Why ‘just get more sleep’ doesn’t work

The following text is a full transcript of the MNT In Conversation podcast episode titled: “Is sleep the missing piece in mental health?“

Think about the last time you couldn’t sleep well. The next day, you might have felt that everything was harder. Your mood was lower, your patience grew thinner, and your thoughts less clear.

That wasn’t just in your head. Sleep affects how we feel, think, and function, and is more interconnected with our mental health than people assume.

This relationship goes both ways. Studies have linked poor sleep to depression and anxiety, yet for some, sleep problems may be the first sign that mental health is shifting.

In this episode, we break down what happens in the sleep-deprived brain, why emotions feel harder to regulate when we are tired, and why some people with depression sleep too much while others can’t sleep at all. We will also unpack where the sleep quantity matters more than timing, what broken sleep really means and what practical steps can genuinely improve our sleep.

Joining us today to discuss these and more is Dr. Lauren Waterman. Dr. Waterman is a consultant psychiatrist at North London NHS Foundation Trust and she specializes in insomnia.

I’m Yasemin Nicola Sakay, your host and global news editor at Medical News Today.

And I’m Maria Cohut, your co-host and features editor at Medical News Today.

And this is In Conversation.

You can listen to this episode in full below or on your preferred streaming platform.

Maria Cohut: Welcome Dr. Waterman. Thank you for joining us in this episode. If you don’t mind, I’ll get straight to the heart of the matter. Perhaps we can start with what actually happens in the human brain when we’re sleep deprived. Could you explain what happens in the body when we have a night of poor sleep?

Dr. Lauren Waterman: First of all, think it’s really important to clearly differentiate between what we mean by insomnia and what we mean by sleep deprivation, because quite commonly they actually get mixed up in places like in the media, and even in scientific articles some of the time. That leads to lot of confusion and to conclusions about one that might not be to do with that. Sleep deprivation is what happens when your brain is ready to sleep. Your brain wants to sleep, it’s going to sleep, but something from the outside is actually preventing you from sleeping. So, for example, you’re a new parent, and there’s a screaming baby waking up all night, or you’re being tortured, and a form of torture is to sleep-deprive and to keep someone awake, make a loud noise when someone is about to sleep so that they do not fall asleep. And sometimes it might be to do with having very, very lousy neighbors, which can affect sleep, things like that, in a very noisy environment, urban environment, for example.

And then you’ve got insomnia and insomnia is where you’ve got the adequate opportunity to sleep, but something inside your brain is stopping you from sleeping. So that’s two very different things. And what happens in the brain is quite different when there’s something from inside that stops you from sleeping within your own brain, and something from the outside that’s stopping you from sleeping. Now, sleep deprivation, where something from the outside is stopping you from sleeping, that’s harmful to human health. That can cause heart attacks, premature death, things like that, especially if sustained for a long time or if very severe. I don’t want to worry people about a bad night’s sleep with a screaming child is going to cause those things, but we’re talking at the most extreme end of the spectrum here.

With insomnia, actually, what happens is there’s a problem within the brain, within someone’s mind that is affecting their ability to sleep naturally. And that usually happens gradually over a period of time. And what happens is the brain actually adapts. So someone who sleeps four hours a night because they’ve got chronic insomnia will not actually have the same long-term adverse effects as someone who is having long-term sleep deprivation because the brain has actually adapted to be able to sleep less and to consolidate that sleep, that high quality sleep into a shorter space of time. So I think that’s the first thing that’s really important to actually define.

Yasemin Nicola Sakay: What does it mean when we wake up at night at a particular time, let’s say all the time, or we always experience disrupted sleep? Does this mean our sleep is any good?

Dr. Lauren Waterman: So it’s really interesting and most people, including experts outside of sleep, know this, but experts even in mental health, in psychiatry and medicine are quite shocked when I tell them this. Actually, we wake up about 10 to 15 times an hour, everyone. So this is an evolutionary thing. It’s so because our brains have changed very little over the last several thousand years, tens of thousands of years. So our brains are still adapted to if we were sleeping in caves, and we needed to be on the lookout; they’re not adapted to living in places with locked doors. So we would wake up many times, check our surroundings, make sure we were safe, and then we would go back to sleep. The same happens now. So many times an hour, you will wake up, check your surroundings very quickly, and then you go straight back to sleep. And that’s one of the reasons we never fall out of bed, because you’re constantly waking up aware of where the edge of the bed is and slightly readjusting your position.

