getting on your nerves? episode 4: wherever I lay my hat

Anna: Welcome to getting on your nerves?, a podcast where we explore the science behind stress, sleep and nervous system regulation. Each episode unpacks why so many of us feel permanently overstimulated and unable to properly switch off through conversations around stress, recovery, wellbeing and the connection between the brain and the body.

Since 2004, This Works has pioneered sleep science through clinical trials, neuroscience research and helping the body to move from fight or flight into rest and digest, supporting better sleep, recovery and nervous system balance.

I am delighted to be joined by Professor Gaby Badre, MD, PhD, Associate Professor. Gaby is a neuroscientist and medical doctor, clinically active in Sweden and the UK and with advanced research activities. He is an internationally recognised expert in sleep medicine and a specialist in clinical neurophysiology and sleep chronobiology disorders.

Gaby is also a long-term scientific advisor to This Works. He is a sleep expert, a master of circadian rhythm, a neuroscientist, and he brings a wealth of experience on the subject of sleep and many other things.

Today, with so much talk about sleep, I’m here to ask Gaby some questions not about how to achieve the most perfect sleep, but about how to be resilient when it comes to sleeping.

In modern life, we don’t always get to control our environment down to the finest detail. So how do we learn to sleep anywhere? What factors do we need to think about, and how do we make ourselves and our nervous systems adaptive enough to be able to sleep, let’s say, in a new hotel when we’ve gone on an exciting new holiday, or on a plane, or in a new house, or in a new relationship?

So without further ado, I’d like to welcome Professor Gaby Badre. Can I call you Gaby?

Professor Badre: Sure. Thank you very much for this introduction. I’m pleased to be here and I hope I’ll be able to answer your questions.

Anna: I’m sure you will, Gaby. I know with all the experience you have and all the years that you’ve been advising and teaching This Works about neuroscience and circadian rhythm, you have always been an absolute wealth of information and knowledge.

Before we get into the core theme about sleep resilience and how we learn to sleep anywhere, I always think it’s good to start by explaining why sleep is important.

Many of us now fully understand that it’s so much more than something we just do at night. But as an expert, tell me: why is sleep important?

Professor Badre: Thank you for the question. First, I would like to add one point that you mentioned yourself.

Usually, we talk about sleep hygiene. How can I make my bedroom perfect? How can I sleep?

I prefer to speak tonight about sleep adaptability. How can I make my brain more adaptable to sleep? I think this is a major issue. It’s a new concept which I would like to address.

Now, back to your question: why is sleep so important?

Sleep is not simply a period of rest. It’s one of the body’s most active biological processes. It’s as important as nutrition and exercise.

During sleep, the brain is very active. It consolidates memory, it regulates emotion, it removes metabolic waste, it strengthens immunity and it restores energy.

Even one poor night’s sleep can impair attention, mood and decision-making, while chronic sleep loss increases the risk of many diseases.

There should be much more respect for sleep than we have today.

Anna: Obviously, as a brand that has been pioneering the idea that sleep is the first step in every skincare routine, we know from our work with you that sleep underpins our health.

It is essential for health and wellbeing, and that has become such a bigger conversation now about the role of sleep for our wellness. To have enough sleep is considered an asset now, whereas I think a decade or so ago we were much more inclined to talk about sleep as something we didn’t need.

We were almost validated for not getting enough sleep. That was a sign of our busy lives. We were very important if we were only sleeping a few hours a night.

So I do think the conversation has moved on from when This Works first started to talk about sleep.

But I think that some of the conversations around sleep now – and I want to really pick up on your point about sleep adaptability – are about building routines and protocols for ourselves, supported by brands and businesses like This Works, offering people products and information.

The nighttime economy, as it’s known, is a very big economy, encouraging people to create the right conditions for sleep, and I’m fully behind that. Obviously, I sell sleep products!

However, I also know that the nervous system needs to be adaptable.

So tell me: why can some people sleep anywhere, wherever they lay their head, and others struggle unless they’ve got their routine?

My son, for instance, we have to travel with a fan wherever we go because he needs that white noise.

Why can some do it and others not?

Professor Badre: May I go back a little bit and tell you a bit about sleep history?

Anna: Yes, please.

Professor Badre: If you look at our ancestors, the apes, they used to sleep in the canopy in the forest, high up to avoid predators.

