S8E34: Webinar Highlights Sleep and MS with Dr Neil Stanley

Dr Neil Stanley (00:00)

the famous post lunch dip, which doesn’t actually require food to have, happens between two and four o’clock in the afternoon. So that is the time you are most likely to want to have a nap. Past four o’clock in the afternoon, you are probably going to start disrupting your sleep,

 

Overcoming MS (00:55)

Today’s episode features audio from the MS and Sleeping Well webinar, part of the Living Well with MS webinar series. Overcoming MS facilitator Zilla Smart speaks with sleep expert Dr. Neil Stanley on the topic of sleep and MS.

 

Dr Neil Stanley (01:13)

I’m a sleep expert. So the title of my talk is MS in Sleep with Different Perspective.

My name is Dr. Neil Stanley. I’m a PhD. So I’m not a medical doctor. My PhD is actually on the use of what is now sleep trackers, but this was many, many years in measuring the effects of medication. And so as I’m not a medic, I can’t give you any medical advice at all, but I can give you some pointers with regards to sleep. So Without further ado What are the functions of sleep? Why do we sleep? We don’t know is the simple answer. We don’t know why we spend up to a third of our life doing this strange thing that is called sleep. We do know that it’s been around forever. Basically the history of sleep goes back at least 450 million years ago. All mammals sleep, birds sleep, insects sleep, and even the most basic organisms are thought to sleep. So it’s a universal phenomenon. We all do it, but as I say, we’re not quite certain why we do it. We know it’s needed for recuperation and restoration of both physical and mental functioning. Physical functioning, well, we can do that during the day and we can repair and recuperate physically during the day. I’m sat down talking to you, I’m pretty comfortable and I’m not doing anything other than thinking about what to say to you next. So my body can be repairing, recuperating building muscle backup, et cetera, et cetera. But during the day, we don’t have time for repair and recuperation of mental functioning. So sleep is much more to do with mental function rather than physical function. Sleep is important for the optimal functioning of the endocrine metabolic and the immune system. So the basic mechanisms of the body are improved by sleep.

Sleep is about something called homeostasis, which is just an incredibly fancy word for balance. Sleep keeps the body in balance. So for instance, with the immune system, if you have just one poor night’s sleep, the next day you’re four times more likely to catch the common cold. So essentially what is happening during the night is the immune system is being optimized. So during our deep sleep, which I’ll come on to in a few minutes, in our deep sleep, we produce things called T cells or killer cells. And these are the cells that roam the body attacking foreign invaders. And we also produce something called cytokines. These are essentially the battlefield commanders. These tell the T cells where to go, where to fight the battle to keep us healthy. Sleep affects all organs of the body.

But as mentioned a bit earlier, sleep is primarily of the brain and for the brain. The only bit of the body that has sleep is the brain. Other bits of the body as mentioned can function or even function quite well without sleep. The brain must have sleep. So what is this thing that we call sleep? Well, sleep is made up of two different states of being non-rem sleep and rapid eye movemenet sleep, REM sleep. And non-rem sleep is further divided into three stages of sleep, each of increasing depth. So non-rem sleep makes up the majority of the night about 75 to 80 % of the night. Stage one sleep is the transition from awake to asleep, makes up about three to 5 % of the night.

And this is the lightest stage of sleep such that if I were to wake you up during stage one sleep, you would say, why did you do that? I want to sleep. So this is the transition from wake to sleep. So if you are awake and you’re going to go to sleep, you will go through stage one sleep whenever you fall asleep. But although it’s only about one to five seconds, it can have large periods of stage one sleep if your sleep is disturbed.

And this is where you’re convinced that you’ve been awake for a very, very long time. But in fact, you haven’t something called sleep state misperception. You believe you have a much worse sleep than you actually do because as I stage one sleep doesn’t feel like that deep restful sleep that you’re used to. Stage two is a 45 to 50 % of night and is essentially true sleep. We spend half the night in stage two.

And you’d have thought that if you spend half the night doing something, that’s going to be really, really important. I told you sleep is important. If we’re spending half the night doing this thing, then it must be very, very important. Well, it might be, but we really don’t have much of a clue what stage two does. It does a bit of everything, but it doesn’t do anything really well. And then we come to stage three sleep.

