Optimizing sleep: bedtime routine, molecule regimen, sleep trackers, & sauna [AMA 42 sneak peek]

1. 0:00 – 2:25

   Intro

   1. PAPeter Attia0:00

      [upbeat music] Hey, everyone. Welcome to "The Drive" podcast. I'm your host, Peter Attia.

   2. SPSpeaker0:10

      Peter, welcome to another AMA. How you doing?

   3. PAPeter Attia0:12

      Doing well. How are you?

   4. SPSpeaker0:14

      I'm not too bad. Not too bad. How's the week going?

   5. PAPeter Attia0:18

      Um, it's good. Uh, we're, we're, we're still, uh, struggling with this decision about to read or not to read the book, so that's, that's the, uh, I guess that's the thing that's on my mind today at least.

   6. SPSpeaker0:30

      That's... So anyone listening, if they have a strong preference either way if Peter should read it or not, let us know and we'll tally up the votes.

   7. PAPeter Attia0:38

      Well, but that's not a-- That's, that's an uninformed vote, 'cause I think people would naturally tend to vote for, uh, the author to read the book. But I have, I have information that they don't have, which is I've already heard myself read a sample of it, and it's absolutely horrible. So, um...

   8. SPSpeaker0:57

      I-

   9. PAPeter Attia0:57

      Yeah. It's really just-

   10. SPSpeaker0:57

       It's not horrible

   11. PAPeter Attia0:57

       ... a question of, if can I be coached into reading it better or do you just-- Is it just, you know, flogging a dead horse and is it better off to just have a professional do it?

   12. SPSpeaker1:06

       Yeah. No, I think if there's anything about you, it's that you're coachable.

   13. PAPeter Attia1:10

       [chuckles]

   14. SPSpeaker1:11

       So I think, uh, I think you could get there. But I th- I think it'll still be interesting to see what people think.

   15. PAPeter Attia1:17

       Yeah. [chuckles]

   16. SPSpeaker1:19

       All right, so Peter, today's AMA, not gonna be about the book, but what it is gonna be about is sleep. So sleep's a subject that, I mean, we've had a lot of podcasts on, um, especially with guest Matt Walker. But it's been about two years since we've had any type of content on it, and it's a topic that we get so many questions on, and we continue to get so many questions on. So what we did is we kinda compiled all those questions for today, and we're gonna kinda discuss all of that. So that will include questions around your pre-bedtime routine, your behaviors as it relates to how you're currently improving your sleep. We'll talk about the molecules that you currently use, pharma, over-the-counter supplements, and how you think about that with not only you and your patients. And then we'll also talk about wearables. You know, what are some of the pros of them? How can they be helpful? And at the same time, what are some of the potential dangers of them in terms of what people think about? So with that said, I think we'll just start jumping into it with question number one.

   17. PAPeter Attia2:23

       Yep, that sounds great.

2. 2:25 – 11:16

   Peter’s current pre-bedtime routine

   1. SPSpeaker2:25

      Perfect. So you shared a bit ago on Instagram kind of your thoughts not only around sleep trackers, but also some changes you made to your pre-sleep routine, which have been really effective. Um, and we received a lot of follow-up questions from the audience where they just wanted to dive deeper into that. And so I think what maybe be helpful is just start with what does your current pre-bedtime routine look like, especially if you're really trying to optimize your sleep for that night?

