Okay, it looks like everyone's now said we'll get started. Thank you very much for joining us this morning.
For the second in the Our Mental Wellness series of webinars that we're running
from the Department of Experimental Psychology here at the University of Oxford.
My name's Cathy Creswell.
I'm delighted to be hosting this session where we're really drawing on the wide expertise that we have across the university for these talks,
which are all focussed on mental health and wellbeing, which we put on really as a reflection of the recognition of the additional stressors
that are being faced by many of our staff and students at this difficult time.
So as we know today, we'll be hearing about overcoming sleep problems.
However, I also wanted to take this opportunity to allow you to the next two upcoming seminars in the series,
which are Managing Depression and Low Mood, which will be held on the 19th of November.
And Overcoming Mistrust and Paranoia, which will be held on the 20th of January.
So please join us for that and we've added all of the talks on our Department of Experimental Psychology YouTube channel.
Say feel free to go back and re watch anything there.
So today we'll be hearing from three members of our university community, starting with a talk from Professor Colin Espie.
And Colin is Professor of Sleep Medicine in the department, at the Nuffield Department of Clinical Neuroscience and is a fellow at Somerville College
and also a senior research fellow in the University's Department of Psychiatry. So thank you ever so much for joining us today, Colin.
And I'll hand over to you now. Thanks very much. Cathy.
And hello, everyone, and thank you very much for taking this initiative for the University and the local community.
I think it's great that these times we're all looking after each other's mental health.
And, of course, Sleep's a very important part to play in that, as as we shall see.
So I know that's that's my background, my affiliations, by training
I'm a clinical psychologist. I do put up resources from time to time on Twitter if you want to look those up.
@ColinEspie and also some discuss some ongoing research and things.
Last week we were thinking with the Mental Health Foundation about the importance of taking sleep seriously.
I was working with them and their campaign that was launched over last weekend and earlier in the year.
Public Health England, as part of their Every Mind Matters campaign also to focus on sleep.
Sleep seems something that's really central to our health and wellbeing.
And what we know that during this time of pandemic, sleep has been even more important to us.
We know from a number of international studies that sleep has been badly affected during these times.
The isolation and confinement has probably contributed to that, as well as the uncertainty and risk that we're all facing.
So there are challenges for all of us and it shouldn't perhaps really surprise us if that's the case.
If we think about the central role that sleep plays in our lives, sleep isn't a nice to have, although it is nice to have.
Sleep is actually a need to have. It's one of life's essentials. And if you think about not having good water supply, enough food.
If you think of the symptoms you would have if there was insufficient oxygen,
then you would understand that sleep, like these other things, has concomnet results.
When we don't get enough sleep either through sleep deprivation or through having insomnia symptoms.
We have a big debt to sleep.
These are just some of the things that sleep does for us is amazing, actually what the brain can accomplish without us when we are asleep.
So much going on. And it has been suggested and read by researchers that sleep is actually the brain's preferred state
because we are kind of out the way at that point and the brain can go on with the work it needs to do,
including clearing toxic waste and regenerating cells.
You know, rest is not as good as a sleep. You don't regenerate cells during rest, only during sleep.
The amino acids, the building blocks of life are synthesised during sleep.
Infection control and immune signalling is heavily dependent on sleep.
And of course, for today's talk and for today's theme
sleep is incredibly important for cognitive and emotional functions.
The regulation of our emotions is heavily sleep dependent and memory
consolidation is much more likely to occur during sleep than during wakefulness.
Our brain is very much smarter than we are, and it makes use of those hours of sleep to do all this important work.
We also know that when sleep is connected with mental health, as often is, that
we can actually improve our mental health if we actually improve our sleep.
This is a big study. It was led by colleague Dan Freeman in Oxford,
demonstrating in a causal way that if you improve sleep with you having difficulties with insomnia, you will improve
also, mental health symptoms. And this is a very, very big study
as you can see, three thousand seven hundred fifty five people were randomised into the trial.
This is probably the largest trial ever conducted in the world of cognitive behavioural therapy.
OK. So this is a study that was published by Dan Freeman and his team.
And I was just saying that this is a very, very big study demonstrating that sleep is essentially important for our mental health and well-being.
And there's another study we conducted even more recently in Oxford showing that if you improve sleep,
you can also improve your wellbeing, your quality of life, a direct relationship, if you like, between sleep and daytime function.
And we're designed as 24 hour creatures – sleep and wake and sleep and wake across the life course – is crucially
important to deliver that rhythm of life and to deliver consciousness even, never mind quality of life.
Sleep is something that is essential thing. We cannot do without it.
But sleep is not really a thing. Sleep is actually a very complex process, and I wouldn't even try too much to absorb the detail on this on the slide.
