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The Grand - Mezzanine

KATE WRIGHT:

OK, welcome everyone. Great to see so many people here. My name is Kate Wright. I'm from the University of Western Australia. And this year UWA is bringing, raising the bar to Perth. What is it? It's ten academics, ten bars, one night, ten talks. And you've chosen to come to one of the most exciting. So, well done.

STUDENT:

Why did you say that?

KATE WRIGHT:

She brought me a drink earlier. We believe that research and innovation shouldn't be restricted to the lab or the lecture theater. We are excited to make education a part of our city’s popular culture through transforming local city bars into a place you could enjoy a drink whilst learning about the impact that our research has in the community. So, without further ado, I'd like to introduce our speaker tonight, the amazing Professor Romola Bucks. And look at the shoes. Aren't they amazing?

(APPLAUSE)

She's got to be a great researcher if she wears shoes like those. And I love them. Professor Romola Bucks started her clinical and academic life in the UK where she trained as a clinical psychologist before specializing in clinical neuropsychology. Not content with two degrees, she pursued a PhD in cognitive neuropsychology from the University of Bristol. She worked for many years with the National Health Service in the UK in the diagnosis and management of dementia before coming to Perth for some well deserved sun. Please welcome Romola.

(APPLAUSE)

PROFESSOR ROMOLA BUCKS:

Thank you Kate.

(APPLAUSE)


Thank you everyone for coming. It's lovely to see so many new faces, and a few old faces. And I don't mean that chronologically. OK, I'll sleep when I'm dead. Hands up anyone who remembers 1992. OK. Do you remember Jon Bon Jovi? Do you remember him singing, 'Until I'm six feet under baby, I don't need a bed. Gonna live when I'm alive. Gonna sleep when I'm dead'? It sounded good, didn't it? 'I'll sleep when I'm dead’. Sleep is for the weak, those lyrics tell us. It's for children, for pikers. By the way, that's a word I had to learn when I moved to Australia. I have a girlfriend who called me a piker when I left her birthday party at ten o'clock to go home to bed. She stayed up until dawn. Sleep is for pikers.

Jon Bon Jovi wasn't simply being poetic. Lots of people see sleep as a weakness, as a waste of time. I want to take a straw poll. Who here wishes they didn't have to spend so much of their time asleep? Put your hands up. Yeah, you're not alone. Margaret Thatcher, some of you will have heard of her,

infamous British politician, perhaps I should've said famous British politician of the 1980s, she was known as the Iron Lady. And that's not least for claiming that she only needed four hours of sleep a night.

Many a leader in politics or industry, most recently Elon Musk, if any of you have you been following his implosion on social media, have claimed that they only need three or four or five hours of sleep a night. In fact, the fewer hours of sleep you need, so the message kind of goes, the harder you are. I think his spectacular implosion might just give the lie to that.

So, look whilst there are some rare and exceptional people who can function on so little sleep and they may even have a genetic advantage, all the evidence I've seen suggests that function is the word for it, not thrive, not be inspired, not be truly creative or pleasant to be around, just function, and only for a short period. Shorten your sleep for too long, over too many nights, and you'll pay for it, either now or in the future or both. And there is a reason after all why sleep deprivation is a form of torture.

So, when I titled this talk, I'll Sleep When I'm Dead, I wasn't simply channeling Jon Bon Jovi, whether I liked the idea of that. I was also making a serious point. Failure to get enough sleep makes you sick, but it may even make you dead. So, if you don't sleep, you will be dead. Here's the kind of short version of this talk. You can all go home now. But don't just yet because I might lose my job.

OK, so I'm going to talk about the ways that poor sleep is bad for us. I'm also going to talk about some of the reasons why we don't get enough sleep. But before I do that, though, I want to consider what sleep is and kind of why we do it. A little bit of theory, OK? But first I want to ask you a question. Raise your hand if you've celebrated a 10-year relationship anniversary. Anyone? Any advance on 10 years? 15? 20? Oh, OK. So, let's do a number that works easily for my math, 12? Yes. Lovely. Well done. Let me do that. OK, you didn't. You only celebrated a nine-year. No, sorry, I kind of add up an eight-year relationship anniversary.

You know I can't add it up. Sorry I'm tired. Believe it or not I am. I didn't sleep the other night. 12 divided by, yeah, here we go. That's embarrassing. I can't add up. Alright, let's try nine years. I could do that one. You didn't celebrate a nine-year anniversary. This is being recorded for posterity. How embarrassing. You actually only celebrated a six-year anniversary. Why? Because you spent three years of that asleep, right? That was my joke. It didn't work. Just bear with me.

(LAUGHTER)

The point I'm trying to make is we do spend a third of our lives asleep, OK? And if we do that, if we spend one in every three hours in sleep, it must be for a really, really, really, really, really important reason, OK? Because if not, it's the biggest mistake evolution ever made. So, what is sleep? Well, first of all, it's a behaviour or rather a lack of behaviour. Every species has a different species specific sleep posture. Most human beings, unless they're very drunk, do it lying down, sleep I mean, with their eyes closed and we don't move around much. It's quiet. It's a quiet activity. And we're generally quite unresponsive to stimuli around us unless it's a really loud noise, like a banging door or a barking dog, in which case you'll wake up to go, "What on earth is going on?" Let the dog out for a pee.

So, your body is quiet. You're unresponsive to the world around you. So, you might think your mind is quiet too, but it's not. It might surprise you to know that your mind is really active during sleep. And what we're actually doing when we're asleep is cycling through two distinct stages during which our brain cells are really busy firing off in rhythmic patterns. The first is what we call rapid eye movement sleep or REM sleep. Anybody know what that is? Another word for it? Yes. Dream sleep. Yes. Thank you. So, and that's because our eyes are moving behind our lids. So, rapid eye movement sleep.

The second, eloquently, is called non-rapid eye movement sleep or non-REM. And in this one we start out in a shallow phase of light, what we call light sleep, progressively cycling into deeper and deeper stages of sleep from stage 1 down to stage 3. And then after that we come back up into that dream sleep or REM sleep. And the lowest stage of sleep is called slow wave sleep. It's so called because the brains waves are deep and slow.

