Matthew Walker - How To Sleep Better (And Improve Your Life)

Full transcript: Matthew Walker on London Real

5:54 Brian Rose: This is London Real. I am Brian Rose. My guest today is Matthew Walker, the award-winning professor of neuroscience and psychology at the University of California, Berkeley and the sleep scientist at Google. Your book, Why We Sleep, takes a groundbreaking look at how sleep is one of the most important aspects of our life, one that is increasingly neglected in modern society and how that can have deadly consequences. Matthew, welcome to London Real.

6:26 Matthew Walker: Thank you so much for having me. It’s a privilege and a delight and a long-time fan, so it’s lovely to be on the show.

6:32 Brian Rose: That’s awesome to hear. You know, this is something that gets everyone’s ears pricked, I think, and everyone really likes you talking about sleep, and I want to get to your journey after a little bit. I think everyone likes sleep.

6:43 Matthew Walker: I don’t know if they like me or you about sleep, but we’ll see.

6:46 Brian Rose: You know, sometimes I’ve had over 500 people here, and it’s the message, the timing, and it’s a lot of times the communicator that really makes a difference, so no pressure. We’ll get into that. But what really strikes me in this book and with you is that, you know, deadly consequences. This can affect the length of your life.

7:03 This can affect diseases, you know, and I don’t think anybody really on this planet has ever been taught that sleep is that crucial and that important. And you make some really bold statements here that, hey, everybody, this is the time to really wake up and take this seriously. You took four years to write this book, right?

7:21 Matthew Walker: I did, yeah, and I wanted to take that time because I wanted the book to not just be a quick hit about, you know, the top ten tips for better sleep or…

7:30 Brian Rose: Which we’ve seen for years.

7:32 Matthew Walker: Which you’ve seen lots of times or, you know, just sleep for the brain. You could write a book on that. For me, this needs to be the comprehensive, I hope, sort of manifesto that would last a significant amount of time. I wanted to write a book that wasn’t necessarily successful but was significant.

7:49 That was my hope. That was not just timely but hopefully timeless to a degree. And to do that, I think you really have to put the work in. And so the book charts everything that you could imagine from sort of the evolution of sleep, sleep anthropology, through to, you know, the deleterious impact of sleep on the body, then speaking about sleep in the mind. It speaks about sleep and dreams.

8:13 And then it goes to sleep in society. What’s happening with insufficient sleep in medicine, in education, in business productivity. And it finishes with a vision, a 21st century sleep prescription. You know, if this is the problem, this is where we’ve come, how sleep has evolved, this is what’s happening with sleep right now. Where do we go from here?

8:33 What do we do? Because I don’t think anyone likes someone who just speaks problems and then doesn’t at least offer a solution path. So the book took four years, in part because I’m not just an author, I’m a professor, I have a sleep center and have to teach, so in part it was time. But it was also, I wanted to invest that time to create the richest tapestry of a sleep book that I could possibly wish for, the book that I would want to read.

8:58 Brian Rose: Yeah, I always tell people here, don’t bring me problems, bring me solutions.

9:02 Right. And so I like to hear that. What is an Englishman from Liverpool doing living in Berkeley, talking about these issues and probably becoming one of the most preeminent speaker on sleep, how did that happen?

9:14 Matthew Walker: I think we’re all accidental sleep researchers in the field, you know, I don’t think when you’re sort of six or seven and in school they say, you know, what would you like to be? You know, I don’t think anyone ever sort of raised their hand and said, I’d love to be a sleep researcher, you know, I want to be a Dr. Feynman astronaut.

9:33 And I started sort of looking at medicine, that was probably sort of the path that I was heading on, but I realized that I was probably more interested in questions than I was answers. And if you’re a doctor, you should very much be interested in answers. And I realized I was probably a scientist rather than a doctor. So I went into neuroscience and I started in my PhD looking at brainwave patterns in people with dementia and trying to differentially work out very early on, are you suffering from Alzheimer’s or Parkinson’s disease or vascular dementia?

10:10 And I was failing miserably. And I was measuring brainwave activity when people were awake. But then I started to read, I go home sort of at weekends with stacks of journals, like sort of little igloo of journals in my bedroom that I go into. And I started realizing that the different parts of the brain that these different dementias would attack, some of them were attacking sleep centers and others weren’t. And so I thought, well, maybe I’m just measuring their brainwave activity at the wrong time.

10:40 I should be measuring them when they’re asleep, not when they’re awake. So I started measuring the sleep of my patients, found remarkable results. And that’s when I started to ask, well, if the sleep is disrupted, I wonder if that’s contributing to the dementia. Is it not just a symptom? Is it a cause?

10:59 And back then, this was 20 years ago, we were still asking the question, why do we sleep? No one could give me an answer. So truly with a lack of hubris and not trying to be arrogant, I thought I would go and study sleep for maybe two or three years. And I would figure that out, not realizing that some of the most brilliant acerbic minds in science had tried to crack the problem and failed for careers. And that was 20 years ago, and I’m still asking that question.

11:28 But now we’ve had to actually upend the conundrum. Sleep used to be one of the last great remaining scientific mysteries. We didn’t know why. Based on the wealth of the data that now is sort of put into the book, we actually have to ask, is there anything that sleep doesn’t support for brain or body? And the answer seems to be no.

11:48 Every physiological system in the body and every single operation of the mind is wonderfully enhanced by sleep when you get it and demonstrably impaired when you don’t get enough.

11:57 Brian Rose: You used to think that there were kind of three pillars in the human body, diet, exercise, and sleep, and now you’ve pretty much said it’s all superseded by sleep.

12:05 Matthew Walker: It is, yeah. I used to think that sleep was the third pillar of good health alongside diet and exercise. But I don’t think that’s true.

12:12 I don’t think the data supports my claim, so I had to reject it. I think sleep is actually the foundation on which those two other things sit. So, for example, if you’re dieting and you’re trying to watch what you eat, but you’re not getting sufficient sleep, 70% of the weight that you will lose will come from lean muscle mass and you will keep all of the fat. The body actually becomes stingy in giving up its fat when you are underslept. And that’s just one of many examples.

12:42 You know, for exercise, it’s very clear, too, that firstly, if you’re not getting sufficient sleep, your probability of exercising firstly the next day is markedly reduced. Secondly, when you do work out, your time to physical exhaustion is decreased considerably, almost by 30%. Your speed of sort of completion of running, for example, your peak muscle strength, even your ability to respire, to expire carbon dioxide, inhale oxygen, that’s decreased. Lactic acid accumulation builds up quicker.

13:15 Your ability to perspire, to cool the body, essential for high-performance sport, that is impaired, too. And finally, your injury risk, this is one of the most recent findings. If you simply look at athletes across a season and then you bucket them on the basis of how much sleep that they’re getting, you know, nine hours plus eight hours, seven hours, six hours, there is a linear relationship with injury risk that the less and less sleep that you have, the higher and higher your injury risk becomes.

13:45 So again, if it’s just to try and sort of emphasize why I change my mind, it really is the bedrock from which those two other things will then subsequently emerge. And if that foundation is shaky, it’s very difficult to think that those two other things are effective.

14:02 Brian Rose: You know, I just finished my Ironman race.

14:05 Matthew Walker: Yeah, yeah. Congratulations again.

14:07 Brian Rose: I kind of jumped in. Thank you. You know, I was 47 years old and I kind of started from scratch. And for 80 days, I was basically training every single day, sometimes twice a day. And my trainer, she said, you know, sleep is one of the most critical components.

14:18 Now, she couldn’t necessarily tell me why or how to get it, but she said, you’ve got to log this every single night. And I’m just listening to the long list of things that I could have been suffering from, injury promotion, injury proponent, you know, perspiration. All of these things are critical components in the Ironman. And so I did get a lot of good sleep. And I can only imagine when I’m on the 22nd kilometer and I got to do 25 that day, like that’s when you need everything, cognitive ability, everything.

14:51 Matthew Walker: And that’s what we see. I mean, it’s a great insight and it’s very intuitive. Sometimes to unmask the lack of sleep that you’re having, you have to put the system under load. So let’s say that, you know, you’re sleeping just five hours a night and I measure your sort of physiology and you’re just at rest in a chair. And sometimes, I mean, there’s lots of things that we can pick up that are already impaired, your immune system, for example.

