Better sleep – tips from a sleep coach

MS Plus acknowledges the traditional owners of the land this podcast has been recorded on, the Wurundjeri people of the Kulin Nation. We pay our respect to their elders, past, present, and emerging.

Jess: Hello and welcome to the MS Plus podcast, the podcast series where we talk about all things related to living well with MS. My name's Jess and on today's episode we're going to be talking about sleep, and as a poet from the 1600s, Thomas Decker once said, sleep is the golden chain that ties health and our bodies together, and I think he was absolutely right.

Getting enough sleep is so important for our overall health and general wellbeing, and a lot of the research tells us that poor sleep can really seriously affect a person's quality of life, as well as increasingly a risk for developing certain chronic health conditions.

So, on today's episode, I'm lucky enough to be speaking with Carla Butler from Ora Sleep Coaching. Carla's passion for sleep coaching was sparked by her own personal tragedy after her father passed away due to chronic disease, partly caused by his poor sleep health, and Carla knew that she needed to take action to protect her own health and longevity.

So, through her own journey to better sleep, Carla has gained a wealth of knowledge and expertise that she now uses to help others live better lives through private coaching, public workshops, and corporate seminars. Carla is a sleep and recovery coach and a women's health coach.

So hi, Carla. Thank you so much for joining me today.

Carla: Thank you, Jess. It's lovely to be here.

Jess: Great. So tell me, why is sleep so important?

Carla: Oh my gosh, so many reasons. So essentially, if you think about it, our lives are really split into two parts, right? We have this part where we're active, we're outputting energy, we're doing stuff, and of course we need to recover, rest and rejuvenate from all that, and that of course is when we sleep.

So when we sleep, we have benefits in terms of focus and concentration. It helps with our impulse control, our decision making, it aids with regulation of emotions, it helps with weight management for a variety of reasons, and there's mental elements to it. It helps with memory, learning, et cetera, and of course, physical elements as well, in terms of training and recovery. And it's really just so, so important because without it, we really can't function as well, I guess, as we should be during the day.

Jess: Yes, absolutely. So why do so many people struggle with sleep issues? This is an incredibly common problem, isn't it?

Carla: Yes, absolutely. I mean, for the clients that I see quite often, it is related to stress and mental alertness or mental arousal. If you think about sitting in front of the computer in taking all of this content, quite often it might be work content or it might be social media content. That's really elevating that mental alertness and to switch our brains off and go to sleep. That actually takes time, so, and then of course, the other element of it is just general life stresses. So, elevated chronic stress, of course, impacting sleep.

And I do wonder if COVID brought all this to the forefront as well. Of course, you had people where, and I was one of these, all of a sudden there's no structure to your life. You're sitting at home, for a lot of people, their bedrooms also became their offices, depending on their environment.

And so all of a sudden, not only are you working longer hours at home, you've got your device right here in front of you all of the time, but there's actually no separation between things like work and personal life. The other element of sleep issues that I quite often see is where people have had an event, an experience, or even a trauma that has affected their sleep in some way, and they've put a behaviour in place to manage it at that time, and it's worked for a short period, but, over time it's actually caused the sleep to worsen and exacerbated the issue. So lots of things that can feed into this.

Jess: And so when we're talking about people having sleep issues, I guess the thing that, for me, springs to mind is, people talk about insomnia, but when we are talking sleep issues, like what sort of range of problems are we talking about?

Carla: Yes, absolutely. Something I hear often is, people complaining about waking up during the night. It’s actually not waking up that's the issue, it's whether you can fall back asleep or not, right? So if you're waking up four to five times a night, that's actually not a problem unless it's taking you more than a couple of minutes to fall back asleep.

So I guess something that I'd like to normalise is that waking up during the night is normal, and, that is okay as long as you can fall back to sleep. So the issue then comes when you do wake up during those times and quite often the brain is flicking on, and you just start thinking, ruminating, making ‘to do’ lists, planning, and that's where it becomes a problem, because you'll lie in bed thinking, you're awake, and you're essentially building in this habit of being awake in bed thinking, and that can sometimes just get worse and worse over time.

