Transcription
Most people will say to me, "Okay, well, what aid do I do? What evening routine should I do? What do I do when I wake up? Should I take magnesium, extra melatonin? What do I need to do?" What are the things that we're all obsessing about that you actually can tell us don't make a huge difference to us? I would say, Stephanie Ramsey, over 20 years experience in improving people's sleep, is the 8-hour rule a myth? Should we really be focusing on our bedtime routine, and how can we improve our sleep quality? You get the—I to call them—the sleep anxiety gremlins. Explain if we're obsessed with this idea that we have to get 8 hours and it has to be every single night; there would be no variability in that. I think people are so confused about: Do I actually have a sleep problem or don't I? What techniques have you identified that help people push those gremlins away? So what could you do? So first thing is, Steph, welcome to the show.
Thank you. Thanks for having me. Where should we begin that will be of most value to people who've seen the word "sleep" and clicked on this episode? Probably how we sleep. So you have two main sleep mechanisms: okay, the H, homeostatic sleep drive, which is like the sort of the—it drives you to actually be able to fall asleep at a certain time of day. And then you have something called your circadian rhythms, which in Latin it literally just means "around 24 hours," and you have certain physiological processes, one of them being your sleep-wake cycle, which is on a 24-hour rhythm. Your sleep drive, this homeostatic sleep drive, it starts from the moment you get up in the morning. So this idea that focusing on your evening routine or even thinking about something you might do to stop waking up in the night when you do, or when you wake up in the night a few times—how can I get back to sleep—it's very flawed because ultimately, in order to have a good drive to sleep, so predictable sleepiness, and then the ability to have a fairly good quality of sleep through the night means getting up at a consistent time in the morning. So it starts from the morning; so you build that pressure. So the irony being is that you spending time awake is building pressure to sleep. You cannot sleep if you haven't been awake, and yet we all fear being awake too long and what sleep deprivation might do to us. When the irony being is when you build up any kind of sleep debt, the first thing you're going to do is feel a drive kick in. But because we're so unpredictable with our get-up times, we don't often see that predictable drive kick in. So it's very interesting to me that we started telling people, "Go to bed at the same time," but actually the most important thing is the get-up. But it's hard, I get it, because when you're struggling to sleep, or kids are making you—or sleep awful, and there's so many things that can affect our sleep, the worst thing you want to do is still get up at the same time. But if you were a little bit more consistent than probably most of the global population is now, we'd all just have better sleep because that one fundamental principle of getting up at the same time is, you know, building a predictable sleep pressure and it's helping your brain to understand when to start that 24-hour cycle which you are going to go through every day, or around 24 hours, I should say.
So as a sleep expert, Steph, what's your own sleep patterns like? I hate being called a sleep expert. I've been doing this for almost 20 years, and I still think I don't know that much about sleep. So let's call me—you prefer—the explorer, some kind of explorer, someone who's fascinated or passionate about this. Um, but what is my sleep like? Well, it's—I would say—I would say my sleep is fairly good, but just like everybody else, hormones impact my sleep; um, what I've done during the day impacts my sleep; stress impacts my sleep; illness impacts my sleep. Is it—is that normal? Of course. With all the knowledge that I've gained, I know that I cannot avoid that happening ever. Short-term, your sleep is supposed to be adaptable and variable. You know, before the Industrial Revolution, we were much more in line with obviously the planet's rotation, as I said, and the seasonal changes. Your sleep was able—and still is able—to ebb and flow with what happens. If you think about it, when you get sick and your body needs to do more because we do a lot of—you know, we—we—we—we reduce inflammation basically when we're sleeping, not just when we're sleeping, but that is a big time we're doing it. So sometimes when you're sick, you need more sleep. Well, if we were—if we're obsessed with this idea that we have to get eight hours and it has to be every single night, there would be no variability in that. You—you actually wouldn't be able to recover very well. Similarly, if you're going through a clock change or a time zone shift, how would your body shift if you were supposed to have eight hours at exactly the same time every single night? So that's not how it works. So I know that variability is normal. I'm pregnant at the moment, I'm 24 weeks pregnant, um, and I know that my—my body is trying to grow bones and that I cannot expect my sleep to be the same as when I was 25 years old and in a very different place. So I think we—it's worrying how we talk about, you know, basically from an adult onward till the day you die, you're supposed to get eight hours of sleep, or—or it's completely impossible.
So can I ask you then about this idea of sleep drive? I understand that getting up at, let's say, 6:30 every day allows you to get into a pattern or into a system, right? But how does that make the sleep that you have better quality sleep when you wake up around about the same time? What you don't have the ability to do is sleep in, and when you sleep in, you're confusing your brain. It doesn't understand then that you still want to feel sleepy at 10:00 or 11:00, and you still want to be able to get through the night. So basically, you—I—I guess a good way of explaining it is a bit like a phone battery. Most of us kind of understand now that with a phone battery, you probably need to let it go down quite a bit, and then you charge it up again, and that's a nice consistent pattern; it's nice and predictable. You understand when it's going to work and when maybe it won't work. But then if you're quite inconsistent about that process, not only do you not know when it's going to work, but you now have a problem with the actual battery not being very strong, and the battery weakens. That's basically what your sleep drive is doing. So if you think about it, when you get up about the same time every day, you can't alleviate any sleep debt that you might have incurred. So what your brain will do, if you really do have anything that it needs to alleviate, is it will make you either go to bed a bit earlier if—if you need to, so you might feel a bit sleepier a bit earlier. But something amazing happens in your brain, which is that you don't always have to—get like for like. So if you lose 4 hours, you don't have to gain 4 hours. I think that expectation really sends us down the wrong track sometimes. What your brain does is it just figures out what stages of sleep that you were missing that it really needs you at that point in time to have the most, and it will increase those in your next night's sleep. So the crazy thing is is that sometimes having a poor night can actually improve the efficiency and the quality of your sleep, but only if you're being fairly consistent; you've got a fairly consistent baseline in your behavior, um, and—and so basically, I guess what I'm trying to say is that if you keep your sleep baseline, or your sleep muscle as I like to call it, strong by some of these very key concepts, it will be a lot harder—because you'll have quite a strong sleep drive—it'll be a lot harder for your sleep to be interrupted. Sometimes your sleep's going to be interrupted, and we have to accept that that's okay, but it will be a lot harder for it to happen. But we don't like thinking that proactively. What we want to think about is, "I keep waking up at 2:30 in the morning; how do I stop that?" That is me, by the way, almost—almost every day, and everything seems like a total disaster in my entire life at 2:30 in the morning. That's—I guess most people will say to me, "Okay, well, what do I do about uh that then? What aid do I do? What—what evening routine should I do? What do I do when I wake up? Should I take magnesium, uh, extra melatonin? Like, what—what do I need to do?" And I'm like, "Well, are you looking after your sleep mechanisms first of all? And if the answer is yes and they're still having these problems, then actually, instead of all that tech and all those aids, we would go down some a route of sleep retraining, which we can talk about, which is entirely different, um, but—uh, I would never—I mean, it's a bit like the athletes' 1 to 2%. All that stuff that people want me to tell them is going to make not very much difference, even if they are evidence-based, which most of them are not; they probably won't make that much difference if you are not looking after those sleep mechanisms because your—your—your baseline sleep is so weak that there's nothing—there's no strength there; there's nothing to work off.
