the times | Tuesday May 24 2022 7
health
better to accept that your needs can
change and adapt so that you enhance
the sleep that you need.”
Indeed, Foster argues that
our western sleep pattern is not
necessarily our biological pattern.
“There’s a ‘biphasic pattern’ that
looks more natural. In the Middle
Ages people used to wake in the early
hours, potter around for a while, then
happily go back to sleep. Now we
have squeezed all our rest into a
narrow window.”
Foster’s circadian-driven ways
are a boon for the young university
students that he teaches. “I only start
classes at 10am, which is brilliant for
them. I remember having to go to 8am
meetings, which were hideous and
I took nothing in,” he says. “During
our teens our sleep hours go forwards
by two hours. Then there is a slow
move to getting up earlier until, when
you get into your fifties and sixties,
your patterns tend to go back to how
you were at six years old.”
Imagine that. Sleeping like a baby
once again. Well we can all hope.
Meanwhile, Foster has plenty of tips
for living as a circadian success.
Breakfast like a king
You are much more likely to burn
calories and lose weight by eating
a good breakfast and lunch than by
eating heavily during the evening.
In the daytime you burn up freshly
consumed calories to survive and
keep active. At night you are burning
stored calories to keep you going, so
your body burns fewer of them in
your state of rest and stores much of
what you ate for dinner.
Yes, take my app — not your
pill, says the Sleepio creator
that digital mental health start-ups
attracted £4 billion of investment in- Espie is keen to distance Sleepio
from Calm, Headspace, Moodfit and
the like — all hugely popular apps.
“I’m not dissing those things, I just
think they are different... they are
wellbeing products,” he says, arguing
that they have not submitted
themselves to serious clinical trials.
Still, isn’t there an irony that Sleepio,
which advocates keeping electronic
devices outside of your bedroom, is
web-based? “Ah, but you don’t take
this into your bedroom,” Espie says.
“You set up your appointments with
the Prof during the daytime, not
during bedtime. It mirrors the
week-to-week cadence like you’d be
coming to see me. But if you were to
go on your device during the night, the
Prof appears in his nightgown.”
One of Sleepio’s techniques is to
break the association of your bed as a
place where you fail to get to sleep; if,
after waking in the night, you can’t fall
back to sleep you should get up, leave
the room and undertake another
activity, such as reading, before
returning to bed and trying again.
Until now Sleepio has been available
mainly to patients in the US, where it
can be offered as part of companies’
private medical packages, and from
last year in Scotland and one or two
postcodes in England. So far 250,000
people have used it, and reviews on
the app store are mixed. It is rated
2.5 out of 5, compared with, say, Calm
with 4.7 or Headspace with 4.8.
Espie acknowledges that various
technical updates to the app have not
gone as smoothly as Sleepio might
have liked. “It’s not the content or the
effectiveness, rather the technical
aspects” that people have complained
about, he says. He also hints that
Sleepio has been hit by “people
trolling” the reviews.
One thing is certain, however. And
that is sleep, or rather lack of sleep, is
increasingly being recognised as a
cause, rather than just a symptom, of
serious health problems. “If you think
about what the fundamentals for life
are, you need oxygen, you need water,
you need food and you need sleep.
Sleep is really nature’s medicine for
mental health,” Espie says.
If a relatively cheap digital course of
cognitive behavioural therapy for
insomnia (CBT-I) can help some
people as effectively as a bottle of pills,
shouldn’t it be available?
Harry WallopT
he news was greeted with a
fair amount of scepticism.
English GPs at the end of
last week were told they can
offer the estimated 800,000
insomniacs in the country a self-help
app instead of sleeping pills.
“A phone app for sleep that teaches
you not to use your phone in bed.
Does not compute,” was a fairly typical
response from one reader on learning
that Sleepio, an online sleeping course,
had been given the green light by the
National Institute for Health and Care
Excellence (Nice). This is the first time
that digital therapy has been cleared
by the medical watchdog and it
potentially opens the door to a radical
way of treating all sorts of conditions.
However, can a cartoon expert,
called the Prof, and his narcoleptic
dog, Pavlov, really do as good a job as
clinically tested pharmaceuticals?
Yes, is the unequivocal answer of
Professor Colin Espie, the co-founder
of Sleepio. And that’s because it has
been through just as many tests as a
prescription pill and has been proven
to work, he says. Being approved
by Nice “was a rigorous process.
We submitted 12 randomised
control trials, a health economic
evaluation, and a two-and-a-half-
year implementation study.”
Espie says sceptics need to
understand that a smartphone or
laptop can do just as good a job as
old-school medication. “This is
quite a transformational moment
for the treatment of mental
health because ultimately what it
does is it acknowledges that
digital therapeutics, like Sleepio,
should be provided alongside
medications as a scalable option.”
One study, involving more
than 7,000 NHS patients, found
that on average patients using
Sleepio got 35.3 hours of sleep a week
before using the app, compared with
an average of 41.2 hours after using it.
Espie, 64, is not your typical digital
pioneer. He is speaking to me via
video from his home near Glasgow the
day the Nice approval was announced
and looks every inch the academic.
“I’m a clinical psychologist by training.
I qualified in the dark ages of 1980.
My kids, even my grandkids, think
it is rather amusing that I’m involved
with a tech company. That’s not my
kind of thing. I’m an academic and
trying to do research to solve human
problems. And one of those is how you
manage insomnia.”
His day job is professor of sleep
medicine at Oxford University. But he
was approached by an entrepreneur
and insomniac, Peter Hames, who had
read Espie’s Overcoming Insomnia and
Sleep Problems. Would he help Hames
to develop an online version of the
course that he outlined in the book?
Espie said yes, on the proviso that
they submitted any course to clinical
trials. More than a decade later,
Sleepio’s holding company, Big Health,
employs 200 people, is headquartered
in San Francisco and has raised about
$120 million (or about £95 million) in
funding from a series of high-profile
tech investors.
Digital mental health has become a
boom area, with one report estimatingt i t bedandtryingagainHappy napping
The rule of thumb with napping is that
the occasional 20-minute nap is not a
problem and may enable you to work
better in the afternoon. The problem
with longer naps is that you go into
deeper sleep and don’t recover fully
into wakefulness. Needing to nap may
show that you are not getting enough
sleep at night. If you have long sleeps
during the day, this pushes back the
time during the evening when you feel
tired, so you go to bed later, sleep less
and feel worse still.Exercise early and late
If you exercise in the morning,
before breakfast, your body is in sleep
mode still so it will use up stored
carbohydrates. However, our peak
performance time for physical exercise
is late afternoon/early evening, so
you can exercise more vigorously late
in the day and burn more energy.
Ideally you might do ten minutes’
early-morning exercise and then do
a longer block later in the day.Avoid the weekend lie-in
Oversleeping hugely at the weekends
is a common mistake. If you’re
suffering severe sleep deprivation
during the week, two long lie-ins
won’t enable you to catch up. Instead
you will miss the morning light, which
is crucial for setting your circadian
sleep times. This will push your
bedtime back and you’ll get less sleep
on Sunday night. So on Monday you
will be in a worse position than when
you started the weekend.Get jabbed before lunch
In the morning your immune
system is most efficient at developing
antibodies to viral invaders, so it’s best
to get vaccination shots before lunch.
You’ll get a three times more powerful
response than you would in the late
afternoon. If you’ve been stressed by
lack of sleep, however, the stress
hormone cortisol will inhibit your
immune response: the vaccination
response won’t be as efficient and
you will develop fewer antibodies
in response to the inoculation.GETTY IMAGESExercise early and late