What You Need to Know About Sleep With Dr. David Cunnington

eCommerce Q&A

Show Notes:
TED talk about the Quantified self
https://www.ted.com/talks/gary_wolf_the_quantified_self
Why Some People Respond to Stress by Falling Asleep
https://www.theatlantic.com/health/archive/2013/12/why-some-people-respond-to-stress-by-falling-asleep/282422/
Here is more information about Jawbone Trackers
https://jawbone.com/up/trackers
More Info about sleep
sleephub.com.au
Sleeptalk Podcast
http://sleephub.com.au/podcast/
National Sleep Foundation
https://sleepfoundation.org/

On this episode of eCommerceQ&A Podcast; Michael talks to Dr. David Cunnington of sleephub.com.au about the unique problems regarding sleep that face the eCommerce business owners of 2017

Transcript:

Intro: Hello and welcome to E-commerce Q&A. This is the show where we address the needs and interests of e-commerce store owners and operators just like you. During the show, we'll cover such topics as how can you maintain a healthy lifestyle while growing an internet business? How can you optimize your shipping? And everything in between. That's right, folks. We're going to address lifestyle as well as the tactical nuts and bolts of growing an e-commerce business. Now E-commerce Q&A.

Michael: Hello, folks, and welcome to E-commerce Q&A. This is the show where we talk about all things e-commerce. Today, we're talking about a topic that you don't normally hear on a podcast about e-commerce, sleep. As you know, we've been on the kick for a while, talking about health related concerns, because if we're honest with ourselves, when we're running these internet companies and these companies that are always on and are never off, there's that temptation to always be working. It's very easy temptation to give in to. I'll totally admit that that's something that I constantly fall prey to. I'm joined today by a very special guest, Dr. David Cunnington. He's a sleep physician and director at the Melbourne Sleep Disorder Center in Australia. David, welcome.

Dr. David: Yeah, thanks very much.

Michael: This is very much a guilty as charged situation. You know? We're talking about a topic that I already know I'm personally not doing well in. I have this belief that oh you know, I know that one day, I'll have more time to sleep, supposedly, or if I just can fit in a little bit more work today, then I'll be ahead of the game tomorrow. Then I'll be able to be more productive next week. It's just horrible now, because I'm only getting six or seven hours of sleep on the best of days. Before we launch into that, I just want to acknowledge that I think my beliefs are completely messed up about this. I'm very curious to know what you think on this topic.

Dr. David: Yeah, a lot of your beliefs are messed up. They're ones that are almost universally held in modern western society. Don't feel too bad about that.

Michael: I don't know that I feel bad. It's one of those things where you know that you have a lot to learn, right? Let's start at the beginning. Can you tell us how you've gotten into sleep medicine?

Dr. David: Well I trained initially as a pulmonologist from Australia. You can tell from my accent. Then for some of my post fellowship training, I actually went to Boston and worked at Harvard, doing some research in the area of sleep. At the same time, the big research group there was looking at how the brain works during sleep. I really got hooked on everything to do with sleep. That was about 15, 16 years ago. I've really ever since worked in the area, pretty broad area of sleep. Because sleep is not just about the medicine, so my day job is as a sleep physician, seeing patients in my practice. Sleep's also about what we do through the day and lifestyle and social factors and cultural factors, which means I get out of the office a bit and do these type of thing, talking to people about sleep and the importance of sleep.

Michael: That's very interesting. I'm really hoping we have time to discuss that. This is a topic where it's kind of like we're spending a third of our day, at least we all know we should be, sleeping. We hardly ever think about it or talk about it, but it's something we're doing every single 24 hours. We're all doing this. What is the correct amount of sleep for most people?

