Click title to see more…

The Sleep to Healthy website is now a 10 lesson course on curing insomnia. 

This course is not a quick fix and it is not easy.  The course is based on CBTi or Cognitive Behavioral Therapy for Insomnia.  CBTi is the first-line insomnia treatment method endorsed by:

• The U.S. National Institute of Health and
• The British Association of Psycho-pharmacology. 
• The American Academy of Sleep Medicine.

 By the end of the “Cure Insomnia” course, students will have the knowledge and tools they need to cure their insomnia.  Not just now, but for a lifetime. 

 Did I mention that it’s free?

 Go to SleepToHealthy.com to get started.

Summary: Guest: Michael Swartz, creator of the Sleep on Cue App discusses:

• An example of someone who had multiple sleep disorders and how he dealt with it.
• Stimulus Control Therapy as part of Cognitive Behavioural Therapy for Insomnia (CBTi)
• Why you shouldn’t try to get to sleep.
• Intensive Sleep Retraining (ISR) as a way to get to sleep more quickly and sleep on demand.
• The Sleep on Cue smartphone app that mimics ISR and how it works
• Dennis talks about his experience with the Sleep on Cue app (his graph is at the bottom of the page)
• Why the Sleep on Cue app won’t work if you use it when you wake up in the middle of the night.
• Why you should include your regular doctor when trying to cure insomnia.
• Why you shouldn’t focus on getting 8 hours of sleep.
• Why reading before bed or when you wake through the night can be a good way to prepare for sleep.

Links mentioned in the show:

Michael Schwartz website: www.sleeponQ.com

Podcast: Sleep On It: http://www.sleeponq.com/sleep-on-it-podcast/

App:  Sleep on Cue:

iPhone https://itunes.apple.com/us/app/sleep-on-cue/id829583727 ,

Android: https://play.google.com/store/apps/details?id=com.sleeponcue&hl=en

Twitter: @sleeponcue, https://twitter.com/SleepOnCue

Intensive Sleep Retraining (ISR): http://www.sleeponq.com/intensive-sleep-retraining/

Sleep Coaching: (Available via Skype): http://www.sleeponq.com/sleep-coaching/

Contact Michael Schwartz: http://www.sleeponq.com/contact-me/

Show notes with approximate time they occur in the episode:

(Note: For your convenience, the following is paraphrasing from the interview, not exact quotes.  For exact wording, listen to that part of the episode)

Introduction:

We started today’s episode with some different music.  It is a recording of today’s guest Michael Swartz.  He opens his podcast episodes by playing blues on the harmonica, so I asked if he would provide some music for this episode and he assented.

Insomnia is complex, but 2 common issues are not being able to get to sleep at the start of the night termed “Sleep onset insomnia”, and waking up through the night and not being able to get back to sleep called “Sleep Maintenance Insomnia”.  It can be frustrating laying in bed as the clock slowly ticks by, wanting desperately to fall asleep, but not having direct control over the elusive switch that puts our brain in sleep mode.

Maybe it’s even more frustrating for us since we live in a hyper-in-control society where our needs are tended to 24-7 giving us what we want, where we want and when we want it.  And yet here is sleep, eluding our desperate pleas.  Maybe sleep will come in now.  Or now.  Or now.

The time that elapses from when we lay down to when we get to sleep is called the sleep latency period.  We can’t force sleep to happen, but we can find ways to help it perform its magic without such long, frustrating delays.  And that is what we are going to talk about today – finding ways to get closer to our goal of sleep on demand.

We are fortunate to have as our guest Michael Schwartz, CEO of MicroSleep, LLC, an organization devoted to improving sleep health and wellness.  Michael is the Program Director of the Clinical Sleep Health and Polysomnography Program at Oregon Tech University.  Michael has over 30 years as a sleep professional.

Michael has his own podcast called “Sleep on It” and he developed a smartphone app called Sleep On Cue.  I have listened to Michael’s episodes and bought and tried out his app and I was so impressed that I asked him to join us on our show.  Michael, welcome to this episode of the Sleep to Healthy Podcast.

3:10 – Michael give us an example of someone you struggled with sleep but was able to work their way out of it. It was somebody with three or four different sleep disorders when they tested him. He had narcolepsy, sleep apnea, and periodic limb movement. It really impressed on him how complex sleep issues can be. They were able to help the patient understand what the issues were.  It was complicated by him being a Greyhound bus driver. They started him on a CCAP for his sleep apnea and medications first for narcolepsy and cataplexy and the periodic leg movements resolved itself on its own. He learned that it’s not uncommon for more than one thing to be going on when they’re having trouble sleep with sleep. That was one of the more interesting cases that he dealt with.

5:50 Michael tells us about stimulus control therapy which is one of the main components of cognitive behavioral therapy for insomnia, CBTi. Our brain is associative, it is associates places and events with physiological states. It is almost continuously doing that. So it also helps in terms of sleep because the same happens with sleep. People with insomnia tend to spend a lot of time in bed awake while they are trying to get to sleep or get back to sleep. They do mental gymnastics to try to get their brain to go to sleep. But the brain has learned to associate the bed and bedtime with alertness and anxiety. Stimulus control therapy is an attempt to reverse this conditioning. The person is instructed to only be in bed if they are truly sleepy or they are asleep. This means they are removing themselves from bed if those two conditions are not being met. And the more they can do that the more chance there is that the conditioning can be reversed. It is true Pavlovian conditioning at work.

8:20 – Michael talks about how you can’t make or force yourself to sleep, you normally can’t sleep on demand. Sleep is a 100% passive event. Going from wakefulness to sleep involves an absence of effort. The only way sleep has a chance of happening is to completely avoid the effort to sleep. It is common in our language to say things like I’m going to try to go to sleep now. But that is misleading. He equates trying to focusing. Sleep needs mental focus to be somewhere else than on sleep. So he personifies sleep by saying things like “sleep needs you to do this” or, “sleep needs you to not do that”. It doesn’t guarantee sleep, but not focusing on sleep is a requirement for the onset of sleep.

