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

Episode Date: October 28, 2019

In this special episode, Matthew Walker returns for his second AMA episode where he provides his expert insight on numerous sleep-related questions directly from listeners. He answers a wide range of questions from the gene that causes the short sleeping phenotype, to the ideal sleeping position, to the optimal temperature for best sleep, to how fasting affects sleep, plus a full dissertation on sleep apnea, and much, much more. We discuss: DEC2—A genetic mutation that produces a short sleeping phenotype [11:00]; What is the best position to sleep in? [22:45]; Should you consider a “sleep divorce” with your partner? [27:00]; The challenge of kids wanting to sleep in bed with their parents [28:45]; Is there an ideal type of pillow? [32:30]; Any data on hammock sleeping? Should adults be rocked to sleep like a baby? [34:45]; The optimal room temperature and body temperature for the best sleep [38:30]; Do humidifiers help? [50:40]; How do high altitudes affect sleep? [53:15]; What is the data on weighted blankets (e.g., the Gravity blanket)? [57:00]; Caffeine—How much, and in what way, does it affect sleep? [58:15]; How does sexual activity relate to sleep quality? [1:04:00]; Should we be sleeping in two phases? First sleep & second sleep? [1:06:30]; Napping—Is there ideal duration? Should we be napping or not? [1:08:30]; Advice for new parents dealing with sleep deprivation [1:12:00]; Understanding your sleep chronotype [1:16:15]; If you drink too much alcohol in a given night, is there anything you can do to make sure your sleep isn’t wrecked? [1:20:45]; How postmenopausal women can manage their sleep problems with (and without) hormone replacement therapy [1:23:00]; Could a daily practice of Wim Hof's breathing method help or hinder quality of sleep? [1:29:15]; Why do some people paradoxically feel more tired the more they sleep? [1:31:15]; Sleep apnea—How to know if you have it, the different types, the causes, and helpful resources [1:33:15]; Is there such a thing called “sleep eating”? [1:45:00]; If Matt was “sleep czar”, what changes would he make to society to improve sleep? [1:46:15]; Catch up sleep: Explaining the difference between retrospective damage and prospective benefit [1:48:45]; Does poor sleep really speed up the aging process? [1:50:30]; Is medicated sleep better than no sleep? [1:53:00]; Does vivid dreaming disrupt the sleep cycle? [1:56:45]; Is there potential benefit to using “binaural beats” or some type of sound to induce better sleep? [1:57:45]; How is sleep affected by fasting and time-restricted eating? [1:59:45]; Is there any evidence that polyphasic sleep (e.g., "Uberman") works? [2:03:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: peterattiamd.com/matthewwalkerama2/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to the Peter Atia Drive. I'm your host, Peter Atia. The drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peteratia-md.com.

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please consider supporting us directly by signing up from monthly subscription. My guess this week is Matt Walker. Many of you are familiar with Matt because in April of this year, we released a three-part series on sleep that was probably one of the most listened to series we ever released.

These have been really popular podcasts, and it's reflected in the fact that many of you have requested a specific AMA with Matt, which we did, and we are now back for a second version of that. For those of you perhaps listening to Matt for the first time, Matt's a professor of neuroscience and psychology at UC Berkeley, and the founder and director of the Center for Human Sleep Sciences. I will gloss over the remainder of his bio because you can find it everywhere else, but needless to say, it has all of these ridiculous accolades, and he's just kind of an all-round total stud. He's also the author of an international bestseller, Why We Sleep,

and very recently in 2019. This year that is, he gave a TED Talk that was incredibly well received. We linked to that previously and we will do so again. Now in this AMA, which again is a reminder, these are for subscribers only. So if you're not a subscriber, you're going to be able to hear a little bit of this. If you are a subscriber, you're going to want to activate your RSS feed so that you can hear this entire thing in an uninterrupted fashion. And by the way, that also means you will hear all podcasts in an uninterrupted fashion without any of the other sort of housekeeping stuff that is not necessarily intended for you at this point. So what do we talk about? We talk about a bunch of

things. We talk about the deck two mutants. These are folks who actually don't need to sleep that much. We talk about a whole bunch of environmental factors that you've asked about as they pertain to sleep, you know, position, temperature, other tools and tricks that may or may not help us sleep elevation, all these sorts of things. We then kind of go into a, you know, what we call, I did or took an AM, this sort of thing, and is it hurting or helping? So getting into caffeine, getting into sex, talking about the role of parents with young kids and things like that. We got into a little bit of sleep apnea before rounding out a speed round where we go through a bunch of, you know, kind of a popery of questions that are all over the place. I thought, just personally, I thought this AMA brought up a lot of questions that I had, so I was really happy to see that.