Dr. David: That's such a hard question. It seems easy at face value, but it's actually a really tough question, because it varies so much from person to person. The latest research shows that there particular gene types where people can sleep much shorter and not seem to be tired or suffer ill consequences. Whereas other people need 9 or 10 hours of sleep.Our professional bodies, like the American Academy of Sleep Medicine put out recommendations saying it should be at least 6, and might need to be up to 10. That's actually not that helpful a recommendation, because if someone asks me how much sleep do I need, they'll say, "Well somewhere between 6 and 10 hours." Like, "Yeah, come on. Help me a bit here." In a sense, what we try to work for working adults is an average of 7 hours sleep eachnight across a week, recognizing there may be days when it's a bit shorter because of late night functions, or you have to get up early for other things. But then trying to program in some catch up later in the week.

Michael: So speaking of catch up, if you can't get whatever the ideal amount of sleep for your own personal body is on a particular night or a series of nights, let's say you're at a conference, is catching up a real thing? Is that even possible to do?

Dr. David: Yeah, absolutely. The good news is it's not a payback in a one to one ratio. If you lose four hours of sleep, it doesn't mean you got to pay that four hours back. It's sort of a bit of a win in that respect. We've all had weeks or even months where we've been busy for work reasons, but then if we take a holiday or take some leave, we'll sleep longer for a day or two, but after that, we're not feeling sleepy and we're not sleeping longer. We've essentially burnt off or paid back that sleep debt.

Michael: Interesting. In technology, we talk about tech debt. It's very much where the more you neglect it, it gets exponentially worse. You know? It's good to hear that if you're behind on sleep, it's not like you're doomed or something. You're going to have to take five years just to catch up on sleep. I believe that for this last year and that was kind of overwhelming for me.

Dr. David: Yeah, absolutely. Someone I saw a couple of months ago, an engineering type, so he's a software programmer actually, had developed his own sort of graphing program, where he was graphing his cumulative sleep debt over the last year. It was just off the charts. It was just something that he felt like he would never be able to overcome, this enormous sleep debt that he calculated that he'd accumulated. Fortunately, that's not how it works.

Michael: Are you familiar with the quantified self movement?

Dr. David: Yeah, absolutely.

Michael: I'm barely familiar. I just met someone who told me about it. It start to make me think, "Oh well if you can catch up so easily, then is it okay to kind of try and optimize your sleep schedule so that you only get as little sleep as really needed for you?

Dr. David: We'll get into that, but no.

Michael: Okay.

Dr. David: One of the helpful things I wish we can measure more variables around health and sleep is using it to make sure we're not running behind. Rather than getting the sense of I'm going to sleep the absolute minimum that I need to, more getting the sense that I'm going to make sure I'm tracking in the mid range of where my sleep need is so that I'm not going to fall below the former or put my health at risk.

Michael: It's kind of like a financial budget, almost.

Dr. David: Yeah.

Michael: You don't want to running on the edge all the time. Okay. We came across an article on the Atlantic saying that excess fatigue can come from having almost a mental overload and therefore needed to to process a lot of emotions, memories, and things like that. Is that true? Does sleep help with processing kind of big mental things?

Dr. David: Not really. So this is one of the things I come across all the time, is people see sleep as the antidote to everything, tired, fatigue, burn out, your emotionally unstable. It's just the place to hide. [Where it's actually 00:07:15] effective where a lot of fatigue can be burn out, stress, worry, mental overload, external circumstances that we feel are like outside of our control. A lot of people I'm seeing in my practice are wishing for sleep to fulfill that function.

Michael: This is another pill for them.

Dr. David: Yeah. Whereas in fact, so much I'm trying to recalibrate them and say, "You know what? It's not about the sleep. Sure, your sleep's disturbed, but I'd expect that given how much stress or how much nervous energy you've been running on. That's the focus, to work on that.

Michael: I really want to come back to that in a few minutes, because I'm very curious about that. A few more questions about sleep itself and then maybe we can discuss these broader topics. Sleep tracker, you started to talk about this. Do you recommend a specific sleep tracker? Do you recommend using like a sleep diary, things like that?