15:18 But there are other things, let’s say looking at your cardiac output where it’s a little bit more difficult to tell at rest. But then as soon as we apply you to a challenge, cognitively for the brain, or cardiovascular for the heart, instantly you see that’s where the lack of sleep reveals itself to you. So it’s that sort of as an insurance policy in some ways, but it’s when you start to extend yourself, it’s that mile 22 as you’re describing, that’s where you see, you know, the payoff of having a good night of sleep.

15:50 Brian Rose: Right. You know, I’ve spoken to over 500 people here in the studio and not a single one of them has ever told me that they get by on a low amount of sleep. You know, they’ve always told me behind the scenes or on camera that sleep is one of the most important things they do. They get that. Even the ones you would expect to be the bravado and the this and the that, they actually don’t because I think they’ve learned over time.

16:13 And, you know, I’ve been trying to get my sleep routine on point and I was wondering if you could tell me what you think of my sleep routine. Yeah, yeah. And so, you know, in preparing for this show, I’ve been taking hot showers every night because of what you talked about, about how that can change our physiology and maybe we can speak about this. For a long while now, I’ve kept my room fairly dark. I’ve turned off the electronic devices.

16:33 I’ve got the ear plugs in and the mask on. I did a little bit of a sleep divorce, you know, a few years ago with my wife and maybe you could talk about that where we currently don’t sleep in the other room. And I’ll talk to you about her sleep with two young boys shortly. We can comment on that. I do stay on my screens later than I should.

16:51 So I’m probably, you know, still on a low lit screen, maybe even up to 11, 11 30 at night. I think I’ve got something on my phone that tells me I need to be going to bed at like 10 40 to get my eight hours. It’s like a new app. You know, I get in there. I’ve been lately trying to take a hot shower before I go in.

17:08 I’ve been using some magnesium cream and that’s kind of what I do and I try to do the same time every night. And I have good and bad results. You know, I’ve always struggled with sleep. You know, when I was drinking myself to death in the banking world, that didn’t help. Yeah.

17:26 Matthew Walker: I mean, alcohol is probably one of the most both misunderstood and most sort of abused sleep aids and it obviously is not an aid at all. It’s actually remarkably detrimental to sleep.

17:37 Brian Rose: It’s a tricky one because it feels like a short term fix as it can kind of get you into the sleep state but it’s not a good sleep.

17:45 Matthew Walker: That’s what people think. You know, you mistake sedation for sleep.

17:49 Alcohol is a class of drugs that we call the sedatives and sedation isn’t sleep. It’s very different. Now, when you drink heavily and you sort of, you know, you fall asleep, I’m not going to argue that you’re awake. You’re clearly not awake but to say that you’ve gone into naturalistic sleep is an equal falsehood. You simply have sedated your cortex.

18:09 The other two problems with alcohol, it firstly will fragment your sleep. So you will wake up many more times throughout the night. So you sort of, if I were to show you your sleep graph with alcohol, it’s just sort of peppered, littered with these awakenings. And a lot of those awakenings, you’re not aware of. There may be just sort of two or three seconds and then your brain tries to go back in and reclaim its cycle and then you back up again so you don’t commit them to memory.

18:36 So you wake up the next day and you feel lousy. You feel unrefreshed, unrestored by that sleep. But you don’t remember anything bad about your sleep. You don’t remember waking up. So you don’t think it was the alcohol.

18:48 You just think, I don’t know why I don’t feel good but I’m having a bad day. That’s the second problem with alcohol. The third one is that alcohol will actually block your dream sleep, what we call rapid eye movement sleep, which is essential for lots of different operations including emotional and mental health. So alcohol should be avoided, you know, the notion of a nightcap even. I would love to embrace that.

19:13 I’m deeply unpopular for saying it but I’m just here to describe the science and the data that we know of and then people can make an informed choice but alcohol is not the sleep aid that people think, unfortunately.

19:26 Brian Rose: Right, so avoid the nightcaps.

19:28 Matthew Walker: Yeah, but you’re doing actually, but just to go back to your own sleep prescription as it were, I think you’re doing fantastic things. The only thing is perhaps light. Our dark deprived society in this modern era and we need darkness to allow the release of a hormone called melatonin to help time our healthy sleep.

19:48 But in modernity right now, you know, we come out of the day into our homes or we stay in offices and our brain is still being told it’s daytime, it’s light because of artificial light and it’s Edison that, you know, in some ways that we have to thank because it was his light company that popularized the, you know, he was the first person that took control of the night and for the first time we dictated when it was light and dark, not the rotational mass of the planet, you know, around the sun. That was transformational in some good ways but also for our sleep. It was a devastating blow.

20:26 So darkness is perhaps the only part of the sleep equation that maybe we could improve on but hot showers or hot baths, great because you come out, your core body temperature drops.

20:36 Brian Rose: Yeah, talk to me about this body temperature and how that helps you sleep. You know, we’ve always heard the grandma thing saying take a hot bath before you go to sleep but never really knew the science behind it.

20:47 Matthew Walker: And you know, part I think of that, I mean, often what I say is that we as sleep scientists are really putting the data behind everything that your grandmother in Shakespeare ever told you about sleep to be honest, you know, I’m not doing anything radical.

21:00 Brian Rose: What did Shakespeare say? I always forget.

21:03 Matthew Walker: Oh, well, he has this lovely line that sleep is the chief nourisher of life’s great feast. I think it’s Macbeth act two, scene two, beautiful, you know, words, just his prose are littered with sleep advice. So I think you’re doing, you know, you’re doing very well there.

21:20 The temperature to come back to it though, your brain and body need to drop the core temperature by about one degree Celsius or about two to three degrees Fahrenheit to initiate sleep. And it’s the reason that you will always find it easier to fall asleep in a room that’s too cold than too hot because at least the cold room is taking you in the right thermal direction that your body wants to naturally go to get good sleep. Now, you could then kind of get recursive and say, okay, that’s good so your body needs to drop but why does it need to drop its temperature or why are we that way?

21:55 We’re that way because we are diurnal species and we were designed to be sleeping at night and our bodies latched on to the natural drop in temperature as a cue and a trigger to fall asleep. And in modernity we have dislocated ourselves with constant ambient temperature or worse still, you know, we don’t ventilate. So we evolved to be told to go to sleep using this thermal cue together with light is the other thing. For a long time we thought it was just light that regulated our sleep.

22:29 It’s not, it’s light and it’s temperature, those two things. And if anything, it may be temperature that’s even more powerful than light but both are powerful. So you get into a hot bath and you think, well, it’s because it makes me nice and relaxed or I get warm and toasty. Relaxed, yes, but toasty it’s the opposite.

22:45 Brian Rose: Because I would think that would raise my temperature and I wouldn’t go to sleep.

22:49 Matthew Walker: Right, exactly. So as long as you don’t stay in the bath for too long or the shower and shower is a good one, what happens is that all of the blood will rush to the surface of your skin away from the core of your body which then takes the heat out from the core and you get out of the bath and you get this massive dissipation of heat. Instead of all of the blood is just brought to these massive radiators that are the vascular surfaces of your hands, your face and your feet.

23:16 They radiate most of the heat out. And therefore the core of your body, the temperature plummets and that’s why you fall asleep faster. So you’re doing great with temperature. Regularity is key as well. I think if there’s a single piece of advice, go to bed at the same time, wake up at the same time.

23:34 Brian Rose: Which is not what anyone teaches you.

23:36 Matthew Walker: It’s not. Well, people get no sleep education whatsoever. And I mentioned this in the book. I did a poll with some colleagues who lived around the world and grew up in different parts of the world.

23:49 And I said to them, when you were at school, did you get those classic lectures or classes about risky behaviors, about drugs and alcohol and safe sex and diet and nutrition, physical activity or PE? It was always part of the regime. Did you have a lecture regarding the importance of sleep? And zero. Almost everyone said yes to all of those other things and no one had a sleep education.

24:16 So to come back to your question, we’re never told about temperature, but in part, we’re never just told about sleep per se.

24:24 Brian Rose: Why is that? How can we miss that big thing? Again, I remember being pulled into the auditorium and going to the sex ed things with the girls and the boys around me going, oh my gosh. And I remember somebody having the talk about drugs and I remember all this stuff.

24:40 But why not talk about this? It’s not taboo. Is it just something we don’t think about because we don’t see it? You know, why? You must have thought about this.

