Insight, Sleep

Transcript

JENNY BROCKIE:   Welcome everybody.  Good to have you with us tonight. Alex, I want to start with you, you took yourself off to hospital emergency last year with some alarming symptoms. Tell us what those symptoms were? 

ALEX FORBES:   I was talking as if I was drunk. I had alarming gaps in my memory and I thought I was having a stroke. 

JENNY BROCKIE:   What happened when you got to hospital? You were asked some questions? 

ALEX FORBES:   I got asked for my date of birth and the day and month trotted out and the year was missing.

JENNY BROCKIE:  You thought it was a stroke? 

ALEX FORBES:   I thought I might be having a stroke, even though I didn't have any sort of paralysis symptoms or a drooping face or anything. The words aspect of it worried me. 

JENNY BROCKIE:   Were you at work when this happened or at home? 

ALEX FORBES:   I was live captioning sport, so we were doing the US Open which means starting at midnight and going through to 8 am.

JENNY BROCKIE:  And how much sleep you were getting while you were doing those shifts? 

ALEX FORBES:   Um, I was getting about three hours during the day. 

JENNY BROCKIE:   And that's all? 

ALEX FORBES: Not for lack of trying.

JENNY BROCKIE:   So how long had that been going on? 

ALEX FORBES:   It was the seventh night when I kind of hit the wall. 

JENNY BROCKIE:   And do you have any idea how much sleep you would have had over those seven days, altogether? 

ALEX FORBES:   Probably twenty odd hours over that seven days. 

JENNY BROCKIE:   Over seven days? 

ALEX FORBES:   Mm-mmm. 

JENNY BROCKIE:   You'd been sent home from work? 

ALEX FORBES:   Well when I arrived to start my shift it quickly became apparent that something was badly wrong. I was slurring my words as if I was drunk and my typing was, you know, I was sending out typos, I just couldn't coordinate myself. 

JENNY BROCKIE:   So once you got into the hospital what happened, what did they discover it was? 

ALEX FORBES:   Initially they gave me various scans and EEG and various things.  In the end they decided it was a global transient amnesia brought on by sleep deprivation. 

JENNY BROCKIE:   And that disappeared once you had a good sleep? 

ALEX FORBES:   I went straight home and slept for about nine hours. When I woke up in the morning nothing had changed and that was the scary part. That's when I went to hospital. Once I was in hospital and got another couple of days of sleeping at night and being awake in the day, I returned to normal and by the time I left hospital after four days pretty much completely back to normal. 

JENNY BROCKIE:   Nothing since? 

ALEX FORBES:   Nothing since. 

JENNY BROCKIE:   Four days in hospital from lack of sleep? 

ALEX FORBES:   Yeah. Well, and from being a dill. 

JENNY BROCKIE:   Shantha, you study sleep, what was going on with Alex and why did his symptoms mimic a stroke? 

PROFESSOR SHANTHA RAJARATNAM, INSTITUTE OF COGNITIVE AND CLINICAL NEUROSCIENCES: So I mean firstly Alex is working shift work and we know in shift workers the body clock that regulates our sleep, you know, is sending a strong signal to be asleep during the night and to be awake during the day and Alex is, as many shift workers do, trying to override that and dampen that signal.

Now over time, Alex is building up what we refer to as a chronic sleep deficit. Our brain's ability to, you know, to make decisions, to process information and so on becomes severely degraded and it's interesting that Alex  describes the parallel with being drunk because there's good evidence that being without sleep for twenty four hours can parallel being, you know, the effects on the brain can be similar to being drunk. 

JENNY BROCKIE:   Fiona, you study sleep and the brain, what does sleep do for, us apart from refreshing us, what does it actually do for our brain? Why is it important? 

FIONA KERR, UNIVERSITY OF ADELAIDE:  Okay. We have about five normal cycles and an average cycle of sleep is about 90 minutes and if you think about it over the evening, over the night, think about it like your brain's working and then playing. Working, filing and playing.  So the first few cycles is mostly maintenance, you clean, the glial cells clean plaque, then probably the last cycle, cycle and a half, you get into filing. And then what the brain does is say okay, what's all the information you've had during the day?  We're going to file that now, we're going to gather it, this goes there, this goes there, but the last bit in REM is where you get very creative thoughts because you've started to recombine, your brain loosens off, you even have epigenetic changes.

JENNY BROCKIE:   So the genes actually change? 

FIONA KERR: The genes actually change in later sleep.   So if you're not getting your last kind of cycle, if you're not getting that sort of seven hours, beware.  And the other things that start to happen is because you have epigenetic changes and different kinds of chemicals, you can also create brand new maps, so neurogenesis, brand new parts to your brain.

JENNY BROCKIE:   And you're losing creativity by the sound of it? 

FIONA KERR:  You're certainly losing that and you also losing your long term memory and if you don't sleep enough, you don't embed what you've learnt, actually lose that information. 

JENNY BROCKIE:  Shantha, when you say that Alex was acting like he was drunk, how drunk? Like when you lose sleep, what is it the equivalent of in terms of drinking? 

PROFESSOR SHANTHA RAJARATNAM: So we know somewhere between in an average person about 17 to 19 hours without sleep equates to, you know, performance impairment of about .05 blood alcohol concentration, so the legal limit. Twenty four hours gets closer to .08 or .10, so it can being pretty significant cognitive or neuro behavioural impairment. 

JENNY BROCKIE:   Michelle Johnson in Perth, you're an emergency doctor, we've left you there so you can get some sleep on your day off. How much sleep do you get when you're doing a long shift in emergency? 

