Why we need to sleep, why REM isn’t the whole picture, and what to do when anxiety keeps you awake at night.

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Everything is worse at three in the morning.

There's that to-do list piling up or that early clinic you've got to make,

or that thing you said to your colleague that you just can't stop thinking about.

These worries just pile up at night and that's on top of that cheeky glass

of wine late at night or that piece of cheese or that doom scrolling when all

you meant to do was set your alarm.

And we are constantly told how important getting a good night's sleep is,

particularly in a high stakes job.

But it's easier said than done, and it does feel like something

we don't have much control over.

So this week in our summer wellbeing series, I'm joined by Dr. Steve Smith.

He's a GP and a self-certified insomniac, and he's developed some training to

help people get a good night's sleep.

Now Steve has worked extensively in the field of substance abuse, and he's

previously been on the podcast talking about the importance of forgiveness,

particularly as a mental health strategy, and he's found some unexpected connections

between substance abuse and sleep, and he's sharing some of his tried and

tested strategies as well as some new and surprising ways to improve both the

quality and the quantity of your sleep.

Spoiler alert is not just about REM sleep.

So grab yourself a hot, milky drink, preferably without any caffeine

if it's after midday, and enjoy this conversation with Steve.

And if you want to start putting his advice into practice, stay tuned

for an exclusive discount on his course, especially for Frog listeners.

If you're in a high stress, high stakes, still blank medicine, and you're feeling

stressed or overwhelmed, burning out or getting out are not your only options.

I'm Dr. Rachel Morris, and welcome to You Are Not a Frog.

Well, hello, I'm Dr. Steve Smith.

I am a GP and for two or three decades I've been working as a GP specialist

in substance misuse in addiction.

but in more recent years I have been working, on the subjects of sleep

and have a great interest in sleep.

And I'm currently working in a clinic in North London where a big part of our

work is helping people with sleep issues.

great to have you back on the podcast, Steve, 'cause you've been here

before talking about forgiveness.

Coming up to a year ago.

Gosh.

And I, it is interesting 'cause that was a big part of your work with,

um, people with addiction as well.

You found forgiveness was a real, a real thing that people needed to

sort of get to the bottom of it.

Is that the same reason why you got into sleep and stuff like that?

I think sleep, sleep is very much a big part of why people

are addicted to substances.

But one of the, my main interests in sleep is my own personal journey with insomnia.

So I've, I've described myself as having been a certified insomniac.

So, um, that's, that's been a big motivator to, to, to study it more,

to look into it and, you know, done a lot of reading, attended

seminars, uh, and and so on.

So that's, that's, um, so it's been, been professional and

personal interest in sleep.

how long have you been a, a certified professional insomniac for?

So when, when did your issues with Sleeping first start?

I, I was actually thinking about that 'cause I was, I and I, I've, I've

thought about it a, a number of times.

I really cannot remember having any sleep issues as a child.

But what I really, really remember having, when I really ha remember having

sleep problems was as a junior doctor.

We, I know as you, as you know, we used to work sometimes

these ridiculously long shifts.

I remember starting on a Saturday morning when I did a one in four weekend and

I was always on call on Monday nights.

Um, so I would, I would start on Saturday morning doing a busy surgical job

where there were always things going on during the night or very often.

And then I would go home on Tuesday, five o'clock crash and would you believe it?

I was on call Mondays and Wednesdays.

And so then, then I would have, then I would work from Wednesday

morning till Thursday evening.

So it was just an exhausting job.

And, and then when there were opportunities to sleep, whether it

was between cases in the middle of the night or when I got home, I was just

so often obsessed with, I've gotta sleep, gotta sleep, that I absolutely

had good doses of sleep anxiety.

So yeah, uh, it's been on and off over the years.

but I, I really understand the issue of sleep anxiety, which, which is one

of the major causes of, of insomnia.

Because you don't often hear much about that, do you?

When when people talk about sleep, they talk about sleep hygiene, yeah, yeah,

we all pretty much know what to do.

But the sleep anxiety and it exists.

I'm literally thinking about three times in the last month where I've

had exactly that where my daughter hap had an operation on her foot, so we're

having to get up really early to get her to the mini bus to get to school.

I'm not sleeping so well 'cause I'm waking up and checking my clock.

I was doing a keynote talk in Edinburgh.

It started at 8 45.

I had a really nice hotel.

It was really comfortable.

I hardly slept a wink that night because I was so worried about missing

my alarm to get up to to do it.

It was just a bit mad really.

So it sleep anxiety, something that happens to everybody or just a few

people, or It happens to most people occasionally, but there are some

few people that get it really bad?

What I would say is it's a major cause of anxiety and it is totally,

ugh, not totally, but it's largely overlooked and poorly understood.

And I think also by medical professionals, by healthcare professionals.

And I, I was at St. George's Hospital in the 1980s, actually

the seventies, let's be honest.

where I was at medical school and it was a particular medical school where sleep was

taught probably better than other places.

But we didn't have very much about sleep at all.

And the only lesson, the only lecture I can remember on sleep.

Sleep hygiene.

That's all we were told.

Yeah, tell them, you know, not to drink too much coffee and maybe,

maybe have a milky drink and exercise here and there and all those things

that maybe we can talk about.

'Cause they're, they are important.

I mean, they, they, they are part of, what people need to tackle, but it's

not, it's not the most important thing.

It's, it is, it's, the way I look at how to help people is, is, is there's

various steps in, in how I help people.

And one, one of them is sleep hygiene, which needs to be looked at early on.

But, but absolutely is the anxiety of not sleeping that is

what really keeps people awake.