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Do we—you tell us about the sleep mechanisms then? What is it that we need to be focusing on? So—um—so like I said, those key sleep mechanisms are your homeostatic sleep drive and that 24-hour cycle that you—you're on whether you like it or not; your—your sleep—that's how—how it works. Um, so what could you do? So first thing is, yes, it's that get-up time. The second thing is the most—one of the most—the most influential external—sort of—uh, influence on that 24-hour cycle is light. So unfortunately, since the Industrial Revolution, we're now sort of working at times where you don't always have light. So what you've got to think now is, "Okay, how can I add in light into my morning?" So what light does is it really helps remind your brain that you need to be awake. We're diurnal creatures, not nocturnal, and what that means is, like plants, we really react to the light. Um, so just exposing yourself—and it can be artificial; yes, it's not as good as natural, but we—you know, we can't help that now; we need to sometimes get artificial light. So just adding bright light to your morning will instantly make you feel more awake. I mean, I was very lucky when I first started my career; I—did a lot of studies; I—I worked back at Harvard Medical School, and we were doing things like depriving people of sleep all night and exposing—using them to bright light in the morning. Now, I'm not saying you can negate the effects of—of uh sleep deprivation, but you absolutely can prove that we're on this weird cycle that if you just do the right things at the right time, your body remembers, "Oh yeah, it's 7 in the morning; she wants to feel awake; she doesn't want to feel lethargic." The act of lying in, interestingly, and not getting that light and movement is the same; it can really help you reduce fatigue and remind the brain that it's supposed to be away. The act of lying in actually perpetuates the problem because your body doesn't know that you're awake, essentially, even if you're not sleeping. Let's just say you're just lying there because you can't be bothered to get up; you actually are—sort of—sort of reinforcing that idea that horrible lethargic—inertia that we get where we're like, "Oh, I just don't want to start my day." We think it's purely about what night sleep we just had; it's not; it's much more to do with your behavior first thing. Your body remembers it; let's just say 10—like one time out of 10 you didn't do this; your body would still remember, "Oh, but usually she's up by now; she's got light going, and she's moving," and so you'll even notice then that you are sort of naturally waking up and feeling all right, um, and it's all because of your—your usual consistent get-up time. When you can, you got your light exposure as much as you could, and you moved your body. So those key things—doing those in the morning—there's so much more powerful than uh any kind of evening routine, and I'm not just saying this from a scientific perspective; I have treated so many chronic insomniacs in—in uh the last 20 years, and it's always the same; those fundamental things aren't in place. I don't—I'm not saying that this will fix a sleep disorder, by the way; there needs to be more that's done, but this is always where you start. And so if you want to avoid it, this is also what you need to do, and that's why in the last few years because I—I've literally just spent my whole entire time fixing chronic sleep problems; I've realized that actually I need to move more into, "Okay, well, how do we help people proactively avoid these problems?" Because actually what I'm seeing in the sleep industry and the field right now is just a lot of scary noise which is frightening people, and guess what? Anxiety does—it makes your sleep worse, so it's not working.
So what are we hearing and seeing that gets your heckles up, winds you up, makes you annoyed? Um, I guess the idea that we are all supposed to be getting more sleep. Everyone actually needs a different amount of sleep. So there's 8 hours—is it—is that a myth? 8 hours a night? Yeah, it is pretty much a myth. And even if you are genetically an 8-hour sleeper, there is absolutely no way in this life that you're going to get it every night, and you don't need to worry about that; you really don't. I think that we've gone far too—I'm not saying we don't need to worry about sleep debt; it's just quite hard to accumulate over time quite a lot of sleep debt if you think about it, and—and we see this in the studies. If you try to keep yourself up for a really long period of time, you will notice that your eyelids will start getting heavy, and you can't do it. It's just that we get it so mixed up; we—we believe that every night should be exactly the same, so we're always look—you know, we sort of get anxious really quickly about what we think is sleep deprivation, and I'm like, "Your sleep doesn't work like that though. It's more like a computer that looks at trends over time, so it's always adapting itself and—ing what uh percentage of the sleep stages, for example, you get in any given night based on what you had the night before," and it's also much more related to your—your patterns of behavior over time rather than what you did last night and what you're going to do tonight, and then that's going to make this huge impact on your sleep. No, no, no. You've got to be consistent over time with the right behaviors. So I guess what I—I—I'm most upset about is when companies, for example, will say, "You can do this, and it's going to fix your sleep," when often what they're saying is, "You've only got to do this or start taking it once, and it will probably improve what you're doing; it will improve your sleep." It—it's just not all, "Try this technique, and then suddenly your sleep will suddenly improve that night." So I guess it's this reactive—um—idea in most solutions out there. And also, if it sounds too good to be true, unfortunately with sleep, it absolutely is. It is a physiological process; your body is smart; your brain is intelligent. Just cuz you did something new once or twice, it's not going to listen to you; it does not trust you; it knows your behavior is unpredictable, so it's going to wait till you do something quite consistently before it adapts, and then it will—if you're doing the right behaviors. But yeah, I just see a lot of this reactive—um, you know, "If you do this, then your sleep's going to get better," and—and again the idea that—I mean, you just look at any of it and think, "Okay, well, how does that affect my drive? How does that affect that 24-hour cycle?" And if you can't get them to explain that to you, then likely it's going to give you the athletes' 1 to 2% instead of the 30 to 60% that most people are looking for when they're looking for an improvement in their sleep.
