Episode Transcript
Speaker 1 00:00:07 Welcome to the Irish Pharmacy podcast. This podcast is brought to you by Total Health and Haven Pharmacies. There are 127 of our independently owned pharmacies located all over Ireland so that we can bring trusted local care to you and your community. And now on the go with this podcast, my name is Sheena Mitchell. I'm a pharmacist from Milltown Total Health Pharmacy. In each episode, I'll be chatting with one of my pharmacist colleagues from the Total Health and Haven Pharmacies where they will blow your mind with all of the amazing information that they have. We aim to bring you reliable and useful health information that you can listen to conveniently at a time that suits you. I'm joined by Pric Murphy from Haven Pharmacy Murphy's in Conard County Wexford, and we are gonna be talking about the very important subject of sleep. When I say Pric is knowledgeable about sleep, I mean he is an absolute wizarding genius when it comes to sleep.
Speaker 1 00:01:01 I couldn't believe how much in-depth information he knew and he really, really helped me to understand all of the factors that we need to consider about sleep. And as he says himself at the end, that we then need to forget about. We talk about sleep expectations and how much sleep we actually need. We discuss insomnia and its causes and any dangers that are associated with a lack of sleep. We also talk a little bit about sleep quality and whether or not this deteriorates with age Horic gives loads of advice on natural ways to support a high quality restorative sleep, and we do discuss the use of sleeping tablets and whether or not naps are a good or bad idea. All in all, this is a really, really informative podcast and I was so glad to be joined by Pric today. Enjoy today I am joined by Pric Murphy from Haven Pharmacy Murphy's in Lanard in county. Wexford, thanks so much for coming on to the podcast today po
Speaker 2 00:01:57 Oh, thanks very much for inviting me. She, I'm delighted to be here and to have an opportunity to talk about one of my favorite topics.
Speaker 1 00:02:03 I know. And before we dive into the very complicated world and a very important topic of insomnia, can you tell me a little bit about your pharmacy and your community?
Speaker 2 00:02:14 I live and work in Wexford Town in an area called Glen, which is just outside the center. I opened the Glen Pharmacy in 2006 and then about 10 years ago I moved it into HA Pharmacy Murphy's as part of the co-op. And I'm delighted to be back working as integral car to the community and to have an opportunity to try and empower people to improve their health through an extra little bit of knowledge is how I'd like to think of it at
Speaker 1 00:02:38 Community pharmacies. We're definitely well placed to do that. So today you are talking to me all about sleep. So obviously everyone knows that sleep is something that happens at the end of the day. It either comes easily or it doesn't, but what would you say being, I'm gonna, I think it's fair to call you after our previous conversations, a sleep expert <laugh>. I know you won't like that title, but you're definitely seriously educated on the topic and that's why I'm so delighted to discuss it with you today. So what is sleep and the importance of it?
Speaker 2 00:03:10 It's such a primordial instinct and, and yet it's a mystery I suppose from a dictionary definition is very much like a condition of the body, the tip of the occurs for several hours at night in which the eyes are closed, our muscles are relaxed and the activity, the brain is altered depending on the phase and consciousness of the surroundings is, is reduced.
Speaker 1 00:03:29 That makes sound very complex.
Speaker 2 00:03:31 It's basically the absence of wakefulness is a better way of putting it, I think.
Speaker 1 00:03:35 Um, and can you have the absence of wakefulness without having quality sleep? I suppose this is the problem.
Speaker 2 00:03:41 Absolutely, and I think like a lot of things we tend to have unrealistic expectations about what our sleep should be. Most people can easily recall their teenage years when they would sleep flat out without any problems if for as long as they like to go to sleep without any delay, the stresses and strains of modern life happen. I mean, everyone is going to experience times in their life where they don't sleep very well and how we react to that is really important.
Speaker 1 00:04:04 This thing about expectations, is there a norm or does it differ from person to person? Yeah,
Speaker 2 00:04:11 On, on average people need between seven and eight hours sleep. Having said that, everybody is individual. There's obviously some instances in history where people like Margaret Thatcher, Ronald Reagan posted how they could survive on little or no sleep. And I think it's no coincidence that both of those people died from Alzheimer's. We'll get to that later on, but it, it's good not to focus on it too much. It's like giving yourself the sleep opportunity. So sleep opportunity is basically the amount of time you're spending in bed, giving yourself the opportunity to sleep. We'll get around to giving a few tips on how you might improve the efficiency of your sleep.