If you're having trouble imagining that, think of a whale in the ocean. So, the surface of the ocean above the waves is wake. Just below the waves is light or shallow sleep, stage 1. Go down a little bit deeper, stage 2. And then down into the bottom, calm, darker, deeper waters, that's the deepest stage of sleep. Now you might think that we just drop into that deep, dark, calm stage of sleep and then stay there for the rest of the night. But we don't. What we actually do is something far more interesting. We go down from stage 1, stage 2 into that deep slow-wave sleep then we come up into a short period of dream sleep, which you may or may not remember, and then we go down again. 1, 2, 3, stage 3, up into dream and down again. And each one of those cycles lasts for about 90 minutes. In the early part of the night, the deep stage of sleep, that's when we have the longest amount of that. And as the night goes on, so our dream sleep stage gets longer and longer. So it's a weird thing to do, isn't it? The cycling. Imagine this whale going up and down. So why are we doing that? Well, the simplest answer is because we're driven to do so. And by that, I mean that there are two drives operating in tandem inside us that lead us to sleep. The first is a biological clock. That's right. You have a clock inside you. I'm going to call that process C for clock. And there's a structure inside the brain called the suprachiasmatic nucleus. I'll be testing you on that later. It always makes me think of supercalifragilisticexpialidocious, but it's actually far more magical.

And what this suprachiasmatic nucleus does is it releases a hormone called melatonin. And that structure tells our body, through those hormones that signal our body, when to sleep and when to eat and when to drink and when to grow. It even tells us when to pee, believe it or not. Now, it's really clever. This internal clock operates on an approximately 24-hour cycle. And when I say approximately, on average, it's 24 hours and 15 minutes, which is no good when you live on a planet with a 24-hour cycle. So the really clever thing is this internal clock that's just chanting away through its cycle, it's doing that regardless of anything else you do. But to make it fit the exact 24-hour day/night cycle we have on planet Earth plus a few seconds, if the physicists are going to disagree with me, we have what's called Zeitgebers, which is a fancy German word for time givers. And what they do is they tell this SCN, this little structure in the brain, to run to 24 hours. And they are things like the light and dark, the daylight and darkness, the Sun and the dark. They're also things like the temperature, the ambient temperature of your room, your bedroom and so on, and things like when we eat and drink and so on. Things like that.

And that internal clock, it drives a daily rhythm in our bodies. Our circadian rhythm and some of you will have heard of that term. So it drives us to sleep at about the same time of day every day and to wake at about the same time of day every day. So that's the first process or drive. But it's a little bit more complicated than that because we have a second one which I'm going to call process S for sleepiness. This is really very simple, this idea. The longer you stay awake, the more tired you feel. Yeah? Everybody knows that. And the way it works is that for every hour that we stay awake, so there is another hormone that builds up in our body called adenosine. The more adenosine you have, the more sleep pressure you have and the sleepier you'll feel. And when the clock process C and that sleepiness process S combine together and say, "Folks, it's time to sleep," normally that's when you'll sleep. That's when you're going to sleep. But that's a very kind of biological mechanistic account of why we sleep. It's actually only the start of why we do it. Because I still haven't explained why we waste a third of our lives doing this thing that we're driven to do by these mechanisms.

And the more complex answer and the more exciting and interesting answer is that it's because all sorts of really, really important things happen when we sleep. In a way, it will be better and simpler if I just listed the things that sleep doesn't have anything to do with rather than the things it does. The list of benefits to us, to our health and well-being of sleep, is very, very long. So I'm just going to touch on a few. Some of the highlights is that we sleep...that's when we learn when we're asleep. It's when we sort through the events of the day discarding or forgetting what's irrelevant, what we don't want to remember, and consolidating or laying down into long-term memory stores the things we do want to remember, so that we can store them and recall them later. It's also when we sort through the emotions of our day and process them and deal with them, which is why people with PTSD can often have problems because they have disturbed dream sleep which is when that's happening. And it's when we grow. Literally, physically grow.

So you can imagine that's why newborn babies spend about two-thirds of their time asleep. Because, really, all they've got to do is learn and grow. It's also when we heal. And we've learned, for example, that noisy and light-filled hospitals, if you've been to a hospital at night, it's not a calm place. That can contribute to things like slowed wound healing and increased risk of infection and need for antibiotics and longer times in hospital. So people are beginning to actually study the impact of sleep in health care. It's fascinating. And just as important, it's when we clean out our brains. It's kind of when we do the mental housekeeping. So recent research is telling us that we're cleaning out the toxic byproducts of a busy, mentally-active brain when our neurons or brain cells are firing. And we do that only when we sleep. And so if we don't sleep properly, our sleep is disturbed, that has the effect of those toxins building up. And that produces risk, an increased risk, of Alzheimer's disease.

Back to Margaret Thatcher, some of you will also know that the iron Lady who only needed four hours of sleep a night, got Alzheimer's disease. Not a coincidence I don't think. So the other thing about sleep is its universal. We all do it. In fact, it's so important that the Guinness Book of Records, that used to have competitions to see who could stay awake the longest, not only banned those competitions but removed all reference to those records from any issues of the Guinness Book of Records because it's so dangerous. It's important for learning and growth as I've said. It's important for well-being. I'm going to talk some more about that in a moment. And yet, we don't get enough. Put your hands up if you think you don't get enough sleep. A lot of people. Thank you for sharing. So

why don't we get enough sleep? There are lots and lots of reasons. But because you all have beds to go to, I'm going to keep it short. I'm going to talk about three. I just want to share three with you.

Reason number 1, society, that's us, requires us to sleep and wake at the same time, everybody, which doesn't suit everybody. Let me explain. As a young woman, I was a night owl. So owls prefer late starts and late nights. They're often not...they're most productive in the evening. I didn't really hit my stride until the afternoon. And I could often work late into the evening and read until 2:00 in the morning and, you know, engrossed in what I was doing and not feeling the need to sleep. But the problem was I also wasn't really awake until 10 o'clock in the morning. And if you woke me up before about 8:00, I was like a bear with a sore head. And I suspect that description fits some of you too. Is there anyone who would describe themselves as a night owl? Yes, just a few. Thank you. Now, look since getting older and since learning about the importance of sleep, soI kind of have to practice what I preach.

I've learned to treasure, absolutely treasure, the precious hours of the night when I can recharge my batteries. OK. And I've also shifted my natural sleep phase to earlier in the day. Getting up earlier in the day and going to bed earlier. And some of that shift is likely to do with natural ageing and it's a normal shift that occurs with age. And some of it is just a requirement of my job. You get up early in Perth. Everybody gets up much later in the UK. Maybe because it's darker, I've had to learn to get up earlier and you eat early. Anyway, I'm going to come back to the point about the shift, the requirements of job in a moment. But by contrast with owls, some people are larks. Larks naturally rise early. You know, the bright-eyed and bushy-tailed and impossible early in the morning and they're going to rise to greet the dawn, and I don't want to greet the dawn. They're full steam ahead, you know, in the morning and then they wind down early in the afternoon. Anybody a lark? A few. And then there's obviously a few people who are somewhere in the middle. It's all right.

