EPI 234: Dr. David Garley Director Of The BETTER SLEEP Clinic. Undiagnosed Sleep Apnea Issues, Top Sleep Tips, Tracking Devices, Prescription Drugs & Melatonin, And Do REM & Deep Sleep Actually Matter?

Welcome back to another episode of the Peak Performance Life podcast. Today, I am very excited to be talking about one of the, if not the most important topic that, you know, we've all heard about, but we're going to really go deep in here today. We got Dr. David Garley with us. He is a director at the Better Sleep Clinic. He is a GP and diagnosis and treats a wide variety of sleep disorders. He previously worked as a respiratory doctor in the NHS Sleep Clinic in the Bristol Royal Infirmary, and he teaches sleep medicines to GPs and other healthcare workers within the NHS and in private clinics. He is going to share a lot of very valuable information. I heard some incredible stats when I heard him speak on another podcast about how so many of us are not even aware of the bad quality of sleep that we're getting or that we may have sleep apnea and how making a few simple changes could potentially make a extend our lifespan and our health span and help us live longer, happier, healthier lives. And that's what we're all about. So David, thank you so much for joining us here today. Thanks for having me on. Yeah, absolutely. Excited to jump into it. Why don't we start with a little background about yourself and how you got into the work that you're doing today? Yeah, absolutely. And it's a question I'd love to answer. So I've had a bit of a varied background from a medical perspective. So I actually first started working in sleep, as you said in the bio, when I was a respiratory doctor. So a lot of sleep disorders actually relate to how you breathe when you sleep. So a lot of the sleep disorders get kind of put under the respiratory team. Now, respiratory medicine is really interesting, but the treatments haven't quite kept up with diagnosis. There's lots of conditions that you know a lot about, but you perhaps can't do as much as you'd want. And you're often left feeling like you want to do more. But sleep is the really big exception to that. So obstructive sleep apnea, that's a sleep disorder kind of associated with snoring, where you get really fragmented, really poor quality sleep. But if you've got a patient who's had really good going sleep apnea for what could be a decade that they are falling asleep all over the place, falling asleep as soon as they get from work, no energy, often mimicking dementia because they've got so much cognitive impairment from this sleep deprivation. And in many cases, depressed that actually once you dive, know someone, which are the grand scheme of things is relatively straightforward, you can put them on really good treatments. So there's something called CPAP treatment for sleep apnea. There's sometimes it's two days later that you're looking at a completely new person. And it's such an addictive place to work. And it really highlighted for me the role that sleep plays in our health and wellbeing because sleep to be fair is a slightly vague subject. And I think sometimes we're a bit hesitant on how to approach it. But then when you see what happens when you restore good quality sleep to someone who's not had it for so long, that it really highlights the importance of this absolutely vital process. And so since then I've moved to general practice, I'm a family doctor now. And as you say, I'm director of the better sleep clinic. So we see a much wider range of sleep disorders. But it's really great to see that positive impact that fixing someone's sleep can have. Oh, yeah, I can only imagine. And I heard you say an incredible stat one time you said something like, I believe it's 85% of people who have sleep apnea don't even know they have sleep apnea. Is that right? That's absolutely right. Yeah. So 85% of people with sleep apnea are undiagnosed. Now part of the problem or part of the reason for that really is that a lot of the signs of obstructive sleep apnea occur at night when you're asleep. So the snoring, the pauses in your breathing, the kind of the choking feeling you can get when your airway closes that unless you have a bed partner who tells you about this, it goes under the radar. And so what you're left with is this kind of drowsy fatigue, you know, low mood, poor concentration memory that you get to in the day. But because sleep apnea develops slowly, these daytime symptoms creep in over time. And you can just think that this is just how life is. And until someone brings this to your attention. That's why there's so many people who go undiagnosed. Yeah. And I mean, if you're listening to this episode and you or someone you know or love snores or just is constantly tired, waking up fatigued, doesn't feeling like they're getting a good night's sleep. This is this is this could be a life changing episode. So make sure you really listen closely. I think, you know, I hear a lot of people kind of casually say like, oh, yeah, you know, my wife has to sleep in the other room because I snore so loud or something like that. And I'm like, man, that's a problem. Like that that that could be. I mean, that's not I don't I think people may think it's normal. I don't think it's normal. I don't think it's again, you tell me, I would love to hear your thoughts like, should people be concerned if they or someone they love is snoring every night? Yeah. So you can just get snoring by itself. So so it doesn't necessarily give you that that fragmented sleep. But certainly if if you're if you're getting snoring and you've got other stuff going on. So if there's the other nighttime symptoms, so the pauses in breathing or the kind of the choking in your sleep or during the day, just not feeling right, that you're you're feeling cognitively blunted, you're excessively sleepy. Now, that's when you should talk to a sleep doctor, a sleep clinic, a family doctor, because the step on from there is actually relatively straightforward. So it's a home sleep test. So these are watchlight devices that you wear for one night. They're different to wearable tech. So they're kind of more detailed, more specialized than that. But it's usually a watchlight device that you wear on one hand with a kind of a finger socket and then a chest sensor is the ones that we use measures really detailed stuff about your sleep. And that's usually fairly diagnostic. So back in the day, you had to go into a hospital