   2. PAPeter Attia2:52

      Yeah, so, you know, this is kind of the result of, I don't know, ma-many years, uh, certainly of tinkering, uh, and also, uh, kind of a, a luxury that I have today that I didn't have pre-COVID, which is the luxury of not traveling, uh, at least not with any regularity. I mean, I used to spend, you know, 150 to 180 days a year or a night-- a year in my own bed prior to COVID, and that's completely changed. Now it might be 340. I mean, so I'm, I'm really able to kind of dial in what I do at home. Um, [clears throat] so... And it's also something I just... I've-- It's, it's something I kinda gravitate towards paying a lot of attention to. So, so a lot of these insights are not necessarily new, but it's just a question of being diligent around putting them in place. So, so one of those, of course, is alcohol. Um, very difficult to have a good night's sleep if you have alcohol in the proximity of bedtime, or even if you have two or three drinks several hours removed from bedtime, it, it still will linger. And, um, that'll, that'll manifest itself in a number of ways, but, but probably most notably, um, is, is kind of a reduction in the, uh, quality of sleep. So you'll see-- you'll trade more deep sleep and REM sleep for light sleep. And then the other thing you'll see is much more frequent wake-ups. Um, so if you're really trying to dial in your sleep, you're, you're gonna have to basically say, "I'm not gonna drink in the evening." And for many people, that just means not drinking, period, 'cause most people are not drinking too much in the daytime and then cutting it out in the evening. The, the other thing that, um, I think I learned a lot when I was fasting like crazy is how much the sort of low glucose empty stomach, um, um, impacted sleep, and it was, it was profound. I mean, one of the things that amazed me when I was fasting was how my, my sleep quality improved in, in ways that, you know, I'd never seen before, frankly. Um, a-and so I generally eat dinner early-ish and, in large part that's 'cause we have kids, so it's sort of, you know, they're going to bed early, so we're eating all kind of early. Um, but I notice that if I pay attention to it, when I go to bed, I'm a little bit hungry. And I think in the past, there were times when I would have just had a little snack, uh, and now I don't. You know, now I just say, "I'm gonna go to bed with a little bit of a hunger pang." Uh, and that, that's also a very positive, uh, effect on sleep. Um, we've talked a lot about sauna and, you know, not to get too far into this rabbit hole, but as you know, I've kind of taken a 180 on sauna. So I would say, mm, six years ago, seven years ago, when we first really did our deep dives into this, I, I came to the conclusion that there was really no benefit to sauna that wasn't captured in a healthy user bias. Meaning, all of the epidemiologic benefits associated with sauna, which are numerous. I mean, let, let's be clear, there are- immeasurable benefits that come from sauna if you buy the epidemiology. In particular, uh, an enormous reduction in cardiovascular mortality and mortality associated with dementia. Um, but I really felt that that was, that was mostly a healthy user bias. And I think over the years with... And we, we do this every two or three years, we go back and internally revise our white papers on this. And I think it was the 2019, late 2019, early 2020, revisit this literature when I, I kinda changed my mind a little bit. And I started to say, "Maybe the magnitudes of the benefits associated with sauna are being, uh, amplified by these biases that can't be controlled for." But the direction of them, the consistency of them across studies led me to believe there's probably something there, in addition to the plausibility of the mechanisms. It's a long-winded way of saying, uh, you know, I've, I've become a pretty diehard sauna convert over the last couple of years. And, um, you know, we, we have one at home now, which, um, uh, you know, I always get asked questions about saunas, so I'll guess I'll give a bi- a bit of a digression on what kind of sauna we have, and it, does infrared, does it have to be dry, all those things. So I'll, I'll... Let's com- let's park that, and we'll come back to it in a second. But, uh, I do try to get into that sauna at least four nights a week, uh, if not five or six. I'm really only limited by, um, you know, how much work I need to get done, but it's, it's become a, a great tool. Uh, and I like it before bed. So I know that there are a lot of people who like to do their sauna in the daytime, they like to do it right after they exercise. I think that's great, but I've been using it basically for two purposes. One, I do buy that there is some, uh, mortality benefit that comes from it. Uh, but, but empirically, the, the impact this has had on my sleep is insane. S- so much so that I, I, I've often wondered, is the mortality benefit of sauna largely attributed to the sleep benefits that come, uh, from its use? I don't know the answer to that question, of course. It would be... These would all be ves- very easy experiments to do if you lived in a resource, um, unconstrained world. Uh, so I'll pause there just to sort of see where you wanna double down on which of those topics.

   3. SPSpeaker8:30

      Well, I think... Yeah, so I wrote down some follow-up questions, and I think the first one is: is there an e- ideal amount of time that you try and have between when you last ate and when you go to sleep? I know it's, it's gonna change from person to person-

   4. PAPeter Attia8:44

      Mm-hmm

   5. SPSpeaker8:44

      ... but just a relative rough number I think would be helpful for people.

