Encore: How to sleep well and what can get in the way

ABC Listen, podcasts, radio, news, music and more. Today on conversations. It's all about sleep. And I think if you look at it from one angle, sleep is one of the strangest things that human beings do. Try this thought exercise. Just imagine the earth is visited by a friendly group of extraterrestrials. When they get here they're super interested in us, and they have all these questions for the people that we've sent to meet with them. But then sometime around midnight.

The humans start yawning, and they slip away to go to bed. And the aliens say, Wait, wait, where are you going? And the humans say, We're off to bed to get some sleep. And the aliens say, Well what is sleep? And the humans reply, Well it's this thing we do where we go into a darkened room, we lie on something comfortable.

And then our conscious mind switches off, and we watch these bizarre self generated movies in our heads. And then, ideally, we wake up eight hours later and feel quite refreshed. And I think it's at this point we've been needing to put forward Associate Professor, Dr. Satapa Mukaji, to explain what's going on. Satapa is a sleep specialist. She's based at Flinders University's Sleep Health Institute in Adelaide, and she's the president of the Australasian Sleep Association.

And this is exciting research because there's still so much. We simply don't know about the business of falling and staying asleep. Hi, said Tapa. Hi.

Take me through a night of sleep. On a good night's sleep. What are the typical stages we go through as we go through that eight or so hours? You're probably aware of this, that you you usually can't fall asleep straight away when you jump into bed. So there is a a a time which which is different for everybody, but you know, it takes a good half an hour, hour for a lot of people to wind down. So it kinda depends Getting ready for a good night's sleep really starts.

um in the evening um and most people are trying to fall asleep during nighttime hours. So that beginning of withdrawing from the world starts even before you get into bed. And so, you know, we've all got little rituals that that help to tell our bodies that we're getting ready for sleep. And part of that is trying to reduce stimulation and some t some people dim the light.

uh a lot of people uh you know hopefully switch off their phones. Uh and then you finally get into bed and and as I said you don't usually fall asleep immediately. Even then it w might take

ten, fifteen, twenty minutes for your brain to start to really relax. And what's happening as you go into that first stage of sleep is your brain waves are actually slowing down. So one of the things that we do as sleep physicians and sleep researchers is we're constantly looking at the brain waves'cause that really tells us when you're awake and when you're asleep and also what stage of sleep you're in.

So your brain waves start to slow down. What what actually happens when we look at the EEG or the electroenkephologram is we can see sleep start To to intrude on wakefulness. So we start to see a little bit of sleep and then people kind of go back into the more alpha waves which are which are characteristic of wakefulness. And as you go off to sleep you start to see more and more sleep appearing. Um and then you actually are asleep and y and you go into Stage one sleep, which is light sleep.

And y you can't just go from stage one to REM sleep, which is dreaming sleep. That there's actually a characteristic pattern that happens. So you've got to be in stage one sleep, four, a while and the a while might be different depending on your age and also how tired you are. Um but maybe let's say, you know, after around forty five minutes you might go start going into stage two, stage one or two, um, depending on how how what your bedrooms like.

And then you stay in stage two sleep for a while and then you start to go into slow wave sleep which is which is even different again. The characteristic waves are different. And slow wave sleep is really a time when uh the waves are even slower than stage one or two with characteristic pattern. And then you get your first lot of REM sleep, which usually has taken about ninety minutes of this cycle before you can go into your first lot of rapid eye movement sleep or or REM sleep.

And this is where your muscles are very relaxed. Your eye movements will be very quick. And so that's why when we monitor sleep we look carefully at whether the eye movements are there or not'cause and that tells us when you're in REM sleep.

Now now when we reach REM sleep, uh are our eyes moving because we're watching our dreams like we're watching a movie on a big screen? I we don't know why, uh why it happens, but but it's it definitely occurs and it doesn't happen in non-REM sleep. So your eyes are not moving but the you've got these very quick eye movements. Y your breathing actually becomes very irregular too in REM sleep.

