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  • Kathryn Pinkham On The Truth About Insomnia

    23rd July 2020

    23rd July 2020

    By Caitlin Bell

    Kathryn Pinkham is the founder of The Insomnia Clinic, the UK’s leading and largest insomnia service. Kathryn’s personalised approach and use of cognitive behavioural therapy (CBT) has helped people across the country transform their lives, so we sat down with her to ask her all our burning questions about sleep, and how we can get better at it.

    Hey Kathryn! What made you start working with insomnia patients?

    My background is in the NHS. I worked in mental health services for a few years and we did some training in insomnia and I absolutely loved it. What I saw is that anyone with a mental health problem almost always has a sleep problem too. If you’re depressed, anxious or stressed, you're probably sleeping badly. And if you aren’t sleeping well, it’s hard to feel well otherwise. 

    In 2013, I was made redundant from the NHS and that’s when I set up The Insomnia Clinic, working one-to-one with people with sleep problems and it’s expanded from there. In the last two years, I launched an online course because actually not everyone needs one-to-one therapy. It can be expensive and time-consuming, and it’s not necessary for everyone. Even though we’re now on Zoom it actually works quite well because it now means anyone anywhere can access our services.

    Kathryn Pinkham The Insomnia Clinic

    So why do we sleep, and why is it important?

    While we sleep we’re regenerating our cells, consolidating memories, and recovering from the day. Sleep is not a passive process. There's work being done. So it’s important for both physical and mental health to get good quality sleep.

    Is there such thing as a 'normal' sleep cycle?

    For me, the eight-hour thing is a bit of a myth. If you can’t sleep, hearing you should get eight hours is the worst possible thing because you're already stressed and already trying really hard. What I say is put quality sleep first. That means falling asleep within half an hour, sleeping until your alarm goes off, getting back to sleep if you do get up in the night, and staying awake during the day. That’s quality sleep. But you can’t out-sleep stress and that’s often the problem in the first place. 

    During lockdown, everyone’s been more stressed than usual and lots of us have been sleeping worse at some stage. Why is that?

    The problem with lockdown and the reason it’s affected people so negatively is because people have stopped setting alarm clocks. They get up later, lose routine, and their body blocks lose that structure that kept them sleeping well. People also couldn’t do as much; it was more difficult to exercise and get out and get fresh air. And one of the biggest factors in insomnia is stress. Anxiety around the virus was high and that lends itself to lying wide awake in the middle of the night worrying about things. 

    The biggest thing that manages how well we sleep is our sleep drive. It’s like an appetite. When you wake up in the morning you start building a sleep drive until you go to bed again. So the longer you’re out of bed for, the stronger that drive is. But the more time you spend in bed, the lower that drive and appetite is. So a lot of the advice I’ve been giving to people while we haven’t been able to do much is go to bed later and get up earlier. Don’t worry about the eight-hour thing. You want to kickstart that drive again.

    So what actually is insomnia? 

    Someone with insomnia is defined as anyone who has problems falling asleep, or if it takes you longer than half an hour to fall asleep repeatedly. It's also waking through the night and not being able to get back to sleep, feeling unrefreshed in the daytime, extremely early wake ups, and sleep anxiety.

    The way insomnia develops is you have a bad night for some reason or another, and we’re very intolerant to not sleeping well. So we panic and try really hard to sleep well, and it actually interrupts our sleep drive because we try lots of things like going to bed early. But this is one of the worst things we can do because the body clock loses its structure. The more time you spend in bed stressing over not sleeping, the more you maintain that negative cycle.

    We also try things like downloading apps or trackers, buying new pillowcases or getting special blinds. But this stuff - called ‘sleep hygiene’ - creates this vigilance around sleep and perpetuates the cycle. It doesn’t matter what triggers the insomnia, it’s what’s maintaining it. And often the things we try end up making it worse.

    What causes insomnia?

    One of the biggest factors is stress. But generally, insomnia develops when you’re missing some or all of three key things that you need for good quality sleep.

    The first is sleep drive, the second is our body clock needs to understand what to do, and the third is a connection with our bed about sleep. If you spend a lot of time in bed or in your bedroom while feeling stressed, your connection with your bed becomes about stress and so you’ll feel stressed when you get into bed.

    So how do you help your patients?

    The first step is always education. You need to make people aware that sleep is fairly simple, and that spending too much time in bed lying awake is actually making it worse. Good sleepers always have a high sleep drive, their body clock knows what to do, and they have a positive association with their bed. They have those things in place. We don’t need all the other stuff. 

