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Understanding sleep
We all sleep. In fact we spend about a third of our lives sleeping, so it’s important to know how to sleep well.
From circadian rhythm to REM sleep, our experts give you the knowledge to get a peaceful night’s sleep.
Understanding sleep with Professor Jason Ellis
Watch in 18 minutes
Watch this fascinating conversation with sleep expert, Professor Jason Ellis, as he explores why some of us struggle to sleep, how to tell if you have a sleep disorder and more.
Sleep is such a huge topic and there's new science and data coming out all the time and it's really fascinating and that's why it's so important that we have sleep experts who study sleep so that they can help us have a better understanding as well. And to help us dig a little bit deeper today and get the latest on those sleep questions that we all want to know more about. I'm joined by sleep expert professor Jason Ellis. Hi Jason, welcome.
Hi Zoe
Hi. So I'm really excited for our conversation because there are so many things that we can discover that are new about sleep and you know about all of it because you're a sleep expert. So to give people a bit of context about your sleep credentials, you're a Professor in Psychology at Northumbria University and Director of the Northumbria Centre for Sleep Research. So you definitely know your stuff. So for anyone who is struggling with sleep, hopefully we can answer some burning questions they might have. So let's start off then with, why is it that some of us struggle to sleep and some people don't?
It's a great first question and I think that we need to think about the biggest impact on our sleep, which is ageing actually. As we get older, the parts of the body, the internal system that really regulates our sleep, which is the body clock, the circadian rhythm, and then there's the drive to sleep, which makes us more and more tired. Both of those start to degenerate slowly and over time but they actually do degenerate, which makes us a lot more vulnerable to not being able to sleep well.
And when you say as we get older, what sort of age does that start to kick in?
It starts around the age of 25, believe it.
25?
Yeah.
I thought you were gonna say 65 or 75. Wow, okay.
It's very small increments, but we are seeing reductions in the amount of melatonin we produce. For example, the amount of deep refreshing sleep that we get year on year, they decrease a little bit.
Really interesting. How long can we cope with poor sleep before it starts to have a significant impact on us?
Well, I think we've all had the odd bad night and the next day we're a little bit more moody, a little bit more irritable. Probably not gonna use please and thank you as much. But actually the system can correct itself and it will correct itself when we start talking about the long-term impact it's poor sleep over months that we're talking about here.
And that's often down to the environment, isn't it? Now where we have mobile devices, we're working longer hours and maybe the opportunity to sleep is not as good as well.
Well, we also got to think about culture. We've got terms that permeate our culture, snooze you lose, I'll sleep when I'm dead, the value of sleep and its ability to correct itself actually is lost in that mix.
So if people say have sleep issues for a week or two and then it gets better, would that be all right or what's the sort of timing?
Generally, if we're talking about stress related sleep problems one to two weeks, that's a normal adaptive response to the stress. You've got a lot more cortisol, a lot more adrenaline, and that's just keeping you awake longer just so that you can try to cope, problem solve, work out solutions. Once we go over that two week mark, those hormones shouldn't really be impacting our sleep anymore.
Okay. Tell me a little bit more about the term sleep anxiety which I've experienced myself actually, a long time ago, where you persistently can't get to sleep and then you start to get very anxious about not being able to get to sleep and the problem sort of gets worse and worse.
The vicious cycle. It's interesting 'cause there's a theory around this that we start out when we stop losing sleep because of stress, it's because of the stress. And it could be a positive stressor like a wedding or something nice but it's still gonna keep us awake. After about two weeks we might see this switch point where the stressor stops you from sleeping and suddenly the sleep becomes the stressor itself.
Yes.
That's what we talk about in terms of sleep anxiety. And there's some really new research actually came out earlier this year, which demonstrates that is the single biggest factor, the sleep anxiety, which makes us go from just a few weeks of sleep disruption to having chronic insomnia.
Wow. Fascinating. So it's actually then this worry about getting to sleep is the issue that's preventing the sleep.
It's self perpetuating.
Yeah. I think there'll be lots of people listening to this who are thinking, that sounds familiar. How do we know when it changes from struggling to sleep so disordered sleeping to actually becoming a sleep disorder such as insomnia.
So when we generally define insomnia, we're sort of talking about three months in duration, that's the clinical definition but actually after those two weeks, something's not quite right and we should be going in and intervening early.
That's interesting as well 'cause I think a lot of us don't, do we let things get worse and worse. A lot of people fall asleep fine, but they suffer sleep disturbance, waking up regularly through the night and struggling to get back to sleep. What's going on there and what can they do?
So this is part of the entire sleep process. If we think about sleep, we sleep in 90 minutes cycles as adults and during that time we're going through stage one and that's the point at which we are having that transit between being awake, being asleep, you know that nodding dog bed.
When you're on the train, I get it. Yeah, neither in or out.
Exactly. And then you might experience something like you've stepped off the pavement too quickly.
Yes.
Yeah. It's called a hypnic jerk. And what that is, is it's a way of trying to get rid of any excess energy that you've got creating a nice smooth transit into the official onset of sleep, which is stage two.
So it's normal then. So that should happen.
Yeah.
Okay.
It's just you may have experienced it, you have the jump but then you go, ah. It's a relief, isn't it? You have the jump, you're like, I actually haven't fallen everything's okay. You take a sigh and then you go to sleep.
That's exactly the passage from being awake in stage one to going into fully sleeping stage two.
But I don't notice that I always do that. Is it that sometimes I'm not aware or. It may be sometimes you're not aware you're very sleepy or it might be that there's not a lot of cortisol left in the system to create the actual physical jump per se.
Okay, fascinating. So interesting. It's 90 minute cycles.
Yes. So we get vulnerable to waking up every 90 minutes. You finish a cycle before you start the next one. So those create vulnerability points. For most of us we'll roll over and we'll go back to sleeping, but if something happens, we need to go for a whee might have a hot flash, our pain medication might be wearing off or we might indeed have pain. That's enough of a window to create an actual awakening. Those are normal, they're natural. The issue becomes can you get back off to sleep after you've dealt with it.
Right. So waking up in the night especially if there's a reason is okay and that's why you shouldn't start looking at what time it is or stressing about being awake. You just need to deal with whatever you need to deal with and just get yourself back off to sleep.
That's exactly the thing that feeds into that sleep anxiety that we're talking about. Are some of us just naturally early rises and some of us actually true genuine night owls? I kind of know the answer to this, but tell us.
Yes, we have something called chronotypes and this is people's performance. Whether they're really good performing in the morning or good at performing in the evening. There's a huge amount of people who actually sit in the middle that we call, intermediate types and they have a lot more flexibility. But what we see is if we take those people who are very morning oriented, our larks and we put them into an evening situation, they don't handle it terribly well. Similarly, if we took somebody who's a real extreme owl and we made them do stuff in the morning, again, they're not gonna perform as well.
And but there are pros and cons to both are there? So if you are a, well, the world is really set up for people who function well in the morning, isn't it? 'Cause we tend to have to get up and either go to school or go to work quite early. But are there some I believe and you can let me know if I'm wrong, that people like me who are night owls we adapt better to shift work and we adapt better to jet lag?
Absolutely. So yes, the world is set up and it's all pre-ordained around the morning, isn't it? It's work time, it's school time, it's getting things ready and that's part of a culture that we have. Whereas evening's a lot more flexible. You are absolutely right, there are some benefits around being able to adapt to changes in your body clock if you're more evening oriented. And so you have that extra flexibility that might help you work better in a shift work environment.
Well, that makes a lot of sense to me. So I wanted to ask next about the different stages of sleep. So you mentioned just then about the first stage of sleep, which is this transition state which can end the jerk.
Yep.
So is that stage one?
