Is Your Home Keeping You Awake? Professor Russell Foster Rethinks the Rules of Sleep

25:56Russell Foster:A lot of the time, if I've got time, I will do that in the morning. I love it. I mean, I will also park further away from work than I need so that I get my morning walk in. So I get my exercise, I get my light, and then I get to a wonderful coffee shop fairly close to work and I have my first coffee of the day. Okay, well, so beyond daylight, is there anything else that we can do in the morning? Yeah, I think one's got to be sensitive to the fact that you've got to be careful about napping. Now, napping, of course, doesn't happen in the morning. It's usually in the afternoon. If you need to nap, it tells you you probably haven't had the sleep that you need the night before.

26:35Russell Foster:But if you're going to nap, and naps can genuinely be beneficial. They can actually sharpen your alertness and your concentration and your ability to solve problems. But they shouldn't be longer than 20 minutes. Because if you go longer than that, then you can go into a deeper sleep, which can be counterproductive, getting out of a groggy sleep state. So you've got to be careful about that. And they should absolutely not be close to bedtime because that nap will push the sleep pressure back, making it more difficult to get to sleep that night. The classic case of napping is in teenagers. They are delayed, and we should touch on chronotype.

27:15Russell Foster:They have a natural tendency on average to go to bed late and get up late. So they're probably needing to be dragged out of bed in the morning. Many teachers tell me that their students literally fall asleep on their desks. They struggle through the day, get home in the afternoon, then they take a two-hour sleep, which pushes back the sleep pressure hugely before bedtime, which means it's more difficult to get to sleep that night. Sleep is shortened at night, your ability to function is worse during the day, and you can fall into an even longer nap in the afternoon. And so there's sort of a tendency of a feedback loop of shorter nighttime sleep, poor daytime performance, longer nap towards the end of the day, poor sleep.

28:00Russell Foster:So one's got to be careful about naps during the day. Towards the end of the day, I think that most people actually don't have a sleep issue, a sleep problem. It's an anxiety or a stress issue. And so I used to be quite rude about mindfulness and other sorts of relaxation techniques. And I was young and arrogant, and I admit to that. and I had it sort of in the same box as crystal waving. And of course, actually, those relaxation techniques are incredibly important at winding down after the stresses of the day. And so you should absolutely use those. Disconnect from the pressures of work, engage with relaxation techniques, whatever it may be.

28:44Russell Foster:It may be listening to music, it may be yoga, whatever, to wind down before you go to sleep. That's incredibly important And we don't pay enough attention to that, not only in adults, but I think in our youngsters as well. We should be teaching them ways to relax, to wind down after the pressures of school and for many of us after the pressures of work. To pick up on what you said earlier, you know, you were just talking about teenagers and chronotypes. We hear about larks and owls, right, in terms of chronotypes. Are we born either larky or owly? Yes. There are three factors that give rise to whether you're a morning, intermediate or late type.

29:24Russell Foster:One is genetics. And that's where we're born with that. And we now know that subtle changes in some of the clock genes and the proteins they encode can either speed up or slow down the clock. And so a faster clock means you want to get up earlier and go to bed earlier. And that makes you a lark. And the reverse is true, of course, for ours. So by their contribution to our genes, our parents are still telling us what time to go to bed and get up. So there's a genetic component. The secondary is how old we are. So from about the age of 10, there's a tendency to want to go to bed later and later and later.

30:00Russell Foster:And that peaks in women at the age of about 19 and a half, in men around about 21. And men on average want to go to bed later than women. So there's that sharp rise from young ages to late teens, early 20s of wanting to go to bed later. And then there's a slow move to a more mourning chronotype. So by the time you're in your late 50s, 60s, you're getting up and going to bed at about the time you got up when you were 10, 11, 12. And that sharp rise of becoming later and a slow decline to becoming mourning is probably driven by the circulating sex steroids in men, testosterone, in women, progesterone and estrogen.

30:48Russell Foster:Bottom line is that somebody in their late 50s, early 60s will be wanting to go to bed about two hours earlier than when they did in their late teens, early 20s. So it's a notable effect. So we've got genes, we've got development, age. And the third area, we come back to my favorite topic, which of course is light. So morning light makes you get up earlier, dusk light makes you get up later. And we did a study on university students around the world and showed that the later the chronotype of these students, the more they were likely to miss morning light, which would advance the clock, and they got evening light, dusk light, which would delay the clock.

