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Do we get enough sleep? - The Global Story podcast, BBC World Service — Transcript

by BBC World Service · 3,382 words · 372 segments · language en · Watch on YouTube

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0:00Hi, I'm Jonny Dymond and from the BBC World Service,
0:03this is The Global Story.
0:06Tossing, turning, feeling wide awake at two in the morning
0:10and struggling to get back to sleep?
0:12We know how bad we feel
0:14after not getting a good night's rest.
0:16We spend around a third of our lives asleep,
0:20but a third of us regularly struggle, and recent research shows
0:24that bad sleep can increase the risks of multiple health conditions.
0:29How harmful is it to get insufficient or irregular sleep?
0:34And given how common it is, can it be improved?
0:45With me today is Russell Foster, professor of circadian neuroscience
0:50at the University of Oxford.
0:51Hello, Jonny. Nice to be with you.
0:53And Dr Nerina Ramlakhan, a physiologist and author.
0:56Hello, Jonny. Lovely to be here.
0:58Let me start with the most important question of the day.
1:02Nerina, how did you sleep?
1:03Smugly, I have to say, I slept beautifully last night.
1:07I celebrate good nights of sleep because for many decades I didn't sleep well.
1:13Russell. How did you sleep?
1:14Actually, extremely well.
1:15I woke up once and then got straight back to sleep again, so all good.
1:19Two very smug guests in our studio.
1:22Delighted with their sleep.
1:23Russell, you specialise in circadian rhythms.
1:27Some people watching and listening may know what that is, others will not.
1:31What are they?
1:32And I suppose why are they so important?
1:35So if we think about what our biology needs to do,
1:38it has to deliver the right stuff at the right concentration,
1:42to the right tissues and organs at the right time of day.
1:44And what our circadian system allows us to do is give a time structure
1:49for our entire biology.
1:51And so it's an internal representation of a day,
1:54which is fine tuning every aspect of our physiology,
1:57every aspect of our biology, to the varying demands
2:01of sleep, activity, consciousness and sleep.
2:06And the critical question, I suppose.
2:08Well, for for ordinary punters like me.
2:11What does the clock recommend
2:15or mandate even as an optimal amount of sleep?
2:18I've often said that sleep is like shoe size.
2:21One size does not fit all, and there have been
2:23some somewhat irresponsible sort of statements saying
2:26if you don't get eight hours of sleep, you're going to die.
2:28Well, that's just nonsense.
2:29I mean, the healthy range for sleep from the National Sleep Foundation,
2:32which I'm a member of that board, is somewhere between six hours,
2:36and it may be up to 10 and a half, even 11 hours.
2:39For some people, the average, true, is about seven to eight hours.
2:42But there's lots of variation between individuals.
2:45Nerina, you have spent what, three decades
2:48helping people to get better sleep?
2:51I think it's ranged from what, schools to psychiatric wards?
2:55What do people tell you causes their poor sleep?
3:00Sometimes people have these really unhelpful beliefs,
3:04these misconceptions about what they should or should not be getting.
3:08And, they go around saying, I've got this amount of sleep
3:10and they're measuring it and they're obsessing about it.
3:13And that in itself is creating problems with their sleep.
3:17It's creating anxiety.
3:19So I think that there's that side of things,
3:22but there's also what I've been observing for the last 30 years.
3:25I started doing this work in the 90s.
3:27I left the academic world and ended up in a health screening clinic
3:30where I was measuring the health of city professionals.
3:33And that's when I started to notice
3:35that more and more people wanted to talk about sleep.
3:37And at the same time, of course, technology had exploded onto the scene,
3:42the internet and mobile phones, and everything was going really fast.
3:46So I've been paying attention to the speed
3:49and noticing how it impacts our human physiology.
3:53And as Russell has said, you know,
3:54the circadian timer and and then how it impacts sleep
3:57and I think that's playing its part, the speed of life.
4:00How does that play a part?
4:01I mean, I understand things that feel like they've got a lot faster.
4:06Does it mean in your eyes that we are unable to slow down into sleep,
4:12because we are spending so much more of our lives
4:15in a sort of heightened state of existence?
4:17That's a very good way of putting it, yes.
4:20We've certainly lost the ability to slow down.
4:23We've lost the ability to oscillate.
4:25I love that word that Russell's used.
4:27But not just at night, but throughout the day,
4:30oscillating all of the physiological processes in the body.
4:34They oscillate in a kind of sinusoidal up and down rhythm.
4:38And I think the way we're living our lives, we've become very restless.
4:41You know, I remember the good old days.