So during sleep, we go through these sleep cycles. We go from being in very light sleep to going down into deep sleep. We call that stage three or stage four sleep. And then we come back up to light sleep again. That usually takes about an hour and a half. Then we go into REM sleep, which is the lightest stage of sleep where we’re dreaming. And then we go down again. The second time we don’t go down into the deep sleep for as long. So the most deep sleep you have is in the first hour and a half of the night.

The second hour and a half of the night you get some deep sleep and usually after that there’s no more deep sleep. So you’re just cycling between the very lightest asleep and stage two, which is still quite light and REM sleep. So that’s why you dream the most in the second half of the night and you’re in your deepest sleep in the first three hours. That’s one reason why people with insomnia, they don’t experience a lot of sleepiness because their brains have adapted to condense that good quality sleep into the first period of the night. So, actually, they can sleep a lot less than you or I.

Maybe they can even sleep for three or five hours. And you might think, gosh, how are you functioning? I would be on the floor with that amount of sleep. It’s because their brains have adapted. We’re just going back to this waking up many times an hour. So every time in the cycle, you go up to the lightest sleep, which especially in the last half of the night, you do a lot. You actually go into light sleep and then you wake up and you go into light sleep and you wake up and you’re waking up, waking up, waking up. Why don’t you remember this? So you can use the example of the confident versus the anxious driver.

So if you are a confident driver and I say to you, how did you get here today? You say, well, I got in my car, I left my house, drove along the A road and then I got here. And if you say to an anxious driver, how did you get here today in your car? They say, well, I came out my house, then there was a, almost walked in front of me and then there was a stop sign and I stopped there and then the lights went green and then I went and you would sort of, you would remember all these bits of the drive because you’re focusing on it.

If you’re a good sleeper, you wake up all these times every hour, but you don’t remember it because you fall straight back to sleep because you’re relaxed. If you have chronic insomnia, your mind has adjusted to start worrying a lot about your sleep. So what happens is you’ll wake up like everybody else, and then you’ll think, “No, I’m awake. I’m never going to get back to sleep again. That’s it, I’m done for the night. How am I gonna go to that meeting tomorrow? I’m probably gonna get fired, I’m gonna lose my job, my wife or my husband’s gonna leave me.” And of course, if you start thinking like that, you’re never going to get back to sleep. So that’s the problem, it’s not the waking up that’s the issue, it’s the staying awake that’s the issue. And I think this is actually very helpful for people to hear because if you know that waking up is not a problem, you might worry less about the fact that you have woken up.

Yasemin Nicola Sakay: Okay, that’s an interesting thing to reframe things, actually, because when I had a month of insomnia, it was awful, and I think I only managed like an hour and a half maximum a night. And I was always so worried about waking up and not being able to fall asleep, so that just made my brain active. And then suddenly I’m like “yeah, the sun is up” [at] six o’clock, seven o’clock in the morning, I can’t do it anymore. But that actually reassures me, I’m like ‘okay’ if it happens just maybe just kind of relax and let it be, because the earlier parts of my sleep are more important, which is great to hear, honestly.

Dr. Lauren Waterman: Absolutely. And that’s why the first session of cognitive behavioral therapy for insomnia CBT-I is this education part, because actually, when you realize what’s going on, then you can actually change the way you’re thinking about sleep and change the kinds of things you’re doing that might be worsening or prolonging that insomnia.

Maria Cohut: I just wanted to pick up on something that you mentioned earlier. We were going to say that people with insomnia, they don’t feel so much tiredness. Then you said, actually, no, that’s sleepiness. The question is, if we have insomnia, are we actually feeling tired because we think we should be feeling tired because we’re constantly sort of feeding back to ourselves this story of we didn’t get enough sleep? Whereas that’s not quite true, it’s just that we’re telling ourselves that we didn’t get quite enough sleep.

Dr. Lauren Waterman: Yeah, absolutely. So it’s really important to differentiate what we mean by tired and what we mean by sleepy. So tired is usually used as a word to mean fatigued, low energy. You haven’t got the motivation or the energy to do things. Sleepy is that you feel like you’re about to drift off. Your eyes are going heavy. You feel like you’re going to off. Maybe you do nod off.