And people, time and time again, especially when I'm, when I'm

working in an addiction clinic, people just don't get that.

'cause they, they've learned.

They've taught themselves that it's substances that they

need to, to get through life.

And, and of course it's not, not, that's, that's true for so many people,

whether or not they go to a drug clinic.

And they've learned that, yeah, if I take this, I sleep well.

And if I don't take it, I don't, I don't sleep.

Um, and so this, they take a lot of persuading that anxiety is an issue and

I'm, that's the clinic I'm working in now.

I'm working in a clinic now where we're helping people manage,

prescribed benzos that's a and another and opiates and z drugs.

And it's, it's a big lesson to, for them to learn that it's sleep anxiety.

'Cause, 'cause so often when people have been taking a substance.

whether it's prescribed or it's illicit or whatever, the, the substance has

actually stopped working a long time ago.

It's, it's, it's lost its benefit, but it's, it's the reason why they don't

sleep when they don't take their, whatever it is, they have their, their

cannabis, alcohol, promethazine, whatever it is, the reason why sleep is poor

is, is because they're thinking, oh no, I haven't had my sleeping tablet.

I'm not gonna sleep well.

like most things in life, the, the root is all up here, isn't it?

It's the way we think about everything and, and, and what's going for us, and

those underlying concerns and worries.

Absolutely.

I mean, I've heard you talking about things at different times, um, in

relation to stress management and so on.

the whole Chimp Paradox, you know, the limbic system, it's a

big part of, of sleep management

And it's really interesting 'cause I must say, yeah, I haven't

really heard about it before.

So obviously there's a, a great book, Matthew Walker, why We Sleep, you

know, fantastic and recommend everybody to, I think every single healthcare

professional should read that, not just for themselves, but so they

can advise their patients about it.

So, um, quick, quick summary.

Let's just give it like a one minute summary, um, Steve,

of why we need to sleep.

So I wanna go on and talk more about sleep anxiety, but let's get out of the way,

first of all, why sleep is important.

And number two, quick, you know, 32nd summary of sleep hygiene.

'cause I think, you know, we, we just need to know it.

And then it's, let's look at the thing that actually really makes a difference.

So why sleep?

Important quick

my goodness.

That, that's such a big subject.

Okay.

It's so important for, for our life, for our health, for

our wellbeing, for creativity.

So just quickly for our life, you did, did you know that if you

consistently sleep less than five hours at night, Your, your risk of

death from all causes is 15% greater.

If you sleep less consistently, sleep less than six hours, at night, you,

you have a 30% increased risk of cardiovascular disease and diabetes.

One is 55% more likely to be obese if you're sleeping less than seven

hours actually compared to somebody who sleeps more than seven hours.

One really big deal.

I mean, this is really big, a really big deal for healthcare professionals who

are managing people in general practice.

It's, I really like to stress that mental health and insomnia

are a two-way street because.

We were all taught in medical school that somebody's come, somebody

presents with insomnia, oh, they must be depressed, probably depressed.

And, and that was certainly how I used to think.

I mean, that's how I, I, I understood most GPs thinking that they're not sleeping.

Well, why are they depressed?

Let's put 'em on antidepressants.

And what's really interesting is how many people are anxious or depressed,

primarily because they've got insomnia.

Gosh.

And it is, it's, and that's so overlooked, um, by so many.

And they are depressed.

They are depressed, but, and so the antidepressants will probably help.

But, but the, but the primary issue is, is, is the insomnia.

Memory.

uh, dementia.

So we detox, our brains are busy detoxing, uh, ourselves of beta amyloid, you the

protein that's, uh, associated with Alzheimer's in the brain during the night.

And there are so many stories of, of people just not sleeping

and, and obviously dementia's common anyway, but it's very like,

closely linked with, poor sleep.

I mean, I remember in the 1980s, uh, I don't, you know, there might be

others listening to this, remembering about the power of, of power naps.

You know, you could sleep, you could, you could rest for 10 minutes and have

the equivalent of two hours sleep.

And that just seemed amazing.

And I think that's how people like Margaret Thatcher got by,

just by, working all night, having these little power nap and, and

functioning, but massive correlation with, with memory loss and dementia.

So that, that, are those a few good reasons,

Gosh, that that's good enough for me.

Yeah.

yeah.

And, and just productivity, creativity, um, um, they're massive as well.

It's just the, it's the laying down of memories and the solving of problems

and things that particularly happens in your REM sleep, doesn't it?

And I think for me, yes, let's, let's get rid of all the AM amyloid.

But actually, if you wanna have an impact, if you want to solve

problems and, and feel better, you need a good night's sleep.

So there's stuff we can do.

And if I was to list sleep hygiene as a, if I remember back to my GP days,

it's make, make the bedroom really dark.

Make it cold-ish, you know, not too well, not too cold, but not too hot either.

Um, don't have any caffeine from midday.

'cause the half, the half life of caffeine is six hours.

So you'll still have aquar, quarter of the strong cup of

I thought it was eight

system, or

Yeah.

Or well, whatever.

Yeah, it's,

yeah.

So avoid caffeine and, and chocolate and stuff like that before bed.

Um, sound, you know, go somewhere quiet.

Um, go to bed at the same time.

Get up at the, get up at the same time.

Absolutely.

Yes.

we are really conditionable creatures, you know, we all know Pavlov's,

Pavlov's dogs and, and, and we can do so much to condition ourselves

to, to sleep, to sleep well.

Um, and so you, you mentioned things about the bedroom, have the bedroom cool, dark,

um, have a good sleeping environment, but, but, but have the bed bedroom.

