The Peter Attia Drive - #77 – AMA #2 with sleep expert, Matthew Walker, Ph.D.： short sleep mutants, optimal sleep environment, sleep apnea, & rapid fire questions

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00:04:09.720 My guest this week is Matt Walker. Many of you are familiar with Matt because in April of this year,

00:04:15.100 we released a three-part series on sleep that was probably one of the most listened to series we ever

00:04:22.380 released. These have been really popular podcasts and it's reflected in the fact that many of you have

00:04:27.500 requested a specific AMA with Matt, which we did. And we are now back for a second version of that.

00:04:33.600 And for those of you perhaps listening to Matt for the first time, Matt's a professor of neuroscience

00:04:37.520 and psychology at UC Berkeley and the founder and director of the Center for Human Sleep Sciences.

00:04:44.240 I will gloss over the remainder of his bio because you can find it everywhere else,

00:04:48.720 but needless to say, it has all of these ridiculous accolades and he's just kind of an all-around total 0.69

00:04:54.700 stud. He's also the author of an international bestseller, Why We Sleep. And very recently in 2019,

00:05:01.460 this year that is, he gave a TED talk that was incredibly well received. We linked to that

00:05:05.620 previously and we will do so again. Now in this AMA, which again, as a reminder, these are for

00:05:11.320 subscribers only. So if you're not a subscriber, you're going to be able to hear a little bit of

00:05:14.260 this. If you are a subscriber, you're going to want to activate your RSS feed so that you can hear

00:05:20.200 this entire thing in an uninterrupted fashion. And by the way, that also means you will hear all

00:05:24.960 podcasts in an uninterrupted fashion without any of the other sort of housekeeping stuff that is

00:05:30.580 not necessarily intended for you at this point. So what do we talk about? We talk about a bunch

00:05:34.720 of things. We talk about the deck two mutants. These are folks who actually don't need to sleep

00:05:39.580 that much. We talk about a whole bunch of environmental factors that you've asked about

00:05:44.380 as they pertain to sleep, you know, position, temperature, other tools and tricks that may or

00:05:50.160 may not help us sleep, elevation, all these sorts of things. We then kind of go into a, what we call

00:05:55.320 I did or took an am this sort of thing. And is it hurting or helping? So getting into caffeine,

00:06:01.380 getting into sex, talking about the role of parents with young kids and things like that.

00:06:06.820 We get into a little bit of sleep apnea before rounding out a speed round where we go through

00:06:11.180 a bunch of, you know, kind of a potpourri of questions that are all over the place. I thought,

00:06:16.180 just personally, I thought this AMA brought up a lot of questions that I had. So I was really

00:06:21.320 happy to see that. And I think we actually got through every single question on the AMA. It took

00:06:27.920 a little while, but we did. And I'm not going to put Matt on the spot, but I suspect he'd probably

00:06:32.780 be willing to do a third round of this in some period of time. Oh, he's giving me the thumbs up

00:06:37.440 because I'm doing this intro while he's getting ready to go for a run. So with nothing else to say

00:06:42.880 on the topic, please enjoy our follow-up AMA with Professor Matt Walker.

00:06:51.560 All right, everyone coming to you from warm Bakersfield, California this evening. Matt,

00:06:57.660 thank you so much for agreeing to sit down again to do an AMA and no less on a day when the two of

00:07:04.180 us are probably about as exhausted as we could be. I mean, I got to be honest with you. If you had

00:07:09.060 said to me, Peter, I don't have it in me to do this. I just want to go to bed right now. I would

00:07:13.320 have seconded that motion 10 minutes ago. Well, firstly, it is a delight and a privilege to be back

00:07:19.560 on. And thank you so much for having me. And thank you for the experience that we've just had here.

00:07:24.560 I would say I am ecstatically exhausted. Yeah, we were sort of joking about it after that last

00:07:32.400 session today that I can understand why there are probably people who have never been involved in

00:07:37.660 motorsport and don't follow it and don't care about it that sort of look at it and think, well,

00:07:41.480 that's not really a sport, is it? I mean, people driving a car fast is not really a sport, but

00:07:46.560 certainly anybody who's done it would disagree with that. Hemingway, there's a great Hemingway

00:07:51.780 quote, which I'm sort of paraphrasing, but the gist of it is there are only three sports,

00:07:57.240 bullfighting, motor racing, and mountaineering. The rest are all games.