and actually stay overnight. And you got rigged up to this enormous machine. So yeah, that's what I thought. That's what I thought. I thought you had to go in and do this whole sleep study and sleep in a place, which is kind of weird, because how can you get an accurate sleep study if you're sleeping in an outside of your normal environment? Yeah, exactly. Exactly. So you sometimes get away with that for sleep apnea because someone's so sleep deprived because the sleep quality is so poor that famously they'll sit in and they're just asleep straight away. But for any other kind of sleep disorder, sometimes actually do two nights in a row and then throw the first night away because that's getting used to it. But it's almost amusing when you see the amount of wires and set up that you need. And then trying to get a representative sample of your sleep. But no, so for sleep apnea, it's pretty much all done at home now. So it's only if there's concerns about another sleep disorder on top of that that they might do. It was called a polysomnogram, full polysomnogram. But no, measure that at home. So, and for us, our device is connect to your smartphone and then go from your smartphone to our cloud. So it's straight away within our team. And then we turn that around one to two days and then you've got your diagnosis. And as you say, it really can be a life changer. So things like fatigue and depression can sometimes seem quite stubborn issues and quite hard to move. But actually, if you find that it's sleep apnea, then that presents a real almost low hanging fruit that you really can treat that and that makes such a difference to your life. Yeah, yeah. I mean, I don't want to scare people too much, but I've heard some crazy stats. I don't know if you know any, but in terms of sleep apnea, if people don't address it, I mean, we're talking about it could take years off your life, not to mention, like you say, the quality of your life, people who are depressed and tired and walking around like zombies all day and not able to enjoy their life. Not to mention that it can take years off your life as well. Right. I mean, it's a really serious issue. Yeah. And so certainly if you think about sleep, so, you know, we sleep on average somewhere around about eight hours, which is about a third of your day. So it's about a third of your life that you spend asleep. Now, if you think about sleep, your blood pressure is lower, your heart rate is lower. So it's a state of relative cardiovascular relaxation. So the natural process of furring up of your arteries that leads to things like stroke and heart attacks has a natural process. But if you spend significantly more time over decades awake in that more stressed cardiovascular state, that that natural furring up of your arteries just happens earlier, which is why if you look at population studies on population levels, people who do get untreated sleep apnea or even insomnia for long periods of time do tend to get these complications earlier. So strokes, heart attacks, heart failure and so on. So it is something that's worth treating. And it's really a perceptive comment of yours, actually, to not scare people. So I think it is a lot of this data is on population levels. So it doesn't mean that necessarily the individual in front of you is going to have, you know, necessarily complications because of that. Because, as we know, with all of cardiovascular health, metabolic health, there's always a very multifactorial about how you exercise, how you eat and so on. But certainly sleep is a core part of that. And so trying to optimize your sleep as best as you can does have an impact on lifespan. Yeah, I mean, if we all just think about it, you know, pure obviously obvious logic is like your body needs oxygen to survive. And, you know, I mean, so many issues. I mean, they're literally people are in pain in their body due to lack of oxygen to certain areas of their body and things like that. So yeah, I think it's incredibly important. And so going back to many people potentially being snorers or not being aware, would you recommend if someone has the means, I'm not sure how much it costs, but if they snore, would you recommend they do one of these at home sleep studies? Is that kind of like the general recommendation? So if you have so what we say, there's a couple of scoring scoring systems actually that can help with this. So one's called stop bank. So this is looking at several things. So one is snoring. So some of it about your sleep snoring and so on. And they tend to turn it loud snoring. So if you can hear it through a bedroom door, they consider that sort of loud. So and this is good. So coming up to Christmas when people go home to their families, you can hear a parent snoring, you know, that's loud snoring. So if you have other things, if you hear that like you get the snoring and then you get a pause and then the snoring starts again, like that is a bit more suspicious, but particularly the daytime symptoms. So daytime sleepiness is the big one. So if you've got a cluster of these symptoms together, then we recommend. And there's so in the UK, there's the National Institute for Clinical Excellence. Nice. So they have a set of nine symptoms. I think if you have three that they suggest to sleep test, but what actually interestingly about sleep, and this is sort of broader than just sleep apnea is that they call sleep disorders a 24 hour condition. And what this kind of means is that people don't really care about sleep weirdly enough. What they care about is the other functions that sleep support. So, you know, wakefulness, energy, focus, concentration, mood. So and these tend to be the things that motivate people to seek help. So if your sleep apnea isn't giving you daytime symptoms, then you often don't present. And interestingly, you often don't tolerate the treatments. So there's always a bit of a split. So when I was working in NHS clinics, it was probably about a third, two thirds would come in because of daytime symptoms. The one third we usually dragged in by a bed partner because the snoring is so loud and they worry that when you get that pause and breathe, which could go on, you know, 15, 20 seconds, sometimes. That's crazy. Literally people are just going to breathe. Yeah, they're holding their breath for 15, 20 seconds in the middle of their sleep, pretty much. Yeah. Yeah. Absolutely. So what happens is your airways closed because you're up airways made