The Peter Attia Drive - #49 – Matthew Walker, Ph.D., on sleep – Part III of III： The penetrating effects of poor sleep from metabolism to performance to genetics, and the impact of caffeine, alcohol, THC, and CBD on sleep

00:00:00.000 Hey everyone, welcome to the Peter Atiyah drive. I'm your host, Peter Atiyah. The drive

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00:04:10.580 for a monthly subscription. Welcome back to the final installment, part three of three of the

00:04:15.060 Matthew Walker series on sleep. If for some reason you haven't yet listened to the first two episodes,

00:04:19.720 I'd recommend going back and listening to those prior to listening to this one.

00:04:23.240 My guest this week is Matthew Walker, professor of neuroscience and psychology at the University of

00:04:27.900 California, Berkeley, and the founder and director of the Center for Human Sleep Science.

00:04:31.420 Matthew earned his undergraduate degree and PhD in neurophysiology in London and subsequently became

00:04:37.340 a professor of psychiatry at Harvard Medical School before moving to Berkeley. His research

00:04:41.240 examines the impact of sleep on human brain function in healthy and diseased populations.

00:04:46.240 To date, he has published over a hundred scientific studies. He has received numerous funding awards from

00:04:51.540 the National Science Foundation, National Institutes of Health, and he's a fellow of the National Academy

00:04:56.260 of Sciences. He's the author of the international bestseller, Why We Sleep, which also happens to be

00:05:01.280 the favorite book of my not yet two-year-old son. He holds many patents covering various consumer-based

00:05:07.860 sleep recordings, sleep tracking, and sleep simulation. He's a sleep scientist at Google where

00:05:12.840 he helps the scientific exploration of sleep and health and disease. He is also an enormous fan of

00:05:18.060 Formula One and my hero, Ayrton Senna. In the final part of this series, we discuss the role of sleep

00:05:23.880 and my weight gain, presumably that of others, sleep and blood sugar, sleep's effect on genes,

00:05:30.360 sleep's effect on the food you eat, the effect of sleep on people's productivity, the relationship

00:05:35.920 between alcohol, caffeine, THC, CBD, and sleep. And that's not all combined, of course. What Matthew

00:05:43.000 is doing today at Berkeley at the Center for Human Sleep Science and other startup projects he's working

00:05:47.340 on. And we close this out with a discussion of Formula One, our mutual favorite thing, driving

00:05:52.880 and sleep. As a reminder, at the end of this series, we're going to take questions for a follow-up AMA

00:05:58.520 with Matthew. Asking questions on the AMA forum and listening to the AMA podcast with Matthew, along with

00:06:04.160 all AMAs, will only be available to subscribers. So if you haven't signed up yet, you can do so now at

00:06:08.780 peteratiamd.com forward slash subscribe. So without further delay, here is the finale with Professor

00:06:15.420 Matthew Walker. I want to talk about another several topics on here, but I want to go back to something

00:06:23.200 that you and I have spoken about before, but I think it's so important. I want to make sure we've

00:06:27.280 got it for all the listeners. One of the most compelling things I ever read, I mean, I think

00:06:34.020 there were several moments in my journey and in the sort of world of sleep that really shook me.

00:06:42.120 One of them was reading this paper out of the University of Chicago, and I believe it was

00:06:47.040 Eve Van Cotter, but it might not have been. It took a group of subjects and it was a very small study,

00:06:54.620 but it was so well controlled because they sleep deprived these and well, they did euglycemic clamps on,

00:07:00.620 you know, day zero. So for the listener, that's a really rigorous test where you inject glucose and

00:07:08.160 insulin into the patient and you keep the glucose level steady by titrating the insulin level. And

00:07:15.480 this is an elegant way to measure one of the most important features of metabolism, which is how well

00:07:20.620 you dispose of glucose primarily into the muscle. And I believe the subjects were restricted to four

00:07:27.820 hours of sleep a night for two weeks. And it's been replicated for four, five, and six hours for

00:07:35.360 one week. Okay. At the end of that period of time, they repeated the euglycemic clamp, again,

00:07:40.560 the gold standard for measuring insulin resistance. And these patients suffered a 50% reduction in their

00:07:47.460 ability to put glucose into their muscle, which again, would certainly rank among the five most

00:07:55.320 important physiologic things to do. Again, to put this in perspective, a normal blood sugar might

00:08:01.480 be a hundred milligrams per deciliter or roughly five millimolar for a normal sized individual that

00:08:07.480 represents five grams of glucose. I'm going to let the siren go by here. Yeah. It's, it may actually be,

00:08:14.600 um, immigration coming to get me finally into deporting me back to the United Kingdom, but sorry. Yeah.

00:08:20.120 So, so you've got five grams of glucose in the bloodstream, which is one table teaspoon. Frank

00:08:27.500 diabetes would be 200 milligrams per deciliter, 10 to 11 millimolar, two teaspoons of sugar. So the

00:08:37.380 amount of glucose you have in your bloodstream is trivial compared to what's in the muscles and in the

00:08:44.620 liver. So imagine losing the ability to put that away by 50%. And as I look back at how metabolically

00:08:55.320 deranged I was at the end of my residency, I can't help but realize something that I think alluded me

00:09:03.900 for a great number of years, which is the role that sleep deprivation played in my weight gain,

00:09:09.960 my insulin resistance, my hypogonadism. I know you and I've joked about it, but I think at the end of

00:09:15.720 residency, my testosterone was about 200 to 220 nanograms per deciliter on a scale where two

00:09:22.600 standard deviations below the mean is about three 50. So, you know, about twice that of a, of a female

00:09:28.920 in terms of testosterone. I now realized that was the sleep deprivation. That wasn't just the cafeteria

00:09:35.480 food. Uh, and by the way, it certainly wasn't a lack of exercise amazingly throughout residency.

00:09:40.920 I still managed to figure out a way to exercise like crazy. And you know, the point there is,

00:09:44.600 despite all of that exercise, despite the power that that should have had on your metabolic system,

00:09:51.800 my guess is that if we'd done that same glucose tolerance test, it would have been way down. And

00:09:58.220 when you think about, you know, that's essentially taking healthy individuals who show no signs of

00:10:04.680 diabetes, limiting them to an anemic diet of sleep, you know, four, five hours for one week now we've

00:10:12.140 seen, and you can get them into a state where someone like you, if you just read their readings

00:10:17.340 at the end of the week and you not think about the experiment, you would probably argue that they

00:10:21.400 may be in a pre-diabetic state at that stage. Sure. You're writing the ret for the metformin

00:10:25.640 prescription. How is this happening, Matt? What is the mechanism by which something so profound,

00:10:31.960 so fundamental and important to our survival is going so awry in such a short period of time?

00:10:38.000 We know the evidence. We we've unpacked this mechanism now. So the way that you regulate

00:10:44.120 your glucose, the way that you sort of have glucose homeostasis is that there are at least

00:10:50.120 two major parts of this equation. The first is that cells in your pancreas called beta cells

00:10:55.900 need to sense the spike in blood sugar, and then they need to release insulin. And then

00:11:02.300 when that insulin is released, it actually tells the cells of the body to reach out and

00:11:09.560 absorb the blood glucose, the blood sugar, and that prevents you from an otherwise dangerous

00:11:15.760 spike in blood sugar. So these two things need to happen. Your beta cells in your pancreas

00:11:21.440 need to release insulin. And then the cells of the body need to be sensitive to that insulin

00:11:28.080 to be then instructed to essentially, you know, suck in that, that blood glucose from the bloodstream.

00:11:36.560 Now, what can happen is that if you have a deficit in one, and you know, I think, you know, pregnancy

00:11:41.840 may be a good demonstration of this where sometimes, you know, the cells of the body become less

00:11:47.560 sensitive to that insulin. But what's nice is that the beta cells in the pancreas, they understand

00:11:54.680 that the cells aren't sucking in the glucose that they need. So they just release some more insulin,

00:12:00.220 and your insulin homeostasis remains in balance. So this is what we call the disposition index. How

00:12:07.040 good are you at disposing of glucose? And, you know, can you manage that disposition index?

00:12:13.920 So what happens with insufficient sleep is unfortunately bad on both sides of those

00:12:20.760 equations. So firstly, we know that when you are underslept, the beta cells of your pancreas

00:12:26.880 become insensitive to the spike in blood sugar glucose. In other words, your body stops releasing

00:12:35.200 enough insulin to deal with the food that you've just eaten. So you're down on insulin. You haven't

00:12:42.620 released enough insulin. That's a bad thing. But maybe it wouldn't be so bad if the cells of the

00:12:48.320 body were just really sensitive to what little insulin is left, and you could still at least

00:12:53.100 clear some of that blood glucose. Unfortunately, that doesn't happen, because what's worse is that

00:12:59.100 the cells of the body actually become insensitive to the signal of insulin. And so the cells of the body

00:13:07.900 stop sucking in as much glucose, as much sugar from the bloodstream. So on both sides of the glucose

00:13:16.820 homeostasis balance, you're kind of a little bit screwed that insufficient sleep means that you don't

00:13:25.180 release enough insulin. So you don't have enough of that signal to begin with. What little has been

00:13:31.120 released, unfortunately, is not listened to and heard by the cells of your body. So those cells

00:13:38.360 actually don't end up dragging in the blood glucose, the gushing kind of monsoon of glucose that's now in

00:13:45.440 your bloodstream after a meal, which means that you end up having an inability on both sides of the glucose

00:13:51.860 equation to clear that blood glucose. That's why you have that type of glucose intolerance, problems with

00:13:58.580 glucose absorption. And to get down to even the causal mechanism in humans, some great studies

00:14:05.300 where you can actually say, why are the cells so mute to the signal of insulin? Why are your cells not

00:14:17.400 listening to insulin correctly and not responding by bringing that blood sugar into them to drop your

00:14:24.000 blood sugar levels? And the answer is this, what they did was they took a group of, again, healthy

00:14:29.160 people, no signs of diabetes. They took a biopsy of cells from around the belly button from the

00:14:35.660 umbilicum. And then you can actually measure how those cells are behaving inside of those cells themselves.

00:14:43.220 So you can kind of like poke around inside and figure out what's happening. They took the biopsy in those

00:14:49.240 same subjects after they've been limited to just four or five hours of sleep. And then they repeated

00:14:54.140 the biopsy when those participants had been sleeping eight hours. So this is, again, one of those

00:14:59.700 beautifully, carefully controlled studies, same individuals, same process. And are they looking

00:15:06.000 at adipocyte or myocyte? That's right. So it's adipocyte. So this is fat cells.

00:15:10.760 Right. So this, I would expect something different in the adipocyte from the muscle cell.

00:15:14.640 I don't think the experiment has been done with the muscle cell yet, but it has been done with the

00:15:18.640 adipocyte. And then they've essentially got these now, these cells outside of the body and you can

00:15:24.040 play around. You can essentially sort of, you know, drip insulin onto those cells and you can ask

00:15:29.680 what's going to happen to those cells in terms of the instruction that they receive from the insulin.

00:15:35.040 One of the critical things that happens when insulin binds to the receptor of the cells

00:15:39.780 is the phosphorylation of something called AKT. And when AKT is phosphorylated, it essentially helps

00:15:48.040 something called the glue four transporter inside of the cell to essentially go to the surface of the

00:15:54.400 cell. And it's almost like the metaphorical straw that gets stuck out of the cell and it's bringing

00:16:01.380 glucose in to simplify it. What you find is that when that cell has been under conditions of

00:16:09.200 insufficient sleep, the amount of insulin required to phosphorylate that AKT to get those cells to

00:16:18.420 start absorbing glucose, you need almost twice the amount of insulin. You need double the amount of

00:16:25.460 insulin to get those cells to do the same thing, which-

00:16:31.200 That's counterintuitive actually. You'd think that the adipocyte would be even more sensitive to insulin

00:16:37.740 as the body works harder to undergo esterification and put fat away, given that the muscle becomes

00:16:50.140 more resistant to insulin. So that's interesting. So of course, this speaks to why many hormones are

00:16:56.760 necessary to drive the metabolic derangement because also the cortisol level would maybe even

00:17:02.480 oppose that. But in isolation, what you just described would actually oppose re-esterification

00:17:07.120 of fatty acid.

00:17:08.320 Yeah. But in my mind, I think what's striking though, it starts to tell you that individual

00:17:14.640 cell types need sleep.

00:17:18.300 Yeah. I was just going to say, what do you think is the communication vehicle? What is telling

00:17:26.600 that phosphorylated sign? Do less of it, be less effective? How is that communicated?

00:17:35.760 That right now, I think we, at least I don't know of what intracellular mechanisms have transpired

00:17:43.580 to decrease the amount of, or the capacity for the phosphorylation of AKT to bring glucose into the cell.

00:17:52.260 There are clearly some kind of signaling mechanisms that are coming extracellularly

00:17:58.300 and telling intracellularly things to do that are either maladaptive or just much less efficient

00:18:08.880 inside of the cell. But to me, that just blows my mind that, you know, we often think of the

00:18:14.380 impact of a lack of sleep on things like behavior, like driving or, you know, making food choices.