Then after a while, humans decided to start sleeping on the ground. However, it was very dangerous. You could not sleep the whole night.

Then they got fire. Getting fire helped protect them from predators. There is a book which has been written by Professor Samson which is quite interesting to follow.

Then, when you have a group, there has been a study done recently in Tanzania looking at an Indigenous group who sleep on the floor. When they sleep in a group, there is always someone remaining awake as a sentinel.

So we still have this kind of sentinel instinct – to be awake and to see if danger is coming.

Sleep is a process which evolved throughout humanity.

There is also something that can happen during sleep, for instance jerking. Some people, when they fall asleep, get a jerk. This jerk is supposed to be something from the time when we were sleeping up in the canopy and falling asleep. It’s a way of reacting.

So sleep is a very complex process involving being aware and being adjustable, adaptable. We have to adapt ourselves.

We know that some people can sleep very well on a plane, in a noisy hotel or almost anywhere, while others struggle in their own bedroom.

These differences reflect variations in brain arousal, stress sensitivity, personality and previous experience.

Some people have a naturally flexible sleep system. Others are more vigilant.

The encouraging message is that adaptability is not fixed. It can often be improved.

That’s what we have to work on. We have to teach people how to improve their adaptability and resilience.

sleep pressure, circadian rhythm and brain arousal

Anna: Building on what you’ve just said, if we take that concept of being able to wake in the night, to act as a sentinel, to protect the group – that sense of responsibility for others – am I taking a leap too far by saying that those who struggle to sleep through the night and wake easily are perhaps the ones who would take on that kind of role of protector in a group?

Am I making too big a leap? What do you think?

Professor Badre: Again, if I turn your question around, with adaptability we have to understand what sleep is.

Sleep is a combination of three things.

First, it is a result of sleep pressure. That means one has to develop sleep pressure in order to be able to fall asleep.

This is a problem with some of my patients and it’s a problem with elderly people, for instance.

When they fall asleep during the day, they take a lot of naps. Even short periods of sleep remove some of the sleep pressure. So when it’s time to go to bed, there is no more sleep pressure.

The second point is the biological clock. We have a circadian rhythm, so there is a time when the gate of sleep is opening.

The third point is the level of brain arousal.

We have to combine these three things in order to be able to achieve sleep adaptability.

Feeling safe, relaxed and confident that sleep will come is just as important as the physical environment.

Anna: Feeling safe is a theme that we’ve been talking about quite a lot at This Works: this idea that the brain takes cues from the environment and interprets them either as cues of safety or reasons to remain vigilant.

Teaching the brain through our environment that it is safe to switch off is something that we can learn to do.

Do you agree with that thesis?

Professor Badre: Yes, but we also have to understand and acknowledge that when you sleep in a new environment, there is what we call the first night effect.

It’s something new.

I mentioned before the sentinel. You are in a new environment and your brain is wondering what’s happening. Is there any predator? Is there any danger here?

Of course, we are more aroused and more awake.

This is a normal situation that one should not dramatise.

Anna: So we should be talking to our friends in the hotel world and saying that for every guest arriving to have a lovely night in your hotel, as a business they should be looking at ways to help keep that nervous system calm.

Because the natural instinct in the brain is to stay vigilant because it’s a new environment.

Professor Badre: And this is very important when we talk about cues.

It’s not only a good bed. It’s not only a nice temperature. It’s a combination of many things – what we call multisensory stimulation.

If we have the ability to stimulate in a positive way, we can get an interesting result and we can promote sleep.

Again, that’s considering that we respect the circadian rhythm and when it’s time to go to bed, that we have enough sleep pressure and that the cues are helping us to decrease brain arousal.

Anna: That’s excellent. Really clear.

how eating and the microbiome can affect sleep

Anna: I think everyone really wants to understand these three things you talk about.

Sleep pressure is interesting. I know about it, obviously, from my work with you.

How does that relate to people who are more adaptive to sleep?

Do you think that one person who takes their dinner at a different time of day because they’ve got a business meeting or an event might find that affects their ability to sleep, but for someone else it wouldn’t?

How does that work?

Professor Badre: I’m going to use a word which is perhaps unknown: holobiome.

Holobiome means that we are one organism: the body and all the guests that we have in our body, the microbiome and microbiota, the bacteria and so on. All of that is one thing.

