The Physical Performance Show: Dr. David Cunnington – Sleep Specialist, Melbourne Sleep Disorders Centre

 In Podcast (The Physical Performance Show)

Dr David Cunnington

In episode 143 of The Physical Performance Show Brad Beer shares a conversation with Dr. David Cunnington – Sleep Specialist, Melbourne Sleep Disorders Centre (Expert Edition)

Dr. Cunnington is a Specialist Sleep Physician who is the co-Director of Melbourne Sleep Disorders Centre. It is a Multi-Disciplinary Sleep Clinic for the diagnosis and treatment of sleep disorders. Dr. Cunnington undertook his training in sleep medicine both in Australia and also at Harvard Medical School, Boston. In addition to David’s training in sleep medicine he has an international qualification in behavioural sleep medicine using non drug treatments to manage sleep. Dr. Cunnington is a prolific media spokesperson, you can find him in radio, TV, his own podcast, he is a sort out expert commentator on this phenomena of sleep. He’s a regular national and international key note speaker, he’s also had a water rave experience in the sporting field as he will share on this episode.

This is an episode not to be missed especially if you’ve ever wondered about your sleep, are you getting enough? Is it the best quality? How can you improve it? This episode will challenge your perceptions about your own sleep and perhaps liberate you to approach sleep differently and to not be so dogmatic about the do’s and don’ts.

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Listen in as we delve into the following:

  • Typical Week for Dr. Cunnington
  • Approach to solving sleep problems
  • Why do we sleep?
  • How can we have a better sleep
  • What happens in a sleep cycle
  • Sleep Deprivation – categories and effects
  • Habits to make sleep easier
  • Things to do to get a better sleep
  • Role of Temperature and Lighting in your bedroom
  • Causes of Insomnia
  • Restless Leg Syndrome
  • Suggestions for getting up in the morning
  • Tips on sleep when travelling
  • Caffeine and Alcohol Effects
  • Screens – how can it affect sleep
  • Melatonin as a supplement
  • Role of sleep in bone density

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Dr David Cunnington Dr David Cunnington


“Be respectful of sleep, create an appropriate space and then be ambivalent on what happens in that space.” – Best Advice
“Drop a sleep belief and cultivate your napping skills.” – Physical Challenge
“Don’t be sleep deprived and drive.”
“Sleep is designed to be disturbed from time to time.”
“Sleep deprivation is broken down into involuntarily and voluntarily.”
“We can’t make sleep come.”
“Try to manage your respect for sleep.”
“We need time off from getting stuff done.”
“As human beings we’re designed to sleep.”
“Sleep is one of those things in life that we can’t control.”
“People with tendency to worry are more likely to develop insomnia.”
“Approach it rationally.”
“Replace the Rise and Grind with Sleep-in and Win!”

To follow Dr. David Cunnington

LinkedIn: David Cunnington 
Twitter:  @David Cunnington
Facebook: @drdavidcunnington
Website: Dr. David Cunnington
Website: SleepHub
Podcast: SleepTalk


0:00 Start
02:03 Introduction to Dr. David Cunnington
04:00 Typical Week for Dr. Cunnington
06:58 Approach in solving sleep problems
08:00 Why do we sleep?
10:05 How to have a better sleep
11:50 What happens in sleep cycle
19:38 Sleep Deprivation – categories and effects
22:46 Habits to do to make sleep easier
25:00 Things to do to make a better sleep
27:14 Role of Temperature and Lighting in your bedroom
32:53 Causes of Insomnia
34:34 Restless Leg Syndrome
37:20 Suggestions for getting up in the morning
42:35 Tips on sleep when travelling
46:10 Caffeine and Alcohol Effects
50:20 Personality Question Round
52:37 Screens – how can it affect sleep
55:10 Melatonin as a supplement to sleep
59:16 Role of sleep in bone density
1:00:25 Physical Challenge
1:02:56 Dr. Cunnington Social Media Handles
1:07:00 Finish

Dr David Cunnington Dr David Cunnington

People Mentioned

Dalai Lama – Spiritual Leader
John Kepertsin – Professor University of Boston
JA (John Allan) Hobson – Harvard Medical School Professor

For questions and comments about this Episode

Send to the show host @Brad_Beer (Twitter)

