Everyday Neuro 020: The Well Intentioned Myths of Sleep and How to Treat Insomnia

Introduction to Sleep

0:00Hello, and welcome to the Everyday Neuro podcast series. I'm your host, Dr. Janine Cooper, and I'm aiming to provide you with the knowledge and inspiration to understand the fascinating world of the human brain. So thanks again for joining me today. And I'd like to start this episode by asking you, how well did you sleep last night? Did you get a deep sleep?

0:36How long were you asleep for? Did you wake up at all? Well, personally, I had a pretty good night's sleep. But often I have really vivid dreams that play out like real time scenarios. So they're in color and you know, it's mostly fun. But on occasions, I have to say not so much. But they're rare. Anyway, many people think sleep is just something we do as humans. But as we'll discover in today's episode, sleep is hugely important for our brain to maintain the balance or the

1:10equilibrium and for us to feel productive and in good mental, physical and emotional health. We're also going to be uncovering some of the myths about sleep and the best evidence based treatment of one of the most common sleep disorders, insomnia. Now to really explore this area properly and learn what insomnia is, we're actually going to be joined by an expert in the field, the amazing Dr. Michelle of the Sleep Sphere. Now Michelle is an NHS trained insomnia specialist,

1:43and she's also a cognitive neuroscientist. And probably one of the most important things to me is that she's a fantastic friend of mine too. So Michelle is going to be with us. And it's her job to help people who are suffering with insomnia using the evidence based approach, cognitive behavioral therapy for insomnia, otherwise known as CBTI. Now this is the gold standard treatment, which uses a range of strategies to improve sleep quality. And it's also known to be extremely effective for people with a range of different physical conditions that include chronic

2:18pain and also cancer, as well as helping to treat mental health conditions such as anxiety and depression. But before we chat with Dr. Michelle, I just want to remind you that any of the information that is in this episode, you can find in the show notes on the web page. So that's the Everyday Neuro web page, and you go to the podcast link, and then to the show notes. So let's take a really good look at sleep and why it's fundamental to our health and well being.

2:54Hey, it's Paige DeSorbo from Giggly Squad. Okay, wait, have you ever had one of those moments where you're like, I should be doing something fun tonight. And then you just don't because you don't have what you need? Because same. But recently, I've been trying to be more of a yes person. And honestly, Amazon Prime has been enabling that energy. Like the other night, I randomly decided I was going to host a last minute girls night, no planning, no groceries, nothing. And instead of spiraling, I just ordered everything I needed and got it that day. Snacks, drinks, even like random hosting

3:25things I absolutely didn't need. But emotionally, I did. And suddenly it went from maybe next time to yes, tonight. That's what I love. Prime Same Day Delivery makes it so you can say yes before the moment slips away. Because let's be real, the only thing worse than a bad plan is a plan you never make happen. Same Day Delivery, it's on Prime. Available in select areas, terms apply. So if you're trying to be more spontaneous or just less chaotic, go to amazon.com slash prime to find millions of items delivered fast.

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Sleep Process

4:45Often when we experience sleep that leaves us feeling rested and ready for the day's activities, we refer to it as a good night's sleep. And as we slumber, our bodies perform many important activities, including the conservation of our energy levels. It also helps us to boost our immune system and even controls the hormones that are responsible for hunger. Sleep promotes restoration of the cells in our tissues, our muscles and our brain. And it really enables our brain to remove a lot of the

5:17toxic waste products that accumulate throughout the day. And then this allows us to feel much more alert when we wake. Sleep also supports our emotional well-being by activating areas that are involved in helping us to feel emotionally balanced. And this includes a region of the brain that we've talked about before called the amygdala. And this is again in charge of regulating our fear response, often called our fight or flight reaction. So when we don't get enough sleep in the short term,

5:50so it might be over a few days, the amygdala can start to overreact. And we might notice this as a feeling of feeling a bit on edge or uneasy. But over longer periods of time, such as weeks or months, we might identify this as feeling stressed or anxious. As well as having a big impact on our overall well-being, another hugely important role of sleep is to help us consolidate or process the

