Mastering Sleep for High Stakes Environments

EPISODE 10:   Mastering Sleep for High-Stakes Environments

Find the episode HERE

In this episode, Martin and Jonpaul talk to Professor Colin Espie, a world-leading expert on sleep and the treatment of sleep disorders, particularly using cognitive behavioural therapeutics (CBTI) to treat insomnia disorder. They discuss how sleep contributes to physical and mental health, the five principles of sleep health and the treatment options for insomnia. They debunk myths such as a ‘sleepless elite’ & explore the intricate relationship between sleep, memory consolidation and trauma recovery.

Guest, Cast & Crew

Colin Espie is professor of sleep medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford where he founded the Experimental and Clinical Sleep Medicine Research Program in the Sir Jules Thorne Sleep and Circadian Research Institute.  He is also the Clinical Director of the Oxford Online Programme in Sleep Medicine and has published over 300 scientific papers and several important books on the subect of sleep.  Colin is also the co-founder of Big Health who created Sleepio, a digital treatment for insomnia. 

Hosted by Martin Jones & Jonpaul Nevin https://www.ophp.co.uk 

Edited by Bess Manley

Produced by WavellRoom https://wavellroom.com/audio/ 

Resources

• Colin’s profile & contact info https://www.ndcn.ox.ac.uk/team/colin-espie 
• Oxford Online Programme in Sleep Medicine https://www.scni.ox.ac.uk/study-with-us 
• Sleepio – a digital treatment for insomnia https://www.bighealth.com/sleepio 
• Colin’s books https://colinespie.com/author/ 
• The 5 Principles of Sleep Health https://colinespie.com/sleep-resources/ 

 

If you’re enjoying this content, please like and subscribe so we can keep improving. And remember to visit WavellRoom.com for their latest articles, podcasts and newsletters. 

Chapters

00:42 Introducing Professor Colin Espie

01:39 The Importance of Sleep in Mental Health

04:15 Why Sleep is Crucial: Physiological and Cognitive Perspectives

06:07 Sleep Deprivation and Its Consequences

14:34 The Concept of the Sleepless Elite

19:52 The Five Principles of Sleep Health

27:16 The Importance of Sleep in Peak Performance

28:14 Understanding Insomnia

31:12 Treatment Options for Insomnia

34:03 The Role of Alcohol in Sleep

36:11 Sleep Banking and Deprivation Training

43:15 Cognitive Behavioral Therapy for Insomnia

49:51 Final Thoughts on Sleep Health

Up Next

Next week, we’re taking a second deep dive into the science of sleep, but this time we’re with Professor Russell Foster, a world-leading expert on the mysterious phenomenon of circadian rhythms, which play a crucial role in optimal human performance.

Transcript

[00:00:00] INTRO: Hello and welcome to the Optimizing Human Performance podcast. I’m Martin Jones, a Human Performance Specialist, Researcher and Educator. And I’m John Paul Nevin, a former Royal Armoury Physical Training Corps Instructor turned academic. Each week we talk to world leading experts about how to unlock the full potential of those who operate in high stress, high stakes environments.

We discuss the latest science, innovative strategies, practical wisdom and inspirational stories in the rapidly evolving world of human performance optimization. The Optimising Human Performance podcast is produced in partnership with the Wavell Room and the Tactical Athlete Performance Centre at Buckinghamshire New University.

In this week’s episode, we welcome Professor Colin Espie to the podcast. Colin is a Professor of Sleep Medicine in the Nuffield Department of Clinical Neurosciences at the University of Oxford, where he founded the Experimental and Clinical Sleep Medicine Research Programme in the Sir Jules Thorne Sleep and Circadian Research Institute.

Colin is a world leading expert on sleep and the treatment of sleep disorders, particularly using cognitive behavioral therapeutics to treat insomnia disorder.

[00:01:13] Martin: Hi Colin, welcome to the Optimizing Human Performance podcast. It’s great to have you with us this evening. 

[00:01:19] Colin: Oh, great to be here, Martin. Great to chat about my favorite subject. 

[00:01:23] Martin: It’s my favorite subject as well. I’ve come love the topic of sleep over the past few years. So I’m really looking forward to this chat. Can you introduce yourself instead of us trying to talk about your many achievements. Can you give us an introduction? What do you do at the moment? how have you got to where you are? 

[00:01:39] Colin: Well, by background, I trained as a clinical psychologist working in the mental health area. And over decades, really now, I’ve come to realize that sleep is probably one of the most important ingredients to protect our mental health and well being. And for the past 12 years or so, I’ve been the professor of sleep medicine at the University of Oxford. And my role there is about leading, the research drive around understanding sleep and how to improve things when we’ve got a sleep problem, how to protect our sleep as well, as well as training activities that we do with professionals, not just in the UK, but worldwide who are keen to understand more about sleep, when they see, people and they’re trying to help them with their day to day problems.

[00:02:23] Martin: Yeah. I’ve been to your course I’ve studied alongside you. And I remember for me, the moment when I realized sleep was so important was trying to understand how to optimize cognitive performance in people in, these high reliability roles, these extreme jobs in defense and security. But at what point in your career did you have that light bulb moment where you realized sleep was something that we really need to prioritize and think about?

[00:02:48] Colin: Well, very early on, actually, Martin, because, I would see people say with depression or with stress or trauma, whatever. And back in those days, I’m going way back to the 80s. I guess what we generally did was we tried to address what we thought was the main problem, the primary problem. Oh, you’re depressed and therefore when people weren’t sleeping well, we thought, oh, that’s a symptom of being depressed.