The Physical Performance Show Brad Beer


Brad: Dr. David Cunnington, this is a really buzz for me. We have been looking to find someone like yourself about all things sleep for some time, noting that it’s such a pillar of optimal health and performance. So welcome to the Physical Performance show Dr. Cunnington.
Dr. Cunnington: Great. Thanks a lot Brad.
Brad: To give us a little perspective in context. Firstly, what does a week in the life of your medical life look like Dr Cunnington? And how did you find your way into this fascinating world of sleep medicine?
Dr. Cunnington: So I’m a clinician and I’m a specialist physician, so I spend my week seeing people with sleep disorders and because I’m a specialist, they’re people that have been referred, so they’re referred by a general practitioner. So people have really got to feel like they’ve got a pretty significant problem before they end up in my office. And about half my week, much like you’d understand as a clinician about half my week is face to face. Patient contact is a bit of paper work, goes around that. And then the rest of my week is we do some research or do quite a lot of teaching, teaching lots of health professionals about sleep and much like yourself, really like generating digital content cause it’s just a great way of providing educational content for both health professionals and the public about topics. And in my case about sleep.
As to how I ended up in sleep? Why not? Isn’t it a great area? It’s just a love it. It’s fascinating. It crosses over into so many other areas of both health, wellness and life. I started off as a trained is a respiratory physician here in Australia and part of that is you train in sleep apnea. So breathing during sleep and then went over to Harvard… it is about 20 years ago, Harvard for two years to do some research in sleep and really got hooked. Then I worked with some awesome people there who just showed me all the different aspects of sleep about neurology, how the brain works, how sleep interacts with society and exercise and performance and space travel and the whole range of different things. And love it, love it if it ever since.
And I’m a bit of a Geek as well and measuring sleep involves lots of gadgets and so it allows me to explore my sort of Geeky tech side as well.
Brad: So it’s ticking all the boxes and would you agree that there has been somewhat of a heightened awareness around sleep in its role in good health and in the athletic population performance in the last maybe five to 10 years?
Dr. Cunnington: Hey, absolutely and it’s interesting or shocking when I’ve worked in the US 20 years ago, we were then acting as advisors to some of the professional sports teams, so baseball teams, NBA teams, let’s say the NFL, you know 40 is a bit more hardcore sort of old school, but they’re into it now as well. And that’s where some of that research about the sort of home and away wins in the baseball games in the US sort of stemmed from. So that sort of works been going on for quite a few years, but it’s filtering down. So now I get the sort of lower tier sports teams, maybe state level teams or even regional teams looking at sleep and travel and how they’re gonna manage that rather than just the top tier professional teams.
Brad: Yeah. I mean it’s still there very much a badge of honour for being sleep deprived, and pushing on and working hard. How do you think we can tackle that? Is it just more Dr. Cunnington’s spreading the message or what’s the grassroots approach to solving that?
Dr. Cunnington: Yeah, absolutely. It’s particularly in the exercise world, rise and grind. So we’re just going to replace rise and grind with sleep in and win, that’s the mantra to go read.
Brad: Sleep in and win.
Dr. Cunnington: Because that’s what the data suggests, it really good data about getting that extra bit of sleep, that recovery, this associated with that and that improving performance, which you’re right. Culturally it’s the, go harder. The way I’m going to win is I’m just going to put in more hours than everybody else. And that’s what’s gonna get me ahead. And not necessarily so.
Brad: Yeah. Gosh, we’re fighting generations and generations with this, the fights very large and obvious question. And you know, I recall as a physio therapy student, David doing some sports physio training at the AIS. And some of the teaching staff, they were talking about the effect of sleep on performance. And I remember someone asking that very question, I’m about to ask. And everyone’s sort of chuckled because I guess we assume we know, but why do we sleep?
Dr. Cunnington: We don’t really know why. So that’s one of the great mysteries. But we know at a basic level, sleep’s important for recovery. So we know as biological beings, if we don’t sleep, we don’t recover. And we gradually have deterioration in performance. But actually wanting to doing physiologically, that’s the bit that’s not well understood. We haven’t really delineated that. There’s one of the doyens of sleep medicine, I Will Dement from Stanford. His definition of why we sleep it’s so we don’t bump into things in the dark. You know, I don’t think it’s as basic as that, that we don’t really understand apart from the fact it’s a restorative process. What I’m talking to people about and ask me questions like, “Well, how do I know if I’m getting enough sleep?” And that encompasses why do we sleep. For my way of thinking it’s if we maintain in good physical and mental health, then sleep’s working for us. And that’s independent of stuff like how long is it? How often do I wake up? I’m aware of things? Do I dream? Do I move? Really if people have good physical and mental health, then it’s working.
Brad: And so why question its merit? I guess the hard thing is how do we know if we’ve got good physical and mental health apart from how we feel?
Dr. Cunnington: Yeah, you’re right, it’s how we feel but in a general sense, if people aren’t ending up in the doctor’s office that often, they probably got reasonable physical and mental health and particularly athletes that pretty attune to that. So not just how you feel, often people are tracking things like heart rate response. They’re doing the same sort of exercise and seeing how far or how fast or what wattage or how they’re … What sort of heart rate range they’re in? So they can get pretty close measurements and notice if anything’s a bit off.
Brad: Yeah. Do you feel that because people get so set in their sleep habits and routines that if people are somewhat chronically sleep deprived, that the difficult thing is it’s impossible or it’s difficult for them to know what it’s like to have better quality sleep or in some cases the sleep deprived person’s case, more sleep because they just don’t have a frame of reference in which to compare how they have been feeling with their mental and physical health.
Dr. Cunnington: Yeah, that’s a really good point. And often people who feel like they’re smashing it, and I see these both in athletes and also in the business world and the small, small business world, particularly their entrepreneurial sort of space. People say, yeah, absolutely smashing it. I’m working really hard and are killing it. Everyone else is sleeping, I’m grinding. And there’s not much insight into the fact, well maybe you’re not doing quite as well as what you think, you know, the wheels are falling off, but the person who powering ahead can’t see it. And that is one of the strange things about sleep deprivation is often people lose insight. It’s one of the things I lose first.
Nice example of that is the driving. So we all know don’t drink and drive, but really we should have that same mantra. Don’t be sleep deprived and drive. But in the setting of sleep deprivation much like with alcohol, There’s a sense of that bravado and lack of insight. And people don’t know how impaired they are. And so I won’t say I’m just not feeling as good as what I should and therefore it shouldn’t be driving. I felt like, yeah, I’m good to go. But if I can manage this and it leads to problems.
Brad: Oh, wow. I like this. Don’t be sleep deprived and drive and then sleep in and win. There’s a new maxims coming out of this.
Dr. Cunnington: Oh yeah, I got some more for you.