So you flipped it on the head—the idea of we should be focusing more on what we do when we get up rather than when we go to bed. But is there anything we can be doing in our bedtime routines that do facilitate? I think again, if you think of this 24-hour cycle that we're on, your body does need anchor points to understand what you want it to do because it—it does have external influences, so one of them being light, for example. You want lots of bright light in the morning and fairly consistent light throughout the day, which most of us just don't get; it's all over the place. But then in the evening, you actually want that to be reduced down to help your body sort of get the signs that it knows that you wanted to start feeling sleepy; tired; it wants you—you—it wants you—or you want it to—uh, start that physiological process of winding down. So light's a really big one. That doesn't mean we all need to be sat in the dark. I feel like people take this out of context—like, just make sure that in—you know, there's a transition—like it—there's definitely a transition from your day and your bright light morning to your evening being slightly—I don't know—like lamps rather than overhead lights and reduced brightness on screens and things like that. The other thing: your brain is really good at remembering; it's like a small puppy or a baby; it's just constantly learning. If you work late, if you—you do things on your phone or—um—things that your body associates with what you do during the day, it's so smart; it's like, "Oh, she wants to—she—she wants to be—she wants me to increase her cortisol and get all problem-solving again because she did this; she opened up Instagram during the day, and she gets really stimulated by all that stuff," and so you're sending these signals to the brain, sort of helping it to understand that you actually don't want to start that physiological process of winding down. So not a case of having like really strong, "I've got to do this at this time, and then I've got to do this, and then I've got to do that," and it—it's very strict; you become very obsessive-compulsive about it; then you become super ritualistic, and then you start to believe that if you don't do it right, that sleep's going to go bad. That's a really problem—a big problem that we have at the moment. But actually, if you just try to have some kind of transition—we often call it a buffer zone in sleep medicine—where you're like, "Well, there's—it's not just day and—"
Then, night. There has to be a bit in between that looks slightly different for you specifically. I can't tell you exactly what to do. Some people love to meditate and relax, and that really helps them calm down. Other people get stressed just by thinking of those prospects, so it's got to be something that you're happy with, that you feel content doing, that's not the same as your daytime. Most of the time, you can't be like this all the time; you've still got to enjoy yourself sometimes. You have to sacrifice sleep in order to, um, do the other uh, you know, components that your body really needs, like socialize and and things that make you happy and help with your mental health. So sleep also can't be the be-all and end-all here. I hope that's not coming across in what I'm saying, because it certainly shouldn't; it's just one component which, by the way, will always be there for you. So no matter what you think you're doing to control it to a certain degree, you don't really need to worry. It's actually one of the things that you can think, "Well, I was doing it before I started worrying, and I'll do it after I started worrying."
So there's an area here that I still find it hard to get my head around, and it back to a lot of the research. So the research has shown that short sleep is linked to an increase in mortality. As much as it's about short sleep, the real key thing there is quality of sleep has a much stronger impact. Research from the University of San Francisco indicates that poor sleep in your 40s accelerates brain aging, with noticeable effects especially in your 50s. The Journal of Epidemiology and Community Health founding consistent sleep schedules can increase the risk of cardiovascular events by 26%, regardless of of sleep duration. So what I don't yet understand is why, when I'm asleep, is it improving my brain, improving my heart, improving my whole cardiovascular system, preventing me from getting dementia, making me less obese? I keep being told, "Go get more sleep to improve your overall health," but I don't understand what happens when I am asleep that does all that.
So when we sleep, we're not actually in this passive state. That historically, that's what we thought before, sort of 100 years ago, when we actually realized that sleep is this thing that we and and there's some things happening in it. We just thought it was this passive state, like a mini death, and actually it wasn't really worth studying, so nobody really cared about it, and there were more important things, like, you know, creating antibiotics at the time, which you know was were going to help us survive. Um, so yeah, we weren't really studying it; we didn't really understand it. But actually, now that technology has improved and we are able to study sleep, we do notice that there's actually a lot going on in your sleep; it's not this passive state. So there are many things; I mean, we will we could be here all day talking about so many of the different things, like, um, your inflammatory response, which you know you're creating cyto-proteins in your sleep to help with your inflammatory response, to help you fight disease, um, and that happens when you're asleep. Yeah, and then you've got things like, um, when you go to the gym and you tear your muscles, most of that muscle repair is happening in your sleep. A lot of cell restoration, growth hormones, it's all happening when we sleep. So that's why I think we've kind of got a bit overexcited and been like, "Well, the surely then the more you get the better," but actually you could be sleeping 10 hours a night and the the sleep be so poor that you're actually better off sleeping a lot less sleep with a much higher quality, and your body will get so much more out of it.
I mean, you said a bunch of things just then which were all quite different. One thing that I still really struggle with in the literature is, you know, lots of people quoting a lot of studies saying if you get less sleep it's bad, but actually there's not—when I look at the research, it's really hard to find differentiation between just a genetically short sleeper, which there are, by the way. We do not all sleep at the same times. They might be less of us that are genetically really short sleepers, but that we do exist, um, and if you just are a genetically short sleeper but you have no problems with the quality of your sleep, those poor outcomes aren't there. We need more research on this, by the way, we really do, but I think that's really confusing people because they're just thinking duration is the answer; I just need to always get more sleep. But I mean, even if that was the case, okay, even if if we categorically could say that we all just need more sleep, which we can't, by the way, because there—it's even when we ask, and we we do metrics for surveys and things, nobody's using the same metrics, like what are you asking about here, like how much how many hours they get, or are you asking about the quality? How do you work out what good quality is versus—we're really bad at talking about, you know, the duration of sleep we get; we're all really bad here. Nobody is very good at predicting how much sleep they get. So even if it was completely true that we, you know, you it was just all about duration, how many people—I mean, I'm asking the audience here—when when you found out that this was what you needed to do, have actually been able to improve their sleep just by the understanding, "Okay, it's all about duration," because what happens is when you think, "Oh, it's just about duration," is you go to bed earlier, and what happens when you go to bed earlier when you're not sleepy, because you're not looking after your sleep drive, you can't sleep; you can't sleep; you get stressed about yeah, and then you get the—I like to call them the sleep anxiety gremlins—which have two weapons: one is that they literally change your brain chemistry straight away, which means that they push sleep away; they literally can increase your cortisol. How are they doing that? Well, because when you start getting stressed, your heart rate gets elevated, and your temperature goes up, and that is exactly the opposite of what you what you want your body to be doing at that point. So just your beliefs have caused you to have the sleep anxiety gremlins come out with their weapons, and the second weapon is they alter your behavior load, so you you know that's when you start thinking, "Oh my God, I need to research how do I sleep better," and that's when you start taking all the supplements and uh doing all the sleep rituals, and then suddenly you're obsessed with doing all the sleep rituals, and your sleep isn't getting any better; it's actually getting worse, and you're getting more and more anxious, and now suddenly not only do you have an ingrained sleep problem because it's been over 3 months now, but you also have sleep anxiety gremlins, so you have two problems. They're not the same; you can have sleep anxiety and no sleep problems, and you can get sleep problems and no sleep anxiety, and that's when people come to see people like me, um, and I have to break all this away and like take away all these massive components, because insomnia isn't just one thing; it's all of these things being built up over time.
