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The Big Sleep - what it is and how to get more

13 July 2016

As a society we are obsessed with sleep. Are we getting enough? What’s the next big breakthrough to help us get more? Our sleep medicine expert explains in the first episode of the Open for Discussion podcast.

In the first podcast of the University of Sydney’s new Open for Discussion podcast series, our host Dr Chris Neff speaks with Dr Ron Grunstein, a professor of sleep medicine at the University’s Woolcock Institute.

Chris and Ron discuss the latest research on the science of sleep, detangling fact from fiction and exposing the big business of big sleep. 

Host: Dr Chris Neff
Guest: Professor Ron Grunstein
Producers: Daniel Gaffney, Michelle Blowes
Editor: Caitlin Gibson

Professor Ron Grunstein
Ron Grunstein is a Professor of Sleep Medicine and head of the NHMRC Centre for Integrated Research and Understanding of Sleep and the NHMRC Australasian Sleep Trials Network.

Transcript

[Music plays]

Chris Neff: Welcome to Open for Discussion, The University of Sydney podcast series. I am your host, Chris Neff. I am a lecturer in public policy and my research looks into emotional issues that impact the public, such as LGBTQI politics, mass shootings and the politics of shark attacks. More about that later.

In today’s podcast, I speak to Dr Ron Grunstein, a professor of sleep medicine at The University of Sydney’s Woolcock Institute. Ron’s interest in sleep began when he did his postgraduate training at Stanford University Sleep Laboratory. His first patient was an anaesthetist with narcolepsy, a condition that caused him to fall asleep and collapse suddenly while in surgery. Ron was immediately fascinated and this kick started his 40-year career in the field.

Ron, welcome to Open for Discussion.

Ron Grunstein: Hi, how are you?

Chris Neff: Good. So, can I tell you how I sleep?

Ron Grunstein: Then can I tell you how I sleep?

Chris Neff: Yes please! So, I go to sleep at 12 o’clock. I take 2 Tylenol and 2 sleeping pills, then I eat a pizza, then I drink a diet coke and then I wait to pass out. How’s that?

Ron Grunstein: It sounds pretty horrific [laughs]. And aaah…well, I mean Tylenol…I mean if you’ve got pain and there’s variable evidence for the effectiveness of those drugs in pain, but if you’ve got pain then that may help you sleep. It is no good to go to bed hungry, but having a big pizza before you go to sleep is probably not a good idea, so there’s a few things you are doing wrong.

Chris Neff: The diet coke, probably not helping.

Ron Grunstein: Yeah, but if you are caffeine insensitive, which some people are.

Chris Neff: Oh, interesting.

Ron Grunstein: Those people could have, sort of, seven short blacks before they go to bed.  There’s a lot…I guess what it highlights, is there’s a lot of variation in how drugs affect sleep or how things affect people’s sleep; environment, light, all those things. And we have to recognise that we can’t make hard and fast rules about everyone.

Chris Neff: You mentioned sensitivity to light. In the world of smartphones… since I wrote all of these questions down on my smartphone while I was lying in bed, getting ready to sleep… what should we do about smartphones? Are smartphones as bad as everyone says and reading Internet before you go to bed, is that hurting our sleep pattern or hurting our ability to go to sleep?

Ron Grunstein: Look, I think the affect of light on sleep varies according to the time of day you get the exposure. So, for example if you get morning light, that is actually good for your sleep and bringing your sleep to a normal time. If you get exposed to light in the evening it generally delays your sleep. And so, particularly light in the blue spectrum (shorter frequency light) is more alerting than other light spectrums, than white light for example. But, the other point I made about the individual variability, is that there are some people who are exquisitely sensitive to blue light and those people will sleep very badly because of exposure. But, again, I stress in some people.

Chris Neff: OK, so what you are saying is that it can affect not just how quickly you fall asleep, but how well you sleep, once you are asleep?

Ron Grunstein: Yeah, there are studies that show that the depth of sleep or the amount of rapid eye movement or ‘dreaming sleep’ can be impaired by the use of blue light. But you can modify that…Apple have got a product that, now it’s totally untested as far as I’m aware, they try and change the light spectrum in the evening, or blue light in the morning and less in the evening, that sort of stuff.

Chris Neff: Interesting.

