#27. Unlocking the strategies for deep sleep

Gez Medinger (42:36): You don't like a draft sneaking in under the duvet.

Emily Kate Stephens (42:39): Exactly. Yeah. So you tend to take an hour between starting to instigate the sleep cycle. And I think one of the things that is really important in what you're doing there the meds and the supplements, sure, but it's this process that you are signaling to your body. This is our routine, just the same as you do with kids when you're teaching them. This is the routine with kids. You have the bath, you read the story, and then it is that wind down period you're teaching your body. This is where we're going in terms of that kind of routine or rhythmic thing. Are you ever reliant on audio books, certain hertz music or meditations? Have you had experience of that? And are there any of those things that you bring into your routine?

Gez Medinger (43:37): So I tried some of the sleep meditations. I found they actually got my brain whirring more than they calmed it down, because as soon as I'm listening to words, my brain switches on. I will use calming music during the day when I take breaks, and occasionally at night as well. I find that less stimulating than meditation type stuff. So yeah, have tried it. It will certainly work for some people, but personally, it wasn't something I found too helpful.

Emily Kate Stephens (44:02): One of my major strategies, and I think it's one of the things that literally saved me in the worst days, is yoga nidra. And for anyone that doesn't know, yoga nidra is not anything physical. It is a form of lying down and having a rest in your body that is not fully entering sleep necessarily, but you are creating this release of consciousness. You're sort of switching off your brain and going into this deep form of meditative rest. And I was reliant on that for years. In the middle of the day, I would do one of those, and it was so calming for my nervous system. I was also in that cycle of insomnia, so I was really, really struggling. And I whilst I knew that I was tired, and believe me, I napped in the day a lot, because sometimes it was almost like narcolepsy. I was so exhausted, but when I was trying to really, really get on top of this and regulate that circadian rhythm, so not take a three hour nap in the middle of the day, I would do yoga nidra, and it's sufficiently calming and refreshing that it would enable me to get through the afternoon. And then a lot of the time I would do, and I still do, if I need it, yoga nidra, or sleep meditations at bedtime, because I find one the actual content and focus a lot of the time, it will focus on your breathing or do a full body scan, and I find that focus on the internal in the physical, enables me to detach from my mental busyness. But the other thing, and I know this from when I was a child, is I always as a child, went to sleep listening to the same audio book, not multiple different audio books, the same audio book every night, again and again. If I could ever not sleep, because I think, like Joffe says, counting sheep, sometimes I will go for a walk in my head, where I will walk really, really familiar routes and notice things along the way. That, to me, seems like quite a mental process, but there's something in the familiarity of it. So there's this rhythmic thing that's induced in my body by going over old material, essentially. So I found one yoga nidra that I particularly loved, and that would always be my one. I don't think it was designed to just put you into a state of sleep, but because of my brain's association of that repetition of things, you find a voice that you like and just listen over and over again. The familiarity, maybe it's comfort, that was one of my major strategies,

Gez Medinger (46:36): And just switching off the cogs, which are just turning in our heads, right? That's one of the challenges. If you've got to calm the body, you've also got to calm the mind. And sometimes distracting the mind is the best way to calm it. We will all have tricks for the sort of things that we think about to try and calm the mind. Well, the first step is becoming aware that it's running around the mind and worrying or being anxious, or thinking about tomorrow, or this upset me, trying to A, recognize that, and then B, distance yourself from it, and then C, distract yourself by thinking about something else that's calming and restful, another useful strategy when it comes to actually just trying to get sleep.

Emily Kate Stephens (47:12): Yeah, hugely. And I rely on my breath work. I have certain breath work techniques that are hugely down regulating. Some of those are on apps that I will listen to other people talking me through breathwork, through meditation. So for me, that's absolutely my tool that I rely on. Now I realize that I probably take my supplements too close to sleep time, but because I don't have such a problem inducing sleep. Now it's, I don't think it's an issue, but I should probably bring that magnesium earlier. One of the big things, just like you, for me, was just setting that bedtime much, much earlier, so aiming to get into bed. Unfortunately, my children now stay up until about 9.30 but aiming and be ready for bed by nine o'clock. Because what I realized is, I think I have spent my entire life like an overtired child that I maybe at seven or eight o'clock in the evening, instead of listening to my body and allowing myself to start to wind down, I'd push myself over that point of tiredness, and I would always stay awake. And I worked with the US time zones for a long, long time, and particularly in 2020 when I was first getting sick, I was running a road trip across the US, so I would be up till two in the morning working. This was probably one of the most detrimental things for my health, was pushing my body that late and completely overriding it. But I always maintained I was always said, Oh, I'm not someone who gets tired. I don't get tired in the evening. I'm so energized in the evening. And in hindsight, I think it was that kind of adrenalized buzzing energy that's not necessarily healthy. So from what you say as well, I think what's really interesting is how much we have tuned into what our bodies are actually telling us what our bodies are actually needing, rather than what our kind of age group society lifestyle is.