But it is there to show you. And this is known REM sleep.
This is an orthodoxy that makes up at 75 percent of your night, non tripping sleep if you like.
You can see there's lots of different elements to it.
And the part of the bottom here, this is deep sleep, but that only makes up maybe 15-20 percent of your night.
Most of your night is spent in light sleep, either stage two sleep or dreaming sleep.
And dreaming sleep is a remarkable thing, because during dreaming sleep, you're actually paralysed, you're functionally paralysed.
So when you see your dog lying there and you say to your partner, look,
he's chasing rabbits because he's, you know, making occasional twitches like you see down here,
but actually, it's flat lining here because they're the muscle activity is actually gone.
And the dog is paralysed, although the eyeballs may be moving just like we do in dreaming sleep.
So you're actually paralysed during sleep. And you've got a very active brain.
It's a fascinating phenomenon.
And all of these elements of sleep really seem to be important to serve all the different functions that that we depend upon.
I asked a couple of scientific colleagues from Ireland, too, to help us to really understand how sleep is regulated.
So I'm going to share a little video with you from them.
And here, here, they are here you'll maybe recognise the, of course, that's Father Ted and Dougal.
Yeah, so it's interesting, isn't it? Here we have Father Ted doesn't he so much deserve to sleep.
He's trying his best. And Dougal seems to have accidentally fallen asleep.
And there's an important truth in this, it is central to how sleep is regulated, sleep is not a voluntary process, just like breathing.
You don't choose to breathe. You don't breathe well when you choose to breathe.
If you focus on your breathing, you'll become more anxious.
Sleep is something that happens to us. It's regulated by our sleep drive.
It's after 10:00 in the morning. If you get up around 7:00 this morning, you're three hours into sleep deprivation.
By the time you get to the evening, 10 o'clock tonight, you'll be 15 hours into sleep deprivation.
And sleep deprivation will be paid. Sleep debt will be paid by the sleep banker overnight.
OK, but there's another wonderful aspect to this, because if it was only a case of that build-Up of sleep debt over the day,
we'd get progressively less and less able to function across the day, you made you feel that you do that already.
But you probably don't, because there's a system called the circadian system that alerts us and keeps us alert during the day
and holds back the pressure of the build-up of the homeostatic drive for sleep the day and releases it into sleep at night.
And what you saw with Dougal there was that in perfect timing, maybe perfect comic timing, but perfect timing for his sleep.
He fell asleep. The sleep gate opened. The sleep that was being repaid, circadian clock, it said go to sleep.
And he fell asleep. Maybe that was the same for Father Ted.
But what he finds is his psychology can get in the way.
His psychology can get in the way.
And that's why psychology can help sleep problems, because we can overcome that kind of problem that Father Ted describes.
And we've all experienced feeling exhausted, so much, wanting to sleep but unable to sleep.
So what is sleep and why does it matter? Well, what we're learning is that sleep is one of life's absolute essentials.
It's essential for physical and mental health
as I've been saying throughout our lives, from the moment we're born right through to our late life. It's not a thing.
It's intriguingly complex of different stages and phases. And all of these pieces are important to deliver the functions that sleep serves.
And sleep is regulated by this drive function by the body clock. But our psychology, you can get in the way or it can help.
Sleep is something that you need to allow to happen. You can't make it happen.
So can we look after sleep and hopefully solve the tricky sleep problems that we all have from time to time, not least at the moment?
Well, I'm going to suggest a few things. We can discuss more of them together afterwards.
One thing is think about how much sleep you actually need.
Become a sleep scientist for a while. You know, I often suggest to people that
it would be good to go to a shoe shop when you're trying to figure out how much sleep you need, because when you go to a shoe shop,
you're met with different sizes of shoe and you're not at all surprised that there
should be different sizes because you've got to figure out which one's gonna fit you.
But it's interesting where sleep is concerned that we often think, how much sleep should I get?
So I would say, well, large size shoe should I have. That doesn't make any sense at all.
There's going to be a range of shoe sizes will fit an adult, but there's going to be a range.
You've got to figure out what fits. You've got to figure out how much sleep you actually need.
And many, many people don't actually do that and still haven't done that.
They just go to bed by convention at a certain time because there's nothing else
to do, because their partner was going to bed at a certain time, because of work. Never really thought about how much sleep you need.
And yet, you know, the answer to learning the primary way in which we learn is not by being taught the primary way.
We learn by trial and error. That's how we learn stuff, you know, like this little baby.
Where does this red block goes? Oh, it doesn't go in a round hole.
It goes in the square hole. All because I've tried it in all of them and I've figured out that's the one it goes in.
So figure it out. Practise, experiment with different lengths of sleep as well as different timings of sleep.
