0:02

Welcome to The Referral. I'm Dr.

0:04

Karan, a surgeon in the NHS

0:06

in the UK. And you're probably sitting there wondering,

0:09

why the hell does a hospital doctor have

0:11

a podcast? Good question. So in

0:13

an average day, I can probably see 10, 15, 20 patients at

0:15

most. And

0:18

I want to reach more. I want to reach tens of thousands,

0:21

maybe even millions. And that's the advantage

0:23

with this podcast. I can give you

0:25

actionable advice and tools

0:28

after speaking with experts every week

0:30

to give you advice that you can take home and

0:32

hopefully improve your health, improve your health

0:35

literacy, and help you take a greater ownership

0:37

of your body and your life so you're

0:40

not led astray by all of these online

0:42

health scammers that's trying to sell you,

0:44

you know, crazy pills

0:46

and diets and potions and remedies that

0:48

you frankly just don't need. Today's

0:51

topic is one of the most important topics

0:53

I'm ever going to cover. This is the single

0:56

most important thing that you do every

0:58

single day of your life. It's sleep.

1:00

And it's very important. As a surgeon,

1:02

I know all too well how important

1:05

sleep is. I'm sometimes operating

1:07

few millimeters or less away from

1:10

organs and blood vessels and nerves that should

1:12

never be cut. And if my sleep

1:14

is bad, then that's potentially bad

1:16

news for the patient, which is why I always

1:19

try to prioritize my sleep before

1:21

I'm operating. Now, we're going to be

1:23

talking in this episode about why sleep

1:25

is important, the things that you're doing

1:27

right now and every night

1:30

for the last few years, that's probably

1:32

tanking your sleep. And we're also going to be giving

1:34

you strategies on how to improve your

1:36

sleep and all the sleep myths that's

1:39

leading you astray. And joining me today

1:41

is Dr. Stephanie Romaszewski.

1:43

She is a sleep expert that

1:46

helps people retrain their brains so

1:48

they can sleep better and hopefully live better

1:50

lives.

1:52

Often people believe that lying in is helping

1:54

them feel better, but actually you're

1:56

only perpetuating and reinforcing

1:59

that horrible sleep.

1:59

inertia that you've got. Yeah, grogginess. Exactly.

2:03

And don't worry, I'm not forgetting about you at home. Crowd

2:05

Science is your opportunity to ask me

2:07

a question.

2:09

This week, Elizabeth asked me about IBS.

2:12

I've suffered for decades, pain

2:14

so bad that I actually faint. If you want to ask

2:16

me questions, get in touch, leave a voice

2:19

note, email, anything you want at

2:21

thereferralpod.com.

2:23

And before I talk to Stephanie, it's time for

2:25

What the Health is Going On in the World of

2:27

Science, Medicine and Health.

2:33

Okay, this one sounds unbelievable.

2:36

A dog helped a woman discover she had

2:38

breast cancer.

2:39

A 50-year-old woman in Nottinghamshed said

2:41

her two-year-old colly cross dog,

2:44

Luna, started jumping and pawing

2:46

at her right breast last April. And

2:48

for whatever reason, she decided to get checked out,

2:51

she went to her doctors, and she ended up having

2:53

a biopsy of the right breast, and it turned

2:55

out to be cancer.

2:57

Now, I would not recommend using your furry

2:59

friend as a cancer detection tool, but

3:01

I was intrigued. Can we use

3:03

dogs as cancer detection

3:05

tools? Can we use them in cancer screening?

3:08

Let's dive into the science behind that. All

3:11

smells that you can smell are basically a result

3:13

of molecules in the air, from freshly

3:15

cut grass to the smell of

3:18

stinking s**t. These volatile chemicals

3:20

or molecules are detected by the smell

3:22

receptors or the olfactory receptors

3:25

in our nose which connect to our brain.

3:27

Now, dogs have a more keen sense of smell

3:29

than humans because they have more of these

3:32

olfactory neurons or these smell receptors

3:34

in their nose. So they can pick up delicate

3:37

notes of certain chemicals at

3:39

a far greater sensitivity than us humans.

3:42

And we also know that certain tumors produce

3:44

these volatile chemicals, lung cancer,

3:46

breast cancer, melanoma, these certain

3:48

types of skin cancer. So presumably

3:50

those volatile chemicals produced by

3:53

those tumors or associated with those tumors

3:55

are being picked up by canines.

3:57

And people have studied dogs for their use

3:59

at detecting cancer and most

4:01

of the studies suggest that dogs are

4:04

indeed better than just pure chance

4:06

at picking up cancer.

4:07

But it's nowhere near 100% and don't get

4:09

me wrong, no cancer detection test

4:12

is 100% but the additional cost

4:14

of training dogs, housing dogs

4:17

and the false positives and false negatives

4:19

you get is just not worth the risk.

4:21

And it's still not clear from the research whether these

4:24

dogs are picking up these special

4:26

molecules that are associated with the tumor

4:28

or just molecules associated with general

4:31

illness.

4:31

And there's also the chance they can be confused with other

4:34

scents and other smells from things

4:36

that we've eaten, for example, garlic or other

4:38

factors like tobacco smoke.

