#72: How to Improve Your Sleep with Dr Maja Schaedel

Are you tired of tossing and turning and want to know if a good night's sleep is ever possible?

In the first episode of season 4 of the Hello Therapy podcast, I'm joined by clinical psychologist and sleep specialist Dr. Maja Schaedel where we unravel the mysteries and challenges of sleep. Maja shares her extensive experience from the NHS Sleep Disorder Centre and her private Good Sleep Clinic, offering practical insights into why sleep is so essential for our health, how different sleep disorders manifest across age groups, and what we can do to improve our nightly rest. 

You'll will learn about the surprising links between sleep and conditions like dementia and anxiety, the realities of insomnia, and actionable strategies for managing sleep disruptions, plus some myth-busting around sleep routines. Whether you've struggled with sleepless nights or just want to understand how to sleep better, this episode is full of valuable tips and eye-opening science.

Highlights include:
08:55 Common sleep disorders explained
19:18 Teen sleep patterns and challenges
28:59 Understanding sleep efficiency
37:46 Strategies for 3am wake-ups
50:22 Mental health and sleep connection
57:30 Top tips for better sleep
01:02:16 Sleep retreats and professional passion

This week's guest:
Dr Maja Schaedel is a clinical psychologist and a sleep expert and has worked with people with sleep difficulties for over 20 years. She runs The Good Sleep Clinic and she founded The Good Sleep Retreat in 2023. Maja also works as the lead psychologist in one of the UK’s leading NHS sleep disorder centres at Guy’s & St Thomas’ Hospital. She regularly speaks on the subject of sleep in the media, including The Telegraph, The Independent, Harper’s Bazaar, Vogue, BBC 4’s Woman’s Hour and Channel 5’s “Breaking the Taboos” on sleep in the menopause. 

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The Hello Therapy podcast and the information provided by Dr Liz White (DClinPsy, CPsychol, AFBPsS, CSci, HCPC reg.), is solely intended for informational and educational purposes and does not constitute personalised advice. Please reach out to your GP or a mental health professional if you need support. 

Transcript

Introduction to Sleep and Mental Health

Dr Liz White 0:02

If you're looking to improve your mental health and well-being, then keep listening. I'm Dr Liz White, a consultant clinical psychologist with over 20 years of experience. Whether you're a frazzled parent, a stressed out professional or finding your way through the challenges of midlife, you're in the right place. Or finding your way through the challenges of midlife? You're in the right place. Through a mix of solo episodes and insightful conversations with expert psychologists and therapists, I'm bringing you evidence-based tools and strategies to help you navigate life's ups and downs with confidence, clarity and compassion. With confidence, clarity and compassion. This is your space to feel seen, supported and empowered.

Dr Liz White 0:53

Welcome to Hello Therapy, welcome to the first episode of season four. Today, I'm talking to Dr Maya Shadel, clinical psychologist and sleep specialist, and we're talking about why sleep is so essential for our mental and physical health. We explore the most common sleep issues, from insomnia and sleep apnea in adults to shifting sleep patterns in teenagers. Maya shares so many nuggets of practical advice, including how to improve your sleep efficiency, the connection between sleep and mental health and strategies for those 3am wake-ups, so let's dive in. So hi, maya. Thank you so much for joining me on the Hello Therapy podcast today.

Dr Liz White 1:44

Well, thank you for inviting me, liz, it's a pleasure to be here. We are talking about sleep which, as I was saying, I can't quite believe that I've never talked about sleep on the podcast before, because it's so central to our well-being and our mental health. But before we get into that, do you want to tell our listeners who you are and what you do Before we?

Dr Maja Schaedel 2:04

get into that. Do you want to tell our listeners who you are and what you do? Yeah, sure. So I'm Maya Shadel. I'm a clinical psychologist and I suppose now I'm sort of like a sleep specialist. So I've really specialised in sleep. So I work at Guy's and St Thomas' NHS Foundation Trust. I'm a clinical psychologist in the Sleep Disorder Centre there and I also co-founded and I'm the director of the Good Sleep Clinic, which is a private organisation which offers evidence-based therapy for people who have sleep problems largely insomnia, but also trauma-related sleep problems as well and I've now just in the last couple of years started running some sleep retreats as well as part of that. So that's, yeah, that's something I can talk about a bit like later, but yeah, they're really really good, they're fun.

Dr Liz White 2:55

yeah, no, I'd love to hear about that. We'll catch up on that later, so let's start with this. This of sleep. Why is it so crucial to our well-being?

Dr Maja Schaedel 3:07

Well, I think now sleep has been really seen as one of those kind of five pillars of health. So we know that nutrition is really important, we know that physical activity and exercise is really important, and also, you know, mental health and social connection. But I think sleep is, in a way, that last pillar, and why it's so crucial is that now we've just got this masses of evidence which shows that if we don't sleep well, it has such a fundamental impact on our physiological functioning. So I think, you know, back in the day when I trained as a psychologist, sleep was seen to be one of those things that got lost along the way of other mental health problems, you know. So we'd I don't know, we'd have like a sheet of sleep hygiene that we might give someone to say you know, try and uh, I don't know cut out caffeine in the afternoon or, you know, try and read a book before bed, and we'd be really hoping that that would then help the sleep.

Dr Maja Schaedel 4:11

But it was very much seen as a feature of other mental health problems and I think we're all starting to understand now that actually sleep problems are in themselves really problematic and if we don't get enough sleep it can actually have a massive impact on our, on our health and well-being, you know, and uh, quite, with quite significant results. So, you know, we now know that sleep deprivation can cause, uh or contribute to obesity, uh, to dementia, lots of mental health problems, but also, even just thinking about cancer, there's certain cancers now that sleep deprivation has been linked to. So I think that we're really starting to understand that if we don't get enough sleep, it's not just a sort of nice to have, it's not just, oh, you know, let's make sure we get a nice night's sleep and that will make us feel bright eyed and bushy tailed. We're actually realising that if we don't get enough sleep, it actually can impact on our longevity, which is really significant. So I think there's been a bit more focus on it in the last 10-15 years, which is really important.