Brad: Let’s have them … Dr. Cunnington Can you share, many people have heard about sleep cycles, but can you practically walk us through what happens, and we’ll  touch obviously, as we go on, how to better get to sleep and trying to fight some of these sleep disorders or be equipped to deal with them. But what practically happens when we get to sleep, what happens from then until when we wake up in terms of these sleep cycles and the processes.
Dr. Cunnington: Arbitrarily divided sleep up into these two categories. One is called non-REM sleep and the other categories called REM sleep. So REM stands for rapid eye movements and then we’ve also divided non-REM sleep into N1, N2, N3. We’ll think of that as increasing depth of sleep as you go from one down two to three. Now that it all sounds very sophisticated but it was actually just decided upon by a whole lot of guys sitting around a table in 1968. So it’s actually a 50 year old convention based on trying to classify brain waves into different… There’s four different stages of sleep. So it’s actually not that sophisticated and there’s lots of times where that breaks down. But what that sleep staging does allow us to do is just get a feel for how sleep progresses across a night. And in the intervening 50 years, once we’ve had this classification system for sleep. What we’ve really learned is for sleep to work well it’s gonna unfold like a book.
So you’ve got to think of it as chapter two comes after chapter one and chapter three comes after chapter two. So if I’m scrolling through a sleep study, which believe it or not is 30 second pages of sleep either 80 hours. There’s 960 pages I will look at in a sleep study. I want to know or be able to predict what comes next based on what’s gone before. And so that’s how I can tell your sleep quality is good because the story unfolds in the right sequence. So often people will tell me, ah look, I’m not sleeping well cause I’m not getting the right proportion of REM or I don’t get any REM or any non-REM or any of this. It’s actually less so the proportions, it’s more that sequence and that’s what the sleep cycle is. So as an individual sleep cycle might last somewhere between 60 minutes and 120 minutes and it’s a progression from non-REM in N1 to then N2, then N3 back to N2 and usually a little bit of REM.
And then the next cycle has that same sequence and the next cycle has that same sequence with changing proportions of those things as the night goes by. So really think of it as both. There’s these mix of how those things progressed with a cycle and then the sequence. So the whole night sort of stringing together like a book, there’s a story that unfolds rather than … For me poor quality sleep, I’m seeing someone with a sleep disorder for example, it looked all out a sequence. It’s like you get chapter 10, then you get chapter 20, and then chapter 11 and then chapter one. I can’t predict what’s going to come next. And that really tells me here that sleep’s not working very well.
Brad: So poor sleep’s less about the proportion of sleep as so many of us would attribute it to, and it’s more about the sequence as you just stated. What is happening in those sequences? Are there practical things that are, that are happening in those deepening end stages of sleep?
Dr. Cunnington: Again, there’s this sort of myths or beliefs that I need to deep sleep. That’s where my memory gets consolidated or I need the REM sleep cause that’s where your this happens. That’s sort of right, but not a hundred percent right because lots of things happen in each stage of sleep and across stages of sleep. So it’s not as if you’d be missing N3, then your memory’s going to be bad or missing REM there’s a particular problem and in fact people can have quite distorted proportions of sleep and still function well. For example, all the antidepressants are very strong REM suppressing medications, yet millions of people that are on antidepressants and feel like they function mostly reasonably well. Not lacking in memory, trouble with learning, couple with concentration, those type of things. Yet that’s actually quite a distorted proportion of sleep. We came to … If we do experiments where we’ll selectively sleep deprive people, those sort of experiments show that probably that REM sleep is more involved in consolidating motor memory.
So think you’re playing the piano or doing a sequence of motor tasks. So you know, athletes trying to maybe something like shot put or discus or something where you’ve got these sequence of tasks you have to go through you’ll learn it a bit like a dance. Whereas at the deeper non-REMs like N2 an N3, are more about stealing the wisdom of our experiences. More about that. Integrating our day to day memories, wiping away the movie, like reply and retaining the meaning of our experiences. Whereas someone has had a traumatic experience and get … is going to go on to develop PTSD. They don’t sleep well after their traumatic experience, they don’t get that deeper sleep, they don’t lose the movie like replay and distil the meaning. What they keep is the movie, like replay of the traumatic event. And that’s what sticks with them.
Brad: Well, so much there. What would … can you practically share as you’re trying to get this unravelling book happening in the sequence as you’ve stated, and you’re a parent of a young child and the child wakes you up at 2 a.m. and you’re somewhere about to go into that next chapter. What happens to the story as the individual gets back to sleep?
Dr. Cunnington: As adults, I could tell you what happens; We get in the way of it. If we just got out the why and let our bodies just get on with the job of sleeping, it’d all sort itself out, which slot back into that sequence and we keep on going. So in a very practical sense is what I see in a sleep study I’ve got someone monitored they’re wired up on measuring their brain waves or the EEG continuously. When a lead falls off, my technician will go in and wake them up, adjust the lead, go back out, and they pick up right where they left off in terms of those sleep stages. But in real life, that’s not what happens. We wake up and go, damn bloody awake again. Now I’ve got to get back to sleep, I gotta be up at six, today is going to be real slow because things … so we get in the way of that sequence restarting because of the narrative and the beliefs and things around sleep.
Whereas we got out the way it would just go back to normal cause as biological beings our sleep and our  sleep system is designed to be disrupted and then get back on with sleeping. You know if you think of that sort of sleeping in a cave and there’s noise, there’s a fire that needs to be tended to, we’re not comfortable we’re sleeping on the ground. You know sleep isn’t this perfect long, continuous, undisturbed experience. In fact sleep biologically for humans is designed to be light just from time to time but the body just then gets back into its rhythm and keeps going.
Brad: So we want to try and get out of the way of it but maybe is the answer this heightened awareness that, hey, if you do have a sleep disturbance, toilet, stop, a screaming child, a loud noise outside, just try and settle back into it? Don’t over think it? Is that the answer to this? This greater awareness or is it something that we can’t really improve?
Dr. Cunnington: Yeah, easy to say and hard to do but, Absolutely. Part of that rationalisation is yeah, rather than ah bugger, you know my sleep been disturbed; it’s okay, that’s how I’m biologically put together to be able to deal with sleep disruptions, deal with what needs to be dealt with, and then just get back on with the job of sleeping.
Brad: Melbourne Sleep Disorder Centre obviously where you founded it and you base yourself from, I know you deal with sleep disorders and conditions, insomnia, sleep apnea and the variety of other conditions. Can you speak to this sleep disorder space and what happens with sleep deprivation? What are the categories of it and what are the actual effects that it can have on health and performance?