So-called deep sleep or slow wake sleep. It makes up about a quarter of the night, 25 % of the night. Slow wake sleep is the deep restorative sleep. This is when your immune system is improving. This is when you feel rested. Deep sleep is what makes you feel rested the next day. deep sleep is vital from the brain’s point of view for three reasons, memory, learning and growth. You only actually grow during your deep sleep. You learn new tasks during deep sleep. So if you do something during the day, you will rehearse that behavior during the night and you’ll be acting better at that behavior at night because you rehearsed it during your deep sleep. And deep sleep is when you lay down memories. So you identify the piece of information that you need to remember you’ve laid down that information, you put it somewhere where you can find it the next day. And you make the connection between that new piece of information and all the other pieces of information that you have in your brain at the time. So deep sleep is vital for them. And it’s called deep sleep because essentially it is very difficult to wake you up during deep sleep. It is very protected because it is so important. Rapid Eye Movement Sleep makes up the last 20, 25% of the night. And Rapid Eye Movement Sleep is when you have your long narrative dreams. You can have dreamlike events throughout the night, but it’s only during REM that you have these long, almost movie-like dreams. And your dreams are involved in emotional wellbeing and emotional memory. So Deep Sleep is about factual memory. What happened. REM sleep is about emotional memory. How do I feel about what happened? So you have to have both of them working together. Everybody dreams, everybody dreams about four five times a night, but you can only remember a dream if you wake up during that dream. If you don’t wake up during the dream, you will not experience the dream. So if you are one of these people who say, I never dream that it indicates that you are a good sleeper. And if you say, I’m always dreaming or I’m waking up every four or five times a night, always during the dream, then that is indicating that you are having a poor quality sleep. how are these things put together?

When you switch the light off, it takes about 15 to 20 minutes before you fall asleep. So a normal person will fall asleep within 15 to 20 minutes. If you take longer than that, it would be indicative that you are experiencing insomnia. But also if you fall asleep the minute your head hits the pillow, that’s not actually a good thing. That’s probably indicating that you are actually sleep deprived. But after 15 to 20 minutes, you’ll fall asleep. You’ll quickly go through that stage one sleep and stage two sleep into your first period of deep sleep. So about 20 minutes after you fall asleep, you will be in your first period of that end three deep sleep. That period will, there’ll be a consolidated period of that deep sleep for about 60 to 80 minutes. And then you’ll have your first dreaming period. Now that first dreaming period may only last 10 minutes long or so. And then you go back down into deep sleep, another consolidated period. And then on a roughly, roughly, very roughly 90 minute cycle, you will have your dreaming periods interspersed with that lighter stage two sleep.

Now your dreaming periods in the latter part of the night can be 30, 40 minutes long or so. And you are preferentially designed to wake up during REM sleep. So if you woke up this morning without an alarm, you almost certainly woke up during a dream. And that’s of course a dream that you will remember. But in the night, you also wake up during your REM period.

And therefore, I’d say one, you’ll experience the dream and some of these dreams may be unpleasant, horrific, which you would experience as a nightmare. Now, a lot of the time people say, How does sleep change with age? Do elderly people need less sleep? They actually don’t need less sleep. Your sleep need barely changes between sort of 25 and 80. But what does change is that you lose that deep restorative sleep at the start of the night. And so sleep feels less refreshing. And because you don’t have that deep sleep, you are more liable to wake up and there is less pressure for you to go back to sleep. So as you get older, are more things to wake you up and there are more things to keep you awake. So while you still need the same amount of sleep, it is harder to get that sleep as we get on in years because we lose that deep sleep. And so we’re in that light stage too or that REM sleep. Now this change in deep sleep can actually happen. It starts happening in males from around the age of 35 or so, women from around the age of 55 or so. And actually by the time you’re 60, 65, men actually have worse quality sleep than women because we have been declining longer than women. But let’s say that is the change. It’s not about a change in how much sleep you need, but the depth or the quality of the sleep. Now, I mentioned how much sleep you need. How much sleep do you need? Eight hours has never been until recently has never been recommended as the perfect night’s sleep. Eight hours is an average, it is not an ideal. Sleep need is like shoe size or like height. We’re all different and to a great degree, it’s genetically determined. So there are some people, very, very few of them, but there are some people who absolutely thrive on just four hours sleep. There are others who actually need nine, 10 hours sleep to feel at their best. I personally need nine and a half hours sleep a night to feel at my best. The majority of people are of course between seven and eight hours, but there are the extremes. So it’s not really about the hours that you sleep, it’s about how you feel during the day. So the one question you need to ask yourself is how do I feel during the day? If you feel tired during the day, when that’s got very little to do with sleep. If you have poor sleep, you’ll feel sleepy during the day. Now you might say, what’s the difference? Well, simply if you climb up three flights of stairs, when you get to the top, do you need a sit down or do you need a sleep?