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What would you do if I came to you and said, "I've got a problem with sleeping"? Is there anything that you would offer in a clinic that people could do on their own home? Um, yeah, so uh what we do in clinic is usually based in the most evidence-based—this is the gold standard—when you when you think you've got something like chronic insomnia, and we can describe what poor sleep is and what poor sleep is and things like that, um, is something called cognitive behavioral therapy for insomnia, which is a mouthful, or CBT-I for short, and I hate it being called this because people just say, "Oh, I've tried CBT for depression, anxiety, all the other things, and it didn't work for me." It's better in my head to call it sleep retraining, because then people automatically kind of understand that one whatever you're about to do is probably something to do with their behavior; it's going to take them time; they're probably going to have to sit in a bit of discomfort; that's kind of what we're saying. But essentially, what is it? Well, it's a it's a few things: one is that you already have from childhood so many sort of um uh things that you think are fact about sleep that are wrong that we have to change. So it always starts with some sleep education. So in a way, what we're doing today is kind of like an initial start to that; you have to understand how sleep works if you want to fix it. Then what we've got to do is we've got to start getting you on the right behavior, so we got to build the foundations, a bit like when you're building a house, you got to start with the foundations, and that's things like getting up at the same time, like exposure, movement, going to bed when you're actually sleepy, tired, even if it's late to start with, because it won't be eventually if you're getting up and being consistent with that morning routine, um, and a few other key things, and we do that over time. We need to teach you that your behavior has to be consistent; it doesn't matter what you're noticing about your sleep, because everyone wants it reactively, don't they? They want it yesterday, or they want to see that whatever they do today affects their sleep tomorrow. No, no, no; it's going to take a while. And then what we do, um, after a bit of repetition and really helping you to really get rid of those beliefs you have about sleep and trying to improve them, is we actually go through something called sleep restriction therapy. So sleep restriction therapy might sound very counterintuitive, but essentially most people who have very broken sleep or really uh what they feel is a low sleep duration, they're spending quite a lot of time in bed, or at least they might not think they're spending a lot of time in bed, but the time they're spending in bed is there's a lot less time sleeping in it. So so there's a huge discrepancy between the how much time I'm spending in bed and how much actual sleep am I getting, and what we need to do is we need to move those closer together. Now what most people do is they go, "Okay, in order to move them closer together, I'll increase my bedtime in order to try to increase how much sleep I'm getting," but here's the thing: even if that works for you, you won't actually improve your sleep condition, because what will happen is—oh, let's just say you spend 11 hours in bed—you might get snippets of extra sleep, but the quality will be so poor, and it will be over such a long period of time, well, now you're dipping into your 24-hour cycle, and part of that is wake time; your body's going to get really confused: "Hang on, when do you want me to eat now? When do you want me to have good moods? Like, I don't know what you want from me," and your sleep certainly isn't going to be better. So actually, reducing how many gaps you have in your sleep is a better idea; it just sounds a bit scary to start with, because you're like, "Well, if I'm restricting my bedtime, what happens if I have a really bad night and I sleep even less?" And that may happen to you in the short term, and it's nothing to worry about. Over time, what would happen is you would eventually notice that as long as you're not sleeping at any other time, you'll notice your sleep drive feels a lot stronger; you will be tired during the day more, and I don't mean that horrible fatigue you get from broken sleep; I mean, you'll be lovely, luxuriously sleepy, tired, like your eyes dropping, that lovely feeling. But what you've got to do is avoid napping, which is the really exciting bit, because you're like, "Oh my God, I haven't felt like this in 20 years," and I'm like, "No, please don't do it," because we're building this up on purpose to help you to fill in the gaps at night time, but then we're not going to keep you there; we're going to slowly, incrementally increase your time in bed out, because we obviously know that you also might need a bit of extra sleep. But you know what the interesting thing is is that a lot of people find that when they do that kind of therapy, the quality of their sleep shoots up, and they suddenly realize that actually the duration they were after might not be needed after all. In a lot of people, it's quality and duration that gets increased, but I just think that's so interesting because everyone's like, "Well, I used to get 8 hours when I was 21," and I'm like, "Well, I think your perception now that you've got broken sleep is probably very different, because back then you probably weren't looking at it quite as much as you are now," so that perception is completely warped, but also it's very likely you're going to get what you needed when you were 21 because you're older now, and sleep changes with age; it changes with hormones; it changes with every single thing you go through, and it's okay, because sleep can adapt that way.