Keep some data, maybe not as much of that. But don't
be concerned about, you know, too much, clock watching and all that business.
Trust yourself to figure out. Babies can do it. You can do.
Then consider yourself. You know, are you somewhat a night owl or are you a bit more of a morning person?
Maybe during COVID, during lockdown, particularly.
we're all becoming a little bit more of a night owl, perhaps going to bed a bit later and getting up a bit later.
We all becoming like teenagers again. Perhaps maybe we're back at work again.
But this this is not just a figure of speech, this kind of idea of the body clock and the timing of things.
It's also part of us. And there are some people who are night owls by nature.
That means they don't actually feel sleepy till late and they don't feel alert until
later in the morning or even into the afternoon in some cases if it's very extreme.
There are also people who are natural morning people, who are not the life and soul of the party, perhaps,
but they tend to feel kind of sleepy up at 8:00 and want to go to bed at night and then wake up at 3:00 or 4:00 in the morning ready for the day.
So there are these clock types as well. But there are also people who are neither owls nor larks, and that's most people.
But when you're thinking about experimenting with your sleep, just think about, you know what,
a clock type you might be in there for that might help you discover which aisle in the shoe shop to go to in the first place.
OK. Insomnia is where it gets a little bit more tricky.
This is a persistent problem affecting 20 percent of the population on regular basis, 10 percent of the population at a clinical level.
And the approaches that help with insomnia come from the cognitive behavioural therapeutics tool box.
I've stopped trying to use the term CBT because people think CBT is a treatment.
CBT is is a methodology of treatment.
It includes, you know, I think I think the American Psychological Association suggests some of the 12 hundred different intervention methods.
So here are some of the ones that have been useful and evidence based for for insomnia.
Some are behavioural like stimulus control therapy, which have been a mention of it,
or restricting your sleep time in bed to to consolidate your sleep.
Some are more mental and cognitive, as CBT suggests, there's a C element to that.
Things like cognitive control, restructuring, paradoxical intention.
There's some relaxation methods that work, sleep hygiene, education is not drinking too much coffee and that kind of thing,
which is not really in itself particularly effective treatment for insomnia
but it's a good thing to look after your hygiene, your lifestyle and have a bedroom environment is conducive to sleep.
So I'm going to give you three examples of techniques that you could use that I think would be helpful.
This is the first one. It's a link, right? There's a chain. It's a connexion.
What is your connection between bed and sleep. Dougal went to bed, fell asleep.
Everything was aligned. He was sleepy at that point. A circadian gate was opening.
He fell asleep. He's likely to then associate his bed to sleep and find that this is a place that I go to bed, bed,
sleep, think bed, think sleep. When we settle a youngster in bed and we get them used to being in bed.
They they know to settle in that bedroom and then settling in that room with you there.
Those connections are built. They fall asleep naturally. We don't put them to bed asleep.
We put them to bed. So they feel comfortable then and they fall asleep and it's all chained together.
That's what we need to try and achieve again if our sleep has become broken. And one of the best ways to do that is what I call the quarter hour rule.
Don't spend too long lying awake in bed.
I don't know, of course, what a quarter of an hour rule, but it's something but like fifteen minutes, quarter of an hour is long enough and you'll know it.
How long have I been speaking? Ten minutes. Probably about that.
So you're know you're able to judge time. You've been doing it for a long time.
You don't need a clock. You doing to watch in bed. Give yourself enough time and you can't sleep.
Get up and do something else. Go back to bed, reconnect with your bed when you feel sleepy.
This is a this is a piece of rope or a piece of string with frayed edges, and I use this to illustrate don't go to bed with loose ends.
Not talking about your split ends. I'm talking about loose ends, right? Tie them off before you go to bed.
Spend a bit of time putting the day to rest. Don't expect that because you're so important and busy and productive,
and you've been working so hard that, you know, deserve to fall asleep. And it's not fair because you're not.
You can't just go off that cliff very easily.
Try to wind down and spend a bit of time just putting the day to rest, rehearsing a little bit "how did today go"
What happened at other loose ends, from that and planning ahead.
What if I got it right? What am I doing the next day and do that before you go to bed.
The day to rest. And this is this is a tribute to my granny who knitted jumpers all the time,
and then she knitted them again and knitted them again using the same yarn.
And you know what? Every time she used the yarn again, the jumper became nice and tight again.
Was before then it got all saggy. Right. Because had been used and pulled over.
And, you know, and you know what kids do with the cuffs that you have jumpers pulled out of shape.
But she was able to re-knit that wool again. Admittedly, the next time I got the jumper, there was band of a different colour on it because I got bigger.