If you need to sit down, you’re tired, fatigued, knackered, exhausted. But if you need to sleep, you are sleepy. So it’s not about feeling tired. There are many reasons why you may feel tired, but tired is not the same as sleepy. If you’ve had enough sleep during the day, you will feel awake, alert and focused during the day. If you feel sleepy, i.e. you could lie down and go to sleep then you have a problem with your sleep which needs to be rectified. So that’s just a very, very brief overview of sleep. And so we’re now going to talk about MS and sleep. So the problem with MS and sleep is of course, MS is the primary condition here. This is the thing that you’re most focused, most worried about is MS.

 

And so it can be easy to put everything into the category of such and such is caused because I have MS or by the MS. The sleep problems may be present before MS, although they may of course worsen after the onset of MS. There can be say, problems that are caused by the MS, and most of these can actually be managed. And also they can be developed independently of MS, you know, across the time course. And these are often complicated by the MS. So it’s not a clear picture. It’s sometimes difficult to say, you know, X was caused because of the MS. It may be there before and wasn’t noticed because on its own it wasn’t that problematical but now the complication with the MS has made it more relevant or important. So there’s a bi-directional relationship between sleep disorders and MS. Say sleep disorders can potentially worsen MS symptoms and decrease progression but also inflammation for instance can cause sleep problems. The precise interaction remains complex and unclear. This is what I’m saying. It’s not easy to say, you know, one is caused by the other. And also factors like disruptive circadian rhythms, we’re all governed by circadian rhythms, a 24 hour rhythm. So things like temperature or cortisol or wake and sleep are all over circadian rhythm. And so these can be affected. It’s immune system dysfunction. Is that a consequence of MS or is that a consequence of the poor sleep occasioned by MS? And also, in your transmitted pathways, the signaling system through the body that may be disrupted because of MS, is that also affecting sleep? Sleep is not just like switching a light switch off. On and off. It’s a very complex process. So as I said, sleep is about homeostasis. It’s about balance. And therefore if the body is unbalanced in that regard, then of course sleep will probably suffer. So if you stick people into a sleep lab and measure what’s known as polysomnographic PSG, so their brainwaves and their body physiological systems, you’ll find that 74 % of MS patients will have a sleep disorder. Now, a sleep disorder can range from insomnia to other issues like obstructive sleep apnea, where you stop breathing during the night, restless legs, where your legs feel funny when you sit still or lie in bed, and that feeling can only be dissipated by you walking around. Of course, that would stop you from falling asleep. All various other problems. And when we talk about various other problems, So, strontocleidomastoma, as I say, this is where you stop breathing repeatedly during the night. This is caused by a collapse of the airway causing a blockage in the back of the throat. So your chest and abdomen are trying to breathe against this blockage, but there’s no airflow through the mouth or nose.

This causes pauses in breathing of around 10 or more seconds. And then as you overcome the obstruction, there’s this roaring snore. But every time you have an obstruction, you have an arousal, you wake up temporarily. So this fragments the sleep to a great degree and can cause real issues with daytime sleepiness, and this can happen hundreds of times a night. So if you may not know you have sleep apnea, yourself, because of course you’re a sleep, but if your bed partner or your carer or whatever tells you that you cause breathing during the night, essentially you have sleep apnea. All you need to do is find out how severe the sleep apnea actually is.

Luckily, there are treatments for sleep apnea. One is a mask that wear that blows air to keep the airway patent. Another one is a box of gum shield and the Dibbler advancement device, which keeps the jaw from dropping back, occluding the airway. And there are coming very soon medications that are beneficial for sleep apnea.