of hard structures and soft structures and the soft structures are held in place by muscles. So as you fall asleep, your muscles naturally relax. So as you as these relax, your airway naturally gets lower. So the first thing that you notice is that the airflow gets turbulent and that makes all these soft structures vibrate, which is the snoring. But with sleep apnea, it closes. So you get that pause, the apnea, but your body's still trying to breathe. So you get this kind of school like sea soaring. So you're trying to pull in air, but your airways closed. So you get this kind of rocking thing. And then you get this as you as you wake up, your airway starts to open. He is. Wow. And then you start breathing. But all that that kind of swinging pressure into intrathoracic pressure swings that you get also, you know, doesn't do your heart any good. And you imagine if you could be getting that for 20 seconds in every minute, you know, if you've got it really, really bad, you know, and that's why some patients you look at have had such severe sleep apnea for such a long time and such a poor cardiovascular state. Sometimes when they get diagnosed, because they've got so much of this going on. Yeah, no, it's not not not a great condition to go undiagnosed, certainly. Yeah, yeah. I wanted to ask you about a lot of people kind of casually take these prescription sleep medications. What are your overall thoughts? I mean, I try to, you know, again, I'm not a doctor. I don't know. I'm not diagnosing anything. But I think a lot of times people would just say, I want to get a better night's sleep and I'll just get a prescription sleeping pill. And then next thing you know, they're addicted to the sleeping pill or could have other side effects or whatever. But you tell me what is your overall kind of thought on prescription sleeping pills? So I think there's a really there's a really good aspect here. Is that people clearly value their sleep and people want to have better sleep? So that's definitely a good thing. But like I said earlier, like sleep, it's not really a concrete concept. And so people sometimes aren't sure about how to approach it. Sleep isn't within our direct voluntary control. It's outside of our voluntary control, which means that when you're your sleep isn't where you want it to be. You can feel powerless. You can feel that you as a person can't do much about it, which isn't actually true. You have an awful lot of indirect control about sleep. But sometimes people do look at medications to do that. And there's ones that you can get over the counter, so without a prescription. So that varies from country to country. But melatonin is quite a big one, certainly in the States and in Australia. And so melatonin is a hormone that's produced by body and is the main hormone for the night phase of your circadian rhythm. So you have the day phase and the night phase of your circadian rhythm. And the circadian rhythm is one of the two key systems that controls our sleep. So the hormone during the day is cortisol. So cortisol, really good hormone, really essential hormone for maintaining daytime physiology. But at night, it kind of switches for melatonin. And melatonin helps promote all the kind of the nighttime physiology of which sleep is one. And it would kind of make sense that if you take the hormone for the night phase of your circadian rhythm, that it will actually help sleep. But we actually don't really see that in a big way. So if you look at big international studies that have looked at the impact of melatonin on sleep, it's not really there's not really any impact at all. For most ages, so from about 18 to 55 years old, there's not really any impact at all. From 55, there is some evidence that there is a weak effect when you sleep. So there is some minor improvement. But it's not normally that dramatic. And a lot of that kind of age related changes, really, because as you get older, you tend to produce less melatonin. So by 55, you probably have reached that kind of threshold where your sleep can be a bit more fragmented. So for some older people, it can help. However, if you speak to people who take melatonin, they will often tell you that their sleep is better. And that goes for a lot of other supplements. And most supplements have no evidence base at all in sleep. But you can't deny that some people find that it is somewhat helpful. And now the reason for this, I think, is actually beyond the actual medication itself. So what often keeps people up and stops people sleeping well is this phenomenon called sleep effort. So this is trying hard to sleep. And you all know the more you try to sleep, the less likely it is to happen. Now, people kind of know this as a kind of basic principle, but I think really understanding is actually quite difficult. And again, I think it comes back to this kind of vagueness and abstractness of sleep. So what is sleep? No one really knows today. And so what's trying to sleep? What's not trying to sleep? These aren't necessarily straightforward concepts. So the idea of taking a tablet to help with your sleep means that you can really let go of trying to sleep. That it's that kind of backdoor into letting go of sleep effort. And I think that's often where the benefit really is that you basically outsourced the effort to a tablet. So in a way, it's like a placebo. I actually had a discussion with someone the other day for quite a long time about whether it truly is a placebo, if it is actually addressing what the core issue is. So placebo is obviously more about, you know, the placebo effect, which you get in, you know, get everything. You get it in chemotherapy, you get it in cardiovascular medicine, but an awful lot in sleep. But I think it's slightly different in sleep because it is actually addressing the very core issue of poor sleep and insomnia, which is sleep effort and a lot of anxiety about sleep. Yeah, that's interesting. Yeah, I am a big believer in the placebo effect. There's certainly a lot of cases where it's proven out true. But yeah, it makes a lot of sense what you're saying. And in this case, it can relieve potentially that stress. I know melatonin. Yeah, it's an interesting one. You hear about it so much. I mean, they're giving 10 milligram, 12 milligram doses is kind of like a common dose here in the US that I see. I've always kind of stayed away from it, even though I actually heard a lot of benefits of it during the pandemic for even immune