But the point is, you can pull your your sleep a needle into that content and knit it back together tightly again.
And the way you do that is by actually spending a little bit less time in bed
to try and tighten up your sleep pattern, to sleep through a shorter window,
so you're then able to stretch it again and get back to the shape you wanted it to be.
So these are some examples of CBT. There's a CBT programme that you can access and Oxford and Thames Valley area that we've developed.
It doesn't cost. It's called Sleepio. You know,
you can go to sleepio.com and access this because we did a big study
recently with a Oxford academic health sciences network funded by a Innovate UK.
And you can go to their website and read that report as well, if you like.
Well, just to give you a little flavour of what Sleepio would look like and how it might help you.
Let me introduce another Prof. Hello there, Martin.
Welcome to sleep. I am the Prof.
And I am here to do everything I can to help you sleep better.
Now you may be thinking, why should I trust you to tell me what to do with nicotine.
the drug found in cigarettes and other tobacco products. So what the programme does, it takes you through six sessions over over six weeks.
It starts with things like sleep hygiene. And then later on it goes on to things that are more based on, you know, CBT techniques.
Let me just find one of those. See what you see looks like. Sleep Prof,
no matter what I do, I can't get to sleep at night. I don't know what's wrong with me.
I'll just lie there wide awake, getting frustrated.
He's driving me mad. I'm sick of it, Prof. Now, what advice should I give him?
So the programme tailors these mental techniques to the problems that you're having with your racing mind.
They could be individual to you and the programme will suggest ways to talk you through things that you can practise on your own.
So these are ways in which you can look after those tricky sleep problems, establish your personalised sleep pattern using trial and error.
The best learning method known to man. Trust your sleep.
Be like Dougal. Use behavioural strategies to strengthen your bed sleep connection like you would do with your kids.
Get it into a pattern. Trust yourself to do it. Use cognitive strategies to manage your mental arousal.
because that gets in the way. That's the psychology that gets in the way.
And learn to sleep like you walk, like you talk, like you breathe.
Without thinking about it. That's my recommendations for how to overcome sleep problems.
Great. Thank you ever so much, Colin. I'm sure people found that extremely helpful.
And actually many of the things that people asked about when they submitted questions did relate to many of the issues that you spoke about.
So it'll be great now to talk a little bit more about those.
So before we start, I'd like to introduce our fellow panel members.
So really pleased that we're also joined today by Dr Felicity White and Dr Dimitri Gavriloff.
And so Felicity is also a clinical psychologist and a Wellcome Trust clinical fellow,
as well as a research fellow at Linacre College and deputy leader of the Oxford Cognitive Approaches to
Psychosis Group in the Department of Psychiatry and of particular relevance to to today
Felicity is leading a novel intervention study to address sleep problems amongst young people at risk of psychosis.
And Dimitri is another clinical psychologist. He's clinical course tutor in sleep medicine in the Sleep and Circadian Neuroscience Institute in the
Nuffield Department of Clinical Neurosciences and is a senior clinical psychologist at the John
Radcliffe Hospital. So thank you so much for joining us today.
And so going to the questions that were submitted, many people who got in touch referred to difficulties with getting to sleep.
So this very much picks up up on the issues that you've highlighted, Colin, and the difficulties that Father Ted was having there.
People particularly talked about how hard it was after a busy day, when there'd been a lot of screen time in the midst of a never ending to-do list.
So I guess whether there are lots of loose ends there. And so it'd be great to hear from the panel what you would recommend people do to
help them turn off their busy minds and to help them get to sleep more easily.
So we've had some great tips on that already from Colin, it'd be great to also hear your thoughts.
If I go to you, Dimitri first. Thanks, Cathy.
I think this is this is really, really important.
And the question is one that I think probably we're all familiar with in terms of our experience as we're all experienced,
a poor night's sleep in this kind of way, having had lots to get on with.
One of the most important things I think that Colin alluded to earlier is what I like to call sort of sleep stopping distance,
thinking about, you know, if you're in a car braking and stopping immediately causes a real mess for everyone.
But if you if you think about sleep in a similar way, we decelerate gradually towards sleep.
Switching off the day and then jumping into bed is probably unlikely to be helpful.
And there's this odd narrative societally that all you got to do is tire yourself out and be really busy,
do lots run around, maybe go for a jog, get really, really tired and really, really exhausted and somehow you fall asleep.
And actually a lot of those activities are really alerting activities, stuff that can keep you going to sleep and cause you to feel even more stimulated.
So doing things that help you relax, unsurprisingly, can be helpful ways to get you to sleep.
But these aren't things that help you feel sleepy. The things that help take away the arousal,
that take away the anxiety, the frustration that masks the sleepiness, that sits just behind the curtain that very often we can't see.