Dr. Cunnington: Yes so most of the sleep deprivation you sort of, if you break it down into involuntary and voluntary and what I’d say is a sleep disorder is involuntary and I’ll come back to what that is. But in society wide most of the sleep deprivation that’s occurring in society wide is voluntary sleep deprivation. I’ve got better things to do than sleeping so I’m going to be doing that and trying to push sleep as far into the corner as I possibly can and just take the minimum I can get away with. So that actually society wide a very big problem because you’ve got a large subset of society that’s under slept, trying to get by and the coping strategy is run on more nervous energy and at some point the wheels fall off. People become stressed, they feel frustrated, unwell, they developed anxiety, they’re not performing well on a whole sort of range of realms of life.
And then they end up in my office, but only after sort of 10 or 20 years when they’ve actually then got established depression, established anxiety they’re on a whole range of pills, they’re in big trouble, but they’re not the ones that come to me initially. So the ones that are more coming to me in that sleep disorder space, think of that is that involuntary sleep deprivation so insomnia is an example of that. Someone who’s setting aside the right opportunity for sleep, they’re making enough space, they are getting into bed at the right time, getting out of the bed at the right time but the sleep just won’t come no matter what they do. So they’re sleep deprived, but it’s not because they haven’t provided the space, they’re wishing for it to come. So that’s one of the most frustrating things about insomnia is just it won’t come.
And I see that sort of thing in athletes a lot because the performance coaches will be getting into them going. You’re only sleeping seven hours at night if you got eight hours or even better if you got nine hours, you’d get that extra 0.1 of the second and you increase your ranking. We can’t make sleep come. And so the perfect way to make an athlete anxious about sleep is to tell him to get more when they’re already trying to get more. And so that’s a lot of the narrative we use around sports teams is rather than telling the athletes to get a certain amount of sleep, we’re using the team structure and the organisation to make sure there’s a quarantined amount of downtime and whatever sleep is going to come, it’s going to come in that space. But not being too worried at how many minutes of sleep come in that space.
Brad: So two categories: voluntary, involuntary in your professional work. In sleep medicine, you mainly work with the people that fall into the involuntary category. But the societal wide, problem of which I’m very much putting both hands up with here, is that I’ve got better things to do than sleeping. I’ll sleep when I must rather than make it a priority. So can we speak to these societal wide problem and what is it that we can do practically to improve our sleep in terms of habits? What would be some of the top habits? So we’ve got an awareness that it’s important, but what would be some of the habits that you would suggest we do to try and fall into sleep easier.
Dr. Cunnington: Yeah. So, I reckon we’re still in the awareness phase to be honest. So absolutely people will, tell you, sleep’s important in the same way they can tell you that not eating unhealthy diet is important, but it’s the implementation all sort of switching from you. I know what’s right to then deciding, okay, I’m actually going to do it. That’s where we’re still at it in that space. And because you’re right,  people still wear as a badge of honour, how little sleep they’re getting, you know, at work everyone has that busy off, I’m busier than you or I’m training harder than you rather than no one’s bragging about how I’m sleeping harder than you are. So catch me if you can. No one’s having that type of talk. So that’s how we need to be conceptualising sleep because then the rest follows.
Because if we’re still in that trying to cheat it, trying to get away with as little as possible, then often what the habits that come from that are all about trying to turbo charge sleep. How do I do it faster? How do I switch from full on to full off quicker so my time use is more efficient and we’re just not robots. We’re biological beings, we take time to wind down and as well as sleep, we actually need time off for rest and recuperation. And so that’s for me, if people just go straight from the right sleep’s important then to the what am I going to do they’ll just go too hard on the what am I going to do and try to turbo charge it or try and max it out or ace it or try and get it to make certain parameters. And again, that’s the perfect pathway that becoming anxious about sleep, trying to control it. In essence comes back to getting in the way of it to make sleep, meet certain parameters and feeding into a tight box that we want to jam it into.
Brad: Right. So we’re going to abandon the paradigm that … and I’m guilty of this. All right it’s important So let’s get it. Turn the computer off overnight and go and get it. So how can we start to get away from this going from full on to full off? What are some things we can do to maybe ease our way into getting to sleep in a better manner being better prepared for this?
Dr. Cunnington: So then part of it is it’s a tricky balance of trying to manage respect for sleep. So we’ve got to be respectful and make sure I’ve got an appropriate sort of place and time for sleep, but then an ambivalence about what happens in that space. So it’s okay. Trust of a good physical and mental health, I’ve created the right opportunity, my brain and body going to take the sleep they need in that space and how much that is is going to vary on a day to day basis. Then also within that recognising that as human beings sleep is one of the important components of restoration that helps us maintain physical and mental health. But it’s not the only one. We also need time off task. So time when we’re not ticking things off, getting things done, running at full time nervous energy.
So that’s also where that concept of allowing an allocated space of time, for example, if you’re aiming for seven hours of sleep, which is a reasonable aim, having that an eight hour space where you just say, right, that is my quarantine time. But recognising within that between the sort of start of that idea was there’s probably going to be a good hour of just feet up, chilling, letting that sort of nervous energy set or getting ready for sleep. I don’t mind if that’s in bed reading, feeling like people are getting more settled, it’s talking with your partner, it’s doing something that we just … it’s just that it’s not getting stuff done. We need time off getting stuff done and as long as there is some time of getting stuff done, that’s the time that the brain is going to gradually wind down and then be ready for sleeping.
Brad: Whereas the fact often we’ve got kids is like right, get the kids down I have a half an hour to get some stuff done. Then I’ve got to get into bed because I got a seven hour window for the alarms going to go to the next day.
Dr. Cunnington: And there’s not a race recuperation part. There might be sleep but there’s not actually any other recuperation in that schedule.
Brad: Create the right opportunity. I’ve written down here and get some time off task, but be at reading, talking to your partner and just getting off the to do list. What’s the role, David, around temperature and lighting in this quarantine space.
Dr. Cunnington: As long as it’s okay, then that’s okay. And so biochem and not too cold, not too hot, not too light, can’t really have too dark, but it just needs to be a reasonable space for sleep. We don’t need a perfect sleep environment for sleeping. Again, you may think that as biological beings, sleeping on the ground in a cave with a fire in the open air. That’s how human beings biologically are designed to sleep not on a $10,000 mattress with blackout blinds and sound insulated sort of noise proofing around the bedroom and don’t get into my sleep sanctuary otherwise you will ruin my sleep. That’s not biologically how our we’re geared up to sleep. It’s how we have come to believe in westernised societies how we can … perfect sleep.
Gwyneth Paltrow has this term I hate called clean sleep. Where the more perfect you are about the things you do with sleep, the more virtuous as you are and the healthier you’re going to be. For me, again that’s just a pathway to getting anxious about sleep because people then build this belief system. I can only sleep if I’ve got my blackout blinds, then I’ve got this and I’ve got that and I’ve controlled the temperature and everything is absolutely perfect. A nice example of that is I run some residential sleep workshops so I’ve got a great partnership with the Golden Door Health Retreat in the Hunter Valley and they run a really great sort of service there.