Jess: Definitely. That's something I guess I hear quite frequently from people with MS, laying in bed and then being very aware that they're not asleep, and it's that almost anxiety cycle of being anxious that you're not sleeping, but you're awake because you're anxious that you're not sleeping.

Carla: Absolutely, and it's a vicious cycle because, as you say, you're then stressing out that you're not sleeping, you're counting down, thinking about how many hours am I not getting? I mean, there's a couple of things that are really important, if that is a challenge for someone.

One is that you don't stay in bed and worry and think and what have you, you actually want to break that cycle of doing that wakeful activity in bed and get up, do something relaxing, kind of call it a circuit breaker. So you're basically getting up, going somewhere else, doing something relaxing and then going back to bed.

And the other one is thinking about not clock watching, not picking up devices, things like that, because it's when you start clock watching and really kind of counting down, that's when you see that anxiety level increase because, depending on what you've got on during the next day, you'll be thinking, “Oh gosh, I've only got five hours sleep. How am I going to be able to do that presentation? Show up like I should be at work. How am I going to manage the kids” et cetera. So, stepping away from worrying about the time and just getting up, doing something relaxing, jumping back into bed.

Jess: Yes, it's interesting you mentioned just then in clock watching, and picking up your phone, is that an issue as well for maybe to do with like the light source and, people that are on their phone at nighttime.?

Carla: Yes, absolutely. And there's a couple of things with device usage or phone usage. So absolutely the blue light can inhibit the release of melatonin, which of course we need to sleep, but the other element of it is the actual content you're consuming. So, you might be scrolling through social media and feeling like it's relaxing perhaps, but, it can actually cause that mental alertness as well, so that is then going to cause you to potentially have difficulties falling back asleep. So, there's two sides to that.

Jess: That's really interesting when you point that out, it's not just the light, but the content as well. One thing that I've heard fairly often is people who might fall asleep before it's their intended bedtime. Maybe someone's accidentally fallen asleep on the couch or, you had a bit of a nap. What's your view on that and how that can have an impact on sleep?

Carla: Yes, absolutely. So there is actually a common misconception that falling asleep. easily or quickly means that someone is a great sleeper, and it’s not true. So if you are someone that tends to fall asleep super easily like that, then it often means that you are underslept. So ideally, if someone is falling asleep on the couch, ideally you'd like to catch yourself before you get to that point and make sure you get into bed.

Particularly if someone is having trouble falling asleep once they're in bed, but they can fall asleep on the couch. That's really indicative of someone who is underslept, but you've probably got this entrainment in place where the couch is a relaxing spot and, for whatever reason, the bed is not the place that your brain associates sleep with.

So we need to retrain that, and the way we do it is we go to bed when we're sleepy. If we're in bed and we can't sleep, we get up and we go somewhere else. Then after a short period, or when we feel sleepy, we go back to bed.

Jess: It's almost like adult sleep training.

Carla: It actually is. So, it's funny, I have a few friends who are actually, paediatrics or, child sleep coaches and many of the strategies are very, very similar. So, for anyone that's having sleep problems that has kids and has gone through that process, just think back to what you did with your kids when they were little, and if you start implementing some of those things, you'll probably find that you might be able to solve some of your sleep issues.

Jess: That is so interesting. And so, I guess, with looking at sleep and the links to health and that is so apparent in so many different areas, and you mentioned, this a little bit of your own story, with. the sad passing of your father. What do we know about the link between sleep and chronic disease?

Carla: Yes, absolutely. So unfortunately, lack of sleep is, as you mentioned, linked to chronic disease. So, cardiovascular disease, type two diabetes, and that's around your body being unable to process sugar as well as it should, cancer. So, it can be really impactful, and I think that it's not as understood as well as it should by the general population. I think there's a feeling that, sleep is just this thing that we do, it's just rest. And therefore, it's often not prioritised, but, it’s not just rest. There are so many processes that are happening during that time. There's brain clearing is, your heart actually has to rest and recover as well. That's why your resting heart rate drops, to give it a break. If you're not sleeping well, your resting heart rate is not dropping, your blood pressure is not dropping, so your heart does not get the recovery it needs, and of course, that's why we see that link to cardiovascular health. So, it is just so important. I wish more people understood it, but that's why I do stuff like this.