So things like, you know, even things like having a bath and just saying, listen, I'm not going to look at my house for two hours before bed.
I'm going to have my time to watch that documentary that I really wanted to
watch or read that book that I really wanted to read and doing things like this.
They don't pertain to sleep. They're not about trying to get to sleep.
They're about trying to relax and having a pleasant evening.
And in doing so, as I say, you allow the sleepiness that's there to kind of say eventually, you know what,
actually it's probably time to head to bed and then you recognise the sleepiness as you head to bed just as as Dougal did.
All right. Thanks so much, Dimitri. Felicity, would you like to add a thing in relation to getting to sleep?
Thank you. And thanks, going for a great talk there as well. And Colin mentioned about this idea of tying up the loose ends.
And I think this can be really important when we've got a very busy day and it can actually situate itself right at the end of a working day.
So that way, before we're even thinking about that time, we have the chance to kind of put the day to rest,
to pull everything together, set our to-do the next day and then make that transition between work or the business of the day.
And then a separate period of kind of relaxing, rejuvenating.
And that's been particularly important, I think, for those of us who've been homeworking,
where perhaps those usual transitions between work and relaxation have been disrupted.
And so putting those the end of the day is a real distinct marker and then being able to move into those relaxing activities.
And the last thing I would just add is that it's really important for our bodies to have rhythm.
So having that wind down routine, as Dimitri was describing where we're moving through those relaxing activities,
allows our bodies to kind of prepare itself to expect sleep next.
We can't force asleep. We can't make it happen, but we can set the scene for sleep to occur naturally.
And so having a regular routine will really help that.
And it will mean that you're hitting that top kind of sleep pressure in a relaxed way just at that moment in line with your body clock.
Great. Thank you very much. So in addition to trouble getting to sleep, another common issue that was raised relates to staying asleep.
So many people are asked about what they can do to help themselves
to get back to sleep when they wake in the night or in the early hours,
and the tendency for this to have come on with age and door hormonal changes was often mentioned in the question.
So it would be interesting to hear your thoughts on that as well. So, Felicity, if I come back to you festival.
Of course, Colin was saying that sleep is this kind of fascinating experience.
It's not one thing that happens. Actually, we're moving through different phases of types of sleep in a particular predictable cycle.
So we move through many different sleep cycles throughout the night. And each one lasts around 60 to 90 minutes.
And at the end of each sleep cycle, we have this momentary waking.
And so for most of us, if we we're able to kind of drift straight off back to sleep and we may not have noticed that we've been waking in the night.
The people that have raised this question, it sounds like those wakings become very pertinent.
And that can be for a few reasons. One, of course, is that the more we've got going on in our lives, the busier we are, the more alert we are then.
That very mind waking can really get our mind just enough space to let all those worries be flooding back in.
Or thoughts about the next day or the to do list or all those things that go through our mind.
And so that kind of wind down down routine to reduce any hyperarousal being on edge
before bed can really help to mean that we're much more calm throughout the night.
And then the other thing is about building up our sleep pressure.
So this is our propensity or need to sleep and we were saying earlier that, this increases with the amount of time that we're awake.
Now, if you go to bed and you're kind of tired but not really tired it's a bit like setting off on a car journey with the tank half full.
You can set off on that journey and you'll get part of the way that you might not reach your destination.
So what we want to do is really increase the sleep pressure so that we're really building
that up and we're ready to fall off to sleep and then stay asleep throughout the night.
That's the aim for that. All right. Thank you very much. And Colin.
Was there anything you'd like to add in relation to getting back to sleep?
Yes. And I think one of the approaches that we use in clinical psychology is is called reframing, cognitive reframing.
So I think, I think, let's just think about a seven or eight hour stretch or a six or seven hours stretch whatever it is.
During the day, is there a six or seven, eight hour period when you're totally concentrating,
when you're totally on things, when you're totally at your peak?
I think I think if we expect her sleep to be just as consolidated period of peak sleep,
you know, when we are kind of unaware of anything, it's just not a realistic prospect.
Well, we can beat ourselves up about it when we find that sleep is broken.
As Felicity was saying, our sleep is always broken.
You know, it's just that you don't realise that most of the time the regular cadence of sleep leads to these fracture points.
There's also lots of lots of micro arousals. When you turn in bed, your partner moves, as a micro arousal.
You know, when we hear a noise outside, there's a reaction in the brain to that because we heard it.
You hear things whether or not, you know, you've heard them, you see things, you can see during your sleep
you're sleepwalking. And yet, you know, People how can you seriously know when you're sleeping.
I think we've got a very naive idea about what sleep is and we overthink it and it's that overthinking of it
that leads to this concern about I'm awake, let's see what's going to happen. Rather than thinking, well, that's all right.
