#347 – Peter's takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma | Quarterly Podcast Summary #5

View the Show Notes Page for This Episode https://peterattiamd.com/qps5/ Become a Member to Receive Exclusive Content https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250505-pod-qsp5&utm_content=250505-pod-qsp5-podfeed Sign Up to Receive Peter's Weekly Newsletter https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250505-pod-qsp5&utm_content=250505-pod-qsp5-podfeed In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Jeff English on the journey to healing from trauma; Ashley Mason on improving sleep and CBT-I; Sanjay Mehta on misconceptions around radiation and its use in cancer therapy and treating inflammatory conditions (such as arthritis and tendonitis); Sean Mackey on understanding and treating acute and chronic pain; and Susan Desmond-Hellmann on insights from her extraordinary career that pertain to the use of AI in medicine, understanding cancer, and the development of cancer therapeutics. Additionally, Peter shares any behavioral changes he's made for himself or his patients as a result of these fascinating discussions. If you're not a subscriber and are listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed https://peterattiamd.com/members/private-podcast-feed/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250505-pod-qsp5&utm_content=250505-pod-qsp5-podfeedor our website at the episode #347 show notes page https://peterattiamd.com/qps5/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250505-pod-qps5&utm_content=250505-pod-qps5-podfeed. If you are not a subscriber, you can learn more about the subscriber benefits here https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250505-pod-qsp5&utm_content=250505-pod-qsp5-podfeed. We discuss: Summary of episode topics [1:45]; Jeff English episode: how trauma shapes behavior and identity, and the value of understanding personal adaptations and working through unresolved emotional wounds [3:45]; Practical behavioral changes and emotional tools Peter has applied since the Jeff English episode [13:00]; Ashley Mason episode: treating insomnia using CBT-I and practical behavioral techniques for improving sleep quality [19:15]; When to seek professional care for sleep issues [30:30]; Sanjay Mehta episode: radiation therapy's evolution, its underused potential in treating inflammatory conditions, and the cultural misconceptions surrounding radiation exposure [33:45]; Peter's predictions and insights for the upcoming Formula 1 season [43:15]; Sean Mackey episode: the neuroscience, classifications, and treatment strategies for chronic pain, and the importance of personalized care [57:45]; Susan Desmond-Hellmann episode: how AI is revolutionizing medicine through advancements in drug development, biomarker discovery, and the potential of training models on private clinical data [1:05:45]; More from Susan Desmond-Hellmann: why cancer is so difficult to treat with drugs, the promise of immunotherapy, and the long-term hope for systemic treatments [1:14:00]; and More. Connect With Peter on Twitter https://twitter.com/PeterAttiaMD, Instagram https://www.instagram.com/peterattiamd/, Facebook https://www.facebook.com/peterattiamd/ and YouTube https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:10Dr. Peter Attia?

  Hey everyone, welcome to a sneak peek Ask Me Anything, or AMA, episode of The Drive Podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.

• 0:39Dr. Peter Attia?

  Welcome to another quarterly podcast summary episode of The Drive. In today's quarterly podcast summary, I'll discuss what I learned from some of the recent episodes of The Drive, focusing on what I think were the most important insights, as well as any changes in my behaviors as a result. This shouldn't be seen as a replacement for listening to or watching any of the original episodes, but this may be a great way to reinforce things that you already saw, or at least point you back to an episode you missed. In today's episode, we cover interviews that I did with Jeff English, Ashley Mason, Sanjay Mehta, Sean Mackey, and Sue Desmond-Hellman. We revisit topics around trauma, therapy, mental and emotional health, insomnia,

• 1:20Dr. Peter Attia?

  cognitive behavioral therapy for insomnia, and improving sleep, radiology, radiophobia, common misconceptions around it, how radiation is used in not just cancer therapy, but also for treating inflammatory conditions such as arthritis and tendonitis, pain, chronic pain, and how to treat them. And finally, discussions around oncology, cancer drug development, and how AI is impacting medicine now and possibly in the future. If you're a subscriber and you want to watch the full video of this podcast, you can find it on our show notes page. If you're not a subscriber, you can watch the sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy this special quarterly podcast summary AMA of The Drive.

