1 00:00:04,940 --> 00:00:10,620 Okay, it looks like everyone's now said we'll get started. Thank you very much for joining us this morning. 2 00:00:10,620 --> 00:00:15,450 For the second in the Our Mental Wellness series of webinars that we're running 3 00:00:15,450 --> 00:00:19,740 from the Department of Experimental Psychology here at the University of Oxford. 4 00:00:19,740 --> 00:00:20,860 My name's Cathy Creswell. 5 00:00:20,860 --> 00:00:29,370 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, 6 00:00:29,370 --> 00:00:36,870 which are all focussed on mental health and wellbeing, which we put on really as a reflection of the recognition of the additional stressors 7 00:00:36,870 --> 00:00:41,400 that are being faced by many of our staff and students at this difficult time. 8 00:00:41,400 --> 00:00:44,940 So as we know today, we'll be hearing about overcoming sleep problems. 9 00:00:44,940 --> 00:00:51,960 However, I also wanted to take this opportunity to allow you to the next two upcoming seminars in the series, 10 00:00:51,960 --> 00:00:57,210 which are Managing Depression and Low Mood, which will be held on the 19th of November. 11 00:00:57,210 --> 00:01:03,450 And Overcoming Mistrust and Paranoia, which will be held on the 20th of January. 12 00:01:03,450 --> 00:01:11,760 So please join us for that and we've added all of the talks on our Department of Experimental Psychology YouTube channel. 13 00:01:11,760 --> 00:01:15,780 Say feel free to go back and re watch anything there. 14 00:01:15,780 --> 00:01:22,650 So today we'll be hearing from three members of our university community, starting with a talk from Professor Colin Espie. 15 00:01:22,650 --> 00:01:29,850 And Colin is Professor of Sleep Medicine in the department, at the Nuffield Department of Clinical Neuroscience and is a fellow at Somerville College 16 00:01:29,850 --> 00:01:36,780 and also a senior research fellow in the University's Department of Psychiatry. So thank you ever so much for joining us today, Colin. 17 00:01:36,780 --> 00:01:40,550 And I'll hand over to you now. Thanks very much. Cathy. 18 00:01:40,550 --> 00:01:46,110 And hello, everyone, and thank you very much for taking this initiative for the University and the local community. 19 00:01:46,110 --> 00:01:51,270 I think it's great that these times we're all looking after each other's mental health. 20 00:01:51,270 --> 00:01:57,840 And, of course, Sleep's a very important part to play in that, as as we shall see. 21 00:01:57,840 --> 00:02:02,970 So I know that's that's my background, my affiliations, by training 22 00:02:02,970 --> 00:02:10,800 I'm a clinical psychologist. I do put up resources from time to time on Twitter if you want to look those up. 23 00:02:10,800 --> 00:02:16,020 @ColinEspie and also some discuss some ongoing research and things. 24 00:02:16,020 --> 00:02:21,150 Last week we were thinking with the Mental Health Foundation about the importance of taking sleep seriously. 25 00:02:21,150 --> 00:02:28,080 I was working with them and their campaign that was launched over last weekend and earlier in the year. 26 00:02:28,080 --> 00:02:34,020 Public Health England, as part of their Every Mind Matters campaign also to focus on sleep. 27 00:02:34,020 --> 00:02:38,730 Sleep seems something that's really central to our health and wellbeing. 28 00:02:38,730 --> 00:02:45,180 And what we know that during this time of pandemic, sleep has been even more important to us. 29 00:02:45,180 --> 00:02:51,780 We know from a number of international studies that sleep has been badly affected during these times. 30 00:02:51,780 --> 00:02:59,100 The isolation and confinement has probably contributed to that, as well as the uncertainty and risk that we're all facing. 31 00:02:59,100 --> 00:03:04,920 So there are challenges for all of us and it shouldn't perhaps really surprise us if that's the case. 32 00:03:04,920 --> 00:03:12,480 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. 33 00:03:12,480 --> 00:03:21,280 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. 34 00:03:21,280 --> 00:03:26,880 If you think of the symptoms you would have if there was insufficient oxygen, 35 00:03:26,880 --> 00:03:33,930 then you would understand that sleep, like these other things, has concomnet results. 36 00:03:33,930 --> 00:03:41,650 When we don't get enough sleep either through sleep deprivation or through having insomnia symptoms. 37 00:03:41,650 --> 00:03:43,870 We have a big debt to sleep. 38 00:03:43,870 --> 00:03:52,520 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. 39 00:03:52,520 --> 00:03:59,140 So much going on. And it has been suggested and read by researchers that sleep is actually the brain's preferred state 40 00:03:59,140 --> 00:04:03,970 because we are kind of out the way at that point and the brain can go on with the work it needs to do, 41 00:04:03,970 --> 00:04:07,480 including clearing toxic waste and regenerating cells. 42 00:04:07,480 --> 00:04:14,290 You know, rest is not as good as a sleep. You don't regenerate cells during rest, only during sleep. 43 00:04:14,290 --> 00:04:18,880 The amino acids, the building blocks of life are synthesised during sleep. 44 00:04:18,880 --> 00:04:22,870 Infection control and immune signalling is heavily dependent on sleep. 45 00:04:22,870 --> 00:04:27,040 And of course, for today's talk and for today's theme 46 00:04:27,040 --> 00:04:31,330 sleep is incredibly important for cognitive and emotional functions. 47 00:04:31,330 --> 00:04:35,920 The regulation of our emotions is heavily sleep dependent and memory 48 00:04:35,920 --> 00:04:41,560 consolidation is much more likely to occur during sleep than during wakefulness. 49 00:04:41,560 --> 00:04:51,160 Our brain is very much smarter than we are, and it makes use of those hours of sleep to do all this important work. 50 00:04:51,160 --> 00:04:55,360 We also know that when sleep is connected with mental health, as often is, that 51 00:04:55,360 --> 00:05:00,850 we can actually improve our mental health if we actually improve our sleep. 52 00:05:00,850 --> 00:05:05,110 This is a big study. It was led by colleague Dan Freeman in Oxford, 53 00:05:05,110 --> 00:05:12,310 demonstrating in a causal way that if you improve sleep with you having difficulties with insomnia, you will improve 54 00:05:12,310 --> 00:05:16,180 also, mental health symptoms. And this is a very, very big study 55 00:05:16,180 --> 00:05:21,040 as you can see, three thousand seven hundred fifty five people were randomised into the trial. 56 00:05:21,040 --> 00:05:27,270 This is probably the largest trial ever conducted in the world of cognitive behavioural therapy. 57 00:05:27,270 --> 00:05:31,720 OK. So this is a study that was published by Dan Freeman and his team. 58 00:05:31,720 --> 00:05:40,370 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. 59 00:05:40,370 --> 00:05:45,580 And there's another study we conducted even more recently in Oxford showing that if you improve sleep, 60 00:05:45,580 --> 00:05:53,830 you can also improve your wellbeing, your quality of life, a direct relationship, if you like, between sleep and daytime function. 