there is a

00:06:25.260 disconnected version of a person that shows up to life relying on maladaptive strategies to replace

00:06:33.920 connection with something else. I think that is a remarkably succinct way to explain things.

00:06:41.140 And it's not judgmental. It's just saying that something happened, a series of things. There have

00:06:46.960 been adaptations. Those adaptations have led to disconnection and maladaptive strategies. This

00:06:54.780 could be things that are perceived of as quote unquote bad, like alcohol, drugs, gambling, but it

00:07:02.080 could be also things that are perceived of as good, such as work or perfectionism. All of those things

00:07:07.660 replace the sense of connection. So this is just an episode that I think you have to go back and listen

00:07:13.400 to. But to me, that was the most important takeaway. He spoke about implicit and explicit

00:07:18.480 memories. So people can explicitly remember an event and think objectively, as I think about that,

00:07:24.800 it didn't really impact me, but implicitly it is impacting them through anxiety or some other type

00:07:31.600 of discomfort. He had a great saying, which is if it's hysterical, it's historical. So I think about

00:07:37.460 this often when I overreact emotionally, when I calm down, I'm usually asking myself, what was that

00:07:43.380 really about? Was it really about the thing that you blew up over? Or was there something deeper

00:07:49.100 that this is reminding you of in terms of a vulnerability or something like that?

00:07:54.180 Very important distinctions here between guilt and shame. Guilt is about, as he described it,

00:07:58.940 making a mistake. Shame is about being a mistake. Some people refer to this as healthy shame and

00:08:03.720 unhealthy shame. Again, it's not necessarily one way to think about this. Okay. We talked about the

00:08:09.140 trauma tree. I've heard so many different people talk about trauma in so many different ways.

00:08:14.180 I still think this is one of the better models. And it's a tree because it has roots and it has

00:08:21.400 branches. And the roots are below the ground and the branches are above the ground. And that is a

00:08:27.600 metaphor for the fact that the roots or the causes are not necessarily visible, while the adaptations,

00:08:34.060 the branches, the branches are indeed visible. So very important to understand in this model that

00:08:40.980 intention is not a requirement for the roots of a tree. What do I mean by that? Sometimes the wounding

00:08:48.380 events, i.e. the roots, are not intentional. They're not driven by people who are intending to hurt.

00:08:57.120 This is, I think, a very important thing for people dealing with trauma to understand,

00:09:01.440 because it's very easy to minimize an event that had an impact on you as a child, for example,

00:09:08.600 if you believe that the person who was responsible for this wasn't trying to hurt you. And that's

00:09:14.220 often the case. So keep that in mind. So what are these? So the five roots are broken down as abuse,

00:09:20.720 which can be physical. Typically that is pretty deliberate. Emotional, sexual. Again, obviously these

00:09:26.800 are generally quite deliberate. Religious. So there's an example where it might not be with a

00:09:32.260 malintent, but of course it has bad outcomes. The next would be abandonment. This can be physical

00:09:37.940 abandonment, literally someone being abandoned by a parent, but it could also be emotional. Neglect,

00:09:43.340 which is obviously distinct from abandonment in that the care provider is still present,

00:09:48.160 but is not paying attention to the child. Enmeshment, which is basically boundary violations,

00:09:53.740 emotional incest. This happens when kids have to grow up far too quickly to be emotional caregivers

00:10:00.420 or peers with parents typically. And then tragic events. These are pretty obvious, typically not

00:10:06.420 subtle. We talk about war. We talk about things of that nature, violent events. Okay. So then we have

00:10:12.220 the branches. And again, the branches are the adaptations here. And the important thing to remember

00:10:18.160 here, and I think this is really helpful for anybody thinking through this for themselves or for

00:10:22.520 others is that adaptations typically work very well for the child that has been wounded. And again,

00:10:29.700 I use the word wounded as kind of a broad emotional term. The problem is they tend to become maladaptive

00:10:35.520 later in life. He gives a great example of a father who is physically abusing the mother of his child.

