The School of Greatness - How Getting Bad Sleep Is Affecting Your Health [MASTERCLASS] EP 1339

Episode Date: October 28, 2022

Today’s Masterclass episode is all about sleep. Three experts on sleep share their tips and advice for how you can sleep both longer and deeper and the benefits sufficient sleep can have for your body.In this episode, Dr. Peter Attia, physician & podcast host, shares the foods we should eat and avoid to get better sleep and why exercising too much is counterproductive.Andrew Huberman, professor of neurobiology and ophthalmology at Stanford, explains the risks of not getting enough sleep and why an excellent night’s sleep actually starts in the morning.Dr. Matthew Walker, professor of neuroscience and psychology at the University of California, Berkeley, teaches how not getting sufficient sleep affects our genetics and why we need to shift the cultural appreciation of sleep.For more, go to lewishowes.com/1339Full Episodes:Dr. Peter Attia: https://link.chtbl.com/1045-podAndrew Huberman: https://link.chtbl.com/1204-podDr. Matthew Walker: https://link.chtbl.com/1154-pod

What is going on? Why is there such mortality risk caused by insufficient sleep? And what we know is that a lack of sleep and typically getting certainly less than six hours of sleep is associated with a higher risk. Welcome to the School of Greatness. My name is Lewis Howes, former pro athlete turned lifestyle entrepreneur. And each week we bring you an inspiring person or message to help you discover how to unlock your inner greatness. Thanks for spending some time with me today. Now let the class begin.

Welcome to this special masterclass. We brought some of the top experts in the world to help you unlock the power of your life through this specific theme today. It's going to be powerful, so let's go ahead and dive in. Yeah, so I think firstly in response to the general question, sleep is probably the single most effective thing that you can do to reset both your brain, but also your body health, of course, as well. And I don't say that flippantly against the notions of diet and exercise. Of course, both of those are fundamentally critical. But if I were to take you, Lewis, and I were to deprive you of sleep for 24 hours, deprive you of food for 24 hours, or deprive you of even water or exercise for 24 hours. And then I were

to map the brain and body impairment that you would suffer after each one of those four. Hands down by a country mile, a lack of sleep will implode your brain and body far more significantly. The only one I would probably lose out on is oxygen. At that point, I'll give it up. You know, sleep will take the silver medal. Oxygen definitely gets the gold. But thereafter, sleep seems to be paramount. Over sleep, food and water, sleep is the most important thing. I would say, yeah, you know, I used to say that sleep was the third pillar of good health alongside diet and exercise. But I think the evidence has suggested that I was utterly wrong. That sleep,

in fact, is the foundation on which those two other things sit. And you can do wonderful things in those two domains, but if you're not getting sufficient sleep, those things tend to be far more futile as a consequence. Yeah. And so what is sufficient sleep then? So right now we recommend somewhere between seven to nine hours for the average adult. Once we know that you go below seven hours of sleep, we can start to measure objective impairments in your brain and your body. And in fact, the number of people who can survive on less than six hours of sleep without showing any impairment rounded to a whole number and expressed as a percent of the population is zero. Without any impairment, what does that mean? So if I can measure lots of

different operations of your brain, let's say your cognition, your attention, your learning and memory, also your moods and your emotions and your anxiety, or downstairs in the body, I can measure aspects of your cardiovascular system or your blood pressure, or I could measure your immune system or your metabolic system, how it's regulating your blood sugar and your glucose. I can measure this sort of pinwheel, this kaleidoscope of health metrics on Lewis Howes. And then I can see when I keep dialing you back with less and less sleep, at what point do I see at least one of those things demonstrating a breaking point? And it's very rare for us to be able to find any individual who can go below six hours of sleep and not show some kind of impairment.

And a great, even frightening demonstration of this, a study took a group of perfectly healthy individuals, and they limited them to six hours of sleep a night for one week. And then they measured the change in their gene activity profile relative to when those same individuals were getting a full eight-hour night of sleep. And what happened? And there were two critical findings. The first was that a sizable and significant 711 genes were distorted in their activity caused by that one week of short sleep. And that's, you know, in some ways, I think about this, Lewis, because it's reality. We know that almost a third of the population is trying to survive on six hours of sleep or less. So it's not just, you know, total sleep deprivation, which doesn't happen

very frequently. It's a common occurrence. What I found most interesting was that about half of those genes were actually increased in their activity, the other half were decreased. Now those genes that were suppressed were genes associated with your immune system, so you became immune compromised or immune deficient. Those genes that were increased in their activity, or what we call overexpressed, were genes associated with the promotion of tumors, genes that were associated with cardiovascular disease and stress, and genes that were associated with long-term chronic inflammation within the body. And I make that point just because, you know, many people, I think,

have this concern about things such as genetically modified embryos or even genetically modified food. about things such as genetically modified embryos or even genetically modified food. But when we don't get sufficient sleep, we are unwittingly performing a genetic manipulation on ourselves. And if we don't let our kids get the sleep that they need, then we're inflicting a similar genetic engineering experiment on them as well. Wow. This is crazy. So what if you've been sleeping less than six hours a night for years what is that saying to your genes and is there a way to recover the gene damage and reverse and go back to a healthy genes healthy body healthy life so firstly we know that short sleep duration so using that sweet spot and we can speak about oversleeping or excess sleep because I think that's an interesting part that hasn't been spoken about too much.

But using that recommended CDC amount of seven to nine hours of sleep, there is a simple fact, firstly, across the lifespan, which is the shorter your sleep, the shorter your life. That short sleep predicts all-cause mortality. But then we can dig a little bit deeper and start to sort of ask, you know, exactly what is going on? Why is there such mortality risk caused by insufficient sleep? And what we know is that a lack of sleep, and typically getting certainly less than six hours of sleep, is associated with a high risk of cardiovascular disease, high risk of diabetes, high risk of stroke, high risk of dementia. And I would love to double click on that and go into the Alzheimer's disease risk because that now evidence is very,

very strong. And then downstairs in the body, we know that there is links between a lack of sleep and certain forms of cancer. After, if I were to take you and limit you to let's say four or five hours of sleep for one week, your blood sugar levels would be so disrupted that your doctor would classify you as being pre-diabetic. So that's not a lifetime, that's just one week. And there's an even more interesting experiment that I think speaks to the subtlety of this, because there is the largest sleep study that's ever been conducted, and it happens actually to around 1.6 billion people across 70 countries twice a year, and it's called Daylight Savings Time. Now, in the spring, when we lose just one hour of sleep opportunity, firstly, what we've seen is that there seems to be a 24% increase in relative heart attack risk the next day, which stuns me.