61 00:05:53,830 --> 00:06:01,150 And we're designed as 24 hour creatures – sleep and wake and sleep and wake across the life course – is crucially 62 00:06:01,150 --> 00:06:08,230 important to deliver that rhythm of life and to deliver consciousness even, never mind quality of life. 63 00:06:08,230 --> 00:06:12,580 Sleep is something that is essential thing. We cannot do without it. 64 00:06:12,580 --> 00:06:24,930 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. 65 00:06:24,930 --> 00:06:28,030 But it is there to show you. And this is known REM sleep. 66 00:06:28,030 --> 00:06:34,570 This is an orthodoxy that makes up at 75 percent of your night, non tripping sleep if you like. 67 00:06:34,570 --> 00:06:37,330 You can see there's lots of different elements to it. 68 00:06:37,330 --> 00:06:43,710 And the part of the bottom here, this is deep sleep, but that only makes up maybe 15-20 percent of your night. 69 00:06:43,710 --> 00:06:50,110 Most of your night is spent in light sleep, either stage two sleep or dreaming sleep. 70 00:06:50,110 --> 00:06:56,780 And dreaming sleep is a remarkable thing, because during dreaming sleep, you're actually paralysed, you're functionally paralysed. 71 00:06:56,780 --> 00:07:00,540 So when you see your dog lying there and you say to your partner, look, 72 00:07:00,540 --> 00:07:06,740 he's chasing rabbits because he's, you know, making occasional twitches like you see down here, 73 00:07:06,740 --> 00:07:12,200 but actually, it's flat lining here because they're the muscle activity is actually gone. 74 00:07:12,200 --> 00:07:19,190 And the dog is paralysed, although the eyeballs may be moving just like we do in dreaming sleep. 75 00:07:19,190 --> 00:07:22,730 So you're actually paralysed during sleep. And you've got a very active brain. 76 00:07:22,730 --> 00:07:24,560 It's a fascinating phenomenon. 77 00:07:24,560 --> 00:07:33,590 And all of these elements of sleep really seem to be important to serve all the different functions that that we depend upon. 78 00:07:33,590 --> 00:07:40,520 I asked a couple of scientific colleagues from Ireland, too, to help us to really understand how sleep is regulated. 79 00:07:40,520 --> 00:07:44,570 So I'm going to share a little video with you from them. 80 00:07:44,570 --> 00:07:55,200 And here, here, they are here you'll maybe recognise the, of course, that's Father Ted and Dougal. 81 00:07:55,200 --> 00:08:01,500 Yeah, so it's interesting, isn't it? Here we have Father Ted doesn't he so much deserve to sleep. 82 00:08:01,500 --> 00:08:06,650 He's trying his best. And Dougal seems to have accidentally fallen asleep. 83 00:08:06,650 --> 00:08:15,500 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. 84 00:08:15,500 --> 00:08:19,500 You don't choose to breathe. You don't breathe well when you choose to breathe. 85 00:08:19,500 --> 00:08:24,110 If you focus on your breathing, you'll become more anxious. 86 00:08:24,110 --> 00:08:28,460 Sleep is something that happens to us. It's regulated by our sleep drive. 87 00:08:28,460 --> 00:08:34,430 It's after 10:00 in the morning. If you get up around 7:00 this morning, you're three hours into sleep deprivation. 88 00:08:34,430 --> 00:08:42,010 By the time you get to the evening, 10 o'clock tonight, you'll be 15 hours into sleep deprivation. 89 00:08:42,010 --> 00:08:49,640 And sleep deprivation will be paid. Sleep debt will be paid by the sleep banker overnight. 90 00:08:49,640 --> 00:08:57,850 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, 91 00:08:57,850 --> 00:09:03,490 we'd get progressively less and less able to function across the day, you made you feel that you do that already. 92 00:09:03,490 --> 00:09:10,240 But you probably don't, because there's a system called the circadian system that alerts us and keeps us alert during the day 93 00:09:10,240 --> 00:09:17,860 and holds back the pressure of the build-up of the homeostatic drive for sleep the day and releases it into sleep at night. 94 00:09:17,860 --> 00:09:27,050 And what you saw with Dougal there was that in perfect timing, maybe perfect comic timing, but perfect timing for his sleep. 95 00:09:27,050 --> 00:09:34,910 He fell asleep. The sleep gate opened. The sleep that was being repaid, circadian clock, it said go to sleep. 96 00:09:34,910 --> 00:09:38,730 And he fell asleep. Maybe that was the same for Father Ted. 97 00:09:38,730 --> 00:09:43,870 But what he finds is his psychology can get in the way. 98 00:09:43,870 --> 00:09:45,460 His psychology can get in the way. 99 00:09:45,460 --> 00:09:54,080 And that's why psychology can help sleep problems, because we can overcome that kind of problem that Father Ted describes. 100 00:09:54,080 --> 00:09:59,960 And we've all experienced feeling exhausted, so much, wanting to sleep but unable to sleep. 101 00:09:59,960 --> 00:10:05,780 So what is sleep and why does it matter? Well, what we're learning is that sleep is one of life's absolute essentials. 102 00:10:05,780 --> 00:10:07,880 It's essential for physical and mental health 103 00:10:07,880 --> 00:10:15,050 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. 104 00:10:15,050 --> 00:10:23,570 It's intriguingly complex of different stages and phases. And all of these pieces are important to deliver the functions that sleep serves. 105 00:10:23,570 --> 00:10:31,560 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. 106 00:10:31,560 --> 00:10:37,210 Sleep is something that you need to allow to happen. You can't make it happen. 107 00:10:37,210 --> 00:10:43,750 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? 108 00:10:43,750 --> 00:10:48,130 Well, I'm going to suggest a few things. We can discuss more of them together afterwards. 109 00:10:48,130 --> 00:10:52,180 One thing is think about how much sleep you actually need. 110 00:10:52,180 --> 00:10:59,880 Become a sleep scientist for a while. You know, I often suggest to people that 111 00:10:59,880 --> 00:11:06,880 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, 112 00:11:06,880 --> 00:11:10,930 you're met with different sizes of shoe and you're not at all surprised that there 113 00:11:10,930 --> 00:11:16,450 should be different sizes because you've got to figure out which one's gonna fit you. 114 00:11:16,450 --> 00:11:21,030 But it's interesting where sleep is concerned that we often think, how much sleep should I get? 115 00:11:21,030 --> 00:11:26,260 So I would say, well, large size shoe should I have. That doesn't make any sense at all. 116 00:11:26,260 --> 00:11:31,300 There's going to be a range of shoe sizes will fit an adult, but there's going to be a range. 117 00:11:31,300 --> 00:11:36,460 You've got to figure out what fits. You've got to figure out how much sleep you actually need. 118 00:11:36,460 --> 00:11:39,850 And many, many people don't actually do that and still haven't done that. 119 00:11:39,850 --> 00:11:43,360 They just go to bed by convention at a certain time because there's nothing else 120 00:11:43,360 --> 00:11:49,600 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. 121 00:11:49,600 --> 00:11:56,170 And yet, you know, the answer to learning the primary way in which we learn is not by being taught the primary way. 122 00:11:56,170 --> 00:12:01,790 We learn by trial and error. That's how we learn stuff, you know, like this little baby. 123 00:12:01,790 --> 00:12:05,710 Where does this red block goes? Oh, it doesn't go in a round hole. 124 00:12:05,710 --> 00:12:13,180 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. 