So that’s a symptom of stress or whatever. And people educated me, the patients, if you like, educated me and say, well, actually I think if I could sleep a lot better, I’d be a lot less stressed. If I could get my sleep at night, I don’t think I’d be so down during the day. And I began to look into it a bit. I began to do some research myself. And, realize that this is truly, what we call a bi directional relationship. between sleep and our physical and mental health. When we’re not well, physically or mentally, we don’t sleep so well. But when we don’t sleep so well, we’re not so well prepared to deal with life.the light bulb moment was probably not so much a moment, but a period of time when I  researched this and found out more about it, listened to what people were saying. I did some of my own research and also kind of realized, if you like, sleep is really nature’s medicine. Sleep is what nature has provided for us in spite of being, we imagine, the most highly evolved species, we still absolutely depend on sleep, in order to function during the day.

So it’s a fundamental thing, a bit like we need drinking water, we need oxygen, we need food, we need our sleep. 

[00:04:14] JP: So Sort of layman’s question, why is sleep important? Why is it important from both a physiological perspective, but also from a psychological and cognitive perspective? 

[00:04:25] Colin: there was a very famous, researcher back in the 1960s, who asked that very same question, why we sleep. and a lot of the studies that have been done, to try and understand why we sleep is to look at the consequences, to people’s, function when you deprive them, of sleep. Either total sleep deprivation or partial sleep deprivation. You get some sleep, but not enough. but also selective sleep deprivation. Sleep deprivation, that is, certain components of sleep are knocked out in the laboratory studies to see what the consequences are. and the consequences are really quite wide ranging.

So what we understand now is that sleep is important for, the clearance of metabolic waste. sleep, for example, is, if you like, the janitor that clears up during the night and there’s a protein, a beta amyloid protein, which may well be implicated in the dementia story, which is selectively cleared at night during sleep.

So there’s a clearance of neurotoxic waste , if you like, a clearing out and freshening up that takes place. But it’s also very important to sleep in order to allow cells to regenerate. So it’s often said that a rest is as good as a sleep. Well, a rest is very, very important. And of course, at times when we can’t sleep, a rest is crucial,but cells don’t regenerate during a rest. They only regenerate during sleep. Post COVID and during COVID, as well, people will have been thinking about the importance of, control over infection. And this is called an immune system, an immune function. And we also know now that sleep is really, really important for what we call immune signalling . it’s a time during which our, ability to fight infection is primed. So these are just some examples physical aspects recovery that are important in relation to sleep. also from a cognitive and emotional point of view, sleep Studies show that from a human performance aspect, people’s ability to perform routine tasks and complex tasks are compromised when we’ve not had enough sleep .

Although we may actually still feel quite confident that we’re doing them well. And this is one of the interesting things. A little bit like when you’ve had alcohol. You may, be impaired in your ability to perform tasks. Other people may notice that, or certainly if you did an objective test, you would see that people were sleepy.

because we’d be making errors of omission and co omission. But you may not realize that you’re making those errors, because you’re kind of a little bit blind, to them. So the ability to, perform well at tasks is degraded. under conditions lack of sleep and also our memory or higher cognitive functions as well, a long answer to a question, but it really illustrates the range of ways in which sleep is crucial.

A final area to just to realize is that, and we see this in kids when they’re not well slept that they get cranky, they get irritable, our emotions are affected when we’re not sleeping well. And that could be to become more hyper aroused. more, more kind of alert and almost difficult to get down from that position because our brain is kind of figuring out you’re trying to stay awake. Okay, let’s try and keep you awake then, but you get a bit frazzled or it could be that you get actually rather morose and somber and detached a little bit more on the depressed side.

So there’s myriad ways in which sleep is absolutely crucial to us, and the research over the past, 70 years, illustrates that in every department, if you like, sleep is important. 

[00:07:44] JP: It’s real interesting what you’re saying there because I just think back to my own experiences in the military and observing when you’ve got like a real high operational tempo, certain situational demands, dictate certain things have to be achieved, certain objectives, And that’s sort of replicated within the training environment as well. And it’s sort of accepted that we need to be able to maintain a high up tempo for various reasons. But then at the same time, it’s like, well, If we do so, do we have the realization of the potential downstream effects not only physiological capability, but more importantly, psychological and cognitive capabilities?

Because if we start making errors because we’re sleep deprived , consequences for high readiness populations, may that be military police, fire service could potentially be quite grave. 

We used to have the expression, oh, you’re chin strapped.

And that, came from the term where you’re that tired, it’s your chin strap or your helmet is essentially the only thing keeping your head up. It’s just one of those things that I wish. when I joined the military and in my early career that we paid more attention to this.

[00:08:41] Colin: I think that there is also a cultural issue there, isn’t there? and I’m sure it’s not just in the military. I think it’s there in business on high performance situations where, to say I’m feeling sleepy or to yawn or to, appear not to be able to deal with that, It’s not something that is, kind of wanted in those situations.

It’s almost like you should push through. We should try and manage this situation. almost deny that we’re feeling that way. so that can be part of difficulty that people have, but let me just balance this up a little bit because highly evolved species and we haven’t evolved to do without sleep, we need rather a lot.

And that’s because we’ve highly evolved brains And therefore we need sleep to be able to function at a level, 

But also, brain is able to try and figure out what is it you’re trying to do, and I’m going to help you with it. So it will recruit an ability to have selective attention to a high, a danger task to monitor threat, for example.

To manage a situation, that’s a survival situation, it will focus entirely your energies and your, your thoughts on that. It will put, sleep to the back of your mind, literally, and enable you to,deal with that situation, because it’s of critical importance. but it would only perhaps do that for a period of time.

You can’t,be on high alert like that you know, for hours and hours and end. The way I often explain this and Martin will have heard me use this expression before in some of my teaching and training that we have to bear in mind that our brain is much smarter than we are.

because it kind of figures out what needs to happen in this situationand tries to help us deal with it. So, oh, I see, although it’s bedtime, it’s nighttime, it’s dark, that you’re feeling sleepy or yawning. I can see that you’re trying to remain awake. I can see you’re dealing with a threatening situation.