So there’s the Epworth sleepiness scale is a scale used by doctors to look at someone’s sleepiness levels. And basically all it asks is how likely are you to fall asleep in the cinema? How likely are you to fall asleep in a car when someone’s driving? How likely are you to fall asleep in a car if you were driving? So someone with insomnia, they feel tired, they feel fatigued, they have low energy. What they don’t feel is sleepy.

And just to clarify, I’m talking about people with chronic insomnia, where this has been going on for more than kind of three months, where the brain has adapted. So the problem for them is that even though they’re tired, they’re not sleepy. And that’s why they’re struggling to fall asleep. That’s one of the reasons they’re struggling to fall asleep. People with chronic insomnia, they do not drift off in the day, but they feel like they need to sleep, but they just don’t feel sleepy. And that’s the problem.

So they might sometimes refer to themselves as tired but wired. So even though they’re tired, their brain is too wired, it won’t die down and it won’t let them sleep.

Yasemin Nicola Sakay: Yeah, I say [I] resonate with that description.

Dr. Lauren Waterman: And part of the reason they’re not sleepy is because over time their brain adapts to not feel sleepy. And part of the reason is that there are these wakefulness pathways in the brain that are different from the sedative pathways in the brain. The sedative pathways of the brain, when there’s more activity in those, it makes you fall asleep.

And that’s what a lot of the common sleeping tablets like zopiclone and the old benzodiazepines like diazepam, that’s the pathway that they work on. But you’ve got this other pathway in the brain called the wakefulness pathway, and that deals with a neurotransmitter called orexin. And in the wakefulness pathway, things can be too active, and that might be why someone is hyperaroused and they can’t fall asleep. So even if they feel sleepy because the sedative pathways are very active, the wakefulness pathways are not dying down.

And that’s why they’re tired, but that’s why they can’t sleep. There’s actually a new medication. It’s been around for quite a few years, but it’s only in the last three years that it’s been licensed in the UK called daridorexin. And that actually works on the erexin system. It inhibits the dual orexin receptor antagonists. So actually works on. So the melatonin pathway or the melatonin cycle is to do with the inbuilt sleep-wake phase cycle of the brain.

Dr. Lauren Waterman: So during the day, naturally, melatonin is a hormone produced in the brain. So naturally, as you wake up, your melatonin levels go down and that allows you to wake up. And then just before you go to sleep, so in the evening, they usually increase and that allows you to fall asleep. They are affected by daylight, especially the bright white light that you get from daylight or from some light lamps, you can stimulate similar effect to reduce the melatonin. That’s one of the reasons they say that high use of screens, especially the blue light or the white light from the screens in the evening, can suppress the natural production of melatonin. I think this is probably a bit more of a problem for children and teenagers. I think there’s a bit less evidence that this is a significant problem for adults, but there’s no harm in putting filter on your phone too. So there’s many apps, for example, and I think even built into the phones now there’s options where after a certain time of the evening it can become more sort of pink red lighting rather than that blue white lighting. And that’s also why people sometimes struggle with their sleep in the winter because they’re not getting enough daylight.

Dr. Lauren Waterman: So it’s really important as soon as you wake up in the morning go try and go outside if you can for half an hour have your tea outside so you get that natural light on. If you can’t go outside, you can get a light lamp. It needs to be strong enough. It needs to be at least 10,000 lumens. So needs to be bright. And it also needs to be really close to your face for about half an hour when you wake up in the morning to actually have that effect.

But going back to the melatonin cycle. So this is a natural cycle that allows you to wake up in the day and go to sleep in the evening. It’s affected by light. You also get a little bump up of melatonin in the afternoon after you’ve had lunch around three o’clock. That’s why people often feel sleepy just after they’ve had lunch. It’s quite common time that people often fall asleep on the sofa. And what the synthetic melatonin does, so the ones you can buy online, is that it acts in a similar way to the natural melatonin. So you take it at night before you go to bed, and it helps to increase the melatonin in your body so that your brain feels ready for sleep. Now, what’s really interesting is that in some countries, melatonin is sold as a pharmaceutical. It’s sold as a medication which means it’s quite heavily regulated. The body in the U.S. that regulates it would be the FDA. Actually in the U.S., the FDA does not regulate melatonin because it’s not classed as a medication, it’s classed as a food supplement, which means it can be sold in supermarkets, online, in pharmacies without prescription.