So physiologically it's very, very different to the other stages of non-REM sleep where breathing is quite regular uh and even in in slow wave sleep our blood pressure uh drops. So but REM sleep is really quite an active part of sleep as opposed to to non REM sleep, a c a completely different state. Is it like the body's reacting uh to the fantasy of the dream? Because the REM REM stage is always associated with dreaming, or is that going too far to say that, that that we think we're in this?

uh world that we're dreaming through that we're moving through it, we're seeing things and the reason why our eyes move and why our breathing changes is because we believe ourselves to be in this altered state. I'm not sure that we could really say that. I think it's a nice um it's a it's a nice way to think about it, but I don't know that we we know for sure. why REM sleep is so different. We we do know that in terms of the function of REM sleep that

REM sleep is really important for memory consolidation, for emotional processing, and also for brain development. So You know, that's why for example, if we're deprived of REM sleep for for whatever reason and and the classic example where that happens is when say say yet there's a new baby in the house. who's waking up every hour. So poor mum or dad are sleep deprived. But one of the things that really happens is they don't go into REM sleep because you need

other hour of of one or two or slow wave sleep before you can get in your first cycle of REM sleep. So You can't get into REM sleep unless you do those other things first. That's right. You have to go through these other stages of sleep. And so if you're constantly getting woken up every half an hour or an hour, it's really hard to get into REM sleep. And if if you think about how you feel if you're being woken up all night

you really are very irritable and you really don't remember things very well either. Um and it's really, really hard to push on during the day if you're just not getting that long period uh to get yourself into REM sleep. So are you saying that REM sleep is the kind of most necessary part of sleep for us, psychologically, emotionally, neurologically, all those things.

I think I think all of it is really important. But but there've been studies where they've particularly looked at people who are not able to get into REM sleep and it definitely affects memory, uh, and emotional processing, that whole idea of feeling balanced and ready to deal with all the issues that happen during the day very much does require REM sleep. But even slow wave sleep is really important for

uh, restoring the brain, helping the brain to recover, and also maintaining and consolidating sleep. So I don't think we can say that one part of sleep's more important, it's all important. But somehow uh we need all those pieces of the puzzle when we sleep to help us to function uh the best that we can.

So what's our brain doing while we sleep, chemically speaking? Is there some kind of cleanup process at work? Definitely, you know, there have been studies that have shown that it it's so important for getting rid of the waste products in the brain. And it's not just the brain,'cause it's happening throughout the whole body. But of course the brain is really the powerhouse of the body. And so it's getting rid of you know, if if our cells are working constantly during the day

then there's a period where the it is a clean up where they get rid of all the nasty toxins. Um also it really helps sleep helps with the immune response. That's what a lot of people don't don't realise that sleep is so important for healing the body. Uh and unfortunately our hospitals are not really set up to help people sleep when they're in hospital, but they probably should be because sleep

really helps uh healing for the body. Uh helps with the immune response if you're trying to fight infection. One of the things your body does is it kind of gets you into bed. uh and you just need to lie there. And if you can sleep, you usually do feel better, uh, if you're unwell. So that's all a part of the body's process is t is to make us um well and function um as good as we can throughout the day. my creative decisions uh happen in the morning, I have to say.

I have to find that I I find that there's only a finite quantity Yeah. Finite amount of decision making ability I have in my in my head during the course of the day. By by late afternoon it's pretty well played out. In the morning when I've woken up, or typically in the shower, this is I think what people say they often get inspired in the shower, it's all been restored and I can suddenly make all these easily make

Quite complex decisions that is a is a power that starts to dribble away by the end of the day. Is this a subject that you're interested in as a researcher? The uh b the refreshing nature of sleep and the way it can re rebuild our power to make decisions at the start of the day? I th I think it look there's many researchers that are interested in this. And I mean it's it's been around for for a long time. We s we all sleep.

species of animal sleep. There is some form of sleep that's needed. And definitely, you know, the old proverb that, you know, if you've got a problem, sleep on it. And then usually you you've got a pathway forward the next day. So sleep really does help um with processing complex information and trying to to help us um see how we can move forward. And and you're exactly right. A lot of people have great ideas in the shower after they've had a had a good sleep.

You're mentioning there the the s the drop in brainwave activity that happens when we go to sleep. I have a very powerful sense that while I'm asleep or at some point during my s my subconscious mind is starting to get up and run around. quite a lot. And I think there's a bit of problem solving that's going on there by the subconscious mind as well. Can you detect that in brainwave activity? Does it suddenly pick up again or in a different part of the brain once once we're asleep?

