May 17, 2026 • 31 mins
Everyone knows we should be getting better sleep, but that's so much easier said than done. That's why we brought in Dr Sumit Samant from Auckland Sleep Clinic to answer Toni's burning questions about how to not just get more sleep but to improve the sleep you do get.
In the episode Toni and Sumit talk about how sleep isn't just a nighttime event, how tracking your sleep may have unintended negative consequences, and Dr Samant's number 1 tip for improving your sleep.
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Speaker 1 (00:00):
We need to talk Tony Street's lifestyle and wellness podcast.
Speaker 2 (00:07):
Well, hello, welcome to we need to talk. Hands up.
If you feel like you can never get enough sleep,
or maybe you've got a great sleep routine and on
paper you're getting enough, but you're still constantly exhausted. I
think so many of us do feel exhausted, and you
want to know why. What if we told you that
sleep isn't just a nighttime event. That's the theory of
E and T and sleep surgeon doctor Sumitt samont So.
(00:30):
Today I thought i'd try and get some answers as
to why we're always so damn tired and what might
be missing in this quest to feel rested. It's lovely
to have you with us today. What do you mean
by sleep isn't just a nighttime event? What does that mean?
Speaker 3 (00:44):
Thank you for having me, Tony, It's fantastic to be here. So, yes,
sleep is not just a nighttime event. From the second
we wake up, our body starts working towards the next
night's sleep. And broadly speaking, there are two systems at
play here. One is a sleep pressure or debt system.
So it's like your battery going flat gradually over the
(01:05):
course of the day. From the time we wake up,
we start building a sleep debt or pressure that we
want to address by the time we go to bed
that night. And the second factor is the internal clock
or the circadian rhythm, which guides the body's physiology into
alert states and then sleep states. And so these two
(01:26):
systems work together a bit like you know, athletes prepare
for a big game or a match or a marathon
by eating the right foods the previous day, getting the
right kind of warm up and exercise the previous day.
So all of that prep is for the next day's game.
So similarly, the body is prepping the whole day to
(01:48):
be able to sleep better at night.
Speaker 2 (01:50):
So when it comes to sleep, do you have and
I'll ask these questions at the very start, do you
have a set time you like people to get to
bed or a set time ideally to wake up and
a perfect amount of hours that you should be getting?
Speaker 3 (02:02):
Yes and no. So the no is because it's highly individual.
People's internal clocks can vary, the amount of sleep that
their body requires can vary.
Speaker 2 (02:14):
So what's that based on? Because I often say to
my family, oh, I'm useless if I don't get a
decent amount of sleep. But then I will have friends
that seem to run fine on five hours.
Speaker 3 (02:25):
Yeah, that's a great question, Tony. So look, everyone will
be useless if they don't get decent amount of sleep,
but that decent amount can vary. So I'll come back
to what your friends say. If you look at high
level population level data and people have charted the risks
(02:48):
of cardiovascular heart issues or even just all cause mortality,
risk of dying from any possible problem against hower sleep,
they get u shaped curve. So at the bottom is
about seven to nine hours, and the going to bedtime
is between ten and eleven pm, waking up time is
(03:10):
six to seven pm. So that subset, that set of
population has the lowest risk. So there is some evidence
behind what an ideal bedtime and wake up time might
be and what an ideal number of hours might be.
But within this high level data, each individual varies. So
(03:32):
it's up to us to do a little bit of
reflection and analysis and information gathering and see what works
best for us. People who say they survive fine, they
do well on four or five hours of sleep. I
don't need more sleep. Sometimes they are people who genuinely
don't need as many hours, but a lot of times
(03:56):
chronic sleep deprivation deprives us of the insight that we
need more sleep, so you stop recognizing the need for
more sleep.
Speaker 2 (04:06):
Wow.
Speaker 3 (04:07):
So that loss of insight often will prompt people into saying, look,
I don't need more sleep. But that's not physiologically necessarily true.
Speaker 2 (04:17):
So they could be suffering in other areas that perhaps
aren't is obvious to them. But it could play out
poticially later for sure.
Speaker 3 (04:25):
Okay, so there's some research which shows that with chronic
sleep deprivation, and I absolutely do not want to be
a scaremonger, hear there is some chronic hypoxic or low
oxygen related or low rest related impact on the brain tissue.
When we sleep, we have a glymphatic system which is
(04:48):
cleaning the brain of all the metabolized that it has
accumulated during the day's work. So if we don't have
enough time sleep time for that glymphatic system to tidy
everything up properly, then we're doing an incomplete cleaning job.
And those metabolites building up over the years can lead
to a higher risk of dementia and memory loss. And
(05:11):
if we don't have the insight that we actually kind
of need to focus on that and need to ensure
a certain minimum hours of sleep. Then we are kind
of setting ourselves up a little bit.
Speaker 2 (05:21):
How many hours of sleep do you get to night?
Speaker 3 (05:24):
I am for about seven. We've got a little one,
so sometimes that's easier said than done, but yes, seven
to eight ideally.
Speaker 2 (05:31):
Okay, good. You always want to know what these sleep
exper gets in and then you go, okay, I'll try
and emulate that. So some people have great sleep routines,
right they might be getting to be at the right time,
they're getting up after having what seven or eight hours
of sleep, but they still feel exhausted. Is there something
that you're seeing with your patients.
Speaker 3 (05:49):
Yes? Absolutely, And that is a hard one because very
often people come to us because they've had sleep issues
for a long time. They've fried a lot of things,
they've triedted diy things, they might have gone to other
sleep clinics. They've worked really hard and their sleep hygiene.
(06:10):
They've got the best possible mattress, the perfect room temperature,
it's pitch dark, all of those things. They'll have their camamle,
they'll have their magnesium supplements, but they're still tired and
they're still not sleeping well, and there's a huge sense
of frustration. They come in wanting surgery yesterday or something
which will fix it right away, and we have to
(06:31):
actually hold their hand, get them to take a pause.
And my colleagues tell me I must be the only
surgeon who doesn't want to operate, and I tell them, look,
if you were a family or if you were a friend,
you know I would not want you to rush into surgery.