DR MICHELLE JOHNSTON:  Not as much as I would like sadly. A long shift for me often would be starting at 9 in the morning and doing some non-clinical tasks, some teaching, and then doing a ten hour clinical shift, finishing around midnight or so, which would mean then finishing up, finishing my work, driving home, trying not to fall asleep driving home. Then getting home and then being wired, wide awake thinking about all the resuscitations, all the decisions that one's made on one's shift, getting to sleep at around sort of 1.30, 2 and then up 5.30 for the children because then the rest of the day, the rest of the world starts.  Their day at, you know, a normal circadian rhythm. So not a lot. 

JENNY BROCKIE:   So what sort of effect does that have on you as a physician? 

DR MICHELLE JOHNSTON:  It's interesting listening to what people have been saying about how sleep deprivation affects you as a person and I guess I'm as much interested in how it affects the patients and my ability to care for patients if I'm sleep deprived or my staff are sleep deprived because I think it certainly does have an effect on your decision making. I work in an environment that's very decision dense so there's a lot happening, a lot of decisions are made very quickly, complex decision making, and there is no question, as we've just heard, that sleep deprivation can degrade that ability to make those complex decisions. 

JENNY BROCKIE:  Has that happened to you? 

DR MICHELLE JOHNSTON: Sadly, yes, it has happened to me. I certainly had a circumstance a good couple of years ago at the end of a very long shift when I was certainly very tired and an elderly patient came in close to midnight, a man who'd fallen over and struck his head and there was a little alarm bell going off in me thinking I really should be scanning this man's head but I honestly believe that fatigue was smothering that little alarm bell and I could hardly hear it and I didn't scan his head.  He ended up having a small brain haemorrhage, luckily it was picked up, we have enough checks and balances in the system where I work, that that was picked up and he came to no harm. But I was quite, I was really quite frightened at the time that my own fatigue was like an adversary to me and my ability to care for patients. 

JENNY BROCKIE:   But you hear emergency doctors and emergency staff speaking of being tired all the time. I mean these are life and death decisions and you're doing them when you’re sleep deprived? 

DR MICHELLE JOHNSTON:  That's very true. I think emergency departments, critical care areas, are twenty four hours, 24/7 thronging metropolises and that's what society expects of them and technology does a great job of keeping up with it and providing that sort of thing but we humans continue to be fallible.  Our circadian rhythms, they haven't kept up with that sort of requirement and that, and we don't give enough credence I think to the real fallibility and the humanness and what we expect to be provided by our critical care staff. 

JENNY BROCKIE:   What would be the longest time you've spent awake working in emergency? 

DR MICHELLE JOHNSTON: Actually working, really only, only, sixteen hours. I know, I do know people who have had to work longer, particularly surgeons.

JENNY BROCKIE:   So do you think you should be working shorter shifts? 

DR MICHELLE JOHNSTON:  I think there are a lot of different solutions that can be considered. Shorter shifts I think is obviously one of the better ones. However, that has trade-offs as well in that, you know, in society economic society it means you're going to be working more days and have less days off so there's always trade-offs. 

JENNY BROCKIE:   Shantha, what do you think about the idea of life and death decisions being in the hands of people who are often sleep deprived and it's not just doctors either, paramedics, police officers? 

PROFESSOR SHANTHA RAJARATNAM: Complex decision making we just heard about is significantly impacted. Thankfully in a society that we've, in the way that we've evolved, there are lots of human factors type solutions and safety solutions to try and catch errors. 

JENNY BROCKIE:   Senate sat for forty hours straight recently to pass some legislation.  What do you think about politicians making decisions on behalf of all the rest of us in those circumstances? 

PROFESSOR SHANTHA RAJARATNAM: Well I guess if we think about the parallel with alcohol intoxication, I mean it seems crazy for us to think that the most significant decisions of the country could be made in that kind of, with that level of impairment potentially. I also think it sends the wrong message to the public because sleep is important for health and here we have, and you know, a blatant disregard for an important aspect of our health. 

JENNY BROCKIE:   So we are leaving decisions about the nation to the equivalent of a bunch of drunks, is that what you're saying? 

PROFESSOR SHANTHA RAJARATNAM: Thankfully we see one isolated instance and I think lots of people have commented on it. 

JENNY BROCKIE:   Mark, a few years ago you tried a different kind of napping, a sleep experiment on yourself.  What did you do? 

MARK SERRELS:  Oh, man, well for every four hours of a day, twenty minutes of that day would be spent sleeping and then I'd have to have another cycle of four hours, I would sleep for twenty minutes within that cycle and I'd just do that forever. 

JENNY BROCKIE:   Why did you do this? 

MARK SERRELS:  Um, I've done a lot of things like this, not sleep related, other things like I've gone on fasts and stuff like that. I'm a journalist so I like to do these insane things and write about them. So that's…

JENNY BROCKIE:  And this is called polyphasic sleep? 

MARK SERRELS:  It's called polyphasic sleep.

JENNY BROCKIE:   So every four hours you'd sleep for twenty minutes? 

MARK SERRELS: Correct. 

JENNY BROCKIE:   And how long did you do that for?

MARK SERRELS:  Well I wanted to do it for a month, that didn't really work out. After about seven days it all just collapsed. 

JENNY BROCKIE:   What happened? 

MARK SERRELS:  Okay, so a couple of times I'd slept, you know, I'd slept through alarms.  I picked up my phone, there's three missed calls on my phone so I'm like okay, that's weird.  So my wife was sleeping next door, I separated myself from my wife so she didn't have to deal with this.  I go through, I say Heizy, that's my wife's name, Heizy, why did you call me?  You called me three times? I was like, she was like oh, just waking up, oh, I heard you leave the house, I heard you leave the house so I wanted to call you to see where you were and what you were doing. 

JENNY BROCKIE:   What time was this, what time of day? 