And what's fascinating, in the fall, in the autumn, when we gain an hour of sleep, there's a 21% reduction in heart attacks. So it's bidirectional. And that's just one hour of sleep. And you see, there was some great recent data. You see a very similar profile regarding that daylight savings shift for road traffic accidents on our streets. I've heard about this.

Tragically, suicide rates as well. And then even more recently, what we discovered is that during that spring time shift, when you lose an hour of sleep, the sentencing of federal judges is significantly harsher because their mood and their emotion is that much worse because of that one hour of sleep that they dole out harsher sentences. So, you know, we can walk, you know, you can ask the question, what about a lifetime? We don't even have to ask about a lifetime of short sleep. We can ask about these really, you know, one week of short sleep or even one night of one hour of lost sleep. And I think that's how fragile our brains and our bodies are to this thing called a lack of sleep. our brains and our bodies are to this thing called a lack of sleep. And you could then ask, well,

you know, why are we so sensitive? Because I can go without food for 24 hours and I can go without water for 24 hours. You know, I'm still not too bad. I'm in fairly decent shape. Why is sleep the exception to that rule? And the answer seems to be this. Human beings are the only species that will deliberately deprive themselves of sleep for no apparent good reason. Why is that? And it was such a unique thing. And what that means is that mother nature through the course of evolution, because no other species does this without real need for survival. And I can speak about some of the exceptions, but human beings are strange like this. In other words, Mother Nature hasn't have to face the challenge of coming up with a solution called sleep deprivation because she's never faced it in the course of evolution. And so there is no safety net in place here. And that's why we think human beings implode so quickly and thoroughly, mentally, cognitively, and physically caused by insufficient sleep.

And why do you think, why is the majority of people bad at getting good sleep? Is it we're distracted? Is it we think we need to be doing more? Is it we're stressed and worried about the past and the future? Is it, you know, what we wish want to work harder? What is the main cause of why we get poor sleep? That's such a fundamental question. And in some ways, it's all of the above plus. So I think the first and I've thought about this a great deal. Why are we suffering this global sleep loss epidemic that we're under right now? I think the first thing is that, unfortunately, sleep has an image problem. That, you know, the PR agent for sleep should be fired. Because we associate sufficient sleep

with this concept of being lazy, of being slothful. And that's a terrible disservice to this thing called sleep. And it is very different to things like diet and exercise. You know, I think a lot of people like to virtue signal with, you know, what they eat. And they certainly are very proud to tell you, you know, I work out five times a week. I'm in the gym at this time of morning. And, you know, all of which I think are great and to be applauded and supported. But we have the very opposite. We have this almost, you know, well, we don't. Some niches of society have this sleep machismo attitude. You know, this kind of you can sleep when you're dead mentality, which, by the way, based on the evidence is mortally unwise. Yeah,

it will lead to both a shorter life and a life that is significantly less healthy. So I think the first thing is we need to change our cultural appreciation of sleep from something that is a waste of time to something that in fact is an incredible investment. It is probably the very best and the most freely available democratic and painless health insurance policy that I could ever imagine. I think the next thing is the way that we work in society. We are working for longer hours and before the pandemic people were commuting increasingly longer amounts of time. What that meant was that people were leaving the house earlier, they were arriving home later, and no one wants to shortchange time with family or Netflix or whatever is your poison.

And so the one thing that has become squeezed like vice grips in the middle of the night is this thing called a sufficient bout of slumber. But then there are plenty of people who give themselves the opportunity to get enough sleep, but they can't obtain it. And that is where things such as insomnia or sleep disorders, things like snoring come into play. And you touch on, and I know that you've spoken, and I'm so grateful for what you've done regarding discussions of mental health. We know that one of the principal roadblocks to getting this thing called a good night of sleep is anxiety. Stress, worry, anxiety, regret, all those things. Resentment, Worry, anxiety, regret, all those things.

Resentment, holding on to all that stuff. That is toxic to sleep. You're absolutely right. And in fact, anxiety and physiological stress is our principal model for the explanation of insomnia right now. It's not the only cause, but it seems to be one of the principal causes. And in modern society, it's become so easy and I'm not finger wagging. I, you know, I'm just as guilty. We are constantly on reception, but rarely do we do reflection. And unfortunately the time when most of us do reflection is when we turn off the light and our head hits the pillow. And that's the last time. That's the worst time.

Oh, you know, because I don't know about you Lewis, but you know, at night in the dark, thoughts are not the same thing. You know, concerns become twice as big or you're 10X the size of concerns. I start to worry, I ruminate, I catastrophize. Yet in the light of day, those things seem very different. And so we can speak about sleep tips perhaps later on,

but certainly getting right with your emotions and your anxiety is key to good sleep. And that's one of the things that prevents sleep. I also think that there is an issue at the public health level. You know, we've had in many first world nations, wonderful government mandates regarding health, regarding drink driving, regarding, you know, safe sex, regarding drugs and alcohol and even food and even inactivity

and sitting. And when was the last time you heard of a first world nation provide a public health message and memorandum regarding sleep? Never. And I don't remember one either. So from every level at, you know, at a public health global, you know, government level down to a workplace level, you know, we lured the airport warrior who's flown through four different time zones in the past three days. They were on email at two and then they're back in the office at six. You know, we, so we need to, we celebrated those people. We did, you know, and the funny thing by the way, is that after about 20 hours of being awake straight, you are as cognitively

impaired as you would be if you were legally drunk. Now, I would never, you know, as a CEO say, I have got this fantastic team of people, they're drunk all of the time. But we do say, I've got this fantastic group of people, they just are at it all hours. They are dedicated. They're always working. You know, they spend minimal time sleeping. They're just all out. They love this project, but we've got this strange mentality. And then I think it comes down to, you know, even within schools, we've got this incessant model of early school start times. And super early, isn't it? It's, it's either what, 630 or seven or something, right? 737, 730. And that data is actually very powerful.

