Module 2: Common sleep problems and causes transcript.

 

Acknowledgement [00:00:00]

Medibank acknowledges the traditional owners and custodians of the land in which we record this audio file, the Wurundjeri Woi- wurrung and Bunurong peoples of the East Kulin Nations. We pay our respect to their Elders past and present and extend that respect to all Aboriginal and Torres Strait Islander peoples today.

Dr Chris Robinson [00:00:17]

Ready, set, sleep. Your body does incredible things while you sleep, which sets you up to be the best version of you possible. I'm Dr Chris Robinson, Chief Medical Officer at Medibank, and with me is Health Psychologist and CEO of the Sleep Health Foundation, Dr Moira Junge. In this episode, we'll discuss common sleep issues and causes, and when it might be time to seek advice from a health professional about your sleep.

Dr Moira Junge [00:00:50]

Until recently, a lot of people didn't even know they could sort of get information about their sleep. I want people to know you can come forward and ask questions about their sleep. I want people to know you can come forward there is help out there.

Dr Chris Robinson [00:00:59]

So, Moira, we hear a lot about different types of sleep issues. Can you tell us about what some of the common ones are, and how people experience them, and what might be causing them?

Dr Moira Junge [00:01:13]

Yeah, it's such an array of different types of sleep problems. Sometimes it's difficulty getting to sleep, might be difficulty staying asleep, waking too early, waking unrefreshed. Some people get too much sleep. There's a term called hypersomnia. Sometimes it can be like a snoring kind of respiratory-related sleep disturbance. That's what's keeping people awake or keeping people sleepy during the day. So there's sort of a... You know, it's a big range, and it depends on people's ages. It depends on sex differences as well. We know that women are more likely to report sleep problems, but we're not entirely sure whether there are true sex differences or whether they're just actually just more likely to be help-seeking and less sort of worried that it's not too soft, you know, not stigma and shame of, you know, talking and seeking help for sleep problems. So, there's several factors. I mean, we haven't even started with the lifestyle. It can be sometimes it's shift work. It can be, you know, racing mind and mental health conditions or just, you know, stress and anxiety, jet lag, of course, hormonal changes, you know, it's at different stages of life, of course, ache and pains, you know, it's a big one for keeping people awake at night. So, from the very young baby right through to the teenager to the older person, there's just the factors that contribute to the disrupted sleep change. And so, it's multi-pronged. It's varied. And it's very, there's a lot of individual variation.

Dr Chris Robinson [00:02:43]

Yeah, that's so interesting. And would I be right in saying there's probably, you know, those intrinsic things. So, it could be think something that is happening to you. And that might be an illness like that's causing pain. It might be an illness that's causing difficulty with your breathing. Or it might just be, you know, jet lag, as you said. But then there's those environmental things, so the things that are outside of the body that are also contributing. And in some cases, I imagine it's probably both.

Dr Moira Junge [00:03:07]

Yeah, absolutely. It's, we know that there is a lot of genetic predispositions to it. Like, you know, some people just sort of, that's their personality type or the way their mouth and jaw are, that they're going to be more likely to be snorers, that kind of thing. And it's interesting you raise that point around some of the individual sort of intrinsic factors or the external ones. Because we know that even though we encourage people to have, you know, some control over their sleep, a lot of it's out of their control. Some of it is just, you know, the job that you have to have. Or your socioeconomic status. Sometimes it's just you, you know, it's the noise, the environments you're in. Like, you know, noisy train lines or households that have too many people in them. And it's not a quiet. So, we need quiet, dark, sort of safe, cool conditions. And it's, yeah, sometimes it's out of people's control how much sleep they're getting or not. But yeah, so the individual ones I like to talk to people about. But I suppose it's this job now, the Sleep Health Foundation. And talking to the masses at Medibank Private, it's actually on a systemic, you know, systematic level. How can we make the changes too that need to, because some of them are going to be just the tweaks you need to do. But some of it's going to be really massive sort of systemic societal changes around valuing sleep more as well.

Dr Chris Robinson [00:04:24]

I think that's so important because we're supporting people to better understand sleep and what contributes to good and bad or suboptimal sleep. And also supporting people maybe to have the courage to go and ask for more help and knowing when they should sleep. They should ask for more help, and knowing when to ask for more help, which I think for so many people, like you touched on, sometimes males may find it more confronting to go and seek help. And so, yeah, I think giving people that permission to seek help when they need it is so powerful. Yeah.

Dr Moira Junge [00:04:49]

And that's a very clear message because it’s, until recently, a lot of people didn't even know they could sort of get information about their sleep or should try and value their sleep. It's sort of like, oh, well, I sleep, you know, I'll sleep when I'm dead or, you know, it's not that important. I've got taxes to pay or, you know. It's interesting I think I want people to know you can come forward.

