September 18th 2018
We're in a sleep deprivation epidemic, according to a leading doctor, who fixed his own sleep debt
March 16th 2018 / 0 comment
Scary thought - even if you're getting eight hours', it might not be the right kind of sleep. On World Sleep Day, Dr Rangan Chattergee reveals what really goes in to waking up refreshed
When was the last time you woke up feeling well rested and buzzing with energy? Nope, we can’t remember either. In his book, The 4 Pillar Plan, GP and star of the BBC One series Doctor in the House Dr Rangan Chatterjee says we’re ‘in the middle of a sleep deprivation epidemic’; we’re sleeping up to 25 per cent less than we did 60 years ago and it’s dramatically affecting our health (not to mention the economy - sleep deprivation is estimated to cost us about £40bn a year).
We know that a good night’s sleep will reward us with more energy, better concentration, better immune systems, a reduced risk of being overweight and better memory to name but a few benefits - so how can we balance our busy modern lives with our much needed eight hours?
Dr Chatterjee has called his own change in attitude to sleep as ‘life-changing’, so we asked the progressive medicine expert everything you want to know about optimum sleeping habits and how to get a great quality night’s kip…
GTG: Have you ever had a problem with sleep? What caused it and how did you solve it?
Dr Rangan Chattergee: I have gone through times in my life where I didn’t sleep that well. At exam times as a medical student, my sleep would suffer as I would be unable to switch my mind off. In fact, unable to ‘switch off’ is one of the most common reasons people to struggle with their sleep. Also, when alternating between day and night shifts as a junior doctor, I found it incredibly challenging to get good quality sleep as I wasn’t very good at adapting to the different shift patterns.
Over the past few years (since I started to really prioritise it) my sleep quality has improved immeasurably. I recommend these techniques to my patients but the key things I have found work for myself are:
No caffeine after noon
Exposing myself to natural light every morning for at least 20 minutes
Switching off all technology 90 minutes before bed. (I call this a #NoTech90 in my book!)
GTG: What kind of sleep issues do you see as a GP in your practice?
Dr C: The whole range! I would say that the majority of my patients, when asked about their sleep, will say that they are not getting enough. Whilst primary sleep disorders do exist, such as sleep apnoea which can require specific treatment, it is important to realise that the vast majority of sleep issues are within our own control. Often we are doing something in our own daily lifestyle which is negatively impacting our ability to sleep at night, without us even realising.
GTG: What sleep issues have you seen a rise in?
Dr C: Inability to fall asleep when going to bed, waking up in the early hours e.g. 4am and being unable to get back to sleep and anxiety related sleep problems.
GTG: When should we resort to taking sleeping tablets and for how long?
Dr C: I rarely prescribe sleeping tablets anymore. They actually sedate you which is not the same as sleeping! We know that they do not provide the deep levels of sleep that we need to recover and rejuvenate. In addition, new research is showing that they may increase the risk of developing other chronic diseases.
GTG: How many hours do we really need? Do we need more sleep now than before or less?
Dr C: We need the same amount of sleep that we have always had. We have evolved over millions of years and our biological requirement for sleep has not changed – what has changed, is society’s perception and the priority given to sleep.
It is important to remember that society has never had as little sleep as we do today. Researchers from Oxford University say that we may be getting 1-2 hours less sleep than we were 60 years ago. This is staggering.
Most of the research points towards 8 hours per night but, as I describe in my book, I prefer to focus on three questions to determine your sleep health. How long does it take you to fall asleep? Do you feel refreshed when you wake up? Do you wake up every morning at roughly the same time without an alarm?
I use these questions as part of my ‘RATE’ questionnaire which many patients find useful to assess their sleep health. [More details in The 4 Pillar Plan]
GTG: What are the benefits of a good night’s sleep?
Dr C: Sleep is arguably the most important component of our health. Better sleep has many benefits including:
Better capacity to learn
Improved immune system function
Reduced stress levels
GTG: What are the effects of sleep deprivation?
