Module 3: Recommendations to help improve sleep health 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 [00:00:20]

Did you know that changes to your lifestyle and bedtime routine may lead to better sleep? 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 our top tips to improve your sleep habits.

Dr Moira Junge [00:00:43]

The regularity is more important than the duration. The exposure to light and dark at the right times is one of the most key aspects of good sleep health.

Dr Chris Robinson [00:00:56]

So Moira, so far we've talked about the common sleep issues and how that varies between different people, things that people should be looking out for. Now let's dive into some of the juicy stuff. What are the strategies that people can implement to help improve the quality of their sleep?

Dr Moira Junge [00:01:13]

So there's several strategies and it's going to be different for different people. People would have heard about this term sleep hygiene, which is really just good sleep habits or things that are conducive to making your sleep better on a regular basis. But the sleep hygiene, I just want to put a little caveat in there that it's a set of sound principles, like good recommendations. However, if you've already got a sleep problem, like quite specifically anxious about it, or you've got severe insomnia, there might be a sleep apnea there, the sleep hygiene in its own right isn't really the only strategy or the recommended strategy. People are going to need a bit more than that. It's similar to if someone who had a, you know, an eating disorder, for instance, and someone gave them a list of healthy eating tips, that's not going to be appropriate. They've gone way beyond that. They probably know. What they're meant to be doing, but they need some specific help.

Dr Chris Robinson [00:02:07]

Everyone is different and everyone's going to need different strategies that work for them and making sure that the strategies match their sleep challenges, be they mild, severe or moderate. And that's, you know, where both podcasts like this can be really important, but also engaging with your health professional, if the circumstances dictate it, is also really, really important. Yeah.

Dr Moira Junge [00:02:28]

And it's super important to realise that your sleep challenges may be very different to the other person. So, or the, you might, you know, look up a list of sort of listicles, I call them like the top five tips, but the top tip really for anyone is to actually try and identify the underlying cause. So that would be a very big hint of what you need to do about it. So we'll get through it. We'll get to it. So, but for example, like caffeine, for instance, that, that will affect, that'd be a good strategy for someone who's having, you know, a lot of caffeine per day. A little anecdote, really, if I may. Um, sometimes when, in my clinical days, a lot of people with sleep problems, they would still, they'd say, no, I haven't had coffee for years, haven't had alcohol for years, haven't been to a 10 o'clock movie for years, but they still don't sleep well. So then I'd say, well, if you liked coffee, maybe, and they really miss it. They really, I said, well, maybe introduce one coffee a day in the morning if you really love it. So things like that, like sometimes people have been really restrictive because they've seen a list of things, but it wasn't the reason for their sleep problem.

Dr Chris Robinson [00:03:32]

Interesting. They've gone for what they've heard about or what they know, and that may not be the solution. Yeah.

Dr Moira Junge [00:03:36]

Their partner or their mother or someone's told them, oh, I heard caffeine's totally evil, but we know that a small amount of caffeine's fine, for instance, which we'll get to.

Dr Chris Robinson [00:03:44]

Caffeine's an interesting one. I know for myself that if I have a coffee after 1.30 in the afternoon, I won't sleep that night. So I just never have one after 1.30. I look at the clock and if it's any later than that, I won't have one. So just knowing what works for you.

Dr Moira Junge [00:03:57]

Absolutely, massive amount of individual variation. Like I'm the same. If I had a coffee now, I wouldn't sleep well. My husband can have a short, black, massive espresso-type coffee after dinner and sleep all night.

Dr Chris Robinson [00:04:08]

So fascinating. I've always been jealous of those people. Talk to me about sleep patterns and trying to get a regular sort of day or eight hours a night. How important is consistent patterns of sleep?

Dr Moira Junge [00:04:20]

So yeah, the regularity is more important than the duration. And that's something that's been out sort of late 2023 or so. It's been international guidelines around really emphasising consistency and regularity and long-term, that being more important than duration for health. So I love that because that's something that people can have a little bit more control of perhaps, except shift workers. But it means it's the same for shift workers, like what you do on an early shift, what you do on a late shift, what you do on a night shift. Be as consistent as possible within sort of the chaos. And even super with young children or the two jobs and all that, they say, I can't be regular. But within what you're doing, be regular if you can. So that's, that's the, and people like that. I think that's actually something they can think about and not fret about the duration or the hours of sleep.