31:33Russell Foster:So that's the one thing we have some control over. So if you're a late type and you're struggling to get up in the morning, what you can do is set the alarm to a decent time in the morning, then get outside to get your photon shower or sit in front of a light box. You've got to do that every day, but it will become much easier as the clock advances through time. And then you can be stably much more of a morning type than you would have been if you'd have just not seen that morning light. I mean, I know you're a sleep expert and not a social worker, but if you're with someone in a relationship and they have a very different chronotype to you, which you must come across a lot, what does one do about that?

32:15Russell Foster:Well, there's lots of things. I mean, there's some data suggesting that the longest surviving marriages are between morning types and evening types, which doesn't obviously make sense. One of my friends interpreted this as rather cynically. That's because you never meet, so you can't fall out. my interpretation is that if you can accommodate the sleeping habits of your partner, you've got the emotional flexibility that is required for a long-term relationship. I mean, that's a bit of fun, but there are some very serious issues. What I've suggested is that if you find it difficult sleeping with a bed partner, then find an alternative sleeping place.

32:55Russell Foster:It's not a reflection on the quality of your relationship. In fact, it can be provided a new basis for the relationship because you will be less irritable, you'll be more empathetic, you'll have a better sense of humour. And so the time that you spend together will be better. Now, one of the great problems, of course, is that it's snoring that provides a huge distraction in relationships. And if earplugs won't work, then yeah, I think finding an alternative sleeping place is perfectly fine. Obviously, you need to discuss it and work it out together, but it's not a reflection on your marriage. I would say one thing, that you need to be very careful that your partner doesn't have obstructive sleep apnea.

33:39Russell Foster:And they basically will be snoring away, and then they'll stop breathing. And then there'll be a big spluttering gasp. That's because the airways have been blocked by the relaxed musculature of the throat, and sometimes the tongue will flip back and block the airway as well. Now, that's important to get sorted out because when you recover from one of those episodes, you get these huge surges in blood pressure, and that can damage the small vasculature in the eye and indeed the brain. And in fact, obstructive sleep apnea has been associated with earlier signs of dementia. You need to go and see your GP and get that sorted.

34:17Russell Foster:One of the great problems, of course, is that partners will not acknowledge that they either snore or might have obstructive sleep apnea. But you can download apps now, which can give you a very good idea of what your snoring is like, and indeed, if you have obstructive sleep apnea. So talk to your GP, but also think about using one of these devices to get some empirical evidence if you're a snorer or not. Bottom line, get obstructive sleep apnea sorted out, but it's no great problem to share a separate sleeping space from your partner. I gave a talk a few years ago and a 25-year-old came up to me and said, how old do you have to be before you can sleep in separate beds?

34:59Russell Foster:Whatever age, as long as both of you are comfortable with that and you can turn it into something positive rather than stigmatizing it, I think it's perfectly fine. As we were talking, I was thinking about my mum who's just about turned 80, right? And for as As long as I can remember, she has slept with the radio on at a very, very high volume. And she'll probably wake up quite regularly during the night. But the sound of whatever's on the radio just helps her drift back off again. But to the extent that I actually don't think she can sleep with silence. Do you come across that from time to time?

35:37Russell Foster:Quite a bit. A lot of people have a white noise generator of some sort. And that's effectively what your mum is doing. She's having a sort of a background stimulus, which is blocking out possibly intrusive thoughts or things. And a lot of people do use it. I mean, if I wake up in the middle of the night, I will use the radio. I'll use Radio 4 Extra and I'll catch up on an episode of In Our Time or whatever, because it's suitably engaging to take my mind off of things, but not too engaging to increase alertness. So after five minutes of fourth century Chinese porcelain, I'm away. But whatever it takes, I mean, there is some slight worry about having the radio on all the time in that what we're doing when we're asleep is we're shutting out all sensory information.

36:31Russell Foster:so that the brain then has the capacity to process encounters during the day, new information during the day, laying stuff down to memory, and, of course, coming up with novel solutions to complex problems. And there's some suggestion, and the data are not that good, that if you're not getting sort of a sensory shutdown at night, your ability to process information might be impaired. But if it's not having any obvious effect on your mum and she's getting the sleep that she needs, I wouldn't worry about it. As I say, many people use a white noise generator. And I, for example, and many of my friends and colleagues will use the radio for something to get me back off to sleep again.