00:08:02.520 And I understand that now so much. I mean, I think we were coming out of the car,

00:08:08.740 the temperatures were over a hundred degrees. We were coming out of the car at the end of our

00:08:12.440 sessions looking visibly thinner as a consequence. And we were probably only in the car for like 20,

00:08:18.520 30, 40 minutes. Incredible. I think I will go home firstly, looking like I slept with a coat hanger

00:08:25.540 in my mouth. And the second is that after the first day I made the decision that I need to sit

00:08:32.420 down. I need to understand what is the minimum I can spend on food, sort of salad, rice, beans.

00:08:38.780 What is the need for me to put a roof above my head? And then everything else in terms of income

00:08:44.120 is motorsport. This was a great couple of days and we had a great crew and a great coach and a great

00:08:53.380 track and amazing conditions. And I mean, I guess I know people, I think get the sense how much we

00:08:59.320 both love this, but we talked about this idea of there's a feeling when you're out there, when

00:09:04.220 everything is in this sort of groove and it's hard to imagine you could be so pulled back from

00:09:10.760 anything else and everything else that's happening. So, you know, people talk about this flow state and

00:09:15.100 you can find this in so many different areas, but I've never experienced it to a greater extent than in

00:09:20.820 a car. You're so right. You are present in that moment and there is nothing else. There's nothing

00:09:26.980 else behind you in terms of recollection. There's no prospection forward in terms of thinking about

00:09:32.560 the future. And I think I would almost liken it to bring it back to sleep because that's of course

00:09:37.220 what I do. But when you first wake up in the morning, there's just that one or two slivers of

00:09:43.180 seconds of time where you remember nothing about yesterday, none of your troubles, difficulties.

00:09:48.340 You remember none of the anxiety that's coming up in the next day. It's just you in that moment

00:09:52.980 and it lasts so briefly. But when you get into motorsports and into a car and on a track,

00:09:58.680 it's that perpetually lap after lap with a lot more G-force. But other than that, that state of

00:10:06.800 being present and pure, there is something incredibly, there's an authenticity of consciousness

00:10:13.500 that you get. And that sounds pompous and I really don't mean it to, but it is an elegant

00:10:19.580 condition. One that leaves you with a neck that is so sore the next morning because of the G-forces

00:10:25.040 that you're pulling. That's the only reason that you remember how difficult it was, but what an

00:10:29.240 incredible gift.

00:10:30.420 What was the highlight for you these couple of days here?

00:10:32.180 I think, I mean, this is really the first time that I've been on track and to understand the

00:10:38.400 limits of a car. Now we had a car that was, it wasn't just your typical street car. It was a notch

00:10:44.060 above that. But to truly understand the limits of a car in a way that you should never, and you must

00:10:50.720 never test on a street and to see how far beyond what I thought it was capable of. And it was so beyond

00:10:59.780 my skill level too. And we got in with this incredible instructor and he took it to the limit,

00:11:05.340 but to feel the limit of a mechanical object designed for purely one purpose and one purpose

00:11:12.980 alone. Oh, that is a very special thing. And to even feel 50% of it or 20% of it is something that

00:11:21.000 I probably will go to my grave remembering.

00:11:23.680 Well, the good news is one, you're going to do it a heck of a lot more because now I've got my hooks

00:11:28.140 in you so you're not going back. But we haven't discussed this actually. So I know that some

00:11:32.440 people, I promise we're going to talk about sleep. Matt and I will stop talking about cars, but I knew

00:11:37.260 when we got to the track that Thomas always wants to shake the car down first. And I was so happy for

00:11:42.700 you to get in the car that first time to see it. And I also knew it was going to have this weird

00:11:46.780 outcome, which is you're going to come out of that car. And in, in one way, it's going to excite you

00:11:51.020 beyond belief, but another way you're going to be like, there's no way that car can move that

00:11:55.260 quickly. Like I'll never be able to make it go that fast. And of course the answer is,

00:11:59.560 of course you won't. Neither of us will. We would spend the rest of our lives and we probably could

00:12:03.040 never get a car to go that fast, but you still got a glimpse of what's possible.