00:18:20.200 We've done some of this stuff with brain scanning and, but your question is so beautifully nuanced

00:18:25.460 because it's actually asking, there is something about a lack of sleep that will get even into cells

00:18:33.080 themselves and alter intracellular functioning. So if you can get a single factor sleep that can have

00:18:44.380 its impact all the way from complex cognitive issues, like decision-making, all the way down

00:18:51.920 to something like intracellular function, my goodness, you need to look out if you're depriving

00:18:59.360 yourself of that one function. And I'll go a step further because there was a great paper published

00:19:04.160 in something called the Proceedings of the National Academy of Science. It's a very prestigious journal.

00:19:08.320 We like to call it PNAS around there.

00:19:10.040 Right. Yeah. PNAS, the acronym. With my students, I'll say P-N-A-S and try to navigate around that 1.00

00:19:18.080 unfortunate acronym.

00:19:19.100 That is hilarious because like, I'm so, you know, far removed that it was just PNAS. Like it was,

00:19:25.520 we never even thought you would have to be politically correct and call it P-N-A-S. 1.00

00:19:29.200 Yeah. I just published, you know, my biggest girth of research in PNAS.

00:19:33.340 Well done. That sounds like your parents must be swelling with pride right now. Could you imagine?

00:19:41.220 And I actually have, we have published a bunch of stuff in PNAS, but this, this side...

00:19:47.440 By the way, this, I just got to pause for a moment. Why is it, here's another evolutionary

00:19:51.440 question. Why is it that any two guys can be hanging out? Like you could have the, I was going

00:19:59.140 to say the president of the United States, bad example. You could take any two male heads of 1.00

00:20:05.260 state and put them in the UN on the floor trying to negotiate a resolution. And like a penis joke 0.99

00:20:12.360 just makes everybody laugh. 0.98

00:20:14.340 Can I just say that within, I think, and people can tell me the time of this in the comments,

00:20:18.940 I think within the space of about 180 seconds, we went from intracellular cascade mechanisms 0.94

00:20:24.880 from phosphorylation of AKT to penis jokes. And it's all my fault. 0.98

00:20:29.560 No, no, no, no, no, no.

00:20:30.320 I use the whole... Now, I want to go back to this because what you said is, it actually scares me

00:20:35.940 more. Here's why. I think that at the surface, everything you opened our discussion with with

00:20:41.220 respect to Alzheimer's disease, I mean, you led with the best punch, right? To me, that is,

00:20:46.260 you could stop there. If sleep disturbance didn't impair your driving, didn't increase your risk

00:20:52.700 of cardiovascular mortality, didn't trash your immune system and double your risk of cancer,

00:20:58.220 didn't give you diabetes. If you took every one of those things away, just driving your risk of

00:21:04.100 dementia is... That's full stop reason enough. Didn't impair your learning. Take everything away.

00:21:10.600 Cardiovascular disease, depression, anxiety, suicidality.

00:21:12.940 Don't worry about it. I'll take it all. But paradoxically, most of those things,

00:21:19.020 because at least we see what the mechanism in, that the mechanism of action is. And even when

00:21:24.280 we don't, like in Alzheimer's disease, I don't think we know exactly the mechanism of action,

00:21:27.840 but there's a plausible theme. But it's this last one that you're bringing up that in many ways

00:21:33.180 scares me the most because it speaks to the ubiquity and the spread and the breadth of that

00:21:42.480 impact. Like there are other cellular facts. Like this is so central that it's impacting and regulating

00:21:50.320 the phosphorylation of a series of enzymes that drive something so seemingly unrelated as a GLUT4

00:21:57.300 transporter to translocate the surface of a cell. Like why in the world would that happen at a single

00:22:03.660 cell level? That should never happen.

00:22:05.420 I love the impact of a process, be it, you know, diet or exercise or food, you know, at that level,

00:22:11.380 the fact that it can transcend almost every biological level of slice that you can do to

00:22:17.580 biology. And to me, I think that the final one, which comes back to the penis, the PNAS paper,

00:22:24.120 takes the final step for me. What they did was they took a group of, again, healthy adults, 0.74

00:22:30.240 and they limited them to six hours of sleep for one week.

00:22:34.600 So they basically made them average Americans.

00:22:36.660 Average Americans, yeah. And then they essentially looked at the change in their gene activity profile.

00:22:43.560 This is from blood.

00:22:44.580 You're not going to tell me there was epigenetic change.

00:22:47.620 Well, relative to when those same individuals were getting eight hours of sleep. And there were

00:22:52.920 two critical findings. First, what they found is exactly your fear. They found that a sizable and

00:22:58.360 non-trivial 711 genes were distorted in their activity caused by that insufficient sleep, which,

00:23:05.740 by the way, again, six hours of sleep, you know, may even sound luxury to some people, but this is

00:23:12.140 very common. So this is not one of those experiments where you say, oh, they limited them to two hours of

00:23:17.380 sleep or they did total deprivation. And that's not ecologically relevant. This is an ecologically

00:23:23.400 relevant manipulation. This is six hours of sleep. It's very common in society.

00:23:27.400 And it distorts, you know, well over 700 genes relative to when those same individuals are

00:23:33.400 getting eight hours of sleep.

00:23:34.780 Let's just put this in context. There's only about 20,000 genes in the human genome. It's not like you

00:23:40.860 said seven genes, or it's not like you said 700 in the presence of 2 billion genes. This is 3%.

00:23:48.620 Right. You have an epigenetic change in 3% of your genome.

00:23:53.460 And this is with an epigenetic change within seven days at a moderate dose of sleep restriction.

00:24:03.740 What was also interesting was the direction that about half of those genes were actually upregulated.

00:24:11.660 The other half were actually downregulated. Those genes that were impaired in their activity

00:24:17.300 were numerous genes associated with the immune system. Those genes that were actually upregulated

00:24:23.320 were genes that were associated with tumor promotion, genes that were associated with long-term

00:24:29.160 chronic inflammation within the body, and genes that were associated with stress and as a consequence,

00:24:34.920 cardiovascular disease. And I find that impressive because many people in society right now feel

00:24:43.100 uncomfortable about the idea of something like genetically modified embryos or genetically modified food,

00:24:50.300 for example.

00:24:51.980 Or CRISPR, right?

00:24:52.760 Or CRISPR, yeah, especially here as we are in Berkeley, it's relevant. But to me, I think that if you feel

00:25:00.040 that way, if you feel uncomfortable about sort of GMOs, genetically modified food, or genetically modified

00:25:07.960 embryos, but you're choosing to get insufficient sleep, and here we're talking about six hours of sleep,

00:25:13.720 then I think you must accept then that you are performing, firstly, a similar genetic modifying

00:25:20.280 experiment on yourself by reducing your sleep amount. And secondly, if you don't let your children get the sleep

00:25:27.120 that they need, you may be inflicting, inadvertently, a genetic manipulation on them as well. 0.99

00:25:33.000 Did that penis, sorry, see to me I can say penis without thinking penis, but now I can't. Did that paper show 0.99

00:25:41.180 the reverse? In other words, once you restored sleep, could you undo any of that genetic damage?

00:25:48.800 Didn't look at it.

00:25:49.500 Because I'm going to take the sort of contrarian view here, which is we're all hosed. Because there's

00:25:55.320 not a single person that hasn't been restricted to six hours a night, so it's almost like we should

00:26:00.520 throw up our hands and wave, which I don't think is the answer.

00:26:03.220 No, I don't think it is the answer, and I think here's why. Firstly, you know, coming back to this

00:26:09.480 argument that sleep is not like the bank. You cannot accumulate a debt and then hope to pay it off

00:26:16.400 at a later point in time. That's why that binging at the weekend doesn't work. So once you've gone

00:26:22.020 without sleep, whatever has happened during that time when you are underslept doesn't seem to be

00:26:28.080 reversible. However, that doesn't mean that from this point forward, it's a waste of time to start

00:26:35.500 sleeping better. And I have evidence for that. We and others have been looking at cognitive decline

00:26:41.780 in older adults, as we've mentioned before. Now, one study looked at a group of individuals who

00:26:46.840 were in mid to later life, and they had sleep apnea, snoring, which by the way, is a devastating

00:26:53.160 condition. If you snore, or your partner tells you to snore, please go and see your doctor, get a sleep

00:26:58.880 test, and get on sleep apnea treatment. But the point was this, they gave them this CPAP treatment,

00:27:06.060 which is this sort of face mask to push the airway open so that you don't snore and you don't go without

00:27:11.400 oxygen. And by way of an experiment of nature, about half of those individuals were compliant

00:27:18.240 with the treatment, about half of them weren't. Those individuals who complied to the treatment

00:27:24.060 and started sleeping better because they had their sleep apnea treated, ended up staving off the

00:27:30.440 onslaught of Alzheimer's disease by about 10 years. So in other words, this is a causal demonstration

00:27:38.760 that if you course correct sleep, you can actually modify your dementia probability risk. And it tells

00:27:47.720 me in some ways, a message of hope, which is that perhaps it's never too late to start sleeping better.

00:27:54.100 Because if I've got evidence that in moderate, in mid to late life, that when you start course

00:28:00.940 correcting bad sleep here, it's a sleep disorder with a particular treatment, that can have an

00:28:06.420 observable benefit in terms of reducing your cognitive decline rate, then...

00:28:12.140 Although it's hard to know, right? Because the people who are compliant with CPAP presumably

00:28:17.180 are doing so for reasons that might also make them more compliant with other inputs such as,

00:28:25.680 you know, nutrition and exercise.

00:28:27.260 Could even be, you know, that the sleep is not actually... So maybe the sleep is the influencing

00:28:33.840 factor, but sleep is not the route through which the benefit comes. It's because you're sleeping

00:28:40.980 that you start to eat better. And we can speak about that relationship between sleep and food choices

00:28:46.900 and caloric intake. And when you are underslept, you are far less likely to be active and motivated to be

00:28:56.040 physically active. When you are physically active, the amount of force pressure that you can generate,

00:29:03.280 the amount of aerobic output that you can generate, the amount that you can resist physical exhaustion

00:29:08.700 when you're sleeping well, all of those things are improved. To your point...

00:29:13.140 If I recall, it's about a 30% roughly... I mean, it's not a...

00:29:16.520 That's right.

00:29:16.540 It's a non-trivial reduction in performance with sleep deprivation.

00:29:19.760 Yeah. I take someone, a healthy person who is physically active, and I limit them to six hours of sleep.

00:29:25.140 You get about a 30% decrease in your time to physical exhaustion. So the idea would be,

00:29:31.040 let's say that you're training for a 10K. And in the days before, for whatever reason,

00:29:36.560 you're down to six hours of sleep. And you've trained to maintain your point of physical exhaustion,

00:29:42.680 you know, to the 10K level. Well, now just with six hours of sleep, I'm going to see you fail at

00:29:48.380 7K. Because I've had a 30% reduction in your time to physical exhaustion. But I think your point,

00:29:56.780 again, is a very good one, which is maybe it's not the sleep directly. It's the sleep transacting

00:30:02.120 its benefits that we know also play into decreased risk for cognitive decline, such that you start

00:30:08.620 making better food choices. The amount of caloric intake that you have is lower. The amount of calories

00:30:15.700 that you expend is higher. Your motivations to be physically active. And when you are active,

00:30:21.300 you work out more intensely and harder. All of those things we know come by way of a benefit of

00:30:27.240 sleep. So maybe sleep is, you know, the root cause, but it's not ultimately the thing that may

00:30:34.020 be transacting it. Now, I think knowing the relationship between sleep loss and Alzheimer's

00:30:39.500 protein pathology that we described, maybe it is playing a part. I don't think we know. But to

00:30:45.040 your point, which is a good one, don't feel as though if you're someone listening to this, and

00:30:50.720 you've been on a diet of five or six hours of sleep for most of your adult life, that all is lost. And

00:30:57.560 you should just cash in your chips and say, well, basically, my fate is now sealed. It's not. I don't

00:31:04.620 think it's ever too late to start sleeping better. I honestly don't. I think the argument that it's

00:31:09.660 too late almost fails on first principles when you just consider virtually every other intervention,

00:31:17.080 right? If you take someone who has diabetes, type 2 diabetes, and, you know, you dramatically change

00:31:23.380 the way they eat and exercise, it's quite clear what you can do. If you take someone who smokes, I mean,

00:31:29.140 smoking might even be a better example, because we have such longitudinal data on risk reduction as

00:31:36.220 time of non-smoking increases after a period of smoking. I mean, that's actuarially mapped up the

00:31:43.880 wazoo, and that's a simple enough intervention that you can attribute it to. It's actually a very

00:31:48.320 similar intervention, right? Because you would argue that in the individuals who stop smoking, they're

00:31:53.160 more likely to make more positive health decisions for the simple reason that if I'm not going to

00:31:59.120 smoke, what else am I going to take seriously in my health? And in the end, for the purist who says,

00:32:06.100 I need a randomized prospective trial to demonstrate this, one, I don't think you're ever going to get

00:32:10.440 it. And I think the reason is we're really at the point where it's going to become unethical to do

00:32:15.980 draconian studies of sleep deprivation, or I don't even think it would be ethical to take,

00:32:21.940 to do a longitudinal study of depriving people with apnea of CPAP.

