Q.Could you tell me about your vision for the Sleepyhead Clinic?
It started off as a clinic to treat insomniacs. Although the NICE guidelines tell us that the long-term treatment for insomnia is something called CBTI (Cognitive Behavioural Therapy for Insomniacs), which is a not pharmacological solution, we weren’t using it in the NHS. We still use sleeping pills even though we know there is no real long-term benefit of those (but they are cheaper). Drugs, unfortunately, will never resolve insomnia- they’re just going to control it in the short term and not that well- sleeping pills are addictive, they change your sleep architecture, they can make you feel rubbish, and worst of all, they stop working. So originally, I had all this training and I realised that most of the patients we were seeing in the sleep clinics could benefit from improving the quality of their sleep (even if impaired by another sleep disorder such as night terrors and sleep talking). I just thought it was crazy that with all this high-tech equipment to diagnose sleep disorders, and with all these different drugs to fix even the least common sleep disorders, we didn’t have a solution in the NHS for people who just struggle to sleep- and that is up to a third of the population. So, I asked the NHS if I could set up a service and I did a few successful pilots in London and Exeter. London has taken on an NHS service which is fantastic, but as you can imagine it’s pretty oversubscribed. The NHS is going through a lot of changes right now, so in Exeter, they said no to the service in the first instance, so I asked if I could go off and do it myself privately which they allowed me to do, and then eventually, we now have a small NHS service as well which is fantastic
Q.So what does your clinic provide and who do you help?
I went off and started the Sleepyhead Clinic in the background whilst still working for the NHS. It was a little manic at the beginning! I started to realise that it wasn’t just individuals who wanted to self-refer for insomnia. There are corporates wanting their employees fixed (we know that sleep issues affect our global economy significantly) and they wanted help with their clients too. On top of this, I was doing one-to-one clinics, group sessions and online sessions all over the world. I also train other medical professionals so that they can have a better understanding of how sleep is affecting the disorders that they are treating, particularly mental health professionals- psychiatrists, psychologists, mental health workers, etc. In the corporate world, I've been doing a lot of work with businesses to either help employees using a stepped care model which can start with talks to make sure they understand the wellbeing of sleep and how it affects them, what they can do to improve it. That might move up to them sending some of their employees to me when there’s absenteeism because of sleep problems and then there are other things we do like workshops - so there is a whole multitude of things which I didn’t realise were going to happen. I problem I thought I would just be treating joe blogs off the street! I’m in my third year of Sleepyhead and I've just decided to reduce my NHS working hours and do far more Sleepyhead work. It’s so vast- I was a medical expert witness last year, I was doing a TV programme, I never really know what’s coming. But the idea, the goal behind Sleepyhead, is to disseminate complex sleep medicine so that the public can benefit from it, for individuals with a sleep problem, for corporate clients wanting to get more out of their business, and training other medical professionals so they can better help there own patients. By doing this, we can slowly change the societal attitude towards sleep which is very flawed right now.
Q. Why is sleep education so important?
We Sleep a third of our lives and it should be something that we all, from a young age, have some basic understanding of. It shouldn’t be a luxury! If you impair your sleep, you impair your entire life. Sleep is one of the only things we do that will impact absolutely everything. When you start to research why we do certain things (for example why we don’t sleep properly), you can see that as humans we are very proactive but we like short-term results – we are not good at being consistent. We also like to do what everyone else is doing- and are much more dictated by our social norms above everything else including hard evidence, research and science! It is also frightening to see how the media can spin evidence through good PR. Just some of the barriers we have against us being healthier, sleeping better. I feel like I’ve got a duty of care to try to detangle these barriers and find ways to disseminate the real, helpful knowledge in an easy to digest way.
Q. Sleep has been in the media a lot lately- is this helping to educate on sleep?
There is a lot of sleep-related stuff coming out of the woodwork at the moment in the media, but my fear is that some of it is scaremongering the public, telling people that if they don’t sleep enough they will have serious medical problems. And then people go away and they are terrified, and try and force themselves to get more sleep – that’s exactly how insomnia can start! We are perpetuating the problem ourselves. There have been a few famous sleep books that have come out, and I think that’s great, but I think the way we disseminate medical knowledge is so important because you can actually do more harm than good- it’s not simply a black and white case of ‘we’ve proved this- lets go and tell everybody’ if you don’t arm the public with the tools they need to help and resolve the issues you can end up making things worse. We tend to panic and make short-term behavioural changes to our lifestyles that we think are good for sleep, but that actually perpetuate our sleep problems! We need to educate the public in a more constructive way, encourage the value of prioritising sleep as it affects so many things- like getting better skin, reducing the ageing process, to losing weight! I think that’s amazing. But we don’t look at it like that. We just see it as something we do. Even just from a psychological perspective, the fact that we get to shut our eyes, finish that day and start a new one is so important. Imagine if we didn't sleep- not just for the physical repercussions- if we didn't sleep life would be a never-ending day! We would never get to put something aside and move on. Sleep, philosophically, is important. It’s got so many connotations- it’s amazing!
