Peter Attia – Sleep Supplements & Hacks

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.

Peter Attia’s Sleep Cocktail

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

1. Phosphatidylserine – to reduce cortisol level – via Jarrow – Phosphatidylserine
2. Kirk Parsley’s Sleep Remedy – to help induce sleep – via Sleep Remedy
3. SlowMag – slow release magnesium, designed to avoid stomach discomfort – via Slow Mag
4. L-Threonate – magnesium that crosses the blood-brain barrier – via Jarrow – L-Threonate

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.

Image via this tweet thread

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.

Image showing the stress feedback loop (source via David Klemm)

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 increase¹The effects of phosphatidylserine on endocrine response to moderate intensity exercise – Starks et al. (2008). This result was originally shown in a 1992 study²Blunting by chronic phosphatidylserine administration of the stress-induced activation of the hypothalamo-pituitary-adrenal axis in healthy men – Monteleone et al. (1992) (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 ³The Influence of Phosphatidylserine Supplementation on Mood and Heart Rate when Faced with an Acute Stressor – Benton et al. (2016)study 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.

Other Sleep Tools Peter Uses

Blue Light Blocking Glasses

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.

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.

Sleep in a cold room

Our bodies naturally drop their core temperature at night, and having a warm room makes this harder. The Sleep Council suggests 60-65°F (16-18°C ) is the ideal temperature range, whilst temperatures below 53°F (12°C) and above 71°F (24°C) are likely to make sleep more difficult. A colder room is easier to modulate with blankets, whereas with a hotter room, there’s only so much clothing you can take off.

Peter is mainly based in NYC and San Diego. When these places get hot, as they inevitably do, Peter tackles this using a product called the ChilliPAD (source tweet).

The ChiliPAD is a temperature controlled topper that circulates water inside to maintain a desired temperature. What’s your desired temperature? Well, it’ll likely be somewhere between 60-68°C, but each person is different. So it requires a bit of experimentation at the start to find what works for you. Once a temperature is set, the ChiliPAD will maintain it throughout the night, even as the temperature in your room fluctuates. For 20% off the ChiliPAD, see this readers discount here.

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.

—
* Update Dec 3 2019: Peter has since learnt from Matthew Walker (University of California Berkeley based sleep scientist)  that sleeping aids like valium actually sedate you, rather than put you to sleep. This means that the brain’s normal sleep cycles (deep sleep through to REM) don’t take place. Thus you’re not actually getting “sleep”, you’re just sedating yourself. The upshot of this is that this section #3 where Peter takes valium can now be ignored. However it doesn’t invalidate the whole protocol, it just means you should rely on falling asleep naturally, instead of ingesting a sleeping pill and using that. The general idea of quickly switching your body over to the new time zone is still a good concept however.
—

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 daily 600mg dose. It’s worth noting that everyone’s sensitivity to the stimulating effects of modafinil will be different. Peter doesn’t seem to be very sensitive to its affects, but for others a dose of 50mg may be plenty. It’s absolutely worth testing with a low dose first and building up, if need.
• 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 modafinil is a strong, prescription only, stimulant. Beyond the difficulties people may experience getting hold of it, it 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 many people it may be enough. As mentioned above, Peter no longer condones the use of valium, after learning about how it induces sedation rather than sleep.

Final Words

Hopefully there are one or two nuggets of value in the above content.

This seems like a good opportunity to mention Peter’s subscription service (no affiliation).

For a small monthly, or annual fee, it gives you access to a whole host of benefits that aren’t available otherwise. Including the new “Qualys” series, which are short (<10 minute) highlights from the back catalog of podcasts.

This is a great way to support Peter’s continued time spent on the podcast, as well as make sure you’re getting all the latest and greatest info.

Further sleep related content that may be of interest:

• Matthew Walker’s 12 tips for good sleep – link
• Peter Attia’s Supplements, Diet & Exercise Summary – link
• Peter Attia Podcast – #47 – Matthew Walker, Ph.D., on sleep – Part I of III – link
• Peter Attia Podcast – #48 – Matthew Walker, Ph.D., on sleep – Part II of III – link
• Peter Attia Podcast – #49 – Matthew Walker, Ph.D., on sleep – Part III of III – link
• Peter Attia Podcast – #58 – Matthew Walker AMA #1 – link
• Peter Attia Podcast – #77 – Matthew Walker AMA #2 – link

References:

• 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)