Gez Medinger (49:09): I used to, for my entire adult life, my bedtime has been getting to bed, 11.30-ish, lights out at midnight

Emily Kate Stephens (49:17): Same

Gez Medinger (49:17): And sometimes, if it'd be one, if it'd be two, that's fine

Emily Kate Stephens (49:20): It's fine.

Gez Medinger (49:20): You know, you just try, yeah, fine. And that was through 2020 that pattern continued, because you have no reason to realize it should. And then I started to, just the sheer exhaustion. And then when I did a little bit of research and found out what the symptoms of a lack of deep sleep, or also the slow wave sleep are, and I was like, oh my god, boom. Yes, a lot of them have crossover with Long Covid, but they're all basically, they will turbo charge your Long Covid if you're not getting enough deep sleep. One of the most effective ways to get more deep sleep is just to go to bed earlier. It's that old, slightly hokey wives tale of the hours before midnight are worth twice as many as the hours afterwards. And that's a reflection of, actually, where the deep sleep happens, and how you increase the amount of time you spend in deep sleep. So once I made that change, immediately helped hugely to my daily function and my symptom burden.

Emily Kate Stephens (50:08): Yeah, and it is that whole chicken and egg thing of trying to right some things, and I agree at points, I used to think, well, maybe this is not Long Covid. Maybe this is just the result of chronic sleep deprivation, but the chronic sleep deprivation was definitely triggered by all of the symptoms, so it's just trying to deal with everything at the same time, trying to somehow dampen everything to move yourself to a better place. Now, in the interview, Joffe gave some advice for coenzyme Q10, oxaloacetate, creatine, chrysin, glycine. He did not go into much detail about those. When I started researching them, I thought, Oh, Gez, this is a whole episode for us. There is so much in this. Do you want to give me one sentence on them?

Gez Medinger (51:02): I might give you two quick ones. Let's start with glycine. It's a simple amino acid that acts as both a building block for proteins and a neurotransmitter in the brain for sleep. It appears to work by lowering core body temperature and calming brain activity. Studies suggest that taking three grams before bed may help you fall asleep faster, achieve deeper sleep and feel more rested the next day. It's considered very safe with minimal side effects. So as soon as I heard Joffe talk about it and then looked it up, I immediately ordered some from Amazon.

Emily Kate Stephens (51:29): Did you?

Gez Medinger (51:30): I'm on the train already. One thing I have not ordered yet, though, is chrysin, which is a naturally occurring flavonoid found in passion flower, honey and propolis. It's thought to promote sleep by binding to the same brain receptors as benzodiazepines. However, the evidence for chrysin is much weaker than for glycine, and the main challenge is that it has very poor bioavailability when taken orally. That basically means that when you eat it and digest it doesn't necessarily go into the right places that it would in the cells that you need it to. So I haven't yet ordered chrysin, but who knows it might be worth a punt?

