Have you ever woken up in the night and felt anxious? Ever been desperate to improve your sleep quality? Wanted to not feel tired during the day? Look no further...  



Karan talks to Sleep Physiologist, CMO & co-founder Re-sleep Stephanie Romiszewski about how to get the best night's sleep, night shifts and maximising sleep, sleep paralysis and busting all common preconceptions around sleep. 



Karan also brings you ‘What The Health’, the latest in health and science in the news, and he answers YOUR questions in ‘Crowd Science’.  



If you have your very own question and want to get in touch, simply head to TheReferralPod.com.



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And you're probably sitting there wondering, why the hell does a hospital doctor have a podcast?

So in an average day, I can probably see 10, 15, 20 patients at most.

I wanna reach tens of thousands, maybe even millions.

And that's the advantage with this podcast.

I can give you actionable advice and tools after speaking with experts every week to give you advice that you can take home and hopefully improve your health, improve your health literacy and help you take a greater ownership of your body and your life so you're not led astray by all of these online health scammers that's trying to sell you crazy pills and diets and potions and remedies that you frankly just don't need.

Today's topic is 1 of the most important topics I'm ever going to cover.

This is the single most important thing that you do every single day of your life.

As a surgeon, I know all too well how important sleep is.

I'm sometimes operating a few millimeters or less away from organs and blood vessels and nerves that should never be cut.

And if my sleep is bad, then that's potentially bad news for the patient, which is why I always try to prioritize my sleep before I'm operating.

Now, we're gonna be talking in this episode about why sleep is important, the things that you're doing right now and every night for the last few years that's probably tanking your sleep.

And we're also gonna be giving you strategies on how to improve your sleep and all the sleep myths that's leading you astray.

She is a sleep expert that helps people retrain their brains so they can sleep better and hopefully live better lives.

Often people believe that lying in is helping them feel better, but actually you're only perpetuating and reinforcing that horrible sleep inertia

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

Crowd Science is your opportunity to ask me a question.

I've suffered for decades, pain so bad that I actually faint.

If you want to ask me questions, get in touch, leave a voice note, email, anything you want at thereferralpod.com.

And before I talk to Stephanie, it's time for What the Health is going on in the world of science, medicine and health.

A dog helped a woman discover she had breast cancer.

A 50-year-old woman in Nottinghamshed said her 2-year-old collie cross dog, Luna, started jumping and pawing at her right breast last April.

And for whatever reason, she decided to get checked out, she went to her doctors, and she ended up having a biopsy of the right breast and it turned out to be cancer.

Now I would not recommend using your furry friend as a cancer detection tool, but I was intrigued, can we use dogs as cancer detection tools?

All smells that you can smell are basically a result of molecules in the air, from freshly cut grass to the smell of stinking s**t.

These volatile chemicals or molecules are detected by the smell receptors or the olfactory receptors in our nose which connect to our brain.

Dogs have a more keen sense of smell than humans because they have more of these olfactory neurons or these smell receptors in their nose.

So they can pick up delicate notes of certain chemicals at a far greater sensitivity than us humans.

And we also know that certain tumors produce these volatile chemicals—lung cancer, breast cancer, melanoma, these certain types of skin cancer—so presumably those volatile chemicals produced by those tumors or associated with those tumors are being picked up by canines.

And people have studied dogs for their use at detecting cancer and most of the studies suggest that dogs are indeed better than just pure chance at picking up cancer.

But it's nowhere near 100% and don't get me wrong, no cancer detection test is 100% but the additional cost of training dogs, housing dogs and the false positives and false negatives you get is just not worth the risk.

And it's still not clear from the research whether these dogs are picking up these special molecules that are associated with the tumor or just molecules associated with general illness.

And there's also the chance they can be confused with other scents and other smells from things that we've eaten, for example garlic or other factors like tobacco smoke.

Dogs are also unable to tell humans which molecules they're smelling and which molecules may be associated with the disease they're picking up.

But the information we've gained from canine cancer detection isn't all a waste.

We can hopefully make molecular tests which can help identify certain molecules and chemicals with certain compounds and use AI, we can use electronic noses which can actually detect these chemicals and help us figure out what type of state of illness or disease or cancer a patient may have.

And that is a wrap for what the health is going on in the world of science, medicine and health.