• 2:10Dr. Peter Attia?

  Peter, welcome to another quarterly podcast summary, Ask Me Anything, episode with Peter Attia. How are you doing? Very well. You excited to be here? I am. No place you'd rather be? No place I'd rather be, nothing I'd rather be talking about. Even a race car? Hmm, maybe. Okay, well, it's good to know you're still being honest. So today, we're going to cover looking back at recent episodes on the podcast. As a reminder for people, these quarterly podcast summaries, they are a way for us to talk about and gather insights from you on what you learned from previous episodes, where your behavior changed, where you're thinking about things differently. But they're not necessarily a replacement for these episodes.

• 2:55Dr. Peter Attia?

  What we often find is people kind of use this accompanying, listening to the episode, or even going back and listening to some sections again, based on these insights. And so for today's episode, we're going to look back at previous ones with Jeff English on all things mental, emotional health, trauma, therapy, Ashley Mason, all things related to getting better sleep, insomnia, CBTI, as it relates to improving sleep. We have Sanjay Mehta, looking at radiology, radiation, different ways to look at how that can be used to cure cancer, and also, interestingly, arthritis. We have Sean Mackey, all things related to pain, chronic pain, and getting over pain.

• 3:36Dr. Peter Attia?

  And then Sue Desmond-Hellmann, which was an interesting episode, kind of looking at her career, but ultimately looking at cancer, oncology, drug development, and even an interesting segment on AI and medicine. So a lot to talk about, a lot of different topics, which I think speaks to who we have on the podcast, which is a variety of people, variety of angles. So I think it should be a good one, a lot of different things to chat through. Anything you want to say before we get started? No, let's dive in. Perfect. First one, Jeff English. All things trauma, mental health, therapy, et cetera. Do you kind of want to walk through your insights from that episode? This was an episode I was really looking forward to doing.

• 4:21Dr. Peter Attia?

  As we discuss in the episode, I've obviously known Jeff for many years. I owe him a great debt of gratitude. And this is one of those episodes where between the time we recorded it and the time it came out is probably eight to 10 weeks. During that period of time, I sent the unedited, just straight audio file of it to no fewer than 15 to 20 people. Meaning I couldn't even wait for this episode to come out to be sharing it with people. So I think that probably tells you something. I will be completely comfortable stating that that will be a record that will last for some time. There's no scenario I can think of where I've taken a podcast before it comes out and shared it with so many people.

• 5:06Dr. Peter Attia?

  I would say that most of the people I shared it with not only found it to be incredibly valuable, but actually wanted to sort of engage with Jeff on a professional level after that. So it's one of those podcasts where if it resonates with you, it's really important. You're going to share it a lot. Okay. So what was this episode about? I mean, it really was a great episode about understanding trauma. And it's such a loaded word that I think it's understandable why people might have some skepticism around that. I think the word does get used a little bit too much. But Jeff has a great definition for it, and I jotted it down, right? Which is that trauma is a moment of perceived helplessness that activates the limbic system. This can be a wounding event, a major event, or maybe a series of smaller events.

• 5:48Dr. Peter Attia?

  And those typically get referred to as big tree and little t traumas. So a big T trauma is something really obvious, being the victim of a violent crime, for example. And little T traumas are like a thousand paper cuts. A parent that was there, but just really wasn't paying attention to their kid. And those can be damaging in different ways. So what Jeff talked about was that in trauma, too often people focus on the what happened part of the equation. But he thinks that it's more important to focus on the how did I adapt? Part of the equation. And as he talked about it, the sine qua non of trauma is that there is a disconnected version of a person that shows up to life relying on maladaptive

• 6:31Dr. Peter Attia?

