‘How do people go to sleep? I’m afraid I’ve lost the knack,” writer Dorothy Parker once said, no doubt regretfully. Then, as now, she was not alone. A quarter of Kiwis have trouble sleeping and the confirmed insomniacs among them will not appreciate your sleep tips and supplement suggestions. They will have tried them all.
British doctor Michael Mosley, though, is not to be put off. After great success with guides on diet, exercise and healthy living, he’s polished up his 2020 book Fast Asleep, which went rather unnoticed during the pandemic, and released 4 Weeks to Better Sleep, with updated evidence and his own personal experiences.
After 20 years of intermittent insomnia, Mosley has been enjoying improved slumber for at least nine months. Last year, he put himself through a clinical trial on sleep at Flinders University in Adelaide and went on to create a four-week schedule to get the sleep-deprived snoozing better. His sleep regime had long involved getting up in the night (as he explains in our extract) but, he told the Listener, those occasions are getting rarer.
Mosley’s new schedule starts with things like keeping a sleep diary, following a Mediterranean diet, and breathing exercises if you wake up in the middle of the night. It gradually includes more intensive regimes, such as sleep restriction therapy, resistance exercise and boosting gut-friendly foods. Weight loss can also play an important part.
But first, some myth-busting. That blue light from your mobile phone, or even the TV, is unlikely to be the cause of sleeplessness. The light is so weak that it can’t possibly be having any effect, says Mosley, so forget the expensive blue light filters. Instead, it’s probably what you’re looking at on your phone that’s stimulating your brain when it should be relaxing and calming down.
Likewise, the claim that cheese gives you nightmares is a myth, although “eating anything that is rich in saturated fat just before you go to bed is likely to disrupt your sleep. But there’s no evidence that cheese is worse than any other food, or that it triggers nightmares.”
What is clear, he says, is that the standard advice on “sleep hygiene” will barely touch the sides for people with real sleep problems and current treatments are either not particularly effective or, like sleeping pills, have distinct downsides.
In the main, sleep supplements are largely ineffective, with the exception of melatonin. “The short answer is that it may [help]. The Cochrane reviewers [a research review] concluded the use of melatonin by night-shift workers increased the amount of sleep they got by 24 minutes.”
As for sleep-inducing food such as kiwifruit, cherry juice and turkey, that’s a “no” to any such claims, according to the evidence.
Sleep restriction therapy
Mosley trained as a doctor, but has made a name internationally as a TV presenter and writer. He reckons his superpower is in recognising the value of possibly forgotten research that has proved effective and then throwing a spotlight on it. In 2012, he resurrected research on intermittent fasting to reverse diabetes (he found it worked on him, too). For this book, he’s gone back to work on sleep restriction therapy that’s been around since the late 1970s and which forms a large part of his programme for treating entrenched insomnia. It was also the bedrock of the Flinders trial.
“There are lots of trials showing the effectiveness [of sleep restriction therapy], but it’s hardly ever used,” says Mosley.
It looks counterintuitive: to get better sleep, you must spend much less time in bed. For Mosley, who was used to going to bed at 11pm and getting up at 7am, he had to get up at 5am. It was brutal at first, but in combination with other interventions, within eight weeks he was declared insomnia-free.
Though Mosley claims his techniques are effective, “at the core of it, you first of all have to work out: what is your sleep problem?”
By taking part in the Flinders trial of 30 people with insomnia, he managed to diagnose himself. He had agreed to present a three-part TV series, Australia’s Sleep Revolution, which has just screened there on SBS. He found out he had obstructive sleep apnoea, where the flow of air into the lungs becomes blocked while sleeping. In Australia, the condition is estimated to affect 10-20% of people, particularly males, although fewer than 5% know they have it. (Rates in New Zealand are estimated to be lower, although more prevalent among Māori and Pasifika populations.)
The 67-year-old also found out he had a body clock running faster than expected. This meant that whereas most people’s core temperature is at its lowest about 4am, his was lowest about 1am. “That could explain why I get so sleepy early in the evening and why I often wake up feeling surprisingly alert at 3.30am,” he writes.
He’s a classic “lark” in that sense, and the “cure” involved being exposed to bright light last thing at night. Within a few weeks, his body clock had shifted two hours later.
While most people would be unable to reproduce the lab conditions he had, Mosley says if you want to try out bright-light therapy, get hold of a SAD (seasonally affective disorder) lamp. It needs to be 10,000 lux – much brighter than your standard overhead light.
If you’re an “owl”, who struggles to get up in the morning, a walk outside in broad daylight might be all the exposure you need to help reset your body clock.
The role of diet
It wouldn’t be a Mosley book without a big section on the impact of food, and once again, there’s a collection of recipes by his wife, GP Dr Clare Bailey. Since his The Clever Guts Diet – about how improving your microbiome can help you lose weight, boost your immune system and improve your mood – was released in 2017, a lot more research on how food affects mood has been published, he writes, including how specific foods affect sleep. One study showed volunteers who ate food rich in fibre and protein enjoyed better sleep, while those who ate a lot of sweet simple carbs veered towards broken sleep. As usual, the Mediterranean diet is the one to follow.
“Going on a Mediterranean diet boosts levels of the ‘good’ bacteria in your gut – these in turn can produce powerful anti-inflammatory agents, as well as ‘feel good’ chemicals, which reduce anxiety,” he writes.
Although he’s written before about junk food having an adverse effect on mood, his next hot-button issue is the link between anxiety and depression among young people and junk food, rather than linking mental health issues to social media.
“Intellectually, it seems obvious [that social media drives teen anxiety] – all that toxic stuff out there. But when they actually drill into it, there have been very few studies I’ve come across that have compelling evidence. That’s what’s got people scratching their heads – if it’s not that, then what else could it be?
“That’s the stuff I love. You start off with something everyone believes, but when you do the clinical studies, the outcomes are not what’s expected.”
What he also loves is being able to shine a light on underdog researchers who have made a breakthrough that will help millions of people. One of them was Australian doctor Barry Marshall, who, from 1984, was arguing, despite ridicule, that the bacterium Helicobacter pylori, not stress, was the cause of stomach ulcers. “I read about it, [and] filmed him at a time when he was regarded as a bit of a looney. Gastroenterologists all said this was nonsense. Then he went on, with [pathologist] Robin Warren, to get a Nobel prize.”
That’s his special skill, he reckons; making the call on what’s worth some limelight and what isn’t. And so far, it’s working.
To read an extract from 4 Weeks to Better Sleep: A Life-changing Plan for Deep Sleep, Improved Brain Function and Feeling Great by Dr Michael Mosley (Simon & Schuster, RRP $38.99) go here.
