Thriving Through Sleep Deprivation: My Podcast Appearance on Cognitive-Performance Protocols

What science reveals about creatine, nicotine, binaural beats, and circadian strategies to sustain peak cognition... even when sleep is compromised.

If you're joining from the In Vivo Podcast, welcome.

I'm Dr. Brandon Luu, an internal medicine-trained doctor currently specializing in respirology. My recent years have revolved around navigating 100-hour workweeks, frequent 26-hour hospital shifts, and intensive board exams. These circumstances have compelled me to rigorously explore evidence-based strategies to sustain cognitive performance and metabolic health under extreme pressure.

I write this newsletter to share clear, actionable, science-backed protocols that enhance memory, attention, resilience, and overall health, particularly during demanding times.

Tim, host of the In Vivo Podcast, was incredibly well-informed and fun to speak with. Not only did we cover cutting-edge topics such as brain energetics, circadian biology, and binaural beats, but Tim's insightful perspectives taught me several new concepts along the way. I'm deeply appreciative of our engaging dialogue.

Below, I'll distill the key insights from our discussion, explaining the science and my personal experience using these strategies.

Creatine: Beyond Muscle Building

Creatine is widely known as a gym supplement for strength gains, but its cognitive benefits, especially under conditions of fatigue and stress, are underappreciated.

Creatine replenishes ATP, your cells’ primary energy source, crucial for optimal brain function, particularly during sleep deprivation and stress or exhaustion. In a fascinating study, participants were sleep-deprived for 21 hours and given a high creatine dose (0.35 g/kg). Remarkably, many of their measures of attention and cognitive performance returned to baseline, or even improved.

As a beautiful demonstration of how creatine helps when your brain is under extreme stress, one study subjected fifteen healthy adults supplemented with creatine (20 g/day for seven days) to 90 minutes of breathing air with only 10% oxygen (atmospheric is 21%). Remarkably, many of their measures of attention which plummeted during oxygen starvation returned to baseline.

Additional research demonstrates that daily supplementation (10 g/day) increases brain creatine levels significantly, suggesting higher doses may be more beneficial for the brain.

I consistently take 10 grams of creatine daily, occasionally adding another 5–10 grams ahead of overnight shifts. Emerging evidence suggests benefits extend beyond cognition to mood stability, insulin regulation, and muscle preservation during immobilization or injury.

Nicotine: A Cautionary Performance Enhancer

Nicotine's reputation suffers due to its harmful delivery methods (smoking, vaping), yet isolated from tobacco, it acts as a cognitive stimulant. Nicotine itself enhances attention, learning, and alertness by activating nicotinic acetylcholine receptors in the brain.

Animal studies highlight nicotine's potential to reverse cognitive impairment caused by prolonged sleep deprivation.

In one study of mice sleep deprived for up to 48 hours, sleep deprivation significantly impaired learning. However, nicotine completely reversed these deficits.

I decided to experiment with this. I cautiously used low-dose nicotine gum (2 mg) during extreme fatigue moments during overnight shifts, observing immediate improvement in focus and reduction of fatigue without any crashes. Also, the days after not sleeping, I also find it gave me a substantial boost when I needed to get work done.

However, nicotine is addictive and can increase heart rate and blood pressure. Human studies specifically examining its effects during sleep deprivation are lacking. If used, it should be approached with caution, limited to controlled doses via gum, pouches, or patches only. It should never be consumed through smoking or vaping. While current evidence is too limited to recommend nicotine for routine cognitive enhancement or sleep deprivation, mechanistic and animal studies suggest it may hold potential as a targeted intervention in extreme circumstances.

Binaural Beats: Simple, Powerful Brain Entrainment

"Binaural beats" are auditory illusions created when each ear hears slightly different tones. And emerging evidence suggests they might hold the key to substantially improving memory and attention. By causing your brain to perceive a rhythmic "beat," binaural beats can synchronize your brainwaves. This has the potential to enhance memory, attention, and mental clarity. But not all beats are equal. Choosing the correct frequency is critical.

One study showed that listening to 20 Hz binaural beats boosts long-term memory recall by approximately 30% compared to white noise.

Another striking study demonstrated that during demanding attention tasks, subjects using binaural beats sustained performance, while control groups' scores significantly declined:

• Control group (quiet rest): Performance declined from 49.3% to 18.4% (-30.9%)

• 14 Hz Beta beats: Performance improved from 50.7% to 54.5% (+3.8%)

I've integrated binaural beats into my deep work and study routines, observing substantial improvements in attention and productivity. For accuracy and effectiveness, I've made the precise frequencies from the research freely available.

Practical recommendation: Use headphones with validated study-based binaural beats during study or focused tasks to maximize cognitive performance.

Exercise: The Ultimate Performance Enhancer

Exercise remains the foundational strategy for combating cognitive and metabolic impairments from chronic sleep loss. Regular aerobic exercise significantly mitigates insulin resistance, inflammation, cognitive deficits, and mood fluctuations.

My residency schedule incorporated:

• Morning aerobic exercise prior to lengthy shifts

• Post-shift outdoor walks or runs to reset circadian rhythms

• Twice-weekly full-body strength training to preserve muscle mass and metabolic health

Aligning Circadian Rhythms: Your Internal Clock Matters

Circadian biology profoundly influences health, cognition, metabolism, and sleep quality. Misalignment is frequently caused by irregular sleep, artificial nighttime light exposure, and nighttime eating. This deteriorates health and cognitive function.

Studies demonstrate simple circadian interventions rapidly improve well-being. Night owls can shift their internal clocks significantly by:

• Getting morning sunlight (or bright lamp exposure)

• Avoiding nighttime blue-light exposure from screens

• Eating earlier in the day

• Avoiding late night caffeine or naps

• Exercise early in the day

Bright light in the morning after sleep deprivation is actually a performance enhancer:

Disclaimer: This content is for educational purposes only and is not intended to substitute professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making any changes to your health, diet, or lifestyle.

Final Thoughts

These evidence-backed strategies can't replace restorative sleep, but provide crucial support during unavoidable sleep deprivation or high-stress periods.

Here is a brief summmary of my protocol:

• Creatine: 10 g/day

• Binaural Beats: 14 Hz for sustained attention, 20 Hz for long-term memory

• Exercise: Regular aerobic training combined with outdoor exposure

• Circadian Habits: Early-day meal timing, morning light, and nighttime screen avoidance

• Nicotine: Rarely, maybe 2-3x/week. Still lacking high quality evidence.

Thanks again to Tim, host of the In Vivo Podcast for facilitating an insightful and enriching conversation.