4:40

Dogs are also unable to tell humans

4:42

which molecules they're smelling and which molecules

4:45

may be associated with the disease they're picking

4:47

up.

4:47

But the information we've gained from canine

4:50

cancer detection isn't all a waste. We

4:52

can hopefully make molecular tests which

4:54

can help identify certain molecules

4:57

and chemicals with certain compounds and

4:59

use AI, we can use electronic

5:01

noses which can actually

5:02

detect these chemicals and help

5:05

us figure out what type of state of illness

5:07

or disease or cancer a patient may

5:09

have.

5:10

And that is a wrap for what the health

5:13

is going on in the world of science, medicine

5:15

and health.

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5:46

Hey you, it's your queer best friend Cameron

5:49

Esposito. And I am super excited

5:51

to tell you about my brand new podcast, Survive

5:54

or Die Trying. Now I am a

5:56

lot of things, but I am no survival

5:58

expert on my new podcast.

5:59

We're gonna learn together bear attacks

6:02

bad breakups I am gonna give you

6:04

the lowdown on how to prepare for

6:06

life's absolute worst case scenarios

6:09

Join me some special guests on survivor

6:11

die trying a comedy podcast that prepares

6:13

you for anything or nothing

6:18

Today I'm joined by dr. Stephanie

6:20

Romuszewski. She is a genuine sleep

6:22

expert. She's a sleep physiologist

6:25

She's worked with Harvard University the NHS

6:28

to help all people who struggle with

6:30

sleep Stephanie Thank you very much.

6:32

You're making the long trip to London and you know

6:35

agreeing to chat about all things sleep. How

6:37

are you?

6:37

I'm very well. Thank you so much for having

6:39

me. I'm always happy to talk about my favorite subject

6:42

really It's my favorite subject and my favorite

6:44

hobby as well on the same wavelength

6:46

here So Stephanie you worked at Harvard

6:48

University, you know, we've got about these 50,000 neurons

6:52

a pea-sized shape called

6:54

a super charismatic nucleus Which

6:56

is the granddaddy the grandfather clock

6:59

which trains all the other billions

7:02

of clocks that we have in each of our

7:04

cells in our body the peripheral clocks and

7:06

they communicates with the master

7:09

clock in our brain like You

7:11

know a lead of an orchestra, you know

7:14

The maestro leading the all the different

7:16

players playing their instruments and there's that

7:19

feedback between the two Which eventually gives

7:21

rise to this 24-hour oscillating

7:24

sleep wake cycle and we need light

7:26

dark, etc Now what

7:29

are some absolute basics that

7:31

someone would need? Just

7:34

to have basic decent

7:36

sleep.

7:36

So in order to sleep well, there

7:38

are a few things that we need and

7:41

it's kind of around about

7:44

The drive to sleep So we have a drive

7:46

that we build up a pressure to sleep

7:49

and the only way to build that is to be

7:51

awake Ironically since people are quite frightened

7:53

of spending more time awake when actually it leads

7:56

to sleep So one

7:58

thing we need is a good timing

8:00

of a sleep-wake cycle. So we need enough pressure

8:03

in order to sleep well at night. So we have

8:05

to actually spend a certain amount of hours awake.

8:08

And then what we need is a good light-dark cycle

8:11

just to give our body the cues it needs

8:14

to sleep and the cues it needs

8:16

to be awake. When we're in darkness, this encourages

8:19

our cues for melatonin, which is

8:21

a sleepy hormone which helps us to sleep.

8:24

And when we're in the light, it helps suppress

8:26

melatonin, which helps us to stay

8:28

awake amongst other things. So having

8:31

a good light-dark cycle is quite important.

8:33

But as you can imagine, as technology

8:36

has improved, our sort

8:38

of natural sleep-wake cycle that kind

8:40

of goes along with the way the Earth is and

8:43

the 24-hour cycle that

8:45

we have, it's been more and more difficult

8:47

for us to do that. And that's why I

8:49

think sleep has become a bit more popular now because

8:52

actually we need to learn how to do this properly if we're going

8:54

to keep manipulating our environment so

8:56

that the light-dark cycles are quite different

8:59

from what we need.

9:00

So I just think it's a bit weird, almost

9:02

like a biological twist, a glitch of nature

9:04

that we need the light to

9:07

start the timer and set up us for

9:10

the day. But equally, we need

9:12

lots of light in the morning. But

9:14

even a tiny bit of light in the evening

9:17

is hugely detrimental.

9:19

Number one, why do you think, and

9:21

would you, if you agree, I don't even know if you'd agree,

9:25

is your wake-up routine

9:27

far more important than your sleep

9:29

routine?

9:30

Yes, I would 100% agree with that.

9:32

It's not just about the light though. So light is

9:34

incredibly important, but setting

9:37

a very specific time to wake up, for

9:39

example, is quite important because

9:41

then your brain understands when to

9:43

build that pressure to sleep every day. And that

9:46

is on a 24-hour cycle. So your

9:48

sleep-wake cycle, a circadian rhythm, it literally

9:51

means around 24 hours.

9:53

And so if you're doing that around the same time

9:55

every day, what happens is you build a pressure

9:58

up, which is fairly practical. predictable.