Dr Chris Robinson [00:05:13]

There is help out there, you know. Yeah, that's such an important message. Moira, we talked a little bit about women being more likely to seek help from their doctor for poor sleep issues or report having poor sleep. Now, we mentioned on some of that maybe just because women may be more prepared to go and engage with a health professional or have a greater relationship there. But are there other sort of more intrinsic things? We know that, you know, the hormonal variation that women go through as they progress through life can have multiple impacts on the body. What's happening here for sleep and, you know, to things like menopause or perimenopause or other hormonal stages for women impact sleep?

Dr Moira Junge [00:05:49]

Absolutely. I think from the... It can, not in all cases, but girls who start to menstruate and right through to sort of the having babies and then the menopausal, perimenopausal age, those hormonal fluctuations can cause some disruption to sleep. But it seems to be maybe about 50% that reports in menopause, for instance. Like quite a few women say, oh, no, I sailed through and that it was no big deal. In fact, a survey from last year said that there was 25% of women sailed through menopause, 25% thought it was really tough, and 50% said, look, you know, I had symptoms, but it was okay. So, it's not everyone that reports, you know, difficulty with sleep. But in terms of sleep, definitely. Women are more likely to report sleep problems, probably because of those factors around hormonal change, more help seeking, you know, more proactive, perhaps sometimes with their health. That's known, it's well documented that women can be more proactive with help seeking. So, I think the hormones that do change around, particularly in menopausal years, that can disrupt the body's temperature regulation, and people will be very aware of, you know, hot flushes, or in America they say hot flashes. And a lot, when they occur at night, it can be so disruptive to sleep. And then in really extreme cases, some women as, you know, full sweating, changing sheets in the night and quite extreme. So, when it's, if it's that extreme, you know, that's when it's sort of, it's a medical sort of seeking a health professional's advice around when it's sort of mild to moderate, there's, you know, what we can do is lifestyle related. You know, just making sure you eat as well as possible, try and get as much sleep as you can, exercise, keep your body weight as optimal as it can be in your, for you in your circumstances. And that sort of stuff can help with, yeah, with those changing sort of years and the fluctuating hormones.

Dr Chris Robinson [00:08:03]

I think that's a really important message and probably even reinforcing to people that if, if, you know, variances in your hormones is impacting your sleep to a way that's impacting your function, don't just fob it off and say, oh, it's just my hormones. You know, there's nothing wrong with going and seeking help for that. So, I think that's so important for people to feel empowered to do that. So, Moira, we mentioned the difference between women having more challenges with their sleep, but I know for men, when it comes to sleep apnea, the risk is generally higher or the prevalence is higher of sleep apnea in men. Talk to me a little bit about that and why are we seeing that?

Dr Moira Junge [00:08:37]

With sleep apnea, it's reported more like four times more likely in men, but when women are of menopausal age, their risk of having sleep apnea is similar to that of men. So, and in terms of men having sleep apnea, I'm not exactly sure. I think it's mostly anatomical, just the way the structure of their jaw and upper airway. But it's more likely to be snorers. But people often have the stereotype of thinking that sleep apnea is going to be in, you know, overweight men. But it's really important to realise that it could be in a range of people. It can be in women. It can be of people of sort of normal weight, not carrying excessive weight. And so there's age-related differences too. It's something that to be aware of, because even I wasn't aware of those things until I, only because I've sort of immersed myself in the sleep world.

Dr Chris Robinson [00:09:36]

That's so interesting. So it almost, you know, the anatomy that you inherit, if you like, from your family, you know, it might be a shorter neck or a longer neck or a shorter jaw or all those types of things all can influence the risks of sleep apnea. So, it's not just, you know, you know, being overweight or obese. It can be people who are of a healthier weight.

Dr Moira Junge [00:09:58]

Yeah. Yeah, absolutely.

Dr Chris Robinson [00:09:59]

It's really fascinating and probably really eye-opening for many people who, you know, are in that category, are of a healthy, but, you know, their loved one may be saying you're snoring every night, you're not sleeping very well and they're feeling tired during the day.

Dr Moira Junge [00:10:12]

Yeah, that's right. And they haven't joined the dots yet. So, it's important to have that just increased awareness is, is so important for, for just getting onto things and hopefully getting them sorted out.

Dr Chris Robinson [00:10:21]

Fantastic. I think that's a really important message to take forward. Now we've, we've, everybody knows someone I would assume that has difficult sleeping, you know, and it might be a frequent thing or it might just happen, you know, intermittently. And I, I know myself when I have challenges sleeping, it can be quite distressing. And I can only imagine for people who are having that night in, night out that, that, that distress or that, you know, that must be really overwhelming for them. What's your message for people who are having difficulty sleeping and, you know, when should they seek help and when is it maybe just part of the normal, you know, variance in sleep?

