Sleep and Longevity: What a Stanford Sleep Doctor Says About Wearables & AI

I'm Ron John Nag, and this is the R42 podcast where AI, longevity science and venture intersect. Welcome Martin, Dr Martin Kowalski, where we're going to learn why do we need sleep? We'll learn about Martin's career, how do you become a sleep doctor? You know, do you sort of dream about that when you're six-year-old? I want to be a sleep doctor. I wanted to be an astronaut myself. I didn't make that, but so Martin, first of all, tell us about you, how do you become a sleep doctor? You're a genius, do you have straight ace as a kid, or did you just work hard? How do you become clever? You teach at Stanford University, you teach your own sleep courses, you're based in Austria, you fly around a lot, you're a Gaysie object lag, how do you become Dr Martin Kowalski? Everyone, John, it's fun to be here, thank you. I'm not sure about the genius part, but I'll take it, thank you. So yes, everything is, you said it's true, I straddle two continents, my partner lives in Austria, so I spend a lot of time there, and the rest of the time I'm here in Silicon Valley. How do they get here? I'll tell you this. I did not want to be a doctor, and hindsight, I think I wanted to be an engineer. As a kid, I was an astronaut geek, and I used to take my toy support to see how they work. That's definitely that, but I grew up in a medical family, both my parents are doctors, and that was a natural path. But it was clear to me that I wanted to build things, even when I was defending my PhD dissertation, I pitched to the whole panel of professors an idea to, that was my thesis, how to measure sleep apnea with nothing but your iPhone, and then back then wired AirPods. Unfortunately, someone had a button on that, so that never became a product. Okay, so why do we need sleep? I mean, I've got a friend who only needs, supposedly, only needs four hours of sleep, but why is sleep existent? Is it an evolution kind of thing? Okay, great question, but allow me to tackle your other question first, your friend. Yes, these lucky individuals exist, we call them super sleepers, and that's about one, maybe two percent of population, and it's mostly genetically determined, and these individuals thrive on four hours or less. They are also almost entirely immune to jet lag. For the rest of us, like, please sleep around seven, seven and a half hours. I'm very jealous of your friend. How about you answer your main question, why do we sleep? Well, first of all, there's a great book by Matthew Walker, and exactly the same title, so I highly recommend that, but short answer would be, think of sleep as not one function, but more of a maintenance window for at least five different systems that cannot run while the machine in the body is in use. So, I can think of number one with the waste clearance, and I specifically mean brain waste clearance on during slow wave sleep, the one that happens in the first third of your nights, the space between your neurons shrank. Allowing the servo spinal fluid to flush out the metabolites, including misfolded proteins, including amyloid beta. So, we definitely want that as a protective motor against neurovigenerative diseases. So, these amyloid beta, for example, that are correlated to dementia. These are these plaques that we're here about. And so, if you sleep better, you have less chance of getting those-- That's precisely what I'm saying. That is precisely what I'm saying. And the second one would be your memory, memory filling. So, your hippocampus, if you'll say-- So, to speak, replace the day back to your cortex, and memory becomes permanent. And then there's this concept of synaptic pruning. So, what that means is during the day, your synopsis, that the points where neurons connect to each other, they get bigger, they get stronger. But, if there was no downtime, the brain would have been overstimulated, like there would be no space to run in anything new. So, during synaptic pruning, sleep scales them back down, so you can learn again tomorrow. The strongest signal survived. The weakest one are just cleared. The number four would be the entire hormonal regulation. And, let's call it immune system housekeeping. I'll practice an example of that would be about 80% of your growth hormone gets released in the first bout of deep sleep, during daily nights. Still, within the same reason, number four, hormonal immune housekeeping, we will, I'm sure we'll touch on that later in our discussion. But, this is why regularity is so critical. Let me give you this example because you know that I traveled between Austria and the West Coast. If I were to land in Austria and get my blood work done, most likely the lab would flag very high cortisol. Not that the flight was so stressful, but my body would be still on some consistent time. If your sleep is regular, the time when the hormones gets released very greatly. And, the fifth function I can think of would be emotional processing. That happens towards the ends of your regular sleep, hopefully regular sleep during REM. REM being rapid eye movements. So, to sum it up, you have at least five distinct reasons for sleep. Brain wave clearance, memory, synaptic pruning, hormonal regulation, emotional processing. People who, you know, depending on which end of your night you trim, you're going to suffer different consequences. If you routinely have to get up earlier than your body prefers, emotional regulation is something that would suffer in it. This would be the first consequence. Like, you'd be much more reactive, much more likely to just lash out on your partner or simply be very impatient. Now, do women and men sleep differently? Or is it the same because we're just all humans? I think, in a non-night to night comparison basis, they sleep very similarly. Over the entire lifespan, yes, we see differences. The