support. A lot of people were talking about it, but also, you know, for sleep. So you hear a lot of things, but personally, I don't really want to start taking anything that may be habit forming if I don't have to. Right. And so, yeah, and magnesium is one that also maybe there's not a whole lot of clinical studies on it, but seems to be kind of a consensus that like magnesium helps you sleep better. I know I take magnesium every night for a number of reasons. Sleep being maybe one of 10 reasons, you know, but yeah, any thoughts on magnesium? Yeah, so I think magnesium, so I think a lot of it is probably going to be about patient selection. So I could imagine that for some people, perhaps those who are naturally low in magnesium, that there can be some benefit. Magnesium isn't a thing that you can absorb very well through your gut. Also remember from hospital days, if someone has very low magnesium, that you normally have to inject it if you want their magnesium to come up because the oral absorption of magnesium is usually pretty poor. And imagine that variation person to person. So if there's a quirk of your gut, you have low magnesium, I could well imagine that some magnesium supplements do help. And so I'm absolutely not close to that as an idea. I suppose, like with a lot of supplements, and I think this is a thing of the over the counter sphere is that often the claim perhaps is a bit of an overreach and they're perhaps over promised. And I think that's perhaps where some of the friction occurs is that they, you know, you get a magnesium supplement, say you sleep eight hours, you know, every night. And it's just not true. So I think it can help and support some people with their sleep. I think the kind of the miracle cure that you sometimes see in marketing, I think, I think that's probably why it occasionally gets a bad name in some circles. Yeah, yeah. And it's not going to cure your sleep apnea, neither melatonin or magnesium is not going to not going to help at all. You got to you got to diagnose this. So I think kind of kind of going back to that. And I do want to transition in a little bit into kind of sleep tips that people can use to get better sleep. But I do kind of want to just circle back a couple of things. Number one, we talked about, you know, making sure a lot of people being unaware. And so getting this sleep apnea at home test that you can now do much simpler than what it used to be and making sure that, you know, you don't have sleep apnea and then need to get a CPAP machine, which I have heard, you know, have they made any progress in making the CPAP machines any more comfortable? Because that is something I did have a friend who had sleep apnea and he's like, man, I this thing on my face every night. I just, you know, it's kind of annoying to sleep with. Is there any progress there? Yeah, I don't know when your friend was having issues, but a lot of it is about the mask. So if you get a mask fit and there's, I don't know, there's a quite a famous picture of, I don't know if it's kind of got its way to the States, maybe it's even from the States of like the bumblebee. And it's like a bumblebee and they've got a photos at the side profile of all the different kind of proboscis, is it? And it's like a thousand different types of kind of insect. It's the same with CPAP masks that you've got thousands and thousands of different types. So what can really help you? We always recommend anyone who gets CPAPs to get it through a clinic because you can buy it online, but you just get a bit stuck because it's a fantastic treatment, but it's probably different to treatments that you've had before. And sometimes you just need a little bit of a nudge with a couple of bits and mask fit is one of those areas. So our physiologists, they're called the sleep team. They, you know, they've, they are very much kind of Jedi master in terms of, you know, the force and understanding what, what would help, you know, looking at your facial profile, whether you're a nose breather, mouth breather and so on and just getting that right and making sure it's set up properly in terms of the straps. But if you can crack that nut, which can definitely be done, then you normally get on all right. And it's even advised. So sometimes people just feel it's a bit of a kind of a close thing to have on, which is fair enough. But even simple advice like watching TV during the day with the mask on, not attached, just getting used to it, building up that familiarity. Because it's so important to get over that initial unfamiliarity with this is a treatment because it can be so life changing. And that's what's sad is that sometimes when people say, you know, I can't get on with CPAP, but they bought it themselves online and not had access to the support that it really could be that kind of treatment. But it's just about going bit by bit, not trying to build Roman a day, but even like, even if it takes a few weeks to get up there, because it's a lifetime condition. If you can get there, even if it's like two months, you know, if you can get there, then it's worth it. Yeah. Yeah. And just to kind of finish up also on the prescription, we talked about melatonin and magnesium. Those are kind of, I would say, less risky than a full on prescription one that I've heard a lot of people getting. And now I know someone who, you know, they have to wean off of the prescription and it caused it acted sort of like an anti-depressant SSRI caused some other deficiencies and issues. And now they're, now they're trying to just recover from the damage that was done by taking this prescription pill for so many years. I mean, is it necessary in some cases? What should people maybe do first before getting a prescription sleep pill, do you think? Yeah, really great question. So they have their role in sleeping tablets, but it's more in acute or short term insomnia. So, you know, a bereavement or a health scare or something like that. Something that's kind of stretched you out in the short term and you've stopped sleeping that sleeping tablets can help get you back on the wagon with sleep and they can stop you perhaps going two, three days without sleep. And then you can get a lot of lots of sort of impact from that. So they do have their role, but really we're looking at courses of two to five days. So not long at all. So the issue occurs when they prescribe for longer term or chronic insomnia. And sleeping tablets firstly is a bit of a