125 00:12:13,180 --> 00:12:20,620 So figure it out. Practise, experiment with different lengths of sleep as well as different timings of sleep. 126 00:12:20,620 --> 00:12:25,690 Keep some data, maybe not as much of that. But don't 127 00:12:25,690 --> 00:12:30,130 be concerned about, you know, too much, clock watching and all that business. 128 00:12:30,130 --> 00:12:35,470 Trust yourself to figure out. Babies can do it. You can do. 129 00:12:35,470 --> 00:12:42,850 Then consider yourself. You know, are you somewhat a night owl or are you a bit more of a morning person? 130 00:12:42,850 --> 00:12:45,440 Maybe during COVID, during lockdown, particularly. 131 00:12:45,440 --> 00:12:50,380 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. 132 00:12:50,380 --> 00:12:56,100 We all becoming like teenagers again. Perhaps maybe we're back at work again. 133 00:12:56,100 --> 00:13:02,380 But this this is not just a figure of speech, this kind of idea of the body clock and the timing of things. 134 00:13:02,380 --> 00:13:06,530 It's also part of us. And there are some people who are night owls by nature. 135 00:13:06,530 --> 00:13:11,500 That means they don't actually feel sleepy till late and they don't feel alert until 136 00:13:11,500 --> 00:13:15,730 later in the morning or even into the afternoon in some cases if it's very extreme. 137 00:13:15,730 --> 00:13:20,770 There are also people who are natural morning people, who are not the life and soul of the party, perhaps, 138 00:13:20,770 --> 00:13:29,170 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. 139 00:13:29,170 --> 00:13:36,940 So there are these clock types as well. But there are also people who are neither owls nor larks, and that's most people. 140 00:13:36,940 --> 00:13:43,210 But when you're thinking about experimenting with your sleep, just think about, you know what, 141 00:13:43,210 --> 00:13:50,530 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. 142 00:13:50,530 --> 00:13:55,150 OK. Insomnia is where it gets a little bit more tricky. 143 00:13:55,150 --> 00:14:02,890 This is a persistent problem affecting 20 percent of the population on regular basis, 10 percent of the population at a clinical level. 144 00:14:02,890 --> 00:14:09,700 And the approaches that help with insomnia come from the cognitive behavioural therapeutics tool box. 145 00:14:09,700 --> 00:14:14,130 I've stopped trying to use the term CBT because people think CBT is a treatment. 146 00:14:14,130 --> 00:14:16,960 CBT is is a methodology of treatment. 147 00:14:16,960 --> 00:14:28,840 It includes, you know, I think I think the American Psychological Association suggests some of the 12 hundred different intervention methods. 148 00:14:28,840 --> 00:14:34,240 So here are some of the ones that have been useful and evidence based for for insomnia. 149 00:14:34,240 --> 00:14:38,690 Some are behavioural like stimulus control therapy, which have been a mention of it, 150 00:14:38,690 --> 00:14:43,420 or restricting your sleep time in bed to to consolidate your sleep. 151 00:14:43,420 --> 00:14:50,020 Some are more mental and cognitive, as CBT suggests, there's a C element to that. 152 00:14:50,020 --> 00:14:53,530 Things like cognitive control, restructuring, paradoxical intention. 153 00:14:53,530 --> 00:15:01,540 There's some relaxation methods that work, sleep hygiene, education is not drinking too much coffee and that kind of thing, 154 00:15:01,540 --> 00:15:04,600 which is not really in itself particularly effective treatment for insomnia 155 00:15:04,600 --> 00:15:12,130 but it's a good thing to look after your hygiene, your lifestyle and have a bedroom environment is conducive to sleep. 156 00:15:12,130 --> 00:15:20,770 So I'm going to give you three examples of techniques that you could use that I think would be helpful. 157 00:15:20,770 --> 00:15:26,110 This is the first one. It's a link, right? There's a chain. It's a connexion. 158 00:15:26,110 --> 00:15:33,090 What is your connection between bed and sleep. Dougal went to bed, fell asleep. 159 00:15:33,090 --> 00:15:38,310 Everything was aligned. He was sleepy at that point. A circadian gate was opening. 160 00:15:38,310 --> 00:15:44,870 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, 161 00:15:44,870 --> 00:15:51,390 sleep, think bed, think sleep. When we settle a youngster in bed and we get them used to being in bed. 162 00:15:51,390 --> 00:15:56,630 They they know to settle in that bedroom and then settling in that room with you there. 163 00:15:56,630 --> 00:16:01,220 Those connections are built. They fall asleep naturally. We don't put them to bed asleep. 164 00:16:01,220 --> 00:16:06,110 We put them to bed. So they feel comfortable then and they fall asleep and it's all chained together. 165 00:16:06,110 --> 00:16:15,400 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. 166 00:16:15,400 --> 00:16:18,650 Don't spend too long lying awake in bed. 167 00:16:18,650 --> 00:16:25,280 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. 168 00:16:25,280 --> 00:16:29,800 How long have I been speaking? Ten minutes. Probably about that. 169 00:16:29,800 --> 00:16:33,580 So you're know you're able to judge time. You've been doing it for a long time. 170 00:16:33,580 --> 00:16:37,810 You don't need a clock. You doing to watch in bed. Give yourself enough time and you can't sleep. 171 00:16:37,810 --> 00:16:43,680 Get up and do something else. Go back to bed, reconnect with your bed when you feel sleepy. 172 00:16:43,680 --> 00:16:51,280 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. 173 00:16:51,280 --> 00:16:56,590 Not talking about your split ends. I'm talking about loose ends, right? Tie them off before you go to bed. 174 00:16:56,590 --> 00:17:02,990 Spend a bit of time putting the day to rest. Don't expect that because you're so important and busy and productive, 175 00:17:02,990 --> 00:17:07,270 and you've been working so hard that, you know, deserve to fall asleep. And it's not fair because you're not. 176 00:17:07,270 --> 00:17:10,240 You can't just go off that cliff very easily. 177 00:17:10,240 --> 00:17:17,770 Try to wind down and spend a bit of time just putting the day to rest, rehearsing a little bit "how did today go" 178 00:17:17,770 --> 00:17:21,160 What happened at other loose ends, from that and planning ahead. 179 00:17:21,160 --> 00:17:25,900 What if I got it right? What am I doing the next day and do that before you go to bed. 180 00:17:25,900 --> 00:17:33,040 The day to rest. And this is this is a tribute to my granny who knitted jumpers all the time, 181 00:17:33,040 --> 00:17:37,300 and then she knitted them again and knitted them again using the same yarn. 182 00:17:37,300 --> 00:17:42,600 And you know what? Every time she used the yarn again, the jumper became nice and tight again. 183 00:17:42,600 --> 00:17:47,210 Was before then it got all saggy. Right. Because had been used and pulled over. 184 00:17:47,210 --> 00:17:52,150 And, you know, and you know what kids do with the cuffs that you have jumpers pulled out of shape. 185 00:17:52,150 --> 00:17:59,880 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. 186 00:17:59,880 --> 00:18:10,090 But the point is, you can pull your your sleep a needle into that content and knit it back together tightly again. 