chris lee

So I used to be a TERRIBLE abuser of sleep. With little kids and a business, I found myself often trying to get a second shift in after the family went to sleep. And I would not infrequently work all-nighters.

My family and extended family constantly were on me about this.

Finally Taking It Seriously

Once I started listening to Peter Attia, I was introduced to Matt Walker, basically the sleep expert that everyone refers to.

Matt wrote the book, Why We Sleep, and that has some really good tips in it. He’s also got his own podcast but you’ll see him on pretty much everybody’s podcast in the health & longevity space.

My Take

With my inclinations away from medicines/supplements and in an effort to try to do things affordably, these are a collection of tips that I’ve got from Attia, Walker and a variety of people in an order that makes sense to me.

Sleep Tips

1. Keep a regular sleep pattern

Your body’s circadian rhythm functions on a set loop.

Establish a regular bedtime and wake time routine. You can’t achieve a healthy sleep routine if you are always waking up at different times.

Pick a wake-up time and stick with it, even on weekends.

2. Start with and increase bright light exposure during the day

Sunlight helps your body manage your internal clack (your circadian rhythm).

Get sunlight in your eyes first thing in the morning for at least 10 minutes if you can. This improves daytime energy and helps nighttime sleep quality and duration.

Get outside for at least 30 minutes per day.

3. Exercise regularly (but not before bed)

Regular exercise also helps with sleep.

In some studies, exercise reduced time to fall asleep by 55%, total night wakefulness by 30%, and anxiety by 15% while increasing total sleep time by 18%.

Don’t perform it too late in the day or too close to bedtime though. Exercise increases alertness and hormones like epinephrine and adrenaline.

4. Reduce irregular or long daytime naps

Long or irregular naps during the day can negatively affect your sleep.

Sleeping in the daytime can also confuse your internal clock.

5. Don’t consume caffeine late in the day

Caffeine has numerous benefits but when consumed late in the day, caffeine stimulates your nervous system and may stop your body from naturally relaxing at night.

Try to avoid caffeine up to 6 hours before bed.

6. Don’t drink alcohol

At this point, it’s been proven that no amount of alcohol has health benefits.

One of the worst things alcohol, especially too close to bedtime, does is impair sleep. It can cause sleep apnea, snoring, and disrupted sleep patterns as well as alter nighttime melatonin production.

Try to limit alcohol and not to drink within 3 hours of bed.

7. Don’t eat late in the evening

Eating too close to bedtime can also impair sleep.

Avoid late dinners and minimise fatty or spicy foods.

8. Don’t drink any liquids before bed

Try to get your hydration needs in early in the day.

Drinking too close to bedtime can cause nocturia (medical term for excessive urination during the night).

Try to not drink any fluids 1-2 hours before going to bed. Also, use the bathroom right before going to bed if you can to try to decrease your chances of waking in the night.

9. Reduce blue light exposure in the evening

Exposure to light during the day is beneficial, but nighttime light exposure has the opposite effect.

This is because of its effect on your circadian rhythm, tricking your brain into thinking it’s still daytime. This reduces hormones like melatonin which help you relax and get deep sleep.

Avoid blue light from electronic devices like smartphones and computers. You can do a bunch of stuff like wearing glasses that block blue light, use an app like f.lux to block blue light on your laptop or computer.

I think the best thing to do is avoid your phone and turn off any bright lights a couple hours before bed.

10. Disconnect Devices in the Hour Before Bed

In addition to the blue light issues, phones, computers, tablets keep your brain active, making it hard to wind down.

Best to develop a habit of disconnect for an hour or more before bed. Never hurts to read (book or Kindle with their alternate screen technology)

11. Optimize your bedroom environment

Make sure your bedroom is set up to facilitate sleep with regard to temperature, noise, lights.

External noise and light can cause poor sleep.

If you can get rid of light sources and keep your room really dark, that is great. Some folks have success with eye and ear masks. Attia likes the Alaska Bear Sleep Mask & has tons of them so finding one is never an issue. Tim Ferriss has been a big fan of the Sleep Master Sleep Mask as it covers both your eyes and ears (though I think he’s switched to WAOAW). He also wears ear plugs.

I use a mask at times but luckily we live out in the boonies with nobody around us.

12. Set a cool bedroom temperature

So I split this one off from environment because I think it’s so important.

Basically, you need to drop your core body temperature by two to three degrees Fahrenheit to initiate sleep and then to stay asleep. That’s why it’s easier to sleep in a cold room than a hot room.