24:51 Matthew Walker: Yeah, I have. I’ve thought a lot about it actually and I think from what I can tell, it’s probably a collection of features that have produced this deficit in a sleep voice in our education. I think the first is probably the fault of people like me. Scientists have not done, I don’t think, as good a job as we could have in communicating the importance of sleep to the public. And it was part of the motivation to write the book.

25:16 It was one of two critical motivations. I think that’s the first part. The second part is, you know, 20 or 30 years ago, we just didn’t know enough about sleep. Or even if we did, I think, you know, how that translates, trickle down, you know, into communities and schools, just was going to take some time. But I’m desperate to try and change that.

25:38 You know, I’d love to work with the World Health Organization, the CDC, I’d love to work with any First World Nation government if they want to think about an educational policy. It is bereft in all First World Nations right now, and that needs to change. So I think the trickle down has yet to occur and happen. I think the final thing comes back to something you hinted at, which is sleep has an image problem that we stigmatize getting sufficient sleep with this label of laziness.

26:07 You know, that we are slothful if we’re getting sufficiency. But I choose my word very carefully, sufficient. I’m not talking about sort of excess. And so I don’t think that has helped. I think communities, even in schools, were resistant.

26:21 And to me, what I find surprising about that mentality is that we don’t always hold that notion. What I mean is that, you know, no one would look at an infant sleeping during the day and say, well, what a lazy baby. You know, and we don’t say that because we know that sleep at that time of life is non-negotiable. It’s absolutely essential. But then somewhere between infancy and now if you look, even toddler age or childhood, not only do we abandon the notion that sleep is essential, but we actually chastise people for getting enough and people become proud to tell you how little sleep that they get.

27:00 So I think that part of, you know, to come back to your original question as to why that voice isn’t there, why we don’t know these things, I think part of it is because we don’t have an educational system that is either aware of sleep or teaching sleep or perhaps I fear embracing and ready to, you know, celebrate sleep rather than stigmatize it.

27:23 Brian Rose: Okay. Let me contrast the room next to me at my house. So my wife is there, my boy is two, my other boy is ten months. They are up and down all times of the night.

27:34 She’s been dealing with these crazy babies for two years. She is massively sleep deprived. She tries to get it whenever she can, sometimes during the day, but it is the constant needs of these children. And I’m just wondering, what does a new parent like that do or someone who’s in that situation where a choice isn’t really seen and now they have to kind of triage the situation? Yeah.

28:00 Matthew Walker: Parenting is a very difficult equation in terms of a sleep solution. Certainly there are things that can help children sleep better. If there’s one piece of recommendation advice I would give to parents for their children, it would be having a bedroom, sorry, a sleep routine. So, you know, bathe your child sort of every night, read a book every night, you know, sort of have a cuddle every night, have a conversation. Whatever it is that you feel works, establish that as a routine and then don’t let it go.

28:33 Keep that routine regular. That’s been demonstrated to be hugely helpful. Then for parents, it’s tricky. Work-life balance, harmony gets in the way. If you can try to structure it, well, if there are two parents, and not everyone has that, of course, but if there are, trying to think about the split-shift workload either dependent on your work schedules or dependent on your natural, what we call your chronotype.

29:01 So, there are morning people and there are evening people. And this is no, it’s not a choice. People think, you know, I want to be a morning person. It’s not your choice. It’s your genetics.

29:13 We know the genes that dictate what’s called your chronotype, whether you’re a morning sort of, you know, lark or you’re an evening owl, you’re a night owl. So, some parents, you know, if they’re the night owls, maybe they, and during infancy, they can take sort of, you know, the first shift because they like to naturally stay awake late into the night anyway. And then the person who’s the morning type can come in and pick up the morning shift. If you are of that separated type, some people are both types same and then that doesn’t work.

29:42 It’s a very difficult equation to solve. And you could also just think back from an evolutionary perspective as to how have we been dealing with this and what’s interesting is that if you look at hunter-gatherer tribes, whose way of life hasn’t changed for thousands of years, they don’t sleep in the way that we do. They don’t sleep as a sort of a separate individual entity. They don’t tend to co-sleep. They actually group sleep.

30:08 They sleep as a collective. You know, family members, aunts and uncles, they all sleep, you know, legs intertwined. And so, you know, sometimes childcare would actually be shared throughout the night amongst a smaller family community. And it’s probably the reason that, by the way, we have these things called chronotypes, morning types and evening types. And I put a theory out there in the book as to why, you know, why aren’t we all of the same?

30:36 Why are we all sort of, you know, separated in this genetic edict of being wanting to stay awake late or wanting to be up early? And I think one answer is because as we were sleeping as a collective, we would all be vulnerable for that eight hours. And that’s a desperate vulnerability. But what if you were to program some variants genetically where some people would probably be staying awake until 2 a.m. 3 a.m.

31:04 Because that’s just natural tendency. Then other people would be waking up at, let’s say, 5 a.m. So now, all of a sudden, what you may have is everyone gets eight hours of sleep, but you as a species, as a collective, you’re only vulnerable for maybe just two or three hours. So you’ve halved or even quartered the amount of vulnerability time. What a brilliant solution by Mother Nature.

31:27 Everyone still gets eight hours, but you’re not vulnerable for eight hours. You’re only vulnerable for two because of the collective sleeping at different shifts. Elegant design. But coming back to the family equation, I think it’s a very hard nut to crack. I mean, maybe that comes down to that fact that the family unit has been sliced and diced by our modernity and along with the temperature being off, the light being on, grandma’s not there, the uncle’s not there.

31:51 You know, we’re not getting this cycle of night and day. We’re so dislocated, we’re so severed from the natural signals that we evolved with and evolved to receive instruction from. No wonder that sleep problems are on the rise, you know, and ballooning exponentially, rates of insomnia now just skyrocketing and sleep apnea, sleep-disordered breathing, where you sort of snoring, you know, as rates of obesity have increased, snoring is directly related to body mass. And you can have sleep apnea if you’re lean.

32:31 It doesn’t mean that you’re an exception. But it certainly is a risk factor. So I think that’s part of the reason why we’re seeing sleep being such a problem. I think it’s probably part of the reason why the book became so popular. I suspect it’s in spite of my writing rather than because of my writing.

32:47 But there is such a desperate need for this thing called sleep. And there is such an appetite and a hunger because so few of us are getting it and getting the amount that we need.

32:57 Brian Rose: Let’s talk about what is actually going on while I’m sleeping. And, you know, again, back to this kind of Darwinian concept, I mean, being knocked out for a 30-year day when you’re on the Savannah, I mean, it must be important because this ain’t good if you’ve watched some of the, you know, Okavanga Delta things.

33:14 You don’t need much time to be out to get taken out by the lion or the wildebeest or whatever. So, you know, there must be some really important things happening here. And I know that I think you even look at sleep to teach us about ourselves, which is fascinating. But, you know, what’s so important to shut us down for those eight hours more if you’re a kid? And I watch my boys sleep and I’m just wondering what’s going on there?

33:35 Because, like I said, it must be super important for our own survival if you’re willing to sacrifice a third of your aware time to keep it going.

33:43 Matthew Walker: Yeah, I mean, it’s a great point. You know, if you take a step back and you think about this thing called sleep, so when we’re asleep, we’re not finding a mate. We’re not reproducing. We’re not socially interacting.

33:56 We’re not gathering food. And worst of all, we’re vulnerable to predation. Now, on any one of those grounds, sleep should have been strongly selected against in the course of evolution. Add them up as a collective. What on earth?

34:13 You know, if sleep doesn’t serve an absolutely vital function, it is the biggest mistake the evolutionary process has ever made. And now we’re realizing that Mother Nature did not make a spectacular blender. That sleep just services every single system within the body. And the changes in the mind and the changes in the brain that happen that we’ve been revealing are stunning. And now you can see what a remarkable investment sleep is, why sleep needed to evolve.

34:44 Actually, though, I put another theory out there in the book, maybe sleep did not evolve. Why do we assume that we started off awake and then evolved to sleep? And I put forward an idea which I think is very probably difficult to prove, but that sleep was the default state from which wakefulness emerged rather than the other way around, that we actually sort of woke up to sort of wake up and become awake. It’s an interesting way to look at it, isn’t it? Because that means that you’re coming out of this sleep state to maybe go take care of some things where then you got to get back to where you should be.