   6. PAPeter Attia8:48

      I strive for about three hours between-

   7. SPSpeaker8:53

      Okay

   8. PAPeter Attia8:53

      ... when I finish dinner and when my head hits the pillow. And again, I just, I just wanna be clear on all this stuff. It's super important not to go psycho on this, and, and I know that when I talk about it this way, it sounds like I'm going psycho. It... I'm not. I, I wanna be really clear. Like last night, you know, my wife and I went out to, uh, you know, one of her friends was having a birthday party, and we went out, and truthfully, I probably ate an hour before going to bed. It didn't phase me, right? It's not like I was sitting there at the restaurant looking at my watch going, "Oh my God, where is the food?" No, no, no. No, no. So, so y- you can do this most of the time and not be a psycho, and I think that's the broader, you know, kind of lens you wanna look at through this, which is these are general principles that are going to get violated quite often, but you wanna kind of revert back to them whenever you can. So, you know, th- this weekend, you know, you're gonna be in town, Lacey's in town. I mean, we got tons of friends in town. This is gonna be a bananas weekend. I promise you there will not be a night I'm going to bed this week where I will have, you know, had three hours [chuckles] of rest between my last meal. Uh, and there probably won't be a night that I'm going to bed where I won't have had a drink. But guess what? Like we have a bunch of friends in town, and that's the way it's going to be. Um, but that's not the norm. And, and I... So I just think, um, with sleep in particular, there's such a psychological component to this that you, you just don't wanna get too wrapped up in your head about this sort of stuff, uh, 'cause I think that can cause more harm than good. So, uh, you, you need to be flexible in this regard as an individual, and I think, and not terribly rigid. So I just hope people can interpret what I'm saying as guidelines that we try to stick to, uh, but, but we have the flexibility to deviate.

   9. SPSpeaker10:42

      Yeah. No, I, I think that's really good, and it kind of fits back to what I believe was the last AMA we did, where we kind of talked about, um, how you kind of think about doing everything together and how sometimes you have to make concessions to live your life, right? And so, so you don't have to be so robotic all the time. And, um, we... On that note, we have a question coming a little later on, which is, um, maybe some of the dangers of sleep trackers.

   10. PAPeter Attia11:08

       Mm.

   11. SPSpeaker11:08

       Not dangers in the sense of-

   12. PAPeter Attia11:09

       Yeah, yeah

   13. SPSpeaker11:09

       ... it causes physical harm, but kind of more so like the psychological piece. So I'll save that for then. But

3. 11:16 – 18:12

   Sauna: Peter’s routine, sleep benefits, and tradeoffs

   1. SPSpeaker11:16

      the other question that I had is I know you like to think about things in like a risk matrix a lot, in kind of like a two-by-two. Like are you picking up a gold coin? Are you picking up a penny? Are you picking it up in front of a tricycle or a freight train, right? And it kind of creates that two-by-two matrix that you like to put into boxes. What's your current view on sauna use in terms of risk/reward? Have you thought about how you would kind of quantify that based on that risk matrix?

   2. PAPeter Attia11:44

      Yeah. And it's gonna depend on the individual. I do think that there are probably some people who, you know, would need to sort of consult with their doctors before getting into a sauna. Because to be clear, you know, when I get into a sauna, it's hot. I mean, we... Our saunas, uh, we run it at about 198 degrees Fahrenheit. Um, and my typical routine is Uh, 15 minutes, and then a cold plunge, and then 20 to 25 minutes. Uh, so, you know, that, by that, by the end of that second stint, you're really, um, you know, you're really sort of taxed. Um, so there, there's clearly a subset of the population for whom that might be a little too taxing. Uh, outside of that, I think, look, the biggest risk of sauna is, uh... And, and, and I, there are other risks. I mean, I've, I've heard horror stories of people that have had accidents in saunas and things like that, so, so we'll sort of bracket that all of those things are possible. But like anything else, it comes at an opportunity cost, because if I, if I think about how much time I actually spend from the moment I decide to get in the sauna until I'm ready to go to bed, it's about an hour. So then the question is, what else could I be doing with that hour that would be potentially better for me? And in my case, I, I don't think there's much, because, because it, uh, you know, my wife and I do it together every night. It's actually a f- uh, a, a way to spend time together and talk. And so, you know, we get all, we get that basically about an hour to kind of talk when we probably wouldn't have otherwise. I probably would've been glued to my computer working, um, and she would've been reading or something like that. But I think for some people, that might not be the case. For some people, that opportunity cost might be too high. Maybe it's taking them away from an hour of sleep that they otherwise need, whereas I'm still able to structure it in a way that I'm still gonna get eight hours in bed. So I think that, that's where I think each person needs to kind of, you know, figure out what they're giving up for, you know, that amount of time. Now, of course, it could be less. You could spend half an hour in a sauna, all told. You know, if you want to spend 20 minutes in, um, you know, it's, call it a half an hour. But, you know, in my, at least in my world, I think every minute counts. I think that's probably true for most people. So, um, I, I, I would say time is a big opportunity cost. Of course, there's a financial cost, you know. Um, I think to easily utilize sauna in one form or another, whether it's dry or infrared or whatever, you know, there's a financial investment in putting one of these things in your, in your home or your apartment. So that also needs to be weighed into it. Um, and again, I don't know that that's so much a risk in the way that we think of, you know, a drug or something like that. Uh, but it's certainly a cost. And then as far as the benefits go, um, I, I think there are benefits. Um, some of them I think are not... Some of them are kinda soft benefits. So again, uh, not to harp on this idea, but, you know, uh, spending more time with your spouse, if that's something that you guys can do together, the, you know, there's no biomarker that's gonna tell you that that's a good thing, uh, but that's a good thing. Um, improvement of sleep, I think, is a, a tangible, uh, way to assess benefit if, if you fall in the camp of people whose sleep is improved by that. Um, as far as the hard numbers that we've covered before in other podcasts around the reduction in mortality, um, I, I, I, I'd be hard-pressed to believe that they're as, that they are as strong as they are demonstrated in, um, in the finished data sets. But, you know, if they're half that, they're still pretty good. Um, so it's harder for me to kinda quantify those benefits. But, um, yeah, that, that, that's sort of where I would sort of put sauna. So, so, so let me give you another example, Nick. I wouldn't put sauna as valuable as exercise. You know, you know, when I start to think about, like, what are the levers? You know, an hour of exercise, I think, is better for you than an hour of sauna if you're really playing the game of, uh, of inches.