When I see some of the people we sleep problems that come to the health retreats often, surprisingly often people travel with rolls of al foil. And as someone who manages people with sleep I know what the al foil’s for. It’s to black out the windows cause someone who’s got insomnia and is worried about their sleep, travels with al foil when they stay in a hotel because if the curtains aren’t good enough, they can al foil out all the windows. And that’s an example of that. I can only sleep if I’ve controlled this environment. It’s respect but ambivalence. It’s got to be dark enough, not too noisy, but it doesn’t have to be perfect.
Brad: So I’m really picking up a theme from your sharings around not creating this expectation that things have to be perfect because that can then drive anxiety, which can have the counter effect of what we’re trying to achieve, which is a good night’s rest. So I’m really picking up a theme here David around-
Dr. Cunnington: Good. I’m glad you’re getting a theme.
Brad: Yep. Around just do your best, don’t obsess and be smart with a few things.
Dr. Cunnington: Yeah, Absolutely. And that is such a tricky balance to be … It is balancing, be respectful, but not too respectful and yet step back a bit from over analysing what happens in that space because they’re particularly the things I see with athletes because they were into measuring performance and the athletes as a whole. They’re very responsible, they try hard, they’re doing everything they can to optimise performance. So they want the checklist and I want to mark everything off on the checklist. Good sleep is one of those things, one of the few things in life we can’t control. It’s almost like you’ve got to go sort of hardcore during the day and then turn into a Zen Buddhist around sleep and  back, right off and just let things be.
Brad: You all are listening to Dr. David Cunnington, sleep specialist, co-director of Melbourne Sleep Disorders Centre, sharing around all things sleeping and how it relates to our health and wellbeing. Support for today’s show comes from Sanitarium PB. Looking to achieve your personal best Sanitarium PB can help. This refreshing drink contains 32 grammes of protein per serve, to help with muscle recovery when included as part of a balanced diet. Sanitarium PB is made with a balanced blend of milk and plant proteins. All your essential amino acids and contains no artificial sweeteners. Find Sanitarium PB in delicious chocolate or vanilla flavours at your local petrol station. Be your personal best. Recover and refuel with Sanitarium PB.
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For now, let’s jump back with this week’s expert addition featured guest, Dr. David Cunnington, sleep specialist.
Going back to insomnia there, is it a fair assumption and that anxiety is one of the key triggers for that or is insomnia one of those conditions that if we knew how to sleep physicians, practitioners like yourself knew how to treat then we wouldn’t be dealing with it as a society. Do we know the causes of insomnia?
Dr. Cunnington: Yeah, we do. So there’s lots of different components to it, but you need a few ingredients and people with a tendency to worry or a tendency to anxiety are far more likely to develop insomnia than someone without those tendencies. Because in essence all of us get acute insomnia every year. There’ll be something that happens that throws out sleep out for a day or two and then it settles back down. Then we’ve got a tendency to worry or a tendency to anxiety that happens, but it just ramps up that, oh, what if this doesn’t settle? You know, what if it doesn’t settle what’s that gonna do for work the next day. And so with each time across a year that you get the transient sleep disturbance just cause of some circumstantial thing. It goes on for that little bit longer and that little bit longer and eventually gets to be this thing that just persists and doesn’t really settle between episodes.
And also see a  tendency to anxiety. We’ve done some recent work looking at personality traits and people with personality traits of a tendency to perfectionism. Hello all your athletes out there, and medical professionals I must say as well. The people with a tendency to perfectionism have absolutely that same risk of developing insomnia cause it’s that, okay, I’m going to control the process, it’s going to put in place something to effect the outcome. I’m going to monitor whether that works. Then if that doesn’t work, I’m going to put in place something else to impact the outcome. And people end up getting this rigidity of thinking around sleep, which feeds into an anxiety about sleep, which guarantees they get in the worry of sleep, overthink it and it starts to just not happen.
Brad: Thank you for sharing. Restless leg syndrome. What is it? How do you treat it and what’s is it caused from?
Dr. Cunnington: Yes, restless leg syndrome is surprisingly common. So, if we do a phone survey and ask people the cardinal symptoms, so do you get of an evening, a sense of needing to move your legs that you can’t comfortably sit still, that ramps up just before bed and it’s worse for the first couple of hours of the night? Or do you go to the movies? Do you get a sense if you can’t keep your leg still this irresistible urge to move? So that one in six of the population will say yeah, I get that. I’ve had that from time to time. And particularly it happens in times of iron flux. So people are chewing through a lot of iron. So pregnancy, perfect example of that. So most pregnant women will get restless legs at some point, but other illnesses, high training where you chew through a lot of iron can also give people a restless legs symptoms.
So that’s the one in six will get it occasionally, but about three in a 100 people get every day and it drives them completely bananas. Where, if they’re just getting ready for bed, their legs get this feeling of a need to move and then you’re lying down and quietly in the bed and just cannot lay still and the legs just want to keep on moving and keep on … Essentially preventing people from getting just sleep. And that lasts a couple of hours before finally quietens down. In those sort of groups, that’s the sort of person who’s coming to see me in my practise, one of the things that I managed and we look at things like iron levels. If iron levels are a bit lower, we’ll look at topping up their iron. It’s a bit of research on magnesium supplements can help for some people.
And if those things don’t settle it, we then look at some of the prescription medications. But that’s not an easy road to go down and it’s not necessarily straight forward.  Restless legs isn’t really driven by lifestyle so much made it worse by caffeine and alcohol. And we published some research looking at mindfulness meditation for restless legs sometimes you could actually improve restless leg symptoms with mindfulness based meditation, not necessarily as a sole treatment that we use it in our really difficult people that we work with her. It might be on multiple medications and still got problems. Mindfulness as it does a nice job of taking the edge off those symptoms.
Brad: So if you are experiencing restless leg syndrome, I guess the encouraging thing here is there are known solutions for it.
Dr. Cunnington: Yeah, actually lots of things that can be done and a good understanding of it. So a good starting point is you talk to your health professional about restless legs if it’s something that’s giving you trouble.
Brad: All right brilliant. It’s morning time and our alarm clocks, obtusely wake us up, we roll over and it hit snooze. Can you speak to what’s happening when we do that? And we then hit it a second time and have the little feeling that we are winning because we’re getting an extra 10 or 15 minutes. Is that effective? Is it not? Any suggestions? Now for getting up in the morning Dr. Cunnington?
