Susan Hoffman: I’m delighted that you could come and spend an hour with us, and with professor Allison Harvey who is here at UC Berkeley in psychology and she runs the lab that’s called the Golden Bear Sleep and Mood Research Clinic in the Department of Psychology. Her impressive resumé to just speak to a few things that you will hear, you’ll get a sense of from her today is that she has resided on many continents, originating in Australia, has done her work in Australia, her research, her teaching. She’s been very active in the UK working at places such as the University of Oxford and Saint Anne’s College and then she came to Berkeley in 2004. We are really delighted to have her join us today to talk called “Tips and Tricks for Improving Sleep: Leveraging Sleep and Circadian Science.” Professor Harvey.
Allison Harvey: Thank you so much, Susan, and good afternoon, everybody. I’m delighted to join you today. This is a topic that’s near and dear to my heart and it’s really hard, at least in my experience, to sleep during all of the things that we are all facing in our lives. And so, I’m excited to have this opportunity and I encourage you as we go that if you have questions, topics for discussion, please add them to the chat and I’ll pause now and then and make sure that we get to them.
I want to begin by just reflecting how important sleep is across all of these different functions. I think this has got into the popular media and many of you all are academics and scientists, you know all of this. I’m not going to go into this, I could speak on this for three hours. These are huge topics, but what I want to do is talk about how to improve our sleep so as to experience some of these benefits.
One of the things that I learned, probably 10, 15 years ago, is that sleep and circadian disturbances aren’t always straightforward insomnia. They’re usually more complicated. There are some folk who spend too much time in bed or they have hypersomnia. There are some people who are night owls. They go to bed really late and wake up really late. There are some folk who are larks. They go to bed early and they wake up early and there are folks who have nightmares. It’s very interesting with all that we’re facing right now as a community. Nocturnal panic attacks are very common and irregular sleep and wake schedules are also incredibly common.
So, one of the perspectives that we’re interested in is instead of getting bogged down into just one approach, just for insomnia, is to create approaches that are helpful to people who might have flavors of more than one or these characteristics of sleep. And so with my colleague, Dr. Dan Bicey at the University of Pittsburgh medical school, who’s a psychiatrist, we have been working on one treatment that could be helpful across these various sleep and circadian disturbances and across mental illnesses and maybe even across some phases of development. So, we’ve been doing this work for children as young as 10 years of age and really working with everyone throughout adulthood.
And one of the pieces with sleep that we’re concerned about is that these kinds of treatments that I’m going to be giving you a flavor of in just a moment are very hard to get and so there’s a dissemination problem. So, if we can work out a way to train providers in one treatment that covers multiple sleep and circadian problems, we might be able to get this treatment to a broader range of people and the treatment itself that I’m going to give you flavor of in a moment is called a Trans Diagnostic Intervention for Sleep and Circadian Dysfunction. And just to say that everything that I’m going to talk about today has its basis in an evidence-based treatment, one of the ones that you can see in this slide. And so, now I want to quickly move on to give you a mini-taster of this approach.
The way I want to begin is inviting you all to come on a thought exercise with me. I invite you to cast your eye, your attention, your mind’s eye, to the rhythmic nature of the world all around us. That night always follows day, day always follows night, that there are four seasons, except in Berkeley and the surrounding area where there seems to be 12 or more seasons. Stars have annual patterns, some flowers close at night and open during the day and some birds migrate annually or biannually. So we live in this very rhythmic world and I think often we’re moving so fast that we miss these rhythms.
Now the body itself is incredibly rhythmic as well. There are circadian rhythms that take it about 24 hours. There are ultradian rhythms — rhythms of less than 24 hours. So, right now we’re meeting at a point in the circadian rhythm that’s a bit of the post-lunch dip and so it is actually time when people tend to snooze off a little bit, particularly on a warm sunny afternoon. That’s a natural part of the circadian rhythm. It doesn’t mean that falling off to sleep is necessarily the right thing to do at this point in the afternoon, but we can talk more about naps in a moment. Then there are infradian rhythms — rhythms of greater than 24 hours. So, these bodies of our are incredibly rhythmic, and again, we’re often obliterating these rhythms of ours with coffee during the day, with alcohol at night.