Only associated in your mind with, with sleep and intimacy and nothing else.

No.

Scrolling through your, and, and get, keep, get your

phone away from your bedroom.

Uh, oh my goodness.

But, um, you know, when, when people are watching TV, even reading, studying,

working, scrolling through Instagram, whatever it may be in the bedroom,

we condition ourselves to be awake.

And that's not even taking into account the blue light, which maybe,

um, is also not insignificant.

So, so all those things that we've discussed, really important.

You've mentioned rhythm, and I think I, I, I like to con consider

rhythm as such a massive subject in itself that it, that it warrants.

A whole, whole discussion, a whole course, a whole, um,

session because it's so important.

Yes.

Get, let's get up, let's get up consistently, get up in a good time in the

morning and go to bed at the same time.

'Cause 'cause then we're, I mean, do we wanna talk about the, the sleep drive?

But the, there's two, two things that are important for sleep drive and one of them

is circadian rhythm and that's massive.

And so if we, if we can be consistent in when we are getting

up, that will really help.

And then conversely when we go to bed.

But also resting, you know, re that, that's, um, I like to say the fight

for the night is fought in the day and, and, and, and so we need to have

a rhythm of rest during the day as well as during the night and during the week.

You know, I've heard you talking about rest and, and to rest during

the day, to rest during the week, have a day off during the week to have.

vacation to have a holiday during the year.

I mean, I think people who don't have a holiday, uh, they have

the same increased cardiovascular risk as people who sleep badly.

And, and there's probably a massive overlap.

You, you, you are, you are 30% more likely to have a cardiovascular

event if you, if you're somebody who doesn't have a holiday.

Well, if you're somebody who doesn't have a holiday, there's probably a

per, you're probably a personality type that's not gonna sleep.

So there's probably different factors that play there.

But, but yeah, lot, lots, lots of things under, under the heading of sleep hygiene.

But, but they're all important.

But, but I think rhythm is massive

Gosh, there's a lot.

There's a lot there that I'm quite interested in actually.

Well, first of all, if I, I'm quite knackered, if I had a few late nights.

Are you saying that actually it would be better for me to get up

at 7 o'clock on a Saturday morning than to stay in bed for those two

extra hours if I can till 9 o'clock?

Well, there's something called, social jet lag, and I can't remember

the name of the psychologist.

It's a German psychologist who coined that phrase.

Now, if, if, if it is, you know, one off.

Yeah, then yeah, sure.

That's, that's fine.

You had a late night and yeah, we'll sleep in, if it's a regular pattern, which is

for a lot of people, it's, it's, it's a massive problem for a lot of people,

they work really hard during the week.

They get up at five in the morning, four in the morning,

whatever time it is, go to work.

And then, then it's tg.

IF thank God it's Friday party, Friday late nights watching movies.

Same again Saturday.

and you've just shifted your body clock.

You might as well have flown to mo to Greece or somewhere, you know, you've,

you've gone forward, you put your, your, um, clock forward three hours or whatever.

and then suddenly you wanna go to bed early on Sunday and then get up early on

Monday and it, and it's, it doesn't work.

So, so if you're doing, if you're doing what you described on a

regular basis and you are sleeping badly, then that's something that

absolutely needs to be addressed.

And, and there's a phrase for it as, as I say,

Social jet like that, that makes a lot of sense to me.

Okay, thank you.

That's useful.

One question students.

Yeah, gosh.

The other thing I wanted to ask you about was rest.

So are you saying that if you are totally knackered, you've really not had any

time to rest in the week, I would've thought, well, you're gonna sleep almost

better 'cause you're so knackered.

Are you saying that actually if you've not been taking the time to rest,

the quality of your sleep is worse?

Or you don't get to sleep as easily or you're gonna wake

up earlier in the morning?

Yeah, it's, it's a, it is a complex answer.

Helping people to sleep better can involve deliberate sleep deprivation.

So one of the most common ways of treating people, and I don't think

it's necessarily the be all and end all is, is, is sleep restriction.

Actually, that's, that's the phrase.

So, so we can improve the quality or, or the technical term is the term is the

efficiency of our sleep by restricting our sleep and then we sleep better.

So, so to a degree that we can use that.

But, but what is, what is bad is, is when, is when we vary

enormously vary what we do.

For example, during the week as compared to the weekend.

If that's a regular pattern, that's not good.

There, there are, there are various myths at play out there.

I've mentioned one, one that I bought into is that, you know,

you can have these power naps.

Another myth is that you can catch up with lost sleep at the weekend

and maybe to a degree you can, but you, you once sleep's lost, it's

lost and you pay a price for it.

So yeah, you know, if you, you get yourself exhausted during the week,

well yes, you probably will sleep well.

There's, we, we have rebound REM.

you know, we, we are programmed if you like to get a certain amount of REM sleep.

And if we deprive ourselves of sleep, then we sort of catch up with it.

So there's a degree of catching up, which is an interesting subject.

Because a lot of people, it's really important for people to understand

that whole concept of REM rebound.

A lot of people take substances to, to sleep well, or so they think

they actually to sedate themselves.

And I like to point out that there's a big difference

between sedation and good sleep.

And when they're, when they're sedated with substances, cannabis, alcohol,

whatever it may be, they're not getting the REM sleep that, that, that they need.

And then, so when they stop taking the alcohol cannabis, they, they

have a, a REM rebound, and then they have these vivid dreams, and then

they have these nightmares and, and then, and then they'll think, oh my

goodness, I need, I need the cannabis.