What would you do during the day if you were finding difficult to concentrate? You take a break for ten, fifteen minutes and you do it again.
You just pick up again. And I think if we can take that kind of approach as well as tighten your sleep up a little bit,
not having too long in bed because you take my grandma's jumper, you stretch it out, it's going to create holes.
We tried to sleep for too long when we're worried about sleep. That's the wrong thing to do.
We're trying to tighten up. So I think that bigger picture of understanding that maybe it's okay, actually,
that you would have time of being awake in the night and you're awake for 10 minutes and you go back to sleep again.
I think that would help a lot if people didn't overthink it. And if you take that approach, you're probably more likely to fall asleep quickly anyway.
All right. Thanks very much. So although many people felt they were struggling with not getting enough sleep,
others got in touch because they were concerned about getting too much sleep.
Is there an ideal amount of sleep and and can we get too much? So, Dimitri, maybe I could go to you first of all.
Thanks, Cathy. This is a really interesting question.
We often think about sleep problems as being very much related to not getting enough sleep, but sleep problems can be really varied.
And when we talk clinically about sleep disorders, we talk about a really broad range of problems people have with their sleep.
One of which is getting too much sleep or sleep happening in a sort of an uncontrolled way.
And I'll focus on sort of more normative examples of things rather than going down that route.
But certainly, I suppose the first thing to bear in mind is if you if you find that you're needing more sleep,
that might be to do with lots of different things,
one of which might be the fact you're not getting enough sleep at a time in which you're supposed to be getting it
but would be ideal to get. Another reason that I think we might get caught up in this idea
of feeling lethargic or or sleepy is because we might not be doing enough activity,
not being as active, being as active as we'd like to be.
This is something that I've seen an awful lot of during lockdown and certainly over the COVID pandemic.
People are unable to get out and do as much as they used to do. They're not as stimulated as they used to be,
and what you notice is that maybe we're spending more time inside when we're not getting as much sunlight.
One thing that's really important for the rhythmicity of this circadian system is sunlight is daily light exposure.
So getting outside every morning and getting the sun hits the back of the eye,
sends the message to the master clock and gets the clock and trained every morning.
If that's not happening in a regular way, if that's happening in an irregular way, if that sunlight isn't particularly bright
that day and spending a lot of time inside, then maybe that that lethargy makes you feel like you're more sleepy.
It's not necessarily sleepiness. It's it's just the fact that there's not that much alertness.
So I think in terms of being practical, a daily activity, getting out and doing plenty good exercise,
all the good stuff that we hear about from all other areas of health.
This is important for sleep too. Dynamic daytime activity is a good predictor of good health, good healthy sleep at night.
Getting regular light exposure in the morning is a good way to banish lethargy and drowsiness that people might otherwise feel.
And if you notice that you're sleepy during the day, then make sure you're getting enough sleep at night.
Because the most common reason why we experience sleepiness during the day is something we we labelled insufficient sleep syndrome,
which is really just this idea that we're not getting enough sleep because we we cut our sleep.
So one of the things we might do is we say I'll stay up and watch another half an hour of Bake Off because I want to see the end of the programme
even though our bodies say "right, it's sleep time now off to bed." We're going
yeah, yeah, well, you know, it's fine, it's only half an hour, but that half an hour multiplied by five days.
Maybe it's not bake off every night, but that's that's 2.5 hours less sleep a week.
That's a lot.
So the point is, if that's happening and a good indicator that might be happening is sleepiness during the day, but also a long lie in on the weekends.
If you notice that you're bingeing on the weekends and catching up all that sleep on the weekends.
Why do you need to catch that up? Because you're not getting enough during the week.
So it's worth just having a kind of a review with yourself about why you might be feeling sleepy.
And of course, if it's something else, then maybe going and seeing your GP is also a good idea.
if you feel that you're sleeping a lot. Great. Thank you very much. Colin,
anything you'd like to add in relation to this issue of sleeping too much?
Yes, I think I think Dimitri covered a lot, a lot of the things that I mean, you know, and and to Dimitri's last point.
Know your own body, know yourself. If something has changed dramatically and you don't feel well,
then you shouldn't ignore it and should get it investigated, ask questions and seek some help.
But equally, you shouldn't ignore it and not do the obvious things like, well,
maybe I'm not getting enough sleep at other times, or maybe I'm drinking too much during lockdown.
Or, maybe I've got this thing is that Dimitri referred to,
it's sometimes called social jetlag. You can look that term up where people are actually over the course of the week getting enough sleep,
but they're bingeing on the weekends and running on empty during the course of the week.
So do obvious things first. I think some things I said too earlier about experimenting with your sleep pattern.