MARK SERRELS:  Oh 4 in the morning roughly, 3 or 4 in the morning. 

JENNY BROCKIE:   Okay, did you realise you were out of the house? 

MARK SERRELS:  I did not realise I'd gone out of the house.  At that moment I realised oh, my God, I must have left the house without me knowing it. 

JENNY BROCKIE:   Okay, so how far were you into sleep experiment when these things were happening? 

MARK SERRELS:  I think this was day six, day five or day six. 

JENNY BROCKIE:   Okay. How was your mental state during this time, what kind of person were you? 

MARK SERRELS:  Oh, a mess, a complete and utter mess, I was an absolute mess. 

JENNY BROCKIE:  You lasted six days?

MARK SERRELS:  Correct, yeah.  And at that point that's when I gave up. that’s when I said okay, time to give up. I went to bed and I swear to God it was the most amazing feeling of my life when I decided to go to sleep, it was just incredible. The relief was just so intense and I slept for fourteen hours. 

JENNY BROCKIE:   Why? I don't get it. I don't get it. Scott, you did it for six months, why? 

SCOTT KEVILL:  Well, I didn't have anything crazy like Mark, that just amazed me.  I'd read about it and it sounded really interesting and I thought this sounds kind of like the crazy thing I would like to try.

JENNY BROCKIE:   Did you have any health concerns about what you were doing to your body while you were doing this? 

SCOTT KEVILL:  I did a little bit. So I tried to keep an eye on things. Because I was working from home on my own business I set things up that I didn't need to drive anywhere. I had meals prepared in advance, I made sure that I didn't have to operate any dangerous equipment and that kind of thing. 

JENNY BROCKIE:   Did you get enhancement from it? 

SCOTT KEVILL:  Absolutely, yeah.  After it got better and after sort of basically after the first week, it was going to really well and I was feeling more alert, more rested than I had even normally and I felt, I felt filled with energy and it was just amazing. 

JENNY BROCKIE:   So how long did you do it for, six months? 

SCOTT KEVILL:  About six months, yeah. 

JENNY BROCKIE:   And why did you stop? 

SCOTT KEVILL:  Well, it's kind of antisocial. 

JENNY BROCKIE:   Kind of?   Fiona, what do you think of this? 

SCOTT KEVILL:  Probably horrified. 

FIONA KERR:  There's a number of really interesting studies around, I guess, short mid-term issues. Most people don't have as good judgment around especially complex processes. So if we think about the fact that a normal long term cycle at night, those first few hours are hugely around cleaning, you know, you've got things like glial cells that's take plaque off your neurons. You've got all sorts of things that have really important impacts for later, Alzheimer’s.  But they go straight into REM they either miss filing or they miss cleaning or they miss - there's all these other things that don't happen. So…

JENNY BROCKIE:   Emily, you're a single mum, you have three kids, two teenagers and a seven year old, you study and you work.  How much sleep do you get? 

EMILY PALK:  Average, five to seven hours. 

JENNY BROCKIE:   Is that every night? 

EMILY PALK:  Most nights, yes. 

JENNY BROCKIE:   How much sleep do you think you need? 

EMILY PALK:  Probably at least seven, I'm always sleep deprived. 

JENNY BROCKIE:   And why are you, why do you sleep so little? 

EMILY PALK:  A combination of work and study and children, being on my own.

JENNY BROCKIE:   Siobhan, you're a sleep researcher. How much sleep does the average person need?  Is there such a thing as an average person when it comes to sleep? 

SIOBHAN BANKS, UNIVERSITY OF SOUTH AUSTRALIA:  Well yes, that's the thing. So we would suggest somewhere around the sort of seven hours, seven to eight hours is probably what most people would need. But we, really, a lot of people are getting a lot less than that and there's the description of five to seven is probably more common for the general population. 

JENNY BROCKIE:   How many people here would get eight or more hours of sleep a night?  Quite a few but not half of you, probably a bit over a third. Okay, who gets six or less hours? Yeah, roughly the same number, I guess. Emily Wang, why do you get, you get six, did you say? 

EMILY WANG:  Yes, and sometimes less, so I normally sleep like 2 or 3 am in the morning and then get up like 7 am or 8 am in the morning so it's a short time, so six hours is a good one for me. 

JENNY BROCKIE:  Why don't you go bed till 2 in the morning? 

EMILY WANG:  I just can't go to sleep like normal people very quickly. So maybe sometimes I'm playing my phone, I'm addicted to that, yeah. 

JENNY BROCKIE:   Okay, you take the phone to bed?

EMILY WANG:  Yeah, and…

JENNY BROCKIE:   And how long would you spend playing with the phone? 

EMILY WANG:  It's maybe three, three hours. 

JENNY BROCKIE:   Three hours on the phone at night? 

EMILY WANG:  Yeah, yeah.

JENNY BROCKIE:   And you wonder why you can't sleep? 

EMILY WANG:  I try to quit but it's hard. 

JENNY BROCKIE:   Anyone else in this situation? Benjamin, how much time are you spending on the phone? 

BENJAMIN:   Similarly, about two, three hours a night. 

JENNY BROCKIE:   A night? 

BENJAMIN:   Yeah. 

JENNY BROCKIE:   When you're in bed? 

BENJAMIN:   Yeah. The 24 hour new cycle, it's addictive, you know, you want to keep up with things, social media, games.  You can now stream television through your phone so there's all these things that are really attractive about it and allow you to zone out, but not sleep. 

JENNY BROCKIE:  So how much sleep are you getting? 

BENJAMIN:   Between four and seven hours, yeah. 

JENNY BROCKIE:   Do you feel tired most of the time? 

BENJAMIN:   Absolutely, but then, and I wonder if there's a correlation here, there's so much coffee available. 