4:44I don't want to give my age away.
4:45But when we had lunch breaks and coffee breaks and tea breaks
4:48and people don't, they're so stretched to the limit.
4:51So we thought technology would make life easier.
4:54And it does in many respects that we can do this sort of thing.
4:57But it does mean that people are stretching themselves
5:00and often against the limits of their physiological capabilities.
5:05Nerina, you mentioned this sort of irony that people, some people,
5:09at any rate, are now getting so anxious about sleep
5:13that it's affecting their sleep.
5:16It leads inexorably to the question,
5:18how can you tell when you're not getting enough sleep?
5:22Well, I try to encourage my, my clients, and you've mentioned some of them.
5:26They might be children in schools.
5:28They could be people in psychiatric clinics.
5:31But a lot of corporate employees.
5:33I try to encourage people to listen more deeply
5:36and to not reach for their phones or their devices first thing
5:40in the morning to see what an app has just told them,
5:43but actually to just when you wake up in the morning,
5:45before you reach outside of yourself to be told X, Y, or Z, just listen.
5:51How do you feel right now?
5:53How do you feel?
5:54And even to listen to the speed of your breathing or the speed of your thoughts?
5:57And then as you go about your day to pay attention
6:00to how the body feels physically, how you feel emotionally.
6:02How are you relating to other people?
6:05Russell? I see you nodding along.
6:06Yeah, I think it's a really good point. I completely agree,
6:09and I think many people fundamentally don't have a sleep problem.
6:12They have an anxiety or a stress problem.
6:14And sleep anxiety is now recognised as an issue
6:19and it arises for lots of reasons
6:20but it means we have a target.
6:22There are things that one can do about reducing one's anxiety,
6:26either before you go to bed, before you go to sleep,
6:29or if you happen to wake up.
6:30There are anxiety reducing regimes that you can adopt to get back to sleep.
6:36And I think an increasing understanding of
6:38why you might be having sleep anxiety is really important going forward.
6:43Russell, I want to ask you about whether or not sleep as a block is important.
6:51I mean, I think a fair number of people watching or listening to the show
6:54will wake up during part of the night and then hopefully get back to sleep,
7:00but worry that somehow the second bit of sleep is not worth as much
7:04as the first bit of sleep. Are they right?
7:05Well, I would argue very strongly that it doesn't matter if you wake up
7:09in the middle of the night, as long as you've got the techniques
7:11of reducing stress and getting back to sleep.
7:13And we've been so often told that the perfect sleep is
7:16an eight hour single block, and that's simply not the case.
7:19As one ages, you're more inclined to have what's called biphasic sleep,
7:25whereby you're going to sleep,
7:26you're waking up, you're going back to sleep again,
7:28or indeed polytheistic sleep.
7:30And historically, there are some studies which suggest
7:34that this may be the default pattern of human sleep.
7:38And the key thing is that if you do wake up in the middle of the night,
7:42the tendency is to think, oh my God, you know, that's it.
7:45I might as well start drinking coffee and doing emails.
7:48And if you lie there and you relax,
7:51you'll almost invariably get back to sleep.
7:54Nerina, we've talked about anxiety over sleep, and part
7:58of that anxiety is that people don't want to be exhausted during the day.
8:01Another part is because of their concern that bad sleep is bad for you
8:08in both the medium term and the long term, are they right?
8:13And if they are, how do we know that it is bad for you?
8:17What aspects of our health get affected by it?
8:20Yeah, there's certainly research that shows
8:22that we can become more prone to disease risk.
8:26And I can see Russell's nodding as well.
8:27But you know things like heart disease, diabetes, weight gain.
8:30Our physiology is a complex interplay of all these hormones
8:35and neurotransmitters
8:36that are beautifully controlled by the levels of light and dark.
8:39But when people are working against these rhythms,
8:42it starts to affect our physiology.
8:44And if that goes on for a chronic period of time,
8:47it can start to affect our health.
8:49And as we get older, and if you look at shift workers,
8:51the impact, you know, disease risk and shift workers
8:55is well documented, particularly as they get older,
8:57past the age of 35, 40, disease risk increases.
9:01And when I worked in the psychiatric clinic,
9:03I started to see the impact on mental health,
9:07people presenting with anxiety and depression, even eating disorders
9:11and addictions and the poor sleep is kind of all wrapped up in there as well.
9:17Sleep is the golden medicine,
9:18but it's also one of the things that can fall by the wayside
9:22if people are feeling unwell and mentally unwell.
