Getting better sleep with Dr. Sophie Bostock

Greg: Charlie, when I say start, do you want to give us a rendition of Insomnia by Faithless?

Charlie:  I can't get no sleep. And then what is it? Give me a note. Give me the note. 

Greg: Do do, oh, that was quite flat, wasn't it?

Charlie: This is the Method, a podcast from Thriva about what health looks like in the real world. There's a lot of health advice going around, but not all of it will make a difference to our lives.

Greg: I'm Dr. Greg Potter. I'm a scientist and health and performance consultant. Yes, I read lots of scientific papers. I occasionally help write them too, and I want to understand how we can live longer, healthier lives. So on this show, we'll work out some sustainable changes to your routine that will actually make a difference to your health. 

Charlie: And I'm Charlie Edmondson. I'm really interested in health and understanding how to stay healthy now for as long as possible, but, and this is the key bit. While I'm not a science expert, I've got a regular job and a regular non-science, nerdy life, and I'm here to remind Greg of what that's actually like. I'm going to keep things grounded in reality and champion your voice.

 Greg: How dare you call me a nerd! We're here to figure out what's good for our health, what isn't, and how to fit being healthy into our busy lives. And to do that, we've got a simple three step method. First, we bring in an expert to unpack the science behind one key health question. Second, we provide some tips and habits you can try right now. And then finally, we put the practice to the test.

Charlie: Each week, we hear from those who have tried and tested our recommendations. We call them the Guinea pigs in the nicest possible way. 

Greg: People like you and I who tell us about their experiences. If it works, it works. If it doesn't, then we're here to offer some advice 

Charlie: We are here to help turn a so-called ideal lifestyle into something that actually works for you. Okay, let's get to the show.

Greg: Charlie, how are you today? Are you all rested?

Charlie: Um, not great to be honest. I went bouldering for the first time yesterday, didn't I? So new sport unlocked, so now I think I'm a professional. Bolder. Boulder. Boulderer. Boulderer.

Greg: I reckon boulderer.

Charlie: Yeah, weirdly, mentally tiring as well as physically tiring, isn't it? And also, which I never thought would be a problem, I can get up the wall, but getting off the wall.

Greg: Oh really? Do you get stuck up there? 

Charlie: Yeah, I was like cowering, clung onto it. So yeah, I'm quite tired today. Um, and I did my long run on Saturday, so I've had quite a busy weekend. How are you?

Greg: I'm well, yeah. Very happy to be here. Semi-well rested. I've had quite a few early awakenings recently. And the reason I asked you about how worse you are is that today we are speaking about sleep with the sleep scientist, Dr. Sophie Bostock. 

Charlie: Yeah. Today's guest, Dr. Sophie Bostock, also known as the Sleep Scientist, is a medical doctor and sleep researcher who's passionate about helping people sleep better and feel more energised. Sophie has worked with leading institutions like Oxford Sleep and Circadian Neuroscience Institutes and help bring evidence-based sleep programs to the NHS. 

Greg: I'm very excited to speak with Sophie. Charlie, is there anything in particular that you're keen to learn from her? 

Charlie: I think I'd like to know, yeah, prioritizing sleep or exercise, that's always a big one in, in my world, I'm an early riser, but whether if I've slept, I've had a late night and I still plan to get up to do, go and do a run or go to the gym, what should I prioritize?

Should I sleep or should I work out? What else would I like to know? Um, naps love a nap. Like if there was a professional sport for napping, I would be world champion. I quite like the phrase nappetiser. That's my favourite nap. And it's about a two hour nap that I have before I then go to bed.

Greg: Wow. 

Charlie: I know.

Greg: That's generally ill-advised. If it works for you, Charlie, then you crack on, but we, we might get in the episode as to why that's the case. 

Charlie:  What would you like to learn from today's podcast, Greg?

Greg: I'm just curious about whether there's any daylight between Sophie's perspectives on my own. It's always interesting speaking with other people who have a keen interest in related subjects. 

Charlie:  And have a sleep off.

Greg: Well, I think you'll probably win that. If it's the actual practice of sleeping, I definitely won't. 

Charlie: Yeah. You're not great at that, are you? 

Greg: I'm okay.

Charlie: I mean, you were voice noting me at what is. 4:00 AM your time. 

Greg: I've just been outed. That is the life of an early bird who then also currently has to wake up very early for work, and I like time to myself. At the start of the day.

Charlie: I feel like people would probably see four or four 30 as the middle of the night. If you wake up at that time, what time are you going to bed? Is it still daylight? 

Greg: No, absolutely not. But I've spent my life getting that kind of question, and I think part of the reason I became interested in sleep is because I have a very unusual body clock, and I've never had my genetics tested, but I think I probably got. A mutation in one of the so-called clock genes, which can influence sleep timing. Because I was the strange child who would ask my parents, can I go to bed yet?

Charlie: Oh, that was me. I've just always been that way. I love going to sleep.