So how could that lead to us getting insufficient sleep? I'm going to ask you another question. I want you to put your hands up if you think that getting to work early or especially before your boss would mean that you'll be seen favourably at work? Is getting to work early a good thing? Put your hands up. Just a few? OK. If you struggle with the early start times at work and you feel that that's a difficulty for you, put your hands up. More of you. Yeah. OK, thank you. So did you know that larks, morning types, are more likely to get promoted? And they're seen as more engaged and committed to their businesses or organization than are owls? Why is that? We associate being an early type, with being a good corporate citizen. If you're the first at work, you must be really keen. Right? And we associate being a later type, someone who doesn't really get fired up until about 11 o'clock in the morning, with beinglazy. But these differences are biological. They're not our choice. They are a feature of who we are just as our hair colour and eye colour are features of who we are unless, like me, you change it.

So if you require everyone to work on the same schedule, if you require breakfast meetings, 7 o'clock in the morning breakfast meetings, or you want people to come to business dinners after work, then what you might be doing is choosing a schedule that disadvantages many of your staff. You're forcing them to work at a time that is suboptimal for them for their emotional and psychological kind of well-being. And you will produce the schedule that will lead to insufficient sleep in your staff. If you're not yet persuaded that it's really important for employees of businesses to get enough sleep, I just want to share a little bit of research with you. So a recent US study found

that insufficient sleep cost four large U.S. companies between two and a half...So two and three and a half thousand U.S. dollars per employee per year in profits. And that amounted to a net capital loss of $54 million. Just from lost sleep. So the problem is that underslept people, employees, colleagues, friends, are not only less productive, they're less accurate, less motivated, less creative, take longer to solve even simple problems, and they're more likely, believe it or not, to make unethical decisions.

Now, since diversity is a key issue in business, I think we should be thinking about sleep diversity as well as racial and gender and sexual identity diversity. But, you know... And that's because of the negative effects that I've just hinted at. I'm going to come back to them a little bit more in a moment. OK, So reason number 2, bad habits. Look, you kind of know this, I suspect, because people like Arianna, Huffington have been going on about it on Twitter and Facebook, whatever, for a long time. But one of the other reasons we don't get enough sleep is because of our daily and nightly habits. These include exercising or eating late at night, drinking late at night. I almost hesitate to say that. I'm standing in a bar after all. Using our computers or smartphones particularly after 5:00 p.m. because they emit blue light. Blue light is the light that comes from the Sun that tells that suprachiasmatic nucleus when to release the melatonin. It's like a hotline to God. It's coming out of your iPhone.

Lying in bed at night ruminating. Who does that? You think about, "Oh my god, I'm going to give a talk in a bar tomorrow when I haven't finished it. Oh my god, I didn't sleep Sunday night at all." Drugs. I've mentioned alcohol, caffeine, nicotine, diet pills. I could go on, but I can see a few depressed faces. But I will mention caffeine because that's a doozy, absolute doozy. OK? What caffeine does is it blocks the receptors in your brain that detect adenosine. So, remember, that's the hormone that builds up the longer you're awake and it's the one that makes you feel sleepy. It doesn't cancel it out, it just blocks you from detecting it. So the hormone’s still building up in the background but you can't hear it. Right? And so the caffeine might be doing a good job of making you feel like you're not sleepy but the hormone is still there, still building up. And when the caffeine wears off, smack. Boy, you get overwhelmed with a wave of tiredness. You’ve had that experience?

If you're now driving home and you're hit with that wave of tiredness because the caffeine is wearing off, your likelihood of an accident is much, much increased. OK. Now, the third one, I want to spend a little bit more time on because this is my passion and I'm sorry you're here and you're captive so tough, is sleep disorders. Now, there are dozens and dozens and dozens of different diagnosable sleep disorders. And we just...I promise you we're not going to consider them all. But the two commonest, you know what the two commonest sleep disorders are? Anybody know?

STUDENT:

(INAUDIBLE)


Say that again.

STUDENT:

Insomnia.


Insomnia. Insomnia, yes. Does anyone know what the other one is?

STUDENT:

Sleep apnoea.


Sleep apnoea, thank you very much. You can come and do the talk now. So I won't ask for a show of hands on this one. But you might be surprised to know that one in nine individuals suffers from clinically significant insomnia at some stage in their life. So if there were 90 people in this bar, that's ten of them. It is pretty common. There are also a host of other health conditions that cause poor sleep including cancer, chronic pain, brain injury and stroke, and most mental health conditions such as anxiety and depression. In fact, it's really hard to think of a single mental health condition that is not also associated with poor sleep and made worse by poor sleep. So it's a nasty spiral. But today, what I want to do is focus on the sleep apnoea because it's also a really common disorder at least when I study. The problem is it's often untreated and it's associated with a whole host of problems. But whilst I'm going to focus on sleep apnoea, the problems that are caused by the poor sleep associated with sleep apnoea are very similar to those caused by all other sleep disorders including just not getting enough sleep because of those really bad habits, because of the choices we make about our life or that we're forced to make about our lives by our work or the demands on our time.

So apnoea comes from the Greek meaning without breath, which is a perfect description of what it is. Because what happens is the upper airway, so the soft tissue in your airway here, it softens when the muscles relax and it collapses. And it's a bit like if you stand on a hosepipe, OK? You can't draw air or water in this case through a collapsed pipe.

N mjjSo, your lungs are moving up and down because the diaphragm is pulling down like a pair of bellows pulling in air, but it's not getting through here because you've got an obstruction. And eventually what happens is you're trying to breathe out to blow out carbon dioxide, so your carbon dioxide levels are going up, which is really bad, makes your blood acid and stuff like that. So, you're trying to breathe in air to replace the oxygen, which is really bad because oxygen is the brain's fuel, it's the body's fuel, and you can't. So, eventually your brain goes, you know what? I think it's time you woke up and took a breath. So, what you do is go (snorting sound). They're awake, don't they? And then you breathe. There are a few strange faces looking at me. What's she doing?

So, it's not just snoring that it produces, it's epic snoring. And if you stop breathing and then you wake, you have to wake up to breathe properly, what you have to do is you might be in that deep, lovely, calm dark sea down the bottom there, and you're forced to come up to a lighter stage of sleep to breathe, or even to wake up to surface completely to breathe. So, instead of going through that nice 90-minute dip and then up to dream and down to slow wave and up to dream, it keeps getting interrupted. It keeps getting interrupted hundreds and hundreds of times a night.

