‘My career in sleep medicine began almost 20 years ago at Matter Private Hospital, Dublin. After qualifying as a Clinical Psychologist, I started working in the neurophysiology department of the hospital, which is attached to the Sleep Disorders Laboratory.
It was there that I got to work with a wonderful mentor named Dr. Katherine Crowe. She’s retired now, but she was the nation’s first dedicated sleep consultant, and she was the one who instilled in me a love of sleep medicine.
The Sleep Disorders Laboratory treats a full range of sleep disorders, from narcolepsy to sleep apnea. People go in for overnight studies, during which their sleep is analyzed with various diagnostic systems.
It is very multidisciplinary. You’re looking at their heart rate, oxygen levels, and movement. You are also watching their brain activity. They have electrodes attached to their skulls, which allows the team to determine the stages of sleep they go through.
I loved working there, and was lucky enough to have had all of these sleep disorders while doing my professional exams in sleep medicine. At the same time, I noticed that insomnia needed specialist treatment. So after training in CBT-I (Cognitive Behavioral Therapy for Insomnia), I established Ireland’s first dedicated insomnia clinic in 2013.
There has been a huge increase in insomnia since the start of the pandemic. I have personally seen a 44 percent increase in people with insomnia in our clinic, and this is linked to several international studies. The epidemic is coming to an end but insomnia is still a big problem. I’ve never been busy.
Many factors are involved in the rise of insomnia, but ultimately, the epidemic has disrupted for many people the circadian rhythm, which is the overall basis of the sleep-wake cycle and the overall basis of human physiology and health.
People were experiencing anxiety, fear, stress and loneliness and this was associated with significant behavioral changes due to changing work schedules and school schedules. All this happened very quickly, and the body does not like change.
Suddenly our working hours became more flexible and people didn’t have to wake up with alarm clock to go to office. But as I learned myself, if you’re too flexible, your sleep starts to get a little rough. And if you’re waiting until 9 p.m. when all the kids are in bed to finish all that work—it’s going to affect your sleep, too.
If you have the flexibility to work from home, you need to try to replicate the office day. Make sure you have a strict start and end time, and make sure you get your proper breaks. Also try not to have an office in your bedroom. Bedrooms are for sleeping, so keep a separate space for working.
There is a whole group of people whose sleep has been hit hard by the pandemic, but there is, in fact, another group of teenagers who were able to fall back on their natural body clock for the first time. Teenagers have a slight delay in their rhythm, so when they suddenly didn’t have to wake up early for school, they actually began to sleep better and get a fair amount of sleep.
The circadian rhythm depends on external factors, and the body depends on us to behave correctly to keep the body stable. That’s why shift workers have terrible problems with their sleep.
But these days, we all are striving for this full night’s sleep and it brings with it many problems. Even the best sleepers have a poor night’s sleep occasionally. This is completely normal, but when the stress and anxiety sets in, the problem persists.
People with insomnia are very ritualistic before going to sleep. Then, if they go to bed at 10 p.m. and they aren’t asleep within five minutes, it just creates anxiety and stress, which turns into an insomnia disorder.
Over the years, I’ve noticed that good sleepers don’t really think about their sleep, and they certainly don’t analyze it. However, poor sleepers know everything about their sleep – they over-analyze it.
Which is why I’m not a fan of sleep-monitoring wearable technology. When a person who is already constantly analyzing their sleep is given another way to analyze it, it turns into a full-blown insomnia disorder. And the technology isn’t perfect either!
Remember, it’s only by looking at brain activity that we can monitor someone’s sleep, but a lot of these devices are monitoring movement levels—basically, how much you move throughout the night.
So if you’re lying there and you’re very relaxed but you’re still awake, the device will probably think you’re asleep. Similarly, if your partner is still tossing and doing all night, it will probably feel like you are tossing and turning as well.
I’m not anti-tech, but technology just isn’t there to accurately monitor our sleep. I am not saying that nothing will happen in the future, but at the moment, these devices are not accurate.
What we call ‘social jet lag’ can also lead to disrupted sleep patterns. It’s just like jet lag only without a good vacation in between. Social jet lag occurs when a person keeps their natural circadian rhythm for a few hours, usually over the weekend, to try and make up for lost sleep.
Let’s say, for example, that you wake up every morning at 7 a.m., Monday through Friday. Then, come weekend, you have a really big lie and you don’t wake up until noon. You have now pushed your body clock forward by five hours, which is the time difference between here and New York. And usually, for each time zone crossed, the body takes a day to recover. So if you’re not getting up by Sunday afternoon, it will take you five or six days to recover from that sleep.
Being too strict in a routine can also affect sleep. Some people go to bed on very strict schedules and have lost the ability to actually feel sleepy. You have to create sleep pressure for the body to get the sleep it needs. Feeling sleepy is really important.
Sleep is very trendy at the moment and there is a lot of misinformation surrounding it. Take for example the idea that the sleep we get before midnight is better than the sleep we get after midnight. It’s actually an old wives’ tale, which probably stems from the theory that we get most of our deep sleep in the first third of the night. It makes no sense when you consider what we call chronology. Let’s say you’re a night owl – you just won’t be able to sleep past midnight.
How much sleep do we need? I don’t like to put numbers on it because everyone is different. Guidelines are between six and 10, but it also depends on what age you are, as our need for sleep decreases as we go through life. It’s not about the numbers, eg. It’s about getting the good quality sleep you get regularly and feeling relatively refreshed within half an hour of waking up.
Even so, many people are still aiming for the ‘perfect’ eight hours of the night. And if you’re someone who really only needs six hours a night, that means you’re trying to achieve something that’s biologically impossible. And this in turn will lead to anxiety and worry, and will turn into a sleep disorder.
What we do know, however, is that if you have the luxury of being able to fall into your genetic makeup or chronology, you are always going to act to the best of your ability. So if you’re a night owl and you have work that starts a little later, it will be in line with your natural circadian rhythm.
Likewise, if you have insomnia and it’s affecting your job, it’s worth talking to your employer about it. Companies are beginning to recognize the importance of well-rested employees, and you might be surprised how many of them are open to more flexible working hours. ,
InsomniaClinic.ie
As told to Katie Byrne