Program: How to win the battle for better sleep

Sana Qadar: I guess it makes sense to start by asking How was your sleep last night?

Melinda Jackson: My sleep was not too bad. I practiced what I preach and yeah, I got my full seven hours, so I'm pretty happy this morning.

Sana Qadar: Yeah. Oh, my God. Lucky you. I can't say the same for myself. I did the classic thing where the second my head hit the pillow, immediately my brain, like, pulled out its top hat and started like, tap dancing away on all the things stressing me out. Or one thing in particular. And yeah, an hour and a half later I was still awake. It was so frustrating. But this is this is a really common thing, isn't it?

Melinda Jackson: It is extremely common and it's actually quite natural.

Sana Qadar: Ah, sleep. So necessary, so elusive sometimes.

Stan Rodski: 3 to 5 of every ten people. You've just tapped them on the shoulder and say, How did you sleep? And they will say, on a scale I didn't sleep well or it was below average.

Sana Qadar: If you count yourself as one of those people under-slept and irritable with a brain that just won't shut up before bed. This episode is for you and it's definitely for me. This is all in the mind. I'm Sana Qadar. We're going to run through some tips for better sleep, things you can do from the moment you wake throughout the day and just before bed. Beyond the standard, "don't look at your phone at night". Today, an episode from our archives on winning the battle for better sleep.

Sana Qadar: That scenario I just mentioned how my brain went into overdrive at the precise moment I needed it to wind down. This is so common. It's long been the subject of tiktoks and internet memes. One that's been kicking around for years is a four panel comic showing a brain, talking to a girl in bed, and the brain says.

brain: Hey, are you going to sleep?

Sana Qadar: The girl replies-

girl: Yes, I am. Now shut up.

Sana Qadar: Then the brain says something. Anything, depends on the version of the meme you're seeing, that sends the girl wide eyed and wide awake in bed, presumably for the next several hours.

brain: Hey, are you going to sleep?

girl: Yes, I am. Now shut up.

brain: But think of all the ways you could get murdered. Farts are just the ghosts of our food. A different version of you exists in the minds of everyone who knows you.

Sana Qadar: Does your brain do this? I mean, maybe it doesn't have those thoughts exactly, but perhaps it pounces on the most embarrassing, stressful or annoying thing to happen that day. Either way, Why?

Melinda Jackson: So I think for one thing, we've been able to distract ourselves and busy ourselves during the day with work and activities and whatever we're doing. But at night it's often the first time that we've kind of allowed ourselves to stop and our brains are like, okay, now I can start doing stuff that I want to do, and then the thoughts just come.

Sana Qadar: This is Melinda Jackson, a sleep researcher and psychologist at Monash University in Melbourne.

Melinda Jackson: I think for some people, particularly people who have insomnia, they develop a conditioned response. So it's almost like Pavlov's dogs. When your head hits the pillow, your head, you know, your head hits the pillow. It's like ringing the bell. And this causes our brains to kind of salivate with all these kind of thoughts and worries and seemingly, yeah, as I say, unimportant information. And it's really hard to break that association. That's why insomnia is very challenging for people to to treat.

Sana Qadar: So has my brain potentially made an association between hitting the pillow and lighting on fire?

Melinda Jackson: I think if it happens night after night and it starts to become a pattern, that's when it can those associations can start to build up. If it's happening once in a while. And you know, your brain is just responding to a potentially stressful situation that you're in at that point in time, then, you know, it's it's okay if this is happening once or twice. And it can be frustrating, of course, but as long as it's not impacting on your full night of sleep too much, then it shouldn't become a chronic problem.

Sana Qadar: Right. Okay. So what are some effective ways to stop this from happening, whether it's, you know, an ad hoc thing or a chronic thing?

Melinda Jackson: So in sleep psychology, we have some very basic kind of sleep hygiene tips that we give people, things like keeping a consistent bedtime, making sure you have like a nice winding down routine, that you're not using too much technology which is going to stimulate your mind both through the content that you're reading, but also because of the light being emitted. But there's also a couple of interesting strategies that people have started to look at. One of them is around cognitive refocusing. So apparently there's been a few TikTok posts recently where people have been talking about what they think about before bed. So one TikTok user talked about dismantling his motorbike in his mind and then reassembling it piece by piece while he's lying in bed. And it might be that you think about scrolling through your favourite parkland. And this is what psychologists would term cognitive refocusing therapy or cognitive distraction. They're techniques designed to change the kind of style and the content of those thoughts to reduce your what we call cognitive arousal. You we're trying to replace unwanted thoughts with more pleasant things.