Uh I mean I think there are p different researchers that have have tried to look at that, but sleep's actually really hard to study because I mean obviously if we are monitoring someone's brainwave We can't have them in an M R I machine trying to see which part of the brain is is lighting up because the noise of the MRI scan will will stop them from from sleeping. A horrible place to be anyway, too.

Yes, and it's so it's it's actually really hard to look at some of those things of what exactly is happening. There have been, you know, some animal studies where they've really tried to look at the different parts of the brain that are active and you know, the the best that we have is the the electroenkefhlogram which

we've got very, very clear um signals in the different stages of sleep. So we can actually see when people are in slow wave sleep or they're in REM sleep or they're in Stage one sleep, we can see the arousals because arousals from sleep or waking up, if you like, are a normal part of sleep.

Um and so we can pick all of those things on the electron kephylogram. And so people have done you know, tried to do studies where for example they when they see someone's in a certain stage of sleep they'll they'll ring a ring a bell. And and so you've all probably experienced when you're asleep and and you know, y in different in the stages of sleep, stage one and two You can u and even in REM sleep you can often arouse quite easily to a noise. But if you happen to be in slow wave sleep

And you might not hear a noise. And and I have been on call for the sleep laboratory and the staff in the sleep lab have had to try to get in touch with me uh at night. And if they happen to ring me and I'm in slow wave sleep, th they'll often say, We rang you at three AM and you didn't answer.

And and I say, Oh, I must have been in slow wave sleep but then if they ring again maybe half an hour later I'll usually answer straight away because if you're in slow wave sleep, your your brain is th the wave the uh your waves have actually slowed down to such an extent that you really have withdrawn from the world and you you may not hear

One of the most horrible things that can happen to me I've found that is if I fall asleep and for whatever reason someone accidentally wakes me up ten minutes into my life. I tend to wake up with my heart pounding wildly and I'm and I'm in a fury too. I'm really not quite m m not myself at all. And I say all these horrible things that I have to apologize for the next day because I've been so wild with rage to be woken up

Ten minutes into my sleep. In the middle of the night, fine. No problem at all. But uh ten minutes in, it's bad. What do you think is going on there? It's kind of the your body is really wanting to go to sleep. So are you talking about a nap during the day? No, at night.

At night. So so you're probably my impression might be that you've you're really Tired and exhausted when you actually get into bed and the fact that you've just gone off to sleep, that your body's ready uh to start going into the different stages of sleep, and then someone wakes you up and and that you know, you're just not not ready for that. Y your body really needed the sleep for the restorative power of sleep and that's why, you know, you wake up and you really not

in a great mood or or anything because um because your body really needs that sleep. Your body is saying, We have to go to sleep right now We know that sleep is essential to live and that Certain regimes will practice sleep deprivation as a form of torture. Will absence of sleep eventually kill a human being? Yes. Um I mean as you've said it it it is a form of torture so you you're not allowed to even um through the Geneva Convention you're not actually allowed to deprive people of sleep.

Um but some of the studies that have been done which were which are really not being done anymore but have been done on animals where they deprived uh rats of of sleep. And in fact they deprived them for about thirty days and around about that thirty day mark the rats died and they actually died of of sepsis or infection. So so that really shows you the importance of sleep for the immune system. What's what what kind of an infection does it work if you don't get sleep?

Well well any infection. I mean, you know, that's it's kind of telling you what I what I said before, that sleep is actually really important for the immune function of of our bodies. You know, any time that you're sleep deprived you're more at risk of picking up a virus or or some other bug uh that's around. And and I many of us have experienced that if you're working really hard and perhaps you're not getting your seven to nine hours of sleep which is what is recommended for adults.

that you're a bit run down and then, you know, the next thing you've got a virus.