    We then start from the basics. The treatment programme I offer is called cognitive behavioural therapy (CBT) for insomnia, which is the NHS-recommended treatment and it's generally a 4-week programme. Most people see results in less than that time. It tackles the behaviours we have around sleep. So looking at increasing that sleep drive, and managing physical and internal parts of the problem. But we also look at someone’s thoughts and beliefs around sleep and try to make those more positive. Insomniacs usually have very negative thoughts about sleep and their ability to cope. It’s not enough to just work on anxiety, thoughts, and relaxation. You have to also deal with the physical part of it too. 

    Have people’s new working environments and lifestyles impacted their sleep?

    Yes. For example, lots of people have been drinking more alcohol than normal. The rules were thrown out the window a bit. But I never tell people you shouldn’t drink at all and don’t drink caffeine, because that’s not real life. Good sleepers do do those things. Obviously don’t go to bed having drunk excessive alcohol regularly, but having a drink every now and then to relax is absolutely fine. It’s all about balance. We just need to start bringing some of these boundaries back in. For example, setting your alarm and making sure you get up when it goes off, staying out of your bedroom as much as possible, making sure you have a firm end time to your working day, and separating your workspace from your relaxing space.

    View this post on Instagram

    There’s a lot of change going on in the world at the moment. If this is making you feel anxious, limit exposure to the news and social media. It’s easy to lose hours staring at screens, watching as things unfold and change. However, it is not going to help your anxiety. Instead, decide how much time each day you’re going to allow yourself for updates. For example, 15 minutes of news in the morning and 15 in the afternoon. Also ensure you’re limiting your time scrolling on your phone through social media. Make sure you only look at trusted resources, select a couple and limit yourself to these only. #menshealth #womenshealth #mentalhealth #health #insomnia #socialanxiety #cantsleep #insomniac #stressed #stress #anxiety #sadness #tired #insomniastory #insomniatreatment #sleepbetter #theinsomniaclinic #cbti #insomniasucks #sleepless #sleep #sleeptips

    A post shared by Kathryn Pinkham (@theinsomniaclinic) on

     

    And why do people say excessive screen time before bed is bad?

    So there’s two things. Firstly, blue light inhibits melatonin. That’s the sleep hormone and without it, you can’t sleep. It’s suppressed during the day by daylight, which is why we aren’t sleepy in the day. When it then gets dark, we start to develop it again and it’s the body’s sign that it’s time for us to go to sleep. And blue light mimics daylight, so if you spend too much time in front of a screen at night you might struggle to develop enough melatonin.

    The second part is that if you’re working or thinking by checking emails, you’re signalling to your brain that you still need to be active. You can use your phone before you go to sleep, but constant scrolling isn’t a good idea.

    What about sleep trackers? Do they work?

    For me, there’s no point. People obsessively track their sleep and decide how they feel based on the results. People will cancel meetings, stop socialising and go about their day with a negative mindset because of what they’ve read on their phone. I don’t think they’re accurate enough and they give the same old advice that won’t actually fix an insomnia problem.

    How does nutrition play into our sleep health?

    As long as you have a normal healthy diet, you’ll have everything you need to sleep well. If you look at ‘good sleepers’, they don’t have a different diet to everyone else. 

    And finally, what are your top practical tips that anyone can try to get a better night’s sleep?

    • Spend less time in bed and make sure you’re properly tired when you do go to bed.
    • If you’re lying awake in the night, don’t stay in bed as you’ll connect your bed to anxious feelings. Watch TV or read a book for a little bit until you feel tired. Don’t set your alarm back later either. Get up when you had planned to.
    • Each day, get into the habit of setting aside 20 minutes to write down what’s on your mind. If you can’t fill 20 minutes with your worries, then you know you shouldn’t be worrying around the clock 24 hours a day. The aim isn’t necessarily to find solutions, it’s to acknowledge your worries and do so at a suitable time instead of in bed.
    • Don’t watch the clock. If you wake up in the night and check the time, you’re teaching your body to do it and it creates anxiety. Until your alarm goes off in the morning you don’t need to know the time. There’s nothing to be gained by it.

    To find out more from Kathryn, you can follow her on Instagram (@theinsomniaclinic) and find her at The Insomnia Clinic.