Q. What is a classic mistake that people make which disrupts their sleep?
Gosh- there are so many! I suppose I could start with the one where we love to dictate our bedtime but we don’t ever really like to dictate our waketime. It’s a bone of contention with me. If you look at the science, waking up at the same time every day is so good for us. Not just good for our sleep, but everything else too. Your internal clock gets to start at the same time every day which means that everything becomes very regular- like when you are hungry, when you are full, when you are alert when you are sleepy. You find that the more regular things are, the more amazing you feel- because your body knows what is coming and it can help you. But what we tend to do instead is dictate our bedtime and have the mentality that we have to go to bed at a certain time to get our full eight hours and if we don’t, the world will end! And by doing that we are actually increasing our anxiety and putting extra pressure on ourselves which makes it harder to fall asleep. The only reason you can sleep is if you’ve built up enough of a drive during the day to sleep. If you dictate your bedtime by going to bed when you are not sleepy, regardless of what you think you should be doing, and then perhaps you snooze in the morning, you are changing the goal posts and your body cannot understand what you want it to do. No wonder we feel groggy in the mornings! For example, if you needed eighteen hours of wake-time to make you sufficiently sleepy, changing your waketime all the time means that you will always be sleepy at a different time. I would suggest that you make sure that you are sleepy before you go to bed and by sleepy, I don’t mean fatigued which is another problem in itself. We always assume that if we’re aching, or our brains are whirring, that we are very sleepy- but actually, that might just mean that we need to rest or go for a walk to clear our heads. Sleepiness is just the ability to fall asleep in a few minutes when your eyelids are heavy and you are physically struggling to stay awake. If you get to that point, you’re going to have a much better quality of sleep and wake up at the same time every morning. If you do that at least 70% of the time, your body understands that habitually that’s normal for you, even if you have a naughty night out or have a coffee before you go to bed. Because for the majority of the time you are doing the right thing, your body clock will naturally revert back to that lovely regular routine. And by not dictating a bedtime, your body will end up dictating it for you, so you might be thinking to yourself, ‘Gosh, If I did that I’m not going to go to bed until 3 in the morning and then I have to be up at 7.’ And it might be like that for the first few days but imagine what would happen when you build up such a good sleep drive that eventually your body is going to want to go to sleep a lot earlier and then you’ll notice that there is a pattern. You might learn that you do need to be asleep by 11, but you don’t dictate that.
Q. What happens if we disrupt that routine?
There will be the odd times that life events/stress/illness alter our sleep. This is normal. But it should go back to normal after a few weeks by itself without the need for us to change our behaviour (but we do, like napping in the day if you can't sleep at night for example, which only exacerbates the problems). Unfortunately we like to dictate and change things as soon as we notice there is a problem. I find the idea of lie-ins interesting as well. We love a lie in– we have taught ourselves that lying in is indulgent. That what better way to spend our weekends then being in bed. This makes absolutely no sense to our natural physiological patterns, or indeed our own societal beliefs that we should all be out seizing the day more! Well, you can’t do that in bed! But alas we now need lie ins because we don’t have healthy sleep routines. We go against our natural sleep processes. Isn't it ironic that we sleep less during the week when we so need it for our performance, and then catch up at the weekend which is our precious social time? It makes no sense. And scientifically, you can’t catch up on sleep the way we think (you can’t alleviate the toxins we build up from sleep debt later I’m afraid…and toxins age us quickly!). Leave that sleep debt behind and move on to a more regular pattern most of the time. It’s ok to not be perfect. But dictating this week of sleep deprivation followed by a weekend of slumber is not the solution. If you had a regular wake time most of the time and naturally got up at the same time every day feeling lovely and refreshed, you’d be bouncing out of bed, enjoying your day and getting on with it feeling good. Now wouldn’t that be nice?
Q. Are there any other sleep myths you can help clarify?
There is, of course, the psychological side of it- this idea that the more sleep you get, the better. It’s all about quality- everybody is different. I cannot tell you how many hours of sleep you need because you’ll be different to me, but I can tell you that the quality is more important. If you’re feeling stressed out before something the next day, you should be thinking to yourself- “right, I’m clearly anxious- so I’m going to distract myself and enjoy myself. I’m not going to think about what relaxes me and what doesn’t, dictate my bedtime and worry about sleep”. As long as you aren’t going to run a marathon and increase your heart rate, enjoying yourself is a much better idea than forcing dictated relaxation regimens on yourself because somebody else has said that’s what you should do. Go and distract yourself, relax in your own way, enjoy yourself in a way that you want to and then go to bed when you’re sleepy. It might be that because you were a bit stressed that you’ll get less sleep, but it’s okay because the quality will be relatively good. And if you look at the research properly, one night of poor sleep isn’t significantly going to impact you to the point where you are actually going to make big mistakes that will get you fired or whatever fears that run through our heads before sleep. We listen to the media which goes on a lot about chronic sleep deprivation and we are terrified- we think one night of bad sleep will lead to losing our jobs (that’s definitely not chronic sleep deprivation!). That’s unrealistic. That doesn’t happen. The probability of our beliefs playing out is so low risk, yet we are full of fear so we are constantly telling ourselves something that just isn’t true.