Sleep itself is incredibly rhythmic. This is the typical night of sleep say in a 20-year-old, and I mention that because sleep does change across the lifespan and I’ll touch on that. One thing that’s true of all of us is that we fall off to sleep and we rapidly cycle down into these deeper stages of sleep. These are important for growth, the repair for our immune system functioning. Then we go back up to the red line here and we get some rapid eye movement sleep. That’s where we do our dreaming, that’s where it’s important for creativity, for memory consolidation and we go up and down, like this across the night.
Stage two sleep is incredibly interesting. It’s one of the lightest stages of sleep. If I wake you up in stage two sleep, you’ll probably tell me you are already awake. It’s a light stage of sleep, it’s easy to wake someone up out of, but it is important. It prepares the brain for next day learning and it has many other important functions. So, a couple of features of sleep here: One is this is an awakening here, so even in a 20-year-old, people are waking up needing to go to the restroom and certainly as we move through the age range, we’ll wake up and we’ll go to the restroom, we’ll go back to bed and probably surf back into a wave of sleep within 20 to 30 minutes.
And we can do some things around the intake of liquids before bed to manage that a little bit, that’s something I’ll talk about a little bit later. But awakening’s a part of sleep, so it’s not realistic for anyone to think that they’re going to hit the pillow, fall off to sleep and not wake up until the morning. Some people are like that — they do actually have awakenings, they just don’t remember them. But not that many people are like that — if you do a survey, which we tend to do these surveys.
The other good news is that if you get woken up in the middle of a stage of sleep, when you go back to sleep, you’ll get the stage of sleep that you most need. So, if we give our bodies the opportunity to sleep, our bodies will get the sleep that we need. Often there are questions about this, so please feel free to shoot them through.
Now, biology has us retain rapid eye movement sleep. As we move through the age range, we retain stage two sleep and we don’t need as much of the deeper stage three and four sleep. But something that we can do to increase our stages in three and four sleep is to get exercise. And exercise means different things for different people here, but being as active as we can — and we’ve gone right from kind of one end of people who are riding bikes through to people who are doing chair exercises. All of them are great and all of them will help sleep.
That’s just a little bit about the cycles of sleep — how rhythmic human sleep is. And then there’s this broader rhythm under which we sleep called the circadian rhythm and this is actually a UC Berkeley story. I’ll get to that in a moment. It’s a wonderful story.
Circadian rhythms are in our bodies and they follow a roughly 24-hour cycle and this helps us sleep, and our job each day is to reset. We do that with the help of these tools: regular meal times, regular movement, regular exercise, regular social cues and light. This is the biggest factor. It you want to do an intervention on your sleep, dim lights the hour before bed and bright lights when you wake up in the morning. Be really realistic about the timeframe. I’m going to help you tomorrow, it’s going to take two to three weeks of establishing this rhythm and over time, that dim light at night, bright light in the morning habit about the same times as well. Being very rhythmic with those times will really help with regularizing and re-syncing the schedule. This is all about rhythms, and great question, thank you.
Exercise influences our sleep because it builds homeostatic pressure to sleep and the homeostatic pressure to sleep is one of the big factors that helps us to stay asleep in those early hours of the morning. Again if you do exercise just on one particular day, you wouldn’t expect a big effect the first night. We always make changes that occur, make them with a view that this is a two- to three-week commitment. Get into a rhythm with exercise and then this is the reason that light is so effective, and this is a picture of the brain looking down from the top and it’s sort of like a section through here.
This is a UC Berkeley story because professor Irving Zuka was one of the discoverers of the circadian clock here, the suprachiasmatic nucleus and he did an elegant series of experiments many years ago, maybe decades ago, maybe in the ’60s or the ’70s, showing that the light from the retina comes through to the suprachiasmatic nucleus, which is the seat of the circadian clock. And then on through to pineal glands.
