keep this to yourself. Stephanie,

the first question I wanted to ask you, and I've got millions and millions of questions to ask you, because this is a topic which, as I said before we started chatting on air, has really piqued in interest over the last three years. I've never had so many of my friends in my sort of close circle ask me questions about sleep, send me articles about sleep. And I don't know what's happened, but as a nation and as a species, I think we've got really, really curious about this idea of sleep and also its importance. The first question I wanted to ask you was how important sleep is. But I think a better way to understand that and the answer is to actually look at the consequences you've seen in your line of work for people that have bad sleep or that have insomnia. So could you speak to that a little bit? I

can. That's a big, big question. What I have seen over the last 16 years of my career is not people coming in dying because they aren't sleeping or uh with really really significant illnesses i've seen people very anxious very stressed very low because their sleep is poor and they are extremely worried about it and i've seen people who are know, at the top of their game and doing really well in life, but are completely crippled by these sleep problems. But it is the fear of bad things, worse things happening to them that is keeping them as stressed and upset as they are. So it's quite interesting because I think the things that bring people to me to get their sleep treated are exactly that. That fear is actually what I'm trying to alleviate rather than fixing their sleep because I think they're going to get so sick that something terrible is going to happen to them. So it's a really interesting question to ask. How does sleep affect us? The reality is we actually we or why do we sleep? We don't know actually why we sleep. We know what happens when we don't sleep but i think we're getting very very confused between those of us that struggle with sleep and those that are actively depriving themselves of sleep like the ceo who says i'll sleep when i'm dead for example sure um you know those of us who are actively trying to sleep when we can't and we will do anything and we we we make our sleep opportunities larger and we still can't get sleep we're not depriving ourselves of sleep we're doing anything we can to get sleep so I I worry about the amounts out there about sleep at the moment and the way that it's the information is being disseminated because I think that's where we're going a bit wrong and all the tracking of sleep and all the tech that comes out i'm not saying it's it's a bad thing i'm just saying that it's almost like we haven't quite caught up with all the information that we have and we can't cope with it quite the way we need to

so you you about the tech that we have now, Apple watches, all these smart devices that are telling us how many hours a day we're sleeping. And also there's, you know, books, there's probably a couple of books on the shelf behind me about the perfect night's sleep or the perfect morning routine or the perfect time to wake up. Where is the bullshit? Oh,

my God. Again, another massive question. There is so much of it. It it's all it's so nuanced you're going to have to ask me some specifics because there is so much there that actually is i mean well the first thing the biggest thing i would say is you know going to bed at exactly the same time every night dictating your bedtime is probably the worst piece of advice i've ever heard and sends people off on all sorts of different tangents which does not help if anything it makes their insomnia is worse because they go to bed in the dark not able to sleep getting more anxious heart rate going up what

should they do instead stay

up until they're sleepy don't worry about it enjoy yourself relax do the things that you probably don't get time to do because you're busy doing all the other things during the day.

Is the problem I have with that approach, which is the approach that I think I've adopted maybe a little bit too much or incorrectly, is if I stayed up doing the things that I want to do, what happens is I'll stay up till 7am just looking at YouTube videos and learning about rockets and looking at like stocks to invest in and stuff. That's that's me to a T. I at some point have to put my laptop down and be like, Steve, just you're going to feel awful tomorrow if you can. I'm looking at this investment fund that you think is interesting.

Yeah, absolutely. To a degree you can. I mean, we can manipulate our bodies to do anything in a lab. I could manipulate your body to sleep when I wanted it to sleep. But that's taking away all the environmental factors, all the behavioral factors of your life. And what you're doing now, you know what, it's not the end of the world. You know, you're obviously coping with it and you're healthy. The problem is you probably won't be able to sustain that. And unfortunately, we are built in such a way that kind of goes with the light dark cycles on this planet. And so to a degree, you are sort of going against that and unfortunately we've got lots of other we've got lots of research showing that after a while you just can't do that forever without implication um so it's not i mean if you think about it insomnia is just a different pattern of sleep you've just trained your brain to sleep differently and you're still surviving with it it's just that most of us don't like that because it's not the rest of society in the way that they're sleeping. Um, and our friends are sleeping and, and it feels like we're the only ones awake in the night. I bet if you didn't have all those things to do and you weren't the way you were and you were up at night and everybody else around you is asleep, it would start to feel like a very lonely, um, anxious place. We're not very rational at night. We're not really made to think in the middle of the night. So we're not incredibly rational. So I don't think it's the end of the world what you're doing. But at the same time, put it this way, I treat a lot of entrepreneurs when they've retired and they're still fairly young, but not in a good place because they have not followed anything that was fairly going along with what our physiological processes want to do. Our bodies are all about regulation. We have clocks in every cell, in every part of our body, and they like regulation. They like time. They like the timing of things to be ready and regular. And when we keep changing those goalposts, it might seem like we're being uber flexible. but actually the reality the reality is is that later on down the line you'll probably find that you won't be able to cope with it as much and