So if you take your dinner late in the evening, what happens?

There are many things happening.

First, you are distending your stomach, so you can have some problems digesting. You can have some gas. You can have some acidity.

You have to have a time for when you eat and it has to be a regular time, as well as the time when you go to bed.

If you change your rhythm, even the guests in your body will react.

They may develop acidity or produce some substances that one special nerve, which we call the vagus nerve, will pick up and communicate to the brain. That can keep you aroused.

At the same time, if your meal in the evening has too much liquid, of course you’ll wake up to go to the bathroom.

So you have to consider at what time you eat, and it has to be very regular, as well as what you eat.

And of course, if you drink some alcohol, alcohol can help you fall asleep, but at the same time it dehydrates you. You may become quite thirsty or you’ll have to go to the bathroom.

So you have to consider all of that regarding your evening meal.

I usually recommend to my patients that they eat at least three or four hours before going to bed.

Anna: We’ve talked a lot about this microbiome that you mention and the fact that it has such a powerful effect on our nervous system.

The microbiota have their own rhythm and their own timing, and actually they don’t adapt as quickly perhaps as we might think.

I think we’ve talked before about when you travel into a different time zone, your gut takes a few more days to catch up than the rest of your body.

Is that right?

Professor Badre: Right, but not only if you have a long journey.

Even if you go on holiday somewhere relatively close, you can often realise that your gastrointestinal system doesn’t work in the same way.

You may have a tendency to have constipation or something similar on the first or second day.

You are readjusting, and this is a kind of adjustment which is very important to consider.

One should not dramatise, but you should be aware of these consequences of irregularity.

sleeping in the heat

Anna: Let me talk about something right now that is very of the moment, which is sleeping in the heat.

You’re in Sweden. I don’t know whether you’re as hot as we are in the UK, but we’re not used to it.

The sale of fans has gone through the roof on Amazon, I’m told reliably, and everybody’s complaining that they’re not sleeping well. It might be the football!

But what do we do about sleeping in the heat?

Because this is part of being an adaptive sleeper, right?

Professor Badre: It’s the same thing.

If we are talking about a bedroom, if it’s too cold or too hot, it can impede your sleep quality.

Of course, if it’s too hot during a heatwave, you have to drink a lot during the day to avoid dehydration.

You have to cool yourself and there are different ways of doing that.

Unfortunately, you cannot sleep as long as when you have a normal temperature. So we have to accept that until we adjust ourselves.

Now we’re talking about climate change, which is going to be permanent. I’m convinced that our body will adjust as it has adjusted during all these centuries.

If we really have a climate change, we’ll be able to sleep better when it’s warmer.

Today, unfortunately, if it’s too hot in your surroundings, it can impede your sleep.

If you cannot get eight hours’ sleep during the night, try to do what the solitary navigator does and get polyphasic sleep.

Anna: Polyphasic sleep. Yes. Tell us about polyphasic sleep.

Professor Badre: Instead of sleeping eight hours during the night, sleep at least four hours so you can get your deep sleep.

During the rest of the day, try to take some short naps which can complete your sleep needs.

cooling the body to prepare for sleep

Anna: So interesting. Let’s explore that.

First of all, just a few things that you’ve told me before and from my own research: being able to cool the body by around three degrees, I think, is what helps us move towards sleep.

The body temperature has to drop. That’s very difficult when the bedroom temperature is 28 degrees.

Professor Badre: You can get a water bottle.

Anna: Okay, tell me.

Professor Badre: Like you use a hot water bottle, you can use a cold water bottle, which can help during the time you fall asleep.

It won’t help you throughout the whole night.

Anna: But it can take the heat away from the body.

Professor Badre: Exactly.

Anna: Am I right in saying that if you cool the wrists and you cool the feet, that can take heat away from the body quickly?

Professor Badre: Right. There have been studies around this in people who have insomnia.

You have to decrease body temperature because decreasing body temperature is one of the first signs to the body that it’s time to prepare for sleep.

If you look at the rhythm of your body temperature, you will see it goes up during the day and starts going down in the late evening.

So what’s important is not increasing body temperature, for instance by going to the gym in the evening or doing a lot of things.

What we can do, as you mentioned, is put your extremities – your feet and/or your hands – in cold water.