I’m keeping you alert because threat is risky to you. So I’ll help you to monitor that situation and manage that situation. But I’ve got limits to what I can do for you. Don’t over ask kind of thing. You know, I think that’s really quite important. So when we talk about sleep deprivation or sleep loss or partial sleep deprivation or loss of elements of sleep, we also have to consider for how long.

It’s the person having to deal with this challenging situation, 

How long can you go without sleep? for some period of time you can. but this is where it’s very important that you self monitor and realize that I’ve actually had a microsleep there.

and you put your hand up and say, I’m, I’m really struggling here. so we have to have that fail safe mechanism, but the brain does try to help us to manage situations that are stressful, and it does so by keeping us alert, and that’s a primitive brainstem, response, a very primitive brain response an externally threatening situation.

[00:11:19] JP: If someone’s in a high threat situation and they’re chronically sleep deprived, can that potentially increase their susceptibility to conditions such as post traumatic stress disorder and the like? 

[00:11:31] Colin: Yes, there’s a kind of intricate relationship between, stressful experiences, the memory and continuing impact of those experiences and the role that sleep plays in the incubation, if you like, of that stress response from the moment it happens right through to the memory consolidation of it over time, because one of the functions that sleep has is to help us consolidate memory. now there’s many studies being done on this. for example, in an experimental context, you give people something to learn in one group you give them the opportunity to sleep after that initial learning period another group , you keep them awake. And of course, when they’re awake, they have the opportunity to keep on rehearsing it. And you might think, well, that’s surely going to be the better learning outcome.

[00:12:20] Colin: And it’s what students do is prior to an exam the next day, But actually the evidence shows that the group who sleep after learning consolidate that, learning better Then the group who continued to remain awake, which is a bit counterintuitive, but it relates to my comment earlier that, our brain is actually much smarter than us.

It doesn’t actually need us in a funny kinda way. it gets on with things when we are out, out the road. and the brain can go on with this task of memory consolidation. there’s also studies show that, if you have positive stimuli, for example, neutral stimuli and negative stimuli. 

Then during sleep, following sleep deprivation, the brain will consolidate the learning of the negative stimuli, because that’s more threatening It will discard the positive stuff in favour of remembering the negative stuff, because that’s to do with survival. So these are experiments that have been done in laboratories.

Now, when you take that to the military situation. People are in critical situations with a lot of, important material to learn and remember and to deal with. and they’re also engaged in trying not to remember some of this stuff, of course, afterwards, because it was, it was so powerful. But the brain has a need to process emotion. therefore, it’s going to say, we need to understand this, we need to know what’s happened to us, we don’t want to just eliminate this immediately, we need to process this. In order to process it, we have to remember it. In order to remember it, you need to sleep. So this is, this is the intricate relationship that’s still being studied and there’s an open question about it’s better for people, have a lot of sleep immediately after traumatic experiences, or actually to taper that in over time and not to just get off duty out of a situation. Great, let’s sleep now. that could be actually making things temporarily worse. It might be better to, gradually get back into your sleep pattern rather than to immediately go from no sleep to loads of sleep, because that could be the worst situation for consolidating post traumatic stress, but we don’t know for sure yet. and it’s one of the reasons that I think a lot of us are interested in understanding more, about, how sleep relates to trauma, or negative images and so on, not just in laboratory experiments, but in real world situations, for example, the military.

[00:14:32] JP: No, really interesting. Thank you. 

[00:14:33] Martin: Just looping back to a bit earlier when we were talking about what happens when, you don’t get enough sleep there’s this group of people that, that I’m sure you’re aware of this idea of a sleepless elite. These people who seemingly get by with very little sleep and attribute their success to that ability to operate sleep deprived or sleep restricted. Do they exist? What are your thoughts on this concept of a sleepless elite? 

[00:14:58] Colin: think one of the things to, to recognize is that,we all have a need for a certain amount of sleep. But that certain amount of sleep may vary from person to person. it’s not a matter of weakness that you may be somebody who actually requires a little bit more sleep than somebody else that’s simply an individual difference and the analogy I often give here is people say, well, how much sleep do I actually need? I’m a 45 year old man . How much sleep do I need? And do you think you just read it off a graph? so we can talk about average requirements for sleep. And of course, you can always work out an average, but by definition of an average, 50 percent of the population is below average. percent is above average. in terms of any characteristic, whether it’s height, weight,shoe size, that you really have to try and find out, what’s the comfort fit for the sleep that you need in the same way as you would, try on shoes for size.

And even if you knew, what your shoe size was, it doesn’t mean that you would not bother trying on shoes when you went to the shoe shop, you would still try them on because it’s about getting it not just roughly right, it’s getting it comfort right. So therefore it isn’t a smart idea to will yourself into some idea of an elite sleeper.

The smart thing to do is to figure out how much sleep you actually need. And to make sure you get that amount of sleep that you need. and I think the risk is, that people will strive towards something that isn’t actually healthy, is not likely to be successful for them. it’s much better to work with individual differences and value them than it is to try and make everyone, stamped from exactly the same mold. And that can be difficult in industry, it can be difficult in shift work, definitely I’m sure in the military. But if you think about another characteristic that relates to our sleep, which is the timing of our sleep We know very well that there are people who are more natural night owls, another group of people maybe more natural morning people or larks, and that’s an adaptive helpful thing if we value the fact that these are individual differences, whereas if we say, well, we’re not interested in people having individual differences and needing this amount of sleep versus that amount Or being a night owl versus a morning person, we actually want to pretend everyone is the same and we’d want to try and convert everyone to being exactly the same. that is folly, think. and there will be a few people, of course, Martin, there will be some people who don’t need as much sleep as others, just the same ways of people who get smaller or larger feet, but it’s not to their credit. It’s the feet they were born with. 

[00:17:32] Martin: Yeah. I often get the question, That effectively, let’s say I need 10 hours, but I’ve got this belief that if I only sleep for four hours, that means I’m awake for 20 and I can be more productive. So So we can, 

we can throw that out the window, right? if I’m going to halve the amount of sleep or even more than halve the amount of sleep, that’s not going to improve my performance. It’s going to be a detrimental. Is that I’m getting that right.

