#49 – Matthew Walker, Ph.D., on sleep – Part III of III: The penetrating effects of poor sleep from metabolism to performance to genetics, and the impact of caffeine, alcohol, THC, and CBD on sleep

Foreign. Hey everyone. Welcome to the Peter Attia Drive. I'm your host, Peter Attia. 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@peterattiamd.com. Hey everybody. Welcome to this week's episode of the Drive. I'd like to take a couple of minutes to talk about why we don't run ads on this podcast and why instead we've chosen to rely entirely on listener support. If you're listening to this, you probably already know, but the two things I care most about professionally are how to live longer and how to live better. 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Again, the podcast will remain free to all, but my hope is that many of you will find enough value in 1 the podcast itself and 2 the additional content, exclusive for members to support us at a level that makes sense for you. I want to thank you for taking a moment to listen to this. If you learn from and find value in the content I produce, please consider supporting us directly by signing up for a monthly subscription. Welcome back to the final installment, Part three of three of the Matthew Walker Series on Sleep. If for some reason you haven't yet listened to the first two episodes, I'd recommend going back and listening to those prior to listening to this one. My guest this week is Matthew Walker, professor of Neuroscience and Psychology at the University of California, Berkeley, and the founder and Director of the center for Human Sleep Science. Matthew earned his undergraduate degree and PhD in neurophysiology in London and subsequently became a Professor of psychiatry at Harvard Medical School before moving to Berkeley. His research examines the impact of sleep on human brain function in healthy and diseased populations. To date, he has published over a hundred scientific studies. He has received numerous funding awards from the National Science Foundation, National Institutes of Health, and he's a Fellow of the National Academy of Sciences. He's the author of the international bestseller why We Sleep, which also happens to be the favorite book of my not yet two year old son. He holds many patents covering various consumer based sleep recordings, sleep tracking and sleep simulation. He's a sleep scientist at Google where he helps the scientific exploration of sleep in health and disease. He is also an enormous fan of Formula One and my hero, Ayrton Senna. In the final part of this series we discuss the role of sleep and my weight gain, presumably that of others sleep and blood sugar, Sleep's effect on Genesis, sleep's effect on the food you eat, the effect of sleep on people's productivity, the relationship between alcohol, caffeine, thc, CBD and sleep. And that's not all combined of course, what Matthew is doing today at Berkeley at the center for Human Sleep Science and other startup projects he's working on. And we close this out with a discussion of Formula One, our mutual favorite thing, driving and sleep. As a reminder, at the end of this series we're going to take questions for a follow up AMA with Matthew asking questions on the AMA forum and listening to the AMA podcast with Matthew along with all AMAs will only be available to subscribers. So if you haven't signed up yet, you can do so now@peterattiamd.com subscribe so without further delay, here is the finale with Professor Matthew Walker. I want to talk about another several topics on here, but I want to go back to something that you and I have spoken about before. But I think it's so important I want to make sure we've got it for all the listeners. One of the most compelling things I ever read. I mean, I think there were several moments in my journey in the sort of world of sleep that really shook me. One of them was reading this paper out of the University of Chicago and I believe it was Eve Van Kotter, but it might not have been. It took a group of subjects and it was a very small study, but it was so well controlled because they sleep deprived these. Well, they did euglycemic clamps on day zero. So for the listener, that's a really rigorous test where you inject glucose and insulin into the patient and you keep the glucose level steady by titrating the insulin level. And this is an elegant way to measure one of the most important features of metabolism, which is how well you dispose of glucose primarily into the muscle. And I believe the subjects were restricted to four hours of sleep a night for two weeks. So you know about.

And it's been replicated for four, five and six hours for one week.

Okay. @ the end of that period of time, they repeated the euglycemic clamp. Again, the gold standard for measuring insulin resistance. And these patients suffered a 50% reduction in their ability to put glucose into their muscle, which, again, would certainly rank among the five most important physiologic things to do. Again, to put this in perspective, a normal blood sugar might be 100 milligrams per deciliter, or roughly 5 millimolar. For a normal sized individual. That represents 5 grams of glucose. I'm gonna let the siren go by.

Here. Yeah, it may actually be immigration coming to get me, finally deporting me back to the United Kingdom, but sorry.

Yeah, so you've got 5 grams of glucose in the bloodstream, which is 1 teaspoon, Frank. Diabetes would be 200 milligrams per deciliter, 10 to 11 millimolar, 2 teaspoons of sugar. So the amount of glucose you have in your bloodstream is trivial compared to what's in the muscles and in the liver. So imagine losing the ability to put that away by 50%. And as I look back at how metabolically deranged I was at the end of my residency, I can't help but realize something that I think eluded me for a great number of years, which is the role that sleep deprivation played in my weight gain, my insulin resistance, my hypogonadism. I know you and I have joked about it, but I think at the end of residency, my Testosterone was about 200 to 220 nanograms per deciliter on a scale where two standard deviations below the mean is about 350. So, you know, about twice that of a female in terms of testosterone. I now realize that was the sleep deprivation. That wasn't just the cafeteria food. And by the way, it certainly wasn't a lack of exercise. Amazingly, throughout residency, I still managed to figure out a way to exercise like.

Crazy. And you know, the point there is, despite all of that exercise, despite the power that that should have had on your metabolic system, my guess is that if we'd done that same glucose tolerance test, it would have been way down. And when you think about, you know, that's essentially taking healthy individuals who show no signs of diabetes, limiting them to an anemic diet of sleep, you know, four, five hours for. For one week now, we've seen. And you can get them into a state where someone like you, if you just read their readings at the end of the week and knew nothing about the experiment, you would probably argue that they may be in a pre.

Diabetic state at that stage, sure, you're writing the metformin prescription. How is this happening, Matt? What is the mechanism by which something so profound, so fundamental and important to our survival is going so awry in such a short period of.

Time? We know the evidence. We've unpacked this mechanism now. So the way that you regulate your glucose, the way that you sort of have glucose homeostasis, is that there are at least two major parts of this equation. The first is that cells in your pancreas, called beta cells, need to sense the spike in blood sugar and then they need to release insulin. And then when that insulin is released insulin, it actually tells the cells of the body to reach out and absorb the blood glucose, the blood sugar, and that prevents you from an otherwise dangerous spike in blood sugar. So these two things need to happen. Your beta cells in your pancreas need to release insulin, and then the cells of the body need to be sensitive to that insulin to be then instructed to essentially know, suck in that, that blood glucose from the bloodstream. Now what can happen is that if you have a deficit in one, and, you know, I think, you know, pregnancy may be a good demonstration of this, where sometimes, you know, the cells of the body become less sensitive to that insulin. But what's nice is that the beta cells in the pancreas, they understand that the cells aren't sucking in the glucose that they need, so they just release some more insulin and your insulin homeostasis remains in balance. So this is what we call the disposition index. How, how good are you at disposing of glucose? And, you know, can you manage that disposition index? So what happens with insufficient sleep is unfortunately bad on both sides of those equations. So firstly, we know that when you are under slept, the beta cells of your pancreas become insensitive to the spike in blood sugar glucose. In other words, your body stops releasing enough insulin to deal with the food that you've just eaten. So you're down on insulin, you haven't released enough insulin. That's a bad thing. But maybe it wouldn't be so bad if the cells of the body were just really sensitive to what little insulin is left and you could still at least clear some of that blood glucose. Unfortunately, that doesn't happen because what's worse is that the cells of the body actually become insensitive to the signal of insulin. And so the cells of the body stop sucking in as much glucose, as much sugar from the bloodstream. So on both sides of the glucose homeostasis balance, you're kind of a little bit screwed. That insufficient sleep means that you don't release enough insulin, so you don't have enough of that signal to begin with. What little has been released, unfortunately, is not listened to and heard by the cells of your body. So those cells actually don't end up dragging in the blood glucose, the gushing kind of monsoon of glucose that's now in your bloodstream after a meal, which means that you end up having an inability on both sides of the glucose equation to clear that blood glucose. That's why you have that type of glucose intolerance, problems with glucose absorption, and to get down to even the causal mechanism in humans, some great studies where you can actually say, why are the cells so mute to the signal of insulin? Why are your cells not listening to insulin correctly and not responding by bringing that blood sugar into them to drop your blood sugar levels? And the answer is this. What they did was they took a group of, again, healthy people, no signs of diabetes. They took a biopsy of cells from around the belly button, from the umbilicum. And then you can actually measure how those cells are behaving in inside of those cells themselves. So you can kind of like poke around inside and figure out what's happening. They took the biopsy in those same subjects after they'd been limited to just four or five hours of sleep, and then they repeated the biopsy when those participants had been sleeping eight hours. So this is again, one of those beautifully carefully controlled studies. Same individuals, same.

Process. And are they looking at adipocyte or.

Myocyte? So it's adipocyte. So this is fat.

Cells. Right? So this, I would expect, something different in the adipocyte from the muscle.

Cell. I don't think the experiment has been done with the muscle cell yet, but it has been done with the adipocyte. And then they've essentially got these, now these cells outside of the body. And you can play around, you can essentially sort of, you know, drip insulin onto those cells. And you can ask what's going to happen to those cells in terms of the instruction that they receive from the insulin. One of the critical things that happens when insulin binds to the receptor of the cells is, is the phosphorylation of something called Akt. And when Akt is phosphorylated, it essentially helps something called the Glu4 transporter inside of the cell to essentially go to the surface of the cell. And it's almost like the metaphorical straw that gets stuck out of the cell. And it's bringing glucose in. To simplify it, what you find is that when that cell has been under conditions of insufficient sleep, the amount of insulin required to phosphorylate that akt to get those cells to start absorbing glucose, you need almost twice the amount of insulin. You need double the amount of insulin to get those cells to do the same thing, which, that's counterintuitive.

Actually. You'd think that the adipocyte would be even more sensitive to insulin as the body works harder to undergo esterification and put fat away, given that the muscle becomes more resistant to insulin. So that's interesting. So of course, this speaks to why many hormones are necessary to drive the metabolic derangement, because also the cortisol level would maybe even oppose that. But in isolation, what you just described would actually oppose re esterification of fatty.

Acid. Yeah, but in my mind, I think what's striking though, it starts to tell you that individual cell types need.