how how does that manifest itself for me so so

for you if you just carried on the way you were then unfortunately yeah we probably would see that um maybe you were getting less sleep than you needed um it probably would be harder for you maybe when you settled into a routine where you were working around the same hours every day. Say you got a certain kind of role that you had to do, which made, you know, you had to have a certain schedule. You might find it quite difficult after a while to stick to that schedule. You might find that you aren't able to sleep as much as you want. The duration and the quality will be impaired. And so you might start all the research around sleep and how important it is for you. You might start noticing things like your cognitive abilities are less. So your memory, things like that. to produce cytokines so the proteins that help us with keeping ourselves healthy and keeping inflammation at bay and things like that all those kind of things will be reduced your healing so when you go and weight training or something like that or you go to the gym and you want your muscles to repair they're not going to be able to do that so well and of course that over time short term it's not a problem over time long term that's when we start worrying about more significant illnesses and disorders that are happening as we get older. And so that's why we see lots of research showing that as we get older, maybe some of these things like Alzheimer's might be related to how we treated our sleep when we were younger. However, I hate it. I hate things like that because I think it frightens people. And the problem is with frightening people is that they go into what they think is most logical things to do. So they might go away after this podcast and think, oh my God, I've just got to go away and get my eight hours because the rest of the information is telling them out there that they've got to get this eight hours of sleep every night. And of course they can't just get that you can't dictate to your body how it sleeps there is a process it follows it and so unfortunately you can never force yourself to sleep you can force yourself not to sleep and that is partly how you fix a sleep problem but you can never force yourself to sleep but you can induce anxiety and stress and depression through that and lack of sleep so yeah in

um if you're an expert in this field so you must as you kind of spoke to there you must get pretty i can feel it when you're speaking get pretty pissed off when you see unhelpful information um being pushed on i don't know social media or online or through books these sort of simplified narratives what are some of the most um common misconceptions that you speak to your patients about you mentioned one there about this like eight hours of sleep being the optimal yeah and even when i put out on my instagram earlier what are the key questions you want to ask um i'm speaking to a sleep therapist expert today um i'd say the vast majority or at least the medium question was uh do i need to get exactly seven or eight hours sleep every