10:40 – Michael explains intensive sleep retraining or ISR which is close to sleep on demand. It is a technique that was developed by some Australian sleep researchers how about 10 years ago. It is repeated short opportunities to fall asleep. In traditional stimulus control therapy, if sleep was not coming easy at the start of the night you would be instructed to get out of bed. And then go back to bed when you feel like you are truly sleepy again. Then later if sleep is a game elusive, to get out of bed again. Then go back to bed when you feel sleepy again. It is an effective strategy, but it can be a bit unstructured. So the Australian researchers decided to structure it by giving yourself a short time to see if sleep happens, and if it doesn’t we will instruct you to get her to bed and then shortly after that lay back down. It is preceded by intentional sleep deprivation. They did this intensive sleep retraining or ISR in a sleep laboratory with EEG (electroencephalogram) probes stuck to the patient’s head. The patients came into the laboratory around bedtime to start the process. The intensive sleep retraining or ISR works by having the patient sleep deprived at home by having more no more than 5 hours in bed the night before. So the homeostatic sleep drive was pretty strong, they were pretty sleepy. They were instructed to lay down and we’re given about 20 minutes to fall asleep. If the patient had not fallen asleep then the technician went in, knowing whether or not the patient had fallen asleep from the recordings on the EEG, and they would tap the person on the shoulder and ask them if they thought they had fallen asleep or not. The patient would answer, and then the technician, who knew the correct answer because of the EEG readings, would tell the patient if they were right or wrong. Correct or incorrect. If the person did fall asleep within the 20 minutes, the technician would let them sleep for a couple of minutes, and then went in and tapped him on the shoulder, knowing they were asleep at that point, woke the person up, asked them if they thought they had fell asleep, the person said yes or no, and the technician would give them the correct answer. Then, regardless of whether the person had fallen asleep or not, the person would be instructed to get out of bed. Then on the next half hour they were instructed to lay back down and repeat the whole process. Given a 20-minute opportunity to fall asleep, giving feedback, have to stay up until the next half hour mark. This was repeated 50 times which took 25 hours to complete the intensive sleep retraining or ISR. From bedtime to bedtime. So in a nutshell, that is intensive sleep retraining.

15:30 – Michael talks about the Sleep on Cue smart phone app for Android and iPhone that he developed that mimics this process intensive sleep retraining or ISR. He developed the app out of a call to action. In 2012 a study had shown that this type of training really helped with insomnia. It was compared with a group that did traditional stimulus control therapy for about 4 weeks. So they compared this 25 hour intensive sleep retraining or ISR program with a 4-week program. And they found that the results were essentially equivalent. They also followed up with the patients up to six months later, and they found that the improvements held. During intensive sleep retraining the person is sleep deprived more and more as the 25 hours progresses, so they were concerned that the learned ability to get to sleep more and more quickly was mainly driven by the greater and greater sleep deprivation. But what it proved was that the brain was actually learning to get to sleep more and more easily, at least partly due to the feedback given with each session. In essence they learned what being sleepy and falling asleep felt like. Dr. Spielman and Glovinsky, two very well-known sleep researchers who reviewed the study, which commented on this remarkable finding and how effective it was, and concluded the review by talking about how technique to do in intensive sleep retraining in a non laboratory setting – at home, needed to be created. He remembers in 2013 staring at that paragraph and thinking yes, this really needs to be developed. And that lead him on the journey to develop to sleep on cue phone app. He started out by trying to develop a handheld device with an accelerometer, battery, you hold in your hand and drop it when you fell asleep. With a smartphone was a natural fit for it because it has a built-in accelerometer.

19:40 – Michael explains how the app works. Ideally this is done after a poor night’s sleep the next night when you are already naturally tired. He tries to follow the original is our protocol. But he did not want people to intentionally be sleep deprived themselves as this was not a good idea for legal & safety reasons. So if you’ve had a poor night sleep on your own, which is usually not a problems for people who are interested in the app, then start to use the app the following night. So at bed time you start the app and you hold the phone in your hand. You let yourself drift off to sleep. After bit of time the phone will vibrate which alerts the user they need to wake and answer the question of whether or not they think they had fallen asleep. If they were just asleep, then it wakes the person up. You can’t get into a deep sleep in just a couple of minutes so it is never a problem with it not waking you up. You answer the question, yes you were asleep or no you’re not asleep, and the phone immediately gives you the correct answer. So you are told whether your perception of whether you were asleep or not was correct. Then the app asks if you want to do it again, if you want to do another sleep trial. If you answer yes, then it prompts you to get out of bed for a few minutes, it has a built-in countdown timer, and then the process repeats. During the sleep trial, the way the phone tells whether you have fallen asleep or not, is by emitting a faint audible tone that sounds similar to a faint foghorn. Instruction is that when you hear the phone, to give it a little shake or a little jiggle. That activates the accelerometer in the phone and so the app knows that you are still awake. If you are asleep you will not hear the tone. This method is based on some research done in the 1960s where they found that our sensitivity too noise falls drastically when we get into Stage 2 sleep. Stage 2 sleep is our most common sleep stage and starts a couple minutes after you fall asleep. So the app can tell right as you reach stage 2 sleep. In stage 1 sleep, which is the initial stage of sleep when you first just off to sleep, very often people did not think they are asleep. It is transitional sleep.

24:20 – Dennis talks about his experience with the Sleep On Cue app.

First, you have to have a lot of self-discipline, it is not fun waking up over and over and over again when you are already sleep deprived. So you have to be willing to suffer a bit in order to reap the benefits. The second thing is it takes a bit getting used to because it feels awkward to be holding your cell phone while you drift off to sleep but adapted to it pretty easily. The third is that although it’s a learning process it is not like learning other skills. It is very intuitive. You’re not following specific instructions. You just have to relax and trust it. The app produces a graph of the time it takes to fall asleep with each trial. Dennis will put his graph on the episode notes of one night’s trial of 14 trials. Dennis went from taking over 20 minutes to get to sleep down to 7 minutes. Part of it is due to be being more and more sleep deprived. He also noticed that after finally going to sleep after the 14th trial that his sleep was deeper and more restorative than he could ever remember.