Restless leg syndrome, as I say, this is a condition where people have described it like ants crawling under the skin or one person described to me as like your legs being full of fizzy water. This happens when you’re immobile and they say it can only be dissipated by getting up and walking around. behavior disorder is a rare condition where you actually act out your dreams and that can cause harm to you either yourself or to people in the environment. And then narcolepsy is an uncontrollable condition where you fall asleep at inappropriate times. So not just whilst you’re in a conversation, but whilst you’re eating a bowl of soup. And then hypersominance is just a fancy name for feeling very, very sleepy. And so MS in itself, but also the conditions associated with MS can cause you to feel very, sleepy during the day. So another study found that 55 % of people with MS had poor sleep, 37 % of them had insomnia, 25 % of them had excessive daytime sleepiness, and 20 % had a risk of this obstructive sleep apnea where you stop breathing. And so MS insomnia, insomnia is sleeping less than you want for most nights of the week. your sleep need can fluctuate or your sleep can fluctuate night to night. Sometimes you can have a terrible night’s sleep, other nights you can have a good night’s sleep, but three out of seven nights where you have poor sleep would indicate insomnia.

So there are a number of things that can cause insomnia, which are related to MS like spasticity, leading to a pee, pain, neuro muscular weakness. One of the things that, people don’t realize is that many, many medications that you may be taking for, symptoms associated with MS may actually be causing poor sleep. So it’s always appropriate to talk to your healthcare providers as to whether the medications that you are on are positive for sleep or actually disrupting your sleep. And if they are disrupting your sleep, are there better alternatives? There may not be. And that’s one of the cruel things about medication. You know, if it treats the primary condition, then that’s a good thing. But if it’s also causing side effects, are disturbing, that’s an unfortunate thing. you know, so you need to see, ask for medicines review from the point of view of sleep. Are there interactions between drugs that some of them trying to put you to sleep, whilst others are trying to wake you up? We’ve discussed sleep apnea and restless legs, limb syndrome, periodic leg movement. We haven’t mentioned, this is where you kick in the night or sometimes you punch in the night repeatedly. People often get restless legs and periodic limb movement confused. Restless legs only happen when you are awake. Periodic limb movement only happens when you are asleep. And I say, this is where you flex your lower leg or your lower arm and you actually kick repeatedly every couple of seconds through the night. Again, you actually might not be aware that you’re doing it. Your bed partner certainly will if you’re kicking them. So again, if your bed partner tells you that this is happening, then you need to address the situation. And then there is insomnia, hyper-rout, which is being very, very awake without a daytime sleepiness. This is the sort of opposite of what you’d expect. You’d expect people to be very, very sleepy during the day. But for some people it’s the exact opposite. They feel very awake during the day because of the sleep stems.

Whether it is sleepiness, fatigue or something else you need to use your words carefully when you talk to your clinician. If you say, doctor, doctor, I’m tired all the time. That’s something very different from I feel very sleepy during the day. That’s a very, so your doctor will be listening out to these things and they might not question you, might not appreciate the difference. You might have to do the hard work for them, but be very careful when you use words like tired or exhausted. If actually what you mean is I’m really sleepy. I really could fall asleep now. It’s impacting my daytime function and impacting my quality of life because I’m sleepy. Tired doctors are probably going to be frank, switch off when you say that, unfortunately. So four questions to screen sleep disorders. This is actually a medical questionnaire, but it’s only four questions. It’s very, very simple. How do you feel during the day? If you feel awake, alert, and focused during the day, you don’t have a sleep problem. If you feel sleepy during the day, you probably do. Are you generally content with your sleep? Yes, I’m content. Well, you don’t have a problem. No.

That’s probably indicating that you have insomnia. Are you excessively sleepy during the day without an obvious cause? This is going to be picking up the things like narcolepsy, hypersomnia and obstructive sleep insomnia. So this is picking up those things that can cause a profound level of sleepiness. And then does your bed partner complain about your sleep? Do you do something during the night that your bed partner actually notices and tells you? Maybe they don’t tell you.

Maybe you actually have to ask them. Maybe people just sort of put up with whatever it is and don’t tell you because they think that you might be embarrassed or annoyed or whatever. So maybe it’s worth having that conversation with your partner. So this can pick up about 90 % of serious slave problems. This is the time that you really do need to have a conversation with your clinician about what’s going on. One of the things to say about treatment, many people with MS are taking one, if not more treatments to help them go to sleep. But some of the drugs that may be traditionally thought of, benzodiazepines, the classic sleeping tablets, make sleep quality worse.