single night yeah um yeah so that is definitely the biggest one we get um you do not that perfection is the enemy of the good have you ever heard that term because at the end of the day it's true yes your body loves consistency and regulation but that does not mean you have to get eight hours of sleep every night. Think about it differently. Think about it over a month, for example. We love this idea of the way we look at time is slightly different to the way your body looks at time. And over a month, you might actually be all right. So maybe one night you get six and a half hours. The next night you get seven and a half. And then the next night you might get slightly different. As long as it's fairly consistent and maybe 80% of the time you're doing fairly well and you're giving yourself the right opportunity to sleep, that's okay. Your body's going to do, you know, it will do what it needs to do. And with that, a caveat to that is this understanding of sleep debt. So we don't understand sleep debt properly. People think it's an eye for an eye. I lose four hours, I must gain four hours. Well, what happens when your body, being as efficient as it is, doesn't actually need you to gain an extra four hours of sleep to recover you. Your expectation is that it should. And when your expectation doesn't get met, you get upset about it and you change your behavior. And that's when you start getting sleep problems, when the reality is your brain is so smart that even in the certain amount of hours that you get normally at night, it can recover you from that sleep deprivation by just improving or increasing the sleep stage that it thinks you miss the most, for example. But because we have a lack of education, we believe we don't get some sleep, we need to regain that sleep. And when we don't regain that sleep, that's when the anxieties and the stresses over not sleeping start. So that's a big one, the sleep debt one. The other one is this idea that fatigue and sleepiness are the same things so yes when we don't sleep well we get a lot of fatigue so fatigue is anything from feeling like your body needs to rest to needing to shut your eyes to pain to your brain buzzing because you've been working so hard for like 48 hours straight and you don't know what to do with yourself but the only definition of sleepiness is the ability to shut your eyes and within a few minutes you're falling asleep so if you were saying to me right now Steph I'm so so sleepy I'd probably say to you well you don't look it because right now you don't look tired in the way that I would expect you to be falling asleep I mean you wouldn't be able to sit still you you would be sort of probably your eyes would be shutting all the time, dozing off, having little micro sleeps, that sleepiness. And that's what we should really be understanding as a cue to sleep. So in the evenings, if you're not feeling that, then don't be worried. Give yourself permission to stay up later you can't dictate what happens to you during the day and there are so many variables that affect your sleep you are never going to be able to control over them having good sleep hygiene how many good sleepers do you know have it so good sleep hygiene is all these things that we get told we should do so the 10 top things that you should do have a warm bath never drink coffee ever again um never have alcohol you know all these things that you're supposed to do but if you look at good sleepers are they following all those things no they're not and they're still sleeping really well and that's to show that most of the time sleeping poorly comes down to brain training and the patterns we get ourselves into you start going to bed early you might be able to get to sleep earlier but you're probably not going to be able to uh have that sleep all the way through the night because at some point or another your body's going to be like well you've had enough now but your expectation is you should be able to sleep till seven and why didn't i sleep till seven or if you lie in you keep changing the goalposts of your wake-up time which is the most important thing that you should be looking at not your bedtime um if you keep changing that goalpost your body doesn't know when to feed you it doesn't know when to make you feel alert because you've changed everything and so of course you're not going to be sleepy at the right time in

the evening the time you wake up is the the much more important time to be focused on yes

the things your morning routine is going to be way more important than your evening routine when it comes to your sleep at night but because people see that as a far away time compared to when you go to sleep they don't really focus on it in fact haven't we been taught in this society that lying in is a luxury i can't believe that we have made it okay at the weekend to lie in so much but during the week one of the only things that gets us up is work it makes absolutely no sense to me i'm not saying it's the worst thing in the world i'm not saying i never lie in but i don't use it as a compensatory method for a bad night's sleep because that's when you're going to get into trouble because

that's kind of throwing your your your schedule off is that what you're saying yeah yeah so if you line on the weekends and you're going to pay for it at some

other point yeah why are we not looking you know if you have to lie in so significantly every single weekend why are we not looking at during the week and thinking why am i doing this to myself at the time when i need it the most i will choose to get less sleep and then at the weekend i'll just compensate and

people and you much of the conversation around sleep and society talks about the amount of hours and it's almost like the amount of hours that i was in the bed um what's your sort of rebuttal to that because quality

over quantity every single time every single time and if you have good quality and you need longer your body will tell you and you will get more sleep but people are so obsessed with duration and I think people don't understand what I mean by sleep opportunity I mean every single night most of the time so about 80% of the time I will give myself a seven to eight hour sleep opportunity, sleep window. But I do not mean that if I'm not sleepy, I take myself into a dark room and shut myself down. I just know that it's there. I've got a bedroom, a place I really want to be to sleep that is available to me during those hours. And I will not sleep outside those hours. And that's the that is the big thing is you can dictate to your body when you don't sleep, but you cannot dictate when you do. And by doing that, you will force your body to be in a nice regular cycle. It's actually really, really simple once you know how to do it. And every time I fix someone of their insomnia there and honestly, 50, 60 years of insomnia, they often turn around to me. They're like, I don't know why i wasn't taught this um when i was younger and i do believe if we taught everyone how to sleep properly give them a proper sleep education when they're little i wouldn't exist insomnia wouldn't exist you

talked there when you referenced your own bedroom i think you spoke about it quite lovingly said i have this place i like to sleep how important is that how important is it to sleep in the same place and for that space to be is there a certain way I should be designing my bedroom is there like a bed that's good or like a pillow because there's lots of fads around yeah

yeah there's a lot of fads around I think your environment is important but I can't dictate to you what that is because we're all so different um yes it's true you don't need loads of technology in your bedroom to sleep I'm not saying technology can't aid our sleep because I think in the future we're going to come up with some crazy cool things that are going to really help us I just think right now we're not quite there I think the least you have in your bedroom that reminds you of the day is really important so obviously screens and light is very important when it comes to sleep but i think people miss are missing a trick when when we say don't look at your phones we're not just saying don't look at your phones because of the light exposure we're saying it because it's reminding your brain of something that you did during the day and so your brain being the smart thing that it is is thinking okay well i'll um i'll i'll increase your cortisol and i'll reduce your melatonin, which is your stress and your sleepy hormones. And I'm going to help you be more alert because you clearly want to be alert right now. And so your brain thinks it's helping you. And then you're thinking, hang on a minute, I just looked at my phone for like three seconds and now I'm buzzing. Why? And it's just because your brain is, your behavior is so much more influential on your physiology than you realize. What

do you think about the snooze button?