So that's what I want to tell you as a
patient as well. Let's take a step back and work
on things. So sleep hygiene can be super effective. And
(06:54):
I tell people look for a lot of pain problems.
Panadol is fine, it works, really weird. You don't need
anything else. That's sleep hygiene, yes, but sometimes you need
to add ibuprofen for better relief. It doesn't mean panadol
won't work, but it needs something else. So sometimes you
need something else along with good sleep hygiene to get
(07:17):
you past the line.
Speaker 2 (07:18):
And what would the equivalent of the ibuprofen be in
the sleep world.
Speaker 3 (07:22):
I've got a checklist for you, so we'll go through that,
and that's basically the combination painkiller analogy. You know you
need you need the right kind of combination or at
least a few of those things so we can dive
into it. You know, breathing well through your nose is
super important, and that is hugely underrecognized. You know, thirty
(07:43):
forty percent of us have allergies. Our noses are stuffy.
We don't know that, or we may not recognize that.
But if we're not breathing well through our nose or
some you know kids have large tonsils or large adenoids,
and if the airflow is pinched because of that, then
we're working harder to breathe, to fill out, to fill
our lungs up.
Speaker 2 (08:02):
I have personal experience of that. I've just had a
nasal polyp surgery and so that I was very blocked
and it's made a big difference.
Speaker 3 (08:11):
I've listened to your radio show and your podcast, and
I knew.
Speaker 2 (08:14):
That you could hear me.
Speaker 3 (08:15):
Yes, yes, I know.
Speaker 2 (08:17):
Even my INTI surgeon said the same thing. He said
straight away. He actually diagnosed Kirie Woodham on news talks
be as well because he could hear how clogged she
was and said, yeah, you're you're riddled with polyps. And
it's made a massive difference having them out fantastic.
Speaker 3 (08:31):
Yeah, that's amazing. So you would have noticed that if
the nose is blocked, then breathing effort is higher. So
through the day you're working harder. The breathing muscles are
working harder, even at night. I tell my patients it's
pretend imagine you're jogging at night in your sleep. So
people wake up tired. And this may not be because
(08:51):
of any sleep issues issue, but it's a simple breathing
or airway issue. So simple nose prays that help with allergies,
hey fever or getting the nose checked, and you know,
any structural abnormality is addressed. That's super important. But along
with that deep breathing exercises, because even if we are
not jumping into no surgery, if we can optimize the
(09:15):
functioning of our breathing muscles so that they can get
fill our lungs up better, do the breathing work more
efficiently with as less effort as possible, then we are
pushing them towards peak performance. But we are dropping the efforts,
so our bodies are not working as hard. So deep
breathing exercises are our no brainer. Along with that, staying
(09:37):
active is really important. There is some really good evidence
that shows that the more sedentary we are, the more
fatigued we feel. Actually, wow, sedentary lifestyles are shown in
studies to push the chances of experiencing fatigue through the
day up to sixty one sixty two percent. So the
(10:00):
less we move, the less we want to move, and
the more difficult movement. Therefore is so even something as
simple as ten minutes of walk after every meal. And
it could be that we park a little bit farther
away from our takeaway place, or we park a little
bit farther away from our workplace and then walk, or
(10:20):
whichever way it is sustainable for us. You know, we
tell families, look, why don't you have like a dance
around the kitchen island party after dinner and you're doing
that for ten minutes? Or do a family walk around
the block after meals?
Speaker 2 (10:37):
Just get into their heabit.
Speaker 3 (10:38):
Yes, that is super important. After the age of forty,
protein becomes an important issue because even just normal lifestyle,
active lifestyle, the body starts losing muscle tissue after the
age of forty, and we need to do something more
to preserve muscle mass, not just build it. If we're
(11:00):
not looking to gain muscle mass just to preserve it.
We need to be more active. We need to be
doing a little bit of weight, even if it is
body weight training, and focus on protein. So those are
small and simple things that everyone needs to do, even
(11:21):
if they've got a diagnosable medical sleep issue, or if
it is a you know, a fatigue insomnia type problem.
Speaker 2 (11:31):
I think a lot of people will find that interesting
because I think, poor sleep, How do I work that out?
But actually there are so many other lifestyle factors that
lead to it as well.
Speaker 1 (11:41):
That we need to talk with Tony Street.
Speaker 2 (11:44):
So you said before that you don't advocate for SOUGERI
why is that.
Speaker 3 (11:49):
I teach on several international sleep courses Europe, Asia, South America,
and there's a lot of appeal for our multidisimary approach
or holistic approach to sleep issues. So people present about
a lot of sleep surgical data and sleep surgical techniques,
(12:09):
and then when I follow that up with hey, take
a step back, why don't we start with what I
want to tell you about our personal trainer and our nutritionist.
And they go, well, we're here to talk about science.
We're here to talk about medicine and surgery. But people
are recognizing the appeal the importance of the lifestyle component,
(12:31):
and when they see our results then it sinks in
further that that multidismary approach is important. So there's a
new global master's program and innovative sleep Techniques management techniques
that being set up by campus by Medica and Rome.
(12:53):
It's a university masters and we are the only center
in Australia and New Zealand that can accept candidates who
want to do that master's program. And that is a
really important being step towards a consistent recognition that we
(13:14):
have to start small, we have to start simple, we
have to start with the lifestyle. We have to have
that rehabilitative and prehabilitative approach to packaging any kind of
medical or surgical intervention for sleep with the right kind
of lifestyle mindset. It's a bit like any chronic problem,
(13:34):
diabetes or whatever else. Once you have it, you have it,
and you might get the best possible result out of
any particular one time treatment. But if the mindset is
not changed for the rest of your life, then you're
at a higher risk of falling back into that same
situation again.
Speaker 2 (13:53):
One thing that I want to talk to you about
is the burnout sleep connection, and that often comes from
people's jobs that are working very hard and then that
is causing bad sleep as well. What's your take on
burnout and sleep?