That's stage one. The actual jerk is the transit into official sleep, which is stage two. Stage two takes up about half of the whole night. We ignored it for many, many years but recently we've started to understand that it's got two main functions for us. The first is it allows us to review the day to determine what do I need to keep? We expose ourselves to a huge amount of information, sight, smells, tastes, do we need all that information? Probably not. So we're determining what do I need, what do I not need so that I can turn the things I do need into long-term memory later on. The other part of stage two is what we call, a sensory gating mechanism. It's a posh way of saying keeping you asleep. So we just use the example of pain. People have pain or maybe the neighbours they've left the television on or they might be having , it's in our interest to stay asleep and so our brain will actually create masking so that it says don't focus on that, focus on the sleep, stay asleep. It actually gates across those sorts of intrusions.
Wow.
Then we go from that into stages three and four or slow wave sleep. A lot of people will hear about it in terms of deep sleep. This is where we fix the body, the immune system.
Really this is where it gets its main activation from. When you're not feeling very well, what do you want to do?
Sleep.
Exactly. Because we want to get the immune system working. The endocrine system. And that's helping us with our fertility, it's helping us with our eating behaviour, it's helping us regulate all of those things around insulin that tends to be also functioning and really efficient during slow wave sleep. The glymphatic system, and this is one that's quite recent, it's our understanding that during slow wave sleep we actually clear out toxins in the brain and those are the toxins that have been associated with things such as dementia.
Wow. So the brain a bit like the lymphatic system of the body, is it then? The brain's actually cleansing away toxic proteins?
Yeah, pretty much putting a washing machine right way through the system. We go from stages three and four, slow wave sleep. We actually go back up to stage two. Check the environment, is it safe to carry on sleeping? Yep. And then we're allowed to go into REM, rapid eye movement sleep. This is where we deal with the emotional and the memory side of things. This is where we regulate our emotions and this is where we consolidate a lot of our memories. So when we've not had a good night, for example, this is one of the reasons we are a little bit more moody, a little bit more irritable or we might even get a little bit more hyper.
Or anxious as well.
Or anxious. Because what's happening during REM is we're putting a cage around our emotions and dealing with them. Trying to keep them to really a nice balance so we don't go in either direction.
Wow.
So stage three then is kind of about the physical body keeping us alive and healthy and stage four is about sort our psychology sort of keeping us in a good nick from a mental health point of view. Which I guess is why we see such close links to poor sleep, short sleep with conditions like depression and anxiety.
Absolutely.
That's because if we're not getting enough sleep at the end, then we're not able to do that sort of repairing and taking care of ourselves.
Absolutely, it's slightly more complex than that though.
Always is, isn't it?
Of course it is. This is why I've got a job. When we're talking about REM, it's how quickly REM comes in as well. REM should come in at around 90 minutes in that first sleep cycle 'cause it's the end. If it comes in too early, it's a really good sign that we are likely to become depressed in a few weeks time.
Wow. God, it's so interesting, Jason, honestly. Anyway, we've gotta move on to the next question. What about napping? Is napping good for us and if so, why?
The first thing I would always ask about napping is, why do you need to nap? If you need to nap, that's generally an indication that there's something wrong with the quality, the quantity or the timing of the sleep that you're getting. Now there are occasions where people will need to nap, new moms, chronically ill people, of course they need to nap. But for the majority of us, why are we napping? Is it that we're sacrificing sleep somewhere along the way?
So staying up late at night working or having to get up too early.
I mean, napping can be beneficial and certainly in the context of learning. For example, we might want to ask people to have a nap after they've learned some information. 'cause it will help them consolidate it, turn it into long-term memory. But we've gotta keep it short.
Yes. But how long can we nap for before it becomes more detrimental?
We talk about 10 to 20 minutes because after that what tends to happen is we start a full cycle. And if you think about it, the full cycle's 90 minutes. If you wake up after 45 minutes, you're gonna have 45 minutes where there's gonna be a little tension, your body wants to finish the sleep cycle and you've got to attend to something in the environment. It's what we call sleep inertia. You know that groggy awful feeling we get?
of feeling worse for it.
Yeah.
Okay, that makes sense. What about dreams and nightmares? Are they a sign of good or bad sleep and is remembering them significant?
Well, it's interesting. We've started to understand a little bit more about dreams but it's still an area that we don't know an awful lot about. What we do know is that if you remember a dream you've woken up. So that's the first indication that it might not be the smoothest transition from being asleep to being awake. We should be finishing the sleep cycle perfectly relaxed without being in a particular stage, which should be in that zone. So if you're remembering dreams, it means that you've woken up during REM. We know that we have REM dreams throughout the night, but we can actually dream outside of REM itself. If we are dreaming in black and white and it's a lot more concrete tied to the world, then it's a non REM dream. The real fantastical, colourful, beautiful dreams that we have or horrible nightmares, they're more REM based.
Okay. So if you have a lie in in the morning, which I know we're not really about to do, but if you do, that's when you have those more concrete dreams.
That's right.
That's when you probably shouldn't be in bed anymore Absolutely.
And you start sweating often as well.
Yeah.
All making sense. All right, final question. Is there any evidence behind white noise or brown noise being good for sleep?
There's a lot of anecdotal evidence. Let's describe what white noise is. Have you ever turned the television on and it's got the shhh in the background?
Yes. Well, not anymore, but back in the older days.
In the old days.
Teletext.
Or if you really wanted to go and listen to your fridge. That low humming noise. That's white noise.
Right, okay.
And then we get lots of different variations which call different colours. So brown noise, we might think about taking our fridge to the river with us and so it's got a little bit more depth in it now we've got pink noise, which actually is more rhythmic. And that's why it's very often used in the context of babies simulating the womb. Is there evidence? There is some evidence, largely anecdotal, but there are a couple of studies which have shown that it's quite beneficial to use white noise in the context of not being able to sleep, masking out other noises from the environment. The partner who snores, for example, some people do use white noise effectively.
Wow. Thanks Jason. We’ve covered a lot of ground there I wish we could talking about it all day and I hope you found that interesting too.
Understanding circadian rhythm
Watch in 4 minutes
Your circadian rhythm drives your cycle of sleeping and waking. Professor Jason Ellis explains how it works, why it matters, and what can cause it to change.
Let's talk about the circadian rhythm, and what we're talking about here is really the internal body clock.
It's giving us our cues of when it's time to go to bed and when it's time to get out of bed.
The main way that we do this is through the production of a hormone called melatonin.
And if we think about a typical day, well, in the morning we're not really producing much melatonin at all.
We need adrenaline, we need cortisol, and these things are gonna help us walk and talk and move and think throughout the day.
But then we go through a shift.
In the early afternoon around four o'clock in the afternoon, we then shift over to the production of melatonin naturally.
In other words, we're actually getting our pyjamas on in the early part of the afternoon.
We'll increase the amount of melatonin we produce, and that will continue.
It's signalling us it's time to go to bed.
The darkness, it's telling us it's time to go to bed.
Eventually, we'll have enough melatonin that we'll want to go to bed.
Then it starts to diminish in the early hours of the morning, replaced by cortisol so that when we're ready to get out of bed, we're ready to go.
The challenging thing about the human circadian rhythm, of course, is it's not actually 24 hours for the majority of us.
It's around 24 1/4 hours long.
Now, what does that mean? In essence, it means that it's quite easy for our body clock to go out of alignment, to not be in sync, really, with the world that we're living in.
And that can create some challenges, but it also can give us some opportunities.
What we do is we rely on external cues to help regulate our body clock.
And we use light.
Light and dark really do give us our best indicators when it is time to go to bed, when it is time to get out of bed.
If we think about it this way, we register that it's dark outside and that's registered by the retina.
We send a signal all the way to the brain and tell the brain, "You know, it's dark. We need to produce melatonin. It's time to go to bed."
Equally, when we see light, we're more likely to stop producing that level of melatonin.
Outside of light and dark, quite recently we've decided that there are other elements that can help us train our circadian rhythm to the world that we're living in.
Most notably food.
There's lots of different foods that we take which can increase the amount of melatonin in the system, but also the timing of food.
If we tend to keep the timing of our food quite stable, it helps keep our circadian rhythm stable.
The third thing we talk about is exercise.
And we all know that there's lots of benefits to exercise, but one of the things that it does help is it helps, through changes in our body core temperature, it helps regulate that circadian rhythm even more.
So these are the great opportunities.