Dr. Cunnington: Man, I must have set you up with that question this is perfect. So we all have an internal body clock and that body clock has a cycle length. Now, we live on a planet that has a 24 hour cycle length, but for humans the median cycle length is 24 hours and 17 minutes. So for the median of the human population, when the alarm goes in the morning, exactly 24 hours after the time it went off the day before biologically it feels like it’s 17 minutes too early and that is two hits of the snooze button. So that is finding that you need to hit the snooze button twice before you feel like you can … Yeah. Okay, now my feet can hit the floor. I can start to get going. You’re right, bang on the median for a normal population. So feeling like you need to hit the snooze button twice. He’s being human.
That aspirational thing we have of waking just before the alarm and leaping out of bed and the sun shining and there’s flowers blooming. That’s three in a hundred of the population. Having an internal body clock of 24 hours, zero, zero minutes or shorter. And so that’s just an aspirational non biological phenomenon that we get sold. If you ate enough vitamins or you were virtuous enough where you trained hard enough, you could turn yourself into that person. Some of the things, a little closer to my heading is the how to make yourself a four a.m. person and it’s just go harder, try harder. And it’s a biological thing rather than a motivational thing. So yeah, hitting the snooze button twice, completely normal. Now there are sort of tiles to that internal body clock link.
So some people would be shorter, there the early morning types, but they’re the minority. The majority, or it’s a bigger tile at the light or not types of the night owls who are going to be more than two hits of the snooze button. They’re going to be, feel it more like a 24 hour, 30 minute body clock or even meant 24 hour, 45 minute body clock. Really feeling like the mornings are pretty tough. So normal to hit the snooze button, the reality is when you need to get up at 24 hours, zero zero minutes each day because we’ve got stuff to do. And work starts at the same time, and the kids need to get to school. So it’s really just recognising it for what it is. Sure, alarms going 17 minutes too early for my biological clock this is going to hurt a bit. But you know what? I’m just going to get out, get up and do it.
And the getting up and doing it, the being upright, the movement of the large joints, the light into the back of the eyes, putting food into our stomachs, all cues in the body clock to hey, you thought it was 24 hours, 17 minutes, the time you were supposed to get up. It really is 24 hours zero zero minutes and it will reset that so that the body clock doesn’t drift out day after day after day. So, cause a lot of people when they come to see me in my practise and I said, “what’s the trouble with sleep?” They say, “well, the trouble I have is when my alarm goes and I first opened my eyes, I feel dreadful. I don’t feel like I’m ready to start the day.” And I was like, “hello, you’re one of the 97 in 100 humans that that’s a normal phenomenon.”
Far too often we judging how the day’s going to go by how we feel when our eyes open. Whereas for it’s normal to only reach 80 percent of their performance capacity. Both be that cognitive performance or physical performance two hours after we wake up after I biological awakening time. So it really the time to judge how am I tracking, you’re up at seven because once you’re at the desk at nine o’clock, instead of being to your day now how am I feeling? Not when you first opened your eyes. Because far too often people when they first opened their eyes like, oh, it’s always going to be another tough day cause I’m really not feeling like getting up right now.
Brad: You have astounded me, and I think it would probably most of the listeners, this is fascinating. So if you’re part of the 97 percent that hit the snooze button twice, once again, be at peace. Things are okay, you’re normal. And then if you’re part of it, 100% of people, I think that apart from the 3% I shouldn’t say that. Wake up feeling great and it takes a little while to get going, don’t despair you’re in the typical bell curve.
Dr. Cunnington: Yeah.
Brad: And these biological clock, it just seems absurd that we’ve had, we’ve got a clock that it’s 24 hours that we run our days by, yet most people have 24 hours and 17 minutes as you state. So the bit that I’m stuck in, I don’t even quite know how to angle my question is the disconnect why and how that this seems bizarre.
Dr. Cunnington: Yeah. Good point. I’m not sure how to account for that either and neither is the field and they sort of body clock researchers don’t really have a sort of theory about why isn’t the median 24 hours, zero zero minutes. Yeah. Not, not sure.
Brad: Well, I’m sure you’ll keep pursuing that one with your research or someone will. Dr. Cunnington, the body clock time zones, we take a vacation or we fly for work. We’re out X amount of hours. Any tips for how to best get around sleep disturbances due to time travel?
Dr. Cunnington: Yeah. So a couple of things. One of these approaching it rationally. So rather than sort of getting too close to it, too emotional, stepping back and looking at it rationally. Now, the rational sort of approach you need a couple of facts. So, one fact is we can only shift one hour to the east per 24 hours without it really starting to hurt or two hours to the West for 24 hours without it really starting to hurt. Now if we add in things like Melatonin at night, light in the morning, we can probably increase that. So maybe up to two hours to the east per 24 hours or four hours to the west per 24 hours. But that’s the constraints. That’s the constraints biology. So I tried to travel Melbourne to London and expecting within 24 hours to be good to go or to do a day shift and then the next day do a night shift and be completely shifted. They’re just non biological desires. There’s no amount of things you can do to shift that.
So then that rational approach is just recognising, say if you are travelling interstate or internationally is going, how many times zones am I going? I’m I going to the west or am I going to the east? And therefore what do I need to plan? I’ll give you an example if I’m going to west coast USA, most of the time it’s somewhere between five and seven hours to the east. Now I’m a bit of an early morning time so I can get, go to the east a bit easier than some. But if I factor in, it’s going to take me two hours per 24 hours and I’m going five to seven hours, then it’s going to be about three days for me to acclimatise to west coast USA time.
Everyone need to hit the ground running. I’m going to start to shift a couple of days before I travel. So two days out I’m going to be an Auckland time. One day out, I’m going to be on Hawaii time and travel day I’m going to be on Los Angeles time. And that’s broken it up into those two hours to the east per 24 hours to be able to shift the body clock. And I’m also going to choose my flights based on my own personal sleep preferences. So not to pick a flight where I know that long leg is yet. I reckon that’s about the time that I would normally sleep and I could fit a reasonable sleep window in that time.
And a nice example of not approaching it rationally and again, one of those sleep retreats that I run up the Golden Door, there’s highly successful business people that I see there. And there was one CEO who was telling me how she’s travelling to many countries and doing big deals with different government regulators in different currencies, she’s got that all sorted, but she’s asking me how do I work out my jet lag? And I’m just like, the jet lag is easy. It’s one hour, two hours to the east and west, how do you deal with the regulations and the currency because that’s her world. That seem simple, whereas the sleep stuff, she’s too close to it because she’s too emotional, not able to step back and look at it in the same way she would it analytically if she was thinking about as a business problem.
Brad: This theme coming through again about your biology and it makes me think of a recent feature performer we had a one of the arguably the greatest endurance athletes ever, six times, Hawaii iron man triathlon champion, Mark Allen and he said you can’t shortcut your biology.
Dr. Cunnington: Nice. Exactly the same for adjusting to jet lag.
Brad: So you can’t shortcut it, just think and approach it rationally and don’t get too emotive about it. There are no hacks.
Dr. Cunnington: Yeah.