Speaker 3 (14:09):
Look? Burnout is an issue close to my heart and
you know, healthcare workers, doctors, nurses, there is a huge
threat and problem and issue with burnout. We've got the
burnout inventory that you know, we can answer a questionnaire
and anyone doing it, don't be surprised if you find
(14:31):
yourself scoring high on it because you know today's lifestyle
is hard on us. Poor sleep, unrefreshing sleep has been
shown in research to be very direct directly related to
future burnout. So doing small and simple things that we
(14:53):
talked about to optimize sleep as best as we can
is a buffer, is a preventative step against any future burnout. Now,
I will say that burnout is a systems issue. It's
not an individual issue. So there's only so much each
individual can do to prevent or minimize the risk of burnout.
(15:14):
The work environment, the life environment, the family environment also
has to be set up in a way that you
minimize burnout. But at an individual level, what we can
do is we can take steps to reduce the risk,
and of course that relationship is bi directional, so burnout
(15:36):
of course also causes sleep issues. So the connection goes
both ways, and the mediators are essentially low energy. So
if you're not sleeping very well, you've got low energy,
you've got fatigue, and therefore you've got smaller buffers towards
the stresses of work and life and your cost soil
levels are higher because it physiologically affects the hormone system,
(16:01):
and then that predisposes us to ill effects off a
chronically raised cortisol and chronically elevated inflammation in the body.
Speaker 2 (16:11):
So if you've got someone that would come to you
right now and say, I'm just exhausted all the time,
I feel like I'm doing everything right, what would be
the first thing you'd tell them? Do you start this
trying to get better at sleep journey?
Speaker 3 (16:25):
Exhaustion of fatigue could be because of several reasons. So yes,
poor sleep or inadequate hours or quality of sleep is important,
so that definitely needs to be looked into, but it
could be other things. So I talked about the nasal problem.
So there's something called UAIS or upper airway resistance syndrome,
and that's essentially breathing through a high resistance airflow narrower passage.
(16:50):
So a simple thing is to go and see the
GP and just get the upper airway checked out, or
you know, for example, in our clinic, you don't need
a referral. You can just contact us and we'll do
that for you. Apart from the upper airway, any other
medical problems, thyroid problems, heart issues, chronic pain, anything that
impacts a good, RESTful few hours of sleep at night
(17:15):
can be a big factor. Along with that low protein,
high fat diet. You know, we all kind of just
reach for whatever we can when we are exhausted, but
that can set up a vicious circle. Less movement predisposes
us to exhaustion and fatigue. So focusing on that alcohol
(17:37):
in moderation is quite important because a it disrupts our
normal sleep architecture. Sleep is not just rest for the
body and brain, it's actually repair regeneration. So if we
are disrupting the reparative and regenerative stages of our sleep
(17:58):
architecture with alcohol or even some medication on board, then
we might be getting enough hours, but it's not the
right kind of sleep, So we have to get enough
of the right kind of sleep.
Speaker 2 (18:11):
What about women in the peerimenopause or menopause phase. Do
you find that sleep gets disrupted through these hormonial changes
for sure?
Speaker 3 (18:20):
So women have got the double whammy. So you know,
they might have the anastomical structure problems that men have too,
but along with that, they have the hormonal changes through life,
you know, right from puberty to childbearing age, pregnancy, post pregnancy,
and then premenopause, perry and postmenopause. So it's just an
(18:41):
you know, a roller coaster of physiology. So that means
that the problems are more complex and research is difficult
to do to find evidence on how best to manage
these problems because research projects are not easy to set
up with hormone changes, so typically male subjects are used
(19:05):
and that's just completely illogical when it comes to menopausal
or female physiology hormone type of you know scenario. So
it is very common for women to have sleep issues
because of changing hormones around premenopause, peri and postmenopause. Women
(19:28):
almost by then or very early on, actually get used
to putting everything else above their own needs. Family, kids, work,
everything comes ahead of their own needs and you know,
we always encourage women to our patients to advocate for
themselves and you know, allow us to advocate for them
(19:50):
because it is a complex issue and you know, we
need to do a lot more about it than you're
doing now.
Speaker 2 (19:57):
Yeah, I've got an example of that my house. My
thirteen year old now sometimes goes to bed after me
because I get up so early that I will often
say right, I'm to bed. At night, I say good
night to the little two who are a bead, and
then my thirteen year old stays up for an extra half.
Now she's kissing me to say good night. We got
a change in my house. Does our sleep change with
the season? So we're winter now, we're about to go
(20:20):
into winter. Is it easier for people to sleep in winter?
Would you say, by and large over the summer months.
Speaker 3 (20:26):
Yes, it is in a way, and our body is
actually physiologically sleep for longer in winter.
Speaker 2 (20:35):
Do we need more sleep in winter like an hibernating beer.
Speaker 3 (20:39):
Yes and no. So we physiologically sleep longer, and that's
because of the change in the ratio between daytime and
night time. So the photo period, the amount of light
that the body is exposed to changes, So that induces
longer sleep times. So the research has shown that it
(21:01):
changes the architecture, so we have more REM sleep and
more dreaming at night. And some might say that the
physiological need for that is to actually counter the ill
effects of mood and depression and seasonal effective depression disorder. Yeah,
(21:22):
so that REM sleep is actually helping us process our emotions,
process our memories from the day, and kind of fighting
against the sad phenomenon. So we physiologically do sleep longer,
and perhaps we do need to sleep longer for that reason.
Speaker 2 (21:43):
Okay, that's good to know. The give yourself a break
this winter and actually take it for your body's needs.
Speaker 1 (21:50):
Nike, we need to talk podcast appreciate on your iHeart
app just step and never miss an episode.
Speaker 2 (21:58):
What is your take on wearables? So things like our
fitbits and our garments and our Apple watches that we
can track our sleep within an inch of their lives.
And I know even at Coast Sam Wallace, who I
Coast host with, he wears a watch and he'll tell
me almost daily how much sleep he got. I can
see that it dictates whether he feels good or bad
(22:19):
about that.
Speaker 3 (22:22):
You've hit the nail on the head, because there's a
term that's been coined called orthosomnia, which is essentially people
losing sleep over what their watches are telling them or
their wearables are telling them. So they might not be
feeling it subjectively, but they're worried that the watch is
telling them that they've not had enough ramsleep. What I
(22:44):
tell people is, look before you ask your watch or
you're wearable or your app how well you did in
your sleep, Ask yourself. So that's the most important thing.
