Whilst a young Peter Attia used to stay awake for heroically long shifts during medical residency, he has since wizened up to the value of sleep. Making 8 hours of sleep per night a non-negotiable where possible. Peter travels a lot and has come up with an interesting hack (which we’ll discuss below) for limiting jet lag. However, on a “normal” West Coast day, Peter will:

• Wake up between 4:30-5pm
• Meditate
• Spend time with family + have breakfast
• Workout
• Start the work day at 10am
• Then try to get to bed early

To aid with sleep, when necessary, Peter favours 4 over-the-counter supplements:

1. Phosphatidylserine – to reduce cortisol level – Peter favours Jarrow Brand
2. Kirk Parsley’s Sleep Remedy – to help induce sleep – sleep remedy website
3. SlowMag – a slow release magnesium supplement, designed to avoid stomach discomfort
4. L-Threonate – facilitates magnesium to cross the blood-brain barrier

Peter mentions the above combination in multiple places, including this Instagram post where he discusses the sleep cocktail he uses for fasting. In the Instagram post he takes 3x capsules of phosphatidylserine (300mg), 2x capsules of SlowMag, 3x capsules of Sleep Remedy, 3x capsules of L-Threonate.

Phosphatidylserine

Peter takes phosphatidylserine (favouring the brand Jarrow, specifically Jarrow PS100), when he wants to lower stress levels (reduce adrenal output) and help facilitate sleep.

Rather than phosphatidylserine’s efficacy just being a “wives tale”, it has been studied reasonably well. Mechanistically it lowers physiological stress by blunting the adrenocorticotropic hormone (ACTH) response to stress – and it’s ACTH that under stress then stimulates the release of cortisol via the adrenal gland.

By lowering physiological stress levels, this may help relaxing into sleep.

Example scientific studies:

• A study showed phosphidylserine reduced cortisol response post exercise, compared to placebo. Whilst this isn’t directly sleep related, exercise is a reliable way to increase cortisol, so it’s interesting to see phosphatidylserine could blunt that increase¹. This result was originally shown in a 1992 study² (so it’s repeatable). Note that in the ’92 study the phosphatidylserine was derived from cows brains (!), which is how they used to get it. Now brands like Jarrow derive it from sunflowers.
• A further ³study showed phosphidylserine improved mood after a stressful event, compared to placebo. Notably this was cognitive stress (mental arithmetic), rather than exercise induced stress.

Kirk Parsley’s Sleep Remedy

Peter typically combines the above Phosphatidylserine with Kirk Parsley’s Sleep Remedy – which is a combination of:

• L-Tryptophan
• 5-hydroxytryptophan (5HTP)
• phGABA – also known as Phenibut
• Melatonin
• Magnesium
• Vitamin D3

Peter diligently notes that he is an investor in the Doc Parsley business (for conflict of interest awareness).

SlowMag

This is a magnesium supplement designed for slow-release and to remove stomach upset sometimes experienced with magnesium supplementation. SlowMag does this by coating the capsules, such that they break down in the small intestine, rather than in the stomach.

L-Threonate

L-Threonate facilitates magnesium crossing the blood-brain barrier, and one of the implications of this is improved sleep quality.

Whilst different brands sell Magnesium L-Threonate, the raw ingredients are provided to them by a company called Magtein who own patents for the product. Thus whether you buy from Jarrow, LifeExtension, etc – the raw ingredients all come from the same source.

Blue Light Blocking

Melatonin is a crucial component of sleep – and increases close to bedtime; causing us feel sleepy. Absence of daylight is a primary trigger of melatonin release, so that as darkness sets in, our melatonin should increase.

Problems occur when that natural evening darkness gets interrupted by artificial light. Whether it’s from the light bulbs in your house, or the screens on the devices you’re using. These all emit blue light, which our bodies confuse for daylight, and suppress the release of melatonin.

Fortunately there are steps we can take to minimize blue light exposure in the evening.