Greg: But that's just so that you could sleep more. For me, it was more because I desperately need this right now because I'm gonna be up freakishly early tomorrow.

Charlie: You didn't answer my question though. What time did you go to bed right now? 

Greg: Between 8:30 and 9. 

Charlie: Oh.

Greg: I know. People are gonna work it out, though. I'm a bit strange.

Charlie: Might endear them towards you, Greg. 

Greg: Anyway, ready to dive in?

Charlie: I know we're gonna go straight in with the science section and you've got some quick fire questions for Sophie, so I'll try and keep up.

Greg: Sophie, it's so nice to have you with us. 

Sophie: Hi!

Greg: Would you be up for a rapid-fire round in which we challenge you to keep your answers to a minute or less? 

Sophie: You've obviously heard me on podcasts before. I'll do my very best. 

Charlie: Greg, I love that you've set that challenge. Greg, there is no way you could do this. Stick to a minute. 

Greg: Absolutely not an immediate fail. Okay, so first question. What are a couple of examples of sleep's roles in maintaining brain health? 

Sophie: Well, sleep is an incredibly important restorative process. It is part of a 24 hour cycle of sleep and wake, and our optimal functioning relies on us sleeping at night and being active during the day, and all of our hormones are wired to optimise performance so that.

We move, we interact socially. We eat, we metabolise during the day, and we repair and recover at night. So the lymphatic system seems to go to work during sleep and particularly during deep sleep. There is this process. By which the gaps between the brain cells actually open up a little bit, allowing for more of this circulation of fluid.

And scientists have worked out that we get these slow pulses of electrical activity that allows the circulation of cerebral spinal fluid, which is a bit like a cleansing system that detoxifies the brain seems to get rid of some nasty proteins that we think are implicated in Alzheimer's disease. 

Charlie: My word. Okay. Gone straight in with the science, haven't we? 

Greg: We can circle back to the long words for you, Charlie. Don't worry. 

Charlie: Right. Just to obviously get into the first bit. So you've said at night that there are all sorts of fluids that clean the brain. 

Sophie: Yeah. I think you can almost think about it like switching on the dishwasher. You have kind of these pulses of fluid that kind of pass by all the cells, and they kind of mop up or push out the dirty gunk that's been accumulating during the day.

I think about sleep as a bit like taking your car to the garage. You know, if you wanna fix something, you don't do it while it's driving along the motorway at 7 miles, 70 miles an hour, you know, you slow everything down to a stop. And that's really what's happening during sleep. The brain likes to wait until certain functions of being really dialled down so that it can focus on recovery.

And what's interesting when you look at hormones, when you change someone's night and day pattern, and this might be through shift work or jet lag, is that some of them will catch up faster than others.

Greg: So what's an example of how sleep affects hormone regulation?

Sophie: Well, I think it's important not just to talk about sleep, but also our circadian rhythms, our body clocks.

So it's not true that you can just get sleep at any phase in that 24-hour cycle. So the real problem for our hormones comes when we disrupt that balance when things go outta sync. So you have this situation where, for example, the hormones that regulate appetite are impaired. So you have increased hunger, you get more, uh, ghrelin, that sort of makes you feel greedy and you get less leptin, which makes you feel full.

So it's quick to see that actually, when you're sleep deprived, you are more likely to consume more calories, for example. 

Greg: And I think the experimental research on sleep restrictions, so allowing people some sleep, but less sleep than they need, suggests that on average, when people lose sleep, they consume roughly 250 more calories each day. Doesn't sound like much, but it certainly can accumulate something meaningful over time. 

Sophie: Sort of an extra doughnut every day. 

Greg: Yeah. Not an American doughnut, a British doughnut maybe!

So hormones, of course, are involved in many different things. One of the systems that they influence is the cardiovascular system. So does sleep disruption affect cardiovascular health? 

Sophie: Oh, certainly. So I think about this from an evolutionary perspective. You know, if you were sleep deprived, uh, a hundred thousand years ago or so, it was probably because you were in danger. There was some sort of storm or predator around that kept you awake.

So the following day, you were on high alert. And that can have an impact certainly on your emotional health, but also on your physical health. This increase in alertness, and that's often associated with higher levels of cortisol. Cortisol is a very energising hormone. So it's very useful to have. It releases glucose into the bloodstream and fires us up for action, but it can also impair our insulin sensitivity.

So what we can get is this accumulation of energy in our blood vessels, we've got more glucose whizzing around. And if that sticks around for a while, that can increase our risk of things like atherosclerosis, which is when your coronary heart vessels get clogged up, uh, contributing to heart disease. And you also will see an increase in blood pressure often.

So our whole cardiovascular system is under more pressure. And one of the lovely things that happens during sleep is that we mop up inflammation. And so if we miss out on sleep, we've missed out on that opportunity to reduce inflammation in the body. And so just on that note, final question in the rapid fire round, which I've turned into a not very

Charlie: We need to redefine rapid fire. 