Sleep. Yeah, yeah. What I was just going to say, what do you think is the communication vehicle? What is telling that phosphorylated sign? Do less of it, be less effective. How is that communicated that right.

Now I think we, at least I don't know of what intracellular mechanisms have transpired to decrease the amount of or the capacity for the phosphorylation of Akt to bring glucose into the cell. There are clearly some kind of signaling mechanisms that are coming extracellularly and telling intracellularly things to do that are either maladaptive or just much less efficient inside of the cell. But to me, that just blows my mind that, you know, we often think of the impact of a lack of sleep on things like behavior like driving or, you know, making food choices. We've done some of this stuff with brain scanning. But your question is so beautifully nuanced because it's actually asking. There is something about a lack of sleep that will get even into cells themselves and alter intracellular functioning. So if you can get a single factor sleep, that can have its impact all the way from complex cognitive issues like decision making all the way down to something like intracellular function, my goodness, you need to look out if you are depriving yourself of that one function. And I'll go a step further because there was a great paper published in something called the Proceedings of the National Academy of Science. It's a very prestigious.

Journal. We like to call it.

Pnas. Around, right? Yeah, pnas, the acronym. With my students, I'll say pnas and try to navigate around that unfortunate.

Acronym. That is hilarious. Because I'm so, you know, far removed that it was just penis like it was. We never even thought you would have to be politically correct and call it.

Pnas. Yeah, I just published, you know, my biggest girth of research in penis. Well done. That sounds like your parents must be swelling with pride right now. Could you imagine? And I actually have. We have published a bunch of stuff in penis. But this.

Is. By the way, I just got to pause for a moment. Why is it. Here's another evolutionary question. Why is it that any two guys can be hanging out like you could have the. I was gonna say the President of the United States. Bad example. You could take any two male heads of state and put them in the UN on the floor trying to negotiate a resolution. And like a penis joke just makes everybody.

Laugh. Can I just say that within, I think, and people can tell me the time of this in the comments? I think within the space of about 180 seconds we went from intracellular cascade mechanisms from phosphorylation of AKT to penis.

Jokes. And it's all my.

Fault. No, no, no.

No. Now I want to go back to this because what you said is it actually scares me more. Here's why. I think that at the surface, everything you opened our discussion with with respect to Alzheimer's disease, I mean, you led with the best punch. Right to me, that is, you could stop there if sleep disturbance didn't impair your driving, didn't increase your risk of cardiovascular mortality, didn't trash your immune system and double your risk of cancer, didn't give you diabetes. If you took every one of those things away, just driving your risk of dementia is. That's full stop. Reason enough, didn't impair your learning, take everything.

Away. Cardiovascular disease, depression, anxiety, suicide, don't.

Worry about the time, I'll take it all. But paradoxically, most of those things, because at least we see what the mechanism in that the mechanism of action is. And even when we don't, like in Alzheimer's disease, I don't think we know exactly the mechanism of action, but there's a plausible theme. But it's this last one that you're bringing up that in many ways scares me the most because it speaks to the ubiquity and the spread and the breadth of that impact. Like there are other cellular fact, like this is so central that it's impacting and regulating the phosphorylation of a series of enzymes that drive something so seemingly unrelated as a GLUT4 transporter. To translocate the surface of a cell. Like, why in the world would that happen at a single cell.

Level? That you can never observe the impact of a process, be it, you know, diet or exercise or food, you know, at that level. The fact that it can transcend almost every biological level of slice that you can do to biology. And to me, I think that the final one, which comes back to the penis, the PNAS paper takes the final step. For me, what they did was they took a group of, again, healthy adults and they limited them to six hours of sleep for one.

Week. So they basically made them average.

Americans. Average Americans, yeah. And then they essentially looked at the change in their gene activity profile. This is from.

Blood. You're not going to tell me there was epigenetic.

Change? Well, relative to when those same individuals were getting eight hours of sleep. And there were two critical findings. First, what they found is exactly your fear. They found that a sizable and non trivial 711genes were distorted in their activity, caused by that insufficient sleep, which by the way, again, six hours of sleep, you know, may even sound luxury to some people. But this is very common. So this is not one of those experiments where you say, oh, they limited them to two hours of sleep, or they did total deprivation. And that's not ecologically relevant. This is an ecologically relevant manipulation. This is six hours of sleep. It's very common in society and it distorts well over 700 genes relative to when those same individuals are getting eight hours of.

Sleep. Let's just put this in context. There's only about 20,000 genes in the human genome. It's not like you said seven genes, or it's not like you said 700. In the presence of 2 billion genes, this is 3%, right? You have an epigenetic change in.

3% of your genome, and this is with an epigenetic change within seven days at a moderate dose of sleep restriction. What was also interesting was the direction that about half of those genes were actually upregulated, the other half were actually downregulated. Those genes that were impaired in their activity were numerous genes associated with the immune system. Those genes that were actually upregulated were genes that were associated with tumor promotion and genes that were associated with long term chronic inflammation within the body and genes that were associated with stress and as a consequence, cardiovascular disease. And I find that impressive because many people in society right now feel uncomfortable about the idea of something like genetically modified embryos or genetically modified food.

For example, or crispr.

Right? Oh, crispr, yeah. Especially here, as we are in Berkeley, it's relevant. But to me, I think that if you feel that way, if you feel uncomfortable about sort of GMOs, genetically modified food or genetically modified embryos, but you're choosing to get insufficient sleep and here we're talking about six hours of sleep, then I think you must accept then that you are performing firstly, a similar genetic modifying experiment on yourself by reducing your sleep amount. And secondly, if you don't let your children get the sleep that they need, you may be inflicting inadvertently a genetic manipulation on them as.

Well. Did that penis. Sorry, See, to me I can say penis without thinking penis, but now I can't. Did that paper show the reverse? In other words, once you restored sleep, could you undo any of that genetic.

Damage? Didn't look at.

It. Because I'm going to take the sort of contrarian view here, which is we're all hosed because there's not a single person that hasn't been restricted to six hours a night. So it's almost like we should throw up our hands and wave. Which I don't think is the.

Answer. I don't think it is the answer. And I think here's why. Firstly, coming back to this argument that sleep is not like the bank, you cannot accumulate a debt and then hope to pay it off at a later point in time. That's why that bingeing at the weekend doesn't work. So once you've gone without sleep, whatever has happened during that time when you are under slept doesn't seem to be reversible. However, that doesn't mean that from this point forward it's a waste of time to start sleeping better. And I have evidence for that. We and others have been looking at cognitive decline in older adults, as we've mentioned before. Now, one study looked at a group of individuals who were in mid to later life and they had sleep apnea, snoring, which by the way is a devastating condition. If you snore or your partner tells you to snore, please go and see your doctor, get a sleep test and get on sleep apnea treatment. But the point was this, they gave them this CPAP treatment, which is this sort of face mask to push the airway open so that you don't snore and you don't go without oxygen. And by way of an experiment of nature, about half of those individuals were compliant with the treatment. About half of them weren't. Those individuals who complied to the treatment and started sleeping better because they had their sleep apnea treated ended up staving off the onslaught of Alzheimer's disease by about 10 years. So in other words, this is a causal demonstration that if you course correct sleep, you can actually modify your dementia probability risk. And it tells me in some ways a message of hope, which is that perhaps it's never too late to start sleeping better. Because if I've got evidence that in moderate in mid to late life that when you start course correcting bad sleep here, it's a sleep disorder with a particular treatment that can have an observable benefit in terms of reducing your cognitive decline.

Rate. Although it's hard to know, right, because the people who are compliant with CPAP presumably are doing so for reasons that might also make them more compliant with other inputs, such as.

Depression. And it could even be that the sleep is not actually. So maybe the sleep is the influencing factor, but sleep is not the route through which the benefit comes. It's because you're sleeping that you start to eat better. And we can speak about that relationship between sleep and food choices and caloric intake. And when you are under slept, you are far less likely to be active and motivated to be physically active. When you are physically active, the amount of force pressure that you can generate, the amount of aerobic output that you can generate, the amount that you can resist physical exhaustion when you're sleeping well, all of those things are.

Improved. To your point, it's about a 30% rough. I mean, it's a non trivial reduction in performance. With sleep.

Deprivation. Yeah, I take someone healthy person who is physically active and I limit them to six hours of sleep, you get about a 30% decrease in your time to physical exhaustion. So the idea would be, let's say that you're training for a 10k and in the days before, for whatever reason, you're down to six hours of sleep and you've trained to maintain your point of physical exhaustion, you know, to the 10k level. Well, now just with six hours of sleep, I'm going to see you fail at 7k because I've had a 30% reduction in your time to physical exhaustion. But I think your point again is a very good one, which is maybe it's not the sleep directly, it's the sleep transacting its benefits that we know also play into decreased risk for cognitive decline, such that you start making better food choices. The amount of caloric intake that you have is lower, the amount of calories that you expend is higher, your motivations to be physically active, and when you are active, you work out more intensely and harder. All of those things we know come by way of a benefit of sleep. So maybe sleep is, you know, the root cause, but it's not ultimately the thing that may be transacting it. Now, I think knowing the relationship between sleep loss and Alzheimer's protein pathology that we described, maybe it is playing a part. I don't think we know. But to your point, which is a good one, don't feel as though if you're someone listening to this and you've been on a diet of five or six hours of sleep for most of your adult life that all is lost and you should just cash in your chips and say, well, basically my fate is now sealed. It's not. I don't think it's ever too late to start sleeping better. I honestly.

Don'T. I think the argument that it's too late almost fails on first principles when you just consider virtually every other intervention, right. If you take someone who has diabetes, type 2 diabetes, and you know, you dramatically change the way they eat and exercise, it's quite clear what you can do. If you take someone who smokes. I mean, smoking might even be a better example because we have such longitudinal data on risk reduction as time of non smoking increases after a period of smoking. I mean, those are. That's actuarially mapped up the wazoo and that's a simple enough intervention that you can attribute it to. That's actually a very similar intervention. Right. Because you would argue that in the individuals who stop smoking, they're more likely to make more positive health decisions for the simple reason that if I'm not going to smoke, what else am I going to take seriously in my health? And in the end, for the purist who says I need a randomized prospective trial to demonstrate this one, I don't think you're ever going to get it. And I think the reason is we're really at the point where it's going to become unethical to do draconian studies of sleep deprivation or I don't even think it would be ethical to take to do a longitudinal study of depriving people with apnea of.