Jess: You're so right, you know, maybe the general view on sleep is, it’s just a thing we do that makes us feel good, but when you read the statistics on the effects of sleep apnoea, can you talk a little bit about sleep apnoea, because that's quite a common issue for people, isn't it?

Carla: Absolutely, and so, sleep apnoea, essentially when your airway closes during sleep, you're cutting off oxygen. For some people this is happening, I think, I think a low apnoea is something like 15 times an hour. It's crazy, so for some people, you're barely breathing, and it does have really strong links to cardiovascular health as well. It's an interesting one for me because, obviously I'm not an allied health practitioner but, as part of my practice I do a very high-level screening for underlying medical conditions that may relate to sleep, because of course, if someone's coming in with any sort of risk of sleep apnoea, the first thing I need to do is ask them to speak to their GP. And it is interesting that the demographic that is supposed to be most at risk of sleep apnoea is older males, older overweight males, but in my experience, I've met plenty of young females who are of, I guess, a standard weight who have actually been diagnosed with sleep apnoea.

So I think we need to probably step away from the assumption that you have to be an older overweight male because it's just not true. And I also have conversations with people where I've said, “have you thought about sleep apnoea?” And they've said, “oh yes, I've definitely got sleep apnoea”, but they don't want to go and actually have it diagnosed.

Jess: That does just sound like, when we've just talked about what sleep is actually doing for your body, maybe people aren't realising the effect that it's having. It's not just for you to have a nice little break and feel refreshed in the morning. Your body's literally doing some serious work overnight. That's really interesting.

Carla: It's actually quite scary, and because I have this, I guess, personal connection. So, my dad passed away quite young, unexpectedly, and he was diagnosed later in life with sleep apnoea. Now that I know so much more about it, I'm positive he always had it because he did always snore, so, so, so loud, was always tired. He also had a couple of other lifestyle factors that would have contributed to that, like drinking and smoking, because that's what you did back then, and because I have this personal connection when I have these conversations with people, I actually get a little bit upset. It just makes me think, you're essentially going to put some of your family in a place that I've been in, you're going to check out early, you don't want to wear a CPAP machine. There are other options. So, for anyone who was worried about the CPAP machine, I know there are other options, but if you could do something to avoid checking out early and leaving your family behind.

Jess: Yes, absolutely, I guess that it's a massive consideration you would think for people, but, even if it's things like sleep and it's effect on things like people's physical performance, is that a factor that occurs?

Carla: Yes, absolutely. So in underslept people, we see things like reaction times reduced, we see sprinting times reduced, thinking about strength, we see power reduced, so this was tested in bench press, deadlift, and I think it was a leg press. So, you have all of these physical aspects as well and, even when we look at the specifics of the positive, there were some studies done on athletes and they saw when athletes were adding a couple of hours a night's sleep. There were swimmers who were faster at swimming, they were faster off the blocks, so their reaction times had improved. Tennis players, their serving accuracy improved, and they also looked at basketball players, so again, speed improved and accuracy of shooting improved.

It's incredible. It's incredible.

Jess: It is fascinating when you think about just getting a bit of extra sleep and the benefits it could provide for you, that you could see in your day-to-day life, it's just fascinating. So now that we know why it's so important, why it's so critical and people know about sleep and good sleep health., how do we get better sleep?

Do you have tips on how people can, achieve a good night's rest?

Carla: Yes, absolutely. It definitely differs from person to person. It depends on their lifestyle and, I guess, what they have available to them in terms of their time, their schedule, et cetera. But one of the really important things that a lot of people are missing is just getting outside, viewing morning sunlight, resetting that circadian clock, that internal body clock each day because, that's how our body knows that it's time to go. That's one that I try to encourage everyone to do.