6:22events of the day. Now this really benefits our learning and memory and our ability to make decisions. And this important process takes place in a stage of sleep that we know as rapid eye movement, often termed as REM. REM is the fourth stage of a cycle of sleep that lasts approximately about 90 minutes. And the other stages are light sleep, so stages one and two, and deep sleep, stage three. The duration and the quality of each stage of sleep can vary significantly between nights

6:59and also people. And we're going to discuss reasons for changes to our sleep quality and duration later in this episode. Now when we talk about our sleep and weight cycles, we're actually referring to our circadian rhythm, which is basically a 24-hour internal clock, or to be really accurate, it's about 24.1 hours. Now it operates subconsciously, and it's controlled by the suprachiasmic nucleus, or the SCN. And this is located in the part of the brain called the hypothalamus. Now these are

7:34complicated names, but they actually refer to small regions of the brain that are located behind our eyes. And the hypothalamus plays a crucial role in many important functions. So things like regulating our body temperature and releasing hormones. And this includes one that is hugely important for sleep. I'm sure you may have heard of it. It's called melatonin. Now melatonin is produced when our internal clock, or our circadian rhythm, tells our body to sleep. Now when we're exposed to

8:08sunlight, this adjusts the clock so that it stays aligned with day and night. And that's why we often feel sleepy if we've been to a time zone that's different to our own, or haven't been exposed to enough daylight. The second process, in addition to our circadian rhythm, that helps to regulate our sleep is something known as sleep homeostasis. And this is also known as our sleep drive or sleep pressure. As our time awake increases throughout the day, we're actually building up more and more of

8:42this sleep pressure. Biochemically, this is adenosine, which is a byproduct of our metabolism. And this sleep pressure then reduces and resets as we sleep. So both our circadian rhythm and our sleep homeostasis or pressure interact to generate the timing of our sleep. Now I don't know about you, but I think that's pretty damn fascinating stuff and really helps me to understand why daylight and getting up possibly at the same time every day and trying to go to bed at the same time every night

9:14is really important. For many people, a good night's sleep is linked to the amount of time spent sleeping. However, the recommended amount is open to debate and it's subject to often misleading information. Now, unfortunately, for people who have chronic sleep issues, this can have a terrible effect on well-being and health. And to talk about this, the myths of sleep, as well as ways to treat chronic

Myths of Sleep

9:40sleep problems, I would now like to introduce you to the fantastic Dr. Michelle of the Sleep Sphere. Hello, Michelle. Thanks a million for joining us today. I'm really excited you've kindly agreed to chat with us because your knowledge in this area is just fantastic. And for anyone listening who has problems with the sleep, I'm sure you'll be able to provide some real insight into how to get support and treatment. Thank you so much, Janine. I'm absolutely delighted to be here to talk to you

10:11about sleep today. Oh, it's just fabulous. So thanks so much, Michelle, because I'm sure there's many people who are listening that would like to know more about this topic because, you know, often we worry about not getting enough sleep and how this might affect us in the longer term. So my first question I'd like to ask you is that I have heard that the amount of sleep we require differs with age. Is this correct? Yes, you're absolutely right, Janine. The amount of sleep that we need definitely changes with our age. Babies, children, teenagers need much more sleep and that's reflective of the scale of

10:46rapid brain and physiological development that's going on. Whereas a senior adult in their 70s will actually get an hour and a half less sleep than they did in their 20s. So yes, sleep changes a lot as we get older. I'd also like to know, Michelle, that I've always been told that I need to get about eight hours of sleep to really feel rested. Now, is that true? And is it also the case that if I don't get eight hours, will there be detrimental effects to me?