35:22 Correct, right. And that’s why I like, that’s why I wanted to present that theory in the book and why I like it because I think it turns the tables on how we think about sleep as a necessity. We think about wakefulness as being the thing that’s necessary, that we accomplish so much, and sleep is the price that we pay for wakefulness. And yes, that’s true in part because sleep is reparatory. It repars a huge amount of the things that happen with wakefulness.

35:52 And I’ve sometimes said that if you look at the data, wakefulness is low-level brain damage, and it’s very clear that that’s the case. And sleep provides a sort of a repairing and a cleansing of that.

36:04 Brian Rose: Low-level brain damage. I mean, that’s hard for people to hear, right?

36:08 Matthew Walker: It is, until you realize if you come back to the stance that you just sort of described elegantly from the theory that we started off from sleep and then we opportunistically began to have these periods of wakefulness, but we always had to go back to the default of sleep because it’s so necessary.

36:26 I mean, sleep is a life-support system, and it is Mother Nature’s best effort yet at immortality. I’ve seen nothing else that comes close to it.

36:36 Brian Rose: Wow. These are powerful statements. And I like where you’re going with this.

36:41 What is happening in this sleep? Because there’s a lot of things going on with memory and with repair and with dreams, and what are some of the things that people wouldn’t think is happening when they’re sleeping? I think a lot of people probably think it’s resting the body, which is probably one of the last things that’s happening. What is going on?

36:59 Matthew Walker: There is certainly a lot of repair that happens.

37:02 I mean, your immune system gets an overhaul. It gets into high gear. It repairs cellular damage. But to think that sleep is a passive state where our bodies are simply quiescent and there’s nothing really going on upstairs in the mind is an absolute falsehood. And we made that mistake for a long time thinking that sleep was just this sort of passive, negotiable state.

37:27 Upstairs in the brain, for example, during some stages of sleep, particularly rapid eye movement sleep, which is the stage from which most of our dreaming occurs, some parts of your brain are 30% more active than when you’re awake. So your brain metabolically is on fire. If I were to place you inside the MRI scanner at my sleep center and show you the pattern of brain activity during REM sleep, it’s an explosion of activity. In fact, if I were to measure your brainwave activity and just measure your activity from your brainwave during REM sleep, I could not tell the difference between you in REM sleep versus you awake because those two patterns of brainwave sort of oscillations are almost identical.

38:11 I have to measure other things to be able to determine whether you’re in sleep or in wakefulness. To go a little bit further to sort of scratch deeper for REM sleep, one of the other remarkable things is that your brain paralyzes your body during REM sleep. And most people don’t know this, but you are in a muscular incarceration. You are physically incarcerated during REM sleep. Why is this?

38:39 Well, it’s a beautiful mechanism. Your brain paralyzes your body so your mind can dream safely. So you stop acting out your dreams, or you don’t act out your dreams. Because you can imagine that if it’s dark, you’re not conscious of your surroundings, you’re not processing the outside world, and you’re dreaming about being the ultimate sort of cage fighter, or you dream that you can fly, you’re going to be popped out of the gene pool very quickly if you start acting out your dreams.

39:05 So there’s a mechanism in place. Occasionally, and particularly in males over the age of sort of 40 or 50, that mechanism can start to degrade. You have what’s called rapid eye movement behavioral disorder or REM sleep behavioral disorder, and you act out your dreams violently sometimes. So that’s a good example of how REM sleep is fervently active. I mean, to go to the lengths of, you know, paralyzing all of your spinal cord neurons so that your brain can get this thing called dreaming and act out this bizarre experience at night is stunning.

39:40 But that’s not to also say that the other stage of sleep, which is called non-rapid eye movement sleep, isn’t essential and active. It very much is. Non-REM sleep is subdivided into four separate stages, what we call unimaginatively stages one through four, increasing in their depth of sleep. So stages three and four of non-REM are that really sort of deep restorative sleep that if you were woken up out of, you would sort of feel groggy. You could even answer a telephone call if it was brief, put it back, and someone would say, God, thanks so much for helping me out last night.

40:13 And you’ll say, you called me? I don’t remember. So deep sleep is also what we call slow-wave sleep. And the reason it’s named slow-wave sleep is because when I look at your brainwaves, if I were to measure your sleep tonight, when you go into deep sleep, you all of a sudden just get these huge, powerful, deep brainwaves, but they’re very slow. They’re maybe going up and down, maybe just sort of two or three times a second.

40:38 Now, what does that mean? As a reference point, when you’re awake, your brainwaves are going up and down maybe 40, 50, 60 times a second, incredibly fast. When you go into deep sleep, they just go into this very slow, rhythmic chant. It’s almost this mantra of brainwave activity. And again, we were fooled as scientists 30 years ago because we looked at that, and it seemed very similar to other states that we see in coma and states of anesthesia.

41:07 So we just thought, well, the brain is just dormant. It’s not doing anything clearly, completely incorrect. It is during deep sleep when we do a lot of information processing. And it’s particularly during deep sleep when we take memories that we recently learned and we essentially cement them into the architecture of the brain. In fact, it’s during deep sleep that there is this elegant file transfer mechanism that happens where your brain shifts memories from a short-term vulnerable reservoir to a more permanent long-term storage site within the brain.

41:42 And that means that you are essentially protecting those memories. You’re taking files from a USB stick and putting them safely onto a hard drive. That happens during deep sleep.

41:52 Brian Rose: And you tested this at Harvard, didn’t you? Yeah.

41:55 You would teach people some certain tasks and then based on the night sleep they got that night, they would either learn them quicker the next day or not be able to progress. I mean, you really tested it. I remember reading some of your research back in the day, I think.

42:09 Matthew Walker: Yeah, so we’ve done a lot of these studies with sleep and memory. And so you need sleep after learning to sort of do that memory transfer so that you remember so that deep sleep essentially future-proofs that information within your brain so that you wake up and you’ve retained rather than you forget.

42:24 And in fact, you can get so accurate with sort of this understanding sleep that by the time you wake up in the morning, even before I test you, I can predict with high accuracy how much you will have remembered. That’s how predictive sleep is. So you need sleep after learning, but you also need sleep, however, before learning. But now to actually prepare your brain a little bit like a dry sponge ready to initially soak up new information. And without sleep, the memory circuits of the brain essentially become waterlogged, as it were, and you can’t absorb information.

43:01 So you need sleep on both sides of the learning equation, sleep to prepare the soil of the brain for fertile sort of seeding of the information, and then you need sleep afterwards to germinate it and secure those roots so that you don’t forget and you will always remember.

43:17 Brian Rose: Okay, and that’s probably happening in stage three and four of the non-REM sleep.

43:22 Matthew Walker: It is, yeah.

43:23 Brian Rose: Okay. So then you could sort of ask, well, is REM sleep this dreaming state?

43:27 Is that important for memory and learning?

43:29 Matthew Walker: And it is as well, but it does something different. We’ve realized that sleep is much more intelligent than we ever imagined, that it’s during dream sleep when your brain actually performs, it’s almost like a form of informational alchemy where dream sleep takes all of those memories that have recently been fixated by the deep sleep. And deep sleep, by the way, comes principally in the first half of the night. REM sleep comes in the second half of the night.

43:56 And we never really understood why there was this imbalance. And one theory I put forward in the book is it’s about information processing, that you need to take what you’ve learned and firstly just fixate it, grab it, cement it. And then comes REM sleep, and REM sleep takes those fresh memories and then it starts to collide them with all of the back catalog of information that you’ve got in the brain. So it’s a little bit like group therapy for memories. And because your memories would be useless if they were just like isolate islands within the brain.

44:29 That’s why computers, for the most part, short of artificial intelligence, computers are kind of dumb in that sense. They’re not particularly intelligent. They can probably store information more vertically than you can. But it’s not smart. The reason that you are smart with your information is because you interconnect that information.

44:48 And it’s REM sleep that actually seems to revise our mind-wide web of associations. And this means that you wake up the next day and you can divine creative solutions to previously impenetrable problems. And this is REM sleep inspiring creativity. So we need all stages of sleep. That’s what we’ve been learning right now.

45:11 A lot of people will say, so what’s the best type of sleep? How can I maximize this type of sleep? You can’t hack it. Don’t think of it that way. Don’t try to hack your REM sleep.

