The Importance of Sleep

Of sleep divorces, atrial fibrillation, biohacking and sleep tips

Greetings,

I hope you all had a good night's sleep. For many of the skeptical cardiologist’s patients who are laser-focused on good health habits, sleep remains the only lifestyle parameter they have difficulty controlling.

I wrote the following newsletter in 2019 and was inspired to revisit the topic of sleep after a discussion with one of those laser-focused, sleep-deprived patients and by my own troubles.

For the most part, I remain skeptical of most of the sleep guru claims. I’ve added some editorial comments in parentheses and at the end of my original newsletter.

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While running this morning I was listening to Peter Attia's podcast with sleep researcher Matthew Walker (author of the NY times bestseller "Why We Sleep" (3)).

Walker would have us believe all of life's maladies are related to poor sleep, including heart disease, cancer, diabetes, Alzheimer's, and obesity. He also states, quite articulately I might add (he’s British), that poor sleep reduces your longevity and your health span. 

While I quite agree that high-quality sleep is really important, the scientific data only show associations of reduced sleep duration and quality with the chronic diseases which plague us and have not proven causality.

In particular, I have not come across any worthwhile studies demonstrating that impaired sleep causes heart disease despite the widespread promulgation of this idea by the industrial-academic sleep apnea complex.

(Despite numerous flawed observational studies suggesting an association between sleep apnea and cardiovascular outcomes including atrial fibrillation the gold standard, high-quality RCT data do not clearly show that treatment of sleep apnea with CPAP improves cardiovascular outcomes (which I describe in detail here). One widespread belief (especially in the world of electrophysiologists) is that sleep apnea is a common cause of atrial fibrillation. A recent study confirmed no benefit of CPAP therapy in reducing atrial fibrillation (see here))

Despite the paucity of data, sleep researchers like Walker are now telling us that we must sleep at least 8 hours per day.

Personally, I've become obsessed with getting a good night's sleep because I know how crappy I feel when I don't get one and because it is the one component of a healthy lifestyle that I seem to have the least control over. 

I've been evaluating various wearable sleep devices, like the OURA ring, and Garmin's vivosmart 4 and Bodimetric’s Circul and haven't been impressed with their accuracy in identifying sleep versus wake or sleep cycles. I'll be writing more about these devices plus home sleep apnea tests in the future. (No posts have been generated, but I have evaluated all these and find them all inaccurate and unhelpful.)

The Standard Sleep Tips

Walker's book concludes with some sleep tips which are taken from this NIH pamphlet

The Sleep Divorce

One sleep aid Walker mentions in the podcast is the sleep divorce-sleeping in separate beds, something my wife and I have been doing for a long time (1).

There were lots of reasons we were waking each other up. We are totally different "chronotypes"-I'm early to bed and early rise, she's a night owl and a late sleeper. She would wake me upon coming to bed and I her upon leaving. Apparently, the only time I was "an unreasonable d*%# was when I was awoken from sleep.

According to Walker, 40% of couples sleep in separate beds. Of the 60% who start in the same bed, 30% will switch beds during the night.

While some partners sleep in separate beds because they are angry with each other, if you are choosing the sleep divorce to enhance sleep quality, the data indicate this will enhance your relationship. Better sleep quality improves mood and better mood leads to improved interpersonal relationships (more patience, more energy for each other). Improved sleep quality also increases sexual hormones and the desire for intimacy.

May your night's sleep be good and the only divorces you experience be of the sleep variety,
-ACP

N.B. I have discovered the ultimate sleep "biohacking" tool and hope to share it with you soon (2).

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(1). Upon downsizing our living space in the last year, my wife and I have been forced to sleep together in a king bed. We have discovered that we are much happier, reunited upon retiring and waking, but with more separation during sleep to minimize disruptions. It also appears that our chronotypes are becoming more similar. Living in Pacific Coast Time nudges the “owl” chronotype who works remotely to get up much earlier.

(1) I’ve been wracking my brain to come up with the “biohacking” tool I mentioned. I’ll do some research and get back to you on this. I can say that I’ve evaluated all the gimmicks and supplements that Peter Attia has to utilize to sleep and I found them to be useless. The list of tips above contains the most important “biohacks” (Yes, I hate that word.) Late alcohol and food consumption is particularly devastating to my sleep quality and my bedroom must be cool.

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"Men marry because they are tired; women because they are curious; both are disappointed"
Oscar Wilde, The Picture of Dorian Gray