one being, as we get older, men typically lose more deep sleep versus women who lose more REM sleep. Right, in the deep sleep, what's happening there versus the REM sleep? The dreaming is in the REM part. What does the dreams do in the REM part? And what does the deep sleep do? Deep sleep is, let's start with the deep sleep. Happens in the first third of the night. The brain waves associated with deep sleep are looking at very slow high amplitude oscillations. In contrast to the time when you're awake, or REM sleep, where everything is very fast, very small amplitude. Deep sleep. Two things that I mentioned already. Number one, a lot of most of your growth hormones is released during your sleep. Number two, the glint fatigue system, brains internal waste disposal system is activated. Two things worth remembering. Fast forward to the last third of the night, and this is something I would like to emphasize. These stages have very, very specific particular places on the time axis of your night. First, third of the night, there's deep sleep that dominates in your cycles. 90-minute cycles, you're going to get most of your deep sleep in the first 30% of your night. And most of your REM sleep will happen towards the ends. And during REM sleep, during dreaming, this is where all of the emotional process I've done. The brain sort of de-fragments itself and goes to all the day time experiences. It's the only time when the brain is both highly active, but neurodrenal is switched off. So it can replay all the emotional memory without all the stress chemistry. It's like overnight therapy. If I were to name this, let's do this. If we were to name the four stages of sleep, that would be n1, which is non-rem sleep 1, this is just your hotel lobby. This is two, maybe 4% of your sleep. It's a transition phase. You just go through the hotel lobby. Nothing really important happens there. If I were to touch your shoulder, you'd swear you're not asleep. Then n2, which is non-rem 2, that's all the wearables called core sleep or light sleep. And that's around 50% of your sleep. Very important. We want to have healthy proportions of each sleep stage. So I would say this is your filling cabinet. This is where all the memories get sorted. Like this one's worth keeping, we're shrinking down the synopsis. This is the filling cabinet. Then deep sleep would be in the car wash station. This is where all the waste disposal happens. And RAM, I would say, therapist's couch. This is all the emotional processing. Hope that helps you visualize the stages. And then the growth hormone, I mean, if you're not growing, I mean, athletes, they'd like that for muscle build up. But if you're older, do you actually need the growth hormone? We're more worried about that waste clearance part. What do you think about that? Sure, let's stay with hormones for moments. It's not just, it's not just grow hormones. So, but let's go under one. You're in a deep sleep. It's actually 80% of your growth hormone, which, in turn, is highly correlated with your insulin sensitivity. So individuals who are sleep deprived, routinely, chronically sleep deprived, will be much less insulin sensitive, meaning their bodies will have to pump up much more insulin to have the same plasma glucose reduction. And, you know, so this is important for anyone. It doesn't matter if you're trying to build muscle mass. But there is more. There are two hormones that regulate rate your hunger and satiety. Grelin, which says, I'm hungry and leptin, I'm full. And these signals get completely mixed up in the absence of sufficient amount of sleep. And, you know, like, even a single night, a single night of missed sleep will reduce your muscle protein synthesis by 20%. So you can spend all the time you want in the gym. But then if you're not sleeping enough, like that was just wasted time. And your testosterone will, in man, will drop by around 25% overnight. And let's say you're going to lose weight. Let's say you're in a diet. Single night of missed sleep, your fat loss, daily fat loss goes down by 50%. At the same time, you're burning your lean muscle mass by more than 60%. So like, everything we want to avoid and all weight loss programs and muscle gain programs, like, I would say start with healthy sleep. Sleep your way to better weight. So can you force yourself to sleep? Sometimes, you know, particularly the jet lag thing, because there's these apps that you can get. So you know, take sleep now when you get on the plane. But notice I was sort of synchronizing the new time zone. I find that quite difficult to do, actually. You know, the little tricks and things that drink caffeine when you're supposed to be away, put his lungs meditate, they can sort of force themselves into a brain zone of meditation state. Can we actually train ourselves to be in a sleep mode? I think you touched on that on a few important things here. So let's differentiate between forcing yourself back to sleep when you say you wake up at 3 a.m. and you're lying restless in your bed. And it's really difficult. And it would be really difficult. And if that's the case, I would actually tell you, like, Rungion, please stop forcing you. Trying to force yourself back to sleep. Please, please get out of bed. Go to your living room, get your candle, get your book. Read for half an hour. And if you feel tired, a reason being I don't want you to build that subconscious, or even conscious association of being in bed frustrated that you can't fall asleep. But what I'm thinking there is I'm wasting 15 minutes of sleep, which I could be. And every minute may come. That's not that. I understand that. But I would like to displace that thought. And actually one of the useful techniques would be, let's say, take a longer word like an orange. And go through every single spell in your mind. And go through every single letter. And