11:16Hey, it's Paige DeSorbo from Giggly Squad. Okay, wait, have you ever had one of those moments where you're like, I should be doing something fun tonight? And then you just don't because you don't have what you need? Because same. But recently, I've been trying to be more of a yes person. And honestly, Amazon Prime has been enabling that energy. Like the other night, I randomly decided I was going to host a last minute girls night, no planning, no groceries, nothing. And instead of spiraling, I just ordered everything I needed and got it that day. Snacks,

11:47drinks, even like random hosting things I absolutely didn't need. But emotionally, I did. And suddenly it went from maybe next time to yes, tonight. That's what I love. Prime same day delivery makes it so you can say yes before the moment slips away. Because let's be real, the only thing worse than a bad plan is a plan you never make happen. Same day delivery, it's on Prime. Available in select areas, terms apply. So if you're trying to be more spontaneous or just less chaotic, go to amazon.com slash Prime to find millions of items delivered fast.

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12:51The issue of whether we really need eight hours of sleep to fear for us is a really interesting point. Well, it's a good general goal to reach for. It's good to bear in mind that not all of us actually necessarily need exactly eight hours. The amount of hours of sleep that we need is a hugely individual thing. And there's variation either side of that eight hour average. There are some who feel absolutely fine on five hours sleep. They feel perfectly good during the day. Where there's others that actually

13:22need 11, maybe even 12 hours of sleep for them to feel good in the day. So what's more important is actually how you feel in the daytime, whether you feel refreshed and alert or not, rather than the actual number of hours. Unfortunately, this eight hour concept is very, very embedded in our culture. And that has created a lot of pressure in those who are worried about their sleep, especially for those with insomnia. And that kind of pressure and anxiety actually makes sleep that, but even more elusive for them. And it's actually feeding and fueling some people's insomnia. So that's an important

13:56point to bear in mind. So I realise it's not always possible, you know, to get the recommended amount of sleep or the amount of sleep you personally need. And so, you know, from time to time, we might experience the occasional short-term change to that sleep pattern that we talked about earlier. But Michelle, could you describe what is the difference between the occasional bad night's sleep that we might have and someone that might be experiencing the kind of sleep conditions that you're able to help with? Yes, Janine. If we experience a few bad nights, as horrible and awful as that is,

14:33it's actually a very normal and natural response to stress. And it can resolve quite quickly. Then we have what's known as acute insomnia. And that's defined as a period of poor sleep, lasting from two weeks to a maximum of three months. And it's usually caused by stress. And actually anything that's challenging or resources. Acute insomnia can fade on its own as time passes and as the person adjusts to the initial stress trigger. It might be helpful to note

15:07the CBTI, a cognitive behavioural therapy for insomnia, is known to help treat acute insomnia and actually acts as a preventative, as in it stops acute insomnia transitioning into something more chronic. So it stops the development of chronic insomnia. And there's actually a really great work coming out from Professor Jason Ellis in Northumbria University on this. I'll definitely be looking out for that. So I suppose I'm wondering, how does initial acute sleep loss

15:40develop into something chronic and persistent? And just need to explain how chronic insomnia is defined. So it's been defined by the International Classification of Sleep Disorders or the ICSD. As despite having the opportunity for sleep, we have difficulty either falling asleep, staying asleep, or waking too early, or all of the above. And that's occurring on three or more nights a week for three months or longer. And this difficulty

16:16is not better explained by another sleep disorder or a medical condition or a medication. And is often typically accompanied by significant daytime distress or impairment in daytime function. For example, feeling irritable, low mood, or difficulty concentrating. A lot of people with chronic insomnia tend not to actually feel sleepy during the daytime. What's more typically described is actually

16:46a feeling of being tired but wired. That's something I often hear in my clinic. I find that so interesting, Michelle, as I'm sure many people are familiar with that feeling, you know, of being tired but wired. And in some cases, I'm sure they're not even aware that they might have the early stages of potential acute insomnia or even chronic insomnia. So could you tell us a little bit more about the mechanisms? Transitioning from acute insomnia into something more entrenched

17:17and longer term is usually caused by what's known as perpetuating factors. And these are ways of thinking and doing to actually feed and fuel the insomnia. So a behaviour example here of one of these perpetuating factors might be chasing sleep. So that might be the likes of going to bed too early or staying in bed late, trying to capture as much sleep as possible, and spending too much time in bed. Hey, it's Paige DeSorbo from Giggly Squad. Okay, wait, have you ever had one of those moments where