You made that TV series with Dr Michael Moseley about... And the most important tip that came out of that series for better sleep were firstly to eat at least three hours before bedtime. What happens if you d eat too close to going to bed? So I think look, it's different for everyone. So and I think that's one of the things that did come out. during the series is that there's a lot of individual variation um and many of the the sleep hygiene tips that we give

will work for for a lot of people but not everybody. So, you know, I've got some patients who, you know, where that three hour rule, you know, you shouldn't eat a big meal before sleep. i works well for them. Uh but for other people, you know, it depends on the timing of your evening meal. So some people are eating between five and and six PM and then they're not actually going to sleep till maybe eleven PM. And s for some people having a bit of a snack before for bed might actually help them

to get off to sleep because it's been, you know, several hours since they've eaten. It also depends how much you eat too. Uh and and I think it it also changes um with ageing as well. So a l a lot of

Older people are eating less um as they get older compared to what they would need when they were younger. If if you're doing a lot of exercise, you might actually need to have something before you go to sleep. I think the key is to sort of work out what works best for you and there's not really one size fits all. One of the other tips was to avoid screens, including T V an hour before bed and I m I think we're all pretty aware of what the blue light of the T V or the screen does.

to our ability to to fall asleep. But but how about the anxiety uh producing effects of things like sco social media? with in you know, anecdotally we just know that people are sitting up later at night doom scrolling through uh social media or or letting themselves be made uh angry or anxious as a result of scrolling through

social media. Are you seeing any correlations there, generational ones, but in younger people particularly who might be more prone to using social media these days, and sleep disorders that might be associated with this kind of behavior? It's a bit too early to say that there's a direct correlation um with with sleep disorders. Um but if we pull it back and just think about good sleep and and and poorer sleep. There's definitely a correlation with

screen time and having difficulty falling asleep and staying asleep. And you know, a lot of a lot of um young people teenagers are really biologically predisposed to wanting to go to bed later. Um, that's just a a biological part of their brain maturing. Um and so if you're if you're on social media or on your screens

what that does is it stimulates the brain rather than getting it ready for sleep. And you're already biologically predisposed to wanting to fall asleep about one AM and then if you're using your screens that might push out to say two AM And then of course if you've got to get up for school or university, you know, seven or eight in the morning, you're actually becoming quite sleep restricted.

Is it a good idea to get out of bed if you've been lying there awake for half an hour, an hour or fifteen minutes? Get out of bed? Yes, we usually say that that's a another really good one. If you happen to be woken up, you know, two or three AM um and you're still awake twenty or thirty minutes later. The really good thing is to get out of bed, go into another quiet, dark room. Once again, don't turn all the lights on.

uh and then wait till you start to feel sleepy and and you will start to feel sleepy. It's just a matter of time. don't do anything too stimulating either. So, you know, don't start playing games, but just sit quietly. Some people listen to relaxation tapes. Other people

You know, might read with a with a dim light. And then when you start to feel sleepy, that's when you go back to the bed. And and that's just one of the things that helps to associate bed with sleep and not wakefulness, which which you think is a really good h sleep hygiene tip.

When you do st start to fall. you do feel this kind of on a good night, this kind of delicious relaxation which is A kind of muscle paraphrase. So it it's different in the non REM sleep and in REM sleep, but in in non REM sleep, which is the first part as you're going off to sleep, your muscles are not really paralyzed but they're just

not as active, you know, and that's when you you have that lovely feeling. But, you know, if you get woken up, you can, you know, get up and move fairly quickly. So they're not completely paralysed. In REM sleep there is

a lot more relaxation of the muscles. Uh and as I said, there's this irregular breathing, the eye movements are quite rapid. Uh so it's a very different state. And if you get woken up in in REM sleep, Sometimes we've experienced a bit of sleep paralysis where Your brain is awake but you actually can't move your body. That just happened to me all the time when I was in my twenties. I'd wake up in the morning and not be able to move and have to sort of push through that feeling to wake up right.

And so I imagine when you're in your twenties that you might have actually been maybe burning the candle at both ends, you might have been a bit sleep depressed. Once or twice the time, once or twice, yeah. And so that's when uh when I say normal people, I say people that don't have narcolepsy. So all the non-narcolepsy people, which is, you know, the bulk of the population, we will experience sleep paralysis when we are more sleep deprived. So meaning that perhaps your alarm woke you up.

uh and your body really wanted a bit more REM sleep and that's why your muscles are still paralysed. There's a little bit of a delay in the muscles being uh woken up. And that's why you sort of lie there and you're awake and you just can't move. And and I've experienced it too when I've had say a nap in the afternoon'cause maybe I didn't sleep the night before, for whatever reason. I have a nap in the afternoon and then I need to wake up.

but my muscles are are paralyzed. So that's the only real time that that uh we would experience that. It's it's to do with the characteristic of sleep itself that obviously we don't want people to start walking around when they're asleep. Um so it's a physiological process where the muscles become less active and are paralysed to so that we don't hurt ourselves and and and of course when

So sleepwalking is probably the the other stage where people are their muscles are not paralysed and they get up and they start moving around and that's really dangerous. So it's a it's a physiological mechanism to make us safe when we're sleeping.