It is tricky to do on your own, I would say. Um, I created a company called Re-Sleep, which was trying to help this kind of training to become more accessible to everybody without them all having to come to a sleep expert, and what we recognize very early on is that even though you can create a bunch of videos and uh make it accessible online, make it cheaper, actually what we realize is you still need sleep experts, and you still need people to talk to and help you, because one, you're a super unique person, and two, asking someone to restrict their bedtime with all these beliefs in the background from 20 or 30 years ago, um, is quite tough to do. So, um, we even realize that, you know, some things you do need that extra support with, especially when you've had it for quite a long time, um, and coming back to the idea that I've tried to actually move a—not move away—I still fix a lot of sleep problems, but now I'm trying to help people avoid them. I recently created something called uh with BBC Maestro, just called "Sleep Better," of course, and the whole point of that is to give someone like a baseline, like, "Okay, okay, okay, it's really noisy out there; I'm really stressed; I don't know what to do; do I have a sleep disorder, or actually is this just something I can improve at home," um, and then what do I need to do? So I created this to be like a bit of a almost like a couple of week intervention that you can do, and either it's going to significantly improve—and it will significantly improve the majority of people's sleep—by getting rid of all the noise, getting them to do some really simple key things, and helping them to understand about sleep better, um, but it's also a bit of like a screening tool, because I think people are so confused about, "Do I actually have a sleep problem or don't I?" So basically, what that course does is it essentially gets you to do the foundations and then also changes your expectations about what you you think your sleep should be, and if after all of that you still find you're having a sleep problem, then perhaps yes, you might have a chronic sleep disorder, cuz nobody really understands, you know, what is good sleep and what is poor poor sleep.
I would say that the definition of a good sleeper, for example, is somebody that—more often than not—it can't be all the time, by the way—more often than not, they are waking up, they're waking up, and they're feeling all right. I do not mean that they're waking up feeling euphoric, because a lot of people go, "I know what a good night's sleep is because when I have it, I feel amazing," and I'm like, "No, no, no; that's a catch-up sleep; that's why you're euphoric; your body did that to you; it increased all the brilliant stages; it did things that we can't do, and now you're feeling amazing." Why do we have those? Cuz I bloody love them when I get them, by the way, and because because uh, you know, in the short term, you know, someone's woken you up in the night, or maybe consistently you got sick for a while, and your body's good at accumulating it in a way that will help you as soon as it can, as soon as it's got over that particular sort of um, I guess uh, I don't know, fixing stage, like when your poorly, your body's in a different mode; it's trying to heal you. As soon as you get out of that and you're able to suddenly be a bit more consistent with your sleep behaviors, it can use that sleep debt to it get your sleep back on track, but only if you're not sleeping at random times of the day. If you are getting up, you're not lying in all the time; what you're doing is you're literally taking away all that lovely sleep debt that your body wants to use to get you back on track, because you're you're just trying to get rid of the sleep debt anywhere you can, any time you can, and that actually is really going to help you unfortunately get a chronic sleep problem. But going back to, you know, what is what is a good sleeper, it's mostly feeling like you are all right most mornings to get up and do your day. You don't worry about your sleep; sometimes you you know, yes, your your evening or your bedtime seems fairly predictable, but sometimes you're not sleepy at the same time, because there are so many things on your life that are affecting your sleep, and you know, sometimes you have to make little sacrifices, so so yes, sometimes you don't get to sleep, but then because you didn't go to sleep till late because you weren't sleepy yet, you didn't force yourself to spend time in bed getting anxious, which only pushes sleep away; you realized that it was quality over quantity, so yeah, you got less sleep, but you're not worried about it; the quality was fairly all right. And sometimes the quality is not going to be great, but because you're not doing all these compensatory things that you think are going to help your sleep in general, your sleep just flows with you. But I think a good sleeper is somebody who actually just doesn't think about sleep that much and effectively just feels all right most of the time.
And looking at really chronic poor sleep, because you are going to have, you know, short-term, you know, under three months, a few weeks of not good sleep, especially if you're going through something that's totally normal; you do not need to worry; that's your sleep ebb and flowing and trying to support you. But if it's going on longer than that, so I would say that someone who really probably needs a bit of help is either physiologically they are finding their sleep is broken at night to the point where it's affecting their day. So this is really important: you might have breaks in your sleep; does is anything to worry about? Not necessarily. Do you find that your day is affected? How's how is your life around your sleep? Do you think about it loads, because there's a whole other problem—remember—of sleep anxiety? Have you just got a really big problem with sleep anxiety, which you can also get support for? So I think after 3 months of having something which has either caused you to maybe four nights out out or more out of seven, you are having quite broken sleep. What does that look like? Well, it could be that you are really struggling to get to sleep, and that's not something you've had before, and it's been longer than a few months now, or you don't have a problem getting to sleep, but you can't maintain your sleep; you keep waking up, or the sleep is really light, and actually this is actually really starting to impact your day now, so it's not just broken sleep; it has to be impacting you in order for it to be an issue. But the issue now is that I'm starting to see that as soon as sleep breaks down, people are so anxious about it that they'll say, "It really is impacting me," and I'm like, "But is it though? Is it really?" Because it probably will sort itself out, because it's so flipping telling us if you're not have sleep, there's a problem; therefore, we naturally assume if you're not sleeping 10:30 till 6:30 every single day perfectly, you must have a problem. Do you know what the first thing I always say to people who are like, "Okay, as soon as I get a sleep problem, what do I do?" And I'm like, "Nothing; do nothing; just continue with your behavior; just continue everything you're doing, and just see if it sorts itself out," because likely it will. If you cannot get increasingly worried about your sleep, because that is another component; if you just completely get anxious about that, then it's not going to work. But really, we have to be giving the advice that in the first instance, because your sleep is so adaptable, it makes sense that sometimes it's going to be a bit variable, and you have to be okay with that, and it will go back to normal. If it doesn't go back to normal, and usually that's because we've changed our behavior and we started getting anxious about it, but sometimes it can be because you have a chronic bladder condition and it's waking you up exactly four times every night, and now your brain's learned a new pattern. Well, there is something you can do about that, but you got to go into a bit of retraining, and it doesn't matter if you still got that chronic condition; we can still make sure the quality of your sleep, the sleep baseline, is a lot better even with your chronic condition; it just might not look like when you were 25 and you didn't have your chronic condition.