misnomer. So they don't give you sleep, what they are are global brain sedatives. And from that sedated state sleep is easier to come by. But you get all the other issues with sedation. So you get the hangover effect in the morning. And you can fall at night. And that's particularly relevant for people who are older, who with poor vision, brittle bones, who are giving sleeping tablets, they do fall and they do break their hips. So that is a serious thing. And as you say, they can be addictive. But the other issue is actually getting off them, even if it's not sort of frank addiction, is that you can get something called rebound insomnia. So they can be difficult to stop from that reason. But the evidence in long term insomnia is really, really poor, really poor evidence of them helping, but lots of evidence of them causing harm. So the best treatment for chronic insomnia is called cognitive behavioral therapy for insomnia or CBTI. So this is by far and away the best treatments. This is what we do. So talking through with people about sleep, about, you know, the mechanics of sleep, talking through the, you know, there are ways that you have an awful lot of indirect control over your sleep and just trying to take control of these factors and nudging your sleep in the right direction, talking about sleep effort and trying to dismantle this fix it approach. Because that is actually often what is perpetuating the problem. So but it's their access to that is the difficulty. So when people can't get hold of CBT from insomnia, all doctors can't prescribe you know, doctors want to help. So sometimes they think that sleeping tablets are the only thing that they can offer. And then that's why you end up with patients in a bit of a pickle. But trying to get people off them can be done. So that's what we do in our clinic and you use CBT for insomnia to do that. So if you're stuck on them, if anyone's listening, and it does feel that they're stuck on them, that it doesn't have to be that way. And you can, you can get off them, it just takes a little bit of thought and attention. Wow, that's phenomenal. So at your clinic, you're doing cognitive behavioral therapy CBT, which is a very commonly known, effective kind of like tool psychologists basically use with with patients, right, to help them with a variety of issues. But I actually had never heard that it was so effective and used specifically for sleep. And and so this is part of your program when you're in your sleep clinic as well. Yeah, absolutely. Yeah, so it's a very robust treatment. So CBT, as you say, is used for anxiety and depression. And it's perhaps more of a broader subject there. But with its sleep, it's much more focused. And it's quite uncommon if you can get that consistency with the steps of CBT from somebody is quite uncommon for your sleep not to be fixed as a result. Now, no treatment is 100%. But it's a solid treatment. But it's just about getting that treatment out there. So part of what we do as well is that we do teach and train on CBT for insomnia to broaden the, you know, widen the range and scale that as a treatment. But it's really, really excellent, really excellent treatment. I love that. That is phenomenal. I had not heard of that before that that sounds just spot on amazing. I'd love to transition a little bit now people listening to how can people get better sleep, you know, in general, what are some of the common, what are the most important things there? Yeah, another great question. So I suppose, going through it, I suppose, what is better sleep or what is good sleep? And there's different ways. I said, there's probably two ways you can look at this. So one is looking at what happens at night. So and often, this is what people will use to describe this. Did you fall asleep quickly? Did you wake up in the night? How many hours did you get? Things like that. That's, you know, fair enough. But we're all quite different on this run. And there is this idea about quality of sleep as well as quantity. And so part of the issue is that because we are unconscious as we sleep that we don't necessarily get that first hand experience of the quality. But what you can do instead, you can look at the things that sleep supports. So you can look at primarily wakefulness. So do you feel awake during the day? Do you feel the urge to go back to sleep before lunchtime? You know, these are key questions for a sleep assessment. How's your mood? How is your energy levels? Concentration? And actually, if all of these are okay, then chances are you probably are sleeping all right. And so it's always good to look at that data. Now, certainly, when you're looking at data on function, you are in a multifactorial arena. So there are other things that can impact that. But it's important to look at both day and night when you're assessing your sleep. But if you feel that your sleep isn't quite where you want it to be, then there are some good things that you can look at. So one is firstly to look at opportunity for sleep. So the commonest cause of sleep deprivation, certainly in the UK, and I suspect it's probably worldwide, is called voluntary sleep deprivation. You have to be slightly careful with that term because what the kind of the voluntary component might be like looking after children or, you know, being a baker and getting up at five or having 12 jobs, so that sort of thing. So there's not always room for manoeuvre, but it essentially is not spending enough time in bed. So a lot of people actually do sleep fine. But the answer is really about trying to restructure your day to allow more time for sleep at night. Now part of that will depend on how many hours that you feel you need as an individual, which is quite varied. On average, it's eight, but range is really seven to nine. So finally, how many hours you need. And also when in the day or night that you really like those hours. And what I'm talking about there is chronotype. So that's there's the two that get used a lot is morning, dark and night owl. And we're all kind of somewhere, most people are somewhere in the middle actually. But knowing when you like to sleep. So you can get a problem if you're very much a night owl. And this is a big thing for children, children, not even teenagers, like if you're 20, 19, 20, anyone is that age, they want to go to bed at like one or two a.m. And then wake up at nine or 10. So if you try and get us on to go to bed at like nine or 10, like it's just not