27:00 – Michael responds to Dennis observations. The app is a sleep trainer, not a sleep tracker, so it does take work. A sleep tracker is passive, it might be worn on your wrist or you may put your phone underneath your pillow and it just tracks your sleep. His app is a trainer and is designed to reverse the classical conditioning which is preventing people from falling asleep. If you go to the gym to condition your muscles, it is very salient, you can feel the additional strength and see your muscles getting larger. With sleep it is more subtle. The app gives you unlimited number of Trials. The original experiment had 50 trials over 25 hours. The app allows you to have more trials per hour since the time is variable and not restricted to every 30 minutes as the original experiment was. Michael recommends doing 12 to 15 trials minimum. After you finish the trials, you just put the phone down and go to sleep. Like the gym, it may not feel very good while you’re doing the training, but you do it for the results that you desire. The same goes for this training app. Michael encourages people to self-regulate and decide how many trials they do, to stop when they really don’t feel like doing anymore, which usually means they are very very sleepy. The graphs are portable and can be emailed or saved. Michael encourages people to email him their graphs and he can comment on them. The graph shows two things, whether you’re falling asleep is getting easier, and whether you’re perception of whether you have fallen asleep or not is getting more accurate. The research indicates that it is this awareness of whether or not you had fallen asleep is actually what is reconditioning the brain. The height of the bar graph indicates the trial time, meaning how long it took to get to sleep. And the color indicates whether you guessed correctly how about being asleep or not. Red means that you’re mistaken, blue means that you are correct. So you want the bars on the graph to be getting shorter and Bluer.

35:30 – the app is not to be used in the middle of the night, just at initial sleep-onset when you are sleep deprived. The app is designed to minimize the impact of using a cell phone just before going to sleep. If you wake up in the middle of the night, follow traditional stimulus control therapy which is to get out of bed, do something boring until you are sleepy again, and then go back to bed.

38:40 – Tips and common mistakes for people who would like to give the app a try. The primary target for the app is for someone who has trouble falling asleep. People who wake up in the middle of the night and have trouble getting back to sleep would be a secondary target group. If a person is taking sleeping medication to get to sleep, and their doctors and they want to taper off from the medication, the app can be a good tool to help with that. One of the common goals when people are using CBTi is to have a later bedtime. The app can be used while you’re waiting for that bed time to arrive to practice going to sleep. It gives you a productive thing to do for your sleep while you’re waiting for your bedtime. It is meant to enhance CBTi, not replace it, as CBTi has several elements to it. It’s best uses for someone who is practicing CBTi and wants a quicker, more robust response to it.

44:00 – It took a lot of time and financial resources to develop the app, and that is why there is a small price for the app. Also, there are no ads, it is a one-time lifetime cost, it is not connected to Facebook or collecting of personal information, and it can run whether you are connected to the internet or not. Some people like to use your earbuds. It is important to use the volume controls to make the sound as quiet as possible. Like a distant foghorn. The app can also do structured naps.

47:10 – Michael shares sleep advice from his decades of experience. Occasional bouts of insomnia are perfectly normal. Sleep gimmicks do not work. He strongly encourages people to give CBTi a chance. It is a lot of work but well worth the effort. Let your regular doctor know about anything about your sleep if you’re struggling. There may be a associations between your medical condition and medications and sleep that you are not aware of. If you find that you get to sleep well but you are frequently waking up to the night, that could be an indication that there is a sleep disorder that needs attention and you should bring it up with your doctor.

51:30 – Michael’s 30 second YouTube video vision: Don’t buy into the message that you need 8 hours of sleep every night. We are all different, and there’s no good evidence that people in past generations slept no more than about six hours or so. So don’t pay heed to the message, and then get anxious about it, and turn to sleeping pills or alcohol as a solution.

52:00 – Something listeners can do today to sleep better tonight to feel and function better tomorrow. Go to Michael’s website sleeponq.com. He has a lot of resources available.  A helpful behavior is to read with an incandescent light source next to you until you feel truly sleepy before you put yourself in bed. The same goes in the middle of the night if you have trouble getting back to sleep. It takes your mind somewhere, and removes the focus from sleep.

Click title to see more…

The Sleep to Healthy website is now a 10 lesson course on curing insomnia. 

This course is not a quick fix and it is not easy.  The course is based on CBTi or Cognitive Behavioral Therapy for Insomnia.  CBTi is the first-line insomnia treatment method endorsed by:

• The U.S. National Institute of Health and
• The British Association of Psycho-pharmacology. 
• The American Academy of Sleep Medicine.

 By the end of the “Cure Insomnia” course, students will have the knowledge and tools they need to cure their insomnia.  Not just now, but for a lifetime. 

 Did I mention that it’s free?

 Go to SleepToHealthy.com to get started.

Summary: Guest: Henry Nicholls, author of Sleepyhead discusses:

• How it can take years to get a proper diagnosis of your sleep disorder.
• That narcolepsy is central to many other sleep disorders.
• How narcolepsy and insomnia are similar.
• How your sleep and life can be improved despite your condition.
• What causes narcolepsy and cataplexy.
• The sleep disorders of most concern: Sleep apnea and insomnia.
• The overnight sleep study and multiple sleep latency tests.
• Why the terms REM and non-REM sleep are inadequate.
• Rapid Eye Movement in fish who don’t move their eyes!
• How precious sleep is and how we should take every means to protect it.

Links mentioned in the show:

Henry Nicholls website: http://henrynicholls.com/

Book:  Sleepyhead: The Neuroscience of a Good Night’s Sleep https://www.amazon.com/dp/1541672577/

Facebook: https://www.facebook.com/SleepyheadByHenryNicholls/

Twitter: @WayOfThePanda  https://twitter.com/WayOfThePanda (the title of one of his previous books)

Show notes with time they occur in the episode:

2:20 – Henry Nicholls talks about his personal struggles with narcolepsy. He was 21 and going to University when he started getting very sleepy. It is a neurological disorder that involves a loss of certain neurons. It usually hits a teenage years but can happen at any age. It is common to be somewhere between normal and pathological and it makes it hard to tell if there really is a disorder. There are lots of other reasons why you might be sleepy, so it can be difficult to diagnose. He would fall asleep almost every time that somebody started a lecture, or he was in a darkened room. Despite fighting it, he could not stay awake.

5:00 – It took 18 months to diagnose which is considered extremely fast. Back then in the 1990s it would normally take 10 to 15 years from onset to diagnosis. It is not for want of trying, everybody with narcolepsy has a story to tell of going to the doctor, but because there is crossover with other symptoms, proper diagnosis gets delayed for a very long time. He got some medications that help with some of the side effects but not the sleepiness and muddled on for the next 20 years. People with sleep disorders tend to work from home because they struggle to work effectively in the workplace. It can be difficult, awkward, and embarrassing. So you end up becoming isolated. He had written a couple of books, and decided to write a book about narcolepsy, but the scope was too narrow, so he broadened it to include other sleep disorders. The pathology that underlies narcolepsy is central to the way the brain controls sleep and the doorway to other Sleep disorders. The result was that it improved his sleep. Which was not expected.