45:19 Brian Rose: Because when people first saw REM sleep and saw the eyes moving, they were like, oh, this has got to be the good stuff. But you’ve got to kind of earn each stage. And each one is a critical, important part.

45:29 Matthew Walker: That’s right. It is.

45:30 You know, it comes back to your point about sort of evolution. If sleep really is such a non-adaptive, non-sort of, I think, vulnerable state, if there was anything that Mother Nature could have shaved off that wasn’t necessary from sleep, she absolutely would have. But we’ve got this thing called, for human beings at least, an eight-hour sleep necessity. And every one of those stages of sleep we’ve now discovered has a function, has a role. Different types of sleep perform different functions at different times of the night, but they all support different functions and benefits.

46:09 So you can’t shortchange the brain on one or the other, unfortunately. It’s almost like we had this massive cerebral cortex that we kind of earned over the last two million years, or we got. And it takes some serious maintenance, right? And it takes the integration of all of that. And if you want it to be the best it can be, you need to put your time in and you sleep.

46:29 And if you reduce your sleep, you’re basically not taking advantage of this beautiful system, this beautiful way of retrieving information and becoming great as a human.

46:39 Brian Rose: And so if we just take a break right now, the people who are watching us, if they’re like, okay, I’m with you, I need to do something about my sleep, I’ve got to go home and sell my household, what are some of the big things that you must have people come up to you on a regular basis and say, I’m having a problem here and there, what are some basic things that people can do to kind of 80-20 the situation, to get a taste of what it’s like to get a regular night’s sleep? What are some of those things that are just glaringly obvious to you?

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47:33 Matthew Walker: It’s called Social Jetlag. We have a name for it.

47:37 I also call it sleep bulimia, because it’s this real binge purge kind of mentality. Can’t you get it back? Can’t you get it back? Well, there was a paper that was published about four weeks ago, and it was sort of quite a contradictory paper relative to all of the other science. And what they found is that if you’re short sleeping during the week, defined as, let’s say, sort of five and a half, five hours, firstly, if you’re a short sleeper, they found that you have a 65% increase of death at any moment in time, 65% increase in mortality risk, which is frightening.

48:12 However, what they found was that if those people who were short sleepers during the week became longer sleepers at the weekend, it did decrease that mortality risk some. So that paper would advocate for you to do that sort of, you know, sleeping late at the weekend. However, there are other data that demonstrate, not for lifespan, but for your health span, that’s a very bad idea, because if you are doing that Social Jetlag, sort of sleeping late, sort of in the weekends, and then you drag your body clock back on a Sunday night to try and go to bed early for the start of the week, it’s torture.

48:49 It’s like, you know, almost flying back and forth from, you know, London halfway to sort of, you know, New York and back. It’s disastrous.

48:55 Brian Rose: I did it for 20 years, it didn’t work.

48:57 Matthew Walker: Yeah, I was going to say yes. And shift work, and we can come on to that too.

49:00 But so there is this paper that sort of put out there, this idea, but it’s interesting. If you dig into that paper, you have to be a bit careful. Firstly, only about 4% of the people that they studied were actually in this sort of magic group of short sleeping during the week and then long sleep during the weekend. So it’s a bit hard to tell whether it’s a representative group. Secondly, though, if you, let’s just assume that that’s their valid population, these short sleepers during the week, long sleepers during the weekend.

49:28 If you then look into the paper at the data and their self-reported health, what you find is that people who do what I’ve just told you to do, which is go to bed at the same time and just get consistently good sleep, weekend and weekday, those people were in very good health. Those people who were short sleeping during the week, long sleeping at the weekend, they were twice as likely to be in very poor health. They were about 30% more likely to abuse alcohol, and they were about 40% more likely to be using sleeping pills, which I hope that we have the time to speak to as well because they’re potentially deathly.

50:06 So right now, I just still don’t think the evidence is sufficient to say that you should sleep in at the weekend. There just doesn’t seem to be enough evidence to argue that you can sort of sleep back the debt that you’ve accumulated. Sleep is not like the bank in that way, that you can’t accumulate debt and then pay it off at the weekend, at least not in terms of health. For reducing your mortality risk by way of short sleep, it’s possible, but you will still be in worse health as a consequence.

50:35 We’ve known that data if you’re in that social jet lag, higher risk of obesity, diabetes, sort of BMI, cardiovascular outcomes, all of those are worse if you keep doing that flip-flopping shift between your sleep at weekends and weekdays.

50:48 Brian Rose: Okay, I want to talk about sleeping pills, but before we do, I mean, you blatantly assert in this book that the less sleep you get, the less long you’re going to live. I mean, and that’s a strong statement. I mean, that’s a wake-up call for a lot of people.

51:03 I mean, if you’re, you know, doing these six-hour night shifts, like you’re just going to live much, much shorter. Yeah. And I usually say when you tell them that, and, you know, maybe if that gets people’s attention right now, you know, what do you tell them to shoot for? What is this number of hours, and can you tell me more about that assertion?

51:23 Matthew Walker: Yeah, so firstly, the last part of the question, the place that people need to aim for is seven to nine hours of sleep routinely.

51:30 Once you get below seven hours of sleep, we can measure impermanence in both the brain and the body. One of the problems with a lack of sleep, it’s part of the sleep problem out in society, is that your subjective sense of how well you’re doing when you don’t get enough sleep is a miserable predictor of objectively how well you’re doing with insufficient sleep. So it’s probably the idea of, you know, a drunk driver at a bar. They’ve had a couple of pints, a couple of shots.

51:56 They pick up their keys and they say, you know, I’m off to drive home. Trust me, I’m fine, I’m fine. And your response is, I know that you think you’re fine to drive, but objectively, I promise you you’re not. It’s the same way with a lack of sleep. We don’t know where sleep deprived, when we’re sleep deprived.

52:11 So you’re walking around thinking, I’m fine. I got this. Give me some coffee. I’m going to be okay. Look at my track record.

52:18 Look at my CV. I always perform. Right. And what you don’t realize is how much better you could perform if you did sleep. So it’s, you know, it’s necessary, but it’s not sufficient for optimal performance.

52:31 And those data are in, you know, in sleep and in the business and the workplace, and we can chat about that too. But to come back to your original point about sleep loss and mortality, that data is very strong. From epidemiological studies now of millions of people, there is that simple truth. The shorter your sleep, the shorter your life. Short sleep does predict all-cause mortality.

52:54 And, you know, I think that’s the first striking finding. The other thing, though, comes back to what we said about lifespan versus health span. You know, we often hear that old mantra, you know, you can sleep when you’re dead. Well, I’m being very serious. It’s mortally unwise advice because if you adopt that mindset, not only will you be both dead sooner, but the quality of that now shorter life will be significantly worse.

53:20 And this is what we’re coming to in medicine right now. We’ve done a fairly decent job of extending lifespan, but what we’ve done a very bad job of is extending health span. So people are living longer, but they’re living longer, sicker. And one way that, you know, that equation can be solved, and you can extend health span, not just lifespan, is by putting sleep in there as part of the health equation, which is completely missing in medicine right now. Here’s another place where sleep is absent as a voice.

53:51 And, you know, sleep should be part of treatment in several conditions, but more so, sleep should be preventative. It’s much easier to do away with disease when you take a prevention standpoint than you wait until the disease happens and then you try to treat it. So sleep is probably one of the most universally available health care insurance policies you could ever wish for. You know, sleep is the Swiss army knife of health. You know, if you’ve got an ailment, it’s more than likely that sleep has a tool within its box that can help you out.

54:28 But yet, you know, sleep isn’t part of the health discussion. I think it’s the neglected stepsister in the health conversation of today. And I just recently, I wrote an article and editorial in one of the largest medical journals called The Lancet.

54:41 Brian Rose: Yeah, you’re firing shots into the medical industry.

54:43 Matthew Walker: Yeah, and, you know, and I feel, you know, I don’t mean to be incendiary, but when the data is so compelling, I think someone has to come up with a voice, and it was called a sleep prescription for medicine.

54:54 And I try to take to task the medical community, and the findings are striking. We know that a junior doctor who’s worked a 30-hour shift will make 460% more diagnostic errors in the intensive care unit. If your surgeon has only slept six hours in the night before they perform the surgery on you, you have a 170% increased risk of a major surgical error, such as sort of organ hemorrhaging or vascular damage. And then what’s sad as well is that young doctors can become part of that statistic, because what we’ve discovered is that after working a 30-hour shift, when a doctor goes back into their car to drive home at the end of that shift, they are 168% more likely to get into a car accident and then be back in the emergency room from which they just came, but now as a patient rather than a doctor.