00:10:44.400 And whenever this happened, the child would run into his bedroom out of fear because dad is getting

00:10:50.580 violent, he's hurting mom. But one day the child's fear that his mother was going to be hurt was so

00:10:57.960 great that he ran into the bathroom and pretended that he was sick as a way to distract the father.

00:11:05.180 So the father screams at the mother and says, ah, look what you're doing. Your hysterical whining has

00:11:09.920 made your son sick. And this temporary distraction actually prevented his father from injuring the 0.82

00:11:16.600 mother. So that was an amazing adaption. That child basically learned that he could be deceptive

00:11:23.620 and manipulative and it actually worked. It was a really good adaptation and it probably will serve

00:11:30.200 that child well for some time. The problem is it will not serve that child well as an adult.

00:11:35.700 He describes these adaptations as old friends that serve you well, but lose their utility and become

00:11:41.540 destructive as you age. And so again, what are these four branches? These four branches are

00:11:46.580 codependency, which he calls an outer reach for inner security. Addictive patterns. Again,

00:11:53.400 these are the most obvious in some ways. So substances, but also work, process, obsession,

00:11:57.940 things of that nature. Attachment issues where the common thread is sort of insecurity. So there's

00:12:03.540 kind of an anxious attachment, avoidant attachment, disorganized attachments. He goes into these in

00:12:08.040 details. And then just kind of a bucket for all other maladaptive strategies here. And I'm sure people

00:12:13.880 can think of many examples. So I think I've learned a lot over the past seven or eight years on this,

00:12:19.900 but I think Jeff sums it up so well. And I've seen this over and over in myself, in my patients,

00:12:25.640 when you're working through trauma, or if you're on the fence about whether or not you should work

00:12:30.520 through trauma, it's worth remembering. You're either going to deal with it or it's going to deal

00:12:35.280 with you. These things cannot be buried. They're going to always, like a whack-a-mole thing,

00:12:41.860 always show up at some point. And you can't play whack-a-mole indefinitely. The first step,

00:12:47.080 I think, is just accepting that that's the case and that there's a better way to be. And that these

00:12:51.780 coping strategies, while incredibly valuable, are probably not helping you. That you may indeed be

00:12:57.540 passing on maladaptive behaviors to your kids if you're a parent. And dealing with something that he

00:13:04.220 describes as putting the adaptive child out of the driver's seat and into the back of the car.

00:13:10.660 So those are probably some of the important things I would take from that episode. I don't think that

00:13:16.120 this summary even remotely serves as a substitute for listening to that. So if you missed that episode

00:13:21.540 and anything I said even remotely piques your curiosity, I think you've got to go back to it.

00:13:26.540 Aside from the insights, are there any behaviors that you changed? Maybe from your relationship with

00:13:33.520 Jeff even prior to this? Or even that behaviors that after people listening to Jeff could start

00:13:39.460 to apply in their own life if they're trying to kind of figure this out for themselves?

00:13:44.240 To practice, we've talked about this on other podcasts, but practicing or understanding what

00:13:49.920 your practice looks like to expand your distress tolerance window. I write about this quite a bit

00:13:55.520 in the final chapter of Outlive. But it's sort of knowing the things that you do that give you a

00:14:01.340 greater operating window. So for example, for many people, meditation is a great tool to increase

00:14:08.960 the probability of responding as opposed to reacting when something happens. Learning the language of I

00:14:15.740 statements. Basically taking ownership for what you think, what you feel, what you do. Working through

00:14:22.520 this triad that he describes as the triangle of vulnerability. So sadness, shame, and fear. And trying to be

00:14:30.640 curious about where you are on that triangle and being more responsive to your own emotional

00:14:38.100 vocabulary around these things. Noticing what your coping skills are. Again, I talk and often joke about

00:14:44.940 some of mine that still exist to this day. E-shopping is an enormous coping skill for stress. I just can't