Cpap. I think the evidence is so overwhelming that yet you're ethically going to be unable to do those things. And it's the same way with kids in school that I think the only option that we're going to have in terms of proving the importance of sleep for school start times and just health in general for kids is, is going to be elongating their sleep if you look over the past 50 years, what we found is that kids across all ages are sleeping about two hours less now than they did 50 years ago, two hours less now. To put that in context, if I went to my ethics committee and said, look, I'd like to take a group of seven year olds, six year olds, and I'd like to lop off two hours of their sleep and I'd like to impose that on them for the next month and study it, is that okay? I'd probably be, you know, put on academic probation for even suggesting that, let alone they would never let me do that. But that's what's happened in society. So I think your point is a great one too, which is we are probably not going to be able to do the sleep restriction studies increasingly anymore. We're going to have to do, you know, the sleep intervention and the sleep extension studies and even some of the sleep intervention studies. Ethically, you may not be able to do it because it's already so clear that you need to be treating the sleep disorder. And you know, sleep apnea is a good example there too, that when you treat sleep apnea and you typically see far higher rates of diabetes in people who have untreated sleep apnea. And when you treat them, you see their diabetic profile improve markedly, but you also see that they start eating less, their choices of food are better, they are far more likely to be physically active once again. So again, I think it's unclear whether it's that direct benefit of sleeping better on things like the pancreas releasing the right amounts of insulin, or the cells in the body being instructed by the insulin to suck in the glucose more, or if it's just higher order things such as you're sleeping better so you make better food choices, you are not as hungry anymore. And you know, we and others have done these studies where you look at sleep and appetite regulation and there I think the date, the data is just as causal and powerful as it is for glucose regulation. You know, what we find is that when you start short sleeping people four, five, six hours a night for one week, the appetite hormones that regulate exactly, you know, that food intake, they're called leptin and ghrelin, they go in opposite directions in ways that you wish they didn't. So leptin is the hormone that essentially is the satiety signal. It tells your brain that you are full, you don't need to eat anymore, you're satisfied with your food, stop eating. Essentially it's that satiety sort of red flag. Ghrelin is the opposite hormone. It essentially says, no, you're not satisfied with your food, you want to eat more. It's a hunger signal, essentially. So what you find is that when you are under slept the leptin, which is saying you're full, don't eat anymore, that signal gets turned down so it's not particularly voluminous anymore. So your brain loses the signal of I'm full, I'm satisfied. And instead ghrelin is actually ramped up. So you start to feel unsatisfied by your food and you will eat more. And so on both sides of that hormonal appetite equation, you essentially downgrade this red flag of satiety and you upgrade the signal of hunger, which then leads to what we've now demonstrated, which is an increase in your caloric intake. People sleeping six hours a night during the week, they will typically eat about 300 extra calories during the day, which may not sound very much, but when you add it up week after week, year after year, it comes to about 70,000 calories. If you look at the actual.

Numbers, and I think it's even more pronounced than that because the caloric arithmetic is complicated because, because of the compensatory components. But I think anybody, I mean, I do this natural experiment of doing too much flying across the country and the east to west, which is a very long day and it's a sleep deprived day because you're used. At least for me, I always want the earliest flight out to have the most time back. That is unquestionably one of the worst eating days of my life, if I let it be. So one of the tricks I've learned for that day, which I now do very well, but I had to be very deliberate about it, was so you're going to fly out of JFK at 6am which means you're waking up at about 4 and you didn't go to bed at.

8.

Right. So that sucks. I go to the airport and I get a really good breakfast, a proper breakfast. Like I eat, you know, exactly what I would want to eat. I don't eat a single thing on the plane, despite all of the dumb snacks that keep coming your way. And I also manage to exert enough self discipline to get on the plane without buying trail mix, which is my absolute airport kryptonite. But here's the thing, then you land in California, it's like 10 o' clock. And what I do is basically have a tiny snack that is also well scripted, like I know exactly what it's going to be, it's like sort of avocado and macadamia nut, highly satiating. And then I don't eat again till dinner and then I go to bed really early. So super early dinner, 5:00pm, super early bedtime, 8. And if I do that, it's awesome. But that requires a lot of work. It just requires a lot of planning and momentary moments of discipline. But if you don't, if you just do that on autopilot, which is basically what you would be doing if you were living that way every day. I mean, I'm amazed at the food choices I want to make. I have. Literally if I look back, there were moments when I caught myself eating a pizza in the airport for breakfast. Like under no circumstance would you do that regularly. And yet like the cravings you get for the craziest things under these sleep deprived. I mean any college kid will know this, right? You're pulling the all.

Nighter. Like you, what do you eat? Yeah, right. And so imagine someone like you who has the knowledge that they have about sleep and then has this maniacal discipline to be able to fast for long periods of time. And even you, with that arsenal of benefit in place, can struggle under the weight of sleep deprivation. No wonder the majority of you know, us non demigods of control will implode so.

Quickly. I'll have to see what Jocko would do under sleep deprived conditions with respect to.

Food. Right? And a gentleman who by the way, I have such incredible respect for in many areas and I would love to have a conversation, just an honest, frank conversation about sleep with him. But it's someone who, you know, I just, my goodness, what an incredible human being. But to come back to your point about food choices, it's not just that you overeat when you are underslept, which you do. And if you pull the all nighter, you will typically eat probably about 450 more calories than when you're well rested. It's also the profile of food that you eat and what I mean by that is if you give people, and these are the studies that have been done, essentially an ad lib food buffet which were at the end of the sleep deprivation period or sleep restriction where you kind of limit them to four or five hours of sleep for the week and then at the end of that you give them this food buffet and you say eat whatever you want, it's up to you. And there's everything from kind of leafy greens to avocados and macadamia nuts, all the way down to Oreos, ice cream and pizza. What you find is that not only do you eat more, but you eat more of the things that you should not eat. So people will actually eat more from the heavy hitting carbohydrates, the stodgy carbohydrates, together with simple sugars. So they'll be going after pizza, cookies, ice cream, and they stay away from things like protein as well as, you know, leafy greens. So in other words, it's not just that you eat more, but what you're eating in terms of both micro and macro groups of food is actually also, also distorted in the wrong direction that you want. So we understand at the hormonal level what's causing these changes. We understand that it leads you to overeat in the excess of probably about 70,000 calories each year, which is about 10 pounds of additional obese mass that you would put on each year, which for some people may be painfully familiar. But we also know what happens in your brain. And we did a study where we took a group of people, we limited them, we restricted their sleep, and then we gave them a full eight hours of sleep, put them in a brain scanner, showed them a whole bunch of different food images. Desirable foods, non desirable foods. What you find is that when you are under slept, the centers of the brain that keep your hedonic desires in check. And it's a part of the brain that we call the prefrontal cortex. That part of the brain was actually taken up offline by sleep deprivation. And that led to the more primitive areas of the brain, regions such as the amygdala, for example, that just erupted in terms of its hedonic response to desirable foods. So you can see that essentially you're losing impulse control networks within the.

Brain, which by the way, brings us right back to the five year old. It's so obvious when we see the kid that missed his or her nap, especially his nap, it seems. And look, as adults, maybe we're not going to throw temper tantrums in the grocery store, but you know what? We're probably a hell of a lot more likely to buy.

Pringles. Right? And you can scale this up. We've just described the litany of causal evidence from circulating hormones to food choices to changes in network brain activity. This idea of sleep leading you on a path towards obesity and diabetes is very clear in input regulation, equation of energy balance. That I think is just unquestionable. But your point is a good one about impulsivity. Think about other sectors where impulsivity is probably not great, yet sleep deprivation is rife. Military, aviation, stock markets. I was speaking to another author who lives here in Berkeley called Michael Lewis, has written some fantastic books, and he was describing how rife sleep deprivation is down on Wall street in terms of trading and money markets. I can only imagine the types of poor decisions and deficits that come by way of your brain shifting into impulsivity when you are underslept. And we're starting to do some work in those financial market sectors as well with choice and decision. I'd love to at some point do a survey of sleep in McKinsey and see exactly what the efficacy of insufficient sleep is. And there's already work out there. We've done some of these studies in Crispons. It's done some of these studies in Washington. If you look at employees who are sleeping six hours or less, the impact is probably fivefold. Firstly, those employees who are under slept will select less challenging problems. So you give them the experiment where you give them a range of problems, and they just typically will choose listening to voice messages or doing email rather than digging into hard project work. Secondly, of the problems that they do select, they end up producing fewer creative solutions, those problems. And that's an issue because it's supposed to be creativity and ingenuity that's driving businesses forward. But you lose that with a lack of sleep. The third thing that we found is that when underslept employees are actually working in groups, working in teams, they just slack off and they just let other people work. It's riding the coattails of other people's hard work. It's called social loafing. Doesn't breed good atmosphere. The fourth thing that they found was that the less and less sleep that an employee has had, the more and more deviant and unethical they became, which comes back to impulsivity and deep emotional sort of eruption, uncontrolled. So, for example, they started to falsify data in spreadsheets. They started to claim the work of other people, even falsify reimbursement claims. And then the final study, which we didn't do, but it was a great study, this was from Christopher Barnes. They looked at the sleep of a business leader, and then they asked their employees how charismatic and inspiring was that business leader from one day to the next. And what they found is that the less sleep that that CEO had had from one night to the next, the less inspiring and charismatic. Their employees rated that business leader from one day to the next, even though they knew nothing about the sleep of that leader, it was evidential in their behavior. So here again, you know, we've gone from intracellular networks and the impact, we've gone from genes to out to changes in food consumption, energy consumption, food choices, changes in brain networks, all the way back up to the.

Workforce. And that last one, by the way, is to me one of the most interesting, which is when you consider what that message is. Because that's a great blinding in the sense that the employees have no idea how much sleep. They might not even recognize what the purpose of the experiment was. I'm sure that if the study was done, they were blinded to even the.

Reason. That's.

Right. If something so socially important, because that goes beyond just being the CEO and being the person that works for the CEO. Right. That speaks to a much broader network of communication and interpersonal skill. You think about that from the standpoint of dating, mating, all of these other things, parenting. I think about, God, what kind of a horrible parent am I when I'm sleep deprived? Because I mean, I just, I can't imagine that I'm doing the same.