 

The SSRIs, the type of antidepressants that many people are on, so Prozac, Talapam, Sirtlain, drugs like that, which are the SSIs, they can actually cause daytime sedation. So they’re actually making the problem worse. And you actually might think, my God, this is a side effect of MS and it actually could be a side effect of the drugs you’re taking. So again, I can’t stress too much about getting a medicine review.

But most thankfully prescription drugs didn’t have a great impact on sleep. But I say if you have got a new medication or you’ve got the dose or something like that and suddenly your sleep feels impacted, then again, it’s worth mentioning to your healthcare professional. So how sleep can catch us back? Well, as I say, if you have a medical condition or a number of medical conditions, treat that medical condition effectively.

They couldn’t be more obvious to be so it may seem trite if you’ve got a serious medical condition to talk about things like sleep hygiene but it’s worth remembering that there are some things that you can do even if you are you know quite ill there are some things you can do to help so you need a sleep promoting environment so one that’s dark quiet cool comfortable you need to be comfortable.

When you sleep, you need to be able to regulate your temperature. You need it to be dark. The body thrives on dark and quiet. So you need to try and optimize the environment. So eye shades, blackout blinds, heavy kerns, earplugs, whatever you can do to help make the environment as comfortable as possible.

A quiet mind and relaxed body. A relaxed body, if you’re tense or in pain or uncomfortable, this sends a signal to the brain saying there is something wrong, you can’t relax here, you can’t go to sleep. Same with a quiet mind. If you’re stressed, if you’re anxious, if you’re worried about things, these are all things that are going to alert you. You can only sleep if you feel safe and secure and anxiety, stress, worry.

These things are things that make you insecure. So you’re having the fight or flight response. Essentially, you either want to hit it or run away, neither of which are compatible feelings for going to sleep. A strong association between sleep and bed. So you should see the bed as the place you sleep. So you should have the perception that when you go to bed, that is the place that you are going to sleep. It is not the place that you read, I’m sorry, not the bed that you watch TV, not the place that you open the mortgage statement or whatever. Now, I appreciate that some people have a different relationship with the bed because of their illness, but to as far as possible, to the extent that you can separate the activities of the day from the bed and see the bed as that thing that you sleep in and you only go there to sleep. No direct effort towards sleep. So lying in bed going, I must go to sleep, must go to sleep, I must go to sleep, I must go to sleep, I must go to sleep isn’t going to help you go to sleep. And absence of regular thought process about sleep. Now I’ve told you that sleep is important. I’ve told you that disorder sleep is not good for you but then I’m telling you not to think about sleep and really that’s the thing. That’s the key thing is just as the Nike advert would say, just do it. If you have a calm, quiet environment, calm, quiet mind, and you go to bed with the intention of going to sleep, then all things being equal, you should get as good sleep as possible. As I say, I know that with medical conditions that that may be sort of, you know, like the highest hill in Holland, it’s there, but it’s not great. But you can do something to make sleep as good as you possibly can, rather than just saying, you know, nothing will work, nothing can help. Some things can actually help improve sleep and any improvement in sleep can only be a good thing. as I say, majority of MS patients have sleep disorders. Many of them can be diagnosed and can be treated. Things like depression, pain, sleep apnea, restless, like all of these things can actually be remedied to a degree of fatigue and daytime sleepiness can be hard to distinguish. So remember to choose your words well. And new muscle weakness at night can be easily missed. So again, you need when you’re talking to your physicians to healthcare professionals to be as explicit and clear when you’re talking about your sleep as possible.

 

Overcoming MS (30:36)

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Zillah Smart (30:50)

Neil, that was really interesting and packed full of information. So lots to take away for people with MS who experience fatigue during the day, is it generally better to take a short nap or try to stay awake until bedtime? And what impact can daytime napping have on sleep quality at night?

 

Dr Neil Stanley (31:09)

Okay, well very simply, let’s say that you are one of these mythical people who actually need exactly eight hours sleep.