  strategies to replace connection with something else. I think that is a remarkably succinct way to explain things. And it's not judgmental. It's just saying that something happened, a series of things. There have been adaptations. Those adaptations have led to disconnection and maladaptive strategies. This could be things that are perceived of as quote unquote, bad, like alcohol, drugs, gambling, but it could be also things that are perceived of as good, such as work or perfectionism. All of those things replace the sense of connection. So, this is just an episode that I think you have to go back and listen to. But to me,

• 7:14Dr. Peter Attia?

  that was the most important takeaway. He spoke about implicit and explicit memories. So people can explicitly remember an event and think objectively, as I think about that, it didn't really impact me, but implicitly it is impacting them through anxiety or some other type of discomfort. He had a great saying, which is if it's hysterical, it's historical. So I think about this often. When I overreact emotionally, when I calm down, I'm usually asking myself, what was that really about? Was it really about the thing that you blew up over? Or was there something deeper that this is reminding you of in terms of a vulnerability or something like that? Very important distinctions here between guilt and shame.

• 7:56Dr. Peter Attia?

  Guilt is about, as he described it, making a mistake. Shame is about being a mistake. Some people refer to this as healthy shame and unhealthy shame. Again, it's not necessarily one way to think about this. Okay, we talked about the trauma tree. I've heard so many different people talk about trauma in so many different ways. I still think this is one of the better models. And it's a tree because it has roots and it has branches. And the roots are below the ground and the branches are above the ground. And that is a metaphor for the fact that The roots or the causes are not necessarily visible, while the adaptations, the branches are indeed visible.

• 8:37Dr. Peter Attia?

  So very important to understand in this model that intention is not a requirement for the roots of a tree. What do I mean by that? Sometimes the wounding events, i.e. the roots, are not intentional. They're not driven by people who are intending to hurt. This is, I think, a very important thing for people dealing with trauma to understand. Because it's very easy to minimize an event that had an impact on you as a child. For example, if you believe that the person who was responsible for this wasn't trying to hurt you, and that's often the case. So keep that in mind. So what are these? So the five roots are broken down as abuse, which can be physical.

• 9:22Dr. Peter Attia?

  Typically, that is pretty deliberate. Emotional, sexual, again, obviously, these are generally quite deliberate. Religious, so there's an example where it might not be with a malintent, but of course it has bad outcomes. The next would be abandonment. This can be physical abandonment, literally someone being abandoned by a parent, but it could also be emotional. Neglect, which is obviously distinct from abandonment in that the care provider is still present, but is not paying attention to the child. Enmeshment, which is basically boundary violations, emotional incest. This happens when kids have to grow up far too quickly to be emotional caregivers or peers with parents typically. And then tragic events. These are pretty obvious, typically not subtle.

• 10:07Dr. Peter Attia?

  We talk about war, we talk about things of that nature, violent events. Okay, so then we have the branches, and again, the branches are the adaptations here. And the important thing to remember here, and I think this is really helpful for anybody thinking through this for themselves or for others, is that adaptations typically work very well for the child that has been wounded. And again, I use the word wounded as kind of a broad emotional term. The problem is they tend to become maladaptive later in life. He gives a great example of a father. Who is physically abusing the mother of his child. And whenever this happened, the child would run into his bedroom out of fear because dad is getting violent. He's hurting mom.

• 10:52Dr. Peter Attia?

  But one day, the child's fear that his mother was going to be hurt was so great that he ran into the bathroom and pretended that he was sick as a way to distract the father. So the father screams at the mother and says, ah, look what you're doing. Your hysterical whining has made your son sick. And this temporary distraction actually prevented his father from injuring the mother. So that was an amazing adaption. That child basically learned that he could be deceptive and manipulative and it actually worked. It was a really good adaptation and it probably will serve that child well for some time. The problem is it will not serve that child well as an adult.

• 11:36Dr. Peter Attia?

