Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
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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, 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, 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 going to 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, 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 three 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 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 two or three 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 in and went to bed. So that's an example of something that's super low key that allowed me to get back into it.
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. 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 of sleep 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. 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 a 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 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. Insomnia sometimes arises from not processing information enough during the daytime. 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 may turn out to be kind of unlikely during the day.
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