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Sleep issues and the science behind it

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Anonymous: Initially I was just like my chest used to hurt. I couldn’t remember what was happening. So I just kept saying my chest like hurts when I sleep. Then at night it started becoming more vivid. If I used to open my eyes I’d see like demons. One very distinct one was like hands holding my face and pulling me inside something. Then I used to have a basketball in a plastic bag in my room. And I remember once I thought that the ball was bouncing in the plastic. Lots of different things; like I’ve seen dead family members and things like that.

Anshu Bahanda: Welcome back to Wellness Curated. In our current series, we’re going to revisit some really valuable insights that have been shared across our podcasts. But from a fascinating new perspective— we’re going to deal with it from the lens of science. Before I start with the podcast, I’d like to request you to please subscribe and rate my podcast because that is what enables me to get more and more speakers and to provide you this podcast for free. 

Today I’m going to talk to you about something which is so essential to our lives and we still struggle with it. I’m going to talk to you about sleep. So a lot of celebrities like Jennifer Aniston, George Clooney, Rihanna, they’ve all struggled with insomnia. What you heard at the beginning was actually about sleep paralysis.

Dr Sheetal Radia: Sleep paralysis, it’s a stage between the wakefulness and going to sleep. When the REM sleep is still not finished, but the person gets aware and conscious, he may feel as if he’s unable to talk or unable to move his body. Or sometimes a few of them may feel a little breathlessness, chokey kind of thing. Sometimes people may feel a lot of discomfort in their chest, thinking somebody is trying to press on the chest heavily. A lot of people, they also get some kind of hallucinations. 

Dr Mangesh Ghulghule: Basically, you have to understand sleep as a phenomenon biologically. It is not a one single event. It works like a well oiled machine. You go from one phase of the sleep to the next without getting disturbed. The REM sleep and the NREM sleep— so that architecture is disturbed in a sleep paralysis episode.

AB: In this episode, as I said, we’re going to explore the likes of melatonin and sleep medications; we’re going to explore circadian rhythms; we’re going to explore sleep difficulties; we’re going to explore nighttime routines. So the philosopher Alain de Botton wrote this book called the ‘Course of Love’, and in that he’s got a fabulous perspective on sleep. He says insomnia is your mind taking revenge on thoughts that you did not address. It’s the unaddressed issues that come up into your mind at night to be addressed. 

There is a concept called hyperarousal. Because you’re stressed and anxious during the day, it shows up at night. And then this anxiety releases hormones like cortisol and adrenaline. This prevents you from going into deep sleep and into REM sleep. 

Kate Mikhail: So that’s one big area. Another one is our cortisol levels. I think the pace of life these days being so fast— our cortisol levels, stress levels can be pushed up. We don’t necessarily have to feel, ‘Oh, I’m so stressed.’ But it’s even just the relentless demands, the relentless messages, alerts, things we have to respond to, noise pollution— these are all pushing our cortisol levels up. And that can stop us from sleeping well at night. That’s one of the biggest things that can stop us from sleeping at night.

AB: Science actually has a solution to breaking this pattern. It’s called cognitive behaviour therapy for insomnia— CBTI. And in this, you’re addressing negative thought patterns and behaviours, and breaking that pattern will then help you sleep. 

KM: Once you understand what shapes our sleep, then you can look at that objectively and go and work out what is shaping your sleep, specifically; what is stopping you from going to sleep at night. Is your mind whirling? Are you thinking about problems during the day? Is your bed uncomfortable? It might be sort of things like that. Or is there light pollution coming in? It’s working out what is stopping you and then dealing with the causes. Without that understanding, you can’t particularly… So it’s a matter of realising that our night and day are completely intertwined and everything that happens in our day impacts our sleep at night. 

AB: Our sleep is actually governed by something called the circadian rhythm. Now, what is the circadian rhythm? It’s just our internal biological clock and it’s influenced by the environment, specifically light, and it governs our sleep and our feeling alert. When this rhythm is disrupted, say, by blue light, if we are looking at a device just before going to bed, our sleep quality can suffer. That’s why turning off gadgets half an hour before bedtime is actually proven to help with sleep. 

KM: I’m taking light as an example for this. I now am very conscious of the light I take in, particularly in the morning. I will, as I said, take in that light, go for an early morning walk if I can. I also have a light box on my desk. If I put on my box, which is just in the corner of my desk here and maybe an hour in the morning— that’s given me 10,000 lux, very, very clear light signals to my brain to sync my circadian clocks and give me a serotonin release and make me more alert for the days. 

AB: Some of the recommendations are to expose yourself to bright light in the morning, to put away your devices half an hour before winding down. Ensure that your room is quiet, dark and cool, and invest in a comfortable mattress and pillows. Also, calming activities helps. 