We've all heard about people who get jet lag, for example, and one of the reasons that jet lag's not as bad as it could possibly be is because the system actually is a little bit more flexible, being 24 1/4 hours long.
So we can use food, light, and exercise in order to try to get us certainly over jet lag.
help us with our shift work, and indeed help us live in the environment we're supposed to.
Busting sleep myths
Watch in 2 minutes
Counting sheep? Napping? Alcohol? Dr Zoe Williams and Professor Jason Ellis disclose the real facts about sleep.
[Counting sheep helps you sleep] It's a myth. Unfortunately, it's too simplistic. What we need is something to really occupy the brain.
[You need less sleep as you get older] Myth. Well, we can get away with ever slightly less sleep as we get older. But it's more the case that when we get older, we might be more likely to have naps during the day rather than get all of our sleep in one block at night.
[Napping makes up for a lack of sleep at night] It's sort of a myth. If you need to nap, it generally indicates there's something wrong with the quality, the quantity, or the timing of your sleep. But let's keep those naps short, 10 to 20 minutes, and keep them early. So really, napping should be done before the afternoon.
[Alcohol helps sleep] That's one of the biggest sleep myths. Whilst having a drink or two might make you feel more sleepy, maybe even help you get off to sleep, it can be devastating to the quality of your sleep, especially in the second half of the night. So no, no good.
[You can catch up on sleep by sleeping more at the weekend] This is a myth. The likelihood is if we try to catch up on our sleep over the weekend, we going to start destabilising both our circadian rhythm, the body clock, and indeed our drive to sleep.
What is REM sleep and why is it so important?
REM sleep is the deepest kind of sleep and it’s when you dream most vividly. Find out why REM sleep is so important.
Sleep problems
How does alcohol affect your sleep?
It's easy to think that alcohol helps you fall asleep, but it can actually disturb it instead. Learn more about how alcohol can affect your sleep in our article.
How to sleep well when its hot
Higher temperatures can make it more difficult to sleep. Amy Gallagher, our Senior Sleep Physiologist, takes us through her tips to sleep in the heat.
How to stop snoring
Snoring is common but it can disturb your sleep, make you feel tired, and affect relationships. Amy Gallagher, our Senior Sleep Physiologist, helps us learn more about how to stop snoring.
Sleep and your health
What is a sleep diary and how can it help your health?
Continuous poor sleep can have an affect on your physical and mental health. This is where a sleep diary can help. Learn how to keep one and how it can benefit your health.
Eight benefits of a good night’s sleep
Getting enough sleep is vital for your health and wellbeing. Our Senior Sleep Physiologist, Amy Gallagher, takes us through the benefits of a good night's sleep.
How does sleep affect diabetes?
The quality of your sleep can affect your blood sugar levels, and that’s important if you live with diabetes. Jed Campbell-Williams discusses how to manage diabetes and sleep.
Life stages and sleep
Your age has a lot to do with how much sleep you need and how much you get. Learn how life stages can impact your sleep.
How much sleep do you need? A guide by age
Sleep can look different as we age. Senior Sleep Physiologist, Amy Gallagher explores how much sleep we need and how it can change as we get older.
Night sweats and disturbed sleep after the menopause
Going through the menopause can mean night sweats, trouble falling asleep, and waking often. Dr Helen Hartley gives us an insight into how to sleep better during the menopause.
How much sleep do teenagers need?
Lead Sleep Physiologist, Julius Patrick, explores why sleep is crucial for teenagers. Discover why it’s important and tips for teens to get a good night’s sleep.
Why do teenagers need so much sleep?
Watch in 4 minutes
With so many big changes happening to teenagers' brains and bodies, sleep is an important time for growth. Understand how to support your teenagers by creating good sleep habits.
Did you know that kids need more sleep when they're teenagers than when they're adults? And the reason for this is that starting from puberty, there's lots of changes in the brain and the body, which they need this extra sleep for in order to help them develop and grow.
A lot of these developments that they're going through actually relate to their performance, as well as their academic work, and so it's vital for them to get a good amount of deep, good-quality sleep.
So what is actually going on here? Firstly, let's talk about the brain. We're supporting critical thinking and problem solving, which are really important to help us in our day-to-day academic work.
We're also functioning in terms of our social and emotional health, and some of those changes that are occurring, which need more sleep, help us develop emotionally, and so we're more resilient and able to focus and feature in terms of our wellbeing. Another core feature, of course, is our impulsivity.
Our teenagers can be quite impulsive because of their hormones, and it's actually sleep that helps start to help us regulate those particular parts of the brain, which help us become less impulsive over time. We can't forget the impact it has on the body as well.
This is a time that we are growing physically, and so we need a lot of deep, good-quality sleep in order to produce growth hormone to help us grow stronger, fight infections, and get all of our hormones in check.
So let's talk about what we can do to help and support our teenagers.
The first is supporting them to establish a good sleep routine.
It's important because when the body clock and the drive to sleep work in tandem, you end up feeling refreshed and able to manage the day, so it's really good.
It's important for them to feel that the bedroom is a comfortable environment, and one of the challenges is, especially with our teenagers, is that they want to use the bedroom as an environment where they do lots of other activities, as well as sleep.
A really good tip is if you could encourage them to demarc different spaces in their bedroom.
There's a space for them to go to bed, and maybe a space for them to do their homework or indeed do their other activities.
That way, if you're separating out the day and the night, it'll be easier for their bodies and their brains to start to associate the bed of sleep, and maybe their desk is somewhere they can work.
Getting our teenagers to talk about stress, anxiety, and the things that bother them can also be very, very helpful. What we're doing here is we're gonna try to release that stress and anxiety before they get into bed because, of course, it's gonna prevent them from getting a good-quality sleep.
So let's talk about electronics.
One of the challenges is that they contain blue light, and that can inhibit the production of melatonin, which is the hormone which tells us it's time to go to bed, and this is critical for teenagers, so we might want to encourage them to leave their electronics out of the bedroom an hour or so before bedtime.
Finally, I would say set a really good example. Talk positively about sleep. It's very interesting. A lot of parents will talk about sleep as, "Oh, I'm so tired. "I didn't sleep very well." Children, and teenagers especially, feed into that. They understand it. We don't want them to start to develop anxiety about sleep themselves.
I'm Professor Jason Ellis. Thank you so much for watching, and I hope those hints and tips will be really helpful in supporting your teenager's sleep.
Sleep and menopause
Watch in 3 minutes
Discover how your hormones and other symptoms of the menopause can impact sleep. Dr Zoe Williams also talks about the psychology of sleep and how your mental health can be affected.
Well, menopause, and the time around menopause, which we call perimenopause, is a time of significant changes to hormones, to our physical bodies, and to our psychology as well.
So there are lots of reasons why that may impact on our sleep.
In fact, sleep disturbance is one of the most commonly reported symptoms and issues that people have when they're going through this period of their life.
So thinking about hormones, both oestrogen and progesterone are declining at this time, and both of those hormones are important in initiating sleeping and giving us a good night's sleep, so there's that direct impact on our sleep.
Then, we can think about some of the other symptoms of menopause, and how they can impact on our sleep as well.
I think the obvious one is night sweats and hot flashes, which can wake people up and be quite distressing.
And the third one is around our psychology. We know that stress, anxiety, and depression are much more common at this transitional time in our lives, and that can impact negatively on our sleep, and poor sleep, of course, can also negatively impact on our mental health.
So what can we do about it?
We can sort of deal with the issue around the hormones by considering taking HRT if it's safe to do so, and HRT is classified as the gold standard treatment for people who are having distressing symptoms of the menopause.
Thinking about some of the physical changes, you know, going to bed at night, trying to create a good sleep environment.
The bedroom should be cool.
It should be dark. It should be quiet.
Trying to minimise any disturbances in the bedroom and trying to keep a regular bedtime and wake time as much as possible.
Another thing is if you can't sleep, and sleep's just not happening, you shouldn't stay in the bedroom.
You should actually leave the bedroom.
Stay in a dimly-lit room, read a book, or listen to a sleep podcast, and then only return to bed when you're feeling sleepy again.