00:32:26.340 I think the evidence is so overwhelming that yet you're ethically going to be unable to do those

00:32:31.580 things. And it's the same way with kids in school, that I think the only option that we're going to

00:32:36.640 have in terms of proving the importance of sleep for school start times and just health in general

00:32:42.420 for kids is going to be elongating their sleep. If you look over the past 50 years, what we found

00:32:49.240 is that kids across all ages are sleeping about two hours less now than they did 50 years ago,

00:32:58.140 two hours less. Now to put that in context, if I went to my ethics committee and said, look,

00:33:03.920 I'd like to take a group of seven-year-olds or six-year-olds, and I'd like to lop off two hours

00:33:10.680 of their sleep, and I'd like to impose that on them for the next month and study it. Is that okay?

00:33:19.020 I'd probably be, you know, put on academic probation for even suggesting that, let alone they would never

00:33:25.680 let me do that. But that's what's happened in society. So I think your point is a great one too,

00:33:31.680 which is we are probably not going to be able to do the sleep restriction studies increasingly

00:33:37.680 anymore. We're going to have to do, you know, the sleep intervention and the sleep extension studies,

00:33:43.060 and even some of the sleep intervention studies. Ethically, you may not be able to do it because

00:33:48.420 it's already so clear that you need to be treating the sleep disorder. And, you know, sleep apnea is

00:33:54.240 a good example there too, that when you treat sleep apnea, and you typically see far higher rates

00:34:00.480 of diabetes in people who have untreated sleep apnea. And when you treat them, you see their

00:34:07.380 diabetic profile improve markedly, but you also see that they start eating less, their choices of food

00:34:15.100 are better, they are far more likely to be physically active once again. So again, I think it's unclear

00:34:22.680 whether it's that direct benefit of sleeping better on things like the pancreas releasing the right

00:34:30.500 amounts of insulin, or the cells in the body being instructed by the insulin to suck in the glucose more,

00:34:35.540 or if it's just higher order things, such as you're sleeping better, so you make better food

00:34:41.720 choices, you are not as hungry anymore. And, you know, we and others have done these studies where

00:34:46.920 you look at sleep and appetite regulation. And there, I think the data is just as causal and powerful as

00:34:54.300 it is for glucose regulation. You know, what we find is that when you start short sleeping people

00:34:59.880 four, five, six hours a night for one week, the appetite hormones that regulate exactly, you know,

00:35:07.720 that food intake, they're called leptin and ghrelin, they go in opposite directions in ways that you wish

00:35:14.260 they didn't. So leptin is the hormone that essentially is the satiety signal. It tells your brain that you are

00:35:22.100 full, you don't need to eat anymore, you're satisfied with your food, stop eating. Essentially,

00:35:28.260 it's that satiety sort of red flag. Ghrelin is the opposite hormone. It essentially says,

00:35:35.780 no, you're not satisfied with your food, you want to eat more, it's a hunger signal, essentially.

00:35:43.160 So what you find is that when you are underslept, the leptin, which is saying you're full, don't eat

00:35:49.640 anymore, that signal gets turned down. So it's not particularly voluminous anymore. So your brain

00:35:56.040 loses the signal of, I'm full, I'm satisfied. And instead, ghrelin is actually ramped up. So you

00:36:05.560 start to feel unsatisfied by your food, and you will eat more. And so on both sides of that hormonal

00:36:13.460 appetite equation, you essentially downgrade this red flag of satiety, and you upgrade the signal of 0.64

00:36:23.980 hunger, which then leads to what we've now demonstrated, which is an increase in your

00:36:30.000 caloric intake. People sleeping six hours a night during the week, they will typically eat about

00:36:36.460 300 extra calories during the day, which may not sound very much. But when you add it up week after

00:36:42.640 week, year after year, it comes to about 70,000 calories, if you look at the actual numbers.

00:36:48.400 And I think it's even more pronounced than that, because, you know, the caloric arithmetic is

00:36:52.520 complicated because of the compensatory components. But I think anybody, I mean, I do this natural

00:36:58.400 experiment of doing too much flying across the country. And the east to west, which is a very long

00:37:06.020 day, and it's a sleep deprived day, because you're used, at least for me, I always want the earliest

00:37:10.200 flight out to have the most time back. That is unquestionably one of the worst eating days of my life,

00:37:16.900 if I let it be. So one of the tricks I've learned for that day, which I now do very well, but I had

00:37:23.840 to be very deliberate about it was, so you're going to fly out of JFK at 6am, which means you're waking

00:37:29.780 up at about four, and you didn't go to bed at eight, right? So that sucks. I go to the airport, 0.77

00:37:37.520 and I get a really good breakfast, a proper breakfast, like I eat, you know, exactly what I

00:37:43.340 would want to eat. I don't eat a single thing on the plane, despite all of the dumb snacks that keep 0.81

00:37:50.160 coming your way. And I also manage to exert enough self-discipline to get on the plane without buying

00:37:57.180 trail mix, which is my absolute airport kryptonite. But here's the thing, then, you know, you land in

00:38:03.640 California, it's like 10 o'clock. And what I do is basically have a tiny snack that is also like

00:38:12.820 well-scripted, like I know exactly what it's going to be. It's like sort of avocado and macadamia nut,

00:38:18.480 highly satiating. And then I don't eat again till dinner, and then I go to bed really early. So super

00:38:23.380 early dinner, 5pm, super early bedtime, 8. And if I do that, it's awesome. But like that requires a lot

00:38:31.220 of work. It just requires a lot of planning and momentary moments of discipline. But if you don't,

00:38:37.860 if you just do that on autopilot, which is basically what you would be doing if you were living that way

00:38:42.560 every day, I mean, I'm amazed at the food choices I want to make. Like I have literally, if I look back,

00:38:49.900 there were moments when I caught myself eating a pizza in the airport for breakfast. Like under no

00:38:55.740 circumstance would you, would you do that regularly? And yet like the cravings you get for the craziest

00:39:02.480 things under these sleep deprived. I mean, any college, any college kid will know this, right?

00:39:07.180 You're pulling the all nighter like you want to eat. Yeah. Right. And so, you know, imagine someone

00:39:13.160 like you who has the knowledge that they have about sleep and then has this maniacal discipline

00:39:19.520 to be able to fast for long periods of time. And even you with that arsenal of benefit in place

00:39:29.640 can struggle under the weight of sleep deprivation. No wonder the majority of, you know, us non-demigods

00:39:39.040 of control will implode so quickly.

00:39:42.680 I'll have to see what Jocko would do under sleep deprived conditions with respect to food.

00:39:46.460 Right. And a gentleman who, by the way, I have such incredible respect for in many areas. And I would

00:39:54.420 love to have a conversation and just an honest, frank conversation about sleep with him. But it's

00:39:58.880 someone who, you know, I just, my goodness, what an incredible human being. But to come back to your

00:40:05.140 point about food choices, it's not just that you overeat when you are underslept, which you do.

00:40:12.560 And if you pull the all-nighter, you will typically eat probably about 450 more calories than when you're

00:40:20.040 well-rested. It's also the profile of food that you eat. And what I mean by that is if you give

00:40:28.340 people, and these are the studies that have been done, essentially an ad lib food buffet were at the

00:40:35.020 end of the sleep deprivation period or sleep restriction, where you kind of limit them to four

00:40:39.360 or five hours of sleep for the week. And at the end of that, you give them this food buffet and you

00:40:43.980 say, eat whatever you want. It's up to you. And there's everything from kind of leafy greens to,

00:40:50.640 you know, avocados and macadamia nuts, all the way down to Oreos, ice cream, and pizza.

00:40:58.680 What you find is that not only do you eat more, but you eat more of the things that you should not eat.

00:41:04.860 So people will actually eat more from the heavy hitting carbohydrates, the stodgy carbohydrates

00:41:11.460 together with simple sugars. So they'll be going after pizza, cookies, ice cream, and they stay away

00:41:19.300 from things like protein, as well as, you know, leafy greens. So in other words, it's not just that

00:41:26.400 you eat more, but what you're eating in terms of both micro and macro groups of food is actually

00:41:34.480 also distorted in the wrong direction that you want. So we understand at the hormonal level,

00:41:41.520 what's causing these changes. We understand that it leads you to overeat in the excess of probably

00:41:47.520 about 70,000 calories each year, which is about 10 pounds of additional obese mass that you would

00:41:53.220 put on each year, which for some people may be painfully familiar, but we also know what happens

00:41:59.440 in your brain. And we did a study where we took a group of people, we limited them, we restricted

00:42:04.700 their sleep, and then we gave them a full eight hours of sleep, put them in a brain scanner, showed

00:42:09.900 them a whole bunch of different food images, desirable foods, non-desirable foods. What you find is that

00:42:15.640 when you are underslept, the centers of the brain that keep your hedonic desires in check, and it's a part of

00:42:23.260 the brain that we call the prefrontal cortex, that part of the brain was actually taken offline by

00:42:29.340 sleep deprivation. And that led to the more primitive areas of the brain regions, such as the amygdala,

00:42:36.660 for example, that just erupted in terms of its hedonic response to desirable foods. So you can see

00:42:44.420 that essentially you're losing impulse control networks within the brain.

00:42:48.760 Which, by the way, brings us right back to the five-year-old. It's so obvious when we see the

00:42:53.880 kid that missed his or her nap, especially his nap, it seems. And look, as adults, maybe we're not

00:43:00.100 going to throw temper tantrums in the grocery store, but you know what? We're probably a hell of a lot

00:43:04.600 more likely to buy Pringles.

00:43:06.580 Right. And you can scale this up. We've just described the litany of causal evidence from circulating

00:43:12.900 hormones to food choices, to changes in network brain activity. This idea of sleep leading you on

00:43:20.880 a path towards obesity and diabetes is very clear. Import, regulation, equation of energy balance.

00:43:28.840 That, I think, is just unquestionable. But your point is a good one about impulsivity. You know,

00:43:35.040 think about other sectors where impulsivity is probably not great, yet sleep deprivation is

00:43:41.080 rife. Military, aviation, stock markets. I was speaking to another author who lives here in

00:43:48.800 Berkeley called Michael Lewis. He's written some fantastic books. And he was describing how rife

00:43:55.360 sleep deprivation is, you know, down on Wall Street in terms of trading and money markets.

00:44:00.860 I can only imagine the types of poor decisions and deficits that come by way of your brain

00:44:08.560 shifting into impulsivity when you are underslept. And we're starting to do some work in those

00:44:13.720 financial market sectors as well with choice and decision. I'd love to at some point do a survey of

00:44:19.020 sleep in McKinsey and see exactly what the efficacy of insufficient sleep is. And there's already work

00:44:24.520 out there. We've done some of these studies in Chris Barnes has done some of these studies in

00:44:27.920 Washington. If you look at employees who are sleeping six hours or less, the impact is probably

00:44:34.320 fivefold. Firstly, those employees who are underslept will select less challenging problems.

00:44:40.740 So you give them the experiment where you give them a range of problems, and they just typically will

00:44:46.120 choose listening to voice messages or doing email rather than digging into hard project work.

00:44:51.360 Secondly, of the problems that they do select, they end up producing fewer creative solutions to those

00:44:58.320 problems. And that's an issue because it's supposed to be creativity and ingenuity that's driving

00:45:04.040 businesses forward, but you lose that with a lack of sleep. The third thing that we found is that when

00:45:09.740 underslept employees are actually working in groups, working in teams, they just slack off and they just

00:45:16.740 let other people work. It's riding the coattails of other people's hard work. It's called social

00:45:21.120 loafing doesn't breed good atmosphere. The fourth thing that they found was that the less and less

00:45:26.420 sleep that an employee has had, the more and more deviant and unethical they became, which comes back

00:45:32.800 to impulsivity and deep emotional sort of eruption uncontrolled. So for example, they started to

00:45:39.560 falsify data in spreadsheets. They started to claim the work of other people, even falsify reimbursement

00:45:45.160 claims. And then the final study, which we didn't do, but it was a great study. This was from Christopher

00:45:52.340 Barnes. They looked at the sleep of a business leader and then they asked their employees how

00:45:58.740 charismatic and inspiring was that business leader from one day to the next. And what they found is

00:46:04.880 that the less sleep that that CEO had had from one night to the next, the less inspiring and

00:46:10.840 charismatic, their employees rated that business leader from one day to the next, even though they

00:46:15.680 knew nothing about the sleep of that leader, it was evidential in their behavior. So here again,

00:46:23.680 you know, we've gone from intracellular networks and the impact we've gone from genes out to changes in

00:46:31.920 food consumption, energy consumption, food choices, changes in brain networks, all the way back up to,

00:46:38.820 you know, the workforce. And that last one, by the way, is to me, one of the most interesting,

00:46:44.920 which is when you consider what that message is, right? Because that's a great blinding in the

00:46:52.500 sense that the employees have no idea how much sleep, they might not even recognize what the

00:46:58.480 purpose of the experiment was. I'm sure that if the study was done correctly, they were blinded as to

00:47:02.920 even the reason. That's right. If something so socially important, because that goes beyond

00:47:08.580 just being the CEO and being the person that works for the CEO, right? That, that speaks to a much

00:47:14.520 broader network of communication and interpersonal skill. You know, you think about that from the

00:47:20.740 standpoint of dating, mating, like all of these other things, parenting. Like I think about,

00:47:26.900 God, what kind of a horrible parent am I when I'm sleep deprived? Because I mean, I just, I can't

00:47:33.960 imagine that I'm doing the same job. And what's interesting, you know, there about sort of dating,

00:47:39.820 mating and parenting, it brings me onto sort of that similar control. One of the interesting things,

00:47:46.300 and this really actually does impact reproductive fitness and reproductive health. It's a great study

00:47:52.400 from Sweden, a colleague of mine there, and they took some individuals and they gave them a full

00:47:59.220 night of sleep and they sleep deprived them. And then they took essentially a portrait shot,

00:48:02.820 beauty picture under both conditions. And then they took a group of independent judges who knew

00:48:09.020 nothing about the sleep that those individuals had got or had not obtained. And they just simply

00:48:15.340 asked them to rate those pictures, essentially like a beauty contest. How attractive does this person look?