Job. And what's interesting, you know, there about sort of dating, mating and parenting, it brings me onto sort of that similar control. One of the interesting things, and this really actually does impact reproductive fitness and reproductive health. It's a great study from Sweden, a colleague of mine there, and they took some individuals and they gave them a full night of sleep and they sleep deprived them. And then they took essentially a portrait shot beauty picture under both conditions. And then they took a group of independent judges who knew nothing about the sleep that those individuals had got or had not obtained. And they just simply asked them to rate those pictures. Essentially like a beauty contest. How attractive does this person look, how sickly does this person look? And how sleepy does this person look? So these, it's the same individual, just under two different experimental conditions. And the judges in this beauty contest have no idea what those two images are. They just see the two images. Despite being blind to the experimental manipulation, you are consistently rated as looking more sickly, looking sleepier, but especially looking less attractive when you have not slept. So there is scientific proof of this thing called beauty sleep. But you know, in truth, it's a real issue regarding, you know, attractiveness. If you're trying to find a mate or if you've got a mate and you're trying to get intimacy and move towards reproduction, you're not going to be looking your best when you are underslept in that regard. So I think, you know, these things Consistently keep playing out under very carefully controlled experimental conditions. You just can't get around it. You know, sleep is. It is a life support system. And I often think of sleep as the Swiss army knife of health. Whatever ailment you face, it's more than likely that it's got a tool in its box that's going to help out. And this decimation of sleep throughout industrialized nations, I think is having a real demonstrable. And I mean that as in literally a demonstratable impact on our health, our productivity, our safety on the roads and the education of our children. There is truly no aspect of a human being's wellness that we've been able to discover that isn't eroded by a lack of sleep. Lack of sleep. It's almost like a broken water pipe in your home in the sense that it will leak down into every nook and cranny of your.

Physiology. That is actually an elegant way to state what I've been struggling to wrap my mind around over the past few hours. Taking a step back, we've gone through so many aspects of the pathology of sleep deprivation. From what I would consider. We started at a somewhat macro level, which is big, chronic diseases that are multifaceted. We went really, really, really micro into something for which we can't even elucidate the mechanism of AKTS phosphorylation, then brought it out to arguably the most macro, which is suitability for leadership and appearance. I mean, you can't get more macro. And a great analogy is water. I mean, as anyone who's ever had a leaky roof has known, and I had a leaky roof in residency that tormented me for two years. Water will always find a way. And that's. I mean, I sort of picture sleep as if you interrupt this system, it is always going to track into something negative. And sometimes it'll be water gushing through the ceiling and sometimes it'll be a slow drip that streaks your wall and you barely know where it's coming.

From. Yeah, it's been very hard to find something that is resistant. There are few things in your biology or your psychology that can retreat at the sign of sleep deprivation and get away.

Unscathed. I think it goes back to the point you made earlier, Matt, which is it is such a ridiculous proposition to sleep that the fact that it is here, the fact that we spent, probably, when you consider our origins at the very beginning, call it half a billion years keeping this strange thing around that on the surface makes no sense. And we've had no Pressure to get rid of it. I mean, that we haven't already resisted. Right, meaning like all the pressure that would get rid of it that we discussed. You know, the inability to get food while you're sleeping, the inability to find a mate, the inability to protect yourself, the inability to care for your children. We resisted all of those things. But it's only in the last 150, 250 years and really in the last 40 years that a totally new pressure has come on board that we didn't have anything to prepare for, that it could be so devastating. Whereas starvation, excess food, we've had lots of time to prepare for that. And again, even though the excess food we have today doesn't look anything like the binging that we would have done years ago. And Rick Johnson has written very eloquently about some of the genetic changes in fructose metabolism that really saved us and enabled us to fatten up in the fall when the fruit were sweeter. At least that prepared us a little bit of, you know, what we would do with excess nutrients in this modern era. At least we had a relatively safe place to store excess energy. And we certainly have a safe way to handle not having energy. I mean, ketosis, starvation, ketosis, if not for that ability, our species wouldn't exist. So we've got that one pretty covered. We just for sleep, we just didn't have the.

Chance. Just there's just nothing there. And I think, you know, part of this now comes to the bleed out of what's happening, which is where people are either so stressed or the diet, exercise, substance intake is such that they are finding all manner of sleep aids. We know for a fact that 10 million American adults in the past month have swallowed some kind of a sleep aid. 10.

Million. I'm actually surprised it's not higher.

Which. Well, and that's all that we can get people to admit to and we know of. You know, I think there's probably a lot of over the counter things that.

Are. Yeah. That wouldn't include necessarily someone taking Benadryl for.

Sleep. Exactly. Tylenol, pa, whatever. And so, you know, I think this is where we're starting to see. And people have a very, I think, complex misunderstanding about what sleep aids actually are. Alcohol is probably the most misunderstood of all of those sleep aids. And it comes back to our discussion about sleeping pills a little bit too, that what I often hear from people is saying, you know, I'm pretty stressed in the evening, I can't fall asleep when I get into bed, I'm Too awake, perhaps because they're not getting enough darkness, or perhaps because of use of caffeine too much, or because of that anxiety. When one of the problems with alcohol is that, well, it does three things to your sleep. Firstly, alcohol, as we sort of mentioned before, is also a drug that is a sedative. So it works on the same class of receptors that sleeping pills actually does. And when you have a nightcap, what you're doing is again just sedating your brain. You're just knocking yourself out. So that's the first thing you think. You fall asleep faster. You don't, you're just losing consciousness quicker, you're not falling asleep quicker. The second thing is that alcohol will fragment your sleep so you wake up many more times throughout the night. Now, typically they're so brief that you don't remember them, but they have a measurable impact on your sleep physiology and as a consequence, your own wellness biology. The final thing that we've discovered is that alcohol is actually very good at blocking your dream sleep, your rapid eye movement sleep. And so what happens is that you end up waking up the next morning feeling unrefreshed and unrestored by your sleep. And some of the times you may think, well, I don't remember waking up with the alcohol, so maybe it wasn't the alcohol, I don't know what's going on. But now you start to feel lousy the next morning. You start to feel that you have this kind of sleep inertia where sleep is still with you and it won't let go of you. So now you start abusing caffeine.

Or by its more technical name, adenosine reducing.

Substance. Correct? Yeah, adenosine muting substance. If you are taking caffeine, you know, before midday, I think a good question is to ask why? Because that naturally should be your peak level of alertness, around 11 or 12. You know, I often used to look before on planes now where you can now use your phones on takeoff. You know, five years ago you couldn't do that. And it was a great experiment for me because I get on a flight at 10 o' clock when everyone on that plane, for the most part depending on their chronotype, they should be getting into the nice sweet spot of their alertness, they should be wide awake. And when finally people could not do anything, they weren't allowed to use their phones, they just had to sit with the boredom of taking off. Boredom unmasked, the state of chronic sleep deprivation. And I would look around and half of the plane was fast Asleep. So what then happens with, you know, alcohol is that you start using caffeine. And caffeine is a problem because everyone knows caffeine, you know, makes you awake. And the way that caffeine works comes back to our discussion of adenosine, which is that adenosine builds up. It's a sleepiness signal. It's telling your brain, get to sleep, get to sleep. The longer, the more that you have, caffeine rushes into the brain and it latches on. It hijacks those adenosine receptors and it just blocks them. So essentially it acts like a remote control for your TV and it just hits the mute button on the sleepiness signal. So your brain thinks, oh, I haven't been awake for 16 hours. Maybe I've only been awake for eight hours because I've just slammed an espresso after dinner. But then the problem with caffeine is that it actually has a half life of about six hours. It has a quarter life of 12 hours. So in other words, if you have a cup of coffee at midday, a quarter of that caffeine is still in your brain at midnight. So the equivalent would be, you know, getting into bed. And before you go to sleep, before you turn the light out, you swig a quarter of a cup of Starbucks and you hope for a good night of sleep. And it's not going to happen for some people. Other people will tell me, well, you know, I'm one of those people with caffeine, I can have an espresso after dinner and I fall asleep and I stay asleep. So no harm, no foul, presumably, isn't that okay? And the danger there, and we've done these studies too, where if you give someone a standard 200 milligram dose of caffeine in the evening and then you measure their sleep architecture, what you see is about a 20% reduction in deep sleep as a consequence of that caffeine being in the system. To put that in context, to drop your deep sleep by about 20%, I'd have to artificially age you by about 20 to 30 years to get that type of reduction of a.

Loss. Is this, is this independent of the caffeine metabolism, snip differences that exist? Is everybody equally like. I've always felt like caffeine doesn't do anything to me. I, I mean, I love coffee, so I make. Most days I'll make a coffee in the morning as a French press, more as the ritual. And I just love the taste and the aroma. But when I'm tired, caffeine does not wake me up. And it just seems to have zero impact on me in any way, positive or.

Negative. And I think that's where we, you know, we don't know. We know that people have different genes that are associated with the enzyme that decomposes caffeine. And that's why some people are very caffeine sensitive or less caffeine.

Sensitive. Yeah, we actually run this on most of our patients. You do? Yeah, if they've done a.

23. If you do a 23andMe, you'll.

Get. Yeah, you can run it into Prometheus and see that. And I mean, truthfully though, Matt, the association isn't as clear as I experience it clinically with people. I've always kind of been jealous of those people who can use caffeine as a true performance.

Enhancer. But the flip doesn't have that.

Effect. It has no effect on.

Whatsoever. What we don't know is those people who have those particular gene profiles that may have the ability to more quickly decompose caffeine, Are they the same people who also don't suffer the same type of deep sleep.

Reduction? I don't think. We.

Know. We don't.

Know. And this gets to something interesting. Right. So going back to the alcohol point, I would add two points. The first is there are a handful of things that my wearing the OURA ring for the past three years has. Has. Has done for me. And I want to disclose that I'm an investor too, and an advisor to oura. So please understand that it's important you know that so that you can take what I'm saying with a grain of salt. But. But what I'm about to say, every single one of my patients has said, and we buy this ring for every single one of our patients. There is no greater behavioral tool to show you the deleterious effects of alcohol than this ring. I mean, you see the effect. And for most people, it is somewhere between zero and two drinks. So in other words, for me, it appears that a single drink four to five hours before bed doesn't appear to have a difference that I can discern anything beyond that. Meaning one drink closer to bed or two drinks, even six hours before bed, my sleep is shot. My resting heart rate will be six to eight beats higher. My heart rate variability is compressed by 20%. My respiratory rate is higher by probably two breaths per minute, one to two breaths per minute. My temperature is up by 0.3 to 0.6 degrees Fahrenheit. It is a kick in the.