Dr Liz White 5:12

Just staying on that point because I've seen those same studies, particularly the studies around dementia. I thought that was really interesting because my background is older adult mental health and working in a memory service. It is just to sort of clarify for people listening. It's not just the odd one or two nights of not sleeping, like those studies. Look at a long term. It's long term. It's over years, isn't it? Am I right?

Dr Maja Schaedel 5:36

yeah, absolutely, and um, there's now quite significant data that that suggests that it is causative, now that sleep deprivation does cause dementia, and they're not entirely sure why that is.

Dr Maja Schaedel 5:50

But one of the reasons that they think might be partly to do with it is that when we get dementia it's partly to do with the buildup of toxins in our brain and those kind of amyloid plaques like the tau protein.

Dr Maja Schaedel 6:02

And we know that when we sleep, those kind of amyloid plaques like the tau protein, and we know that when we sleep there's this really important process called the glymphatic process, where we essentially we flush out all of our toxins. So our glial cells in our brain shrink and it flushes through cerebral spinal fluid and it kind of like acts as a a really like a nice detoxifying process that we have every night when we sleep, and so this flushes away all the toxins and then of course, the next day we build up all these kind of byproducts just from functioning during the day. Now, if we don't get enough sleep, our brain doesn't have enough time to flush away those toxins, and so you could see that that might build up, especially if there are those toxins like the amyloid plaques and tau protein. So, um, that could be one of the ways that actually it might be contributing to dementia it's fascinating, isn't it, in terms of sleep problems.

Dr Liz White 6:56

So what are the common sleep problems that you see in your clinic?

Dr Maja Schaedel 7:01

yeah, and this is really interesting because there's quite a big difference between what I see in my private clinic and what I see in my NHS clinic. Okay, so in my private clinic I would say, um, mostly it's insomnia, and that's because insomnia is just such a huge problem. So we now know that, uh, you know, one in four people can struggle to sleep every week. You know, it's a really huge issue and I think it's also one of those conditions that has such a big impact on how people feel. So I think that you know, if you don't sleep or you struggle to sleep, it can actually really impact on your emotional well-being. So I think it's one of those conditions that people are really motivated to change, especially privately, and that's partly because there isn't an NHS service really that can manage the demands of the massive insomnia problem that we have.

Dr Maja Schaedel 7:57

And that is a real issue because I mean, I've worked in sneak disorder centres in the NHS for years now sneak disorder centre in the NHS for years now and there's a really strict referral criteria and eligibility criteria for most services and most of the time insomnia doesn't really get seen. It has to be alongside other sneak disorders but also insomnia kind of isn't seen as significant enough of a mental health problem to be referred to mental health services. So it has really slipped through the gaps, I would say for years and years, which you know is a real issue. So in private my private work in the Good Sleep Clinic we see a lot of insomnia.

Dr Maja Schaedel 8:35

Another one that we see a lot of is the sleep disorders that affect teenagers and young people.

Common Sleep Disorders Explained

Dr Maja Schaedel 8:40

So we see people, we see children who are 11 years and up at the good feet clinic and one of the big shifts that occurs in your teenagers in your adolescence is that you go from having a kind of quite an early phase sort of sleep uh circadian rhythm which is kind of like your internal body clock, where you're used to getting up kind of right and early and then when you you hit sort of 13 14.

Dr Maja Schaedel 9:05

This goes massively back the other way and we become night owls. So you have all these young people and adolescents who are really struggling to fall asleep but also really finding it hard to get up the next day, and that can have a big impact on some developing sleep disorders. One is called delayed sleep phase syndrome. So that's actually where your daytime becomes your night time and your night time becomes your day time. You kind of circle back around so that actually you're awake during the night and asleep during the day, and so that can take quite a lot of work and uh, you know, trying to help people to to bring it back, but in the nhs there's such a massive range of sleep disorders that affect people.

Dr Maja Schaedel 9:48

One that is treated a lot and seen a lot is obstructive sleep apnea.

Dr Maja Schaedel 9:52

And that, essentially, is where we struggle to breathe during our sleep and actually this goes often really unnoticed. So lots of people little little moments in their sleep where they actually stop breathing and they won't be aware of it. And there's certain things you can. You know that we've got some screening tools that we can use. But you know things like snoring is an indicator, or sleep apnea, if a partner you know says that they can kind of notice little pauses in the breathing at night, or if you wake sort of with a gasp. But even so, for women this presents slightly differently, especially going through the menopause. So the rates of sleep apnea go up when you're going through the menopause and it kind of presents itself a little bit differently like headaches, sometimes dry mouth and tiredness and depression as well. So we know that that CPAP is a big issue and it's actually one that really does need treating because, again, this is one that has quite significant consequences in terms of health and actually really does impact on longevity. So it's one that we really try to make sure people get treatment for.

Dr Maja Schaedel 11:00

And there's all sorts of other neurological difficulties as well, like restless leg syndrome, narcolepsy, idiopathic hypersomnia.

Dr Maja Schaedel 11:07

So we have sort of a range where sometimes it's lack of sleep, but sometimes it's excessive daytime sleepiness and actually struggling to feel well, even when you've had loads and loads of sleep. So there's actually a real, like a real range of sleep disorders that can affect people, actually a real, like a real range of sleep disorders that can affect people, and I'd say that some of them a bit more physiological and some of them are more psychological, but more often than not they kind of go hand in hand. That it's actually really common to see people who have both sleep apnea and insomnia, and that's partly because, if you're really struggling to sleep, because you're waking up loads during the night from all these little sort of gaps in your breathing, then you're awake and then you're struggling to go back to sleep and then you can start to panic and start to feel concerned about not going back to sleep, and that's often the start of insomnia. So I'd say that it's a kind of real, um, real mixed bag.

Dr Liz White 12:00

I mean, I've got so many questions in my mind from just what you said there. Can I just pick up on the teen thing, because I have a 16 year old who, um, got three years GCSE, so that's great, oh well, thought, but yay, um. But we, you know, yeah, we really noticed that, the sort of shift in sleeping patterns and, you know, sometimes he goes to bed, bed after us. We go to bed quite early because we're old, but it's sort of knowing, isn't it? Sort of when is it becoming a problem in terms of like what, as a parent, how do you prevent it going into? I can't remember the name that you called it now, but it's something more problematic. What would you?