come up with a noun and visualize that object in your-- anything to keep that nagging thought of, oh my god, I have a very stark tomorrow. I'm losing a precious 15 minutes. Because that's how-- This is how I'm productive. Variation of the counting. She-- let's talk about the athlete level. The British cycling team went into what's called micro-optimization, not just sleep. The sleep was one of them. And when they traveled from place to place, they'd been their own sheets, spin their own pillows, do the blackout curtains. And they calculated they got four minutes extra sleep. And their level, though, I think the coach thought actually made a difference that their level of athletic performance is-- do you think that's the case? Or is that more just part of many, many optimizations that a team like that would have done? I think the letter, honestly. I have a hard time believing that whatever device that they were using, let's say, probably oral rings. A lot of athletes either have whoop or oral rings. These devices simply do not have the time resolution that's sufficient to claim the case that was four minutes. Let's go to wearables. Well, I thought, oh, I'd go to bed at 10. And then I woke up at 6. That's my 8 hours. But when I put my wearable, it turns out it's not 8 hours. I mean, I do go to bed at 10. And I wake up at 6 or even 7. It says, I've got four and a half hours. And so all these stats of years ago, before wearables, say people go to-- no, they need their 7 hours of sleep. Do you think there are factoring in 7 hours of real sleep, which some of the wearables are sort of counting? Or does it mean going to bed at 10 and waking up at 6? So great points. And first of all, what we are talking about right now is called a sleep physician called sleep efficiency. And it's literally the number of minutes that they were spending a sleep in relation to the total bed time. I think majority of people, when they talk about the supposed be 8 hours, they think, I went to bed at 10 p.m. and I woke up at 6. Not the actual time spent. Yeah. Now, having said that, we are fortunate to have great wearables these days. And while I do not believe in sleep staging, it's entertainment. It's great, but I don't really believe in that. Staging, meaning how much deep sleep, how much REM sleep, how much core sleep. Most of today's wearables are really excellent at measuring sleep onset and sleep duration. So this is the signal you can trust. But that's often different to the olden days, pre wearables, where you go to bed at 10 and you wake up at 6. And he's after, he's got my 8 hours, right? Whereas you still may only have got the 5 hours or 6 hours because he hasn't measured all the differences. Do you think the new, and I know you've said really it's not 8 hours, it's 7 hours, but do you think the new real term may be mismeasured? And maybe we only need 6 real hours versus 8 real hours. Because the old 8 real hours wasn't really 8 real hours. It's just sleep onset, sleep suspension, right? So, Rojo, this is probably one of the most common questions in sleep medicine. How many hours should I be sleeping? And the answer is highly individual. There's no single number. But if you absolutely-- if you were to force me like, hey, Martin, you have to give me a single number. What is this? It would be 7 or something around 7. And there is this very interesting study and tons of studies on that actually. That sleep duration is sort of a ushaped curve. We're both too little and too much. too little being less than six and too much bang I think over nine is detrimental to our health with the sweet spot being at I think 730 this is this is what I aim for and and to give you a little bit more context I think I pay more attention to my go-to battle arm than my wake-up arm like I consciously plan my okay this is this is the winding down phase so that I won't have my seven and a half hours but I will actually budget in my 168 hour grid week grid nine hours per night assuming that like yes there there would be some time needed to slow down and get into the proper mindset right so how do you actually what how do you actually go to sleep what's what's your recommended advice so for good sleep health and I think you know I've read about and you've talked about before that you know sleep at the same time every night even if it's only four hours you're for four hours and at least sleep at the same time that's actually more important than the duration I'm not sure if you can confirm that right yes and I'm glad you you picked up on that this would be if there's one thing worth taking away just one thing from our conversation today that would be it that would be regularity like it's a much better this sentence is really worth remembering regularity is a much better predictor of all calls mortality than duration meaning if you say Martin I can only give you six hours with great regularity or an erratic seven and a half I'll take it to six and then what about I've heard this and I don't quite make any sense to me sleep before midnight is more important than sleep after midnight but why would that make any difference if it's dark anyway well does that is that true I think that's a that's a very broad statement it and it's not necessarily true or untrue I would ask a follow-up question for whom I would want to know what is your chronotype which is your genetic mostly genetically determined predisposition towards bedtime because if you're a super night owl meaning someone who goes to bed very late and then sleeps in long then I don't have a problem with you're going to by the way past midnight on the other hand if you're a super morning bar yeah you get the points right right right okay so yeah bottom line it shouldn't make any difference then right if you're well if you're a knight if you're a midnight person tell me well the again it's not that