Greg: Well, it's all relative, isn't it, Charlie? What are some roles of sleep in physical performance? 

Sophie: I think speed is the first thing that we notice. If you don't sleep, you're still gonna be able to get up, go to work. You know, function to a certain level. I think the, the first things that start to go are really reaction time. Whether you are just sitting at your desk trying to respond to emails rapidly, or you're actually on a playing field and you're, you're catching, you're running.

If we're sleep deprived, then we're gonna be slow to respond. We make more errors. But actually when we're well rested, we can respond more quickly, but also more intelligently, our processing speed of our brain. So it speeds up, we're better able to analyse complex information. And this makes sense from a stress perspective.

So when you are stressed, your adrenaline, your cortisol levels go up, and you probably will have experienced this if you've been late for a deadline. You know, you can be laser-focused. Stress can be incredibly helpful, but it can also interfere with our ability to think outside the box, to kind of put complex information together.

Be creative, and I think that cognitive ability is visible in sport as well as in work. You know, when you see your favourite players, they are the ones who are creative on the pitch. So I think very often it's difficult to separate cognitive performance from physical performance. 

Greg: We also tend to see that coordination drops off when people aren't well rested. And there have been a few studies showing, for example, that serving accuracy in tennis players tends to be worse when people are short on sleep.

Charlie: So Sophie, just to be clear, the thing about reactivity, I suppose that probably explains why when I've not slept, sort of, I feel like I can't focus or probably get to the end of certain tasks. So does sleep deprivation affect our ability to learn and process new information as well? 

Sophie: So I would say that when it comes to learning a memory, we have an interesting prejudice when we are sleep deprived, so we tend to focus more on the negative things that have happened. There's some research that shows that we will prioritise in our brains, those things that might perform a sort of survival function. So I imagine as you are learning, it's kind of like a sponge. You know, you, you suck up this information. You have these electrical signatures, which are your manifestation of what has happened that day. And during sleep, we consolidate that information. We move memory from the short term memory storage bank in the hippocampus into the much larger cortex so that it stays with us for longer, and that refreshes our ability to learn the next day.

Greg: So slow, rapid fire. Round over Sophie. I'm curious, you touched there on the fact that people might have fewer positive emotions when they've experienced sleep disruption. What do we know about how poor sleep influences relationships then? 

Sophie: Oh, and anyone who, uh, as a close member of a couple, will probably be able to answer this question. Charlie's smiling at me. We know that when you are sleep deprived, you are more impatient, you're more irritable. There's some research showing that you're not only more likely to argue, but you are more likely to be negative and accusatory in your problem solving approach. So it's as if the brain goes on to high alert. You are permanently wired when you're sleep deprived, and you're definitely in a, a higher state of activation and potentially quick to anger. 

Charlie: Is there sort of a link between, oh, you know, is it a bit like a chicken and egg scenario again, in terms of you feel low in your mood typically, and therefore you sleep poorly or you've slept poorly and then therefore you feel low in your mood? Is it sort of, one influences the other?

Sophie: Yeah, you're absolutely spot on. It's a bidirectional relationship, so we know that after a night without sleep, uh, for some people they can actually reach clinical levels of anxiety the following morning. So this is in healthy people. One night without sleep can push their levels of anxiety up to that level. So people who normally don't have an issue with mental health. We will feel a little bit more worried about things. They'll feel more anxious. We often feel more irritable. The brain is being pushed into a state where it kind of feels unsafe.

And then if you are anxious during the day or you have a lot of negative emotions, you're far more likely to sleep poorly at night. And in the long term, we know that there's this relationship between prolonged sleep problems and increased risks of anxiety and depression. And where you do have patience with anxiety and depression, you'll.

Typically see that at least two-thirds of them, if not more, also suffer from sleep problems. So the two things definitely go side by side. Um, but for me, the exciting part is that sleep is like a, a kind of a, a Trojan horse for mental health. You know, even if you don't, you have someone who maybe is a bit reticent about getting treatment for anxiety or depression, something they might see as a mental health disorder. If you help them to improve their sleep, they will see improvements in their mood and, and actually improving their sleep is pretty straightforward. 

Charlie: So I guess it's probably a slightly different question, but is there a predisposition to sleeping badly that means we're more likely to experience these mental health issues, or should we just take that worry out of our heads?

Some of my friends think it's absolutely wild that I can nap and they couldn't consider ever having a nap, but I've always just been a good sleeper. Is that, is it genetics? 

Sophie: There definitely is a genetic, um, element to our sleep patterns. You know, this is a biological characteristic and it's gonna have quite a lot of variation.

In particular, we know that our sleep-wake rhythm are chronotype. We think probably at least 50% of that is genetics. So if you know that you are. Parents, your siblings are all night owls, and you feel more like a night owl. It's likely that there's a genetic component, but it's also heavily influenced by behaviour.