   3. SPSpeaker15:50

      Yeah. Definitely. And then the other follow-up I had written down is, you kinda mentioned a little bit, but kinda your view on dry, infrared, kinda the temperature you like to keep it at, that kinda stuff. Where, where do you kinda end up on there?

   4. PAPeter Attia16:06

      Well, I get asked this question a lot, and m- m- my answer is, I don't think we know if infrared and dry have the same benefits. They're a very different mechanism. They produce a very different feeling if you're in them. Um, and the literature is mostly on dry saunas. So, you know, for that reason, and just for the fact that I wanted to have a, a pretty large sauna, and I like the experience, the cedar, the s- the rocks, the dumping water on it, that whole thing, you know, that, that's just why we went with a dry sauna. But not everybody has the space for one. And the infrared devices, y- you know, they sell devices that are relatively inexpensive, relatively small, such that, like, if you, you know, if you, if you live in a tiny apartment, you could still have one. And you might only be able to seat, you know, yourself in it and nobody else. Um, but that's, you know, there's s- I still think there is a benefit there, uh, though it's going to be much more difficult to quantify by attribution to the, to the literature.

   5. SPSpeaker17:11

      And I've also heard you and, I've also heard Matt Walker talk about this, which is, like, even though as it relates to sleep, you know, the benefits of a sauna can be there, but for those people who don't have access, can't get access, even kind of like a warm bath or even a hot shower can still have some of those sleep benefits, that it's worth people testing before they go to bed, those types of activities, correct?

   6. PAPeter Attia17:38

      Absolutely. A- and I think that's just kind of the broader theme around sleep, is you, you have to kind of try things several times and realize if they work for you or not. I, I think there are probably some people who, if they do sauna before bed, it would probably have a negative impact on their sleep. Um, uh, whereas if they did it earlier in the day, it might produce a better outcome. So I think you just have to, again, it comes back to flexibility and, um, and, and, and, you know, being, being kind of, um, experimental in how you think about stuff.

   7. SPSpeaker18:11

      Yeah.

4. 18:12 – 22:02

   Importance of keeping an open mind as new information arrives

   1. SPSpeaker18:12

      And then the last follow-up question I had, wasn't planning on asking it, but it's kind of come up a few times, um, from various episodes. I mean, mainly in, like, strong convictions loosely held, and that's an episode we do every 100 episodes where it's kinda like, where has your opinion changed? And, you know, in one of the recent AMAs, you talked a little bit about, you know, time-restricted feeding and how your opinions change and the importance of protein. And even in this episode, you know, you're talking about your view on sauna has, um, kinda changed over time as new information becomes available, and as truthfully, you know, what you see with your patients in practice, right? Like, a lot of times you're taking what the literature says and seeing how it applies to people, and there's always gonna be that small group of people who are like, you know, well, like, why has your opinion changed? How can you change your opinion? How, you know, how can you speak about something now in this way and then change it? You know, what's... How do you think about that in terms of, like, your journey and kind of how you work with patients, you know? And I know, again, to tie back in a previous AMA, you talked a lot about how the biology of aging's so confusing and so complex that there's always gonna be changes. Any advice you would have for people who are maybe a little more rigid and not open to that change in their opinions or their ideals?