10:00

So when you feel sleepy becomes

10:02

fairly predictable in the evening because

10:05

of the time you woke up for sure light

10:07

is going to reinforce this

10:10

habit light is so good at helping

10:12

you to feel awake and to set that

10:14

kind of goal post I guess you could call

10:16

it really really important. I would

10:19

say though that when it comes to actually

10:22

having light in the evening yes for sure sort

10:24

of Exposing yourself to light can

10:26

definitely shift your sleep-wake cycle

10:29

in time

10:29

the actual effects of

10:33

Having a little bit of very bright

10:35

light Before you go to bed

10:37

on a given occasion isn't

10:40

necessarily going to for example delay

10:42

your sleep onset Significantly, but

10:44

it's our habits over time and

10:46

that's where sort of I do my work

10:49

Really is trying to help people understand that when

10:51

it comes to your sleep It's your habits

10:54

your behavior over time, which is going

10:56

to set that metronome It's gonna it's

10:58

gonna consistently help you predict what

11:00

your body wants to do and what it needs

11:02

to do And when you're gonna

11:04

feel sleepy and when you're gonna feel awake and that's not

11:07

just with your sleep. That's with your appetite hormones

11:09

That's with your mood regulation. That's with

11:11

your temperature regulation So actually your

11:13

sleep-wake cycle and the behaviors you have around

11:16

your sleep-wake cycle are going to impact other

11:19

patterns or Rhythms

11:21

that you have your physiological rhythms,

11:23

which is fascinating.

11:24

It's Absolutely fascinating. It's

11:26

going back to that same analogy

11:29

of you know that grandfather clock

11:31

in the brain Feeding into and

11:33

having a sort of a bi-directional chat

11:36

with the clock in your intestines The

11:38

clock in your pancreas in your liver which

11:40

determines what hormones your gut

11:42

releases at certain times Which is why I always

11:44

tell people you know I'm a obviously

11:47

a bowel surgeon when I tell patients

11:49

similarly when you have a sleep routine You also

11:51

need to have a bowel routine because you

11:53

go to the toilet

11:54

every day for a number two at 8 a.m

11:57

chances are every single day because

11:59

the

11:59

you've woken up at a certain time,

12:02

that triggers a cascade or

12:04

a domino effect of hormones throughout

12:07

the body that tells you, okay, you've

12:09

woken up at 7am, I'm going to make you

12:11

hungry at 7.30, I'm going to start your

12:13

bowels getting into motion at 8, I'm going to make

12:15

you more energetic at 9. Because

12:17

actually, exactly like I said, that wake

12:19

up time is almost the

12:22

starting point, the starting flag which says, okay,

12:25

all systems go, all the hormones

12:27

are going to be synchronized at this exact time,

12:29

it's like

12:29

music.

12:30

Yeah, absolutely. And that's how

12:32

we talk about it in sleep as well. But

12:35

I think the reason that as humans we struggle

12:37

with this concept is because we

12:40

are sort of born in this very reactive society.

12:42

So we expect to see results very quickly.

12:45

But what happens is, something

12:47

happens, let's just say you have a bad night's sleep,

12:49

and you make decisions based on your bad

12:51

night. So for example, you might lie in, you

12:54

might decide not to go to the gym, not to

12:56

eat at your usual times, not to,

12:58

you know, or to go to bed early, or

13:00

basically to just rest more and have more

13:03

passive activity during the day, because you're trying

13:05

so hard to either recover from the bad night,

13:08

or to make sure that you don't have

13:10

it again. But the problem is, is what you're really

13:12

doing is you're teaching your brain to move

13:14

away from what it's used to. So

13:17

where you think your behaviors or your coping

13:19

mechanisms are going to help you with the bad night

13:21

you've just had, they're actually going to reinforce

13:23

the problem, teach your brain that it's okay

13:26

to have this pattern. And you're going to end up

13:28

with more broken sleep, and more broken

13:30

other

13:30

things during the day. Like for example,

13:32

your appetite regulation, your mood regulation,

13:35

I couldn't have said it better myself, you just said it very

13:37

beautifully.

13:38

If you're consistently,

13:40

you know, eating in bed, or

13:42

you're watching TV in bed, your

13:44

brain thinks that's okay.

13:47

And actually, I'm in bed, the bed

13:49

is no longer a sleep chamber. It

13:52

is now the TV room. Yeah,

13:53

it's awake time, it's something and

13:55

I've got to change this person's brain

13:57

chemicals to help them stay awake.

13:59

as we don't realize how important

14:02

or influential our own behaviours

14:04

are, because we think we're being super

14:07

reactive to our bodies,

14:09

but our bodies are being super reactive to us. I

14:11

think the way I describe it to my patients is,

14:14

think of the brain like a small puppy. If

14:16

you've ever had to train a puppy or even a

14:19

baby to sleep or anything like that, you

14:22

will understand that it does take more

14:24

consistency than our usual patients

14:26

or our expectations will allow. And

14:29

so that's when people struggle and fall

14:31

into patterns like insomnia. People think

14:33

that insomnia, for example, which is very

14:35

broken sleep for a

14:38

good proportion of your time, people

14:40

think it's some sort of trigger like stress,

14:43

hormones, new medication, illness,

14:45

something's happened in your life, environmental change.