So it's all very complex, but the the real reason for it is so that we're safe when when we are sleeping, because we have to sleep. I think there's nothing more lovely to observe, the kind of sleep that you see in a very small child and infants, the way they go to sleep and ideally they stay asleep for a little while as as well. What kind of sleep ritual did you have as a little girl, Satapa when you were growing up?

Oh, thinking back now, like like I think like a lot of people, um, my parents used to, you know, give me a bath. uh and then I would hop into bed and then there was story time uh and then it was lights out so Uh, you know, most most parents are trying to have some rituals that help their children to to get ready for bed and to for the brain to realise that it's time for sleep. And so, you know, most

um most children would have specific rituals that that really helped them. And for me it was all about bath time and then story time. You ended up pursuing a career in medicine and into various kinds of respiratory illnesses. What led you from there into the world of sleep research?

So I think it was really a timing thing because when I was doing my respiratory training that was in the uh early nineties, the whole idea of sleep medicine was in its infancy. So Around about the late eighties was when we started to be able to measure sleep fairly routinely with with the sleep studies that that we even do today where we measuring the brain waves and also measuring the eye movements and so on. So around that time when I was doing my respiratory training, sleep was

as a field was quite young and not many people knew much about it. So I went on and did my respiratory training and then I did my PhD which was actually in lung cancer and then I went off to to Harvard Medical School for my uh postdoctoral work. And it was there that I got to meet some some very, very experienced sleep researchers. And it got me thinking about, oh, I don't really have the skills

as a sleep physician to really help people with sleep problems. So then I came back to Australia uh in the early two thousands and that's when I did my sleep training in Perth and really, you know, spent a few years uh honing my craft and then um went on and did a lot of research in into sleep. And and that was a really great time because

you know, sleep was very new and we were just learning so much about sleep and we're still learning about sleep. It's a great field'cause there's so much uncharted water. You were speaking there before about the physiological benefits of sleep, which are really obvious and apparent and we all know about it when we don't get enough sleep. What about dreaming? Do we get any kind of physiological benefit from dreaming? Do we know anything about that?

So, you know, once again the physiology tells us that Dreaming is really when you're in REM sleep and that is so important for learning, memory consolidation, emotional processing, and also for brain development. So, you know, if you're trying to learn something new, uh, it's so important to you know, obviously you're learning new techniques, what whatever it is.

to actually have good sleep because the next day when you come back to whatever you were learning you will have actually consolidated all that work that you did the day before because of sleep. And dreaming? We don't really understand why we dream and of course once again dreaming is is really, really difficult to measure.

Uh, you know, some of the skilled researchers will get people to work on something and then they'll get them to go to sleep and the minute they start dreaming they wake them up and they they ask them what they were dreaming about. But most of the time we don't remember our dreams. But we know that everybody dreams, uh and it's only occasionally that you will actually remember

what you're dreaming about. And sometimes it relates to something that you that you were doing the day before. But a lot of the time it can be something completely different. It can come out of nowhere. You were talking before about how the muscles become somewhat paralyzed as as we sleep, particularly when we go into our uh REM sleep, and this is one of the things that stops us.

sleepwalking. So therefore or parasomnia I think you call it, don't you? W when when that goes on, there's some kind of dysfunction there where that m muscle paralysis hasn't set in. Given that you're often uh working with or dealing or treating people who have this condition, how far can they wander? What what what stories do you know about how far people can travel while they sleep?

So, you know, obviously it it's actually quite common sleepwalking, particularly in in children. And usually in children it's a it's a non REM parasomnia. And most, you know, the the the extreme examples are when people are able to do complex movements in fact can open the front door and go and go out on the road. And obviously that's a huge, you know, very dangerous situation.