Thinking about psychological changes, you know, if you are experiencing anxiety, depression, or high levels of stress, then these should be seen to, so see your GP, and see what support is available for you.
But obviously, if your sleep is massively improved by some of the other things we've spoken about, then you might start to see an improvement in your mental health.
A couple of physical things to think about as well.
The declining in hormones can affect our muscle strength, and actually we see a tendency to gain weight at this time.
That can increase the risk of snoring and sleep apnea. So it's really important to think about lifestyle as well, trying to eat nutritious foods, focusing on putting good nutrition into the body, and trying to reduce the amount of sugar and fast food that we eat, and trying to be active.
I think there's never been a more important time in a woman's life to think about taking up physical activity or increasing that physical activity with a specific focus on things that help us build and keep hold of our muscle.
Sleep and stress
Watch in 6 minutes
Join Dr Zoe Williams and Professor Jason Ellis as they talk about how stress and anxiety impact sleep. Learn about the importance of having downtime before you sleep and treatments for sleep conditions.
As a busy working parent, we know that you're spinning loads of plates all the time and this can make it really difficult to switch off at night and get to sleep. In fact, a survey of Bupa customers, half of people said they wished they slept better, saying that stress and anxiety was the number one thing that prevented them from sleeping well. So I'm here with Professor Jason Ellis who is a sleep expert and who specialises in helping people get a better night's sleep. So Jason, why does stress and anxiety stop us from sleeping? Why is it that we can't just switch off and go to sleep?
Wouldn't that be lovely.
Wouldn't it?
There's two main issues going on here. The first, you've had a really busy day, you've had a lot of tension. If you haven't got rid of that tension, you're gonna take it into the bedroom. You're not gonna get comfortable, you're not gonna be able to fall asleep very easily. The other thing of course is that mental tension. Lots and lots of thoughts. The challenge is of course when you go to bed at night, you have some quiet time.
Yeah.
And it's usually the only quiet time you get. And so those thoughts are gonna invade, could I have done something different? What could I do about this situation? And again, they're gonna prevent you getting off to sleep.
I know, I know. I get into bed and it's often the first chance I've had to think about the next day, like is it tomorrow that he's meant to wear pyjamas to nursery and is this gonna happen? Have I booked the taxi? And then there's that temptation to get the phone out and start doing stuff, which is devastating. So what advice would you give to somebody then who is really busy, lots going on in their life and they're struggling with this switching off at nighttime?
Believe it or not, you already got there. Except we should be doing it a couple of hours earlier.
Right.
If we give ourselves an opportunity to put the day to bed before we go to bed, then we're gonna be more in control. So all those things like, well, what did I do today? What have I got to do tomorrow and the things I need to put in place tomorrow, like sort out the pyjamas. If you wrote those down a couple of hours beforehand, you're gonna have so much more control. The other thing I would say is give yourself some time to worry as well. Sounds odd, but giving yourself some contained time to worry isn't going to translate it back into the bedroom.
Okay, yeah I often think, we almost feel like we're not meant to worry. We're meant to have it all together. But actually accepting that, yeah, this is quite anxiety provoking. There are things to worry about doing it not just when you're about to go to sleep. That sounds like a good idea. Jason, you are an expert in cognitive behavioural therapy for insomnia. Can you tell us a little bit about CBTI?
Yeah, so CBTI is a range of techniques that we use mainly to identify and challenge any dysfunctional beliefs around sleep. For example, I need eight hours otherwise I'm not gonna function tomorrow.
We don't really necessarily.
No, and sometimes we'll get seven hours and feel fabulous and have a great day. Sometimes when we eight, things don't go so well. So it's identifying any of those attitudes or beliefs that may be helping keep the insomnia alive.
Okay.
Then we talk about behavioural techniques. One of the challenges is that it's quite logical and rational. If you're not sleeping well, go to bed early, have a lie in. They actually tend to fragment the sleep process itself.
Right.
And so what we have to do within CBTI is find the optimal sleep window for you. Try to keep it consistent, really ensuring a deep, good quality sleep.
So it's like it's back to that regular bedtime and wait time.
Yep.
Even at the weekends.
Sadly so.
Okay, obviously with CBTI, ideally it's a therapeutic process where you ideally have a professional guiding you, but are there some sort of proven strategies and sort of tips and advice you can give us based on that that that most of us could perhaps think about incorporating into our sleep routine?
I would certainly think about something called stimulus control, which is one of the powerful aspects of CBTI. Two general rules, only use the bedroom for sleep and sex. And really if you are in bed and you're awake, get out of bed. Because what we start to do is we start to get angry. We start to get frustrated, we start to get miserable. They're not conducive to sleep. Let's take those out of the bedroom, go and do something quiet. Go back to bed when you're sleepy and tired again. Let's break that association with the bedroom being a combat zone. The other thing I would always say is about effort. Don't try to sleep. Again, sounds very strange, doesn't it? But normal sleepers don't try to sleep.
Right.
They get into bed and they do it. The more that you actually try to sleep and not achieve it, the more physically tense and anxious. See, I'm doing it now as I'm doing it.
You're making me feel tense. Thinking about the stress of getting into bed and knowing you're not gonna sleep and then trying to, you know, do various things to get yourself off, which don't work.
Don't try, it'll happen naturally. Your body's designed for it to happen naturally.
It's not happening.
Sleep and ageing
Watch in 3 minutes
Join Professor Jason Ellis as he talks about how sleep changes as you age. Discover how sleep becomes vulnerable from the age of 60 and the factors that affect it.
So sleep does change as we go through the lifespan and most of these changes, believe it or not, start around the age of 25.
But let's translate that into how it looks when we're older.
When we're around 60 years old, our sleep is very vulnerable, and the reason it's vulnerable is because there's been changes in both our sleep processes, which I'll talk about, but also in the other things that happen in our lives, those life transitions also can make us more vulnerable.
So let's start talking about some of those things that are changing within our sleep.
Melatonin, for example, and melatonin helps regulate our circadian rhythm, when we want to go to sleep and when we get up. Unfortunately, we start to lose the ability to produce melatonin naturally as we get older.
The second major change is around the actual dynamics of the sleep itself.
When we talk about sleep and the different stages of sleep, the one that's really important to us is slow-wave sleep, deep sleep.
The challenge is, we lose about 2% of our ability to generate slow-wave sleep every decade after our 20s, so when we're in our 60s, we're actually not producing a lot of slow-wave sleep when we're in bed.
That translates into the ability to repair, the ability to function our hormones and get everything else working properly.
The third thing, of course, is our drive to sleep, and if we think about babies, for example, babies, they don't need much time awake before they need another sleep.
As we get older, this amount of time that you need to be awake in order to generate enough of a drive to sleep at night, increases, so by the time we're in our 60s and 70s, it can take 15, 16 or even 17 hours to generate enough pressure for us to get off to sleep at night.
So those are the general changes that we see in sleep. What about lifestyle?
Well, as we get older, we're more viable and more prone to illnesses, we're gonna need to take more medications, and these things can impact on our sleep as well. Most medications do impact on our sleep.
We also, because of things such as retirement and changes in our schedules, there's more opportunity for us to nap during the day.
Napping is okay, but it can impact on the sleep that you're getting at night, so we need to be careful when we're actually napping.
And then, finally, we've got the issue of an illness.
Most illnesses are going to increase the chances and the vulnerabilities for waking up during the night.
So it's not necessary that your sleep has to change as you get older, we're just a little bit more vulnerable and we need to give it a little bit more care and attention.
Inside Health
Our Inside Health series encourages you to take steps towards a healthier lifestyle. Our medical experts pass on their knowledge to you through our online events, videos and articles. Check out our sleep event and get inspired to make lasting, positive changes.