JENNY BROCKIE:   You're a disaster area, aren't you, really? 

BENJAMIN:   Absolutely. 

JENNY BROCKIE:  So you drink a lot of coffee as well? 

BENJAMIN:   Oh absolutely, it counteracts that. 

JENNY BROCKIE:   And you haven't thought about stopping any of this to try and get more sleep? 

BENJAMIN:   Well you know, you've got two addictions playing off against each other.  You've got the addiction of electronics and that aspect of things, and then you've got the caffeine addiction which fires you up as well. So both of these, it becomes a cyclical pattern where your working week is a bit of a running disaster because you're constantly in this cycle. So interrupting is hard. 

JENNY BROCKIE:   I'm interested that you recognise all of this, you know what's going on but it doesn't change your behaviour. 

FIONA KERR: Whenever you watch, whenever you look at your screen or you hear a ding from the, you know, the pager, then you get a spike of dopamine.  So it's an absolute addiction and the other thing is it's blue screens so it changes how the melatonin works in your brain. If you have a blue screen in front of your face, so not the television, that's actually not so bad, but you've had your IPad, the typical thing is you sit down in the evening, you think this is my time and you get the IPad out or your phone and it's close to your face, it's a blue screen, it then changes how melatonin reacts on your brain and changes the way that you are sensitised to light in the circadian rhythm. 

JENNY BROCKIE:   So why is melatonin important? 

FIONA KERR:  Because melatonin is one of the major things that sets or resets the phase of your circadian rhythm. So if you have natural light very early in the morning, it will phase it earlier. If you have late evening light, it tends to phase it later. That's one of the reasons why cyclic, the later you are, the more you phase it that way. 

JENNY BROCKIE:   Let's talk a little bit more about screens.  Jasmine, you're 11, what time do you go to bed? 

JASMINE KOTZ:  I usually go to bed at 11 pm and I fall asleep at maybe 3 am. 

JENNY BROCKIE:   What do you do between 11 and 3? 

JASMINE KOTZ:  Well I'm usually on my phone and like playing games. 

JENNY BROCKIE:   So you're awake a lot? 

JASMINE KOTZ:  Yeah.

JUDITH KOTZ:  Yes, sometimes she'll actually go almost a 36 hour period without sleep.  So she'll be up at 7 for school, go to school, through the night she won't sleep, she'll go to school again and you think by the time she gets home she'll be ready to drop. She'll be tired as but no, she goes all the way through to 11 again and then falls asleep. 

JENNY BROCKIE:   Jasmine, how do you get up in the morning and how do you get to school and concentrate? 

JASMINE KOTZ:  My parents just wake me up and I just get out of bed. 

DAVID KOTZ:  Drag you up. 

JENNY BROCKIE:   Drag you up, would you keep sleeping if you could from 7? 

JASMINE KOTZ:  Yeah. 

JENNY BROCKIE:   So you would keep going?  So on holidays do you sleep for longer? 

JASMINE KOTZ:  Um, yeah. 

JUDITH KOTZ:  Yeah, she flips around on holidays.  So she'll sleep through the day and up at night and sleep through the day and up at night. But this isn't just since she's, you know, it's not just a recent thing, this has been happening since she's basically born. She's not a very good sleeper.  We tried through the years, you know, the warm baths, warm milk, we tried getting her up earlier so she'd go to sleep at night. We tried exercising at night so she would maybe drop to sleep. So the electronics have only just come in recently.

JENNY BROCKIE:   What did you think when you were listening to what Fiona was saying about screens?

JASMINE KOTZ:  I kind of agreed with her. 

JENNY BROCKIE:   Would it change you from doing that though? 

JASMINE KOTZ:  I'm not really sure, maybe not. 

JENNY BROCKIE:   Yeah, it doesn't sound like it would actually. So Judith, what lengths have you gone to try and get her to stop using the screen? Do you take the phone away? 

JUDITH KOTZ:  Yeah, we did, disconnect the internet, all those sort of things, we did that for, you know, several weeks at a time but it made no difference to her sleep pattern. She was still, still up. 

JENNY BROCKIE:   And how do you go at school, how are you with school work? 

JASMINE KOTZ:  I think I'm really good with school. Like really good with maths and English and spelling. 

JENNY BROCKIE:   Judith, it's not affecting her school work? 

JUDITH KOTZ:  No, I've spoken to the teachers to see whether it affects her at all and they said no, she's doing quite well. So I'm quite surprised that she keeps the level that she does with the amount of sleep she has. 

JENNY BROCKIE:   Would you like to sleep more Jasmine? 

JASMINE KOTZ:  Yeah.

JENNY BROCKIE:   But you just can't get out of the pattern or you don't want to get out of the particular pattern? 

JASMINE KOTZ:  Yeah, I just can't get out of the pattern. 

JENNY BROCKIE:   You can't get out of the pattern. Chris Seton, you're a paediatric sleep physician.  Jasmine's only eleven years old, what do you make of that story? 

DR CHRIS SETON, WOOLCOCK INSTITUTE OF MEDICAL RESEARCH:  Jasmine says very clearly that really she's saying I've got a delayed sleep phase. 

JENNY BROCKIE:   What does that mean? 

DR CHRIS SETON:  And that means her body clock is really telling her to go to sleep very late and get up very late. Most of us when we sleep, when we get up in the morning we feel fresh and as the day goes on we feel tireder and tireder. Jasmine described a sort of jet lag effect which is part of delayed sleep phasing whereby paradoxically when you first get up in the morning you feel the tiredest and that's because your melatonin levels are very high. They should be high in the middle of the night, not in the mornings. So kids like Jasmine have morning lethargy and they have great trouble getting out of bed and they get better as the day goes on.