14:48

And that is true. All of those things

14:50

can impact your sleep. But that's

14:52

actually really normal. And we need to

14:54

normalise that process. If we

14:56

left our bodies alone and we didn't freak

14:59

out and think, oh my God, I've got to change what

15:01

I do because my sleep has suddenly become broken. Probably

15:04

your brain is so smart, it would figure out

15:06

how to get back on track because it's got an underlying

15:09

pattern that it knows well. However,

15:11

we are over promoting sleep

15:14

hacks and things which are never

15:16

going to fix your sleep. Not because they haven't

15:18

come up with the miraculous evidence based sleep

15:20

hack. It's because all

15:23

of those sleep hacks are things that they say

15:26

you just do them either once or a couple of times

15:28

and it's going to completely fix your sleep. But unfortunately,

15:30

it's all about consistency with the right behaviour.

15:33

So what is it we can do

15:35

to allow that pressure to

15:37

build up throughout the day, apart from just staying

15:39

awake as much as possible throughout the day? What can we do? So

15:42

the most important thing is to more

15:44

often than not, and I say this because

15:46

perfectionism is not helpful here either,

15:48

is try to get up around

15:51

about the same time every day. The more

15:53

we lie in and teach our brains

15:55

that actually you want an extra couple of hours

15:57

of sleep and it doesn't even have to be sleep.

16:00

Even if you're just spending more time

16:02

in the bed, sort of not being

16:04

awake, not really being asleep, you're

16:07

confusing your brain and it doesn't really know

16:09

whether to start you feeling hungry and

16:11

alert and all those things. You are confusing it. It doesn't

16:14

really know, it's essentially confusing it. And often

16:16

people believe that lying in is helping them

16:18

feel better, but actually you're only

16:21

perpetuating and reinforcing that horrible

16:23

sleep inertia that you've got. Yeah, grogginess.

16:25

Exactly. Whereas if you wake up around

16:27

about the same time every day or at

16:29

least as much as you can, or more often than you don't,

16:32

you're going to start to notice that the

16:35

way you feel becomes much more predictable. So

16:37

a common sleep hack is people saying,

16:39

you should go to bed at the same time each night. And

16:42

this drives me insane because

16:44

unfortunately the way that most of us interpret

16:46

that information is we actively force

16:49

ourselves to go to bed when we are not

16:51

sleepy. And so what happens is you

16:53

go to the bedroom, a place where there's absolutely

16:56

no stimulus, it's pitch black

16:57

or hopefully it's pitch black.

16:59

And then you wonder why your brain

17:01

starts whirring, especially if you're

17:04

not sleepy. And if you haven't been dealing

17:06

with any of your stress, of course your

17:08

brain, given no stimulus,

17:11

it's going to all come up. Whereas

17:13

if you actually wait until you feel sleepy,

17:15

that's really important. But if you

17:18

really want to start this properly, you start it from the morning.

17:20

So you start waking up around about or

17:22

getting up around about the same time each day, even

17:24

when you've had a bad night. And I promise you

17:27

after a couple of weeks even, if you're fairly

17:29

consistent, you will start noticing that

17:31

your sleepiness becomes way more predictable.

17:33

We spend a lot of time getting anxious

17:36

and worried about not sleeping. And

17:38

I would argue that the effects of that

17:40

anxiety and that stress is way

17:43

more bad for you than a few nights of poor

17:45

sleep. I really don't want this

17:47

information to become like another sleep hack where

17:50

people think that they're being forced to do something

17:52

that they find uncomfortable. It's just

17:54

more often than you don't. We are not saying here that

17:56

lying in every now and again is bad

17:59

for you.

17:59

not the problem. But I'm going to make it a consistent habit.

18:02

Exactly. If you're using these things as

18:04

compensatory habits, that's

18:06

where something is going wrong. If you, every

18:09

weekend, have to lie in by an hour

18:11

or two,

18:12

and during the week you're not giving yourself an opportunity

18:15

that, well, that shows you're not really giving yourself

18:17

a good opportunity to sleep, then that

18:19

is not good for your brain. It does not recover that

18:21

way. To a degree, sleep

18:23

debt is unrecoverable.

18:25

Having all of this

18:27

sleep-related anxiety and the

18:29

popularity of sleep, which is a double-edged sword,

18:32

is the rise of consumer-level

18:35

technology, devices, gadgets, apps,

18:37

et cetera. About 18 months ago,

18:39

I have a friend who's really

18:42

interested in technology and health and

18:44

biohacking. He lives in the US. He's

18:47

a school friend of mine. We were talking

18:50

backwards and forwards for around a year.