Ron Grunstein: I’m not selling the product because as I said it hasn’t been tested. And other people have glasses that can cut the blue light out and so forth. So, look it’s a big problem, and a big problem in teenagers, who may well be more sensitive than older people. You know, people who use devices in the bedroom. The more devices they have, the worse they report their sleep.

Chris Neff: OK, do we really catch up on sleep? When I pull an all-nighter; marking or doing an exam or reading a book, and then I sleep in for 14 hours the next day, am I really catching up on sleep?

Ron Grunstein: Actually, the research is only starting to emerge now because, what you are talking about (recovery sleep) has never been well studied and it’s taken… I think it’s of interest to the military and of interest to space flight, things like that.

Chris Neff: That’s what I’m talking about.

Ron Grunstein: So there’s a lot of money now that has gone into that. And I guess the people doing work in the area all basically say don’t overestimate the power of recovery, it sometimes takes a lot longer and more hours than you think. So, if you have a few nights of bad sleep, one night is not going to be enough. Again, there is a lot of variation; some people can recover very quickly, other people are real… really problematic, they never really recover.

Chris Neff: Is that also true with jetlag? Like there are these people, who land and they’re fine and everything’s perfect, and then there’s me… and I’m like two weeks, it takes me… like if I’m in the US for two weeks or three weeks, it takes me two weeks when I get back to Australia. Like, is that…

Ron Grunstein: Yeah, I think that it’s the same phenomenon as why some people can handle rotating shift work better than other people. It’s probably to do with how quickly your melatonin rhythm adjusts and shifts, and the ones who are slow will have more jetlag symptoms.

Chris Neff: I am a slow melatonin adjuster

Ron Grunstein: Yeah.

Chris Neff: OK.

Ron Grunstein: I guess you are.

Chris Neff: Is drinking water… like the things that people say, are they real? Like; drink water, try melatonin. Do those…

Ron Grunstein: Look, I think there are a lot of things written about jetlag but, not a lot of large scale research. So, the melatonin story; there are different theories and not a lot of proof.

Chris Neff: So, is melatonin a real thing? Like the taking of melatonin… or has that become sort of one of those old wives tales that might work for 5 percent of the population, but doesn’t work for most people. What do you think the scoop is on…?

Ron Grunstein: So, melatonin is a hormone that is produced by the brain; the pineal gland at the base of the brain. And, it is a hormone of darkness. So, when the environment gets dark, melatonin levels rise and when it gets light, melatonin levels fall. So, there is this circadian rhythm of melatonin. And melatonin is part of the signalling system for sleep. So, clinically, the usefulness of melatonin hasn’t been convincingly proven for anything.

Chris Neff: For anything?

Ron Grunstein: Look, let me put it in to perspective. Melatonin is a drug, which is not owned by any company.

Chris Neff: Yep

Ron Grunstein: So, therefore doing a 10 000 person study using melatonin or a placebo, unless the government funds that, it’s not going to have legs. So what you have is a lot of little studies, and hopefully those sorts of studies will help give us some sort of evidence. Largely for jetlag, for sleep problems in children and all these sort of things that have been touted for melatonin, even its role as an antioxidant to prevent cardiovascular disease. There’s no big, large-scale study because no one is funding them.

Chris Neff: OK, so a lot of what we know about melatonin is not evidence based?

Ron Grunstein: No, but a lot of people buy it. I think there are figures to show more people buy melatonin in the US than Vitamin C tablets, not that there’s much evidence for Vitamin C either.

Chris Neff: No.

Ron Grunstein: People think melatonin might be a sleeping tablet and there is some evidence that delayed release melatonin in elderly people can help their sleep, but not in younger people. But if you take melatonin during the day, when your melatonin levels are near zero, it actually can induce sleep. So, [laughs] you’ve got to be careful about it.

Chris Neff: OK, just to re-cap then Ron; what we’re saying is, even though there’s an entire industry that’s based on telling us that taking melatonin pills will make you sleep better, we don’t know that for sure yet.

Ron Grunstein: We don’t know that. But, I mean, I should qualify that there are certain sub-groups like for example totally blind people, there is some evidence that melatonin in a regular time basis or melatonin-like substance can help their sleep. I just want to reflect that the research is not of large size.