going to happen. So just being aware about that and just get your window and I'll say was the first really important thing. Other things that you can do. So you want to make your bedroom the best environment for sleeping in and doesn't have to be kind of two engineered, but cool, dark and quiet is what we normally say. So you want the bedroom cool, because when you transition from the wake phase to the sleep phase, if you're circadian, this is marked with a drop in your core body temperature of about a half to one and a half degrees Celsius. So if you're very hot, you can't make that transition. This is why in the peak of summer, no one sleeps very well. When it's freezing cold, you'll get there. But in summer, you can forget it because if you can't do that temperature transition. So having the bedroom cool can can absolutely help. You want the bedroom dark. Partly because if it's very bright, you can't get to sleep. But it's also if you perceive light through your eyelids, it might not wake you up, but it pulls you to shallow estates of sleep. So you might not wake up completely, but you just spend more of your night in the shallow estates of sleep, which means when you wake up in the morning, when your alarm goes off, even if it's been the right quantity of hours, you still might feel unrefreshed. And it's the same with noise actually. So if it's noisy, you might not wake up, but you just wake up a little bit. And so earplugs can help with that. Yeah, yeah, it's good stuff. Actually, white noise, my wife and I have been using a white noise machine for a long time. It seems to work. But again, we don't want to turn it up too high, but kind of just enough to drown out the outside. But I did, when I was kind of measuring it, which is the next thing I actually want to ask you about is measuring. I actually have an eight-sleep. I have a lot of friends that are either wearing an aura ring or an eight-sleep or some sort of sleep tracking device, whatever. There's so many of them these days. And so we're looking at like a lot of REM sleep and deep sleep, right? These are kind of like the two major markers that it seems these sleep trackers are giving us. Do you have any kind of rule or best practice there? Should we each be getting like at least 90 minutes of REM sleep and 90 minutes of deep sleep? Or what do you think about all that? I think about it a lot because patients always ask questions about it. So it always comes up. So there are guidelines on how what a typical person would have in terms of the stages of sleep. But this is the other interesting thing, again, is that we talk about sleep architecture and your route through the different stages of sleep on a typical night. But this is a process that we don't engage with at all. Apart from a snippet of a dream that we might remember, we have no real idea about what stages we've gone through and we can't really influence it. All you've got is that daytime feeling of sort of how it went and how you know these daytime functions and how they're supported. So I'm a bit old fashioned, but I actually think these are the best way to really assess your sleep. And the other thing is sometimes a bit of a question mark on the accuracy of the devices. So if you really want to have a proper idea of your sleep architecture, then you have to do the polysomnogram. So that's the inhospitable test with the electrodes on your head. So that's the gold standard. Now, the medical devices that we have are accurate. So they look at other markers of the stages of sleep, but they still get passed through a trained physiologist who's a, you know, often masters level physiologist who has to go through it unit by unit and often re-score, re-stage the sleep in order for that to be considered accurate. So a lot of the devices that you'll find, certainly from the high street, particularly if it's like an ur, or you know, any kind of ring that has one point of contact on a finger, it's never going to be that accurate. When you look at the head-to-head studies, they've been 50% accurate. Now wearable tech does vary, and they are always getting better. But the moment they're not really, most of them aren't really accurate enough to give too much of an idea. But the issue of kind of the broader issue with that is it does encourage sometimes a too meticulous view of sleep. And sleep is fundamentally different to all these other areas of healthcare. So if you were to take healthcare as a really basic triad of exercise, nutrition, and sleep, the exercise, nutrition, again, more concrete concepts, a lot more value in that kind of meticulous approach sometimes, calorie counting, looking at carbs, macros and whatnot, exercise looking at, you know, now you can look at what zone of exercise you've been in quite reliably through wearable tech. But sleep is fundamentally different because the more you think about it, the less you tend to get of it. And so sometimes that broad brush stroke approach is really what you need. And certainly there's several patients who will come through our clinic each month who are who are just perhaps looking a bit too closely. The best thing you can get with wearable tech is a healthy curiosity with your sleep. And I am always curious to see what tech might suggest my REM is, but I always take it with a pinch of salt. They're not always accurate. And also the other thing is that sleep as a specialty is quite far behind a lot of the other specialties. And part of that is because when someone's asleep, they're unconscious and you can't really study them very well. But we never really know what the norm about REM and all that stuff is like. What REMs for is like, I wouldn't say guesswork, but there's a lot of uncertainty about large parts of sleep medicine, which I think most people in sleep medicine would probably admit, maybe not publicly, but I think certainly in secret, they've been like, yeah, to be fair, it's a bit vague. Yeah, yeah, it's really interesting. I mean, I will say I will agree with you, you know, oftentimes I'll feel like I didn't get a good night's sleep. And then those are the, when I first started tracking my sleep, I was, I was obsessed with it. And then I said, this is bad. And then I just stopped, right? Because I was like waking up and like running to check my score in the morning and stuff. I mean, it was, that's just the absolute wrong way to do it. It is interesting, isn't it? Yeah, it is. Because you're all into it, right? Did I get