00:12:08.140 And I think one of the difficult things with driving is everyone drives, but not everyone plays

00:12:14.860 different professional sports. So if you see a pitcher throwing a ball and you think that is a

00:12:20.260 remarkable skill. Yeah. We all throw a ball every now and again, but almost every day,

00:12:25.120 most people, or perhaps not every day, but people are driving all of the time.

00:12:29.060 So I think that fools people into thinking, well, how much more skill is required to be not just a

00:12:36.120 driver, but a race car driver. And it turns out it is just as large as you sitting, watching your

00:12:41.960 television and seeing David Beckham bend a ball into the net. By the way, my Liverpool supporter,

00:12:47.420 it's a bad example considering as Manchester United history, but you get the idea, which is,

00:12:52.520 I think we get fooled into thinking that it really isn't that much more difficult. How much more do

00:12:58.680 you have to train and how much more skilled do you have to become? And the answer, as I've learned

00:13:03.780 by turning the car backwards a few times over the past two days is a great deal, but gosh.

00:13:09.920 But that's part of its joy. I think is, I was talking about this on another podcast once, which was

00:13:13.840 the beauty of something like car racing. And I feel the same way about archery is they are really

00:13:19.080 easy to do at some level. In other words, anybody can drive a car and anybody could shoot a bow,

00:13:25.420 maybe not well or not far or whatever, but they're very difficult to do well. Whereas tennis is kind

00:13:32.620 of hard to do. If you took someone who's not remotely athletic and you handed them a tennis racket and

00:13:37.820 made them go and play against somebody, they might not even be able to return a single serve,

00:13:41.180 but everybody can drive. Yeah. The bandwidth of opportunity is great. So it's not too hard to

00:13:46.920 get on the bottom rung. Yeah. Well, we're going to work on our curriculum and we'll build that a

00:13:51.580 curriculum over the next few years with the goal of you owning a race car one day. And I just want

00:13:56.100 to be able to put one sticker on it and you know what that sticker is going to say. I do. And I'm not

00:13:59.900 going to repeat it here, but an inbound sticker for my Mazda Miata MX-5.

00:14:04.660 Nice. So moving on to the AMA, which is why we're here, Matt, this is a first time when we've had a

00:14:12.020 repeat AMA on the exact same topic. And I think it speaks to two things. The first is how much people

00:14:18.620 want to understand sleep. And I think that's such a credit to the way you've been able to articulate

00:14:25.520 it and the attention you have brought to this subject. And then the second point is really also that

00:14:31.380 it's that you are very proficient at talking about it. And the breadth of questions we get on

00:14:38.400 this is incredible. I mean, we're going to lead off with kind of some technical stuff. And then

00:14:42.200 there's some great questions. I looked through this list recently and it's really fun because

00:14:46.160 people think of better questions than I can think of. Yeah. And if anyone's starting to lose

00:14:50.200 a little bit of attention or will to live at this moment, I promise you masturbation is coming up. 0.98

00:14:54.740 So stay tuned. Yes. All right. So let's start by talking about, 0.98

00:14:59.060 this is actually kind of a question from me because this question feeds out of an email

00:15:03.660 exchange you and I had several months ago about the DEC2s. So these are a genetic mutation that

00:15:10.320 produces a short sleeping phenotype. Can you tell us a little bit more about people with this mutation

00:15:14.360 and what it does? Yeah. So these are the acclaimed short sleepers that people have started to become

00:15:19.280 aware of. I mean, it got a lot of media attention and the gene is called DEC2, DEC number two.

00:15:26.080 And they are the short sleepers that we found. They are a genetic mutant that seems to,

00:15:32.780 which sounds a little bit X-Men by the way. These are individuals who have a gene that,

00:15:37.300 and that gene seems to mean that they don't sleep as much as most people or as much as most people

00:15:45.560 should be sleeping. So their sleep need is lower than we have typically seen before.

00:15:51.980 And I think there are several important things to point out to the public. Firstly,

00:15:57.060 when I describe the short sleeping gene phenotype, most people start to think, well, that's probably

00:16:03.920 me. I think I'm one of those who can get away with five hours of sleep. Firstly, the probability that

00:16:09.340 you are a DEC2 carrier is very low. It's a fraction of a percent of the population right now.

00:16:15.600 So you're far more likely to be struck by lightning in your lifetime, it turns out statistically,

00:16:20.660 than to have this gene, just to sort of frame that context and expectation in people's mind.