What happens?

You have a dilation of your vessels. The capillaries dilate, so you are releasing internal heat. By doing that, you decrease your body temperature.

Some people have even mentioned taking an anti-fever pill, but I think that’s something else.

Putting your hands or feet in cold water can indeed help you.

Anna: I think that’s a really good piece of advice for all of us.

There are mattresses on the market now – Eight Sleep is an example – where there’s a topper for the bed and it cools, dropping the temperature before sleep and then increasing the temperature before you wake.

Your body temperature rises before waking and that’s part of the cycle.

But these things are expensive, right?

So for those of us who don’t have these gadgets, being able to put your hands and feet in cold water before you get into bed might just allow you to drop into sleep.

Then keeping a fan on your body, taking the heat away, even if it’s a small bedside fan, can do the job of keeping the temperature sufficiently low not to keep waking.

polyphasic sleep and protecting deep sleep

Anna: But you mentioned polyphasic sleep.

We’ve been talking about sleep, you and I, for nearly 10 years.

I had a baby shortly before I met you, and sleeping with a young baby is very difficult. I used to worry that I was going to go crazy because I didn’t have my eight hours.

And you said to me, “Don’t worry, Dr Persaud. You only need four. Four good hours.”

I thought about that and I was like, yes, because otherwise humans wouldn’t have survived. Babies always wake. It’s normal.

Then there’s this idea of needing to stay awake and stay alert because you were living on the floor, not all up in the canopy.

So humans adapted and can get sufficient sleep without taking all of their sleep in one go.

I think polyphasic sleep is biologically sound.

Then we think about napping. You and I did a whole piece of work and research on napping.

This Works created a spray for napping because it is a very useful way to manage the nervous system and get sufficient sleep.

But you also told me, “Never sleep for 60 minutes, Anna. It’s either 20 or 90.”

Can you explain a bit more about that?

Professor Badre: Well, absolutely not 90.

Anna: Oh, it’s not 90! Tell me, how many minutes?

Professor Badre: Let me pick up something that you said.

Why do I say four hours of sleep?

I have some patients working in the banking sector, and these young people, traders, cannot sleep eight hours a night.

The first time I got someone and told him, “You have to sleep eight hours,” he answered me, “Are you a nut?”

He has a high salary and wants to trade during the night with the States or with Asia.

So I told him, “Okay, give me four or five hours’ sleep at night.”

Why?

Because then you get your deep sleep.

Remember that we have two major sleep periods: deep sleep and REM sleep. Each one has its importance and has a function.

Deep sleep is very important for recovering, for implementing memory, for the immune system and for cleaning the brain of the waste accumulated during the day.

So give me these four or five hours.

The rest you can get by taking naps, and the nap should not go over 20 minutes.

Why?

Because then you have a risk of falling into deep sleep.

And if you fall into deep sleep, you will wake up like a zombie.

That’s why it’s very important to get a few bouts of 20-minute sleep during the day to compensate.

Think about solitary navigators, people sailing around the globe. They cannot sleep for eight hours. They learn to get these bouts of sleep.

That’s why I say: sleep four hours during the night if you have no other possibility, and take a couple of sleep bouts during the day of about 15 or 20 minutes.

Anna: But let me push you on the 90-minute issue, because my understanding of the sleep cycle is that it’s around 90 minutes.

If you wake up at 60, if you go beyond the 20 as you said, you’re in deep sleep and you have sleep inertia if you wake up. You feel horrible.

Whereas if you’ve done the full cycle, including some REM if that’s possible, and you wake up at the top of the 90, then you’ve had the full experience and some of the benefits for your nervous system, including the emotional regulation that comes with REM.

Is that right? Can I say that?

Professor Badre: That’s right.

At the same time, you have to know that if you have REM deprivation or even deep sleep deprivation, when you fall asleep, the first thing the body does is get you into the sleep stage you need in order to recuperate.

You can realise this yourself.

If you take a short nap of 15 or 20 minutes, you can dream as well.

That means if you really have a shortage of REM sleep, you can get it.

Now, back to your point. Yes, it’s true that if you can get the whole cycle and wake up at the end of a REM cycle, you can feel comfortable.

That’s why when people wake up in the morning, when I ask them, “How was your sleep?” they might say, “I feel very tired when I wake up.”