Shomit Mitter: So if you start dealing with chronic stress, you will start dealing with sleep [issues]. So let me give you a few tips on chronic stress, and then I’ll give you a few pointers for sleep, in particular. Chronic stress is about looking after yourself. I’m going to give you everyday things that work. So, number one, at the end of every day, you’ve got to ask yourself three questions and answer them positively. Number one, what did I do for my body, and under body there are three things. One, how well did I eat? Now, eating well is not about protein, carbs five a day, and so on. From the emotional point of view it is the primal, the wise you like the parent and the child, which is the potentially panic side. It’s the first thing your mom did with you when you were born. So it’s about calming yourself. It’s about loving yourself. It’s exercise. When you go for a run, it’s not about the Fitbit [or] how many steps you do when you go for a run— it is about getting away from it all. Second, what did I do for my mind? When you exercise the mind, when you feed it stuff that is inspirational, you have a certain distance from your stressors. And the third is, what did I do for my soul? I’m going to give you a quick exercise here, one quick little way of stilling the mind. It’s a difficult exercise, more difficult than it sounds. Okay, try and count up to, let’s say, 25 breaths without losing focus. Just spend a little time and try and count up to 25 breaths without losing focus. Why does that calm you? Because one thing that happens when we are in stress mode is this scattered mind. ‘What’s going to happen here?’ ‘What’s going to happen there?’ ‘Oh, my God, what about that?’ But when we just focus on the breath, even for a short period of time, everything calms down. All right, that’s the first thing— get your day together. 

But now I’m going to give you a few tips for sleep specifically, all right? Now, the first one is— I’m going to take you through the day. Because getting sleep right is not just getting the evening right, it’s getting the day right. Okay, now I’ll start with the most unpopular thing. Try to wake up at the same time every day, regardless of whether it’s a weekday or a weekend. Mind is a creature of habit. And if it knows this is my waking up time, this is my going to sleep time, it does it very well. When you party till three in the morning on a Friday and a Saturday, and you wake up at noon, you jet lag yourself. And then on Monday and Tuesday and Wednesday, you’re picking up the pieces, and you just got your act together around your workday routine, and then you jet lag yourself again, and that’s not a good thing. So the first thing you have to try and do is— try and wake up at roughly the same time every day. Number one. Number two, once you’re awake, have as much exposure to daylight as you can. Natural light, I don’t mean lights indoors. Have breakfast outdoors if you’ve got an outdoors or a conservatory. If you’ve got a conservatory, have a coffee outside. This is very, very important— to have as much light intake first thing in the morning because it’s as important to signal to the brain that it’s morning, wake up, get your act together as it is at night to say, hang on, switch off, it’s night. Facets of the same thing. That’s the second thing. The third thing is to keep yourself calm through the day by breathing. Now, how do I remember to breathe through the course of a day? It’s not a habit. I mean, I’m breathing a little bit, but I’m not breathing optimally. So take one deep breath before any significant new activity in the day. I sit down to do my emails. Who am I emailing? I sit down to lunch, what am I eating? Et cetera, et cetera, et cetera. One deep breath. And what we’re doing is, it’s called anchoring. We are linking the breath to the activity. And a few times you have to do it manually, you’ve got to think about it; but after a while, it becomes a habit. It’s a bit like you get in the car, you now put on the seatbelt without thinking about it. 

AB: Sleep is not just one long stage all night. One thing is falling asleep. But then people wake up in the middle of the night and they’re like, no matter what we do, we can’t go back to sleep. So what do you suggest for that?