I'm Cameron Esposito and I have a lot of jobs.

I'm an actor, you've seen me on ABC's A Million Little Things.

I'm a standup comic, bestselling author but I am no expert at survival.

On my new podcast, Survivor Die Trying, we're going to learn together from shark attacks to tsunamis and bad breakups.

This is your 1 stop shop to prepare for the absolute worst case scenario.

Join me and some special guests on Survivor Die Trying, a comedy podcast that prepares you for anything.

Listen and follow wherever you get your podcasts.

She's worked with Harvard University, the NHS to help all people who struggle with sleep.

Stephanie, thank you very much for making the long trip to London and, you know, agreeing to chat about all things sleep.

I'm very well, thank you so much for having me.

I'm always happy to talk about my favourite subject.

Brilliant, it's my favourite subject and my favourite hobby as well.

So, Stephanie, you worked at Harvard University, you know, We've got about these 50, 000 neurons, a pea-sized shape, called the suprachiasmatic nucleus, which is the granddaddy, the grandfather clock, which trains all the other billions of clocks that we have in each of our cells in our body, the peripheral clocks, and they communicate with the master clock in our brain, like a lead of an orchestra, the maestro leading all the different players playing their instruments, and there's that feedback between the 2, which eventually gives rise to this 24-hour oscillating sleep-wake cycle when we need light, dark, etc.

Now, what are some absolute basics that someone would need just to have basic decent sleep.

So in order to sleep well there are a few things that we need and it's kind of around about the drive to sleep.

So we have a drive that we build up a pressure to sleep and the only way to build that is to be awake Ironically since people are quite frightened of spending more time awake when actually it leads to sleep So 1 thing we need is a good timing of a sleep-wake cycle so we need enough pressure in order to sleep well at night, so we have to actually spend a certain amount of hours awake and then what we need is a good light-dark cycle just to give our body the cues it needs to sleep and the cues it needs to be awake.

When we're in darkness, this encourages our cues for melatonin, which is a sleepy hormone, which helps us to sleep.

And when we're in the light, it helps suppress melatonin, which helps us to stay awake amongst other things.

So having a good light-dark cycle is quite important.

But as you can imagine, as technology has improved, our sort of natural sleep-wake cycle that kind of goes along with the way the Earth is and the 24-hour cycle that we have, it's been more and more difficult for us to do that.

And that's why I think sleep has become a bit more popular now, because actually we need to learn how to do this properly if we're going to keep manipulating our environment so that the light-dark cycles are quite different from what we need.

So I just think it's a bit weird, almost like a biological twist, a glitch of nature that we need the light to, you know, start the timer and, you know, set up us for the day.

But equally, we need lots of light in the morning.

But even a tiny bit of light in the evening is hugely detrimental.

Why, number 1, why do you think, and would you, if you agree, I don't even know if you'd agree, is your wake-up routine far more important than your sleep routine?

The light is incredibly important, but setting a very specific time to wake up, for example, is quite important because then your brain understands when to build that pressure to sleep every day.

So your sleep-wake cycle, a circadian rhythm, it literally means around 24 hours.

And so If you're doing that around the same time every day, what happens is you build a pressure up which is fairly predictable.

When you feel sleepy, it becomes fairly predictable in the evening because of the time you woke up.

For sure, light is going to reinforce this habit.

Light is so good at helping you to feel awake and to set that kind of goal post, I guess you could call it.

I would say though that when it comes to actually having light in the evening, yes, for sure, sort of overexposing yourself to light can definitely shift your sleep-wake cycle in time.

The actual effects of having a little bit of very bright light before you go to bed on a given occasion isn't necessarily going to, for example, delay your sleep onset significantly, but it's our habits over time.

And that's where I do my work really, is trying to help people understand that when it comes to your sleep, it's your habits, your behavior over time, which is gonna set that metronome.

It's gonna consistently help you predict what your body wants to do and what it needs to do, and when you're gonna feel sleepy and when you're gonna feel awake.

And that's not just with your sleep, that's with your appetite hormones, that's with your mood regulation, that's with your temperature regulation.

So actually your sleep-wake cycle and the behaviors you have around your sleep-wake cycle are going to impact other patterns or rhythms that you have, your physiological rhythms, which is fascinating.