00:16:25.800 The second, I think, interesting part of this is, well, how much do they sleep? And we've got all

00:16:33.020 of these sort of chest beating heads of state like Thatcher and Reagan, and more recently,

00:16:38.240 Donald Trump, espousing five hours or four hours. Is this the realm of the DEC2 individual?

00:16:45.180 And the answer is no. So if we bring these individuals into the lab and we just take

00:16:50.640 away their phone, no clocks in sight, and we just let them sleep what we call the habitual amount.

00:16:56.840 So you put them to bed, you let them fall asleep when they want, and you let them wake up and you

00:17:01.440 let them sleep as much as they typically would want, or even physiologically can. And where they come

00:17:08.260 out is at about 6.25 hours of sleep. In other words, six and a quarter hours of sleep.

00:17:14.060 So this is not your five hours or four hours. And this is the genetic mutant that is the short

00:17:21.420 sleeper, and they are getting six and a quarter hours. And the reason that kind of concerns me is

00:17:27.260 if you look at America right now, the average American adult is sleeping about six hours and

00:17:32.760 31 minutes during the week. So genetic mutant only needs a few minutes less than what the average of

00:17:41.580 the population is getting. Now, by the way, that's the average, which must mean that there's a large

00:17:46.660 tail of the distribution that is sleeping considerably less than six and a half hours.

00:17:52.700 A vast proportion of them do not have the DEC2 mutant gene.

00:17:55.640 And just to refresh everybody's memory, when you do that same type of a sleep study on the majority

00:18:00.760 of the population, the rest of us have an equilibration at how many hours is the optimal?

00:18:06.040 Yeah, it's somewhere between about seven and a half to nine and a half hours.

00:18:10.300 That's an enormous range.

00:18:11.780 It is an enormous range. And some of that has to do with age, because as we get older, even though we may

00:18:17.680 need as much sleep as we did when we were younger, physiologically, we just can't generate that sleep that we need,

00:18:24.820 which may actually be pulling that number down because those numbers are generated.

00:18:28.540 Because we don't generate enough adenosine?

00:18:30.220 It actually may be that we generate even more adenosine as we get older, but there are a number

00:18:34.740 of reasons why. Firstly, the parts of the brain that deteriorate with aging, your brain doesn't

00:18:40.420 deteriorate homogeneously as you get older. Some parts of the brain deteriorate what we call atrophy

00:18:46.340 more quickly than others. Unfortunately, those areas are the sleep generating areas, particularly the deep

00:18:52.740 sleep generating areas, especially a region that we call the prefrontal cortex and the middle part

00:18:58.720 of that. So take your thumb, stick it between your eyes, raise it up about an inch or an inch and a

00:19:04.020 half, and you're right there. That's your medial prefrontal cortex. That's a deep sleep generating

00:19:10.480 region. It's one of the epicenters for the generation of cortical deep sleep. That part of the brain

00:19:15.600 atrophies quickly, it also accumulates beta amyloid most significantly and early on.

00:19:22.620 So for that sort of sweet spot for the general public, we can do those washout studies where we

00:19:27.920 bring them into the lab, or you can do another great study. People just took them up hiking in

00:19:33.080 the Rocky Mountains, dislocated them from all of modernity, no electricity, no phones, not even

00:19:38.640 matches a candlelight. And firstly, what you find is that they sleep long. They slept sort of almost

00:19:45.040 close to, on average, about nine hours. Now, these were pretty young, healthy folks. Probably the

00:19:50.360 more striking part of that data to me, however, was when they were sleeping. If you look at what

00:19:55.020 they were saying their habitual bedtime was, it was 11 midnight, and they were actually going to bed

00:20:01.820 around sort of 9, 9.30 in the evening. And it always strikes me when you think about this term

00:20:08.280 midnight and what it actually means. Midnight actually means middle of the night. And it is

00:20:14.660 when you let yourself sleep in harmony with the natural edict. But for most of us, that's the time

00:20:20.640 when we think, well, yeah, I should just send my last tweet or check my email. That's midnight for us.

00:20:25.880 But so for the deck twos, they definitely seem to sleep less, but it's nowhere near the proclaimed

00:20:31.720 sort of media hype that is just four or five hours. They need still considerably more.