Speaker 1 00:04:42 We speak about insomnia and a lot of people may feel they have insomnia, but maybe don't because of unrealistic sleep expectations. I probably fall into that category sometimes, but yeah, in terms of time taken to fall asleep or waking a lot during the night, like what is insomnia? You know, when is it just a few bad nights and when does it become an actual problem?
Speaker 2 00:05:07 The way people would define it is about 19% say they wake up early, about 19% say they have trouble falling asleep, but 25% need a daytime nap to survive. And about 43% will tell you they have both issues, like problems initiating sleep, staying asleep. The issue is, as you've clearly pointed out there, that there's very different perceptions of what a good night's sleep is. And just to give you a few more statistics reported, insomnia does increase dramatically with age. From 18 to 34 year olds, it's about 14%, 35 to 49, it's only 15%. But once people go over 65, it's dramatic, it's 25% over 60 fives. That would lead us on maybe to have a look at what are the phases of sleep and what is the sleep cycle and how do those sleep cycles change. As we get older, there's a natural change that occurs and maybe not to be too disappointed. Okay.
Speaker 1 00:05:56 Talk me through that then, because I'm definitely interested to hear about age because you're right, definitely. It seems to play a big part in the narrative that the older you get, the more difficult sleep is to find, I suppose. So how does the sleep cycle actually work? It,
Speaker 2 00:06:14 There's essentially two phases. There's a non REM sleep and there's REM sleep. The non REM sleep is separated into N one, N two and N three N one is very transient, 15 minutes N two is usually quite short as well. And the N three is what we call deep sleep or slow wave sleep. And it turns out that's a really fundamental physical requirement for physical wellbeing of the body and particularly wellbeing of the brain. And then the next phase is REM sleep. So for a healthy young person, what tends to happen is they'll have about five sleep cycles in the night and early in the night. The N three or the deep sleep is the most pronounced one and they'll get very little rem and as the sleep cycles go on through the night, the REM becomes more pronounced. That's time when we dream and our muscles are paralyzed during REM sleep.
Speaker 2 00:06:58 So there's actually very little difference in looking at the brain activity of somebody who's awake and going through REM sleep. And if their muscles weren't paralyzed as a an evolutionary mechanism, we'd be acting out our dreams, which would be very danger first. Yeah, very dangerous <laugh>. But the other interesting thing from an endocrine or hormone point of view, a lot of hormones are released during that first phase of deep sleep. So that's why it's so critical and perhaps that's why the old phrase in Ireland was an error before 12 was war two. After. I would say that the mechanism for that would be that growth hormone is released primarily during that deep phase slow wave sleep. And if you miss your first cycle, so you're out late and join yourself, which is essential to do, and then preface all this discussion with people should live their lives and not dwell on sleep too much. That leads to, it's almost like performance anxiety. And to go back to the REM sleep, then REM sleep is critically important for cognitive function and for psychological wellbeing and mental health. That would appear to be the really important issue there in having good creativity, better concentration during today. So the REM sleep is kind of therapy for the psychological wellbeing and the deep sleep is primarily for a physical wellbeing.
Speaker 1 00:08:03 This is a very random question, which you may not know the answer to <laugh>, but I was having the conversation with someone the other day about ability to remember dreams or not. Yeah. Does that kind of relate to if you wake during that REM sleep period within the cycle,
Speaker 2 00:08:20 It's primarily where people doze off early in the morning. You tend to go back into REM sleep and then you're disturbed and you, you tend to have a better recollection of it. You'll often hear people saying, older people don't need as much sleep as people get older, they're more resilient to sleep deprivation, but it doesn't actually mean they don't require it, it's, they're just less able to generate that slow wave sleep. What you tend to see as people get older is shorter periods of deep sleep. Essentially the efficiency goes down and along with that the REM reduces and the deep sleep produces.
Speaker 1 00:08:52 My children will ask me why do I need to sleep? And you're kind of explaining to them that that is the time that you process your day's learnings and your body helps Absolutely. To, to restore itself and yeah. You know, heal itself and all the tissue muscles have a chance to, I suppose, recuperate during that time. Absolutely,
Speaker 2 00:09:12 Yeah.