Dr. David: Yeah, so sleep diaries are pretty simple. The good side is it's down and dirty. You don't need any tech. The bad side is we're not always that great at estimating how much sleep we get. If you take a look at people that aren't great sleepers, we can tend to underestimate how much sleep we're getting. I do like sleep trackers. The one I used to like is the Jawbone range of trackers. In essence, they're a victim of their own success. They were so good as a consumer device that they've now sort of withdrawn from the market and repackaging and rebranding as a professional device. They're going to reappear in the professional market. The other ones, FitBit, I don't mind. They do a reasonable job of measuring total amount of sleep. The light sleep, deep sleep, that sort of stuff, man, they're not so good about that, but it can give people an idea of how much sleep they're getting, not just each day, but it's actually really helpful to look across a week and across a month to make sure you're not behind. The key is to be pretty much a disinterested observer of it, like a financial budget. Make sure you're just tracking on range, not to be riding the rollercoaster of the, "Oh my god. I only got four hours sleep last night. It's going to be terrible today. Am I going to get through the day?" Not looking at it in that emotive type of way.

Michael: Let's talk about supplements. We can talk about pills, but given the definition of a supplement is something that's going to support in an overall-y good thing that you're doing. I think I just made up a word. Are there are any supplements that you recommend for promotion of sleep, or maybe I'll broaden it, boosting energy generally.

Dr. David: So a view for each side, so in order to try and improve sleep or to boost energy. People are trying to do lots of things already, particularly on the boosting energy side, caffeine's the sort of drug of small business and the drug of entrepreneurship to help with energy levels, [inaudible 00:09:59] sleep, but both in awake and asleep sense.It's interesting, that term supplement or natural. If anything works, it's working by changing brain neurochemistry. Don't kid ourselves that because it's a supplement or it's herbal or plant based that it's working via some sort of pixie dust or magic type of phenomenon. It is working by changing brain neurochemistry, in the same way a prescription product might be. I'm therefore somewhat cautious about supplements, even though I'm less concerned about risk, because one of the things that can happen with supplements is people get a sense of outsourcing the sense of responsibility of sleep or energy to the supplement, rather than looking at what other things they can do to help manage sleep or help manage their energy levels. That often means they don't get a satisfactory response, because they'll still be eating poorly, working too many hours, not managing stress, not have the right behavior around sleep, and just expecting the supplement to patch over those ills or deficits.

Michael: You know, you've alluded to this idea that there are better ways of handling things like lack of energy, lack of clarity. Maybe we should transition at this point and talk about what those are. How do you generally start off with clients who are coming to you with these types of concerns?

Dr. David: Yes, so one of the things to talk about is if someone's tired and not sleeping well is to try and unpack and work out is it a predominantly not sleeping will the cause of the tiredness. It really is. The times when that is true is when someone's got a genuine medical sleep disorder, so something like obstructive sleep apnea or restless legs or a really difficult insomnia, something that's evolved over a number of years. Lifestyle factors haven't been able to fix it. For the majority of people, the not sleeping well is tied up in what they're doing across the day, whether it's how they're managing energy levels, and I'd like to use the term nervous energy, rather than stress, because then if you think of that as nervous energy, it can come from a range of different things. It can be behaviorally. We're all proud of running like a busy bee. Go hard, so that you're sort of running ahead of everybody else. That is actually harnessing the sympathetic nervous system. It's turning up, deliberately turning up that nervous energy drive now sstafo that we can feel like we can get more done. That has consequences at night. If you're running on nervous energy right through the day, you shouldn't expect to be able to just go into bed, feel calm, feel quiet, drop readily to sleep, and during the night, stay asleep for prolonged periods, because that nervous energy is still going to be ticking along the under surface. I try to look at how people run their day. If people's day is from the time the alarm goes in the morning until the time they're getting into bed at night, they don't stop, and even once they're in bed, there's that thinking about their business. People with small business, you know, you're working in the business during the day and thinking about the business and what you're going to do with the business at night. It's a real challenge. It's trying to look at what people do across the day, and often, making them take a break through the day and try and work on ... If these people are pushing harder, it can actually reduce their energy levels, reduce performance. The way to move forward sometimes is actually building in some down time.

Michael: How much down time would you recommend building in for an average day, week day?