17:53you're like, I should be doing something fun tonight? And then you just don't because you don't have what you need? Because same. But recently, I've been trying to be more of a yes person. And honestly, Amazon Prime has been enabling that energy. Like the other night, I randomly decided I was going to host a last minute girls night, no planning, no groceries, nothing. And instead of spiraling, I just ordered everything I needed and got it that day. Snacks, drinks, even like random hosting things I absolutely didn't need. But emotionally, I did. And suddenly it went from maybe next time to

18:24yes, tonight. That's what I love. Prime same day delivery makes it so you can say yes before the moment slips away. Because let's be real, the only thing worse than a bad plan is a plan you never make happen. Same day delivery, it's on Prime, available in select areas, terms apply. So if you're trying to be more spontaneous or just less chaotic, go to amazon.com slash prime to find millions of items delivered fast. 102 miles ago, the oil light came on 100 miles ago, you noticed now it's time to head

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19:21A cognitive example here would be ruminating about sleep and worry about the consequences of poor sleep. And both of these examples, this behavioural and cognitive example that I've given here, they're incredibly natural, normal responses in a way that we try to compensate and cope with this initial sleep loss. But unfortunately, it becomes part of this vicious cycle and actually makes our sleep worse. And just to note here that it might be the case that the initial stress or trigger

19:54of our sleep loss in the first place might actually have resolved or gone at this point. But now the insomnia is existing in its own right. So the poor sleep is now the focus of your stress here now in the case of chronic insomnia. So the stressor has gone, but the sort of behaviour, this insomnia is now with you and obviously something that needs professional treatment most likely. Now, I think one of the areas that I've always found a little bit tricky to navigate is the difference

20:28between insomnia and sleep deprivation. I've read quite a bit about it and I find the area gets a little bit muddy. So I'm really hoping that you can really shed some light to us on this area. So what is the difference between, you know, sleep deprivation and insomnia? Yes, the difference between sleep deprivation and insomnia is a really important distinction to make. So with insomnia, we have the perfect conditions for sleep. We have the perfect

21:01opportunity to sleep. But sleep does not come to us. So we don't have the ability to sleep despite having the opportunity. And this is something that can become predictable as it happens night after night. And because it becomes predictable, physiologically, our brains and our bodies can adapt to this. So physiologically, we adapt in order to protect us from the sleep loss. So actually we develop a protective mechanism here in the instance of chronic insomnia. However, with sleep deprivation,

21:40it's actually the reverse going on. So with sleep deprivation, I have the ability to sleep, as in I could fall asleep right now, but I don't have the opportunity to sleep. So something is keeping me awake. For example, the neighbour's dog is barking, or the baby is crying, or I have an illness or a condition, for example, sleep apnea that's waking me up. So all of these events are unpredictable. And with these events being unpredictable, physiologically, we can't adapt or habituate

22:17in the same way. And it's for this reason is why sleep deprivation is actually more harmful than insomnia. And also just to note, if you're not giving yourself enough time for sleep, that's actually sleep deprivation, not insomnia. And another thing to note is that you might notice in some media headlines, articles about sleep that might be out there. Sometimes insomnia and sleep deprivation can

22:47kind of get lumped together in these articles. And there can be quite scary headlines out there. But unfortunately, this just feeds and fuels our anxiety, especially in those people who are predisposed towards having insomnia. So it's just something important to be aware of and to keep in mind when you see information out there about sleep, to be aware of this important distinction between insomnia and sleep deprivation. So they're actually two, they're related, but there's actually

23:19two different processes going on and they have different consequences for us.

Insomnia Treatment

23:23Oh, you've really helped me to understand the difference. You really have. And so now that we understand in more detail about insomnia, what is the best effective treatment, Michelle?

23:34Yes, Janine. So the most effective treatment for insomnia is known as cognitive behavioural therapy for insomnia. And this is essentially a multi-component treatment strategy that addresses our thoughts and behaviours that negatively affect our sleep. It's known as the number one recommended treatment, both here in the UK by the NHS, by the National Institute of Health in America, and also the number one treatment for chronic insomnia in Australia, and also internationally

24:05all around the world. CBTI is backed up by over 100 large clinical trials. And actually, there's so many studies coming out that it's actually quite difficult to keep up with the amount of literature that comes out week after week. So it's an amazing amount of evidence that really supports this as such an evidence-based treatment strategy for chronic insomnia.