Speaker 1 00:09:12 Yeah. And then when you think of elderly people, they're the one group who actually probably need quality sleep more because the demands on their body are more difficult. Absolutely.
Speaker 2 00:09:23 Cause as a community pharmacist like yourself, doing my utmost to help my patients, I always like to get to the root cause. And it's obviously very difficult when people have different conditions and which one comes first and what leads to another. But sleep was coming up again and again as I discussed it with people. And then when I read Matthew Walker's book, it became really clear and frightening to be honest, as he outlined what the consequences of poor sleep were. Time to exhaustion after poor sleep is reduced, aerobic capacity is reduced, and ability to do cognitive things or concentrate or focus and and learn new tasks is reduced. So from an evolutionary point of view, you'd imagine it's a very inefficient thing to spend almost a third of our lives lying down and not aware of our surroundings. But in fact, the more and more evidence that's out there is that a shorter amount of sleep on average leads to a shorter life.
Speaker 2 00:10:11 I mean, that's a profound statement, but the evidence is overwhelming. And even if you just look at some of the main conditions that we're treating in community pharmacy and primary healthcare like diabetes, even after seven nights of taking young healthy people and depriving them to about five hours sleep, they're sugar levels are equal to someone who's pre-diabetic and their hormone levels are reduced. Men's testosterone levels are equivalent to somebody about 10 years older than them. You can also measure the female hormones are significantly reduced even after that short time period of sleep deprivation. Anyone's familiar with physiology would know that there's a, a lymphatic drainage system in the human body that works like, uh, the opposite to the bloodstream and very slowly transports dead cells and proteins and things back around the body. Well, we, it's a relatively recent discovery that there's a glymphatic system in the brain, and this is activated primarily during that deep slow wave sleep.
Speaker 2 00:11:00 And that's where the channels in the brain literally open up and the cerebral spinal fluid washes out all the proteins that shouldn't be there. They're built up as a, as a kind of a byproduct of metabolism. And of course the brain is, it uses 20% of our, our glucose, it's going through an commencement of work. So the tau proteins and the beta amyloid proteins, which are markers for dementia and Alzheimer's disease can be measured as elevated even after a short number of, of nights of sleep deprivation. So that's kind of like the causal mechanism. We already knew by association that people who suffered from poor sleep over many years, it was one of the main lifestyle risks of dementia are Alzheimer's. But we didn't really have a causality of it and now we have some evidence to, to show that. So it can be a bit frightening as you read, increased cardiovascular risk and the sugar metabolism, I suppose, which can lead to obesity and an inability to metabolize sugars properly. Deliver doesn't function properly, either. Normally deliver, produces sugar from gluconeogenesis, from fat, and that doesn't function properly either when someone doesn't have a good night's sleep. So then it's, it becomes a spiral where someone craves the wrong foods, they eat the wrong foods, they go for stimulants. People should understand that caffeine, while it's a very healthy thing to use in moderation, we should be aware that it takes quite a long time for caffeine to wash out of the system. It has an impact on our ability to sleep, quality of it, and going to sleep.
Speaker 1 00:12:23 That's really interesting. I know I've been talking a lot about diabetes lately and obesity and one thing that came up that I was kind of talking about in life at the moment, it's changed on how it was a few decades ago. So people are working more, so it's more common to have two working parents in a household or two partners working and trying to juggle life commitments. Then obviously the financial burdens that people are facing with the housing crisis and the cost of living crisis, all of these things are maybe adding stress to people add to that then a decreased ability and time to maybe meal plan and shop smartly and understand the diet that we're eating. So like it's very easy to go in and just pick up something processed, but obviously that brings its whole other realm of problems with the fat levels and the, the macros that they contain.
Speaker 1 00:13:23 Yeah. Um, or don't, and you know, all of that. And then add into the fact that people are so fatigued by living in this world that we find ourselves in now that they get in and in the end of the day and they need to find a way to de-stress. And okay, some people will do that in healthy ways by drinking camomile tea maybe or going for a walk. But with our climate and our daylight hours, that can be difficult. And it was certainly well reported that particularly during covid when stress levels were high, people were using things like alcohol to try and sedate them into some sort of sleep or relaxed less anxious state. And I'm assuming all of that is very unhelpful for sleep as well.