I need the alcohol to stop, stop these terrible nightmares, which

is what I have certainly seen repeatedly, um, in the clinics.

So sleep restriction has its place, but it's not something that that's, that's

good when it's uneven, as it were.

So are we saying then that REM sleep is literally the holy grail of sleeping?

That's what we're really trying to get as much of as possible.

No,

Oh, okay.

I always, I always believed that.

'cause when I had some sleep tracker on, I was like, it was pretty

low on REM, but, you know, high on the other things, but, okay.

What type of sleep are we aiming for then?

We, what we want is a nice good cycle.

We want a good cycle.

We want, we want the, the different, the four phases of sleep.

We want, we want light sleep.

We want deep sleep and, and we wanna come outta deep sleep with REM sleep.

And you, you referenced creativity and, and the benefits

to our emotional wellbeing.

During REM sleep, that's massive.

But during deep sleep where we're out of it.

there's a lot of restoration going, a lot of muscle rebuilding.

I, I think I'm right in saying that there's a surge in, um, growth

hormone during, during sleep in general, but during deep sleep, a

lot of muscle repair takes place.

A lot of, you know, just mentioned the benefits of sleep, muscle repair.

Athletes are much more likely to have accidents, to have, to have injuries,

sorry if, if they don't sleep.

So, um, and that, and there's, you know, various things there.

There's muscle repair, there's coordination.

Talking of, um, being poorly coordinated.

When we're sleep deprived, we might as well be intoxicated with alcohol, and

that, and that's something to, to re remember when you've got doctors that have

been working really long shifts in mental, mental ability and, and coordination

is impaired by poor sleep, just in the same way as it is with alcohol.

But no.

So yeah, we want, we want rem sleep, we want deep sleep and,

and we want the light sleep.

And, and actually understanding what light sleep is, is, has been for me and

for many people, a game changer as well.

Recognizing that light sleep is on the edge of consciousness.

' Cause a lot of people are in, are in light sleep and they're cognizant, they're

thinking things and that what they can be thinking is, oh no, I'm not sleeping,

when actually they're in light sleep.

so when you've, when all night you think, I just haven't slept a wink all

night, you probably, you know, without being like, thing I'm, I'm awake.

But actually it's likely that for quite a lot of that, if you haven't

been like, just looking around and thinking, should I get up or not?

But you, you've just been conscious, you've been thinking all night.

That might be because you've been in light sleep, not because

you've actually been awake.

Yes.

There there's two conditions that are worth thinking about in relation to

insomnia, and you've mentioned sleep tracking and, and then we could bring

sleep tracking into the, into this.

There's ortho insomnia and paradoxical insomnia.

Now I absolutely remember, see, I can think of one particular case of

what we call paradoxical insomnia, where somebody believes themselves

to have slept badly and they have in fact slept a whole lot better.

I just remember being on the ward.

I was a, I was, it's my very first house job.

Um, and just, I remember somebody snoring heavily on the ward.

I was working during the night and then on the ward round in the morning,

he just told me how badly he'd slept.

And I thought, no, you didn't.

And, and yeah, we don't remember how well we sleep.

And that's, that's one thing, but also a lot of sleep is light sleep.

And so if we, if we're anxious about not sleeping, we can be remembering

when we were in light sleep thinking we were not sleeping and, and

then counting that as poor sleep.

So that's one of the bene there, there's pros and cons of where

of, of, of, um, sleep trackers.

So I've mentioned paradoxical insomnia.

The, the value of a sleep tracker can be, and I, and I've really benefited from this

myself in the past, is whether it's on a phone or a watch, one of the benefits is,

looking back and thinking, oh my goodness.

the night wasn't half as bad as I thought it was.

And that happens so often.

So that's so, so it is good to track your sleep, but when you start looking

at it every, when you, well, when, when you wake up in the morning, think,

oh no, I didn't have enough sleep.

I didn't have enough REM, I had too much this, too little of that, then the

whole obsession with sleep, which is what a lot of people get, particularly

with sleep trackers, is, is in itself a cause of sleep, anxiety and insomnia.

So I've, I've heard a number of people, uh, one person in particular in a sleep,

sleep therapist saying, no, no to sleep trackers, but they have their place.

But, but use them with care.

I mean, it's, I think the same goes with blood pressure monitors.

People start getting really anxious about their blood pressures when they're

checking their blood pressure and

well, any sort of monitoring, right?

It makes you more obsessed with the figures and then you end up treating the

figures and not, not the thing that's going on and that, that, that makes sense.

So not a good idea to use sleep trackers unless you're sort of really needing

it for a certain thing, perhaps.

Or if you're the sort of person that's gonna get a bit obsessed

by it and get worried by it,

Yeah, I, I would say I, I'd say it's, it is often got a place, actually,

'cause I think there's a lot of people who can be reassured by it.

But what you've gotta do, you've just gotta do it.

Use it with care.

And it gives you good data, doesn't it?

Because you can see how alcohol would affect your REM sleep or things like that.

And that, that was one of my big disappointing discoveries is just

the effect of alcohol in your sleep.

And that's the one thing that's maybe cut right down, because even

just after one unit, two units, your sleep is really disrupted,

which is so depressing, isn't it

is.

but, um, and of course there are people who will use the alcohol to get to

sleep, but even people who don't have an issue with alcohol, as you say, have

got to be aware that they're not gonna, they're gonna knock their rem yeah,

as you say, even with a small amount.

Well there's, that's another reason for eating early.

Okay.

We, we, we mentioned mentioned, um, sleep hygiene, go backtrack to sleep hygiene.