00:48:21.040 How sickly does this person look? And how sleepy does this person look? So these, it's the same

00:48:28.160 individual just under two different experimental conditions. And the judges in this beauty contest

00:48:32.600 have no idea what those two images are. They just see the two images. Despite being blind to the

00:48:38.980 experimental manipulation, you are consistently rated as looking more sickly, looking sleepier,

00:48:46.740 but especially looking less attractive when you have not slept. So there is scientific proof of this

00:48:54.080 thing called beauty sleep. But, you know, in truth, it's, it's a real issue regarding, you know,

00:49:00.460 attractiveness. If you're trying to find a mate or if you've got a mate and you're trying to get intimacy

00:49:06.180 and move towards reproduction, you're not going to be looking your best when you are underslept in that

00:49:12.500 regard. So I think you, you know, these things consistently keep playing out under very carefully

00:49:19.680 controlled experimental conditions. You just can't get around it. You know, sleep is,

00:49:25.280 it is a life support system. And I often think of sleep as the Swiss army knife of health. Whatever

00:49:33.740 ailment you face, it's more than likely that it's got a tool in its box that's going to help out.

00:49:40.220 And this decimation of sleep throughout industrialized nations, I think is having

00:49:46.780 a real demonstrable, and I mean that as in literally a demonstrable impact on our health,

00:49:55.480 our productivity, our safety on the roads, and the education of our children. You know, there is,

00:50:03.440 there is truly no aspect of a human being's wellness that we've been able to discover

00:50:10.860 that isn't eroded by a lack of sleep. Lack of sleep, it's almost like a broken water pipe in

00:50:19.000 your home in the sense that it will leak down into every knuck and cranny of your physiology.

00:50:24.800 That is actually an elegant way to state what I've been struggling to wrap my mind around

00:50:29.960 over the past few hours. Taking a step back, we've gone through so many aspects of the pathology

00:50:37.360 of sleep deprivation from what I would consider, we started at a somewhat macro level, which is

00:50:43.860 big chronic diseases that are multifaceted. We went really, really, really micro into something

00:50:50.740 for which we can't even elucidate the mechanism of AKT's phosphorylation. Then brought it out to

00:50:56.720 arguably the most macro, which is suitability for leadership and appearance. I mean, you can't get

00:51:03.780 more macro. And a great analogy is water. I mean, as anyone who's ever had a leaky roof has known,

00:51:12.800 and I had a leaky roof in residency that tormented me for two years, water will always find a way.

00:51:19.680 And that's, I mean, I sort of picture sleep as if you interrupt this system, it is always going to

00:51:27.420 track into something negative. And sometimes it'll be water gushing through the ceiling,

00:51:33.200 and sometimes it'll be a slow drip that streaks your wall, and you barely know where it's coming

00:51:39.260 from. Yeah. It's been very hard to find something that is resistant. There are a few things in your

00:51:48.760 biology or your psychology that can retreat at the sign of sleep deprivation and get away unscathed. 0.98

00:51:55.780 I think it goes back to the point you made earlier, Matt, which is it is such a ridiculous

00:52:00.860 proposition to sleep that the fact that it is here, the fact that we spent probably when you consider,

00:52:10.880 you know, our origins at the very beginning, you call it half a billion years, keeping this strange

00:52:18.200 thing around that on the surface makes no sense. And, and we've had no pressure to get rid of it.

00:52:25.400 I mean, that we haven't already resisted, right? Meaning like all the pressure that would get rid

00:52:29.800 of it that we discussed, you know, the inability to get food while you're sleeping, the inability to

00:52:35.040 find a mate, the inability to protect yourself, the inability to care for your children.

00:52:38.520 We, we resisted all of those things, but it's only in the last 150, 250 years, and really in the last

00:52:46.420 40 years that a totally new pressure has come on board that we didn't have anything to prepare for

00:52:51.040 that it could be so devastating. Whereas starvation, excess food, we've had lots of time to prepare for

00:52:58.260 that. And again, even though the excess food we have today doesn't look anything like the binging that

00:53:03.440 we would have done years ago. And, and, and Rick Johnson has written very eloquently about some of

00:53:09.940 the genetic changes in fructose metabolism that really saved us and enabled us to fatten up in

00:53:16.600 the fall when the fruit were sweeter. At least that prepared us a little bit of, you know, what we would

00:53:22.080 do with excess nutrients in this modern era. At least we had a relatively safe place to store excess

00:53:29.980 energy. And we certainly have a safe way to handle not having energy. I mean, ketosis, starvation,

00:53:36.380 ketosis, if not for that ability, our species wouldn't exist. So we, we've got that one pretty

00:53:41.420 covered. We just, I, for sleep, we just didn't have the chance.

00:53:45.700 Just, there's just nothing there. And I think, you know, part of this now comes

00:53:49.200 to the bleed out of what's happening, which is where people are either so stressed or the

00:53:58.260 diet, exercise, substance intake is such that they are finding all manner of sleep aids. You know,

00:54:06.340 we know for a fact that 10 million American adults in the past month have swallowed some kind of a

00:54:13.380 sleep aid. 10 million.

00:54:15.820 I'm actually surprised it's not higher.

00:54:17.860 Which, well, and that's all that we can get people to admit to. And we know of, you know,

00:54:23.800 I think there's probably a lot of over the counter things that are, you know, that wouldn't include

00:54:28.280 necessarily someone taking Benadryl for sleep.

00:54:30.140 Right. Exactly. Tylenol, whatever. And so, you know, I think this is where we're starting to see,

00:54:36.500 and people have a very, I think, complex misunderstanding about what sleep aids actually

00:54:43.080 are. Alcohol is probably the most misunderstood of all of those sleep aids. And it comes back to our

00:54:51.100 discussion about sleeping pills a little bit too, that what I often hear from people is saying,

00:54:56.520 you know, I'm pretty stressed in the evening. I can't fall asleep. When I get into bed, I'm too

00:55:01.920 awake, perhaps because they're not getting enough darkness, or perhaps because of use of caffeine too

00:55:06.700 much, or because of that anxiety. One of the problems with alcohol is that, well, it does three

00:55:13.000 things to your sleep. Firstly, alcohol, as we sort of mentioned before, is also a drug that is a

00:55:18.380 sedative. So it works on the same class of receptors that sleeping pills actually does.

00:55:23.980 And when you have a nightcap, what you're doing is again, just sedating your brain. You're just

00:55:29.260 knocking yourself out. So that's the first thing you think you fall asleep faster. You don't,

00:55:33.420 you're just losing consciousness quicker. You're not falling asleep quicker. The second thing is that

00:55:38.700 alcohol will fragment your sleep. So you wake up many more times throughout the night.

00:55:44.040 Now, typically they're so brief that you don't remember them, but they have a measurable impact

00:55:50.460 on your sleep physiology. And as a consequence, your own wellness biology. The final thing that

00:55:56.920 we've discovered is that alcohol is actually very good at blocking your dream sleep, your rapid eye

00:56:01.700 movement sleep. And so what happens is that you end up waking up the next morning, feeling unrefreshed

00:56:08.340 and unrestored by your sleep. And some of the times you may think, well, I don't remember waking up with

00:56:14.840 the alcohol. So maybe it wasn't the alcohol. I don't know what's going on. But now you start to

00:56:20.620 feel lousy the next morning. You start to feel that you have this kind of sleep inertia where sleep is

00:56:26.980 still with you and you won't let go of you. So now you start abusing caffeine.

00:56:30.760 Or by its more technical name, adenosine reducing substance.

00:56:35.640 Correct. Yeah. Adenosine muting substance. If you are taking caffeine, you know, before midday,

00:56:42.840 I think a good question is to ask why, because that naturally should be your peak level of alertness

00:56:48.880 around 11 or 12. You know, I often used to look before on planes now where you can now use your

00:56:54.560 phones on takeoff. You know, five years ago, you couldn't do that. And it was a great experiment for me

00:56:59.900 because I get on a flight at 10 o'clock when everyone on that plane, for the most part,

00:57:04.020 depending on their chronotype, they should be, you know, getting into the nice sweet spot of their

00:57:08.300 alertness. They should be wide awake. And when finally people could not do anything, they weren't

00:57:14.600 allowed to use their phones. They just had to sit with the boredom of taking off. Boredom unmasked

00:57:22.140 the state of chronic sleep deprivation. And I would look around and half of the plane was fast asleep.

00:57:27.440 So what then happens with, you know, alcohol is that you start using caffeine. And caffeine is

00:57:34.040 a problem because everyone knows caffeine, you know, makes you awake. And the way that caffeine

00:57:39.420 works comes back to our discussion of adenosine, which is that adenosine builds up. It's a sleepiness

00:57:45.120 signal. It's telling your brain, get to sleep, get to sleep the longer, the more that you have.

00:57:50.320 Caffeine rushes into the brain and it latches on. It hijacks those adenosine receptors

00:57:55.360 and it just blocks them. So essentially it acts like a remote control for your TV and it just

00:58:01.160 hits the mute button on the sleepiness signal. So your brain thinks, oh, I haven't been awake for

00:58:06.920 16 hours. Maybe I've only been awake for eight hours because I've just slammed an espresso after

00:58:12.360 dinner. But then the problem with caffeine is that it actually has a half-life of about six hours.

00:58:19.840 It has a quarter-life of 12 hours. So in other words, if you have a cup of coffee at midday,

00:58:27.440 a quarter of that caffeine is still in your brain at midnight. So the equivalent would be,

00:58:33.400 you know, getting into bed and before you go to sleep, before you turn the light out,

00:58:37.820 you swig a quarter of a cup of Starbucks and you hope for a good night of sleep.

00:58:41.460 And it's not going to happen for some people. Other people will tell me, well, you know,

00:58:48.560 I'm one of those people with caffeine. I can have an espresso after dinner and I fall asleep and I

00:58:53.280 stay asleep. So no harm, no foul, presumably. Isn't that okay? And the danger there, and we've done

00:59:00.500 these studies too, where if you give someone a standard 200 milligram dose of caffeine in the

00:59:05.340 evening, and then you measure their sleep architecture, what you see is about a 20%

00:59:10.980 reduction in deep sleep as a consequence of that caffeine being in the system. To put that in

00:59:17.300 context, to drop your deep sleep by about 20%, I'd have to artificially age you by about 20 to 30 years

00:59:25.260 to get that type of a reduction of a loss of deep sleep.

00:59:29.020 Is this independent of the caffeine metabolism snip differences that exist? Is everybody equally,

00:59:35.480 like I've always felt like caffeine doesn't do anything to me. I mean, I love coffee. So I make,

00:59:40.620 most days I'll make a coffee in the morning as a French press, more as the ritual. And I just

00:59:45.160 love the taste and the aroma. But when I'm tired, caffeine does not wake me up. And it just seems to

00:59:53.160 have zero impact on me in any way, positive or negative.

00:59:56.860 And I think that's where we, you know, we don't know. We know that people have different genes that

01:00:02.320 are associated with the enzyme that decomposes caffeine. And that's why some people are very

01:00:08.620 caffeine sensitive or less. Yeah. Like we, we, we actually run this on most of our patients.

01:00:14.920 If they've done a 23 and me, yeah, you can, you can run it into Prometheus and see that. And,

01:00:20.480 and I mean, truthfully though, Matt, you know, the association isn't as, as clear as I

01:00:25.700 experience it clinically with people. I've always kind of been jealous of those people who can use

01:00:31.340 caffeine as a true performance enhancer. Yeah. Um, but it just doesn't have that effect.

01:00:36.200 It has no effect on me whatsoever. What we don't know is those people who have

01:00:40.280 those particular gene profiles that may have the ability to more quickly decompose caffeine.

01:00:46.600 Are they the same people who also don't suffer the same type of deep sleep reduction?

01:00:51.140 I don't think we know. We don't know. And this gets to something interesting, right? So,

01:00:55.420 you know, going back to the alcohol point, I would add two points. The first is

01:01:00.280 there are a handful of things that my wearing the aura ring for the past three years has, has,

01:01:07.360 has done for me. And I want to disclose that I'm an investor too, and an advisor to aura. So please

01:01:11.820 understand that you, it's important, you know, that so that you can take what I'm saying with a

01:01:15.480 grain of salt. But, but what I'm about to say, every single one of my patients has said, and we buy this

01:01:23.980 ring for every single one of our patients, there is no greater behavioral tool to show you the

01:01:30.580 deleterious effects of alcohol than this ring. I mean, you see the effect. And for most people,

01:01:38.360 it is somewhere between zero and two drinks. So in other words, um, for me, it appears that

01:01:48.080 a single drink four to five hours before bed doesn't appear to have a difference that I can discern

01:01:57.600 anything beyond that. Meaning one drink closer to bed or two drinks, even six hours before bed,

01:02:04.820 my sleep is shot. My resting heart rate will be six to eight beats higher. My heart rate variability

01:02:13.160 is compressed by 20%. Yep. My respiratory rate is higher by probably two breaths per minute,

01:02:22.260 one to two breaths per minute. My temperature is up by 0.3 to 0.6 degrees Fahrenheit.