And this circuit in the brain is super important and light is the big factor in this circuit because it releases melatonin. Melatonin’s released by the pineal gland. It helps us to feel sleepy and it’s stimulated by darkness, meaning that when it’s dark, the pineal gland releases melatonin and it can only be released in the dark with dim light conditions is good enough. It can’t be released in the light, and of course all of us have access to computers, to electricity in our homes, and all of these mean that we can be up well beyond our bedtimes and we’ve also got to be careful with these when we get up in the middle of the night. We don’t want to keep the lights off completely, say, when we go to the restroom — we don’t want to fall. So, having dimmer lights in say the bathroom, and you can get these plugin lights for I think $2.75 from hardware shops, I’m sure they’re on Amazon, that just shed a little bit of light that you can put in the hallways and the bathroom that are much preferred.
And so, this is really interesting, in terms of the best time of the day to exercise. It’s a good question, we don’t know that yet as this is a topic that I wish there was more research on. The research is only a small amount of research. It’s not clear. Well, it seems that cardiovascular exercise or weight-bearing exercise weights, all of these seem to work and it’s not clear whether the morning or the evening is better, certainly not within two hours of bedtime and I would encourage you to do your own experiments on that. Two weeks of exercise at a certain time of the day, and switch it up.
Now similarly, the data on Kindles, iPads, it’s not very clear at this stage. It’s a very, again, complicated thing to do research on, but if you can dim the lights on those devices, put them in night mode if there is night mode, it looks like that is okay. But it’s one of those areas to watch and wait to see what the science is going to say. Sometimes, there are people who are prone, many of us to worry and rumination, and sometimes then doing something like watching television at night can help with falling off to sleep. The problem is how to get the television to turn off and not wake you up again. And that particular experiment hasn’t been done to the best of my knowledge, for television related to melatonin release. And so, keeping the television further away from your bed is better.
Now, of course, from a sleep perspective, the gold standard would be don’t have devices, be in dim lights, read the old-style standard book, which I haven’t got near me. I’ve got all my devices near me. That would be the ideal because the others are a source of light, potentially a source of arousal. You know, with your iPhone, maybe take work email off it, maybe take social media off it. Anything that you might be tempted to look at in the middle of the night, that’s not going to serve you well. Lots of great questions there.
The question about taking melatonin: We don’t know much about melatonin long-term effects. People are not doing as much research on melatonin, because frankly there’s no drug company pushing it and so we don’t know as much about it. I think with medications, there’s always a time and a place for medications and primary care physicians are usually very skillful about making sure that people are on the right dose of different things. Of course, I’m a psychologist, not a pharmacologist, so I always stay within my domain of expertise.
But let’s talk a little bit more about darkness. This is a powerful cure. As I said, it triggers melatonin release, makes us feel sleepy and so don’t turn on the major lights, if you can possibly avoid it. And here’s the thing: There is actually some research showing that it’s not just sleep that’s important for us humans, it’s also darkness. So, being in dim lights is important. I am like you, Karen — at times, I get up and I do email in the early hours of the morning, try to go back to sleep, and get a little bit more sleep. Between you and me, it’s not a good practice. It is exposure to light at a time of day that’s not great for us. So it would be much better to be in dimmer light conditions in those early hours.
Having said that, we’ve all got to do what we can, particularly looking after ourselves at this really difficult time in history, and so being careful around that would be recommended. But why have I got a conductor here and a whole orchestra. Let me tell you about this and this is little known biology and I don’t know why it’s little known. We have clocks in every cell and the organs of our bodies. We have like 80,000 different clocks in our bodies and to keep this orchestra clocks in tune, we’ve got to wake up and go to bed at about the same time every day. And so, the ideal condition would be dim lights at night for about an hour, go to bed at about the same time every night, switch off the light to go to sleep at about the same time, wake up and get sunlight at about the same time in the morning.
That regularity helps to keep this orchestra of clocks in tune, and increasingly, we are seeing that this kind of regularity really has health implications — it’s good for our health to be able to do this.
So, probably none of us are flying anywhere right now or only for emergencies, but you know, when we all did, remember what it was like to be jet lagged. It’s very easy to do this to ourselves on a weekly basis, so just to underscore, let’s not live in a jet-lagged situation. Trying to have very regular bedtimes and wakeup times is super important.