And I think we actually got through every single question on the AMA. It took a little while, but we did. And I'm not going to put Matt on the spot, but I suspect he'd probably be willing to do a third round of this in some period of time. Oh, he's giving me the thumbs up because I'm doing this intro while he's getting ready to go for a run. So with nothing else to say on the topic, please enjoy our follow up AMA with Professor Matt Walker. Alright, everyone, coming to you from Warm Bakers Field, California this evening. Matt, thank you so much for agreeing to sit down again to do an AMA and no less on a day when the two of us are probably about as exhausted

as we can be. I mean, I got to be honest with you yet. If you had 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 have seconded that motion 10 minutes ago. Well, firstly, it is a delight and a privilege to be back on and thank you so much for having me. And thank you for the experience that we've just had here. I would say I am ecstatically exhausted. Yeah, we were sort of joking about it after that last session today that I can understand why there are probably people who have never been involved in motorsport and don't follow it

and don't care about it that sort of look at it and think, well, that's not really a sport, is it? I mean, people driving a car fast is not really a sport, but certainly anybody who's done it would disagree with that. Hemingway, there's a great Hemingway quote, which I'm sort of paraphrasing, but the gist of it is there are only three sports, bullfighting, motor racing, and mountaineering. The rest are all games. And I understand that now so much. I mean, I think we were coming out of the car, the temperatures were over 100 degrees. We were coming out of the car at the end of our sessions, looking visibly thinner as a consequence. And we were probably only in the car for like 20,

30, 40 minutes. Incredible. I think I will go home firstly looking like I slept with a cotangler in my mouth. And the second is that after the first day, I made the decision that I need to sit down, I need to understand what is the minimum I can spend on food, sort of salad rice beans. What is the need for me to put a roof above my head and then everything else in terms of income is most a sport. This was a great couple of days and we had a great crew and a great coach and a great track and amazing conditions. I mean, I guess I know people, I think, get the sense how much we both love this, but we talked about this idea of there's a feeling when you're out there, when everything is in this sort of groove, and it's hard to imagine you could be so pulled back from anything

else and everything else that's happening. So, you know, people talk about this flow state, and you can find this in so many different areas, but I've never experienced it to a greater extent than in a car. You're so right. You are present in that moment. And there is nothing else. There's nothing else behind you in terms of recollection. There's no prospection forward in terms of thinking about the future. And I think I would almost liken it to bring it back to sleep, because that's of course what I do. But when you first wake up in the morning, there's just that one or two slivers of seconds of time where you

remember nothing about yesterday, none of your troubles, difficulties, you remember none of the anxiety that's coming up and the next day, it's just you in that moment and it lasts so briefly. But when you get into motor sports and into a car and on track, it's that perpetually lap after lap with a lot more G-force. But other than that, that state of being present and pure, there is something incredibly, there's an authenticity of consciousness that you get and that sounds pompous and I really don't mean it to, but it is an elegant condition. One that leaves you with a neck that is so sore the next morning because of the G-force is that you're pulling. That's the only reason that yeah you remember how

difficult it was but what an incredible gift. What was the highlight for you these couple of days here? I think I mean this is really the first time that I've been on track and to understand the limits of a car. Now we had a car that was it wasn't just your typical street car, it was a notch above that. But to truly understand the limits of a car, in a way that you should never and you must never test on a street, and to see how far beyond what I thought it was capable of. And it was so beyond my skill level too, and we got in with this incredible instructor and he took it to the limit, but to feel the limit of a mechanical object designed for purely one purpose and one purpose

alone, that is a very special thing and to even feel 50% of it or 20% of it is something that I probably will go to my grave remembering. Well, the good news is one, you're going to do it a heck of a lot more. It was now, I've got my hooks in you, so you're not going back. But we haven't discussed this actually, so I promise we're going to talk about sleep. Matt and I will stop talking about cars. But I knew when we got to the track that Thomas always wants to shake the car down first, and I was so happy for you to get in the car that first time to see it.