187 00:18:10,090 --> 00:18:13,340 And the way you do that is by actually spending a little bit less time in bed 188 00:18:13,340 --> 00:18:17,630 to try and tighten up your sleep pattern, to sleep through a shorter window, 189 00:18:17,630 --> 00:18:22,640 so you're then able to stretch it again and get back to the shape you wanted it to be. 190 00:18:22,640 --> 00:18:30,030 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. 191 00:18:30,030 --> 00:18:33,320 It doesn't cost. It's called Sleepio. You know, 192 00:18:33,320 --> 00:18:37,550 you can go to sleepio.com and access this because we did a big study 193 00:18:37,550 --> 00:18:47,240 recently with a Oxford academic health sciences network funded by a Innovate UK. 194 00:18:47,240 --> 00:18:50,620 And you can go to their website and read that report as well, if you like. 195 00:18:50,620 --> 00:18:56,870 Well, just to give you a little flavour of what Sleepio would look like and how it might help you. 196 00:18:56,870 --> 00:19:04,970 Let me introduce another Prof. Hello there, Martin. 197 00:19:04,970 --> 00:19:08,980 Welcome to sleep. I am the Prof. 198 00:19:08,980 --> 00:19:13,330 And I am here to do everything I can to help you sleep better. 199 00:19:13,330 --> 00:19:19,090 Now you may be thinking, why should I trust you to tell me what to do with nicotine. 200 00:19:19,090 --> 00:19:26,890 the drug found in cigarettes and other tobacco products. So what the programme does, it takes you through six sessions over over six weeks. 201 00:19:26,890 --> 00:19:36,700 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. 202 00:19:36,700 --> 00:19:43,590 Let me just find one of those. See what you see looks like. Sleep Prof, 203 00:19:43,590 --> 00:19:48,550 no matter what I do, I can't get to sleep at night. I don't know what's wrong with me. 204 00:19:48,550 --> 00:19:53,960 I'll just lie there wide awake, getting frustrated. 205 00:19:53,960 --> 00:20:02,230 He's driving me mad. I'm sick of it, Prof. Now, what advice should I give him? 206 00:20:02,230 --> 00:20:09,200 So the programme tailors these mental techniques to the problems that you're having with your racing mind. 207 00:20:09,200 --> 00:20:17,440 They could be individual to you and the programme will suggest ways to talk you through things that you can practise on your own. 208 00:20:17,440 --> 00:20:27,460 So these are ways in which you can look after those tricky sleep problems, establish your personalised sleep pattern using trial and error. 209 00:20:27,460 --> 00:20:32,510 The best learning method known to man. Trust your sleep. 210 00:20:32,510 --> 00:20:40,490 Be like Dougal. Use behavioural strategies to strengthen your bed sleep connection like you would do with your kids. 211 00:20:40,490 --> 00:20:48,140 Get it into a pattern. Trust yourself to do it. Use cognitive strategies to manage your mental arousal. 212 00:20:48,140 --> 00:20:52,780 because that gets in the way. That's the psychology that gets in the way. 213 00:20:52,780 --> 00:20:58,630 And learn to sleep like you walk, like you talk, like you breathe. 214 00:20:58,630 --> 00:21:06,620 Without thinking about it. That's my recommendations for how to overcome sleep problems. 215 00:21:06,620 --> 00:21:10,820 Great. Thank you ever so much, Colin. I'm sure people found that extremely helpful. 216 00:21:10,820 --> 00:21:17,990 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. 217 00:21:17,990 --> 00:21:22,130 So it'll be great now to talk a little bit more about those. 218 00:21:22,130 --> 00:21:25,500 So before we start, I'd like to introduce our fellow panel members. 219 00:21:25,500 --> 00:21:31,910 So really pleased that we're also joined today by Dr Felicity White and Dr Dimitri Gavriloff. 220 00:21:31,910 --> 00:21:36,800 And so Felicity is also a clinical psychologist and a Wellcome Trust clinical fellow, 221 00:21:36,800 --> 00:21:41,300 as well as a research fellow at Linacre College and deputy leader of the Oxford Cognitive Approaches to 222 00:21:41,300 --> 00:21:47,780 Psychosis Group in the Department of Psychiatry and of particular relevance to to today 223 00:21:47,780 --> 00:21:53,990 Felicity is leading a novel intervention study to address sleep problems amongst young people at risk of psychosis. 224 00:21:53,990 --> 00:22:02,300 And Dimitri is another clinical psychologist. He's clinical course tutor in sleep medicine in the Sleep and Circadian Neuroscience Institute in the 225 00:22:02,300 --> 00:22:07,250 Nuffield Department of Clinical Neurosciences and is a senior clinical psychologist at the John 226 00:22:07,250 --> 00:22:11,790 Radcliffe Hospital. So thank you so much for joining us today. 227 00:22:11,790 --> 00:22:19,730 And so going to the questions that were submitted, many people who got in touch referred to difficulties with getting to sleep. 228 00:22:19,730 --> 00:22:27,380 So this very much picks up up on the issues that you've highlighted, Colin, and the difficulties that Father Ted was having there. 229 00:22:27,380 --> 00:22:34,910 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. 230 00:22:34,910 --> 00:22:42,680 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 231 00:22:42,680 --> 00:22:46,850 help them turn off their busy minds and to help them get to sleep more easily. 232 00:22:46,850 --> 00:22:52,340 So we've had some great tips on that already from Colin, it'd be great to also hear your thoughts. 233 00:22:52,340 --> 00:22:56,870 If I go to you, Dimitri first. Thanks, Cathy. 234 00:22:56,870 --> 00:23:00,360 I think this is this is really, really important. 235 00:23:00,360 --> 00:23:07,630 And the question is one that I think probably we're all familiar with in terms of our experience as we're all experienced, 236 00:23:07,630 --> 00:23:12,200 a poor night's sleep in this kind of way, having had lots to get on with. 237 00:23:12,200 --> 00:23:18,620 One of the most important things I think that Colin alluded to earlier is what I like to call sort of sleep stopping distance, 238 00:23:18,620 --> 00:23:24,740 thinking about, you know, if you're in a car braking and stopping immediately causes a real mess for everyone. 239 00:23:24,740 --> 00:23:30,470 But if you if you think about sleep in a similar way, we decelerate gradually towards sleep. 240 00:23:30,470 --> 00:23:35,540 Switching off the day and then jumping into bed is probably unlikely to be helpful. 241 00:23:35,540 --> 00:23:42,050 And there's this odd narrative societally that all you got to do is tire yourself out and be really busy, 242 00:23:42,050 --> 00:23:49,050 do lots run around, maybe go for a jog, get really, really tired and really, really exhausted and somehow you fall asleep. 243 00:23:49,050 --> 00:23:58,820 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. 244 00:23:58,820 --> 00:24:04,640 So doing things that help you relax, unsurprisingly, can be helpful ways to get you to sleep. 245 00:24:04,640 --> 00:24:09,740 But these aren't things that help you feel sleepy. The things that help take away the arousal, 246 00:24:09,740 --> 00:24:18,770 that take away the anxiety, the frustration that masks the sleepiness, that sits just behind the curtain that very often we can't see. 247 00:24:18,770 --> 00:24:25,880 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. 248 00:24:25,880 --> 00:24:28,670 I'm going to have my time to watch that documentary that I really wanted to 249 00:24:28,670 --> 00:24:32,570 watch or read that book that I really wanted to read and doing things like this. 250 00:24:32,570 --> 00:24:35,850 They don't pertain to sleep. They're not about trying to get to sleep. 