Nodding Off: Book review and interview with Professor Alice Gregory

After the publishing sensation of Matthew Walker’s 2017 blockbuster Why We Sleep, you’d be forgiven for thinking there was little else to add to the public conversation about 21st century sleep science.

But with her debut popular science book, Professor Alice Gregory, a UK-based researcher who has been helping to unlock the mysteries of sleep for the past two decades, has proved that sleep science, far from being an exhausted topic, is an endlessly fascinating rabbit hole of surprising facts, discoveries and counter-intuitions.

Professor Alice Gregory

One of my favourite sleep books of 2018, “Nodding Off: The Science of Sleep from Cradle to Grave” is structured in chapters that address the different ways sleep changes as we progress through life, from babies, to pre-schoolers, school-age children, adolescents, adults, and finally the elderly.

Despite having over 100 scientific publications to her name, thankfully, when writing for a lay audience, Gregory takes on the role of story teller, rather than dusty lecturer.

The author also manages to blend a very personal touch into the book, explaining how her own accounts of motherhood and professional life have continually influenced the ways she approaches her research.

Communicating via email, I asked the professor about the book, her views on issues like baby sleep training, teenagers, mental health and the future of sleep research.

Jeff Mann (JM) Hi Alice, I really enjoyed your book, can you briefly explain why you chose to pursue an academic career in sleep research, despite it being a relatively neglected subject area at the time of your undergraduate studies?

Alice Gregory (AG) Thanks a lot for your kind feedback. I can share with you the exact moment I decided to become a sleep researcher. It was towards the end of my undergraduate degree and we had a brilliant new lecturer give a talk on sleep.

She argued brilliantly how important it was for every aspect of our lives. It was like someone had switched on a lightbulb. Of course sleep is hugely important – so why wasn’t it being given attention it deserved in our day-to-day lives?

Why wasn’t this topic being given more attention in psychological research too? Shortly after the talk, I got in touch with the lecturer and we embarked on a collaboration (which led to me co-authoring my first scientific paper in the field of sleep). I haven’t looked back since.

JM: You also explain in your book how becoming a parent – after many years of being involved in research – gave you new insights into your chosen field of expertise. How did this experience impact on your work and your interest in sleep?

AG: Before I had children, I would write statements such as ‘sleep consolidation occurs during the first six months of life with sleep becoming more concentrated during the night’ and it meant little more to me than an interesting process that was developing.

Once I’d had children, these same words meant something entirely different. Night wakings during the first six months might mean no undisturbed for parents for this time (and in fact, night wakings tend to go on for much longer than 6 months).

For someone who had slept very well, the experience of having to wake to feed or change a baby was an absolute shocker. Having kids also led me to write my book. I wanted to share my knowledge about the science of sleep but embed it in the realities of life.

I’ve also recently written a second book called The Sleepy Pebble and Other Stories (to be published soon by Nobrow) which is an anthology of bedtime stories which incorporate techniques aimed at helping children relax before sleeping.

Together with a co-author, we have spent many years developing this book. We contacted a lot of leading experts and we invited 100 families to read one of the stories to their children for 3 consecutive nights.

I have also read all of the stories to my children a lot of times now. They are harsh yet brilliant critics. They give me honest feedback and it’s always spot on.

JM: One of your areas of expertise is educating parents about baby, infant and toddler sleep. With such a personal, emotive subject, how do you counter, let’s say ‘non-scientific’ views and opinions on divisive topics such as attachment vs cry-it-out sleep training?

AG: Some parents have very strong ideas about infant sleep that do not necessarily fit with what we might have learned from scientific studies to date (although that’s not to say scientists have all the answers…there is still a lot to learn).

I’m happy to share what I have learned over the years with others, but if people are happy with their choices and don’t want further information – I would never try to provide unwanted advice.

There is one exception to this and that concerns infant safety. I’d always raise the topic if I didn’t think an infant was safe when sleeping. Other than that I appreciate that families are all unique and what may be a choice for one is not necessarily for another.

JM: You discuss in your book the many changes that happen in adolescence that affect sleep. What in your view are the most important facts the public needs to be aware of regarding adolescent sleep ?

AG: It’s hard to know what the wider public are and are not aware of these days when it comes to sleep. I feel that sleep has been ignored for so long, but that is no longer true. So many people are now keen to promote the importance of sleep.

These include sleep researchers of course, but also those with a much larger reach, including celebrities such as Arianna Huffington.  Recently, I’ve found myself lecturing on sleep-related topics that used to be entirely new to an audience. Now most people in the lecture hall will be familiar with the topic I’m talking about, which they’ve already heard about from the press.

Given this, I am not sure how much of this will be new, but I think that when it comes to adolescent sleep – the most important thing is to appreciate that the change in sleep timing is hard-wired. We see adolescents going to bed later than before and wanting to wake up later.

This change in timing is associated with puberty and happens regardless of what type of things an adolescent likes to do or where they live. It’s even been found in other mammals too. The message from this is that this change in behaviour should never be considered to be lazy. Instead, we ideally need to change society to fit with this pattern.

