#394 ‒ Sleep pharmacology: the role of medications in healthy sleep, the promise of emerging therapies, and the evidence for common sleep supplements

Hey, everyone. Welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members. And in return, we offer exclusive member only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. If you want to learn more about the benefits of our premium membership, head over to peteratiamd.com forward slash subscribe. Welcome to this episode of The Drive. In this episode, I focus on sleep pharmacology. Now we've had plenty of previous episodes about sleep. We've talked about sleep biology, sleep hygiene, even cognitive behavioral therapy for insomnia or CBTI, and even different sleep supplements. But we've never done anything more than sort of a skim of the surface on sleep medications. And the intention of this episode is to fill that obviously very important void. Sleep is a biological imperative. A pioneer of modern sleep research first put the problem this way. If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process has ever made. When you're asleep, you can't protect yourself from predators, you can't hunt, You can't find a mate. You are, as the phrase goes, dead to the world. But natural selection insisted that we do it anyway, every single night for our entire lives. That should tell you something. To make this practical, I wanna give you a simple way to think about sleep problems because most people, including most clinicians, don't diagnose them correctly. Almost every sleep issue can be traced back to one or more of four things. First, sleep pressure, that buildup of the drive to sleep the longer you're awake. Second, circadian timing, whether your internal clock is aligned with the light dark cycle. Third, hyperarousal, a state where your brain is effectively holding the gas pedal down when you're trying to sleep. And fourth, sleep architecture, the quality and structure of the sleep you're actually getting. Every tool we're going to talk about, behavioral, psychological, or pharmacological, works by acting on one or more of these, and most failures happen when you apply a perfectly good tool to the wrong problem. Few organisms in their natural environment have trouble sleeping. So how did we get to a place where thirty six percent of US adults fail to get the seven hours of sleep that most people need each day for optimal health and functioning? Where …