simple because I would want to know are we talking about the one off or are we talking about the regularly right oh yeah so I can I can tell you this because like this is this is interesting one of the things that I do at Stanford now is I run a study on sleep and longevity in centenarians and in fact I just came back from Selenia like literally four days ago I'm still jet like myself where I was interviewing centenarians and I'm talking to them about their sleep habits and these people live without wristwatches or iPhones they literally rely on the natural day and night cycle there's there's no question of like staying well possibly like no the sun is down they go to bed right right it's okay tell me about sleep apnea what is it how does it happen and how do you recover from it okay let's start with it is very common it is very common it's grossly underdiagnosed I think some studies say this up to a third of Americans mostly mostly males suffer from some sort of sleep apnea sleep apnea means that throughout the night there are periodic poses in your breathing depending on the on the actual cause of the breathing cessation this could be mechanical meaning you're at some point your everyways collapse this could be a lot of your nose or your palate your throat there's some sort of mechanical obstruction that's that's obstructive sleep apnea on the other hand we we have say central sleep apnea which means your brains then fails to send signals to your sends to send the respiratory drive and you just stop breathing but there's nothing wrong in terms of mechanics super important to to get a diagnosis and I would say if your partner notice that you're snore and notice the poses in your breathing that's that's a red flag that's that's don't try to diagnose yourself go see a specialist or if you know you're snore and notice an excessive daytime sleepiness excessive meaning like you know falling asleep but the red lights in traffic or or while reading or sitting on a couch and watching TV in fact something useful something that anyone any of your listeners could do is as Google a it's called app worth sleeping at scale yes as test it's just a number eight situations and your self perceived likely are without falling asleep and then a given situation and then if you actually have sleep apnea will it show up in the wearable no yes yes it's graphic specifically let's talk about there's a there's a couple of products that they do it very well let me start with apple watch because this is a by far most common wearable and apple apple has very good results when it comes to detecting sleep apnea having said that like it has to be of moderate or severe intensity they they don't claim to detect early stage sleep apnea it apple an apple watch or the health apple would not tell you hey you have sleep apnea but they will say like we've noticed some irregularities in your breathing go see a specialist but that's that's very useful and and you you can rely on that or I can you look at the I'm sorry can you actually look at the graph yourself I think you know no no no no you will only get a signal you don't make it a signal and then or arm or are ring they call it breathing regularity and I think garment goes with the same thing and and again they're they're very useful metrics but if they flag something it probably means it's really about time here you went to a doctor I like to look at through the correlation of two things combination of the things breathing regularity and overnight oxygen because like as a clinician as actually I care more about your overnight oxygen levels than breathing cessation like yes it is possible to have mild sleep apnea that is not really clinically relevant because your oxygen never never dips if it does that's a different story that's that's that's more troubling but you have any question what are you doing about it and I'll just I'd like to cover this really quickly if it's time to see a specialist you would either stay in a hospital for an overnight sleep study this is what I used to do for a long time sticking sensors to people foreheads overnight and and then we monitor your your all the parameters of your sleep and breathing and respiratory glide for overnight over two two dozen different channels and then CME and T specialist or a homeroid doctor typically drive two ways either a surgical approach if there's a mechanical anatomical obstruction that can be fixed or sleep with a seatbelt so a device that provides positive air pressure and opens up your ways so we get there I would like to know how much do you weigh because like this is the number one thing like obese individuals overweight individuals actually yes I was going to suggest that can you necessarily which is kind of like you can't like know anyway ahead of time even without doing the test can you say well maybe can I if I just lose weight will it make me snore less yes love this just just because my understanding is the weight that the actual bulk changes the dynamics of the airflow and it could just lose weight and then all other things happening I see reflux and a lot of things seem to start to disappear that will disrupt your sleep is that correct that is there is 100% correct I would even tell you more recently one of the GLP ones theories epitoids has actually been cleared for treatment of sleep apnea it's it's only recommended for if I remember correctly patients with BMI over 35. But think about it, a weight loss drug, something that was designed originally as a weight loss drug. Already the fall work, first about now. Yeah, there are other ways to lose weight, because GLP ones have other issues. Sure, sure, sure, and so the root thing is losing weight. Probably make long-term sleep apnex. There's one more thing that I'd like to emphasize here. Alcohol. Alcohol will make. I'm sure you must have noticed this, like I don't