Let’s talk more about regularizing sleep and wake. Now, this does not sound like rocket science but, well, it’s hard for us humans to do this. Now, in the treatment that we do, we typically take several weeks over this. We make a long-range goal for regular bedtimes, regular wakeup times, and we make sure that these paths are spaced sufficiently apart so that people have sufficient opportunity to sleep. For adults, sevenish, seven and a half hours would be great. So, that would be the long-term goal. Now, just say your goal is seven hours. Give yourself a little bit more of an opportunity to sleep because to take into account that it’s going to take time to wind down and go off to sleep. Give that half an hour at the beginning of the night, there will some awakenings in the night, so half an hour again, so the sleep opportunity might be eight hours time in bed. So that might be the long range goal.
The short-range goal is what we’re going to go for week by week, and these are small steps that we’re going to take, and we usually only move 30 to 60 minutes each week. The circadian system can adjust to us moving a little bit more quickly, but usually moving in that range is what we would aim to do. And what we really want to try and do is minimal fluctuation across the sleep-wake schedule of the nights of the sleep. And so, of course, there’s going to be weddings, there’s going to be nights of anxiety because we’re waiting for a COVID test or we’re upset by what has just seen on the news. This is life. We all are pretty good at coping with a night of poor sleep but we just don’t want to make it a habit and of course, we’re going to be problem solving everything that gets in the way.
And some things that will help scaffold, the wind down is the regular bedtime and the regular wakeup time is to have a personalized wind down. And this is something that, again, people say, “Oh, I’ve done that.” But let me encourage you to take a cold hard look at your wind down yet again. This is a time for relaxing, sleep-enhancing activities: reducing light, especially from technology, reducing or ceasing substance use. Alcohol and sleep is a big topic … We’ll get to that … not good for sleep, helps us to get to sleep at the beginning of the night but it’s a contributor to those early-morning wakenings, which is bad news, I realize. This has to be highly individualized in our experience and we do arrive at collaboratively with our clients. We start at about the same time every night.
And so, this is the wind down that I devised with one of the clients who I worked with. She said that she shouldn’t watch news shows. She should only watch reruns because it’s easier to switch it off and to go to sleep and they’re comforting. We do want to nurture a sense of well-being in those nighttime bedtime hours. I think as humans, at this point, we either have too many people in our lives and in our faces or we’re lonely and we’re maybe feeling that as we go off to sleep and humans are, we’re animals, we need to go to safe burrows and nests in order to sleep. So, things that are comforting really make a difference to us.
I remember working with one person who said, “Please don’t take the television away from me at night. It’s my best friend, I really enjoy it.” And that’s great — we’ve got to do those things that are comforting and calming, and that’s true in the middle of the night, too, in those early morning awakenings I know a lot of people are having at this point. Quickly, a wakeup routine and then I want to spend some time on the chat and answering some questions there.
Again, you might think, “I’ve got this,” but I want to encourage you to take a look at this again. The wakeup is the anchor. Hey, here’s the thing. If there’s one thing I hope you’ll remember in 10 years time, it’s this. If you’re having trouble with your sleep, wake at about the same time every morning. It is the anchor around which your circadian rhythm can align. It’s really powerful to get that and anchor in, wake up at about the same time, open the blinds, get some sunlight, do that for three weeks, test it out, and to recognize that wakeups for many of us are not easy. So, in the treatment that we do with a lot of folk, and a lot of the folk we’re working with are depressed, have bipolar disorder, a lot of people with schizophrenia, too, we really specialize in the mental illnesses, but broader than that, too.
But we’re often working on not hitting the snooze on the alarm, maybe making the bed, so the incentive to get back in is reduced, heading for the shower, take a brisk walk, get sunlight. That’s the biggest one. And this is not to say that you need to get out of bed within two minutes. Enjoy 15 minutes in bed — how calming, relaxing it is — then get up and go get into the day. And to say a little about these winding down and the waking up, sleep is like a dimmer switch. It’s not a light switch. It takes time to wake up and so some people will fall asleep like that, but most people will not. Most people will take 20 to 30 minutes to fall asleep, particularly in those early morning hours.