Don't be frightened to to experiment with it, to try and get it better.
And you'll know from your own data by knowing your own body, you know,
whether or not you're feeling better and differentiate fatigue from sleepiness. Fatigue
people don't fall asleep. Fatigue people feel tired.
Fatigue and sleepiness only partly correlated the different kinds of things that differentiate those two.
And the best solution to fatigue is activation. OK, thanks very much.
So in addition to questions about being asleep versus being awake,
we also had a number of questions about particular experiences people have when they're asleep.
So lucid dreams or nightmares, sleepwalking or talking
and what people might be up to do if these are causing disturbance, so distress, so Felicity, it would be great to hear your thoughts on that.
You know, just picking up about dreams and nightmares. These can really leave their mark on us whenever we've woken up
perhaps more particularly intense dream or nightmare, we really feel the emotional effects of that.
We kind of feel those emotions very intensely having come from that nightmare.
And we can notice this kind of hanging over into the next day,
we might find that we're kind of cross with somebody if they've done something in a dream and we're kind of annoyed at them.
One, even though we know it didn't happen, we kind of have the same intensity of the emotional reaction.
And that's kind of related to the intense imagery that we were experiencing when we're having these dreams or nightmares.
And not only do these nightmares have a knock on effect on the next day,
but often the content can reflect some of the worries or thoughts or concerns that happened the day before that might be going on at night.
And so thinking about what we can do about these,
really the first is how do we reduce the likelihood that we're going to have nightmares or intense dreams?
This comes back to creating a kind of calm and safe environment before we go off to sleep.
We need to feel safe and we need to feel calm before our body will allow us that experience of sleep.
And so we want to think about bringing down any of that sense of high levels for arousal or worry before sleep.
So relaxation and that calming winding down routine before bed.
And then, if dreams or distressing nightmares do occur in the night,
the first step is really just to reground ourselves into the present moment, to recognise that the dream is over,
that it's not real and that we are back in this present moment and we're safe enough.
And if you tend to have distressing dreams or nightmares
very often, you might want to leave a note for yourself by the badge kind of message from your daytime self.
So on waking, you can have that cue to remember that it's okay, even though it felt very intense
and you've woken from this nightmare. actually you're safe enough and the dream is over.
If you tend to have repetitive content, so you're having the same kind of nightmare, the same story seems to play out night after night,
then there is an approach called imagery re-scripting in which you can actually change what happens in the nightmare or dream.
And you could kind of almost like a movie director. You can rewrite the ending.
And this means that you can change the meaning and the emotions that go with it.
So you might if you have a distressing dream, you might change it
so it has a funny ending so that any attacker, instead of reaching you, actually slips up on a banana skin or something
and so you can kind of take the heat out of it with the same nightmare.
So those are just a few ideas with responding to those kinds of dreams and nightmares.
Thank you very much. Dimitri, would you like to add anything?
So you also asked Cathy about sleepwalking and things like that for these, these are quite distinct from what we call REM related activities.
So nightmares are I think that happened in REM sleep. This is the emotion processing piece.
This is where we're having emotional narrative in our
narrative dreams. But sleepwalking, sleep, talking and and things like night terrors, which are common in young children.
These are what we call non rem arousals or non REM.
Partial arousal is incomplete arousal where the brain sort of is, if you like, half asleep, half awake.
So a crude way of explaining it.
But you see it, as Colin mentioned earlier, you can get people that do very intricate, very complex activities whilst asleep.
So this case examples and I'm aware of people riding motorcycles in their sleep, which is just particularly extreme.
But there are you know, the more common stuff is walking around or or sometimes calling out.
Now, that happens in the transition from what we call slow wave sleep, the deep sleep we get at the beginning of the night,
the deep restorative sleep we get at the beginning of the night to lighter sleep stages, lighter sleep into deep sleep.
And that transition isn't happening as smoothly as it might otherwise happen to see you get these unusual things happening.
And very often they they are, I mean, they're all the benign sort of things that happen.
We call them parasomnias in the jargon, but they're not a problem necessarily.
If they're happening very frequently and they are beginning to interrupt your sleep or interrupt the sleep with those around you,
for example, if you have a young child, it's having a night terror that happens very frequently.
Often the best thing to do is to think about what's making these things happen in terms of their severity or their frequency.
And there's two things primarily that increase the severity and frequency of these episodes at night.
And one is being sleep deprived and the other one is high levels of arousal.
Before bed. And so these two things are good areas to think about.
The first one is, is that young person, if it's a child who's who's having lots of nightmares.
Are they getting enough sleep where they sleep deprived? Are they very agitated or worried about things before bed?