01:02:27.260 It is a kick in the groin. On every one of those levels, you know, that's, that's exactly what we

01:02:35.660 see in the scientific evidence. You know, you need heart rate to drop, you know, heart rate variability

01:02:41.360 is, you know, usually far higher with sleep, especially good sleep. The same is true for the

01:02:46.980 next morning. If you've been getting good sleep, temperature and respiration are critical as well.

01:02:52.000 We know that you need to drop your core body temperature by about two to three degrees Fahrenheit

01:02:57.540 to initiate sleep. And that's the reason that you will always find it easier to fall asleep in a room

01:03:03.260 that's too cold than too hot because the cold is at least taking you in the right temperature direction

01:03:09.840 for good sleep. Yet alcohol with this thermogenic profile starts to increase your core body temperature,

01:03:17.560 which is the exact opposite of what has to happen for good sleep. So you're going to get more

01:03:22.780 fragmented sleep. You get more awakenings. You disrupt REM sleep. It fits exactly the profile

01:03:29.320 of the scientific data. So, you know, people can take your comments if they want with a grain of salt

01:03:34.680 should that, you know, invest a thing sort of, you know, lead to, but I can tell you here as a sleep

01:03:40.020 scientist that what you're describing is exactly what you see in the scientific literature.

01:03:44.520 And the reality of it is I think every one of my patients who at least wears their ring,

01:03:49.200 some of them won't wear the ring for reasons I don't know, but any patient who wears the ring

01:03:53.780 reports the same thing. And it's this, they'll report it on the same four metrics. The second

01:03:58.140 thing I want to point out, which is, um, alcohol inhibits vasopressin. And so anybody who's, who's,

01:04:07.680 who's had something to drink knows you tend to pee a little bit more. And some people might think,

01:04:13.120 well, you know, the reason you're peeing more is you're just drinking more. But the reality of it,

01:04:16.720 that's not true. You're peeing disproportionate to the volume you're consuming because ethanol

01:04:22.980 inhibits a hormone called anti-diuretic hormone. So if you inhibit the anti-diuretic hormone,

01:04:30.160 it has a pro-diuretic effect. And so if it, if everything you just said weren't bad enough,

01:04:36.460 now imagine taking a diuretic before bed. I mean, do you really want to make your sleep any worse?

01:04:45.520 I mean, and by the way, I used to be so dumb that I, if I drank before bed, I would actually take 0.69

01:04:53.020 vasopressin. I would take 0.2 milligrams of vasopressin to at least not like make me get up, 0.75

01:05:00.220 which of course is, I mean, talk about the most backwards logic in the history of civilization.

01:05:04.640 Yeah. Or you could just try to be a little bit more sensible with the alcohol. Yeah.

01:05:09.220 Yeah. Yeah. It's, it's incredible. The other thing I've noticed is a very high carbohydrate meal

01:05:14.020 and especially a crap carbohydrate meal. So, you know, like high quality carbohydrates don't seem 0.56

01:05:20.100 to do this, but I mean, and it's funny, I'm admitting all the horrible things I do, but it's

01:05:25.500 good. I think people need to know just how much of a failure I am.

01:05:27.920 It's just you and me here, Peter. Don't worry.

01:05:30.240 At least once every few months, like I just cave in and I just, an hour before bed, I just 0.98

01:05:37.440 binge eat something stupid as beyond, like a bowl of cereal that like I just can't resist 0.97

01:05:43.500 or something. It basically produces the exact same architecture as that drink, as those two 1.00

01:05:50.860 drinks. I want to go to another compound that I get asked about a lot. And truthfully, I just

01:05:57.400 don't know the data. And that is, well, we'll start with THC and we'll move to CBD. And then

01:06:03.040 the THC touches, I guess you could think about it through two lenses, right? Which is the developing

01:06:08.720 brain versus the quote unquote developed brain. So let's start with the latter since I think it's

01:06:16.520 more clear in the former that the developing brain probably is not benefiting from THC. So it's probably

01:06:22.300 not even worth asking the question, is THC a good sleep aid in a teenager? I think the answer would

01:06:27.500 be clearly no. But you and I, is THC a pro-sleep compound?

01:06:36.180 No. I don't think I'd feel comfortable in suggesting that it's a pro-sleep compound.

01:06:41.940 And would you say that independent of strains? I mean, you know, anybody who's experimented these

01:06:46.300 things will tell you, you know, well, sativa maybe not, but indica, yes.

01:06:51.220 I mean, firstly, I don't think we have enough data to, you know, pinwheel out the different strains

01:06:57.160 and sort of parametrically slice the strain pie, as it were, and ask that. But what I do know from

01:07:04.420 the evidence, firstly, I should say that, you know, acute use of THC typically has a quote unquote

01:07:10.900 beneficial effect such that it will decrease the amount of time it takes you to fall asleep.

01:07:15.820 What's called your sleep latency.

01:07:17.940 That's the only thing it impacts is latency.

01:07:19.900 So it reduces the latency and it makes it feel as though, well, and you are.

01:07:24.520 And that would give you more duration.

01:07:26.160 So yeah. So you're falling asleep faster. Total duration, not so much. But what is happening,

01:07:33.240 however, unfortunately, is that that THC, just like alcohol, has been shown to be a very robust

01:07:40.300 blocker of your dream sleep of your REM sleep. Add that to the fact that with chronic use of THC,

01:07:48.200 you build up a tolerance to the benefit on falling asleep faster so that now you actually have to

01:07:55.420 start using more of the compound to get the same reduction in sleep onset time means that that

01:08:04.680 tolerance and dependency, I don't think is necessarily a good thing. When you then cease

01:08:10.180 the use of THC, what you find in the studies is a pretty horrific insomnia rebound where people

01:08:19.160 then actually have miserable sleep. And it usually typically leads to then falling off the bandwagon

01:08:25.840 of abstinence if that's their goal. And people then to start having to use again to gain back that

01:08:31.640 crutch that you may not necessarily have needed otherwise. So I think the evidence right now,

01:08:40.620 especially with the REM sleep blocking effect of THC and the importance of REM sleep that we know of,

01:08:46.880 I just don't feel comfortable in thinking that THC itself is really the sleep aid of the future.

01:08:54.220 And that there is more evidence on the THC side. CBD is starting to gain more research traction.

01:09:03.200 I don't think there's enough studies done. I think part of the reason with CBD is, and THC,

01:09:09.480 it's just, it's hard to do these studies because they're hard to get funded because of still some of

01:09:14.940 the moral. And now I am not, again, I'm not puritanical about this. I'm not casting any judgment

01:09:21.100 at all. And I've often thought, well, you know, what would it take? Maybe, you know, I should do

01:09:26.660 like a Kickstarter and try and crowdsource enough money to do the appropriate CBD studies. Because

01:09:33.740 I think CBD is more promising on the data right now. The data for CBD is that you get that benefit

01:09:41.520 of falling asleep faster.

01:09:42.820 By the way, would you, just to interject for a second, would you be able to get an IRB approval to do

01:09:47.360 a real world study where a bunch of people were just using wearables and you could homogenize

01:09:54.060 and uniform the wearable and the CBD and things like that, but without having to do it as an

01:09:59.020 in-house sleep study? Do you think the wearables are good enough that you could get enough data

01:10:04.760 in the community?

01:10:05.700 I would probably do a hybrid. I mean, the irony of THC and CBD often being used as hybrids is not

01:10:13.280 lost on me, but I would probably do a hybrid where I would do some tracking of sleep ecologically in

01:10:19.620 the home setting as it were, and then have a couple of nights where they would actually come in and we

01:10:24.580 would measure their high grade sleep quality because the trackers out there right now, you know,

01:10:29.420 they're just not quite accurate. They're not clinical grade enough for me to understand the

01:10:34.440 quality and the stages of your sleep. I think trackers are not bad right now.

01:10:38.360 But even those metrics, you'd get a clue, right? Like even with the ethanol.

01:10:42.260 Somewhat of a clue. Yeah, you can see it. I think, you know, people often ask me what's the

01:10:46.320 best sleep tracker, and I would say it's the sleep tracker that you wear every night. You know, I think

01:10:51.560 most of them are much of a muchness in terms of their current inaccuracy. So I would do a hybrid

01:10:57.420 study probably where I would do some tracking outside with things like wristwatches or rings, and then I

01:11:03.540 would do some in-laboratory studies. But I think for CBD, things are actually looking more promising.

01:11:09.040 CBD does give you that same benefit. You fall asleep faster. You don't seem to get the hit on

01:11:14.940 REM sleep. Now, I don't think there's enough studies for me to yet feel comfortable in saying

01:11:19.620 definitively you don't. But for the small handful of non-placebo-controlled trials, for whatever it's

01:11:28.520 worth, and we are talking about, hands up here, everyone, no recommendations, no promissorial notes.

01:11:35.480 This is just very early tentative preliminary evidence suggests that you may not get the REM sleep

01:11:41.240 deficit, which is good. The other thing is that you typically don't see the dependency issues, nor do

01:11:49.720 you get the insomnia rebound when you stop using CBD. And the final thing I think that's interesting

01:11:58.080 with CBD is that it may actually have some benefits in certain sleep disorders. There's some as the

01:12:04.240 little bit of evidence that it may reduce the severity of sleep apnea, but I think that that's

01:12:09.680 just, you know, one or two studies. There's some benefit that's happening in PTSD with CBD treatment to

01:12:17.380 help with PTSD sleep problems. And sleep problems are real problematic issues with PTSD patients. So I think

01:12:25.220 anything there that could be of help, as long as it's medically safe and doesn't compromise your

01:12:30.600 sleep, unlike THC, would be a good thing too. Probably two caveats, or at least one caveat, it does seem to

01:12:38.660 be somewhat dose dependent. I don't think it's very clear right now what the optimal dose is. There have

01:12:45.620 been some times where people have actually suggested that the use of CBD at a certain dose is actually wake

01:12:51.260 promoting rather than sleep promoting. So I think there may actually be this U-shaped function when

01:12:57.480 it comes to CBD, that what, or some kind of a function. I don't know what the function is going

01:13:03.420 to be, but there's going to be perhaps a sweet spot of a dose concentration that is optimal for CBD's

01:13:10.500 benefit on sleep. And there may be other doses that are actually detrimental to sleep, and we need to

01:13:16.680 stay away from them. How is CBD doing that and having that kind of benefit of sleep? There was

01:13:23.480 actually even some evidence that it may actually increase the amount of deep sleep, which was

01:13:28.040 interesting. And that was just one single study, small study. Again, I'm not believing it. I'm not

01:13:33.800 going to go out there and start telling people to take CBD on the basis of that single study. I am saying

01:13:38.940 that I think it's got promise right now, but we don't know. How could it be doing that? Well,

01:13:45.140 one of the interesting things could actually be thermoregulation. In some of those studies,

01:13:50.820 they were actually finding that the core body temperature decreased with CBD administration.

01:13:57.060 And we were just describing that when you drop core body temperature, you sleep better.

01:14:01.700 When you increase core body temperature by way of something thermogenic like alcohol,

01:14:06.880 or it's just a hot room or a big meal, that increase in core body temperature is worse for sleep.

01:14:12.700 So CBD may actually be having its mechanistic benefit through the thermoregulatory system is

01:14:19.460 one of my hypotheses. The other is that it's indirect through its anxiolytic benefits. I think

01:14:26.140 probably the greatest, strongest evidence out there right now for CBD's clinical efficacy

01:14:32.260 is for anxiety. And I actually think, and I've tried to read as much of that data as I can. I think

01:14:38.040 it's actually pretty interesting. I think one of the major causes of insufficient sleep and poor sleep

01:14:44.520 right now is that everyone is just cranked in terms of anxiety and that they wake up or, you know,

01:14:50.680 we are constantly on reception in this modern day of life. And the only time that our brain goes from

01:14:57.040 reception to reflection is when our head hits the pillow. And that's the last time that you need to be

01:15:03.480 ruminating and catastrophizing and having that Rolodex of anxiety. So I think if CBD is efficacious

01:15:11.660 for lowering anxiety, and anxiety is one of the causes of poor sleep in society, then part of that

01:15:19.100 benefit may not be through a direct mechanism on sleep regulating centers, but instead a secondary

01:15:25.600 benefit of lowering anxiety, which perhaps lowers that sympathetic fight or flight branch of the nervous

01:15:32.940 system, which means that you shift into a more parasympathetic state, and or it drops core body

01:15:38.940 temperature, both of those routes, I think, are in my mind, the tenable hypotheses that in, you know,

01:15:46.020 a crowdsourced study that I would want to do. And I don't know if people want to do that study, you know,

01:15:50.840 comments in wherever comments can be.

01:15:53.880 I'll speak for myself. I would love to see that study because anecdotally, not so much in myself,

01:16:01.560 but I also think I sleep reasonably well. But in people who don't sleep that well, I have anecdotally

01:16:11.160 seen some pretty impressive results with CBD. And other times I've seen nothing. And what's interesting

01:16:18.440 is in some of the people in whom I've seen impressive results, it's people who have been largely

01:16:23.560 recalcitrant to other big guns. Again, I think whenever you can sleep without pharmacology,

01:16:29.280 you're doing a good thing. But when you look at things like trazodone, thorazine, with their

01:16:35.520 anti-ruminative properties, and you see patients who, even at 25 and 50 milligrams, doesn't matter.