Eating suppresses melatonin.

So if we're eating a big meal late in the evening and having a drink with

it, then let's not expect to have the best night's sleep, let alone

the dyspepsia we might be having.

it did make me laugh when I read, um, Matthew Walker's book about

why we sleep, the, the one piece of advice they gave about alcohol.

They said, well, you know, we can't in any good conscience say that it's

okay to drink alcohol for sleep, but we can say that if you get drink

alcohol, drink it at nine o'clock in the morning because it'll be out

your system by the night, I'm, yeah,

So, okay, so we've got these different types of, insomnia.

We've talked a little bit about, about sleep hygiene.

One of the reasons I think people get difficulty sleeping or that the reason

I find difficult sleeping is when you're suddenly waking up worrying about stuff.

and that does interfere with my sleep sometimes.

But now you've mentioned the sleep anxiety.

I'm wondering whether it all sort of.

Interacts and in and intermingles.

So what do you think actual anxiety is a more common sleep

blocker than sleep anxiety?

Or do you think sleep anxiety has a, has an even bigger role than we thought?

Well, they're all interrelated.

One thing I would say is that, you know, recovery from sleep, and I use that word

recovery 'cause I, I liken it almost to drug and alcohol recovery is, it's

a journey and it's not a quick fix.

Um, I've heard you talking, I heard you talking once about the fact that

you are a, you help people manage stress, but you, there was a time when

you were talking about how you were drifting into, into stress yourself,

and, and we can know all the answers, uh, but I, it, it happens to us all.

And I, for the me routine is a really big deal when I've lost my routine and

then life is frantic, i've got lots of things on my mind, they may not, they may

not necessarily be bad things, actually.

They may just be busy things.

A lot of things I'm thinking about planning.

when my, when my head is, when I'm frantic, I'd say it's being

frantic is, is a massive issue.

Whether or not it's things you're actually anxious about.

But yes, it's, it's a big, it's an interplay.

So you could be anxious about, you can be anxious about whatever it is, your health,

your, your, your, your relationships, finances, whatever it may be.

And so of course that that's gonna be a big deal.

So, so that's why I like to say the fight for the night is sports in the

day, let's, let's, let's make time in the day to manage our anxieties so that

when we wake up in the night, we can think, yeah, I've, I've parked that one.

And, I'll tell you one massive game changer for me and this, this isn't,

I haven't, I, I, I came across it and I hadn't a while back, and I've not

heard anybody else say, this is during the night when you are asleep, your

prefrontal cortex activity is suppressed.

And I thought, wow, isn't that, that's such a big deal.

'Cause, 'cause again, you've, you talk about chimp brain and human brain.

Well, our human brain goes to sleep before our chimp brain does.

And, do I, do we, do we need to talk about what that means?

I think probably a lot of people know that, but you know, our, our, our,

our limbic system, our amygdalas are, are, are, are much busier than our,

our thinking brains during the night.

So that's just say, that's our threat detection system.

So the thing that's gonna, uh, make you feel anxious and worried and

detect threats all over the place.

So they, that, that's what you're talking about when talking about

the chimp brain, the, the amygdala versus the prefrontal cortex, which

is the rational side of things.

So, so, and, and again, you know, when, when you, when you're lying awake and you

can rationalize, when you can, when you, when you've got enough, consciousness to

think, right, I'm anxious, I'm thinking about this stuff, but it's, I, I can

actually, I can actually, I, I've done this now and it really helps, is I, I

think, right, I don't, I don't, I can't, I'm not in a good place to think about

what might, what, whatever it might be, this, this meeting that's coming

up because I'm not using my prefrontal cortex, and I've been able to do that in

light sleep and, and, and think, right, I'm gonna park it, leave it for tomorrow.

Takes a lot of practice.

That's where learning to be mindful comes in, I believe.

But, but, but a big, a massive interplay between anxiety, sleep

anxiety, and again, it's, it goes back to what I was saying earlier.

There's a, it's a two-way street.

Men, good mental health, poor mental health, and insomnia are a two-way street.

One causes the other both directions.

So I mentioned it in relation to depression earlier on, but of course,

exactly the same applies to anxiety.

I was in India and I saw this man with a t-shirt It, it just said in

the daytime, I don't believe in ghosts at nighttime, I'm more open-minded.

I thought, yes, that's, that's, that, that's exactly it.

Um,

Or we start just completely catastrophizing and worrying

about stuff that, and I think sometimes your brain just even

looks around things to worry about.

Um, which is quite uncanny, isn't it?

That's why useful to keep like a piece of paper by your bed.

So I was thinking, well, I'm just gonna write it down and I'll make

sure I worry about that tomorrow.

So don't worry in a chimp or amygdala, I'll worry about that

tomorrow and then tomorrow I'm like, oh, that's, that's not important.

But I think that's, that's useful because we worry then we worry about

the worry and then we worry about not sleeping and then we get ourselves

mixed up in the right old muddle.

And I guess that's, that's part of the problem with sleep anxiety.

So we worry about not sleeping and then we worry about worrying about not sleeping.

Before you know it, you've got a million worries all over the fact

that, yeah, you might not have enough sleep for tomorrow or you might miss

your alarm or, or something like that.

What can we do if, like, if, like me, you've gotta suddenly get up really early

because you've got keynote talk or you're gonna miss a plane, or you know, so you've

got less than normal, you've got a early deadline and you lie awake all night.

Or the second one, I guess is for somebody that has had a lot of trouble

sleeping in their lives, and then it just becomes a chronic, oh gosh, am I

going to, am I gonna get sleep tonight?