So if you, for example, don't have to get up in the mornings and like to work late at night and keep the lights on, that's actually gonna delay your circadian rhythm. So you will just reinforce. This night, owl tendency, we also change with age naturally anyway, and I would just like to reassure everyone that I think we are all capable of being good sleepers if we create the right environment, the right conditions, but also if we have the right beliefs about sleep. I think a lot of my work as a sleep specialist is supporting people to develop confidence about sleep because of course, as soon as you worry about it and you worry that you're not getting enough or you're worrying that you're not getting it at the right time, then that worry pushes us into this state of anxiety, this state of hyper arousal.

And it becomes much, much harder to have a good restorative night's sleep. So although there are definitely some familial, some inherited aspects of sleep, I think far more important is the belief that we have, that we are good sleepers. 

Greg: That's exactly what I was gonna emphasise, and I think a few people have said. Adults need seven to nine hours of sleep per night. But there certainly are people who need less than that, and there are people that need more than that. And you mentioned there that there's variation within a person too, so if you are more physically active, you might need more than at times when you are more sedentary. What are some of the factors that influence how much someone needs, say, across a given year?

Sophie: I think periods of travel, you know, we mentioned circadian disruption. Um, I've just come back from the US and, uh, it's taken me over a week to get my body clocks, get my sleep back on track. And so travel is stressful on a number of levels. Very often you get dehydrated. It's kind of stressful. Um, there are also times where you may be accumulating a bit of a sleep debt, so you know that for a period of time, perhaps you had some deadlines at work, you've been getting a little bit less than your sleep need, and you head into the weekend and you're trying to catch up on sleep, but you still feel fatigued on Monday morning, and that may well be because you need more. You know, you can't just pay it all back in one night. I'm often asked questions about sleep debt. I'm sure you are as well. You know, do you have to pay back every hour of sleep? But as a rule of thumb, I think the important thing is that if we're tired, we need to catch up on sleep.

Charlie: So we've covered the why and how sleep works and what disrupts it, and now it's time to chat about some practical tips for those of us who are going through a phase of particularly bad sleep and need some advice now. Say, if I knew I was having a particularly busy week at work and I knew my sleep was maybe not necessarily disrupted, but probably gonna be a bit shorter, late nights, early mornings. If then I just upset it's okay because at the weekend I'm gonna have massive naps on a Saturday and a Sunday. Does that help counteract or, you know, is it...

Sophie: I guess there is this idea of banking sleep in advance of a sleep challenge. And I think this is really interesting area and we don't know huge amount, but for a lot of people it seems that you can. Bank extra sleep in advance of a sleep challenge. And this has certainly been shown in a sporting context. So if you get someone who's routinely getting, say, seven hours of sleep, but actually they try and get an extra hour leading up to a time trial, for example, it seems that they may do slightly better.

There is a bit of a debate about whether that extra sleep is actually just addressing. A deficit or whether they're getting a performance advantage through extra sleep, if that makes sense. Yeah. Is it that they're normally sleep deprived and the extra sleep is just really what they ought to be getting anyway? Or actually, yeah. They've probably been training quite intensely. Yeah. So the jury is out, but certainly trying to bank sleep in advance of a sleep challenge seems to make us more resilient.

Charlie: I'd be curious to know, I know you've sort of been mentioning there around sort of consistent sleep. If you can sort of get that nailed, you're probably gonna see improvements. What, what would someone do that, I'm just thinking about situations with people with young families where there are prolonged periods of inconsistent sleep. You know, how long does it take to gain that back? You know, if you're not talking about just one night of inconsistent sleep or shorter periods of sleep than you would like.

Sophie: I'd love to tell you that there was a mathematical equation that could predict exactly how much sleep you need. It's not that simple. You know, you will encounter some parents for whom those early months of life when uh, they have a newborn and. The newborns will typically not have any circadian rhythm, and they're usually waking up every two hours. and people bounce back to differing extents. But I think. It's really important to note that when we are sleep deprived, our brains are incredibly clever at trying to recover. So we'll tend to get a higher concentration of deep sleep after a period of sleep restriction. And then in terms of catching up, I'm actually quite a fan of naps. It's probably a really good strategic option. You know, it's gonna be the most restorative thing versus relying on caffeine or something to keep you going. I would say, stick to 20 to 30 minutes max. You know, I think it was NASA that coined the power nap at around about 28 minutes, and this was thought to give enough sleep to improve alertness, mood concentration for the subsequent two to three hours without getting into deep sleep. So if you are gonna nap, I would always say keep it short. 

Charlie: Sleep when the baby sleeps. But if that's not sort of feasible, what is there another technique to try and recoup some of the benefits of that sleep can bring through other means.