I ask, “Did you dream?”

Everybody is dreaming.

So if you wake up during the dream, that means you have been waking during REM sleep, and you are very close to the wake stage, which is a positive thing.

Anna: So going back to this idea of sleeping in the heat, I’m going to summarise it as follows.

If you only get the four hours because you wake up and you’re too hot, don’t stress. Do your best to fall back into a natural sleep.

But if you can, take a 20-minute nap during the day, or a 90-minute one if you have the chance, to keep your overall sleep needs met during a period of intense heat.

But you’re also making the point that we adapt.

We will adapt. We already do adapt.

It’s when we suddenly wake up and it has become 35 degrees from what was 23 the day before that I think everybody, including the train systems, goes into shock.

We’ve got more heat coming and hopefully people will get more comfortable with sleeping in the heat.

how strict should sleep hygiene be?

Anna: So let’s talk about sleep hygiene, Professor Badre, because you and many others have taught us about the importance of what we should and shouldn’t do.

We’ve all got a bit obsessed with sleep hygiene.

What’s the flip side to sleep hygiene, coming back to this point about learning to be a more adaptive sleeper?

Let’s go back into that world if we can.

Is sleep hygiene good? Where do we draw the line with sleep hygiene? How strict should we be?

Professor Badre: Everybody is talking about sleep hygiene.

What is sleep hygiene?

First and foremost, it is regularity.

We have a rhythm and we should not forget that sleep is part of the rhythm.

It’s very important to keep a regular rhythm.

Of course, you are young. Sometimes you want to go to a party. You can disrupt the rhythm, but that shouldn’t mean that you dramatically increase your waking time in the morning.

Try to keep as much as possible to the same waking-up time. You can take one or two more hours.

Take adolescents and teenagers as an example.

During the weekdays, they cannot fall asleep at eight o’clock. They fall asleep at midnight and wake up at seven or six o’clock to go to university.

So they have a sleep shortage of one or two hours on Monday, Tuesday, Wednesday and Thursday.

They accumulate a sleep debt. That might be five or six hours.

Now Friday is here.

What do they do?

They go out. They go back to bed at three o’clock in the morning and sleep until one or two o’clock in the afternoon.

They do that on Friday evening and probably on Saturday evening.

But then Sunday arrives. Tomorrow they are going to university, so they try to go to bed at the same time.

What’s that?

They are travelling from Europe to the States during the weekend and coming back again.

Anna: That’s a great way to put it.

Professor Badre: They have this jet lag – social jet lag – but it’s also like normal travelling jet lag.

That’s very important to consider.

The first thing is to have regularity.

If you go to bed late because you’re at a party, okay, you can sleep until nine or ten, but not one or two in the afternoon, because then you disturb everything.

That’s the first thing.

And you have to try as soon as possible to get back to your normal schedule.

Now, of course, if you’re travelling west or east across many time zones, you have to adapt yourself progressively.

You have to accept that the first nights will be quite difficult, especially if you are travelling eastward.

Westward is much easier because you win one hour.

Our biological clock is closer to 25 hours than 24, so travelling west can be easier to adjust to.

You have to consider that.

Sleep hygiene: first, the rhythm.

Second, as I said, even the rhythm of the meal. At what time you eat should be regular too.

Third, you have to have a normal environment.

don’t try to solve your problems in bed

Professor Badre: Don’t use the time when you are in bed to resolve your problems.

You have to trust your subconscious.

I used to give an example.

You walk in the street and meet a friend. You start talking about a common friend. You try to pick up his or her name and you cannot get it.

It’s on your tongue, but you don’t get the name.

Then you leave your friend and a few minutes later the name pops up.

So what happened?

You were no longer concentrating on it.

The same thing applies at bedtime.

If you try to solve a problem, you may never get a solution.

Ignore that. Trust your subconscious.

You should not try to solve your problems.

You have to get some trivial thoughts.

Don’t try to think about what you’re going to do tomorrow.

As I mentioned before, don’t go to the gym one hour before going to bed. Don’t eat late. Keep a regular time in bed with a nice environment.

If it’s too hot, you can get an eye mask which has some gel that can be cooled. The cold can cool you a little and help cool the brain.

All these kinds of things can help you.

fragrance, light and other sensory cues

Professor Badre: Then we have the cues as well.