Groin on every one of those levels. That's exactly what we see in the scientific evidence. You need heart rate to drop. Heart rate variability is usually far higher with sleep, especially good sleep. The same is true for the next morning. If you've been getting good sleep, temperature and respiration are critical as well. We know that you need to drop your core body temperature by about 2 to 3 degrees Fahrenheit to initiate sleep. And that's the reason that you will always find it easier to fall asleep in a room that's too cold than too hot, because the cold is at least taking you in the right temperature direction for good sleep. Yet alcohol, with this thermogenic profile starts to increase your core body temperature, which is the exact opposite of what has to happen for good sleep. So you're going to get more fragmented sleep, you get more awakenings, you disrupt REM sleep. It fits exactly the profile of the scientific data. So, you know, people can take your comments if they want with a grain of salt, should that, you know, investor thing sort of, you know. But I can tell you here as a sleep scientist that what you're describing is exactly what you see in the scientific.

Literature. And the reality of it is, I think every one of my patients who at least wears their ring, some of them won't wear the ring for reasons I don't know. But any patient who wears the ring reports the same thing. And it's this. They'll report it on the same four metrics. The second thing I want to point out, which is alcohol inhibits vasopressin. And so anybody who's, who's, who's had something to drink knows you tend to pee a little bit more. And some people might think, well, you know, the reason you're peeing more is you're just drinking more. But the reality is that's not true. You're peeing disproportionate to the volume you're consuming because ethanol inhibits a hormone called antidiuretic hormone. So if you inhibit the antidiuretic hormone, it has a pro diuretic effect. And so if everything you just said weren't bad enough, now imagine taking a diuretic before bed. I mean, do you really want to make your sleep any worse? I mean, and by the way, I used to be so dumb that if I drank before bed, I would actually take vasopressin. I would take 0.2 milligrams of vasopressin to at least not like, make me get up, which of course is, I mean, talk about the most backwards logic in the history of.

Civilization. Or you could just try to be a little bit more sensible with the alcohol. Yeah, yeah.

Yeah. It's incredible. The other thing I've noticed is a very high carbohydrate meal and especially a crap carbohydrate meal. So, you know, like high quality carbohydrates don't seem to do this. But I mean, and it's so funny I'm admitting all the horrible things I do, but it's good. I think people need to know just how much of a failure I.

Am. It's just you and me here. Pizza. Don't.

Worry. At least once every few months, like I just cave in and I just. An hour before bed, I just binge eat something stupid is beyond like a bowl of cereal that, like I just can't resist or something. It basically produces the exact same architecture as that drink as those two drinks. I want to go to another compound that I get asked about a lot and truthfully, I just don't know the data. And that is. Well, we'll start with THC and we'll move to cbd. Then the THC touches. I guess you could think about it through two lenses, right? Which is the developing brain versus the developed brain. So let's start with the latter, since I think it's more clear in the former that the developing brain probably is not benefiting from thc. So it's probably not even worth asking the question, is THC a good sleep aid in a teenager? I think the answer would be clearly no. But you and I, is THC a pro sleep.

Compound? No, I don't think I'd feel comfortable in suggesting that it's a pro sleep.

Compound. And would you say that independent of strains? I mean, anybody who's experimented these things will tell you, well, sativa, maybe not, but indica.

Yes. I mean, firstly, I don't think we have enough data to pinwheel out the different strains and sort of parametrically slice the strain piece, as it were, and ask that. But what I do know from the evidence, firstly, I should say that, you know, acute use of THC typically has a quote unquote beneficial effect such that it will decrease the amount of time it takes you to fall asleep. What's called your sleep.

Latency. That's the only thing it impacts is.

Latency. So it reduces the latency and it makes it feel as though. Well, and you are giving you more duration. So yeah, so your falling asleep faster. Total duration, not so much. But what is happening, however, unfortunately, is that that THC just like alcohol, has been shown to be a very robust blocker of your dream sleep, of your REM sleep. Add that to the fact that with chronic use of thc you build up a tolerance to the benefit on falling asleep faster so that now you actually have to start using more of the compound to get the same reduction in sleep onset time means that that tolerance and dependency, I don't think is necessarily a good thing. When you then cease the use of thc, what you find in the studies is a pretty horrific insomnia rebound where people then actually have miserable sleep and it usually typically leads to then falling off the bandwagon of abstinence if that's their goal. And people then start having to use again to gain back that crutch that you may not necessarily have needed otherwise. So I think the evidence right now, especially with the REM sleep blocking effect of THC and the importance of REM sleep that we know of, I just don't feel comfortable in thinking that THC itself is really the sleep aid of the future and that there is more evidence on the THC side. CBD is starting to gain more research traction. I don't think there's enough studies done. I think part of the reason with CBD is and thc, it's just, it's hard to do these studies because they're hard to get funded because of still some of the moral. And now I am not. Again, I'm not puritanical about this. I'm not casting any judgment at all. And I've often thought, well, you know, what would it take? Maybe, you know, I should do like a Kickstarter and try and crowdsource enough money to do the appropriate CBD studies because I think CBD is more promising on the data right now. The data for CBD is that you get that benefit of falling asleep.

Faster. By the way. Would you just to interject for a second, would you be able to get an IRB approval to do a real world study where a bunch of people were just using wearables and you could homogenize and uniform the wearable and the CBD and things like that, but without having to do it as an in house sleep study? Do you think the wearables are good enough that you could get enough data in the.

Community? I would probably do a hybrid. I mean, no, that makes sense. The irony of THC and CBD often being used as hybrids is not lost on me. But I would probably do a hybrid where I would do some tracking of sleep ecologically in the home setting, as it were, and then have a couple of nights where they would actually come in and we would measure their high grade sleep quality. Because the trackers out there right now, you know, they're just not quite accurate, they're not clinical grade enough for me to understand the quality and the stages of your sleep. I think trackers are not bad right.

Now. But even those metrics, you'd get a clue, right? Like even with the ethanol, somewhat of a.

Clue. Yeah, you can see it. I think people often ask me what's the best sleep tracker? And I would say it's the sleep tracker that you wear every night. I think most of them are much of a muchness in terms of their current inaccuracy. So I would do a hybrid study probably where I would do some tracking outside with things like wristwatches or rings and then I would do some in laboratory studies. But I think for CBD things are actually looking more promising. CBD does give you that same benefit. You fall asleep faster. You don't seem to get the hit on REM sleep. Now I don't think there's enough studies for me to yet feel comfortable in saying definitively you don't. But for the small handful of non placebo controlled trials, for whatever it's worth. And we are talking about Hands up here everyone. No recommendations, no promissorial notes. This is just very early, tentative preliminary evidence suggests that you may not get the REM sleep deficit, which is good. The other thing is that you typically don't see the dependency issues nor do you get the insomnia rebound when you stop using cbd. And the final thing I think that's interesting with CBD is that it may actually have some benefits in certain sleep disorders. There's some as the little bit of evidence that it may reduce the severity of sleep apnea. But I think that that's just, you know, one or two studies. There's some benefit that's happening in PTSD with CBD treatment to help with ptsd. Sleep problems and sleep problems are real problematic issues with PTSD patients. So I think anything there that could be of help as long as it's medically safe and doesn't compromise your sleep, unlike THC would be a good thing too. Probably two caveats or at least one caveat. It does seem to be somewhat dose dependent. I don't think it's very clear right now what the optimal dose is. There have been some times where people have actually suggested that the use of CBD at a certain dose is Actually wake promoting rather than sleep promoting. So I think there may actually be this U shaped function when it comes to CBD that what? Or some kind of a function. I don't know what the function is going to be, but there's going to be perhaps a sweet spot of a dose concentration that is optimal for CBD's benefit on sleep. And there may be other doses that are actually detrimental to sleep and we need to stay away from them. How is CBD doing that and having that kind of benefit of sleep? There was actually even some evidence that it may actually increase the amount of deep sleep, which was interesting. And that was just one single study, small study. Again, I'm not believing it. I'm not going to go out there and start telling people to take CBD on the basis of that single study. I am saying that I think it's got promise right now, but we don't know how could it be doing that? Well, one of the interesting things could actually be thermoregulation. In some of those studies they were actually finding that the core body temperature decreased with CBD administration. And we were just describing that when you drop core body temperature, you sleep better. When you increase core body temperature by way of something thermogenic like alcohol or it's just a hot room or a big meal, that increase in core body temperature is worse for sleep. So CBD may actually be having its mechanistic benefit through the thermoregulatory system is one of my hypotheses. The other is that it's indirect through its anxiolytic benefits. I think probably the greatest, strongest evidence out there right now for CBD's clinical efficacy is for anxiety. And I actually think, and I've tried to read as much of that data as I can, I think it's actually pretty interesting. I think one of the major causes of insufficient sleep and poor sleep right now is that everyone is just cranked in terms of anxiety and that they wake up or, you know, we are constantly on reception in this modern day of life. And the only time that our brain goes from reception to reflection is when our head hits the pillow. And that's the last time that you need to be ruminating and catastrophizing and having that Rolodex of anxiety. So I think if CBD is efficacious for lowering anxiety and anxiety is one of the causes of poor sleep in society, then part of that benefit may not be through a direct mechanism on sleep regulating centers, but instead a secondary benefit of lowering anxiety which perhaps lowers that sympathetic fight or flight branch of the nervous system, which means that you shift into a more parasympathetic state and. Or it drops core body temperature. Both of those routes, I think, are, in my mind, the tenable hypotheses that in, you know, a crowdsourced study that I would want to do, and I don't know if people want to do that study, you know, comments in wherever comments can.

Be. I would. I'll speak for myself. I would love to see that study because anecdotally, not so much in myself, but I also think I'm. I sleep reasonably well. But in people who don't sleep that well, I have anecdotally seen some pretty impressive results with cbd, and other times I've seen nothing. And what's interesting is in some of the people in whom I've seen impressive results, it's people who have been largely recalcitrant to other big guns. Again, I think whenever you can sleep without pharmacology, you're doing a good thing. But when you look at things like Trazodone, Thorazine, with their antiruminative properties, and you see patients who, even at 25 and 50 milligrams doesn't.