Dr. David: It really varies from person to person. I also think of it as you've got to have a period of skill acquisition or learning a new behavior. When we're teaching someone, one of the techniques we might use is mindfulness space meditation. If we teach someone that, we might give them a prescription of about 30 minutes, 6 days a week. We might do that for 6 to 8 weeks. People then get a sense of some confidence in that skill and feel like they've got some skills. Then someone in there will match it then to their working day. For someone who doesn't really have their own office, or doesn't have defined down time during the day, it might be little one to three minute breaks periodically every one to two hours. That's sort of just a minute movement, where for one minute each hour, it's just pausing, taking the foot off the accelerator. For someone who's work has a bit more structure and they've got a break in the middle of the day, it might be taking 10 minutes out to like walk. Just leave the office. Get out of there for 10 minutes. Or it might be some time at the side of the day, or transitioning at the end of the day, having a defined period where I'm home. I've now got the kids in bed. I've done a little bit of work to just square out the day. Now I'm going to take 10 minutes just as a transition to mark that transition from I'm mentally active, get things done sort of person, to now I'm transitioning into the I'm winding down. My day is done.

Michael: I think this is kind of the [nub 00:14:58] of the issue, in a sense. I have a six year old daughter. She's very similar to me in her personality. One of the things that I see in her that I also struggle with myself is a tendency to seek stimulation. My wife and I look at her. When she's being hyper and crazy and not obeying very well and things like that, we say, "Oh she's over stimulated." We're just going to give her some downtime. Then a little bit of extra sleep, some more napping, just kind of calming her life down. Then after a while, she's fine. It's made me think about my own life, because I think ... I read an article which was saying that it's possible to get addicted to overstimulation. The idea being that this really just wanting something to change kind of like the whole idea of a change is as good as vacation, but wanting a million vacations during the day. Just almost seeking to become distracted. I'm curious. Is this an actual thing? Is over stimulation a real problem? How does that play into all this?

Dr. David: Absolutely. It's part of our modern society. There's different terms people use. It might be distractibility, lack of attention, divided attention. I struggle to watch television, in particular the major sort of channels or cable channels, because there's so many moving parts on the screen at one time. It's just feeding that whole divided attention. People I see would say things like, there's no way I could read a book. I couldn't even read a chapter in a book. Once an article goes beyond 500 words, they think, where's the next thing? When I talk about mindfulness space meditation, really what mindfulness is is training us in a skill of maintaining observation in the present moment. That's a really nice skill for just training people to focus on the one thing, and sit with that one thing. It's not something that comes naturally, because we're trained to actually be looking for the next thing, even while we're on the one thing that we're doing. Practicing that skill is the bit that takes time, is getting people to be much more comfortable in order to focus on the one thing for a period of time. I say it too in people, who come to my office, who report that they're not sleeping very well. I'll ask them, "How long could you sit still for without a phone, without a book, without a screen before you felt you needed to get up and do something?" Often that's a very short period of time.

Michael: Right. I have a friend that has insomnia. He was recently diagnosed with cancer. I'm just kind of curious if sleep disorders are ever linked with really serious diseases like cancer.

Dr. David: Yeah, absolutely. Sometimes it's hard to work out what's the chicken and the egg. Most of the research that's out there essentially shows that if you take cross sectional data, that people with sleep disturbance then are at higher risk in the future of developing medical illnesses. The problem with that data is that lead time's pretty short. What we actually think is that maybe that's it's part of an early sign of the cancer was the sleep disturbance.

Michael: Oh wow.

Dr. David: It was only when the cancer got picked up some months later. I think of sleep sometimes a bit like the canary in the coal mine in terms of health. For someone who they're used to sleeping a certain way and their lifestyle's exactly the same, but sleep changes, that for me is a bit of a red flag. Something changed with health. Is there something that's shifted, and therefore, we're going to see something else appear in due course? Don't think of it so much as someone with long standing insomnia that's going to cause them to have cancer. There is a small signal with that. A data set of nearly 70,000 women who worked night shift over 30 years, so we're talking of very big stimulus or very big impact os sleep disturbance over a very prolonged period of time had a small and very small increased risk in breast cancer. That's where some of that sort of statements about poor sleep will cause cancer comes from, but the magnitude of the risk is pretty small, and the amount of sleep disturbance they had was really big.