00:20:36.720 And do we know if there are any health consequences to people that have a deck two mutation? Is it

00:20:42.000 acquired or are there any twin studies that could compare or at least sibling studies?

00:20:47.860 There are, there've been some twin studies that they've looked at too. One twin has the gene,

00:20:51.960 one does not. And you actually get some interesting findings from that, which I'll come on to in a

00:20:56.960 second that may explain why they could be a short sleeper. The answer to your question though,

00:21:02.840 the health consequences is that we just don't know. And we don't know for two reasons.

00:21:06.720 Firstly, we haven't known about this genetic mutation for very long. So we haven't been able

00:21:13.860 to actually pick up these people and then track them longitudinally across the lifespan and see

00:21:19.000 as they move with age, are they filled with more disease, less disease, or no difference in terms of

00:21:25.880 their risk ratio for these typical things that we know are causally related to a lack of sleep?

00:21:30.880 Are they living more with sort of disease right now at whatever age they are? There's just too

00:21:36.860 few of them for us to make any statistically meaningful sense of that equation. So I think

00:21:43.800 right now the answer is going to come much later for humans. I think the answer could come more

00:21:49.080 quickly. However, if we look at genetic mouse models, where we create that same mutant and you

00:21:54.660 can fast track those questions. But in terms of humans right now, I think we just don't know.

00:22:00.740 And do we know if they disproportionately suffer one stage loss versus another?

00:22:05.520 Yes, they seem to under certain conditions. So one way that we can try to assess what your sleep need

00:22:12.300 is paradoxically is to bring you into the lab, deprive you of a night of sleep, and then look at how

00:22:19.020 hard you rebound in terms of your sleep appetite on the following recovery night. And that's almost a

00:22:26.180 way for us to sense or get a measure of how sort of healthy and virulent is that sleep system. And

00:22:32.780 that's what they've done with these individuals. Firstly, what you see is that when they sleep,

00:22:37.680 when they have their sleep recovery and their rebound, they rebound much harder in terms of deep sleep.

00:22:43.540 They actually have a lot more deep, non-rapid eye movement sleep. So that's dreamless sleep,

00:22:48.820 and especially the deeper stages of deep sleep. It's even more evident if you look at the electrical

00:22:54.100 quality of that deep sleep, not just quantity minutes, but the actual power and depth of those

00:23:00.320 deep sleep brainwaves. So at that level, I started to actually get quite bullish on the idea that this

00:23:07.020 genetic phenotype may actually truly be capable of surviving on six and a quarter hours a night

00:23:13.720 without any harm, because just the sheer raw turbocharged quality of their deep sleep is so high

00:23:20.940 that essentially they can accomplish what we can in six and a quarter hours that would normally take

00:23:26.780 someone like me eight hours and 10 minutes or so. However, if you looked into that data a little bit

00:23:32.900 more, there is a more troubling sign. So actually, just to come back to that, what would be the

00:23:37.220 analogy? It's almost like glucose clearance. If someone is really healthy in terms of their metabolic

00:23:42.900 profile, their ability to clear glucose and get it out of the system is just ultra efficient.

00:23:48.840 That's kind of how they are. And it's almost as though they're clearing adenosine, which is this

00:23:53.280 wake chemical that builds up. And at night, we must sleep in part to clear out that adenosine,

00:23:58.720 that sleepiness. And they just do it in greater efficiency. So it's sort of, they are the true

00:24:04.660 glucose heroes in the sleep world, as it were. But when you look at that data, something else emerges,

00:24:10.920 they actually suffer from getting less rapid eye movement sleep. And this is what started to make

00:24:17.280 me more concerned about the phenotype. Why am I more concerned if they're getting more deep sleep? A lot

00:24:22.860 of people say, it's the deep sleep that I need. Well, firstly, you need all stages of sleep.

00:24:27.960 It's such a fragile, idiotic state to be in this thing called sleep, that if there was any stage 0.85

00:24:34.000 of it that could have been weeded out in the course of evolution, Mother Nature would have done away 0.99

00:24:38.460 with it hundreds of thousands, if not millions of years ago. We know that they all have a function.