If you cannot fall asleep, you can use some cues.

Fragrances are very important.

You can use that alone or together with other similar sensory stimulation, such as auditory stimulation.

The other thing is light exposure.

You should not expose yourself to darkness too early.

Why?

Because you start producing melatonin too early, and when it’s time to go to bed you have already released quite a lot of melatonin.

You should not be under bright light, but you should also not be in the dark for the few hours before going to bed.

Anna: That’s a really interesting point because light is very powerful, from my understanding, in terms of impacting our rhythm.

We take our cues from the wavelengths, both morning and evening.

But this idea of darkening the environment as a cue: when do you think we should start to turn off the overhead lights?

If we want to go to bed at 11, when should we start to turn off the overhead lights and just have a more gentle, lower level of illumination?

Professor Badre: I usually say half an hour before.

Anna: Only half an hour? Really?

Professor Badre: Yes.

Anna: Interesting.

Professor Badre: Another thing which is very important is to get a routine.

Usually you are watching TV and people switch off the light.

Keep some light on when watching TV.

Then you say, “It’s time to go to bed. I’m tired. I’m sleepy.”

So you’re going to brush your teeth, put on your pyjamas and then go to bed.

But that takes about half an hour.

You were on the way down and you were sleepy, but then it takes you half an hour and you get up again.

So when you go to bed, you are just going up again, and that’s why you cannot fall asleep.

You have to be prepared when you watch TV so that you are able to jump into bed very quickly, within a couple of minutes, when you get that sleepy feeling.

when sleep hygiene becomes orthosomnia

Anna: These sleep hygiene techniques you’ve shared are great.

I do many of them myself because I really want to protect my sleep.

I think you know I use a tracker to track my sleep quality, so I’m very aware that if I change something in my sleep hygiene, I can see what happens to my deep sleep and my REM sleep, and I try to maximise both.

So I’m super conscious of that.

However, I also want to live a full life.

I like to go to parties. I like to occasionally drink alcohol. I travel.

And I don’t want to get too obsessed because, at the end of the day, becoming obsessed with sleep becomes another problem that I have to think about.

So what’s your advice?

We’ve talked about being aware of sleep hygiene but also being resilient.

How do we strike the balance?

How should I look forward into my summer and think about getting the right sleep, but also having balance and agility with my sleep?

Professor Badre: Have you heard about the word orthosomnia?

Anna: No. Tell me. This is a good word.

Professor Badre: Orthosomnia is when people get obsessed about their sleep.

Anna: Ah, yes. Orthosomnia.

Professor Badre: They usually look at their watch. They look at their wearable. They try to see every time, “How did I sleep?”

Another point which is very important with my patients, for instance, is exercise.

People say, “I have to breathe. I have to do the breathing exercise.”

But that puts pressure on you.

If you do it in a natural way, it’s okay.

But if you stress yourself to do this exercise in bed, then you increase your arousal.

That’s why you should do everything very easily.

Don’t struggle. Don’t push yourself to do things that will increase your level of arousal.

Anna: At night?

Professor Badre: In bed.

Anna: In bed. Okay. Don’t stress myself in bed.

Professor Badre: Some people try to do breathing exercises.

Anna: Oh, breathing. Yes. And actually we know that for certain people breathwork can be activating. It doesn’t calm you.

Professor Badre: It can work because it addresses the parasympathetic system in the autonomic nervous system, which is a good thing.

Like stimulation of the vagus nerve in the ear can help you.

But at the same time, it can put pressure on you.

That’s why you have to avoid this paradoxical situation.

It addresses your parasympathetic system, which will decrease your alertness, but at the same time you put pressure on yourself: “I have to do that.”

So you have to avoid any must.

The word “must” at bedtime should be avoided.

Before going to bed, do whatever you want, but never in bed.

Anna: I think that is a mantra we should all take.

There should be no “must” in bed.

I love that. That’s great.

how much should we trust sleep trackers?

Anna: But can we go back to this tracking issue, Professor Badre?

Obviously, you carry out many clinical assessments. You do it in your own personal world with your patients, but you also do studies with your academic colleagues.

You measure people’s heart rate. You measure their sleep architecture. You measure how their nervous system is responding to the environment.

So you do it clinically.

Now we all have more access to these tools and we want to learn.