  He describes these adaptations as old friends that serve you well, but lose their utility and become destructive as you age. And so, again, what are these four branches? These four branches are codependency, which he calls an outer reach for inner security. Addictive patterns. Again, these are the most obvious in some ways, so substances, but also work, process, obsession, things of that nature. Attachment issues where the common thread is sort of insecurity. So there's kind of an anxious attachment, avoidant attachment, disorganized attachments. He goes into these in details. And then just kind of a bucket for all other maladaptive strategies here. And I'm sure people can think of many examples. So I think I've learned a lot over the past seven or eight years on this.

• 12:20Dr. Peter Attia?

  But I think Jeff sums it up so well. And I've seen this over and over in myself, in my patients. When you're working through trauma, or if you're on the fence about whether or not you should work through trauma, it's worth remembering, you're either going to deal with it or it's going to deal with you. These things cannot be buried. They're going to always, like a whack a mole thing, always show up at some point. And you can't play whack a mole indefinitely. The first step, I think, is just accepting that that's the case. And that there's a better way to be and that these coping strategies, while incredibly valuable, are probably not helping you, that you may indeed be passing on maladaptive behaviors to your kids

• 13:00Dr. Peter Attia?

  if you're a parent and dealing with something that he describes as putting the adaptive child out of the driver's seat and into the back of the car. So those are probably some of the important things I would take from that episode. I don't think that this summary even remotely serves as a substitute for listening to that. So if you missed that episode and anything I said even remotely piques your curiosity, I think you've got to go back to it.

• 13:26Speaker 01

  Aside from the insights, are there any behaviors that you changed? Maybe from your relationship with Jeff even prior to this? Or even that behaviors that after people listening to Jeff could start to apply in their own life? If they're trying to kind of figure this out for themselves.

• 13:44Dr. Peter Attia?

  To practice, we've talked about this on other podcasts, but practicing or understanding what your practice looks like to expand your distress tolerance window. I write about this quite a bit in the final chapter of Outlive. But it's sort of knowing the things that you do that give you a greater operating window. So for example, for many people, meditation is a great tool to increase the probability of responding as opposed to reacting when something happens. Learning the language of I statements, basically taking ownership for what you think, what you feel, what you do, working through this triad that he describes as the triangle of vulnerability.

• 14:26Dr. Peter Attia?

  So sadness, shame and fear, and trying to be curious about where you are on that triangle and being more responsive to your own emotional vocabulary around these things. Noticing what your coping skills are. Again, I talk and often joke about some of mine that still exist to this day. E-shopping is an enormous coping skill for stress. I just can't stop buying stupid things online when I am stressed out. I feel fortunate in some ways. Really glad that it's not drinking too much alcohol, but it's still a distraction. Even if the worst thing it does is set me back a few dollars, it's preventing me from connecting.

• 15:10Dr. Peter Attia?

  And it's preventing me from accepting and dealing with what it is that's happening. I think there are other things, but I think those would be a great place to sort of start. And obviously we talk about so much more in this episode.

• 15:19Speaker 01

  Someone who, let's say, has listened to the episode and are listening to us and they're like, this is something that I've maybe been ignoring in my own life or pushed aside and decided up to this point not to deal with it. I know you also have patients who are like that. And so when you're talking to people and trying to encourage them to take the first step and to figure out this journey for themselves, any advice you have for those people, just in case they're on the other end, listening here?

• 15:47Dr. Peter Attia?

  I just can't say enough about it. It's one of the things I enjoy talking about with patients more than anything, because even though patients come to our practice because they want to improve their lifespan, they also care about health span. And it's easy to forget that emotional health is a piece of health span. And I think when a person is sort of caught in the vicious cycle of what's often the response to and the adaptation to traumatic events, not necessarily exclusively as children, but often as children, they're not living this connected life that Jeff talks about. And I can just share from personal experience that being disconnected versus being connected is all the difference in living.

• 16:30Dr. Peter Attia?

  And it's not like you flip a switch and everything is fine. It's a process, it's a journey, of course, but I've never met a person who's addressed their negative adaptations and come out on the other side and said, I wish I didn't do that.

