Last updated: 05 Dec, 2022

How following all the rules might be the reason you’re not getting a good night’s sleep.

No blue light after 8pm! Chamomile tea before bed! Eight hours or more... or else! 

In recent years, the world of sleep has become far less relaxed than you’d expect. Between wearable sleep trackers and an ever-growing obsession with self-optimisation, sleep has become the latest on a long list of activities you’ve done your whole life, but apparently should be doing better.  

But what if trying so hard is making sleep harder to come by?  

Dr Moira Junge, a registered health psychologist and the CEO of the Sleep Health Foundation, wants to set the record straight. She breaks down a listener’s sleep diary and explains the tools and tactics at play – and why you probably don’t need to use them all, all the time! 

 

   

 


Transcript

SPEAKERS

Moira Junge, Cassie, Sandro Demaio

 

Cassie  00:02

So, my usual sleeping routine, I'd say is not very consistent, I don't have a consistent bedtime. I don't wake up at a consistent time either. I would hope I'm the majority of the population, but probably not. I think, I'm a big thinker. So, when I go to bed and there’s silence, that's probably the time that I make a lot of mental lists.

So, I've come to a point where I need to actually write those down before I go to bed. Otherwise, it's something that will keep me up. So usually, when I go to sleep, for the last few years, I've just been trying to shower at night, because I think it sets me up really well, for a good night's sleep. It's just I know that if I'm showering, I'm going to be going to bed. So, I'm a bit like a baby like that. Setting up a nice little routine.

I do struggle to fall asleep. So, I do end up on my phone a lot. And when I'm trying to be good, I will read, which tends to work a lot. But, I think I've just fallen into bad habits of relying on my phone as a little bit of a crutch. More often than not, I fall asleep with the sound of like nature sounds. So, I use a streaming service to either get the sound of water or thunderstorms, that kind of thing, so that it's nice and relaxing when I fall asleep.

 

Sandro Demaio  01:31

This is Cassie. We asked her to record a sleep diary as she tries three different ways to tackle her sleep issues.

 

Cassie  01:38

Day one, I've been asked to go to sleep tonight without using my phone at all prior to falling asleep. So, I'm probably in the next hour gonna just go through my normal nighttime routine, have a shower, and see if that makes me sleepy at all.

 

Sandro Demaio  01:55

Sleep is at the core of good health. And without enough quality sleep, everything from your mood to your body starts to break down. There's so much information out there about getting a good night's sleep. But what is a good sleep anyway? Is the information out there right for you and does a one size fits all approach work, if you're trying to get better rest. I'm Dr. Sandro Demaio, and this is In Good Health. Dr. Moira Junge is a registered health psychologist and the CEO of the Sleep Health Foundation. And she's going to help me unpack Cassie’s attempts to sleep better. So Moira on the first day, Cassie didn't use her phone in bed. How much is our screen part of the problem?

 

Moira Junge  02:42

Well I suppose I can comment from being a practitioner who worked in the 90s when people didn't have a smartphone in their room, and they still had sleep problems. So, we can't put everything on to the device. But back then it was other things, it was so the device really represents distraction, avoidance, not prioritizing sleep. So, you can insert whatever could be a device, could be watching TV, could be knitting, could be cleaning the house.

 

Sandro Demaio 3:06

Damn knitting.

 

Moira Junge 3:07

The damn knitting gets in the way. But of course the device has attracted a lot of attention because of not only the stimulation of it, but the, the blue light emitting from the device. 

 

Sandro Demaio  03:17

Yeah, that's exactly so I always get told the blue light sort of hits your retina and wakes you up like it's morning. 

 

Moira Junge 3:23

Yeah.

 

Sandro Demaio 3:24

My knitting doesn't seem to do that. How much though I mean, does that make a difference

 

Moira Junge  03:27

Yeah, so it does make a difference. But there's research recently showing that there's a 50-fold difference in individual differences in your response to light. So, some people say oh, it doesn't worry me, you know, it doesn't worry me at all, and others are really sensitive to it. So, it's the same with caffeine, you know there's, you line people up, and there’s a 50-fold difference. So, these days though most of the devices have the night mode that they have sort of more an orangey yellow glow, rather than the blue light. So, the blue light is, you know how we can't see light in the rainbow but we know there's a stream you know, lots of different colors there. The blue light is the one that suppresses melatonin, and melatonin is of course is the hormone we need to initiate and maintain sleep. So, if that's suppressed obviously we're not going to, we would be delayed with our sleep and not have good sleep.

But I think in addition to that because most people get around that with the you know the blue blocking, with either glasses, there's sort of devices that can do that, or on the device itself is actually not emitting blue light anymore. So, I really encourage people to think about though, no matter what it is, not so much the knitting, it's just you know, it's distraction and avoidance and not prioritizing going to bed.