JENNY BROCKIE:   And where does that sleep problem come from? I mean why does she have that delayed sleep pattern? 

DR CHRIS SETON:  It's most likely genetic. 

JENNY BROCKIE:   Oh, that's interesting? 

DR CHRIS SETON:  We see now a lot of teenagers with this, perhaps 15 percent of teenagers have this tendency, so we have teenagers who don't go to sleep and then others who can't go to sleep. So Jasmine's one of the ones that can't go to sleep. 

JENNY BROCKIE:   How you would fix it or try to fix it? 

DR CHRIS SETON:  Well we have…

JENNY BROCKIE:  Mother is all ears? 

DR CHRIS SETON:  I mean retraining Jasmine's sleep would take several months. So what we do we train her to her late body clock by conditioning her to a late bed time. We do get rid of the electronic devices. We establish a pretty strict bed time routine, it would start with a hot deep bath, some light reading, music, so chilled music on a play list, a snack and a drink and then bed time. And it's like boot camp, it's very, very strict and after four or five weeks the brain gets used to this so that when the bath comes, the brain is already thinking about sleep. And so these are called sleep onset cues.

JENNY BROCKIE:   And how long do you have to do that for, before it starts to kick in, months or weeks? 

DR CHRIS SETON:  So year 10 to 12 kids will take five to six weeks; Jasmine might take four or five weeks and we document this in sleep diaries so we can sort of objectively measure it. And really, you then have to maintain it to some extent and maintaining it means continuing a pre bed time routine, being pretty strict with electronic devices. I mean electronic devices for Jasmine, the blue light effect is really like having someone at her bed time to shouting at her to stay awake so it really makes the body clock even later. So it's a compounding effect and the new devices which are quite small and portable, the kids hold them very, very close, the blue light effect is much higher than on big devices like TV. The other thing that happens with children is, the Americans describe this as the bed becomes the place of conditioned arousal. So the games that Jasmine plays, as you've heard, cause dopamine secretion, addiction, they also cause adrenaline secretion and the adrenaline keeps you awake.  So if you do that too much in or on the bed, even when you take the devices away, Jasmine's brain's thinks the bed is place for wakefulness, not for sleep. So this retraining takes some time. 

JENNY BROCKIE:   The bed is a place of conditioned arousal? 

DR CHRIS SETON:  That's right. 

JENNY BROCKIE:   The bed has always been a bit of a place but you know, we won't go there. 

DR CHRIS SETON:  It's a quaint term. 

JENNY BROCKIE:   It is a quaint term. Judith, you are listening so intently to this, I was watching you just then, you were hanging on every word. 

JUDITH KOTZ:  Yeah. 

JENNY BROCKIE:   Have you tried any of it? 

JUDITH KOTZ:  We have. 

JENNY BROCKIE:   Have you tried it for that long though? 

JUDITH KOTZ: No, probably not the six weeks, we've tried it like probably two weeks at a time? 

JENNY BROCKIE:   Chris? 

DR CHRIS SETON:  This is like training for a marathon and I think this is a common mistake that people make.  They're disappointed with the results and doing it for a longer time will definitely be effective. What's good about Jasmine is she's in the early stages of this, even though her sleep sounds really bad it is nothing compared to what it would be like in year 10, year 11, year 12. 

JENNY BROCKIE:   It's going to get worse? 

DR CHRIS SETON:  Yes, the body clocks gets later through teenage years, kids sleep less because they think they need less sleep. We have great difficulty in the kids from year 9 to year 12 because their body clocks so delayed, they often have mood disorders by then and they're very, very hard to fix. So we really welcome the pre-teenagers. 

JENNY BROCKIE:   I might put you two together after we finish in here. Tosin, you're 18? 

TOSIN AJAYI:  Yeah. 

JENNY BROCKIE:   And you're at uni, what time do you go to sleep?

TOSIN AJAYI:  On average somewhere 2 to 4. 

JENNY BROCKIE:   Why? 

TOSIN AJAYI:  Well as a lot of people said, I'm on my computer a lot and it's not really a sign like I'm wasting time, like watching TV shows and everything. And there are just some nights I feel like if I have like slept all day the day before, I feel like I just wasted an entire day so might as well catch up that night. 

JENNY BROCKIE:   Do you feel good about it? Do you enjoy it or is it something that you're saying to yourself I shouldn't be doing this, I shouldn't be doing this? 

TOSIN AJAYI:  Normally I'm like I shouldn't be doing this but it doesn't really stop me.

JENNY BROCKIE:   So you get to bed between 1 and 4, what time do you get up? 

TOSIN AJAYI:  Well, on days that I have uni it's around 6 to 7.

JENNY BROCKIE:   So when uni's on you're getting between three and six hours sleep? 

TOSIN AJAYI:  Yeah. 

JENNY BROCKIE:   Do you think it is doing you any damage? 

TOSIN AJAYI:  I think so because I've, like a lot of people have told me I look very tired a lot of the time. I often like zone out during uni and yeah, I waste a lot of time not, like studying and stuff and yeah. 

JENNY BROCKIE:  What kind of damage can lack of sleep have?

DR CHRIS SETON:   I think Tosin demonstrates too what a hard sell good sleep is to young people, and we can quote all the research that we want and the young people that I see and treat, one of the hardest, the two hard bits are getting up in the morning and the other hard bit is convincing a young person of the detrimental effects. 

JENNY BROCKIE:   What are they? 

DR CHRIS SETON:  I told a boy the other day who's driving that a recent study showed that in the US when school starting times were made later to accommodate kids with late body clocks, there was a 70 percent reduction in teenage road accidents. 

JENNY BROCKIE:  Wow!

DR CHRIS SETON:  So that's a reduction that's greater than seat belts, greater than drink driving laws and yet it doesn't really sell well. 