01:16:42.760 Yeah. That's right.

01:16:43.600 You know, it's not helping them sleep. And yet, you know, CBD ends up having, yeah.

01:16:49.180 And at that point you start to think, well, it's less likely to be the placebo effect because you've

01:16:53.580 tried all of these other things that didn't work. Why would this silly little oil work? And, you know,

01:16:58.720 I'll share a sort of unrelated story that speaks to this role of anxiety, because this kind of brings

01:17:03.400 it back to this idea of mental health that I think is such an important part of longevity.

01:17:08.980 I have a patient whose sleep has really eroded in ways that I can't even imagine. And it's been

01:17:16.140 quite devastating to watch. And this is an individual who's done everything that you would ask someone to

01:17:22.420 do, right? This means, you know, you control the room temperature, you control the light,

01:17:27.760 you control the nutrients, you eliminate the alcohol, you eliminate the caffeine, an hour of

01:17:32.840 meditation a day. I mean, this is everything. But, you know, this person's in the midst of a very

01:17:38.280 difficult personal struggle. And that's, so by the time you're at, you know, 50 milligrams of

01:17:45.140 Thorazine to just try to shut off the ruminative properties, and you would get some intermittent

01:17:50.460 benefit, but not long-term. So in the end, what he was able to do was enter into a clinical setting

01:18:00.440 under which he was able to therapeutically utilize MDMA to deal with some of the issues that were

01:18:07.020 predisposing. And again, I want to be very clear what I'm saying here. I'm not saying he went to a

01:18:12.420 party and did ecstasy, right? To the listener. This is a clinical administration with a therapist of

01:18:20.460 MDMA to address the underlying trauma and anxiety and depression of the situation.

01:18:27.820 The next day and for months to follow, and we're still at that standpoint, his sleep is fixed.

01:18:36.620 Now, I think that is an outlier situation, but sometimes these outlier situations provide

01:18:42.480 an insight into a mechanism. And I think in this person's individual, because we had already fixed

01:18:50.160 all of the sleep hygiene metrics. I mean, we had literally done everything in our toolkit. And

01:18:56.840 that's a toolkit that has about 10 tools in it. To see this one thing, this one intervention work,

01:19:02.980 and, you know, the patient would describe this as a transformational life experience,

01:19:07.540 was just another example of the power of the mind and how the mind can sort of get in its own way at

01:19:12.820 times. And the power of the mind in terms of it essentially deconstructing this thing

01:19:19.940 called a full night of sleep is, I think, so critical. And more and more now, we are seeing that

01:19:28.580 the causes of sleep difficulties and sleep problems are shifting from, you know, typical biological

01:19:36.460 problems to increasingly psychological problems. I think that rise in anxiety has walked in lockstep

01:19:46.560 with a rise in insomnia. And I think we've got enough evidence to suggest that those two are probably

01:19:52.460 not coincidental, but are significantly interrelated is probably the strongest thing I could say right

01:19:58.480 now. So it doesn't surprise me that if you have something that essentially is, you know, a mental health

01:20:07.620 reset on your Wi-Fi router in a demonstrable, you know, in a marked way, that could lead to essentially the same

01:20:18.300 type of reset in that physiological thing called sleep. It doesn't surprise me, you know, whether or not, you

01:20:24.680 know, that is the treatment for everyone, you know, is, and you are very clear about that, and I enjoy that. But it

01:20:31.780 doesn't surprise me that if you fix mental health, you fix, and we've seen this bi-directionally, we do a lot

01:20:37.800 of work on sleep and mental health. And it's very clear that I can take people who don't have any

01:20:43.920 problems with mental health, depression, poor mood, anxiety, suicidality. And when you sleep deprive them, you

01:20:51.260 can instigate many of those conditions. In fact, I can, within one single night of sleep loss, I can put

01:20:58.160 someone who is non-clinically anxious to a level of anxiety where they would have a clinical anxiety

01:21:04.400 disorder diagnosis. That's how quickly it can happen. So yes, sleep can impact your mental health. And

01:21:12.040 what's interesting is that psychiatry, in the past 25 years, I have not been able to discover a single

01:21:18.900 psychiatric condition in which sleep is normal. Which to me was quite profound when we added it up.

01:21:28.160 That I can manipulate sleep in mentally well people and then produce, by way of the excising of sleep,

01:21:37.720 mental ill health tells me that there is a causal direction from insufficient sleep to poor mental

01:21:45.160 health. That sleep is essentially emotional first aid in that regard. However, don't mistake that for

01:21:52.480 the fact that it's a two-way street as well. And I think what you're describing here is a state of

01:21:58.500 mental ill health. And when you course correct that mental ill health, you then correct the sleep.

01:22:07.140 And so I think the relationship between sleep and mental health is bidirectional. I think it's a two-way

01:22:15.980 street. Is the traffic flowing more in one direction than the other? Perhaps. And perhaps psychiatry has

01:22:22.340 had it wrong for the past 50 years. They used to think that the poor sleep in their patients that they

01:22:27.840 knew about long before we published scientific data, that was a symptom of the disorder rather than

01:22:35.480 considering it a potential predisposing cause of the disorder. So I think psychiatry is starting to

01:22:44.560 undergo a revolution when it comes to sleep and understanding how fundamental sleep is to the

01:22:50.680 maintenance of good mental health. I think it's the bedrock of it. You can stack up the different

01:22:57.720 physiological body systems and the different operations of the mind, but I would put mental

01:23:02.600 health pretty high up there in terms of one of the things that falls apart quickest. And the reason I

01:23:10.200 can say that is because essentially we start with these sleep deprivation studies and we can just

01:23:16.240 keep sampling the organism, which is the patient, the individual, you know, every hour. And we can just

01:23:22.400 look to see the further you go into sleep deprivation, what is the trajectory of impairment in brain and body

01:23:30.040 systems? And some, you know, come on tap later in the sleep deprivation, others very, very quickly.

01:23:37.420 Essentially what we're trying to ask is what is the recycle rate of a human being? And after about 16

01:23:43.820 hours of wakefulness, things start to go wrong. And the things that start to go wrong soonest and

01:23:49.780 perhaps most severely, one of those things certainly is your mental health, anxiety being one of them,

01:23:56.020 mood being the other, depression.

01:23:57.920 It's interesting, right? How long it can take for certain things to ravage the brain, neurodegenerative

01:24:02.760 disease that manifests clinically in dementia, and yet how quickly certain elements of the brain will

01:24:08.900 demonstrate the limitation, memory consolidation and anxiety as two examples. You're in your sabbatical

01:24:17.280 year, correct?

01:24:18.320 I am. I'm finishing it up right now. Yeah.

01:24:21.240 So what else are you doing with your time besides being incredibly generous and sitting here with me?

01:24:28.500 Yeah. So I still, even though I don't teach, I still am here at the sleep center. I'm the director

01:24:36.680 of the center for human sleep science here at Berkeley. And we continue to do all of our research. So I'm

01:24:43.340 still, you know, directing the center. I'm writing grants. I've been doing a lot of public advocacy.

01:24:49.780 I've been doing a lot of public speaking now that the book has come out and I'm doing sort of television

01:24:55.220 media. I've also got a couple of startup companies that are emerging. One of them has just gone public.

01:25:02.720 It's a brain stimulation company. This comes from work that's out there in the literature showing

01:25:08.420 that if you can try to essentially electrically sing in time with deep sleep brainwaves, you can

01:25:14.020 boost the amplitude and the size of those deep sleep brainwaves. We're hoping to try and transfer

01:25:18.880 that same technology into older adults and those with dementia. Can we salvage some aspects of their

01:25:26.500 learning and memory by way of boosting back their deep sleep? That's one of those possibilities.

01:25:32.380 Can you say how the device works? Is it a device that sits in the room?

01:25:35.420 No, it's actually a device that you place on your head.

01:25:38.000 So it actually measures the waves.

01:25:39.740 It both measures the waves and then it inserts electrical voltage into the brain. And essentially

01:25:46.320 what we're trying to do is measure when you're having those sleeping brainwaves and almost act

01:25:52.520 like a choir to a flagging lead vocalist that you're trying to sing in time with the electrical

01:25:58.720 stimulation of the deep sleep of older adults, which is diminished by 50 to 80%, but giving them

01:26:04.840 an electrical sort of, you know, stimulation to try and every time they have a deep slow wave boost

01:26:11.400 the size of that slow wave. And in doing so try to almost double the amount of memory benefit that

01:26:17.800 you get from sleep, because that's what we've already been able to demonstrate in young, healthy

01:26:21.600 adults. So that's one of the companies.

01:26:25.200 What's that company called?

01:26:26.280 It's called Stim Science. And that's together with a set of co-founders that we just recently

01:26:31.820 got seed funding for from Koshala Ventures. Then I'm starting to think about writing a

01:26:37.500 second book and unclear exactly what it would be. I think there's probably three candidates

01:26:42.080 right now. The other thing that we're trying to do as well, though, is raise funds for the

01:26:48.820 sleep center. We've just moved to this beautiful new building that we're in with the new sleep

01:26:52.900 center. So we're trying to raise philanthropic funds because, you know, and I think you've done

01:26:59.040 this, you know, wonderfully, and you've done work with Gary Tubbs to try and, you know,

01:27:02.980 create this, this vision for how you can fund science in ways that typical funding mechanisms

01:27:10.460 will never do. And that's what we need at my sleep center is that we need philanthropic

01:27:17.520 support. And there is now currently through the university, they've granted the ability to name

01:27:23.300 the sleep center for philanthropic donation. So I'm now just trying to move that work out.

01:27:28.360 So I guess this is a shameless plug that should anyone out there wish to have a legacy name

01:27:34.180 to name the center that is there. But just to give you a sense of some of these, you know,

01:27:38.400 studies, one of these other studies that I'm fascinated by in our elderly cohorts, it's not

01:27:44.260 just the deficit in deep sleep that happens as you age, which it does. There is also this strange

01:27:50.580 cluster of outliers of people in their seventies and eighties that when I put their data of sleep

01:27:57.140 and deep sleep plotted against all of the young healthy adults that we've studied, some of those

01:28:02.600 older adults seem to be incredibly resistant to age-related sleep decline. Why? No one is willing

01:28:11.280 to kind of give me the money to do the studies, which is the inverse. You know, it's easier to get

01:28:16.240 money to explore when things go wrong, but you can get insights into those critical questions

01:28:22.840 by looking at also when things go anomalously right. And a good example of this is the blue zones.

01:28:30.400 You know, this work that was done starting by National Geographic, where they looked at longevity

01:28:36.000 and they found that there were these pockets throughout the world where people seem to live

01:28:40.500 longer. Now, I think some of the data there is controversial, but it was a good idea that you

01:28:46.960 could look, is there something about their social fabric? Is there something about their diet,

01:28:50.780 their exercise? No one in terms of these blue zones has asked the fundamental question about sleep.

01:28:59.940 Why? You know, that's going to be fiendishly difficult for me to get funding for. So one of

01:29:06.080 the things that I'm trying to do right now is raise money for the sleep center to do what would be

01:29:12.080 otherwise impossible fundamental research to make critical discoveries on the flip side of where I

01:29:18.880 think we can make real inroads into understanding sleep, which are usually typically very difficult

01:29:26.100 to get funded. These are kind of more blue sky research questions, but could make real impacts.

01:29:31.400 But sorry, I interrupted.

01:29:32.040 Where does sleep reside within NIH? Which of the 17?

01:29:37.300 It resides in most of those branches. You know, it resides in the National Institute of Aging. It's there for

01:29:44.600 neurology. It's there for cardiovascular disease. It's there for metabolism, glucose. And it's there for NIDA,

01:29:52.380 which is the Institute for Drug Abuse. So it's prevalent in all of them. But I would say that-

01:30:00.040 But paradoxically, it doesn't have its own institute.

01:30:02.640 No, it doesn't.

01:30:03.460 Which it seems like it ought to.

01:30:07.020 Well, if you were to think that exercise, nutrition, and sleep are the three fundamental

01:30:12.420 ingredients that, as best we can tell from the science that we've done as a human species,

01:30:17.340 keeps us alive and longer living and living longer well.

01:30:21.180 And yet those things all spread across the entities as opposed to stand in their own,

01:30:27.360 which there's benefit to that. You would argue they shouldn't be siloed. They should be studied.

01:30:31.020 But of course, you could almost argue for a matrix as opposed to-

01:30:36.500 That's right. So yeah, what you really want is horizontals and verticals. And when you put those

01:30:40.200 together, you create the matrix that you've just described. So I would say, you know, I think NIH has

01:30:44.880 definitely supported a huge amount of sleep research. And they support some of the research

01:30:52.300 that we do here at the Sleep Center. And I'm incredibly grateful and very fortunate to have

01:30:57.240 those grants. They're very hard to come by. But there's also, I keep running into these fundamental

01:31:03.120 questions that when I write these grants, they're difficult to get money for. And I understand why,

01:31:09.520 because you've got government policies, you've got particular institutional mandates that you have

01:31:17.160 to fill. They're just not going to fund these research programs. So that's another thing that

01:31:22.000 I'm doing is trying to raise money for the Sleep Center, then with these startup companies, and then

01:31:28.080 also just doing our fundamental basic science.