00:14:53.180 stop buying stupid things online when I am stressed out. I feel fortunate. In some ways, I'm really glad that 1.00

00:14:59.760 it's not drinking too much alcohol, but it's still a distraction. Even if the worst thing it does is

00:15:04.720 set me back a few dollars, it's preventing me from connecting. And it's preventing me from

00:15:11.380 accepting and dealing with what it is that's happening. I think there are other things, but I

00:15:15.560 think those would be a great place to sort of start. And obviously, we talk about so much more in this

00:15:18.920 episode. Someone who, let's say, has listened to the episode and are listening to us and they're like,

00:15:24.400 this is something that I've maybe been ignoring in my own life or pushed aside and decided up to this

00:15:31.260 point not to deal with it. I know you also have patients who are like that. And so when you're

00:15:36.020 talking to people and trying to encourage them to take the first step and to figure out this journey

00:15:40.640 for themselves, any advice you have for those people just in case they're on the other end

00:15:45.580 listening here? I just can't say enough about it. It's one of the things I enjoy talking about with

00:15:51.020 patients more than anything, because even though patients come to our practice because they want

00:15:56.580 to improve their lifespan, they also care about healthspan. And it's easy to forget that emotional

00:16:02.960 health is a piece of healthspan. And I think when a person is sort of caught in the vicious cycle of

00:16:10.180 what's often the response to and the adaptation to traumatic events, not necessarily exclusively as

00:16:17.840 children, but often as children, they're not living this connected life that Jeff talks about.

00:16:22.920 And I can just share from personal experience that being disconnected versus being connected is all

00:16:29.020 the difference in living. And it's not like you flip a switch and everything is fine. It's a process.

00:16:33.960 It's a journey, of course. But I've never met a person who's addressed their negative adaptations

00:16:40.260 and come out on the other side and said, I wish I didn't do that.

00:16:42.820 So this is a question we get asked a decent amount to the website. So it's here as well.

00:16:47.740 You in the book of Openly Talk podcast that you went to two centers to kind of like do in-depth

00:16:54.340 work on this. Oftentimes people just ask, hey, what are those called? So they can look them up as well.

00:16:59.760 Obviously these aren't the only two, but do you just want to state those where if people are looking

00:17:04.480 for a first place to start, two that you found beneficial for you?

00:17:08.180 Yeah. The first place was called the Bridge to Recovery. I went there in 2017. That's actually

00:17:13.080 where I met Jeff English. We talk about that a lot in the podcast. The second place I went

00:17:18.340 in 2020 was called PCS, Psychological Counseling Services. And I would recommend both of those

00:17:24.280 places very, very highly. And I think PCS focuses on more than just trauma, but it's very trauma

00:17:32.500 focused. The Bridge is really a trauma-based residential program. And again, I'm sure there

00:17:39.080 are others out there that are maybe equally wonderful. I know that for many people, obviously

00:17:44.760 I've encouraged a number of people to go to these locations and many have. Everyone acknowledges as I

00:17:52.000 did upfront, like, are you kidding me? How about I just keep working with my therapist for an hour,

00:17:56.960 or twice a month? That can work, but sometimes it doesn't. And sometimes you actually need to

00:18:03.420 undergo immersive therapy.

00:18:05.620 I was going to have you give this metaphor because you've talked about it before, but I think it clicks

00:18:09.020 with people, which is the idea if you want to learn a language, one hour a week tutoring in a class is

00:18:15.840 good, but sometimes moving to that country and being forced into that is how you're going to learn

00:18:21.040 better.

00:18:21.860 Yeah, exactly.

00:18:22.560 Last question on this, just because I need to do it. And there's probably people wondering,

00:18:27.160 have you ever bought anything in one of those shopping stints? And you've thought a week later,

00:18:31.640 like, oh, this was actually awesome. I'm glad I did. And if so, what was the best thing that came

00:18:37.120 out of that?