We've got lots of questions from members of the high-performance audience, and we'd like to go through a few of them if we can, cuz I think this is helpful for people; we've got all kinds of questions brewing in their heads. So so we've had a a question here saying, "I love to nap to catch up on sleeping, just to feel better. Is that okay?" So uh, napping is a really controversial topic, I think now, um, so yes, we know that um sleep in general is obviously really quite good for us, okay, but you can't really nap if you don't need to, okay? So if you find that you're having to nap quite regularly, and that has something that's something that's changed for you, and you have to do that in order to recover, something's going on. So either your sleep at night is disrupted; maybe it's environmental; maybe there's a baby, um, or maybe uh maybe you've got something wrong with your sleep architecture, so there's other sleep disorders like sleep apnea which can affect your breathing at night; they're not going to help; you're not going to sort of drop down dead at any point, because your brain's so smart that it's just constantly trying to get you to breathe again, which involves you uh waking into lighter stages of sleep, but the problem with that is that you feel absolutely exhausted in the morning and during the day, so you could have had 10 hours of sleep, but you still feel like you need more sleep to catch up. So in that in that instance, excessively napping in order to feel okay is actually telling us that there's a problem. So usually it's the
The length of the naps, or how often you have to have them, that are really helping us to understand, okay, is there's something going on here. But then you could probably, and you can absolutely train yourself to nap more during the day, as long as you're happy that your expectations of your sleep at night need to change. Because your sleep at night will lightly need to change because you can't just oversleep; it's it's not a thing.
So I love a Sunday cuddle on the sofa with my wife, a movie on, kids watch the movie, and you might have a snooze; we have a nap. Like that's fine, right? It's it's absolutely fine. But probably the fact that you can do that on a Sunday shows some kind of debt somewhere. But absolutely, if it's not happening too often and it's something you really love and enjoy, it's not going to affect you. I think it's just all about expectations. Like I love having a little nap every now and again. I don't use it as if I used it as a compensatory tool all the time; I would end up getting chronic insomnia because it would teach my brain that I didn't want to sleep the same at night time. But if it's every now and again, especially if your sleep baseline in general is quite strong, then sleep debt will probably correct itself quite quickly. It's when your baseline is all over the place and your sleep is all over the place, but then you still expect this nap to... you're so interesting, cuz I'm I'm 47, you're 48, 49, 49. Have you ever considered our age together, been on the earth for a century, that having a nap actually damages your sleep in the night? No, I've never... cuz it's sort of... you can't imagine that there's a like I don't know, it does... it's not it's not necessary. Like I don't want everyone to think, "Oh my God, if I have a nap it's going to damage my sleep at night." But if you consistently did it loads and you didn't change your expectations of what happens to you at night, cuz some people will be listening, they'll be like, "Well, I've had a nap ever since I was young," and I'm like, "Yes, but that shows me that probably you have a very sort of like what you think is right with your sleep, which it probably is," um, is a very different expectation than someone else might have. So if you had a 20-minute nap in the day and you're an eight-hour sleeper, um, maybe if you weren't having that nap during the day you might be an eight-hour and 20-minute sleeper, for example. But because you've never experienced that, your expectations are different. So I think it's it's tricky; it's a nuanced area. I'm not even super confident; it's just that I've been doing this for so long now that even with seeing so many different wonderful unique people, it's always a similar thing that's going on. Even when I'm treating like um a a premier league footballer, for example, um, I will always start with these like uh basic fundamental uh sleep practices. Because when I talk to them, they're still their doctors are still just giving them sleeping pills and sleeping aids and all these things, and I'm like, "Well, yeah, obviously you're not sleeping; has anyone actually talked to you about these things over here, the way your sleep actually works?" It's just so fascinating; we're all the same and yet we're all so unique.
Another another question that's coming from our audience, Steph, is um about those sleep Gremlins. What techniques have you identified that help people push those Gremlins away? So sleep anxiety. I, in my head, the way I've looked at it over the years is very similar to having an actual broken sleep. On remember, they're two separate things; they definitely affect each other, but they're two separate things. Um, it's not just one thing that's going to get you over those sleep anxiety Gremlins. Okay, so first of all, you do need to understand where where is this anxiety coming from? What beliefs do you hold about your sleep? But then if you just try to change that person's beliefs because they've had them for 20 years, it's probably you're probably not going to be able to do it, right? Just cuz I tell... well that's not how your sleep works; their anxiety doesn't just suddenly go away. But it's a start, right? And then what I do is I do get them to do some things around their sleep that I know will provide them with some evidence that what they think about their sleep is not true. If I, you know, "I'm not going to sleep tonight; I already know I'm not going to sleep tonight," that kind of thing, right? So there's a lot of work around different things, and you can do things, very reactive things like trying to be uh more relaxed and doing relaxation exercises. There's something called the paradoxical intention technique where you do exactly the opposite. So instead of trying to get to sleep, which does not work because it has nothing to do with your homeostatic sleep pressure, what you could do is you could lie in bed; I always say lie in bed like a starfish, look up at your ceiling, at your pitch black ceiling, and keep... it's so hard in a pitch black room, by the way, to just look up and keep your eyes open and look up at your ceiling and then just gently tell yourself, um, you know, "I'm not going to go to sleep, and I'm going to keep my eyes awake nice and gently." And if you're the kind of person, only if you're putting extra pressure on your sleep and you already have a strong sleep drive, that's also really important, then you will likely fall asleep by doing exactly the opposite. So what I'm trying to say is that sleep anxiety is not something that there's one a one fix cure all. There's... when I see someone in clinic I use a combination of techniques, and the only reason I do that is through trial and error through the last 20 years of, you know, just prescribing some a relaxation technique; it's like, "Well, they've already tried that; that obviously that's not going to help; there's too much in the way here." But one of the biggest things is just helping humans understand that if they want to see real behavioral change, physiological change, that they might have some sort of control over, you're going to have to sit with discomfort for a while while these things take effect. So a lot of people will try one thing; they'll say, "Oh, well, I've already tried that." I often have people say, "I've already tried that," and I'm like, "Uh-huh, and how did you do it? And what else were you doing with it?" Like, and and it it's it's always this reactive, "Oh, I didn't see a a change in three days, so I just stopped doing it." And usually with any kind of thing, behavioral change like a diet change or a movement change, you probably need at least a few weeks, if not months, to really start to see these changes. Um, and I think sleep anxiety is one of those things. It's hard because to a degree we have to work with it. So I have to get them to do certain behaviors which isn't necessarily going to get rid of that sleep anxiety or even the broken sleep in the short term, and I have to have somehow help them feel so safe and secure and trusting that they're going to do that so that I can give them the evidence and slowly change their minds about what they think. So this isn't this isn't a straightforward um... I wish I could give you a straightforward black and white solution, um, but you can do it. Absolutely. The starfish technique though, I'm taking that away. Yeah, take it away.