Sana Qadar: Right, yeah. It's part of the appeal. The fact that those kinds of things, the motorcycle or the walk in the park, they're not emotionally charged.

Melinda Jackson: Exactly. And in fact, there was a research study that that looked at this technique in people with insomnia and they actually trained them up to do this technique. And so they actually had to think about, you know, a topic that was able to maintain their attention. It had to be compelling and engaging enough for them to think about before they go to sleep. But the second important factor is that it wasn't emotionally arousing. You know, it couldn't be something that was really negative or exciting or worrisome. It had to be fairly neutral.

Sana Qadar: So what's a good way of figuring out what that thing could be for you then? Like, i.e. me, How would I narrow down on what's the neutral thought I should have before bed?

Melinda Jackson: It's really up to you. It's up to the individual about what is something that you are really drawn to. So it might be something like redecorating a room in your house or if you're a football fan, you might mentally design plays for various game circumstances, for example, or thinking if there's like a particular Netflix show that you're interested in coming up with a new ending for for one of the episodes.

Sana Qadar: That's interesting. That all sounds like quite involved, actually. And but that would work still.

Melinda Jackson: It potentially could as long as you don't get start ruminating on that that thought content, of course.

Sana Qadar: Okay. What do we know about how many of us struggle to get good sleep?

Melinda Jackson: So there was a report from the Sleep Health Foundation a few years back, and they found that nearly 40% of Australians experience inadequate sleep. So,

Sana Qadar: Wow, that's huge.

Melinda Jackson: Four in Ten. Yeah. And you know, there's a range of reasons for this. Some people obviously have a clinical sleep disorder like insomnia or obstructive sleep apnoea. So we think around 1 million Australians have one of those disorders. So that's obviously impacting their sleep. Around 2.5 million have health problems that affect their sleep. So things like chronic pain for example. But then there's more than these numbers. There's 3.8 million who routinely fail to get enough sleep because of their own schedules, etcetera.

Sana Qadar: Wow. So like lifestyle factors.

Melinda Jackson: lifestyle factors. And as I say, it's these competing pressures of work and social life and family activities. But really, the vast majority of people are just not making time for sleep.

Sana Qadar: Part of the problem is we don't sleep like we used to. These days, the general expectation is eight ish hours in one block overnight. At least in non siesta observing countries like Australia. But that's not how we evolved.

Stan Rodski: The brain is actually set for a very different world 100,000 years ago where you didn't just tuck yourself away for a number of hours and wake up pleasantly, at the end of it, you were alert for whatever might come after you. We would have repeatedly woken up to quickly observe that we're still safe or whatever it might have been going on, and you can see that in the patterns.

Sana Qadar: This is Stan Rodski. He's a neuroscientist and author of The Neuroscience of Excellent Sleep. And the patterns he's talking about are the approximately 90 minute sleep cycles we all run through.

Stan Rodski: We come in and we go and we go deep and we come out and we go back in and we go deep. But they get shallower and shallower as the night goes on until the need to wake up, of course.

Sana Qadar: So these cycles are why many of us wake up at various times in the night. It's actually a pretty normal thing, which is very welcome news to me because I always thought there was something wrong with me that I would spontaneously wake up at 1 or 2 in the morning and then sometimes struggle to fall back asleep. This explains everything.

Melinda Jackson: Yeah, it's important for people to understand that, you know, waking up 1 or 2 times during the night is very normal. You know, we actually that's what we would expect to see. As long as you're able to fall back to sleep, you know, within a reasonable time, then that is a very normal sort of pattern. And in fact, in this pre-industrial times, we actually saw that a lot of people had what we call split sleep schedules where they would sleep for a few hours in the early evening, then they'd wake up in the middle of the night and do some activities. They might go and chop wood on the line under the light of the moon and and do other things and maybe even socialise. And then they'd go back and have a second sleep in the second half of the night. So there's actually evidence of, of these types of schedules happening back in those historic times.

Sana Qadar: Yeah. Why would people do that? Why was that the way sleep was organised?

Melinda Jackson: I guess because they didn't have any lighting, you know, So they, they were just governed really by the sun. Right. And so, you know, when it was dark and when it was light, well, that's when you, you know, would typically be awake and asleep. But I think people found that they had these sort of awakening periods. And instead of just lying there and getting frustrated, they would would get up and there'd be a lot of social activity happening. And I think since the Industrial Revolution, then that's when we've started to see things like insomnia and and these kind of clinical conditions come about, which weren't really such a big issue before then.