KM: Yes, well, again, it’s looking at causes and taking preemptive action during the day. So it’s called fragmented sleepers. When we wake up in the night, it can make us really tired the next day if we haven’t had that restorative sleep, if we wake up too many times. So there can be things as simple as caffeine and alcohol. They disrupt and fragment our sleep, as does cortisol. Cortisol fragments our sleep. So it’s looking at the causes. What can you do in the day to help set that up and stop it happening? Learning your caffeine cut off or point or whatever. But also, of course, it can just become a habit after a while. So even if you take away all those things, the habit is there. So, dismantling that habit, which I have a chapter on the ‘Science of Habits,’ where I talked to Dr. Carl S. Smith. He’s a habit expert. Absolutely fascinating how habits establish themselves in the brain, why your brain reaches for one habit over another, and what we can do to dislodge one and set up another one that we do want. But I mean, one thing to remember if you do wake in the night, is really, might sound easier said than done, but it’s not; is to just don’t worry about it. It is perfectly natural to wake up between sleep cycles. We sleep in these roughly 90 minute sleep cycles. So we go from being awake into a light sleep, into a deeper sleep. Then we go into our REM, rapid eye movements, dream sleep, and then we can surface between that and our next 90 minutes sleep cycle. So it’s not the end of the world, it is perfectly natural. So you can just tell yourself, you can use suggestions just [sort of like], I don’t have to worry about this. I will just go back and have however many more sleep cycles I’m going to have tonight, because obviously, worrying— it triggers our fight or flight, and then that triggers the hormones that come with fight or flight. So that is going to wake us up, and make us mentally alert. Of course, not reaching for a blue/ white light is another. That is a complete no no, because that will send wake up light signals. Keeping it dark, doing some controlled breathing, you can increase your slow brain waves. If you can reduce your breath to sort of breathe into five, out to five, or even up to ten, in and out. Reducing your breath to sort of right down to six or three a minute can increase those slow brainwaves. Because interestingly, insomnia is classified as a subjective disorder by the American Academy of Sleep Medicine. And what that means is it comes down to our personal perception of how well we’ve slept, how much we’ve slept, how long it took us to get to sleep, because, interestingly, they’ve done studies on this. Insomniacs often take less time to fall asleep than they thought. They wake less often than they think, and they do have deep sleep, but like you say, they wake up feeling exhausted. So, first of all, remind yourself that insomniacs do get more sleep. Reassure yourself you are getting enough sleep. 

AB: Perhaps using mindfulness or relaxation techniques will be very, very helpful. Now, a lot of you increasingly are turning to sleep medications, whether it’s melatonin, whether it’s other medications, sedatives, hypnotics. There is a buzzword at the moment called five HTP. Five HTP stands for five hydroxytryptophan. It’s an amino acid. And this is required in making serotonin, which, as you know, is the neurotransmitter responsible for us being happy. Serotonin is required to make melatonin, which is your sleep hormone. A lot of people are taking five HTP thinking it’s just an amino acid, it’s not a hormone, it’s not going to be dangerous. Let’s see what the experts have to say.

And in terms of melatonin, what is your view on that? Because there’s a lot of mixed reports on that.

KM: Well, melatonin, yes, there have been a lot… 

AB: In terms of, sorry, taking artificial melatonin supplements.

KM: Yes, they’re supplements, yes. I mean, with supplements, there’s a lot of evidence to say that they can really help, obviously, in the short term, with jet lag, and if you’ve had an upset or been ill or stressed, it can help. I mean, I would say, ideally, get a brand recommended, possibly from your doctor in this country. In the UK, it’s on prescription. In other countries, you can get it over-the-counter, but just maybe be sure of the brand you’re buying so that the quantity is correct, the quality is correct, although I would say push up your own melatonin levels. There’s so much we can do to maximise our melatonin levels. One would be increasing tryptophan in our diet. Tryptophan, you find protein foods, high protein foods, animal products, but also beans, pulses, that sort of thing, and oats, a wonderful source of tryptophan. And with tryptophan the body needs to produce serotonin, the happy hormone, which in turn, we need to produce melatonin, the sleep hormone. So if you have lots of tryptophan in your diet, that’s a really good starting point. I mean, I’ve got a whole thing on quality nutrition, the ideal time to eat certain foods for sleep. But tryptophan is a very good starting point and then also to protect your melatonin levels at night so that they’re not suppressed by blue/ white lights, particularly up close phones or screens. 

So protect your melatonin. Dim the lights so that when your brain, your eyes relay the “it’s getting dark” message to the brain, then your body will start releasing melatonin which starts going up about 09:00 p.m. usually. 

SM: Another thing as you’re approaching bedtime, have a hot bath or a shower for two reasons, one obvious, one not obvious. The obvious one is that warm water relaxes the muscles. You’ll sleep better. The second one is more interesting. It’s that the shower is hot and the room is cool in comparison. So when you go from hot to cool, what does the brain think? The sun has set. Sunset brings two things. You see the light goes and we all focus on the light. But actually, if you can somehow trick the brain into believing that the sun is set because the temperature went down as well, that’s a very good way of also coaxing the body to sleep that it’s now better. 

AB: So there you have it, the science behind how you can sleep better. It’s a blend of understanding your circadian rhythm. It’s the right environment, managing your stress and being mindful of what you eat. Implementing changes based on these scientific insights can transform the way you sleep and as a result, significantly improve your quality of life. Thank you so much for watching. Remember, good sleep is not a distant dream. For more on leading a healthier, happier, more hopeful life, please subscribe to our podcast Wellness Curated and get your friends and family to subscribe too. Thank you for listening. See you next week.