Sleep uncovered
Watch in 45 minutes
Listen in as we talk about the science of sleep, why sleep matters, and how to build good sleep behaviours. Featuring:
- Dr Zoe Williams – NHS GP and TV medic
- Amy Gallagher – Senior Sleep Physiologist at Bupa’s Cromwell Hospital
- Jason Ellis – Professor of Sleep Science at Northumbria University
Welcome to Inside Health, where we aim to provide you with expert support on the health issues that affect all of us and also give you some practical tips and advice to take away too. Today's topic is something that I think affects all of us at some point in our lives and that is sleep. So whether you are juggling work and family, dealing with an illness, coping with stress, going through menopause, adjusting after retirement, or have a newborn, there are things always getting in our way during life that can impact on our ability to get a good night's quality sleep.
In fact, in a recent people customer survey, over 90% said that they don't get good quality sleep and only 2% said they get more than eight hours a night. So we know that it really is a big issue.
Let me give you a flavour of what's coming up today. First, I'll be joined by Amy Gallagher, who's a Senior Sleep Physiologist at the Cromwell Hospital.
I'll be starting off by chatting about why sleep is so important. Amy will then give us some top tips on good sleep behaviours and what we can all do to reset our bedtime habits to help get us into a good sleep routine. I'll then be joined by Professor Jason Ellis for a fascinating conversation on understanding sleep more deeply and getting the answers that we all really need to know. And finally, we'll be answering some of your questions that have been submitted ahead of today's show. So lots to fit in.
So Amy, really great to have you here today to unpack this key topic. You and I speak to people about their sleep all of the time. It's really common that people have issues and it can be so debilitating when people are not sleeping, whether that is a one-off period of a sleep issue or a sort of longer standing sleep condition. So let's start by, I think, digging into why is sleep so important? What types of things are happening when we're asleep?
So there's actually quite a lot of changes that occur during our body while we're sleeping. So it's a total body experience and it's an active process. So starting from the head we have obviously when our eyes close we start to progress through different stages of sleep. And as this starts to happen, our body experiences changes in our heart rate, in our respiratory rate and also in our muscle as well. So our muscle relaxes throughout the body. We then have sort of changes in our hormonal regulation as well. So sleep is responsible for regulating certain hormones and these are all associated then with things like immunity, cell regeneration, muscle repair. And then we also have our memory consolidation. So our memory consolidation occurs as a result of changes in our brainwave activity. So it's very important.
So many things going on and what's really fascinates it's different phases of sleep or different stages of sleep. There are different things that happen, aren't there?
It's important to try and get through all of those stages. Are there any physical consequences of prolonged poor sleep? I mean, does it put us at higher risk of certain types of conditions?
So unfortunately, yes. So sleep is closely related to a lot of chronic disorders and diseases as well. So we experience sort of changes in our weight and also changes in blood pressure. It's associated with worsening of things like diabetes, it's linked to cancer and also to changes in our mental health and also things like our skin is impacted, mood is impacted also. So yeah, it's got quite a large effect on the body.
And what about our mental health then? So how does poor sleep impact on our mental health?
So it can cause a lot of disruption. So poor sleep is linked to mood changes and then that reduced focus and concentration throughout the day and over time that can then result in sort of anxiousness or anxiety sort of increasing. And that risk of insomnia then also increases as our anxiety risk increases. Like a like a vicious cycle
It's a vicious cycle. And then with a lack of sleep and that increased anxiety and changes to our life as a result we can start to experience depression also. So it's quite a key point of our mental health.
And we talk about having a good night's sleep most people would say that is as simple as getting eight hours but is it a bit more complex than that?
It is more complex than that. But a good rule of thumb is to aim for seven to nine hours. So where eight hour sleep is ideal, it's not necessarily possible in today's society.
We know from our survey that only 2% of people were getting eight hours or more.
And it doesn't surprise me, it is unfortunately something that we really need to focus on and put more attention to and be aware of our sleep patterns and how we respond to sleep.
And then obviously menopause with what happens in hormones there, we know that that's very detrimental to sleep. And what about older adults as we sort of go beyond retirement?
So the menopause is a huge change that women experience and I think we're gonna speak about that slightly later as well and the changes we can experience in that. But for the general population, both male female, we experience a change in our sleep needs so we actually have a reduced need for sleep and our structure of how our brainwaves change throughout the night also changes and reduces as we sleep throughout life. So we do experience those changes. Naps maybe become more common as we often see older people taking a daytime nap. And then we also have an increased risk of sleep disorders. So stuff like sleep apnoea or sort of REM behaviour disorders or restless leg syndrome can all start to impact how we sleep and how replenish we feel after our sleep.
It tends to feel a little bit doom and gloom, doesn't it? But I know you have loads of top tips, that are things that we can doYeah.
To improve our sleep. So shall we head through to the bedroom and have a chat about that there?
Sounds good.
So here we are in this beautiful bedroom and for people who don't have a sleep disorder but have disordered sleep, there are lots of things that we can do to improve our sleep. And I think sometimes people might hear these things and think they already know, but if we're really honest with ourselves, we do develop bad habits over time and it is really important stuff. So what sort of tips do you have that we can all do to I guess develop a better sleep routine and have a better chance at getting a good night's sleep?
So there's quite a lot of steps that we can take towards improving our sleep.
So the first one would be to create a routine. So we wanna be making sure that we're trying to go to bed at the same time every night and again waking up at the same time every morning. And where that may seem like how does that fit in with modern day life and society? It's about adapting what we do during our waking hours to accommodate that. And that just helps regulate our circadian rhythm which is our internal clock for sleep.
Does that mean at the weekends you should still be getting up at the same time you do during the week?
Yes. So where I know a lot of us, myself included, are quite guilty of not doing that, it is important to try, especially if we're going through a phase of poor sleep and insomnia like symptoms. We wanna be making sure that we are being really regimented on our sleep routine.
Okay, we might not want to but it might be the thing that helps. Exactly. And that's why we've got a little alarm clock here. We do.
And I know that that shouldn't really be next to the bed, should it? Where should it be?
So ideally we would have it turned around away from the bed so we don't wanna be watching the clock or the times throughout sleep. So we wanna be making sure that when we're sleeping we're fully focused on the bed. That being said, we do all have to wake up in the morning and often if we need to go to work for earlier than we want to wake up, we definitely need an alarm. So making sure that we have the alarm within the room where we have to get up and outta the bed but not directly facing us so it's gonna stimulate us. And the reason for an old fashioned alarm clock is.
Yes, so we don't want any mobile devices in the room. So here you've got your mobile phone, there's a laptop.
Can I just put this down on the floor?
Ideally not. So this shouldn't have even entered the room. The bed is not a place to do work emails. It's not a place to watch any movies or Netflix or TV, nothing of this work so we want that out of the room.
Well you sleep experts I know say that the bed should only be for sleep and sex and nothing else.
Exactly.
And the brain recognises that that's what it's for.
Yeah. So we wanna stimulate a routine that is just for resting. So we don't want to be stimulated by crazy art or loads of different furnishings or lights coming through the room. So we wanna make sure that our sleep environment is proactive for sleep.
So what about curtains then? 'Cause there's a lot of light shining through these curtains that we have here.
Yes. So you just caught me as I was going to highlight that, unfortunately as lovely as these curtains may be, they're not actually that effective in terms of our sleep. So the amount of light coming through these, ideally we would have a blackout blind behind these and that would just prevent light from infiltrating into the room during our sleep time. So that's one option. We can also put on an eye mask which a lot of people helps their sleep. But it is best to try and create the room to be that sleep environment so that we don't need those accessories.
So it is like making the room like a cave, isn't it? Exactly, yes. Make it dark, ideally quiet and a bit bland.
Yes, and on top of that as well, we wanna make sure that it's a nice temperature, so cool. So ideally about 18 degrees celsius, if you can control the temperature and making sure that we're not completely covered in soft furnishings which then increase our core body temperature.
So I need to get rid of this lovely cushion as well. Ideally. Pop that off the bed. How's that done?
Another thing that we are reluctant to get rid of from our room is our lovely pets. So dogs, cats, rabbits, whatever fluffy friend it is that you have in the room should not be in the sleep environment.
Why is that?
Because they can distract our sleep. So they cycle through sleep on a different stage and time as us. So we wanna make sure that there's minimal distractions within the room.
Should we get rid of that then?