COLIN Yes, I mean, think there is this idea in society in general, in high performing situations, and it happens with senior executives who, to be honest, get burnt out actually rather quickly, and become rather somewhat expendable in that business situation because, treating, hours of sleep as hours of off duty, you know, downtime is wasted time, or could be spent more valuably .

That almost sleep is not productive. And I think we need to try and challenge that and think, well, actually, the productive time is sleep. during the daytime, you’re expending energy. diminishing. Your capability. the longer you’re awake, in order to, to need restored, if you like, to get back to good function for the next day.

So sleep is a restorer. sleep is what enables us to be productive. It’s not something that’s unproductive. It’s an enabler of productivity. again, I think being able to challenge us with evidence is really, really important. bring the science into this.

It’s not a matter of opinion at the end of the day. you could challenge the average person to hold their breath, right? And some people hold their breath for maybe two and a half minutes, but they’re not gonna do it for very long because you can’t do without it. so we need to do some experiments there, in the real world to help people recognize.

that, it’s not a flaw, if you like, it’s a strength, it’s a natural biological drive, it’s a need, an empowering of the individual’s capability, and people will make better and wiser decisions, when they’ve had much sleep as they possibly can get.

And I realize in many situations, it’s not possible to get. all of the sleep that you require. and I think the brain does help compensate for that, but I think the wise thing to do would be to say, well, can we keep those, periods of time when people have to be awake or have to be on duty?

Can we keep those relatively limited and not become a chronic problem and allow people time to recover, to rest, to recuperate,and back to their best self, if you like. 

[00:19:52] JP: Colin, when I was researching for this episode, I came across your short report in the Journal of Sleep Research on the five principles of sleep.

 Could you just take us through that piece of work 

[00:20:02] Colin: Yeah. So, so the, five principles of sleep health, arose, just as a way of explaining the importance of sleep, to the general public, during COVID. and I was doing some work with, Public Health England, and they wanted to incorporate it into their mental wellbeing. plan. how do you get a good night’s sleep? And of course, if you search on the web,about getting a good night’s sleep, what you mostly find is don’t drink too much coffee.

get a comfortable bed. all these things. Now there’s nothing wrong with those things, but it didn’t really seem to be The key message we should be trying to give to people, if you think about the animal kingdom, for example, they don’t sleep well because they don’t drink coffee.

They don’t sleep well because they’ve got a certain tog of doovey. These are not the reasons people are sleeping well either. But even more so because When people struggle with sleep, they’re desperate to find a solution. And then they Google it and they find these things like caffeine and exercise and all that stuff, which is important.

And they think, I’m already doing all that. don’t even drink coffee. And so they’re not finding a solution. So the five principles of sleep health, I’ll just summarize briefly what they are. First of all, it’s about valuing sleep. That sleep is to be something that is valued. If you think about what is it you value in your life, you value your, independence , you, value your family, your children, you value relationships, your team, whatever.

so I think it’s about, understanding that sleep is a fundamental commodity. it’s not a nice to have, although it is nice to have it, it’s a need. So the beginnings of sleep health is understanding that sleep is not an optional extra. It’s not a, I’ll take it when I can get it.

It’s, it’s something that has to be the core my life in the same way as, you would never contemplate doing without food. You never contemplate trying to live in an environment where there was no oxygen because you wouldn’t survive. So it’s fundamentally seeing its value. and then the second principle is about because you value it, you prioritize it. You put your kids first, You put your family first or the things that you value first. So prioritizing it then from a public health point of view is to, how do I make sure that I get sufficient sleep in order to be able to function well? and that sometimes means making decisions in our day to day lives, which means sorry guys, I need to head off, I need to get my sleep, spoiler at the party or whatever it happens to be.

It’s about prioritizing it, not just in my head, I prioritize it in my behavior. I prioritize it. And that’s sometimes where leadership comes in as well by demonstrating other people that it’s not a weakness, to be hungry. It’s not a weakness to be thirsty. It’s not weakness to need to sleep.

 I think, in some ways we are still pack animals and we need a leader.

and the leader is going to take us to survival , it’s going to take us to food, water  shelter. Is the leader not going to take us to, good sleep, recovery? Is the leader going to allow us to be vulnerable? Sleep deprived and at risk, I’ve been in that situation before, advising leadership groups around this, where often there is a culture and I’m not talking about the military, but in business circles.

They say, ah well we fly our people first class that’s how we invest in people and therefore if we’re paying that money we expect them to be sharp because we’ve paid for that. I say, well, that’s not actually, how you show leadership in this situation, because, we’re not adapted to international travel quite like that.

And you can’t buy it. you’ve got to invest in people in a different kind of way. you know, so I think there’s a cultural aspect to organizations as well,that then permits people. to find their ways of dealing with situations and comes up with resources and solutions for them, shift patterns, deployment patterns, rest patterns, recovery patterns, et cetera 

because if you were to ask me, what is the one big investment organizations, teams could make that would make a difference to peak performance? It would be about make sure. Your team is well rested, well slept and performing well.

The third principle is, recognizing that we need to personalize our sleep. That we’re not clones of each other and we should celebrate individual differences. And it’s a process of discovery to find out how do I personalize my sleep? There’s no credit. to being the person who actually requires a bit less sleep than somebody else. You don’t deserve that. that just happens to be the case. You might not need as much sleep as somebody else. and likewise, somebody who’s more naturally a morning person, more naturally a night time person. I often say to people, you know, how can you have got to 40 years of age and you don’t know yourself, how long is it going to take for you to know yourself? And part of knowing yourself is a bit knowing your habits, your needs, your requirements. And that’s what personalizing your sleep.