 

Cassie  04:32

So last night I tried going to sleep without having my phone or using my phone before bed. And I think it actually went really well. So I read about 15 pages of a book before I just was too tired to keep my eyes open, so I switched off the nightlight and went to sleep pretty much straightaway. I checked my smart watch in the morning, and it looks like I slept for about five and a half hours which is a little bit too little for me to feel completely awesome today. But I definitely didn't really wake up too much in the middle of the night, I left my phone in another room so that I wouldn't be tempted at all, to have a look at it at any point in the night. And in the morning when my alarm went off, I thought it was pretty handy. I had to actually get out of bed to physically turn off the alarm. 

 

Cassie 5:22

Today, I've been asked to not have any caffeine. I'm actually going into work today as well. So, we'll see how that goes. I have a bit of a train commute in and then a long day. I'm not a big caffeine drinker, don't have coffee, but I do enjoy pretty much like one tea in the morning and one around three o'clock. So, I'll just see how I go. But yeah, with five and a half hours sleep, not sure how flash I feel. But we'll see.

 

Sandro Demaio  05:53

What about caffeine because some people don't drink coffee after 12, some people it's after three. I've got people who can take like a double, you know, you're at the end of the dinner party. You’re like does anyone, anyone want coffee? You're expecting everyone, obviously to say no, it's nine o'clock, what are you talking about? I’m lying, it's usually seven o'clock and I'm ready for bed. And some people have two, like a double espresso and they go straight to sleep. So how much does caffeine make a difference? 

 

Moira Junge  06:16

So, I would say we know that caffeine is eliminated out of the system, you know, sort of four to six hours later. So, most people should be fine with a, a coffee midafternoon at the latest. But as we all know, and I'm married to one of them, that you know having a short black after dinner, and they can sleep all night. So, it's um again, like we've just talked with like the blue light as well, it's very much tailoring it to you and understanding what works for you what doesn't work for you, taking a lot of personalization approach to your sleep.

 

Cassie  06:47

I went to sleep pretty quickly last night, and I've woken up, feel pretty good. I'm not 100% sure not drinking any caffeine for the day actually did very much for me. But having said that I'm not a big coffee drinker anyway. 

 

Cassie 7:03

Tonight, I was asked to basically dim all the lights, put my phone on night mode, as soon as the sun kind of started to set. So, I've just been hanging out with kind of dim lights. It's about 12:35am. So, I'm probably going to head to bed now.

 

Sandro Demaio  07:22

You can hear that Cassie tried to make her environment mimic the natural light cycles of day and night. What exactly is that doing to her sleep?

 

Moira Junge  07:31

We recommend that once it's dark outside, that you should be in dark conditions as well. So, because the brain gets the messages that it's dark via the eyes, via the optic nerve, goes right into the brain, the you know, the pineal gland starts secreting melatonin. So, if you're not in the right conditions, you're not going to have all that lovely textbook stuff that happens. So, Cassie tried to you know, she was just in, in the dim light. But I noticed she was still awake at 20 past 12. But I think because it was just one night and it's just, it's not going to shift, your body clock is going to take a bit of time to shift, like maybe a number of weeks. So...

 

Sandro Demaio 8:05

Weeks really?

 

Moira Junge 8:06

Yeah, probably like when, when we have like say a teenager with delayed sleep phase syndrome. And they, their body clock is such that they're not really initiating sleep too well, after say 2am 3am. And they're getting up at six for school and parents, everyone's going crazy. Because it's you know, it's such a distressing time, lots of anxiety surrounding that. When I was a clinician full time, we could shift their body clock, but we would wait for the school holidays and just, and take a couple of weeks to just gradually shift their body clock back via light, using light at the appropriate times. And sometimes plus or minus melatonin, you know, orally at night.

 

Sandro Demaio  08:41

So, Cassies clearly trying to address some of the big barriers that can disrupt her sleep. But there's no real silver bullet here is there.

 

Moira Junge  08:49

So, she was thinking about strategy. She had heard about caffeine, she'd heard about, you know the light. And she's heard about not having a device next to her. So, all really good things. But none of them on their own are going to be any kind of magic cure. And they're going to have to be in combination, or they're going to have to be the thing that's affecting you. Because maybe the caffeine wasn't affecting her. Maybe the light is not something that’s really sensitive to her. So, it's something that, we've got these kind of, simple answers sometimes like, you know, often it's tell us the top five tips, or tell us you know all that sort of stuff to really complex questions

 

Sandro Demaio  09:22

Everyone loves their top tips. Let's be honest.

 

Moira Junge  09:24

Exactly. So yeah, so l would talk about principles. 

 

Sandro Demaio 09:28

Yeah right.