Actually, scientists have done studies on some of the most commonly sold melatonin brands, including in the U.S., and they’ve done one in Canada. And what they found was that most of these supplements had no or almost no active melatonin in them, even though on the bottle or on the box, it said that they had a certain number of milligrams of melatonin. And occasionally they actually had a lot more than they were supposed to have because they’re unregulated.

Dr. Lauren Waterman: One thing that a lot of people don’t know, including pharmacists and doctors, is that melatonin supplements or medications are sensitive to light. So in the U.S., for example, they’re very commonly sold as gummies in a bottle. You open the bottle, you take out a gummy. The light hits the gummies and deactivates all the active melatonin. So, actually, even if it had melatonin to begin with, it doesn’t have melatonin in it anymore. So it’s much more important to buy them sold as sort of wrapped sachets, know, in foil sachets, like you do with some medications, in capsules, ideally, they’re light-resistant capsules. Unfortunately, I don’t think you can even really buy these in the U.S. It’s very hard to find anything like that. So, unfortunately, if you’re spending lots of money on melatonin, beware that it might not actually have melatonin in it.

The good thing though is that if, well, I might have ruined it for you, but if you believe it’s got melatonin in it, actually placebo from the studies is a very effective sleeping tablet. So as long as you think that you’re buying something safe, then I won’t say to stop it.

Maria Cohut: I had no idea about the interaction between light — just exposure to light, and melatonin. You’ve put me in mind of another thing. What about all of these herbal supplements, particularly valerian root extract, I think is very common, something that people take sometimes to manage anxiety, but also to help them fall asleep more easily.

Do they do anything? Do they actually have a sedative effect? Are they actually helpful for people who do have chronic insomnia? Or is it just that most of the time when we do find them useful, it’s because of that placebo effect that you just mentioned, in which case, great.

Dr. Lauren Waterman: Yeah, I mean, there’s not a huge amount of evidence for herbal supplements for sleep. The most important thing for sleep is whether your brain believes it’s going to fall asleep. And if you have lavender tea before bed every night and you fall asleep well, I’m not going to say stop having lavender tea before bed.

Dr. Lauren Waterman: A lot of it is to do with these associations. That’s what actually cognitive behavioral therapy for insomnia, CBT-I, targets mostly is those associations. So for example, if you sleep well, there’s this process that goes on in the brain called classical conditioning. I don’t know if everyone will remember that from high school psychology, but essentially what happens is you have a stimulus. The stimulus causes an automatic reaction in the brain. And then if you pair that with another stimulus, can lead to the same reaction happening with the second stimulus even when the first one is not there.

So, Pavlov did this with his dogs. It was called Pavlov’s dogs. So he tested this out with his dogs that he noticed that when they smelt the food they would salivate. That was the automatic reaction. That was called the unconditioned response. Then if he rung the bell and showed them the food, they smelt the food, they would also salivate because the food was there. Then he noticed if he just rang the bell without showing them the food, they couldn’t smell the food, they would also start to salivate. So this was a new conditioned response. And this happens to dogs, it happens to all animals. It particularly happens to humans because our brains are more developed. It happens even more to humans. And because of this classical conditioning, our brain starts to associate things with sleep or not sleeping. And it’s very powerful, which is why if you can reduce it, if you can reverse it, that technique is very powerful for sleep.

We call that sleep stimulus control. So I’ll give an example. If you are a good sleeper and you’re on the sofa, you start to feel a bit sleepy, you go into your bed, you turn off the light, you put the covers over you, that bed and that bedroom and the feeling of the sheets on your skin will be the stimulus for you to fall asleep. So your brain has learnt that when you see and experience and feel these things, your brain will sleep. That’s the automatic conditioned response.

