Sleep regularity is a stronger predictor of mortality risk than sleep duration (2023)
https://academic.oup.com/sleep/article/47/1/zsad253/7280269I have seen many doctors, including sleep specialists, regarding insomnia. They all pointed to one source as the reason for the sleep issues: stress. And they all wanted to put me on prescription sleeping pills. I said no to that. Sleeping pills can cause dependence, and they often treat the symptom rather than the underlying cause. As a software developer, I am used to finding and fixing the underlying problem instead of relying on the quick fixes these doctors were offering me.
After much research, I figured out what I believe was the underlying problem, and the fix for it. The underlying problem was magnesium deficiency. As a software developer, I spend much of the day doing mentally demanding work. This is the kind of stress the doctors were talking about. Stress can increase the body's demand for magnesium and may contribute to low magnesium levels.
The cells in our body depend on minerals such as calcium and magnesium for normal function. In muscle and nerve cells, calcium helps switch the cell into an active state, while magnesium helps keep that activation under control and supports the return to a resting state. When you are low on magnesium, your muscles may remain tense and your nervous system may have a harder time settling down. That can contribute to muscle stiffness and difficulty sleeping.
The solution, in my case, was magnesium supplements. They fixed my muscle stiffness issues and my sleep issues. A special form of magnesium called magnesium L-threonate may be especially helpful for the brain because it appears to raise brain magnesium levels more effectively than some other forms.
I found gwern's take on Melatonin interesting: https://gwern.net/melatonin
A small excerpt:
> One might object that they do not wish to tamper with their natural sleep, even if melatonin is a normally-secreted hormone.
> Sad to say, I would point out to such readers that they are already profoundly tampering with their natural sleep cycle, and indeed, all of Western civilization is tampering with it; most of my readers do not even sleep multiple times during the day, as ‘Nature intends’ and as humans have usually slept through history, but rather in a single 7–9 hour long block.
> [...]
> Finally, there are multiple lines of research suggesting chronic sleep deprivation is prevalent among young adults (including historical comparisons). It is striking that unemployed adults sleep a full hour longer than the employed , and that when normal adults are placed in settings without artificial light like camping or without any time indicators, they sleep longer than before - exactly as if they were sleep deprived.
> There are few to no side-effects to melatonin use in adults (there is uncertainty about the risks & benefits in children & adolescents28), and it is not addictive or habit-forming like caffeine is. The usual dose for a night is 0.5-3 mg and I take 1.5mg [29]; my dose is highly likely to be too high. High doses may well be responsible for why some people try melatonin and report that it does nothing or hurts them, since in one study, the best dose for old people was 10x smaller (0.1mg or 0.3mg) and for one blind person, 0.5mg [30 31 32] . Zhdanova et al 1996 found 0.3mg & 1.0mg to affect sleep onset similarly. A study of delayed-release melatonin found with their high dose of 4mg (but not 0.4mg) elevated melatonin levels 10 hours after bedtime ( Gooneratne et al 2011) - potentially interfering with waking time.
It is difficult to find doses as small as 1mg sublingual (dissolve under the tongue) in my area. Everyone is trying to sell you 5-30mg chewables. And, I expect everyone is buying them under the assumption that more is better. But, here it explicitly is not.
The way melatonin works well for me is to wait until I'm already settled into bed and should be asleep, but I'm not. Do a couple body scans to relax for real. Try to think about something mindless. Then if I'm still awake, pop 1mg under my tongue. I'll usually wake in the morning with half of it drooled on my pillow :P
It usually takes 15-30 minutes before I get noticeably drowsy, but I feel no more groggy the next day than if I slept sober.
- a long uninterrupted night cycle and a short (20-60 mins) afternoon nap. Around 2pm. - a night cycle split into two halves. With a 1-2h break (maybe up to 3h) starting around midnight to 2am.
The former is still very common, and imho stretching the definition of multiple cycles. The latter is more historical (more common when there are long winter nights and no electricity).