Dr Chris Robinson [00:05:13]

I like that mention of control. When I used to do shift patterns, I used to do seven nights on, seven nights off. And I would always have dinner, regardless of what time it was, I got home. Because to me, dinner signalled, you know, I was going to bed soon. And so I would have breakfast when I woke up and dinner, you know, and I found that was my. It was my way of inserting a regular pattern around the variance in my shift works. Now, tell me about spending the right amount of time in bed or even in your bedroom. Because I know some people, particularly teenagers, like to hang out on their bed. They spend a lot of time in there when they're not sleeping. Talk to me about that.

Dr Moira Junge [00:05:48]

Oh gosh, how long have we got? I'll be brief. It's really, really important. Probably it's one of the most important things of someone who's having difficulty with sleep is to match the time in bed with the amount of realistic sleep you're going to get. So even these teenagers who are bed rotting, it's called, have you heard that terminology? It sounds awful. But it's to the point. Yeah. Sort of, sort of sitting in bed, at least with my teenagers, I say, look, just be at least on top of the covers. And that's some kind of differentiation that you only under the covers on your side, on your side of the bed that you like to sleep only when you're ready for sleep. So you don't attempt to be in bed except when you're sleepy and tired and ready for sleep. And because all the rest of it if you're doing your homework and you're watching things and you're on your phone, you're doing stuff, got your laptop, there's too many other things going on that the brain doesn't have a very good response to that, you know, bed equals sleep, that I'm ready now, all the signals and like a, like a sleep signal, like, you know, a dummy for a baby or a silky blanket, or there's that conditioning, that classical conditioning that, that we know that humans, how we learn and how we form patterns. So I think that's, yeah, spending the right amount of time in bed is very important, particularly if you're someone who has, you really want eight hours, you've heard it's important. You jump into bed to maximise your opportunity for sleep. You get into bed at 10, you get out of bed at six, but you're only getting four or five hours. The first thing I do clinically, and the first thing you'll see, and if you know, in a sort of a sleep program is to match the time in bed. I say, well, look, you're, I'm actually going to prescribe that you're only in bed for four or five hours. And they go, no, but that makes them really anxious because I want eight, but it's the first thing you need to do. So that's a, it's a huge, important tip.

Dr Chris Robinson [00:07:31]

That must be a shock to the system initially for people, but I can see why, because the bed should be somewhere of rest and relaxation. And if you're lying in bed, wondering why I'm not sleeping, it's going to become a place of anxiety or stress. And that's the wrong environment. Yeah.

Dr Moira Junge [00:07:46]

It becomes, it's a conditioned response that it's not the right place. So you want to have fall back in love with bed and have this trust that it's a place where you sleep.

Dr Chris Robinson [00:07:54]

Brilliant I love that. Fall back in love with bed. Now you touched on very briefly there, you know, mobile devices and electronics in bed. And we hear a lot about, you know, making sure you're switching off the device at the right time. Talk to me about that. What should people be doing around sleep and using their mobiles and what not?

Dr Moira Junge [00:08:10]

It's a very interesting one because we're sort of changing, well, at the Sleep Health Foundation and international guidelines, trying to be a little bit more nuanced about it. Clearly people need to minimise their usage of devices, et cetera. And I would say, don't have them anywhere near the bed. But in terms of the lead up to bed, if you're doing a little bit of phone usage and it's not too stimulating and it's helpful for you and it's unwinding and it's perhaps 20 minutes or so, that doesn't seem to have any harm. So a lot of people, especially when they know what I do for a job, they think it's the wrong thing to be on their device and they're not allowed to be on their phone. I'm always doing it like sort of under the covers, like a secret, like something secretive. But people need to, we have a harm minimisation approach in a way, like don't be too guilty if you're on your phone, but absolutely minimise. It absolutely make sure it’s not too stimulating, making sure it's less than 20 minutes or so. And, you know, the, and the light that, you know, the, the whole component around the device use is not only the stimulation, but the, the, the blue light component coming off the screen. We know that blue light is the one that suppresses melatonin and melatonin is required for initiating and maintaining sleep. So most devices these days have a standard night glow though. But so people think, they're okay, but it's not so much only the light, it's the stimulation. So there's another, it's sometimes conflated with, you know, people being really addicted to their screens and therefore not getting enough sleep. It's not really a sleep disorder per se. It's actually, it's, well, it's problematic they're not getting enough sleep, but it's another issue they need to sort of, to, to deal with. So we would say just making sure that your electronic device use is not in bed, preferably even sort of outside of the bedroom that you charge your devices. But that's hard. I know even I have mine next to my bed because I don't, I wanted to get messages of, of kids that are in trouble.