If how you feel about how well rested you feel
in the morning after your sleep is more important than
what the watch tells you. So if you're feeling well,
(23:07):
that's a really good start. There is some good use
for the data that we get, and that is essentially
not by itself, but in conjunction with, say, whatever intervention,
whether it is lifestyle based well being type invention or
a medical or surgical intervention, we can compare the before
(23:27):
and after and get an idea of how well things
are going. But in absolution it's not as important. As
we kind of start getting worried about these days.
Speaker 2 (23:39):
Do you think, speaking of these days, do you think
people are taking their sleep more seriously than perhaps we
were ten twenty years ago. Do you think people understand
now how it can adversely affect us?
Speaker 3 (23:51):
Again, I will say yes and no, and that is yes. Absolutely,
there is way more awareness about sleep, which we love.
You know, there's a lot of scientific advocacy that has
gone gone in behind the scenes over decades, which is
now bearing fruition. So absolutely people are more aware. Why
(24:13):
people are also more aware is because entrepreneurs are discovering
that the well being industry is a huge, multi billion
dollar industry and sleep is a pillar. So there's a
lot of social media activity around sleep and well being. Now,
(24:36):
a potential problem with that is if people do not
follow science or follow evidence as best as possible when
they are promoting certain things. So a colleague of mine,
who's one of the most well known sleep surgeons in
the world, talks about fog. Fog is tiny water droplets.
(25:00):
So but we can't drink fog. We can't open our
mouths and take in fog, and that will quench our thirst.
So it doesn't serve a useful purpose per se, but
it blinds us. So the millions of social media posts
on everything about sleep, a lot of them are like
fog particles they don't actually help us, but there's a
(25:25):
whole bunch of useful scientific information that is available, and
that is where we as healthcare providers have to meet,
you know, people, because that's the space within which people
are getting their information.
Speaker 1 (25:40):
Lasts.
Speaker 3 (25:41):
But there's a recent paper that's come out literally just
last week which actually talks about the importance of healthcare
professionals to be in the social media space because it
is important to bring science into that sphere. If you
think about chat, GPT or you know, any of these
ai they rely on publicly available information to formulate their answer.
(26:05):
So if somebody is asking Chad GPT for information, they're
going to get information that's not necessarily behind payworld research articles.
So just publishing high quality evidence is not enough for
scientists or healthcare professionals. We have to actually bring that
knowledge out into the public sphere.
Speaker 2 (26:26):
Get it to the audiences.
Speaker 3 (26:27):
That's correct. People are way more aware of the importance
of sleep, and there is an evolving approach to how
to get better sleep. But there's a lot of fads
and a lot of misinformation, and there's some really good
information which is fantastic because you know, previously people were
(26:50):
just not aware no.
Speaker 2 (26:51):
Just cutting through and finding the grunty stuff. I love
that you're pro getting that information out on social media
because that's what I do in my business, trying to
get paid to confidently talk on camera because a lot
of our academics aren't comfortable doing so, and unfortunately that
is the best medium to get things out there. I
want to finish by talking about napping and just getting
your views on it. I'm a big fan of a nap.
(27:14):
I can think of nothing more than in the middle
of the day crawling in to be in my pajamas
and getting a recharge. Does it work for us? Do
you advocate for napping?
Speaker 3 (27:22):
It does work for us. And again, napping is really
good in certain situations and when you do it right,
so less than thirty minutes is the rule. Less than
thirty minutes. It can be very helpful because if the
sleep pressure or sleep debt is building up too rapidly,
it can offset that A bit recharges a bit. It's
(27:45):
a bit like you know, you might charge your phone
at the end of the day when you're going to bed,
or if it needs a charge in the middle of
the day. You just put it on for ten minutes
and it's got some more juice in it. So that's
what napping does for us when it's less than thirty minutes.
Speaker 2 (28:00):
So no longer than thirty ever, No oh, I thought
I could nat for ninety minutes and get away with that.
Speaker 3 (28:05):
No, now, Tony again, not to scare you, but more
than sixty minute naps have shown strong positive correlation with
cardiovascular problems and all cause mortality.
Speaker 2 (28:18):
Wow, that's staggering. So okay, I'm going to seat my
alarm now for twenty eight minutes and make sure I
only net for that. Okay, So why do you think
that is?
Speaker 3 (28:29):
We don't have a very clear answer. So this association
has been seen again in high level population level data,
which has kind of just created those associations by virtue
of statistical analysis. But theories and hypotheses are that longer
(28:50):
nap times are associated with less physical movement in general
through the day, and that we know has implications when
it comes to cardiovascular problems. And it could be that,
you know, if you're not moving well enough through the
day we are napping for long periods, then when we
are moving, you know, our heart is not primed and
(29:12):
conditioned well enough to take extra strain and therefore we
can get carry vascular problems, and the same goes for
metabolic problems. If we're sleeping a lot, particularly after a
big meal, our insulin is spiking a lot more. That's
causing spikes of inflammation within the body, and then that
can cause widespread kind of multi system problems in the body.
Speaker 2 (29:34):
Wow. Well, if there was one thing that you could
finish this podcast by telling people that are listening to
this who want to be well rested, they don't want
to be walking around exhausted, what would that be? Could
you put it down to one single idea?
Speaker 3 (29:47):
Look, the checklist that we talked about, get one, two, three,
four and five underway is a really relatively simple and
quick thing to start. But if it was one thing
and only one thing, then I would say, focus on
getting good morning sunlight as soon as you can twenty
(30:09):
to thirty minutes if possible, as soon as possible after
waking up. Is the strongest influencer of our body's physiology
and our body's internal clock and all of the factors
being the same. That is the biggest boost to regulating
(30:33):
our sleep in a consistent way that we have found.
Speaker 2 (30:37):
Oh, I love that. Thank you so much for your
time today. Fascinating. Just when I thought I knew most
things about sleep, I learned two three really new facts
today that I will take with me. So appreciate your time.