9:24We produced a model a few years ago suggesting that yes,
9:28at the core there's an overlap between the fundamental mechanisms
9:31in the brain that are generating normal sleep
9:33and those that are generating normal mental health.
9:36I mean, key neurotransmitters.
9:37So that if you have a change in a neurotransmitter that predisposes you
9:41to a mental health condition,
9:43it's almost certainly going to have an impact
9:46on sleep at some level.
9:47But the key thing is the poor sleep,
9:50because of its impact on our cognition, our emotional responses
9:53and our physiological responses can make the mental health condition worse.
9:57And poor mental health can feed back and make the sleep worse.
10:01So we did some experiments a few years ago
10:04on individuals who were on the psychosis spectrum.
10:06This was led by Dan Freeman, whereby we were able to partially stabilise sleep.
10:11And what was so wonderful is that you were able to reduce the levels
10:14of paranoia and the hallucinatory experiences.
10:16So there's an absolute link between poor sleep and levels of
10:22of mental health severity.
10:23Russell, what about mental degeneration?
10:25Because there has been talk of a link to dementia.
10:28I mean, there's been a long sort of correlation that poor sleep
10:32in the middle years is associated as a risk factor for dementia
10:36in the later years,
10:37and there's never been a really satisfactory explanation for that
10:41until recently.
10:42And there's been a recently discovered system within the brain
10:45called the lymphatic system, which clears out toxins
10:49and misfolded proteins, one of which is beta amyloid,
10:53and build up of beta amyloid - which is like chewing gum,
10:56sticking in cells and making them not work very well -
10:59a buildup of beta amyloid has been associated, of course,
11:02with dementia and Alzheimer's.
11:03Now the lymphatic system is turned on whilst we sleep and
11:07actually is clearing out some of those misfolded proteins and other toxins.
11:12And so it could be, and this is all correlation at the moment,
11:15that poor sleep in the middle years affects the lymphatic system,
11:19and that predisposes you to some of these degenerative conditions.
11:24I want to turn, if I can,
11:25to the impact of both the lifestyles people lead
11:30and also where they live in terms of how much daylight they see.
11:35It's really about the impact of less daylight upon people
11:41and whether it changes how much sleep they need or that they feel they need.
11:45Russell, has there been research into this?
11:47Yes, quite a bit.
11:48We've done some and there are many labs around the world.
11:52So basically what the circadian system needs to be of any use at all
11:56is to set the internal clock to the external world.
11:59And the most important daily signal is the light dark cycle.
12:03And so morning exposure to light especially is really important
12:07in setting the clock.
12:09How much have you worked with night shift workers and the impact
12:13that their work has on their sleep patterns and their health?
12:16Quite considerable amount actually, I have done quite a bit of work
12:20in the past with police services,
12:22other emergency services, hospital workers and
12:28helping them to manage those shifts and to manage their rest
12:32when they're working shifts and when they come off shifts,
12:35it's a really important consideration
12:37because there are so many health implications of working shifts
12:41and missing out on those crucial kind of hours of sleep
12:45that they should be getting at night.
12:47I mean, is it as unhealthy as we are now led to believe?
12:50The levels of light and dark and the way that impacts the health,
12:53it impacts our physiology and night shift workers,
12:56shift workers are very prone to not just physical ailments.
13:01They can be prone to mental health, emotional and
13:04and even the social implications.
13:06I think the divorce rate...
13:08in fact, I was married to a shift worker.
13:10Right. Past tense.
13:14But it has implications for health, relationships.
13:19And what's interesting, I think, is that the assumption
13:21by employers is that people will adapt to the night shift work,
13:25and they don't.
13:26And the reason they don't is because of light.
13:28So they're under relatively dim light in the workplace at night.
13:32Then we'll be exposed to natural light during the day,
13:34and the clock will always defer to the brighter light signal
13:37as being daytime, which it is.
13:39So in a sense, what you're doing is having to override this entire biology,
13:44saying you should be asleep.
13:46And one of the problems,
13:47of course, is that you override it by activating the stress axis.
13:50And as we know, sustained stress activation distorts our physiology.
13:55One aspect that gets hit is our immune system.
13:58So nightshift workers are more vulnerable to infection
14:02and indeed cancer.
14:03So the World Health Organization now has designated nightshift work
14:07as a probable carcinogen because of the higher rates of colorectal cancer,
14:11breast cancer that have been documented in nightshift nurses.
14:14I want to talk about solutions very much because I don't want
14:19the audience to walk away desperately depressed by the whole thing.
14:24Your top tips if you would for sleep.