JENNY BROCKIE:   Why? 

DR CHRIS SETON:  I think sleep's not very sexy. I think it's free, maybe if we paid for it, it would be, and I don't think you can necessarily see the tangible benefits of it unless you have good sleep. So what happens, the teenagers I see who are chronically sleep deprived do not have insight into how they would feel if they had good sleep. They're chronically like this so they're like this every day. 

JENNY BROCKIE:  So they just think that's what life's like? 

DR CHRIS SETON:  That's right, that's normal. 

JENNY BROCKIE:   How many teenagers do you estimate are chronically sleep deprived? 

DR CHRIS SETON:  Well our studies and studies overseas show that 70 percent of teenagers are sleep deprived. The US Health Department has listed teenage sleep deprivation as a public health issue. It's got to be really bad to get listed so you've got obesity, diabetes, heart disease and teenage sleep deprivation. 

JENNY BROCKIE:   How much sleep do teenagers need, is it different to what adults need? 

DR CHRIS SETON:  It is and this is what's interesting.  So through teenage years aged 12 to 18 your sleep requirement doesn't decrease. So there's a disconnect between the social normal which is, as you get older through teenage years you go to bed later, and the research shows us that teenagers right from 12 to 18 need around nine hours sleep on average. So we think bad sleep in adolescence predicts later problems both related to moods, heart disease, diabetes, obesity. The key thing in teenagers is they're learning and, as you've heard earlier, REM sleep consolidates learning.

JENNY BROCKIE:   What do you think hearing all of that Tosin, about the possible consequences of not getting enough sleep? 

TOSIN AJAYI:  Well I feel like I should at least like try now because I think, you know, I just feel, I just thought it was oh, I'm just missing sleep. Oh, only be tired, what's the worst that can happen? 

JENNY BROCKIE:  Jasmine, what do you think listening to all of that? 

JASMINE KOTZ:  Um, I feel like I should really try to go to sleep more earlier so I can wake up, so I could wake up earlier and just try, just to set my body clock, so I can sleep like an average person. 

JENNY BROCKIE:   Emily, you notice the impact of screen time as well on your teens and but also on you.  How? 

EMILY PALK:  There's just no way I'm going to sleep for at least an hour after I close the laptop. And my phone's worse so I just have a blanket rule, I just don't touch my phone after about 8 o'clock because even ten minutes of just flicking through Facebook trying to catch up on what everybody's doing…

JENNY BROCKIE:   So when you're awake in the night, is your mind racing?

EMILY PALK:  Yes, but I've practiced meditation and things like that for years to try and help myself wind down. I don't drink coffee after 5 o'clock and with screen time knowing that I'm going to need at least an hour after I've been on my laptop, so there are things that I've learnt to do to help. 

JENNY BROCKIE:   Ally, you have insomnia, what's the longest you've gone without sleep? 

ALLY NICOLOPOULOS:  I can go three or four days, so two full nights no sleep and then have two hours sleep and keep going. Or depending on what my life is like at the time I could have fourteen hours sleep and still be tired.

JENNY BROCKIE:  And how long has that been going on for? 

ALLY NICOLOPOULOS:  I've had on and off sleeping issues all my life.  Probably the last year, I would say it has been pretty bad again. 

JENNY BROCKIE:   Have you tried to get help for it? 

ALLY NICOLOPOULOS:  I have. It's something that is very new to me, both admitting that I have some very severe sleep issues but also attributing it myself to kind of my mental health. I'm so desperate to go to sleep but there's just something stopping me. 

JENNY BROCKIE:  What sort of things do you use to get to sleep? 

ALLY NICOLOPOULOS:  Look, that's where I say I think I give up so easily is that I will try, for instance, like doing the twenty minutes in bed and then removing myself from bed and doing something else and then waiting until I'm feeling really quite tired and then going back to bed. I honestly can't tell you how I deal with it. I just function, I do what I do. 

JENNY BROCKIE:   What about the idea of broken sleep Fiona? Is it better to get up if you can’t go back to sleep and do something and then go back to bed or is it better to just stay in bed?

FIONA KERR:  There are so many different pieces of really good evidence for unfortunately different kinds of ways to deal with it. So…

JENNY BROCKIE:   So there is no answer to this question? 

FIONA KERR:  It depends on who you are.  Sometimes people will get up and that will allow them, as long as when they get up they don't do things that then make them wide awake. You can lie there and try and relax but if that makes you more upset, then that just stresses you more.

JENNY BROCKIE: What should people do when they can't sleep like that? What's the best thing to do Shantha? 

PROFESSOR SHANTHA RAJARATNAM: Well, it's a real challenge.  I would say that altering behaviours in human beings is generally very, you know, a huge challenge.  This is why exercise programs, dietary programs, have, you know, there's been significant difficulties in getting traction. I think here what we have is, you know, a GP is a good starting point. Unfortunately in Australia and in the western world, sleep problems like this are often managed in the long term with sleeping medications and I think the public has a view that if they get a medication then this might be something that's easy to address the problem.

I would say that insomnia is very effectively managed by psychologists who are skilled in cognitive behaviour therapy for insomnia.  It has a very high success rate for people who maintain the program and this is something that psychologists are very good at being able to work with the individual to continue to motivate them. 

JENNY BROCKIE:   Ally, have you tried sleeping tablets and things? 

ALLY NICOLOPOULOS:  Yeah, so I have tried many sleeping tablets. I've been spoken with a couple of doctors and instance and I find it really hard to communicate this to my doctor, for instance. I have a psychology background and I actually had a discussion with her and said look, I think that this is, this is stemming from this and this is what's happening and that is how the patterns, you know, developed and I just again got prescribed sleeping tablets. 