Matter. That's.

Right. You know, it's not helping them sleep. And yet, you know, CBD.

Does.

Yeah. And at that point you start to think, well, it's less likely to be the placebo effect because you've tried all of these other things that didn't work. Why would this silly little oil work? And, you know, I'll share a sort of unrelated story that speaks to this role of anxiety because this kind of brings it back to this idea of mental health that I, I think is such an important part of longevity. I have a patient whose sleep has really eroded in ways that I can't even imagine. And it's been quite devastating to watch. And this is an individual who's done everything that you would ask someone to do. Right. This means you control the room temperature, you control the light, you control the nutrients, you eliminate the alcohol, you eliminate the caffeine. An hour of meditation a day. I mean, this is everything. But this person's in the midst of a very difficult personal struggle. So by the time you're at 50 milligrams of Thorazine to just try to shut off the ruminative properties, and you would get some intermittent benefit, but not long term. So in the end, what he was able to do was enter into a clinical setting under which he was able to therapeutically Utilize MDMA to deal with some of the issues that were predisposing. And again, I want to be very clear what I'm saying here. I'm not saying he went to a party and did ecstasy right to the listener. This is a clinical administration with a therapist of MDMA to address the underlying trauma and anxiety and depression of the situation the next day and for months to follow. And we're still at that standpoint. His sleep is fixed. Now, I think that is an outlier situation. But sometimes these outlier situations provide an insight into a mechanism and I think in this person's individual, because we had already fixed all of the sleep hygiene metrics. I mean, we had literally done everything in our toolkit. And that's a toolkit that has about 10 tools in it. To see this one thing, this one intervention work, and you know, the patient would describe this as a transformational life experience, was just another example of the power of the mind and how the mind can sort of get in its own way at.

Times. And the power of the mind in terms of it essentially deconstructing this thing called a full night of sleep is, I think, so critical. And more and more now we are seeing that the causes of sleep difficulties and sleep problems are shifting from typical biological problems to increasingly psychological problems. I think that rise in anxiety has walked in lockstep with a rise in insomnia. And I think we've got enough evidence to suggest that those two are probably not coincidental, but are significantly interrelated is probably the strongest thing I could say right now. So it doesn't surprise me that if you have something that essentially is a mental health reset on your WI fi router in a demonstrable, in a marked way that could lead to essentially the same type of reset in that physiological thing called sleep. It doesn't surprise me whether or not that is the treatment for everyone. And you are very clear about that, and I enjoy that. But it doesn't surprise me that if you fix mental health, you fix, and we've seen this bidirectionally, we do a lot of work on sleep and mental health. And it's very clear that I can take people who don't have any problems with mental health, depression, poor mood, anxiety, suicidality, and when you sleep, deprive them, you can instigate many of those conditions. In fact, I can. Within one single night of sleep loss, I can put someone who is non clinically anxious to a level of anxiety where they would have a clinical anxiety disorder diagnosis. That's how quickly it can happen. So yes, sleep can impact your mental health. And what's interesting is that psychiatry, in the past 25 years I have not been able to discover a single psychiatric condition in which sleep is normal, which to me was quite profound when we added it up, that I can manipulate sleep in mentally well people and then produce, by way of the excising of sleep, mental ill health tells me that there is a causal direction from insufficient sleep to poor mental health. That sleep is essentially emotional first aid in that regard. However, don't mistake that for the fact that it's a two way street as well. And I think what you're describing here is a state of mental ill health. And when you course correct that mental ill health, you then correct the sleep. And so I think the relationship between sleep and mental health is bidirectional, I think, is it's a two way street. Is the traffic flowing more in one direction than the other. Perhaps, and perhaps psychiatry has had it wrong for the past 50 years. They used to think that the poor sleep in their patients that they knew about long before we published scientific data that was a symptom of the disorder, rather than considering it a potential predisposing cause of the disorder. So I think psychiatry is starting to undergo a revolution when it comes to sleep and understanding how fundamental sleep is to the maintenance of good mental health. I think it's the bedrock of it. You can stack up the different physiological body systems and the different operations of the mind, but I would put mental health pretty high up there in terms of one of the things that falls apart quickest. And the reason I can say that is because essentially we start with these sleep deprivation studies and we can just keep sampling the organism, which is the patient, the individual, you know, every hour. And we can just look to see the further you go into sleep deprivation, what is the trajectory of impairment in brain and body systems. And some, you know, come on tap later in the sleep deprivation, others very, very quickly. Essentially what we're trying to ask is what is the recycle rate of a human being? And after about 16 hours of wakefulness, things start to go wrong. And the things that start to go wrong soonest and perhaps most severely. One of those things certainly is your mental health. Anxiety being one of them, mood being the other.

Depression. It's interesting, right? How long it can take for certain things to ravage the brain. Neurodegenerative disease that manifests clinically in dementia, and yet how quickly certain elements of the brain will demonstrate the limitation. Memory consolidation and anxiety as two examples, you're in your sabbatical year.

Correct? I am. I'm finishing it up right now.

Yeah. So what else are you doing with your time besides being incredibly generous and sitting here with.

Me? So I still, even though I don't teach, I still am here at the sleep center. I'm the director of the center for. For Human Sleep Science here at Berkeley, and we continue to do all of our research. So I'm still, you know, directing the center. I'm writing grants. I've been doing a lot of public advocacy. I've been doing a lot of public speaking now that the book has come out and doing sort of television media. I've also got a couple of startup companies that are emerging. One of them has just gone public. It's a brain stimulation company. This comes from work that's out there in the literature showing that if you can try to essentially electrically sing in time with deep sleep brainwaves, you can boost the amplitude and the size of those deep sleep brainwaves. We're hoping to try and transfer that same technology into older adults and those with dementia. Can we salvage some aspects of their learning and memory by way of boosting back their deep sleep? That's one of.

Those. Can you say how the device works? Is it a device that sits in the.

Room? No, it's actually a device that you place on your.

Head. So it actually measures the.

Waves. It both measures the waves, and then it inserts electrical voltage into the brain. And essentially what we're trying to do is measure when you're having those sleeping brainwaves and almost act like a choir to a flagging lead vocalist that you're trying to sing in time with the electrical stimulation of the deep sleep of older adults, which is diminished by 50 to 80%, but giving them an electrical sort of, you know, stimulation to try. And every time they have a deep, slow wave, boost the size of that slow wave and in doing so, try to almost double the amount of memory benefit that you get from sleep. Because that's what we've already been able to demonstrate in young, healthy adults. So that's one of the.

Companies. What's that company.

Called? It's called STEMScience, and that's together with a set of co founders that we just recently got seed funding for from Kosher Ventures. Then I'm starting to think about writing a second book and unclear exactly what it will be. I think there's probably three candidates right now. The other thing that we're trying to do as well, though, is raise Funds for the sleep center. We've just moved to this beautiful new building that we're in with the new sleep center. So we're trying to raise philanthropic funds because. And I think you've done this wonderfully and you've done work with Gary Tubbs to try and create this vision for how you can fund science in ways that typical funding mechanisms will never do. And that's what we need at my sleep center is that we need philanthropic support. And there is now currently, through the university, they've granted the ability to name the sleep center for a philanthropic donation. So I'm now just trying to move that work out. So I guess this is a shameless plug that should anyone out there wish to have a legacy name to name the center that is there. But just to give you a sense of some of these studies, one of these other studies that I'm fascinated by in our elderly cohorts, it's not just the data deficit in deep sleep that happens as you age, which it does. There is also this strange cluster of outliers of people in their 70s and 80s that when I put their data of sleep and deep sleep plotted against all of the young healthy adults that we've studied, some of those older adults seem to be incredibly resistant to age related sleep decline. Why? No one is willing to kind of give me the money to do the studies, which is the inverse. You know, it's easier to get money to explore when things go wrong, but you can get insights into those critical questions by looking at also when things go anomalously right. And a good example of this is the blue zones. You know, this work that was done starting by National Geographic where they looked at longevity and they found that there were these pockets throughout the world where people seem to live longer. Now, I think some of the data there is controversial, but it was a good idea that you could look, is there something about their social fabric? Is there something about their diet, their exercise? No one in terms of these blue zones has asked the fundamental question about sleep. Why? You know, that's going to be fiendishly difficult for me to get funding for. So one of the things that I'm trying to do right now is raise money for the sleep center to do what would be otherwise impossible fundamental research to make critical discoveries. On the flip side of where I think we can make real inroads into understanding sleep, which are usually typically very difficult to get funded. Or these are kind of more blue sky research questions, but could make real impacts. But. Sorry, I.

Interrupt. Where does sleep reside within NIH, which of the.

17. It resides in most of those branches. You know, it resides in the National Institute of Aging. It's there for neurology, it's there for cardiovascular disease, it's there for metabolism, glucose, and it's there for nida, which is the Institute for drug abuse. So it's prevalent in all of them. But I would say.

That. But paradoxically, it doesn't have its own.

Institute. No, it.

Doesn'T. Which it seems like it ought.

To. Well, if you were to think that exercise, nutrition and sleep are the three fundamental ingredients that as best we can tell from the science that we've done as a human species, keeps us alive and longer, living and living.

Longer. Well, and yet those things all spread across the entities as opposed to stand in their own, which there's benefit to that. You would argue they shouldn't be siloed, they should be studied. But of course, you could almost argue for a matrix as opposed.

To. Yeah, what you really want is horizontals and verticals. And when you put those together, we create the matrix that you've just described. So I would say, I think NIH has done, has definitely supported a huge amount of sleep research, and they support some the research or some of the research that we do here at the sleep center. And I'm incredibly grateful and I'm very fortunate to have those grants. They're very hard to come by. But there's also. I keep running into these fundamental questions that when I write these grants, they're difficult to get money for, and I understand why, because you've got government policies, you've got particular institutional mandates that you have to fill. They're just not going to fund these research programs. So that's another thing that I'm doing is trying to raise money for the sleep center, then with these startup companies, and then also just doing our fundamental basic.

Science. Now, are you formally involved with Google in some way as well? I've seen some of your talks there. But do you work with.

