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

Where this was said

Sleep hygiene, circadian alignment, and the medical causes of insomnia: building the foundation for effective sleep treatment

At 8:20 · chapter starts 7:15

Before any medication enters the picture, Attia argues, the foundation must be behavioral. Circadian alignment requires regular wake times, morning sunlight, reduced evening light exposure, and a cool, dark bedroom. Homeostatic sleep pressure is cultivated by exercising intensely earlier in the day, avoiding naps, and not drinking coffee in the afternoon. For those with circadian-specific problems — owls who can't fall asleep, larks who can't stay asleep, or chronic social jet lag on weekends — circadian interventions take priority. For those with excessive daytime sleepiness, fragmented sleep, or heavy caffeine dependency, sleep pressure consolidation matters more. But sleep hygiene alone cannot fix hyperarousal. And before reaching for medications, Attia wants clinicians to rule out medical culprits. Restless leg syndrome affects 3% of adults globally but up to 13% by American self-report. Obstructive sleep apnea, driven by the obesity epidemic, likely affects about a third of US adults — 39% of males, 26% of females — with roughly 20% of cases severe. And mood or anxiety disorders, present in about a third of US adults in any given year, come with severe insomnia rates of 25–45% in sufferers, doubling when both are comorbid.