But I believe there is a percentage of the population that finds this very distressing.

Do you agree, and what’s your advice?

Professor Badre: Yes.

At the same time, you cannot close the door.

We have AI today and you have more and more wearables relying on artificial intelligence to get your results.

Most of the systems are not clinically validated, but in the near future I’m convinced that they will be much better.

That will be a benefit for doctors because, as you mentioned yourself, as a subject you can see the quality of your health, including sleep, get some advice and eventually be connected to a physician.

Today, as it is, they are still not validated and they put pressure on you.

You wake up in the morning, you look at your wearable: “Oh, I got a very bad night.”

That will reinforce your tiredness or whatever you’re feeling: “It’s because I slept badly.”

So I think one should be very careful with these wearables.

Use them as a gadget, but don’t use them to adjust your lifestyle.

That’s my advice.

Anna: That’s good advice.

I think I’ve seen a study that showed what happened to a group of subjects who were told that they did not have good sleep quality because of a device and were then asked to evaluate how their day went, versus a placebo group who had exactly the same sleep quality but were told that they were fine.

Their mental perception of how tired they were changed completely because of the data.

So I think certainly for short-term problems, perhaps we shouldn’t get too attached to our device.

But I take your point about tracking devices becoming health indicators if they’re accurate and carefully interpreted by medical professionals.

I think that’s very interesting.

heart rate variability and the nervous system

Anna: One of the areas that you and I have talked about recently is heart rate variability.

The fact that it’s a proxy for your nervous system and the agility of the nervous system.

Do you have anything to share on heart rate variability?

I think more people are aware that it’s an indicator of their nervous system function.

What do you think people should keep in mind when they look at heart rate variability?

Professor Badre: Heart rate variability is a very important indicator of what’s happening.

Again, as I said, we have two systems in the autonomic nervous system.

We have the sympathetic and the parasympathetic.

The sympathetic is fight or flight.

Whenever something happens, you activate your sympathetic system to be able to react immediately.

Then you have to bring that down, to slow it down, and the parasympathetic enters the game.

Of course, when you go to bed, we have to decrease the sympathetic and let the parasympathetic take over.

If you make an HRV recording when you go to bed, you will realise that your parasympathetic system is taking over if you’re not stressed or having any other problem.

HRV is very important to look at sleep quality.

Even with HRV, you can recognise the REM period compared to other stages because you increase your activity during REM.

don’t catastrophise a bad night

Professor Badre: I would like to add another point.

If you sleep badly one night, you should not take it as a catastrophe.

I used to ask my patients: “Okay, you sleep badly one, two or three nights, but do you realise that on the third or fourth night you have a better sleep?”

If they answer yes, there is a periodicity.

What does this periodicity mean?

It means they have had a sleep debt and suddenly the sleep pressure is so high that they can fall asleep.

This is a very positive thing in order to address rehabilitation.

So don’t dramatise if you have two or three bad nights and suddenly you have a better night, because then it can be addressed in this way.

what to do when you wake at 3am

Anna: Actually, that takes me to something else you and I have talked about in the past.

If you are someone who wakes up at 3am because you’ve got into a cycle of 3am waking, correct me if I’m wrong, but your advice is maybe to get up out of bed and wait, allowing enough sleep debt to build up again so you don’t build a negative association with being in bed and being unable to sleep.

Am I saying the correct thing here? Correct me. I’m sure you will!

Professor Badre: I go a bit against many of my colleagues.

If you wake up at three in the morning and of course you’re completely awake, that’s one thing.

But if you wake up, what I advise is: go to the bathroom, drink some cold water, don’t put on the light.

Come back to your bed, turn over the pillow so that it gets fresh, and try to fall asleep.

If you leave the bed and start watching TV or reading, you increase your alertness. You wake up completely.

Instead of entering the sleep gate again, you have to wait one or two cycles before being able to fall asleep.

Anna: Interesting. Okay.

Professor Badre: So I’m against this idea of leaving the bed.

However, you can go to the bathroom, you can change the temperature of your bed, and then try to come back to bed and fall asleep.

give your brain something trivial to focus on

Professor Badre: I also give a recommendation to my patients.

When you are in bed and cannot sleep, your brain is working. It cannot simply be still.