Why don't you chuck that one? So we get rid of this out of the room. Bye-bye doggy.
And we can keep them nice and safe in the kitchen. After that then we should have a nice environment to sleep within.
Okay, so we've got our routine, we've got our nice sleep environment, what about things we can do for the rest of the day, our lifestyles?
Yeah, so lifestyle factors do start to infiltrate sleep. So coffee in the morning only. So we shouldn't be having coffee after about two or three in the afternoon. And for those people who are struggling a lot with sleep, increasing coffee during the day in order to stay awake and function is actually not a good treatment plan and eventually it's gonna start to go out of control both the sleep and the caffeine. So we wanna make sure that you're being careful and considerate with your caffeine intake.
And alcohol as well. That's terrible for sleep, isn't it?
Yeah, so alcohol is terrible for sleep. A lot of people actually think having a few drinks might help them fall asleep and that's not exactly true. So it may help you fall asleep but it definitely won't help you stay asleep or get the sleep that you require. So it actually suppresses that dream sleep. So it's important to make sure that we're not drinking too close to bedtime and also making sure that we're not over drinking.
Okay. Anything else we can do in the day?
Yeah. So exercise as well is a great activity that we can do preferably not right before bedtime because we'll be almost high off the endorphin. So we wanna make sure that we're doing it at least a few hours before bedtime.
Eating healthy. So making sure that we're getting our three meals in and then any snacks as well and trying to avoid high sugar food especially towards bedtime.
Right, okay. And I've got some earphones here. So I guess the question is, if you've done all of that and you're still led here at night and you cannot sleep, what else can you do? I'm guessing it's to use these.
Yes, it is. So unfortunately it's something that we've all most likely experienced at least once or twice in our life and it's a really unpleasant experience. But there are things that we can do to try and take the focus off not being able to fall asleep or initiate sleep. So having something within the bedroom that you might find relaxing or mindful or encouraging meditation.
So for some people that will be reading the book. So for me personally, I read my book before bed every night and it works perfectly well. For other people that could be torturous asking them to keep popping out a book in the middle of the night. We also don't want it to be a very topical, exciting read because.
Just carry on reading, exactly. With the headphones, they're a good option for anybody who finds it sort of bedtime stories or sleep podcasts. It can be really helpful to pop one of those on making sure there's no digital sort of clocks nearby the bed. So popping on one that's already saved earphones on and helping yourself to sort of fall into that restful state.
And I know people will wanna know how long? How long should you stay in bed for and obviously people shouldn't have clocks or have access to time, but how can they tell when it might be the right time to get up?
So if after... If it's starting to feel anywhere between sort of 15 to 20 minutes, definitely within the half an hour we should be getting up and heading outside the room. But obviously that's gonna be how it'll feel because we won't be looking at our clocks. So whatever feels like it's been that amount of time and you're really struggling, then that's a good guide to get up and leave the room.
Okay, so I guess if you're sort of feeling like this is just not happening, sleep is not happeningYeah, it's not happening, leave the roomGet out.
And concentrate on something else for a bit and try again later.
Well, thank you for that. That's really, really interesting and I think like we said at the start, if we're really honest with ourselves, there are some things we might not really want to do in that but they could make a big difference if we're struggling with our sleep. I think also to add that people who are having consistently poor night's sleep over a period of time should see their GP 'cause it could beDefinitely.
There's a sleep disorder going on.
Yes, definitely.
And if people have just had a baby... Sorry, can't help you with that one, can we? No. Hopefully the good will follow, but not initially.
Sleep is such a huge topic and there's new science and data coming out all the time and it's really fascinating and that's why it's so important that we have sleep experts who study sleep so that they can help us have a better understanding as well. And to help us dig a little bit deeper today and get the latest on those sleep questions that we all want to know more about. I'm joined by sleep expert professor Jason Ellis. Hi Jason, welcome.
Hi Zoe
Hi. So I'm really excited for our conversation because there are so many things that we can discover that are new about sleep and you know about all of it because you're a sleep expert. So to give people a bit of context about your sleep credentials, you're a Professor in Psychology at Northumbria University and Director of the Northumbria Centre for Sleep Research. So you definitely know your stuff. So for anyone who is struggling with sleep, hopefully we can answer some burning questions they might have. So let's start off then with, why is it that some of us struggle to sleep and some people don't?
It's a great first question and I think that we need to think about the biggest impact on our sleep, which is ageing actually. As we get older, the parts of the body, the internal system that really regulates our sleep, which is the body clock, the circadian rhythm, and then there's the drive to sleep, which makes us more and more tired. Both of those start to degenerate slowly and over time but they actually do degenerate, which makes us a lot more vulnerable to not being able to sleep well.
And when you say as we get older, what sort of age does that start to kick in? It starts around the age of 25, believe it.
25?
Yeah.
I thought you were gonna say 65 or 75. Wow, okay.
It's very small increments, but we are seeing reductions in the amount of melatonin we produce. For example, the amount of deep refreshing sleep that we get year on year, they decrease a little bit.
Really interesting. How long can we cope with poor sleep before it starts to have a significant impact on us?
Well, I think we've all had the odd bad night and the next day we're a little bit more moody, a little bit more irritable. Probably not gonna use please and thank you as much. But actually the system can correct itself and it will correct itself when we start talking about the long-term impact it's poor sleep over months that we're talking about here.
And that's often down to the environment, isn't it? Now where we have mobile devices, we're working longer hours and maybe the opportunity to sleep is not as good as well.
Well, we also got to think about culture. We've got terms that permeate our culture, snooze you lose, I'll sleep when I'm dead, the value of sleep and its ability to correct itself actually is lost in that mix.
So if people say have sleep issues for a week or two and then it gets better, would that be all right or what's the sort of timing?
Generally, if we're talking about stress related sleep problems one to two weeks, that's a normal adaptive response to the stress. You've got a lot more cortisol, a lot more adrenaline, and that's just keeping you awake longer just so that you can try to cope, problem solve, work out solutions. Once we go over that two week mark, those hormones shouldn't really be impacting our sleep anymore.
Okay. Tell me a little bit more about the term sleep anxiety which I've experienced myself actually, a long time ago, where you persistently can't get to sleep and then you start to get very anxious about not being able to get to sleep and the problem sort of gets worse and worse.
The vicious cycle. It's interesting 'cause there's a theory around this that we start out when we stop losing sleep because of stress, it's because of the stress. And it could be a positive stressor like a wedding or something nice but it's still gonna keep us awake. After about two weeks we might see this switch point where the stressor stops you from sleeping and suddenly the sleep becomes the stressor itself.
Yes.
That's what we talk about in terms of sleep anxiety. And there's some really new research actually came out earlier this year, which demonstrates that is the single biggest factor, the sleep anxiety, which makes us go from just a few weeks of sleep disruption to having chronic insomnia.
Wow. Fascinating. So it's actually then this worry about getting to sleep is the issue that's preventing the sleep.
It's self perpetuating.
Yeah. I think there'll be lots of people listening to this who are thinking, that sounds familiar. How do we know when it changes from struggling to sleep so disordered sleeping to actually becoming a sleep disorder such as insomnia.
So when we generally define insomnia, we're sort of talking about three months in duration, that's the clinical definition but actually after those two weeks, something's not quite right and we should be going in and intervening early.
That's interesting as well 'cause I think a lot of us don't, do we let things get worse and worse. A lot of people fall asleep fine, but they suffer sleep disturbance, waking up regularly through the night and struggling to get back to sleep. What's going on there and what can they do?
So this is part of the entire sleep process. If we think about sleep, we sleep in 90 minutes cycles as adults and during that time we're going through stage one and that's the point at which we are having that transit between being awake, being asleep, you know that nodding dog head.
When you're on the train, I get it. Yeah, neither in or out.
Exactly. And then you might experience something like you've stepped off the pavement too quickly.
Yes.
Yeah. It's called a hypnic jerk. And what that is, is it's a way of trying to get rid of any excess energy that you've got creating a nice smooth transit into the official onset of sleep, which is stage two.
So it's normal then. So that should happen.