251 00:24:35,850 --> 00:24:39,260 They're about trying to relax and having a pleasant evening. 252 00:24:39,260 --> 00:24:43,670 And in doing so, as I say, you allow the sleepiness that's there to kind of say eventually, you know what, 253 00:24:43,670 --> 00:24:51,760 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. 254 00:24:51,760 --> 00:24:59,340 All right. Thanks so much, Dimitri. Felicity, would you like to add a thing in relation to getting to sleep? 255 00:24:59,340 --> 00:25:07,170 Thank you. And thanks, going for a great talk there as well. And Colin mentioned about this idea of tying up the loose ends. 256 00:25:07,170 --> 00:25:13,950 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. 257 00:25:13,950 --> 00:25:20,050 So that way, before we're even thinking about that time, we have the chance to kind of put the day to rest, 258 00:25:20,050 --> 00:25:28,380 to pull everything together, set our to-do the next day and then make that transition between work or the business of the day. 259 00:25:28,380 --> 00:25:32,430 And then a separate period of kind of relaxing, rejuvenating. 260 00:25:32,430 --> 00:25:36,690 And that's been particularly important, I think, for those of us who've been homeworking, 261 00:25:36,690 --> 00:25:41,790 where perhaps those usual transitions between work and relaxation have been disrupted. 262 00:25:41,790 --> 00:25:49,530 And so putting those the end of the day is a real distinct marker and then being able to move into those relaxing activities. 263 00:25:49,530 --> 00:25:55,380 And the last thing I would just add is that it's really important for our bodies to have rhythm. 264 00:25:55,380 --> 00:26:01,950 So having that wind down routine, as Dimitri was describing where we're moving through those relaxing activities, 265 00:26:01,950 --> 00:26:05,700 allows our bodies to kind of prepare itself to expect sleep next. 266 00:26:05,700 --> 00:26:12,230 We can't force asleep. We can't make it happen, but we can set the scene for sleep to occur naturally. 267 00:26:12,230 --> 00:26:15,360 And so having a regular routine will really help that. 268 00:26:15,360 --> 00:26:23,000 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. 269 00:26:23,000 --> 00:26:30,770 Great. Thank you very much. So in addition to trouble getting to sleep, another common issue that was raised relates to staying asleep. 270 00:26:30,770 --> 00:26:33,710 So many people are asked about what they can do to help themselves 271 00:26:33,710 --> 00:26:39,170 to get back to sleep when they wake in the night or in the early hours, 272 00:26:39,170 --> 00:26:44,750 and the tendency for this to have come on with age and door hormonal changes was often mentioned in the question. 273 00:26:44,750 --> 00:26:55,140 So it would be interesting to hear your thoughts on that as well. So, Felicity, if I come back to you festival. 274 00:26:55,140 --> 00:27:00,340 Of course, Colin was saying that sleep is this kind of fascinating experience. 275 00:27:00,340 --> 00:27:10,410 It's not one thing that happens. Actually, we're moving through different phases of types of sleep in a particular predictable cycle. 276 00:27:10,410 --> 00:27:16,960 So we move through many different sleep cycles throughout the night. And each one lasts around 60 to 90 minutes. 277 00:27:16,960 --> 00:27:21,240 And at the end of each sleep cycle, we have this momentary waking. 278 00:27:21,240 --> 00:27:29,110 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. 279 00:27:29,110 --> 00:27:33,900 The people that have raised this question, it sounds like those wakings become very pertinent. 280 00:27:33,900 --> 00:27:41,990 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. 281 00:27:41,990 --> 00:27:49,050 That very mind waking can really get our mind just enough space to let all those worries be flooding back in. 282 00:27:49,050 --> 00:27:54,000 Or thoughts about the next day or the to do list or all those things that go through our mind. 283 00:27:54,000 --> 00:27:59,820 And so that kind of wind down down routine to reduce any hyperarousal being on edge 284 00:27:59,820 --> 00:28:05,820 before bed can really help to mean that we're much more calm throughout the night. 285 00:28:05,820 --> 00:28:09,930 And then the other thing is about building up our sleep pressure. 286 00:28:09,930 --> 00:28:17,340 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. 287 00:28:17,340 --> 00:28:26,550 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. 288 00:28:26,550 --> 00:28:31,890 You can set off on that journey and you'll get part of the way that you might not reach your destination. 289 00:28:31,890 --> 00:28:36,990 So what we want to do is really increase the sleep pressure so that we're really building 290 00:28:36,990 --> 00:28:41,670 that up and we're ready to fall off to sleep and then stay asleep throughout the night. 291 00:28:41,670 --> 00:28:45,240 That's the aim for that. All right. Thank you very much. And Colin. 292 00:28:45,240 --> 00:28:50,330 Was there anything you'd like to add in relation to getting back to sleep? 293 00:28:50,330 --> 00:28:59,300 Yes. And I think one of the approaches that we use in clinical psychology is is called reframing, cognitive reframing. 294 00:28:59,300 --> 00:29:10,510 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. 295 00:29:10,510 --> 00:29:16,000 During the day, is there a six or seven, eight hour period when you're totally concentrating, 296 00:29:16,000 --> 00:29:21,010 when you're totally on things, when you're totally at your peak? 297 00:29:21,010 --> 00:29:26,410 I think I think if we expect her sleep to be just as consolidated period of peak sleep, 298 00:29:26,410 --> 00:29:33,670 you know, when we are kind of unaware of anything, it's just not a realistic prospect. 299 00:29:33,670 --> 00:29:38,410 Well, we can beat ourselves up about it when we find that sleep is broken. 300 00:29:38,410 --> 00:29:41,540 As Felicity was saying, our sleep is always broken. 301 00:29:41,540 --> 00:29:48,670 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. 302 00:29:48,670 --> 00:29:56,920 There's also lots of lots of micro arousals. When you turn in bed, your partner moves, as a micro arousal. 303 00:29:56,920 --> 00:30:02,440 You know, when we hear a noise outside, there's a reaction in the brain to that because we heard it. 304 00:30:02,440 --> 00:30:06,300 You hear things whether or not, you know, you've heard them, you see things, you can see during your sleep 305 00:30:06,300 --> 00:30:11,900 you're sleepwalking. And yet, you know, People how can you seriously know when you're sleeping. 306 00:30:11,900 --> 00:30:18,400 I think we've got a very naive idea about what sleep is and we overthink it and it's that overthinking of it 307 00:30:18,400 --> 00:30:23,950 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. 308 00:30:23,950 --> 00:30:29,590 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. 309 00:30:29,590 --> 00:30:35,380 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, 310 00:30:35,380 --> 00:30:41,530 not having too long in bed because you take my grandma's jumper, you stretch it out, it's going to create holes. 