24:30CBTI is known to bring specifically an improvement in our sleep efficiency, also an improvement in our sleep latency, so that's how long it takes us to fall asleep. Also an improvement in our awakening time and a reduction in our awakenings during the night. And also it brings an increase in our total sleep time. CBTI is also known to be more effective in the long term than sleep medication. So there are studies that have shown when you compare CBTI and sleep medication head-to-head

25:06that in the short term, both sleep medication and CBTI are equally effective. However, in the longer term, the improvements generated by CBTI actually are much more longer lasting and remain and are persistent over time compared to sleep medication. So the impact of sleep medication, as you probably know, does wear off much more and more quickly. And one of the many fantastic things about CBTI is that

25:37there's no side effects. And of course, it's completely natural treatment. And I think that's going to be of great relief to many people who don't like taking medication. So, you know, there's other sort of conditions I realise that probably CBTI can support alongside chronic insomnia. Could you tell us what those are, please? CBTI has also been shown to work successfully and those who have other medical issues as well. So for example, those with chronic pain, those with cancer, people with mental health conditions,

26:09such as anxiety and depression, and also in people with post-traumatic stress disorder, PTSD. I just think this is such a fascinating area. And also knowing that CBTI can, you know, help a whole collection of issues is just so important alongside chronic insomnia. Michelle, I just want to give you a huge thank you for joining us today. I'm sure there are many people alongside me who really now get the difference between sleep deprivation and insomnia.

26:41But also, I'd like to ask you one last question. And that is, what if somebody listening today does identify with some of these symptoms, and they'd like to seek more support? Could you tell us how we can contact you and how we can get more information? Thank you so much for having me, Janine. I really appreciate it. Fantastic to be on your amazing podcast. If anyone would like to contact me, I'd love if you can get in touch. My website is The Sleep Sphere. So if you just put The Sleep Sphere into Google, that should come up. And on that,

27:15I have some free resources. So that includes some audio relaxation guides and also some articles on sleep and insomnia. My email address is michelleatthesleepsphere.com. And my Instagram is at thesleepsphere. If anyone would like to have some support from me, I offer assessments and also six-week CBTI courses. Just to let you know, I can offer those over Zoom as well. I often do these

27:47sessions over Zoom with clients from all around the world. Thank you so much. Thank you, Michelle. And that's the wonderful Dr. Michelle from The Sleep Sphere. So today, we've really covered what is insomnia and how it differs from sleep deprivation. And I really hope it's given you some insight, I know it has me, into just, you know, what the differences are, those processes that are at the bottom of chronic insomnia and how we can use CBTI to effectively

28:19treat the symptoms of chronic insomnia without the need for medication. But perhaps you're thinking, well, I don't really have any real problems with sleep. But I would like to know more about how it affects my thinking and my mood, as well as some top tips for those occasions where you might feel you're not getting a good night's sleep. Well, I've created a bonus exclusive episode that you can get if you're a member of ACAS Plus or Patreon. And in that episode, you'll get lots of new top tips

28:54and ways to promote sleeping patterns that are really healthy. So that brings me to the end of

Conclusion and Resources

29:01this episode, which has been dedicated to sleep. I want to say a big thank you for joining me. And as always, please look after that incredible brain of yours. Until next time, take care.

29:27Hey, it's Paige DeSorbo from Giggly Squad. Okay, wait, have you ever had one of those moments where you're like, I should be doing something fun tonight. And then you just don't because you don't have what you need. Because same. But recently, I've been trying to be more of a yes person. And honestly, Amazon Prime has been enabling that energy. Like the other night, I randomly decided I was going to host a last minute girls night, no planning, no groceries, nothing. And instead of spiraling, I just ordered everything I needed and got it that day. Snacks, drinks, even like random hosting things I absolutely didn't need. But emotionally, I did.

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