You know, D, have sleep apnea, do you? Yeah, I was going to ask you about it, but I ask noticed that um it's coincided uh I lost my dad three years ago, and the sleep apnea has coincided in the last three years where and is it is it it's been diagnosed so or do you just... No, it's self-diagnosed, but I I sort of wake up and like with the fear that I'm going to swallow my tongue, okay, and it'll happen three or four times a night where it's very sudden; it's like that panic. So that could... I mean that is often something that people feel with sleep, but it's also something you can feel and not have sleep apnea at all, just to let you know. Um, one thing about sleep apnea is that most people stop breathing five times or under a night, an hour sorry, every night. I think my doctor Google my might give it a label that it doesn't deserve. No, no, no, no, but I think it's important so... um, we all stop breathing when we uh sleep at night for uh periods of time; it's when that that becomes quite um repetitive over an hour. So when we're looking at over five times an hour... I mean, I used to treat people that were stopping breathing like 150 times an hour, and then of course that's when it really starts to have an impact on your body. For example, the first thing you'll notice is that you'll feel very excessively sleepy during the day, and either you or someone else will notice that you keep either snoring and then sort of or gasping and then stopping and then it feels like they're dead, and you're like, "What's going on?" And then suddenly that massive snort or snore will suddenly happen. Uh, yeah, but in in the night sometimes, but yeah, but you tiredness as well is a thing. Yeah, so um the the most common reason behind at least obstructive sleep apnea, because there are different types of apneas, is usually weight gain around the neck area. Okay, so the other thing you could... so the first thing I was thinking when you said it was when your um father passed away uh was I was thinking, "I wonder if you gained any extra weight, not just around your neck area, because you can't just gain weight around your neck area," but did you gain any extra weight? In in certain individuals, like sleep apnea runs in my family; I only have to gain 5s to start snoring. It doesn't necessarily mean I'm overweight. Yeah. Um, and then obviously if I gained more weight, I likely would very much get sleep apnea because the more weight around your airway the more likely your airway is to collapse because your airway when you're sleeping is very relaxed; it doesn't have to be as strong, and you don't need to be breathing as strongly as you are when you awake. Um, but the problem is on a very nice relaxed airway you're it's easier to flop it shut or to at least narrow it significantly, which is often where snoring comes from because of that extra weight around the airway. But is what you're describing sleep apnea? I would ask you other questions like, "How sleepy are you during the day? Could you actually have a nap on a regular basis um quite easily?" Because a lot of people feel tired, but when I say, "Okay, well, if I said to close your eyes and have a nap, could you do it?" But in sleep apnea cases, most likely the answer is yes. Could you? No, not really, not all the time. Um, so it could be it could be a mild version of it, but you're now suddenly you've had it a few times, and this was such an adverse reaction that you remembering it now, and now it's become a thing where... and it could be learned where you're waking up... the other thing it could be is a bit of a night terror type situation where you're waking up and you're you're making an assumption of what you think has happened um or your body's trying to make sense of it. Um, but night terrors are often where we just jump up and there's some fright or something. I mean that was like in the months after I'd lost my dad; I had a like I would wake up once a night panicking that I hadn't taken some medication or I was late to get there to to help somebody, like and that was like a real sense of panic. It's horrible because you're a general in surges, and it just it's it's a horrific thing to happen to you in the middle of the night. Um, genetically some of us are more uh likely to get those than others. Like other people in your position might have just had fragmented sleep and maybe got a bit of insomnia from grief and all the things that you go through, whereas someone like you and I actually get night terrors every now and again, especially when my sleep is not regulated. Um, basically what night terrors are are when you transition between sleep stages um it's just something has disrupted that process; it could be anything from something internal to something external, like a lorry driving by, and it can just trigger these events. And making your sleep more regulated and and uh trying to improve your sleep overall can often make an improvement on those. But in that particular case, if it is night terrors, things like alcohol, caffeine, nicotine, chemicals that you're putting into your body in the few hours before you go to bed are going to make a significant impact; you'll notice that they'll happen more. I certainly notice if I've drunk too much alcohol, not at the moment, but in the past, um, especially when I was a student, I would have night terrors, um, but I rarely get them now because my sleep is fairly consistent most of the time.
A couple more questions from people. Um, what do I do if I I'm a regular waker-uper in the night because I think a lot of people wake up, then they panic they're not asleep, and that prevents sleep? So what is your advice for people that have those regular wakeups? So if you really are right at the beginning and you're not panicking, uh, then I suppose the answer would be nothing because it's probably it's probably just a short-term thing or could be that you do wake up once or twice a night, but as long as everything's fine, it's all it's there's nothing wrong; don't worry. If you are starting to panic, that can also turn into a pattern, and you can also start to get insomnia that way. Um, so if it's happened for longer than three months, then it could be that you you need to do some sort of sleep retraining, as we described, CBT-I. Um, but if this is under three months, but it is happening to you, it is impacting your day, is starting to stress you out, um, I would look at the fundamentals first. So that get-up time, um, enjoy your wake time, stop worrying about your sleep, because the more you worry about it, the worse it will be. So focus on that morning routine. When you go to bed, make sure that you are really sleepy, tired. Get ready a bit before bed; the act of brushing our teeth and you know being really really sleepy and then having to get ready for bed is is this kind of sort of you've you've cut the lovely process up; don't do that. Uh, get ready for bed a bit earlier; doesn't have to be super early, but just just a little bit earlier so that when you are feeling like you're you're nodding off, you you're going to have a really strong drive which will put you to sleep quicker, and likely the quality of your sleep will be better. So you want to be doing those things quite consistently for a while. If you are waking up in the night in in the short term whilst you're doing this process and you're trying to see whether that's really going to improve your sleep overall, um, then when you wake up in the night and this still does happen to me, by the way, obviously like I if I have to sit and talk to 500 people in real time, I will get nervous the night before, so I just don't go to bed until much later, and I'm just like, "Okay, four hours of good quality sleep is much better than tossing and turning for seven to eight hours in bed." So it's about avoiding the bedroom. Um, and if you do wake up in the night and you really can't get back to sleep and it's starting to become a bit of a stress, leave the bedroom. But the problem with that is that most people have this sort of belief with that that leaving the bedroom is going to wake them up further. But as long as you're still in your evening sort of head, so you're not doing the things that you you know make you feel stimulated that you would do during the day, the lights aren't all on, you might feel sleepy again, and then you can take yourself back to bed. But if you don't feel sleepy again, resting is the next best thing to sleep. So why are we all so worried about it? The the one big difference between me and most people is not all the knowledge; it's literally the idea that I just don't worry when I can't sleep, and that's happening right now because I'm pregnant, so I get pregnancy insomnia, um, but I'm really not that bothered about it; I know what's happening; I'm growing some bones for goodness sake; I can't expect my sleep to be on par. Absolutely. And talking of worry, um, I have a daughter that doesn't go to sleep till about half ten; she's only 11. She lays there; she doesn't go to bed that early, maybe half ten time, but she won't fall asleep; she'll come in our bedroom a couple of times, then and she likes to go to sleep listening to an audiobook, and eventually she'll be asleep. But we cannot get her up like in the morning; I need her up by about 7:00, about 7:20; I'm dragging her out of bed. Is there a way of moving her...? How old is she again? 