Speaker 3 (30:49):
Oh, thank you for having me Tony. It's such a privilege.
Speaker 1 (30:51):
Thanks for listening to We need to talk. Contact us
on Instagram and we need to talk with Tony Street
or email. We need to talk at Coast Online doco
dot in z
We need to talk Tony Street's lifestyle and wellness podcast.
Speaker 2 (00:07):
Well, hello, welcome to we need to talk. Hands up.
If you feel like you can never get enough sleep,
or maybe you've got a great sleep routine and on
paper you're getting enough, but you're still constantly exhausted. I
think so many of us do feel exhausted, and you
want to know why. What if we told you that
sleep isn't just a nighttime event. That's the theory of
E and T and sleep surgeon doctor Sumitt samont So.
(00:30):
Today I thought i'd try and get some answers as
to why we're always so damn tired and what might
be missing in this quest to feel rested. It's lovely
to have you with us today. What do you mean
by sleep isn't just a nighttime event? What does that mean?
Speaker 3 (00:44):
Thank you for having me, Tony, It's fantastic to be here. So, yes,
sleep is not just a nighttime event. From the second
we wake up, our body starts working towards the next
night's sleep. And broadly speaking, there are two systems at
play here. One is a sleep pressure or debt system.
So it's like your battery going flat gradually over the
(01:05):
course of the day. From the time we wake up,
we start building a sleep debt or pressure that we
want to address by the time we go to bed
that night. And the second factor is the internal clock
or the circadian rhythm, which guides the body's physiology into
alert states and then sleep states. And so these two
(01:26):
systems work together a bit like you know, athletes prepare
for a big game or a match or a marathon
by eating the right foods the previous day, getting the
right kind of warm up and exercise the previous day.
So all of that prep is for the next day's game.
So similarly, the body is prepping the whole day to
(01:48):
be able to sleep better at night.
Speaker 2 (01:50):
So when it comes to sleep, do you have and
I'll ask these questions at the very start, do you
have a set time you like people to get to
bed or a set time ideally to wake up and
a perfect amount of hours that you should be getting?
Speaker 3 (02:02):
Yes and no. So the no is because it's highly individual.
People's internal clocks can vary, the amount of sleep that
their body requires can vary.
Speaker 2 (02:14):
So what's that based on? Because I often say to
my family, oh, I'm useless if I don't get a
decent amount of sleep. But then I will have friends
that seem to run fine on five hours.
Speaker 3 (02:25):
Yeah, that's a great question, Tony. So look, everyone will
be useless if they don't get decent amount of sleep,
but that decent amount can vary. So I'll come back
to what your friends say. If you look at high
level population level data and people have charted the risks
(02:48):
of cardiovascular heart issues or even just all cause mortality,
risk of dying from any possible problem against hower sleep,
they get u shaped curve. So at the bottom is
about seven to nine hours, and the going to bedtime
is between ten and eleven pm, waking up time is
(03:10):
six to seven pm. So that subset, that set of
population has the lowest risk. So there is some evidence
behind what an ideal bedtime and wake up time might
be and what an ideal number of hours might be.
But within this high level data, each individual varies. So
(03:32):
it's up to us to do a little bit of
reflection and analysis and information gathering and see what works
best for us. People who say they survive fine, they
do well on four or five hours of sleep. I
don't need more sleep. Sometimes they are people who genuinely
don't need as many hours, but a lot of times
(03:56):
chronic sleep deprivation deprives us of the insight that we
need more sleep, so you stop recognizing the need for
more sleep.
Speaker 2 (04:06):
Wow.
Speaker 3 (04:07):
So that loss of insight often will prompt people into saying, look,
I don't need more sleep. But that's not physiologically necessarily true.
Speaker 2 (04:17):
So they could be suffering in other areas that perhaps
aren't is obvious to them. But it could play out
poticially later for sure.
Speaker 3 (04:25):
Okay, so there's some research which shows that with chronic
sleep deprivation, and I absolutely do not want to be
a scaremonger, hear there is some chronic hypoxic or low
oxygen related or low rest related impact on the brain tissue.
When we sleep, we have a glymphatic system which is
(04:48):
cleaning the brain of all the metabolized that it has
accumulated during the day's work. So if we don't have
enough time sleep time for that glymphatic system to tidy
everything up properly, then we're doing an incomplete cleaning job.
And those metabolites building up over the years can lead
to a higher risk of dementia and memory loss. And
(05:11):
if we don't have the insight that we actually kind
of need to focus on that and need to ensure
a certain minimum hours of sleep. Then we are kind
of setting ourselves up a little bit.
Speaker 2 (05:21):
How many hours of sleep do you get to night?
Speaker 3 (05:24):
I am for about seven. We've got a little one,
so sometimes that's easier said than done, but yes, seven
to eight ideally.
Speaker 2 (05:31):
Okay, good. You always want to know what these sleep
exper gets in and then you go, okay, I'll try
and emulate that. So some people have great sleep routines,
right they might be getting to be at the right time,
they're getting up after having what seven or eight hours
of sleep, but they still feel exhausted. Is there something
that you're seeing with your patients.
Speaker 3 (05:49):
Yes? Absolutely, And that is a hard one because very
often people come to us because they've had sleep issues
for a long time. They've fried a lot of things,
they've triedted diy things, they might have gone to other
sleep clinics. They've worked really hard and their sleep hygiene.
(06:10):
They've got the best possible mattress, the perfect room temperature,
it's pitch dark, all of those things. They'll have their camamle,
they'll have their magnesium supplements, but they're still tired and
they're still not sleeping well, and there's a huge sense
of frustration. They come in wanting surgery yesterday or something
which will fix it right away, and we have to
(06:31):
actually hold their hand, get them to take a pause.
And my colleagues tell me I must be the only
surgeon who doesn't want to operate, and I tell them, look,
if you were a family or if you were a friend,
you know I would not want you to rush into surgery.
So that's what I want to tell you as a
patient as well. Let's take a step back and work
on things. So sleep hygiene can be super effective. And
(06:54):
I tell people look for a lot of pain problems.