What we found is that when we delay school start times, first academic grades increase, truancy rates decrease, psychological and psychiatric issues decrease. But then what we also discovered is that the life expectancy of students increased. And you may be thinking, well, hang on a sec, how do you measure that? And the leading cause of death in teenagers 16 to 18 is actually not suicide. That second, it's road traffic accidents. Really? And here, sleep matters enormously. And I'll give you one example. It was in Teton County in Wyoming. They delayed their school start times from 7.30 in the morning to 8.55. By the way, what are we doing trying to educate our children at 7.30 in the morning? No, I can't think. Yeah, I mean, I remember being in school and being, every day was hard for me.

Every day I was tired, every day it was hard to focus or I'd be irritable or wanted to like, you know, jittery or something, but it was like so hard to focus. And then you're at lunchtime and then I eat and I'm tired again afterwards. And you want me to focus and pay attention at a desk. It's like, that doesn't work like that for me, especially on no sleep or very little. Well, for any, any, you know, sort of developing brain, it doesn't work like that. And for some people to make a 7.30 a.m. start time, school buses will begin leaving at six o'clock or 5.30 in the morning. That means that some kids are having to wake up at 5, 5.15.

This is lunacy. And what we've understood from the academic grades, and I'll come back to the car accidents in a second, when sleep is abundant, minds flourish. And when it's not, they don't. And what we've discovered with the road traffic accidents in Tenton County, when they made that shift, the only thing more remarkable than the extra one hour of sleep that those kids reported getting was the reduction in car crashes. The following year, there was a 70% drop in vehicle accidents. And to put that in context, you know, the advent of ABS technology, anti-lock brake systems, that dropped accident rates by 20 to 25%,

and it was deemed a revolution. Here is the simple fact of getting enough sleep that will drop accident rates by 70%. So, you know, I need to get off my soapbox. But what I would say is this. I think if our goal as educators is to educate and not risk lives in the process, then we are failing our children in the most spectacular manner with this incessant model of early school start times. Is anyone listening to this that you've been speaking about this to, and they're actually adopting this new model, whether it be work time or school time or just integrating this? Do you know systems that are integrating this? There have been some, and I think I've tried to do this in the education domain. I've tried to do this within medicine because the way that we train residents is almost inhumane.

Actually, it's not almost, it absolutely is inhumane. And the statistics there are stunning as well. And then I've tried to do it in the workplace too, because I do a lot of speaking events at sort of Fortune 500 companies. And at first, I think I took the wrong approach where I was really speaking a little bit more about sort of the compassionate approach, you know, speaking a little bit more about sort of the compassionate approach, you know, why it's good and kind for people to gift them more sleep. Because I see sleep as a biological necessity. And if it's a biological necessity, then I think

it's a civil necessity. And if it's a civil necessity, sleep is a civil right. But what I would say is that that wasn't particularly well received. You know, I'd go into business companies and say, your employees, you know, they're desperate for more sleep. They will be happier and healthier. Or I would speak about medicine and I would speak about what it was doing to the patients and the harm, and it would fall on deaf ears. What I then realized is that if you're going to change large organizations, you have to speak in their currency, which is money. And then I would describe the medical malpractice lawsuits that would commonly cost savings within medicine firstly and then

administration started to change the tune because before that you know there was almost this old boys network in medicine where we went through residency and it's almost a hazing and despite armed with incredible data to the contrary I think the mentality ten years ago when I started trying to do that was my mind's made up. Don't confuse me with the evidence. Crazy. Why? It's because they went through that themselves and so they want to pay it back or something. I think so. I think there was some of that. I went through hell, so everyone else has to go through hell. Yeah. Right. It's a rite of passage. If you are tough enough, you'll make it through. It's kind of like bootcamp,

You know, if you are tough enough, you'll make it through. It's kind of like boot camp, which I don't think we need to do anymore. And then within business, you could describe, you know, the Rand Corporation did an independent survey a couple of years ago. And what they found was that insufficient sleep will cost most nations about 2% of their GDP of their gross domestic product. So here in the US, that number was $411 billion of lost productivity due to insufficient sleep. In Japan, it was $130 billion. My home country, the UK, it was over $50 billion. So if I could solve the sleep loss crisis within the workplace, I could almost double the budget for education in the US or I could halve the healthcare deficit.

So when you speak about money, then people start to listen. So that's how I've tried to communicate. And I don't think I'm a particularly good communicator. And I've been sometimes bull in a china shop, as I probably have been for the first however long we've been talking. But it's just because I'm so, you know, I'm just desperately passionate about this thing called sleep. And some years ago before I started trying to, I wrote a book and then I've been doing podcasts. Sleep was the neglected step sister in the health conversation of today. It was a second citizen. And I was so sad to see the disease, the sickness, the harm, the lack of productivity, the impact on education that a lack of sleep was having.

Your thoughts about sleep and how you frame this, some of the research and the science that you've studied around this, and what we should be thinking about around sleep. Sure. So sleep is the fundamental layer of mental and physical health. If there's one thing that we should all be doing is working toward sleeping long enough and deeply enough 80% of the time. I think that 80% is a good goal because things happen.

Travel happens, kids happen, illnesses happen. The weekend, you're going out, whatever. Until you are sleeping long enough and deeply enough, 80% of the nights of your life, you are functioning suboptimally. And what's the biggest risk then if we're not getting enough sleep? Okay, so there are a number of risks to not getting enough sleep. Deficits in learning, deficits in the immune system, reduction in testosterone and estrogen in both men and women.