Dr Maja Schaedel 12:41

say about that? Yeah, and this is a really interesting one because actually, um, researchers have found that because young people have this later circadian rhythm, they actually tend to do better when they go to bed later and they get up later. And you know, we're actually trying to understand, like, why is it that teenage, why does this happen? And some of the theories that have been put forward are that actually this was when teenagers were starting to become more independent and actually they might be going off, socializing, making those connections with their peers, whilst their sort of parents were tucked off in bed and kind of getting an early night. So actually it, from an evolutionary point of view, this might have had a function, but it's certainly something that feels like it affects most teenagers and for some it really affects them, and in some areas of the country they've actually piloted starting school and college an hour later just to see if that really impacts on their functioning.

Dr Maja Schaedel 13:42

So I think that, you know, generally, generally speaking, they do tend to prefer if they go to bed later and wake up later. But of course, as we know, schools don't tend to work that way and a lot of kids have to wake up at 6, 30, 7 in the morning, which can feel really early. So in terms of when it becomes a problem or not, I would say that the really big risk factors are just before going back to school after a holiday. So the summer that you know, the end of the summer holidays, the start of the autumn term and again the Christmas holidays and the Easter holidays, when you have these big chunks of time where they can kind of sleep as long as they want in the late morning and they can go to bed as late as they want. I would say that that tends to be, you know, the danger zone. Like how do you get it back on track? Um, and I would say that you know there is, there are some kind of tips and advice for that.

Dr Maja Schaedel 14:33

You know, generally speaking, it's it's great to have a lie in, but if you can kind of limit it a little, bit, so it's not the whole morning, I think when it becomes a problem if you feel that your teenager can't really function, if they're woken up a bit earlier and you know they're really struggling during the day to get up and go to college, for example, adapt their bedtime and wake up time yourself and it's just not kind of working and it's it's somehow run away with itself.

Dr Maja Schaedel 15:08

That's probably the point to try and seek help, because I think it can feel overwhelming, and also for kids who are neurodivergent, this is a particular issue. So kids with ADHD and autism generally find that they struggle more with this, I'd say, and that can also pose challenges for parents who are trying to, on the one hand, really protect their rest and making sure that they get enough time asleep, but also needing to kind of protect their education and whatever they're doing during the day. So I think it's a bit of a challenge, yeah, yeah it's certainly a bit of trial and error, isn't it?

Dr Liz White 15:44

and my kids always know when it's and holidays coming to an end, it's like a week before I'm like, right, you're gonna get up at seven o'clock each morning to prepare you for school. Um, yeah, that's a good idea. Yeah, but, um, and it's picking up on sleep apnea, so that sounds like it. Yeah, it's a really common issue, but something that, uh, you know, can sort of go on for years. I guess, if you're not really noticing, um, and if somebody was worried about that, is it just a case of going to a gp and getting referred somewhere, or how does it work?

Dr Maja Schaedel 16:18

yeah, exactly so. There are certain risk factors. So male, being overweight and being over the age of 55 are generally considered to be more risk factors. And also if you've noticed snoring, that's a really key one to look out for. But, like I say, for women, as they go through the perimenophores and into the menophores and postmenophores, well, that tends to be more of an issue.

Dr Maja Schaedel 16:45

I would say that other things to look out for is if you feel tired when you wake up and you have a dry mouth or you have a headache. And again, if a partner has kind of picked up on it and noticed that there's some sort of breathing irregularities that they've noticed. Or the other thing is that if it looks like you're sleeping throughout the night, you feel completely exhausted the next day and you can't quite understand why that is. I would say it's worth going to a GP and actually asking for a referral to a sleep disorder center and they will be able to assess it, and usually that requires just asking a set of questions and doing maybe doing some measurements. Sometimes they ask you to wear something like a wearable um to measure, uh, your sleep at night and then occasionally they might ask you to kind of come in for a more prolonged stay of staying over for a night or so. But yeah, it's.

Dr Liz White 17:32

It's definitely something to ask your gp about and ask specifically for a rush for a sleep disorder center I've, um, sometimes I've talked to clients about getting a referral and having you're going to one of these sort of sleep studies, yeah, where they put things on your head and sort of you know, measure, measure your brain as you're asleep and things, and I've always thought that must be pretty difficult to go somewhere completely new and get into someone else's bed or like a hospital bed and go to sleep, because if that was me I'd find it really difficult.

Dr Maja Schaedel 18:05

Oh, it is so hard and there is a bit of a joke, you know that. Actually, how easy is it to sleep when you're wired up? You're literally got wires all over, you've got camera on you, you're in a hospital bed, and we know that actually, generally people uh sleep worse when they're in an unfamiliar setting. You know, even if you're going to a hotel for a night or you're at a conference, that we know generally people tend to feel that they struggle to sleep in an unfamiliar setting. So, yes, there's definitely issues with that.

Teen Sleep Patterns and Challenges

Dr Maja Schaedel 18:33

We tend to take that into consideration and there are some really brilliant technicians whose job it is to really analyse the night and they're incredibly skilled and they're able to really pick out what might be going on. So that will all be taken into consideration in the analysis of someone's sleep at night. You know so, for example, if actually they struggle to sleep completely, it might mean getting them back in another time, or it might be trying to find a different way of measuring it again, like a wearable um might be the way forward. But yeah, it is a bit of a joke. We kind of try and make it really nice, you know like. So they're nice rooms and the staff are all really lovely, but there's only so much. You can kind of suspend your disbelief that you're in your own bed at home when you've got these wires all over you, but it sounds like you're not on a trolley in the corridor.

Dr Maja Schaedel 19:22

Hopefully not. It's not that bad the trolley in the corridor?

Dr Liz White 19:26

hopefully not it's not that bad. The nhl is struggling, but hopefully it's not that bad. So I saw one of your um I think it was instagram posts where you talked about sleep efficiency and I was really intrigued by this. Can you tell us a bit more about that and sort of how can we improve our sleep efficiency?