• 16:43Speaker 01

  This is a question we get asked a decent amount to the website, so it's here as well. You, in the book of openly talk podcasts, that you went to two centers to kind of like do in-depth work on this. Oftentimes people just ask, hey, what are those called? So they can look them up as well. Obviously, these aren't the only two. But do you just want to state those where people are looking for a first place to start? Two that you found beneficial for you?

• 17:08Dr. Peter Attia?

  Yeah, the first place was called the Bridge to Recovery. I went there in 2017. That's actually where I met Jeff English. We talk about that a lot in the podcast. The second place I went in 2020 was called PCS, Psychological Counseling Services. And I would recommend both of those places very, very highly. And I think PCS focuses on more than just trauma, but it's very trauma focused. The Bridge is really a trauma-based residential program. And again, I'm sure there are others out there that are maybe equally wonderful. I know that for many people, obviously, I've encouraged a number of people to go to these locations. And many have. Everyone acknowledges, as I did upfront, like, are you kidding me?

• 17:54Dr. Peter Attia?

  How about I just keep working with my therapist for an hour, twice a month? That can work, but sometimes it doesn't. And sometimes you actually need to undergo immersive therapy.

• 18:05Speaker 01

  I was gonna have you give this metaphor because you've talked about it before, but I think it clicks with people, which is the idea, if you want to learn a language, one hour a week tutoring in a class is good, but sometimes moving to that country and being forced into that is how you're going to learn better.

• 18:21Dr. Peter Attia?

  Yeah, exactly.

• 18:23Speaker 01

  Last question on this, just because I need to do it. And there's probably people wondering, have you ever bought anything in one of those shopping stints? And you've thought a week later, like, oh, this was actually awesome. I'm glad I did. And if so, what was the best thing that came out of that?

• 18:37Dr. Peter Attia?

  Hmm. I mean, truthfully, and this is obviously just terrible rationalization. I think most things I buy in my e-shopaholic bursts, I'm pretty happy with them. Not all of them. I have bought some really stupid things. And what I tend to do is give them away so that I don't see them again, which is actually counterproductive because I should keep more of those things as a reminder of my bad behavior. In other words, I should surround myself with more of the consequences of those actions.

• 19:12Speaker 01

  It's a great answer. I've spoken like a true shopaholic in that.

• 19:15Dr. Peter Attia?

  Spoken like an addict.

• 19:16Speaker 01

  Actually, yeah, actually, these things are all really awesome. And at the end of the day, I'm really glad I have them.

• 19:22Dr. Peter Attia?

  Right. It's this horrible selection bias. I keep the things that are awesome. I give away the things that are not awesome. It's awful.

• 19:28Speaker 01

  Yes. So does that mean anyone who's ever gotten a gift from you should think that this is actually Peter getting rid of stuff that he doesn't want? Or it doesn't quite work that way?

• 19:38Dr. Peter Attia?

  Doesn't quite work that way. I give away much more than just my non-awesome stuff.

• 19:42Speaker 01

  Okay, that's good. Good to know. Moving on, Ashley Mason. This was a great episode on sleep, insomnia, CBTI, how to improve your sleep. Very, very interesting. I know we talked about already wanting her to come back for part two because we didn't even get through near everything we were hoping to do. So do you want to start with walking through your biggest takeaways, insights from this episode?

• 20:07Dr. Peter Attia?

  Yeah, boy, Ashley is a force of nature. We had sketched out a lot of things we were going to talk about, but we never got out of insomnia and CBTI because I felt like it was just too important to stay there and gather all that information. So yes, definitely we'll have to have Ashley back. So I learned a lot. Honestly, what I came away with is thinking that, okay, I feel like I almost know enough to help people through part of the CBTI playbook without even having to refer out to CBTI. And I think that the takeaway from this episode should be that you can do a lot of CBTI on your own, which is not to say you shouldn't reach out to a practitioner if you're struggling. But the good news is so much of the heavy lifting was covered here. So

• 20:50Dr. Peter Attia?

  first of all, let's just start with the semantics, right? So insomnia must persist for months. It must interfere with life and it must cause distress. This isn't just a few nights of bad rest. So we don't want to over pathologize this. So we're really trying to focus on a meaningful reduction in sleep. CBTI, or cognitive behavioral therapy for insomnia, is one of the most effective tools for addressing serious insomnia. Fifty to 60 people who utilize this achieve a complete remission. And 70% show improvement. So there are lots of contributing factors to the development of insomnia.