00:18:38.120 I mean, truthfully, and this is obviously just terrible rationalization. I think most things I

00:18:46.120 buy in my eShopaholic bursts, I'm pretty happy with them. Not all of them. I have bought

00:18:52.480 some really stupid things. And what I tend to do is give them away so that I don't see them again, 0.99

00:18:59.700 which is actually counterproductive because I should keep more of those things as a reminder

00:19:04.960 of my bad behavior. In other words, I should surround myself with more of the consequences

00:19:10.960 of those actions.

00:19:12.520 That's a great answer. Spoken like a true shopaholic in that.

00:19:15.820 Spoken like an honor.

00:19:16.560 Actually, yeah, actually, these things are all really awesome. And at the end of the day,

00:19:21.340 I'm really glad I have them.

00:19:22.400 Right. It's this horrible selection bias. I keep the things that are awesome. I give away the things

00:19:26.860 that are not awesome. It's awful.

00:19:28.960 Yes. So does that mean anyone who's ever gotten a gift from you should think that this is actually

00:19:34.040 Peter getting rid of stuff that he doesn't want? Or it doesn't quite work that way?

00:19:38.520 Doesn't quite work that way. I give away much more than just my non-awesome stuff.

00:19:41.580 Yes. Okay. That's good. Good to know. Moving on, Ashley Mason. This was a great episode on

00:19:48.460 sleep, insomnia, CBTI, how to improve your sleep. Very, very interesting. I know we talked about

00:19:56.040 already wanting her to come back for part two because we didn't even get through near everything 0.61

00:20:00.920 we were hoping to do. So do you want to start with walking through your biggest takeaways,

00:20:05.520 insights from this episode?

00:20:06.540 Yeah. Boy, Ashley is a force of nature. We had sketched out a lot of things we were going to

00:20:12.300 talk about, but we never got out of insomnia and CBTI because I felt like it was just too

00:20:17.780 important to stay there and gather all that information. So yes, definitely we'll have to

00:20:21.220 have Ashley back. So I learned a lot. Honestly, what I came away with is thinking that, okay, I feel like

00:20:28.280 I almost know enough to help people through part of the CBTI playbook without even having to refer out to

00:20:35.900 CBTI. And I think that the takeaway from this episode should be that you can do a lot of CBTI on your

00:20:42.640 own, which is not to say you shouldn't reach out to a practitioner if you're struggling, but the good

00:20:47.160 news is so much of the heavy lifting was covered here. So first of all, let's just start with the

00:20:51.840 semantics, right? So insomnia must persist for months. It must interfere with life and it must cause

00:20:58.080 distress. This isn't just a few nights of bad rest. So we don't want to over pathologize this.

00:21:05.180 So we're really trying to focus on a meaningful reduction in sleep. CBTI or cognitive behavioral

00:21:11.260 therapy for insomnia is one of the most effective tools for addressing serious insomnia. 50 to 60

00:21:18.440 people who utilize this achieve a complete remission and 70% show improvement. So there are lots of

00:21:27.600 contributing factors to the development of insomnia. So you have predisposing factors like genetic

00:21:35.160 past experiences. You have precipitating factors such as a life crisis, divorce, enormous stressful

00:21:42.640 experiences at work. And then you have perpetuating factors or coping strategies like what you do when

00:21:50.220 you are in this state of insomnia. Now CBTI only focuses on the latter. It does not concern itself with

00:21:58.460 what your predisposing factors are. It doesn't even care what the precipitating factor is and doesn't try

00:22:04.040 to stratify people based on those things. It basically says, you're here, you're having

00:22:08.620 significant insomnia, what are you doing to cope with it? And how do we address that? So in that

00:22:14.160 sense, the treatment is independent of the first two. Of course, I should just say this before we go on,

00:22:20.160 you do need to address any sleep pathology like restless leg syndrome or sleep apnea before engaging in

00:22:26.220 is. So you have to rule out that kind of stuff. Okay. So CBTI is really about addressing this triangle