Dr Chris Robinson [00:10:09]

Or when the alarm goes off.

Dr Moira Junge [00:10:10]

Or when the alarm goes off and things like that. But I certainly don't engage with my phone overnight or, or just in the, but I do listen to podcasts or things like that. So sometimes it's the amount of engagement, it's the type of use, the type of stimulation and the light settings.

Dr Chris Robinson [00:10:22]

Yeah, fantastic, I think, I think that's a really good message. It doesn't have to be hard or fast. It just needs to be, do the sensible things. Less is good. You know, the light is important. The stimuli is important and noting all those things. I think that takes us to a really nice place around, you know, trying to relax before you go to bed and like making sure you're unwinding and you, you know, you're not coming straight from a marathon and jumping into bed or you're not having a big heated work meeting and then jumping straight into bed. Talk to me about the importance of relaxation.

Dr Moira Junge [00:10:53]

We need to create a buffer zone for ourselves. And if it's coming off work, coming off emails, coming off meetings. And making sure that you do relax. It sounds really obvious, but it's something people have forgotten to do, to have this unwinding period, especially very busy people. So make sure you protect yourself, have an hour or so at least of unwinding. And that can be TV use, can be, as I said, it could be a tiny bit of screen use, but just particularly, you know, with all the other caveats there.Yeah, and just making, sometimes it can be just a gentle exercise, can be have a glass of hot milk, whatever. It is like, you know, your favourite shows, reading books, listening to music, just whatever it is for you. People will work out what works for them. And it not only is relaxing, it serves as a bit of a sleep signal then, you know, like you were talking about your meals with the night shift. We give ourselves the right messages and trigger the brain to have predictions of what's coming next and have this expectancy effect. So, you know, you manage your expectations around in a positive way that, oh, I think I will sleep well, probably, and this is my, I'm setting myself, I'm setting myself up for success.

Dr Chris Robinson [00:12:03]

I love that. For me, it's reading a book and like a proper old school paper book, sitting there reading it. I find that really relaxing. {Moira: Yes, me too}. And it's my favourite thing to do before bed. And almost, you know, when I travel, if I forget to take a novel with me, I'm almost stressed that I haven't got my book to read. Now, we've touched a little bit on caffeine and, you know, how we need to avoid that before sleep. Well, many people do need to avoid it before sleep. Other things that we commonly hear about is alcohol and smoking, and in particular, probably not drinking before bedtime. Yeah. Tell me a little bit about that. And what is, what impact is that having on getting to sleep as well as the quality of sleep?

Dr Moira Junge [00:12:41]

Well, people forget to, I mean, nicotine obviously is not healthy at all. There's no safe level. So people should try and quit smoking and get some support with that. And smoking before bed is a stimulant. Like it actually has been shown to just not help with getting off to sleep. It's not, not, not certainly no relaxant. And caffeine, we've already talked about that, you know, but minimal amounts of caffeine are okay. But sort of perhaps six or seven hours before bed, but longer for some people like, like you and me. Alcohol is unfortunately a sort of, it's used quite commonly for, as a relaxant. It's relatively cheap. People don't have to go to the doctor, et cetera. It's a, it's a concern of, you know, that we have for alcohol for sleep. So it does make people feel sleepier and more relaxed. But even moderate amounts of alcohol are quite bad for sleep quality and in lots of awakenings, going to the toilet, et cetera, and feeling unrefreshed the next day. So alcohol is a, it's not a good choice for, for sleep. And we always, we try and talk about separating your drinking from your sleeping in that like three to four hour buffer. So a couple of, a glass or two within standard guidelines with dinner, and then three or four hours later going to sleep, it shouldn't have any impact. It shouldn't have any negative impact on your sleep.