Verily? Do you work with Google? Yeah, so I do. So right now I'm also a scientific advisor for Verily, which is formerly known as Google Life Sciences. So I do help Verily to try and help shape their mission of sleep. And I've also been a consultant for many of the other large tech companies out there and many of the fitness trackers as well. But right now I do also do some time at Verily to try and help with many of their exciting visions regarding how you could use the resources of a big technology company like Alphabet to try and do things differently than the way that the government does health. I think we'll need both of those forces, and both those forces will be for good. But it's a wonderful place to be. You've got incredible people there, and the way in which they see problems is different. The time course over which they want to solve those problems is different, and the solutions and the expertise that they bring to those health problems are different. So when I got the chance to work at Google Life Sciences there, or essentially be an advisor there, I jumped at the chance. It was great to try and help shape that.

Mission. Matt, I had a list of probably five pages worth of things that I wanted to discuss with you, and we covered many of them, but I would say we covered half of them truthfully. And I think the only solution is we probably have to sit down again sooner rather than later. And amazingly, we were pretty good about not getting into cars, which is. I mean, we could have spent this entire time talking about Formula.

One. Maybe that's the second half of the second conversation. Should people not generally lose the will to live when they hear my voice for, you know, several hours, which is what most people do, unfortunately. But I would be so thrilled to come back at any time you would wish me to. And same for the audience. And if that second time did involve a little discussion of all things cars and car racing, including Formula one, it is one of the few things, you know, I. I've never been a big fan of alcohol, not because I'm down or against it. It's just I've never really liked the taste. So I typically don't drink. I'm caffeine free. Just because I'm one of those people who's sensitive to caffeine. But the one vice that I have, my biggest weakness is cars. Car racing. Oh, it's a wonderfully terrible affliction. I adore all things.

Automotive. The next time we do this, let's do it in San Diego so we can sit in the simulator and, I don't know, maybe just do a hundred laps of Coda or something like that. Yeah, it's.

It's. That would be such a gift. That really would be. I'll take you up on.

That. You know, it's possible that by the time this comes out, we'll already know the answer to this question. But given where we are right now, which is in late February, what is your take on this year's season? I mean, early testing looks really good for Ferrari. Looks like that front wing is Giving Mercedes a little bit of.

Difficulty. Yeah, they struggle on.

Me. If you had to predict 1, 2 and 3 this year in both constructor and driver, how would you handicap it now? And these are impossible questions to be.

Clear. Yeah, I don't know about driver. I think I'm going to put Ferrari 1 and 3, Mercedes 2 and I.

Think. So the huge question then is Vettel Leclerc. I mean, where are you going.

On? Okay, if you're going to push me, I would say Vettel one. And I think Hamilton, you know, obviously is going to probably be number two there with Mercedes. That's my suggestion, or I would at least say that that's going to be the first half of the season. You know, Mercedes as a team, technologically they are fantastic too. And I think that they could rebound, you know, if this first or all the data I've seen is just the one set of testing data that, you know, you and I have both seen here now in February, and it looks like Mercedes has got a rip roaringly hot car on their hands. But I think Mercedes is Ferrari. Sorry, Ferrari. Yeah, sorry, sorry, sorry. Ferrari. I think Mercedes is capable technically though, of coming back in the second half of the season to make sure that that car performs. So they've got a good chance. And Hamilton, with the skill that he has, I think may be able to hang in there until that technology and the engineers come good. I would also just love, as a British man to see McLaren do a little bit better. I love them as a car brand. I've never had the opportunity to be in one of their cars. I've only had the chance to look at them and usually that means that I become an even more incoherent human being and then I dribble and, and want to typically tend to lick the car. Just to be honest, if you.

Had to have as a daily driver, so cost doesn't matter, but it's got to be the car you drive. You take a 720 or a.

P1. I think the P1, just the rattle alone that happens on that carbon monocoque with driving around would probably prevent it from being a daily driver for sure. Would I like to have the uptown problem of having a P1 as my daily driver? Absolutely I would. But I think 720s I could live with every day. You know, look, I could go with any one of their models, you know, put me in any one of the five series that they've come out, I would adore too. That may actually be a more relaxing car. But I'd love to see. Well, firstly, I'd love to see myself in a McLaren, but what I was about to say was I'd love to see McLaren doing a little bit better. And I've got a soft spot for Bruce McLaren and what he did for the automotive.

Industry. And it was a remarkable era of driving. And he died relatively soon after Clark. Right. I mean, he did, unfortunately, very tragically, shortly after Jim Clark.

Died. Yep, that's.

Right. But I mean, that was the era where the exception and not the rule that you.

Retired. Yeah. And, you know, it's that and then plus my similar obsession that you have with Iron Senna and the history that he had with McLaren, too. Of course, he then transitioned to Williams later, but there was something special about that time where he was with McLaren that makes me just want to see McLaren do better, too. If you look at McLaren's rise in just road cars and what they've done, they have scaled more quickly in terms of incredible technology and competing with the likes of Ferrari and Porsche within such a short time period. And I think Ron Dennis, who is the mastermind behind McLaren in that regard, is just a man of genius. And so, you know, they came out with the 12C, and there was a lot of discussion that it was. It didn't have the heart of a Ferrari or a GT3 or a GT3. You know, it didn't have the. The emotional temperament that would excite you, that it was perhaps somewhat of a clinical car. And I think they've been better at increasingly increasing the emotionality into their cars. But I also think that part of them is resistant to that idea of necessarily the emotionality, but just the precision and performance that you can get from those cars. And they're doing emotionality better, but in terms of precision and performance. I don't know if anyone touches them right now in terms of their.

Evolution. I have not driven a McLaren. I've never driven one. And I have friends who have them, and they've said, you know, you're welcome to come into it. I just haven't. I don't know why I haven't done it, but I've driven lots of Ferraris, I've driven lots of Porsches, I've driven lots of these other cars. And it's. Everything you say has been reiterated to me by the McLaren drivers, who themselves have driven all of these other cars. So just my curiosity is equally piqued, and I'm a bit ashamed to say I don't know why I haven't just taken someone up on the offer to do.

This. Please do. And then can you write me a long email so that I can live vicariously through the gift that was given to.

You? We'll figure out a way to do it together now. So one more question before we figure out something else to do. The 1988 McLaren versus the 1993 Williams, which, again, you don't compare them car to car, totally different technology. But you could make an argument those were the two most dominant cars in Formula 1. I'm guessing your heart is with the MP4. 4. But. But what do you think about that 93 Williams? I mean, that's a car that doesn't get as much attention as I think it deserved. I mean, it was so technologically.

Advanced. It.

Was. Some have argued it is to this day, the most technologically advanced Formula one.

Car. If you look at some of the shots where, you know, they've got different, you know, computers plugged into it, you know, and they're always making musical symphonies with the engine and the suspension, the chassis, the dynamics of damping. It was just next level. It was kind of almost this step function that we'd been going along with race cars and we've been having beautiful evolution, and then all of a sudden, revolution came along with that car. So I would actually go for the Williams, you know, and again, this probably goes against my sort of my McLaren Bent, but it was just such an exercise in engineering passion that lent itself to this clear night and day, almost next day.

Benefit. And obviously Prost won that year. Was Hill the other.

Driver? Yeah, I believe he was his name in.

Hill.

Yeah. So, yeah. Because Mansell was driving at that time. Well, yeah, I just.

Don'T. Yeah, Mansell was with Williams the year before. He won in 92 in the.

Williams. Yeah.

Yeah. It's just such an amazing, great.

Era. I mean, I love watching now, and there, you know, there's still competition that's relevant there, and there's still, you know, I think there's lots of good, colorful characters, but I just can't help thinking that there was these eras during Formula one, you know, even back in the days of, you know, James Hunt, for example, who I just adored, that kind of just fly by the seat of your pants, you know, he was also in a McLaren, also in a McLaren, too. And then, you know, there was this lovely kind of passing of that chalice from him to a Senna, and I think it was happening when he was commenting, maybe it was with Murray Walker when Senna was finishing up his last race in the season. When he was with the John Player car, you know, that beautiful kind of black and gold sort of. The Lotus. Yeah, sorry, the Lotus, yeah. With that. And, you know, you could just hear the excitement in Hunt's voice as to what this young potential prospect called Ayrton Senna could possibly be. And for me, it was just this lovely kind of, you know, generational shift from one driver to the next. It was a driver who knew how to spot talent and to see that, you know, talent. And you could hear in the emotionality of James Hunt's voice that type of affirmation that you will next be one of the great. And I read all of that. You know, I think it's probably nonsense, but for me that was beautiful too. But there's been great eras, you know, Hunt and then Senna and now it's just different. But I still watch and I still love it. And I think with four wheels.

It'S sort of funny, like, I mean, truthfully, we can all sit here and poo, poo, the sound of the engines today and stuff, but the reality of it is, when you hear them, it doesn't matter. It's still Pavlovian. I mean, you just can't stop drooling. They're such beautiful.

Machines. Yeah. And if you just hear them at full chat, coming down a straight and it goes past you and you've got any small modicum of gasoline that runs in your veins, the hairs on your back of the neck will stand up and you'll say, yeah, I was wrong about it all going away in this modern era. Truly.

Not. Well, we'll see what happens this year. But I think you're right, I think it's going to be really competitive. I think despite the challenges Mercedes have had, you can't count them out. They're just so damn good and dominant. Yeah, of course, Lewis is incredible. So I'm not actually a huge Ferrari fan as the team, but I like Vettel a.

Lot.

Yeah. I think the culture of Ferrari is broken. I think that's actually become quite public in the past year. I think it's a lot of people have made that pretty clear that it's sort of a toxic culture and it's a stark difference to see how those two garages operate. Just as a fan, if you're there and you can sort of see what's happening, it's a stark difference. So, anyway, it should be fun. Talk about another sport where, like, all sports sleep really matters. I mean, I can't imagine any athlete that's under more difficult sleep conditions than a Formula one driver. Because, you know, it's one thing if you play in the NBA, you're going to fly a lot, but you have a three hour time zone max. And based on how the conferences work and how the schedules work, it's not like you're going plus 3, minus 3, plus 3, minus 3, plus three, minus three. When you look at Formula One, first of all, it's a ten month season basically. I mean it's, you know, when you include preseason testing and it's truly a global sport and it's not even like it's structured perfectly well. It's not like they comb through Europe, then go over to Asia and then, you know, hit a little Australia and Melbourne on the way over to North America and then hit South America. It's not even done in the logical way that you would do it if you were optimizing for Continental.