12:20 – The book gave him a newfound ability to function and sleep well. He struggled with writing the chapter on insomnia with authority because narcolepsy, where you have trouble staying awake, seems the opposite of insomnia, where you have trouble sleeping. Narcolepsy is classified as hypersomnia, where you sleep too much. But if you add up the total amount that he sleeps, it’s not much more than what you are supposed to be getting. But the quality of the sleep doesn’t exist. It is completely dysfunctional sleep. It is like being awake the whole time. Narcolepsy was the first sleep disorder identified. That was in the 1800s. It is a very broken nighttime sleep. He does not sleep. He has a lot in common with somebody with insomnia. One of his treatments was cognitive behavioral therapy for insomnia. He learned their techniques for breaking insomnia and they were extremely helpful for him. It let him to look at himself beyond being a narcoleptic, but as being a human being who can have other Sleep disorders that are treatable by other means. This led him to a much better sleep, although still far from normal. He found things that he could control that he had been ignoring.

18:20 – Henry Nicholls talks about the pathology of narcolepsy. The human brain has about a hundred billion neurons. The cells at issue are in that hypothalamus, a small part right in the middle of the brain. And they occupy a tiny fraction of the hypothalamus, there are only about 30 to 50 thousand of these cells. They did not know of their existence, and did not know about the chemicals that they secrete. And what the chemicals did. It is one of the most important orchestrating systems for the entire brain. It controls many things, among them alertness of the entire brain. It is called hypocretin. Or orexin. It was discovered 20 years ago. It is a protein, which they then linked to narcolepsy. Understanding that explains a lot about narcolepsy. It is a neurodegeneration that is contained to those cells. In the majority of cases is it is an autoimmune attack, which means your own immune system attacks and kills the cells. They go in about the space of a week. It is basically just bad luck as there are a number of conditions that have to align for this to happen. The hypocretins have three functions, the first being the alertness function. You wake up, it switches on the whole brain. It also moderates how the neurons interact with dopamine. Dopamine is a motivation chemical. The neurons struggle to respond to dopamine as you normally would. So when you’re not motivated, it is harder to stay awake. The third is that it moderates the serotonin system. Serotonin is responsible for mood and depression steps in. It is likely also responsible for a secondary aspect of narcolepsy which is cataplexy. With cataplexy, I giggle trickles down right through the serotonin and causes a paralysis. It is the same state that our bodies experience during the dreaming state or paradoxical sleep where you lose control of your motor activities. So when you’re making a joke that you think is funny, you collapse onto the floor. What matters is whether or not the person with cataplexy thinks it is funny. This can be dangerous. In his life it is a relatively fun thing, it happens when he’s laughing. While mirth is the most common trigger, other emotions can trigger it as well such as anxiety or fear. He can get cataplexy when he gets really angry, but he doesn’t collapse, his head just falls to his chest. It happens when he is telling his children off and gets really angry, then his head will fall to his chest and they know he is serious. Cataplexy can strike 20, 30, 40 times a day. Then it becomes psychologically destructive. You starve cataplexy by stop having emotions. That is not a good way to live.

29:40 – Henry Nicholls talks about sleep disorders of most concern. The big ones would be insomnia and sleep apnea. About one in 20 people will have sleep apnea. If you have or suspect you have sleep apnea, you absolutely have to get it checked out. The consequences are that it destroys sleep, but you can also die. It is when you stop breathing, then you wake up and have a broken sleep, but during the non-breathing the level of carbon dioxide in your blood rises, it creates a panic, the capillaries in the lung without oxygen shut down, it puts the heart under extreme pressure, and so it puts your cardiovascular system on her high-risk.

If you snore you are at risk of sleep apnea, or if your partner notices that you stop breathing while you’re sleeping, and you must get it checked out. And if you have insomnia, there are ways of improving the situation.

36:00 – How you can speed up the time to diagnosis if you suspect you may have a sleeping disorder. The issue is especially important not only to be able to sleep well, but that you’re waking health is predicated on having a good night sleep. Of all the thousands of medical conditions, there is not one that would not be improved with better sleep. There are many reasons why you might not be getting a good night’s sleep, so doctors have a hard time diagnosing that. So you going to have to learn a lot yourself, and be persistent. There are also self-help things you can learn about and do through books. You have to take it on yourself to provide the information they need to make the proper diagnosis.  You could even video or audio record yourself snoring or collapsing.

40:40 – The overnight sleep study and the multiple sleep latency test underpin the diagnosis of most sleep disorders. The overnight sleep study is when they hook you up to sensors and record your brain and body activity while you sleep as well as be watched over by sleep specialists. This is done in a sleep laboratory or a hospital. It picks up electrical patterns that show what stage of sleep the brain is in. It doesn’t tell us what the brain is doing but it indicates some patterns of activity. It can pick up if you’re breathing has stopped as in sleep apnea. It can reveal the quality of your sleep, for instance with narcolepsy it is very very frequent dreaming. REM sleep comes instantly when you fall asleep instead of the normal which would be 90 minutes after falling asleep. The brain needs long consolidated periods of deep sleep, but people with narcolepsy rarely achieve that. So the overnight sleep study can pick up very many different types of sleep disorders including restless leg disorder. The other test is specific to narcolepsy, and it’s called the multiple sleep latency test. They get you to go back to sleep after you’ve slept for the night which would normally be very difficult for people to do. They turn out the lights and you lie down and most people would just lay there for 20 minutes unable to sleep. But with people with narcolepsy you can put them in that dark room at any time of the day and tell them to do nothing and they will immediately fall asleep. Usually within one minute, but certainly within 5 minutes. So they do that to you multiple times. If you fall asleep quickly each time and especially if you also go into REM sleep right away, it is a good indication you have narcolepsy. Then to confirm it they would take some fluid out of your spine and look for the hypocretin which would not be there.