311 00:30:41,530 --> 00:30:45,980 We tried to sleep for too long when we're worried about sleep. That's the wrong thing to do. 312 00:30:45,980 --> 00:30:53,020 We're trying to tighten up. So I think that bigger picture of understanding that maybe it's okay, actually, 313 00:30:53,020 --> 00:31:01,270 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. 314 00:31:01,270 --> 00:31:08,490 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. 315 00:31:08,490 --> 00:31:14,120 All right. Thanks very much. So although many people felt they were struggling with not getting enough sleep, 316 00:31:14,120 --> 00:31:18,340 others got in touch because they were concerned about getting too much sleep. 317 00:31:18,340 --> 00:31:26,350 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. 318 00:31:26,350 --> 00:31:28,990 Thanks, Cathy. This is a really interesting question. 319 00:31:28,990 --> 00:31:37,520 We often think about sleep problems as being very much related to not getting enough sleep, but sleep problems can be really varied. 320 00:31:37,520 --> 00:31:44,110 And when we talk clinically about sleep disorders, we talk about a really broad range of problems people have with their sleep. 321 00:31:44,110 --> 00:31:51,130 One of which is getting too much sleep or sleep happening in a sort of an uncontrolled way. 322 00:31:51,130 --> 00:31:56,710 And I'll focus on sort of more normative examples of things rather than going down that route. 323 00:31:56,710 --> 00:32:04,270 But certainly, I suppose the first thing to bear in mind is if you if you find that you're needing more sleep, 324 00:32:04,270 --> 00:32:08,210 that might be to do with lots of different things, 325 00:32:08,210 --> 00:32:12,980 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 326 00:32:12,980 --> 00:32:19,870 but would be ideal to get. Another reason that I think we might get caught up in this idea 327 00:32:19,870 --> 00:32:25,180 of feeling lethargic or or sleepy is because we might not be doing enough activity, 328 00:32:25,180 --> 00:32:28,660 not being as active, being as active as we'd like to be. 329 00:32:28,660 --> 00:32:34,930 This is something that I've seen an awful lot of during lockdown and certainly over the COVID pandemic. 330 00:32:34,930 --> 00:32:39,940 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, 331 00:32:39,940 --> 00:32:46,180 and what you notice is that maybe we're spending more time inside when we're not getting as much sunlight. 332 00:32:46,180 --> 00:32:55,360 One thing that's really important for the rhythmicity of this circadian system is sunlight is daily light exposure. 333 00:32:55,360 --> 00:32:59,350 So getting outside every morning and getting the sun hits the back of the eye, 334 00:32:59,350 --> 00:33:03,250 sends the message to the master clock and gets the clock and trained every morning. 335 00:33:03,250 --> 00:33:09,670 If that's not happening in a regular way, if that's happening in an irregular way, if that sunlight isn't particularly bright 336 00:33:09,670 --> 00:33:15,060 that day and spending a lot of time inside, then maybe that that lethargy makes you feel like you're more sleepy. 337 00:33:15,060 --> 00:33:19,390 It's not necessarily sleepiness. It's it's just the fact that there's not that much alertness. 338 00:33:19,390 --> 00:33:26,020 So I think in terms of being practical, a daily activity, getting out and doing plenty good exercise, 339 00:33:26,020 --> 00:33:29,080 all the good stuff that we hear about from all other areas of health. 340 00:33:29,080 --> 00:33:36,220 This is important for sleep too. Dynamic daytime activity is a good predictor of good health, good healthy sleep at night. 341 00:33:36,220 --> 00:33:46,210 Getting regular light exposure in the morning is a good way to banish lethargy and drowsiness that people might otherwise feel. 342 00:33:46,210 --> 00:33:51,580 And if you notice that you're sleepy during the day, then make sure you're getting enough sleep at night. 343 00:33:51,580 --> 00:33:58,060 Because the most common reason why we experience sleepiness during the day is something we we labelled insufficient sleep syndrome, 344 00:33:58,060 --> 00:34:01,960 which is really just this idea that we're not getting enough sleep because we we cut our sleep. 345 00:34:01,960 --> 00:34:07,510 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 346 00:34:07,510 --> 00:34:10,850 even though our bodies say "right, it's sleep time now off to bed." We're going 347 00:34:10,850 --> 00:34:16,300 yeah, yeah, well, you know, it's fine, it's only half an hour, but that half an hour multiplied by five days. 348 00:34:16,300 --> 00:34:20,980 Maybe it's not bake off every night, but that's that's 2.5 hours less sleep a week. 349 00:34:20,980 --> 00:34:22,120 That's a lot. 350 00:34:22,120 --> 00:34:29,290 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. 351 00:34:29,290 --> 00:34:33,520 If you notice that you're bingeing on the weekends and catching up all that sleep on the weekends. 352 00:34:33,520 --> 00:34:37,270 Why do you need to catch that up? Because you're not getting enough during the week. 353 00:34:37,270 --> 00:34:42,790 So it's worth just having a kind of a review with yourself about why you might be feeling sleepy. 354 00:34:42,790 --> 00:34:48,190 And of course, if it's something else, then maybe going and seeing your GP is also a good idea. 355 00:34:48,190 --> 00:34:52,320 if you feel that you're sleeping a lot. Great. Thank you very much. Colin, 356 00:34:52,320 --> 00:34:58,210 anything you'd like to add in relation to this issue of sleeping too much? 357 00:34:58,210 --> 00:35:06,720 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. 358 00:35:06,720 --> 00:35:13,900 Know your own body, know yourself. If something has changed dramatically and you don't feel well, 3 00:35:13,900 --> 00:35:20,920 then you shouldn't ignore it and should get it investigated, ask questions and seek some help. 360 00:35:20,920 --> 00:35:25,750 But equally, you shouldn't ignore it and not do the obvious things like, well, 361 00:35:25,750 --> 00:35:32,260 maybe I'm not getting enough sleep at other times, or maybe I'm drinking too much during lockdown. 362 00:35:32,260 --> 00:35:36,570 Or, maybe I've got this thing is that Dimitri referred to, 363 00:35:36,570 --> 00:35:44,350 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, 364 00:35:44,350 --> 00:35:51,190 but they're bingeing on the weekends and running on empty during the course of the week. 365 00:35:51,190 --> 00:35:58,120 So do obvious things first. I think some things I said too earlier about experimenting with your sleep pattern. 366 00:35:58,120 --> 00:36:02,540 Don't be frightened to to experiment with it, to try and get it better. 367 00:36:02,540 --> 00:36:05,920 And you'll know from your own data by knowing your own body, you know, 368 00:36:05,920 --> 00:36:10,510 whether or not you're feeling better and differentiate fatigue from sleepiness. Fatigue 369 00:36:10,510 --> 00:36:14,870 people don't fall asleep. Fatigue people feel tired. 370 00:36:14,870 --> 00:36:21,250 Fatigue and sleepiness only partly correlated the different kinds of things that differentiate those two. 371 00:36:21,250 --> 00:36:28,820 And the best solution to fatigue is activation. OK, thanks very much. 372 00:36:28,820 --> 00:36:32,810 So in addition to questions about being asleep versus being awake, 373 00:36:32,810 --> 00:36:38,120 we also had a number of questions about particular experiences people have when they're asleep. 