Jump. Right. Jet lag in control is horrific. And there in that sport, if you're talking about margin of error and reaction time, we don't currently have essentially a breathalyzer for sleep deprivation, which we should. And I think, you know, there's ways that we can think about that too. But if there is one gold standard measure of insufficient sleep, it's not only just your response time, your basic reaction time, but it's the number of times that you miss a response, what we call a lapse or an error of omission. You, you omitted a response that should have been happening. It is so obvious that insufficient sleep impacts your basic reaction time and your missing of choice response times. And in Formula one or in any vehicle racing at high speeds, you know, response times and reaction times, you're talking about margins of error here that are 0.00x, you know, and six hours of sleep for one week can drop your reaction time by up to 3 to 400 milliseconds. Now, 3 to 400, you know, almost half a second in terms of slowed response times in Formula one can make the difference between you being first and you being somewhere basically.

Nowhere. Yeah. The other thing I've noticed, and this is one of the things I enjoy about having a simulator, is I get to test stuff out. I mean, I've figured out that even after one drink I drive worse in a simulator, even though I am not legally drunk. Right. I probably have a blood alcohol of 0.0302. I mean a very low blood alcohol after one drink and someone my size who metabolizes things so quickly. But I don't drive well and I know this is clear as, you know, as clear as day. Because when I drive with my coach, we drive virtually inside of iracing together. So he's in the cockpit with me, seeing my telemetry, seeing the drive, the whole thing. And it's just a different game. And it's not actually just reaction time. The other thing I've noticed is there's something about my spatial coordination that goes down. So I actually think that that's a bigger problem than the reaction time. I think the bigger issue is you're just. You're never quite hitting the right apex. You're never quite finding the right grip in the track. And this is. Even when you know the track like the back of your hand, you're just off. So. So.

It'S. Spatial attention is one of the things that we can study. We do it with brain scanners very.

Quick. I think that's what's killing.

Me.

Deprivation.

Yeah. Yeah. That I think, together with also just specific choices. You know, if you're racing, you know, you can. If you're by yourself and you're on the clock, that's one thing to worry about. As soon as you put other cars on the track, you make it strategic. When you make it strategic, you make it about decision choices. Do you dive into that apex when you know that you've got someone on your flank? Do you not? When is the time to break? Do I want to break later? Do I have the downforce? Where am I with my tires? You can go through a whole litany of decision making that has to happen within split seconds of time. Decision making again, you know, sleep. Critical component of.

That. And just judgment. I mean, I think that's right. Even having a microscopic miscue on your judgment. And as you said, it's hard enough when you were on a track by yourself, just trying to bang out best lap times the moment someone else is there. And it's incredible how much your judgment can be impaired, even subtly, to do something stupid. For me, you know what it is? It's impatience. I am much more impatient under that.

Situation.

Impulsivity. Yeah. Very.

Impulsive. Respect to the child in the.

Supermarket. Yeah, yeah. Just much more likely to. You know, for example, you think about it. Let's say you have 10 laps to go, and there's one car you need to pass. You know, you think about that for a moment. You've got all the time in the world to figure this out. You. You want to wait until it's perfect. And yet I can see it in myself. There's this belief with like, well, I just got to do it now. It's got to be on this lap. It's this lap or never that I totally irrational thinking. And I have to wonder because it's not. We do see these guys who are gods. I mean, you know, you've driven race cars, I've driven race cars. So we can watch that sport and appreciate it maybe more than the casual observer. Like we know how good they are. Just like someone who plays soccer and watches Messi can appreciate him more than I can, right? Or someone who plays tennis can look at Federer and actually explain why he's so great. That's what we can do with these Formula one guys. And yet sometimes you see them do things that really don't make sense. In the light of this conversation, it's hard to wonder how much of that could be due to impaired sleep, given the again grueling schedule that they have to keep and the enormous time zones they're constantly skipping with very little recovery. I mean it's impossible actually, because on many occasions they won't show up in a new city until Monday or Tuesday. And if you've hopped eight hours.

In a time zone, a great demonstration of this is just simply driving a race car is physical as well. It requires physical fitness and non trivial physical fitness. And a good example of this is that when you're trying to mismatch your physical performance relative to your natural circadian rhythm, which is what happens when you're jet lagged, you are not going to be performing at your optimal sweet spot. And I can tell you that because if you look at the number of world records that are broken in the Olympics, they are statistically far more likely to occur. World record breaking efforts at the peak of most human beings circadian rhythm, which is around about 1 to 2pm in the afternoon. Far more world records broken in the Olympics at that moment on the circadian phase. And if you look earlier in the morning or later in the day, that probability curve actually decreases down. And it's common across all sports. So that shows you that when you are in harmony with your circadian rhythm, your ability to perform physically, according to at least world records, is, is optimized and maximized. So I can only imagine that when it comes to race car driving, if you're shifting between time zones so dramatically and you're not finding ways to optimize your circadian rhythm biology nor your sleep, you are losing a competitive advantage. And you as a team could spend 10 million on trying to shave off 0.1 of a second in a car, which would be heroic as an engineering accomplishment. Yet you could be shaving off 0.4 or 0.5 by way of human error, by way of this thing called insufficient sleep or mismatched circadian rhythm. So as with many things that we're finding now with technology, we're starting to get to the saturation maximum of engineering and technology accomplishments. What we're finding is that the weakest link, the lowest hanging fruit, may no longer be technology. It may no longer be tire compound or downforce. It may be the human being themselves. And if you look at that constellation of things that are taken care of in race car drivers and in most high performance athletes, diet, nutrition, mental health, those three things are well on the radar map of most of them. Sleep, usually.

Not. Yeah. And as you know, because you've driven and I've driven, when I think about what separates people like us, who are enthusiasts from people who are professionals, it's really this ability to be consistently exceptional. I mean, I've probably had individual laps, you know, that were really, really good, where like you could squeak. Like, if you only saw me do that one lap, you'd think, that guy's good. But I don't think I've ever strung together three laps that you could look at and say, wow, that guy's really good. And, you know, that's sort of the, in many ways the challenge for even the best in the world, which is you can't make a mistake on 70 laps. That's two plus hours sometimes. And I think to your earlier point about the reaction times and the speed with which the world is coming at you, when you're driving a formula one car, this need to be incredibly focused, have a level of concentration that, you know, if you think about it, there's no other sport I can think of that requires that level of focus and concentration for, for that long. You know, most sports, you have breaks and you could say, well, sure, if you're on a straightaway, maybe you have a bit more of a break. But I don't know. I don't know about you, but even when I'm on the straightaways going flat out, I'm already going, okay, where's the break zone? Boom, boom, boom. Yeah, yeah. There's really no moment where I'm not.

Focusing. Right. In cognitive neuroscience, we call that essentially a time on task effectively, which is that the longer that you're doing it, does your performance change as a function of time? And firstly, the answer is yes, that your sustained attentional Ability starts to wane the longer that you perform just about any cognitive task. It turns out what's interesting with sleep deprivation is that the effects, the unmasking of insufficient sleep grows the longer that you apply the brain to a task. So maybe for the first 30 seconds, they may be performing 10 seconds at the level of someone who's sleep rested or their own level when they're sleep rested. But you've got to go into kind of minute four or minute five before you really start to see the lines deviate from one another. And that's what we call a time on task effect. And that is most prevalent in what we call sustained attention, sustained spatial attention, which comes right back to exactly what you were discussing. So certainly, I think if it's a missing ingredient in a racing team, it would be a cost savings to you and a point scoring benefit that you may want to look.

Into. Well, Matt, until next time. This has been, I mean, really, really insightful. And when I think about how much I probably know about sleep to begin with and how much I have learned even from this discussion and certainly from reading your work, I'm incredibly grateful. And I do think that this is probably the single biggest deficit within the toolkit of most physicians. And I'm, you know, few people are more critical of the absolute dearth of rigor in the nutrition field. But I think this is worse. And it's not the dearth in the quality of the research, it's the dearth in the translation of that research to clinical application. I agree. I think the research in nutrition is the worst research of all things just. And again, it's not to be critical of the people doing it, it's the difficulty in studying it. But at least there's a greater effort to translate what is known into practice. But here, this is the biggest chasm. That said, I think your work has had a greater impact here than anything I'm aware of. And I wish you all the continued success. I think you could argue part of our humanity depends on.

It. Thank you for giving me firstly that affirmation because I am on a mission to try to reunite humanity with, I think the sleep that it is so desperately bereft of and having this type of forum where you can disseminate that knowledge. I mean, what you described there is that the research has not been translated to the clinical practice. You're absolutely right. And that's part of the work that I do with trying to be a sleep advocate. But another part of that is just the transmission of that sleep knowledge. To the general public as well. And I think people you know, I'm not I can't speak for any of my colleagues, but early on in my career I don't think I did a very good job at communicating science, the importance of sleep to the public through the science. And that's what I've been desperately trying to course correct with the book and then just trying to be out there and having this type of a forum, this type of an opportunity, a long form discussion with, you know, just a fascinating, intelligent mind like yourself who has an incredible listenership. To be given that platform is such a privilege. And so I have an immense amount of gratitude for this time that you've been providing me with. Thank you Peter. Thank.

You. Pleasure is mine. Thanks man. You can find all of this information in@peterattiamd.com podcast there you'll find the show notes, readings and links related to this episode. You can also find my blog@peterattiamd.com maybe the simplest thing to do is to sign up for my subjectively non lame once a week email where I'll update you on what I've been up to, the most interesting papers I've read, and all things related to longevity, science, performance, sleep, etc. On social you can find me on Twitter and Instagram and Facebook, all with the ID peteratti amd. But usually Twitter is the best way to reach me to share your questions and comments. Now for the obligatory disclaimer. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice and note no doctor patient relationship is formed. The use of this information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnoses or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have and should seek the assistance of their healthcare professionals for any such conditions. Lastly, and perhaps most importantly, I take conflicts of interest very seriously. For all of my disclosures, the companies I invest in and or advise, please visit peteratiamd. Com.