And similarly, for many people, waking up in the morning is not that easy to do either and we call that sleep inertia. It’s actually a thing in sleep science. It’s the feeling of grogginess that occurs for the first hour upon waking. These feelings are normal. They indicate the transition from sleep to wake, and they don’t necessarily mean that you didn’t get enough sleep. Most of us have sleep inertia each morning. Guess what, we medicate it with coffee, and just to say, there are some alarm clocks for folk who are having trouble waking up in the morning. It’s called Clocky and this is pretty funny. It jumps off your bedside table, it has massive G-wheels and it bounces around your room, until you catch it, solve a puzzle. And you know, I’ve shared Clocky with a bunch of people and it has actually helped some people. This one’s funny. This is where you put money into your alarm clock and if you don’t get up at the time that you were supposed to get up, it will chew up your money.
Let’s come back to the slides in just a moment and just go a little bit to the chat here thanks for all the questions, everybody. So I want to go back. Unfortunately, I don’t know much about fibromyalgia. It is a disorder, as far as I’m aware, of fatigue and I know that sleep and fibromyalgia have been linked, and so these sorts of strategies are typically recommended for all of these conditions that have this biological basis. It doesn’t mean that we can’t also help with some of this more psychological kind of behavioral basis. I will look up fibromyalgia. I should be more up to date with that.
And there is this problem of light pollution in our communities. Even though we have blackout curtains, there’s often like a great street light outside our window, and I think what a lot of people end up having to do is to get pretty [inaudible] … I favor these ones. With too many people in my household, I’m trying to work and these have been great. They’re pretty soft and something really soft and comforting over your eyes, not over your nose, too. It can be harder to breathe in, that can be disconcerting.
And let’s see, so that groggy feeling when folk wake up, that’s sleep inertia. It doesn’t mean that you didn’t get enough sleep, and so I do think a lot about the sleep field and our kind of mission to say, we’re all sleep deprived. It makes us anxious and if we’re anxious, we can’t go to sleep and so, I actually have to tune those out even as a sleep researcher, because it makes me anxious and if I’m anxious, I can’t sleep. We need to be in safe burrows and nests and drop our anxiety. Now, when they say eight to nine hours of sleep, ideally teenagers would be getting like eight and a half to nine hours, ideally, young adults. This is from the National Sleep Foundation: Young adults: eight to eight and a half hours, adults in the middle to older years: between seven and eight hours would be ideal.
But many folk are hovering around 6.5 hours. I’d love you to be getting 6.5, seven hours, and we’ll talk about things that get in the way of that. So sleep apnea is one of the things that can get in the way of that. Symptoms of sleep apnea: snoring… many of us snore without sleep apnea, so it’s not diagnostic… alongside dryness in the mouth on waking. Physicians need to refer people to a sleep doc to work out if they have sleep apnea. It is a condition where people are waking up many, many times across the night. So, daytime sleepiness, like actually dropping off to sleep many times during the day, can be a signal of sleep apnea. It’s very common. That can be something that gets in the way of good sleep.
The treatment for that is CPAP — you wear a mask as you fall off to sleep that keeps the airways open and it’s like a one-night cure, but you have to wear it and you have to wear it the whole night. Takes a bit of getting use to, but it is a great thing and it really helps people.
So, let’s see what else I can spot. Yeah, that’s stage two sleep, Pam, is really good sleep. Oh, can we talk a little bit about perception of sleep? Here’s the thing, the moment of falling asleep is defined by the absence of memories. We do it in darkness, even if we have a clock near us, we check the clock, we can fall off to sleep. We didn’t know we fell off to sleep, because remember, falling off to sleep is defined by the absence of memories. You wake up again, you check the clock, it’s 15 minutes later, but you fell asleep for 10 minutes. Now, turn the clocks around. These do not help our sleep. Believe it or not, when I was in England, we did a whole bunch of experiments on clock watching. It makes everybody feel much worse and anxious, so getting rid of those clocks is really important.
So, yeah, so Seasonal Affective Disorder, you know what, the latitude that we live in in Berkeley, we don’t get as much of it. Although these foggy mornings that we’re getting, they’re rough on a lot of us, but even light on a cloudy day, sunlight on a cloudy day is still really wonderful for our circadian rhythms, and the expertise with light boxes is you’ve got to be very careful the time of the day that you sit in front of them, because they do have a clock-switching effect and it’s powerful. So, getting involved with the a sleep doctor would really help with Seasonal Affective Disorder.