Speaker 2 00:14:12 Yeah, that's a really interesting topic and it, it just leaves me into two important points. There's of course there's genetic links to all these things and nobody's responsible for the, whatever conditions they're suffering from, but we, we need to try and empower them to realize there are things they can do to help to tweak it. So like while a certain amount of caffeine has been shown to be healthy, it's important to note that caffeine has a five hour half life and our ability to metabolize caffeine actually reduces as we get older. I suppose a simple rule of thumb would be not to consume caffeine, eight to 10 errors before you plan to go to bed. In an ideal world anyway, <laugh>, it's the caffeine metabolism, it's just going to delay sleep. But more importantly it reduces sleep efficiency.
Speaker 1 00:14:51 I'm just going to say, I'm sitting here drinking a coffee and it's half passport <laugh>. Oh,
Speaker 2 00:14:56 I just, I just had one before we started. So <laugh>, you know, it's
Speaker 1 00:14:59 Good. This is ideal world stuff, ideal
Speaker 2 00:15:02 <laugh>, ideal world, perhaps keep your caffeine into the earlier in the day if possible. Sleep is governed by a couple of simple things. There is a chemical in the brain called adenosine, and as that builds up, our sleep pressure builds up. It does fluctuate, but caffeine blocks adenosine receptors. So when you have your first cup of coffee in the morning, it blocks the receptors and then as the caffeine wears off, sometimes mid-afternoon or circadian rhythm takes a natural dip and it's very tempting to have another cup of coffee. A little trick actually is if you don't consume caffeine for the, about the first hour of the day, adenosine receptors kind of settle more in the morning and then your first coffee, it won't have as much impact on your feeling of wakefulness as it wears off. It's about to go back to the alcohol issue, you know, there's been a lot of research pedald about over the years about a certain amount of alcohol, particular red wine being good for you, that has been completely refuted in recent years. There's no amount of alcohol totality for the body from a sleep perspective. The sedation you get from alcohol is terrible, particularly disrupts rem sleep. Now, if someone can stay in bed for long enough, their REM sleep will start to recover towards the end of the night as the sleep cycles come along. But alcohol reduces the amount of time of sleep and it reduces the efficiency to sleep.
Speaker 1 00:16:13 Okay. So just because you feel like you're having a great night's sleep after a few glasses of wine, what you're saying is the restorative quality of that sleep is not there,
Speaker 2 00:16:25 It's not there. Your, your ability to concentrate is obviously compromised the next day. Cardiac, it's fake sleep. <laugh>. Yeah, yeah, it's fake sleep As, as a runner over the years, I can testify that when you track your heart rate while you're running after alcohol, it's just a rule of thumb, but you'll, you'll be putting in a lot more cardiac effort for a lot slower pace, that type of thing. Okay. Blood pressure goes up when people don't sleep enough. There's a lot of other issues, but just I think it's important to outline that alcohol is not a way to improve someone's sleep.
Speaker 1 00:16:53 Just to throw balance to that conversation, and I know you already did there, but I think really what we're trying to say, alcohol is not the answer to your sleep issues and obviously everything in moderation.
Speaker 2 00:17:07 Perhaps you could try and drink with your meal maybe a little bit earlier in the night, give your body a chance to metabolize some of the alcohol,
Speaker 1 00:17:14 But it's not that quick win that you think it is. No, yeah. Okay. You spoke about running, and I don't wanna bore people because I know we're both avid runners <laugh>, and we could go down a very slippery slope here, but for me, if I'm going through periods of poor sleep, it's generally because I'm not exercising or getting out. Even for me, I need to see the outside world. So I'm not a great treadmill runner. I prefer to be out and seeing the world around me. It makes me feel a little bit more grounded also, I don't think the dogs would appreciate the treadmill, but <laugh>, you never know. I might try that out. So you know, I, I definitely find that I get a great night's sleep after I have done physical exertion. And I think this is translatable to everyone because not everyone has to run, it could be a, you know, a gentle walk or whatever you're able to, but is there an association between exercise and sleep and also the outdoors and sleep?