18:53

Every night we'd have phone calls because we wanted

18:55

to make a sleep-tracking app, which

18:57

was better than all of the rubbish that's

18:59

out there at the moment. We thought most of these apps

19:01

are sensing the motion

19:04

of the person during sleep and maybe heart

19:06

rates and some noise maybe, which

19:08

is not really a great indication of

19:11

what sleep stage someone is in. Are

19:13

they in deep sleep, et cetera, compared

19:15

to polysaminography, which is looking at brain

19:18

waves, eye motions, breathing rate,

19:20

heart rate, which is much more robust. These

19:23

sleep-trapping apps, probably 20, 30% of

19:26

the time, are not accurate at all. We wanted

19:28

to make a really good one. We found

19:30

a few things which were pretty shocking. Number

19:32

one, the algorithm for this sleep-tracking

19:35

apps are really closely hidden

19:37

from people. Number

19:39

two, the apps that are there at the moment

19:42

are driving anxiety. If

19:44

I have a good sleep tonight and my app says, nope,

19:47

you've not got enough REM sleep or N-REM sleep

19:49

or the non-rapid eye movement sleep

19:51

or you've not got this, you've had a bad night's sleep.

19:54

Then if I'm looking at my app and saying,

19:56

the app is right, I've had terrible sleep,

19:58

even though I feel great, I can't.

19:59

to someone like you, who's a sleep expert with

20:02

a sleep lab and says, can you fix my sleep?

20:04

And you

20:05

thinking this guy's sleeping well, but why is

20:08

he coming to me? Because of these apps, these apps

20:10

are driving anxieties around

20:12

sleep.

20:12

Absolutely. So really, even if

20:15

the apps are entirely accurate,

20:17

they're actually not that helpful. Why are we

20:19

tracking our sleep if there's nothing wrong? And

20:22

if there's something wrong, why are we not going

20:24

to the experts the way that we

20:26

do if we have an eye problem, for example, or a gut

20:28

problem, we go and see someone. But

20:30

again, it's often because sleep was like

20:33

this forgotten area of medicine. And

20:35

so now everyone is chipping into it, which

20:37

is amazing. And technology is improving.

20:39

And I don't think we can poo poo technology

20:42

altogether. I believe that eventually

20:44

we will evolve with it. But that's the

20:46

problem. Our brains have not evolved along

20:48

with the technology. And so yes, okay,

20:50

some numerical figures, okay, that might

20:52

be some sort of some use. And even

20:55

in treatment of insomnia,

20:57

we do in our own way track sleep,

21:00

but actually we don't use trackers.

21:01

You don't give the metrics. You

21:04

give somebody the technology, but you're not really explaining

21:06

to them, do you know what, actually, you're only supposed to get 20%

21:08

of REM. So don't worry. And also, it's not going to be the

21:11

same every single

21:12

night. So forget about

21:14

tracking your non REM, your

21:16

REM, your different stages of sleep and the depth

21:18

you got, because the average

21:21

consumer does not need to know the proportions

21:23

of each one. They fluctuate with individuals,

21:25

they fluctuate throughout the night, the proportions

21:28

change. And actually you need to focus on their habits

21:30

around sleep rather than the

21:33

actual metrics of sleep that your app tells

21:35

you.

21:35

Yeah. I mean, a much simpler way to

21:37

look at it is think I just need to

21:39

keep, I call it your sleep muscle, which

21:42

doesn't really exist, but I call it the sleep muscle. And

21:44

I talk about trying to keep the sleep

21:46

muscles strong.

21:47

Yeah. And I'm a shift worker. I

21:50

do night shifts, I do

21:51

odd unsociable hours, could be 1am

21:53

to 9am in the morning, 9pm to 9am, various shifts. It

22:00

makes me feel sick to even think about it now. As

22:03

a shift worker, there's

22:05

plenty of research out there now which

22:07

suggests that it increases mortality

22:10

of your lifetime, morbidity with increase

22:12

your risk of cancer, increase

22:15

your risk of diabetes, heart disease,

22:17

dementia. This is what the cost

22:20

of shift work is, particularly night shift.

22:23

What are some simple strategies

22:25

that someone could do not to negate them, because it's

22:27

impossible to negate them by stopping doing the shift?

22:30

What are some strategies to delay

22:33

or at least offset a little bit the negative

22:35

effects of shift work?

22:36

So there is still consistency

22:39

to be had. Sorry, it's my favorite word. I can

22:41

use it a lot. Yeah, no, we're all for consistency. When I talk

22:43

to most people who don't do shift work, we're

22:45

asking them to have a regular wake up time,

22:47

right? Well, even if you have to have two

22:50

different wake up times, try and just

22:52

make it two. So there's lots of

22:54

shifts you can have, right? Especially in healthcare.

22:57

But actually when it comes down to it, often

23:00

the sleep opportunity for most

23:02

of them can be around about the same

23:05

time, right? Unless you're on a complete

23:07

day shift to night shift. But even then,

23:09

okay, you've got two different

23:12

sleep shifts as it were. So

23:14

make two regular wake times. Give

23:16

yourself an opportunity that doesn't change

23:19

for sleep. Now, when I say opportunity to sleep, what

23:21

I mean is, let's say you give yourself

23:23

a seven hour window, let's just say.