374 00:36:38,120 --> 00:36:42,740 So lucid dreams or nightmares, sleepwalking or talking 375 00:36:42,740 --> 00:36:53,630 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. 376 00:36:53,630 --> 00:37:01,270 You know, just picking up about dreams and nightmares. These can really leave their mark on us whenever we've woken up 377 00:37:01,270 --> 00:37:07,420 perhaps more particularly intense dream or nightmare, we really feel the emotional effects of that. 378 00:37:07,420 --> 00:37:12,600 We kind of feel those emotions very intensely having come from that nightmare. 379 00:37:12,600 --> 00:37:16,710 And we can notice this kind of hanging over into the next day, 380 00:37:16,710 --> 00:37:23,080 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. 381 00:37:23,080 --> 00:37:29,490 One, even though we know it didn't happen, we kind of have the same intensity of the emotional reaction. 382 00:37:29,490 --> 00:37:36,930 And that's kind of related to the intense imagery that we were experiencing when we're having these dreams or nightmares. 383 00:37:36,930 --> 00:37:40,890 And not only do these nightmares have a knock on effect on the next day, 384 00:37:40,890 --> 00:37:48,920 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. 385 00:37:48,920 --> 00:37:51,260 And so thinking about what we can do about these, 386 00:37:51,260 --> 00:37:57,710 really the first is how do we reduce the likelihood that we're going to have nightmares or intense dreams? 387 00:37:57,710 --> 00:38:05,210 This comes back to creating a kind of calm and safe environment before we go off to sleep. 388 00:38:05,210 --> 00:38:12,070 We need to feel safe and we need to feel calm before our body will allow us that experience of sleep. 389 00:38:12,070 --> 00:38:18,890 And so we want to think about bringing down any of that sense of high levels for arousal or worry before sleep. 390 00:38:18,890 --> 00:38:24,390 So relaxation and that calming winding down routine before bed. 391 00:38:24,390 --> 00:38:28,590 And then, if dreams or distressing nightmares do occur in the night, 392 00:38:28,590 --> 00:38:35,690 the first step is really just to reground ourselves into the present moment, to recognise that the dream is over, 393 00:38:35,690 --> 00:38:41,190 that it's not real and that we are back in this present moment and we're safe enough. 394 00:38:41,190 --> 00:38:44,460 And if you tend to have distressing dreams or nightmares 395 00:38:44,460 --> 00:38:50,760 very often, you might want to leave a note for yourself by the badge kind of message from your daytime self. 396 00:38:50,760 --> 00:38:56,180 So on waking, you can have that cue to remember that it's okay, even though it felt very intense 397 00:38:56,180 --> 00:39:01,960 and you've woken from this nightmare. actually you're safe enough and the dream is over. 398 00:39:01,960 --> 00:39:09,460 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, 399 00:39:09,460 --> 00:39:17,380 then there is an approach called imagery re-scripting in which you can actually change what happens in the nightmare or dream. 400 00:39:17,380 --> 00:39:21,550 And you could kind of almost like a movie director. You can rewrite the ending. 401 00:39:21,550 --> 00:39:25,810 And this means that you can change the meaning and the emotions that go with it. 402 00:39:25,810 --> 00:39:29,840 So you might if you have a distressing dream, you might change it 403 00:39:29,840 --> 00:39:36,010 so it has a funny ending so that any attacker, instead of reaching you, actually slips up on a banana skin or something 404 00:39:36,010 --> 00:39:40,930 and so you can kind of take the heat out of it with the same nightmare. 405 00:39:40,930 --> 00:39:45,340 So those are just a few ideas with responding to those kinds of dreams and nightmares. 406 00:39:45,340 --> 00:39:48,920 Thank you very much. Dimitri, would you like to add anything? 407 00:39:48,920 --> 00:39:58,670 So you also asked Cathy about sleepwalking and things like that for these, these are quite distinct from what we call REM related activities. 408 00:39:58,670 --> 00:40:03,620 So nightmares are I think that happened in REM sleep. This is the emotion processing piece. 409 00:40:03,620 --> 00:40:07,640 This is where we're having emotional narrative in our 410 00:40:07,640 --> 00:40:17,750 narrative dreams. But sleepwalking, sleep, talking and and things like night terrors, which are common in young children. 411 00:40:17,750 --> 00:40:22,320 These are what we call non rem arousals or non REM. 412 00:40:22,320 --> 00:40:29,180 Partial arousal is incomplete arousal where the brain sort of is, if you like, half asleep, half awake. 413 00:40:29,180 --> 00:40:30,660 So a crude way of explaining it. 414 00:40:30,660 --> 00:40:38,360 But you see it, as Colin mentioned earlier, you can get people that do very intricate, very complex activities whilst asleep. 415 00:40:38,360 --> 00:40:45,760 So this case examples and I'm aware of people riding motorcycles in their sleep, which is just particularly extreme. 416 00:40:45,760 --> 00:40:51,920 But there are you know, the more common stuff is walking around or or sometimes calling out. 417 00:40:51,920 --> 00:40:57,500 Now, that happens in the transition from what we call slow wave sleep, the deep sleep we get at the beginning of the night, 418 00:40:57,500 --> 00:41:05,180 the deep restorative sleep we get at the beginning of the night to lighter sleep stages, lighter sleep into deep sleep. 419 00:41:05,180 --> 00:41:12,470 And that transition isn't happening as smoothly as it might otherwise happen to see you get these unusual things happening. 420 00:41:12,470 --> 00:41:19,040 And very often they they are, I mean, they're all the benign sort of things that happen. 421 00:41:19,040 --> 00:41:23,330 We call them parasomnias in the jargon, but they're not a problem necessarily. 422 00:41:23,330 --> 00:41:29,600 If they're happening very frequently and they are beginning to interrupt your sleep or interrupt the sleep with those around you, 423 00:41:29,600 --> 00:41:34,640 for example, if you have a young child, it's having a night terror that happens very frequently. 424 00:41:34,640 --> 00:41:41,930 Often the best thing to do is to think about what's making these things happen in terms of their severity or their frequency. 425 00:41:41,930 --> 00:41:48,080 And there's two things primarily that increase the severity and frequency of these episodes at night. 426 00:41:48,080 --> 00:41:53,570 And one is being sleep deprived and the other one is high levels of arousal. 427 00:41:53,570 --> 00:41:58,610 Before bed. And so these two things are good areas to think about. 428 00:41:58,610 --> 00:42:02,660 The first one is, is that young person, if it's a child who's who's having lots of nightmares. 429 00:42:02,660 --> 00:42:08,600 Are they getting enough sleep where they sleep deprived? Are they very agitated or worried about things before bed? 430 00:42:08,600 --> 00:42:13,610 Or have they got things on the mind before bed might be causing them to maybe 431 00:42:13,610 --> 00:42:18,800 inadvertently causing them to be awake for longer and then being unsettled. 