I love this question, Ellen, thank you. Wake with an alarm. There’s no loveliness with waking naturally. Waking at about the same time every day with an alarm is important for regularizing your bedtime and your wake up time. You’ll hear a million different back and forth advice on that, but what we find is if people don’t wake with an alarm, their wakeup times get very irregular and therefore, their sleep times get very irregular as well.
Let’s see, there’s lots of questions and there’s some other things I want to get to and some of them are relevant to many of the questions here and I’m glad to see there’s some sharing within the group, too, for some tips and tricks, so that’s wonderful. I’ll come back to the chat in a little bit, but let me just finish this piece because I really want to offer these things.
For many of us, it’s not usually falling asleep at the beginning of the night where folk experience this, it’s in the early hours of the morning. Wake up at 3 a.m., boom, the weight of the world is on our shoulders and the best reasoning in the world, we just cannot switch off the worry. And so, there’s no like magic answer here. I think a lot of us, need to be re-training these brains of ours. Reducing news intake and changing the associations between our heads hitting the pillow with practices like savoring or gratitude practice. I think a lot of us are turning to things during the day, like journaling, and meditation to try to let go of some of the worries and concerns that we have.
Now, one of my other big interests is habit formation and again, these are not going to be quick fixes. These are commitments of two to three to four weeks, but we can, like Pavlov’s dogs, re-train ourselves to associate our head hitting the pillow with gratitude practice with savoring and just to bring that message home, I want to show you this quick video. I’m going to control the volume here, because it can be loud, and I’ll say why this is relevant in a moment.
We don’t know the learning history for that particular little baby, but it does illustrate that we’ve got to be really careful what we associate our beds with and if we’re used to waking up at 3 a.m. and eating ice cream, guess what? We’re going to start waking up at 3 a.m. hungry for ice cream. So, whatever we’re conditioned to, we do have the opportunity to try to treat ourselves away from that conditioning.
So let me cover just a couple more things. This is for insomnia. This is something I would prefer you — if people have insomnia — to be able to get this from a provider, but it is a set of principles you can try on your own, too. One is to go to bed only when sleepy, but here’s a couple of caveats that’s respecting that we all have to do some things to help us to get sleepy at about the same time every day, and for some people, we’re not going to get sleepy until we’re in darkness, and then to use the bed ideally only for sleeping, even sex. Now this is, I know this really strict and almost no one sticks to this, but if you are going to be treated for insomnia, we would suggest this, for just a short period of time, because what we want to do is re-associate the bed with falling asleep, as a place that’s calm, comforting, and we can fall asleep, and we repeat all of this as often as necessary.
I skipped an important point. If we’re unable to sleep in about 20 minutes, not watching the clock, just based on your felt sense. Remember the clock really gets in the way of sleep and during that 20 minutes, this isn’t a time to go to work, do email, do your housework. It’s a time to be calm, to be comforting, to be in dim light condition, get up until sleepy, and then go back to sleep. And also, the recommendation here is to awaken at the same time every morning, regardless of the total amount of sleep. And during the period where you’re getting this treatment, to not nap would be the ideal recommendation. Now naps, we say, if you really have to have them, have them before 3 p.m. and only for 20 minutes because naps longer than that will discharge the homeostatic pressure to sleep.
Now, I’m going to skip that. I want to get to this. With sleep, we are always looking at eight plus tweaks. When people come to us, and our therapists are first getting trained with us, they say, “Oh, I think I’ve found the one thing, it’s the television.” It’s never one thing. It’s tweaks, it’s eight plus tweaks. Here are some checklist items here. Cut out checking the clock. It’s a source of bright light and arousal. Cut down on caffeine. So, folk with delayed sleep phase problems, if you’re a night owl and you’re a happy night owl, fabulous. There’s nothing wrong with that, but if you’re a night owl and you’d like to bring your bedtime forward, cutting down on caffeine can really help you get sleepy earlier. We all metabolize caffeine a little bit differently.