It's going back to that same analogy of that grandfather clock in the brain feeding into and having a sort of a bi-directional chat with the clock in your intestines, the clock in your pancreas, in your liver, which determines what hormones your gut releases at certain times.

Which is why I always tell people, you know, I'm obviously a bowel surgeon, When I tell patients similarly, when you have a sleep routine, you also need to have a bowel routine because if you go to the toilet every day for a number 2 at 8 a.m., chances are every single day, because the, you know, you've woken up at a certain time, that triggers a cascade or a domino effect of hormones throughout the body that tells you, okay, you've woken up at 7am, I'm going to make you hungry at 7.30, I'm going to start your bowels getting in motion at 8, I'm going to make you more energetic at nine." Because actually, exactly like you said, that wake up time is almost the starting point, the starting flag, which says, okay, all systems go, all the hormones are going to be synchronised at this exact time.

And that's how we talk about it in sleep as well.

But I think the reason that as humans we struggle with this concept is because we are sort of born in this very reactive society.

So we expect to see results very quickly.

Let's just say you have a bad night's sleep and you make decisions based on your bad night.

So for example, you might lie in, you might decide not to go to the gym, not to eat at your usual times, or to go to bed early, or basically to just rest more and have more passive activity during the day because you're trying so hard to either recover from the bad night or to make sure that you don't have it again.

But the problem is is what you're really doing is you're teaching your brain to move away from what it's used to.

So where you think your behaviours or your coping mechanisms are going to help you with the bad night you've just had, they're actually going to reinforce the problem, teach your brain that it's okay to have this pattern, and you're going to end up with more broken sleep and more broken other things during the day, like for example your appetite regulation, your mood regulation.

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

If you're consistently eating in bed or you're watching TV in bed, your brain thinks that's okay and actually I'm in bed, the bed is no longer a sleep chamber, it is now the TV room.

Yeah, it's awake time, it's something and I've got to change this person's brain chemicals to help them stay awake as we don't realise how important or influential our own behaviours are because we think we're being super reactive to our bodies, but our bodies are being super reactive to us.

I think the way I describe it to my patients is, think of the brain like a small puppy.

If you've ever had to train a puppy or even a baby to sleep or anything like that, you will understand that it does take more consistency than our usual patients or our expectations will allow.

And so that's when people struggle and fall into patterns like insomnia.

People think that insomnia, for example, which is very broken sleep for, you know, a good proportion of your time, people think it's some sort of trigger like stress, hormones, new medication, illness, something's happened in your life, environmental change.

All of those things can impact your sleep.

But that's actually really normal and we need to normalize that process.

If we left our bodies alone and we didn't freak out and think, oh my God, I've got to change what I do because my sleep has suddenly become broken.

Probably, your brain is so smart it would figure out how to get back on track because it's got an underlying pattern that it knows well.

However, we are over promoting sleep hacks and things which are never going to fix your sleep.

Not because they haven't come up with the miraculous evidence-based sleep hack.

It's because all of those sleep hacks are things that they say you just do them either once or a couple of times and it's gonna completely

But Unfortunately, it's all about consistency with the right behavior.

So what is it we can do to allow that pressure to build up throughout the day, apart from just staying awake as much as possible throughout the day?

So the most important thing is to more often than not, and I say this because perfectionism is not helpful here either, is try to get up around about the same time every day.

The more we lie in and teach our brains that actually you want an extra couple of hours of sleep, and it doesn't even have to be sleep.

Even if you're just spending more time in the bed, not being awake, not really being asleep, you're confusing your brain and it doesn't really know whether to start you feeling hungry and alert and all those things.

It doesn't really know, you're essentially confusing it.

Whereas if you wake up around about the same time every day, or at least as much as you can, or more often than you don't, you're gonna start to notice that the way you feel becomes much more predictable.

So a common sleep hack is people saying, you should go to bed at the same time each night.

And this drives me insane because unfortunately, the way that most of us interpret that information is we actively force ourselves to go to bed when we are not sleepy and so what happens is you go to the bedroom, a place where there's absolutely no stimulus, it's pitch black or hopefully it's pitch black and then you wonder why your brain starts whirring, especially if you're not sleepy and if you haven't been dealing with any of your stress, of course your brain, given no stimulus,

Whereas if you actually wait until you feel sleepy, that's really important.