Now, if you sleep badly, if you have chronic insomnia, what happens is that conditioned response is different. So you might be on the sofa. And I say this to people with insomnia. Have you ever had this situation where you’re on the sofa, it’s midnight, you start to feel sleepy. You’re like, ⁓ great. I’m starting to feel sleepy. I guess I’ll go to bed. You get changed into pajamas. You get into bed. You turn the lights off. You go under the covers and boom, your eyes are wide awake. And suddenly you’re super alert. Now, generally they will all say yes, that sort of experience. And the reason that is happening is that the bed in the bedroom has become a stimulus for not making you feel more sleepy, but making you feel more awake. What we need to do is reprogram that association in the brain so that the bed in the bedroom becomes a stimulus for helping you sleep, not for waking you up.

Now, there are certain techniques we can use for that. One is to avoid doing anything in your bed in your bedroom that doesn’t involve sleep. Now we say, okay, you’re allowed to get dressed, you’re allowed to have sex, because we’re not mean people. But outside of that, do everything else outside of the bedroom. The bed in the bedroom needs to be your place where you are only sleeping. And that enables you to reprogram, rewire your brain so that it gets used to your bed in your bedroom being a place where you sleep.

What happens if you’ve got a shared accommodation? You can’t really leave your bedroom. Some people live in a bed set in a studio. They can’t do that. Say, okay, well, then you pick the next best thing. Maybe you put a screen around your bed. So it separates the room into the bed and bedroom. Maybe you at least don’t sit on your bed in the daytime. You make your bed and you sit on a chair. You sit on a bean bag. Just try to keep the bed and the bedroom as separate from your daytime activities as you can so that it starts to associate it with just sleeping. Otherwise, your brain associates the bed and the bedroom with work, arguments, stress, being awake, talking on the phone, all these kinds of things.

The other way is to, again, try to reduce the amount of time that you’re lying in bed at night when you’re not sleeping. So that might be that if you’ve gone to bed, we call it the 15-minute rule. It doesn’t have to be exactly 15 minutes. We don’t want anyone watching the clock for this.

But if you’ve gone to bed at night and it feels like it’s been around 15 minutes and you’ve not fallen asleep, you’re still quite awake. You need to get up, go to another room, find something else to do. Doesn’t matter what it is. As long as it’s, you know, you can watch TV. Just don’t watch a horror movie. Don’t watch the last episode of your favorite TV show. Nothing that’s going to get you too excited or too awake. But anything that you might enjoy. Don’t do work. Housework’s fine. Just something that’s fairly relaxing.

And then when you start to feel sleepy again, remember when I said sleepy means you feel like you’re about to nod off, your eyes are feeling heavy, then you go back to bed and the same thing repeats itself. If you haven’t fallen asleep within around 15, 20 minutes, you get up and do the same thing. Now this does two things. One, it helps this classical conditioning, the sleep stimulus control so that you’re not associating that bed in the bedroom with lying awake, being anxious, tossing and turning. So it helps to reverse that association.

And the second thing is that one of the reasons that people with insomnia have such low quality of life is that they’re spending all this time lying in bed just thinking of things, worrying about their life, worrying about sleep. That’s no fun for anyone. This way, instead of lying there awake, they get to do something that they actually enjoy, that actually enhances their quality of life. So there’s some of the techniques that CBT for insomnia includes, but they are very effective.

Yasemin Nicola Sakay: Okay, interesting. You’ve given us some really good tips on how to get better sleep. Basically, you’ve told us to avoid blue light, white light, bright light from devices before bed. And then you’ve told us to kind of create these little rituals, for example, if lavender tea helps you do that, or when you feel sleepy, you need to immediately go to bed, listen to your body, get those cues. You’ve also told us to kind of condition ourselves. So if we’re sitting in bed, starting to overthink we should get up, disrupt that pattern and then get back to bed as soon as we feel sleepy.

Dr. Lauren Waterman: I’ll just correct you there, Yasemin. So actually if you are feeling if you’ve got chronic insomnia — so, I just want to clarify here. The rules are different if you’re a great sleeper versus if you have chronic insomnia if you’re a great sleeper, it doesn’t really matter what you’re doing. Have your lavender tea It doesn’t matter because you’re a good sleeper. If you’ve got chronic insomnia long-term insomnia, the rules are different. The better you stick to these rules, the better you will recover from your insomnia.