• 21:31Dr. Peter Attia?

  So you have predisposing factors like genetics, past experiences. You have precipitating factors such as a life crisis, divorce, enormous stressful experiences at work. And then you have perpetuating factors or coping strategies, like what you do when you are in this state of insomnia. Now, CBTI only focuses on the latter. It does not concern itself with what your predisposing factors are, doesn't even care what the precipitating factor is, and doesn't try to stratify people based on those things. It basically says, you're here, you're having significant insomnia. What are you doing to cope with it? And how do we address that?

• 22:13Dr. Peter Attia?

  So in that sense, the treatment is independent of the first two. Of course, I should just say this before we go on. You do need to address any sleep pathology like restless leg syndrome or sleep apnea before engaging in this. So you have to rule out that kind of stuff. Okay, so CBTI is really about addressing this triangle of thoughts to feelings to behaviors. So picture a triangle, thoughts, feelings, behaviors, where each one is influencing the next. And the discussion with Ashley was really a great way to kind of go through all of the behavioral changes to mitigate insomnia, which fall under the themes that are, I think, bucketed as sleep hygiene, stimulus control,

• 22:57Dr. Peter Attia?

  time in bed restriction, cognitive techniques, and relaxation techniques. So let's just talk about each of these. Sleep hygiene is something that listeners of this podcast are very familiar with. These include things like keeping the room temperature cold in the mid 60s, even if you need to wear socks, keeping the room as dark as possible, and using an eye mask if that's necessary. It means not drinking too much fluid after dinner to reduce the probability that you need to get up and pee at night. This means addressing prostate issues if you're a male, things of that nature. It means getting rid of down comforters and heavy blankets, which disrupt the circadian temperature rhythm. Remember, when we're in bed,

• 23:39Dr. Peter Attia?

  we're supposed to get into bed and rapidly begin a process of cooling to get into our deepest sleep before we begin to warm, a couple of hours before we wake up. She said anything with duvet in it should be banned. So basically, anything that's gonna keep too much heat in is a bad idea. Okay, what's stimulus control? Stimulus control means limiting the bed to only two things, sleep and sex. Everything else happens somewhere else. That means no phone. That means no reading. And while those are obvious, the other thing she made a really clear point about was no worrying. Now, you might say, well, who sets out to worry in bed? But what she really means by that, and I think this is very important,

• 24:20Dr. Peter Attia?

  is that you don't want to spend time laying in bed awake. So if you're laying in bed and you're awake, especially if you're worrying, you need to get out of bed and do something else. So she talks about people who suffer from insomnia. One of the important things you have to do is get them out of bed for 20 to 30 minutes to do something really low key. She had a funny description of, get out of bed and do something that you would be embarrassed if your colleagues at work saw you doing it. In other words, don't get out of bed at 3:00 in the morning to go and work for 30 minutes. Get out of bed for 30 minutes to read a trashy magazine or watch some silly sitcom, but something that's not really activating

• 25:04Dr. Peter Attia?

  and allow yourself to get a little bit sleepy and then come back to bed. By the way, not long after the podcast with Ashley, and I rarely experience insomnia, but I went through a couple of days when I was being jolted up at 2:00 or 3:00 in the morning and could not get back to sleep. And my inclination was sort of to sit there and just fight it and fight it and fight it. And finally, on the third night, I was like, why am I not just doing what Ashley said? So as soon as it happened, I got up, went out to the couch in the family room, threw down an episode of Silicon Valley, which, as you know, you and I talk about this all the time, like one of the greatest shows of all time, and then just went back. And went to bed. So that's an example of something that's super low key that allowed me to get back into it.

