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

00:00:10.880 is a result of my hunger for optimizing performance, health, longevity, critical thinking, along

00:00:15.940 with a few other obsessions along the way. I've spent the last several years working

00:00:19.660 with some of the most successful top performing individuals in the world. And this podcast

00:00:23.620 is my attempt to synthesize what I've learned along the way to help you live a higher quality,

00:00:28.360 more fulfilling life. If you enjoy this podcast, you can find more information on today's episode

00:00:33.000 and other topics at peteratiyahmd.com. Hey everybody, welcome to this week's episode

00:00:43.360 of the drive. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast

00:00:48.580 and why instead we've chosen to rely entirely on listener support. If you're listening to this,

00:00:53.820 you probably already know, but the two things I care most about professionally are how to live

00:00:59.060 longer and how to live better. I have a complete fascination and obsession with this topic. I

00:01:04.760 practice it professionally and I've seen firsthand how access to information is basically all people

00:01:09.920 need to make better decisions and improve the quality of their lives. Curating and sharing this

00:01:15.100 knowledge is not easy. And even before starting the podcast, that became clear to me. The sheer volume

00:01:20.380 of material published in this space is overwhelming. I'm fortunate to have a great team that helps me

00:01:25.800 continue learning and sharing this information with you. To take one example, our show notes are in a

00:01:31.600 league of their own. In fact, we now have a full-time person that is dedicated to producing those and

00:01:36.460 the feedback has mirrored this. So all of this raises a natural question. How will we continue to

00:01:42.700 fund the work necessary to support this? As you probably know, the tried and true way to do this is to

00:01:48.320 sell ads. But after a lot of contemplation, that model just doesn't feel right to me for a few

00:01:54.200 reasons. Now, the first and most important of these is trust. I'm not sure how you could trust me if I'm

00:02:00.400 telling you about something when you know I'm being paid by the company that makes it to tell you about

00:02:05.080 it. Another reason selling ads doesn't feel right to me is because I just know myself. I have a really

00:02:11.280 hard time advocating for something that I'm not absolutely nuts for. So if I don't feel that way about

00:02:16.660 something, I don't know how I can talk about it enthusiastically. So instead of selling ads, I've chosen

00:02:22.060 to do what a handful of others have proved can work over time. And that is to create a subscriber

00:02:28.240 support model for my audience. This keeps my relationship with you both simple and honest. If you value

00:02:35.300 what I'm doing, you can become a member and support us at whatever level works for you. In exchange, you'll get

00:02:41.660 the benefits above and beyond what's available for free. It's that simple. It's my goal to ensure

00:02:47.300 that no matter what level you choose to support us at, you will get back more than you give.

00:02:52.880 So for example, members will receive full access to the exclusive show notes, including other things

00:03:00.380 that we plan to build upon, such as the downloadable transcripts for each episode. These are useful beyond

00:03:07.100 just the podcast, especially given the technical nature of many of our shows. Members also get

00:03:12.900 exclusive access to listen to and participate in the regular ask me anything episodes. That means

00:03:19.860 asking questions directly into the AMA portal and also getting to hear these podcasts when they come

00:03:25.800 out. Lastly, and this is something I'm really excited about. I want my supporters to get the best

00:03:30.780 deals possible on the products that I love. And as I said, we're not taking ad dollars from anyone,

00:03:35.620 but instead what I'd like to do is work with companies who make the products that I already

00:03:39.900 love and would already talk about for free and have them pass savings on to you. Again,

00:03:46.420 the podcast will remain free to all, but my hope is that many of you will find enough value in one,

00:03:53.560 the podcast itself, and two, the additional content exclusive for members to support us at a level that

00:04:00.380 makes sense for you. I want to thank you for taking a moment to listen to this. If you learn from and

00:04:05.320 find value in the content I produce, please consider supporting us directly by signing up

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 0.98

00:20:12.360 just makes everybody laugh.

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

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

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,

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.

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,

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

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.

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

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

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

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

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

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

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

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

01:59:50.240 peteratiamd.com. Maybe the simplest thing to do is to sign up for my subjectively non lame once a week

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

02:00:06.040 Twitter, Instagram, and Facebook, all with the ID peteratiamd. But usually Twitter is the best way

02:00:11.580 to reach me to share your questions and comments. Now for the obligatory disclaimer, this podcast is

02:00:16.220 for general informational purposes only and does not constitute the practice of medicine, nursing,

02:00:21.000 or other professional healthcare services, including the giving of medical advice. And note,

02:00:26.140 no doctor patient relationship is formed. The use of this information and the materials linked to the

02:00:31.680 podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for

02:00:36.660 professional medical advice, diagnoses, or treatment. Users should not disregard or delay in obtaining

02:00:42.220 medical advice for any medical condition they have and should seek the assistance of their healthcare

02:00:46.740 professionals for any such conditions. Lastly, and perhaps most importantly, I take conflicts of

02:00:52.540 interest very seriously. For all of my disclosures, the companies I invest in and or advise, please visit

02:00:58.540 peteratiamd.com forward slash about.

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

Episode Stats

Summary

Transcript