So disruption of hormones, disruption of gut microbiome, increased cancer risk. There are a bunch of things. The severity of those things depends on a lot of other things too. Prior health, other health conditions, context, age, occupation. If you're not getting enough sleep and you're a high-rise construction worker, it's different than if you're an office worker. So we need to sleep enough. Now, what's enough sleep? This is an interesting question. Enough sleep has been argued at six hours. Other people, it's seven hours. Other people, it's eight hours. It's basically waking up without an alarm clock

and feeling rested. Insomnia is actually a medical term nowadays. And insomnia is essentially diagnosed as falling asleep during the middle of the day due to lack of sleep at nighttime. But many people who are having trouble sleeping at night are not falling asleep during the middle of the day. They're dealing with grogginess or crankiness or other effects of having fragmented sleep. What are the main causes of not being able to fall asleep? Is it rumination? Is it traumas that you're holding on to? Is it arguments? Is it selfination? Is it traumas that you're holding onto? Is it arguments? Is it

self-doubt or insecurities? Is it your nap too much? Is it the foods you ate too late? Like, what would you say are the main causes of not being able to fall asleep? All of the above. But the primary one is a failure to turn off your thoughts. Okay. And I think that might provide a good anchor point for us to talk about some protocols. Really, an excellent night's sleep begins in the morning. I talked about this on the previous episode, so I won't go into detail. But everyone should get as much bright light in their eyes, ideally from sunlight, first thing in the morning, 10 to 30 minutes outside, depending on how bright it is.

Eyeglasses or contact lenses are fine. Don't wear sunglasses if you can do it safely. If you wake up before the sun rises, turn on bright lights, then go outside once the sun rises. If you have no access to sunlight, use a daytime simulator or similar, like a ring light, and get that light in your eyes. Okay. So that's all of that in a compact form. Caffeine. You can inhibit falling asleep with caffeine.

You have to figure out when your threshold is. For me, I can drink caffeine up until about three, even four o'clock in the afternoon and sleep like a baby. And still sleep well. Yes. And Matt Walker, our good friend Matt Walker, would say that my sleep isn't as good as it would be had I cut caffeine out earlier. By like 11 or 12 a.m.

Right. And I want to acknowledge Matt is the Michael Jordan of sleep science. You're the LeBron James. Well, no. No. Thank you for the compliment. But no, I'm not. I know a lot of the science and the protocols,

but that's Matt's wheelhouse. And so if he says something, it's true. And if I say something and our opinions conflict, it's likely to be something that the data are still emerging or in that case, default to Matt being correct because I just out of due respect for his expertise. So caffeine, you know, for some people they can have a two o'clock espresso, 2 p.m. espresso. Some people it's 4 p.m. Some people can drink caffeine at 8 p.m. and fall asleep. But there I would say it's problematic because you're disrupting the architecture of sleep and the brainwaves associated with sleep,

the chemicals and so forth. So get that morning light, cut your caffeine off at the time that allows you to fall asleep. That morning light also sets the timer on your melatonin rhythm. So you have this gland in your brain called the pineal gland. That pineal is the source of melatonin. Melatonin makes you sleepy,

but it does not keep you asleep. Okay. Melatonin starts to rise in the late evening and continues into the night and then eventually tapers off. This is naturally occurring melatonin release, not supplemented melatonin release. The fastest way to slam melatonin to the pavement and eliminate it in your system is to look at bright light for, I hate to tell you this, even a few seconds. You mean at night? At night is typically when melatonin rises.

It's when it's released in the bloodstream and when it has this effect of making us sleepy. It does a number of other things too. You want more melatonin at night, is that right? You do. And if you wake up in the middle of the night or it's eight o'clock and you decide that you want to go to bed at nine or it's nine o'clock,

you want to go to bed at 10 and you go into the bathroom and you flip on the bright lights, your melatonin levels just got crushed down to zero. So having lights on is the worst thing you can do. Yes. And it doesn't matter if it's blue light, red light, purple light, green light, bright lights inhibit melatonin very acutely. And therefore you want to avoid exposure to bright lights at night if your goal is to be asleep. So the simple rule that governs all this stuff is when you want to be alert, get bright light in your eyes, ideally from sunlight. So that's true in the morning and throughout the day. And when you want to be sleepy or asleep, avoid bright light in your eyes. Now, many home environments don't allow you to have zero lights.

And that's not actually necessary. You can just dim the lights in the evening. Ideally, you also avoid overhead lights because the neurons in the eye that trigger this melatonin suppression and so forth, they reside in an area of the eye that views upper visual space. So you could have desk lamps and just dim those down. If you're going to work on a screen, dim it way down. Will blue blockers help? Yes, but if the light is bright enough, you're still going to inhibit melatonin release.

So how bad is watching TV at night? If the TV isn't too bright. If it's farther away. Farther away. Yeah, and maybe you wear blue blockers. I mean, some people take this to the extreme. They wear sunglasses. I think that's a little extreme.

Now, candlelight and moonlight, surprisingly, doesn't seem to block melatonin. Now, maybe a really bright moonlit night, full moon, the lunacy associated with the full moon might actually be due to a suppression of melatonin and an increase in alertness. So those are the things as it relates to light. Then there's this issue of people who have trouble staying asleep. So they can fall asleep fine, but they wake up at 2 or 3 in the morning. I happen to do this. If I go to bed around 10.30, I tend to wake up around 3 and I use the restroom. Yeah, I tend to drink a lot of fluids and I have to use the restroom.

This is true at every age. This is not just some aging related thing. That's fine. I just keep the lights dim and use the bathroom and then you go back to sleep. Very normal, very healthy. One of the best things I ever did for my sleep was to keep my phone out of the room so that when I wake up at three in the morning, I just didn't start scrolling the newspapers is typically what I'm doing online. And then you're just waking up your brain, not three in the morning, I just didn't start scrolling the newspapers is typically what I'm reading online. Gotcha. And then you're just waking up your brain, not just by the light, but by the content.