01:31:31.560 Now, are you formally involved with Google in some way as well? I've seen some of your talks there,

01:31:36.560 but do you work with Verily? Do you work with Google?

01:31:39.600 Yeah, so I do. So right now, I'm also a scientific advisor for Verily, which is formerly known as

01:31:44.480 Google Life Sciences. So I do help Verily to try and help shape their mission of sleep. And, you know,

01:31:53.020 I've also been a consultant for many of the other large tech companies out there and many of the

01:31:59.140 fitness trackers as well. But right now, yeah, I do also do some time at Verily to try and help

01:32:05.220 with many of their exciting visions regarding how you could use the resources of a big technology

01:32:12.240 company like Alphabet to try and do things differently than the way that the government

01:32:18.280 does health. I think we'll need both of those forces and both those forces will be for good.

01:32:23.340 But it's a wonderful place to be. You've got incredible people there. And the way in which

01:32:30.880 they see problems is different, the time course over which they want to solve those problems

01:32:37.140 is different. And the solutions and the expertise that they bring to those health problems are

01:32:43.540 different. So when I got the chance to work at Google Life Sciences there or essentially be an

01:32:49.980 advisor there, you know, I jumped at the chance. It was great to try and help shape that mission.

01:32:54.320 You know, Matt, I had a list of probably five pages worth of things that I wanted to discuss

01:33:01.860 with you. And we covered many of them, but I would say we covered half of them, truthfully.

01:33:06.380 And I think the only solution is we probably have to sit down again sooner rather than later.

01:33:12.860 And amazingly, we were pretty good about not getting into cars, which is, I mean, like we could

01:33:19.900 have spent this entire time talking about Formula One. Maybe that's the second half of the second

01:33:25.500 conversation should people not generally lose the will to live when they hear my voice for,

01:33:30.460 you know, several hours, which is what most people do, unfortunately. But I would be so thrilled

01:33:37.420 to come back at any time you would wish me to, and same for the audience. And if that second time

01:33:43.560 did involve a little discussion of all things cars and car racing, including Formula One,

01:33:52.020 it is one of the few things, you know, I've never been a big fan of alcohol, not because I'm down or

01:33:57.540 against it. It's just, I've never really liked the taste. So I typically don't drink. I'm caffeine

01:34:02.420 free just because I'm one of those people who's sensitive to caffeine. But the one vice that I have,

01:34:07.960 my biggest weakness is cars, car racing. Oh, it's, it's, it's a wonderfully terrible affliction.

01:34:15.800 I adore all things automotive. The next time we do this, let's do it in San Diego. So we can

01:34:22.680 sit in the simulator and, I don't know, maybe just do a hundred laps of CODA or something like that.

01:34:29.420 God, I love that. Yeah, it's, it's, uh. That would be such a gift. That really would be.

01:34:34.900 I'll take you up on that. Well, we'll do that. You know, it's possible that by the time this

01:34:38.520 comes out, we'll already know the answer to this question, but given where we are right now,

01:34:44.020 which is in late February, what is your take on this year's season? I mean, early testing looks

01:34:50.640 really good for Ferrari. Looks like that front wing is giving Mercedes a little bit of difficulty.

01:34:56.220 Yeah, they struggled, didn't they? If, if you had to predict one, two, and three this year in both

01:35:03.540 constructor and driver, how would you handicap it now? And these are impossible questions to be,

01:35:09.640 to be clear. Yeah. I, I don't know about driver. I think I'm going to put Ferrari one and three,

01:35:16.220 Mercedes two. And I think, I feel.

01:35:20.440 Oh boy. So the huge question then is Vettel, Leclerc. I mean, where are you going on?

01:35:24.260 Okay. If you're going to push me, I would say Vettel one. And I, I think Hamilton,

01:35:28.360 you know, obviously is going to probably be number two there with Mercedes. That's my suggestion.

01:35:34.640 Or I would at least say that that's going to be the first half of the season. You know,

01:35:39.480 Mercedes as a team, technologically, they are fantastic too. And I think that they could rebound,

01:35:46.140 you know, if this first, all, all the data I've seen is just the one set of testing data that,

01:35:50.980 you know, you and I have both seen here now in February, and it looks like Mercedes has got a

01:35:55.360 rip roaringly hot car on their hands. But I think Mercedes is keen Ferrari. Sorry, Ferrari. Yeah.

01:36:02.440 Sorry, sorry, sorry. Ferrari. I think Mercedes is capable technically though, of coming back in the 1.00

01:36:07.260 second half of the season to make sure that that car performs. So they've got a good chance. And

01:36:12.580 Hamilton with the skill that he has, I think may be able to hang in there until that technology and

01:36:18.360 the engineers come good. I would also just love as a British man to see McLaren do a little bit

01:36:25.200 better. I love them as a car brand. I've never had the opportunity to, to be in one of their cars.

01:36:31.780 I've only had the chance to look at them. And usually that means that I become a even more

01:36:37.120 incoherent human being. And then I dribble and want to typically tend to lick the car. Um, just

01:36:44.020 to be honest, uh, if you had to have as a daily driver, so cost doesn't matter, but it's gotta be

01:36:49.420 the car you drive. You'd take a seven 20 or a P one. I think the P one, just the rattle alone that,

01:36:57.760 that happens on that carbon monocoque with driving around would probably prevent it from being a daily

01:37:04.720 driver. Would I like to have the uptown problem of having a P one as my daily driver? Absolutely. 1.00

01:37:10.680 I would, but I think seven 20 S I could live with every day. You know, I look, I could go with any 1.00

01:37:17.600 one of their models, you know, put me in any one of the five series that they've come out. I would

01:37:22.200 adore too. That may actually be a more relaxing car, but I'd love to see, well, firstly, I'd love to see

01:37:28.400 myself in a McLaren. Um, but what I was about to say was I'd love to see McLaren doing a little bit

01:37:34.600 better and I've got a soft spot for Bruce McLaren and what he did for the automotive industry and

01:37:40.900 his philosophy and mentality. It was a remarkable era of driving and he, he died relatively soon after

01:37:48.960 Clark, right? I mean, it was very shortly after Jim Clark died. Yep. That's right. I mean, that was

01:37:55.140 the, that was the era where the exception and not the rule that you retired. Yeah. And you know,

01:38:01.040 it's, it's that. And then plus my similar obsession that you have with Ian Senna and the history that

01:38:08.540 he had with McLaren too. Of course he then transitioned to Williams later, but there was

01:38:14.320 something special about that, that time where he was with McLaren that makes me just want to see

01:38:20.160 McLaren do better too. If you look at McLaren's rise in just road cars and what they've done,

01:38:28.220 they have scaled more quickly in terms of incredible technology and competing with the likes of Ferrari

01:38:37.260 and Porsche within such a short time period. And I think Ron Dennis, who is the mastermind behind

01:38:44.920 McLaren in that regard is just a man of genius. And so, you know, they came out with the 12 C and there

01:38:53.560 was a lot of discussion that it was, it didn't have the heart of a Ferrari and GT3 or GT3, you know,

01:39:01.380 it didn't have the, the emotional temperament that would excite you that it was perhaps somewhat of a

01:39:08.040 clinical car. And I think they've been better at increasingly increasing the emotionality into their

01:39:15.140 cars. But I also think that part of them is resistant to that idea of necessarily the emotionality,

01:39:22.740 but just the precision and performance that you can get from those cars and the, the doing

01:39:30.040 emotionality better. But in terms of precision and performance, I don't know if anyone touches

01:39:35.960 them right now in terms of their evolution. I have not driven a McLaren that I've never driven one.

01:39:41.200 And I have friends who have them and they've said, you know, you're welcome to come into,

01:39:43.940 I just haven't, I don't know why I haven't done it, but I've driven lots of Ferraris. I've driven

01:39:47.920 lots of Porsches. I've driven lots of these other cars and it's everything you say has been

01:39:53.440 reiterated to me by the McLaren drivers who themselves have driven all of these other cars.

01:39:59.080 So just my curiosity is equally piqued and I'm a bit ashamed to say, I don't know why I haven't

01:40:04.980 just taken someone up on the offer to do this.

01:40:08.120 Please do. And then can you write me a long email so that I can live vicariously through

01:40:12.680 the gift that was given to you? We'll figure out a way, we'll figure out a way to do it together.

01:40:16.760 Now, so, so, so one more question before we figure out something else to do. The 1988 McLaren

01:40:23.900 versus the 1993 Williams, which again, you don't compare them car to car, totally different technology,

01:40:32.200 but you could make an argument. Those were the two most dominant cars in Formula One.

01:40:37.600 I'm guessing your heart is with the MP44, but, but what do you think about that 93 Williams? I mean,

01:40:45.300 that's a car that doesn't get as much attention as I think it deserves. I mean, it was so technologically

01:40:51.460 advanced. It was incredible. Some have argued it is to this day, the most technologically advanced

01:40:58.020 Formula One car. If you look at some of the shots where, you know, they've got different, you know,

01:41:03.320 computers plugged into it, you know, and they're always making musical symphonies with the engine

01:41:08.140 and the suspension, the chassis, the dynamics of damping, it was just next level. It was kind of

01:41:16.040 almost this step function that we'd been going along with race cars and we've been having beautiful

01:41:22.640 evolution. And then all of a sudden revolution came along with that car. So I would actually go for

01:41:29.600 the Williams, you know, and again, this probably goes against my, sort of my McLaren bent, but it was

01:41:36.020 just such an exercise in engineering passion that lent itself to this clear night and day, almost next day

01:41:48.320 benefit.

01:41:48.600 And obviously Prost won that year. Was Hill the other driver?

01:41:52.820 Yeah, I believe he was.

01:41:53.680 Yeah, because Mansell was driving at that time. Well, yeah, I just don't know.

01:42:00.700 Yeah, Mansell was with Williams the year before. He won in 92 in that Williams.

01:42:04.060 Yeah, yeah, yeah.

01:42:05.700 It's just such an amazing.

01:42:06.900 That was such a great era. I mean, I love watching now and there, you know, there's still

01:42:11.380 competition that's relevant there and there's still, you know, I think there's lots of good

01:42:17.460 colorful characters, but I just can't help thinking that there was these eras during Formula

01:42:24.940 One, you know, even back in the days of, you know, you know, James Hunt, for example, who

01:42:30.240 I just adored that kind of just fly by the seat of your pants, you know, he was-

01:42:35.660 Also in a McLaren.

01:42:36.340 Also in a McLaren too. And then, you know, there was this lovely kind of passing of that

01:42:41.640 chalice from him to Ayrton Senna. And I think it was happening when he was commenting, maybe

01:42:48.060 it was with Murray Walker, when Senna was finishing up his last race in the season when he was with

01:42:57.080 the John Player car, you know, that beautiful kind of black and gold.

01:43:02.280 Yeah, the Lotus.

01:43:02.860 So yeah, sorry, the Lotus, yeah, with that. And, you know, you could just hear the excitement

01:43:09.360 in Hunt's voice as to what this young potential prospect called Ayrton Senna could possibly

01:43:16.420 be. And for me, it was just this lovely kind of, you know, generational shift from one driver

01:43:22.260 to the next. It was a driver who knew how to spot talent and to see that, you know, talent.

01:43:28.560 And you could hear in the emotionality of James Hunt's voice, that type of affirmation that

01:43:36.480 you will next be one of the great. And I read all of that, you know, I think it's probably

01:43:41.400 nonsense. But for me, that was beautiful too. But there's been great eras, you know, Hunt

01:43:46.740 and then Ayrton Senna and now it's just different. But I still watch and I still love it.

01:43:53.080 Yeah, it's sort of funny. Like, I mean, truthfully, we can all sit here and poo-poo the sound of

01:43:58.940 the engines today and stuff. But the reality of it is, when you hear them, it doesn't matter.

01:44:03.440 It's still Pavlovian. I mean, it's, you just can't stop drooling. They're such beautiful

01:44:08.400 machines.

01:44:08.880 Yeah. And if you just hear them at full chat coming down a straight and it goes past you

01:44:14.740 and you've got any small modicum of gasoline that runs in your veins, the hairs on your

01:44:22.080 back of the neck will stand up, you know, and you'll say, yeah, I was wrong about it all

01:44:28.760 going away in this modern era. Truly not.

01:44:31.520 Well, we'll see. We'll see what happens this year. But I think you're right. I think it's

01:44:34.760 going to be really competitive. I think despite the challenges Mercedes have had, you can't

01:44:40.560 count them out. They're just so damn good.

01:44:43.480 And dominant.

01:44:44.060 Yeah. And yeah.

01:44:45.080 And of course, Lewis is incredible. So I'm not actually a huge Ferrari fan as the team,

01:44:51.040 but I like Vettel a lot.

01:44:52.740 Yeah.

01:44:53.320 I think the culture of Ferrari is broken. I think that's actually become quite public in

01:44:57.320 the past year. I think it's a lot of people have made that pretty clear that it's sort of

01:45:01.560 a toxic culture. And it's a stark difference to see how those two garages operate. Just

01:45:07.380 as a fan, if you're there and you can sort of see what's happening, it's a stark difference.

01:45:11.880 So anyway, it should be fun. Talk about another sport where like all sports, sleep really matters.