So, actually, for people with chronic insomnia, you don’t actually want to go to bed just because you feel sleepy. So say you feel sleepy and at 7pm, if you go to bed at 7pm, you probably won’t fall asleep. Maybe you do fall asleep, you probably wake up in an hour. And one of the really common things that people do when they have insomnia is they start trying to spend extra time in bed, either napping in the afternoon, or they’re spending like 12 hours in bed at night. And then they complain that they’re waking up a lot, and they’re spending a lot of time awake. And that’s because the sleep becomes too fragmented when you make the window in which you can sleep too wide. So, actually, one of the techniques from CBT-I is to compress this window. And there are some people for which this isn’t 100 % safe, especially, you know, without the advice of the doctor, for example, if you’ve got bipolar affective disorder, we need to be careful about compressing the sleep.

But for people without significant mental health problems or things like epilepsy, actually condensing that window of sleep is potentially the most effective treatment for insomnia. So that means going to bed later and getting up earlier. So setting your alarm at the same time every day, that’s important for everyone, getting up regardless of whether it’s Sunday, regardless of whether you’ve slept well, and then for some people actually going to bed later. But certainly you shouldn’t be going to bed if it’s 7pm and you’re feeling sleepy and that’s not your usual bedtime.

Maria Cohut: On that note, there’s two sets of advice or recommendations that are commonly cited. One is that most adults, not everybody, but most adults need around seven to nine hours of sleep per night in order to function well. And the other that we should always go to bed or as much as possible, go to bed at the same time every night. Are these pieces of advice actually helpful and are they accurate? Is that accurate advice?

Dr. Lauren Waterman: That’s a really good question. So I’ll start with the one about going to sleep at the same time every night, because I think it’s quite relevant to what I’ve just talked about. If you are a good sleeper, it’s quite helpful to go to bed at the same time every night, because as I say, you have this automatic conditioning response where you go to bed, even if you’re not sleepy, you get into bed, you feel sleepy, and you fall asleep. Now people who have insomnia who are not good sleepers, that is not happening. So actually, if you go to bed and it’s too early, or

If you go, let’s say you go to bed, it’s your usual bedtime, but you’re not sleepy yet. If you have insomnia, you’re probably not going to sleep. And what is going to happen is you’re going to lie there tossing and turning. You’re going to increase this association of the bed and the bedroom being a stimulus for being awake, being hyper aroused, not being sleepy, being anxious. So actually it’s counterproductive. So the, again, the advice is different if you’re a good sleeper, but you just need to be better at going to bed, not staying awake too late versus if you have a sleep problem, an insomnia problem, in which case it’s important not to go to sleep until you’re sleepy and it’s late enough to go to sleep. The important thing actually is to wake up at the same time every day. I mean, if I ask you what was the morning that you feel the most sleepy, which would it be of the week?

Maria Cohut: I, so actually I personally do kind of try and wake up at the same time every day. I think my body has got used to that, but when I sleep in, I actually feel less energetic, if that makes sense. When, whenever I happen to sleep in, I do feel less energetic and like I have less zest for life and I don’t really want to do as many things. There’s a sense that I’ve lost some time as well.

Dr. Lauren Waterman: Yeah, so it’s out of sync with your body clock, isn’t it? But the other thing is that most people will say that Monday morning is the morning they feel really sleepy.

Yasemin Nicola Sakay: That is definitely the morning I feel the most [sleepy].

Dr. Lauren Waterman: So the reason you feel so sleepy on Monday morning is because probably couldn’t get to sleep very early Sunday night, or if you did, it wasn’t very good quality. The reason you couldn’t get to sleep well on Sunday night is because you slept in on Sunday morning. So it’s actually what time you wake up that sets your whole body clock for the day. And that’s why it’s more important the time you get up rather than the time you go to bed. So there’s actually something called sleep fuel.

So when you wake up in the morning, until when you go to sleep, your brain starts accumulating the sleep fuel. This is actually a chemical in the brain that accumulates from the moment you wake up. So if you wake up at 7am, maybe the sleep fuel, for example, will get high enough to be able to sleep by the time you get to 11pm. But say you wake up at 11am, then at 11pm, you won’t have accumulated enough sleep fuel yet to get to sleep. And that’s why you struggle to sleep. So the time you get up in the morning is the time

It influences the sleep fuel and your whole body clock for the day and what time you’ll sleep that night. That’s also why napping in the afternoon really affects your sleep, even if you nap for half an hour, because it’s actually taking away from this important sleep fuel that you’ve been accumulating during the day. eats away at it. And then you haven’t quite got enough when it comes to the time you wanted to go to bed in the evening.