Ideally, bedroom temp should be 65-68°F (18-20°C).

One of the things I do is always do a hot shower before bed to help with this process. Brings the blood to the surface. And when our body surface is warm, it dumps the heat from the core of our body.

Attia, Tim Ferris and pretty much everybody in the longevity space sleeps with a cooling mattress or mattress cooling pad. In the old days, people started with the ChiliPad by Ooler (now sleepme). At this point, most people have moved to a mattress or pad from a company called Eight Sleep. It’s expensive. These devices can vary the temperature of the bed by person and at different times (allowing you to dial in your ideal preferences). They also track sleep data like an Oura ring or a Whoop.

I haven’t pulled the trigger on one of these yet but something I’m thinking about.

13. Try a pre-sleep routine to relax to wind down

Listening to relaxing music, reading a book, taking a hot bath, meditating, deep breathing, and visualization are all things that can be effective.

14. Take a hot bath or shower

I mentioned this above but I think it’s a good separate strategy.

In addition to relaxing oneself, it helps cool the body’s core temperature. It warms up the extremities, getting more blood supply into them. This draws blood away from your core and allows your core temperature to drop

15. Reserve Your Bed for Sleep and Sex Only

Don’t linger in your bed. If you do, you’re training your brain that your bed is not only for sleep. You want your brain to have a strong mental association between your bed and sleep

This also means, get out of bed in the morning. And if you can’t fall asleep (for 20 minutes or more), get out of bed & do something relaxing in low light. Come back when you’re tired.

16. Keep a Sleep Diary

Some folks find keeping a daily sleep journal beneficial. It can help you to identify factors that might be helping or hurting your sleep. This is not really my bag but it can help.

17. Consider supplements

So I prefer to try to do things other than pharmacology first but I’ve listed some things other folks recommend. I do take magnesium and electrolytes daily.

• Glycine – Attia takes 2 grams. Some studies call for 3. It inhibits motor activity during rapid eye movement (REM) sleep. The hope is that it is calming the central nervous system.
• Ashwagandha – Attia takes 600 milligrams. It reduces activation of the hypothalamic pituitary adrenal access and the cortisol release.
• Magnesium L-threonate – Attia takes roughly 2 grams. Matt Walker talks about a correlation with insomnia & magnesium deficiency.

Some other stuff:

• Melatonin – A lot of people recommend this. Attia does not. It down regulates melatonin receptors in the brain so the brain gets sort of desensitized to it and can interfere with natural melatonin efficacy.
• Ginkgo biloba – A natural herb that may aid sleep, relaxation, and stress reduction. Evidence is limited.
• Valerian root – May help you fall asleep and improve sleep quality.
• Lavender – Can induce a calming and sedentary effect to improve sleep.
• Attia also takes a couple of drugs called Pregabalin & Trazodone.

 

So I follow a lot of people…

And one of my primary interests over the past few years has become healthspan (how well you live) and lifespan (how long you live).

Some of my other favourites in the healthspan space are Ben Patrick (of ATG/@kneesovertoesguy), Oliver Burkeman (his work on philosophy and psychology of time management and happiness), Iñigo San-Millán, Ph.D. (his work on Zone 2 training), Andy Galpin, Ph.D. (his work on exercise & training), Matthew Walker, Ph.D. (his work on sleep), Alan Couzens (his work on exercise/training), Kelly Starrett (his work on mobility), Keegan Smith (his work on strength and athletic performance training), Andrew Huberman, Ph.D. (his podcast on science and science-based tools for everyday life), Layne Norton, Ph.D. (diet/nutrition/training) and Michael Easter, MA (his work on rucking & discomfort).

Peter Attia Background

But the one who I have taken most from is Peter Attia, MD and his research and content.

Attia has a medical practice that works to lengthen patients’ lifespan and simultaneously improving their healthspan. He publishes much of his research and strategies on his podcast, The Drive and after a long time, published his book, Outlive: The Science and Art of Longevity.

He’s got a very interesting past where he combines experiences and strategies from a range of areas. Got his medical degree from Stanford, trained for five years at the Johns Hopkins Hospital in general surgery, spent two years at the National Institutes of Health as a surgical oncology fellow at the National Cancer Institute, left medicine to work analysing credit risk at McKinsey & Co. & then came back to it. He has bachelor’s degree in both mechanical engineering and applied mathematics.

I think all of those go together in an interesting way (medicine, interest in fitness, data/analysis orientation from mathematics & engineering, focus risk/reward from his consulting days) to support his current Body of Work.