 

Moira Junge 09:29

That's what you know, in the sleep world, we have to talk about principles rather than, so I'll just give people you know, top five tips. But they're going to be, they have to be tailored to that person. So it's more you know, so nurture your body clock, understand the effects of caffeine, all those sorts of things.

But they're, I mean there’s five principles that have been talked about from one of my, like an Oxford scholar who's, he's been really instrumental with sleep. And I followed his work over, you know, a couple of decades now. So, he talks about he's a, he's had a published thing this year, looking at the five principles of sleep and like valuing sleep, prioritizing sleep, personalizing sleep, trusting in it, protecting it, but they're the things that will help. The clinical population is very different to the general public. In sleep, like say my specialty was insomnia.

And what I would tell to someone, tell someone with really chronic insomnia so bad that they found themselves a clinician who specialises in insomnia via their GP, via a sleep physician, waiting several months to see me, they're really desperate. And that person, there’s things I tell them, that is very different to Cassie.

Like Cassie from the sleep diary voice, she was a young person. And she was pretty happy with, you know, saying up to 12:20am, she was really energetic, you know, she's only getting five or six hours, she knows she probably needs more than that. There's no humans that would get away with less than six hours routinely. So, we say people need seven to nine, as adults. But some, okay, let's sort of outliers, okay, on six, and some that are, need nine or 10. And all of them are considered normal, just that the average is about eight.

 

Sandro Demaio  11:08

So, they're all normal, anything in that window is normal?

 

Moira Junge  11:11

Anything may be appropriate. We say may be appropriate, but we, the recommendation...

 

Sandro Demaio 11:14

May be appropriate?

 

Moira Junge 11:16

Isn't that interesting? May be appropriate, because knowing that this  say is a small sort of group, yeah, that it might be okay for them. But that most people, the vast majority, need about seven to nine. So,so average eight. So that whole eight hours story is a bit like saying everyone needs to be 65 kilos, or everyone needs to have a shoe size of eight, you can't really say that, it's just so much sort of nuance and, and depends on so many other factors.

 

Sandro Demaio  11:41

And there's so much sleep science out there that, it's so easy to either misinterpret or be trying tips that might not be right. 

 

Moira Junge  11:50

Just because what you've heard on the radio or, you know, that might apply to you. There's, there's different, you know, different applications. So, I think what's happened with sleep, there's an insatiable appetite for sleep, like talking about sleep. Every time I'm at a dinner party, anyone who knows what I do there, talks to me about their sleep problems.

The media loves to talk about sleep. So, we've kind of got the cart before the horse a little bit in that, we haven't caught up as a society with, you know, recommendations and education in schools and education in workplaces. And with the actual proper science, there’s a lot of noise about sleep, and all this stuff around, oh it's the devices, and it's the caffeine and, and of course, all of those things do contribute. But it's also remembering that people did have sleep problems a long time ago.

So there's a great opportunity to talk about sleep and the nuance and, and just getting the, yeah getting the facts right, and not thinking that, that it's whatever, and certainly whatever you try, like, say if you try to cut our caffeine, and if you try to not have your device, that you do that for a really concerted period of time. Like several weeks, you know, you can't expect any change in one night.

 

Sandro Demaio  12:57

So what does, what does good look like when it comes to our sleep? Because I feel like it's such a loaded question. 

 

Moira Junge 13:03

Yes.

 

Sandro Demaio 13:04

But what does it mean to get a good night's sleep?

 

Moira Junge  13:05

I'd love to not talk, talk in terms of good and bad. I think people saying they're a bad sleeper straightaway, we’d change that language and just say, look, don't don't label yourself a bad sleeper, it's part of the thing. Be more optimistic and positive in your language, that maybe you're not getting adequate sleep. But it doesn't, don't take the blame. Don’t say you're a bad sleeper, but someone who's getting adequate sleep. So what, so in inverted commas what good sleep looks like, is that they feel that they're refreshed, and it may not be restored, they may not feel it the minute they wake up, I certainly didn't feel like that this morning. You know, it's more like once you've been awake for an hour or so and you've had your shower and you’ve had your exercise. Then you monitor how you feel, do you feel restored. You don't feel like going back to sleep yet, good. You're probably getting enough sleep.

If you're able to have your, fulfill your roles like in occupational settings and social settings, that you're able to just fulfill your roles without having accidental sleeps like unintentional naps, then you're probably getting enough sleep.

But so, the poor, the people who feel like they're not getting enough sleep, they know, you know, they know, it's they're not prioritizing it. They probably sometimes it's just, it's not even their fault. It's just the systemic, you know, the amount of work, you know, doing two, three jobs, or having a lot of, you know, caring responsibilities and not getting enough support. So that's the thing that will go for sure. Like, you know, you know, you’ll sacrifice sleep for deadlines, and I mean, even I do that. 