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    Discussing Truth & Transparency with Anj Magecha
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It took quite a while for me to recognise this but eventually I found myself in a place where I was tired of being constantly unhappy and knew something needed to change. It was at this point I decided to forget all the expectations I had previously put on myself and just do the things that made me happy, with the knowledge that everything else would fall into place. I began getting more into training and lifting and begun fuelling by body with protein powder and supplements such as the Power Booster. Now I feel happier and healthier than ever and want to help other people to achieve the same. View this post on Instagram A post shared by anj |mental health+fitness| (@grow.with.anj) Our campaign for January is truth and transparency. What do you think the importance of this is, particularly in relation to the health and wellness industry? There are so many health and wellness influencers who are not truthful and transparent in their journey, and it makes people feel like a failure when they aren't getting the results that are falsely promised to them. For example, there are people who've become millionaires, have massive brand deals and are living a life that most people could only dream of, all off the back of their fitness transformations. Everything about them just screams success and obviously people want to emulate this. But if those same people don’t disclose the full story people are never going to achieve this and they’ll feel like they’re the problem, because if someone else can do it, why can't you? Humans are quintessentially social creatures; we're always going to be comparing ourselves to one another even when we try to be mindful. So, it's so important to understand that you can save someone a lot of pain by just being honest. This is something that I used to get angry about, but now I know that anger will never be the solution and that you just need to be that other voice and hope that you can help as many people as possible. So, how do you try to be this voice of truth and transparency, particularly within the health and wellness space? I think it’s important to remember that to be entirely truthful and transparent about your journey you also need to be vulnerable enough to share the moments when it isn’t easy. Sharing these moments is infinitely more valuable than just showing the highlights because it makes us realise that we all go through them. However, in the health and wellness industry this isn’t the norm; people use photoshop and promote ‘fat burners’, and avoid any vulnerability, creating this pressure to conform. I think to break this cycle, we all need to be a little more vulnerable. Because whilst waking up at 5am and walking everywhere might make you feel happy and fulfilled, some people need 10 hours of sleep and sometimes you’ll want to sit in front of the TV and watch something mindless. This doesn’t make you a failure and by being honest with yourself about what truly makes you happy and portraying this in a vulnerable way you can help other people realise this too. As you mentioned, the space does currently have a lack of transparency, so how do you discern the truth from the myths? When it comes to fitness and nutrition, I always try to think about who the information is coming from. I hate being a cynic and I love to think that everyone has everyone else's best intentions at heart, but I think it’s important to consider what would this person have to gain if they weren't really telling me the entire story? Then you also need to consider what their credentials are. Are they a doctor or dietitian or are they just someone who looks good? It’s so important that you can know and trust your source of information. I also think, that there’s no one size fits all approach, and the most important source of information should be yourself. For example, I love chaos and I thrive under pressure, so taking five minutes to write affirmations down just doesn’t fit with me. It’s important to trust your own intuition and timing. If you can do both these things then when influencers promote low calorie diets in partnership with these big brands you can ask yourself, what are their credentials, what do they stand to gain and is this something that I think from my own experiences would work for me and make me happy? What is a truth that you've learned during your journey that you're passionate about and think that everyone should know? To get something you've never had you must do something you've never done. What I mean by this is that it's not your fault if something hasn't worked for you. A lot of people blame themselves for not sticking to diets and fitness regimes but if you didn’t stick to it, it’s not you that failed, it’s the diet/ fitness regime that failed. There's a reason why it was so difficult for you to stick to it; perhaps it was too restrictive and resulted in binge eating. Perhaps it was stopping you from enjoying meals out and living your life fully. The answer should never be to blame yourself. You just have to try something new. Create a meal plan which allows you to feel good without restricting yourself and cutting out whole food groups, try a sport you actually enjoy and keep trying new things until you find something that works. You’ll never get to a different destination by taking the same route over and over again. View this post on Instagram A post shared by anj (@anjmagecha) Finally, it feels very relevant to discuss this during January. There’s always this huge influx of mixed advice, myths, and fads at this time of year so what’s your opinions on this and particularly the idea of New Year New Me? I think it's utter rubbish (laughs). You don't need to change people. It's just January. The only changes you should ever make are the ones that genuinely make you happier and you can make these year-round. We all experienced this during lock-down too, there was this huge hustle culture and pressure to use lockdown to learn a new skill or achieve your dream body, and if you weren’t doing this, you were lazy. It made me feel rubbish and I know lots of other people felt the same. It’s so important to try to drown out the pressure and just focus of being in touch with what makes you come alive and what makes you happy. Shifting my focus from external validation to internal happiness is the most important change I made when transitioned from the miserable person I was, to the person I am today. Of course, in the spirit of transparency, not every day is a good day for me and some days I have identity crises and some days I break down. But that's all just part of the job. We’re all a work in progress and the sooner you can embrace all of this and focus on do what makes you happy on a daily basis instead of doing what you think should make you happy, it will open so many doors. To keep up with Anj, check out her Instagram and TikTok for more content on truths vs myths. Read more
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