And I also knew it was going to have this weird outcome, which is you're going to come out of that car. And in one way, it's going to excite you beyond belief. But another way you're going to be like, there's no way that car can move that quickly. Like, I'll never be able to make it go that fast. And of course, the answer is, of course, you won't. Neither of us will. We would spend the rest of our lives and we probably could never get a car to go that fast. But you still got a glimpse of what's possible. And I think one of the difficult

things with driving is everyone drives, but not everyone plays different professional sports. So if you see a picture throwing a ball and you think that is a remarkable skill, yeah, we all throw a ball every now and again, but almost every day most people, well perhaps not every day, but people are driving all of the time. So I think that fools people into thinking, well, how much more skill is required to be not just a driver, but a race car driver. And it turns out it is just as large as you sitting watching your television and seeing David Beckham bend a ball into the net, by the way, my Liverpool supporters. That's a bad example, considering as much as the United History. But you get the idea, which is, I think we get fooled into thinking that it really isn't

that much more difficult. How much more do you have to train and how much more skilled do you have to become? And the answer, as I've learned by turning the car backwards a few times over the past two days is a great deal. But gosh. But that's part of its joy, I think, is that I was talking about this on another podcast once which was the beauty of something like car racing and I feel the same way about archery is

they are really easy to do at some level. In other words, anybody can drive a car and anybody could shoot a bow, maybe not well or not far or whatever, but they're very difficult to do well. Whereas tennis is kind of hard to do. If you took someone who's not remotely athletic and you handed them tennis racket and made them go and play against somebody, they might not even be able to return a single serve, but everybody can drive. Yeah, the bandwidth of opportunity is great. So it's not too hard to get on the bottom row.

Yeah. Well, we're going to work on our curriculum, and we'll build out a curriculum over the next few years with the goal of you owning a race car one day. And I just want 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 going to repeat it here, but an inbound sticker for my Mazda Miada MX-5. So moving on to the AMA, which is why we're here.

Matt, this is a first time when we've had a repeat AMA on the exact same topic, and I think it speaks to two things. The first is how much people want to understand sleep. And I think that's such a credit to the way you've been able to articulate it and the attention you have brought to this subject. And then the second point is really also that it's that you are very proficient at talking about it. And the breadth of questions we get on this is incredible. I mean, we're going to lead off with kind of some technical stuff. And then there's some great questions I look through this list recently.

And it's really fun because people think of better questions than I can think. Yeah, and if anyone's starting to lose a little bit of attention or will to live at this moment, I promise you masturbation is coming up. So stay tuned. Yeah. All right, so let's start by talking about this is actually kind of a question from me because this question feeds out of an email exchange you and I had several months ago about the deck twos. So these are a genetic mutation that produces a short sleeping phenotype. Can you tell us a little bit more about people with this mutation and what it does?

Yeah, so these are the acclaimed short sleepers that people have started to become aware of. I mean, it got a lot of media retention and the gene gene is called deck to DEC number two. And they are the short sleepers that we found. They are a genetic mutant that seems to, which sounds a little bit X-men, by the way. These are individuals who have a gene that, and that gene seems to mean that they don't sleep as much as most people, or as much as most people or as much as most people should be sleeping. So their

sleep need is lower than we have typically seen before. And I think there are several important things to point out to the public. Firstly, when I described the short sleeping gene phenotype, most people start to think, well, that's probably me. I think I'm one of those who can get away with five hours of sleep. Firstly, the probability that you are a deck to carrier is very low. It's a fraction of a percent of the population right now. So you're far more likely to be struck by lightning

in your lifetime. It turns out statistically than to have this gene, just to sort of frame that context and expectation in people's mind. The second, I think, interesting part of this is, well, how much do they sleep? And we've got all of these sort of chest beating heads of state like thatcher and Reagan and more recently Donald Trump. It was spousing five hours or four hours. Is this the realm of the deck to individual and the answer is no.