   2. PAPeter Attia19:35

      I mean, I don't think it's anything I haven't said before. I, I think it just comes down to what you anchor to. If you anchor to being right or if you anchor to knowing the truth, I, I... If you can be more in the camp of the latter, it's easier for you to accept change. Um, if you, if you anchor to being right, um, you can sometimes get the right answer, but if that answer changes, it becomes difficult to change. So I think that's part of it. I think part of it is also understanding the nature of science and the scientific process, um, which is that, you know, even the best experiments don't produce certainty. They just increase the probability of one idea being more likely than another. And in that sense, there really isn't much that's black and white in science. Um, most things are shades of gray. Now, some things are really, really dark shades of gray. I mean, it's really clear that, um, you know, we code from DNA to RNA to protein. Uh, it's called the central dogma. But turns out there are a couple of little exceptions with y- you know, viruses that go the other way around. Uh, and, and, and s- so, so on the edges, there's always going to be exceptions, uh, potentially for things that are even sort of ironclad, and very few things are that ironclad. Um, so I mean, again, we could go down the rabbit hole of the whole debacle of COVID, right? How many things were deemed absolute certainties when they had no business being deemed certainties? Um, so I think if, if there was a little bit just m- more acceptance of, um, how uncertain things are and operating in a world of probabilities, uh, I think it would just be a lot easier for people to, to kinda navigate the changes that are, that are coming. And I will say this. I, I don't find at the level of interacting with my patients that this poses a problem. I, I think that... I, I, I ha- I have a hard time thinking of an example where a patient was, you know, frustrated or disappointed that we were changing our point of view on something in the, in the face of new information. I, I, I actually think they, they appreciate that.

   3. SPSpeaker21:59

      Yeah. Definitely.

5. 22:02 – 26:07

   Importance of reducing stimulation leading up to bedtime

   1. SPSpeaker22:02

      Um, anything else you wanna touch on regarding your behavioral pre-sleep routine before we move to kind of your current sleep molecule regimen?

   2. PAPeter Attia22:12

      Yeah, I think the last thing I'd say is really, um, [clears throat] like trying to be as unstimulated as possible before I go into bed. So I even, like, floss and brush my teeth before doing the sauna so that once I'm done with that sauna, like it's dark, I basically just go to bed. I'm not even going into the bathroom, turning the lights on. I'm certainly not looking at my computer or my phone or anything like that. So that, that's probably another part of why the sauna is beneficial to sleep. You know, it could... There's so many reasons here, and one of them could simply be that it's a forced hour of bringing myself down, um, as opposed to, you know, working right up until the last minute, brushing teeth, flossing teeth, jumping in bed. So, uh, I, I think that's also a big part of this, is just kind of dialing down the rheostat of, of stimulation before bed.

   3. SPSpeaker23:13

      Yeah. No, I mean, that makes a ton of sense. Um, so what about the molecules then? What is kinda like your current sleep molecule regimen?

   4. PAPeter Attia23:23

      [upbeat music] Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a member. We created the membership program to bring you more in-depth exclusive content without relying on paid ads. Membership benefits are many, and beyond the complete episodes of the AMA each month, they include the following: ridiculously comprehensive podcast show notes that detail every topic, paper, person, and thing we discuss on each episode of The Drive; access to our private podcast feed; the Qualies, which are a super short podcast, typically less than five minutes, released every Tuesday through Friday, which highlight the best questions, topics, and tactics discussed on previous episodes of The Drive. This is particularly important for those of you who haven't heard all of the back episodes. It becomes a great way to go back and filter and decide which ones you want to listen to in detail. Really steep discount codes for products I use and believe in, but for which I don't get paid to endorse, and benefits that we continue to add over time. If you want to learn more and access these member-only benefits, head over to peterattiamd.com/subscribe. Lastly, if you're already a member, but you're hearing this, it means you haven't downloaded our member-only podcast feed where you can get the full access to the AMA, and you don't have to listen to this. You can download that at peterattiamd.com/members. You can find me on Twitter, Instagram, and Facebook, all with the ID peterattiamd. You can also leave us a review on Apple Podcasts or whatever podcast player you listen on. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterattiamd.com/about, where I keep an up-to-date and active list of such companies. [upbeat music]

Episode duration: 26:07