Dr Maja Schaedel 19:40

yeah. So sleep efficiency is a measurement that's used, especially when working with someone with insomnia, and really it just refers to the percentage of the time that you spend asleep compared to the time that you spend in your bed. So if you go to bed at 10 o'clock and you wake up at six in the morning, you've had eight hours in bed. But if you're only sleeping for four of those, that tells us something about you having a much lower efficiency than someone who spends those eight hours asleep. And so, generally speaking, we want we know that people who have at least 80% sleep efficiency tend to. You know that tends to be good, that's normal and healthy. A lot of people have over 90% actually. So you know that tends to be good, that's normal and healthy. A lot of people have over 90% actually. So you know, without sleep disorders, we know that people have high sleep efficiency. But when it becomes much more problematic is if you're spending hours in bed but not sleeping, and this tells us something, because it's not just that you're struggling to sleep, it also shows us that you're spending a lot of time in your bed, but that's not time that you're spending asleep. And of course, that can be really problematic because we are creatures of learning so quickly, you know, we learn habits and associations really really quickly. And if we spend, you know, several hours tossing and turning and struggling and thinking through all sorts of dilemmas from the day and things that you've said to someone last week and you're kind of really spending that time trying to sleep but not sleeping, our brain does start to learn, oh OK. So bed is not just a place I sleep, Bed is also the place that I do all this fretting. Bed is not just a place I sleep, bed is also the place that I do all this fretting and it it almost becomes second nature to do that and we could. It becomes a learned behavior. So we've got to be really careful of that, because a lot of people come to me and say I can't sleep, I think it must be stress. But actually, you know, like I, I don't know, I I feel okay, I'm not that stressed, but I don't know what to do, and I think it's really important to know that. Yes, stress can be one of the reasons that we struggle with sleep and it for sure can spark off a period of insomnia. But you'd be surprised at how much of the time insomnia becomes really like a habit, it's like a learned behavior. So you know, it's so common for people to say you know, I've done everything to kind of fix this I'm, I'm no longer stressed, I'm exercising loads. You know I'm, I've sorted out my routine, I've got a good wind down routine. Why? Why am I still not sleeping?

Dr Maja Schaedel 22:17

And when we look at it, it really is that your brain has just got used to waking up in the night for several hours. You know, and and we do certain things to reinforce that as well, you know. So, for example, if you get up in the night and you think, well, I know what's going to help, I'll go downstairs and get a bowl of crunchy nut, cornflakes or something. Well, again, that's reinforcing that sort of behavior of yeah, uh, eating in the middle of the night. And, of course, if you give yourself any sort of sustenance, your brain will learn that that's a good. I'll do that tomorrow.

Dr Maja Schaedel 22:49

Then, if I'm going to get that nice bowl of something, but even things like going to the loo so you know, needing the loo at night it can be for sure it can be to do with sort of physiological difficulties, like, say, for men at a certain age in terms of prostate difficulties and also for women going through the menopause. That can change a bit. But actually we see so many young people who are going to the loo all the time during the night and, um, and it can become just this habit. It's like, oh okay, it's two in the morning, my body knows that it's time to wake up. Go to the loo, come back again and when you look at it, actually they don't need the loo, um, necessarily, it's really that they're just kind of used to. It's like a groove. You know, your body is just understanding that this is what I'm supposed to do right now and is this a thing, right?

Dr Liz White 23:37

so when I've had periods of um not sleeping very well, uh, I realized that if I look at the clock, if I have a clock in my room, or look at my phone I know you shouldn't have your phone by your bed, but I do um and and you, you sort of you know, if it's like two in the morning or something, then the next night you're more like I'm more likely to wake up at 2am, even if I've. You know, yeah, because I've looked at the clock and I sort of realized this years ago and realized I've just got to not look at the clock and then hopefully the next night I won't wake up at the same time. Is that a thing or have I just made that up?

Dr Maja Schaedel 24:12

No for sure. So this again, it's all to do with this like incredible body clock that we have and you know, there's all sorts of things that affect our body clock, or circadian rhythm of uh, things that affect our body clock, uh, or circadian rhythm, and you know, and there's a bit in our brain, the suprachiasmatic nucleus, that helps to control this and it and it helps to understand what light is coming in, um, and that helps us to know what daytime is or if it's nighttime. But also it also controls the release of different hormones. So, like melatonin, which is like that sleepy hormone, and we tend to have that produced naturally and released in the early hours of the evening when the sun is going down, um, but we also know that cortisol is produced in the morning. So there's different functionings of our brain to help us to understand when we need to be awake and when we need to be asleep, right, and that body clock can help us to remember what time it is.

Dr Maja Schaedel 25:09

So people often say, you know, I have this experience where I'm waking up at the same time each day and I haven't got an alarm on, but my body is just waking up at the same time and again, it's this learnt this kind of habitual. My brain has clocked it that this is the time that I now wake up and look at something. And, interestingly, if you have a clock or a phone or something that tells the time it and you look at it during the night, that in itself can spike a reaction in your stress hormones. And so if you were to see it like three in the morning and you were really hoping it was seven and you'd had a really lovely long sleep, you could imagine being really disappointed and frustrated.

Dr Maja Schaedel 25:50

And often people say they feel really angry and annoyed and they turn over and their partner is sleeping brilliantly next to them and you know the road is quiet and everyone just know that even the foxes are asleep and you're feeling like how is this so unfair? And you know it just has such an impact on us when we see that time so that for that reason we suggest people leave their their clocks out of reach. But again, you know, if you don't have a sleep problem I don't think it's it's an issue like all the the kind of sleep hygiene advice I think is really to help people get the best sleep. But a lot of people don't don't need to, you know, they just sort of sleep brilliantly and and uh, and I have lots of patients who are very envious and you know, find it really hard when they hear about people who sleep so pretty at night.

Dr Liz White 26:37

But yeah, if you don't need to you don't need to, because I guess in our line of work well you know we see lots of different people, don't we? And certainly in my, in my experience working with people with depression, anxiety, stress, a lot of people over the years have said I wake up at three in the morning or four in the morning and I cannot get back to sleep, and that that in itself can be really distressing someone because it it has a bit of a cascade effect in that you know, if they're then getting up at four am, they've got a long day ahead of them. That can really impact their mood. And I guess I'm really interested in your thoughts around just that particular thing like how would somebody manage that? Because I wonder if what I've been telling people over the years is wrong or whether it would just be interesting to see what you'll say about that.