And, you know. You're activating it again as opposed to coming back to sleep. Exactly. And sometimes there's a comment and they're like, why is it, you know, your thinking is not very good in the middle of the night. The other thing is you want to keep the room cool.

So in order to fall asleep, your body has to undergo a drop of, in temperature of one to three degrees Mm-hmm. There are a couple ways to accomplish this one is keeping the room cool. The other is to And that's ideal actually because you can put a hand or a foot out We actually lose a lot of our heat through what's called our glabrous skin So the palms of our hands the bottoms of the feet I always put my feet out of the sheets and just let them feel the cool air.

That's right, and that's a great way to cool off your core body temperature. You're probably doing that unconsciously in your sleep as well. If the room were too warm, the only way for you to cool off would be for you to put your hand in a bucket of cold water,

and generally people don't have that accessible. And then you're gonna go pee if you're doing that too. Right, exactly. And then of course there are all these products nowadays of things that cover, yeah, that cool the bed. I'm supposed to try one of these soon. I haven't tried one yet. I tend to just keep the room cool. Cool, yeah.

What do you keep it at? I keep it around 67, 65. That's a little cooler than what I do. I put it at about 67, 68. Okay. But I tend to wake up hot in the middle of the night, like throw the comforter off and go put some cold water on my face. Wow.

So don't obsess over waking up too much. And if you do, try and stay away from screens. Or if some people will read a book, dim light again. Yeah. And then falling back asleep. Some people are waking up at two or three because they are going to bed too late. Their melatonin has run out. So imagine that you're naturally somebody who should go to bed early, around nine.

But we all have this ability to push forward and stay awake if we have to. Much easier to stay awake than to force yourself to go to to stay awake than to force yourself to go to sleep. Very hard to force yourself to go to sleep. So let's say your system, you start releasing melatonin around 9 p.m., but you stay up until 11. Then you get into bed, you fall asleep around 11.30, and at 3 in the morning you suddenly wake up. Well, that's because your melatonin tapered off

and there's a wakefulness that's occurring. And so ideally you would start going to bed earlier. Now there's a lot of discussion out there about so-called chronotypes. So night owls, morning people, people that follow a more typical schedule, typical would be going to sleep somewhere between 10 30 and 11 30, waking up somewhere between 6 30 and 8. Then there are the people that like to go to bed at 2 a.m., sleep till 10. And then there are people that like to go to bed at 8 and wake up at 4. Huge variation out there. It tends to change across the lifetime.

Yeah, you're a season of life for years. That's right. And adolescents and teenagers tend to stay up later and want to sleep in. And there's actually some evidence that they can learn better if they are allowed to use that schedule. But most schools won't adhere to that schedule. You've got to wake up at 6 and go to school at 8 or whatever. Yeah. Once you enter adult life, you're generally somebody who's going to have to learn how

to go to bed early and wake up early or at least wake up early. Now naps, you should feel comfortable, the data say naps, you should feel comfortable napping for 90 minutes or less at any point throughout the day, as long as it doesn't interfere with your nighttime sleep. So some people like me, I love naps, but it doesn't interfere with my nighttime sleep. It doesn't. It does not. So you can take a 60 minute nap. Generally 20 to 45 minutes. And then you, you fully fall asleep or you're kind of like awake and just resting. Yeah. I can fall asleep anywhere, anytime and i can fall asleep at a gun range yeah it's um what it's in can you sleep sitting up too like this oh yeah that's a gift anywhere that's it is although it it could reflect that

i'm pushing my system a little too hard oh um but it's it is a it is useful at times incredible it is you can fall asleep right on a plane or? Anywhere. Leaning against a subway station and anywhere. If I need sleep, I'm going down. That's incredible. Yeah. So the other thing is that during sleep, a number of things happen.

And we can talk about slow wave sleep and REM sleep. But one of the most important physiological functions of sleep is to clear out some of the cellular debris that accumulates throughout the day. The cellular debris creates cognitive deficits. It actually may be related to the aggregation of proteins and things that relate to dementia and Alzheimer's. It's the so-called glymphatic system. The lymphatic system is a system of moving through immune cells and clearing out of debris from the body. The glymphatic system is a kind of a equivalent system that exists in the brain that involves so-called glial cells, which are support cells, but also do many things actively. They're

not just doing support. The glymphatic system is like a washout of the brain's debris. And that system seems to function best when feet are slightly elevated above the brain. There's some interesting data from University of South Carolina coming out now that show that if you can get your ankles elevated a little bit higher than your chin, that's great. When you're sleeping? While you're sleeping. What's it do for you? It increases the glymphatic clearance. And there's some data that it can improve function of the brain. The studies that are happening now that I'm aware of, I'm in touch with that group, are mainly geared towards people that have had head injuries.

So concussion and TBI of various kinds. But they also are seeing interesting effects in typical folks that don't have any traumatic brain injury. So I put a pillow underneath my ankles when I fall asleep and to get a little bit of that elevation. And then during the day, if ever you can't get a nap or you are going to get a nap, put your ankles up on the couch and lie down on the floor. That itself can get some of the clearance of the glymphatic system. And that helps you sleep better? It helps you just clean out the system? It helps your brain function better

when you wake up from sleep. Interesting. That's what the data are starting to show. That's cool. Some of the things I described, like the light viewing, is baked into the neuroscience literature, hundreds of papers, published papers.