Speaker 2 00:18:15 The first question, either anaerobic or weight training improves sleep as does aerobic exercise like running or walking. But you're hitting a really important point here that doing something outside helps us. Our circadian rhythm to rebalance every cell in our body has a 24 hour clock, a circadian rhythm. They've done experiments on putting people living down in caves and there's quite a large percentage of population like me night owls and their circadian rhythm is a little bit longer than 24 hours every day. We need to learn a few tricks to try and reset our circadian rhythm for that day. And the easiest way to do that is exposure to daylight. So running outside in the morning or walking outside in the morning is a fantastic way to improve the circadian rhythm. And our hormonal response is discovered a few years ago that there's a set of cells in the eye that have nothing to do with sight and they help to regulate the the sleep wake cycle.
Speaker 2 00:19:06 These cells are linked back to the thing called the super charismatic nucleus, which is right behind the two optic nerves where the two optic nerves crisscross and if you like, it's the conductor of the circadian rhythm. So whenever someone gets out and gets light exposure, that sends a message then to the pale gland, which is a small little land, the back of the brain to start producing melatonin about 12 hours later. So that's a really good way linking the body. And I think there's some interesting research being conducted at the moment about consequences of different parts of the body not being in sync and not following the circadian rhythm. So for example, maybe cardiac health where the heart is working on a different schedule. You touched on food being really important. I mean if we eat very late at night, it can affect our sleep ability as well.
Speaker 2 00:19:49 The rule of thumb now is you reckon about three hours before bed is when you should have your last large meal, about 35% of insomnia cases. There is a psychiatric illness involved. So it'd be important for people to realize if they have a really big issue with sleep and insomnia, that they should consult their doctor because doctor will take that into account and primarily that issue is depression and that should be addressed. But 15% then is where people start thinking too much about their sleep, put themselves under pressure, and now we have the ability to measure our sleep cycles really easily with activity trackers. And as a, a fellow runner, I'm sure you have a a tracker to, to look at your running and it'll tell you how much sleep you got. There'll have to be a new area of study on this to all this information we're tracking back consciously. How does that affect the brain's ability to, to regulate us All this information isn't useful. Yeah,
Speaker 1 00:20:36 I take off my watch whenever I'm not running because it just mess my head telling me to move
Speaker 2 00:20:41 Pretty much data, I mean there's a couple of other things there like restless leg syndrome, there's about one in 10 people tell you they're terrible sleepers and when you bring them into a sleep lab, they actually have no issue at all. It's just they're slightly more perceptive of the interruptions to their sleep. They just call that paradoxical insomnia. But the circadian rhythm in the literature is only attributed in about one in 10 cases. But I would venture to say that it's a lot more significant than that because the circadian rhythm is what we've evolutionary designed to live and, and modern life is taking us further and further away from that as we need to commute more as we have more electronic devices that are part of our lives now. And I'm not going to sit here and tell you that I don't look at my phone late at night or check my emails last thing at night, but it, it's just to be aware of few little tricks. Like you can turn the blue light filter off in your phone, blue light is known to disrupt melatonin release, you can delay it by about 90 minutes and melatonin doesn't indicate quality of sleep, but it's, it's very important for getting to sleep that nice sleepy feeling. And they should always say you shouldn't go to bed until you feel sleepy.
Speaker 1 00:21:41 Just on that actually obviously there is a seasonal variance in our morning light and at what time it arrives. Does that have a big impact?
Speaker 2 00:21:51 Absolutely. Like there's gonna be naturally different amounts of average sleep during the wintertime, especially living in a place like Ireland where we have such long days in the summer and and short days in the winter and it, it is definitely worthwhile in getting blackout blinds to block out light, especially if you're trying to get children to sleep longer or to sleep longer yourself. That blue light as it comes in through the, the blinds of the curtains will, will stimulate wakefulness.