And what that means is it disturbs the quality of your sleep. You don't get that lovely deep sleep. You don't get that dream sleep that we need and both of those are really important for health and wellbeing. Also you're not getting enough oxygen, which is kind of quite bad for your brain. So, these

arousals don't just disturb you, they disturb your bed partner too, leading to what apparently is called a ‘sleep divorce’, which is basically a fancy word for saying you've been banished to the couch or the spare bed because you're making too much noise.

Now apnoea is a huge problem. It's a problem that rises markedly with age. So, if you're in a sort of 30 to 49 age bracket, one in ten men and three in 100 women will have it. But when you're in your 50s and above, those numbers are nearer to two in ten men and one in ten women. So, it's really, really common. And the prevalence is rising because it's associated with obesity and the kind of diet and lifestyle we have. So again, if we think about if there are 90 people in this bar, another ten or 20 will probably have sleep apnoea. Some of them will be the same people because they often co-occur so if you get one you often get the other.

But the thing that I find absolutely terrifying is that sleep apnoea is often undiagnosed. So, for every 15 or so people who we know have sleep apnoea, there's estimates there’sanother 85 we don't know about. Which I think is to me that's a scary number. So, how bad is this apnoea for us? So, I've talked about the fact that you're not getting enough air, you're not getting enough oxygen because the passage to the lungs is blocked. And that can happen hundreds and hundreds of times a night. So, two things are happening. One, you're waking up so you've got disturbed sleep, and that's really bad for you. Two, you're not getting enough oxygen fuel for your brain. And it's not just your brain. Your heart needs oxygen, your liver needs oxygen, all your organs need oxygen. The car can't go without fuel. We can't run without oxygen.

So, what happens is that this condition produces all sorts of side effects. A whole host of negative consequences for physical health, social and emotional wellbeing and thinking and memory skills. Now physical, the list of physical conditions that are produced, physical problems produced or associated with sleep apnoea is like a who's who of conditions, kind of you name it, it's there. Inflammation, it's because your heart has to work really hard to pump the remaining oxygen that you've got in your body around. You also get higher blood pressure, hypertension. In fact, just one night of disturbed sleep, you can put your blood pressure up in ways that we can measure.

Increases your risk of heart disease, heart heartbeat problems, arrhythmias or heart rate problems, stroke. Of course it's terrible, I'm depressing you all. Diabetes, insulin resistance, obesity and overweight. It makes you fat. Increased risk of cancer, reduces your immune function, reduces your fertility. And the final curtain, it increases the risk of death, which is hence the title.

But it isn't just physical health that's impacted. It's also social and emotional wellbeing. As I said, it affects your partner's sleep too or other family members, but it also makes us more emotionally unstable. Like everybody who doesn't sleep is like a tall two-year-old. We get irritable and grumpy and we're sloppy about things. We can be more aggressive when we don't sleep.

The really worrying thing is we know that if we show someone who's not slept well and we're not talking about complete sleep deprivation, but just a bit of sleep deprivation. Sleep restriction as we call it. We show them faces of emotions and the faces are quite neutral. When we haven't slept, we're more likely to interpret those faces as angry or negative. So, now imagine you're a police officer or you're in Iraq and you haven't slept properly and you're walking down the street and you meet someone, someone who's doing something perfectly innocent and has a quite neutral face,

you're more likely to interpret their facial expression as aggressive or negative. You can just work through the consequences of what that might be.

It also increases our risk, sleep problems, of anxiety and depression and as I kind of hinted at, it can lead to relationship strain. I've already talked a bit about work productivity being reduced, but the other one that really worries me about not getting enough sleep, whether it's for sleep apnoea or any other reason, is that it reduces public safety. We're more likely to have an accident at work, we're more likely to have a car crash. Did you know that if you woke up at six o'clock this morning and you don't go to bed till one o'clock tomorrow morning, which means you are awake for just 19 hours, that will produce an effect on your attention and your reaction time behind the wheel equivalent to being legally drunk to a 0.08 blood alcohol reading? That's without adding alcohol. Just staying awake for 19 hours will have that effect.

It's illegal to drive drunk. It's not illegal to drive tired. Just compute that for a moment. It has the same effect on us of being legally drunk. In fact, Matthew Walker, who wrote this book, and if anybody's interested and wants an accessible book about sleep and why we sleep, I recommend Matthew Walker's book, he actually makes the point that he thinks that drowsy driving is more dangerous than drunk driving.

It's a pretty extreme kind of statement, but think about this. When you've had alcohol, your reaction time is slowed down. It will take you longer to notice what's going on around you and it will take you longer to take evasive action, but you will take it. When you're drowsy, what can happen is you can have micro-sleeps behind the wheel. You could nod off for five to ten seconds and not know it. So, you won't take evasive action, you won't do anything because you're not awake. And then you'll wake up and you won't realize that you weren't awake. So, that's why he argues that drowsy driving is worse than drunk driving. I think that's a kind of reactionary statement, but I guess it makes the point.

So, look, if that wasn't bad enough, the physical problems, the social emotional problems, I know I'm full of doom and gloom Auntie Kate, sorry. Lack of sleep is also a problem for our mental skills, for our memory and thinking skills. My research group, some of my students are here actually. So, we collectively, they do the work, I take the credit. Not really.

We've been contributing to what is a very strong international evidence base around the problems of poor sleep for our thinking and memory skills. Not just sleep apnoea but all aspects of poor sleep. So what is the effect? Well, I think I've already alluded to the fact that it affects concentration. So it makes it particularly difficult for us to pay attention for a period of time, say, scanning the environment for a threat like we do when we're driving a truck or a car or if we're an air traffic controller, for example. It also makes it harder for us to learn new information. That could be visual information, that could be verbal information. And it makes it harder for us to learn it and then retrieve that information for use later. So if you're a student and you're studying, sleep is really really important to learning and to being able to remember that information for an exam later. You'll thank me for that one. So, look, we're more likely to forget to pass on a message or to recallsome important information we've learned at school or at work.