23:25

It doesn't mean you have to sleep seven hours, but you're giving

23:28

yourself the opportunity. But once

23:30

that opportunity is gone, so that you're

23:32

no longer in those seven hours, you're no longer trying

23:34

to sleep, that's important. Specifically

23:37

for night shift workers, using

23:39

sunglasses for example, when you go home

23:41

in the morning, incredibly

23:44

helpful. And also, though

23:46

this can be incredibly hard, I know because I used to do night

23:48

shifts, try to keep that environment

23:50

that you're sleeping in dark. To be honest,

23:53

if you can open your eyes

23:55

in your bedroom or wherever you sleep and

23:57

you can see stuff, it is not dark anymore.

24:00

enough. So even if you have to use an

24:02

eye mask, it's really important that you

24:04

get that darkness, especially because

24:06

we're not natural nocturnal creatures.

24:09

So you've got to try and fake it, essentially.

24:12

And you can fake it, but you've

24:14

got to try and manipulate your

24:16

environment, or at least have some accessories like

24:18

dark eyeglasses that can help you.

24:20

Light alarms can be helpful here to

24:23

wake you up nicely for a night shift

24:25

instead of a noise, which is quite horrible.

24:28

Also just things in terms of not

24:30

being nocturnal creatures. We don't metabolize

24:32

very well at night, and I'm sure you can

24:34

talk about this more than I can, but I

24:37

wouldn't suggest that people are eating very,

24:39

very heavy meals at night time.

24:41

When I first started night shifts as a

24:43

first year doctor, I really struggled

24:45

because I'd never done it before and I wasn't used to

24:47

it. But over time, manipulating

24:50

a few things. So I'd manipulate

24:52

the temperature, and this probably is

24:55

good for anyone sleeping anyway. When

24:57

we're going to sleep, our natural core body temperature

25:00

is dropping. So to assist

25:02

in that, keeping a chill, coldish

25:05

room may help you get to sleep faster. So

25:08

when I was on the shift, I would try

25:10

to wrap up warm fleeces

25:12

and whatnot when I could to keep myself

25:14

alert and warm. And then when I get

25:17

back home, be cool. And finally, the

25:20

other thing is you mentioned mail times there as well.

25:22

Now, a lot of people think when

25:25

night shift is like jet lag, but the difference

25:27

is when you have jet lag in a different environment, you

25:30

have access to that environment light.

25:32

On a night shift, you have no light. So it's

25:34

not jet lag. It's just somewhere

25:37

where you shouldn't

25:39

eat

25:40

in this new shift zone. You

25:42

should actually, well, I found

25:44

it works for me anyway, keep your normal

25:47

eating patterns.

25:48

And that somehow, probably due

25:50

to the interaction between the, you know,

25:53

the clocks in the gut and the brain or whatever,

25:55

it helps to almost stabilize

25:57

the fluctuations in your sleep.

25:59

a really good one and I wish I had known that when I was doing

26:02

night shifts back in the day because I was thinking, yeah,

26:04

I mean, I did not handle them well. That's one of the reasons

26:07

why I loved learning about sleep

26:09

because, you know, if I had

26:11

known how to do it better, I would have.

26:12

So before obviously, you

26:15

know, meeting and talking to you today, I put

26:17

out a story on my Instagram, just reaching

26:19

out to people, you know, who follow

26:21

me and come in with their sleep

26:24

questions. And there are literally hundreds

26:26

and hundreds of questions. So I'm going to pick

26:28

a few and let's just

26:30

chat about them. So

26:32

Clancy Isn't Dead asks,

26:35

scientific explanation behind sleep paralysis.

26:39

Okay, so sleep paralysis is

26:41

where essentially your body has

26:43

not woken up with your brain and

26:46

you can have it at various times. Now, sleep

26:48

paralysis is usually either a sign of

26:52

other sleep disorders or

26:54

more commonly, I see sleep

26:56

paralysis when sleep is quite

26:59

broken. We're not really regulating

27:01

it very well. So our behaviours around our sleep aren't very

27:04

good. Alcohol and caffeine

27:06

can be unhelpful when it comes to sleep

27:08

paralysis.

27:09

And

27:10

essentially, some people seem

27:12

to have a genetic predisposition to

27:15

having sleep paralysis when

27:17

their sleep is broken or when they're going through stress

27:19

or when they're not looking after their sleep properly. So

27:22

some of us might have night terrors. So

27:24

night terrors are where people sort of wake up screaming

27:27

and either hallucinate that there's often

27:29

it's a spider or something like that.

27:31

Other people might have sleepwalking,

27:34

sleep talking, some people will have

27:36

sleep paralysis. It is sometimes a sign

27:39

of another type of condition called narcolepsy,

27:42

but that is more of an unusual condition to

27:44

have. So

27:44

sleep paralysis is basically a software

27:47

glitch where, you know, the body's

27:50

lagging behind the brain. That's actually

27:52

fascinating. I could sit here talking hours

27:54

about sleep and I'm sure neither of us would

27:56

fall asleep at that conversation. And hopefully, you

27:58

know, the listeners have taken away some important stuff

28:01

and aren't falling asleep. And actually, I

28:03

sort of hope they are falling asleep, given

28:05

what we're talking about. Before we wrap up here,

28:07

you had a question for me.

28:09

I did. So it's kind

28:11

of a two-parter. One was,

28:13

so what made you

28:16

become a surgeon? What makes you wake

28:18

up every morning and do the job that you do?