37:17OK. So that sound, what about visual clutter in a bedroom? How does that feed in?

37:24Russell Foster:So there's some interesting data on that. And so you will have heard of artificial light at night, Alan. And there's a lot of discussion about how bad it is for birds, migratory birds and insects and all the rest of it. And there's some evidence that keeping the lights on in the bedroom at night increases your risk of cardiovascular disease and it can impair some of the structure of sleep. And it may, there's some suggestive data, that it may increase your chances of developing cancer. Now, I think we have to be very cautious about this because we didn't have a clear mechanism up until recently.

38:02Russell Foster:And there was a very nice study that looked at healthy young males, those who had to sleep with the lights on, and those in complete darkness. And the sympathetic system and the stress axis was pumping out stress hormones at a much higher level within the individuals who had the lights on compared to people in complete darkness. And of course, that could explain why you have higher rates of cardiovascular disease and cancer, because if you're over-activating the sympathetic nervous system, you know, blood pressure is increasing, you're probably throwing more glucose into the circulation. And I should add that type 2 diabetes and obesity is also associated with keeping the lights on at night.

38:43Russell Foster:And of course, an elevated stress axis could suppress the immune system and make you more vulnerable to cancer. so there is suggestions that just light in of itself at night without darkness might not be good for our health the data are emerging I'm pretty convinced that something interesting is going on but we do need some more work visual clutter which you know if we have a visually very complicated environment does that affect our ability to get off to sleep well if the lights are off no but if the lights are on then it might well do yes um well i suppose that's interesting isn't it about how light your bedroom should be in relation i think to children because children sometimes they're scared of the dark i mean i've got three young children myself you know i know they always like to have a nightlight on if they don't have a nightlight on they tend to wake up in a you know extreme panic about one in the morning it's quite interesting and they get very disoriented What do you think about children in relation to light at night time?

39:49Russell Foster:I think if it's dim light and the sort of thing you get from a night light is going to be something like five lux. It's very low. So it's not going to interfere with alertness and shifting the clock. And if it is needed as a comforter, I think that's perfectly fine. Somebody very irresponsibly a few years ago said, Ah, the doubling in childhood leukemia since the 1950s is because people are now using nightlights. And what those lights will do is suppress melatonin. Melatonin is an anticarcinogen, and that's why we're getting more leukemia. Absolute nonsense. The light is way too dim to have any effect upon the melatonin system.

40:32Russell Foster:And anyway, the suppression of melatonin has not been linked to higher rates of cancer in individuals. So I had to spend quite a bit of time, you know, speaking to parents saying, oh, my goodness, you know, my child needs a nightlight. But now I'm told it's going to cause leukemia. No, it won't. Almost certainly not, because there's no evidence for that at all. OK, well, that's good to hear. I mean, it goes to the issue, though, of, you know, what you should be doing if children wake. and of course you know I speak from my own perspective here is that you have to encourage self-calming so I think many of us to begin with as parents are anxious and so any noise or squeak will go rush in and of course you know the child will want that it will want the physical contact and possibly even you know food and I think what you've got to do is wait pause let the child you know self-comfort and then fall back to sleep again it's a very difficult balance i know but i know a lot of people who you know in children are five or six and they're still waking in the middle of the night expecting their parents to go in comfort them and they're not capable of self comforting and that can i think be a bit of a problem okay well on that then what about bed sharing with children what are your views on that one yeah i mean it's done it's common practice in in many societies.

41:52Russell Foster:Interestingly, it's usually the mother that bed shares and the father sleeps in an alternative space. Japan is a classic example of where that occurs. You know, I'm not an expert in this area, but I don't see any problem with it if as long as it's not something that the child becomes utterly dependent upon and can't independently sleep after a few years. That would worry me a bit. It's interesting, our eldest child, we were living abroad and there was this huge storm and we thought oh my god you know the trees are going to come down and crush the house so we brought a little one she was what six months into the bed and thought well if we're going to go we'll all go together type thing and she wriggled around and was such an impossible bed partner uh we put her back in her cot

42:40Russell Foster:and she's now now she should now a very successful uh consultant pathologist who sleeps very well i imagine who who does sleep very well yeah but she does the right things she gets morning light and she does exercise in the morning she's off to the gym like it and then and then i suppose the other thing in the bedroom is temperature right so what should we be aiming for there yeah very good i mean so part of sleep initiation is a drop in core body temperature it's only about a degree but if you stop that then it's more difficult to get off to sleep so the suggested range for most people is sort of 17, 18 degrees, certainly not warmer.