49:40 – The current definition of REM and non-rem sleep is simply inadequate. The EEG does not tell us anything about what is happening inside the brain. So REM stands for rapid eye movement, that by itself really doesn’t tell us anything about what is happening inside the brain. Originally there is a huge focus on REM sleep because that is when we dream and there was a big focus on dreaming. But now we know that non-rem sleep is extremely important. So nobody paid attention to the non-rem sleep even though it was important. The definitions are superficial. What we really want to know is which brain regions are doing what while we sleep. The researcher who made that statement has a difficulty with the definition of REM sleep since he studies fish who do not have the rapid eye movement but have all the other characteristics of what happens in the brain during REM sleep. It is defined by the paralysis that we have during REM sleep, not by the eyes moving rapidly. It is a carryover from the early days of research in sleep and the obsession with rapid eye movement and dreams. It Is by studying animals that we learn what’s actually happening inside our brains when we sleep.

55:50 – His fantasy YouTube video would be to get the message about how precious sleep is out there. Society ignores the true importance of quality sleep. And the damage that is caused by dysfunctional sleep. The video would be an animation of entering into the cells of the brain and display the basic function of the neurons and how they spread out to other sleep disorders so you can see the very many ways that sleep can be damaged. And how much care we need to be taking care to protect our sleep. It is a precious object that we need to protect all the time. There are many things that we need to juggle at the same time to sleep well.

Click title to see more…

The Sleep to Healthy website is now a 10 lesson course on curing insomnia. 

This course is not a quick fix and it is not easy.  The course is based on CBTi or Cognitive Behavioral Therapy for Insomnia.  CBTi is the first-line insomnia treatment method endorsed by:

• The U.S. National Institute of Health and
• The British Association of Psycho-pharmacology. 
• The American Academy of Sleep Medicine.

 By the end of the “Cure Insomnia” course, students will have the knowledge and tools they need to cure their insomnia.  Not just now, but for a lifetime. 

 Did I mention that it’s free?

 Go to SleepToHealthy.com to get started.

Summary: Guest: Carolyn Schur, workplace sleep expert discusses:

• Living as a night owl in an early bird world.
• The impact of poor sleep on workers, employers and business owners.
• The benefits of good sleep in the workplace.
• How workplaces can hinder the sleep of their staff.
• The roles and responsibilities for staff and employers.
• Specific elements of a sleep friendly workplace.

Links mentioned in the show:

Carolyn Schur’s website: www.carolynschur.com

Books:  Working ‘Round the Clock: A Survival Guide for Shift and Night Workers, Chasing Success, Birds of  a Different Feather, Alert @ Work:  All available at https://carolynschur.com/product-category/books/

LinkedIn:  https://www.linkedin.com/in/carolynschur/

Show notes with time they occur in the episode:

2:30 – Carolyn talks about her personal life in Saskatoon, Canada.

4:10 – Carolyn talks about being a night owl in an early bird world. As a teenager she struggled with getting up in time for school. Being a night owl became especially problematic in the workplace, especially getting to work on time. It was especially frustrating because they would notice that she was coming into work a bit late, but she didn’t get credit for staying at work long after everybody else had gone home. And she always got her work done. So she wondered why they focused so much on what times you got to work rather than the quality and quantity of work that she was able to achieve.

It was a source of guilt for her, so she just focused on what the work she was doing and doing it well. She started to become more assertive and saying that she would not come to the early morning meetings.

8:00 – This experience has resulted in her encouraging organizations to have flexible work schedules and the focus on the quality and quantity of work being achieved. And achieving goals and outcomes.

9:20 – Poor sleep has a big impact on the worker. And their experience of work. When find i can’t sleep and you come to work you will feel sleepy and grumpy. You will not be able to do your best work. You are more likely to have conflict with others when you are grumpy. When you’re well rested you feel better and so your interactions with others are more productive. It avoids conflict and misunderstanding. Issues come up every day. If you don’t have the emotional wherewithal to deal with it effectively, everybody suffers. You don’t do your best to work, and you don’t feel well, and you don’t have good interactions with your fellow workers.  You are less likely to get promoted.

12:00 – For the employer, the issues are safety and injuries, and another is the cost of Health Care. And workplace insurance. Staff are more likely to make mistakes, have injuries, have accidents. All have consequences to the employer. Sleepy workers have higher levels of absenteeism.

13:40 – The benefits to workers if they do get sleep well is that you feel healthier, you’re in a better frame of mind, you’re more productive. You have increased creativity and ability to problem-solve. Sleep allows us to emotionally and intellectually refresh ourselves. If you want to perform well at work you need to sleep well. Better interactions with staff.

15:50 – There is a return on investment for the employer to put systems in to have staff well-rested. There is a lot of data to prove this. It is the cost of healthcare, the cost of sick time, the cost of absenteeism, cost of turnover. This is especially true for people with sleep disorders especially if they are not diagnosed properly.

When there are accidents or even deaths you can also take a hit to your brand. Poor workplace sleep practices can also make it difficult to recruit good quality staff. Potential employees can find out that the organization doesn’t really care about the health and well-being of their staff.

19:00 – Workplaces can negatively impact the sleep of their staff if they can’t sleep. They have very stressful workplaces. For instance, demands on production, or interactions with other employees, or a boss who is the dictator. Or any other multiple of reasons. When you’re stressed at work, you probably won’t sleep very well, and when you don’t sleep very well, it adds extra stress at work. Another big issue is overtime and on-call work where it is excessive. Then you just don’t get adequate rest time. When there’s excessive overtime there is then the lure of money and employees will desire the money despite the negative impacts on their sleep and their health and well-being.

22:30 – the employer needs to set the tone and expectations around sleep and Wellness. The two branches need to work together, the employer needs to have a good environment that allows good sleep, and the staff need to protect their sleep as well. She once gave a presentation at an organization that had horrible work schedules for their staff. Excessive overtime, very poor employee-employer relationships, all kinds of grievances. It was a toxic workplace. She was supposed to do a series of presentations to the employees, but after the first presentation she went to the client and told them that she will not do the presentations. She can’t tell the employees what to do to fix their sleep when the employer creates an environment where that’s not possible. So the employer has to set the tone.

26:30 – Providing facilities and services conducive to good sleep. These are things that an employer can do by design to make sure that staff have what they need at the workplace, that supports people not becoming fatigued. They can have access to sources of healthy food. This helps them overcome fatigue. Make sure the staff have adequate and frequent rest breaks. We have a natural physiology with the brain where it needs to rest about every 90 minutes. Allow our muscles and our brains to have a rest and have a snack. You could also provide resting facilities such as wellness rooms or quiet rooms. Where they can take 15 or 20 minutes to regenerate and gather their thoughts. Have a quick nap and then be good for work again. This is becoming more common. It’s especially popular in places where there is long hours of work such as technology companies.