432 00:42:18,800 --> 00:42:25,000 But I mean, these these things are there and they're very common and they're not a problem, per say. 433 00:42:25,000 --> 00:42:30,650 But when they do start to interrupt sleep or start to get in the way of other people's sleep, 434 00:42:30,650 --> 00:42:35,330 then doing something about them is often about thinking about what might be keeping them going. 435 00:42:35,330 --> 00:42:40,010 So lots of children and young people struggle with falling asleep and staying asleep. 436 00:42:40,010 --> 00:42:44,960 And by and large, these experiences of difficulty falling asleep and staying asleep 437 00:42:44,960 --> 00:42:49,790 can can be considered kind of normative. Developmental learning is that there are times when 438 00:42:49,790 --> 00:42:56,690 children learn to policy independently and we think about things from an evolutionary perspective. 439 00:42:56,690 --> 00:43:01,460 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. 440 00:43:01,460 --> 00:43:06,630 So actually part of this is kind of a facet of us living in a modern age. 441 00:43:06,630 --> 00:43:15,560 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. 442 00:43:15,560 --> 00:43:21,020 And that context is one for which they have behaviour associations, often at present. 443 00:43:21,020 --> 00:43:25,760 So things like having a parent or a caregiver in the room with them will mean that that's 444 00:43:25,760 --> 00:43:30,480 that's how they learn to fall asleep by having having that that stimulus there with them. 445 00:43:30,480 --> 00:43:34,160 So when they wake up subsequently in the middle of the night, as we all do 446 00:43:34,160 --> 00:43:42,380 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. 447 00:43:42,380 --> 00:43:45,710 And if you notice that's happening or if that's an issue, 448 00:43:45,710 --> 00:43:51,230 then one of the most important things is to start helping that child fall asleep independently to begin with, 449 00:43:51,230 --> 00:43:55,010 because once they know how to fall asleep independently at the beginning of the night, 450 00:43:55,010 --> 00:44:01,190 then they'll they'll be much more likely to sleep through the night and to reinitiated sleep effectively. 451 00:44:01,190 --> 00:44:06,200 And there can be lots of reasons, other reasons why children might struggle to fall asleep. 452 00:44:06,200 --> 00:44:15,140 But another one that's worth mentioning is that as we as we grow, as we get older, our sleep timings change, too. 453 00:44:15,140 --> 00:44:22,630 And so although we think of bedtimes as being primarily a societal construct, actually there's a biological underpinning to this. 454 00:44:22,630 --> 00:44:29,630 The body clock starts to get later and later as we get into older, older childhood, sorry, and into adolescence. 455 00:44:29,630 --> 00:44:31,880 And you may find that actually sometimes at bedtime, 456 00:44:31,880 --> 00:44:36,710 that has always been that child's bedtime is now out of date, if you like, a little bit too early. 457 00:44:36,710 --> 00:44:43,250 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. 458 00:44:43,250 --> 00:44:48,320 And then the fact that they can't get to sleep may then frustrate or irritate them or make it 459 00:44:48,320 --> 00:44:56,240 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. 460 00:44:56,240 --> 00:45:01,820 So getting the bedtime right is also really important. 461 00:45:01,820 --> 00:45:08,900 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. 462 00:45:08,900 --> 00:45:14,240 They're not ready for bed until much later. But, of course, school still starts at the same time. 463 00:45:14,240 --> 00:45:22,100 So there's this squeeze on their sleep, which means often teenagers are getting much less sleep than they actually need. 464 00:45:22,100 --> 00:45:26,200 So one thing is to try and get on the same page as a whole family. 465 00:45:26,200 --> 00:45:33,170 And that can be renegotiating what bedtime means. In fact, many teenagers may need to go to bed far after you do. 466 00:45:33,170 --> 00:45:37,760 And so being on the same page with that and agreeing with the young person, with siblings, 467 00:45:37,760 --> 00:45:42,170 and feeling confident and having a plan with that young person to get themselves to bed at a time 468 00:45:42,170 --> 00:45:47,420 when they're going to be able to fall off to sleep more naturally aligned with that body clock. 469 00:45:47,420 --> 00:45:55,850 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 470 00:45:55,850 --> 00:46:01,250 and at a time that suits. The other kind of thing I'd just raise about the bedroom environment 471 00:46:01,250 --> 00:46:11,810 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 472 00:46:11,810 --> 00:46:18,290 with friends and connecting online is also from the place where people are studying or just taking a bit of downtime. 473 00:46:18,290 --> 00:46:24,590 And that can mean that actually the bedroom becomes associated with all sorts of other activities and not just with restful sleep. 474 00:46:24,590 --> 00:46:30,620 And as we've been saying, it's really important for young people to be able to associate bed with sleep. 475 00:46:30,620 --> 00:46:34,640 So one thing that might be helpful is having another space, if possible, 476 00:46:34,640 --> 00:46:40,910 for young people to study or work so that the bedroom can be saved just for sleep. 477 00:46:40,910 --> 00:46:47,000 And particularly if that's not possible, then only laying down on the bed at night time. 478 00:46:47,000 --> 00:46:51,320 So that's associated with sleep. And if your in your bedroom during the day or even the evening, 479 00:46:51,320 --> 00:46:57,710 sitting up and making sure there's a distinction and kind of try not to be on the bed if possible. 480 00:46:57,710 --> 00:47:01,610 And the last thing I think is that many of us live alone on the weekends. 481 00:47:01,610 --> 00:47:08,090 And that's particularly true physically for teenagers, often because they've had a kind of build up of need for sleep. 482 00:47:08,090 --> 00:47:11,780 They've been saying that a whole week because it's being squeezed throughout the week. 483 00:47:11,780 --> 00:47:20,150 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, 484 00:47:20,150 --> 00:47:25,690 maybe a short lie in, but nothing too long that might disrupt that regular pattern. 485 00:47:25,690 --> 00:47:29,830 So that does bring us up to the end of our allotted time. 486 00:47:29,830 --> 00:47:35,350 So I just wanted to take this opportunity to just remind you all again about the next session in our series, 487 00:47:35,350 --> 00:47:39,790 which is on Managing Depression and Low Mood on the 19th of November. 488 00:47:39,790 --> 00:47:44,830 And of course, I'd like to say huge thank you to our speakers for joining us today. 489 00:47:44,830 --> 00:47:51,880 I think it's been such an interesting and hopefully very useful, very practical talk and clearly extremely timely. 490 00:47:51,880 --> 00:47:57,310 I mean, I might imagine it always helps. So thank you so much for giving us your time this morning. 491 00:47:57,310 --> 00:48:01,320 We really appreciate it. And I'd also just like to say first, thank you to Halley, 492 00:48:01,320 --> 00:48:07,420 Nicola and Kaja for their excellent organisation that's enabled this series to be such a success. 493 00:48:07,420 --> 00:48:21,185 And of course, thank you all very much for joining us. Goodbye.