But most people don't usually go outside the bedroom and of course that's good because it's less likely that they'll hurt themselves. But some people that I know have actually you know, they've fallen out of bed or they've they've broken their arm or or they've injured their bed partner.

So, you know, it it's a real safety issue if you if you are prone to having sleepwalking or or a type of parasomnia where you get up and and move around. So usually when we hear that someone's moving a lot and and getting out of the bed, then we try to use various medications to to stop them from moving so much.

Um but the other thing with with all parasomnias is often they tend to occur when people have restricted their sleep, so had less sleep. So If if you're someone that that is prone to sleepwalking, it's likely to happen, say for example, if you travel and you're you've been flying uh and not getting as much sleep, then it will probably happen that night when you arrive.

somewhere and go off to sleep. So so you you can be aware and alcohol also will make it worse. So you really have to know the triggers and and be very aware uh that that you are likely to sleep war.

And also we would also say really important to not stay in in hotel rooms with with balconies and and things like that because you can actually, you know, open the the balcony door and and fall out and you're fast asleep. So And we do tell people if they're very prone to this to to have alarms that go off if they if they walk outside the bedroom.

There's a really common belief that you should absolutely never ever wake up a person while they're sleepwalking. Is that real or is this just one of those things like You know, d don't you need to wait half an hour before getting back into the pool and go swimming. Is there any truth to that idea that you should never wake people up while they're sleepwalking?

Look, I I I haven't ever heard that one but but I think you can wake them up and particularly if they're moving around the house, it's important to wake them up because they're not

They're not aware of what they're doing in a way that you or I are if the if they're walking to the fridge and opening the fridge. And they could hurt themselves. It depends what stage of sleep they're in. If they're in non REM sleep They're usually quite amenable to if you just lead them and say, look, let's just go back to bed and you can just lightly grab their arm and then lead them off into the bedroom and they'll probably just jump back into bed and go off to sleep.

So, you know, I I think you can wake them up and you probably should because otherwise they could hurt themselves.

You were talking before about narcolepsy, which is another one of those kind of alarming sleep disorders, the condition where you can just seemingly fall asleep at any time. What's going on in the brain that makes the person who has narcolepsy just crash into sleep? So for people with narcolepsy, their brain and body just wants them to be asleep most of the time. And that's because they don't have arexin in the body. Um and so And that's the wakefulness. It helps. Right.

It helps with that. So so they don't they don't have that and so their body always wants to be asleep. And so for them they need to have more sleep than than we do. So, you know, if we need seven to nine hours as an adult to feel rested, they might need ten or eleven hours. So they need more sleep overall, but also for them, having a a twenty minute nap can actually be very restorative to help to to maintain wakefulness. So

they can just fall asleep at the drop of a hat, i particularly if they haven't had a lot of sleep. And we do tend to use various medications to Maintain alertness, but there are times when they would need to have a power nap and You know, it's very challenging if if you have narcolepsy because trying to have a nap during the day when you're at work, you know, your employer may not understand why why you need that.

Oh God, I wish can you put out a plea for all employers to say a napping couch, you can get so much more out of your employees if you let them nap during the day and then wake up they can then power on work much more effectively. I'm I'm I'm asking you to be a spokesperson for this personal cause of mine here.

Yeah. Right. Well I mean I think some some organisations um they understand that. So, you know, they do have napping areas for staff. And and you know, I think It's the kind of thing if you're at your desk and you're feeling really sleepy, maybe you know, maybe you didn't have a good night's sleep or you're or you're just need a nap. A twenty minute nap is very restorative and you can set your alarm and wake up and then you're exactly right. You can power on during the day.

You mentioned there that narcolepsy seems to be caused by a deficiency in this brain chemical erection. Are there some theories about what might have caused this deficiency, this neurochemical deficiency? So we don't really know, but there are some hints that it could be an environmental cause. And when I say an environmental cause, I mean it could be a virus.

uh or or something from an external environment that has affected that person's neurons in the hypothalamus and and told them to stop making arexin. And there are some hints that that this p is probably the case. So I don't know if you remember

Uh, there was a SARS epidemic that affected not so much Australia but other parts of the world. Oh yeah. Including China, Canada, a lot of other parts of the world were affected and They came up with a vaccine for SARS and they administered particularly in in China and there was a wave of narcolepsy that happened after they vaccinated um these people against SARS.