32:20 – Providing sleep education, sleep facts and things to help you to sleep. The first would be to cover the benefits of adequate sleep and sleep facts and why to simply sleep. This lets them know that having a good sleep is not an option, it’s something that they really have to make a priority and make changes if they think i can’t sleep. We tend to make sleep a low priority, and this helps make it a high priority to get staff to look for things to help you to sleep. The second would be education about sleep disorders, sleep facts and answer why can’t I sleep and when to take a sleep test. It doesn’t take a lot of time, but the benefits can be huge for those who are suffering from a sleep disorder and want to simply sleep and to know about things to help you to sleep. Then the sleep disorder can be diagnosed and treated which has a big payoff. The third is fatigue management. And how to maintain alertness. It can also include stress management, especially the fact that to sleep well helps to reduce stress.

35:40 – Also it’s important to provide education to the employers. And safety supervisors and HR professionals. So they know some sleep facts that any policy that they implement could have an impact on sleep and workplace wellness.

36:40 – Policies and procedures. One issue is to do sleep disorder screening and sleep tests. Providing support to people who have sleep disorders including insomnia. This includes supporting people who are on a stress leave in part due to sleeping issues and who can’t simply sleep. It can include flexible schedules. Flexible schedules can accommodate night owls, but also people that have other life events happening such as caring for children or even their parents. If they have more control then they feel less stressed and will simply sleep better and perform better. It can include napping policies. But it can’t be an uncontrolled napping policy. You need to be able to ask for it and explain why you need it and why you’re doing it.

40:20 – Some of the elements of a good napping policy. The first is that an employee can request a nap with their supervisor and not think that I can’t sleep. So the supervisor knows where their staff are and what they’re doing. The nap should be no more than 20 minutes to sleep well. Employer does not have the responsibility of making up for your sleep deprivation by providing hour and a half long naps. They’re responsible for making sure that you are safe in the moment and a 20-minute nap will be adequate to ensure that you can get that quick refreshment. And only one nap per shift. Another is the nap is away from your workstation, not your head on your desk. It could be a recliner or a yoga mat.

43:40 – Operational considerations. Control the stress level in the workplace. Reducing persistent and excessive overtime is a huge issue. If you look at your turnover rate, your sick time, your accident rate you will see that excessive overtime does not pay. You can correct that that by having adequate staffing. In some workplaces they don’t even get work breaks, so it’s hard to talk to them about health and wellness in the workplace. If you are working shift work, then having best practices shift work schedules is important. So have schedules that allow adequate rest and let them sleep well.

49:00 – What you can do today so you sleep better tonight and feel and function better tomorrow: Look at managing your stress, and if you don’t sleep well look into the possibility that you may have a sleep disorder and look for things to help you to sleep. If you sleep well when you do sleep, but you’re not getting enough sleep, then you need to make sleep a higher priority and put “sleep before chores”. This means that you’re going to give yourself the gift of sleep today even if you have more things that need to get done.

50:00 – You can go to her website which is www.carolynschur.com, there’s lots of printed resources, presentations, and a wealth of articles on all these topics that we talked about today, as well as a podcast with two minute presentations.

Click title to see more…

The Sleep to Healthy website is now a 10 lesson course on curing insomnia. 

This course is not a quick fix and it is not easy.  The course is based on CBTi or Cognitive Behavioral Therapy for Insomnia.  CBTi is the first-line insomnia treatment method endorsed by:

• The U.S. National Institute of Health and
• The British Association of Psycho-pharmacology. 
• The American Academy of Sleep Medicine.

 By the end of the “Cure Insomnia” course, students will have the knowledge and tools they need to cure their insomnia.  Not just now, but for a lifetime. 

 Did I mention that it’s free?

 Go to SleepToHealthy.com to get started.

Summary: Guest: Dr. Neil Stanley , author of “How to Sleep Well: The science of sleeping smarter, living better and being productive” discusses:

• How sleep is critical to proper weight control.
• The ways sleep impacts our relationships.
• The essential need for sleep for children.
• The three basic elements to prepare for a good night’s sleep and sleep well.
• Why sharing your bed with a partner could be a major sleep disruptor.

Links mentioned in the show:

Dr. Stanley’s Website: http://thesleepconsultancy.com/

Book: How to Sleep Well: The science of sleeping smarter, living better and being productive https://www.amazon.com/How-Sleep-Well-Neil-Stanley/dp/0857087681

Twitter:  https://twitter.com/drneilstanley @drneilstanley

Show notes with time they occur in the episode:

3:10 – Sleep and weight control. The more sleepy you are, the more likely you are to consume calories. First, when you are sleepy you crave sugary and fatty foods. With an increase of about 33%. And a 24% increase in appetite overall. You have an increase in a hormone called ghrelin. It tells your body to eat, it is the appetite hormone. And you have a resistance to leptin. It is the hormone that tells you that you are full. So when you’re sleepy, you want to eat, you want to eat sugary and fatty foods, you eat them and you keep eating them because you don’t feel full. One night of poor sleep will increase consumption of calories the next day between 400 and 1000 calories. People that are sleepy put more seasoning on. And they eat fewer vegetables. Weight control can also require motivation, and sleep deprivation results in lower willpower. We are less able to think about longer-term payoffs such as weight control. And this crosses over to exercise which is also required for weight control because we are less motivated to exercise. Sleepy people have a 75% higher chance of having a sports-related injury. Dr. Stanley uses a well-being triangle with nutrition, exercise and sleep. Sleep supports both. The most important thing is they get a good night’s sleep and then the other two will be much easier to control.

7:20 – Sleep and relationships. We show less empathy, we have more negativity, more negative feelings towards our partner, we’re more irritable, we’re quick to lose our temper. We need REM sleep to handle the emotional content of Our Lives. With children, they express their thoughts through their behavior since they don’t have the words, so sleep can adversely affect their behavior. When we are sleep deprived we don’t judge other people’s actions or tone of voice or social cues as well. Even our sense of humor is affected where a humorous remark can be misinterpreted. The adult will argue more with a child if they are not well rested. In a couple, if just one partner does not have adequate sleep and it affects their relationship negatively the next day. People with sleep problems have a higher rate of divorce. There’s more conflict in the workplace if the workers are sleepy. Staff can be more dishonest at work if they lack sleep. Workers can spot if their manager is sleepy and they will be more demotivated. So it is fundamental to for avoiding conflict.