Michael: Now you said something that I'd like to key in to for second. You mentioned that them working at night constituted a sleep disturbance. Can you expand on that?

Dr. David: Think of that as working, and where we think the risk comes from is you're working at at time when your body clock is expecting to sleep. Your behavior is out of sync with your internal body clock. Whilst we can all do that if we need to pull an all nighter or if we need to work a night shift, we can do it, but our intrinsic body clock will still be expecting us to sleep. Your immune system, your immune surveillance, regulatory mechanisms that control appetite, feeding, fasting, activity, energy levels are all expecting you to be asleep. When we constantly are out of sync with our internal body clocks, that's where we see impacts on health. Not just in terms of health risk, but chronically feeling tired.

Michael: Then that's based on basically when is the sun coming in, when is the sun coming down. That's what he circadian rhythm is ultimately based on, right?

Dr. David: Yes, so that's ... We're biological beings and sort of grew up in a very natural environment. That's where we've sort of evolved from. Our own internal body clock is synchronized by those external cues. Everybody's clock is slightly different. There will be some people who are early birds, prefers to go to bed at nine o'clock, for example, and be up at five. Others are more night owls, preference to go to bed at one and be up at 9 or 10, and be in the office at 11. Recent research shows that rather than the early bird gets the worm, and those early morning types are the hardworking ones, which some of the belief in modern industrial society sort of [betrays 00:21:14] that belief, in actual fact if people worked according to their own intrinsic clock, the night owls started work at 11 and worked until 7 PM, they perform equally well as the early birds that start work at 8 and finish at 5. It's a matter of, for a given individual, recognizing their preference and making sure they're roughly in sync as best they can with that preference.

Michael: Interesting. We've discussed mindfulness and meditation. Are there any other lifestyle focused remedies for lack of a better term, or practices that you can advocate?

Dr. David: Yes. On the sort of slowing down side, it doesn't have to be as structured as mindfulness. Particularly for small business owners and entrepreneurs, it really boils down to permission, you know, guilt free permission. That's the key. To pause would take some time out. In recognition then, in the business and leadership literature, there's good research showing that people who sleep less, because they've traded off sleep for work or other activities, make worse decisions, have less happy employees, have workplace cultures that aren't as positive and have greater staff turnover. A really good research showing that for business owners, managers, and leaders, taking a little bit of time out, allowing enough opportunity for sleep, makes a big difference in terms of their performance. It's not just about hours at the desk or hours at the wheel, it's about how well rested we are. They're trying to get people around that so that they can guilt free give themselves permission to take some time out. It doesn't have to be as formal as meditation. It can be, you know, I'm just going to go for a walk. Just going to spend half an hour with the kids, and not half an hour with the kids where you're then taking phone calls and planning things and on the phone, but actually half an hour with the kids, focused on what the kids are doing. That's on the sort of slowing down side. Then on the boosting energy side, there's really good research from the depressionliterature, but also in the fatigue literature about a technique called behavioral activation. You can sort of summarize that as get up and go. First thing in the morning, people are still feeling a little bit sluggish, rather than that, you know what? I'm just going to rest here a bit longer. Actually getting up, but not getting up and starting work, but getting up, getting outside because that helps cue in the body clock to the natural light dark cycle, and moving, because the physical activity wakes up a lot of the body functions and gives energy.

Michael: Interesting. So it seems like there's a productive cycle and there's a vicious cycle. You can correct me if I'm wrong, I'm just trying to understand this, but the vicious cycle that I'm thinking of is when you're not getting enough sleep, you're just stressed out and then you can't sleep as well. Your body is wired, because you didn't slow things down before you needed to sleep. Is that correct so far?

Dr. David: Yeah, it is correct, but it's not on a day to day basis. It's not a case of if we've been busy over months, we slow down one day, we'll get the return that night. It takes weeks for that to unwind.