Also making it a “Western” problem is kinda weird? There are other cultures where single cycle sleep has existed. Even hunter-gatherer groups with little to no contact with the west. And alternatively afternoon naps are still quite common is some western areas. I guess the main thing that prevent it would be the classic work day schedule.
The usual suggestions from doctors for first line treatment are more mild medications that have drowsiness as a side effect, prescribed at low dose. I would actually prefer many of these low dose options over some of the high dose melatonin supplements. Melatonin is a hormone and taking it can throw off natural production
The reason diphenhydramine Is associated with a slight increase in dementia risk is the anticholinergic properties. This risk increase is from correlational studies on other medications with anticholinergic medicines being taken for many years by elderly people, so the risk of taking Benadryl occasionally is low to none.
The prescription alternatives like doxepin have the same antihistamine properties without the anticholinergic properties when used at the prescribed dose.
This is an example where people can get themselves into the wrong outcome by assuming anything their doctor prescribes is a last resort quick fix, but anything they can source by themself is safer and superior.
It’s not a good idea to take Benadryl for many years, but occasional use or even for months while going through a difficult period isn’t going to cause dementia.
As someone who has never been a regular coffee consumer, I really didn't want to end up with the dual dependence of melatonin at night and then caffeine in the morning.
This thread is stimulating me to want to get my magnesium checked, but barring that I've found the most effective sleep interventions are the basic ones: get some exercise earlier in the day, and don't do screens for the last few hours before bed.
But I don't think it does anyone any favors to oversell the idea that it has "few" or "no" side effects -- it has mild side effects, most commonly reported in the literature are daytime fatigue, headaches and GI symptoms, and also nightmares. Mild doesn't mean it isn't a nonstarter for some people.
It's also important to remember that there are major gaps in what we know about melatonin; notably the effects of chronic supplementation are not well-studied, but earlier final awakening has been documented and this is quite commonly reported in anecdata -- I can contribute a datapoint there, as can most people in my circles who have used it.
To be clear, melatonin is great and useful, but as someone with a rare lifelong chronic sleep disorder who is intimately familiar with this substance, I think it's most useful when we're clear on what we know, what we don't know, and what actually are the limitations on a substance.
Just because downing a bottle of it probably won't cause systemic organ failure or otherwise any kind of medical emergency in most people doesn't mean there aren't tradeoffs to consider when using it, especially if you are sleep-challenged
for people getting 7 hours of sleep you're good. Improve your sleep hygiene, ok, but artificial interventions to get 8 may not be worth it for you.
I tried magnesium before but didn’t see any effects after a week so threw in the towel. Then I read a comment by someone here that had the exact same symptoms as me (brain wouldn’t turn off), explained the underlying cause, suggested L-threonate, and explained that it’s a long-term deficiency and might take some time to build up sufficient reserves.
I have had insomnia my entire life, since I was a child. I would go to bed around midnight and fall asleep at 3am, if I was lucky. I simply could not get my brain to disengage.
Within a month of supplementation, I thought I noticed a bit of improvement. By two months, my insomnia was gone. Not better. Gone. I fall asleep within minutes now.
I also find sauna before bed is good. I have a bed chiller so I can crank up the sauna before bed and not sweat a lot. Generally if I sauna and take the aforementioned supplements I sleep well. Exercise also seems to help me out a lot. If I exercise during the day, and a 4-5 times that week in general, I tend to sleep well.
Funny how it's basically do all the things you're supposed to do - exercise, diet, stress management - then sleep is then easier.
I dont have problems normally, just cant sleep in high altitude, 3000m is already showing mild effects. Guess what, I do/did quite a bit of mountaineering, its easy to get above 5000m in himalayas, highest I've been in tent attempting to sleep before summit push was 6000m on Aconcagua. Tried both Mg and melatonin up there over multiple nights, 0 improvements. I had highest O2 blood level measured in 5500m by doctor (mandatory there) from whole group.