13:10 – Children and sleep. Good sleep is fundamental to every aspect of a child’s development. Memory, learning, growth. Every important aspect of a development of a child occurs during sleep. If a six-year-old is deprived 45 minutes of sleep it affects their behavior, performance in school. And the six-year-old child needs 10 to 12 hours sleep at night so 45 minutes is not a big change in their amount of sleep. They have a lot more of the deep slow-wave sleep so they don’t wake up. A newborn needs 16 to 20 hours of sleep, a 10 year old needs about 10 hours. You can draw a line between those two points to get a good prediction. A four-year-old needs to daytime naps, a six-year-old needs one daytime nap. Some parents think that if a child is sleeping that it’s missing out on important aspects of its life, but nothing could be further from the truth. They need sleep time to process all the stimulation they get during the day. There’s no magic to it, a bath and a story or lullaby and put them to sleep. They need to be comfortable and feel safe. Our grandparents did not have trouble putting their children to sleep, it is a modern phenomena. In their preteens they start to be more like adults in their sleep needs. Teenagers are different and teenagers are odd. They’re going through puberty and physical and relationship changes so they need more sleep than adults. But they are odd in that they need to go to bed later than adults as there’s a shift in their circadian rhythm. The shift is at most 2 hours. They should be going to bed around 11 or 11:30 and sleeping for 9 or 9 and 1/2 hours. A teenager who says they can’t get out of bed at 9 in the morning might be telling the truth.

18:10 – The three basic principles to get a good sleep if you think I can’t sleep or wonder why can’t I sleep. We should not make it overly complex. It is a simple solution to a simple problem. Dr. Stanley has shared thousands of sleep tips on his Twitter feed which is @drneilstanley, but they all fall into three categories. The first is a bedroom that is conducive to sleep, one that is dark, quiet, cool, comfortable. In many European countries the bedroom is often called The Sleep room which is probably a better term. All you should do there is sleep, nothing else. Besides sex. If you’re not sleeping, you should not be in your bedroom. Dark means truly dark, blackout curtains or an eye mask. Even LED lights should be covered up to get a good sleep. Quiet means 35 decibels occasionally going up to 45 decibels. Large truck going by on the street will be about 70 decibels. If you’re in an air-conditioned office and everybody stayed quiet, that would be about 35 decibels. snoring is 75 to 95 decibels. There are comfortable earplugs. Cool is 16 to 18 degrees centigrade, which is around 65 degrees Fahrenheit. You need to be able to lose one degree of body temperature overnight, and most of the heat is lost through the skin exposed on the face. So you can leave the temperature at a low setting overnight. For comfortable you need to invest in a good bed. You spend more time in your bed than anywhere else in your life, by the time you’re 70 you will have spent 220,000 hours in a bed versus 80,000 working. Our bodies are different, so you should try out lots of beds thoroughly, and avoid a one-size-fits-all solution such as ordering through the internet.

24:20 – The next is a relaxed body. It may not be how you cure insomnia, but it will help you to sleep well. You need to be physical during the day, preferably outside in the fresh air, and it doesn’t have to be going to the gym or running. And third, you need to have a quiet mind. If your mind is racing, if you are worried, if you were angry, if you are ruminating, if you’re thinking then you will not get to sleep. So you need to find a way that quietens in your mind, it doesn’t matter what it is, as long as it quietens your mind then that is the right solution for you. It should be similar to a childhood read routine, such as bath, book, bed.

28:20 – Dr. Stanley talks about partners sharing a bed and how to sleep well. It may be why I can’t sleep. We think that if we don’t sleep with our parent partner, then our relationship is in peril. Historically we have had many different sleeping arrangements from sleeping in groups together, to having separate rooms and beds. The rich historically never slept together. It was in the Victorian era when sleeping together started becoming more normal. It was only after the second World War that double beds became popular. 25% of people don’t share a bed most nights with their partner. Lack of intimacy may suggest a problem with your relationship. Sleeping apart does not. It is a mature pragmatic solution to a problem. In 2005 Dr Stanley produced the paper that showed that much of our sleep disturbance is caused by our partner. It may be a sleep solution for you and help you sleep well. If you sleep with your partner and you are getting a good night sleep, then there isn’t a problem to be solved.

34:10 – One thing that we could do today to sleep better tonight and feel better tomorrow. The most important thing is that we need to treasure sleep. We sleep at the end of the day because we have to, not because we want to. Then you will start doing the behaviors that you need to do to get a good night’s sleep.

36:10 – Resources that dr. Stanley has available to help people sleep better. His book How to Sleep Well available wherever fine books are sold. His website that has a lot of information that is not in the book is http://thesleepconsultancy.com/. On Twitter where he posts a sleep tip a day @drneilstanley https://twitter.com/drneilstanley .

Click title to see more…

The Sleep to Healthy website is now a 10 lesson course on curing insomnia. 

This course is not a quick fix and it is not easy.  The course is based on CBTi or Cognitive Behavioral Therapy for Insomnia.  CBTi is the first-line insomnia treatment method endorsed by:

• The U.S. National Institute of Health and
• The British Association of Psycho-pharmacology. 
• The American Academy of Sleep Medicine.

 By the end of the “Cure Insomnia” course, students will have the knowledge and tools they need to cure their insomnia.  Not just now, but for a lifetime. 

 Did I mention that it’s free?

 Go to SleepToHealthy.com to get started.

Summary: Guest: Sleep expert Dr. Neil Stanley , author of “How to Sleep Well: The science of sleeping smarter, living better and being productive”:

• Insights from 37 years as a sleep expert, researcher and consultant
• What surprised him about sleep advice during that time.
• What happens to us physically and in the brain during sleep.
• The difference between feeling tired and sleepy and why that is important.
• The Epworth sleepiness scale, larks and owls.
• A survey Dr. Stanley conducts with his audiences and what that tells us about our state of sleepiness.