And if people aren’t sure how to do that, then it’s a matter of trial and error. you try things out because sometimes we’re anxious to stick exactly where we are at the moment, saying, well, maybe I’ve not got it quite right. Maybe I should be trying to get to bed a bit I would waken, early because I’m a morning person, so therefore, maybe I sometimes need to go to bed a bit earlier or adapt more personal way to a circumstance. So valuing, prioritizing, personalizing, and then crucially trusting. Trusting sleep is really, really important because in 40 odd years, I’ve never met a single person who could get to sleep. I’ve only ever met people who could fall asleep. I’ve never met a good breather who can breathe well by trying to breathe better.

It only makes you more preoccupied. and there’s so much this conversation we’re having just now, for example, we’re speaking, I hope reasonably fluently.but we’re doing that because the brain is kind ofallowing it to happen. It’s flowing. We’re not in control of it. We can see each other because we’ve got the cameras on, we can hear each other because we’re listening, but it doesn’t mean we’re good at listening or good at seeing.

It just kind of happens, right? and therefore, sleep is something that we need to trust to happen.and paradoxically, if you try to get to sleep you get preoccupied with it, you’re not actually trusting it to happen, then you’ll end up remaining awake. So trust is really important. It will get in its pattern if you personalize it, allow it to happen, and it will come when it’s ready.

and lastly, beyond valuing, prioritizing, personalizing, and trusting your sleep, we need to protect it. Whatever you value, you will protect. With your life, if need be. so how do you protect your sleep? and one way in which you might protect it is by, being willing to speak out loud and say sometimes, sorry guys.

I’m tired, I’m sleepy, and that shows some leadership, and it protects it, but it’s also about protecting it from the invasion of negative thoughts and The invasion restless mind, So trying to put the day to rest, for example, before you go to bed, try and work through things, sort them out and close the book in the day. Very simple things. That you might teach your children to say, right, it’s time to go to bed. Let’s put that aside. Let’s have a nice, quiet environment.

Let’s have a routine in some ways we’re still children. We still require that protection.

[00:27:08] JP: That’s a brilliant summary there. 

[00:27:10] Martin: That’s awesome. can we talk about insomnia? You mentioned you’ve treated insomnia, you’ve written the books, you, well versed on insomnia.

First and foremost, what are we talking about? What is insomnia? And then how do we help people who are suffering? 

[00:27:23] Colin: Well, insomnia is simply an extension of something that everyone has experienced. Everyone has had a bad night of sleep and everyone knows, even if that’s all happened very occasionally.

How miserable it can be when you can’t get to sleep, you can’t get back to sleep, and you wake up very early in the morning. Your sleep is curtailed. Everyone has experienced that. But insomnia is happening on a regular basis. Usually, we talk about three or more nights per week.

for a period of about three months. So, more often than not, you’re not sleeping well, and it’s become like a chronic pattern. So insomnia is not just a situational poor night of sleep that everyone kind of understands, and it’s accounted for by something that’s happening the next day or something.

Because in those circumstances, You know, if you have a bad night’s sleep, typically you will sleep better the next night. There’s what we call a homeostatic drive. if you’re deprived of water, you become thirsty. if you’re deprived of food, you become hungry. you’re deprived of sleep, become sleepier. 

and you recover. the next night or soon afterwards. So it’s really more a pattern where it’s not recovering and you’re getting more bad than good and it’s ending up getting into chronic difficulty, not just for the nights themselves, but also for the functional consequences. in your day to day quality of life, whether that’s in terms of your, mental health, emotional well being, or your cognitive health, your ability to function,

and people typically, look for help when they’re having both difficulties at night and during the day. the example I often give people to help understand what I mean by the functional consequences is to consider the situation where you’ve broken your leg.  And you go to emergency department, of course you do.

So why are you going there? And he said, I’m going there because I’ve broken my leg. say, well, that’s not why you went, is it? you went because you walk. It’s the functional consequence that helps people to see that this is now serious. You know, up until then, you might wobble along, literally. that’s a long answer to the question, but I think it’s an important differentiation that it’s an extension of a normal experience.

Just like depression. Everyone has felt down, sad, low, maybe even really low from time to time, but it’s a passing thing. It’s a momentary thing. Depression is a prevailing feeling of misery. and it invades your life. insomnia is not something that people are unfamiliar with. It’s something that, becomes more like a medical or clinical problem when it becomes that relentless, chronic problem of not being able to sleep at night and not being able to function as well as you should during the day. 

[00:29:57] Martin: 

So, when people come to you with this persistent problem with initiating sleep, maintaining sleep, or early morning awakening, what can we do to help these people? What are the treatment options for individuals who are suffering? 

[00:30:12] Colin: Yes, right. So the treatment options, broadly speaking, are pharmacological, taking a medicine of some kind, and most medicines in this category are sedative kind of medicines. So they’re designed, to try and shut down the nervous system.

they don’t tend to promote natural or normal sleep. They tend to interfere with sleep to some degree. but sleeping pills have been around, for millennia, probably of different kinds. And of course, pharmaceutical grades, sleeping pills have been around for decades and decades. That’s one approach, but actually most people would prefer not to use medication to help themselves sleep, particularly if it’s a chronic difficulty, Martin, because then you think, well, how long am I going to have to take pills for?

And a lot of these pills are really only effective over the course of a few nights, and most of them are not recommended to be taken beyond a week or so. And doctors themselves are not keen to give people, pills for sleep. then the other approach is what’s called cognitive behavioral therapy.

And cognitive behavioural therapy does really two things, and it says it on the tin, if you like, the cognitive bit. helps people to deal with and overcome this racing mind phenomenon that they experience as a causal thing. I can’t sleep because my mind’s racing. it gives people tools to address that.

And the behavioral piece is really about your pattern. Getting your sleep back into a routine now, we can talk a little bit about what these techniques might be in a moment, but let me just say that it’s quite commonly misunderstood that a pill is going to be biological treatment, and have its means of action through changing your biology or addressing them.