43:19Russell Foster:For elderly people, it might go up to 22 degrees or a little bit warmer because of the change in circulation. But really, what you've got to be able to promote is that slight drop in core body temperature, which is why some people swear by a, not a hot, but a warm bath or shower before they go to bed, because what that will do is dilate the blood vessels in the skin. So blood will move from the core to the periphery. And of course, it'll lose heat in the process, promoting that slight drop in core body temperature and allowing you to get off to sleep. Oh, I see. That's interesting. I didn't realise that was why.

43:58It's called the warm bath effect, isn't it? Yeah, exactly. Yeah. So the other thing I'd like to talk to you about is technology because we obviously track our sleep in a quite unprecedented way, don't we? I mean, I have a Garmin watch, for example. I don't take it off at nighttime. In the morning, it tells me, first thing, how well I've slept. I try not to take too much notice of it, to be completely honest, but people track their sleep in all sorts of ways, rings, you know, mats on the bed and so on. I was just going to say, has that increased use of technology helped us get more sleep or has it helped has it actually contributed to less sleep do you know

44:39Russell Foster:from my experience for many people i've talked to i think it causes increases sleep anxiety so if i just a step back in principle a tracker could be useful so in the same way that if you want to lose weight you change your eating behavior you weigh yourself in the morning you see there's been a drop in weight, which is what you presumably want, and that reinforces the change in the eating behavior. And of course, you could use a tracker like that. You're not getting the sleep that you feel you need. You change your habits, and the device tells you you've got better sleep that night or longer sleep or whatever.

45:18Russell Foster:The problem is they're profoundly inaccurate for defining sleep stages. They're good for telling you roughly when you went to sleep and when you woke up, and if you happen to wake up in the middle of the night. But telling you you've had a good night or a bad night of sleep is something to be, well, they can't do it accurately. And I would ignore that completely. So as long as you don't take them too seriously, if you're using them to track your sleep duration and your sleep timing, that's fine. But don't rely on them in any greater detail. And as I say, loads of people have come up. I mean, the most extreme case was an individual said, I'm really worried I'm really worried I don't get enough slow wave sleep and I said well how do you know and they said well you know my tracker says I'm not getting enough deep slow wave sleep and I said well these are really inaccurate I wouldn't worry too much he said no no no I wake myself up I set the alarm for three o 'clock in the morning because I know I should have had most of my slow wave sleep during the first half of my sleep episode and then I check how much sleep slow way of sleep I've had.

46:20Russell Foster:You know, that's a level of anxiety which these things can generate. And I assume that chap isn't unique. But it's a great example of where the data is being used completely meaninglessly. And it goes back to what we were discussing earlier. Am I getting the sleep that I need? You know, can I function optimally? Do I oversleep on three days? You know, am I forced out of bed, my alarm clock? We should rely on our bodies to tell us about the quality of sleep, not at a device which at the moment are not sufficiently accurate to give us a proper assessment of our sleep yeah okay caffeine i'm very sensitive to caffeine and i know some people are and some people aren't if i drink caffeine at any time of day i probably won't sleep very well or i'll struggle to get to sleep why does it affect different people so differently yeah so So what caffeine is doing is blocking the receptors that allow the brain to detect how tired it is.

47:20Russell Foster:And so you genuinely feel more alert after a cup of coffee because you block those receptors in the brain that would say, yeah, you've been awake a long time, you need to sleep. So that's what caffeine is doing. And so the waking day for many is fueled by caffeine. And we certainly feel more alert. And I think the driving code says that if you're driving and you want to feel more alert, you know, you take a cup of coffee and 30 minutes later, you get back on the road. The problem with caffeine is that it can hang around in the body for really quite a long time. And as you say, people vary enormously in their sensitivity to caffeine.