Episode’s Habit Crusher:  How to crush a bad habit. James Clear’s book: Atomic Habits: An Easy & Proven Way to Build Good Habits & Break Bad Ones, https://www.amazon.com/Atomic-Habits-Proven-Build-Break/dp/0735211299 , www.stickk.com

Links mentioned in the show:

Dr. Stanley’s Website: http://thesleepconsultancy.com/

Book:  How to Sleep Well: The science of sleeping smarter, living better and being productive https://www.amazon.com/How-Sleep-Well-Neil-Stanley/dp/0857087681

Twitter:  https://twitter.com/drneilstanley   @drneilstanley

Show notes with time they occur in the episode:

2:00 – Dr. Stanley Talks about his personal life

4:20 – Dr. Stanley talks about his 37 years in sleep research. He started his career at The Institute for Aviation medicine. This was in 1982 when they had long-duration flights. Looked at things like jet lag, aircrew workload shift work, medicines you could take and safely fly, medicines you could take and get a good night’s sleep so you could fly the next day. He was a 16 year old at the time. He stayed there for about 10 years and then moved to the University of Surrey where he created and ran the largest clinical trial laboratory at the time. That was a 24 bed unit, he designed and constructed the 12 finest bedrooms anywhere on the planet, dark, totally quiet, temperature controlled, single beds. About 10 years ago he became freelance so he now travels the world lecturing about the importance of sleep to Healthcare professionals, doctors and nurses, to patient groups, to charities and schools, and to members of the public. 10 years ago nobody was talking about sleep, but now we get huge amounts of coverage in the media. He gives a hundred to a hundred and fifty lectures a year, and writes about sleep, has a column in one of the Sunday newspapers in the UK, and works as a sleep expert with companies who are in the sleep field and who he believes are credible.

8:20 – Dr. Stanley talks about what surprised him during his 37 years in the area of sleep and studying sleep facts. He was surprised how little things have changed. We may have learned more about sleep in the last 60 years than the previous 6000, but our advice to patients and sleep solutions has not changed. We have all these apps, and smart devices, and fancy mattresses, and none of these are of any use as sleep solutions if you’re not willing to do the basics. Unfortunately you can’t make money out of doing the basics. You need to go back to the basics, a dark and quiet bedroom, a calm, mind, a relaxed body.

12:10 – Dr. Stanley discusses what happens physically and mentally while we sleep and sleep facts. The physical aspect is not as important as we think. The body can get a lot of rest, recuperating and repairing, such as well when we sit. The immune system is fortified while we sleep because it is not working as hard. After one poor night’s sleep, the next day you are three times more likely to catch the common cold. The endocrine and the metabolic systems are resting.

But sleep is really from the brain and for the brain. Only in the deepest sleep, the N3 or slow wave sleep, is the activity in the brain reduced to any degree, by about 25%. It’s sorts all the information it’s received during the day and decides whether some of it is important and needs to be laid down as important permanent memory, or whether it is unimportant and can be safely forgotten. The brain rehearses behaviors that it learned during the day. We get about 17% better at a task after we have slept. It also deals with emotional memories and emotional well-being. Deep sleep is about factual memory, and REM sleep is about emotional memory.

Other sleep facts are how REM sleep helps with relationships. It can get rid of toxic by-products such as beta amyloids which are found in Alzheimer’s patients. That may be why people with insomnia are three times more likely to develop Alzheimer’s. We only physically grow while we are asleep, especially specifically in the deep sleep. We are not pushing against gravity while we are sleeping. So with even one poor night sleep, we’re more likely to get an illness, more likely to get into an accident, our mood and behavior is changed towards their partner and children, teenagers do worse at school, we just don’t perform at our best. There are long-term effects such as depression, anxiety, obesity, diabetes, stroke, heart disease, but these are not massively statistically significant. You’re more likely to die from other causes then you will as a result of poor sleep. So we want to get a good night sleep for physical, emotional and mental health.

19:40 – Dr. Stanley talks about the difference between sleepy and tired. And how we can tell if we’re getting enough sleep. When you get into your 20s, your sleep needs become fixed for life. Elderly people do not need less sleep. They find it difficult to get to sleep but they still need the same amount. Sleep need is like height, it’s genetically determined and we are all different. An important sleep fact is that 8 hours is not an ideal, it is simply an average. You have short sleepers and you have long sleepers. Anything between 4 and 11 hours can be considered normal sleep. It’s about getting the sleep that is right for you so if you need 4 hours sleep there’s no sense staying in bed for 7 hours to sleep well. Figuring out how much sleep you need boils down to answering one simple question. How do you feel during the day? If you are not getting enough sleep, you will have daytime consequences. Regardless of whether you got to sleep quickly or not, whether you are up during the night, whether you woke up early, bad judgment is how you are feeling around 11 in the morning when you are on your rising phase of performance that tells if you sleep well. Tired has nothing to do with having enough sleep and whether you sleep well. Tired has to do with having a bit of a rubbish life, all the mundane aspects of living such as daily commute, tasks, jobs, etc. That means I want to rest and take a break, not go to sleep. If you need to sleep you are sleepy. If you need to rest and sit down, you are tired. The problem is that we use the term tired to being sleepy which causes confusion. It is a problem with doctors trying to determine whether their patient is tired and lacking energy versus sleepy and wanting to sleep. We can be exhausted from being physically active, but not be sleepy.

24:10 – We discussed the Epworth sleepiness scale as a sleep test. It is a widely used questionnaires developed in Australia about 25 years ago as a sleep test. It asks you about different situations that you might be in and How likely you would be to fall asleep. The score of over 10 would imply excessive sleepiness and that you don’t sleep well. There’s the Horne and Ostberg Morning and Evening questionnaire. It is about being Larks and owls, morning people and evening people. About 25% of people are strong morning people, about 25% or strong evening people. This is an important thing to know about your sleep. Whether you are a lark or an owl is genetic. You try to work in harmony with your genes. The most important self-assessment is to listen to your body. When the body is sleepy, go to bed, simply sleep.

27:10 – Dr. Stanley Often performs an informal survey with his audiences to see how tired they are. Nobody has responded has a 10 mean meaning they are the most awake they have ever been. Most people are content to be a six or a seven. This seems like a bit of a failing on our part that our expectations are so low. Especially considering how much emphasis we put on fitness and nutrition. Some people in the middle of the day are putting their hands up at a 4. You probably wouldn’t want them to be doing something like driving a car or something that was safety-critical. Most people would not think about drinking and driving, yet they would drive at that level of sleepiness. The same goes with turning up at work being sleepy.

Next episode, Part 2 of Sleep Expert, we cover sleep solutions and how to simply sleep, why can t i sleep, and sleep well and how to cure insomnia, things to help you to sleep.

33:50 – Habit Crusher: Using punishment and an accountability partner to crush a bad habit or stick to a good habit.