And it just feels great. And for anyone who actually has this as a regular practice in their life, and I know this as well, and I've spoken to many people that are the same, when you are used to getting that morning sunlight and you miss it, you feel terrible. You actually feel really out of sorts because it also provides focus, concentration as well, so that's one that I always recommend. And I mean, it's free. Sometimes it can be tricky to add into your morning, depending on what you've got going on, but all it takes is five minutes, five minutes with your coffee out on the balcony, or perhaps a walk around the block, jumping off the train, or tram a stop early and just walking those last five minutes to work. So it can be brought in, hopefully reasonably easily for most people.

Jess: And it's good to get that vitamin D as well.

Carla: Absolutely, also, so many benefits from getting sun at any time in the day. The other one I always recommend, because many of the clients I see do have a challenge around stress and mental alertness, is really thinking about what you're doing in the lead up to bed, particularly if you are someone who has trouble falling asleep or, if when you wake, either during the night, or early in the morning and can't fall back asleep. That's often related to stress, so really thinking about having some sort of stress management, I guess, strategy activity during the day, but then also thinking about what you're doing for that last hour of your evening. So in terms of lighting, in terms of the content you're consuming, are you doing something relaxing to really help dampen down that alertness, because if you're staring at your work laptop or staring at your phone right up until the last second that you turn the lights out, that is probably going to contribute to having difficulty falling asleep or when you wake later your brain just flicks on just like that.

Jess: And would you say is it important to have regular bedtime? Going to bed at the same time each night, how'd that sort of work?

Carla: Yes, absolutely. So, our circadian rhythm, our internal body clock, it essentially governs every process in our body, and it works like a clock, right? These processes all happen or like to happen at the same time every day, so that includes things like peak mental alertness, peak strength when your body is most ready to digest, and of course, sleep and wake as well. So ideally we wouldn't be changing our bed wake times by more than about 30 minutes each day, and saying that there's no problem with having a big sleep in once in a while, but if you're doing that consistently every weekend, so for example, if you are staying up late on a Friday night, sleeping in on a Saturday morning, staying up late on a Saturday night, sleeping in on a Sunday morning, when you get to Monday, you've effectively shifted your circadian clock.

So, if anyone does struggle on Monday mornings, they might want to look at what they're doing during the weekend and maybe just play with those timings, right? Because it potentially makes life really difficult.

Jess: So, but what I hear you saying though, is we can still have a sleep in every once in a while.

Carla: Absolutely, and actually, also naps. There's absolutely no problem with having a nap as well. If you are someone who tends to sleep okay during the night, so you fall asleep, fine, but you just find for whatever reason, maybe you've had a really bad sleep one night, or you maybe get seven hours, but you feel like you need some more sleep, there's no problem with having a nap, just keep it no later than three o'clock ish, and keep it under half an hour, but absolutely, big advocate of naps.

Jess: That's a great tip, especially, again, a lot of people with MS, even just managing fatigue, being able to have a nap. I've heard a lot of people worry about whether that's going to then affect their sleep at night. So, it's good to know that does fit in with, having good sleep.

Carla: Absolutely, and again, it's individual, right? Play with it, have a nap knowing that, oh, it might muck up tonight's sleep, but okay, at least you've tried it and now you know, and you can also play with the timing so maybe it needs to be a little bit earlier. The reason that naps can sometimes affect evening sleeps is due to sleep pressure. So essentially, you've got sleep pressure building for all of your waking moments and then once you nap, that sleep pressure dissipates.

So it's a little bit like hunger, right? You get hungrier and hungrier. You have a little snack. Oh, I have my snack too late. Now I'm not hungry enough for dinner or I have my snack early enough and now I can have dinner. It's the same sort of thing, so it might be a case for someone to bring that nap earlier, for example, to make sure that they've built up enough sleep pressure again before they go to bed. So yes, play with these kinds of things and see what works.

Jess: Yes, those are some great tips. And I guess for people who maybe are having poor sleep or just even trying to manage that, we hear a lot of talk about health monitoring devices, or there's apps for everything like other resources or tools that are really good to help people with monitoring or managing their sleep, things like Apple watches, do they even add any value for this sort of thing?

