59 pages • 1 hour read
Outlive: The Science and Art of Longevity
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Part 3, Chapter 16-EpilogueChapter Summaries & Analyses
Part 3, Chapter 16 Summary: “The Awakening: How to Learn to Love Sleep, the Best Medicine for Your Brain”
In Chapter 16, Attia focuses on sleep because “poor sleep can take a wrecking ball to both your long-term health and your ability to function day-to-day” (352). Despite its relationship to health, sleep remains undervalued in most industrialized nations, including the US. Attia hopes to change perspectives on sleep.
He first addresses the question “How long do we need to sleep” (354)? Based on studies, including those conducted in dark caves, humans need around eight hours of sleep per night. Sleep-deprived individuals underestimate how too little sleep impacts their performance and energy levels. They adapt to this state. Once they start getting good quality and quantity sleep, however, they immediately see a difference. Too much sleep (excess of 11 hours) has similar adverse health effects as too little sleep.
Attia turns to how sleep impacts the body. Lack of sleep impacts our metabolic health. It gives seemingly healthy people, like Navy SEALS, “old-man blood,” which is when their inflammatory and hormone markers are decades older than their actual age. Poor sleep causes insulin resistance, wrecking metabolism. Lack of sleep also causes stress, which harms metabolic health. Stress at night while an individual sleeps can elevate glucose levels. The body releases the stress hormone cortisol. Cortisol not only triggers the release of glucose but also prevents the body from utilizing glucose in the fat and muscle tissues, likely to prioritize glucose going to the brain. Continued high overnight glucose can lead to type 2 diabetes. Poor sleep also changes our eating patterns: Sleep-deprived people consume larger amounts of poorer-quality foods.
Long-term sleep disruption also impacts heart health. People who sleep poorly at night have higher resting heart rates and lower heart rate variability, both of which hurt the heart’s health. These traits increase an individual’s risk of heart disease.
Sleep, especially good quality, is also critical to brain health, particularly as we age. At night, we cycle between two sleep stages: non-rapid eye movement (NREM), which includes deep and light strength sleep, and REM, which is where we dream. Deep NREM helps with memory retention and clearing out cellular junk in the brain. REM helps with creativity, problem solving, processing emotional memories, and maintaining emotional awareness. Deep sleep declines with age, perhaps related to “changes in growth hormone secretion” (364). Research suggests that chronic poor sleep might be one driver of Alzheimer’s disease.
Part 3, Chapter 17 Summary: “Work in Progress: The High Price of Ignoring Emotional Health”
In Chapter 17, Attia discusses the biggest roadblock to longevity: emotional health. Emotional health should not be used interchangeably with mental health. Mental health comprises “disease-like states such as clinical depression and schizophrenia, which are complex and difficult to treat but do present with recognizable symptoms” (388). Emotional health includes mental health but has a broader definition. Attia notes that emotional health “has more to do with the way we regulate our emotions and manage our interpersonal relationships” (389).
Attia focuses on his treatment for anger management, workaholism, and depression, and how failing to address his emotional health threatened his healthspan. After ignoring his emotional health for decades, friends and family encouraged Attia to try counseling and wellness residential programs. These programs helped Attia begin to deal with childhood trauma. While children are resilient and can adapt to trauma, it often results in them growing up “to become maladaptive, dysfunctional adults” (387). This dysfunction represents itself in four ways: addiction, excessive reliance on others, habituated ways of reacting (e.g., anger), and attachment disorders. Attia notes that he fits three of these trauma branches. Attia struggled most with his relationship with himself. He notes that his “deep self-hatred and loathing still contaminated most of [his] thoughts” (395), which he wasn’t recognizing on his own. Through counseling and work, Attia slowly began to address his self-hatred, including by practicing dialectical behavior therapy (DBT), which helps him recognize self-destructive emotional states and change or manage them before they become too explosive.
Like physical health, it takes constant planning and effort to address emotional health. Similarly, failure to address our emotional health will reduce our healthspan. Attia argues that dealing with emotional health is harder than physical health because “we are often less able to recognize the need to make changes” (389). Often, it is friends and family who encourage us to improve our emotional health, as was the case for Attia.
Epilogue Summary
In the Epilogue, Attia reiterates that longevity is meaningless if you are unhappy. The most important question people need to ask themselves is, “why do we want to live longer?” (410). The why should be forward-thinking and have clarity and purpose.
Part 3, Chapter 16-Epilogue Analysis
In these final two chapters, Attia reveals several factors that are central to The Importance of Living Better for Longer, some of which are issues Medicine 2.0 barely acknowledges (although this is starting to change). The first is that chronic sleep disruption leads to poor health all around. Attia underscores the need for people to maintain good quality and quantity of sleep as they age. While there is no magic bullet for sleep, there are different ways to assess sleep habits, including wearing a sleep tracker, completing the Pittsburgh Sleep Quality Index, and using tools to help someone identify if they have insomnia.
The second conclusion is that emotional health may be the most critical part of healthspan. Issues around emotional health, such as feeling lonely or despair or not being able to connect and have healthy relationships with oneself and others, all negatively impact physical health. It takes a lot of work to “monitor, maintain, and restore our emotional equilibrium” (399), in part because it does not come innately to us. Attia encourages readers to investigate medications, mindfulness meditation, therapy, and various other tools that can help them improve their emotional health. The point of longevity is to enjoy our older years.
Attia also continues to refute more myths about health. While big pharmaceutical companies tout the benefits of sleep medications, Attia underscores that they are terrible for people and do more harm than good. One of the primary reasons is that sleep medications mimic sleep. They induce consciousness rather than enabling someone to slip into the natural sleep stages. As a result, a person taking sleep medications still does not get the benefits derived from natural sleep.
Attia suggests that one way to sleep better (after ruling out sleep apnea) is to pay special attention to sleep environments. Often, people sleep in environments that are not conducive to sleeping. The environment needs to be dark. LED household lighting is especially bad for sleep because the brain views the blue light as sunlight (and thus tries to coax us awake). Minimizing access to this lighting type will help prepare the brain for bed. Reducing our use of phones, laptops, video games (which all also have blue light) as we get closer to bedtime will also prevent minds racing as we try to fall asleep. Attia also recommends that we sleep in a cooler temperature. He also cautions against drinking alcohol or coffee too late at night, since both mess with the natural sleep cycles. Exercising too close to bedtime might also prevent us from a quality night’s sleep. Finally, Attia suggests that we need to mentally prepare ourselves for sleep, which might include meditation, reducing our intake of something that would cause us anxiety, etc.
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