Some of the things like the glymphatic system, it's kind of cutting edge, it's on the way. But because the safety margins of raising your ankles are so large, I mean, there's nothing dangerous about that. How long do you need to do it for to get the benefits? Oh, I think these are immediate benefits. Two minutes or 10 minutes? Oh, no, you're doing this the whole night that you're asleep,

your ankles are elevated. If you wake up and you happen to kick the pillow out, it's not the end of the world. But the idea is that you don't want to be sleeping with your head above your ankles either. There is some evidence that when people travel on planes and they're sleeping in chairs, that that's not equivalent to the kind of sleep they'd get when they're lying flat. That's interesting. Independent of all the other things that are happening. And we know this because there are

great sleep labs at Stanford School of Medicine, at UPenn, back east and elsewhere, where people actually go into a clinic and sleep either upright or at different angles. And they're looking at all this at the level of data. Okay. So here's one for you. What's the best position to sleep on your back, on your side, on your stomach? Great question. And it really, truly depends. And it probably depends on how hot you run. So I tend to run really warm. A lot of the cooling of the body occurs from the palms and bottoms of the feet, but also from the upper back and scapulae because we accumulate what's called brown fat there. It's not the blubbery fat that's under the skin. It's like a furnace. Actually, you can increase the density of brown fat by going into cold water repeatedly for, you know, one to three minutes several times each week. It means your furnace actually burns hotter. It

allows you to be in cold temperatures more comfortably. Some really beautiful data just published on this. So I don't like to sleep on my back because I start heating up. Start sweating. That's right. So I tend to sleep on my side. I sleep in that, what is that? It's like soldier position. But then again, there's some people that have shoulder issues and then they can't do that. I'm relatively flexible through my shoulders, not super flexible, so I can do that.

It really depends. Now of course, if you're sleeping on your stomach, how do you elevate your ankles? It starts becoming a little bit, we are not just science experiments. And so you have to assume that you're not going to get everything exactly right. But keeping the room cool, keeping the cool being under a warm enough blanket, but then extending a hand or an ankle out so that you could cool off during the middle of the night,

that's going to be good. Keep the room dark, although complete pitch black doesn't seem to be as good as having a little bit of light somewhere in the room. But you don't want a bright blue light or red light anywhere in the room that's going to wake you up. Some people like me have very thin eyelids, exceedingly thin eyelids. Some people have very thick eyelids. So some people are more bothered by a light in the room than others. It really varies.

So you have to just tune things to your particular environment. I'm curious about the neuroscience before you go to sleep. How do we set our minds up to, you were saying before about a lot of people, it's hard for them to sleep because they can't shut their mind off. Is there something we should be thinking before we shut it off to set our sleep up for success mentally and then to really build into the next day where we wake up feeling like clear-minded and without this brain fog where we have more motivation where we have more you know energy and excitement towards the next day and then doing that in a pattern every night is there any science

around that is it like listening to a hypnosis that could be very helpful which will help you clean clean out whatever is going on through the day and get clear and ready for the next day, but also fall asleep so you're not thinking about it. You know, is there anything that can help you have better dreams so that you sleep better? Like, what have you found there in the neuroscience? Yeah, so glad you asked this question. There's some really interesting data from a guy named Chuck Charles Zeisler, who is at Harvard Med. from a guy named Chuck Charles Zeisler, who is at Harvard Med. He's done beautiful studies on sleep in humans for many decades and a really fantastic physician and researcher.

They observed something interesting, which is that about 90 minutes or so before your natural bedtime, there's a spike in alertness, planning, and almost anxiety that all people undergo, and it's a normal, healthy pattern. The idea, and it's a just-so story because we don't really know, I nor Chuck Zeisler nor anyone else was consulted at the design phase, as we say, but we assume this came about because prior to going to sleep, we need to shore up everything for safety. We need to lock things down, make sure everything's in its place because we are very vulnerable in sleep. Nowadays, this might manifest as you need to go to bed at 10.30 because you have to get up at 6, etc.

And then right around 8.30 or 9, you start finding yourself running around doing various things. Many people worry about that and they think, oh, I'm really stressed because I actually need to go to sleep and here I am wide awake. It tends to subside very quickly. So just the knowledge that that's a normal, healthy spike in alertness and activity, I think can help a number of people. I want to make sure I mentioned that. The other thing is preparing the mind, as you said, turning thoughts off. Turning thoughts off is a skill. We've talked before, gosh, almost a year or more ago about Yoga Nidra. Yes. Which is, there are many, many Yoga Nidra scripts available on YouTube free of cost. The ones I particularly like are the ones by Kamini Desai.

K-A-M-I-N-I-D-E-S-A-I. Kamini Desai. I just really like her voice. I don't know Kamini, never met her. These are free scripts. They're yoga nidra scripts that last about 20 minutes. They involve some breathing, some meditation type stuff. But they teach you to turn your thoughts off,

which is really wonderful. Because a lot of people, they just get stuck in this rumination. Now, is there an ideal protocol prior to sleep? It depends because some people find they have their greatest clarity after the kids are asleep and they're sitting there. So I wouldn't say don't work or do work. You know, you do want to avoid strong stimuli before sleep. So do you really want to watch, you know, a politically charged or violent movie right before sleep. So do you really want to watch a politically charged or a violent movie right before sleep? Well, that depends on how triggered you tend to be by politics or violence. Some people aren't triggered, other people are. But that aside, you don't want to

go to bed either too hungry or too full because that can inhibit your sleep. A healthy meal, let's say an hour before bed. I'm talking about grains and lean meat and healthy stuff. Or if you eat pizza an hour before bed, are they both going to impact your ability to sleep better? Or is the quality of the food before you go to bed matter? Yeah, that's a, that's a really good question. Uh, the short answer is yeah, it does matter. Um, so the, the, probably the two things that would have the greatest determination, um, would be the simplicity or glycemic, the simplicity of the carbohydrates for the glycemic load, because that's going to impact the sort of glycemic roller coaster you go on at night. And then probably the amount of protein, because that

has a greater contribution to what's called the thermogenic effect of food. So the thermogenic effect is how much does your body temperature actually rise to digest the food? Our bodies want to be very cold at night. So anything you do that opposes that leads to lousy sleep. So what foods help you sleep better that keep you colder? What are those foods? Whether it's an hour before or three hours before? Yeah, honestly, it's like almost anything you're going to eat is going to come with something that's going to slightly raise your temperature.