JENNY BROCKIE:   You say that wine sometimes helps you sleep? 

ALLY NICOLOPOULOS:  Yeah, I don't usually drink but about two months ago I decided to have one of these sleeping tablets with a glass of wine and I got to sleep. But for me…

JENNY BROCKIE:   I don't even know we should be broadcasting that.  But anyway, keep going and then I'll get someone to comment about it. 

ALLY NICOLOPOULOS:  It worked but for me it was also like having that discussion with my GP to say well, what you're prescribing me is addictive, I know I have an addictive personality. I'm here telling you I have an addictive personality, yet I still left with the prescription.

JENNY BROCKIE: Okay, can I just ask our experts the alcohol question? I mean we've had a couple of people say that having a couple of glasses of wine helps them to sleep. Everything I've ever read says the opposite, that alcohol is really bad for sleep. What's the answer? 

PROFESSOR SHANTHA RAJARATNAM: So the alcohol could initially - it has two phases.  Initially it helps you to fall asleep but then it has this rebound effect and it can arouse the brain and this is the risk in using alcohol as a strategy to help you to sleep because it can potentially help you to fall asleep, but then in the middle of your sleep it can disrupt it. So you can become highly aroused and alert. 

JENNY BROCKIE:   Anyone relate to that? Yes, quite a few people, hands up. 

ALLY NICOLOPOULOS:   I find that that is the case and particularly I think with anxiety, I think because it's, the alcohol will suppress the anxiety, it suppresses it enough for, because anxiety can be an issue for me falling asleep, I think it suppresses the anxiety enough for you to fall asleep but when you do wake up, I wake up ten times more aroused than if I haven't had it at all and not had that initial sleep.

JENNY BROCKIE:   Judy, you run your own company, how much sleep do you think you need? 

JUDY SAHAY:  Well I actually sleep about four to five hours a night. I think that's sufficient for me to be honest. So it's not really about I need to get eight hours of sleep and I find that over time that your body just gets so used to it. So you know, four to six hours of sleep, like five hours of sleep, is more than enough for me to, you know, to run the company.

JENNY BROCKIE:   So you don't think it affects you at all? 

JUDY SAHAY:  No, not at all. In fact if I sleep around eight to nine hours I actually feel more tired. I feel that, I feel sort of drained half way through the day so for me four to six is just perfect. 

JENNY BROCKIE:   Anyone want to comment on that?  Siobhan? 

SIOBHAN BANKS:  Yeah, I would say that certainly we know there's a big range to the sleep need and we've alluded to it a little bit before saying that some people need a little bit more than others and there are a sort of lucky few it seems that are able to get by with a small amount of sleep, or smaller than average amount of sleep. 

JENNY BROCKIE:  Is there any evidence that people who do sleep less though have, you know, not as good health outcomes as people who sleep seven or eight house? 

SIOBHAN BANKS:  We don't actually really know and we see that there is this small group of people who seem to be able to withstand that, you know, deep debt, that sleep restriction, so they can sleep eight hours but it's not too bad if they only get four or five. However, we do also know that you get used to that amount of sleep.  So your ability to know that you're more sleepy than you were yesterday actually wanes and so you become used to feeling a certain way and you might then use coffee to supplement or you might have little naps here and there in the car, being driven somewhere.

JENNY BROCKIE:   Do you do that Judy? 

JUDY SAHAY:  No, not at all. I can't sleep during the day, it's one of the things I can't do. 

SIOBHAN BANKS:  It sounds like you're one of those lucky ones? 

JUDY SAHAY:  And I don't drink coffee either so it's not something…

JENNY BROCKIE:   So you don't drink coffee?  

JUDY SAHAY:  No, so it's not something…

JENNY BROCKIE:   So you're going to defy everything single thing that Siobhan's saying? 

SIOBHAN BANKS:  You could be biologically one of those people that just need less sleep. 

JUDY SAHAY:  Yeah. 

JENNY BROCKIE:   Judy says she's feels terrible if she sleeps eight hours or more. Is there such a thing as over sleeping? 

SIOBHAN BANKS:  It does seem to be that in much higher numbers, so sort of ten, twelve hours sleep in a day, that that seems to be related to poorer outcomes. So people not being as healthy. Those studies could be also picking up people who have mental health issues or other reasons that are causing them to stay in bed longer. For yourself it's probably more around physiologically you've become so used to that certain amount that when you have the opportunity to sleep longer, your body's kind of like woohoo, time to sleep and it's wanting more. And so that groggy feeling is almost your body changing to that new threshold and if you continued with that sleep for a longer period of time, going back to perhaps that six hours that you were reporting before that you did years ago, then your body would become more used to that, and dropping back to the four would suddenly feel different.

JENNY BROCKIE:  Yes.  Shantha, what did you want to say? 

PROFESSOR SHANTHA RAJARATNAM: I would say and I agree with Siobhan, it's very difficult in this case whether Judy's, the sleep pattern is reflective of an innate biological need or it's just become your lifestyle. We don't know just because you feel fine that your appetite regulation may change, your metabolism may change, your, you know, several other aspects of physiology, your immune system and so on. That is the only caveat I would place because at this stage we don't know yet if these lifestyle driven short sleepers, that, you know, appear to cope well if you measure their cognition, their attention, they're coping well but we don't know if all the other physiological systems cope. 

JENNY BROCKIE:   And there is evidence that lack of sleep can lead to things like diabetes, cardiovascular problems. 

PROFESSOR SHANTHA RAJARATNAM: Yes. 

JENNY BROCKIE:   What else? 