 

Sandro Demaio  14:31

So, I mean that that really brings us to the bigger question. So, if we take a step back as a nation, how many of us are not actually getting a good night's sleep?

 

Moira Junge 14:40

We know that at least 40% probably a bit higher are reporting on any given night, not getting adequate sleep. 

 

Sandro Demaio 14:48

Wow. 

 

Moira Junge 14:49

And we know out of that group, it's 15% have the diagnosable, meet the criteria for chronic insomnia. 

 

Sandro Demaio 14:55

And what does that mean? 

 

Moira Junge 14:56

So, it means it's been more than most nights of the week, inadequate sleep, like they're not not able to initiate or maintain sleep. And we don't put a number, there’s no number on it, doesn't mean X amount of hours or anything. It's just this sort of broad international classifications of what insomnia is. And that it's been for several months. And some classification say three months, some say six, it use to say 12 back when I used to work, so it's been, it's so it's usually a long time. Like, it's not just, and it's not due to something else. And it causes just subjective distress, and a lot of impact in your quality of life. So, there might be people out there who say you have five or six hours or so but they’re fine, that their quality of life is fine. They're not distressed by it, they've got energy. And they sort of know that, oh, yeah, like, I probably don't get enough sleep sometimes. So of that, so that 15% of have what, we what we know is chronic insomnia. And most of them have sort of, it's been so bad for them to have to, sort some kind of, you know, they've got a diagnosis. And they've seen some kind of health professional, and often they're on medication, even though we know even the medical people would agree, that non-drug strategies are the best long term for insomnia.

 

Sandro Demaio  16:05

People sometimes get stressed about not getting enough sleep..

 

Moira Junge 16:09

Yes, yes!

 

Sandro Demaio 16:10

Is it such that it starts to affect their sleep, is that is that a thing?

 

Moira Junge  16:12

That is a thing, it's so ironic. And you know, there's also orthorexia and orthosomnia, you know, this monitoring too much of your sleep will in fact, ironically, paradoxically, make your sleep worse, and have you, give this sleep specific anxiety. But I guess in the general population, if you don't have anxiety about your sleep, and you really, really, really intrigued by our data, then sleep tracking is okay. But there's this small subgroup of people who do get really anxious about things like that, and then put too much pressure on themselves. And people with insomnia and like that condition, insomnia, they, you know, they've got their personality type is such that they usually really hard working, diligent, conscientious, a little bit of an over achiever, you know, prone to worrying. And so that profile, they should just put this tracker in the drawer. But you know back in the olden days talking about the 90s. The equivalent was folders and folders and folders, reams of manila folders of sleep diary that they’d put pen to paper. So, the equivalent of been monitoring it too much. So, with respect, I'd say thank you I’ll take those, let's stop the monitoring, now. You know, just for just for the next few weeks at least, don't don't monitor your sleep, we're going to monitor your body, you know, internal, how you feel about things. And when you're sleeping and tired go to bed then, rather than just hold this, I must get my eight hours.

 

Cassie  17:31

Look, I think having to experiment and try three different tips, it was definitely a little bit of a nudge to actually do something about getting better sleep. So for sure, I think I definitely will try to limit how much time I'm on my phone. And I have to say actually, last night, I tried dimming the lights. And initially it was quite like a romantic feeling. It was real mood lighty. And I was like what's going on? I think in the end, it was great. I think it just puts you in a really nice mood. And it's like a form of self-care, right? Like you're off your phone, you're relaxed, you're having a nice shower, like things are just really chilled out. So those are probably the two things that I’ll definitely try more often. Look, I'm not going to aim for perfection doing it every single night. But if I can implement it three, four nights a week, that would be great.

 

Moira Junge  18:21

Because the sleep itself like whether all the stuff Cassie talked about, all that all the tips and all that, it boils down to really the regulatory systems like our homeostatic, sort of sleep pressure, and our circadian system. And if we get those right, and they're doing their thing, and that varies with different people what that means for them to be right. Then this beautiful sleep will come to you in spades, and I think that I've worked in health for a long time, and I've just never seen a more modifiable thing than sleep. And it's such an important thing because when you're sleeping well you'll feel better, you'll eat better, you'll have the energy to move better. I just think it's the foundational you know pivotal thing with, with all health.

 

Sandro Demaio  19:02

Thank you Cassie for putting your sleep habits under the microscope for us. And to Dr. Moira Junge for breaking down why you might need to change the way you think about a good night's sleep. And thank you, for listening in to In Good Health. If you're enjoying the show, make sure you hit follow so you don't miss an episode. And there's already been a bunch of great episodes this season. So, check those out if you haven't yet. in good health is a VicHealth podcast produced by DeadSet studios and hosted by me Dr. Sandro Demaio.