Michael: Then there also seems like a healthy productive cycle, where even if you feel a little bit tired, going ahead and getting up, getting your body moving, and then towards the end of the day, slowing down, taking time off, that will aid in having more energy the next day.

Dr. David: Yeah, absolutely. Sometimes it takes a bit of a circuit breaker to see that. That's, what I say is, we talked about, before we started recording, you know, I'm on retreat at the moment. I'm having a week out at a health retreat, partly so because I'm teaching guests about healthy sleep habits and managing energy. They'll have that recognition that actually taking some time out, then when they get back into their day to day lives, are much more confident that taking some time out's going to help them make better decisions.

Michael: Interesting. Dr. David, I'm wondering if you can share with our guests a bit about how they can learn more about these topics and potentially benefit from your services going forward as well as your podcast.

Dr. David: Yeah, so we've got an online site that's got information about sleep. That's sleephub.com.au, and also on that site, we host a podcast called Sleep Talk. Sleep Talk's available on iTunes and Google Play and other podcast apps or podcast catchers. If people are looking for information, there's information there. I also write for Huffington Post, so there are articles on Huffington Post that are written about sleep with these sort of message. Some other good sources of information about sleep, the National Sleep Foundation in the United States provides a good source of information about sleep as well.

Michael: Do you do things like coaching or individualized therapy with folks that are maybe not in Australia?

Dr. David: No. My day job or my regular job is I'm a medical practitioner in Melbourne, Australia. Because I'm a credentialed medical practitioner, my medical indemnity and medical registration doesn't cover me offering services to people outside of Australia.

Michael: We may need to solve that problem. Well, very interesting. [inaudible 00:26:32] fun kind of question which is at what point should someone who thinks they're having sleep problems, at what point should they actually seek something a little bit more strong, like concerted services from a practitioner such as yourself or sleeping pills. I don't even know if sleeping pills are a good idea, but when do you need to escalate your treatment of your own sleep problems?

Dr. David: Yeah, so if you feel like you're not sleeping well and have done some of the commonsense things, like implementing some good practices around sleep, allowing enough time to wind down, reflecting on the degree of busyness and balance and making sure that it's not just a case of going 24/7, and still not sleeping well, that's the time to go and talk to your health professional.

Michael: Okay. Makes sense. Well did you have anything else that you'd like to leave everyone with here?

Dr. David: Yes, a couple of other points. Some of the language around sleep, often I also find with people that are running businesses or entrepreneurs, they want to absolutely squeeze the most out of sleep. They're trying to get sleep to be absolutely perfect. For sleep to work well, it's got to be good enough, not perfect. If people strive hard to get sleep absolutely perfect, they can paradoxically develop a bit of an anxiety about sleep. I'm constantly tweaking it, monitoring it, putting in place mechanisms around sleep. We really need to just step back and let the body do its thing with regards to sleep. The second point would be embrace napping. Although napping's not necessarily part of the business culture, you've seen large companies now introduce nap pods and those types of things, but it works for people in small business and entrepreneurs as well. It doesn't have to be as structured as going into a pod, but again, giving yourself permission, feeling a bit tired, not making headway, actually take some time out. Close your eyes for a bit, even if you just rest. You'll find you're much productive when you then get back to it.

Michael: I'm so glad you discussed napping. I was feeling like, "Hmm, I could use a nap about now."

Dr. David: I encourage that.

Michael: Yeah. Well thank you so much for your time today. I've learned quite a lot. I'm surprised by a lot of the things you said and that's great.

Dr. David: It's a pleasure.

Michael: Oops. Sorry, folks. We lost Dr. David's audio at this point. So here I am recording the ending later. I did get nap. It was very refreshing. I've started taking more naps since then. In fact, I just got up from one just now. I encourage you take one whenever you're feeling down. It will help your perspective. So Dr. David's podcast is linked in the show notes as are the other resources like you can expect. If you have any questions about sleep that you'd like us to forward to Dr. David, send those to [e-mail]. That's S-E-L-L-R-Y. As always, thank you so much for listening. Have a good week.