And so that has that led to a lot of work, particularly in China, which really mapped out very clearly that it was related to the vaccination. And so it does lend itself to supporting that hypothesis that that some sort of an environmental trigger, perhaps a virus or an immune type response was was uh responsible for the uh those neurons in the brain not producing arexin any

And I'm just remembering that s famous sleeping sickness that swept through the world in what was it, the early twentieth century or thereabouts? That thing where the a virus is related there to excessive sleepiness. Yes. I've seen this strange form of narcolepsy uh during a comedy show where a young woman would get quite excited, burst out into laughter, and then just be knocked out as soon as she burst. into laughter. What do we know about this particular form of narcolepsy called catapult?

So it's kind of that that state change that we were talking about with sleep. So sleep is is completely different to wakefulness. And we talked about how your muscles are paralyzed. So what's happening is she's experiencing emotion which is like the trigger in the brain to make her fall asleep and then the muscles become paralyzed. So it

wakefulness one second and then it's sleep. The body is asleep the next second and that's when she's her muscles are paralysed because the body is saying you're asleep. But yes, it's it's a sudden state change from wake to sleep. And of course the laughter is the trigger that's causing it. And I mean obviously in the hypothalamus where the erection making neurons are

that's also where much of our emotional processing occurs. So so it it makes sense that that part of the brain is is really the powerhouse of the brain and We feel floppy. We get all floppy when we're laughing really hard. Yeah, yeah, yeah. And I think we've all experienced that. Um, but these people with with narcolepsy, I mean obviously if if you get cataplexy as part of your narcolepsy, and not everybody does, that's also a a a fairly rare phenomenon.

But if you do have cataplexy then you do have to be really careful. Um and you know, you've got to let people know that that you could fall down and obviously we don't want people to injure themselves. So there are medications that can help to moderate the the cataplexy and and stop that from happening.'Cause obviously if you were driving for example and you laughed while you were driving, you know, that could be really dangerous. So

So, you know, there's a lot of different things that we can do to c help to control the cataplexy. Um, and one of them is really just making sure that the people around you are aware and will, you know, look out for you in case um you do have one of these episodes.

Oh, the type of I just imagine this condition must really torment people who have it, cataplexy particularly, to be constantly aware that any sudden outbreak of emotion might bring you crashing to the ground and might or make you a kind of a a public spectacle and also put you at risk of physical injury.

There are good treatments that we have now to to help to moderate that um the impact of a of a cataplexy and and you know that's what we would we would definitely if someone's having these episodes every every few days or ev every week, we would definitely ask them to take medication to to help them control it.

When people are having problems getting to sleep. And I do. I try to practise a kind of I mean I suppose it might be called mindfulness, but I try to exert as best I can some kind of mental discipline and not to w try not to let the mind worry into uh m move into worrying things or dwelling on things. to try and get into a familiar story that I might already know. Is this part of your work, this kind of this kind of for want of a better word, mindfulness approach to getting better sleep?

It definitely is and it it's sort of it's different for everybody because we have so many things in our lives that can impact our sleep. But we all have difficulty sleeping. Um, and I have the same issues from time to time. And I think one of the most important things is most of us can function quite well, pretty well. even if we haven't had a really good night's sleep, if say you've only had a few hours' sleep compared to your normal seven hours.

So you can still go to work, you can still do most of the things. Um and then the next night uh you just go to bed at your usual time and you'll probably go off to sleep faster. So so trying to reduce that anxiety of, you know, it's three AM you gotta be up at six to be at work and you're having some trouble going back to sleep. So

reducing that anxiety about the fact that you're not asleep is actually a part of of helping you to actually get off to sleep. Because if you start to get all worked up that, oh I really I really need to be asleep

that just makes it much harder to go back to sleep. But but realising that you've had a few hours, you'll still be able to get through your day uh with only a few hours of sleep and then the next night you'll you'll get a good night is kind of reassuring and helps to take away that anxiety and hyper arousal which then makes it really hard to go back to sleep.