How am I sleeping?

All that sort of stuff.

So do you manage those in two completely different ways?

Or is it the same sort of thing either way?

Yeah.

I, I think you, you, you, you manage things together and I think you've,

we've gotta talk about people who have chronic insomnia versus people whom

it's just an intermittent problem.

One thing that's really helpful to recognize is that actually it's

not the end of the day, if you really sleep particularly well.

You know, we can function.

I mean, I remember one of my worst nights, actually, this is before I

was working as a junior doctor, so maybe, this was a medical student.

I remember the day before my pediatrics exam.

And I, I just had this sudden thought at 8:00 PM that I, I, I

dunno anything about pediatrics.

And I literally stayed awake all night.

Re I was up, I was up reading pediatrics textbook.

Stupid.

I mean, it just, you know, but I, I thought I've got to go through it and,

um, and, um, but yeah, the exam went fine and it, the point being that we,

we c if it is an occasional bad meeting, occasional meeting, and we're thinking,

um, oh, I've gotta go to sleep well for, for that meeting tomorrow, we can also

tell ourselves, well, even if I don't, it's not gonna be the end of the world.

But that, so that, that's for, for, for, for the occasional.

Um, bout of insomnia.

For the, for the chronic in insomniac, it's, it's, it's different.

We, we need to be more, you know, we need to be more purposeful in managing

that on a, on a daily basis, I'd say.

So what sort of techniques would you be recommending to people

for, for that sort of thing?

I, I, I have a, a, a four step approach.

I, we, we've talked a bit about the sleep science and I, I think

understanding sleep science is important.

We've talked about sleep hygiene and that and that, and I would,

that's another key thing.

And then rhythm and then, and then what, what we massively need to

do, having done the other things, arguably, arguably first, is to work

on what I call having a sleep mindset.

What I think is massive, absolute game changer.

Is something called a, it's a more modern therapy.

It's called Accept Acceptance and commitment therapy.

And when we spoke, I think, I think it was May last year, so it was coming up

to a year ago, we talked a bit about accepting the things that we can't

control, having the courage to change the things that we can, and that's such

a massive, massive part of my journey, and, and, and those that I have, I've

helped to, to come to, to, um, a better place with in terms of life in general.

But, um, in terms of bed sleeping better in particular.

Learning to relax about the things that, that I don't have any control over.

I don't have, nor do you, nor does anybody listening to this, generally speaking,

we do not have the ability to say, right, I'm gonna lie down now and go to

sleep unless you're totally exhausted.

You can't choose to go to sleep at, I'm gonna go to sleep at 10:30 PM tonight.

It's not within my skillset.

And so if I learn to accept that and don't fight against that desire to

go to sleep, I've gotta, I've gotta fall asleep, I've gotta fall asleep.

I've don't fall asleep.

I'm gonna be so tired if I learn to accept that, I can't control that, but

what I can do is I can control the things that are within my skillset are what

we talked about in terms of, our sleep environment and how much caffeine we

drink and so on, and my, and then I can control what I choose to think about,

and I can control how much rest I take then, then sleep probably will follow

And so is there any other way that ACT therapy helps?

Because I think I, I love ACT therapy and when, when I've sort of heard

about it before, I think I've read a couple of books about it, one of the

things that has been really powerful for me is being able to choose

the thoughts that you latch onto.

So sort of accepting the thoughts that's there and either just, and, and

trying to detach yourself from, oh, I, I'm noticing I'm having the thought,

or I am thinking rather than, or I am stressed, or I'm thinking I'm stressed.

I'm noticing I'm having the thought, I'm stressed.

Therefore, that you're sort of distancing yourself each time.

absolutely.

What particular distancing things have you found have helped you

when it comes to the sleep?

An anxiety.

What's the sort of changing in the thinking that's helped?

there are a couple of things, and the first thing you've just, first

thing you've mentioned is, is massive.

Is, is, is, you know, as soon as we say to ourselves, oh, I'm having a, an

anxious thought, ooh, I can feel my heart beating, I can feel the tension in my

neck, or whatever it is, as soon as we describe our, describe what's going on,

we have distanced ourself to some degree.

So, and, and, um, the phrase that I love is, um, not being at

the mercy of, of that thought.

So, so choosing, choosing to notice it rather than be at the mercy of it.

Um, so that's one part of, of, that's a big part of acceptance

and commitment therapy.

For those that are not familiar with it, it's, it's, it's, it's a therapy

that came, was devised by somebody called Steven Hayes in the 1980s.

So it's really relatively, um, recent.

I mean, I feel it's based on ancient wisdom, but big part of it is just

learning to, to be mindful, be observant.

And the other thing is, is what, what Stephen Hayes is and, and his and his

successors have really helped us to do is to, is to recognize that the things

that we worry about don't actually have the power that we think they do.

So what ACT therapists do is they encourage, encourage us to see

our anxieties as monsters, sleep monsters, whatever it is, you know?

And, and, and that, that has, that has been really helpful.

So see it as a monster that, that can't actually hurt you.

It's like, it's like a dog that's barking.

It's really a really scary bark dog, but it's on a lead, it's chained.

And so it can, it can bark really loudly, but it can't actually,

you, you know, it can't bite you.

And if you start thinking, yeah, that dog or that monster, um, it's, that's, it's

keeping me awake, but it can't hurt me.

And if I, if I, if I focus on it, if I bark back at the dog or the monster,

it'll bark back even louder and it'll, and it'll, and then I'm on a downward spiral.