Sana Qadar: And if you add to that the prevalence of light exposure at night these days, stressful jobs, technology, phones in bed, TVs in bedrooms, it's no wonder so many of us struggle. So let's talk tips for better sleep now. We've covered some briefly already, but we'll get into more detail here. And some of these might seem obvious, others less so. Melinda's number one tip for getting better sleep is one you've probably heard of before, but possibly also ignored.

Melinda Jackson: I think the number one tip is about trying to regulate your circadian timing as much as possible. And so we really recommend that we go to bed and wake up at the same time every day or, you know, give or take 15 minutes or so, try and be as regular as possible. That's a really great way to kind of try and start to regulate that circadian timing.

Sana Qadar: Your circadian rhythm or timing refers to your body's internal clock. And even though keeping a regular schedule isn't always achievable, here's why it's so effective.

Stan Rodski: The brain is seeking patterns, and it doesn't do that because it has a little sort of library it goes to and thinks, What do I like and dislike? The brain seeks patterns because it is its most efficient energy use. If it's got a pattern, it can do things easily and quickly. It can use the least amount of energy to make things happen. And that's why we have habits. We don't seek habits, but the brain wants habits because it doesn't have to think twice about it, doesn't care about whether it's a good habit or a bad habit. That's a decision that occurs in the emotional parts of your brain, and that's a whole different. But at the energy level, being able to be in schedules for sleep are so important.

Sana Qadar: Okay, so say you've stuck to the same bedtime, but still you're struggling to fall asleep. We've talked about how cognitive refocusing can help. That's building a motorcycle in your head like that one Tiktoker Melinda mentioned. Here are some extra ideas for drifting off the brain.

Stan Rodski: Communicates with the outside world via its senses. There's no other way in or out of there. So if we can actually think of improving sleep as improving anything we can for our senses, one of the therapies that is talked about a lot and there's some good science behind all of these, but just the aromas sort of therapies, the the smell can be quite inducive of sleep or being awake. Coffee.  That's unlikely to induce you to sleep. Whereas the smell of some form of the vanillas, for example, are a very conducive of sleep.

Sana Qadar: Right, so there is evidence of that.

Stan Rodski: There is absolutely evidence of that. Now in and of itself, it might not impact you hugely, but think about the edges. Where you're trying to fall asleep, you know, is a place where you can lose an hour easily in the process. So I'm talking about in those edges and you've also got the sounds. There's a lot of work going on with sounds at the moment. And you know, the calms and the oceans and the what have you. But I particularly like the science behind the the binaural beats, you know, putting different levels of of beat into a sound in two different ears does show itself in evidence to in fact create the sort of brainwave that is induced in sleep.

Sana Qadar: That's really interesting because I feel like a lot of the ads I get on my Instagram and other social media are for these sleep apps that have binaural beats or, you know, white noise, alpha waves, all of it. And I have wondered whether that's that's a thing that does actually help and have evidence behind it.

Stan Rodski: It does help and there is immense evidence around it. Having said that, there's so you got to find the right you know, it's like everything here, anyone can throw anything together. It's got to be careful. And we're just beginning to understand a multitude of other effects which are good effects.

Sana Qadar: Yeah. With the binaural beats and sort of the sound stuff you can do to relax yourself. Is that the same as aromatherapy in that it makes the biggest difference in that last hour where you're trying to get to sleep?

Stan Rodski: It is absolutely right. Yes.

Sana Qadar: Okay. That's very that's very handy to know because I do feel like I'm the kind of person that spends about an hour tossing and turning before I finally drift off.

Stan Rodski: Absolutely. And if there's a thought that's really running through, you've just got to get up. I often say, look, if you're not asleep in 10 to 15 minutes, get up and do something boring. You know, don't do something to activate everything. Don't go to the fridge. Don't go to the smokes. Don't go to the grog. Don't do any. Don't do anything that your brain gets a reward for.

Sana Qadar: What's a boring task you recommend?

Stan Rodski: Well. Well, in my case, it would be reading a golf magazine. And I can assure you, by the third page, I'll be. I'll be ready to. Okay. If this is my alternative, I go back to bed and I'm off.

Sana Qadar: This same approach works if you find yourself wide awake in the middle of the night as well. Note to self, the key, Stan says, is by keeping what you're doing boring, you're telling your brain there is no reward in being awake. That's why scrolling on your phone doesn't count. It's too stimulating and rewarding for the brain. Okay, so you've slept through the night. You maybe had to wake up, but you've managed to get yourself back to sleep. Now it's morning. Turns out you can prep yourself for better sleep from the moment you wake up just by helping your circadian rhythm regulate. And to do that, you need light.