One of the more worrying, I think, even than that problems, is the effect that it has on what we call executive skills. So these are our high-level thinking skills like planning and problem-solving and

mental flexibility. And these are all negatively affected by not having enough sleep including sleep apnoea. So we find it difficult to shift from one idea to another flexibly. We find it difficult when we can't sleep to inhibit irrelevant information, paying attention to the things that are important and ignoring the rest. That filtering is affected by poor sleep. We find it harder to think and reason and solve problems and be flexible and creative. And we also just think more slowly when we're tired and sleep-deprived. So, look, that's all really bad news. There is good news in here. The good news is we can do something about it. In fact, we can all do something about our poor sleep. We can do something about sleep apnoea. There are a number of treatments, but the most common and most of all studied and effective one is continuous positive airway pressure.

So what you do is you wear a mask either over your nose or nose and mouth, kind of like this, and it's attached to a tube. You look a bit like Darth Vader. And there's a pump, and the machine pumps air into your airway to keep the airway open. That's very effective. And happily, if you use one of those devices and now your sleep apnoea is treated, it helps to improve the memory and thinking skills and the health problems that I've outlined. But there are also things that we can do to improve our sleep even if we don't have apnoea. If we just have poor sleep for other reasons to do with bad habits or worrying or whatever. Some of the things we can do is, remember I said that that Process C, the circadian rhythm, the internal clock is driven by the sun. If you're someone who has difficulty waking up in the morning and you need to, get out and get some early morning sun. Lots of that lovely bright light. Don't wear sunglasses. Make sure you don't get burned, but you want to get that light into your eyes. So polarizing sunglasses are not going to help. And that will help drive you to sleep at the right time of day.

Avoid exercising late at night. I'm not going to say avoid exercising completely although clearly, I have. Avoid alcohol. Oh my god, I feel terrible. I'm standing in a bar saying, ironically, don't drink. I'll be frank though, alcohol affects sleep. It affects the quality and the quantity of sleep. So if you do have a drink, which I perfectly understand, mine is red wine and the odd gin and tonic, if anyone's buying, I would recommend that you don't do it every night and try and do it in moderation because it will affect your sleep. Avoid caffeine particularly in the evenings. And if you're someone who finds it difficult to go to sleep, take a hot bath or a shower in the evening. There's a reason why your mum, your mom and dad, made you have a bath when you were little and then put you in pajamas and then put the lights on dim in your bedroom and read you a bedtime story. And it wasn't just because that's what you do. It's because when you get into the bath, it's warm. So all the blood vessels in your body, they expand, they dilate to help keep your temperature down. Because if your organs, your heart and lungs and some, get too hot, it's really bad for you. Then when you get out of the bath, they're still dilated. So you cool down. It cools down your core.

And when you cool down your core, that helps you feel sleepy. So it's a little trick. I also recommend the dim lights and somebody reading you a bedtime story. But I do not recommend reading a bedtime story on an iPad. Remember the blue light, very bad. Telling you to wake up, hot bath telling you to go to sleep, body very confused. So don't use electronic devices after 5 o'clock if you're someone who has any difficulty going to sleep. Please. And it's going to be really hard since now everybody is stuck to their devices, myself included. And then the other one is temperature. You should be sleeping in the nude folks. Right? Very nice nightwear, very nice pajamas. Take them off afterwards. Go to bed naked afterwards. Go to bed naked? Why? Because you need to have a cool bedroom to sleep. What temperature do people run their aircon or heating at? 20, 21, 22? Your

bedroom should be about 18 degrees. It should be really quite cold. Why? Because that cool temperature also helps tell your body that it's time to go to sleep. If you have a hot room, which I know is kind of difficult in the summer in Australia, that makes it worse. Put your hands and feet out of the bed as well. And, yes, as I said, you should sleep naked. I thought you didn't think you'd hear that in a bar.

So, look, I'm going to stop now because I'm hoping that you'll ask me some questions. But let me just wind up. You can probably tell I'm a real fan of sleep. But I'm mindful of the fact that we all have to go to bed tonight, so I want to finish with some wise words from a great British playwright, William Shakespeare. Anybody who knows Shakespeare, there's a play. I can't call it by name because it's bad luck. Otherwise, known as the Scottish play. I'll tell you later but I'm not allowed to say it aloud because it's bad luck apparently. And this character begins with M ends in H. He said, "Sleep that knits up the ravell'd sleeve of care, the death of each day's life, sore labour's bath, balm of hurt minds, great nature's second course, chief nourisher in life's feast." Shakespeare was writing words to put into the mouths of a Scottish King, but he was also telling us about the importance of sleep. He was saying what I've just said to you and he was right. Sleep that knits up the ravelled sleeve of care, sleep that soothes away all of our worries. The death of each day's life, the activity that ends each day. Just he's more poetic than me. Sore labour's bath, balm of hurt minds, that rests the weary worker and heals our mental hurts. Chief nourisher in life's feast. It's the most nourishing thing we can do in life.

So Shakespeare's prescription and mine, and if I were a doctor I would be writing you this prescription, is very simple for a healthy life. Take sleep once a day for eight hours. Thank you.

KATE WRIGHT:

That was fantastic. Thank you, Romola. I'm sure there are lots of questions but I'm going to get in quick and ask one anyway. Can you have too much sleep?


Can you have too much sleep? Yes, you can. There are guidelines about how much sleep we should have depending on our age. So as a very young child, we need a lot of sleep. Even as a teenager, we probably need ten or 11 hours of sleep. Most of you should be getting somewhere between seven and nine hours sleep a night, and probably aren't.

If you're getting more than that, that can sometimes be a signal that there's something wrong, either an illness or a medical problem, a mental problem like depression. Whether or not oversleeping causes those things or is a symptom of those things is less clear. But yes, we can oversleep. And unfortunately, whilst you can catch up a little bit if you haven't slept enough during the week, sleeping in for hours and hours and hours during the weekend is just going to give you what we call a sleep hangover, but it doesn't actually fix the problem. It's very depressing. Do we have another microphone?

KATE WRIGHT:

We have one over here.


OK, any other questions? Please don't let me stand here.

STUDENT:

Thank you.


OK, thank you.

STUDENT:

Fantastic talk by the way.


Thank you.

STUDENT:

Can you catch up on sleep? Does sleep debt exist or is that a bit of a myth?


Sort of yes and yes and yes.

(LAUGHTER)


So, you can catch up a bit, alright? So, if you've had a poor night, the next night you will have a very much stronger sleep drive. Remember that adenosine is kind of stacking up and it will drive you to feel more sleepy and to sleep for longer. But if you've spent a long time, if you're chronically sleep deprived, no, you can't catch up.