And some people will say, recognize that okay, I'll thank my amygdala

'cause it's trying to help me.

You know, we, our amygdalas are lifesavers, aren't they

in the right circumstances?

And you're crossing a field and a bull's chasing you, thank, thank God for a,

for the amygdala, which gives you then releases the adrenaline, which causes

the adrenaline to come up, which means you escape from the t from the bull.

But we don't want, we don't, we don't want its help at nighttime.

And so we can thank the amygdala if we want to, um, and, and then

just sort of diffuse the, the power of that sleep monster.

So I think, I think, um, the, it, it's a, it's a silly picture,

but I, I don't mean it silly.

It's, you know, it, it sounds, sounds a bit inane, but it actually

works to to see your anxiety as a monster that can't actually hurt you.

And the fact that if you engage with that dog, the anxiety or the

monster, that actually just, it just gets louder and louder and louder.

You've just gotta ignore it.

It's fascinating this, this sleep mindset stuff.

If there have been any sort of quick hacks that have really helped you, any

sort of mantras or quick shifts that have helped you with the, that sleep mindset

and to get rid of your sleep anxiety?

I, I mean there are some quick fixes and one is to believe that you can do it.

I mean, what I say to people, I say any to anybody who.

has insomnia.

I'll say there probably was a day when you slept like a baby.

Nobody had to teach you how to sleep when you were a baby so you can sleep.

So, so many people, I've heard so many people tell me, I can't sleep.

I'm deficient in something.

I don't, my brain doesn't produce melatonin.

I'm, whatever it may be.

I think they've got a lot of people truly believe they've got a

physical cause for their insomnia.

And you say, no, you know, you, you've got what you need and

you once slept like a baby.

And to, to learn to believe that you can sleep like a baby again, that's maybe

sometimes we can have breakthroughs.

Absolutely we can have breakthroughs and we learn how to manage certain issues.

But I thi I think what my, what I would encourage people who've got chronic

insomnia and when we say chronic insomnia, we mean insomnia that's

persisted for more than three days a week for more than three months.

Um, I'd say well see it as a journey.

And um, another little metaphor is, which I think is really helpful.

is somebody paddling on a boat in a, on a, on a river where everything's

lovely and the gr trees are green and the sky is blue, the bird

singing, it's all very ni nice.

You're in this paddle boat and behind you is a waterfall, and if

you stop paddling, you'll be slowly dragged back into the waterfall.

So for me and for people that I've, um, helped, I encourage

just to see it as a journey.

You're gonna keep paddling and it's very similar to people maybe who've had, who

have got tendency towards an addictive behavior or or substance, whatever.

It's, it's not there, there aren't many quick fixes.

So how many people do actually have a medical condition

that means they can't sleep?

You know, what percentage of, of everyone with insomnia will find out that there is

a sort of physical medical reason for it?

Is it just tiny, tiny tiny percentage?

Yeah, it's, it's, it's relatively small there, but there are a bunch of, um,

sleep disorders and, and there will probably be people listening to this who

have got, who've got physical issues.

Now there's obstructive sleep apnea.

and that's a physical issue, which is, which is really, it's really

significant and it is often, it's badly, it's often not diagnosed.

Is it 2% of women, 4% of males and, and, and increased with people with obesity.

So there's not an insignificant number of people have.

And, and there, there is a physical cause there's, there's intermittent,

um, sort of partial collapsing of, of the airways, which causes intermittent

choking and snoring, having snoring, which then wakes the person up.

Sometimes they don't really realize that they've woken up

and then they fall asleep again.

But they've had significant impairment of, of the normal sleep rhythm.

Um, there's restless leg syndrome, whether that's truly a physical issue,

you know, the sleep movement disorders.

And that affects a lot of people.

And that's up to 10% of people actually.

Um, sometimes, sometimes for them there's iron deficiency, which is a factor.

And then, and then, yeah, there, there, there are circadian rhythm disorders,

whether that's, uh, a physical cause, but, but it's, but it's a recognized issue.

There's narcolepsy, there's, there's, there's various other

sleep disorders, but, but, but the biggest problem with sleep that

causes so much distress is insomnia.

And the one, perhaps the most single, most important factor is sleep anxiety.

Um, I guess that's good news, isn't it?

Because that means that we can overcome it.

That means it can get better.

It's a journey.

Just because you don't see it well now doesn't mean you are never going to

be able to, but it's gonna take, gonna take a bit of time, gonna take a bit of

effort, and I guess it's like everything.

Wouldn't it be great if there was just pill you could take and totally cure it?

Unfortunately, with sleeping, we, the pills often make it worse, don't they?

Or, yeah, they cause they cause extra problems.

But like you said, it's a journey.

It takes work.

But the great news is you're in control of it.

If it's to do with the way we are thinking and what's in our mind,

then there are things we can do.

Yeah, and actually you, you asked about physical causes of insomnia.

What I didn't think to say is, yeah, there's a lot of people

who've got secondary insomnia.

So insomnia is, there's different ways of categorizing it.

And one way is primary versus secondary.

And secondary is secondary to what may be a physical or, or a secondary, uh,

physical or a mental primary cause.

So, you know, we've talked a lot about the mental health issues that may be

the underlying cause for insomnia, but of course there's a lot of people who

can't sleep 'cause of pain, genuine pain.

And, and so the clinic I am, working in at the moment in London is, is for people

who are, have ended up on high doses of prescribed opiates and benzodiazepines.

And so they, they will attribute their poor sleep to their backache,

their sciatica, their postoperative pain, whatever it may be.

And that probably is a factor, but actually.