Q. So true. I’m guilty of doing that myself!
We all do and have been since we were children. Even if I’m lecturing the next day in front of a lot of people, its enough to make me feel a bit daunted. And I have to remind myself that it isn’t going to be a normal night for me. I can’t go to bed at 11 and expect to fall asleep right away if I’m very anxious. I put my papers down, go and relax and do something that makes me happy and then I can go to bed feeling sleepy and knowing that the sleep I do get is better than a drawn-out, staring up at the ceiling, fragmented night, waking up feeling exhausted.
Q. I know you’ve just talked about not being too rigid with your bedtime, do you have a bedtime routine that you would recommend to people on a loose or general basis?
My bedtime routine would start in the morning because, at the end of the day, you can’t treat sleep like it’s something that you can fix two hours before you go to bed. The best thing you can do is to start incorporating some sort of breathing or wind-down or relaxation techniques that you can do during the day to avoid sleep problems in the first place. Because the more that you pause to be mindful, the quicker you will be able to wind down when going to bed. It could just be three times a day doing some proper belly breathing. One minute three times a day after three meetings, for example, just to clear your head- have a bit of daydreaming, look out the window and just stop and breathe. However, if you already have a sleep problem, learning to wind down won’t suddenly fix it now. It’s back to building up the sleep drive and possibly getting some further support from a sleep specialist. Whilst relaxation and being mindful is a good way of avoiding sleep issues before they happen, once they are there as we have already mentioned, your sleep drive is the only thing that’s going to get you back on track. The other thing you can do is treat everything with regularity and consistency. If you do exercise, try to do a bit every day, move whenever you can during the day, stay active on a regular basis. Try and eat meals around the same time of day every day. Because then your body understands what you’re trying to do and it will work with you. Your brain is a bit like a puppy and it needs to be trained. It will often reinforce whatever you are doing. If you start making some bad habits, your brain is so smart it will reinforce your behaviour and soon you will start to believe it’s something you have no control over when in fact you started it in the first place! It will help you want that chocolate bar at three in the afternoon if that’s what you did for the last three days – it will help you crave it! It will assume that you want it and give you all those withdrawal symptoms so that you feel like you need it. Similarly, if you start making good habits, your brain will also reinforce those.
Q. Are there any practical tips for doing this?
Particularly for working out what winds you up and what winds you down; If you were to take every activity you do during the day- put a note by each thing for one day, how it makes you feel rated 1-10. 10 out of 10 being energised and 1 out of 10 being very docile, relaxed, and passive. I bet you any money there’ll be a couple of things on that list that you are doing at completely the wrong time, making it more likely for you to have sleepy dips when you don’t want them and making you more energized at the wrong times like late at night when you do want them! There are some things in the morning that make you feel really relaxed- and while it’s important to feel like that during the day, you might find that you are doing some things in the evening that are highly energising that you could switch around and make it easier to wind down before you go to bed. Treat your day like your morning is for the most energising things and your evening is for winding down. For most people that will be avoiding work- doing things that you enjoy and things that make you content and organised. It’s always really helpful at some point in the evening- not just straight before you go to bed- to write out some sort of to-do list for the next day. When you write it, make sure they are things that are actually possible and likely to achieve the next day, as opposed to a great long list. It has to be something reasonable that you are 100% going to be able to get done. Because when you go and do those things the next day, your body is going to feel nice and content because we love ticking off a to-do list and that will make us feel nice and calm for that night. By writing a list at a time in the day that you feel active, you’re engaging your brain to think about those things at a time which is more appropriate than just before you go to bed. And once you get into a habit of writing these lists, you’ll get the feeling you get when you accomplish these things just by writing them down because your brain trusts that you are going to follow through with your intentions After writing the list, I would get ready for bed, do all the things I’d usually do just before bed like brush my teeth- and then I would do any things that still need to be done like load the dishwasher or make the kids’ lunches so that I don’t get into bed and then panic that I haven’t done those things. And once those things are done, that’s when you have your me-time. You can do whatever you want to do. I wouldn’t be prescribing some huge relaxation routine- I’d prescribe things you really enjoy doing and haven’t had any time during the day to do so that you are happy before you go to bed. And yes, if they can be more relaxing things than energising things, that’s great but the most important thing is that you’re happy and that you’ve done what you feel you could have done with that day. So, by the time you go up to bed, you don’t have to brush your teeth or put your pyjamas on, so there are no interruptions of that lovely sleepy feeling and you can go to bed knowing that you did everything you could that day.