11. Um, so she's just about to go into those teenage years; there's a lot of a lot of listeners have probably similar age kids in this book start cuz our son our younger son is like... she used to be out like a light at half eight and sleep. Yeah. So um, unfortunately for parents, I don't think they're going to like this very much, but um, when we become teenagers, we naturally do need later sleep. So we have a bit more of a delayed sleep phase, so it will look different to a parent's sleep because naturally they probably do need to lie in and and they naturally want to go to bed a bit later, and then also the sleep is longer. So all the things that a parent doesn't want are there. And to be honest, I would say that the there is obviously huge issues with this, and there's lots of controversy about when schools open and things like that because it's not really conducive to how their physiology is trying to help them um and for them to grow. Um, but I think it's about trying... although some kind of consistency is really helpful, it doesn't matter what age you are; some kind of consistency in what's happening with your behavior is good. With teenagers, I would just say that leave them to it in terms of let them sleep in if they need a bit more sleep sometimes; just try and see if there's some kind of consistent, even if it's actually the days that they don't go to school, they get up at a a different time. Even if you've got two patterns going on, try to keep those patterns as consistent as possible rather than all over the place. She is consistent; it's always about half... it's always up at... on the weekend it's always... yeah, and it will change again when she is older. I think um some of the issues I see is when people go through that transition from being quite a delayed sleep phase sleeper uh because they're teenagers and then suddenly having to go to a 9-to-5 job in their early 20s, but their body hasn't quite caught up with them, and that does help because it will get them into a routine, but sometimes that's also when sleep problems start because it's all over the place, and they just don't they don't know what to do. So it's always about... it doesn't matter when you get up, but if you can be somehow consistent with it, you're going to feel better.
And can you... like you made a distinction there between you said the second best thing after sleep is rest; would you tell us the difference between the two? I mean, there there's a huge difference. I mean, we absolutely need sleep in order to do all those things, like I said; it's not such a passive state. But I think the reason I say that is because people are starting to panic so much about not sleeping. But just think about it; when there's a huge difference between sleep deprivation, which by the way is actively restricting yourself or somebody else restricting you, when you literally can't keep your eyes open and that baby is crying or the phone rings and you're on call and you've got to go in and you're just like, "I literally I could sleep right now; I I could literally shut my eyes." And then when your body goes, "I don't want to sleep right now," do you really need to worry? If your body is saying that, I mean, it could be in a different pattern, which I know is a problem for you, and you can change the pattern, but that... do we need to worry? No. Resting, let's do some resting; it's the next best thing. Even resting your mind at the moment, like, you know, back in the day when we were, you know, cavemen and women, we didn't even have as much information as one Netflix episode in a day happen, and now we've got so much to kind of um process. And part of your but brain uh when you're sleeping does do some of that memory and emotional processing, but I think even just resting and doing things very differently to what you do during the day has is hugely powerful. It's just not it's not the same as sleep; it's not going to give you the same type of restorative effects, but it's still restorative, especially if you're not having the same kind of rest as you do during the day, where you might be sat on your phone scrolling through Instagram. It's not that Instagram is inherently bad as such; it's more just that your brain is doing so much information processing, and obviously I mean there's about mental health; there's so much we could talk about there, but um yeah, so resting at nighttime, if you can't sleep, wonderful; just do something different to what you do during the day.
Steph, you have been reassuring; you've been nuanced; you have you've been so helpful, and I think the lovely thing is there is so much misinformation out there, born out of people wanting to be a so-called expert and getting people to buy their programs or follow their routines or sell them a or something. To have you talk in a way that is like the biggest thing is not to worry, and the simplest thing is to have a regular get-up time. I mean, what a what great advice for people to all begin. Um, thank you so much. Before we finish, final question: What's the first thing that you would like people to think about if they've been intrigued or triggered in a positive way somehow from this conversation and they think, "Right, you know, I maybe need to get a a little handle on my sleep or understand it better," what would you love them to do this evening or tomorrow morning as a start? I think take one thing that you heard me talk about and just do it more often than you don't, so consistently. Um, don't you don't need to be perfect; what I don't want you to do is turn you into being obsessive about the right things just because I've talked about what the right things are; it doesn't mean you become obsessive; you will not fix your sleep that way. So it's just taking one thing and being consistent, and I guess just knowing right now, just coming away and being like, "Actually, I'm doing all right; my sleep's still going to be here; I don't actually need anything to sleep." Even I've created programs to help people, but you don't actually need anything to sleep; it's existed before we had this conversation and the uh Industrial Revolution and everything else, and it will exist after; doesn't matter how bad your sleep looks like. So that's kind of what I'd love people to take away, and that there is support out there if they need it, but just remember that there is, because I think with sleep, people don't realize that there are sleep experts, and I hate the word expert, but specialists, people that have studied this for a long time that can help you. But it's so easy to go to TikTok or Google or just a doctor who doesn't have experience in sleep medicine and get your advice because there's much more of that; it's easier to get... You see, so brilliant. Thanks for your time. Thank you. I don't think you can be high performance by...
Yourself? I don't think it exists.
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I'm interested in what kind of lessons you could pass on to our listeners. That is the most interesting question I've ever been asked in my life. This is high performance, available to you, your people, and your business right now.