So, you can have a sleep debt in the sense that you can be down on what you should be getting in terms of sleep, but (a) you can't pay it all back, and (b) unfortunately you can't go into credit at the sleep bank either, OK? So, it's not like you can say, OK, this week I'm going to be mostly sleeping 12 hours because next week I'm on the raz every night. It doesn't work that way, OK? I'm really, really sorry to say that. Good question though. Thank you. Anyone else? Down here?

STUDENT:

Alright, great talk. Thanks Romola. I'm just wondering the Spanish siesta, are they onto something. Does it matter if we take it across multiple instances? Is it only the total that adds up?


It's a great question. So, the answer is, yes, they are onto something. Which is why it's really, really sad that it's disappearing. So, you don't have to get sleep in one big chunk. You just have to get

enough of it in enough 90-minute cycles to be able to get down into that lovely deep sleep and then up into the dream sleep, OK? So, if it's too broken up or too chopped you weren't good enough. So, if you nap, that's great. That adds, that will be added to the total.

But in Spanish cultures, historically it's changed. They used to go to sleep very late. They'd eat at 9:00 and not sleep till 11:00. I remember walking around the plazas in Spain and they were little toddlers at midnight running around. I was like, why aren't you like this screaming wreck? It's because they slept in the afternoon. Sadly, in Spain and in South America, the nap is disappearing, but they’re not going to bed earlier because culturally they're still doing all that staying up late. Sleep deprivation is becoming a big issue.

But what I would say is this myth that if you don't sleep for solid eight hours without a single break, there's a problem, it's just that it's a myth. It's normal to wake up once or twice in the middle of the night. You know, you might hear something, you might need a drink because you're thirsty because your air con it's too hot. You might need a pee. That's normal. What isn't normal is to lie there worrying about it for hours and so it stops you getting the amount of sleep you need. So, you can take it in chunks. The important thing is it good enough. It's a really good question. Next question? Some people over here at the back.

STUDENT:

Thanks. You mentioned that exercising late is not good. But from what I heard, it's good to exercise in the afternoon, at night. So, do you have a time?


Yeah, look…

(LAUGHTER)

I did very carefully say I'm not saying don't exercise. It's really interesting. If this is one of those challenges, right? Everybody says you must exercise. Exercise, diet these are the pillars of health, but so is sleep. When do we exercise in a busy world? We get up at sort of half past sparrow fart in the morning. Excuse my French. And then, that was English but don't mind, and then and then we go and exercise, right? And that's a problem because we're not really awake, right? We're exercising when our body wants to be asleep, big stressor. Or we then do a full day's work and then we go to the gym at nine o'clock at night and we exercise then.

And so what does that do? That lifts your heart rate, OK? Lifts your core body temperature so you heat up. It basically is saying to your body, it's time to be awake now, right? Because my muscles are pumped. And then you go home and you might eat late and then you're lying there going, why can't I sleep? Well, because everything you've been doing, you're saying to your body, it's not sleep time. It's wake time.

Ideally, you would exercise in the middle of the day or in the early afternoon. But who can do that? So, I do get it. I really do. But I just think that some, I mean some people, they'll be fine. They can, they're fine, they can exercise early in the morning and they're fine. Others they can exercise at night. It doesn't affect their sleep. And if you're one of those people, great. But if you're someone for

whom that exercise regime, when that timing is a problem, which means you're not sleeping, that is something that you need to address.

It's very individual. Some of us are locked somewhere else, some wake up easily, some can stay awake easily. We're very different and there are genetic differences behind that. So, I don't want to give you a prescription because it's not the same for everyone. But I bet you know when you're exercising too late or too early. Yeah, thank you.

STUDENT:

Thanks for the nice talk (LAUGHS). Why some people experience sleep paralysis can be quite scary. And can we prevent them?


What was the first word?

STUDENT:

Sleep paralysis.


Why do some people?

STUDENT:

Why do some people have it?


It's a really interesting phenomenon. So, sleep paralysis is, I haven't really talked about this, but when you dream, okay, in that dream state your eyeballs, your eyes are moving, but actually we often dream that we're running or flying, that's a good one, or fighting or whatever. Now because when we're dreaming, we're actually activating the motor cortex in our brain. If nature wasn't clever, we'd actually be acting those out in our sleep. And some people do that and so they dream having a fight and they punch their bed partner or something awful or they get up and they jump out a window or they do acrobatics or they think they can fly. And that's a very serious sleep condition.

So, nature is very clever. Nature says, I'm going to turn off the muscle movement. I'm going to paralyze you whilst you're dreaming so that you can't damage yourself. Occasionally the timing of that paralysis turning off is late. It happens just after you wake up. So, you come awake, you come to consciousness and you can't move. Absolutely terrifying. Don't panic. Just wait and eventually the paralysis will wear off quite quickly actually, and then you'll be able to move. But that moment of I'm trapped inside my body and I'm fully awake and I can't move, I can't imagine what that might be like.

But that kind of sleep paralysis is quite common and what I would say is it will wear off quite quickly. I don't know of any treatment for it. I mean I'm not a sleep physician. But if it's a problem for you or a friend and it's really causing a lot of distress, ask your GP for a referral to a sleep physician who can actually do a proper overnight sleep study and will be able to diagnose and discuss treatments. I

don't do drugs. I'm a psychologist. Well, except for wine and gin and tonic as we said. OK, next question. Yes.

STUDENT:

Thank you so much. That was excellent, very entertaining. My question goes back to the fact you were talking about driving and how driving and sleep deprived can be much more dangerous than driving drunk. So, I'm wondering, is there any way we could pin down those drivers, we can stop them, we could somehow measure, oh, actually you're really sleep deprived, can you get off the road? Can you please just leave the roads because you are actually more dangerous than someone who is drinking and driving or drunk driving?


Yeah, I mean I don't want to give the impression I think drunk driving is not a problem, OK? I was being it was hyperbole, OK? I was trying to get a reaction out of you and I think it worked. But yes. So, car manufacturers are beginning to design systems in cars that actually can look at your eyes because you know when you start to fall asleep you start to blink. Your eyelids dip and then they come up. You know that when you see people doing that?

STUDENT:

Yeah.


And the cars, the smart cars, can actually detect that. The RAC designed a car a few years ago, the engine turned off. If it detected this, it just wouldn't go. So, I think that technology is actually going to be able to protect us from our own idiocy by basically saying you're too tired to drive and you won't turn over. And that's a really interesting and cool idea. So I can see that coming. I think we better take it away from that table. Give it to the lady in the front here, she's not with them. Oh, well never mind. I'm teasing. I was [INAUDBLE] with the question. You go ahead. I'm sorry.