Understanding Sleep Efficiency

Dr Maja Schaedel 27:34

Well, I think that, you know, often people say, uh, oh, that's not insomnia, because I'm fine going to sleep. But actually that is, that is insomnia, because insomnia is essentially struggling to either fall asleep or staying asleep. And so I think that the waking up in the middle of the night, you know, at three or four in the morning, is a huge issue and probably, you know, in some ways more distressing Because, like you say, it's like the clock is on and you're just running out of time to get the rest that you need. So there's a few things that are worth thinking about when that happens. First of all, I really would ask the question is it a woman in her 40s? Is she perimenopausal? And the reason I say that is because that's often when women start to really struggle with that particular issue. They don't often struggle falling asleep in the first place because they are exhausted, but they do wake up at three in the morning and struggle to get back to sleep, and, and largely the reason for that is because of the increase in your vasomotor symptoms.

Dr Maja Schaedel 29:20

So things like hot flushes, night sweats, your body temperature goes up and in order to fall asleep, we need our body temperature to come down by one to two degrees. We we also need a whole load of other things to happen, which which, generally speaking, they do that. We need our breathing to to calm down, we need our heart rate to slow down, we need our muscles to relax, but we also need to get cooler in our core body temperature. And if you find that you're just sitting on the sofa in the evening, this, this could happen. Naturally you might find you get a bit chilly, want a blanket around you, want your slippers on. This is your body getting ready for bed, right. But when you're perimenopausal, you get these spikes in high temperature and and your body feels hot, um, so that can really just wake up people. And, of course, once you're awake, then there's other factors that click in.

Dr Maja Schaedel 30:13

So, again, if you're perimenopausal, your anxiety levels often go through the roof. So people start to experience anxiety when they've never had anxiety before. You start to worry about not coping the following day, worrying about feeling overwhelmed day, worrying about feeling overwhelmed again. That's another feature of the perimenopause. Women just describing that they you know the things that they used to be able to manage. They're no longer feeling able to manage like the multitasking that they were so good at is now gone, you know gone. So I would ask the question you know, are they in their 40s essentially, which is when the main, that main perimenopausal period happens? And it's all to do with the fluctuations in the in the female sex hormones, in estrogen and progesterone. So that's one thing I would ask and there are certain things you can do for that. So I would really recommend them speaking to their gp and maybe think about, you know, hormone replacement therapy is a really popular option. Now, of course, that that's not the only thing, but it's worth just kind of considering it and knowing what your options are when it comes to that stuff.

Dr Maja Schaedel 31:15

And the other thing that I think happens more and more is that we get our timings of sleep really messed up. So it feels counterintuitive to say, okay, if you're sleeping badly, delay your bedtime, don't get an early night, but essentially that's exactly what you should do. So to say, ok, if you're sleeping badly, delay your bedtime, don't get an early night, but essentially that's exactly what you should do. So one of the things that people really struggle with is that they're so tired, you know, if you've been awake since four in the morning and you have a day at work and you're having to cook dinner or sort out the kids or whatever it is. Then you get to sort of eight in the evening. You put your feet up, maybe you've had a glass of wine, you're on the sofa and people fall asleep really easily, yeah, so I would say that if you're falling asleep, that's me. Add to everyone. Liz, you know it's so easy to do, but the problem is there's research that shows there has a disproportionate impact on your sleep at night.

Dr Maja Schaedel 32:14

So essentially, even if you're just dozing off for 15 minutes, say, it has a really big impact on your sleep at night. And that's partly because, in order to sleep well, we need something called sleep pressure, which is really like tiredness that builds up during the day. So the longer you are awake, the more pressure you build up, and when you go to sleep this gets flushed away again by that glymphatic system that we were talking about earlier. So we have this sort of process of building up sleep pressure, which is associated with a byproduct in the brain called adenosine, and then during the night this gets flushed away. A byproduct in the brain called adenosine, and then during the night this gets flushed away. So when it comes to having enough sleep pressure at night.

Dr Maja Schaedel 32:57

Generally speaking, if we're tired enough, we've been active enough, we have enough sleep pressure to fall asleep even if you've dozed on the sofa at eight o'clock for a few like 15 minutes or so but do we have enough sleep pressure to see us through the night? And that's the problem. So the dozing on the sofa, I would say then and this is kind of like naps as well if you're napping, if you're falling asleep earlier on than when you're actually going to bed, at sort of half 10, 11 o'clock or whenever it is, if you're sleeping earlier than that, you're going to be impacting on your sleep at night and the quality of the sleep that you can get at night. So, generally, one of the things that you can try to do is to stay awake in like throughout the whole day. So I'm talking like feet on the ground, like back against the sofa, rather than the feet up you might want to.

Dr Maja Schaedel 33:50

Sometimes wine or alcohol can make people feel more sleepy, so maybe just think about, uh, reducing that or like moving it earlier in the evening. And, generally speaking, it's good to stay awake as long as you can, and then when you can't, it can't stay awake any longer and you feel your eyes drooping. You then go to bed. But it means that you might actually find that you've got a better quality of sleep at night and you're not waking up at three in the morning. And there's one more thing that I think does get in the way is when people fall back to sleep really late on in the morning. So they've been awake at, say, four in the morning, but then they might fall back to sleep at sort of seven and then they might sleep for another hour or two and then that again have a knock on impact to your sleep pressure building up the following day. So I would just say you know, it's just about having a really regular wake up time as well.

Dr Liz White 34:52

OK, and someone who let's say, someone listening is that person who is sort of regularly waking up at like two, three, four in, but doesn't normally get up till seven, say um, and it's really impacting their, their lives. Are there any strategies that you would like, a you know, a great strategy to kind of help get them either back to sleep quickly or I know you said all about those some great tips in terms of like let's, you know, we'll think about the book, you know, before you even get to bed. But is there anything they can do at three in the morning when they're wide awake lying there?

Dr Maja Schaedel 35:17

yeah, yeah, absolutely, um, oh, it's so. You know, this is actually one of the reasons why I ended up getting pulled into sleep and stuck in sleep. It's just because I think that that experience of being awake at three in the morning is so devastating, um, and I really have always just felt for people so much. So I think there's one thing I would say is to do is to do something different.