Melinda Jackson: Just go straight to the blinds, open up your blinds, get some bright light, or go outside for a walk. Walk down the street and get your coffee. Just making sure that the natural light is hitting your eyes. And that helps to regulate the hormones like melatonin that really, you know, the key signal for our brain that it's day and night. So bright light in the morning is really important as well.

Sana Qadar: If you want to get more detailed with your morning routine, here's what Stan suggests.

Stan Rodski: You know, do some certain exercises at the extremities. You're just wiggling your toes and fingers. That actually activates all the neurones in that band across the top of your head between your ears, which is all of your controllers. You get those neurones going first and watch how quickly you come out of the sleep and you'll feel more refreshed.

Sana Qadar: Then there are things you can do during the day to prime yourself for better sleep. Stan recommends giving yourself minor breaks throughout the day, and one way to do this is the 20, 20, 20 exercise.

Stan Rodski: No doubt that through the day the brain does benefit from having periods in which we can rest and the 2020 is right. Now, you know, any of your listeners or yourself, you can literally look up from what you're doing, find something that's 20m away, focus on that for 20 seconds and relax for 20 seconds. As part of that process and this really stops your brain from continually processing. And so if you give it an opportunity to rest through the day, you're more likely to sleep better at night.

Sana Qadar: And if your idea of rest during the day includes a nap, here is the optimal way to do it.

Stan Rodski: Cannot be longer than 30 minutes and is best between 2 and 4. If you need it. Don't nap, if you don't need it, it's, Have a relax, do the breathing, do the 20 2020. But if you need a nap then 30 minutes will allow you to get into that sleep cycle just enough to get an incredible benefit. You go for 35 minutes and your brain will want you to finish the 90 minute cycle.

Sana Qadar: What if it takes you forever to fall asleep, though?

Stan Rodski: Well, this is part of that that process whereby using some of these relaxation techniques can be a good entry point into that.

Sana Qadar: Right.

Sana Qadar: Then at night, if you've got your wind down, routine lights are low, you stay away from technology just before sleep. Here is why a bath can help.

Stan Rodski: Temperature. Your body needs to drop from 37.2 down to 36.7 and it can go down to 36.5 and it's going to go up and down through the night. But in that initial phase, that's why a bath works so well before bed to induce a sleep. Because because it's not the bath. It's that your body temperature drops after the bath. Right. And then getting into bed, that actually helps you fall asleep.

Sana Qadar: For people who work shift work or who have young kids. I'm putting myself in the young kid category. Are you basically just like screwed for the duration of the time you're either in that job or your kids are young? Like, there's no way to really help your circumstances and your circadian rhythm there.

Melinda Jackson: Of course, with shift work, it's a completely different story and it's just about trying to manage your sleep opportunities during the day and when you can, making sure that your bedroom is nice and dark, that family members are respectful of your your need for sleep. But shift workers are notorious for getting less sleep. And so trying to counter this with some naps before shifts like I was talking about with the split sleep schedules. So getting seven hours, if it's broken into a five hour block and a two hour block is just as good as getting seven hours straight, for shift workers.

Sana Qadar: Yeah, that's good to know. Okay. And then those of us with young kids, young kids,

Melinda Jackson: I've been through this, too, and it does get better. Look, I think, you know, obviously there's times in our lives where things are very disrupted. You know, it's really challenging for carers, whether you're caring for young children, whether you're caring for people with a chronic condition or even dementia, where these people are you know, individuals are waking up a lot during the night and that's disrupting the carers sleep as well. And this is a really, really big issue in our society and a lot of the research that we're doing at the moment is around carer's sleep. You know, you just need to try and create an environment for when you do have a sleep opportunity to make sure you're getting the best chance of falling asleep as quickly as possible.

Sana Qadar: Yeah, yeah. And the carers point brings me to actually. Tell me about like the impact that stress has on sleep, because we talked at the beginning about how, you know, my brain last night was ruminating on a stressful thing in my life, but when we're in a stressful period of our lives in general, like, why does that impact sleep so much?

Melinda Jackson: Yeah, it is well established that stress and sleep are intimately connected. And interestingly, there's a lot of overlap between the neurochemistry and the neural networks that are activated during the stress response and the same networks that regulate our sleep as well. So you can see that there's actually a very strong neurobiological reason for this link. And indeed, stress is considered to be the major precipitant of insomnia in most cases. We think that a psychological mechanism underpinning the link as well is this rumination idea. So the rumination was most likely going to occur at night when our minds are, you know, free to wander. And this is really thought to be the mechanism for poor sleep related to stress.

Sana Qadar: At what point should a person consider getting help if they're struggling with sleep? Like what's the threshold for, actually, this is getting more serious and I might need help.