I think if you have to use it on a regular basis, you need to start questioning why you always need to snooze. Unfortunately, the research shows that snoozing does not benefit us at all. And actually, if you think about it, if you are a snoozer you know how many times does that actually make us feel better doesn't exactly delays

sorry no i i think it's nonsense as well i did i one of my modules when i was doing psychology in school was about sleep and um understanding the different phases of sleep made me realize that the snooze button is i think totally pointless because it's you have to be in a certain phase of sleep for you to get real benefits and within 15 minutes it's impossible to get to that phase right absolutely um a lot of people when they you know when they knew that I was speaking to you today um they want to know how they can sleep better in the short term tonight they're looking for some kind of quick fix to the to a problem they've had for a long time what would you say to those people okay

so the first thing i'd say is that you're never going to find that reactive very quick method it's never going to happen and even if you find it i promise you it won't work in the long term it might control your condition in the short term but not in the long term i can teach you how to read to sleep but it's going to take you a few weeks, not a night. But in the meantime, don't worry. It's OK. Like part of this is I just there is a solution. So what I do is called cognitive behavioral therapy for insomnia. It is not the same as CBT for depression or anxiety or anything else. And it is just about retraining yourself to sleep and building up that strong sleep drive. You have to do that over time um but in the short term i usually tell people that they do not need to worry nothing bad is going to happen to you and the reality is that it's more your mood that will affect your day when you wake up in the morning than the bad night's sleep you just had so i know we've got evidence to show that when you have a bad night's sleep your cognitive abilities etc are going to be reduced however if you think about how you generalize that you're not you're not going to lose your job you're not going to perform horrifically in that meeting because you didn't get a good night's sleep it would be far better for you to go to bed later and make sure you're lovely and sleepy and only get four hours than to go to bed eight hours before that meeting and toss and turn and be fidgety and stressed and anxious all night that's what i do i still get nervous when i have to do like a lecture in front of 500 people of course i get nervous but instead of you know focusing on my notes just before i go to bed i'll put everything aside i'll go and enjoy myself do something i really love to do i'll get ready for bed a bit earlier than usual just so that I do not have to think about anything when I get sleepy and when I am sleepy even if it's two three four hours later than usual I know that I'll go and have a really lovely three or four hours sleep and then I'll wake up and I'll be like great I know I'm going to be a bit sleepy today but that's only going to help me sleep tonight and I'm going to have an epic day I don't care that I'm a bit sleepy sleepiness is amazing sleepiness is such a good thing for you why are we teaching people that sleepiness is a bad thing you need sleepiness to sleep I've

got two questions there the first I'm sure is it feels like a very um related sort of question to what you've just been talking about there which is do you sleep well I'm sure you get asked this all the time at every party every time you it's like asking a comedian to tell a joke right it's like how is your sleep okay

so most of the time my sleep is fairly good because i've been lucky enough to be educating myself through this for the last 16 years but it's not good all the time because it's totally normal after some kind of life stressor, new illness, some dramatic change in our society like we're seeing right now for your sleep to change and for it to be poor. OK, it is totally normal to have sleep problems. We will all get them. You will never find someone who does not have a sleep problem at some point in their lives. but there is a difference between somebody who has a short-term sleep problem and when the initial issue resolves itself the sleep problem goes away and the person who has now unfortunately got a long-term sleep problem the difference is the behavior it is not the person it is not some trait that you have over someone it's not something genetic there are there are all of those things that do feed into for example insomnia but the reality is the thing that seems to perpetuate sleep problems is not usually the original trigger so we cannot blame the divorce for example 20 years ago i'm not divorced but i'm just making an example so 20 years ago we get divorced and it's a really stressful situation and it stops you sleeping for a month okay but now you're remarried and you're perfectly happy but you've got a 20 year insomnia problem we cannot blame the divorce for that anymore and also somebody else who's gone through the same situation same illness or divorce or new medication would not have had that sleep problem 20 years later so what is it and i believe and we know that most of it is your behavior after a few weeks of a sleep problem most people will freak out and they'll start changing their behavior so they might start lying in they might start going to bed early they're trying desperately to improve their sleep opportunity because they believe the mere act of lying in a bed for longer is going to miraculously give them a stronger sleep drive and make them get through whatever it is they need to get through when the reality is and this is usually how we treat insomnia or one of the ways we actually deprive you of your sleep opportunity so we don't deprive you of sleep but we do deprive you of your sleep opportunity so we only allow you to be in bed for a certain amount of time and that fixes it but that's frightening because we're teaching people that sleep is so bad or not sorry not sleep is so bad but sleepiness is so bad that they don't feel that they can build up that strong sleep drive without something terrible happening to them so the way we are disseminating knowledge right now is not working and we have got to find a way to change that you