Dr C: There are multiple effects. Even one night’s sleep deprivation will cause you to be more resistant to the hormone insulin. This makes it much harder to control your blood sugar levels. I have some patients with type 2 diabetes whose blood sugar I am unable to get under control with better diet and movement. However, once I start addressing their sleep health, their blood sugar control improves. We forget that the body is interconnected and improving your sleep has a knock on benefit on many aspects of your biology including your weight, energy, attention, performance. Good sleep also reduces your risk of diseases such as Alzheimer’s and heart attacks.
We're in the middle of a sleep deprivation epidemic. As a society, we are simply not getting enough. All the way though March I will be talking a lot about sleep! Got some fantastic FB live conversations lined up and twice a week throughout March, I'll be talking live on @ITV with @itvlorraine about how we can all get more sleep. First one will be tomorrow (Tuesday) morning at 8.30am on ITV- tune in and join the conversation if you can. How many hours of sleep do you get a night? #The4PillarPlan #LorrainesSleepRevolution #sleep #relax #notech90 #screenfreesabbath #meditation
GTG: What is ‘sleep debt’ and how do you catch up?
Dr C: The longer we are awake for, the more sleep debt we accumulate. This is one of the key drivers of fatigue, in that, the more sleep debt we have, the sleepier we feel. We think that we can ‘catch up’ on our sleep at the weekend but this is simply not true. In fact, having a lie-in at the weekends starts to play havoc with your body’s daily rhythm which could make it harder for you to fall asleep that evening and get up on time the following morning.
GTG: What counts as ‘good sleep’?
Dr C: ‘Good sleep’ is sleep that leaves you feeling refreshed, energised and restored. I have a RATE questionnaire in the book to help people assess if they have had ‘good sleep’.
GTG: What are your tips for the perfect sleep environment?
Dr C: The most important thing is that the room is dark. Lots of electronic devices emit light even when off. My tips would be to charge your phone outside your bedroom and buy an old-fashioned alarm clock! I also think a good sleep practice is to remove TV from the bedrooms. Remember, your brain is a highly associative organ. That means you really want to train your brain that a bedroom is for intimacy or sleep… and not for Netflix!
GTG: What is your ideal night time routine?
Dr C: Like many people, I have a busy job and young children – I don’t always manage to stick to my ideal night time routine. Ideally, I start my wind-down for bed around 8 or 8.30pm. My phone will go off and I will only do relaxing things such as reading a book or having a bath. I try my best to avoid having emotionally stimulating discussions such as talking about financial matters, although this can be harder to control! Also, I NEVER check emails right before bed.
GTG: If you wake in the night, even if only for five minutes, what effect does this have on your sleep cycle?
Dr C: This is not a huge problem. The key is not to overly stimulate yourself if you do wake up. If you need to visit the bathroom, do so with a dim light. (Red light is ideal as it has the least effect on your body’s daily, circadian rhythm.) The last thing you want to do is look at your smartphone to check the time as this exposes you to the bright blue length wavelength of light and can wake your body up.
GTG: Why do we sometimes feel completely unrested even though we’ve been unconscious for seven hours?
Dr C: It is about the quality of your sleep rather than simply the time spent asleep. Some people will have caffeine before bed and tell you that they can actually fall asleep for the whole night. However, we know that they will not have accessed enough deep, restorative sleep.
In addition, technology before bed can play a role. I have patients and friends who, if they are on their screens right before bed, may actually fall asleep but will not wake up fully refreshed. When they adopt my #NoTech90 they often report having the same amount of sleep, yet they wake up feeling refreshed.
GTG: Do you recommend any sleep apps or tech?
Dr C: Switching your mind off is the best way to encourage sleep and my favourite app for this is a meditation one, ‘Calm’.
GTG: What are your top 5 ways to improve sleep?
Dr C: Have a routine – having a set wake up time and, ideally, bed time every day is probably the most important sleep tip.
Exposing myself to natural light for at least 20 minutes every morning. Enjoy your caffeine in the morning, and no later than noon!
Have a set bedtime routine so that your body knows that it is winding down for sleep. Ensure your bedroom is completely dark – so take out electronics and invest in blackout curtains or blinds.
For more information visit Dr Chatterjee’s website here.
‘The 4 Pillar Plan’ by Dr Rangan Chatterjee is available to buy now.