There have been campaigns to push back school start time for adolescents for example with positive results. In reality, in many places, school start times are still early – so adolescents need to do what they can to cope with this.

For example, if their bedtime is very late, they might want to try to slowly and gradually bring it forward. To improve sleep at this stage of life (as well as others) people might also want to think about avoiding blue light (that which is towards the shortest wavelength end of the visible spectrum and which is emitted by many phones and tablets) before bedtime.

A lie in at the weekend can be helpful to cope with missed sleep during the week – but it also brings issues (namely social jetlag, where sleep timing changes between week days and the weekends) and is not as good as regularly getting enough sleep and keeping a consistent sleep schedule.

JM: You also write about an often neglected topic, that is, how the elderly experience sleep. What are the main myths and misconceptions about sleep as we get older?

AG: There are certainly some myths and misconceptions about sleep in older adults and I’ll give you just a couple. First, some may assume that sleep problems are an inevitable part of aging.

It’s true that certain problems can increase during this stage of life. For example older adults may spend a greater proportion of the night awake as compared to younger adults. Sleep apnoea and restless legs syndrome are common in older adults too, and nocturia (urinating during the night) may become more frequent.

However, this is not an inevitable part of aging, and some older adults report sleeping very well.

Coupled with the misguided idea that sleep problems are inevitable in older adults, there is also a misconception that poor sleep should be endured in our older years, because there is nothing much we can do about it.

This too is not true. Take for example an increased number of toilet trips during the night. These may be due to the body producing increased urine at night – but could also be due to depression leading to night waking or a sleep disorder such as sleep apnoea waking the sufferer.

It’s important to understand what is leading to these night time visits to the bathroom so that causes can be addressed resulting in improved sleep at night.

JM: Your research also deals with many aspects of the interaction between sleep and mental health. How might better education about sleep influence our current attitudes towards mental health care and wellbeing?

AG: When I first got involved in the field there was this this idea that sleep was just one of many other symptoms of certain psychiatric disorders. For example, we might feel depressed or anxious which might mean that we were not able to sleep or we might wake up during the night ruminating or worrying.

This ‘symptom’ was sometimes dismissed as just one of many others. We’ve moved on from this idea and now understand that sleep difficulties can forecast the arrival of other problems. An early sign that certain disorders may be developing can be that we stop sleeping well.

This can provide a window of opportunity to check in with someone and make sure they are supported as well as they can be to perhaps even prevent the arrival of other difficulties. What’s more, there are more and more studies that indicate that by improving sleep you can address other difficulties.

For example, in a study led by Professor Daniel Freeman from the University of Oxford, students with insomnia were given Cognitive Behavioural Therapy for insomnia (CBT-I). As compared to no treatment, those receiving CBT-I found their insomnia had improved, but they also had reduced levels of paranoia and hallucinations too.

Education about the importance of sleep is lacking at every level. Kids often think sleep involves doing nothing and is boring. We need Jamie Oliver style interventions in schools to help children understand why sleep is so valuable to them.

Perhaps even more sobering, education about sleep is often lacking from medical training – so many of our doctors also do not know enough about this important topic.

Given the importance of sleep for our mental health care and well-being, providing further information about sleep would be valuable. In terms of how it might influence our attitudes towards mental health and well-being – perhaps discussions about sleep are a good place to start a dialogue about mental health.

People seem to love talking about their sleep and this can be a good starting point to talk about how someone is feeling and behaving during the daytime too.

JM: Your book is refreshing in that you’re very honest that we’re still figuring out the many mysteries of sleep and that sleep research spans many diverse areas of expertise.  How do you see the future of sleep research, given that the topic of sleep is inter-discplinary – whereas academia is still largely built on the notion of specialisation?

Thank you for this comment – it means a lot because I think there was initial concern that drawing out subtleties in this way might make Nodding Off feel more like a textbook than a popular science book.

However, it was important to me to describe things as accurately as possible and the lack of a clear message in places reflects the science. Take for example the message that we are getting less sleep than ever before.

That is a clear message which is easy to digest – but the situation is not that clear cut. For example, in a study led by Dr Kristen Knutson from Northwestern University, time diaries were examined from eight different studies conducted between 1975 and 2006.

While there was not much support for the idea that short sleep has become more of an issue over recent years – when full time workers were examined separately, short sleep did increase over time.

So short sleep may be a problem for a particular demographic but not others. The data are mixed so it’s hard to provide a clear take home message here – but that is the way science often unfolds.

In terms of the future of sleep research, I fully agree that interdisciplinary research is going to play a crucial role. For my own PhD, I studied sleep difficulties in relation to psychopathology in the Social, Genetic, and Developmental Psychiatry research centre.

Leading experts from diverse fields had been brought together and their collaborations led to incredible developments in different fields. We need more of that. I have collaborated with psychiatrists, clinical psychologists, geneticists, social psychologists, statisticians and developmental psychologists too.

Nobody can be an expert in every topic, so we need to pool expertise to do the very best interdisciplinary research.

Let’s hope that research of this type eventually leads to better nights of sleep for all of us.

Nodding Off: The Science of Sleep from Cradle to Grave is published by Bloomsbury and is available at Amazon

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