So I just generally say, try to not eat too much before bed. And I go out of my way to avoid the two things that I think are worse. So I just say, I wouldn't have huge protein before bed. And I don't want to have anything that's going to raise my blood sugar before bed. So I'd have an avocado before bed. I'd have something that's like, I just generally don't eat before bed. The body really rewards you in terms of if you wait or if you don't eat right before bed, is it going to sleep better, sleep deeper, be cooler,

and therefore help you have more energy the next day if you don't eat before bed? Yeah. And this is, at least for me, been most easy to exhibit. And I think many of my patients would agree during periods of fasting. So fasting is kind of a funky state because you're altering so many other things in the physiology. But one of the things that happens, especially by about the second day of a water only fast, is you really are seeing the impacts of what deep sleep can look like in a state that is

totally absent food. And it's very interesting because you're competing with two forces, one that's keeping you awake and one that's helping you sleep a lot deeper. The one that's keeping you awake is cortisol. You have more of it. You have more stress hormones when you're fasting. Cause that's the thing from a prehistoric standpoint that would have been going on, right? Fasting would trigger a signal that says, go get more food, right? Be alert, be focused. Be alert, go get food. Like we don't want to die. And so that's kind of keeping you awake.

But the flip side of that is the total absence of nutrient is allowing you to get into this amazing sleep and your body temperature is really going down because your body's turning down its metabolism. So I actually find fasting sleep to be some of the most amazing physiology because I'm watching this plummeting temperature, rising heart rate variability, falling heart rate, all of these really valuable things, but a little bit of rising cortisol that can lead to shorter sleep times. But I still feel quite rejuvenated by sleep. If you're a kid and you're eating a lot of junk food, you're not sleeping, you're staying up late because you're whatever, playing video games all night, but you've got all this

energy all day and you're active. Is there a negative for in your early ages, teens, early twenties through lacking sleep, eating poorly, or is there a way to recover in your twenties from the damage you've done in a year before 20? Yeah, that's a good question. I mean, certainly you can break it down into sort of the behavioral habit side and you can talk about it through the physiologic lens. The good news is before the age of 20 or 30, we are pretty remarkably resilient. I mean, you're an athlete, so you can relate. How old are you now, Lewis? You're near 30s. 37. So you might not have fully appreciated, I'm 47, so I'm a full decade older than you. And when I think about 17 to 27 to 37 to 47, I can really talk about those

decades through the lens of resilience. Like at 17, you could shoot me and I think I'd still get up the next day. Like you just couldn't, right? You're Superman. Yeah. You're absolutely Superman. And I don't know. I feel like the first observation of not being Superman for me kind of kicked in about 42-ish, about five years ago, was the first time I was like, oh, so this is what people talk about, right? You can't just go out and crush it every minute of every day. And I think that's just one lens, which is through the lens of exercise, but the same is true of physiology, right? Or I'll give you another example. Many of my patients have observed this. I've observed this. I was never a big drinker in college, but certainly there were enough occasions in med school or college where I'd go out and drink far more than anyone should.

And yet somehow the next day I could get up at six in the morning and go and do whatever I need to do. I remember one night actually being out drinking until three in the morning. I mean, having so much to drink, it was ridiculous. And somehow getting up at six in that morning to do a hundred mile bike ride. Oh my gosh, man. Probably still partially drunk, but felt fine by about like two hours into the ride. Today, if I had three glasses glasses of wine like the headache i'm going to have the next day is going to last me till the middle of the day is that because your body was able to assimilate the glucose into the muscles and it used it for its to its advantage then and now it's like it takes over it's a very good question i really i mean i could i could sort of

you know speculate on what it is but i i just think there's an over, so there's this thing called homeostasis, right? Which is one of the hallmarks of youth. And it's one of the hallmarks of aging. And you know, it's, it's the ability to, or it's, it's our lack of homeostasis. We lose this ability to get the body back into the zone of optimal performance. So everything about the human body is very particular. For example, take pH, which is the amount of acidity in our body. We're so highly regulated. Our body really needs to be at a pH of 7.4. So 7 would kill you and 7.6 or 7.7 would kill you. And this is a scale that goes from zero to 14 to put that in perspective. Okay. So tiny perturbations will kill you. How good is our body at staying in that? Amazing. Temperature, right?

You go much below about 94, you're dead. You go much above about 104, you're dead. How good are we at staying in that range? Oh, I mean, good. I mean, we generally stay within a 1.5 degree band. So this homeostasis thing is amazing. It gets weaker and weaker as we get older. And so your ability to tolerate bad food, bad sleep, sedentary behavior, more stress, all those things, it just gets weaker and weaker and weaker. And I think it declines non-linearly. So again, what you experience as a decline between 30 and 40, it's bad. 40 to 50, yeah, that's worse. 50 to 60, you can fall off a cliff. Is there a way to reverse this? I don't think we know. I think you can definitely slow the progression of it.

And I would say you probably can reverse it, right? So just as you can clearly reverse diabetes, diabetes is a glucose homeostasis problem and it's clearly reversible. So there are probably some variants of this that are harder to reverse than others, but no, I think we can reverse this process, but it gets harder. It gets harder as time goes on and it gets harder the the further, the further you are into, you know, sort of the physiologic trap. What are you doing to reverse it now that you've been experiencing this kind of, not maybe a cliff, but a dip over the last five years for yourself? How are you thinking about it? Well, I sort of had a change of heart five years ago. So actually six years ago, 2014.