Q. What about sleep tracking apps? Would you recommend those?
I think apps are great for short periods of time like when you’re doing exercise but I think that adding technology to nighttime is idea good idea. I just don’t think we need to do it. Sleep is something we innately do and you should be able to do it all by yourself. Sleep trackers are not as accurate as they need to be if you really want to look at sleep in an objective way. You’re only going to start to get anxiety if it’s telling you in the morning that you got a bad night’s sleep but your perception was that your sleep was alright. If the sleep tracker is telling you that it wasn’t, then you’re going to start having issues that weren’t there before. How can you know that tracker is accurate? I think it creates more anxiety than it’s worth unless you are one of these people who can use a tracker and not let it affect your behaviour or what you do. Unfortunately, most of us will see that information and worry and change our behaviour to try and fix it. And without the proper education, behaviour changes in the wrong way and we end up perpetuating sleep problems rather than fixing them. So, at the moment I would say that the kinds of trackers that you wear during the day are probably not the things you should be wearing at night. It’s a nice thing to be able to take off your clothes from the day, put your pyjamas on, strip away all your jewellery, and go to bed naked from technology. Yet, what people are doing is going to bed with technology. I think it would be great if we could just let go and wake up to a new day without over-analysing this lovely time when we are just supposed to be content and relaxed.
Q. Is it true that an hour before midnight is worth two after midnight?
We go through different stages of sleep all the way through the night. In the first part of our sleep we tend to have deeper and more physically restorative sleep and during the second half of the night, we have more REM sleep which we believe is more to do with memory and the psychologically restorative side of what we need. that is why it has come about that the first half of the night has certain merits over the second half of the night. However, actual timings of sleep are always going to be down to the individual. We have morning types, we have evening types, we have ‘standard’ types. So, you could say that going to bed before midnight is good for most people. But to say that an hour before is like two hours after is not necessarily accurate.
Q. For businesswomen or working mums, are there any specific everyday things that many of us do that late interfere with our sleep?
One thing that women don’t do is carve out enough time for themselves. The time before bed is the perfect opportunity for some time that isn’t all about the business or all about the kids or other people. The other thing that I already mentioned was pausing throughout the day for just a few minutes where you look out the window and daydream. It’s so good for you- there’s so much evidence for it. It's good for your efficiency too. Another thing we get wrong is how we use light. We know the negatives of using light at bedtime but even during the day making sure you get outside and get daylight in the morning is crucial. Natural daylight helps your natural physiology- it helps decrease melatonin which helps you feel less sleepy in the morning and more alert. So, if you work in a dark office, going outside or finding light spaces like the kitchen or bathroom can be beneficial to give you a bit of a lift. Generally, exposing yourself to natural light in the mornings and having less light in the evening can help with sleep. Naps are another thing- generally speaking, if you sleep in the afternoon it will affect the quality of your sleep at night. Some people prefer to nap and then only get five hours’ sleep at night, but if you’re expecting that you will still want your seven or eight hours’ sleep at night but are listening to the media advice to nap during the day, that’s when you might struggle. Whatever works for you is working. Don’t change anything if you are waking up feeling refreshed and falling asleep feeling content. If you’re aren’t, then yes- reevaluate. There’s lots in the media about taking vitamin B12 or magnesium for sleep but if you don’t have a deficiency in those things, it's not going to do anything. Spending money on supplements is not going to miraculously change your sleep, especially if you have underlying sleep problems. If you’re deficient and are taking supplements to be efficient, it probably will help your sleep to a degree but it’s never going to solve ingrained sleep problems. That’s something a lot of businesswomen will do- they are very proactive people trying to help themselves but there’s no quick fix for sleep issues. The last thing I would say is to be mindful of how you view sleep. If we see a bad night’s sleep as an indicator that we will have a bad day, we are becoming powerless. If we have a bad night, we focus so much on just getting through the day that we cancel exercise and social interactions. How depressing is that? The best thing you can do is go through the day as normally as possible without changing your behaviour because that drive will help you sleep well that night. Equally, not having enough sleep during the week and trying to catch up at the weekend will only perpetuate sleep problems. The key is to be is as regular as possible. Just be kind to yourself.
Q. What’s your most memorable trip and why?
I just came back from Nicaragua and Colombia. Nicaragua has miles of untouched beach, volcanoes, and a landscape you wouldn’t see in the UK. So, at the moment, probably Nicaragua, but the jungles of Colombia were beautiful too!