He is in a unique position with all of that experience and skills that most doctors don’t have at all.

I really like that his recommendations are based on good science & data. And that he changes beliefs as new data comes out. One of his principles is “strong convictions, loosely held.”

His practice is quite boutique, focusing on healthspan/lifespan. More of a consultant. He’s the doc for Tim Ferris, Rogan, Hugh Jackman, a bunch of San Fransisco tech founders you know the names of, various famous Hollywood folk and Wall Street muckity mucks.

I’ve heard his retainer is anywhere from 90-150K/year. And he’s not even their primary care doctor.

Healthspan/Lifespan Approach

The high level basics of his belief start with the strategy to delay the onset of the major diseases as long as we can through a variety of interventions.

Much of today’s medicine is focused on treating people after they develop disease.

His focus is on doing as much as possible to prevent the onset of those diseases.

And then he is also super focused on building our mental and physical capabilties up to super high levels (with respect to things like muscle mass/strength, bone health, cardiorespiratory fitness, metabolic flexibility) so that as the inevitable declines that comes with age eventuate, we are still left with a good degree of health and fitness.

The Four Horsemen of Death

80% of the deaths of people over 50 who do not smoke are caused by 4 diseases/syndromes.

They are:

1. Atherosclerosis (comprised of  cardiovascular disease & cerebrovascular disease)
2. Cancer
3. Metabolic Disease (everything from hyperinsulinemia to insulin resistance to fatty liver disease (NAFLD & NASH) to type 2 diabetes)
4. Neurodegenerative disease (Alzheimer’s disease being the most common)

Attia’s Five Interventions

His belief is that the best way to avoid/mitigate the Four Horsemen are through a series of interventions.

The categories he groups them into are:

1. Exercise – MOST CRITICAL intervention for many
   • Stability
   • Strength
   • Aerobic Fitness
   • Anaerobic Fitness
2. Sleep
   • Critical to get 8 hours or so of good sleep
3. Nutritional Biochemistry
   • Diet agnostic but needs to build metabolic health/flexibility
   • Very pro-keto for several years but has eschewed any specific diet religion
   • Some principles
     • Need to be on a caloric appropriate diet. For those needing calorie restriction
       • time – reduce your feeding window to achieve caloric restriction
       • dietary – eliminate certain foods/food groups from your diet to achieve caloric restriction (keto/low carb/vegan)
       • caloric – eat whatever but track your calories to ensure you’re in caloric restriction
     • Protein is critical to growing/maintaining muscle mass – necessary for metabolic health
     • Fiber is needed.
     • Micronutrients are needed.
4. Pharmacology – ALL of this would be individual to the person but some common mentions are…
   • Takes a series of regular supplements like creatine, magnesium, electrolytes, etc.
   • Aggressive in reducing ApoB for cardiovascular health which often results in statin use (or PSK9 inhibitors or other)
   • While he doesn’t recommend for all, takes rapamycin for longevity (doesn’t take metformin any longer)
5. Emotional Health – also completely individual

Exercise Efficacy

So although Attia caveats that all of the interventions are particular to a given person, assuming everything is in a degree of order, exercise is the most effective intervention to increase lifespan and healthspan.

“Exercise is by far the most potent longevity ‘drug,'” says Attia in his book Outlive. “The data are unambiguous: Exercise not only delays actual death but also prevents both cognitive and physical decline better than any other intervention. It is the single most potent tool we have in the health-span-enhancing toolkit—and that includes nutrition, sleep, and meds.”

As an example, it’s accepted that smoking or diabetes will double or triple a person’s risk of death.

Exercise can have double the positive impact that those do.

• High cardio respiratory fitness (having an elite VO2 max – in the top 2.5% of their age bracket) has a 5-fold reduction in all cause mortality.  That is the most highly correlated metric to a long life.
• And the second most highly correlated metric to length of life is composite metric of strength & muscle mass. High strength and muscle mass has a 3-fold reduction in all cause mortality.

There are no drugs that have anywhere near these levels of reduction in mortality.

Statistically speaking, smoking,  hypertension, type 2 diabetes, even the presence of cancer has less of impact on the shortness of a person’s life than excellent levels of VO2 max and strength.