know if you snore, but I'm pretty sure it must have happened to get some point in your life, especially after two or three glasses of wine. Alcohol is this insidious little agent that makes falling a sleep much easier and relaxes the muscles of your throats, making everything mechanically worse, and then you sweat and you wake up because your metabolism goes into overdrive in the second half of your night. Right, so you think coming out scotch to go sleep easier is actually counteracted because of the mechanical. That's your nightcap, your horoscope. I think you should ever talk about alcohol. It's almost any amount of alcohol will disrupt multiple factors, the human body, but it can be social, can't it? Are there other factors that help you sleep well? If you're socially not worried, what that possibly counteractly, mechanical disadvantages? I don't know if. I don't think it could counteract the mechanical disadvantages, but you know, a lot of folks can't sleep because let's say anxiety in those individuals having high quality social life probably helps. Right, just take the age off and then then you can go to sleep, otherwise you'll maybe worry about lots and lots of things. But you haven't seen on your own Aurora, and I know you use one. The effect of it is. Oh, you have a wolf, okay. No, I've noticed ones. Even these things pick up on them, even one glass of wine. Your HRV, your heart rate variability will go down, even after a few glasses. Okay, my friends got 95 on the Aurora Rinks score, a mine 74. Do I need to catch up to get 95? How good can you get? The deep score is, is that what you're referring to? Yes. I say don't bother. I say don't bother. This is entertainment. First of all, we don't really know what exactly goes into this deep score. It's, it's Oraz, like we have vague ideas, you know, it's duration, it's regularity, it's, it comes with a, but it's a proprietary metric. The main message here I would like to leave with listeners with is track trends, not nights. I do not believe in any individual like, you know, in fact I built my own dashboard and every single night I have at least my ordering and my Garman. But I look only at an aggregate. I look at a week long moving average. That's what interests me, because you just can't trust them yet, like, yes. So it's a score of 95 and you're 75. Tell me what time do you go to bed and what time your friend goes to bed and how long do you sleep? Like, this is something I care about. Right, right, right, right. So the sleep, is it related to, you know, in children, for example, in different sleep habits, no teenagers in notoriously, apparently can't gap in the morning. Well, no, why is that? Do we have to pay more attention when we're younger than versus when we're older? When we're, you know, we're kind of, maybe a bit more robust and we're used to things, but it's sort of in the learning phases of a young adult, and I guess it's up to 25, but the brain's not developed until the age of 24, 25. You said at the beginning that sleep is used for brain optimization to some extent, the waste clearance and plaques. I would think young people don't have too many plaques. So is it different for young people? So sleep changes throughout our lifespan. That's that's for sure. Like we know that you were installers, they need a lot of 20 hours of sleep. And that needs gradually declines throughout our lives. And you're right, I don't think that's 18, 20-year-olds have to worry about lack of accumulation, but they probably do worry about focusing memory. And unfortunately, the educational system, the school system, in the US, are pretty much anywhere else in the world. Isn't built for teenagers. Like if you, if we force teenagers to their classrooms and desks at 8 a.m., that's simply not compatible with that stage of their lives. Like they are, for lack of a better word, in a state of mild permanent jet lag. In fact, I don't remember which state it was in the US, but one state conducted an interesting experiment. They shifted the school times by one hour later. And you know, the rate of the rate of car accidents caused by teenage drivers dropped dramatically. And it was just one hour. So your teenager who struggles to get to school and to be there on time for the first class, it's not lazy. It's just biology working against them. So, what are the teenagers on the weekend? Do we wake them up or let them sleep? That is a great question, I think. I would say, and this is just just my answer, I'm not saying during their studies, probably there are studies, I just have no other way. We can't change school and they probably are sleep deprived. So in the absence of a better solution, as in going to school later regularly, and missing classes, I would say yes, let them sleep, let them catch up on the sleep bed, let's reduce that sleep bed. Now, the same thing is not necessarily true for adults. Like, I don't want you to have that social jet lag. Social jet lag is what we call the discrepancy the difference between your bed times during the week and weekend. You absolutely don't want that you messes up with your circadian rhythm, that messes up with the ton of hormones when they get released. So, in adults, to the extent where you have control over your schedule, I would love to see the same weekdays weekend bed times within, say, half an hour. Okay, that was supplements, let's talk better in the last little bit. I take glycine, I've tried magnesium glycinate, I've tried magnesium DNA, I guess one of these things cuts through the blood vein barrier, which is in a barrier that stops things get through to the brain. I find glycine works for me a bit better than the other magnesiums. Melatonin is out there, it makes me groggy in the morning. How much do you, how much do you want to turn into do you take? Yes, I do know that your recommend is lower, it's 1 milligram