Or have they got things on the mind before bed might be causing them to maybe
inadvertently causing them to be awake for longer and then being unsettled.
But I mean, these these things are there and they're very common and they're not a problem, per say.
But when they do start to interrupt sleep or start to get in the way of other people's sleep,
then doing something about them is often about thinking about what might be keeping them going.
So lots of children and young people struggle with falling asleep and staying asleep.
And by and large, these experiences of difficulty falling asleep and staying asleep
can can be considered kind of normative. Developmental learning is that there are times when
children learn to policy independently and we think about things from an evolutionary perspective.
We didn't put our children to sleep in the cave next door. They slept round the fire with us and we all huddled down.
So actually part of this is kind of a facet of us living in a modern age.
But one of the things that's important to bear in mind is that when someone falls asleep, when a child falls asleep, they do so in a context.
And that context is one for which they have behaviour associations, often at present.
So things like having a parent or a caregiver in the room with them will mean that that's
that's how they learn to fall asleep by having having that that stimulus there with them.
So when they wake up subsequently in the middle of the night, as we all do
and as is normal in sleep at various points in the night, they might then require their parent or caregiver to be there again, to resettle them.
And if you notice that's happening or if that's an issue,
then one of the most important things is to start helping that child fall asleep independently to begin with,
because once they know how to fall asleep independently at the beginning of the night,
then they'll they'll be much more likely to sleep through the night and to reinitiated sleep effectively.
And there can be lots of reasons, other reasons why children might struggle to fall asleep.
But another one that's worth mentioning is that as we as we grow, as we get older, our sleep timings change, too.
And so although we think of bedtimes as being primarily a societal construct, actually there's a biological underpinning to this.
The body clock starts to get later and later as we get into older, older childhood, sorry, and into adolescence.
And you may find that actually sometimes at bedtime,
that has always been that child's bedtime is now out of date, if you like, a little bit too early.
So they may get into bed and they may be trying to sleep with their body clock, maybe saying, you know what, we're not quite ready for sleep yet.
And then the fact that they can't get to sleep may then frustrate or irritate them or make it
obvious to them that they're unable to fall asleep, which may then induce a bit of anxiety or arousal, which may keep them up even later.
So getting the bedtime right is also really important.
I'd add to that, Dimitri, that for teenagers, it really is the key, as you say, that body clock shifts so they're not feeling tired or sleepy.
They're not ready for bed until much later. But, of course, school still starts at the same time.
So there's this squeeze on their sleep, which means often teenagers are getting much less sleep than they actually need.
So one thing is to try and get on the same page as a whole family.
And that can be renegotiating what bedtime means. In fact, many teenagers may need to go to bed far after you do.
And so being on the same page with that and agreeing with the young person, with siblings,
and feeling confident and having a plan with that young person to get themselves to bed at a time
when they're going to be able to fall off to sleep more naturally aligned with that body clock.
So kind of creating as a family a bit of a sleep team that everyone can kind of work together towards getting a young person sleeping through the night
and at a time that suits. The other kind of thing I'd just raise about the bedroom environment
is that for many teenagers, their bedroom is the only private place that they have in the place where they're on their phone or laptop or socialising
with friends and connecting online is also from the place where people are studying or just taking a bit of downtime.
And that can mean that actually the bedroom becomes associated with all sorts of other activities and not just with restful sleep.
And as we've been saying, it's really important for young people to be able to associate bed with sleep.
So one thing that might be helpful is having another space, if possible,
for young people to study or work so that the bedroom can be saved just for sleep.
And particularly if that's not possible, then only laying down on the bed at night time.
So that's associated with sleep. And if your in your bedroom during the day or even the evening,
sitting up and making sure there's a distinction and kind of try not to be on the bed if possible.
And the last thing I think is that many of us live alone on the weekends.
And that's particularly true physically for teenagers, often because they've had a kind of build up of need for sleep.
They've been saying that a whole week because it's being squeezed throughout the week.
But actually, that can make Monday morning even harder. So try to stick with a routine every day of the week, even on the weekends,
maybe a short lie in, but nothing too long that might disrupt that regular pattern.
So that does bring us up to the end of our allotted time.
So I just wanted to take this opportunity to just remind you all again about the next session in our series,
which is on Managing Depression and Low Mood on the 19th of November.
And of course, I'd like to say huge thank you to our speakers for joining us today.
I think it's been such an interesting and hopefully very useful, very practical talk and clearly extremely timely.
I mean, I might imagine it always helps. So thank you so much for giving us your time this morning.
We really appreciate it. And I'd also just like to say first, thank you to Halley,
Nicola and Kaja for their excellent organisation that's enabled this series to be such a success.
And of course, thank you all very much for joining us. Goodbye.