Dr Maja Schaedel 35:39

Basically, if you're lying in bed and you're not falling back to sleep easily, you know, definitely try getting up and uh and reading a book, doing something restful, remember, in order to kind of sleep. It's like you can't go to sleep if you're feeling really anxious and unsafe. So if you can somehow find a way of getting back into a place of feeling safe and I find that reading a book is really good to that, people sometimes find listening to music One of my favourite ones that someone used, which I really loved and I think is a really good one, is especially in the summer months is actually just opening their back door and kind of getting a breath of fresh air and looking into the sky, looking at the stars and actually taking a moment just to kind of, yeah, take a step outside of their brain and that kind of flustered, frustrated place that they can get sucked into.

Strategies for 3am Wake-Ups

Dr Maja Schaedel 36:33

So really, the goal of the getting up is to shift your mentality, shift your physiological state and take yourself away from that kind of worked up place. So I do think that that's worth a go. Sometimes it doesn't work and sometimes people say to us I've really tried that and it makes me more anxious. You know, getting up in the middle of the night, um, and for those people I would say, you know, okay, well, we don't want you more anxious. Um, maybe it's about propping your pillow up in your bed and listening to a podcast or listening to an audiobook or doing a relaxation strategy. Um, you know, and people like often have subscriptions to karma or a head space and they can be brilliant for this kind of thing.

Dr Maja Schaedel 37:18

My absolute favorite one that I think is really effective for people is, you know, the progressive muscle relaxing exercise, where you're squeezing your muscles and relaxing them, just that sort of systematic tensing of your muscles and releasing the, the tension, because I think it distracts you away from those really difficult thoughts that you get pulled into, but it also allows you to focus on relaxing your physiological self rather than that kind of cognitive self. So I find that a brilliant one to use, but I do, I think, any kind of anything that brings you to the here and now. I do one. In my practice I use a lot of acceptance and commitment therapy, and one of the ones that I use is a kind of grounding exercise in the bed where you're focusing on the touch of your sheets or like the feel of your pyjama, like butter Classic. Oh, that's great, yes, so I really like that.

Dr Maja Schaedel 38:14

Anything that can kind of bring your attention back to the here and now and take you away from those panicky thoughts. And then the last set that I'd say that worked really, really well is the kind of thought diffusion exercises where you're trying to help your brain understand and remember that your brain doesn't always get it right and that your brain is telling you right now that it's worth panicking about and you're going to be overwhelmed tomorrow and you're going to not be able to cope. But maybe this is one of those examples of when your brain is panicking you to try and keep you safe, but actually it hasn't got it right and actually you'll be fine and actually maybe what's best is to try and disengage from that thought and actually bring it back to something else.

Dr Maja Schaedel 38:51

So I think those sorts of strategies work really well as well.

Dr Liz White 38:54

Yeah, I use that a lot because a lot of people sort of end up in absolute fear of sleep or not getting to sleep. Sorry, so it's, you know you, and it only takes like a couple of nights, really, for some people to kind of get into that headspace of utter anxiety that they're not going to be able to manage. And you know, I guess I think back to when my kids were babies. You know, I guess that's the time in my life where I've experienced long term sleep deprivation, which most parents do, I think, to some extent, and it's very easy to slip into. I'm really worried about not sleeping and how am I going to cope with everything that I've got going on? And it's working on how to not engage with those anxious thoughts at three in the morning or whenever it is, because that, as you so eloquently said about the cortisol and everything else, it just puts you into that kind of threat mode of function, doesn't it? And is is the opposite of what you need when you're trying to get back to sleep.

Dr Maja Schaedel 40:00

It's so, so tough for people you know you're so, you're so right, and I do think that that is one of the biggest kind of reinforcing factors that occurred in insomnia. It becomes the fear of not sleeping and that itself, like you say, and the problem is like we all know that it is important and you know that it actually does affect us, so it's. This is why I find some of the CBT strategies not not overly helpful always, because it's like trying to convince yourself of something you know isn't true, like actually if you can't sleep or you haven't slept, you do feel bad, and if you haven't slept well, it can really impact on how much you enjoy something the next day. So I think that there's a kind of reality to not sleeping that is really, really hard and actually this is what we remember in the middle of the night and one of the reasons we do remember that is that between the hours of 1 and 4 am we're much more irrational and this is partly because our frontal lobes shut down but yet our amygdala is kind of firing, yeah, and we are sort of really engaged. So we sort of feel much more alarmed and inert and threatened.

Dr Maja Schaedel 41:14

But our ability to rationalize that and actually say do you know what. I think I'm going to be all right, it's, it just doesn't happen. So I really think that it's a massive issue and um and like you, I mean I had had an experience of when I had a know and I had a baby who didn't sleep well, and that was actually my one experience of insomnia was, you know, the not really thinking how much, not really feeling confident that I'd be able to cope if I hadn't slept, and that fear and that sort of sense that if I don't sleep I'm not going to be able to I don't know be the best mum ever or whatever it was that I wanted, whatever standard it was I had in my head that I had to meet, I think, is enough to really it's enough to keep you up. So I do think it's really difficult.

Dr Liz White 42:04

That one, yeah, and I guess that takes me to a question I wanted to ask you about the link between mental health and sleep. I guess, sort of the way that I think about this is that it's difficult to know the cause and effect, isn't it? Because, um, you know, if you're stressed, that might impact your sleep, um, but then you sleep less and then you get more stress. So, yeah, I'd be really interested in your thoughts about how mental health does impact our sleep.

Dr Maja Schaedel 42:32

Yeah, I mean, that's the sort of one area I think that we just know it, that sleep and mental health are so sort of tightly bound together. And, um, you know, like we were saying at the beginning there, the impact on sleep when you have an anxiety or depression is huge. So we know that when we're down and depressed it affects sleep. We know that when we're anxious it affects it affects sleep. We know that when we're anxious it affects sleep. I think what's been more interesting is the more recent research which has really shown this very strong link that goes the other way, especially with anxiety, and that actually we can have a sleep problem that can then cause us to feel anxious. And that really fits with what a lot of patients say. They really do say you know what? I think this started with a sleep problem and now I'm really scared about how I'm going to be able to cope. I think it's a really interesting one because, of course, if we were able to really address sleep in a meaningful way in the NHS, I'd be interested to see what the impact would be on anxiety and depression. But you know sleep difficulties, they don't just affect anxiety and depression. I think there are sleep difficulties present in every single mental health diagnosis that sleep is disrupted and I think you know, again, it's a bi-directional relationship. So one of the things you know I talk to my patients about is that it goes both ways and so if you don't sleep, of course it's going to make you more anxious and low the next day, and if you're low and anxious the next day it's going to affect your sleep and we get into this big sort of vicious circle. So I think it can be helpful for people to know that thing. But also we know, actually there's a lot you can do to improve sleep. So actually you know something like CBT for insomnia has a brilliant evidence base and is actually, you know, the gold standard of treatment that we can offer.