So if we bring these individuals into the lab and we just take away their phone, no clocks in sight and we just let them sleep what we call the habitual amount. So you put them to bed, you let them fall asleep when they want and you let them wake up and you let them sleep as much as they typically would want or even physiologically can. And where they come out is it about 6.25 hours of sleep, in other words, 6.25 hours of sleep. So this is not your 5 hours or 4 hours. And this is the genetic mutant that is the short sleeper and they are getting six and a quarter hours. And the reason that kind of concerns me is if you look at America right now, the average American adult is sleeping about six hours and 31 minutes during the week.

So genetic mutant only needs a few minutes less than what the average of the population is getting. Now by the way, that's the average, which must mean that there's a large tail of the distribution that is sleeping considerably less than six and a half hours. Vast proportion of them do not have the deck to mutant gene. And just to refresh everybody's memory, when you do that same type of a sleep study on the majority of the population, the rest of us have an equilibration at how many hours is the optimal? Yeah, it's somewhere between about seven and a half

to nine and a half hours. That's an enormous range. It isn't an enormous range. And some of that has to do with age because as we get older, even though we may need as much sleep as we did when we were younger, physiologically, we just can't generate that sleep that we need,

which may actually be pulling that number down because those numbers are generated. Because we don't generate enough adenosine? It actually, it may be that we generate even more adenosine as we get older, but there are a number of reasons why firstly, the parts of the brain that deteriorate with aging, your brain doesn't deteriorate homogeneously as you get older, some parts of the brain deteriorate or what we call you get older. Some parts of the brain deteriorate or what we call atrophy more quickly than others. Unfortunately, those areas are the sleep-generating areas, particularly the deep sleep-generating areas, especially a region that we call the

prefrontal cortex and the middle part of that. So take your thumb, stick it between your eyes, raise it up about an inch or an inch and a half, and you're right there, that's your medial prefrontal cortex. That's a deep sleep generating region. It's one of the epicenters for the generation of cortical deep sleep. That part of the brain atrophies quickly, it also accumulates beta amyloid most significantly and early on. So for that sort of sweet spot for the general public, we can do those wash-outs studies where we bring them into the lab or you can do another great study. People just took them up hiking in the Rocky Mountains, dislocated them from all of modernity, no electricity, no phones, not even matches a candlelight. And firstly, what you find is that they sleep long, they slept

sort of almost close to on average about nine hours. No, these were pretty young, healthy folks. Probably the more striking part of that data to me, however, was when they were sleeping. If you look at what they were saying the habitual bedtime was, it was 11 midnight and they were actually going to bed around sort of 9, 9, 30 in the evening. And it always strikes me when you think about this term midnight and what it actually means.

Midnight actually means middle of the night. And it is when you let yourself sleep in harmony with the natural edict. But for most of us, that's the time when we think, yeah, I should just send my last tweet or check my email. That's midnight for us. But so for the deck two, they definitely seem to sleep less, but it's nowhere near the proclaimed sort of media hype that is just four or five hours. They need still considerably more. And do we know if there are any health consequences to people that have a deck two mutation?

Is it acquired, or are there any twin studies that could compare, or at least sibling studies? There are. There have been some twin studies that they've looked at to. One twin has the gene one does not, and you actually get some interesting findings from that, which I'll come on to in a second, that may explain why they could be a short sleeper. The answer to your question, though, the health consequences, is that we just don't know, and we don't know for two reasons. Firstly, we haven't known about this genetic mutation for very long. So we haven't been able to actually pick up these people and then track them longer tunely across the lifespan and see as they move with age, are they filled with more disease, less disease or no difference in terms of

their risk ratio for these typical things that we know are causally related to a lack of sleep? Are they living more with sort of disease right now at whatever age they are? There's just too few of them for us to make any statistically meaningful sense of that equation. So I think right now, the answer is going to come much later for humans. I think the answer could come more quickly, however, if we look at genetic mouse models where we create that same mutant and you can fast track those questions. But in terms of humans, right now, I think we just don't know. And do we know if they disproportionately suffer one stage loss versus another?