It always invariably becomes compounded and it becomes a mixed picture.

And, and so the anxiety aggravates the pain and, and, and, and very

often, even though there may be some genuine underlying pain that's

coming into play, if we can deal with the, the mindset, then we can make

things a whole lot more tolerable.

And of course, a, a big part of pain management is, is the mindset as well.

I know you've sort of mentioned mindfulness earlier on, but you know,

that's a huge part of pain management as well, and I can imagine it's part of sleep

management and, and everything like that.

So just yet another reason why meditation, that sort of thing can be really helpful.

Steve, there, there's so much we could talk about with this.

Um, and in a minute, I know you've got a, a course that you've done.

So anybody who wants to dig in deeper to this will be able to, do this

course and that find out more and, and really hear some of your tips and

techniques in, in much greater detail.

Could you just share what was your top three things?

You know, if, if someone came to you and they said, right,

well, I'm, I'm struggling.

I can't really find a cause.

I'm not really, um, in, in any pain.

I don't think I've got a physical thing, but it's just, just getting worse.

What was your, what would the basics we would say, okay, these three things, just

go and do, go and have a look at now?

The number one and two is to pray whether or not you believe anybody's

listening, still pray the serenity prayer.

God give me the grant, me the serenity, and we talked about this,

to accept the things I cannot control.

That's number one.

Accept the things I cannot control.

I cannot control my insomnia.

Accept it, don't fight it.

Number two, courage to change the things I can and again, that's massive.

And, and I guess what I was gonna say for number three really comes onto

number two, but I'm gonna say anyway, is, is really work on a healthy routine.

I love this expression.

Somebody said, put your phone to bed.

Parent your phone.

You know, we, we, those of us that have had kids, we like to put our beds, our

kids to bed at an early, an early time so that we can then enjoy the rest of the

evening without whilst they're asleep.

We'll, put your bed, put your phone to sleep, leave it in another room.

I mean that is my number one sleep tip.

Whenever we do any training, it's like, yeah, 'cause uh, you check

your phone or, and the main problem is, is everyone uses their phone.

It's an alarm clock.

And this is probably part of the reason why I can't sleep when I go away, because

of course I don't take my alarm clock.

So I use my phone.

But then what you did before, the minute you just about to go to sleep,

you check that you've set your alarm on your phone and while you're there,

you check your texts, you check your messages and you think, well,

while I'm here just check my emails.

And what am I doing tomorrow?

Check your diary and before you know it, you've done half an hour more of work.

So forget the blue light.

Forget anything.

It just intrudes in, it makes work and everything else that you get obsessed

with and distracted by, intrude into everything and so no wonder can't

sleep because your brain is going.

And even at home, when I find, when I've maybe got my phone next to my

bed, 'cause maybe one of my teenagers out really late and I think, well,

I can't put my phone down, so I need to be able to hear it if they're in

trouble, I find myself scrolling on it, even when I know it is just stupid.

It's so annoying.

So I think number one tip, and honestly I have bought myself an

alarm clock, and it's a digital one because I hate ticking, from Amazon.

It costs like 20 quid.

It's honestly the best buy ever, and it's really reliable.

It never, it never alarm, never doesn't go off and all that.

So it's, you know, honestly, top tip, I think Steve, that's absolutely

I just make add to that actually, there, there I, I have

what I call a Sabbath phone.

' Cause because it's, you know, Sabbath is not, is not, doesn't

have to be anything religious.

It's about just means having a rest, have a rest once a

week, have a digital Sabbath.

But we, we, goodness me, you know, I, I, I like listening to music.

So my, I've used my, I need, I need my phone for Spotify and then

I, I like to do meditations and I use the me the phone for that.

Well have a phone that doesn't have your email, your Facebook and everything else.

A separate phone that you use when you are off duty.

Even better.

I'm looking around my desk.

Oh, it's over there.

I've got a thing called a brick, which I haven't used yet.

Have you heard about the brick?

Well, I've heard of people referring to their

No.

This is an actual brick and, hang on, I'm just gonna get it.

Wait a sec. Can I just say, I have no financial interest in the brick company,

but my friends told me about this.

And it comes in a little box.

You stick it on your fridge.

And what the brick does, you download the app onto your phone and the it turns your

phone into a brick phone, into a no phone.

Or you can choose what apps you want it to access and what it blocks.

But if you want to unlock it, you literally have to go and tap your

phone on the brick to unlock it.

So it turns your smartphone into a brick or, or, or whatever you want.

So you could leave Spotify on it, for example.

Um, and everything that you need.

you can, then you can choose, you don't have to have everything

off your phone, but I thought that was absolute genius idea.

So yeah, I have to set that up.

Anyway, steve, it's been wonderful to have you with us.

If people wanna find more about you and more about your sleep

course and everything else that you do, where can they find you?

Where's the best place to go?

so I, I've set up a website, it's called fightforthenight.com, and I've

got a sleep course on there, which is, um, expanding really all the

things that we've been talking about.

And, um, I'm delighted to be able to offer, I think it's really, really

very well priced anyway, but for anybody who follows your podcast,

we've got a, a code, which is FROG20, which gives you a 20% discount.

So do, do, check that out.

Use that code as a discount.

I think, you know, if you struggle with sleep, then get on and do this course.

It's part of their like courage to change the things that you can get yourself.

Get yourself educated.

Get a book, read the Matthew Walker.

Why we, why We sleep book and all that sort of stuff.

Steve, thank you so much for being here and, uh, be good to

chat again soon at some point.

Thank you.

My pleasure.

Thank you for having me.

Thanks for listening.

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