Maria Cohut: And here I was thinking that I was feeling sleepy on Monday mornings because I was dreading the week, the rest of the week, it’s just too much.

Dr. Lauren Waterman: I mean that might be a reason.

Maria Cohut: I just wanted to sort of clarify, it so basically what’s more important is waking up at the same time every morning rather than how much sleep you get at night if you’re someone with insomnia. Is that correct?

Dr. Lauren Waterman: That’s right, because if you wake up at the same time every morning, you’re more likely to sleep better the next night. And obviously when we’re looking at something chronic like insomnia, we’re looking at the bigger picture, how are we gonna cure this insomnia? And actually that’s the way you go about it. So you might feel more sleepy for that day, but it’s going to be better for the coming days, the coming weeks, the coming months.

Yasemin Nicola Sakay: And when should people start talking [with] their doctors about a sleep problem?

Dr. Lauren Waterman: Yeah, so everybody experiences occasional bouts of poor sleep, or short-term insomnia, we can call it. So, for example, maybe you’ve got the flu, or in London, [for example] we don’t have aircon. So if it’s really hot for a week in the summer, you might struggle to sleep that week. Maybe there’s some work stress or life stress going on for you that affect your sleep. Now, for a lot of people, when that stress or that heat or that flu goes away, the sleep returns back to normal.

But what happens is if you start worrying a lot about your sleep and you start thinking about sleep in a certain way that like we’ve talked about, and if you start doing things to try to compensate, like going to bed really early, napping, oversleeping in the morning, then actually that can lead to a short term sleep problems or short term insomnia becoming chronic. So it’s actually really important to stop those thoughts and behaviours in their tracks before they turn a short-term sleep problem into chronic insomnia.

So it can be helpful to go and speak to your doctor or your therapist about this. The awareness amongst clinicians internationally about CBT-I techniques is actually quite low. And that’s because, as I explained before, in the past, we used to think about insomnia as a consequence or a symptom of other disorders. So we didn’t really give much effort to or much resourcing to improving insomnia. And actually, in medical schools, for example, it’s just not taught very well.

So a lot of the time, doctors, family doctors, and even mental health doctors might know a lot more about sleep hygiene, which is a group of techniques that can be helpful for some people. But when someone’s got actually chronic insomnia, it doesn’t usually help on its own. And they don’t have very much awareness of cognitive behavioral therapy for insomnia. Also, a lot of the time, they don’t realize the impact the insomnia can have on your quality of life, your health, and your well-being.

So sometimes you might need to speak to an insomnia specialist to actually get that correct advice or be referred for cognitive behavioral therapy for insomnia. CBT for insomnia is recommended by the clinical guidelines for insomniacs that’s chronic. So by definition, we usually mean over three months, but also that is likely to become chronic. And you might have an idea that your insomnia is likely to become chronic because you’re starting to have these unhelpful thoughts and behaviours around your sleep. That would be the way to think, okay, I’m worried that this has been going on for a while, it seems to be getting worse, it’s not getting better, I seem to be worrying a lot about my sleep, I’m sleeping at the wrong hours, and that might be when you think, okay, I better nip this in the bud and go and speak to a professional.

Maria Cohut: Thank you so much, Dr. Waterman. That was so amazing. That was such a fantastic discussion. So much food for thought. I’m just going to keep mulling over this for the next [days] — well, hopefully not overnight, I’m going to try and keep those thoughts out of my bedtime routine. But that was so fantastic. So much new information for me there, I’m going to admit. We definitely need a follow-up episode, right?

Yasemin Nicola Sakay: Yes, we definitely will need to do a part two of this, but thank you so much for joining us.

Dr. Lauren Waterman: No problem, it’s great to speak and I just really like raising awareness about insomnia and how you can actually treat it because I think we can do a lot more to get it treated more in the U.K. and internationally.

Yasemin Nicola Sakay: Thank you for tuning into this episode of In Conversation from Medical News Today. This has been Yasemin Nicola Sakay.

Maria Cohut: And Maria Cohut.

Yasemin Nicola Sakay: For more information about how much sleep we need, what happens when we dream, and more, go to medicalnewstoday.com. Until next time.