Your biology and that CBT is a kind of psychological treatment dealing simply with changing your mind at some level. I think that’s kind of an incorrect way of thinking about it because cognitive behavioral therapy has a very direct impact on your biology as well. Because as soon as you begin to change your behavior, sleep pattern, you’re affecting the way your sleep expresses itself.

and we begin to affect, our sleep drive and the timing of our sleep. And we can tune that up to be not just better psychologically, but better biologically. And likewise, If a sleeping pill is like a sedative to help down regulate an arousal level, to take stress levels down, there are also cognitive techniques that do the same and help to de-escalate tension, stress and so on and have a very distinctive relaxation effect which is measurable physiologically.

So CBT is not just some kind of psychobabble, some kind of therapy for weak minds. actually a very powerful psycho biological treatment, that affects our actual ability to sleep. 

[00:33:00] Martin: Can I just ask where does alcohol fit? I know in the UK, there’s a concept of a nightcap and I’ve had people talk to me about that. That’s part of their sleep routine. It helps them get to sleep. Where are you on alcohol as a sleep aid? 

[00:33:12] Colin: well, part of the difficulty here, of course, is that it is actually quite effective, in the short term.

so some of the sleeping pills act very similarly to alcohol. Alcohol is a sedative drug. and it does a reduce. muscle tone, it is a relaxant, it does have effects terms of downregulating the arousal system. It numbs the senses and in extreme doses, of course, it actually literally causes you to be unconscious. of course a lot of people have either by hook or by crook discovered, this,and sometimes people are in the habit. of taking some alcohol in order to help themselves sleep. but it’s a very short term solution to a problem that’s become chronic. because like anything you need to increase the dose to get the same effect over time.

And that can be a dangerous thing to do. Alcohol also suppresses a component of our sleep that people will probably be familiar with called REM sleep or rapid eye movement sleep. It tends to abolish rapid eye movement sleep in the early part of the night. this is one of the ways in which stops your sleep being normal.

But as the alcohol wears off in your system during the night, you’re likely to have what’s called a rebound in the REM sleep, and this is dreaming type sleep towards morning. and sometimes, those dreams can become more disturbed, even nightmarish in people who are drinking regularly or too much.

What it shows us in a way though, Martin, is that people are trying to find their own solution. If you like, alcohol is a self-help solution. I’m doing this privately in my own living room. I’m trying to fix this problem myself. and in some ways that’s admirable that people should be trying to solve the problem themselves. But this is actually what cognitive behavioral therapy does as well. It is a way of learning skills that you can use in your own environment. It’s about empowering people to solve the problem themselves, but not necessarily by using, using alcohol. 

[00:35:08] JP: Colin, , in certain high readiness organizations, a, term often used is sleep banking, obviously people trying to get additional sleep before they go into certain, operational roles.

[00:35:17] Colin: there is,some, experimental evidence, that you can bank a certain amount of sleep. It’s a short term investment in the bank. if something is immediately coming up, then it may assist you on that night or the subsequent night.

It’s not something that you can do for a few days or a week or a fortnight kind of thing. It’s something that might short term held. a little bit like,if somebody is a, pearl diver,they will hyperventilate in order to oxygenate the blood.

So it helps you make that two and a half minute, pearl dive, a three and a half minute or four minute pearl dive or whatever, but it, it doesn’t help you much beyond three minutes, right? Do you know, it’s a short term. benefit is worth considering because some situations are unavoidable where people are going to be sleep deprived.

it has to be done thoughtfully though. and bear in mind too, you can’t just sleep at will. So although you may give people the opportunity to bank some sleep, it doesn’t necessarily mean that they’re going to be able to sleep. it’s worth considering the sleep banking piece. And, I think, should be perhaps thoughtfully introduced into people’s routine. .

[00:36:16] JP: just sort of expanding upon that further in certain organizations , there’s a, belief you can conduct sleep deprivation training and that’s going to improve your ability to operate while sleep deprived. 

[00:36:28] Colin: My thoughts on that would be that if you train yourself under sleep deprivation. then you should train yourself in doing so to recognize sleep deprivation and to know when you are sleep deprived.

That’s probably the principle advantage of it to realize the vulnerability associated with insufficient sleep. rather than, to see it as some kind of inoculation that’s going on. It’s more raising awareness. I think it would be very, very valuable. And so you know what it’s like, to feel sleep deprived.

You become familiar, with it, and you know what steps to take to try to address it, manage it, and where possible to mitigate it. But it’s not some kind of, it exposure therapy, I’ve now overcome this problem. I’ve been trained in this, so I no longer have it.

That would be a rather risky perspective to take. I think one should be very respectful,of,the impact that sleep deprivation has on us and mindful that when it’s happening and retain that awareness rather than becoming more blase about it. I think also, there’s a lot to be said for training people to do things well under optimal conditions so that you can apply them in difficult situations rather than learn to do them in the most difficult situations.

because I think there’s what we tend to call in science a sensitivity specificity problem here,that you may be throwing babies out with bath water. By, a challenge that is so difficult for most people, that you’ve lost a lot of talent, a lot of skill, a lot of capability in some individuals by simply, placing the, if you like, the fault line in the wrong.

Wrong position. what if people under optimal conditions can’t perform well? is, that surely not, an equally if not more important thing.so I think it’s important that people understand,the amount of sleep, the timing of sleep, the nature sleep deprivation and raise awareness and discussion about it in the airline industry.

think we can see there that there’s been a development of a lot of euphemistic language that nobody actually talks about feeling sleepy. Nobody talks about being sleep deprived. They all talk about fatigue management. it’s a little bit of denial of the truth to my mind, because when you’re fatigued , , You can usually overcome fatigue by behavioral activation.

You can get up and do stuff, and you keep yourself, busy, occupied. and, uh, you can get yourself out of a sense of tiredness and fatigue. Whereas, when you’re actually sleepy, activation like that is much less effective. and actually what you’d be better to do is to find protocols where people can be permitted short naps.

