Summary
Overview
In this episode of What's Up Docs, Dr. Zand and Dr. Chris van Tulleken discuss sleep disorders with Dr. Sophie West, lead of the Newcastle Regional Sleep Service. They explore various types of sleep disorders including insomnia, parasomnias like sleepwalking and night terrors, restless leg syndrome, and REM sleep behavior disorders. The conversation emphasizes that while sleep disorders are incredibly common—affecting about a quarter of the population—many can be effectively managed with proper sleep hygiene and cognitive behavioral therapy rather than medication.
Understanding Healthy Sleep and Sleep Disorders
Dr. Sophie West introduces the concept of healthy sleep, emphasizing that there's no one-size-fits-all approach. She explains that healthy sleep involves falling asleep within about 20 minutes, experiencing normal night wakings, and feeling refreshed upon waking. The amount of sleep needed varies by individual, contradicting the rigid eight-hour rule many people believe in. Sleep disorders are remarkably common, with GPs reporting that many consultations involve sleep-related issues.
- Healthy sleep should take about 20 minutes to fall asleep and you should wake feeling refreshed
- The amount of sleep needed varies by individual - seven to nine hours can all be normal
- Sleep disorders are very common and represent a significant portion of GP consultations
- About 4% of the population suffers from restless leg syndrome
" Healthy sleep is where people ideally fall asleep fairly easily. Typically, that should take about 20 minutes. And then they have a number of phases of sleep stages during the night. "
" The amount you need is the amount you need to feel refreshed and to not feel sleepy the next day. So if you aren't someone who can sleep eight hours, but you're more of a seven hour sleeper, then seven hours is fine. "
Cognitive Behavioral Therapy for Insomnia: A Counterintuitive Cure
Dr. West explains that chronic insomnia—difficulty falling or staying asleep—is often perpetuated by anxiety around sleep itself. The gold-standard treatment is cognitive behavioral therapy for insomnia (CBT-I), which counterintuitively involves sleep restriction. Patients are instructed to wake at 6am regardless of sleep quality, avoid napping, and delay bedtime to midnight or 1am, essentially limiting time in bed to rebuild a positive relationship with the bedroom environment. This approach has stronger evidence than sleeping medications.
- Chronic insomnia involves habitual inability to fall asleep or return to sleep, causing daytime fatigue and frustration
- CBT-I involves setting a regular 6am wake time regardless of sleep quality to establish routine
- Sleep restriction means going to bed late (midnight or 1am) to increase sleep pressure and rebuild positive associations with the bedroom
- CBT-I has stronger evidence than sleeping medications and can actually fix insomnia rather than just mask it
" Sometimes the more you're trying to get to sleep, focused on your sleep, the more stimulating that might be for you. And therefore, the harder it is to get to sleep. "
" Sleep restricting them can be very effective. And we call this cognitive behavioral therapy for insomnia when it's done in a structured format. "
" The cognitive behavioral therapy for insomnia I've just described has a huge evidence base, randomised control trials showing it's effective. And if you like, it can fix insomnia, whereas the sleeping tablets may just help you sleep but not fix the underlying problem. "
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