Melinda Jackson: Yeah. So if you've been experiencing a sleep issue for a number of months and you've tried a few different strategies yourself and it's not improving. And I think the third factor is that is actually impacting on your daytime functioning. That's the time when we need to probably go and speak to someone. And I think a lot of people feel that if they go to their GP, they'll just prescribe sleeping medication. But there are also cognitive behavioural therapies for insomnia and they can give you some really helpful cognitive strategies to help with things like rumination. And sometimes we just have these dysfunctional thoughts about our sleep as well, like we must get eight hours or I won't be able to go and do that presentation tomorrow. Yeah, like this black and white thinking is not conducive to to good sleep. It just makes us more anxious.

Sana Qadar: That's interesting, the anxiousness about sleep, because I've definitely had points in my life where I have fallen into that, where particularly when I was working in breakfast news, you know, I was waking up at 2 a.m. or 4 a.m. and so I got very anxious about falling asleep. It's like I would become so anxious about the sleep that I actually would spend a huge amount of the night just worrying about getting to sleep. You know, It was completely counterintuitive.

Melinda Jackson: Yes. And this is one of the biggest problems, really. Like it's a vicious cycle. And so there's a couple of things that you can do there. The first is really just trying to say to yourself, look, I've been doing breakfast radio every day for the last three months and, you know, I have some mornings I feel great, but some mornings I don't. And I still perform just the same. The audience doesn't know, I'm still able to perform and it just helps you to let go of that, you know, Oh, I must get this sleep or I'm not going to be able to perform tomorrow. The second strategy is kind of interesting. We call it paradoxical intention, and we actually get insomnia clients to go to bed and try not to sleep.

Sana Qadar: Oh, wow. That's amazing.

Melinda Jackson: And so for some people, that's kind of. A good strategy and it works. And that's so many, you know, so many different.

Sana Qadar: Reverse psychology.

Melinda Jackson: Exactly. Yeah. Right.

Sana Qadar: Yeah, That's brilliant. Okay, we'll try that next time I struggle.

Melinda Jackson: Different horses for different courses, you know?

Sana Qadar: Um. Do you get hassled for sleep advice at parties like a doctor might for a medical advice? Like, is it your party trick.

Melinda Jackson: All the time.

Sana Qadar: Amazing.

Melinda Jackson: All the time.

Sana Qadar: What's your number one tip you dole out or what do people ask you?

Melinda Jackson: A lot of people, some common things recently have been around melatonin use. That's a big one. Um, but yeah, just about you know, people like to talk about how little sleep they're getting and how bad their sleep is. And, and it's just I'm always curious about what's their definition of bad. Yeah. And you know what I think, I think sometimes we can catastrophize a little bit about our sleep. And of course that's going to make things worse

Sana Qadar: Oh my gosh, that's me. And just on melatonin, because you raised it briefly, yay or nay. Thoughts on that?

Melinda Jackson: Look, it has a place for for some people, if you've tried other things and they haven't worked, it's a good short term strategy. You know, it's not recommended for longer term use. And I think it always needs to be an adjunct to some other type of behavioural therapy as well. Right? We can't just have a crux of melatonin, but it's great for things like jet lag and shift work and regulating our circadian rhythms, which is very different to when people take it to try and fall asleep because that's not really, you know what it is in our body for.

Sana Qadar: Okay, perfect. Finally, for people who are listening, who whose attitude to sleep might be, you know, a bit cavalier, I'll sleep when I'm dead. Why should they care about prioritising their sleep? What's your parting advice?

Melinda Jackson: I think that, you know, sleep is just so fundamental to all elements of our health and well-being. And it might be that you're able to cope at the moment with getting only 4 or 5 hours of sleep and you're fine the next day. But sleep is also a risk factor for some forms of cancer, cardiovascular disease, diabetes. But more importantly to me is the risk of later anxiety and depression. So not to be too dramatic. You know, I'm not saying everyone who gets five hours of sleep is going to get depression, but I just think that we need to really use it as a health tool and a performance enhancer to not only help us at the moment, but for our future well-being.

Sana Qadar: Right. Okay. So don't catastrophize, but don't be careless either.

Melinda Jackson: Exactly. It's about a middle ground.

Sana Qadar: That is Melinda Jackson, sleep researcher and psychologist at Monash University in Melbourne. And you also heard from Stan Rodski, author of The Neuroscience of Excellent Sleep. And that's it for All in the Mind this week. Thanks to producer Rose Kerr and sound engineer Ann-Marie Debettencor. I'm Sana Qadar. Thanks for listening. I'll catch you next time.