55:47 Brian Rose: This is lunacy. You know, what is with this culture of doctors staying up all hours? I mean, I thought I’d remember a few years ago, even in the States, where they finally said to, like, long-haul truck drivers, like, this isn’t happening. You had guys out there going 20-hour shifts, 30-hour shifts to make the money, but I think it was actually, okay, legally, you cannot do this. You cannot do this.

56:07 Why, of all places in the herald halls of our medical industry, are people pushing the limit? Do no harm is the promise that you make. These people are taking care of your family. And these are good, and by the way, I’m not trying to sleep shame, you know, medicine or any individual, you know. Doctors do wonderful things, nurses, the whole staff.

56:29 Matthew Walker: I am so admiring of the work that they do. But they look tired. It’s the system that is imposing this great sleep depression on them. And you’re right. You know, you look at truckers, transportation, you look at aviation, you know, all of these things now have policies in place.

56:47 You know, why isn’t there that same policy in medicine for sleep? And part of it is perhaps due to sort of a slight, maybe an old boy’s network that we went through it. You should go through it, too. It’s a hazing, you know, it’s this macho idea. And that’s just hubris.

57:04 To think that through years of training on the job, that you can do away with something that Mother Nature took 3.6 million years to put in place is arrogance, and it costs lives. We know that one out of every 20 junior doctors will kill a patient due to a fatigue-related error. So there are lives being lost to insufficient sleep. And also, by the way, it works for the patient, too. The place that you need the benefit of sleep most is probably the place where you will at least get a decent night of sleep, which is on a hospital ward.

57:41 Think about the neonatal intensive care unit. We used to leave lights blazing. Now, you know, we’ve done studies where we’ve looked at regularizing light in the neonatal intensive care unit. As a consequence, they have more structured wake sleep cycles. They have about a 50% to 60% increase in their oxygen saturation.

58:00 They have faster weight gain, and they exit the neonatal intensive care unit five weeks earlier. It’s sleep. You know, why don’t we do this in hospital wards for adults? You know, on a long-haul flight, you and I will probably get given a face mask and earplugs. Basic necessity probably costs less than a pound or less than a dollar.

58:18 Why don’t we do that in all hospitals? Even that could help. But to come back to your initial question also, where does that maniacal junior doctor, sort of medical resident training program come from? And it’s a fascinating and sad story. The original residency program in the United States began at John Hopkins University, and it was started by a surgeon called William Halstead.

58:46 Brian Rose: What year was that?

58:47 Matthew Walker: This was back in the 1920s and 30s when they were starting to establish it, and they brought him in. And at the time, he was doing revolutionary work on anesthetic agents and analgesia for surgery. And one of the things that they were looking at was actually cocaine. And it turns out that cocaine is a local nerve-blocking agent.

59:10 So if someone has taken cocaine, if they snort a cocaine, often their nose and face will go numb. And the reason is because cocaine, like lidocaine, is a nerve-numbing agent. So he was studying the actions of this drug, and his name was William Halstead. And he started to dabble in his own supply, and tragically he became a cocaine addict. But then he started the medical residency program as a cocaine addict, and he was known for pulling these heroic long shifts.

59:43 They could go for like two or three days straight, awake all the time. And people just thought he was spectacular, that this man just was superhuman. He didn’t need sleep. No one knew about his dirty habit. But the problem was that he then designed the medical residency program in the mold of his own cocaine habit behavior, which was sustained wakefulness.

1:00:07 And so he demanded that people lived at the hospital. That’s why it’s called a residency. You live as a resident. And he required his young trainee doctors to stay awake as long as he could. And it turns out that he started to understand his habit, and I write all about this story in the book.

1:00:26 He sought help. He knew he had a problem. He then went to a clinic that would try to get him off the cocaine, and part of the treatment problem to deal with going cold turkey was that they would give him morphine to try and help with the pain. He came out of that program, not only having not kicked his cocaine habit, but now he had a heroin addiction as well. So it’s the story of an accidental addict, but we still hold that maniacal, inhumane practice of training our doctors to extreme degrees with terrible patient and doctor consequences.

1:01:03 That’s just a weird cultural hangover in that industry.

1:01:06 Brian Rose: It was a great series called The Nick. I don’t know if you got to watch it. It was like two series. It was directed by Steven Sutterberg, but it was 1900 exactly in New York City, and it was the Knickerbocker, which was the hospital.

1:01:17 Basically, you’re describing what was happening. The doctors were using cocaine for the first time and getting addicted to it. There’s this final scene where they ship him off to some clinic somewhere to deal with it, and they’re giving him heroin. They’re giving him opiates, and it’s just like, oh my gosh, and you’re just seeing what this happens. Same with Cider House rules.

1:01:35 They became addicted to ether. They were using ether for pregnant women and for abortions. Michael Caine’s character in Cider House rules, he becomes an ether addict, and he ends up dying of an ether overdose.

1:01:50 Matthew Walker: You can’t see it. It’s almost like someone who’s sleep-deprived or addicted to cocaine.

1:01:56 Brian Rose: You can’t even see it, and you’re the doctor, which is crazy. What’s been the response from medical industry when you’re firing these shots? By the way, I really appreciate you doing that, because you have a big platform. It would actually probably be very convenient for you not to write that article right now, and yet you’re doing that and taking a lot of this energy and visibility you have to go after that and make a big change. What’s the response been like?

1:02:22 Matthew Walker: Overall, it’s been very positive, and I tried to write the article. I didn’t try to write it in a completely combative way. I tried to, in some ways, almost make a dispassionate, simply a fact-based article to keep emotion out of it, which is very difficult for me because I feel so passionate about this mission of sleep. When you see the suffering and the disease and the sickness that comes from that, you want to do something about it. For the most part, I’ve had a lot of support, and somewhat surprisingly, a lot of support from young doctors.

1:02:54 They’ve been saying you feel almost tortured by this regiment and regime, and they’ve been very supportive. I think the higher-up, the hierarchical structure has been less embracing of the article.

1:03:08 Brian Rose: How do you change that?

1:03:10 Matthew Walker: Well, I think firstly, you make the case on the basis of empathetic, compassionate appeal, no harm attitude. If that doesn’t work, I think the other way that you can approach this is simply on the pounds and pennies and dollars-cents case of it.

1:03:27 That’s a place that I could go to very easily and write the same article because where you’ve started to see some change in the medical system has been when lawyers have become involved, and they’ve actually realized the cost of malpractice suits because of fatigue. You make the case in some ways, and if it doesn’t work, then you go back and you speak in the language of currency, of finance, and you make that, and usually dollars and pounds speak louder than compassionate appeals.

1:03:53 Brian Rose: So you’re writing that article as we speak and see.

1:03:56 What about this sleep divorce concept? Hopefully, my wife is watching. I’ll be honest, the history of my life, I’ve always had a hard time sleeping with a partner. I remember as soon as I could afford it, I got a king-sized bed, and I remember being sprawled out on there and just not wanting anyone to sleep with me. My ex-girlfriend in New York City used to come out and find me on the sofa and drag me back into bed at like three in the morning.

1:04:19 I might have even gone out there in stage three of an REM. I don’t know. But societally, we’re taught that that’s what loving couples do and that that’s what’s expected, and yet I’ve always had a problem with it, and luckily, my two recent sons have put me in a situation where I get my bed back. But I don’t know how long this is going to last, and maybe I’m being selfish. So can you speak on that?

1:04:41 Because I think you did something similar in your personal life, too.

1:04:46 Matthew Walker: Yes, so there is this concept that we’ve come up with of a sleep divorce, and if you survey people, about 40% of people, as long as you do it anonymously, and we’ll come back to why, report having a sleep-separate situation with their partner that they go to bed, either on different beds in the same room or in different beds in different rooms. Of those remaining people who still sleep in the same room, almost 70% of them will tell you that their sleep is either disrupted by their partner or that they know that they disrupt their partner’s sleep.