Dr Moira Junge [00:10:58]

Yeah, it's a really important point and it's, we have to have nuance with this, with sleep. I think in general, we all have to sort of ride the bad nights out as much as we can. They sort of understand that life happens and there's, you know, as with all the things we talked about earlier, it's from kids through to pain, through to stress, et cetera, there's going to be times we don't sleep well. So the tricky thing is to know what's normal and when should I seek help? And so if it's affecting your quality of life, like there's sort of social and occupational impairments, like it's just not coping with jobs or, you know, getting up or being, some people just realise they're not even going to anything, any movie or any party or not doing anything at all anymore, then that's, that's occupational and social dysfunction. You know, it's impairing that. So you need to sort of talk to a trusted health professional. Not everyone, very few people will need to see a health professional with sleep stuff. Like a lot of just understanding the nuances of sleep will help. A lot of self-help stuff and, you know, the tips we'll get to does help a lot. Um, but yeah, it's really important. If people, but if they've tried everything, if they've sort of had an adequate opportunity to sleep, put in some self-help things, being quite sort of sensible about it, and they're still not functioning well, a lot of impairment, then that's when, usually maybe many weeks or a few months of trying, you know, wouldn't, you're not going to turn your sleep around in two weeks. It's a bit like if you were 30 kilograms overweight and you thought, I'm going to lose this weight. And then two weeks later, it didn't work. That's, you're not going to, you just have to, you know, it's going to take maybe six months at least. So with the 30 kilogram example, but with sleep problems, like it's, if you've had sleep problems for a long time, you have to understand that it will take many months, if not many, many weeks, if not many months to turn that ship around and start to see a difference.

Dr Chris Robinson [00:12:53]

Yeah. So I think there's the key message I'm taking away from that is, you know, is required to be a degree of patience almost in, you know, acknowledging that sleep is going to take time to improve. However, not waiting for catastrophic health consequences, you know, when, you know, you've had, you've lost your job or you've had complete social breakdown. If you're starting to see any early signs of, you know, inability to function at work or inability to engage with your friends and family and your loved ones in the ways you normally would, that's kind of the time you would start to seek help. Is that what you think?

Dr Moira Junge [00:13:27]

Yeah, absolutely. And even, yeah, I like your word catastrophic. I don't wait until it's severe because the thing I worry about most with sleepiness or is, is on the roads, and road safety. So if anyone's having unintentional naps, so falling asleep in meetings that you should be like, especially if you're talking or, you know, a meeting, it's fair enough to fall asleep in a meeting after lunch in the dark and it's a very boring person. But if it's unintentional naps, when you really think, wow, that took me by surprise, that's, that's excessive daytime sleepiness. Yeah. Okay. That's a really good distinction. Yeah. And, and just that, uh, and sometimes, people have, um, preoccupied with sleep. And this is my role, you know, my, my past life as a clinician, sometimes people get just really worried about sleep. And, and that's, and that's something that we didn't, you need to get sorted out because you're never going to get your sleep fixed, being really worried and obsessing about it and being very vigilant and tracking it too much. Or so that in itself, if you realise that you think, oh, actually, I think I might be becoming a bit preoccupied with my sleep, a little bit obsessed with it. Um, and I'm really worried about, I'm even worried about the nighttime coming. I start to feel a bit anxious about that thinking, oh, what's going to happen tonight with my sleep. That's when I would have a discussion too, with a trusted health professional, because that's common. And that's what I, that's a, that's a common psychological factor with sleep.

Dr Chris Robinson [00:14:52]

It's, it's interesting. You, you call out that point around fear of the nighttime. I've heard that from patients and colleagues where they talk of patients who, um, say that, you know, I, I'm afraid that I'm not going to sleep. So I get anxious about the nighttime coming. Yeah. And then lonely, isolating sense of just being there by yourself and not able to sleep is, I can only imagine how challenging that is for people.

Dr Moira Junge [00:15:10]

That's right. A vicious cycle creates.

Dr Chris Robinson [00:15:17]

Moira, it's been another fantastic conversation. In our next chat, we're going to be talking about some tips to help us improve some of these sleep issues and challenges that we've talked about today.

Dr Moira Junge [00:15:26]

Fantastic. It's been my pleasure.

Dr Chris Robinson [00:15:30]

Thanks for joining us today. This discussion is part of the Medibank Sleep Well challenge which aims to help members improve their sleep by learning about healthy sleep habits. If you’ve already joined the challenge, keep up the great work and continue to try at lease one healthy sleep habit every day. Don’t forget to log your progress at the end of each week in the MyMedibank app. If you haven’t joined the challenge yet, go the MyMedibank app, head to the challenges section, and hit join. We’d love to have you. Live better with Medibank.

Dr Chris Robinson [00:16:01]

Please note the content in this recorded discussion is general in nature and is not intended to replace individual health professional care. For people who have been diagnosed with a sleep disorder or have any other preexisting medical conditions, please seek advice from a healthcare professional before participating in this challenge.