or so and normally the pills are 3 milligrams or 5 milligrams even. Of course, you can't get it in the UK over the county like you can here, I'm not sure why that is, but some countries you can't actually get it. So, I think, and there's actually sleeping pills, quote-unquote, that you can get prescribed from the doctor. What is your use of supplements, see the prescription or otherwise, you recommend or should think about or people should try? I think the usual thought is try these things and see what works for you, but what do you think? Okay, let's start with Melatonin probably by far the most common new sleep supplement. A couple of things, I personally use it a lot, but that's because of my lifestyle, as you know, like I travel to Europe every, say, five weeks. So, I use it as part of my jet lag protocol to help me either delay or advance my sleep phase and I take very little, contrary to what's sold in whole foods here, mega doses of 10 milligram pills. You only need 0.5, several hours before bedtime. I really like, I really like this, I can look it up for you later, this brand that has dual coating, dual release melatonin, so immediately and delay release, so that the first dose hits you within an hour and then the second one dissolves, say, around 3 AM, and that's I think 1.5 milligrams, so that's what I like taking, but I do it for jet lag, and beyond jet lag, I don't use it routinely. Now, having said that, it is absolutely recommended in order in the materials. Say, past, you reach your 70s and naturally your pineal glands, which produces which secrete melatonin, calcifies to certain extent. And it functions simply deteriorates. It's incapable of producing a much melatonin, typically to be 0.5 milligrams, that's the natural levels that we secrete naturally. In that case supplementing melatonin is a great idea. So that's why older people sleep less, months other reasons, older people just seem to sleep. The sleep drive is just weaker. It's not that they sleep less because they want to sleep less. No, they would love to sleep as much as younger individuals. It's just the sleep drive is weaker. But going back to your question, like, what else do I take? There is some, not super strong, but there is some evidence for magnesium glycinate. So I typically take 400 milligrams an hour before bed. It works well for me. And it's gentle on the stomach. Like some other forms of magnesium are quite, it can be quite irritating. The one you mentioned, Theronate, that's the one that supposedly crosses the blood brain barrier. Honestly, I have not seen much difference. And equals one here, but I have not seen much different. I'm with you on glycine. I look at some trials, I know it's very safe. And I agree that there seems to be positive effects. One other thing that I would add is Althiamine, found in, I think, green tea. It's great, 200 milligrams before an hour before. And it's very good for anxious sleepers. That helps. Let's wrap up on a little bit. Let's discuss what you're seeing in the world today. We're both together talk about what we're seeing in the world today for longevity with a relaxation sleep axis. I mean, the last guess I talked about peptides, you know, are you taking the peptides? There's no real clinical evidence for them yet, but sometimes people swear by them. Have you got any opinions? I don't. I don't take any peptides. Now, having said that in terms of peptides for sleep, we have what's at the A-cleared and proven and that with GLP1 analogs, but in specific cases. Yes, there's a peptide, a PRP one is there. Then there was an interesting article in the economist, I think, last month, is brain about to have GLP1 moments. And I'm not specifically talking about orexen, peptides. So we may see something, but that's typically targeting narcolepsy, but it's entirely possible that we will soon see say micro dozing of these compounds for weightfulness maintenance in health, otherwise, self-individuals. So that might be interesting. There's a lot of peptides that are still in the biohacker space for inscience, but I have not. I don't take anything. Well, I think there's a book for our body. I think it's about 20 years old and it says, you know, what you need to do is look at what the biohackers are doing because they're experimenting on themselves. And then finally, the scientists realise and then they start doing an actual real experiment. And then the big farmer look at what the scientists are doing and then they bet to try for it. And then finally, they get a drug, but it takes a few years for doctors to realise it's out there. And so it's 20 years between when the biohackers are doing it, before we can buy it in the get it prescribed for you. And so, of course, that's why we have here, our 42, to discuss these things. So, you know, what we hear, heard it here first, we'll have to look thinking about, you know, keeping eye on that one. And now, now, we cover venture on our 42 as well because, you know, science is great, but we've just looked in a drawer and we've seen some of these wearables that have made an impact. But what are your ideas for the venturing in sleep? Now, we've got the mattresses, got the wearables. And you've got your own ideas as right, Martin, so maybe you can tell us a little bit about that. I'll tell you two things. So, first, let's look a little bit over the wearables. I'm a huge fan of wearables. This is how I ended up at Stanford. I'm a physician, but I also had hardly my builder. I've been building wearables for eight years. I had a company with American Olympic and Bodermeller. We tried to revolutionize skiing by inventing new sort of sensors for skiing. So, I took all of that, combined it and came to Stanford. And I see a lot of interesting wearables every year or so, or I know one else come up with new wearables, new sensors. But there's little that's being