Yeah.
Okay.
It's just you may have experienced it, you have the jump but then you go, ah. It's a relief, isn't it? You have the jump, you're like, I actually haven't fallen everything's okay. You take a sigh and then you go to sleep.
That's exactly the passage from being awake in stage one to going into fully sleeping stage two.
But I don't notice that I always do that. Is it that sometimes I'm not aware or. It may be sometimes you're not aware you're very sleepy or it might be that there's not a lot of cortisol left in the system to create the actual physical jump per se.
Okay, fascinating. So interesting. It's 90 minute cycles.
Yes. So we get vulnerable to waking up every 90 minutes. You finish a cycle before you start the next one. So those create vulnerability points. For most of us we'll roll over and we'll go back to sleeping, but if something happens, we need to go for a wee might have a hot flash, our pain medication might be wearing off or we might indeed have pain. That's enough of a window to create an actual awakening. Those are normal, they're natural. The issue becomes can you get back off to sleep after you've dealt with it.
Right. So waking up in the night especially if there's a reason is okay and that's why you shouldn't start looking at what time it is or stressing about being awake. You just need to deal with whatever you need to deal with and just get yourself back off to sleep.
That's exactly the thing that feeds into that sleep anxiety that we're talking about.
Are some of us just naturally early risers and some of us actually true genuine night owls? I kind of know the answer to this, but tell us.
Yes, we have something called chronotypes and this is people's performance.
Whether they're really good performing in the morning or good at performing in the evening. There's a huge amount of people who actually sit in the middle that we call, intermediate types and they have a lot more flexibility. But what we see is if we take those people who are very morning oriented, our larks and we put them into an evening situation, they don't handle it terribly well.
Similarly, if we took somebody who's a real extreme owl and we made them do stuff in the morning, again, they're not gonna perform as well.
And but there are pros and cons to both are there? So if you are a, well, the world is really set up for people who function well in the morning, isn't it?
'Cause we tend to have to get up and either go to school or go to work quite early. But are there some I believe and you can let me know if I'm wrong, that people like me who are night owls we adapt better to shift work and we adapt better to jet lag?
Absolutely. So yes, the world is set up and it's all pre-ordained around the morning, isn't it? It's work time, it's school time, it's getting things ready and that's part of a culture that we have. Whereas evening's a lot more flexible.
You are absolutely right, there are some benefits around being able to adapt to changes in your body clock if you're more evening oriented. And so you have that extra flexibility that might help you work better in a shift work environment.
Well, that makes a lot of sense to me. So I wanted to ask next about the different stages of sleep. So you mentioned just then about the first stage of sleep, which is this transition state which can end with the jerk.
Yep.
So is that stage one?
That's stage one. The actual jerk is the transit into official sleep, which is stage two. Stage two takes up about half of the whole night. We ignored it for many, many years but recently we've started to understand that it's got two main functions for us. The first is it allows us to review the day to determine what do I need to keep? We expose ourselves to a huge amount of information, sight, smells, tastes, do we need all that information? Probably not. So we're determining what do I need, what do I not need so that I can turn the things I do need into long-term memory later on. The other part of stage two is what we call, a sensory gating mechanism. It's a posh way of saying keeping you asleep. So we just use the example of pain. People have pain or maybe the neighbours they've left the television on or they might be having a row, it's in our interest to stay asleep and so our brain will actually create masking so that it says don't focus on that, focus on the sleep, stay asleep. It actually gates across those sorts of intrusions.
Wow.
Then we go from that into stages three and four or slow wave sleep. A lot of people will hear about it in terms of deep sleep. This is where we fix the body, the immune system. Really this is where it gets its main activation from. When you're not feeling very well, what do you want to do?
Sleep.
Exactly. Because we want to get the immune system working. The endocrine system. And that's helping us with our fertility, it's helping us with our eating behaviour, it's helping us regulate all of those things around insulin that tends to be also functioning and really efficient during slow wave sleep. The glymphatic system, and this is one that's quite recent, it's our understanding that during slow wave sleep we actually clear out toxins in the brain and those are the toxins that have been associated with things such as dementia.
Wow. So the brain a bit like the lymphatic system of the body, is it then? The brain's actually cleansing away toxic proteins?
Yeah, pretty much putting a washing machine right way through the system. We go from stages three and four, slow wave sleep. We actually go back up to stage two. Check the environment, is it safe to carry on sleeping? Yep. And then we're allowed to go into REM, rapid eye movement sleep. This is where we deal with the emotional and the memory side of things. This is where we regulate our emotions and this is where we consolidate a lot of our memories.
So when we've not had a good night, for example, this is one of the reasons we are a little bit more moody, a little bit more irritable or we might even get a little bit more hyper.
Or anxious as well.
Or anxious. Because what's happening during REM is we're putting a cage around our emotions and dealing with them. Trying to keep them to really a nice balance so we don't go in either direction.
Wow. So stage three then is kind of about the physical body keeping us alive and healthy and stage four is about sort our psychology sort of keeping us in a good nick from a mental health point of view. Which I guess is why we see such close links to poor sleep, short sleep with conditions like depression and anxiety.
Absolutely.
That's because if we're not getting enough sleep at the end, then we're not able to do that sort of repairing and taking care of ourselves.
Absolutely, it's slightly more complex than that though. Always is, isn't it? Of course it is. This is why I've got a job. When we're talking about REM, it's how quickly REM comes in as well. REM should come in at around 90 minutes in that first sleep cycle 'cause it's the end. If it comes in too early, it's a really good sign that we are likely to become depressed in a few weeks time.
Wow. God, it's so interesting, Jason, honestly. Anyway, we've gotta move on to the next question. What about napping? Is napping good for us and if so, why?
The first thing I would always ask about napping is, why do you need to nap? If you need to nap, that's generally an indication that there's something wrong with the quality, the quantity or the timing of the sleep that you're getting. Now there are occasions where people will need to nap, new moms, chronically ill people, of course they need to nap. But for the majority of us, why are we napping? Is it that we're sacrificing sleep somewhere along the way?
So staying up late at night working or having to get up too early.
I mean, napping can be beneficial and certainly in the context of learning. For example, we might want to ask people to have a nap after they've learned some information. 'cause it will help them consolidate it, turn it into long-term memory. But we've gotta keep it short.
Yes. But how long can we nap for before it becomes more detrimental? We talk about 10 to 20 minutes because after that what tends to happen is we start a full cycle. And if you think about it, the full cycle's 90 minutes. If you wake up after 45 minutes, you're gonna have 45 minutes where there's gonna be a little tension, your body wants to finish the sleep cycle and you've got to attend to something in the environment. It's what we call sleep inertia. You know that groggy awful feeling we get? of feeling worse for it. Yeah.
Okay, that makes sense. What about dreams and nightmares? Are they a sign of good or bad sleep and is remembering them significant?
Well, it's interesting. We've started to understand a little bit more about dreams but it's still an area that we don't know an awful lot about. What we do know is that if you remember a dream you've woken up. So that's the first indication that it might not be the smoothest transition from being asleep to being awake. We should be finishing the sleep cycle perfectly relaxed without being in a particular stage, which should be in that zone. So if you're remembering dreams, it means that you've woken up during REM. We know that we have REM dreams throughout the night, but we can actually dream outside of REM itself. If we are dreaming in black and white and it's a lot more concrete tied to the world, then it's a non REM dream. The real fantastical, colourful, beautiful dreams that we have or horrible nightmares, they're more REM based.
Okay. So if you have a lie in in the morning, which I know we're not really about to do, but if you do, that's when you have those more concrete dreams.
That's right.
That's when you probably shouldn't be in bed anymore Absolutely.
And you start sweating often as well.
Yeah. All making sense. All right, final question. Is there any evidence behind white noise or brown noise being good for sleep?
There's a lot of anecdotal evidence. Let's describe what white noise is. Have you ever turned the television on and it's got the shhh in the background?
Yes. Well, not anymore, but back in the older days.
In the old days.
Teletext.
Or if you really wanted to go and listen to your fridge. That low humming noise. That's white noise.