good sleep today? And then it's like, oh, no, my score is low. And then like you kind of gets in your head, right? The plus going back to the placebo effect, which oddly enough, now I have a friend who had an aura ring and an eight sleep and would wear them both. And he said that the eight sleep always gave him better sleep scores than the aura ring. And I said, Oh, good, I want the eight sleep then because I just want the sleep device to tell me I had the best sleep ever. So I can get the placebo effect and feel better that day. But when I feel good, I actually don't want to check the score because I don't want to see a bad score. If I actually wake up and feel groggy and tired, then I might check the score. And then sometimes it shows me a good score. And I say, Hey, maybe I'm not so bad today. You know, I feel better. So yeah, there's so much psychological factor there. But so it's interesting. It's more about how you feel than how much REM and deep sleep are attracting device says. Yeah, makes a lot of sense. I'd say so. Yeah, yeah. Yeah. Yeah. So okay, so great. So sleep tips, you said cool, dark room, getting making sure you have that block those hours of sleep. You know, I did always I have heard a few times I'm curious, like I have heard people say, Well, if you get to bed by 10, you're going to get better sleep because the window from 10 to 12 is I mean, I don't know, you know, if that's any of that makes sense. Like I remember when I first heard it, I'm like, How does my body know what time it is if I sleep eight hours, I sleep eight hours, like what's the difference. But as I've kind of got older and learn more about circadian rhythm and stuff like that. I'm curious what your start is about on that. Yeah, so it is it is a it is a thing. So you're nice. If you look at, you know, say roughly eight hours of sleep, you can split the night in two. So first half second off. So the first half, so you still go through sleep in a cycle. So you fall asleep into what we call non REM one. So very the absolute lightest sleep what you do during Netflix, if it's not interesting, then you go a little bit deeper to non REM two, which is still considered light sleep, but just a bit deeper. And then after maybe 30 minutes, say 30 40 minutes, you have your non REM three. So this is the really deep sleep that you need to get to feel properly refreshed in the morning, the really good stuff. You work your way out essentially to the surface. Have your first bout of REM sleep. So it's your rapid eye movement, your vivid dreaming sleep. So that is a sleep cycle, the average time of which is about 90 minutes. And you have a series of sleep cycles throughout the night. But your sleep cycles in the first half of the night have more non REM three. And in the second part, they have more REM. So if you go into bed an hour early, you're more likely to have more non REM three than if you stayed in bed an hour late. So this is why the old wives tell they're saying like an hour before bed counts for two after. So it is kind of true. If you are feeling really sleep deprived, you will get the benefit more if you go to bed an hour earlier. And this is why with with getting more REM in the morning, this is when your alarm goes off. You're normally in the middle of a really quite bizarre dream, because you're statistically more likely to be in REM. So it is a mid tree. And okay, that's good to know. Very, very interesting. What about morning sunlight and kind of starting this circadian rhythm clock? You know, we've heard a lot about what's your opinion on that? Yeah, so circadian rhythm is one of the two systems that controls our sleep. And this is just this natural rhythm, this natural momentum you have that tells us is it day or is it night. And we've evolved this because as a species, we're so reliant on light to carry out what we do that we're not a species that can hear well, you know, we can't sniff our way through a forest that we need to be able to see to be able to do things. And so we've evolved to be active during the daylight hours and sleep at night, this carries on with the cycle. And so when you are exposed to daylight, this is the week they call get called time queues. So or the often use of German term, they're called zeitgebers, timekeeper, and light is the most strongest one. So when you have that exposed to daylight early in the morning, it just helps reinforce the wake phase if you're circadian rhythm. So this can help you feel alert and encourage I suppose daytime physiology during the day. But it also means that your sleep will arrive more naturally at night. And this is a thing with sleep that often, if we're not sleeping well, we focus an awful lot on the night, but actually by shifting your focus to the day and carrying out these activities that really reinforce the wake phase of our circadian rhythm, that you do get that benefit with sleep as well. So light is really important. Moderate. Sorry, is there a certain amount of time you think we need to be in the sunlight is five, five, 10 minutes enough? Do we do we need to get in or we had an eye doctor on the podcast who said never look into the sun, you know, that kind of stuff. I guess, you know, we just want to get sunlight. I try to go out and take my shirt off in the sun. I'm lucky I live in Vegas where it's sunny pretty much every day or year round. So I like to go outside and take off my shirt and get sun on as much of my exposed skin as I can. I try to get 30 minutes most mornings when I can. And that feels great. Like I want to get enough sun. Obviously, I don't want to get a sunburn, but I want to get a good amount of sun. But I've heard of potentially only needing maybe even five minutes in the sun. What do you think? I think it's tough to get real world experience with that. So one of the issues with circadian science is it doesn't really move out of the lamp very well. So a lot of what the research you read, I'll probably get shot down for say, but like the real the real experience is that it is quite hard to get. And a lot of this is based on personal experience. So and also another thing that really reinforces the wake phase of a circadian rhythm is being awake. So it's kind of hard to separate, you know, what light and mindsets are really important things as well. And certainly getting out into the daylight lifts your mood. And when you're in a good mood, you feel more alert. And so there's no there's no blood test of