So either the brain will pick up endogenous and external thoughts and pictures and try to work on them, and you start worrying, or you can feed the brain with some interesting things.

Then the brain will be active without worrying you.

That’s why I recommend to my patients: watch a film in the evening or read something interesting, and when you cannot fall asleep, try to play back this film or this book.

But it has to be something very fresh.

You cannot think about a film you saw yesterday because it has already been processed by the brain.

Anna: Interesting.

Professor Badre: Give the brain something to catch onto.

Anna: I think that is such an interesting point because I don’t think I’ve seen that said somewhere else.

The brain will latch onto things because that’s how it functions.

It will latch onto thoughts. It will take you into the future or into the past and try to solve problems. It could be trying to predict.

Whereas what you’re saying here is focus the brain on a recent experience which is pleasant. It’s not something that requires interpretation.

You’ve focused your brain back on reliving that film you’ve just watched or that book you’ve just read, just as an observer of that information, and the brain will put itself back to sleep.

Professor Badre: Exactly.

Because we have what we call ultradian rhythms.

We have the circadian rhythm and the circadian rhythm is modulated by ultradian rhythms.

You mentioned before the cycles – the 60-to-90-minute cycles.

That’s why I say: go to the bathroom, turn the pillow over, go back to bed and think, within 20 minutes, if I don’t stress myself, I will enter the sleep gate again.

Give something trivial to the brain, but interesting.

Nothing to do with yourself.

If you are planning a trip to Spain, don’t try to think about a film about Spain because then you will think, “Do I have everything ready for my trip to Spain?”

Just give the brain something trivial so it can focus on that.

Anna: I’ve learned that myself.

I have had more disrupted sleep in the last probably three months than I have for a long time.

There are stressors in my life which are keeping me awake or waking me, but I also know that the worst thing I could do is to try to start resolving those stressors at five in the morning.

Over the last month, by doing as you suggest, I accept that I’m awake but hopefully it won’t be for too long.

I don’t try to make myself go back to sleep.

I just try to focus my mind on something that, as you say, isn’t interesting. It’s just a nothingness.

And what’s happened in my experience now is I have retrained myself to wake back up at seven in the morning.

Those early 5am rises have stopped.

But in my initial week I was panicking: “Oh my goodness, I’ve become a 5am waker. I don’t want to be a 5am waker.”

I was panicking that I wasn’t getting enough quality REM at the end of the night.

But yes, I can validate your advice. It certainly did work for me.

sleep adaptability over sleep perfection

Anna: So Professor Badre, we have covered quite a lot about this idea of being able to sleep anywhere.

Is there anything else that you think we should take from this conversation?

We’ve covered lots of sleep-related issues. Obviously, we could talk about this for hours and hours, but I’m mindful of your time.

Any last things to share with the people listening?

Professor Badre: As I said when we started this conversation, don’t think so much about sleep hygiene.

Think about sleep adaptability.

How can I make my brain more adaptable?

Think about that.

Don’t panic. Everybody can have one or two bad nights.

As I said, see if you have a periodicity.

If you sleep only five hours a night for a period, okay, try to compensate during the daytime, but before 2pm in order not to impede your night-time sleep.

Take a 20-minute nap.

Again, look at warmer countries like Spain. People have a siesta, and the siesta can be very important if you take it at the right time and at a regular time.

As I said, it should be either 20 minutes or one or two cycles. It’s better to have 20 minutes.

So my recommendation is: don’t panic. Try to be rational.

Another indicator that your sleep is bad is to look at your gastrointestinal tract.

If you have problems, that can mean your gut is not happy, and that is another indicator of your sleep.

Very often, people with chronic insomnia have signs of IBS, irritable bowel syndrome.

So that is something one has to be very careful about.

Anna: Maybe we can have another podcast conversation all about the gut, because I know you know so much about it.

I think people are learning a lot more and are curious about the foods they should and shouldn’t eat and the role of supplements.

But I think we’ll save that for another day.

Professor Badre, thank you so much for joining me today for this really helpful conversation around sleep adaptability and being able to sleep wherever we are.

But mainly, the message you’re telling us is: don’t worry.

Sleep is something that you can learn to do, and we can be flexible in our attitude towards it.

So thank you so much for today.

Professor Badre: It was a pleasure. Thank you, Dr Persaud.

Anna: Thank you.