STUDENT:

So you might've mentioned it, but I might've taken a micro nap. Well, what's happening? So what are the main reasons for sleep apnoea?


OK, I don't know that I really did. So, one of the common risk factors for sleep apnoea is overweight because if you've got a lot of fat around the neck, it puts pressure on the neck. It also does something really interesting is it kind of pads out our cheeks from the inside. So it narrows the airway, which makes it more likely to obstruct. But not everybody with sleep apnoea is overweight, there are skinny apneics too. And that seems to be more of a genetic risk. But it's more common in people who are seriously overweight. So one of the treatments which can be effective is to lose weight, take the weight off the neck, and that helps. There was a research study, by the way, I love this, that actually tried to strengthen people's throat muscles by teaching them to play the didgeridoo. If you're an oboe player or a wind instrument player, you will know how strong your

neck muscles get. And apparently oboe players have a reduced risk of sleep apnoea. That’s fascinating. Let's go play the oboe, yeah, I've had the idea of learning to play the didgeridoo actually.

STUDENT:

So, the hormone that accumulates over time and makes someone sleep. Could it be people like Elon Musk produce less of this hormone? Can you measure that hormone? And for people that are chronically sleep deprived, do they have a surplus of that hormone in their system? And also side note, my other question was that why don't some people remember their dreams (LAUGHS). Because I don't, And I'm just wondering why. Because everybody does dream. I just don't remember them.


OK, let's talk about. So yes, this is a lot. So I'll try and do my best. You might have to remind me because I haven't slept very well, and remember memory is not very good when you don't sleep very well. So the adenosine, it builds up. The longer you stay awake, the more it builds up. So if we believe Elon Musk, by the way, I think he's a numpty right? It's a technical term that, then he's just got an overdose of that constantly. When you sleep, you degrade it, you break it down, but it's only when you sleep, you’re not.. You're not making more. So you've got to sleep to get rid of it. Alright, when was the car... The tanks just filling up and up and up. So no, I don't think he's less sensitive to adenosine. I think it's bravura. I mean if you've seen some of the things he's tweeted, and then had to retract. You've seen the rants and the behaviour, you've seen that he's behaving like a two year old with a temper tantrum.

That is exactly what I would predict from someone who's only sleeping three or four hours a night. It's curable. Idiocy isn't, sleep deprivation is.

STUDENT:

Is there a way to measure that hormone at each point in time?


You can measure it. Again, it will be measured in the sleep lab, but typically you wouldn't do that except for experimental purposes, yes. And you asked me about dreams, I wish you hadn't asked me about dreams. Look, I don't know why some people remember their dreams and others don't. There are people who claim that if you... If you practice trying to kind of rehearse what you were just dreaming, the moment you wake up, you will remember it, it's just huge individual differences. The important point is not that we remember what we dream about because it doesn't really make sense. The important point is that we do dream because dreaming is when we are...

Well, if I start off, when we're in non-dream sleep, what we're doing is we're sorting through the events of the day and we're kind of sorting out what we want to keep and what we don't. We may be replaying an emotional experience and argument or your boss telling you off at work or something in our heads. And when we dream, that's when we do two important things. One, we lay down for longer storage for later recall the things that we've decided are important, but also we subtract the emotion from the memory. We sort of annihilate of it. We take the emotional heat out

of the memory. And so that in that REM sleep is really important for emotional well being. It's how, it's one of the ways in which we process, we work through difficult emotional experiences. Or even very, very, very happy emotional experiences and sort of tone them down a bit so that we can manage them in perpetuity. So dream sleep's really important, it doesn't matter whether you remember it or not. You don't need to remember it, you just need to do it, yeah?

STUDENT:

I have a question about our dad. So he's a chronic coffee drinker, as in he's cut down from 10 cups a day to seven. And he actually needs two cups of coffee at night to go to sleep. How does that work with the caffeine and the hormone?


Really? Okay.

STUDENT:

If he doesn't have them, he doesn't sleep.


I don't know, but I can guess, I can hypothesize what might be going on. So let me just come back to your dad, but let's just talk about caffeine. So what caffeine is doing is it's... Like, as I said, it's blocking our ability to detect the sleep hormone adenosine, and the reason why I've been saying to everyone, her dad aside because he's unusual, do remember that, thatyou should avoid drinking caffeine at night, is because particularly if you drank, say even at 5:00, the half life of caffeine. So how long it takes the average person's liver to break down the caffeine to half of the amount that was in the cup he drank is five to seven hours.

So you drink one cup of coffee. You haven't got rid of all of that caffeine for 10 to 14 hours. And that caffeine is continuing to have an effect on you all that time. So it should be having an effect on your dad, but human beings are wonderful. So I'm going to guess a little bit. One of the things that we often have is rituals. We all have little rituals, things that we believe help us to do things. I throw salt over my shoulder, right? We have a favorite pillow, and children have a favorite toy. We have to do things in a certain order in a certain way. And those rituals or behaviours can be anything. And because we like patterns in our world, we learn to associate those behaviours or those rituals with a particular outcome. So it could be just association. So it would be interesting if he couldn't detect decaffeinated coffee, which still has caffeine in it, 15% to 30% of the same amount of caffeine in a normal cup. But if you could give him that and he didn't notice, 'A' it will be better for him, but 'B' might still have that learned association effect. Even hot chocolate wouldn't be great. Give him peppermint tea or chamomile. or valerian or hops or something.

STUDENT:

I'll try it. We'll have a little experiment at home I think.


Thank you, blue Milk, milk and hot water, that's what my granddad used to drink.

STUDENT:

Hi, Romola? My question is related to different types of sleep medication. So just anecdotally, I've heard that whilst the insomnia medication does let you get that sleep and does knock you out for the whole night, when people with insomnia wake up, at least the ones I know, they're still having problems focusing, concentrating. They don't feel rested, etc. Now is that true and if it is true for different types of medications, say zolpidem or melatonin or is it specific to one particular type?


That's a really good question, thank you. Yes, look, sleep medications are sedatives, as alcohol is a sedative. So what it is that you're doing is sedating you. So you go to sleep, but it's not normal sleep, it's not that lovely, you know the whale going down and coming up and going down, it's not normal sleep. So whilst you think you're sleeping, when you're taking sleep medication, you're not sleeping well. It's not good quality sleep, which is why you then wake up in the morning with all of the cognitive difficulties, all of those concentrating sort of dull feelings that you, that you would have had you been awake.

Truth is that it would be far better to use a psychological therapy for many cases of insomnia than a medication. Apart from the fact that we, as I've just said it doesn't it doesn't produce what I call good quality sleep, so it doesn't refresh you and restore you in the way that really good quality natural sleep does.