Sophie: I think my only amendment to that statement would be just sleep whenever you can. You know, sometimes that's gonna be when the baby sleeps, but I know that new parents feel all sorts of pressures to be these kind of super humans, the perfect parents, you know, but still to cook and clean and do the washing and all the other things. It can often feel completely overwhelming. And if someone says to you, well, you've got to sleep when the baby sleeps. There's nothing worse for sleep than putting pressure on when you can sleep. So, you know, I would just say to anyone in a situation where they're incredibly sleep deprived, you know, look for opportunities where you can sleep. Accept help where help is offered to you. You know, if the neighbour comes around and says, do you want me to watch the baby for half an hour? So you can just have a rest, just say yes, and there is no way that you can really get through parenting a newborn and not feel sleep deprived. It is unfortunately, a, a slight rite of passage. So, yeah, it's always gonna be hard. There's not a way to really make it easy, but certainly teamwork is a key part of that.

Greg: Yeah, and I think that brings us nicely to a subject that you understand well, which is insomnia. So just on that subject, a lot of people will have some sort of acute insomnia when they feel stressed out, and it's not necessarily negative stress. Maybe your wedding is coming up and you're just really excited about it and sleep temporarily goes out the window.

But maybe you've just had an argument with your spouse and you are working through that again and again in your mind, and therefore you struggle to fall asleep. The problem is that sometimes acute insomnia. Which is perfectly normal, becomes chronic. So do you have any thoughts about what people can do to cope at those times and try and minimise those transitions to the chronic form of insomnia, which is what we're trying to avoid.

Sophie: Yeah, that's a really good question. And you're absolutely right. The first step is to say, do you know what poor sleep at certain times is completely normal. Another one that I would add to that list is, is grief is bereavement. You know, I sometimes encounter people who say, you know, my sleep's been awful since this, this terrible thing happened, and the first thing I say is that's at a totally normal reaction to, you know, extreme life events.

And the most important thing is actually to just keep going with your normal daily routine. The problem comes when we change our behaviours. We change our habits to try and cope with the impacts of sleep deprivation, and that actually perpetuates the problems. So there's a a lovely model called the three Ps model from a psychologist called Arch Spielman, and he explained that there are kind of three reasons that people develop.

A chronic insomnia. First of all, you've got the P, the predisposing factors. So there are certain characteristics that make someone at greater risk, such as being a woman, getting older, having a more conscientious personality. And you mentioned rumination there. I think that's one thing that I'd, I'd add to the list and then we've got the precipitating factors, the triggers. So that's often some kind of stress. And as you say, it's often a negative one, but it, it might be something positive, a big thing that you can't stop thinking about. But the thing that actually pushes that temporary insomnia into a chronic problem is the third P is the perpetuating factors.

And for a lot of people that can be trying to compensate for sleep loss by increasing their caffeine intake or using alcohol to try and relax and wind down in the evening, that actually makes the problem worse. And when we're tired, we don't feel like going to the gym. And maybe we're craving some late night comfort foods, and those things will also disrupt sleep. But I would say that the most common is something that we call conditioned arousal. And this is a. We actually train the brain to worry in bed. if you spend a lot of nights lying in bed, worrying about not sleeping, then every time you wake up at two or three o'clock in the morning, the brain goes, oh yeah, I know where we are. We are in that place where we worry about not sleeping. And so part of that is changing the routine, changing that reaction.

So if you wake up and you feel wide awake at two or three o'clock in the morning, actually, you get out of bed, you go somewhere else, maybe read a book, maybe watch a movie. Doesn't really matter, but you stop trying to sleep. And then when you are sleepy and you feel your eyelids feeling heavy, that's when you get back into bed.

Um, but we call this forming a positive bed sleep connection. So you only get into bed when you're actually tired and if you're not sleepy or you are worrying about sleep, get outta bed, take that worry out of the bedroom. I know you've sort of mentioned there about keeping obviously. Bedroom for sleep.

Charlie: Is there any sort of things to actively avoid? Because I think about, just from personal experience, I could probably scroll on my phone quite aimlessly and I would stay awake for longer. But if I read a book, I probably would get half a page down and I will be asleep instantly. Is there anything, if you are struggling to sleep, actively avoid doing? Yes. Maybe do something that's not focusing on trying to fall asleep, but probably don't do. These few things. 

Sophie: Charlie, I have a sneaky feeling you've answered your own question. Is it read a book and don't go on your phone? You know, anything that is kind of activating for you. So for most people, this is gonna be scrolling on their phone. Some people will claim, yeah, that really helps me fall asleep. I would question that. Um, those little, little dopamine hits tend to keep us alert, but. It wants to be something which is sufficiently distracting that you are not actively trying to sleep. Uh, so a number of things that people have mentioned to me, for example, watching old reruns of friends, something gently entertaining, but you kind of know what's gonna happen. Or maybe it's doing Sudoku or crosswords, which are absorbing but not captivating. Reading for most people is a good one, but some people hate reading. It's gotta be something which you want to do 'cause you've gotta get out of bed to go and do it. But nothing that you can't sort of stop in order to go back to bed when you're feeling sleepy. 

Charlie: I also just another one. Um, I sleep with a TV in the bedroom. Is this a big no-no? I fall asleep to the TV every night.