Brad: Great. You’ve set a lot of people are free from the stress around that and striving I think around the jet lag and travel. David, caffeine, alcohol, what do we need to be aware of in terms of trying to optimise our sleep around the use throughout a day or into the evening?
Dr. Cunnington: It’s a funny thing if people have good sleepers and a good proportion of the population are good sleepers, no matter how it disrespectful they are asleep. To be honest, people don’t need to be too careful about it and probably don’t need to think about it. It’s more in the realm of if people are not naturally good sleepers and feel that sleep’s a bit vulnerable or a bit fragile, that it’s then again taking a rational approach to it. So caffeine is a stimulant and so you can use caffeine for good. First thing in the morning to help with that inertia and to help to get going, can be a performance enhancer for in an athletic sense. But then the negative effects of caffeine, it’s got a very long half life. So it’s going to keep that mental stimulation going for a lot longer than what people wish it did. So it’s going to potentially get in the way of sleep and make it harder to switch off at night. So people do want caffeine, first in the morning, try to avoid it after lunch.
Alcohol, a little bit of alcohol, probably not a big deal, but as alcohol gets metabolised, the metabolites are stimulants. And so alcohol has this sort of two pronged effect. First part of the night, people can feel like it might help them relax, switch off, get off to sleep, but about halfway through the night it comes metabolised. It’s actually making them wake up and making sleep restless. And people feel hot and uncomfortable and then they wake up feeling tired. And if someone’s having insomnia, they’ll attribute that to, well, I didn’t sleep well because I’m probably can drink enough, I didn’t sedate myself enough. May end up drinking more the next day and it’s a bit of a vicious cycle into just drinking more and more and using alcohol as to turbocharge switch off to what not.
Brad: So we do really need to be aware of how we engage with those substances because there are real effects. So trying to avoid caffeine after lunch and be aware of the effect of alcohol in the evening a little bit might be okay.
Dr. Cunnington: Yeah, absolutely.
Brad: This is a very difficult question for someone of your knowledge around this topic, but if you could boil everything you’ve learned through your professional career, your time at Harvard Medical School, working with professional sporting teams in the US, here in Australia at the Sleep Disorders Centre, Melbourne Sleep Disorder Centre. What would be the one bit of advice you’d like people to take from, the sharings that you can offer?
Dr. Cunnington: So it goes back to what I was talking about, about the respectful of sleep, creating an appropriate space, but then be ambivalent about what happens within that space. And trust that brain and body will take the sleep they need.
Brad: That simple?
Dr. Cunnington: Yeah.
Brad: Wonderful. If you missed last week’s episode, a featured performer episode featuring US track and Field Star, Nick Simmons. 800 metre silver world athletics championship medalists and Jewel Olympic representative than here’s a  little snippet of what you missed.
Nick Simmons: I think that as I became a wiser businessman and started to understand how money works, I could see that in track and field there were billions of dollars exchanging hands and yet all the athletes around me were living under the poverty line. And it just didn’t make sense. I started digging and I’m like, holy cow. All of these governing bodies, they just skim off so much money from the system that very little has a chance to make it down to the athletes and that’s a travesty because without the athletes we don’t really have it in an event at all. Do we?
Brad: To tune into the rest of episode 142 featuring Nick Simmons. Jump over, download the episode from within your favourite podcast player and while there check out the archives, featured performers, expert additions, interest additions in coaches corners that in right back to the very first episode featuring it surf lifesaving Ironman champion Allie Day. For now let’s jump back with this week’s guest expert addition, Dr. David Cunnington, sleep specialist from Melbourne Sleep Disorders Centre.
Fun Question to get to know the personality behind Dr. David Cunnington sleep specialist, three people at a dinner table, who are at yours and why?
Dr. Cunnington: Yeah, it does give an insight into my personality. So the Dalai Lama, why not? What a great character. The bit I’ve seen of him, he’s just a fantastic personality, great sense of humour, good story teller but extraordinarily wise. So he’s good.
Jon Kabat-Zinn, so everyone might not know Jon Kabat-Zinn, but he is a professor from UMASS in Boston, University of Massachusetts, who really brought mindfulness to medicine. So it sort of brought mindfulness out of that sort of spiritual space and brought it into a hospital setting and started using them initially and persistent pain, but as now used it in depression and anxiety. And we did some collaborative research with him in developing mindfulness for insomnia and he’s just a wise guy, lots of really great teachings about how to use mindfulness. And he’s also worked with some sports teams.
And then the third one is J. Allan Hobson. So people might not have heard of him either but he’s professor of psychiatry … Was, he’s now 85 professor of psychiatry at Harvard University and I had the pleasure of working with him 20 years ago at the end of his working career. And he’s old enough to have done a lot of the research in the 60s on LSD and conscious states and dreaming, and just got this fascinating insight about how we cross over these boundaries between sleep, wakefulness, when does consciousness start and end, and what the dreams actually consist of.
So it can be between him and Dalai Lama and Jon Kabat-Zinn, I’d have a good discussion around, it’s coming back to sleep. That’s my geekiness about sleep. But around what sleepy is and when does consciousness start. And what are we doing when we have these sort of dreams and ruminations during sleep?
Brad: Well, that does speak to your deep love of sleep and deep sleep dare I say. But what an interesting table. David, a lot of people wanted us to know, I guess around the screens, the advent of the iPhone and our modern technologies, anything we need to know around screen use in the evening?
Dr. Cunnington: Absolutely. So the screens have blue lights, so blue waves linked light on the back of the eye, suppresses Melatonin production and we’ll then delay the onset of sleep. So screens can be a factor, particularly people who are having trouble with sleep. So once the sun’s gone down, people should be conscious of how much blue light exposure they’re getting and the most common source we get is from screens. So all the operating systems on devices now have a automatic setting, you can set a night shift on the iOS operating system. Well, it takes a lot of the blue light out of the screens and makes it a much warmer colour temperature. You can get similar apps and some of the operating systems have it for desktops and laptops as well. So being very conscious about blue light exposure once the sun’s gone down because late at night, that sort of blue light close to the eyes is like the midday sun biologically to our body clocks and that he’s going to be alerting and make it harder to get to sleep.
Brad: And what’s the latest you leave using screens before trying to go to sleep or create that space is as you termed it.
Dr. Cunnington: That’s tough. And it’s really tough for different populations. So I’ve worked with a couple of adolescents this week, and the parents had been taking their off them at 9:00 PM and making them go to bed. And these are adolescents that weren’t sleeping until midnight and then these poor adolescents are locked in their rooms in the dark for three hours. And it’s like cutting on adolescent arm off. And there’s no that’s just such a negative thing cause it’s just building time to get anxious about sleep.