• 25:48Dr. Peter Attia?

  The next one here is really, really hard for people to wrap their head around sometime, but it's called time in bed restriction. Previously, people referred to this as sleep restriction, which the name of that is obvious. So why would you do such a thing? Well, the problem is for many people with insomnia, they're actually spending too much time in bed and their sleep efficiency is really low. They're spending a lot of time in bed because they're tired, because they're not sleeping and it becomes a vicious cycle. Now, anybody who's used a wearable for sleep or uses anything that measures sleep probably notices a calculation that gets spit out called sleep efficiency. Sleep efficiency is time sleeping divided by time in bed.

• 26:29Dr. Peter Attia?

  You want to be able to hit at least 85% here. I should say you want to be able to hit about 85% here. So to be clear, if you're hitting 95%, you're not giving yourself enough time in bed is almost assuredly the case. And if you're hitting 75%, you're probably spending too much time in bed. So to restrict time in bed, you want to first understand your typical time asleep with a sleep diary. And then you add a 30 minute buffer to get your target time in bed. So you can also determine the ideal wake up time and base your time in bed off this wake up time. So getting your wake up time right is key. This is the thing that you want to be fixed.

• 27:11Dr. Peter Attia?

  And then your bedtime starts to take care of itself as you build up sleep pressure over time. You've probably heard me talk about this on the podcast before, the more consistent your wake up time is, even on weekends, the easier it is to control sleep hygiene. The term of people who let their sleep schedules move on weekends and they sleep in a lot later, which is understandable, right? Like if you work Monday through Friday and you're getting up at five in the morning, it is real tempting on the weekends to sleep till eight or nine o'clock. The problem is that process of social jet lag is devastating for your circadian rhythm. So she describes focusing on process S, which is

• 27:52Dr. Peter Attia?

  Sleep pressure to standardize what she calls process C or circadian rhythm. And we talked a little bit about sleep trackers. She does not recommend using them if you're struggling with insomnia. And I couldn't agree more from our own practice. One of the first things we do when people are struggling with sleep is we get them to take their sleep trackers. And at best, put them away, at worst, throw them out. Once this kind of gets in your head, it becomes a brutal cycle. So you don't need this to fix the problem. Cognitive techniques, I found this to be very interesting. Schedule time for worrying. Again, for many people, the waking up part then triggers the set of ruminating thoughts.

• 28:34Dr. Peter Attia?

  Insomnia sometimes arises from not processing information enough during the daytime and spending too much time in bed ruminating. So she has her patients schedule worry time by intentionally putting something on the calendar where they literally write down all the things that they are worried about. And they might have 20 minutes a day to do that. And then they don't have to feel the need to process this at night. So you think about the things that you would normally think about laying awake in bed. And all of a sudden, it gets a lot better. She does something called tracking the degree of belief, which means asking yourself, how much do I believe this is true? So a lot of times people will find the things that seem absolutely certain in the evening

• 29:17Dr. Peter Attia?

  may turn out to be kind of unlikely during the day. They just feel more certain of it before bed, which increases worrying. So again, these are some of the techniques. I won't go through all the other stuff. There's some stuff she talks about on relaxation, which I think is helpful. And she also talked about A B testing, other things that are probably less effective. She wasn't a huge proponent of blocking out blue light, but she said it's always worth trying. If wearing red light or blue light glasses in the evening helps, she's like, by all means, great. Give it a shot. Obviously experimenting on timing of caffeine, medication, supplements, all great. But her view is just test those things out. So yeah, I would say those were kind of the big things.

• 30:01Speaker 01

  And Peter, remind me, did she talk about anything on like sleep supplements, sleep prescription drugs that people should think about, potentially use if they're going through this?

• 30:12Dr. Peter Attia?

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• 31:40Dr. Peter Attia?

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• 32:12Dr. Peter Attia?

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• 32:56Dr. Peter Attia?

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