Physical effort makes better sleep for literally everybody, thats age old knowledge and I havent met a single exception yet.
I'm skeptical that avoidance of "relying on the quick fixes" generalizes to software developers as a whole :)
Which type, if you don't mind my asking? And how long did it take before you felt the benefits? I took it for a month once (forget which type) an hour before bed and nothing changed.
I've not noticed any significant difference between the other two.
Much more deep sleep with Glycinate, some folks don’t like it because they feel too groggy after waking.
Oddly, it has the opposite effect as sleeping pills on me, it doesn't make me sleep more but I'm more rested when I wake up. It even happened a few times that I only slept 5 hours but still could focus well at work and bike intensively for an hour in the evening, without glycine that was impossible.
At 20 euro/kg I think I'll take it for the rest of my life, and it probably will add a few years to my life.
The study that made this claim was performed by the person who patented magnesium L-threonate and sells it at a high price. They go after any company that tries to sell cheap generic versions. The study was in mice and only showed small increases.
Magnesium L-threonate doesn’t get absorbed into your body and go into your brain as a lot of the supplement podcasts and social media posts have been implying. Magnesium supplements like this dissociate into their components in your digestive tract. Magnesium and threonate get absorbed separately. So if magnesium L-threonate has some special properties, it would be because threonate does something to improve absorption or maybe has other effects in the body, but that’s a big if. Remember that the person claiming it works better has been making a lot of money off of that one study.
If you have the cash and don’t mind paying the price then there’s no reason to switch. Many people find that magnesium glycinate, which is cheap, works just as well if not better. Glycine supplementation has been found independently to improve sleep, so taking a magnesium supplement that dissociates into magnesium and glycinate might be helpful in its own way.
Magnesium builds up in the body. Some people are deficient and get strong effects from initially correcting the deficiency. Take high doses for too long and you can start accumulating enough to get into excessive magnesium range, which brings problems. That was previously a rare observation but it’s occurring more as people get into magnesium supplements from podcasts that encourage constant high dose protocols and repeat claims that everyone is severely deficient. Keep the dose moderate.
> And they all wanted to put me on prescription sleeping pills. I said no to that. Sleeping pills can cause dependence, and they often treat the symptom rather than the underlying cause. As a software developer, I am used to finding and fixing the underlying problem instead of relying on the quick fixes these doctors were offering me.
“Sleeping pills” could mean a lot of things. Few doctors will put a patient on long-term hypnotics with high dependence liability like Ambien in the 2020s. Most doctors are hesitant to prescribe them at all in the current environment, and when they do it’s short term. I would be very surprised if you went to multiple doctors who offered to prescribe you something like that as a new patient without a complicated history. Even the people with significant long term insomnia complain about how hard it is to get doctors to prescribe those.
What they usually recommend is weaker medications with somnolence as a side effect, but the effect is weaker and doesn’t target pathways prone to addiction. Trazodone, doxepin, and a few others are common. These are not in the same category as what people think of as “sleeping pills” like Ambien that have higher dependence and addiction liability. They should not be dismissed together as one big category of drugs that are all bad for you.
There were some generic versions available but the Magtein people go after them. They have to in order to protect their cash cow until the patent expires.
I think this is just what happens if you read a lot of supplement forums and listen to the supplement podcasts a lot: You start developing elevated beliefs about the supplements, disdainful beliefs about doctors, and think you’re making superior choices having done your own research. That last point is some times critical for the supplements working, because if you believe you’re taking something special after having cracked the mystery by listening to 50 hours of Huberman or Rhonda Patrick (as examples) then the placebo effect will supercharge the result. Having belief that you’ve solved the problem makes the effects much stronger, especially for cases like this where the underlying problem was already pointed out as being stress related.
Hmmmmmmm
People sharing their experience doesnt immediately mean AI-generated advert
"Health" and more specifically the supplement industry is just a revolving door of fads. There's also survivorship bias, those who are obvious get banned quickly.