Four Pillars of Exercise

1. Stability
   • Attia pursues a series of boutique exercises for stability that are a combination of Dynamic Neuromuscular Stabilisation (DNS) techniques and ones his personal trainer, Beth Lewis, has developed.
   • I personally am a big fan of Ben Patrick (of ATG/@kneesovertoesguy) for exercises that address stability, neuromuscular range and joint health.
2. Strength – Attia focuses on movements that develop
   • Grip strength
   • Concentric & eccentric loading
   • Pulling motions
   • Hip hinging
3. Aerobic efficiency
   • Zone 2 to widen VO2 max base – basically stead state training right a level where a person is still able to clear lactate (around 2 mmol/L)
   • Absent monitoring of lactate, RPE (rating of perceived exertion) can be useful to stay in this range. That rate of lactate clearance is about the level of activity where you can maintain a conversation but it’s not comfortable – basically if you were on the phone, the person would definitely know you were exercising.
   • This training helps develop mitochondrial function which improves energy production and the efficiency of fat-burning.
   • Prescription of a minimum of 3 hours per week (4x 45 min sessions or 3x 30 min sessions).
4. Anaerobic performance
   • Zone 5 to train VO2 max peak
   • Prescription of 1 set weekly of 5 sets of 4 minutes at the highest output you can sustain followed by 4 minutes of recovery.
   • Airbike, rower, stair master, treadmill are all good for this.

Sleep

Sleep is another area I’ve really focused on trying to improve. I make it a priority and try to get 8 hours every night.

I’ve also moderated some other behaviours so as not to impair sleep. Getting good sleep is really the primary reason I’ve minimised drinking alcohol.

Some of the Tips I Think Are Most Helpful

Have a bit more at https://chris.ly/sleep/.

• 1. Keep a regular sleep pattern
  • Your body’s circadian rhythm functions on a set loop. Establish a regular bedtime and wake time routine, even on weekends.
• 2. Start with and increase bright light exposure during the day
  • Sunlight helps your body manage your internal clack (your circadian rhythm). Get sunlight in your eyes first thing in the morning for at least 10 minutes if you can as it helps nighttime sleep quality and duration.
• 3. Exercise regularly (but not before bed)
  • Regular exercise also helps with sleep but don’t perform it too late in the day or too close to bedtime. Exercise increases alertness and hormones like epinephrine and adrenaline.
• 4. Reduce naps
  • Long or irregular naps during the day can negatively affect your sleep. Sleeping in the daytime can also confuse your internal clock.
• 5. Don’t consume caffeine late in the day
  • When consumed late in the day, caffeine stimulates your nervous system and may stop your body from naturally relaxing at night. Try to avoid caffeine up to 6 hours before bed.
• 6. Don’t drink alcohol
  • At this point, it’s been proven that no amount of alcohol has health benefits. And it absolutely does is impair sleep. Try to limit alcohol and not to drink within 3 hours of bed.
• 7. Don’t eat late in the evening
  • Eating too close to bedtime can also impair sleep. Avoid late dinners and minimise fatty or spicy foods.
• 8. Don’t drink liquids before bed
  • Try to get your hydration needs in early in the day. Drinking too close to bedtime can cause nocturia (medical term for excessive urination during the night). Try to not drink any fluids 1-2 hours before going to bed.
• 9. Reduce blue light exposure in the evening
  • Nighttime light affects your circadian rhythm, tricking your brain into thinking it’s still daytime. Avoid blue light from electronic devices like smartphones and computers. You can do a bunch of stuff like wearing glasses that block blue light, use an app like f.lux to block blue light on your laptop or computer but I think the best thing to do is avoid your phone and turn off any bright lights a couple hours before bed.
• 11. Optimize your bedroom environment
  • Make sure your bedroom is set up to facilitate sleep with regard to temperature, noise, lights. Get rid of light sources and keep your room really dark. Some folks have success with eye and ear masks/plugs.
• 12. Set a cool bedroom temperature
  • Ideal bedroom temp should be 65-68°F (18-20°C). Many people who are into longevity/healthspan use a cooling mattress or mattress cooling pad. At this point, most people in the space have moved to a mattress or pad from a company called Eight Sleep.
• 14. Take a hot bath or shower
  • In addition to relaxing oneself, it helps cool the body’s core temperature. It warms up the extremities, getting more blood supply into them. This draws blood away from your core and allows your core temperature to drop
• 15. Reserve Your Bed for Sleep and Sex Only
  • Don’t linger in your bed. If you do, you’re training your brain that your bed is not only for sleep. You want your brain to have a strong mental association between your bed and sleep.

Other stuff…

I’ll write more on his other stuff soon but those are the things of my current primary focus.

I’ve also improved and prioritised my sleep tremendously after abusing it terribly for years (working WAY too many late nights).