Carla: Yes, look, it depends on the person. I would say that, if you are someone who tends to get a little bit stressed and anxious around the sleep that you are or are not getting, then potentially having a device enforcing that may not be the best way to go.

With my clients, I actually tend to use a paper and pencil. I go old school, so they actually monitor their sleep through that, and the beauty of that is it's based on your own perception rather than an external device. The other thing to be aware of, and I wear two, but I don't monitor my sleep with them, and I don't check them every day. That's the trick for me.

But also when we're looking at sleep and the different stages of sleep, particularly REM sleep and deep sleep, the devices that we as consumers can buy, I'm not particularly accurate when it comes to that breakdown. So if you're seeing something that is suggesting that your REM sleep is super low, for example, that may not be the case and, from time to time, I do actually look at the statistics from both. And I can tell you that on a single night, these will be vastly different when it comes to the different stages of sleep. So I think it's really important to be aware of that, they can be great in terms of tracking lifestyle behaviours and seeing how that impacts, but I normally recommend to clients that if they are looking at a device that they're really just looking at the overall sleep and focusing more on actually how they feel. Do you feel mentally refreshed? Do you feel physically refreshed? Rather than relying on this external data, which may not be accurate.

Jess: Yes, that's such a good point to not be ruled by apps and your phone and things like that. So, is this also where things like, yourself and how sleep coaching can help educate people? Like, what is your role as a sleep coach and what sort of work do you do with people?

Carla: Yes, absolutely. Essentially, I'm a health coach specialising in sleep and health coaching is all about guiding people to meet their health and wellness goals through lifestyle changes, habit changes. So as a health coach, I essentially work with someone to figure out what exactly they want. Obviously with me, it's quite often better sleep, but there's always goals behind that, right? Like, there's a reason why someone is actually caring about their sleep. Maybe it's to do with family or business or, whatever that might be. So looking at what the actual goals are and then working with someone to actually figure out what is the best and, I guess, quickest way to improve sleep.

So I like to work with people and get them sleeping better as soon as possible, but also keeping in mind that habits take time to change. So it's about making small changes, spaced out, giving them time to embed, but also working with the client to make sure that it actually fits in with their lifestyle, right?

There's no point in me telling a single mother of three that they need to get outside every morning for a 30-minute walk, you know what I mean? So it's very much client led, and really working with the client to figure out what did they want and how does it work into their lifestyle?

Jess: Yes, I think that's such a great thing. And, even just providing that education, as we were talking about, just knowing what a lack of sleep is actually doing. So I guess if you had one top tip for people to really take away to help them get a better night’s sleep, what would that be for you?

Carla: Well, I've already shared the morning light, but what I'm going to do is also share another one, another tip that a lot of people have not heard of, but I think it's really useful, particularly because we spend a lot of time in artificial environments, right? If you are someone who, for whatever reason, is not going to have control of your evening environment, and what I mean by that is, you're going to be somewhere where all of the lights are bright on, maybe you need to work late that day, so you're going to be staring at your computer and there's going to be all this blue light. If you pop outside and actually view the twilight sky, that is going to desensitise you to the effects of artificial light later that evening.

And again, it just makes you feel great. So, yes, give that a crack.

Jess: And it's great too, that connection to nature. There's a lot of benefits for that, just being outdoors.

Carla: Absolutely! Flick the shoes off, stand in the grass.

Jess: Carla, this information is just so helpful and really sort of eye opening, some of those things that we've spoken about. So, thank you so much for your time and your strategies. I think that, if people even just have a look in, maybe reassess how they're feeling each day after they're sleeping, if they're having concerns, go and chat to your GP and talk to them about your sleep quality, because it can be just so vital for health.

Carla: Absolutely.

Jess: Fantastic. Thank you so much, Carla.

Carla: Pleasure. Thank you.

Jess: For more information on anything we have covered today, please get in touch with MS Plus Connect on freecall 1800 042 138 or email [email protected].

And don't forget to find the MS Podcast on your favourite podcast player such as Apple, Spotify, Google Play, Overcast, or you can just access the podcast directly on the website. Go to msplus.org.au

If you liked the podcast, please leave us a review.