Chris Neff: You know, in the sales pitch that is being given to the widespread public, they’re not being told, you know, the best evidence we have for this is with people who can’t see. You know, that’s not the message that the public is being told.

Ron Grunstein: Well if you take melatonin at the wrong time you can make your jetlag worse, so, it’s a challenge.

[Music plays]

Chris Neff: You are listening to Open for Discussion, a University of Sydney podcast series. I am your host, Chris Neff.

In each episode I speak to an academic, in my office, to hear how their work is being used, and sometimes abused, in the wider world.

So, Ron, you know if you listen to the media, they’ll tell us that our sleep is awful. That we work longer hours, that we sleep less time; that we are doing it all wrong! What are your thoughts?

Ron Grunstein: Yeah, that there should be a sleep revolution and we are in sleep crisis! Look, the facts are that there are colleagues of mine, at the University of Sydney, who’ve shown that sleep duration (the length of time people sleep) hasn’t really changed in the past 20 years. They use these time-use surveys; where people say how much they work, how much they go to parties, all that sort of stuff. And so, people allocate how much time they go to sleep. And they say that hasn’t changed.

But, what is clear from a number of different studies, including our own, is that people are more dissatisfied with their sleep. So, is that because of light, you know too much light or stress? We don’t know. But, I’m concerned that there are vulnerable people who are kind of on the edge about their sleep. And they read all this stuff about, ‘gee you don’t get enough sleep, you’re going to die tomorrow’. And that increases their anxiety, increases their dissatisfaction with sleep and their perception of their sleep quality. So, I don’t think it’s necessarily very helpful to read all that stuff; it’s a difficult situation.

Chris Neff: Well especially because sleep is something that everybody does, it’s a guaranteed market.

Ron Grunstein: There is a big business… as you said; big sleep, big business. I mean, there is that sort of factor; treatment for sleep apnoea devices or snoring devices, all that sort of stuff. So, there’s a lot of that pressure. But, what the problem is  for a lot of people is their perception and maybe even their depth of sleep is affected.

So, there are a lot of theories about insomnia now that in fact the brain of an insomnia patient is not as fully asleep as someone who is a normal sleeper. And that’s a big area of research.

Chris Neff: That’s fascinating. So it could be that there’s a marketing industry that’s determined to try to tell us that we’re not sleeping as well, to sell us products. But, in the… so we’re manufacturing our own problem. And they’re happy to provide the solution for a certain cost.

Ron Grunstein: Just to take the problem of the brain not being asleep fully. I know you’re interested in sharks.

Chris Neff: Yes.

Ron Grunstein: So this is very important to recognise…

Chris Neff: I was going to get to a shark question.

Ron Grunstein: Yeah. Whales and dolphins, I know they’re not sharks, but they sleep one half of their brain at one… you know, at a time. So, that’s how they monitor their situation; you know, if there’s a trawler coming to catch them and all that sort of stuff. So, it’s a bit like the insomnia patient; you know, I mean, there is some evidence if you throw a human in to a novel environment they start to develop a bit of this ‘one hemisphere at a time’… not the same as a whale or a shark. Yeah so it’s sort of interesting how biology is giving us some clues about treating insomnia.

Chris Neff: That’s fascinating. Well what do you think is the future for sleep research? I mean, given… like we’ve just discussed; there is a market that is trying to, sort of, tell a couple of different false stories about the effectiveness potentially of melatonin and about the difficulties that people have sleeping. Where is the research going?

Ron Grunstein: I think the research is going in a lot of different directions. I mean, I think there are some big questions to understand. I mean, for example ‘what is the effect of sleep disorders or sleep problems on the development of brain degeneration?’ That’s a big question that we’re trying to work with, because obviously if you can improve people’s sleep, you may impact on their brain. I think in sleep apnoea, the recognition is that the disease is not one disease, but it’s got different causes. And, I guess, you asked the question about recovery sleep; so, just understanding the fundamental biology of sleep, is, you know… if you don’t get a good night’s sleep or you don’t get a whole night’s sleep; how long does it take to recover? How safe are people if they don’t recover? And all that sort of thing. There’s probably a ton more questions, but they’re sort of the main ones we are trying to address.

Chris Neff: That’s great.

[Music plays]

Thanks for listening to Open for Discussion, a University of Sydney podcast.

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