You can get used to it. Your body gets used to the drugs it doesn't work anymore. You need more of it. By contrast, there are psychological therapies, a really well researched therapy called cognitive behavioural therapy, which are available online. You can actually do an online CBT course for insomnia.

And these therapies we know do have an effect on some individuals with insomnia, not everyone because there's different kinds of insomnia but they're very effective. And what they do is they teach you good sleep habits some of which I've talked about. They also help people address the things that are making them not sleep well. The things that are having them lying there at night going over and over and over and over stuff that happened in the day or what's going to happen the next day.

They help address the ways that we think about sleep that can be unhelpful. Like the idea that if I wake in the night that's a terrible thing, that if I don't get you know, exactly nine hours of sleep I'm going to be a wreck the next day.

And those kinds of anxiety thoughts, anxious thoughts, can actually produce the very thing we fear which is poor sleep because a brain that is going over and over and over something is not a calm brain. It's an active brain.

So, one of the other things that you learn in psychological therapy for insomnia is relaxation therapies. Techniques to quieten the mind and help you sleep. So my I would say, you know this is the kind of conversation to be had with a doctor or a sleep physician because different reasons, there are different reasons why people have insomnia and they’re different kinds of insomnia. But I

would consider very seriously a non-drug related treatment. And alcohol is not a cure for insomnia, folks, despite what you think.

STUDENT:

Hello, I'm an operator, truck operator on the mines up north. I do shift work. We've learned all about doing fatigue management techniques. One that I'm really interested in 20 minutes nap. What's the science behind the way that that can help you wake up people get rid of a micro sleeping and things that goes on?


That's a great question. So the evidence is good. It depends on why you're napping so if you're a shift worker it can be helpful. The problem is if you nap for too long, it can actually steal sleep pressure because it gets rid of some of the adenosine from when you actually want to sleep so then you can't sleep.

At a very short of about 20 minutes is evidence based to help you deal with that acute nodding off behind the wheel. If you are driving a truck, if you're in the Kalgoorlie superpit or where's your mine site? In the Pilbara right. So if you're in it, if you're in a massive truck, I mean, a single tire is like $80-100,000. If you drive too close to the rock face you blow the tire. I mean you blow your bonus too but you blow the tire.

If you if you fall asleep this is a really very big Tonka toy to be driving off the edge of a ramp. So, that's why more and more the industries like mining are looking at fatigue management and are implementing evidence-based treatments like short naps. But if you sleep for too long in your nap that will then affect your sleep during the time of day or night when you are meant to be sleeping which then can actually make the problem worse not better. So it's about the right dose.

Why is it 20 minutes. It's a really good question. The answer seems to be to do with if you sleep for too long you get a full sleep phase down into that deep sleep up into dream sleep and that seems to reduce the sleep hormones so much that it affects later sleep.

And the evidence is really that we've just tried, scientists tried with participants like yourself, different lengths of nap and found that 20 minutes seems to be optimal. So that's why it's really evidence based. Exactly why? You need a neuroscientist perhaps to talk to you about the hormones and the chemicals in the brain and so on but that seems to be evidence-based.

Oh my God, we're still going. One at the back there and then one here. Oh and one here. Is that you? No not me. OK, it's alright, I won't pick on you.

STUDENT:

You mentioned sleep hangovers. So for those of us who really enjoy the idea of catching up on some sleep on the weekend is there an ideal amount of extra sleep to get and is it affected by whether we go to bed early or sleep in later?


It's a really good question. The answer is yes. If you're going to try and catch up on sleep it's really important to try and catch up on sleep when your circadian rhythm is trying to get you to sleep. So, staying up till midnight and then staying in bed till midday, not going to do it. it's just going to make you feel awful. Go to bed at 8 for Christ’s sakes. Right.

And then maybe stay in bed till eight and wake up at 7 perhaps naturally, you might actually wake up with the sun because if you don't wake up naturally you're still tired. But yeah, so you can do it a little bit but you can't catch up with everything. And definitely earlier in the night is better. So you know, we're meant to be asleep when it's dark. We are after all animals, primitive. We're meant to be asleep when it's dark and awake when it's light.

And for crying out loud how can anybody not get enough sunlight in Australia? I was born in the UK it's dark like three quarters of the year. So get out there and get some sun, be awake with the sun, be asleep with the dark. There's another question? Yes, just here.

STUDENT:

We don't get enough sunlight Romola. She's not listening, we don't get enough sunlight Romola because we work at UWA. But anyway, thank you for a wonderful talk. My question was, Fitbits, are they worth like, do you recommend them because it monitors my sleep and tells me how much I haven't slept because I work UWA?


I'm not going to rise, right Fitbit, that's a really good question. Anybody else have an accelerometer device like a Fitbit or anything like that? A lot. OK, so it's a little complicated. I think they're a good idea if you are interested in sleep and you want to learn more about your sleep patterns and you want to get an idea about whether your sleep is a problem.

But you need to be careful of two things. One, because I think it works by measuring movement. It's got an accelerometer in it like you’ve got on your phone. So what it's doing, is it's making the judgment that when you're not moving you're asleep, when you're moving you're awake. But a), you could be tossing and turning and actually be asleep and not know it. And b), we've all lain awake not moving thinking oh my god I'm counting down the hours and the Fitbit will say you're asleep so it's lying.

It's not lying it doesn't think but it's not telling you the truth. So, on average things like Fitbits overestimate how much sleep you're getting by about 50 minutes and that can vary to as much as 150 minutes. And for a few people leave and underestimate sleep and on average they overestimate sleep. So my concern about using a Fitbit is you might look at it and go well Romola, said that I needed eight hours and itsaid I got eight hours or seven and a half is that alright? It actually meant you got six and a half. And the answer is probably not. You might be okay but probably not.

So, use them as a guide but not as gospel. That's the first point and the second point is this, I have a friend who obsessively looks at her Fitbit so much so that she starts to worry about her asleep and it interferes with her sleep because she's worried about how much sleep she's getting.

My advice to her was take the bloody thing off. So, yes within reason, I think anything that helps you understand your behaviour and a behaviour that is so critical to health is a good thing. But within reason.

KATE WRIGHT:

So, thanks very much from (INAUDIBLE) that was really fantastic and I'm really grateful to the audience as well for so many excellent questions. So thank you Romola. Thanks to all of you for coming along and we hope we'll see you next time we raise the bar. (APPLAUSE)

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