alertness, unfortunately. It's like it's so subjective. But I mean, I'm so jealous of the experience you've just described about being in Vegas and just getting out into 30 minutes. I mean, we barely have 30 minutes of sunshine in the UK at the moment. It's just very, very dark and dingy. But you know, I'd feel like a million dollars after that. And then I know that I would feel alert and that so I mean, I'd say, you know, if you can get 10, 15 minutes in and even if it's just a walk around the block, then I think you'll feel the benefit of that. Yeah, yeah. Anything else I know, I've heard you talk about people being on their phones, which so many people do in bed. Tell us a little bit about that. Yeah, so so being on your phone, I mean, the phones, they dig a lot of they get a lot of fact to be fair. And this week, obviously, Australia is now banned social media for 16. So think, I think a lot of what people use their phones for are meant to be kind of engaging, particularly social media, activating your mind. I mean, from my point, I'm not hugely on social media, but certainly work emails that if I do that in bed, I can guarantee I'm not going to sleep very well, because my mind should have been activated. It's less about the blue light. I think there's often been a lot of worried about blue light and the impact of you know, if that's stimulating the wake phase of your circadian rhythm when you should be winding down for sleep, it's probably less about that and more about the content that you're using your phone for. And that also means that if you wake in the night and you can't sleep, we always say find a relaxing and distracting activity to do. Now a lot of people just love watching TV, you know, and so that's okay. But sometimes they don't because they're worried about the screen light. But that's okay. So just finding something that you enjoy and if that's watching TV or, you know, watching football, you know, there's no that's not the worst thing in the world, but probably try to avoid social media, YouTube, you know, the usual suspects. Yeah, yeah, I wear blue light blocking glasses. I do like wearing them at night. And especially because I do actually, when I go to sleep, I do put on a comedy and I put the sleep timer on for 30 minutes. And that's kind of how I like to fall asleep. But one thing I'm very careful of is don't first of all, don't watch any new show that I've never seen before that's going to capture my attention and keep me up. I watch a comedy show that I've already seen before that it's just kind of making me laugh and going to sleep with a smile on my face and just kind of some background noise. But I'm not I'm not so engaged that I have to be paying attention. I certainly will never watch anything like ultra violent or dramatic or anything like that. I think that goes back to social media and and things that you were kind of talking about before. But yeah, wearing the blue light blocking glasses does it does I do feel it I do feel like it takes some strain and fatigue off of my body. So yeah, I do enjoy wearing them even though I get made fun of all the time for for wearing these red sunglasses at night. Yeah, that's a lot of what we encourage in sleep is that, you know, you have to acknowledge the rich diversity of humans and we all sleep differently. And I think it has with any sleep advice is to make it generic and say this is something for everyone. It really isn't that case. So I think that's a cool to like not be evidence based. But you know, that some people do get benefit from certain things. And you know, it wouldn't be our job to to say that that's not the case, because you can't really take away from someone's personal experience. But and then we always encourage people to really reflect on what helps their sleep and take control of those factors. So it's great to hear that that is something that you're doing. Yeah, yeah. Well, Dr. Garley, this has been incredible. A lot of great information here. And more importantly, I really hope that people who are listening going back to the beginning of the episode, especially if you or someone you know is snoring regularly, you know, every once in a while, someone might get a stuffy nose and you might snore a little. But if someone's snoring consistently, every, you know, almost every day, I would highly recommend that they reach out to to you and and do one of these at home sleep tests, please tell people how can they learn more and find you and what are all the things kind of that you offer you can do an at home sleep test, even if you're in the US with you guys? Tricky the US. So we're UK based, but we do have other online resources. So if you want to find out more about sleep, then do come to our website. So we're thebettersleepclinic.co.uk. I'm on social media as well. So everyone Instagram, TikTok, a few other channels say, and we're always throwing out content and really keep you got questions just far as a question on there. We're really happy to get back to you. Amazing. Amazing. Well, this has been great. And we'll have to do an update sometime. We'll have to bring you back if you're if you're open to it, because this was just amazing. And yeah, I hope we can do it again sometime. Sounds good to me. Thanks for having me on. Thank you. Thank you for listening. If you enjoyed this episode, it would really mean a lot to me if you would forward this episode along to any friends, family members, anyone that you think that would get value out of it and learn something important. The mission at peak performance is to help people prioritize and transform their health. And so if you think someone will get value, please, please, please do forward this episode along to them. Also, if you could please rate and review and subscribe on whatever podcast player you are listening to this on, we would greatly appreciate that as well. It means a lot. And I want to tell you about a couple of new products that we just released, you can get 20% off your first order at buypeakperformance.com. That's BUYpeakperformance.com. We just released a brand new grass fed beef protein isolate. This is my favorite new protein powder, because it's great for muscle building and recovering and all that kind of stuff. But it doesn't give the stomach discomfort and gas that a lot of people get from, you know, different types of proteins like whey protein, some types of plant proteins can do the same as well. 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