47:58Russell Foster:The receptors that detect tiredness that are blocked by caffeine can be very variable between individuals. And so for me, I don't drink caffeine after two o 'clock in the afternoon because it can hang around in the body for five to nine hours, which can potentially delay my sleep at night. And the problem there is people have fueled the waking day with caffeine and then will try and reverse it with a sedative like alcohol. And alcohol is a very effective sedative, but it doesn't provide a biological mimic for sleep. And in fact, it can disrupt sleep and actually harm some of those really vital elements that go on in the brain during sleep, which is memory formation and the processing of information.

48:41Russell Foster:So I think one's got to be very careful with caffeine, work out your level of sensitivity and, of course, avoid it. I mean, the good rule of thumb is don't drink after two o 'clock in the afternoon. yeah okay well with alcohol then we all know that feeling or most of us know that feeling of getting home after a long day having a glass of wine or a beer or something and it does definitely make you feel more relaxed and it makes you think to yourself oh sleep's probably going to be a bit easier tonight because I feel calmer where do you stand on alcohol because it seems to me it's not necessarily a binary thing.

49:19No, I agree.

49:20Russell Foster:And of course, there are data coming out at the moment. I think the latest advice I saw online was no alcohol at all. Any level of alcohol harms your health. I would like to see those data unpacked. I mean, I think a small amount of alcohol to relax you in the evening, because what alcohol is doing is activating the GABA pathway, which is an inhibitory neurotransmitter, which reduces those excitatory neurotransmitters that keep us awake. So that's how it can make you feel more relaxed. Magnesium is another agent that's been associated with augmenting GABA and making you feel more relaxed. I think a small amount of alcohol is fine.

50:04Russell Foster:And I might have a glass of wine occasionally, or a whiskey and soda, or something like that. The problem is, if you become dependent upon it, And then you need more. I mean, this is the problem with sleeping tablets, alcohol. You need more and more to get the same effect. And when you realize that half a glass of wine isn't enough and you're drinking two or three, then you have a problem. so I think occasional low levels wouldn't worry me particularly but that's not the advice that government is providing they're saying no alcohol at the moment as I understand it there's a there's a paper out recently but personally I mean clearly this is not clinical advice this is personal advice I would not worry if I'm having half a glass of wine or a small whiskey occasionally of an evening.

50:51I just want to ask you about my own personal experiences of sleep which I'm sure before a lot of people share. When I was younger, I had a period, you know, my late teens, early twenties, particularly where I was in a bit of a spiral where I was chasing sleep rather than allowing it to arrive naturally. I started worrying about going to bed, you know, come afternoon, evening thinking, oh, I'm just going to lie there. I'm not going to be able to get to sleep. It always baffled me that people would, you know, they'd rub their hands together and they'd say, oh I'm going to sleep so well tonight and I would think to myself how do you possibly know that because as far as I'm concerned you know it doesn't take reservations in that way you know I just didn't experience in that way so if someone's in a bit of a spiral in that way how do we learn to allow sleep to arrive naturally rather than chasing it well you're quite right if

51:50Russell Foster:we try and chase sleep it's always going to get away from us and and what it is is developing those habits and techniques of sleep hygiene, of trying to get into a rhythm. And it's this winding down that we talked about earlier. It's what you're doing at the end of the day to disconnect from all the problems. So for example, many couples' lives are so busy that they first of all don't have time to wind down. But also it's perhaps the only time that they get to meet each other for a discussion is when they're lying in bed together before they go to sleep. and that's great but what you shouldn't do is then start to discuss your concerns about the children or finances or whatever so it's trying to avoid those stressful situations certainly in our household those topics are absolutely forbidden when you're lying in bed together before you go to sleep it's adopting sleep hygiene and it's de-stressing about sleep and it's not worrying if you wake up it's not worrying if it takes a bit of time to get to sleep you will i I mean, we as a species have been sleeping for a very, very long period of time.

52:54Russell Foster:What's changing in our lives is that they become more complicated and we have potentially, I guess, more to worry about. And so it's a matter of de-stressing, getting rid of those issues and also using good sleep hygiene. And sleep will almost always sort itself out in individuals. Okay. So those three o 'clock in the morning catastrophizing sessions that we're all familiar with. What's happening in the brain there and what do we do about that? Yeah, it's really interesting because we're always told not only should we get the perfect eight hours, which we've agreed is nonsense, it's also this perfect solid block of uninterrupted sleep.