Sophie: That's a really interesting one. And all the, all the advice used to be, you know, keep televisions out of the bedroom and, um, actually there's some survey research that suggests that maybe the TV is not the worst thing in the world. You know, if you are masking anxious thoughts with a gentle distraction, a TV is probably a gentler way of keeping you awake than, for example, using your phone. I know a lot of people use audiobooks to fall asleep at night… Just allow your brain not to focus on worries in particular, that can be really helpful. 

So it depends where you're at. 

Charlie: Uh, yeah, well, me and Greg had a brief conversation about this before and I think I am a very good sleeper and I can nap for two hours and feel absolutely fine. So, yeah, I think I'm probably a bit of an anomaly.

Greg: The reason that we spoke more about it Sophie is because Charlie was having those naps, which she calls nappetisers very late in the day. I have it just before, and I said that for some people that might be ill-advised.

Sophie: Yeah, I think ideally before three o'clock, three or four o'clock max? Yeah. 

Charlie: Oh, no, this is like seven till 9:00 PM 

Greg: No, not seven. 

Sophie: Not seven. 

Charlie: Okay. 

Greg: No, Crump, not advisable. Oh dear. So before we fully move on from insomnia, and there's one particular group of people that when I'm working with them to try and help improve their sleep, their sleep tends to be reluctant to improve, and that is people who have insomnia and have early awakenings, they can't get past a certain time For some reason, it's like they've got a really loud internal alarm clock. So I'm just curious about what your guidance would be for those people who might otherwise be doing things well, but they're really struggling to push back the time in which they wake up. 

Sophie: Well, I think the first thing to say is that waking up during the night is normal. You know, we all sleep in cycles. We don't just have a constant sleep and it's perfectly natural and normal to wake up sometimes in between sleep cycles. Uh, and for me, the question is, are you able to fall back to sleep again? And if they really want to and they can't, then that does suggest an issue with cognitive arousal. So it may well be that they've got a lot of stressors in their life, which they are worrying about.

And some of these cognitive exercises like writing down your worries, talking through things, therapy can be incredibly helpful. But there may also be in a scenario where. They've almost forgotten how to relax. We can't just push through our days. It's 300 miles an hour and expect to fall asleep really easily.

You know, our days ought to be a series of cycles where we activate and then recover and activate and recover. You know, we wanna do some of that relaxation in advance of getting into bed. 

Charlie: Yeah, I remember when I was swimming a lot and our sessions were always really late at night and that post the physical, your body was physically exhausted, but your mind, I dunno whether it was the chlorine, I don't know, you know what it was, but it was impossible to switch off.

Sophie: We can't separate out, you know, mind and body. And if you, if your body is is tense, then your mind is also gonna be tense. But the great advantage there is that the reverse is also true. So even if your mind feels like, oh gosh, I've got so much going on. If you focus on physical relaxation, perhaps with some breath work or an exercise call, progressive muscle relaxation where you tense and then gradually relax.

All of the muscles in their body, then that can have a calming effect on the mind. So there was an interesting study actually that was published earlier this year, um, looking at wearable data, and they actually found that exercise within four hours of bed could still impact on the quality of sleep. So it depends on intensity. So the more intense the activity is, the longer you really need to wind down before you get into bed for a restful sleep. 

Charlie: Gosh, four hours. That's quite difficult. Then if you, I know that seems a lot. Yeah. I'm just thinking, you know, if I think by the time I get home from work, it's nearly seven o'clock, and if I've got to, you know. It'd be then catch 22, wouldn't it? Do you exercise and then stay up till midnight?

Sophie: Yeah, no, I, I have the same where sometimes I haven't had a workout today, do I just get on the bike? Um, and I think if, if that's the only opportunity that you've got to exercise, I would still say exercise, but maybe just think about a slightly lower intensity and think about how am I gonna wind down afterwards? So for example, your body temperature actually falls by about a degree in order to get into deep sleep. So if you do vigorous physical activity just before bed, you've probably got some adrenaline, maybe a bit of cortisol surging around your body, and that is gonna make it much harder to get into deep sleep.  So what we want to do is have this. This wind down in advance of bed so that our breathing rate slows down. Our heart rate slows down. So warm bath, warm shower, or just anything that's gonna after the activity. Make sure you are creating this runway of an opportunity to relax before you get back into bed again.

Greg: The thing that I wanted to turn to next is snoring, just because I think a lot of people assume that snoring is a bit of a nuisance for a person's bad partner, but it's probably benign. However, a. I don't think that is the case, and I think the science very much backs that up. So, Sophie, what would you say to someone who knows they're a Sonora and who maybe doesn't feel at their best? Maybe they're quite sleepy, maybe they're struggling to concentrate during the day. Maybe they have some health issues too. What would you say to someone about their snoring? 