talked about the type of therapy you offer cognitive behavioral therapy for insomnia. One of the elements you've described is this sleep deprivation, which is in essence, you're stopping people sleeping, I'm guessing throughout the day to focus them on their sleep opportunity.

Yes. So it's less about restricting their sleep and more about restricting their bedtime. So often when you come across somebody who's had a sleep problem for a fair while, enough to come to see me, they're usually spending more time in bed than they are sleeping. So, for example, they might be in bed for around 10 hours, but they're only sleeping for, say, six hours. And so what I would do is I would restrict them in the first instance only. So it's only mildly to six hours in bed because or five hours in bed whatever they're sleeping for i would we would we would never really go lower than five hours because at the end of the day we're only um uh sort of guess it's all a bit of guesswork here um and that's important that it's like that and we're not over tracking sleep because that has its own issues um and then for a week or so i'll keep them on that schedule and try and get them to strictly stick to it which is quite scary for somebody who thinks the total opposite way is going to fix them even though they've got no evidence that it works it doesn't matter they've been doing it for a long time so it's quite hard to get someone to do this and then once we can get them to sleep for around 90 percent of that five or six hours whatever they spend in bed, then we can start increasing their sleep time out very, very slowly. But people sort of get very over eager about this. It's called sleep restriction therapy, or there's lots of different ways of calling it. People get overexcited about it, and they're obsessed with reaching that 90% efficiency, so they can move on and add time. I try to always explain to people, and indeed I do online courses in sleep that they can do themselves, and I'm always trying to explain to them, it's not about adding more time. Imagine if you are getting to five or six hours sleep efficient every night for seven days as an average, that's really good. That's so much better than the broken sleep you were getting before. Think about the new quality that you have built. How amazing is that? When's the last time you went for a week and you had that consistent sleep? And when they start thinking about it that way, they're like, oh my God, yes, this is so much better. And I'm even able to add more time now. And we slowly, incrementally start adding sleep out. And that's how you fix it. I mean, it's not everything because you've got to work on the mindset. you've got to work on the re-educating people. What are those

other pieces of the therapy? So yeah you've

got to, so first of all. One is

the sort of sleep restriction as you called it.

Yeah one area is you've got to be re-educated on sleep much like we've been chit-chatting away today. That's how I will talk to someone and I will try to help them understand. I'll try and pick out a lot of the things that they talk to me about, but it's trying to help them understand where the myths are and where the facts are with sleep. Because a lot of their ideologies around sleep will be directly influencing their behavior. And so as soon as you can change that, and it's not as simple as just saying that's right and that's wrong. You've got to keep doing it and they need to trust you and you've got to find a way and the right language to speak to that person. Once you've done that, you can start with the sleep restriction. And then, of course, whilst there is no evidence that relaxation or anxiety reduction is going to directly and reactively fix a long-term sleep disorder, after you've started improving your sleep drive and using the sleep restriction therapy to do that, then yes, we do need to start looking at how do you bring yourself back to balance during the day? Is it stress and anxiety that got you here in the first place because you're working too much and you got yourself into the wrong patterns? How are you going to process more during the day? How are you going to balance more during the day? We need to look at those things, but we need to look at them with the right expectations which is that they are not going to make you sleep because once that expectation is not met you feel really inadequate and then you feel like nothing can help you and then you get hopeless and out of control and lonely about your problem so all this lots of different sort of elements like a pyramid to try and help someone

with