I did it recently and found out basically all my b vitamins were in the toilet along with my vitamin D level. I started taking a b complex vitamin and D3 supplement and found immediate improvements to brain fog and exhaustion.
The Magnesium RBC Test measures magnesium inside red blood cells, providing a more accurate assessment of magnesium status than serum tests.
When a serum Mg test comes out low, the patient already has severe deficiency and visible symptoms, so isn’t very useful unless you’re investigating a systemic issue.
As explained by my endocrinologist.
Or is there a "maximum low level deficit" which you will never leave with just eating the right stuff?
(Like VitamineD deficit - it can get so low, that you cant fix it by "just going more into the sun")
Doing a quick search for magnesium-rich foods, it seems like it would take either an unsustainable focus on eating these foods to see results on a similar timeline or an extremely prolonged timeline to see similar results.
That said, I am not a doctor or nutritionist. But my instinct is that you can get so far in the hole with a lifetime of magnesium deficiency that supplementation is by far the most time- and lifestyle-efficient to digging yourself out. Whether or not switching to magnesium-rich foods can sustain you being at correct levels will end up depending on what the size of the deficit was in the first place, but is probably worth a try.
For me, avoiding high histamine foods as well as histamine liberators had helped tremendously.
The theory:
Anti-histamines like Benadryl make you sleepy by blocking histamine.
Well, instead of blocking the histamine, get rid of it in the first place by avoiding histamine foods (for example aged or preserved meats).
The brain histamine in your neurons is primarily synthesized from an amino acid. The histamine levels in neurons are different than the levels in mast cells.
There are a lot of degrees of hand waving in your theory that don’t work.
As a software developer, I am a much better doctor than actual trained doctors, and am definitely immune to any placebo effects.
I don’t know what people think you learn in medical school that makes you an infallible source of health knowledge.
The problem is not with evidence-based medicine itself, but with how the evidence is generated. The gold standard of medical evidence--a large, randomized, double-blind clinical trial--is extraordinarily expensive. In practice, much of this research is funded by private industry, which must have a reasonable expectation of earning a return on its investment. That naturally directs research toward treatments that can be patented, commercialized, and sold at a profit.
This creates a structural blind spot. Many naturally occurring compounds cannot be patented in their natural form, making it difficult to justify the enormous cost of conducting the kind of trials that modern medicine demands. As a result, potentially useful natural therapies often remain under-studied, not because they have been proven ineffective, but because the economic incentives to investigate them are weak.
This is the reason your doctor is much more likely prescribe Ambien CR than to suggest trying magnesium supplements.
Do you know they’re wrong? Please don’t invoke Dunning Kruger like this, it’s cliché and also wrong to do. There’s no indicator for whatever it is Dunning & Kruger showed, you cannot know if it applies to a single person. Their main plot showed a positive correlation between confidence and competence. Their paper has problems, their methodology has been rightly questioned, and some attempts to reproduce have failed. Plus keep in mind that, ironically, for people who are intimately familiar with the debate over DK, using it to essentially name-call someone backfires and has the opposite of the intended effect, it makes the name caller look confidently ignorant.
I don't know what the hell I was taking too much of, but I didn't have a good way to test it. I wish the body had some indicators.
They do factor in shift work as a categorical variable, and employment status as a categorical variable not taking into account occupation. But probably occupation (not a variable here) interacts with sleep status. Any job that involves a lot of flying (pilot, crew, people travelling for business) get more cosmic radiation exposure, for example, and potentially more sleep disruption. Certain operations and manufacturing jobs correlated with exposure to carcinogens also likely correlate with less regular sleep, possibly in a way that isn't corrected for by the limited shift work categories.
Regular sleeping hours as a marker for a less stressful life?
Also ran across this:
https://pmc.ncbi.nlm.nih.gov/articles/PMC5105607/
I doubt it's the actual reading. Maybe having a calmer life where you take the time to relax with a book.