1:05:21 Of those people who go to bed together and sleep in the same bed, 30% to 40% will also say that they wake up in a different location. And almost 60% of people will tell you that one of their relationships has ended because of problems with sleep disruption in their bedroom. So it’s a huge issue, but there’s a terrible taboo around it, which is that if you’re not sleeping together, then you’re not sleeping together. And we are so ashamed and afraid of telling our friends or even our family that we sleep in separate beds that it’s a terrible secret in those people who do it.

1:06:03 They never describe it, which is a problem because probably more people would do it if it was socially acceptable and spoken about. And I think the irony is that when you’re not sleeping well, you’re not as likely to have an intimate physical relationship with someone. So firstly, a man who is sleeping just five or six hours a night will have a level of testosterone, which is that of someone 10 years their senior. So that critical…

1:06:32 Brian Rose: That’s a serious statement.

1:06:34 Matthew Walker: Well, it’s a dramatic… A lack of sleep will age a man by a decade in terms of that critical aspect of sexual wellness and virility. And it is an important hormone. Sometimes it gets a bad rap because of anger and rage. But for most people, it’s a critical hormone for encouraging physicality in your relationship and intimacy.

1:06:53 We see equivalent impairments in female reproductive health caused by a lack of sleep. So what you tend to find is that when people are being disrupted… Now, it’s not a sleep divorce isn’t for everyone. Some people co-sleep and do it well, and that’s great. For many, however, it’s a problem.

1:07:10 And when they sleep in separate rooms, their sleep gets better. And what they end up reporting is firstly, having a better relationship emotionally with their partner. They connect. They’re not fighting all of the time. Plus, they gain back the sexual drive.

1:07:27 And ironically enough, they end up having a better sex life because of sleeping in separate locations. Now, you can do things to try and sort of placate what otherwise feels like a separation. You can have a bedroom routine where, you know, before you go to bed, you can both be on the bed. You can have a cuddle. You can say good night.

1:07:47 You can build in a routine. And then whoever wakes up first, you know, someone wakes up second, they can text you, and you can go back through and say hello and good morning.

1:07:56 Brian Rose: You’re kind of like you were with your kids, like tuck them in and kind of wake them up, and it could be kind of this fun routine.

1:08:02 Matthew Walker: Yeah, you can still… Because in truth, that’s what people really miss about sleeping together.

1:08:07 Sometimes, for a small portion of people, it’s about the safety of having someone else there. It’s also about sort of maybe having the physical sense of someone there. But for the most part, the real thing that people miss by sleeping in separate places is being able to say good night and being able to say good morning. We can solve those two things. You can just build them into your routine and still get the sleep that you need.

1:08:30 Brian Rose: I love it. I hope she’s listening. Let’s talk about sleeping pills. This is something that’s serious. You know, I think, you know, you said something like 10 million Americans are taking them, you know, at any point.

1:08:43 We know these things get abused. We’ve heard crazy stories about people that use these things and do things that don’t make human sense. What is your take on sleeping pills? Are they ever good? And what kind of things does it do to your sleep?

1:08:57 Just what are your thoughts?

1:08:59 Matthew Walker: Yeah, so I write about this in the book. There’s a whole chapter because, again, I don’t think this information has been adequately communicated to the public. I’m not anti-medication. I should say that first.

1:09:13 You know, when medications work, I am all for them. And people in the drug industry, you know, many of these scientists and researchers, they’re desperately trying to help people with diseases and do good by creating these drugs. The simple fact is that none of the sleep drugs that we currently have produce naturalistic sleep. Again, they’re a class of drugs almost like alcohol. They’re called the sedative hypnotics.

1:09:37 So, again, what you’re really doing is just knocking out the cortex of the brain. And if I were to look at the electrical signature of your sleep when you’re on these sleeping medications, it’s not the same as natural sleep. So that’s the first thing. That perhaps wouldn’t be so bad if it didn’t come with deleterious consequences, and there are many. Firstly, what we’ve realized is that sleeping pills have been associated with a significantly higher risk of death.

1:10:02 And it’s quite large, too, and one of the cities I review is one of the largest where they looked at 10,000 people who were taking sleeping pills of a variety of types, relative to 20,000 very well-matched controls. And they looked at them across it just a two and a half year period. And what they found is that people taking sleeping pills were about four times more likely to die across that two and a half year period than those who weren’t taking sleeping pills.

1:10:28 And what was striking is that it didn’t take much. Even people who were just taking maybe 10 or 15 sleeping pills per year still had about a two to three percent, sorry, two to three times higher risk of dying. Just dying from any circumstance. They didn’t necessarily try to sort of break down in that study what was deathly. They just had the mortality records.

1:10:49 But we’ve since done a little bit more digging, and what we’ve discovered firstly is that sleeping pills are associated with a significantly higher risk of developing cancer, as well as infection, that’s the other thing.

1:11:01 Brian Rose: Wow, that’s counterintuitive.

1:11:03 Matthew Walker: Now, I think it’s important to put in place here that right now those studies are simply associational. What we mean is that they’re just correlational. We can’t necessarily say that it’s causal right now.

1:11:14 And let me just play the other side of the table for a second. It’s possible that those people who’ve been struggling with sleep all their lives, who are now the people who are taking more sleeping pills, are simply dying earlier because of the poor sleep that they’ve been having before they ever started taking those sleeping pills. So it’s the lack of sleep beforehand that’s so deathly. And the sleeping pills is just a correlate of how bad their sleeping problems were, and it looks like the sleeping pills are the cause.

1:11:42 That’s possible too. Same way with cancer because we know a lack of sleep is so related to cancer. However, it’s equally possible that sleeping pills are deathly and carcinogenic. And if you look at some of the animal studies that are uploaded to the FDA website, you actually see some of that carcinogenic impact with sleeping pills too, and that information is not out there. So all of which is to say people should know that information about sleeping pills if they’re taking them.

1:12:14 Oftentimes doctors aren’t aware of it. Doctors, by the way, this is something else I spoke about in the Lancet article. It’s not really their fault that they’re not more sleep proactive with their patients. Doctors, on average, in their medical curriculum, and I surveyed them, get only about two hours of sleep education. A third of their patients’ lives are spent sleeping, but they only get two hours of sleep education.

1:12:34 They don’t have as much time.

1:12:36 Brian Rose: Striking, you know, as a conversation.

1:12:38 Matthew Walker: But to doctors aren’t necessarily aware of the consequences of sleeping pills. What’s important to know is that they don’t need to be the first-line treatment. There is something called cognitive behavioral therapy for insomnia, or CBTI, and you work with a therapist.

1:12:53 It is being shown to be just as effective as sleeping pills in the short term in terms of its benefit for sleep. But better still, unlike sleeping pills, when you stop working with that therapist, you continue to gain the benefits. You continue to sleep well. In fact, a recent study demonstrated that those sleep benefits are still seen ten years later. With sleeping pills, one of the other problems is that you stop using them, and not only do you go back to the bad sleep that you were having before, but your sleep is often worse.

1:13:23 It’s called rebound insomnia when you stop taking those drugs. So now you have to start taking more of those sleeping pills to get back to where you were so you can develop tolerance, and then you have daytime sleepiness. You sort of get groggy during the day. So my opinion right now is that if we were to come up with a sleeping medication that I think is efficacious, beneficial, doesn’t have health consequences, and produces naturalistic sleep, I would be a very vocal advocate of it.

1:13:51 Right now it’s not. And you’re right, in the last month, ten million people, at least in America, have swallowed some kind of sleeping pill in that time period, which I think speaks to this desperate need for sleep. And to put the statistics in place, it’s a remarkable moneymaker. I joke in the book that it took George Lucas, I think, about 40 years to build up about $4 billion in profit revenue from the Star Wars franchise. 40 years, 30 years.

1:14:25 It took Ambien about 22 months to amass $4 billion in profit. That’s how desperate I think our hunger for sleep is and how problematic sleep is in society. I think that’s one of the other reasons that the book took off. I think it’s this lack of knowledge and science not being communicated together with this global sleep loss epidemic that has happened over the past hundred years. And the escalation of disease that’s associated with that lack of sleep, there’s this perfect storm.

1:14:56 We knew more and more about sleep, and we saw sleep having this great depression in society over these decades. And I think that’s why the book, the time for the book was right. And I was just very lucky.

1:15:08 Brian Rose: Well, we look back in 50 years and kind of look at, like when you watch an episode of Mad Men where they’re smoking Lucky Strike on filters and drinking during the day and doing all these obviously unhealthy things, well, we look back on us now and say, what are people doing, like these silly obvious things?