For someone who’s a digital native of like an adolescent in 2018, I’d almost settle for them having the phone as a distracter because they don’t deal with empty space particularly well. Whereas if someone’s comfortable with empty space and comfortable with reading, yeah an hour’s a good, length the time. So sort of it can, we talked about have that eight hour window, thinking for seven hours of sleep and some winding down time at the start. So yeah, once you switch into right, I’m going to bed mode, then it’s screen down, switch to something that’s not got that light in it. Yeah. That’s where a book, something like that can be helpful cause that’ll help give that bit of a barrier between the screen time and they’re trying to get to sleep.
Brad: Once again, it comes back to that, not obsessing about it, but just being aware. I think this is so helpful. Two M’s, Melatonin and measureables. For those that want to try and hack their way to getting to sleep, Melatonin as a supplement. Anything you’d suggest around its use and its effectiveness or otherwise
Dr. Cunnington: Melatonin’s best use is to augment shifting the body clock. So that’s where there’s the best data in the best research around it to use. There is also a good data for a people who are unwell and have got a sick body clock if you like, and helping to reestablish their body clocks. I think someone in intensive care who’s quite unwell.
For your healthy athlete, I’m not convinced Melatonin is necessarily going to do that much. It might have a mild sedative effect. So if some people about four in 10 people find Melatonin does have a mild sedative effect, but just because it’s Melatonin’s a naturally occurring hormone in the brain and you can get synthetic Melatonin, which is what we use these days. It doesn’t mean it’s necessarily a natural product. It is still people taking something and essentially outsourcing the responsibility for sleep to a product and putting all that expectation in that product. So for me, I’m not too worried about from our drug safety point of view about Melatonin, but I’m worried about, rather than winding down and developing good sleep habits in a healthy way of thinking about sleep. I mean, I go hard take some Melatonin that’s going to switch me off. If that doesn’t, I’m going to take some more Melatonin and going to switched me off even quicker.
Brad: Yeah, so just being aware, it’s not a magic bullet. Nothing replaces being respectful of sleep and creating that space. Measureables. I know that what we can commercially get outside of your professional setting in a sleep lab is a far cry, but is there any merit in those are they’re not really measuring great data at the moment with the Fitbits or whatever they may be.
Dr. Cunnington: They’re not too bad. There’s lots of examples when they don’t perform particularly well. There’s a general rule. They’re not too bad. We did some work. It’s funny, we’re having a hell of a time getting a paper published where we had a hundred people where we’ve had him in a sleep lab and they wore an equivalent of a Fitbit called a Jawbone. They’re not in business anymore, but they were my ex favourite device. Another device called a Beddit, which is a thing that goes under your mattress and measure sleep. And then another bedside device that uses ultrasound to measure your breathing, measure sleep.
So three consumer devices, we found, they all actually worked pretty well compared to a sleep study. We were having trouble getting it published because all the editors and people in the field go, no, that can’t be true. And so we keep getting knocked back. So we’re just massaging that a little when we keep submitting it for publication. They’re actually not too bad. And for me they can be used for good or used for bad.
So you’ve heard me talking about don’t get obsessed and don’t over think it. So plenty of people who look at it too carefully and they ride the roller coaster of the variations in sleep on a day to day basis. Then look in the morning and go, Oh crap, today’s going to be bad because look what happened with my sleep last night. That’s the bad. The good is someone who’s looking for example as good for athletes looking at okay across last week I got my 50 hours of sleep and that was spread. Very varied each day. But I’ve got 50 hours across the week. This week I’m tracking it 46 cause I’ve been a bit busy. I know that now on the weekend I’m going to have to programme in some downtime so that I’m not hitting into the week after under my longterm average sleep. So much in the same way as you might track your stress in terms of how much exercise you’re doing, it’s tracking where you’re at in terms of how much sleep you’re getting to make sure you don’t fall behind.
Brad: Okay. That’s some really good insight there around the wearables and I guess if you using them, continue to use them, but just take the data as it comes, and once again, don’t obsess around it.
Dr. Cunnington: Absolutely.
Brad: I must ask a question of self interest with the work I do with a lot of runners with often bone stress injuries. I recall reading papers around sleep deprived athletes and people in studies having lower bone mineral density scores. What’s the role of a sleep with regards to bone health, bone mineral density from your knowledge and the link?
Dr. Cunnington: I’m not convinced there’s great data linking those two and the statistical sort of mind in me. My sort of … as a journal reviewer my sort of mind goes, what was the confounder? Cause for me, the runner who I think of traditional risk factors for stress fractures, it’s how many miles you’re doing largely or at least one of them. And how many the runner who’s doing more miles is usually the one who’s getting less sleep cause they’re working harder at it. And so is it the lack of sleep that’s causing the bone problem or is the lack of sleep just another marker of the same thing that’s given that a stress fracture. So I’m not convinced about the causality and just wonder whether they just to markers of a certain type of behaviour.
Brad: It makes sense. Dr. Cunnington we appreciate, I appreciate your time and insights and every guest of this show, including expert additions of which you are featured as one, issue listeners with a physical challenge for the week. So this can be a challenge of any magnitude. What is Dr. David Cunnington is physical challenge to listeners for the week?
Dr. Cunnington: So. I’ve got two: So number one is drop a sleep rule or a sleep belief. So think about things that you might have that I should or I shouldn’t about sleep and cross one off, leave it aside. And if the next week, the sky hasn’t fallen in, pick another one, strike that off. So there, start to whittle away, that sort of rules I should and I shouldn’t about sleep. We want sleep to be pretty easy going.
And then the second one sort of follows on from that is cultivate your napping skills. So it’s actually being able to nap is a great skill to have, but across life. Parents with young kids are from a bit sleep deprived during the week. So that ability to write, I’ve got 20 minutes, we’re going to put the feet up, catch 10 minutes of sleep is a really great way of being able to just get through the week and not have any trouble. And for athletes, napping easier also really helpful. Prior to performance, a little bit underdone, we sleep. Napping helps people to catch up. And the way to cultivate the napping skills is just to be comfortable with empty space, putting the feet up. Be comfortable, if I sleep I sleep. If I don’t I don’t, but I’m just going to have this bit of downtime.
Brad: And is there a maximum for the how long constitutes an efficient nap verse a not productive nap.
Dr. Cunnington: It depends on the purpose. And so I power nap just that. Okay. Pre performance or I just need to feel a bit better for the next couple of hours. That’s that shorter nap. We want maybe a 20 minute opportunity and obtain and 15 minutes of sleep maybe in that opportunity. Whereas if it’s a satellite afternoon and you’ve been tracking that you’re a bit under done for the week because you had a couple of late nights. Yeah, an hour and a half, two hours. You know what, whatever you need just to feel like you’re resetting for the next week.
Brad: So nappers be encouraged and keep going. David, I am going to drop one sleep rule and that is to not obsess about getting at least seven or eight hours. Is that a good place to start for me?
Dr. Cunnington: Absolutely. Great place to start.


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