01:45:17.560 I mean, I can't imagine any athlete that's under more difficult sleep conditions than a Formula

01:45:24.160 One driver. Because, you know, it's one thing if you play in the NBA, you're going to fly a lot,

01:45:28.880 but you have a three hour time zone max. And based on how the conferences work and how the

01:45:34.380 schedules work, it's not like you're going plus three, minus three, plus three, minus three,

01:45:38.640 plus three, minus three. When you look at Formula One, first of all, it's a 10 month season,

01:45:42.600 basically. I mean, it's, you know, when you include preseason testing and it's truly a global

01:45:48.280 sport. And it's not even like it's structured perfectly well. It's not like they comb through

01:45:54.060 Europe, then go over to Asia and then, you know, hit a little Australia and Melbourne on the way

01:46:00.000 over to North America and then hit South America. It's not even done in the logical way that you

01:46:05.380 would do it if you were optimizing for continental jump.

01:46:08.780 Right. Jet lag imposed is horrific. And there in that sport, if you're talking about margin of error

01:46:15.720 and reaction time, we don't currently have essentially a breathalyzer for sleep deprivation,

01:46:22.460 which we should. And I think, you know, there's ways that we can think about that too.

01:46:26.160 But if there is one gold standard measure of insufficient sleep, it's not only just your

01:46:33.100 response time, your basic reaction time, but it's the number of times that you miss a response,

01:46:38.400 what we call a lapse or an error of omission. You omitted a response that should have been happening.

01:46:44.580 It is so obvious that insufficient sleep impacts your basic reaction time and your missing of

01:46:54.040 choice response times. And in Formula One or in any vehicle racing at high speeds, you know,

01:47:01.680 response times and reaction times, you're talking about margins of error here that are 0.00x,

01:47:09.760 you know, and six hours of sleep for one week can drop your reaction time by up to three to 400

01:47:19.320 milliseconds. Now three to 400, you know, almost half a second in terms of slowed response times

01:47:26.560 in Formula One can make the difference between you being first and you being somewhere basically

01:47:34.080 nowhere. Yeah. The other thing I've noticed, and this is one of the things I enjoy about having

01:47:38.540 a simulator is I get to test stuff out. I mean, I've, I've figured out that even after one drink,

01:47:46.520 I drive worse in a simulator, even though I am not legally drunk, right? I probably have a blood

01:47:52.440 alcohol of 0.03, 0.02. I mean, a very low blood alcohol after one drink and someone my size who

01:47:58.060 metabolizes things so quickly, but I don't drive well. And I, and I know this as clear as, you know,

01:48:03.760 as clear as day, because when I drive with my coach, you know, we drive virtually inside of

01:48:09.100 iRacing together. So he's in the cockpit with me, seeing my telemetry, seeing the drive, the whole

01:48:14.500 thing. And it's just a different game. And it's not actually just reaction time. The other thing I've

01:48:20.160 noticed is there's something about my spatial coordination that goes down. So I actually think

01:48:26.680 that that's a bigger problem than the reaction time. I think the bigger issue is you're just,

01:48:32.180 you're never quite hitting the right apex. You're never quite finding the right grip in the track.

01:48:38.500 And this is even when you know the track, like the back of your hand, you're just off.

01:48:43.140 So it's spatial attention is one of the things that we can study. We do it with brain scanners

01:48:48.000 very quick. I think that's what's killing me.

01:48:51.920 Sleep deprivation. Yeah. That I think together with also just specific choices, you know, if

01:48:58.540 you're racing, you know, you can, if you're by yourself and you're on the clock, that's one thing

01:49:03.780 to worry about. As soon as you put other cars on the track, you make it strategic. When you make it

01:49:09.720 strategic, you make it about decision choices. Do you dive into that apex when you know that you've

01:49:16.780 got someone on your flank? Do you not? When is the time to break? Do I want to break later? Do I have

01:49:22.740 the downforce? Where am I with my tires? You can go through a whole litany of decision-making that has

01:49:29.660 to happen within split seconds of time. Decision-making, again, you know, sleep, critical

01:49:36.600 components of that. And just judgment. I mean, I think even having a microscopic miscue on your

01:49:43.320 judgment, and as you said, it's hard enough when you were on a track by yourself, just trying to

01:49:48.940 bang out best lap times. The moment someone else is there, and it's incredible how much your judgment

01:49:54.700 can be impaired even subtly to do something stupid. For me, you know what it is? It's impatience. I am 1.00

01:50:01.060 much more impatient under that situation. Impulsivity. Yeah, very impulsive.

01:50:05.900 Comes back to the child in the supermarket. Yeah, yeah. Just much more likely to, you know, for example,

01:50:11.680 you think about it. Let's say you have 10 laps to go, and there's one car you need to pass.

01:50:18.780 You know, you think about that for a moment. You've got all the time in the world to figure

01:50:22.660 this out. You want to wait until it's perfect. And yet, I can see it in myself. There's this

01:50:28.320 belief with like, well, I just got to do it now. It's got to be on this lap. It's this lap or never

01:50:33.360 totally irrational thinking. And I have to wonder, because it's not, we do see these guys who are

01:50:42.280 gods. I mean, you know, you've driven race cars. I've driven race cars. So we can watch that sport

01:50:48.180 and appreciate it maybe more than the casual observer. Like we know how good they are. Just

01:50:53.420 like someone who plays soccer and watches Messi can appreciate him more than I can, right? Or someone

01:50:58.240 who plays tennis can look at Federer and actually explain why he's so great. That's what we can do

01:51:05.040 with these Formula One guys. And yet, sometimes you see them do things that really don't make sense.

01:51:10.480 In the light of this conversation, it's hard to wonder how much of that could be due to impaired

01:51:16.120 sleep given the, again, grueling schedule that they have to keep and the enormous time zones they're

01:51:23.440 constantly skipping with very little recovery. I mean, it's impossible actually, because on many

01:51:30.140 occasions, they won't show up in a new city until Monday or Tuesday. And if you've hopped eight hours

01:51:36.740 in a time zone. A great demonstration of this is just simply you're, you know, driving a race car is

01:51:42.660 physical as well. It requires physical fitness and non-trivial physical fitness. And a good example of

01:51:51.180 this is that when you're trying to mismatch your physical performance relative to your natural

01:51:56.500 circadian rhythm, which is what happens when you're jet lagged, you are not going to be performing at

01:52:02.100 your optimal sweet spot. And I can tell you that because if you look at the number of world records

01:52:10.060 that are broken in the Olympics, they are statistically far more likely to occur, world record breaking

01:52:18.660 efforts at the peak of most human beings, circadian rhythm, which is around about one to 2pm in the

01:52:25.200 afternoon. Far more world records broken in the Olympics at that moment on the circadian phase.

01:52:31.540 And if you look earlier in the morning or later in the day, that probability curve actually decreases

01:52:38.640 down and it's common across all sports. So that shows you that when you are in harmony with your

01:52:45.400 circadian rhythm, your ability to perform physically, according to at least world records is optimized

01:52:53.240 and maximized. So I can only imagine that when it comes to race car driving, if you're shifting

01:52:59.580 between time zones so dramatically, and you're not finding ways to optimize your circadian rhythm

01:53:06.200 biology, nor your sleep, you are losing a competitive advantage. And you as a team could spend 10 million

01:53:14.520 on trying to shave off 0.1 of a second in a car, which would be heroic as an engineering accomplishment.

01:53:22.040 Yet you could be shaving off, you know, 0.4 or 0.5 by way of human error, by way of this thing called

01:53:30.280 insufficient sleep or mismatched circadian rhythm. So as with many things that we're finding now with

01:53:36.040 technology, we're starting to get to the saturation maximum of engineering and technology accomplishments,

01:53:43.960 what we're finding is that the greatest weak, the weakest link, the lowest hanging fruit may no longer

01:53:49.800 be technology, it may no longer be tire compound or downforce, it may be the human being themselves.

01:53:56.500 And if you look at that constellation of things that are taken care of in race car drivers,

01:54:02.040 and in most high-performance athletes, diet, nutrition, mental health, those three things

01:54:08.840 are well on the radar map of most of them. Sleep? Usually not.

01:54:15.080 Yeah. And as you know, because you've driven and I've driven, when I think about what separates

01:54:20.840 people like us who are enthusiasts from people who are professionals,

01:54:24.840 professionals, it's really this ability to be consistently exceptional. I mean, I've probably

01:54:32.120 had individual laps, you know, that were really, really good, where, like, you could squeak,

01:54:40.920 like, if you only saw me do that one lap, you'd think, that guy's good. But I don't think I've ever

01:54:48.080 strung together three laps that you could look at and say, wow, that guy's really good. And,

01:54:55.040 you know, that's sort of the, in many ways, the challenge for even the best in the world,

01:55:01.280 which is you can't make a mistake on 70 laps. That's two plus hours sometimes. And I think to

01:55:11.360 your earlier point about the reaction times and the speed with which the world is coming at you when

01:55:17.680 you're driving a Formula One car, this need to be incredibly focused, have a level of concentration

01:55:27.440 that, you know, if you think about it, there's no other sport I can think of that requires that

01:55:32.300 level of focus and concentration for that long. You know, most sports, you have breaks. And you could

01:55:39.780 say, well, sure, if you're on a straightaway, maybe you have a bit more of a break. But I don't know,

01:55:44.360 I don't know about you, but even when I'm on the straightaways going flat out, I'm already going,

01:55:50.040 okay, where's the break zone? Like, yeah, yeah, there's really no moment where I'm not focusing.

01:55:55.820 Right. In cognitive neuroscience, we call that essentially a time on task effect,

01:56:00.620 which is that the longer that you're doing it, does your performance change as a function of time?

01:56:06.340 And firstly, the answer is yes, that your sustained attentional ability starts to wane the longer that

01:56:12.340 you perform just about any cognitive task, it turns out. What's interesting with sleep deprivation is

01:56:18.480 that the effects, the unmasking of insufficient sleep grows the longer that you apply the brain to a

01:56:26.960 task. So maybe for the first 30 seconds, they may be performing, you know, 10 seconds at the level of

01:56:33.840 someone who's sleep rested or their own level when they're sleep rested. But you've got to go into

01:56:39.500 kind of minute four or minute five before you really start to see the lines deviate from one

01:56:46.080 another. And that's what we call a time on task effect. And that is most prevalent in what we call

01:56:51.840 sustained attention, sustained spatial attention, which comes right back to exactly what you were

01:56:56.860 discussing. So certainly I think if it's a missing ingredient in a racing team, it would be a cost

01:57:03.840 savings to you and a point scoring benefit that you may want to look into.

01:57:10.820 Well, Matt, until next time, this has been, I mean, really, really insightful. And when I think about

01:57:17.980 how much I probably know about sleep to begin with, and how much I have learned even from this discussion,

01:57:23.660 and certainly from reading your work, I'm incredibly grateful. And I do think that

01:57:28.480 this is probably the single biggest deficit within the toolkit of most physicians. And I'm, you know,

01:57:38.320 few people are more critical of the absolute dearth of rigor in the nutrition field. But I think this is

01:57:45.480 worse. And it's not the dearth in the quality of the research, it's the dearth in the translation of

01:57:51.400 that research to clinical application. I agree.

01:57:53.700 I think the research in nutrition is the worst research of all things. Just, and again, it's not

01:57:58.720 to be critical of the people doing it, it's the difficulty in studying it. But at least there's

01:58:03.060 a greater effort to translate what is known into practice. But here, this is the biggest chasm. That

01:58:08.740 said, I think your work has had a greater impact here than anything I'm aware of. And I wish you all

01:58:14.100 the continued success. I think you could argue part of our humanity depends on it.

01:58:17.880 Thank you for giving me, firstly, that affirmation, because I am on a mission to try to reunite

01:58:24.480 humanity with, I think, the sleep that it is so desperately bereft of. And having this type of forum

01:58:30.760 where you can disseminate that knowledge. I mean, what you described there is that the research has not

01:58:35.440 been translated to the clinical practice. You're absolutely right. And that's part of the work that I do

01:58:40.400 with trying to be a sleep advocate. But another part of that is just the transmission of that sleep

01:58:46.940 knowledge to the general public as well. And I think people, you know, I'm not, I can't speak

01:58:52.740 for any of my colleagues, but early on in my career, I don't think I did a very good job at

01:58:57.060 communicating science, the importance of sleep to the public through the science. And that's what

01:59:03.380 I've been desperately trying to course correct with the book, and then just trying to be out there

01:59:10.040 and having this type of a forum, this type of an opportunity, a long form discussion with,

01:59:16.160 you know, just a fascinating, intelligent mind like yourself, who has an incredible listenership

01:59:21.920 to be given that platform is such a privilege. And so I have an immense amount of gratitude for this

01:59:30.040 time that you've been providing me with. Thank you, Peter.

01:59:34.780 You can find all of this information and more at peteratiamd.com forward slash podcast. There you'll

01:59:44.820 find the show notes, readings and links related to this episode. You can also find my blog at

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01:59:55.960 email where I'll update you on what I've been up to, the most interesting papers I've read, and all

02:00:00.580 things related to longevity, science, performance, sleep, et cetera. On social, you can find me on

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The Peter Attia Drive - April 15, 2019

#49 – Matthew Walker, Ph.D., on sleep – Part III of III： The penetrating effects of poor sleep from metabolism to performance to genetics, and the impact of caffeine, alcohol, THC, and CBD on sleep

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