00:22:32.880 of thoughts to feelings to behaviors. So picture a triangle, thoughts, feelings, behaviors, where each

00:22:39.940 one is influencing the next. And the discussion with Ashley was really a great way to kind of go through

00:22:46.540 all of the behavioral changes to mitigate insomnia, which fall under the themes that are, I think,

00:22:52.940 bucketed as sleep hygiene, stimulus control, time in bed restriction, cognitive techniques,

00:23:00.660 and relaxation techniques. So let's just talk about each of these. Sleep hygiene is something that

00:23:06.300 listeners of this podcast are very familiar with. These include things like keeping the room

00:23:11.240 temperature cold in the mid sixties, even if you need to wear socks, keeping the room as dark as

00:23:17.460 possible and using an eye mask if that's necessary. It means not drinking too much fluid,

00:23:22.720 after dinner to reduce the probability that you need to get up and pee at night. This means

00:23:28.240 addressing prostate issues. If you're a male, things of that nature. It means getting rid of

00:23:33.340 down comforters and heavy blankets, which disrupt the circadian temperature rhythm. Remember when we're

00:23:38.280 in bed, we're supposed to get into bed and rapidly begin a process of cooling to get into our deepest

00:23:44.180 sleep before we begin to warm a couple of hours before we wake up. She said anything with duvet in it

00:23:50.560 should be banned. So basically anything that's going to keep too much heat in is a bad idea.

00:23:55.740 Okay. What's stimulus control? Stimulus control means limiting the bed to only two things,

00:24:02.460 sleep and sex. Everything else happens somewhere else. That means no phone. That means no reading.

00:24:08.620 And while those are obvious, the other thing she made a really clear point about was no worrying.

00:24:14.020 Now you might say, well, who sets out to worry in bed? But what she really means by that,

00:24:18.400 and I think this is very important, is that you don't want to spend time laying in bed awake.

00:24:25.500 So if you're laying in bed and you're awake, especially if you're worrying, you need to get

00:24:30.840 out of bed and do something else. So she talks about people who suffer from insomnia. One of the

00:24:37.200 important things you have to do is get them out of bed for 20 to 30 minutes to do something really

00:24:41.740 low key. She had a funny description of get out of bed and do something that you would be embarrassed 0.99

00:24:47.640 if your colleagues at work saw you doing it. In other words, don't get out of bed at three in

00:24:52.840 the morning to go and work for 30 minutes. Get out of bed for 30 minutes to read a trashy magazine or

00:25:00.080 watch some silly sitcom, but something that's not really activating and allow yourself to get a little

00:25:06.140 bit sleepy and then come back to bed. By the way, not long after the podcast with Ashley, and I rarely

00:25:12.660 experience insomnia, but I went through a couple of days when I was being jolted up at two or three

00:25:18.920 in the morning and could not get back to sleep. And my inclination was sort of to sit there and just

00:25:24.280 fight it and fight it and fight it. And finally on the third night, I was like, why am I not just

00:25:29.360 doing what Ashley said? So as soon as it happened, I got up, went out to the couch in the family room,

00:25:34.780 threw down an episode of Silicon Valley, which as you know, you and I talk about this all the time,

00:25:39.660 one of the greatest shows of all time, and then just went back in and went to bed. So that's an

00:25:43.420 example of something that's super low key that allowed me to get back into it. The next one here

00:25:48.840 is really, really hard for people to wrap their head around sometime, but it's called time in bed

00:25:53.900 restriction. Previously, people referred to this as sleep restriction, which the name of that is

00:25:58.920 obvious. So why would you do such a thing? Well, the problem is for many people with insomnia,

00:26:03.320 they're actually spending too much time in bed and their sleep efficiency is really low.

00:26:08.500 They're spending a lot of time in bed because they're tired because they're not sleeping and

00:26:13.580 it becomes a vicious cycle. Now, anybody who's used a wearable for sleep or uses anything that

00:26:19.640 measures sleep probably notices a calculation that gets spit out called sleep efficiency.