Dr Maja Schaedel 44:24

And it's actually, again, one of the reasons why I really got stuck in sleep was because I really felt like this was one area that it really did work. You know people did actually start sleeping. If you, if you do CBT-I, so I think that if you can fix sleep, so but you can essentially really improve mental health. So I always ask, and I think the thing to ask people in assessment is what is the area of your mental health which is affecting you the most, and it's a really interesting one because I work with lots of people with trauma and even for people with post-traumatic stress disorder. You'd be surprised how many people say if I could just fix my sleep, I actually think I would find the rest of it more manageable. So sometimes I think it's actually about it can be more appropriate just to start on something like CBTI, which can actually be done in quite a relatively small time frame, and then the rest of the the other difficulties can then sometimes feel like they click into place a bit more, you know.

Dr Liz White 45:24

I mean, everything that you said today is just fascinating, and I'm really interested in your top tip for getting good sleep. So out of all the all the knowledge and experience that you have, you have to choose one. No, but just like what? What would you say to people listening who maybe are struggling with their sleep a bit in different stages of life? Like what is something that they they can do to help themselves?

Dr Maja Schaedel 45:50

oh miss, you're really putting me on the spot to just have a fun.

Dr Maja Schaedel 45:55

Can I get around it by saying that I'm choosing between two and then, okay, is that a cop-out? Yes, no, no, it's not at all. Um, so, on the one hand, the really practical thing that I think people can do is often actually just to top and tail their sleep, and what I mean by that is going to bed a bit later and waking up a bit earlier. So what that does is it improves your sleep quality and if you'll spend essentially improving your sleep efficiency as well, potentially because if you spend less time in bed, that time is hopefully then going to be more likely to be asleep, and then you're setting up really healthy habits for your, for your sleep and your body and your brain yeah, so I would say, essentially, going to bed a bit later. If you're struggling with your sleep and you're finding your you know lots of insomnia, I would say, go to bed a bit later, maybe half an hour later, and wake up half an hour earlier. Okay, just to give that a go. I think that can really really help.

Dr Maja Schaedel 46:50

And then the other thing I think is more of a kind of approach to sleep and and I would say that the approach that I think is really that is really helpful is one of acceptance and I know that that there'll be people who'll sort of roll their eyes and, oh goodness, you know, that's just so hard to do and like really one of those things that you feel like people can say, oh, you just got to accept it, as if it's like this easy thing to do. But I don't mean a kind of accept that you're having no sleep kind of acceptance. I mean that in the middle of the night, if you can't sleep, one of the things that keeps people up more than anything is the fight, it's the tussle, it's the struggle and I would say just being able to almost step away from that and just allow it to be there. I use this personally. I often sort of say what will be will be, you know when it comes to sleep remembering that actually sleep.

Dr Maja Schaedel 47:40

Funny enough, we don't get to control sleep. We don't get to control how we fall asleep or or when we fall asleep. It's really helpful to remember that, like to actually relinquish control there, because it will be what it will be. We can't. Unless we're being sort of knocked out by some heavy sedative. We generally can't actually control our sleep. So I would really encourage people just to lean into that and just to feel like you know what tonight will be, what it will be, and if I don't sleep that well tonight, it will mean that I'll probably sleep better tomorrow night. Yeah, and actually just yeah, allow yourself to accept that.

Dr Liz White 48:13

It's just not in your control what I often say to clients and to myself when I'm having trouble sleeping sometimes is taking the pressure off getting to sleep and actually shifting more to I'm just going to rest tonight. I'm just going to rest. I'm going to rest my body and my eyes and my mind and if sleep comes, great. But that's what. I'm just going to rest tonight. I'm just going to rest. I'm going to rest my body and my eyes and my mind and if sleep comes, great. But that's what I'm focusing on rather than getting, as you say, getting into that struggle with oh my god, I've got to go to sleep. Yeah, it just doesn't help sometimes, isn't it?

Dr Maja Schaedel 48:44

yeah, I think that's a really good one, absolutely like taking the pressure off the need to actually sleep and just change it. Yeah, another one that I like which is a bit like that is almost I'm going to just enjoy being horizontal and lined out like how nice is that, after you've had like a busy day, just to be in a comfy space where you can just enjoy not having to do anything. Um, I think that's a good one, yeah yeah, well, well, thank you so much.

Dr Liz White 49:10

There's been so much value in this episode thank you so much for coming.

Dr Maja Schaedel 49:14

Thanks for having me. It's been really lovely to chat about it.

Dr Liz White 49:17

Liz, you're welcome. So last couple of questions um tell me why you you are passionate about sleep like, where does that passion come from?

Dr Maja Schaedel 49:28

um, well, that's a good question, liz. I think there's a few things that have led to me feeling passionate about sleep. Um, one of the things that I think, uh, is really important is that actually, as psychologists, I think that we are looking for areas that we can make a real difference. You know, I think that actually, when we find something where we feel like actually our skills really match with this or our skills are really suited to this, um, and I think, with sleep, this was one area that I, as soon as I started working in sleep, I just saw the difference it made, and I think that clinical psychologists in particular, I just think have the skill set because, of course, you've got a background in mental health, so you've got all the the kind of knowledge of working in mental health, but then you're also able to really focus on this specific kind of behavior change, um, using stuff that we actually know really works. So I actually just found that there was part it was something about being the fact that it was just being effective really. So I really that's partly why I got stuck in sleep.