Dr Chris Robinson [00:13:54]

Now, shifting on from what we drink to what we eat. Tell me about, you know, what should we be doing around food and bed?

Dr Moira Junge [00:14:03]

Yeah, so much, such a good area. Like there's so much more we need to know in this area and watch this space, I think. But in the meantime, definitely not going to bed. We're on a full or empty stomach, not too full, like having a, at least a couple of hours after your main meal, two or three hours, preferably after a big lot of food. And again, making sure you're aware of what's going into your mouth, like as healthy as possible, preservatives and things that sometimes can be really stimulating for people. So yeah, it's giving that buffer zone before, like after a big meal. Some people would like to have a light snack, particularly if meal, if the meal has been three or four hours, well, you know, two hours or so beforehand, just a light snack can be really helpful. So I think about, say, my parents, my grandparents, you know, a tiny bit of slither of toast and a cup of hot drink, a cup of hot milk. It's funny, isn't it, that the science is coming back to it. It's all coming back. They're on to something. They're on to it. Just, just it's something that can be quite calming. And so you don't get too hungry in the night and you're not too restless.

Dr Chris Robinson [00:15:07]

Imagine that contributes to that sort of relaxation ritual that we spoke about as well, that if, you know, a piece of toast and a bit of hot milk is really relaxing for you and helps with that ritual of preparing for sleep, then that's good.

Dr Moira Junge [00:15:20]

Yeah, it does become kind of the sleep signal.

Dr Chris Robinson [00:15:23]

But maybe not a giant bowl of spaghetti bolognaise before bed or something like that.

Dr Moira Junge [00:15:26]

No, absolutely not.

Dr Chris Robinson [00:15:28]

Now, the last one that I really wanted to touch on was around the impact on sunlight or sun exposure, and we hear a lot about this both for people who are jet lagged or people who are shift workers. Tell me about that. What should we be getting in regards to light exposure?

Dr Moira Junge [00:15:44 --> 00:17:37]

Yeah, I would say if I had to say, I have to give you my number one tip, like the exposure to light and dark at the right times is one of the most key aspects of good sleep health. So we know that melatonin is secreted in dark conditions. It helps us sleep. And we know that in bright light conditions, like going out in the morning, melatonin is suppressed. So we need to be aware of that. And you don't have to be a neuroscientist to understand those two things about when you want your melatonin in or circulating around your body or when you want it to be sort of suppressed. So it's very important to get out in the light in the morning if you can, depending on if you're a shift worker, perhaps we can think about the other end of the day, but getting that melatonin. And sort of set to zero, increase in your alertness, body temperatures increase, you feel so much better, set yourself up for the day. You're actually likely to feel full sleepier at a regular time if you're having that regular morning exercise. So I know for me, if I don't have my morning walk, I actually have more problems sleeping that night. So it's a very interesting thing that sometimes the things for sleep are during the day or first thing in the morning. It's not what you do just before bed. Sometimes that's too little, too late. I set myself up with the morning. Light exposure, get my body temperature up. And it's sort of, and if you're an eight hour sleeper, which we know not everyone is, but say for example, you need to have 16 hours of wakefulness, like sleep pressure, sort of you need to earn the right, if you like, to get your eight hours. So this, if you go out in the morning at a set time and you get the light, you sort of set yourself up with this regularity of 16 hours of wakefulness, 16 hours of sleep pressure, bang, your body gets these predictabilities. You feel the sleepiness comes again, melatonin, It'll come out at the right times, that regular time. So the regularity is key, which, and the light is key.

Dr Chris Robinson [00:17:37]

Now we've, we touched on this a little bit before, but you know, the reality is life happens. People do shift work, people travel overseas or whatever it may be. So, you know, not everyone's always going to be able to adhere to every single one of these strategies and not every single one of these strategies is going to work for everyone. What's your thoughts around that?