Speaker 1 00:22:15 And what about conversely then in the winter using, you know you can get those, are they called sun lamp? Yeah. You know, white light for the morning exposure to that for 10 minutes. Is that helpful or is that Yeah,
Speaker 2 00:22:26 It is definitely helpful even leaving the exercise out of it. I wouldn't encourage someone who's trying to make a change to their sleep wake cycle to just have their morning to your coffee outside. If it's sunny, 10 minutes is enough, if it's very cloudy as it often is in Ireland, trying to l it out to 10 or 15 minutes and just that kind of gazing off into the horizon. It sounds touchy feely but it has been shown to to help to regulate that sleep wake cycle. Obviously then if someone becomes more energetic they could maybe go for a walk around the block if they have the time. But in absence of the ability to do that, one of those lamps can help to a person to wake up and feel better. And
Speaker 1 00:22:59 One other question about causes at the moment, obviously there's a lot of chat which is great, it's very welcome that there's a lot more chat about things like the menopause and pregnancy obviously is another time for women specifically. Yeah. Where hormone levels fluctuate naturally, are female hormones a big contributor to sleep issues or how do they impact sleep?
Speaker 2 00:23:20 I think one of the main ways they impact sleep is by core body temperature. So in order to facilitate sleep, your core temperature has to come down by about one degrees cent integre. The hormones can have an impact on that core temperature. The ambient temperature in the room would need to be lower for the female than it would be for the male. So it might be that you need different type of duvet or something like that. There might be practical solutions. But certainly the hormonal thing, and particularly during the menopause, it seems to be a huge factor where the quality of the sleep dramatically reduces. And even during earlier stages, like during the pering menopause where the lack of sleep itself could have a significant impact on the hormone production. Yeah, the data is more clear coach when it comes to the male testosterone, but there's clearly a link there as well with female hormones. Yeah,
Speaker 1 00:24:02 That makes so much sense after what you said earlier about you know, nighttime being a, a time where your hormone production is controlled and hormones are obviously key to these phases in women's life. So it does make sense to link one with the other. You've already given some great tips on improving sleep, but before we move on to general sleep hygiene and just practical measures that people can use, there's two things really. So first of all, obviously you spoke about how mental health problems can be a contributor and that if persistent sleep problems are there or you think your sleep problems are very significant that you should see a doctor. But are there other occasions where people should see a doctor? And I suppose as a follow on to that, what is the role of sleeping tablets that people may then be prescribed or not?
Speaker 2 00:24:52 We've both seen, and I'm sure our colleagues in farms, you've seen quite a high incidence as sleeping tablet prescribing and despite the fact that it's no longer advised as first line therapy, but with a health system that's clearly strained, it's difficult for prescribers to have the time. Probably there's an absence of ability to refer people. I mean the first line treatment for insomnia is cognitive behavioral therapy. Probably difficult to access for the percentage of people that are suffering from it. When you look at the meta-analysis or the review of the data on large scale figures of people on sleeping tablets, the overall mortality rates or the risk of people dying when they're taking part in these studies correlates to how often they're using the sleeping tablets and compared to non-users, their health risks is poor and I'm sure there could be other factors involved there, but in essence the sedation that people experience from sleeping tablets doesn't appear to be improving their general health, physical or mental. Okay. So while they might have a place short term when people are undergoing severe stress, a prescriber might feel it's necessary. We really should be exploring all other avenues before they're given to a patient long term
Speaker 1 00:25:57 Find the root cause.
Speaker 2 00:25:58 Yeah. Ideally
Speaker 1 00:25:59 We've spoken about the first 10 minutes of the day and it's worth setting your clock that little bit earlier.
Speaker 2 00:26:06 Stress is a really important thing to bring into this. If someone is under physical stress, like working physically very hard or there's a lot of demands on their cognitive abilities, whether it be through the day to day looking after the family and through workplace and all the different challenges people experience now in commuting and whatnot that perhaps are ancestors didn't have to deal with just to build in little periods of rest into the day as well as to facilitate stress reduction of trying to help being more relaxed and when we're going to bed.
Speaker 1 00:26:32 I know earlier you said 25% of people I think it was feel that they needed an nap. I try and avoid naps purely because I feel like it mostly would negatively impact my ability to fall asleep then later on and I end up staying up way too late. In general, are naps a good idea for people?