Sophie: In that scenario, I would suggest that that person goes to get a sleep apnea test. There is no question, you know, you want to find out if someone has heard you, particularly if they've heard you gasping or pausing for breath during the night. If you're waking up with headaches with a dry mouth, if you're struggling to stay awake at any time during the day. Especially if you are driving, these are all warning signs that something is interfering with your deep sleep. And it may well be this condition of sleep apnea where the airways narrow to the extent to which the flow of oxygen to the brain is being interfered with during the night.

And that means that the brain doesn't immediately wake you up. But what it does do is it pushes you out of the deeper stages of sleep into lighter sleep, so you can easily go through nine hours. And wake up just feeling exhausted because you've just been stuck in this lighter stage of sleep. And again, there's so much that you can do, um, to treat and prevent sleep apnea and snoring.

So myofunctional therapy also called. Or pharyngeal therapy. And Charlie apologies. Um, for, for all the words, 

Charlie: that's fine. I'll just, I'll just wait. 

Sophie: But effectively this is like going to the gym for your airways. You actually strengthen the muscles of the tongue and the upper airway so that they are less likely to collapse at night. And we've also got a number of nerve stimulating devices, either implanted or now there's one that you can stick under the chin that actually sends a little electrical impulse to prevent the tongue from falling back during sleep. You've also got like a gum shield that you stick in your mouth to stop the jaw falling back. So go get treated, find out what the condition is that you are trying to treat and get, get the right advice. And sleep apnea itself is very heterogeneous. It's not just necessarily driven by somebody having more body fat than they would like, which is contributing to the upper airway collapsing. Sometimes it's got something to do with the face. Sometimes it's in part because of the position in which they sleep and so on. Add to that menopause as well. Men and women as we get older are at greater risk of sleep apnea, but I think the, the decrease in progesterone in particular as we get older, reducing muscular tone, uh, for women. You know, you might never have been a noer for the rest of your life, but actually this might be something that you. Develop in your forties, fifties, sixties. So if you are worried about it, go and get a test.

Charlie: So basically, if you're snoring and you're often tired, it's time to get some personal training for your tongue or your nose. Mine's out of the gutter, please.

Greg: Charlie, I think we've got some listener questions. Do we? 

Charlie: We do, yes. This is what we call the experience segments. We ask people to send us questions and reflect on their own dilemmas around sleep. 

Greg: Fantastic. 

Charlie: Our first question is from Nicola in North Lincolnshire on circadian rhythm in the winter. So she's asking:

Listener: Hi. For the last three months, I've been going outside for five to 10 minutes after I've woken up. This is derived from research. I have read about the benefits of light exposure in the morning to sync with my circadian rhythm. However, now we are in the winter in the uk. This isn't daylight when I get up. Is there any benefit to still getting outside?

Sophie: Great question. There's always a benefit for getting outside and moving your body, but in terms of syncing your circadian rhythm, you are gonna get more impact from a very bright artificial light at that time of day. Uh, so you can get dawn simulation alarm clocks, uh, which will emit up to 10,000 luxe.

And most of the research that's been done on seasonal affective disorder, which is the kind of more severe form of low mood in winter that actually reaches clinical levels. Typically uses a SAD lamp seasonal affective disorder lamp, which will emit at least 2,500 lux. And I mentioned this 'cause when you buy one, you can kind of check, um, what the light intensity is, and you wanna sit by that for about half an hour.

That should be enough to reset your circadian rhythms but certainly rather than going outside in the dark for 10 minutes, I would sit by a bright artificial light for 10 minutes. Interesting. So I'm a big morning exerciser. I love it in the summer, but obviously in the winter it's, it's sort of quite difficult.

Charlie: I've just started marathon training, so my mileage is going up and up, which means my alarm is getting earlier and earlier. I'm curious, though, about sort of obviously the, the positive aspects of exercise versus less sleep. Is there one that you should probably try and prioritise more than another, or is it just again, another balancing act?

Sophie: It's always a compromise, and it's gonna depend on your daily routine. You know, if, if the morning is the only time that you can exercise, then I'm always gonna say fit in the exercise rather than not exercising. But there was a recent study actually that came out a few weeks ago where they tried to look at what's the relationship between sleep and exercise, which is kind of more important. And they actually found that if you get more sleep, you are going to end up exercising more. That was a stronger relationship versus the impact of exercise on sleep. So it was a vote for sleep first, and then probably the amount of exercise you do will improve. So if push came to shove, I'd be like, you know, do half and half.

Charlie: Perfect. Our next question is a voice note from a listener called Dan. 

Listener: Hi, my name's Dan and I'm from Benson in South Oxfordshire. And my question is. Magnesium before bed seems to be the trendy supplement to take for better sleep. And does it actually work? Because I would say people for hundreds of years have been getting pretty good sleep without supplementing magnesium at night. Okay. Thank you. Bye. 

Greg: I love Dan. 