Dr Moira Junge [00:17:56]

Absolutely. I think individual variance, keep that in mind. Managing expectations of sleep and of yourself and not putting too much pressure or being too rigid about any one strategy. And just making sure too, that it's not going to be, it's not going to be immediate. It's going to take some time. So the amount of people who say, oh, I tried what you said. And like two days later or two weeks later, it didn't work. Really encourage people to just say, it's going to be, it's a process. So it's many weeks, many months of being able to see the changes.

Dr Chris Robinson [00:18:24]

I think that's such an important take home that, you know, you need to give this time. You need to be patient when it comes to your sleep. And making one change today may not mean you have a better sleep tonight. But if you make that one change regularly over a longer period of time, you should hopefully, if it's the right change for you, start to experience better sleep. And so it's going to take time.

Dr Moira Junge [00:18:47]

Yeah. And then you can have immediate effects as well. Like it can happen. It can be, especially with reducing alcohol. And caffeine and those sort of stimulant type things. And caffeine, people can, they might, they might have a sense of, wow, actually, immediately I felt it that very first night. But to manage expectations, don't expect it to be the very first night.

Dr Chris Robinson [00:19:04]

And I imagine for people who have just disrupted sleep versus disordered sleep, so they might just have the odd bad night of sleep. Yeah, yeah. They can probably be like, oh, actually, I had a glass of wine just before bed or I was on my phone and I was getting some stressful emails. And probably if they think about it, can link that poor episode of sleep back to whatever was different in that instance prior.

Dr Moira Junge [00:19:25]

Yeah, absolutely.

Dr Chris Robinson [00:19:27]

I'm sure like many others, Moira, for myself personally, when I find that, you know, work's stressful or life's becoming a little bit demanding, I find it hard to switch off at night. What would your advice be for me in that instance or for anyone else who, you know, they're having that rough day, they're having that stressful week at work and they're just finding during that time that it's really difficult to get prepared for sleep?

Dr Moira Junge [00:19:47]

Yeah. Which even me, like I, you know, I know all the answers to sleep and I will have the poor night every now and then as well, particularly when I'm worried and stressed. So when you're worried and stressed, don't expect just, just manage your expectations about sleep that night. Sit up a bit later. Don't go immediately into the bedroom. Even if you think I must get my eight hours. So try and resist the temptation to look at time, like clocks or devices. And yeah, it's important to just sort of learning how to switch off, like just doing, reading for you or going for a walk, whatever you can do, some gentle exercise. I think that mindfulness can be a really good thing. I think it's a really effective strategy. I think that, but it has to be practiced during the day. It's not like you're going to immediately just learn it on the spot. Like if you've never done it before, don't start it then. Have a bit of a. When you're already stressed. Yeah, when you're already stressed. Have a bit of a habit that you've formed over weeks and use that as a skill when you need it on these occasions. But I think one of the most helpful thing is just, just sit up a bit later. And even sometimes I just have to sit up and watch a movie and heaven forbid it might be even 1am, something like that. Just, just to, and I'm, I'm better off, I'll get less sleep, but probably better quality from just not trying to sleep when I'm just really beside myself with a bit of stress or whatever's going on. So for goodness sake, just, you cannot force yourself to sleep. It's like you cannot force a two year old to eat their vegetables. You have to do, you know, just have to sit back and just provide the right conditions and just see what happens. Brilliant.

Dr Chris Robinson [00:21:21]

I love that. With so much information out there about how we can improve our sleep, it can be hard for people to determine what actually works. I'd be keen to hear your thoughts on a few of the following strategies, if that's okay. So let's start with eye masks and earplugs.

Dr Moira Junge [00:21:36]

Yes. Well, they, eye masks and earplugs may be helpful if, particularly if you're in a noisy or light environment, particularly for shift workers. But if it's not the cause of your sleep problems, too much noise or too much light, it's probably not going to be effective. So horses for courses.

Dr Chris Robinson [00:21:52]

Perfect.Napping during the day.

Dr Moira Junge [00:21:55]

Okay. Not evil, but making sure you just do short naps. And being aware of the reason for the napping. If you're excessively sleepy all the time, and that's probably, you know, you're getting inadequate sleep, you're getting, you probably have a, you could have something like sleep apnea that we talked about before. So if you're having short naps and less than 20 minutes or half an hour or so, and they're not too close to your major sleep period that night. So usually about seven hours or so in between. So the naps are actually okay. They're really important.