Yes, they seem to under certain conditions. So one way that we can try to assess what your sleep need is paradoxically is to bring you into the lab, deprive you of a night of sleep, and then look at how hard you rebound in terms of your sleep appetite on the following recovery night. And that's almost a way for us to sense or get a measure of how sort of healthy and virulent is that sleep system. And that's what they've done with these individuals. Firstly, what you see is that when they sleep, when they have their sleep recovery and their rebound, they rebound much harder in terms of deep sleep. They actually have a lot more deep, non-rapidine

movement sleep. So that's dreamless sleep and especially the deeper stages of deep sleep. It's even more evident if you look at the electrical quality of that deep sleep, not just quantity minutes, but the actual power and depth of those deep sleep brainwaves. So at that level, I started to actually get quite bullish on the idea that this genetic phenotype may actually truly be capable of surviving on six and a quarter hours a night without any harm, because just the sheer raw turbocharged quality of their deep sleep is so high,

that essentially they can accomplish what we can in six and a quarter hours that would normally take someone like me eight hours and ten minutes or so. However, if you looked into that data a little bit more, there is a more troubling sign. So actually just to come back to that, what would be the analogy, it's almost like glucose clearance. If someone is really healthy in terms of their metabolic profile, their ability to clear glucose and get it out of the system is just ultra-efficient. That's kind of how they are. And it's almost as though they're clearing a denocene, which is this wake chemical that builds up

and at night we must sleep in part to clear out that adenosine, that sleepiness. And they just do it in greater efficiency. So it's sort of, they are the true glucose heroes in the sleep world, is it worth? But when you look at that data, something else emerges, they actually suffer from getting less rapid eye movement sleep. And this is what started to make me more concerned about the phenotype. Why am I more concerned if they're getting more deep sleep?

A lot of people say, it's the deep sleep that I need. Well, firstly, you need all stages of sleep. It's such a fragile, idiotic state to be in this thing called sleep. But if there was any stage of it that could have been weeded out in the course of evolution, other nature would have done away with it hundreds of thousands, if not millions, of years ago. We know that they all have a function. So, why am I concerned so much about REM sleep studies them back in the 1980s with rats that will probably never be done again for ethical reasons. They took them and they split them up into three different groups and they

deprived them of sleep and they deprived them until they died. The three groups with a following total sleep deprivation, selective deep sleep deprivation, selective deep non-rem sleep deprivation and selective REM sleep deprivation. The first finding was that the rats in the total sleep deprivation group died after about 9-11 days of total sleep deprivation. How much were they being deprived? Total. They had almost no sleep at all. So these were people monitoring them around the clock, no sleep day after day after day. And those rats died

essentially as quickly from a lack of sleep as they did from a lack of food. If you want to sort of put things head-to-head, sleep is just as essential as food in terms of life support. What was more interesting, however, was that when you looked at the two groups that were selectively deprived, the group that was deprived of deep non-REM sleep was still able to get all of the REM sleep that they wanted, and vice versa the group that was deprived of REM sleep got all of the deep sleep that they wanted. The rats that were deprived of rapid eye movement sleep, what we typically think of as dream sleep, they died almost as quickly as the total sleep deprivation group. The deep sleep deprivation group, it took

them almost twice as long in terms of deprivation before they died. So in terms of a life support system, which stage of sleep is more important on the basis of these mortality status, you would argue that REM sleep is the more life-essential ingredient. Now, they all are, but which one is more life-sustaining? That data would argue REM sleep, which brings me back to the deck, too, is if the first suffering from a lack of REM sleep does that mean that their mortality risk is actually higher? We just don't know, but that's the only countervalence for us to the first part where I was quite bullish.

The next set of questions, Matt, are we've organized them as environmental. We've got a lot of questions about sleep position. Starting with one, does your sleep position. So starting with one, does your sleep position matter specifically on your back, on your side, head propped up with a pillow on your stomach? Is there any evidence that one of these positions is better or worse than others? I'll exclude or I'll create a caveat which says notwithstanding the mechanical issues associated with it. So presumably for someone with apnea, we would assume that laying on your back would be a worse position than laying on your side. Feel free to address that, of course, but I'm assuming the person who asks this question is looking for more than just that mechanical issue. You can find all of this information and more at peteratia-md.com forward slash podcast.

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