Cut down on alcohol. Some people at this anxious point in the world actually need to almost cut out caffeine and almost cut out alcohol. Have regular bedtimes. I can’t underscore this enough. Even more important is regular wakeup times. Accept that a poor night of sleep is going to happen. This is a very anxious time and it’s okay for that anxiety to come through and it affect our sleep. Don’t let anyone tell you that, “This is a disaster, you’ve got to be sleeping for blah, blah, and blah reasons.” It’s just going to make you more anxious. We’ve got to accept that we’re not going to sleep well with everything that’s happening.
Consider the timeframe for your tweaks. It’s got to be a two- to three- to four-week timeframe. So, when you’re trying these eight plus tweaks, don’t expect it to happen straightaway. Romantic lighting at night before bedtime and rid the bedroom of light pollution, whether that’s the black out plans, putting towels over your windows. In the summertime, I don’t think that we need table cloths, just take them off and put them on the windows. Being careful will liquid intake a few hours before bedtime. Now, this is one to consult your physician on, because we don’t want anyone getting dehydrated, but also the more we take in, the more we’re going to have to get up and go to the restroom at night and that does disturb our sleep.
Increase our exercise. We talked about perception and sleep, and misperception of sleep. We so often think we were awake and we were actually asleep, so trust that your body — it might be getting more sleep than you think it is. These vicious cycles of the racing mind are really difficult. Much for these mind cycles are never going to get back to sleep. “I [inaudible] tomorrow, I will get sick,” versus, “It’s so nice to be comfy here. I feel so calm,” and casting your mind to something that’s much more helpful for getting off to sleep again. And so, I can stay until 4:30 p.m. if people have questions, and I’ll go back through the chat as well.
I do want to thank you all for having me here and I know some OLLI members have been participating in one of our treatment studies and I will put into the chat my colleagues for the person who’s doing the coordination for the treatment study that we’re doing. But here’s the thing: It is different doing a treatment with a provider. What we often have is folks say, “I’ve tried that, I’ve tried that, I’ve tried that,” and what we always say is, “You know it might be that we put it together in a unique way, with me as your coach and as your supporter, week by week to individualize this program for you, we might be able to make more progress,” and usually we find if people come with an open mind, even if they’ve tried a lot of these things, it can really be so helpful. So thanks, Andy.
What should we do when we get up for 20 minutes? Get warm, have slippers, something comforting, our boots, I’m Australia, by your bed, a blanket. It’s nice when we have a cat, I don’t have a cat at the moment, to see if we can pet. That’s got to be one of the most relaxing things ever. But dim light, so it might be looking through a magazine, it might be journaling. If you are going to switch on the television, just make sure that the television’s well back from you and it’s something relaxing. It’s not the time to watch the news or car racing. Something relaxing — reruns, a nature show, these kinds of thing and pre-plan it is really helpful.
You know the sleep changes during the pandemic is a great question, Sarah. I think one of the big things is we don’t have the schedule, so I think we’ve got to impose the schedule on ourselves: regular bedtimes, regular wakeup times. It’s super, super important. Let’s go back here and that’s why we need our alarm clocks, getting in that exercise is really important. Now I’ve seen reports saying that people are getting more sleep. That’s not been my experience. I’m definitely getting less sleep and more anxious sleep, so it might just depend on who you are and how you’re responding to this pandemic. Who knows?
Absolutely, dreams and nightmares are being reported much more commonly. You know, for kids with a different school schedule, no early start time, I think it has been super helpful for them.
Here’s a great question from Karen, so if you are a night owl and you want to treat yourself, what you do is you bring your bedtime forward and your wakeup time forward, by about 20 minutes to 30 minutes each week. Keeping a sleep diary really helps, too, with if you can’t reduce some sort of intervention on yourself, but backing up your bedtime really slowly and just checking this list here that I’ve got up on this slide, because making sure that you’ve got all your tweaks in to give yourself the opportunity to go to sleep, so caffeine probably has to finish much earlier.
Oh, this one’s super important: Napping in front of the television at night feels so good, but it’s a disaster to sleep. This cocktail, a nap before bed, some alcohol, and too much caffeine in the day — you’re pretty likely to have early-morning wakenings, those 3 a.m. awakenings, find it hard to get back to sleep again. If you can knock out that nap in front of the television at night, knock down alcohol and caffeine, I think you’ll find a pretty big difference with your sleep.