PROFESSOR SHANTHA RAJARATNAM: So diabetes, cardio vascular disease, obesity, depression, heart attack, stroke, all of these have been linked to insufficient sleep. The risk of motor vehicle crash as well is a very serious one, we talked about earlier. 20 percent of serious car crash injuries in the general population are due to sleepiness and sometimes people don't detect that they're sleepy because as Siobhan described, they become so programmed to operating on this level of sleepiness.  And so you know, these are major problems. 

JENNY BROCKIE:   Fiona, you think we should all take a nap at work.  Why? 

FIONA KERR:  Because we're two cycle animals. So if we get back to the fact that we have that sort of alignment in the middle of the day, there's really interesting work done on not only taking a nap but the length of the naps. So they do different things and that's why you have to be specific about what you do. So if you nap really simply, if you nap for less than ten minutes it doesn't really do very much, so about ten is the minimum power nap. It allows us to be more alert and more effective and for our memory to improve a little bit.

JENNY BROCKIE:   Is there a particular time of day that you should do it? This should be done during the day? 

FIONA KERR:  Yes. 

JENNY BROCKIE:   And that's why you say it should happen at work? 

FIONA KERR:  People tend to, I could say one to three but that's really prescriptive.  It depends also when you get up but around the middle of your sort of twenty four hour sleep cycle. So the siesta time was a really good time in general for it to happen. 

JENNY BROCKIE:   But the Spanish are trying to do away with siestas? 

FIONA KERR: They are and I would say don't, we should get it back. In China they're having more and more of them. You've got things like Google sleep pods. In Google if you don't have your twenty minute nap you're asked why because they know just how much it increases capacity and alertness. So if you need alertness, those sorts of things, it's the twenty five minute snap.

The valley of death is the thirty to sixty minutes so very often people say I've tried napping, it's awful, I get all fuzzy headed, don't like it. What happens with the thirty to sixty minutes is your body then thinks, your brain thinks you're going to go into a full REM cycle.  So the frontal lobe powers down, if you like, and that's when you get that really horrible kind of fuzzy grogginess. So you either have the short nap if you just want to be alert or if you want to be creative or if you've got a complex problem to solve, or if you want to learn something quite complicated, then you go for the sixty to ninety because that gives you a full cycle of REM.

JENNY BROCKIE:   Employers will be interested in the prospect of that.

FIONA KERR:  There's a number of, there's all different things now. You've got everything what looks like a soft fluffy diver's helmet that you can put on that takes away noise and…

JENNY BROCKIE:   I've seen those. 

FIONA KERR:  That's right, you just lie on your desk for twenty minutes, that's absolutely the best thing to do if you can't do anything.

JENNY BROCKIE:  You're saying that this would increase productivity? 

FIONA KERR:  It increases a number of things. Minimum it increases alertness, increases memory, cognition, mood, enhances your mood, you're not as grumpy any more.  There's all sorts of benefits to even the twenty five minute nap. If you want the creative complex problem solving you have the long nap. 

JENNY BROCKIE:   Anyone here take a nap at work? Yes?

SHWU TONG:  Yeah, I have been guilty of having naps at work, I do feel guilty when I sat that but I often feel…

JENNY BROCKIE:   Why do you feel guilty? 

SHWU TONG: I feel like I shouldn't be napping on a job but I'm so tired that, you know, my productivity level decreased. 

JENNY BROCKIE:   So how much do you sleep at night?

SHWU TONG: Probably about average of six hours. 

JENNY BROCKIE:  Okay, and how often would you sleep at work? 

SHWU TONG: Not very often, only when I'm really, really tired. 

JENNY BROCKIE:   And for how long? 

SHWU TONG: Twenty minutes or so, yeah. 

JENNY BROCKIE:   And do you feel better after it? 

SHWU TONG: Yeah, yeah. 

JENNY BROCKIE:   We have to wrap up. Anyone got any questions they want to ask about sleep before we do? Yes? 

FEMALE: Fiona, you mentioned before about the blue light. The new updates on the Iphones have a kind of like a tinted screen on it. Do you think that makes a difference? 

FIONA KERR:  There's some evidence that it can make some difference. One of the problems though is it's part of, as we've talked about, it's a complex stimulant.  So one of the problems is if you still have that dopamine spike by actually looking at the phone, hearing the message, playing the game, the blue light becomes one of the things that is an issue. It's the behavioural thing of, you know, pick up a book instead so those sorts of changes in your behaviour.

JENNY BROCKIE:   We do have to wrap up. Just very quickly, what's the best advice that you can give all of us about how to get more sleep? Who'd like to kick off with that, Siobhan? 

SIOBHAN BANKS:  Try and make it a priority. I suppose try and see it as something beneficial, try and keep on a good schedule so a regular schedule of getting up at the same kind of time every day. And allowing yourself some wind down time.  I think we need to take an hour or so before we plan to go to bed to have that wind down time. 

JENNY BROCKIE:   Anyone else, Fiona? 

FIONA KERR:  One of the things that we don't - we haven't talked about at all is exercise. We don't get enough, it's one of the issues that we have as a society. So certainly in fact you should run or walk, do something aerobic every single day for your brain, it will keep it healthy and it certainly does improve the capacity to sleep. 

JENNY BROCKIE:   Chris? 

DR CHRIS SETON:  I agree, I think the three pillars of health are good sleep, good nutrition and exercise and I think if you can do that you're way ahead in the health stakes. I think too the other thing I might mention, I mean we've talked about it tonight, sleep training sometimes takes a bit of time and I'd encourage people to be patient with it and pretend you're training for an athletic event, a marathon or something. You're not going to do it in one day or two days, it's slow and I'd encourage people to keep at it. 

JENNY BROCKIE:   Thanks very much for joining us tonight. Lots more to talk about you. All we have time for here but do keep talking on Twitter and on Facebook. Thanks everybody, very much.