If you have two hours of sleep in the afternoon, your body is only going to need to get another six hours at night. Now that might be okay. That might suit you, but it also might mean that you wake up at four o’clock in the morning feeling cold and scared. so, it’s, really up to you. the advice really is not to have a nap.

 

So you have as long of nighttime sleep as possible. However, if you have been regularly having a nap, there’s no guarantee that if you stop having those naps, that suddenly you’ll shift that sleep into the night. So you have two hours in the day, six hours at night. You stop having it two hours in the day and you still only get six hours at night. So you’ve actually done yourself a disservice. You’ve lost your two hours of sleep.

It’s about getting the balance right. If you really feel that you are needing to sleep, that you are sleepy and it is not going to disrupt your life, then have a nap if that works for you. But just be prepared that you may get less sleep at night. If that suits you, then don’t worry about it. But if you then go, my God, I’m not sleeping at night well, napping is probably the issue.

 

Zillah Smart (32:39)

And does it, would it make any difference if somebody felt like they needed the nap to maybe have a cut off time during the day to not have a nap past? So maybe keep it earlier afternoon or?

 

Dr Neil Stanley (32:51)

Well, the post lunch dip, the famous post lunch dip, which doesn’t actually require food to have, happens between two and four o’clock in the afternoon. So that is the time you are most likely to want to have a nap. Past four o’clock in the afternoon, you are probably going to start disrupting your sleep, regardless of how long a nap you have, whether you have a short nap or a long nap. So four o’clock is probably the cutoff of how late you have a nap. Morning you shouldn’t need a nap because you’re on your rising phase so you should be actually getting up more awake but around two to four o’clock is when you should if you do need a nap that’s when you’re going to feel the most need for it.

 

Zillah Smart (33:36)

Lovely, thank you. Another one, how can shift work? This is a tricky one, I know. Particularly rotating shifts or overnight working affect sleep, fatigue and other MS symptoms. And also what practical strategies can people with MS use to manage these effects while working irregular hours?

 

Dr Neil Stanley (33:55)

It’s very difficult. Some people don’t mind shift work, they seem to adapt very easily. Other people find it a terrible thing to go through, even though it’s just a job. Some people find they can’t cope with it at all. It really depends on your shift patterns, how you cope with those shift patterns. So I say there is no easy answer to it. If you get home after a night, you need darkness, you need quiet to get sleep. One thing that people shift workers don’t do is eat healthily because if they’re in a big factory, the canteens close and so you junk out the vending machines and take in healthy food. Don’t nap too late in the night because that will stop you going to sleep when you do go home to sleep Don’t use caffeine too late in the night because again what you want to do is you want to come off that shift and go straight to bed and if you’re using caffeine to keep yourself awake that will keep yourself awake as you get into bed in the mornings is actually going to Exacerbate the problem. So there are many issues around shift work and it’s not easy to give a quick and simple answer.

 

Zillah Smart (35:08)

It’s a tricky one when you don’t have that choice with, you know, changing your shifts or whatever. Okay. So you mentioned that common MS symptoms such as bladder problems, muscle spasms, pain and temperature sensitivity are other ones can disrupt sleep for people with MS. So are there any other strategies that you haven’t mentioned that can help people manage these symptoms and achieve more restful sleep?

 

Dr Neil Stanley (35:33)

Yeah, again, there are different things. mean, I say medications are key in finding the right medication for the condition. Temperature, using natural fibers to wick away the moisture. People don’t realize that sweating is actually part of your body’s cooling process. And so you need to wick away the sweat off the skin, because if the sweat stays on the skin, it’ll actually switch the cooling process off and therefore you’re going to actually feel hotter if you sleep naked than if you did wearing cotton pajamas perversely. So temperature again it’s having separate duvets on the bed so you can have the duvet you want that is different from your partner. I mean I’m the world’s leading advocate of sleeping separately if that’s a possibility.

 

So you can toss and turn and be uncomfortable and remedy that yourself without disturbing your partner. But as I say, it is about treating the symptoms correctly with the correct medication that hopefully does not disturb sleep.

 

Zillah Smart (36:39)

I’ll just add a little tip in there if I may. So I’ve been talking to various people, and we were talking about bladder problems and somebody said they always need to get up in the night for the loo, but then they had mobility issues which made that more difficult and more of a large thing. So we were talking, saying things like making the route to the toilet as easy as possible. So maybe put in like night lights if you like, or if mobility is really a problem having kind of like a commode next to next to try and stop that disruption.