done in terms of intervention. There's a lot of sensing. There's not so much in terms of intervention. I would love to see, I'm thinking here, for example, earbuds with built-in EEG sensing and some sort of acoustics simulation. There's a bunch of products like that. So, I like that. I like interventional wearables. What I'm building is a new platform. Code name first lights. And you're looking to take it first then. And it's an analytics layer that sits on top of all different completely hardware gnostics. Take any wearable you want and build a hyper-personalized sleep optimization recipe. And that's my biggest pain point with with today's wearables. They measure the outcome, the sleep. But they almost don't know anything about the inputs. They don't know if they guessed that you had a glass of wine, but they don't know it. They don't know what it was in your calendar. They don't know that you had a late heavy meal or a particularly hard workout. Maybe your Garmin does know that. But they like to take into consideration all of the different life variables in designing an AI-assisted personalized protocol. Tell me what you want to ask me. What do you want to ask me on any topic, but maybe a sleep topic as well? If you and I talked about it before but we were always joking like not really thinking about it in practical terms. If we were to build that sleep mimetic, a drag that allows us to behave like super sleepers and sleep drive on four hours. How would we use AI today? How would we model that? Yeah, well, there's a lot of analysis in this discussion. Modern AI is based on something called Neuron Networks. These are computational models where we have a little mini-computer but written in software and each computer connects to another computer. Just like the brain is, the brain's got 100 billion neurons and each neuron's connected to a few thousand other neurons and modern AI has that in a computational way and this concept of synaptic pruning is where you just throw away half the connections of some of the connections and it still works if it works better. No kids who suffer from ADD years later, they don't suffer because they've got that synaptic pruning. So maybe you can use AI to try and, yeah, I mean, maybe the military will want it or even everybody else will want it. Can you make do with four hours of sleep? Can you use AI to actually figure out what connections you can throw away and you can do that computationally? But can you say, oh, well, you need to sleep like this to throw away these connections. So you can sleep better the next day with less hours of sleep. I mean, I'm in a longevity area. I mean, one great idea of what is thought. Now, we're trying to get an extra 20 years of life. So get from 100 to 120 or 80 to 100. What have we got from eight hours of sleep to four hours of sleep? And when you get that extra 20 years now, instead of waiting until the end, do you think that's a great idea? No, it's a great idea, but if you really were to do it right now, you're just going to take the extra 20 years and go from 80 to 60. We don't want that. We want the benefit of four hours in terms of time saving and keeping us healthy. Well, I'd like to say the average age of death in America is 78. And the world is 74, by the way, because some countries have less sleep. And so I'd just have the same 80 years, but with four hours of sleep instead of eight hours of sleep. And so that's equivalent to 100 years. And now, I think my venture capital class, I asked, you know, GLP1 in hindsight, It's so obvious as a market, everyone wants to be thin, but there's only enough, you know. hindsight. Isn't this a blockbuster? If people could just take a pill, live healthy sleep, but with only four hours instead of eight hours. Isn't that a blockbuster or do you think people just like, I kind of actually like sleeping. So even if I could sleep four hours, I'd actually still like to sleep for eight hours anyway. Is there pleasure in sleeping? Am I not just allowed to sleep just for the pleasure of it? Instead of the brain waste, the waste production and the clinical benefit of it. Yeah, the clinical, why not just use it as pleasure? People do do that. They sleep on the beach and things like that, right? At the point, yes. There's been able to get pleasure in sleep, yes. So you don't think we can actually invent a drug for that to sleep four hours before I gave you that objective function? No, I know there's several groups working on it, but I think you can target very specific aspects of sleep. Can it be done holistically for everything that sleep in compasses? I'm a bit skeptical, both in the long-term safety and efficacy of all of that. Right, so you can't actually do without sleep. People have done experience where people go without sleep for a week or something, but there's a sleep debt being, right? They eventually just fall asleep and you just catch up, sleep all day to catch up with your sleep that you've lost. Like of sleep will kill you much, much faster than like a food. Yes, well, there's some occupations that go without lots of sleep, right? Yeah, people have who are night workers. We know that they seem to have stress and more illness than if it were not. Absolutely. A shift to work is definitely one of the risk factors for multiple health conditions. For example, prevalence of some cancers is much higher in shift workers. You know, here's an idea for you in a question. Imagine, I think this would only work in very dense urban populations, but imagine if we hired for occupations that require shift work, say nurses in hospital or any, honestly, any activation that requires work at night. What if we hired people with very specific criminal times? What if we only hired super nightouts for in case of hospital for nurses that have to do night shifts? I think we'll dramatically reduce the health risk