14:27And I want to hear from both you, Russell and Nerina,
14:29start with you, Russell. Your top ideas for,
14:33I suppose, the relatively simple things that people can do.
14:35I think making sure you're getting morning light
14:38to stabilize the circadian system and making sure that you're winding down
14:42and you're de-stressing, whether that be exercise
14:46or whatever before you go to bed.
14:50There are other things I think that one can factor in.
14:53And I sort of talked about this fairly recently,
14:56that if your partner snores, for example,
14:59or you find difficulty sleeping in the same space as your partner,
15:05obviously you would have checked
15:06that they haven't got obstructive sleep apnea,
15:08but it's not an indicator of the quality of your marriage
15:11if you sleep in separate rooms.
15:13And I know a lot of people have real problems with that concept,
15:18but actually it's not the end of a relationship.
15:20It's the beginning of a new one.
15:21You'll be more refreshed, you'll be happier,
15:24you'll have a greater sense of humour, and you can turn it into
15:26who's going to make the tea in the morning type stuff.
15:28So I agree with everything Russell has said.
15:30There we go. Of course, that's good.
15:31Especially I love the one on,
15:34you know, negotiating separate caves as well.
15:37I think that's very important.
15:39So these are the five things that I recommend to my clients
15:43with the clients, patients and a version of this
15:45to school children as well.
15:46And athletes, all of them, these five things,
15:49what they do, 10 to 14 days of doing these things,
15:52I have noticed they start to reset the nervous system
15:55from this highly activated stress side
15:58to this more restful sleep accessing part of the nervous system.
16:02Okay. Have I sold it?
16:04I'm gasping for it. I can't wait.
16:06Okay. Number one, eat breakfast in the morning.
16:10Don't skip breakfast.
16:12So eat within about 30 to 45 minutes of rising.
16:15Big thumbs up from Russell. Okay. Thank you.
16:17So, number two, don't use caffeine as a substitute for food.
16:21Eat first, then have your coffee.
16:23That's what I did this morning.
16:24Ideally no more than one or two a day.
16:26Ideally no caffeine after midday.
16:29I would say number three, make sure you're well hydrated.
16:32Number four, get to bed earlier.
16:36So I recommend that people start preparing to go to bed
16:40around 9:30, 10:00ish.
16:42I don't mean get into bed and be asleep,
16:45but get into your lovely haven of a bedroom and be restful.
16:49You could be reading a book,
16:50you could be meditating, you could be journalling.
16:53This is about sort of advising your body that it is bedtime.
16:55Yes, and finding that sweet spot for restfulness which will enable you
17:00to kind of access then those deeper phases of restoration.
17:03Number five, stop flooding the brain
17:08with the wrong kind of light at the end of the day.
17:10So Russell talked about getting light in the morning,
17:13the light shower in the morning.
17:14But similarly we need to pay attention
17:16to how we're misusing light at the end of the day.
17:19What's the wrong kind of light?
17:20Blue light from your phones, your electronic devices.
17:24The activating effect that they have on our sleep.
17:28It's the doomscrolling and and all the rest of it.
17:31And so that's actively different from reading a book?
17:35Well, actually the initial study suggested that it was.
17:39It is, yes. When we're reading a book,
17:41the eyes. If you're reading a paper book,
17:44your eyes are moving almost in a hypnotic way from left to right.
17:48Often when people are reading on a screen,
17:50and even if it's one of those light corrected screens,
17:53you know, they're sort of reading almost in a question mark.
17:55You know, the eyes start to speed up and speed reading.
17:59But as Russell said, it's that doomscrolling
18:01and what we put into our minds before we go to bed
18:05has an impact on where we reside in the nervous system.
18:09And at the end of the day,
18:10when the hunter gatherer feels safe, the hunter gatherer sleeps.
18:14If you're doomscrolling, if you're looking at the news,
18:16if you're looking at the dating sites telling you that no one loves you,
18:19if you're looking at share prices, if you're looking at all your emails
18:22and what's going to hit you the next day, that doesn't make you feel safe.
18:26We will leave it there.
18:28Russell, Nerina, thank you so,
18:30so much for both your analysis of what has been going wrong
18:34and your suggestions of how things might go right.
18:37Thank you very much indeed.
18:38Great pleasure. Great pleasure.
18:40And thanks so much to you for watching.
18:42If you want to hear more episodes of The Global Story,
18:45go to wherever you get your podcasts.
18:47There's one big international story every single day.
18:52And of course, if you want to see more of us on YouTube, you can subscribe.
18:55We'd love to hear your comments.
18:56Just pop them below.
18:58But for the moment, thanks very much and goodbye.

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