You might measure the speed of your car by putting your hand out of the window and notice that the wind force on your hand is strong when the car goes fast.
Putting your hand out of the window and then blocking the wind with a book doesn't make the car slow down.
Keyword: "associated"
EDIT: I meant to communicate that it doesn't make the car slow down as much as your hand behind and blocked by the book (feeling almost no wind), would imply.
Perhaps someone who has a consistent schedule is hypothetically more likely to make healthier choices on average?
I would imagine that someone with a very regimented life tends to stick to a lot of healthy habits. They aren’t going out to the bar every night, then waking up at 6am for their morning routine.
I have a very consistent sleep schedule now and it is a real pleasure. I my sleep schedule has 2 or 3 3-4 hour stretches of solid sleep. I make my own schedule now so sleep is usually available when I'm ready.
Sometimes changing the correlated item, also affects the cause, through a link of causual changes.
E.g.: "Night visits to the fridge linked to high cholesterol".
Now, that's just correlation: it's not the visiting of the fridge, it's the snacking.
But if you read that and stop visiting the fridge, you likely reduce your snacking too as a side effect, and thus lower your cholesterol, without consciously trying to address the primary cause.
Maybe it's because I don't see how sleep regularity is a factor you can change as willingly as visits to the fridge, or maybe its because I don't see why people wouldn't just eat more before heading to bed.
It could also just be that I find a treatment of symptoms to be less desirable than causes.
In some cases it might be hard (e.g. insomnia), in others it might be as easy as e.g. changing your schedule, or stopping binge-watching/gaming/doomscrolling late, or some such change.
>It could also just be that I find a treatment of symptoms to be less desirable than causes.
It is more opaque.
But the point is not that it's necessarily easy. It's rather than even if X -> Y is mere correlation, by forcing yourself to fix X (even if hard), the resulting changes might also help with Y.
And technically "bad sleep" here isn't necessarily a symptom either. It can be a co-effect of the same symptom.
But I guess what might be slightly triggering is claiming that it's a "simple" target. Don't I wish I could sleep on command and better?
So a clear question is - why do people choose to sleep or why do they naturally sleep irregularly?
Because for that there must be a logical cause in the first place. They say they control for mental health and all that, but is it then that ultimately it comes down to preference in their mind? I'd think most people want to sleep in healthy way.
Basically - if they were able to control for all possible confounding variables, what exactly was the cause of irregular sleep?
Anecdotally I can say that I sleep more irregularly the more stress there is, and stress could easily affect health, but if they controlled for stress, what then?
I guess ultimately they are saying it's a desirable target to measure, so it's fine in that sense. They are not really saying that choosing to sleep irregularly is what is causing the issues.
To be clear, I apply an equal deep skepticism to most fields that aren't math (in the sense of a priority) or physics (in the sense that you aren't trying to study the entire world, but a specific set of phenomena that you can reliably control enough + repeat to run intervention on), whether the results agree with me or not. Maybe a bit of intellectual closed-mindedness. But then that means that me, personally, I can't in good faith use the criticism as a proper 'debunk' argument - at best it's a heuristic to avoid spending cycles to evaluate it (which is 'rational' behavior, as much as I hate that word, IMO).
The way I see these is "these persons invested a lot of time putting this together and all I have to counter it are personal vibes", so unless my LLM of choice can find plenty of conflicting papers, I tend to assume it's reasonably valid work.
E.g. considering some common causes like work stress - if they did the causation and compared people who did the same type of work, and they controlled for stress levels then why did one group of people have sleeping regularity issues more than compared to others?
Like there has to be some other driver then that they didn't control for, as in personality, environmental or physical difference?
Most people do want to have healthy sleep, the ones who don't usually have something causing those issues.
At least they aren’t shift workers
Do you think our ancestors slept exactly 8 hours a night from 10pm to 6am? No they slept when they wanted.