Because the solution to sleep deprivation is doses of sleep. It’s not. willpower. So therefore the differentiation, I think, between fatigue and sleepiness is really quite a crucial one. and,I think that’s sometimes overlooked. I’m not sure exactly what happens in the military situation there, but, it’s certainly something I’ve discussed with the airline industry on a number of occasions.

because what pilots need when they’re off duty and long haul flights is not rest, they need sleep. To offset sleep loss experiencing, they need bits of both 

[00:39:37] JP: brilliant. point on self awareness and just people being aware of being tired, but then more importantly, how does that impact upon them?

 that self reflection, that sort of inner monologue to realize what could potentially mean. Because far too often I think, especially in military cultures, that macho environment they just crack on. I can get, I can deal with this, but the consequences of not operating at your optimal capability as we’ve discussed today can be quite grave .

[00:40:02] Martin: it’s interesting that the fatigue countermeasure idea what I always talk to people about is that none of those countermeasures will overcome the need to sleep. if you have the opportunity to sleep, you should do.

 you these countermeasures in place of sleep.

[00:40:19] Colin: Yeah. So if we take 

a civilian example of that, Martin, you follow sleep at the wheel, When you’re driving, you will be convicted,

potentially imprisoned, on the same basis as if you were when drunk. highway code clearly says got to be aware, you’ve got to be responsible, you’re accountable for being fit to drive. So the countermeasures that people sometimes use when driving when sleepy, and people know they’ve done this, we’ve all done it, you know, driven on a bend and thought, Oh my goodness, I hit the rumble strip, there.

It takes a second or two to drive off a bend, off a motorway, 70 miles an hour. and the countermeasures that people are constantly telling us they’ve been using don’t work. I opened the window, I put the music up loud. I pinched myself. People bite their lips. they bite into their fingers to try and do all kinds of 

to try and keep themselves awake. Now, these countermeasures might work in relation to fatigue or tiredness. They do not work in relation to sleepiness. What highway code tells you you need to do is come off the motorway at the safest point. have a caffeinated drink. and then have a brief nap why have a caffeinated drink? Because that boosts, alertness. The caffeine takes some time to kick in. The nap kicks in immediately. So if you have a five to ten minute nap, you will actually feel quite restored after a brief nap.

The caffeine will then kick in, and you’ve actually affected your journey by 15 minutes, but you’ve made it much more probable that you will complete your journey safely and you will not kill anyone else on the road. It’s as simple as that. we have a tool to use, which is the nap.

A nap doesn’t mean I’m going to sleep for an hour, you can get a lot of restoration out of a brief nap of 10 minutes or so.

[00:42:07] Martin: the most shocking technique I’ve heard of was, sharpening a stick and jabbing it into a leg. I’m not sure that worked either, can we go back to the CBTI techniques that you mentioned about how to treat people who are suffering with these insomnia symptoms or insomnia disorders? how do we do it? So what are the actual things that comprise this therapy or this umbrella term of what CBTI is?

[00:42:30] Colin: Right. so I’ll let you into secret. It’s not a secret, but an insight that the active ingredient in cognitive behavioral therapy for insomnia, the active ingredient is sleep.

 CBT does is corral your sleep in such a way that it actually becomes potent and influential in your life again and begins to direct you rather than you trying to, if you like, initiate it.so if we take the behavioral piece first , the B in CBT, there’s a technique that we, commonly recommend people use, which is called sleep restriction therapy.

Now you’re not actually restricting your sleep. It’s a bit of a misnomer. restricting the time during which you’re going to allow yourself to sleep . and the analogy I often give people here is, of my grandmother’s knitting., that old sweater. that was overworn and was full of holes that the raw material was actually perfectly fine and she proved that to you when she tore it out and knitted it back into a jumper for you with an extra bit in it because you’d grown, but the point is you could take the raw material and stitch it back together tightly.

Now what happens in insomnia is because people have not been sleeping well, they generally tend to spend more time in bed to try and catch up because they’re getting insufficient sleep. So what we do in sleep restriction therapy is say, how much sleep are you actually getting?

And they say, well, I’m only getting five hours or six hours or whatever it happens to be. I’m in bed for seven or eight. And I say, well, that’s the problem. You’re not going to sleep seven or eight hours by trying to sleep an extra two or three lying awake in bed because your sleep pattern is fragmented.

It’s like an old sweater that’s out of shape. We need to rip the material out and see how much raw material is there. Okay, there’s five hours or six hours. Go to bed for five or six hours. And say, well, I’m not going to sleep, through that. and say, well, it’s not working at the moment, is it?

So why don’t you try this experiment of time, going to bed for a shorter duration? what tends to happen in those circumstances when people are staying up later?getting up early in the morning, doing that seven days a week, is they begin to find really quite quickly that they’ve slept through that shorter window.

and they begin to say things to me like, you see, you know, I said I was going to stay up till half past twelve and then get up at six in the morning. I’m really struggling to stay awake till half past twelve. And see when I’m getting up , I’ve had to set an alarm now to get up at that time. Because what they’re finding is that their sleep is filling the available time period that you’re making for them and because it’s consolidated sleep, it’s wanting to push out beyond those boundaries.

Like sweater, it’s stretchy again. And then you can say, okay, go to bed a little bit longer and see if you can sleep a little bit longer and then you gradually tease it out. we talked earlier on about personalizing your sleep. You find out, what is the amount of sleep that I actually need.

And when is the best time for me? I actually get my sleep better if I go to bed early and except that I get up at a week at five in the morning, I’m a morning person or actually I’m better if I go to bed a bit later because I’m a bit of a night owl and I sleep on a bit later. So that’s one, that’s one example of a behavioral technique.

But you’ll see from that example, Martin, that This is why I’m saying that, cognitive behavioral therapy is not just some form of psychology for the mind. It’s actually, about reshaping your biological sleep drive,and using that,to, become dominant again and trusting it.

to happen. you’re not, becoming a good sleeper in the sense of being good at sleeping. What you’re actually doing is you’re enabling sleep, to take control,again. And of course, the good sleeper, doesn’t claim any special skill. They don’t know how they do it. And that really takes us to the C bit.