53:34Russell Foster:That's also nonsense. I mean, Richard Eckert has written a wonderful book called At Day's Close, where he's looked in the pre-industrial era at human sleep patterns. And what he describes from the diaries and the documents of doctors of the day is what's called a biphasic sleep pattern, which is people go to sleep, they wake up, they go back to sleep again, or polyphasic, which is repeated, wake up and go back to sleep again. And in fact, most of us will wake up from rapid eye movement sleep several times during the night, but we never become consciously aware of it and we go back to sleep again.

54:11Russell Foster:But those of us who experience biphasic sleep, who wake up and become conscious of it, then need to say, this is perfectly normal. I mean, if I stay relaxed, if I listen to my bit of Radio 4 Extra or whatever it is, I will get back to sleep. And the problem is people don't know that that's what's normal. So they think, oh my God, I might as well get up, start doing emails and drinking lots of coffee. It's about staying calm. You may want to leave the sleeping space. You may want to go to another room, keep the lights low, read a few pages of whatever it is, Jane Austen, listen to some relaxing music but find those tips that work for you and not to get anxious about falling back to sleep again i wish people would know that this is a perfectly normal pattern and one shouldn't worry about it yeah so much of what you said today i think is very reassuring because you're quite relaxed about it all actually you know you're quite relaxed about people using screens you're quite relaxed about the idea that we do sometimes wake up in the middle of the night and that's fine.

55:12It's normal. It's natural. You've talked about the idea that our chronotype can change as we age. You know, these are quite reassuring things, I think, because we're all going to have periods where we don't sleep as well as in other periods, right? Is that fair to say?

55:27Russell Foster:That's absolutely right. And I will often, you know, speak to 60, 70-year-olds and say, oh God, I wish I had the sleep that I had when I was 30. Well, you won't, but different isn't necessarily bad. It's so much of managing expectations about our sleep and we become so anxious about sleep. You know, we now have a diagnosable condition called sleep anxiety. And it's a great shame because, you know, it's arisen in recent years, perhaps because of the overuse of apps, perhaps because of inappropriate advice by certain colleagues. And we just need to relax and enjoy the sleep that we get. It's really good advice.

56:03Well, with that in mind, I'd love just to ask you one more question. And that is, you know, if you could encourage people to change just sort of one thing, specifically around the home, in context of the home, what would you encourage them to do?

56:17Russell Foster:Well, I think there's the mindset, first of all. I think we should stop thinking of sleep as this rather unruly, naughty little creature that we have to bludgeon into submission, but rather think of it as a teddy bear, something that we should embrace and cuddle and gain enjoyment from. So there's that sort of sleep is not an enemy. It's a profound friend. And if we embrace it, we'll get the sleep that we need. So there'd be a mindset change. I guess the other thing would be, I think we Brits are kind of mean about spending money on mattresses and duvets and decent pillows. And again, our individual bed requirements change, but it's worth splurging.

57:01Russell Foster:You know, go to the shops. lie on the mattresses, try out the pillows. 30 % of our lives will probably be spent in a bed. And so it's worth investing in seriously to get the kind of sleep that you need by getting the mattress, pillows and duvet that you need. Fantastic. I'm there. I'm going down the shops. Thank you so much, Russell. That's been so interesting. It's really good to meet you and I've taken a lot from that. So thank you very much. Oh, it's a great pleasure, Matt. Thank you for such great questions.

57:35Thanks very much to Russell and thanks to all of you for listening as always. I really, really appreciate you being here. I'm pleased to say that my new book, which is also called Homing, very imaginatively, has been signed off by the publisher. So we're in the final stages of choosing covers and exciting things like that. And I just wanted to say that I'm going to plan to share some of the ideas from the book with our members on Patreon over the coming months. So do look out for those. I'll be back next week with another house tour episode it's a really really special one I think and I'm very excited about sharing it with you all a bit of a legendary figure in my view with just an amazing place and a really fantastic story so look out for that in the meantime thanks again for listening talk to you all very soon and all that remains to say is that this episode was produced by Podshop with music by Simeon Walker bye for now

58:31Thank you.