Like, John Carmack said that he NEVER burned out, never went into a dark corner (verbatim from his interview), and everyone agrees that he works like a machine. And I don't think he actually spent a lot of mental training to achieve that stability, because, he has been like that from a young age. This is THE best thing you can have in the world, if you want to achieve something, anything. If you don't have the mental toughness, you won't be able to make through that 10,000 hours (cliche, I know). I guess that's also why many self-help book talk about being consistent -- to be consistent, is to have mental stability. And I think there is a whole difference, between someone who trains his mental to stay stable for 6 months, then collapse, from someone who actually doesn't need to train and just be stable somehow.
This also leads me to realize that good sleep is one of the fundamentals of a stable mind. As a parent, I actually don't remember when was the last time I had a good sleep, and my definition of a night of good sleep is perhaps just trivial for someone else. At the same time, I consider myself lucky, because at least I don't suffer from serious mental issues. I still have a job and a house, and that's better than many out there.
This then leads me to despise the human body. It is a machine so delicate that you have to be very lucky to be super productive, whatever your definition of being productive is. It seems to ignore the input in short term (e.g. you can eat garbage food for a month and nothing really happens, or, you can sleep 4-6 hours every day for the last 6 years and still function normally), but once the long term shows up it is very hard to reverse. And there are so many theories focused on it that we have no idea which one is best for the individual. You might as well spend years doing A/B test on yourself and still have no idea what the hell is going on. Or you need to be super rich to have some medical team monitor you 7/24 to figure out what the hell is going on.
Believable is important because you have to internally 100% without a doubt believe that what you're doing is the right thing to be doing now.
As soon as the "what ifs" starts to creep in for the big picture items or goals, that can destroy everything. I'm not talking about running into technical implementation problems along the way (those can be fun), it's more like "did I pick the right language for this?" level of questions that sit in the back of your mind.
Personally when I find something to work on that I like and will have what I think is a favorable outcome, it's easy to put in 8-10 real 100% laser focused hours into a task every day, even if it spans weeks or months. I'd like to think most people can do this too, the hard part (for me at least) is having these things to work on.
I try to turn what-ifs into actions. Instead of a what if rumination it is a small task, or a small trial of something, or a move in general forward rather than not. Not even remotely close to doing this well all the time, but I notice an overall boost in mood and productivity when I reorient my mint to progress rather searching in the uncertainty space.
> https://x.com/ID_AA_Carmack/status/2069799283369345247
That's because he was the one burning people out while he was there living out his hobbies.
Basically my doctor's biggest concern right now is making sure I don't die in my sleep because of something the device records that I and my wife never even know happened. Its a point of debate right now how much to disrupt my life with side-effects to do that.
This has been game changing and keeps me on a regular sleep routine.
I get the study design is not causal and all, but this R^2 looks very underfit for a study that claims a stronger predictor?
Last year I did an experiment of sorts while unemployed for a time and found that if I just slept and woke when tired that my sleep time would naturally recess and eventually "flip" after about a month.
My entire life I've wondered why I feel incredibly tired and found waking up so difficult. Turns out that if you follow your bodies dominant sleep cycle it's a synch to wake up. Unfortunately, it doesn't work with modern life very well.
The cortisol spikes are what get me. I can drink or not drink, exercise or not exercise, take magnesium or not take magnesium. The brain wants to tell me at 630 or 7 all the things that can go wrong or todos, instead of letting me sleep til 8. Sometimes it's much earlier than that.
I also wake up at the slightest sound or movement. It's been like this since I was a child. I'm defective, and all the bro science Youtube videos with top 10 science -based 'hacks' don't solve the problem. Know what does? Anti anxiety medication, but doctors don't prescribe benzos anymore.
Some more discussion then: https://news.ycombinator.com/item?id=42022151
like "garbage collection"
ADHD, for example, is correlated with both sleep cycle issues and worse outcomes in life (including higher rates of crime and participation in risky activities).