Right, okay.
And then we get lots of different variations which call different colours. So brown noise, we might think about taking our fridge to the river with us and so it's got a little bit more depth in it now we've got pink noise, which actually is more rhythmic. And that's why it's very often used in the context of babies simulating the womb. Is there evidence? There is some evidence, largely anecdotal, but there are a couple of studies which have shown that it's quite beneficial to use white noise in the context of not being able to sleep, masking out other noises from the environment. The partner who snores, for example, some people do use white noise effectively.
All those neighbours next door that you're talking about with the loud TV. Absolutely.
It sort of drowns out all the... Okay, Jason, so interesting. Thank you so much.
I could literally sit here and chat to you about this all day. We've covered a lot of ground there though, so I think let's go and join Amy again now and we can answer some of your questions.
So in our final part of today's show, I'm back with Amy and Jason to answer some of your questions that have been submitted before today's event. So the first question is, it's one for you Amy, since I hit menopause, my sleep has really deteriorated. What's the best solution?
So it really depends on what the problem is, so what's causing it? So as we experience the menopause, we might have a change in weight, we might increase our snoring threshold and as a result of this we might actually be experiencing sleep apnoea which can cause excessive daytime sleepiness or tiredness or just overall dissatisfaction with our sleep quality. We also experience changes to our mental state. So anxiety, depression, and also a change in our sleep hormone which may actually be increasing our insomnia.
And also another point to mention is actually our changes in temperature. So spikes in our temperature which we refer to as hot flushes and whether or not they're sort of causing sleep arousals as well it's could be a contributor.
So I think that there are so many various different things going on throughout menopause. It's really trying to find out what they are and finding the solutions. Exactly.
Rather than there being one solution. Thank you. Will sleeping tablets, melatonin or sleep remedies help me and are there any dangers?
So we prefer natural remedies. So natural remedies in lifestyle factors tend to have a hugely positive impact on sleep when used correctly and when used as a combined sort of approach. Medications are available and often have to be prescribed through our GP and they're often given on a short term sort of dosage. And the reason for this is because they can become quite reliable.
So we end up almost believing we need these medications to encourage sleep whereas having them on a short term period allows us to have that sort of almost placebo effect which can often actually reverse insomnia or insomnia like symptoms. So it depends and it's again, person by person approach.
And what are some of the more natural remedies that you say you can use alongside lifestyle?
So things as simple as chamomile tea before bed can make a huge change. Melatonin also. So melatonin is a sleep hormone that's produced within our body, but again, that should be used correctly and safely. And so asking a professional for help in how to balance that within their life can really be of proper importance.
Okay, alright then. Jason, how effective/accurate are sleep trackers on my phone?
Well if you're a normal sleeper and you don't get anxious about your sleep, they can be used quite effectively. They're quite accurate actually in terms of sleep duration. So how long you are actually getting per night. The challenge comes when we start to look at sleep disorders, they're not terribly accurate for people with sleep disorders. But also a lot of them telling us information about what stages of sleep. Well I can tell you that that is not terribly accurate. We tend to have to use an awful lot of electrodes in our laboratories to work it out, so we're not really gonna get it from our watches.
Okay. So can give you a reasonably accurate length of time you were asleep, but not perhaps much more than that?
Not really.
Okay. Does lack of sleep put me at higher risk of dementia?
Great question. There is an association between short sleep durations for a long period of time and disrupted sleep and dementia. We think this is because during slow wave sleep, that deep sleep that we get, we're clearing out the brain and we're clearing out particular toxins, beta amyloid, which is largely associated with dementia. Now that's great in the sense that it gives us an opportunity as well because if we can start to manage sleep, are we gonna start to manage people getting dementia or at least the pathway.
And I think, many people are very scared of getting dementia. So I think this information, it's not there to scare us actually it should empower us. I think we can all make tweaks at least to improve the quality of our sleep and I think that's quite a motivating factor potentially for people.
Absolutely.
Amy, are there some sleeping positions that are better than others?
Simply put, no. So it's quite a common question, how can I improve my sleep if I sleep on my side, if I sleep on my back? It comes down to each individual. So obviously if we experience back pain or shoulder pain, we might find a position comfortable and another position not comfortable. The only time that it sort of really comes into importance is when we have supine dependent disorders. So particularly our sleep apnoea where lying on the back actually increases the number of events that we're having. So how many times we're having those stoppages of breathing. In those cases we would try and train the body to sleep in a non supine position.
So that's not on the back. Not on the backOn the side or the front. Again, it can be on the front. It really comes down to preference and throughout life our sleep position may change as our body changes also. So yeah. So not necessarily a perfect position for sleep.
And I once had a tip, I think it was from you Jason, many years ago that you can strap a tennis ball onto the centre of your back so that if you roll over onto your back during sleep, you'll automatically shift back onto your side or your front.
Yep.
Does that work?
It does, thankfully, due to technology improvements, we actually have what is now just a band that sits around the waist. It's much less in intrusive and uncomfortable, but yes, it would be a really good.
I'm old school.
It would be a very good way of preventing that supine sleep for sure. Jason, this is one for you or you can tell us why. Why do my legs twitch in my sleep?
So what tends to happen is that some people have got a problem whereby they actually have slight twitching in their legs at night and it's called periodic limb movement disorder. And I happen to be one of those people who suffers from it. Now I don't actually remember these events and many people who have them don't remember them, but it does lead you to feel a lot more fatigued and tired during the day because you've had slight awakenings during the night. We tend to separate this out from something called restless leg syndrome, which is more as you're getting ready for bed. Itchy, crawly, uncomfortable sensations in the legs which prevent you from getting off to sleep at night. But they are quite joined. Now there are things we can do, we can go and see our GP, talk to the GP about medication or other options. And what's interesting I think and a reminder for everybody is that you can be a professor of sleep and actually we're still affected by these things, aren't we? As humans, we can still be affected.
You can still also go unnoticed despite your plethora of sleep knowledge. It's these things can go without being caught until sort of our symptoms take over and suggest that there is actually a sleep disorder there.
And I guess and yours was only picked up because you volunteered to test out some new equipment, you were the Guinea pig.
Exactly. I decided to try out the new equipment myself and then my technician comes and says, "Look at this." And I think, "Well, that's terrible." And then she tells me it's me so it's okay. We can do something about ourselves.
The next question, for people who work shifts, I have a lot of experience with that, what can they do to minimise any issues relating to poor sleep?
Of course, shift work is not great for us and the things that we can do to help minimise it, focus really about our relationship with light, dark and valuing the time that we sleep. Before the end of a night shift, it's best to try to cool down with light, not get too much access to light, you'll start to wind the body down getting ready. When you do get home, don't fall asleep on the sofa, go to bed. The sofa is a daytime zone. You're gonna have people outside, you're gonna have noises, the washing machine might be going and let people know that you are actually on a night shift. Equally, if you're getting ready for a night shift, getting access to light before the night shift, it's gonna give you that extra alertness to get through.
Alright, really great tips there. And finally, a very, very, very common problem I hear about is how can I stop snoring? Or actually often it's how can I get my partner to stop snoring? I think if we add the answer to that, we would be very rich.
Yeah, it's an interesting one. Snoring, there are a couple of things that make snoring worse. So if you've had alcohol for example or we use some sleep medications, they tend to relax the throat and therefore it's more liable to closing ever so slightly. If there is snoring, it's not to be taken as a trivial thing. I know in society we tend to do so but actually it's important to go and check to see whether it is something more severe, obstructive sleep apnoea, which would need treatment. And there are plenty of treatments available.
The thing is often the person who's not snoring that is the one whose health can suffer, isn't it? 'Cause there's always then the having different beds as well, having a sleep divorce.
Sleep divorce, yes.
To prevent a real divorce.
Yeah, it can make a huge difference and it can increase lots of other things that in life which then enhance the relationship. So it's not to be feared. Yeah. Well, Amy, Jason, thank you so much for that and I really hope that there was some takeaways there that will help you. I think the bottom line being, we can all make some changes to improve our sleep. So feel empowered, not afraid.
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