Sophie: I love that. I've got a lot of sympathy with Dan, um, because. I think he's right. There are an awful lot of other ways to sleep well without taking magnesium. Having said that, if you are magnesium-deficient and you improve your levels of magnesium, there is some evidence from randomised control trials that sleep quality can improve. The difficulty is knowing whether you are magnesium deficient or not, and that's gonna partly depend on the diet that you have. And also your stage of life and the amount of physical activity you do. So if you've been experiencing chronic stress, you do a lot of exercise or you're going through perimenopause, your odds of magnesium deficiency are a little bit higher.

Also, if you're an older adult, you may well find that you have low levels of magnesium. So it's one of those where I'm like. Do you know what? It's not very expensive. Um, and why not do a little experiment? You know, be a scientist of yourself. There are a lot of people who swear by magnesium after taking it for one night, and I would suggest that that is more likely to be the placebo effect, where they're taking some things so they're worrying a little bit less about sleep, and so their sleep improves. Give it at least two weeks before you decide whether it is the answer for you. 

Charlie: So just on sort of the impact of medication on your sleep, we've got another question in from Deborah. So she's asking, so many people take antidepressants, but the subject of insomnia as a side effect is never mentioned in the vast information out there. We need help. Is there any advice you could give to anyone on that sort of topic?

Sophie: I think with any medication question, it's always incredibly important to discuss with your doctor, you know, they know your medical history, but also to read the, uh, the dreary side effects that come with any medication. Um, and sometimes they may well be a, a, a compromise to come to, but for the most part, we have so many treatment options out there. Cognitive behavioural therapy for insomnia is the number one recommended. Treatment so that alongside other medication can be incredibly helpful.

Charlie: So Sophie, if we were to leave listeners with one big takeaway, what would that be?

Sophie:  I think while we were talking, I was just reflecting on the impact of lack of sleep on our mental health. And as you said, you know, that can make us feel very anxious, very irritable. Is it enough to just try and catch up at the weekend? Well, all of those days that you are sleep deprived. What happens is that your brain goes into this kind of anxious state, this irritable state, and this self-critical state, and we don't always wanna wait until the weekend to feel better. So what I would say to people who are feeling tired, sleep deprived is just recognise that some of that self-criticism is caused by lack of sleep. And if you're feeling like that. Be kind to yourself. You know, this understanding of sleep means that we can hopefully look at ourselves with a bit more self-compassion. And even if you haven't got time to get extra sleep, you can be kind to yourself in other ways. Take the opportunity to take breaks during the day. You know, take the chance to relax, to eat well, to try and restore the body in other ways, even if you can't sleep. And of course, when that opportunity comes for sleep, embrace it with both hands. But in the meantime, just be a little bit more self-compassionate, I think.

Charlie: And finally,  Sophie, what kind of sleeper are you?

Sophie: One who hugely values sleep?

Charlie: Do you have a good sleeping routine?

Sophie: Yeah, I think I'm pretty good, but I'm pretty normal as well and, and sometimes the routine gets disrupted and I have to kind of go back to basics. I think the most important thing about sleep is not to worry about it too much. You know, everybody has the odd poor night and I'm not afraid to sometimes have sleep disruption, but knowing that.

The moment that I can, I'm gonna go back to waking up at the same time, getting outside every day and having a good one down routine before bed. If I put those things in place, I know that I'm gonna sleep well. 

Greg: Thank you very much, Sophie.

Sophie: Thanks. 

Greg: It's been a pleasure. 

Sophie: No worries.

Music

Charlie: And that's a wrap on this week's episode. If you want to learn more about Sophie's work, head over to the sleepscientist.com. That's Sophie's website and education platform where she's got some great resources you can learn from.

Greg: You've been listening to the Method Health in the Real World. A podcast brought to you by Thriva. If you don't know about Thriva, it's a health tracking platform that helps you see exactly where your health is heading, what to work on and how to do it. So they use painless at-home blood testing to show you what's going on in your body. Your results are analysed by accredited labs and based on the tests, you get personalised guidance from real doctors, not AI ones. People use Thriva like a compass testing every few months to help steer their health to where they'd like it to be. It's a great tool to start feeling more empowered about your health and to get information you need to make progress even when life is a bit hectic. 

Charlie: Thriva also has some great content out there that can help you get to grips with complex health questions exactly like what we try to do on this podcast. And all of that is free to access. So if you want to learn more, just head over to thriva.co. That's thriva.co.

Greg: And of course, if you loved the show subscribe, why would you not do that? It takes just a few seconds and you won't regret it.

Charlie: You can also leave a review or send us an email with your own health questions. We want to cover the topics on your mind, so send them over to themethod@thriva.co and don't hold anything back, maybe a little bit. Hold a little bit back.

Greg: A special thanks to Thriva team and to Lower Street for helping us bring the show to life. Content direction by Rich Cousins, Hamish Grierson, Tamar Loach, Vishal Shah, and Katie Yockey. Production from Lise Lovati with the help of Sam Datta Paulin and Daria Lawson. Sound design by Alex Rose. 

Charlie: We are your hosts, Charlie Edmondson and Greg Potter and we'll see you next time. 

Greg: Bye, Charlie. 

Charlie: Bye, Greg.