If I give you one example of a cognitive technique. that actually, when we’re engaged,with an insomnia problem, it becomes a little bit like a performance anxiety, that’s the term that we sometimes use. And I’ll give you other examples of, natural phenomena that are affected by overthinking them.

The human sexual response . is one.typically there’s nothing wrong with the apparatus, but if people think there is something wrong and they try to perform and they’re overthinking it, then they won’t perform. stammering is a lot to do with self monitoring too much and trying to speak fluently, trying not to make a mistake.

Better not make a mistake, better not make a mistake. An intention tremor, a bit the same. I better not, shake. I better not drop this. I better not blush. blushing was the worst thing possibly to happen. and even in more everyday mundane things, like in sports, there’s a fine line between being prepared and accurate and trying to drive the ball too deliberately down the middle and have the worst slice ever, And the best way to reverse the psychology is actually by trying to remain awake when you feel sleepy. Not thinking, here we go, here we go boys, we’re about to fall asleep. That’s me awake again. It’s about saying, I’m feeling a bit sleepy now.

feeling a bit sleepy. Let’s stay awake for another second. Keep my eyes open for a few seconds longer. And what you begin to experience when you reverse the psychology like that is you realize that you’re removing psychology out the way and you’re allowing the sleep drive to express itself. and then people realize that they can fall asleep involuntarily.

They’re falling asleep without trying to fall asleep. and that’s when they realize, I overthink this anymore because I fall asleep even when I try to stay awake. So there’s a lot more to it in terms of the nuance, but broadly speaking, what we’re doing with cognitive behavioral therapy is setting a pattern that’s adaptive to allow sleep to,deliver its best self to us, by filling available gaps, allowing them to stretch out to the, we need them to be initially constraining them and then reversing our anxiety and effort to sleep by allowing ourselves to fall asleep naturally again by tempting ourselves to remain awake.

so these are just some examples of many, many different thingsthat are in the cognitive and behavioral therapy toolbox, if you like, all of which are really designed to allow sleep to express itself the way it does for a good sleeper rather than to become a, an expert tightrope walker that you’re now an expert sleeper.

That’s never going to be good for anyone. And that’s not what good sleepers do. 

[00:48:42] Martin: That’s great. That’s a great way describing it. you always come up with good ways of describing these things.

So that, that was awesome. Colin, wewe’ve taken a lot of your time and, uh, I’ve thoroughly enjoyed this. It’s been a real masterclass on sleep. And how to manage it, what we like to do is to hand it over to you for the,final word just to give you that opportunity to talk about anything that we’ve not talked about yet, or to reinforce anything that’s particularly relevant or important to you.

So over to you for the final words.

[00:49:10] Colin: Well, I mean, I, I would just rehearse a little bit, what I said earlier on, Good sleep health is within everyone’s grasp. it really is about understanding that this is something very valuable and precious, is there for us. Sometimes we need to tempt it to express its best self for us.

but it will struggle to do that unless It thinks we’re giving it attention, when you value something, you prioritize it. When you prioritize it, then you respect it. and also respect the fact that this is something we need to personalize to get right for us. Don’t try to be somebody else.

 Personalize your sleep. And learn to trust it. and the CBT thing above all is about trust. It’s about not trying to become or overcome .

[00:49:52] Colin: It’s 

[00:49:52] Martin: It’s 

[00:49:53] Colin: not about striving. It’s not about winning, defeating the enemy, if you like. It’s about embracing, something that’s and that wants to deliver for us, but we need to provide the parameters that it’s going to work best for us. And once we’ve got it in good shape to protect it. 

And listen, a lot of this is easily said, because I know a lot of people struggle with sleep problems. some of them are like insomnia, some of the most post traumatic things. These are very, very difficult things to live with. but the cognitive behavioral approach has been shown to be very, very effective, even if it takes a little bit of time.

And if you’ve had a difficulty sleeping, for months or years, then it is worth spending some days and weeks getting it right and not getting impatient, not getting hopeless or helpless that, oh, this isn’t working. Sometimes we’re in a bad sleep habit. We need to get back into a good sleep habit.

Trust yourself to be able to do that. and, I’m sure you’re going to sleep a lot better than you were before. And if you’re already a good sleeper, then, appreciate it. have high regard for it and maintain it that way . 

[00:50:50] Martin: Fantastic. Absolutely brilliant. I did say that I’d give you the final word, but the final, final word is how can peoplecontact you?

Where do they find out more about the excellent work you’re doing and the services that you provide

[00:51:03] Colin: at Oxford, where I work, we try to make ourselves available for teaching and training. I guess primarily we’re trying to figure out ways that are going to help as many people as possible.

And that isn’t always by just forming an orderly queue at my door. Because that can be a very inefficient way of helping people. So what I’m trying to do is train as many people as possible to become good sleep professional, sleep clinicians, so we can help other people, working with organizations as well as individuals.

We’re doing work at the moment, for example, looking at shift work in doctors and nurses, working with systems as well as with individuals, and we put resources,online through Oxford, also, I’m on Twitter or, X as it is now and put resources up there from time to time.

And there’s also some self help materials books and so on that, you can make available to people. 

 Yeah, I’ll definitely put those in the show notes, everyone can access the excellent books Thank you, Colin. Again, thoroughly enjoyed that. Really appreciate your time. Thank you for joining us.

Pleasure. 

[00:52:04] OUTRO: Thank you for joining us on the Optimizing Human Performance podcast, a Wavel Room production. If you’re enjoying this content, don’t forget to like and subscribe so that we can keep improving. And remember to visit wavelroom. com to find their latest articles, podcasts, and newsletters. If you know someone who could benefit from our discussions, please refer them to our show.

Your recommendation is our highest compliment.