Panadol is fine, it works, really weird. You don't need
anything else. That's sleep hygiene, yes, but sometimes you need
to add ibuprofen for better relief. It doesn't mean panadol
won't work, but it needs something else. So sometimes you
need something else along with good sleep hygiene to get
(07:17):
you past the line.
Speaker 2 (07:18):
And what would the equivalent of the ibuprofen be in
the sleep world.
Speaker 3 (07:22):
I've got a checklist for you, so we'll go through that,
and that's basically the combination painkiller analogy. You know you
need you need the right kind of combination or at
least a few of those things so we can dive
into it. You know, breathing well through your nose is
super important, and that is hugely underrecognized. You know, thirty
(07:43):
forty percent of us have allergies. Our noses are stuffy.
We don't know that, or we may not recognize that.
But if we're not breathing well through our nose or
some you know kids have large tonsils or large adenoids,
and if the airflow is pinched because of that, then
we're working harder to breathe, to fill out, to fill
our lungs up.
Speaker 2 (08:02):
I have personal experience of that. I've just had a
nasal polyp surgery and so that I was very blocked
and it's made a big difference.
Speaker 3 (08:11):
I've listened to your radio show and your podcast, and
I knew.
Speaker 2 (08:14):
That you could hear me.
Speaker 3 (08:15):
Yes, yes, I know.
Speaker 2 (08:17):
Even my INTI surgeon said the same thing. He said
straight away. He actually diagnosed Kirie Woodham on news talks
be as well because he could hear how clogged she
was and said, yeah, you're you're riddled with polyps. And
it's made a massive difference having them out fantastic.
Speaker 3 (08:31):
Yeah, that's amazing. So you would have noticed that if
the nose is blocked, then breathing effort is higher. So
through the day you're working harder. The breathing muscles are
working harder, even at night. I tell my patients it's
pretend imagine you're jogging at night in your sleep. So
people wake up tired. And this may not be because
(08:51):
of any sleep issues issue, but it's a simple breathing
or airway issue. So simple nose prays that help with allergies,
hey fever or getting the nose checked, and you know,
any structural abnormality is addressed. That's super important. But along
with that deep breathing exercises, because even if we are
not jumping into no surgery, if we can optimize the
(09:15):
functioning of our breathing muscles so that they can get
fill our lungs up better, do the breathing work more
efficiently with as less effort as possible, then we are
pushing them towards peak performance. But we are dropping the efforts,
so our bodies are not working as hard. So deep
breathing exercises are our no brainer. Along with that, staying
(09:37):
active is really important. There is some really good evidence
that shows that the more sedentary we are, the more
fatigued we feel. Actually, wow, sedentary lifestyles are shown in
studies to push the chances of experiencing fatigue through the
day up to sixty one sixty two percent. So the
(10:00):
less we move, the less we want to move, and
the more difficult movement. Therefore is so even something as
simple as ten minutes of walk after every meal. And
it could be that we park a little bit farther
away from our takeaway place, or we park a little
bit farther away from our workplace and then walk, or
(10:20):
whichever way it is sustainable for us. You know, we
tell families, look, why don't you have like a dance
around the kitchen island party after dinner and you're doing
that for ten minutes? Or do a family walk around
the block after meals?
Speaker 2 (10:37):
Just get into their heabit.
Speaker 3 (10:38):
Yes, that is super important. After the age of forty,
protein becomes an important issue because even just normal lifestyle,
active lifestyle, the body starts losing muscle tissue after the
age of forty, and we need to do something more
to preserve muscle mass, not just build it. If we're
(11:00):
not looking to gain muscle mass just to preserve it.
We need to be more active. We need to be
doing a little bit of weight, even if it is
body weight training, and focus on protein. So those are
small and simple things that everyone needs to do, even
(11:21):
if they've got a diagnosable medical sleep issue, or if
it is a you know, a fatigue insomnia type problem.
Speaker 2 (11:31):
I think a lot of people will find that interesting
because I think, poor sleep, How do I work that out?
But actually there are so many other lifestyle factors that
lead to it as well.
Speaker 1 (11:41):
That we need to talk with Tony Street.
Speaker 2 (11:44):
So you said before that you don't advocate for SOUGERI
why is that.
Speaker 3 (11:49):
I teach on several international sleep courses Europe, Asia, South America,
and there's a lot of appeal for our multidisimary approach
or holistic approach to sleep issues. So people present about
a lot of sleep surgical data and sleep surgical techniques,
(12:09):
and then when I follow that up with hey, take
a step back, why don't we start with what I
want to tell you about our personal trainer and our nutritionist.
And they go, well, we're here to talk about science.
We're here to talk about medicine and surgery. But people
are recognizing the appeal the importance of the lifestyle component,
(12:31):
and when they see our results then it sinks in
further that that multidismary approach is important. So there's a
new global master's program and innovative sleep Techniques management techniques
that being set up by campus by Medica and Rome.
(12:53):
It's a university masters and we are the only center
in Australia and New Zealand that can accept candidates who
want to do that master's program. And that is a
really important being step towards a consistent recognition that we
(13:14):
have to start small, we have to start simple, we
have to start with the lifestyle. We have to have
that rehabilitative and prehabilitative approach to packaging any kind of
medical or surgical intervention for sleep with the right kind
of lifestyle mindset. It's a bit like any chronic problem,
(13:34):
diabetes or whatever else. Once you have it, you have it,
and you might get the best possible result out of
any particular one time treatment. But if the mindset is
not changed for the rest of your life, then you're
at a higher risk of falling back into that same
situation again.
Speaker 2 (13:53):
One thing that I want to talk to you about
is the burnout sleep connection, and that often comes from
people's jobs that are working very hard and then that
is causing bad sleep as well. What's your take on
burnout and sleep?
Speaker 3 (14:09):
Look? Burnout is an issue close to my heart and
you know, healthcare workers, doctors, nurses, there is a huge
threat and problem and issue with burnout. We've got the
burnout inventory that you know, we can answer a questionnaire
and anyone doing it, don't be surprised if you find
(14:31):
yourself scoring high on it because you know today's lifestyle
is hard on us. Poor sleep, unrefreshing sleep has been
shown in research to be very direct directly related to
future burnout. So doing small and simple things that we
(14:53):
talked about to optimize sleep as best as we can
is a buffer, is a preventative step against any future burnout. Now,
I will say that burnout is a systems issue. It's
not an individual issue. So there's only so much each
individual can do to prevent or minimize the risk of burnout.