Um so I think that's that's a really important thing. And as you say the mindfulness, so you know, the counting sheep thing, try to do something that is pretty boring. You don't wanna be doing anything particularly active'cause then that'll just make you stay awake more. Going into the other room, sitting, listening to something,

uh just trying to meditate, all of those things will help to calm you down and then when you feel sleepy, go back uh to the bedroom. I've got friends and they are male friends who've seem to suffer from this seem to suffer from this more than women. It's after s many years of poor sleep and grumpiness that they've only been able to realise that they've been suffering all the all along from a form of sleep apnea. Are people very often unaware that they have sleep apnea?

I think I think a lot of people are unaware. I mean sometimes they come to us um in the medical profession because of the snoring which is disrupting, you know, their their bed partner. But a lot of times people just assume that snoring and not sleeping well is is just a part of getting older, but it definitely isn't.

And a lot of people have sleep apnea who who are not aware of it. Um, we know that when we've done population based studies that about, you know, twenty five percent of the of the adult population have got sleep apnea. And many of them are completely undiagnosed. I was discovered to have had sleep apnea at one point.

And it was suggested to me it was probably some kind of mild allergy related, which was true. I treated the allergy and it's been fine since then. It's it's amazing. I I was amazed that such a complex problem, in my case, in any case, could be fixed so quickly and easily. Well I think I think it's because uh physiologically you breathe through your nose and your mouth.

if your nose is blocked for whatever reason, and maybe in your case it was allergies, then your mouth opens and then you're kind of relying on the the back of your throat to remain open and of course your tongue can move backwards and just obstruct the airway quite easily. So if you if you open the nasal passages and allow people to breathe well through their nose, then by treating the allergy in your case

then that restores the patency of the of the airway and the sleep apnea is treated. And that's a really interesting area'cause there's different um you know, different people who have different factors which contribute to them having sleep apnea.

I've also read about a hard but effective form of therapy for people who are not going to be able to do that. insomniacs, which is sleep restriction, where you actually restrict the amount of sleep you get in order to reboot your system. What do you think of that? Tell me how that works and what you think of it. So sleep restriction therapy is a part of cognitive behaviour therapy for insomnia, which is a you know, a well proven treatment for insomnia. And insomnia is

when people have difficulty falling asleep and staying asleep and they've had that for more than three months. So what sleep restriction does, and it kind of comes back to what we were talking about earlier, in that That biological pressure for sleep. is often lost in people with insomnia who are in bed but they're spending as much time awake as they are asleep. So what happens is the bed becomes a place for being awake and also sleeping.

So what you do with sleep restriction therapy, um, which as I said is a part of cognitive behaviour therapy for insomnia, is that you instead of letting people be in bed for maybe ten or eleven hours. And a lot of people with insomnia, because they're only sleeping a few hours, they think that if I get into bed and I spend longer time in bed

then I'll actually get more sleep. But in fact it's kind of a it's it's kind of the the other edge, uh the other part of it is that by being in bed more, you're allowing yourself to stay awake more. So th we what we do is we stop them from being in bed for so long. So we say, well you depending on what time they're normally going to bed and getting out of bed, we restrict them to only maybe four or five hours of sleep.

And we say you're not allowed to go to bed until one AM, for example, and then you have to get out of bed at six AM. Wow, really? Gee, I bet people aren't happy about that. But um I suppose they're so desperate they'll try anything at that stage. And it and it does work. So you do that, you know, with with your psychologist telling you exactly what times. And that's the only time you have for sleep. And so what happens is after the first night where maybe you didn't sleep much at all.

The next night you are really, really sleepy and tired and it's really hard to stay awake until midnight or one AM. But when you actually get into bed, you fall asleep a lot faster. And it's'cause it's that biological need for sleep kicks in. And then you start sleeping so m a lot more. So you will sleep for that four or five hours. Whereas before you might have been in bed for ten but only sleeping for five hours.

So in that way it's resetting your body's ability to fall asleep and stay asleep and starts that association that bed is a place for sleep, not being awake. Mr. Tapper, it's been brilliant speaking with you and thank you so much. Thank you. doctor Sutaba Mukiji is professor in respiratory and sleep medicine at the College of Medicine and Public Health at Flinders University in South Africa.

I spoke with her in twenty twenty four. Today's episode of Conversations was made on the lands of the Gadigal people. The producer was Mickey Morris. Executive producer was Carmel Rune. I'm Richard Feidler. ABC Listen. Podcasts, radio, news, music, and more.