Blue Light Blocking Glasses

Peter uses Gunnar glasses, which are designed to block blue light, whilst not looking too absurd whilst on.

Peter notes that when it comes to devices, there are blue blockers built into both iPhone (called Night Shift) & Android (called Night Light) operating systems. Whilst on computers you can use f.lux (Mac & Windows).

Whilst these should be more than adequate, Peter views the glasses as an insurance policy, and definitely notices a difference in his sleep quality.

Peter’s Jet Lag Minimization Strategy

In Peter’s AMA #4 he outlines a strategy he uses to minimize the effects of jet lag when you need to fly somewhere and acclimatize quickly. He notes that for places where you have time to acclimatize, then this protocol is unnecessary.

The overall strategy revolves around immediately putting yourself in the time zone of the destination when you leave.

So for example, if you left San Francisco at 2pm and were flying to London, which would be 12am (8 hours ahead), you’d want to sleep as soon as you get on the plane, and wake up when it’s morning in London.

This is much easier said than done, as it goes against your circadian rhythm. To achieve something like this, Peter uses a combination of sleep inducing products, and stimulants to modulate sleep and wakefulness.

In the above scenario, flying from SF to London at 2pm, Peter would use a cocktail of 3 products to immediately get to sleep on the plane:

1) Phosphatidylserine (preferred brand Jarrow PS100):

• To get cortisol levels down (which is tough during the middle of the day).
• Taking between 100mg and 600mg.
• Take this approximately 30 minutes before boarding the flight

2) A single dose of Kirk Parsley’s Sleep Remedy.

• Peter takes the capsule form for convenience

3) 10mg of Valium

• Making sure not to take this too early, which could cause you to feel sleepy before reaching the plane (!)
• Note that Valium is a prescription medication, also known as diazepam. It’s used to treat muscle spasm’s and fits – and it makes you feel drowsy. If you’re going to use Valium to follow Peter’s protocol, note that Valium is a strong drug that should be used with the caution you would apply to any prescription based medication – including looking at side effects and possible drug interactions.

After taking the above cocktail of 3 products, and once settled on the plane:

• Peter would notify the air steward that he will be sleeping for multiple hours, and to not disturb him during the flight
• Then set an alarm to wake up when it’s morning in London

Upon waking, Peter would then need to stay awake for the rest of the day. Again, going against his circadian rhythm. To aid this, Peter would take 200mg of Modafinil.

• Modafinil is a prescription drug used to treat the symptoms of narcolepsy (narcolepsy being an issue that causes people to fall asleep during the day, against their will).
• 200mg is about 1/3 the maximum 600mg dose.
• Modafinil isn’t technically a stimulant, but it does promote wakefulness strongly, and it would be incredibly hard to sleep having once taken it.
• Whilst modafinil can generally can be considered a safe drug, it is absolutely worth testing with before following Peter’s guidance. I personally find it way too stimulating to want to take, having experimented with it. But for others, they like and use it without issue.

That covers the products Peter uses to promote sleep or wakefulness against the natural circadian rhythm.

Lastly, leading up to the flight, Peter would start nudging his sleep schedule closer to the pattern of the destination.

One comment I would add to the above protocol, is that valium and modafinil are both strong, prescription only drugs. Beyond the difficulties people may experience getting hold of them, they also may be a little too extreme for some. Given that consideration, I still think the general strategy is useful to be aware of, and could be adapted to ones personal preference. For example, the modafinil could be substituted for a caffeine based stimulant such as coffee. Whilst it may not be as effective, for some people it may be enough. Similarly, the combination of phosphatidylserine and the sleep remedy may be enough for some, not requiring the additional valium.

1. The effects of phosphatidylserine on endocrine response to moderate intensity exercise – Starks et al. (2008)
2. Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men – Monteleone et al. (1992)
3. The Influence of Phosphatidylserine Supplementation on Mood and Heart Rate when Faced with an Acute Stressor – Benton et al. (2016)