associated with shift work if we could match it to natural rhythm of people. It's more likely going to be the other way around. So you've got your nurse or you want to take a job as a white trist and a nightclub or something that lasts till 4am and you're going to say, "Well, before I take this job, maybe I should take a test, a measurement of some kind." Exactly. That could be a whole genetic marker there. Is it a whole genome sequence? Yes. There's multiple genes that determine it, and yes, it's going to be determined. Probably any full genome scan will reveal that. So if you take that, then you say, "Okay, it's a great job. It's not for me. I need to find another one." I don't know how we all listed it as for many individuals, but if you have the luxury, I would definitely use it. Since we're talking about shift work, when the important message here would be, if you are someone who does shift work, and there's nothing you can do about it, and at least try to keep that same rhythm, the same schedule, the same shifts. Are you going to be the worst thing that can happen are erratic nightsheds or rotating nightsheds, where you know, when you start at midnight, at least at 8am and 4pm, that is bad. At least within, you know, lesser evil, like keep the bed times consistent. All right, now, what do you think? I mean, do you think taking catnaps can reduce my need for sleeping at night? Catnaps might be 20 minutes, maybe even two hours. And I hope when you say 20 minutes, I'm not so happy when you say two hours. Like, if you can keep it to, I think the rule that I like is no more than 30 minutes. What if I enjoy the two hour now? What can I have one? I'm not sure if I still agree that it's a nap, but that's two hours. Why don't you stay with, let's assume you're someone who goes to bed at 11, right? So, I don't want you to nap past 3pm. 8.5 hours from your bedtime, and then half an hour. Yeah, the whole point is you have to nap, then you're not going to go to sleep early at night, and so, but maybe I just, maybe like some people, I just enjoy a nap. Why can't I just enjoy sleep? Well, you can, but can you sleep well? Can you sleep well? Can you take that two hour long nap? Can you sleep well enough? Well, what I think what you're saying is, if you add multiple naps with your sleep, that's not as good as a long stretch. That is not what you're saying. I am not a huge believer in polyphasic sleep. I personally don't like that. So, multiple hormones regulate your sleep, but one of them is adenosine, and that's the compound that generates deep pressure. It's the same compound that's blocked by the same receptors that are blocked by caffeine. So, when you drink coffee, caffeine in that coffee blocks receptors that typically point to adenosine, but a nap will clearer adenosine, so would you reduce your sleep pressure? That's making it more difficult to follow sleep later. That's why I want to give your body enough time to build up the sleep pressure again. This is why the sleep behind the control. What's behind the control? No later than 3pm. All right. Now you want to say it, sex and sleep. I know you want to say it. What? You're up two minutes. Tell us about sex and sleep, so you always inject that into your lectures. I love experimenting and measuring on myself to the absolute core of my girlfriend that I have to measure everything. I would even tag it in my aura app. But jokes aside, there are absolutely proven studies that sex before sleep, it will make you less time to follow sleep. Your lowest heart rate will be lower. Generally, the sleep quality definitely goes up. I think the ranking was sex with a partner, with an orgasm that was the highest rated one, followed by sex with a partner, followed by sex on your arm. That was the effect was diminishing us on the scale. Great. Okay. So bottom line, Martin, I'm advised to the center for lifestyle medicine, where they have the pillars of lifestyle medicine. I'm an investor in neuroage, we have the pillars of brain aging. Maybe you can just summarize, and you've sort of given it through this talk, the pillars of sleep. Maybe you can give it to the pillars of sleep. I'm happy to do that. You know, I will tell you about the framework that I first heard from Matthew Walker. I really like the framework. So here it is. Q, Q, RT, and it stands for quality, quantity, regularity, and timing. And I'll define them for you very quickly. So quality, that is, I want to see the correct architecture of your sleep. I want to see the nice proportion and duration of deep sleep, of REM sleep, and of course sleep. I do not want to see too many awaken eggs. I do not want to see too much sleep latency, meaning lying about trying to fall asleep. That will be quality. Quantity is pretty self explanatory. We talked about it. I want to see seven hours, seven and a half. That would be great. Regularity, I don't think there's any point rehashing that, but please go to bed every single line within an hour of the same time. The timing is interesting, because this means sleeping in alignment with your chronotype. So if we roughly divide people into night hours, normal types, and morning larks, the value, the return on investment from eight hours of sleep within your window is going to be great. The same eight hours, if you sleep for four hours past your optimal bedtime, will not give you as much benefit. That there will be a simple frame or quality, quantity, regularity, and timing. I'm going to try and get extra sleep, because I'm entering the younger competition. You're entering the younger competition and trying to get younger in six months. I think sleep is one of my secret weapons, the only problem is I'm trying to improve it. All right, okay, Martin, thank you for being with us. It's been a great conversation. You heard it here first. Follow the R42 podcast wherever you listen to podcasts.