00:26:24.840 Sleep efficiency is time sleeping divided by time in bed. You want to be able to hit at least 85%

00:26:31.640 here. I should say you want to be able to hit about 85% here. So to be clear, if you're

00:26:36.300 hitting 95%, you're not giving yourself enough time in bed is almost assuredly the case. And if

00:26:43.500 you're hitting 75%, you're probably spending too much time in bed. So to restrict time in bed,

00:26:50.320 you want to first understand your typical time of sleep with a sleep diary. And then you add a 30

00:26:56.580 minute buffer to get your target time in bed. So you can also determine the ideal wake up time

00:27:01.260 and base your time in bed off this wake up time. So getting your wake up time right is key. This is

00:27:08.340 the thing that you want to be fixed. And then your bedtime starts to take care of itself as you build

00:27:15.300 up sleep pressure over time. You've probably heard me talk about this on the podcast before. The more

00:27:21.020 consistent your wake up time is, even on weekends, the easier it is to control sleep hygiene. The term of

00:27:28.840 people who let their sleep schedules move on weekends and they sleep in a lot later, which is

00:27:34.440 understandable, right? Like if you work Monday through Friday and you're getting up at five in

00:27:37.680 the morning, it is a real tempting on the weekends to sleep till eight or nine o'clock. The problem is

00:27:43.040 that process of social jet lag is devastating for your circadian rhythm. So she describes focusing on

00:27:50.240 process S, which is sleep pressure to standardize what she calls process C or circadian rhythm.

00:27:58.100 And we talked a little bit about sleep trackers. She does not recommend using them if you're

00:28:02.640 struggling with insomnia. And I couldn't agree more from our own practice. One of the first things we do

00:28:07.900 when people are struggling with sleep is we get them to take their sleep trackers and at best put them

00:28:13.840 away. At worst, throw them out. Once this kind of gets in your head, it becomes a brutal cycle.

00:28:19.140 So you don't need this to fix the problem. Cognitive techniques. I found this to be very

00:28:24.160 interesting. Schedule time for worrying. Again, for many people, the waking up part then triggers

00:28:31.880 the set of ruminating thoughts. Insomnia sometimes arises from not processing information enough during

00:28:38.320 the daytime and spending too much time in bed ruminating. So she has her patients schedule worry time

00:28:45.340 by intentionally putting something on the calendar where they literally write down all the things

00:28:51.260 that they are worried about. And they might have 20 minutes a day to do that. And then they don't

00:28:56.980 have to feel the need to process this at night. So you think about the things that you would normally

00:29:01.740 think about laying awake in bed, and all of a sudden it gets a lot better. She does something called

00:29:06.540 tracking the degree of belief, which means asking yourself, how much do I believe this is true?

00:29:11.840 True. So a lot of times people will find the things that seem absolutely certain in the evening may

00:29:17.940 turn out to be kind of unlikely during the day. They just feel more certain of it before bed, which

00:29:22.980 increases worrying. So again, these are some of the techniques. I won't go through all the other

00:29:28.040 stuff. There's some stuff she talks about on relaxation, which I think is helpful. And she also

00:29:32.900 talked about A-B testing other things that are probably less effective. She wasn't a huge proponent

00:29:38.160 of blocking out blue light, but she said it's always worth trying. If wearing red light or blue

00:29:44.840 light glasses in the evening helps, she's like, by all means, great. Give it a shot. Obviously 0.93

00:29:50.660 experimenting on timing of caffeine, medication, supplements, all great, but her view is just

00:29:56.680 test those things out. So yeah, I would say those are kind of the big things.

00:30:00.620 And Peter, remind me, did she talk about anything on like sleep supplements, sleep prescription

00:30:07.560 drugs that people should think about potentially use if they're going through this?

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The Peter Attia Drive - May 05, 2025

#347 – Peter's takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma ｜ Quarterly Podcast Summary #5

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