(15:14):
The work environment, the life environment, the family environment also
has to be set up in a way that you
minimize burnout. But at an individual level, what we can
do is we can take steps to reduce the risk,
and of course that relationship is bi directional, so burnout
(15:36):
of course also causes sleep issues. So the connection goes
both ways, and the mediators are essentially low energy. So
if you're not sleeping very well, you've got low energy,
you've got fatigue, and therefore you've got smaller buffers towards
the stresses of work and life and your cost soil
levels are higher because it physiologically affects the hormone system,
(16:01):
and then that predisposes us to ill effects off a
chronically raised cortisol and chronically elevated inflammation in the body.
Speaker 2 (16:11):
So if you've got someone that would come to you
right now and say, I'm just exhausted all the time,
I feel like I'm doing everything right, what would be
the first thing you'd tell them? Do you start this
trying to get better at sleep journey?
Speaker 3 (16:25):
Exhaustion of fatigue could be because of several reasons. So yes,
poor sleep or inadequate hours or quality of sleep is important,
so that definitely needs to be looked into, but it
could be other things. So I talked about the nasal problem.
So there's something called UAIS or upper airway resistance syndrome,
and that's essentially breathing through a high resistance airflow narrower passage.
(16:50):
So a simple thing is to go and see the
GP and just get the upper airway checked out, or
you know, for example, in our clinic, you don't need
a referral. You can just contact us and we'll do
that for you. Apart from the upper airway, any other
medical problems, thyroid problems, heart issues, chronic pain, anything that
impacts a good, RESTful few hours of sleep at night
(17:15):
can be a big factor. Along with that low protein,
high fat diet. You know, we all kind of just
reach for whatever we can when we are exhausted, but
that can set up a vicious circle. Less movement predisposes
us to exhaustion and fatigue. So focusing on that alcohol
(17:37):
in moderation is quite important because a it disrupts our
normal sleep architecture. Sleep is not just rest for the
body and brain, it's actually repair regeneration. So if we
are disrupting the reparative and regenerative stages of our sleep
(17:58):
architecture with alcohol or even some medication on board, then
we might be getting enough hours, but it's not the
right kind of sleep, So we have to get enough
of the right kind of sleep.
Speaker 2 (18:11):
What about women in the peerimenopause or menopause phase. Do
you find that sleep gets disrupted through these hormonial changes
for sure?
Speaker 3 (18:20):
So women have got the double whammy. So you know,
they might have the anastomical structure problems that men have too,
but along with that, they have the hormonal changes through life,
you know, right from puberty to childbearing age, pregnancy, post pregnancy,
and then premenopause, perry and postmenopause. So it's just an
(18:41):
you know, a roller coaster of physiology. So that means
that the problems are more complex and research is difficult
to do to find evidence on how best to manage
these problems because research projects are not easy to set
up with hormone changes, so typically male subjects are used
(19:05):
and that's just completely illogical when it comes to menopausal
or female physiology hormone type of you know scenario. So
it is very common for women to have sleep issues
because of changing hormones around premenopause, peri and postmenopause. Women
(19:28):
almost by then or very early on, actually get used
to putting everything else above their own needs. Family, kids, work,
everything comes ahead of their own needs and you know,
we always encourage women to our patients to advocate for
themselves and you know, allow us to advocate for them
(19:50):
because it is a complex issue and you know, we
need to do a lot more about it than you're
doing now.
Speaker 2 (19:57):
Yeah, I've got an example of that my house. My
thirteen year old now sometimes goes to bed after me
because I get up so early that I will often
say right, I'm to bed. At night, I say good
night to the little two who are a bead, and
then my thirteen year old stays up for an extra half.
Now she's kissing me to say good night. We got
a change in my house. Does our sleep change with
the season? So we're winter now, we're about to go
(20:20):
into winter. Is it easier for people to sleep in winter?
Would you say, by and large over the summer months.
Speaker 3 (20:26):
Yes, it is in a way, and our body is
actually physiologically sleep for longer in winter.
Speaker 2 (20:35):
Do we need more sleep in winter like an hibernating beer.
Speaker 3 (20:39):
Yes and no. So we physiologically sleep longer, and that's
because of the change in the ratio between daytime and
night time. So the photo period, the amount of light
that the body is exposed to changes, So that induces
longer sleep times. So the research has shown that it
(21:01):
changes the architecture, so we have more REM sleep and
more dreaming at night. And some might say that the
physiological need for that is to actually counter the ill
effects of mood and depression and seasonal effective depression disorder. Yeah,
(21:22):
so that REM sleep is actually helping us process our emotions,
process our memories from the day, and kind of fighting
against the sad phenomenon. So we physiologically do sleep longer,
and perhaps we do need to sleep longer for that reason.
Speaker 2 (21:43):
Okay, that's good to know. The give yourself a break
this winter and actually take it for your body's needs.
Speaker 1 (21:50):
Nike, we need to talk podcast appreciate on your iHeart
app just step and never miss an episode.
Speaker 2 (21:58):
What is your take on wearables? So things like our
fitbits and our garments and our Apple watches that we
can track our sleep within an inch of their lives.
And I know even at Coast Sam Wallace, who I
Coast host with, he wears a watch and he'll tell
me almost daily how much sleep he got. I can
see that it dictates whether he feels good or bad
(22:19):
about that.
Speaker 3 (22:22):
You've hit the nail on the head, because there's a
term that's been coined called orthosomnia, which is essentially people
losing sleep over what their watches are telling them or
their wearables are telling them. So they might not be
feeling it subjectively, but they're worried that the watch is
telling them that they've not had enough ramsleep. What I
(22:44):
tell people is, look before you ask your watch or
you're wearable or your app how well you did in
your sleep, Ask yourself. So that's the most important thing.