 

Dr Neil Stanley (37:12)

Yeah, mean, having night lights so don’t switch the bright light on so that doesn’t wake you up. So yeah, or even put those luminous footprints that you get on escape routes on ships. You can buy those from Amazon, stick them on your carpet, and so you just follow the luminous footprints.

 

Zillah Smart (37:30)

Somebody has asked, after you mentioned, forgive me if I say this wrong, apnea hypopnea index.  They asked, what if your AHI is 5.99?

 

Dr Neil Stanley (37:45)

You know, there’s these cutoffs so there’s zero mile moderate and severe. At if it’s above 15 if your ahi is above 15 It should really be treated. At less than 15, that would really be dependent on how you feel great during the day, then it probably wouldn’t be treated. If you feel sleepy during the day, then you’d have to mention, you know, so it’s not just the figure, it’s how you feel during the day that’s important. So 5.99 would not be automatically treated unless you have these daytime, you know, sleep during the day.

 

Zillah Smart (38:27)

Okay, so if I wake up during the night and struggle to get back to sleep, what’s the best approach if this happens? Is it better to stay in bed or to get up for a while? Because I know people, different people say different things for this don’t they?

 

Dr Neil Stanley (38:41)

Well, if you can get up and go i to a different room and doing something different, relaxing is the advice. So you don’t want to be lying in bed, tossing and turning and getting ever more frustrated doing that panic mass. Now I don’t fall asleep now. You know, I won’t ever get to sleep and I won’t wake up and go. So if you can then get up, go to another room and do something quiet, relaxing, listen to music, knit whatever, read a book, And then when you feel sleepy again, go back to sleep. But you should be thinking about doing that after about 20 minutes or so before you start getting very frustrated. I realize that some people, as you mentioned with mobility issues, may not be able to easily get out of bed. So in that case, reading or having your little ear pods in to listen to something.

But just to say, stop trying to go to sleep because that won’t work. So basically ignore the problem until you feel sleepy again.

 

Zillah Smart (39:39)

I personally, I tend to put my headphone in and play some kind of podcast that is very complicated that can’t really follow and then I fall back to sleep again. Okay, the next one, should you try to wake up at the same time every day?

 

Dr Neil Stanley (39:53)

This is one of the key pieces of advice that is given. The reason for this is because, you start waking up around 90 minutes before you actually wake up. So your body temperature starts increasing cortisol, which is the thing that gets you up and going, starts increasing. So if you, if your body knows when you’re going to wake up, it can start preparing. If your body has no idea what time you’re going to wake up, then you can’t of course prepare. So.

One, it becomes a good habit and two, allows the body to prepare so you’ll wake up feeling bright-eyed and bushy-tailed. So yeah, absolutely anchoring your sleep to a time point that works for you. Yeah, of course, plus or minus one hour every once in a while, but waking up at the same time is a very powerful change that you can make to your sleep.

 

Zillah Smart (40:46)

Thank you. Kind of linked to that. But can the timing of exercise influence sleep quality?

 

Dr Neil Stanley (40:53)

The jury’s out on this one. it used to be said that you shouldn’t exercise late at night. And then some researchers decided to do a review of all that information and found absolutely none. And so they actually did some studies and they showed that as long as your blood pressure, your body temperature and your heart rate reduced back to normal, you can exercise as much as you like and as close to your bedtime as you like, as long as you have an effective wind down, chill down, period. but as I say, of course morning exercise outside until you get that quiet mind to wake you up is much better. But if don’t be scared to exercise late at night, as long as you, go back to baseline, temperature, etc.

 

Zillah Smart (41:45)

Yeah, great. is Quetiapine one of them? That’s it. One of the meds that have worse sleep quality or also SSRIs, do they also affect?

 

Dr Neil Stanley (41:57)

SSRs are in general alerting drugs so they can cause poor sleep. Quetiapine is similar, it is liable to cause poor sleep. If it has any effect on sleep at all, will probably make sleep worse.

 

Zillah Smart (42:14)

Is there anything we can do to promote deeper sleep specifically?