28:20

Really good questions, actually. So

28:23

reason why I became a surgeon

28:25

is I knew I always wanted to do

28:28

something with my hands. So maybe

28:31

a gastroenterologist who's doing

28:33

gastroscopies or colonoscopies, putting

28:35

cameras down people's throats, her bottom ends.

28:38

But the medical side of things

28:41

and doing ward rounds and

28:43

medicine where it

28:45

was a lot of trial

28:46

and error, umming and auring,

28:48

and let's try these antibiotics. They don't

28:50

work. Let's try these ones, or let's do these

28:53

blood tests and figure out what's going on. It was

28:55

a lot of pondering

28:58

and it was a very slow-paced environment.

29:01

When I got a taste of surgery and

29:03

the immediacy of the results that you

29:05

see, for example, someone comes

29:08

in with appendicitis. They are

29:10

very sick. You see them, you

29:12

figure out immediately within five or 10 minutes

29:14

what's going on with them. You take them to the

29:17

operating room, you cut out their

29:19

appendix, you wash them out inside,

29:21

and then literally hours later they feel great

29:24

and they go home the next day. For

29:26

me, the immediate impact

29:28

of seeing that and what surgery could

29:30

do was astounding. And also the

29:32

fact that in general

29:34

surgery, specifically what I deal with, I

29:37

find that even surgeons, my bosses

29:40

who are in their 60s, are still

29:42

flummoxed with a problem every now and then,

29:44

which for me I love, which truly

29:47

means you are learning lifelong and

29:49

you are never, you know, there's

29:51

always another barrier, another peak

29:53

to overcome. So that's why I

29:56

got into surgery. I love the hands-on and

29:58

the immediate fast-paced environment. bit

30:00

of an adrenaline junkie, you could say. And

30:03

I found that my why is

30:06

disseminating accurate information, but

30:08

also just educating myself. I'm not going to sit

30:10

here and give you the cheesy

30:14

corny lines that everyone

30:16

standing for medical school interviews is, oh, I love to

30:19

just help patients. I want to help society

30:21

and that. Yes, but I'm also, there's

30:23

a more selfish reason as well. I just

30:25

love learning stuff. I'm already

30:28

changing the way I'm thinking about certain

30:30

things and dogmatic views I had. So

30:32

again, I've learned something.

30:34

Great. I'm glad. Yeah. So Stephanie,

30:37

thank you again so much for coming. Thank you so much

30:39

as well. I hope you sleep well tonight and I hope

30:41

I sleep well tonight. But the key is no

30:44

pressure. No pressure.

30:47

If you want to check out what Stephanie does, she

30:49

is the CMO of the ReSleep Clinic.

30:51

That's re-sleep.com.

30:56

Now this segment is nothing to do with ducks,

30:58

but it's got plenty to do with quacks

31:01

and quackery and useless misinformation

31:03

out there. I'm going to dispel all of those

31:05

myths that you think are true, which

31:08

are completely false and give you

31:10

the pure science behind the actual

31:12

health.

31:13

So

31:16

here we go with the first one. Night owls

31:18

and people who stay up all night are

31:21

lazy.

31:22

Now this is a whole can of worms.

31:24

Clearly people have different chronotypes.

31:27

This is different sleeping patterns.

31:29

You might've heard of phrases and terms

31:31

like night owl, morning lark,

31:33

et cetera. Now when someone

31:35

is a night owl, this means they're

31:38

in line, their body is in line with

31:40

a sleeping pattern, which has them go

31:42

to sleep later because they feel tired

31:45

later on, maybe past midnight, past

31:47

1am and they have to wake up

31:49

later in the morning, maybe 9, 10, 11am.

31:53

This is normal. This is part of

31:55

their normal genetics. We have,

31:57

as we mentioned in the episode, clock gene.

33:59

thousands and thousands of people.

34:01

This week's question is from Elizabeth and she's

34:03

asking about IBS.

34:05

How

34:31

do I actually achieve the recommended 5

34:34

to 10 a day when

34:35

I have to have a low fiber diet? I'd

34:38

really appreciate your help. Thank you.

34:40

Elizabeth, thank you so much for that really

34:42

insightful question. And I know tons

34:45

of other people have asked me similar questions about

34:47

IBS, about fiber in their

34:49

diet as well. So this is a really, really

34:51

topical one. Good question. And just

34:54

before I go ahead with my answer, I

34:56

just want to emphasize as well, this is for

34:58

educational purposes only. This is

35:00

not medical advice. So hopefully

35:03

the information I'm about to give you will help in some way, but

35:06

use it as a springboard to do your own

35:08

research and always consult with your

35:10

own doctor before you do anything.