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

So you start waking up around about or getting up around about the same time each day, even when you've had a bad night.

And I promise you, after a couple of weeks, even if you're fairly consistent, you will start noticing that your sleepiness becomes way more predictable.

We spend a lot of time getting anxious and worried about not sleeping, and I would argue that the effects of that anxiety and that stress is way more bad for you than a few nights of poor sleep.

I really don't want this information to become like another sleep hack where people think that they're being forced to do something that they find uncomfortable.

We are not saying here that lying in every now and again is bad for you.

If you're using these things as compensatory habits, that's where something is going wrong.

If you every weekend have to lie in by an hour or 2 and during the week you're not giving yourself an opportunity that, well that shows you're not really giving yourself a good opportunity to sleep, then that is not good for your brain.

To a degree, sleep debt is unrecoverable.

Driving all of this sleep-related anxiety and the popularity of sleep, which is a double-edged sword, is the rise of consumer-level technology, devices, gadgets, apps, etc.

About 18 months ago, I have a friend who's really interested in technology and health and biohacking.

And we were talking, you know, backwards and forwards for around a year.

And every night we'd have phone calls because we wanted to make a sleep tracking app, which was better than all of the rubbish that's out there at the moment.

We thought, you know, most of these apps are using, you know, sensing the motion of the person during sleep and maybe heart rates and some noise maybe, which is not really a great indication of what sleep stage someone is in, are they in deep sleep, etc., compared to polysomnography, which is looking at brain waves, eye motions, breathing rate, heart rate, so which is much more robust.

These sleep trapping apps, you know, probably 20-30% of the time, not accurate at all.

And we found a few things which were pretty shocking.

Like number 1, the algorithm for the sleep tracking apps are really closely hidden from people.

And number 2, the apps that are there at the moment are driving anxiety.

Because if I have a good sleep tonight and my app says, nope, you've not got enough REM sleep or NREM sleep or the non-rapid eye movement sleep or you've not got this, you've had a bad night's sleep.

And then if I'm looking at my app and saying the app is right, I've had terrible sleep, even though I feel great, I come to someone like you who's a sleep expert with a sleep lab and says, can you fix my sleep?

And you thinking, this guy's sleeping well, but why is he coming to me?

Because of these apps, these apps are driving anxieties around sleep.

So really, even if the apps are entirely accurate, they're actually not that helpful.

Why are we tracking our sleep if there's nothing wrong?

And if there's something wrong, why are we not going to the experts the way that we do if we have an eye problem, for example, or a gut problem?

But again, it's often because sleep was like this forgotten area of medicine.

And so now everyone is chipping into it, which is amazing and technology is improving.

And I don't think we can poo-poo technology altogether.

I believe that eventually we will evolve with it.

Our brains have not evolved along with the technology.

And so, yes, okay, some numerical figures, okay, that might be some use.

And even in treatment of insomnia, we do in our own way, track sleep, but actually we don't use trackers.

You give somebody the technology, but you're not really explaining to them, do you know what, actually you're only supposed to get 20% REM, so don't worry.

And also it's not going to be the same every single night.

So forget about tracking your non-REM, your REM, your different stages of sleep and the depth you got, because the average consumer does not need to know the proportions of each 1.

They fluctuate with individuals, they fluctuate throughout the night, the proportions change.

And actually, you need to focus on the habits around sleep rather than the actual metrics of sleep that your app tells you.

Yeah, I mean, a much simpler way to look at it is think, I just need to keep, I call it your sleep muscle, which doesn't really exist, but I call it the sleep muscle.

And I talk about trying to keep the sleep muscle strong.

You know, I do night shifts, I do odd, unsociable hours, could be, you know, 1am to, you know, 9am in the morning, 9pm to 9am, various shifts, and it makes me feel sick to even think about it now.

As a shift worker, you know, there's plenty of research out there now which suggests that it increases mortality over your lifetime, morbidity with increase your risk of cancer, increase your risk of diabetes, heart disease, dementia.

This is what the cost of shift work is, particularly night shift.

What are some simple strategies that someone could do, not to negate them, because it's impossible to negate them bar stopping doing the shift.

What are some strategies to delay or at least offset a little bit the negative effects of shift work?

When I talk to most people who don't do shift work, we're asking them to have a regular wake up time, right?

Well, even if you have to have 2 different wake up times, try and just make it 2.