Speaker 2 00:26:50 Generally they're not advised particularly for people that consider themselves to suffer from insomnia, but they do have a place, and I don't think they should be discounted if, if someone is going to nap, the ideal time would probably be between one and three depending on their lifestyle. And ideally for something between 1345 minutes, if you kind of start going into a full sleep cycle of one and a half hours, I think the ability to sleep that night is severely impaired and
Speaker 1 00:27:15 It can be hard to imagine fitting that into a working day. I actually have a girl who works <laugh> for me and she's amazing on her lunch chair, she's like, don't talk to me. So she'll eat for a half an hour and then she'll sit in the chair, which you know, I mean it's a fine chair for eating your luncheon, but she <laugh> literally put the head down, earphones in and off she goes. And I'm just like, that's
Speaker 2 00:27:38 Amazing's a a great skill. I'm envious. Yeah, yeah. To be able to relax that much and have that ability, essentially you try and convince people to go to sleep when they're sleepy and, and, and try not to lie awake in bed for long periods of time
Speaker 1 00:27:51 The next day if we have a bad night's sleep, there is a tendency to mentally punish yourself or tell yourself that, well now you're not gonna be able to do this and you're not gonna be able to do that cuz you didn't have a good night's sleep and why didn't you have a good night's sleep Now you're not gonna be able to concentrate. Whereas in reality that's not true because you've probably had enough quality sleep over the last few nights. Um Oh yeah,
Speaker 2 00:28:13 Absolutely. Say from having run over 10 marathons, I can say that like coming up to the Martin, no matter how you try and convince yourself, usually the nerves will get you the night before and you'll have a very poor night's sleep but the ability is there, you can still go out and physically run and it doesn't seem to have much impact on it. It's very slight. Perhaps it's good to have confidence in our, in our body's ability to adapt. And there's a couple of other interesting mechanisms like we don't, our immune system isn't quite as effective after a poor night's sleep and things like that. But again, best not to focus on these things. Easier said than done. So take all this knowledge in and then forget it and <laugh> don't, don't focus on it. Whatever you do,
Speaker 1 00:28:49 I bring you on for the great topic, tell us everything and now we need to forget it. <laugh>. <laugh>. But actually I think it's all really reassuring because in essence what we're saying is that our bodies are much more abreast to adapting and to surviving and then as you said, compensating over maybe following nights in ways that we won't even see. And to have faith in that process and allow that to remove the stress and anxiety associated with sleep.
Speaker 2 00:29:22 Yeah, absolutely. Just, just in ourselves and and our abilities to do it. And I know there can be very challenging times after particularly poor night's sleep. I personally think the nap is a great device there, you know, to time it and turn off your phone and no interruptions and even if you don't sleep, that relaxation period is gonna have a significant benefit. There are some supplements like magnesium, which can help, we're seeing a lot more prescriptions for melatonin which can have a place in helping to, to shift the sleep cycle to a a healthier rhythm, heartly, circadian rhythm. But of course all these things should, you should consult with your, with your doctor before taking them.
Speaker 1 00:29:57 So in the meanwhile, set yourself up for success and
Speaker 2 00:30:01 Absolutely
Speaker 1 00:30:02 All of the things that will help promote a good night's sleep will actually help with an awful lot of other health factors.
Speaker 2 00:30:11 Absolutely. You know, watch your sugar intake just before bed, it's gonna activate your frontal cortex, activate your brain, you start thinking about things too much and the screen time can be a double whammy cuz it activates your cognitive thinking and it also delays the melatonin release. So absolutely set yourself up for success. You know, the more modern homes can be too warm for sleeping. So the optimal temperature seems to be about 18 degrees for a bedroom. It's okay to be wrapped up but the, the room itself shouldn't be higher than that. We should be turning down our lights, get some lamps, don't have particularly LEDs, have a blue light. We shouldn't be using those late at night. It's just trying to wind down, try not to exercise just before bed either because that increases core temperature and then it's difficult to get the core temperature down sufficiently to get to sleep without going to see a profession about cognitive behavior therapy. There's some interesting resources online, podcasts and things like that.
Speaker 1 00:31:04 Yeah, any suggestions?
Speaker 2 00:31:06 And there's a particularly good one called the Sleep School in London, the main professor there. It's just convincing people to have confidence in their ability to sleep. We can all influence our meal times, small changes but significant.
Speaker 1 00:31:19 And a lot of these changes are things that we don't wanna hear to be perfectly honest. Like we want a magic fix, I don't wanna hear it, then I have to stick to a regular sleep pattern, be sensible with my coffee intake, do some exercise. Like these are in essence things that we should all know but it's not the reality that you remember to put them into practice. Yeah, and I think that's key.