Emily Kate Stephens (52:01): Okay. And I will tell you about creatine monohydrate. It's a compound made from three amino acids that is actually typically, I think a lot of us would consider it to be something that's taken by kind of gym bros, but it is pushed massively in the media at the moment, particularly for women in perimenopause, and it plays back into what we talked to Davenport about and what Joffe references in this interview. It enhances energy production. It assists with oxidative phosphorylation, and it helps to replenish the ATP. Now that is why it is used by people who are doing a lot of sports, and that is why it is this kind of performance enhancer in sports. There are now a lot of studies to suggest that the way that it increases energy in your body, it also operates on the nervous system and brain in the same way to boost your energy, maintain your pH levels, and it can definitely help with brain fog. There are studies to show that it increases sleep duration, and it can help a lot in major sleep deprivation, but from what I read, it suggests that it is more to do with the fact that it makes you more energized in the day than necessarily enhances the quality of your sleep. But it's such an interesting one that I would like to dig into it in more detail at a later date. I think the thing with that, with the chrysin, glycine, is that they all are well tolerated and generally considered safe. The other two that he mentioned is oxaloacetate, which I think trade name is BenaGene. And again, that plays into the Krebs cycle, into the energy production. Oxaloacetate is something that is part of that whole process in our bodies. It is innately in our bodies. And studies show that oxaloacetate is significantly lower in the plasma of ME/CFS patients. There has been the REGAIN study from the NIH really, really dug into it, and it definitely shows improved sleep as a reported benefit. And I think again, the sleep quality is improved by the regulation of the metabolic processes other than anything else. So it's metabolic processes in the day, but in your body and brain generally, that are improved by it. And the final one that I just touched on is coenzyme Q10. A lot of people have been recommended it. It is an antioxidant that protects the cells. There are trials to suggest that it does help with sleep. It's super interesting. I have started taking creatine only about a month ago, and look, I feel good, but I can't say that is to do with the creatine

Gez Medinger (54:41): This is one of the challenges with all the anecdotal stories of people taking supplements that you'll see on social media. I took supplement X and immediately it was great, or I took supplement y and it wiped me out, even assuming that there are no changes to your daily patterns or what you eat or what you drink or what supplements you take, what medications you take, or what stress you're under, or any of these other influencing factors. It's a relapsing and remitting condition. So when people are anecdotally saying, I did this and felt better, it's so hard, whether it's a medication or a supplement, to know where we're coming from on it and with the anecdotal stories, so you have to be looking towards the studies. But there aren't very many high powered studies of the sort of supplements we're talking about, especially in the context of Long Covid.

Emily Kate Stephens (55:25): And with also, the fact that supplements still are not rigorously regulated. So when you are dealing with medical grade melatonin, that is one thing. But the things that we are talking about here are things that are going to be promoted by, as Joffe said, what does he call them?

Gez Medinger (55:42): Wellness wankers?

Emily Kate Stephens (55:44): He did not use that term! Hopium merchants.

Gez Medinger (55:50): Hopium merchants. Yeah, there's a lot of that out there, and it's very hard. Almost the entirety of the science in Long Covid exists within this middle space between something that's well established, and stuff that's obviously complete nonsense. And where you put stuff within that huge spectrum is really tough, and all of these supplements exist in that space. So it's very, very hard to get a clear handle on how effective they might be.

Emily Kate Stephens (56:14): So people do need to do their research into brands and into what testing has been done on anything that they might consider buying. And on the flip side of what you just said, there is also that fact that if people are already in a state of crash, it's that idea that you can't add to your symptom set bucket with a new supplement or drug when you're already in this dysregulated state. It was Melanie Hoppers that was saying to me, you can't add things when you're in that crash, because your body is so overloaded already it doesn't necessarily know what to do with it. So a lot of the time we in desperation, think, Oh, I'm in a horrible state. I'm going to try this. It's also best to try those things when you are in a slightly more stable state as well. Maybe the effects and not necessarily the supplement that you added, but your physical state when you tried it. There is so much gray area in this. I am going to adopt the term "regular armamentarium" that Joffe used for the supplements and things that I take, but actually I don't take any medication apart from HRT now, but I do think that the progesterone that I take is huge for my sleep, because I notice when I don't take my progesterone that I do struggle to sleep. So whilst I think that I'm not actually taking any one drug perhaps that might enhance my sleep, I'll probably find that the hormones that I take have had a huge impact on my sleep. That is a whole subject for another episode. Gez, thank you so so much for joining me today. I'd love to hear from people. I would like to know if Gez and I breaking things down in this way, talking about these subjects is helpful to you, and if you are enjoying this more personalized approach to it. Gez, thank you so much for joining me.

Gez Medinger (58:08): Thank you for having me see you next time.

Emily Kate Stephens (58:10): See you next time. Thank you for listening to Make Visible. Please do like follow or subscribe to listen to our next episode where we'll be uncovering more insights into complex chronic illness. This was brought to you by the team at Visible, a group of scientists and engineers whose lives have been affected by energy limiting health conditions. We're building wearable technology that's helping 100,000 people measure and manage their complex chronic illness. To find out more about what we're working on and how Visible could help you visit our website at makevisible.com

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