00:24:44.720 So why am I concerned so much about REM sleep? Studies done back in the 1980s with rats that will

00:24:50.560 probably never be done again for ethical reasons. They took them and they split them up into three

00:24:55.540 different groups and they deprive them of sleep and they deprive them until they died. The three 0.90

00:25:00.920 groups were the following total sleep deprivation, selective deep sleep deprivation, selective deep

00:25:07.160 non-REM sleep deprivation, and selective REM sleep deprivation. The first finding was that the rats in

00:25:13.560 the total sleep deprivation group died after about nine to 11 days of total sleep deprivation.

00:25:18.880 How much were they being deprived? Total. They had almost no sleep at all. So these were people

00:25:24.420 monitoring them around the clock, no sleep day after day after day. And those rats died essentially

00:25:31.960 as quickly from a lack of sleep as they did from a lack of food. If you want to sort of put things

00:25:36.920 head to head, sleep is just as essential as food in terms of life support. What was more interesting,

00:25:42.260 however, was that when you looked at the two groups that were selectively deprived,

00:25:46.360 the group that was deprived of deep non-REM sleep was still able to get all of the REM sleep that they

00:25:52.820 wanted and vice versa, the group that was deprived of REM sleep got all of the deep sleep that they

00:25:57.920 wanted. The rats that were deprived of rapid eye movement sleep, what we typically think of as dream

00:26:03.260 sleep, they died almost as quickly as the total sleep deprivation group. The deep sleep deprivation

00:26:11.340 group, it took them almost twice as long in terms of deprivation before they died. So in terms of a

00:26:18.900 life support system, which stage of sleep is more important? On the basis of these mortalities data,

00:26:26.320 you would argue that REM sleep is the more life essential ingredient. Now they all are, but which

00:26:32.140 one is more life sustaining? That data would argue REM sleep, which brings me back to the deck twos.

00:26:37.820 If they're suffering from a lack of REM sleep, does that mean that their mortality risk is actually

00:26:43.320 higher? We just don't know, but that's the only countervalence force to the first part where I was

00:26:48.920 quite bullish. The next set of questions, Matt, are, we've kind of organized them as sort of environmental.

00:26:56.900 So we've got a lot of questions about sleep position. So starting with one, does your sleep

00:27:03.780 position matter specifically on your back, on your side, head propped up with a pillow on your stomach?

00:27:11.340 Is there any evidence that one of these positions is better or worse than others? I'll exclude or I'll

00:27:19.240 create a caveat, which says notwithstanding the mechanical issues associated with it. So presumably

00:27:24.520 for someone with apnea, we would assume that laying on your back would be a worse position than laying on

00:27:31.220 your side. Feel free to address that of course, but I'm assuming the person who asked this question

00:27:35.420 is looking for more than just that mechanical issue. You can find all of this information and

00:27:42.140 more at peteratiamd.com forward slash podcast. There you'll find the show notes, readings, and links

00:27:48.080 related to this episode. You can also find my blog at peteratiamd.com. Maybe the simplest thing to do

00:27:54.400 is to sign up for my subjectively non-lame once a week email, where I'll update you on what I've been up to,

00:27:59.460 the most interesting papers I've read, and all things related to longevity, science, performance, sleep,

00:28:04.960 etc. On social, you can find me on Twitter, Instagram, and Facebook, all with the ID peteratiamd.com, but

00:28:11.660 usually Twitter is the best way to reach me to share your questions and comments. Now for the obligatory

00:28:16.220 disclaimer, this podcast is for general informational purposes only and does not constitute the practice

00:28:20.920 of medicine, nursing, or other professional healthcare services, including the giving of medical advice.

00:28:26.520 And note, no doctor-patient relationship is formed. The use of this information and the materials linked

00:28:32.760 to the podcast is at the user's own risk. The content of this podcast is not intended to be a

00:28:37.400 substitute for professional medical advice, diagnoses, or treatment. Users should not disregard or delay in

00:28:43.220 obtaining medical advice for any medical condition they have and should seek the assistance of their

00:28:47.780 healthcare professionals for any such conditions. Lastly, and perhaps most importantly, I take conflicts of

00:28:53.860 interest very seriously. For all of my disclosures, the companies I invest in and or advise, please visit

00:28:59.860 peteratiamd.com forward slash about.

The Peter Attia Drive - October 28, 2019

#77 – AMA #2 with sleep expert, Matthew Walker, Ph.D.： short sleep mutants, optimal sleep environment, sleep apnea, & rapid fire questions

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