1:15:27 Do you think it will be like that in 50 years?

1:15:30 Matthew Walker: I hope it will be. And I’m starting to see some of the tide of change. I do think we are with sleep where we were with smoking 50 years ago in the sense that all of the data was there. We have all of the science to show that it is just like smoking.

1:15:48 It’s carcinogenic, but it’s much more sort of problematic than smoking. And it’s not just linked to heart disease. Insufficient sleep is linked to Alzheimer’s disease, to diabetes, to depression, suicidality, anxiety, all of these things. Everything that’s killing us in the developed world has a significant link to, if not causal link, to a lack of sleep. So I do believe that we are at that stage where everything about the science is telling us we need to increase it and stop the great sleep neglect.

1:16:16 But we’re not yet doing anything about it. So I hope that in 50 years’ time or in 20 years’ time, we could have this conversation again. And there will be a great sleep reform because more people, perhaps, like myself, communicate the science of sleep to the public. But I often think, when was the last time you saw any First World Nation, any government of a First World Nation, have a public health campaign regarding sleep? I don’t remember one.

1:16:43 And we have these campaigns for drink driving, for diet, for exercise, for risky behaviors, for drugs. There is no message of sleep out there. And I would love to work with any First World, any government nation that wants to produce a public health campaign regarding sleep. We need one. And it makes pounds and dollar sense.

1:17:08 We could save countries vast amounts of money. The Rand Corporation, for example, did a survey some years ago. And what they found was that insufficient sleep costs most developed nations about 2% of their GDP. 2% you think that sounds trivial. But here in the United Kingdom, that’s 30 billion pounds of lost financial revenue due to insufficient sleep.

1:17:31 In America, it was $411 billion. Japan, $138 billion. If you solve the sleep loss crisis, this sleep loss epidemic in societies, you could almost double the education budget or you could almost halve the health care budget. Today, as we speak, the Prime Minister of the United Kingdom announced a 30 billion pound injection of capital into the NHS, the National Health Service here. And people are aghast, how are you going to fund this?

1:17:59 Well, it comes from Brexit. Well, I could solve that right now and still give you 10 billion pounds in change left over. I could give you 20 billion pounds for the health care industry.

1:18:12 Brian Rose: Matthew, what’s it like being famous?

1:18:15 Matthew Walker: When I become famous, I’ll tell you, but I am certainly not famous right now.

1:18:20 Brian Rose: I know you said, look, this isn’t your natural persona. You’re probably more of an introvert, more of love doing that lab work, and yet you realize this is a crucial part of making change out there. How are you finding this whole process and having to step up and be the spokesman and write these articles to take shots at people? I mean, what’s that process like? Is it strange? Are you embracing it?

1:18:42 Matthew Walker: I don’t know about embracing it. I don’t know if I’m very good at it yet, but it’s very difficult actually for me. I think I’m someone who is very, I’m very insecure by nature. As you said, I’m an introvert. I also am an approval junkie, so I desperately want people to like me and I’m not very good with conflict.

1:19:05 I’m very conflict averse as a person. And all of these things don’t tend to make you a very thick-skinned public figure. And so I will read all of the reviews. I look at all of the comments on YouTube and all of those things. I’m very, very vulnerable too.

1:19:22 So I’d like to say that I’ve developed an immunity against some of that, but right now I’m still vulnerable. But the reason I keep doing it, and you could ask me, well, why? Why would you do that, is because I feel it is my mission and I just understand the terrible toll that is taking on humanity. And I want to try and help be part of that. I would like to leave this world in a slightly better sleep state than I entered it in.

1:19:50 And that’s my goal. And if I can achieve that, I think I will hopefully get past some of the insecurity and the hurt that happens when you become a public figure. But yeah, I don’t like being necessarily a lightning rod, but if that’s what’s required to try and help save people’s lives, for now, I’ll definitely do it.

1:20:07 Brian Rose: I think it is required. My advice is stay off the YouTube comments, trust me.

1:20:11 Matthew Walker: I get a lot of them.

1:20:12 Brian Rose: Have someone read them for you. That’s the best thing. And then just give you the filtered version because reading them is just, it’s not good for the psyche.

1:20:18 Matthew Walker: That sounds like a good self-preservation mechanism.

1:20:20 Brian Rose: Yeah, but when you write, you’re not averse to conflict, and that’s what I think is a beautiful thing. So you found your medium to put these bold ideas out there, and when it’s backed up by research, it’s saying a lot. And again, I’ve spoken to a lot of people over the years, and it’s the message and the timing and the person who can really communicate it. And I think you’re all those things. So you owe us to keep moving forward, and again, it’s going to take time.

1:20:41 I mean, look at messages being delivered to humanity to change their behavior. You could go back to, you know, smoking, slavery, Me Too movement. It takes people long periods of time of hammering away that this is not okay. We’ve got to change our behavior to make it happen. And, you know, this is something that’s so crucial.

1:20:58 And again, if you have… That’s a really good… I mean, it’s, you know, what you’re telling me, which is wonderful advice to hear, I think, is that, you know, if this is your mission, this is not a sprint. It’s a marathon. And, you know, don’t necessarily expect change overnight.

1:21:12 You know, the wheels of bureaucracy turn desperately slowly, almost glacial. So, yeah, that’s a wonderful piece of advice, and I think it’s hard. Yeah, I just had a guest last week named Rick Dublin, and he’s been working for a association called MAPS, and he’s been on a 30- or 40-year mission, you know, to make it legal to use certain psychedelics and MDMA for post-traumatic stress disorder and for depression research. And he’s like, I got a 100-year plan.

1:21:38 And I’m just like, how do you do this? And he’s just like, I really believe in the mission. So if it takes 50 years or 100 years, it’s okay. Every day I’m getting up doing work I know is valuable. So I hope maybe that can be something to think about.

1:21:50 Matthew Walker: It does help. And I think, you know, to come back to what you’re saying about him, for me, it’s the same type of passion. You know, I am in love with sleep. I’m in love with everything that sleep does for us. I’m fascinated by where we go every night, what we do for a third of our lives in this thing called sleep.

1:22:07 And I am deeply passionate about the wellness that it gifts us. And the decimation of sleep throughout industrialized nations is having a demonstrable impact on our health and wellness. It is a silent sleep loss epidemic. I think it is fast becoming one of the greatest public health challenges that we face in the 21st century. And our lack of sleep is a form of, a slow form of self euthanasia.

1:22:32 And we have to try and solve that. And I hope I can try now.

1:22:35 Brian Rose: Yeah, this is a serious problem. You know, I’ve only recently started taking my sleep seriously. And it’s a huge component on how productive I can be, how loving I can be, how a better person I can be.

1:22:44 I just noticed it. And these points in this book really hit home. So thank you for writing. It’s called Why We Sleep. I recommend people pick up a copy.

1:22:51 Brian Rose: I guess Amazon is the usual ways, right?

1:22:53 Matthew Walker: Yep. Amazon, just about all book outlets carry it, so.

1:22:56 Brian Rose: And I guess you’re going to keep doing research and let us know the latest things that are happening.

1:23:02 Matthew Walker: I would love to.

1:23:03 Brian Rose: OK, fantastic. Well, as you know, on London Real, we say it’s about the journey. Thank you so much for dropping a lot of these ideas. I think anybody watching should just go and take a real honest look at their sleep routine. And again, think of yourself as the one that’s had five drinks and wants to drive home.

1:23:17 Like, really? Are you really being honest about your sleep? And again, I’ve met some of the most incredible athletes, billionaires, rock stars around the world, and not one of them has ever told me that they skimp on their sleep. And so I think this is serious. I think sleep is the single most effective thing you can do to reset your brain and body health.

1:23:36 That would be the line for the summary for me, if there was one from the book. I love it. Thank you so much for writing this.

1:23:42 Matthew Walker: Thank you. I wish all the best.

1:23:44 Brian Rose: Come back and see us soon.

1:23:45 Matthew Walker: Thank you for gifting me this voice as well, by the way, because I can’t do this work by myself. I need wonderful people like yourself to sort of provide these forums and these stages. So it’s my actual pleasure to thank you for gifting me with this voice and stage to do this. So thank you again.

1:24:01 Brian Rose: My pleasure. Thank you. All right, thanks.