Dr Chris Robinson  [00:22:31 --> 00:22:37]

I'm glad to hear that because my Saturday afternoon 15 minute nap at about three o'clock. That's my favourite part of the week.

Dr Moira Junge [00:22:37]

Me too.

Dr Chris Robinson  [00:22:39]

Now, this is one I'm guilty of. I'm a little bit of a fanatic when it comes to sleep tracking and using my, my watch to do so. Tell me about sleep trackers.

Dr Moira Junge [00:22:48]

Well, in a nutshell, sleep trackers, they can be really helpful or in some cases they can be a bit of a hindrance. So the person who you ask yourself, really, is it helping me to get better sleep and staying on track? And increasing my motivation and setting goals? Or is it making me a little bit more worried? Really? I'm more worried now about my sleep and therefore not sleeping well. So people can just ask themselves that. And if it's the latter, like you're getting more worried, just have it for your steps and stuff during the day, but put it in the drawer overnight and be aware that they're not, not all of them are entirely accurate. Even the really good ones, they're pretty good now, but particularly with sleep and wake, but they're not as good as you might think with the sleep staging. So what percentage of REM and deep sleep, et cetera. And also, as I said earlier, all stages are great. Like even light sleep is good sleep. So don't, you can, people can get really obsessed with the numbers.

Dr Chris Robinson [00:23:42]

So I think the message there is it's helpful. Don't fixate on it. Yeah. And it's more about, are you feeling like you've had enough sleep and you're waking up fresh versus, oh my gosh, I didn't get enough REM tonight. {Moira: Yeah, absolutely}. Now you hear a little bit about people who, you know, might sleep in on the weekend because they've not slept so well during the week. What, what impacts can that have? Is that going to be the cure all to kind of, you know, eliminate that sleep debt?

Dr Moira Junge [00:24:06]

Yeah, I think the best thing is, again, try and be as regular, regular as possible. You can't really bank sleep in advance, but you can and have permission to sleep in a bit. If you're having, if you are carrying a sleep debt, like on non-work days, for goodness sake, if you can sleep in an extra hour or two, that's not going to be harmful. But you really, the consistency is key. You can't really bank it ahead.

Dr Chris Robinson [00:24:29]

I'm up at five o'clock regardless. It doesn't matter what day of the week. Oh, really? When I got to bed, if it's five o'clock, I'm awake. And sometimes it's a curse, sometimes it's a blessing, but it sounds like you're saying that's not too bad of a thing. No, not at all. Is it true that we can train our bodies to manage with less sleep?

Dr Moira Junge [00:24:44]

Not really, not really. We can actually masquerade as morning types and we can sort of cope, particularly if we're trying to get naps in or, you know, shifting our cycle a little bit over time. But in general, we are who we are. The amount of sleep we need with our timing, whether we're a night owl, et cetera, that's fairly set, like the colour of our eyes and skin. But yeah, so try to be true to yourself. You can't really hide from your sleep needs and it doesn't, you can't really train yourself. I think there'd be certain podcasts or people might have a different view to that. But the science as we know it right now is that you, you know, you sort of are who you are with your sleep.

Dr Chris Robinson [00:25:28]

Fantastic, Moira. I think there's some really, really helpful tips. Certainly, I'm going to make some changes in the way that I approach sleep because of that. So thank you so much. It's been fantastic, really informative and I've really enjoyed the conversation.

Dr Moira Junge [00:25:39]

I really enjoyed it as well. And I wish everyone the best with their sleep challenge.

Dr Chris Robinson [00:25:44]

The best night's sleep for everyone.

Dr Moira Junge [00:25:46]

Sleep well.

Dr Chris Robinson [00:25:48]

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 already joined the challenge, keep up the great work and continue to try at least 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 to the MyMedibank app, head to the challenges section and hit join. We'd love to have you. Live better with Medibank.

Dr Chris Robinson [00:26:20]

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 pre-existing medical conditions, please seek advice from a healthcare professional before participating in this challenge.