Speaker 2 00:31:42 A lot of these things are advice your grandmother has probably given you, you know, and it depending on your mindset, like I like to see data to convince me of something that is already common sense. And I know all these things I'm mentioning are very obvious, but there's a good body of data to back them up now. And I see that happening more and more in medicine. We're going to see the importance of, well you don't even have to call it exercise, the importance of movement. You know, generation ago we, everyone had to wash their clothes, wash their dishes, hang them out on a line, all these different tasks that were part of the daily routine that are now no longer necessary. Yeah. They walked everywhere, cycled everywhere. It's just to introduce a bit of balance back into our lives and these things are worth prioritizing because
Speaker 1 00:32:21 It's like we've over commercialized, strip it all back to where our grandparents were and yeah, that'll
Speaker 2 00:32:27 Be from, from a food perspective, don't eat anything your grandparents couldn't eat if it wasn't available to them. Do not eat it. It's very confusing when you see all the different types of diets that are out there and the overwhelming data, particularly when it comes to sugar levels and diabetes, all these different illnesses that are becoming more and more part of the discussion and all the inflammatory illnesses that are out there. All these things are made worse by our sugar levels and the fact that the body is either in one phase or the other, we're either storing energy or we're in a repairs phase and using that energy and even if there's any amount of sugar in your system, that repair phase can't start.
Speaker 1 00:33:09 One of those buzzwords at the moment is intermittent fasting and huge. Yeah. So intermittent fasting in terms of just restricting your food hours to an eight hour period during the day, ideally starting early and finishing early, yeah. That is beneficial to sleep.
Speaker 2 00:33:28 Absolutely. This, there's a secondary benefit to the sleep and there's a, there's a relationship there between sugar levels and getting the proper hormone releases of growth hormone and the other hormone secondary to that, that are triggered by that. So all that process essentially your body goes into repair phase when we enna enable it. As I always say to people, you wouldn't fix a highway with cars going up and down the road when your gut replaces itself. Every nine to 10 days
Speaker 1 00:33:56 We're at a crossroads where we either to continue to allow ourselves to be influenced and dictated to by commercial organizations that have one agenda, which is sale of their product. Or we choose to go back to basics and follow a natural path and try and bring ourselves back to, I suppose original humanity for yeah. Want of a better phrase.
Speaker 2 00:34:22 And, and that's why I keep mentioning the, the circadian rhythm and of course there's different genetic differences in how much sleep people need and some people prefer sleep early in the day, some late. And in some parts of the world where the, the siesta is still the common thing, health outcomes seem to be superior than ours, for example, even with no obvious improvement in, in lifestyle issues. So it's just good to be aware if you do try and measure what are you measuring and we should be looking when it comes to food and exercise and sleep and all these things, it's quality, not quantity too. A short effective sleep could be just as good as a, a longer disrupted sleep.
Speaker 1 00:34:59 Keep it simple.
Speaker 2 00:35:00 Absolutely.
Speaker 1 00:35:02 Thank you so much for explaining all of that and going into so much detail because you really are a complete wealth of knowledge on the topic and I would implore anyone in the expert area to hop into Haven Pharmacy, Murphy's Clint Lanard to tap into some of this genius because Oh
Speaker 2 00:35:21 Thanks very much. You're too kind.
Speaker 1 00:35:22 No, it's you're, you know, an asset to your community and it's, it's hard to, I suppose strip the nonsense from the fact and it's been really great to have the opportunity to do that today and
Speaker 2 00:35:34 Hopefully this discussion will make it a bit easier for people to understand the overall issues involved if we can reduce a little bit of that anxiety around sleep and just realize that you know what, even if you feel like you're awake a lot, perhaps you're not as awake as much as you think.
Speaker 1 00:35:47 And this is why this podcast is great, because community pharmacists are experts over a whole wide range of areas. Communication time can be restrained because of the nature of the setting. We are impassioned and very passionate about reaching out and supporting our communities and this allows us time to do it, which is fantastic.
Speaker 2 00:36:11 I really appreciate the opportunity. Thanks very much.
Speaker 1 00:36:14 Thank you.