35:12

Now, Elizabeth, IBS and for anyone else listening

35:14

as well, IBS Irritable Bowel

35:17

Syndrome is a very complex topic. You

35:19

may have heard of some of the classic

35:22

symptoms of bloating, chronic

35:24

abdominal pain, you know, erratic

35:26

bowel habits, which may involve constipation,

35:29

may involve loose stool or diarrhea or

35:31

a combination of both, you know, flitting between

35:34

both on a daily basis, on a weekly

35:36

basis. It is very complex and

35:38

there are lots of subtypes. The first

35:40

thing I want you to make sure is

35:42

that you've actually got a formal

35:44

diagnosis of irritable bowel syndrome. There

35:47

are lots of conditions that mimic

35:50

IBS and that IBS mimics as well. Things

35:52

like colitis, inflammatory bowel

35:55

disease, where you may have inflammations

35:57

of your entire colon or various other

35:59

parts of your colon. your digestive tract. So,

36:01

you know, whatever bowel symptoms you're having,

36:04

if they're chronic, go and see a doctor.

36:06

They may want to organize, you know, certain

36:08

tests for you, blood tests, a

36:10

history, an examination, and

36:13

that may help clear up what you're suffering

36:15

with. Now, let's get into the details

36:17

about IBS and your question specifically

36:20

about a low-fiber diet in IBS.

36:23

My take on that is that people

36:25

with IBS, humans generally,

36:27

do not need a low-fiber diet.

36:30

The problem with IBS is

36:32

that there are certain types of fiber

36:35

which might trigger your symptoms even

36:37

more, and there are certain types of food,

36:40

foods which are traditionally known as high

36:43

in FODMAPs. Now, people with

36:45

IBS and humans in general mostly

36:47

do not need a low-fiber

36:49

diet unless you've specifically

36:52

undergone recent bowel surgery or

36:54

there is a specific condition that you're suffering

36:56

with, a flare-up of inflammation

36:58

of your colon, certain things like that. But

37:01

a low-fiber lifelong diet

37:03

generally for most people, even

37:06

with IBS, is not recommended.

37:08

The problem comes with the type

37:10

of fibers and the type of food

37:12

that you might be consuming. Most people

37:14

with IBS find that there are certain foods

37:17

which are traditionally known as high

37:19

FODMAP foods which trigger their

37:21

symptoms and make it worse.

37:24

FODMAP foods could include those things

37:26

which your bacteria can feast on and digest

37:28

and ferment which causes bloating,

37:30

cramps and all of those traditional IBS

37:33

type symptoms. So you still

37:35

need to be getting a good amount of fiber.

37:37

I usually recommend to my patients when

37:39

I see them in clinic to be aiming for at least 25

37:42

to 30 grams of fiber a

37:44

day, both a combination of insoluble

37:46

fibers and soluble fibers. But

37:49

low FODMAP vegetables which have

37:51

plenty of fiber which you can think about

37:54

including include some of these things.

37:56

Bean sprouts, carrots, chives,

37:59

cucumbers, eggplant, ginger,

38:01

as a bunch of things. Look up on Google

38:04

vegetables that have a low FODMAP.

38:06

Similarly, look up low FODMAP

38:08

fruits online so you can get a list of all

38:10

of these food and fruits which have plenty

38:12

of fiber but also will be

38:15

less likely to trigger some of your symptoms. If

38:17

you have IBS and you've got a chronically

38:20

low fiber diet, long term that

38:22

is going to worsen your symptoms because it can increase

38:24

the risk of you having constipation, worsen

38:27

your diarrhea and lose stool potentially. So

38:30

definitely stay away from a low

38:32

fiber diet and even if

38:34

you introduce higher amounts of dietary

38:36

fiber, start low and

38:39

go slow. Additionally, if you're struggling

38:41

to really find foods which you know

38:44

are going to add to your fiber content, it's

38:46

been proven in studies that fiber supplements,

38:48

also known as functional fiber, things

38:51

like psyllium husk, can help

38:53

to relieve symptoms. Now it must

38:55

be noted that some of these fiber supplements

38:58

may not have the entire nutritional

39:00

package and added benefits as real

39:02

foods but they will still go some way to

39:05

improving some of your symptoms. Elizabeth,

39:07

again I want to thank you for that question and I hope this

39:09

can help in some way. I

39:11

know dealing firsthand with patients who

39:14

have chronic abdominal pain, this can be a real

39:16

nightmare. So hopefully you can learn

39:18

something from this, take it away, apply it to your

39:21

life. If you'd like to ask a question just

39:23

like Elizabeth, feel free to get in touch at

39:25

thereferralpod.com. Now this

39:27

was the first time someone's got in

39:29

touch with a voice note so

39:32

I loved that. I loved hearing from you guys

39:34

so you know going forwards in the future,

39:36

please feel free to send your own

39:39

voice note in so I can hear your voice and it'll

39:41

almost be like a little virtual consultation

39:44

but obviously for educational purposes only. This

39:47

has been a Sony Music Production. Production

39:49

management was Jen Mystery. Videos by

39:51

Ryan O'Meara, DOP Charlie

39:54

Moore. Studio engineer was Ed Gill.

39:56

Music by Josh Carter. Grace

39:58

Lakewood and Hannah Talbot were the producers and

40:01

Gaynor Marshall and Chris Skinner are the executive

40:03

producers. If you enjoyed this

40:05

podcast, you are going to love more.

40:08

So for even more actionable tips, hit

40:10

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40:12

if you enjoyed it, which I know you did, a five-star

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40:16

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40:16

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