So, thanks, Claire, so caffeine, everybody’s different. Some people have to cut off before 10 a.m., some people have to cut off at noon, some people can go through at 2 p.m., but here’s the thing, it has a really long half-life. And so, you can fall off to sleep because there’s enough homeostatic pressure to fall off to sleep, but then you’ll wake up in the early hours of the morning because the caffeine’s kicking again as the homeostatic pressure to sleep is wearing down. Now alcohol, it’s more reducing the amount of alcohol. Dinnertime would be a good place to cut off alcohol, if you do need to have alcohol. I mean alcohol’s so nice, isn’t it, but reducing it as much as possible. No cutoff time for food. We don’t want a big heavy meal going into bed, because our bodies will prioritize digestion over sleep.
So, let’s see, other questions that I haven’t got to yet. Yeah, thanks, Richard, great question. I don’t know anything at all about these different substances. I should. It’s pretty common. Here’s the thing: We do work a lot with substance use in community mental health settings and I’m dredging up some memories here. What I remember from that is that … I haven’t got the slide here, I often do … is that every single substance we take in has an impact on sleep and so, usually it depletes one or more of the sleep architecture stages that I showed you earlier, and different substances impact different stages. So just check, which of the stages of sleep is it going to impact because what that means is that if you come off a substance that has been, say, depleting rapid eye movement sleep, that is once you stop taking it, you’re going to get a big rebound in rapid eye movement sleep or REM sleep and guess what? That doesn’t feel that good.
It actually feels like you’re awake all night, that REM rebound, because REM is where we do our dreaming, so it can actually feel like you’re awake. It’s another stage of sleep that’s really hard to perceive as whether it’s sleep or whether it’s awake.
I want to go back and check if there’s some other quick ones that I can answer and maybe be … Oh, hypersomnia is sleeping a lot. So, checking out why we’re sleeping a lot with a physician, sometimes we’re on sedating medication, and talking to the physician about whether they can be changed at all. If it’s nothing physical, biological, some people do need more sleep. There’s individual differences in sleep need, but shouldn’t be going above eight, eight and a half hours. Ideally, these bodies of ours do need to get up and move, and so what we tend to do is get people to keep a sleep diary and to start setting goals for reducing the amount of time they’re in bed and the amount of time that they’re asleep and so that they’re getting better quality sleep for a shorter period of time.
Okay, well, we’re coming to the end of our hour together. I’m just going to see if I can spot maybe one more question here, and so Laurie asked a great question: Why is it we have these nocturnal wakenings in the early hours of the morning here? These are stages of sleep that are lighter, they’re easier to wake up out of. This is also… we’ve been in bed for a period of time, might need to go to the restroom at that time, as well, and then when we go back to bed, our minds are overtaken with anxiety maybe or like, “I really want to get back to sleep kind of thoughts,” which also make it difficult to get to sleep.
So, Susan asked a question about night terrors. You know, night terrors, nightmares, bad dreams, these are all part of our lives at this point where we have such challenging lives that we’re watching unfold, everything on the news and now if someone’s having night terrors a lot, it is a good time to and see a sleep doc. Little kids have a lot of sleep terrors that they just grow out of and us as adults have them, too. But if we’re having them really regularly, it’s a good thing to get a referral to a sleep medicine doctor.
So at this point, I think I might hand back to Susan. Is that right, Susan, or do we just say goodbye? I’m not sure, I’ll await instruction.
Susan Hoffman: Professor Harvey, thank you so very much. This information has been timely and for some of us, urgent information and so wonderful to have the practical tips that you’ve given us. We can’t thank you enough for all that you’ve provided and I know that if we had a round of applause, we would give it to you and we’re really thrilled that we do have OLLI participants working with you in the research arena and I know that as you’ve mentioned, that you will be again looking for people, probably sometime in the fall. You had mentioned to me earlier, in October.
Allison Harvey: Yeah, that’s right. I’ll put the email for the project coordinator in here, so if people are feeling inspired to work on their sleep, do email Heather and say that you’re interested. Thank you, Susan, for the kind words and thank you to everyone for coming along today. It’s a real pleasure to talk.
Susan Hoffman: Okay, thank you.