So there's lots of shifts you can have, right?

But actually, when it comes down to it, often the sleep opportunity for most of them can be around about the same time, right?

Unless you're on a complete day shift to night shift.

But even then, okay, you've got 2 different sleep shifts, as it were, so make 2 regular wake times.

Give yourself an opportunity that doesn't change for sleep.

Now when I say opportunity to sleep, what I mean is, let's say you give yourself a 7 hour window, let's just say.

It doesn't mean you have to sleep 7 hours, but you're giving yourself the opportunity.

But Once that opportunity is gone, so that you're no longer in those 7 hours, you're no longer trying to sleep.

Specifically for night shift workers, using sunglasses, for example, when you go home in the morning, incredibly helpful.

And also, though this can be incredibly hard I know because I used to do night shifts, try to keep that environment that you're sleeping in dark.

To be honest, if you can open your eyes in your bedroom or wherever you sleep and you can see stuff, it is not dark enough.

So even if you have to use an eye mask, it's really important that you get that darkness especially because we're not natural nocturnal creatures.

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

And you can fake it, but you've got to try and manipulate your environment or at least have some accessories like dark eyeglasses that can help you.

Light alarms can be helpful here to wake you up nicely for a night shift instead of a noise, which is quite horrible.

Also, just things in terms of not being nocturnal creatures.

We don't metabolise very well at night, and I'm sure you can talk about this more than I can, but I wouldn't suggest that people are eating very, very heavy meals at night time.

When I first started night shifts as a first year doctor, I really struggled because I'd never done it before and I wasn't used to it.

But over time, you know, manipulating a few things.

So I'd manipulate the temperature, and this is probably is good for anyone sleeping anyway.

You know, when we're going to sleep, our natural core body temperature is dropping.

So to assist in that, keeping a chill, coldish room may help you get to sleep faster.

So when I was on the shift, I would try to wrap up warm, you know, fleeces and whatnot when I could to keep myself alert and warm.

And finally, the other thing is you mentioned meal times there as well.

Now, a lot of people think when night shift is like jet lag, but the difference is when you have jet lag in a different environment, you have access to that environment's light.

So it's not jet lag, it's just somewhere where you shouldn't eat in this new shift zone.

You should actually, well, I found it works for me anyway, keep your normal eating patterns, And that somehow, probably due to the interaction between the, you know, the clocks and the gut and the brain or whatever, it helps to almost stabilize the fluctuations in your sleep.

And I wish I had known that when I was doing night shifts back in the day because I was thinking yeah I mean I did not handle them well that's 1 of the reasons why I loved learning about sleep because you know if I had known how to do it better I would have.

So before obviously you know meeting and talking to you today I put out a story on my Instagram just reaching out to people you know who follow me and come in with their sleep questions and there are literally hundreds and hundreds of questions.

So I'm going to pick a few and let's just chat about them.

So Clancy Isn't Dead asks, scientific explanation behind sleep paralysis?

Okay, so sleep paralysis is where essentially your body has not woken up with your brain and you can have it at various times.

Now, sleep paralysis is usually either a sign of other sleep disorders, or more commonly, I see sleep paralysis when sleep is quite broken.

We're not really regulating it very well.

So our behaviours around our sleep aren't very good.

Alcohol and caffeine can be unhelpful when it comes to sleep paralysis.

Essentially, some people seem to have a genetic predisposition to having sleep paralysis when their sleep is broken or when they're going through stress or when they're not looking after their sleep properly.

So night terrors are where people sort of wake up screaming and either hallucinate that there's, often it's a spider or something like that.

Other people might have sleepwalking, sleep talking.

It is sometimes a sign of another type of condition called narcolepsy, but that is more of an unusual condition to have.

So Sleep paralysis is basically a software glitch where the body's lagging behind the brain.

I could sit here talking hours about sleep and I'm sure neither of us would fall asleep at that conversation.

And hopefully, the listeners have taken away some important stuff and aren't falling asleep.

And actually, I sort of hope they are falling asleep, given what we're talking about.

Before we wrap up here, you had a question for me.

1 was, so What made you become a surgeon?

What makes you wake up every morning and do the job that you do?

So reason why I became a surgeon is I knew I always wanted to do something with my hands.

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Sleep Myths Exposed!