So I sort of hung up my bike, which at that point, I'd switched from swimming to cycling as sort of my main sport. But at that point, a couple of things had happened. So one, I had become very familiar with a lot of emerging research on excessive cardiovascular training, which again, is a rich man's problem. Ultra marathons, ultra biking, ultra swimming, hiking. That's right. That's right. So again, and it's the same sort of curve, right? Where as exercise dose of exercise goes up, mortality comes down, but it has this little bit of a J where once you start to get into hyper amounts of exercise, especially over the age of 40,

you're actually driving an increase in mortality. Now, again, yes. Does that mean like running a marathon once a year or is it running a marathon every week? Yeah. Great, great point. Running a marathon once a year, probably not increasing your mortality at all. But running 40, 50 miles a week probably is, especially at that age. Now, again, this gets to your point about resilience. Someone in their 20s doing that doesn't seem to have any impact on mortality. It really only seems to be an issue if you continue. In fact, I did an interview with a cardiologist, James O'Keefe on my podcast, who is, you know, the world's expert on this. And, and, um, it was actually James's work six years ago. Cause I heard

him speak at a conference 10 years ago, we became friends. I, you know, it's one of those things. I'm sure you've experienced this where you hear something and you don't want it to be true. So you basically come up with all the reasons you're going to poke holes in it until you find the evidence the other way. Yeah. Yeah. And eventually it became very difficult to ignore that this hyper amount of exercise was counterproductive. So that's one piece of the change six years ago. It's probably bad that I just committed to doing the marathon next year yesterday. That's all right though. You'll be fine. I just think don't do one a month. Yeah, exactly. And then I think the second thing was I realized, it was sort of funny, but

I realized my prime was so far behind me that I needed to think about what was I doing this in service of? And not that I needed anyone other than myself to do these things because I'm very self-motivated. But just as a joke one day, I asked my wife, I said, hey, do you know what my PR is for 20K? Bike, run, or swim? Yeah, bike on a 20K bike on the time trial. And I was like, this is my wife. She hears me talk about this stuff all the time. I have spreadsheets and models and data, and I analyze my power data every single day. And I'm trying to break the record for San Diego. I'm really so switched on to this. She'll probably get it within a minute. She'll guess what my PR

is within a minute. She was off by 20 minutes, meaning she wasn't even in the zip code. So I was like, huh, that's funny. It's literally the most important person in my life, couldn't care less about this. And what I realized was, I need to start thinking about a different sport, which is the sport of longevity. So what does it mean to be a kick-ass hundred-year-old? And so that was the beginning of a mental model for me that in the past two years has gained much more traction called the centenarian Olympics. So how do you train to kick ass at a hundred? Should you get there? And of course, everywhere along the way. So that now dominates my landscape of training, which means I don't,

you know, care about how fast I can, you know, ride a 40 kilometer time trial, because that doesn't quite fit into what a centenarian needs to be able to do. What is your mindset going into a 40 mile bike then, or some type of experience? Is it more the joy of it? So I don't, I don't, I don't, I don't train. No, my training is very specific, but now it is fundamentally organized around four pillars. So the pillars being stability, strength, mitochondrial or aerobic efficiency, and anaerobic performance. And so each of those then has a super layered detail approach. And I still ride my bike four hours a week. So it's a fraction of what I used to do. And it's now very much geared to a certain energy system and a type of training.

What was the fourth one? Stability, strength, mitochondria and mitochondrial efficiency or aerobic efficiency. And then the fourth and final one is anaerobic performance. So you focus on those four metrics now on a day-to-day basis. So you focus on those four metrics now on a day-to-day basis. Yeah. Yeah. Those four pillars sort of make up the training program, which is then in service of something that I invite every patient to define for themselves, which is because you will have a different set of variables for me potentially.

But my Centenary Olympics has 18 events in it. I want to be able to pull myself out of a pool where there's a one-foot gap between the water and the curb, lift myself up. I want to be able to hop over a three-foot fence. I want to be able to walk three miles in an hour. I want to be able to carry two 10-pound bags up four flights of stairs. I want to be able to goblet squat 30 pounds because that's about the weight of a kid. I want to be able to get up off the floor without using my hands. So I could rattle off all of my 18 things and you would say, Peter, those seem really easy. And you'd be right as a 37-year-old stud. But the point is- As a six-year-old, a lot of them aren't easy. Most 60-year-olds couldn't do this if their life depended on it. And I have yet to meet, but maybe one person in their eighties or nineties who can.

And so that's the aspiration is to get to that level in your eighties or nineties. How do you work that backwards to inform your training in your sixties, in your fifties and in your forties? And it's actually very hard. And as I'm getting into, I'm three years away from 40, what should someone in my age range be thinking about when they're, I'm healthy, I feel good. Maybe I have some aches and pains here and there when I'm training hard or something. But for the most part, I feel amazing. What should I be thinking about moving forward so that I continue to feel amazing and have the ability to do these things? I think it's never too late to at least become familiar with what

these ideas mean. It doesn't mean that you have to go whole hog and devote yourself to this. I've obviously made a very conscious choice that I don't go to swim meets. I don't go to bike races. that I don't go to swim meets. I don't go to bike races. I don't train for those things anymore. And a big part of that is just time. There are only 168 hours in a week and I have a very clear set of priorities and I'm willing to set aside 10 to 12 hours a week for exercise, which by many people's standards is still quite a lot, but probably by the standards that you exercise and certainly by the standards that I used to exercise, I've never exercised so little in my life. So I have to be very efficient with every one of those minutes. And that means I'm laser focused on the four principles of that.

In your case, I think it comes down to saying, okay, how much time do you want to devote to the long game? How much time do you want to devote to the short game? How much time do you want to devote to the short game? Another way to think about this would be investing. If you're looking at an investment portfolio, you might say, how much do I want to put both time and money, so the actual capital I set aside, but also the amount of time I spend deliberating over it into my retirement account, versus how much do I want to invest as a day trader for short-term gains, for money that I'm going to be using in the near term that's maybe even supplementing my income

today? You could have totally different strategies for that, and that's totally fine. So I'm just in the category where I'm only thinking about long-term permanent capital. And so that's the first question is you have to decide how do you want to do that? And it might be that you say, you know, Peter, at 37, I just want to focus on running a marathon. I've always wanted to do an Ironman. So I'm going to go and do that. And, you know, I want to climb Mount Everest and that's going to require, like, you might have a whole bunch of these bucket list things. And truthfully, I would say do them now because it's only going to get harder.

Because you're not going to be able to do it later. Yeah. Yeah. I mean, I don't think you're going to want to do it later. So get those things out of the way. I hope you enjoyed today's episode and it inspired you on your journey towards greatness. Make sure to check out the show notes in the description for a full rundown of today's episode with all the important links.

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