 

Dr Neil Stanley (42:19)

No, very simple. No, isn’t. The only thing that you can do to improve your deep sleep is sleeping better. Your body regulates the proportion of the stages of sleep as necessary. So even if you only have a small amount of sleep, your body will prioritize getting that deep sleep. So that your body can balance the stages together. If you get more sleep, your body will, if necessary, get more deep sleep. But most people get the deep sleep they need even with a small amount of sleep, unless their sleep is disrupted by things like sleep apnea or whatever, where you don’t actually go into deep sleep.

Don’t trust your sleep tracker. They can’t measure the stages of sleep. Trust how you feel. If you feel awake, again, if you feel sleepy during the day, then you have an issue. If you feel awake, alert and focused, then you don’t have a sleep problem. But don’t trust your sleep tracker. It is highly, highly unlikely that your sleep tracker is accurate in measuring deep sleep or light sleep or REM sleep.

 

Zillah Smart (43:37)

OK, so another one we hear a lot about, is there evidence of melatonin or magnesium improving sleep?

 

Dr Neil Stanley (43:46)

Magnesium, no. Melatonin, is not a hypnotic. Melatonin has very little ability to put you to sleep or to keep you asleep. What melatonin does melatonin is a signal. It tells you when you should be going to sleep. So it rushes around the body saying, on.

It’s gone dark, we should think about going to sleep. There are many other processes after melatonin that actually put you and keep you asleep, but melatonin is a signal. So it’s what we call a chrono biotic. It tells the time. It’s not a hypnotic. It doesn’t put you or to keep you asleep. So melatonin is not like a sleeping tablet. doesn’t work like a sleeping tablet and it won’t have the same effect as a sleeping tablet.

But if you have jet lag or whatever, it may be beneficial, but actually to put your to keep your state, the evidence just isn’t there.

 

Zillah Smart (44:40)

So another one, does sleeping position make a meaningful difference to sleep quality? Just thinking about those of us who experience pain or stiffness or mobility difficulties.

 

Dr Neil Stanley (44:52)

Not in general, no. mean, if you are in a big enough bed and there’s no restraint on you, you move position about 12 to 14 times a night. So you are moving. Nobody’s a back sleeper or a side sleeper or a front sleeper. That’s just not the way it is. You move into all positions about 12- 14 times nine. If you have mobility issues, that may be different, but no, your body will find the most comfortable position that it can find. Unconsciously, it will do that for you. just say have a comfortable bed or comfortable sleeping area and your body will get the comfort it needs and it won’t make a difference. Of course, if you have an uncomfortable mattress with strings sticking out of it or whatever, then that’s going to be an issue. if you can get comfortable, then it should not have any effect on your state of well position you stay in.

 

Zillah Smart (45:53)

Great, thank you. Can consistent poor sleep contribute to difficulties with memory concentration or brain fog?

 

Dr Neil Stanley (46:02)

Yes, absolutely. It’s a perfect description of what poor sleep does for you. As I say, deep sleep, that most important part is when you lay down memories. So if you don’t get the deep sleep, if you have disturbed sleep, you will not be laying down memories or you will not be making those connections between that new information that you have and information that you already have. So yes, brain fog, there’s something called sleep inertia which is a foggy feeling that you have for up to two hours when you wake up in the morning. And that’s caused by having poor sleep as well. So that’s pretty much a description of what poor sleep does for you.

 

Zillah Smart (46:42)

Thank you. If you have a few bad nights of around four hours sleep, can you catch up with a long 12 hour sleep?

 

Dr Neil Stanley (46:50)

Not really. If you miss sleep, you’ll make up some of it the next night. So if you miss deep sleep, you’ll make up 100 % of that deep sleep. So if you have a very bad night and the next night you’ll sleep like a log, you literally won’t move because you’re in that deep sleep the whole time. So you can catch up on a couple of nights sleep, but having a 12 hour sleep,

 

isn’t going to really make up for all that you’ve missed so we know from recent studies that consistency is more important so going back to that question that we answered earlier about having the fixed wake-up time having a fixed wake-up time even though you feel you’re getting less sleep is actually better probably than trying to catch up on sleep.

 

Zillah Smart (47:42)

Brilliant. So just a final thank you all for joining. Thank you again to Neil. Take care and we’ll see you again soon.

 

Overcoming MS      (47:51)

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