If how you feel about how well rested you feel
in the morning after your sleep is more important than
what the watch tells you. So if you're feeling well,
(23:07):
that's a really good start. There is some good use
for the data that we get, and that is essentially
not by itself, but in conjunction with, say, whatever intervention,
whether it is lifestyle based well being type invention or
a medical or surgical intervention, we can compare the before
(23:27):
and after and get an idea of how well things
are going. But in absolution it's not as important. As
we kind of start getting worried about these days.
Speaker 2 (23:39):
Do you think, speaking of these days, do you think
people are taking their sleep more seriously than perhaps we
were ten twenty years ago. Do you think people understand
now how it can adversely affect us?
Speaker 3 (23:51):
Again, I will say yes and no, and that is yes. Absolutely,
there is way more awareness about sleep, which we love.
You know, there's a lot of scientific advocacy that has
gone gone in behind the scenes over decades, which is
now bearing fruition. So absolutely people are more aware. Why
(24:13):
people are also more aware is because entrepreneurs are discovering
that the well being industry is a huge, multi billion
dollar industry and sleep is a pillar. So there's a
lot of social media activity around sleep and well being. Now,
(24:36):
a potential problem with that is if people do not
follow science or follow evidence as best as possible when
they are promoting certain things. So a colleague of mine,
who's one of the most well known sleep surgeons in
the world, talks about fog. Fog is tiny water droplets.
(25:00):
So but we can't drink fog. We can't open our
mouths and take in fog, and that will quench our thirst.
So it doesn't serve a useful purpose per se, but
it blinds us. So the millions of social media posts
on everything about sleep, a lot of them are like
fog particles they don't actually help us, but there's a
(25:25):
whole bunch of useful scientific information that is available, and
that is where we as healthcare providers have to meet,
you know, people, because that's the space within which people
are getting their information.
Speaker 1 (25:40):
Lasts.
Speaker 3 (25:41):
But there's a recent paper that's come out literally just
last week which actually talks about the importance of healthcare
professionals to be in the social media space because it
is important to bring science into that sphere. If you
think about chat, GPT or you know, any of these
ai they rely on publicly available information to formulate their answer.
(26:05):
So if somebody is asking Chad GPT for information, they're
going to get information that's not necessarily behind payworld research articles.
So just publishing high quality evidence is not enough for
scientists or healthcare professionals. We have to actually bring that
knowledge out into the public sphere.
Speaker 2 (26:26):
Get it to the audiences.
Speaker 3 (26:27):
That's correct. People are way more aware of the importance
of sleep, and there is an evolving approach to how
to get better sleep. But there's a lot of fads
and a lot of misinformation, and there's some really good
information which is fantastic because you know, previously people were
(26:50):
just not aware no.
Speaker 2 (26:51):
Just cutting through and finding the grunty stuff. I love
that you're pro getting that information out on social media
because that's what I do in my business, trying to
get paid to confidently talk on camera because a lot
of our academics aren't comfortable doing so, and unfortunately that
is the best medium to get things out there. I
want to finish by talking about napping and just getting
your views on it. I'm a big fan of a nap.
(27:14):
I can think of nothing more than in the middle
of the day crawling in to be in my pajamas
and getting a recharge. Does it work for us? Do
you advocate for napping?
Speaker 3 (27:22):
It does work for us. And again, napping is really
good in certain situations and when you do it right,
so less than thirty minutes is the rule. Less than
thirty minutes. It can be very helpful because if the
sleep pressure or sleep debt is building up too rapidly,
it can offset that A bit recharges a bit. It's
(27:45):
a bit like you know, you might charge your phone
at the end of the day when you're going to bed,
or if it needs a charge in the middle of
the day. You just put it on for ten minutes
and it's got some more juice in it. So that's
what napping does for us when it's less than thirty minutes.
Speaker 2 (28:00):
So no longer than thirty ever, No oh, I thought
I could nat for ninety minutes and get away with that.
Speaker 3 (28:05):
No, now, Tony again, not to scare you, but more
than sixty minute naps have shown strong positive correlation with
cardiovascular problems and all cause mortality.
Speaker 2 (28:18):
Wow, that's staggering. So okay, I'm going to seat my
alarm now for twenty eight minutes and make sure I
only net for that. Okay, So why do you think
that is?
Speaker 3 (28:29):
We don't have a very clear answer. So this association
has been seen again in high level population level data,
which has kind of just created those associations by virtue
of statistical analysis. But theories and hypotheses are that longer
(28:50):
nap times are associated with less physical movement in general
through the day, and that we know has implications when
it comes to cardiovascular problems. And it could be that,
you know, if you're not moving well enough through the
day we are napping for long periods, then when we
are moving, you know, our heart is not primed and
(29:12):
conditioned well enough to take extra strain and therefore we
can get carry vascular problems, and the same goes for
metabolic problems. If we're sleeping a lot, particularly after a
big meal, our insulin is spiking a lot more. That's
causing spikes of inflammation within the body, and then that
can cause widespread kind of multi system problems in the body.
Speaker 2 (29:34):
Wow. Well, if there was one thing that you could
finish this podcast by telling people that are listening to
this who want to be well rested, they don't want
to be walking around exhausted, what would that be? Could
you put it down to one single idea?
Speaker 3 (29:47):
Look, the checklist that we talked about, get one, two, three,
four and five underway is a really relatively simple and
quick thing to start. But if it was one thing
and only one thing, then I would say, focus on
getting good morning sunlight as soon as you can twenty
(30:09):
to thirty minutes if possible, as soon as possible after
waking up. Is the strongest influencer of our body's physiology
and our body's internal clock and all of the factors
being the same. That is the biggest boost to regulating
(30:33):
our sleep in a consistent way that we have found.
Speaker 2 (30:37):
Oh, I love that. Thank you so much for your
time today. Fascinating. Just when I thought I knew most
things about sleep, I learned two three really new facts
today that I will take with me. So appreciate your time.
Speaker 3 (30:49):
Oh, thank you for having me Tony. It's such a privilege.
Speaker 1 (30:51):
Thanks for listening to We need to talk. Contact us
on Instagram and we need to talk with Tony Street
or email. We need to talk at Coast Online doco
dot in z
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