Dr Maja Schaedel 50:41

I mean, in terms of my own experience, my own sleep, I often get asked that. You know, it's one of the things that um, people are most interested about, like I don't know if it's like a journalist or something like what do you do? You know, do you sleep well, or how do you sleep? Yeah and um, and you know, in truth, I do sleep well, um, but that's not to say that I don't have my own vulnerabilities when it comes to that. Like I I do, I do adopt, um, some of the strategies that I that I talk about, um, and I think that there's nothing worse than being up in the middle of the night and and like we were, we were talking about before, my one experience of having a few nights where I essentially didn't sleep at all and I had a newborn baby, I think, really affected me because I, in that moment, I was thinking, oh okay, I have to be on form, I've got this baby and I have to be a good mother, and I can't not sleep.

Dr Maja Schaedel 51:43

And in that moment, the thing that actually really helped me, in that moment and I was lucky that it didn't take too long but in that moment, the thing that actually really helped me, in that moment and I was lucky that it didn't take too long, but in that moment, the thing that really helped me was just taking the pressure off. I sort of identified that it was. What was stopping me from sleeping was this pressure that I had to be some sort of all singing, all dancing, like amazing mother going to baby yoga and, you know, keeping the house really nice and looking presentable, and just generally all the pressure that I felt, um, as a, as a new mom. And as soon as I just sort of allowed myself to not do that and I said, look, just look rubbish, don't cook anything. The house will go to pot, like, don't worry, like just allow it to be what it'll be, be in your pajamas all day long. Essentially, you'll be good enough, you'll be a good enough parent, in that moment, um, even if you haven't slept.

Dr Maja Schaedel 52:40

And I really do think that that was a sort of level of kindness that I offered myself in that moment, um, and I really it really helped me. I offered myself in that moment, um, and I really it really helped me to just go back to sleep, um. So I think that I think there is something, I think we're very unkind and I think we really lack compassion for ourselves when it comes to sleep and we can be so hard on ourselves and I, I suppose I think that as a psychologist, I want to be able to help people find that again, you know. So, yeah, I think it's. It's a combination, in a way, of just knowing the distress it causes when people can't speak and also feeling like I'm quite effective in that particular area.

Dr Liz White 53:21

I suppose you know yeah, yeah, I really resonate with that because of my experience with my kids my first child more so, um, it does really affect you, um, and I think I just remember thinking I just need to keep him alive, um, and I'm just going to focus on that, yeah, and everything else can just sort of, you know, fall by the wayside and you know, in the end it worked out, but yeah, it's tough. I'm really interested in what you said right at the beginning of when we started recording. You mentioned that you do Stalip retreats, so please tell me about that and can I come?

Dr Maja Schaedel 54:07

on one. Yes, absolutely. Oh, liz, I just love them. Yeah, we set them up. I think the first one we did was 2023, actually.

Dr Maja Schaedel 54:16

So it's been going a little while now and essentially I was speaking to someone who runs a spa hotel. Um, someone who runs a spa hotel and she was asking me if I might be interested in running a workshop or doing something on sleep, and I said, well, you know, what I really want to do, and have been wanting to do for some years, is to do a retreat where people can go to fix their sleep, and this has been largely um has been born out of what people have asked me that they want. So the amount of people that I've had that have said to me I can't fix my sleep at home, I just need to go somewhere. Do you know anywhere that I can go? And I really didn't like I just there's nowhere that in the UK anyway that you can go and and actually focus on sleep. There were a couple that were set up that were looking a bit more like a nice, you know, massage and some lavender scented kind of hand cream and things like that, that were more focused on a kind of relaxing experience, which I'm sure would be very nice. But you know, as a clinical psychologist I felt like I wanted something to be really effective. So I was like we've got all this knowledge about what we know, know really helps sleep and how can we deliver that in a really short period of time but in a lovely spa hotel setting. So we essentially came together and designed this sleep retreat and I just think it's it works really well. So they come on the sleep retreat and they stay in one of these six spa suites, so the the rooms themselves are around the spa. So they are. They don't have to hear the noises from the the old Tudor building of the hotel, like they are completely sort of immersed in the spa. Uh, they.

Top Tips for Better Sleep

Dr Maja Schaedel 56:12

We start by having like quite a chunky workshop where I'm actually going through all the strategies that I would really be wanting them to kind of think about, and it's like a whistle-stop tour of CBT for insomnia and an act, and I teach them some strategies. We do a couple of strategies, they go off and they the again. The program is designed to help them sleep, so it's it's actually quite active. There's lots of um exercise, because we know that exercise and physical activity are really good for sleep. Um. There's also relaxation as well, with things like uh, you know the, we do a breath work session, there's a yoga session and they all have an individual hour-long consultation with me where I'm doing a kind of bespoke um guidelines and recommendations for them individually.

Dr Maja Schaedel 57:00

So it's quite, it's quite tailored and they get quite a kind of um, they get a lot of information and they get a lot of time with me. Um, and then the following day, uh, they do some, we do more consultations and then on the final day there's another workshop, um, so I would say it's like really heavy on. It's the sort of thing that you could uh get uh from a psychologist over a number of weeks, I would say. But we've kind of tried to condense it but also to help them have this really lovely time, and I think we really just wanted it to be effective so that then, when they go away from the hotel, that they can take on those real the stuff that really works as opposed to the kind of lavender spray which you know doesn't have an evidence base.

Dr Maja Schaedel 57:48

So I think, um, I'm really, I'm really proud of that and it's been really popular, and so I now do about four a year. Um, yeah, we've got another couple towards the end of year this year and then, yeah, but they're really lovely, they're in Sussex and so they're in this beautiful sort of lovely area where you can go for lovely walks and there's a gorgeous outdoor pool and, uh, you know it's, it's a really lovely thing to do. So I, I, yeah, I think it's a nice way of trying to combine, um like psychology and evidence-based stuff with actually a really like relaxing experience which is designed for well-being. Do you know what I mean?

Dr Liz White 58:28

is it? I'm gonna guess that it's mostly women that go in the sleep retreats, is it it?

Dr Maja Schaedel 58:34

is, although funnily enough, last, both times there have been men. So the last time there were two men, um, in fact the last one, um, someone flew down from glasgow for it um having really again wanting to find somewhere that they could just go away, fix their sleep and then um go back to their life, you know, and I think there is a bit of a gap for that you know. So I think that you know, I, yeah, I'm pleased that we can sort of offer that to people and it is a really, it is really lovely and it's a lovely hotel as well.

Dr Maja Schaedel 59:05

So they're nice, peaceful there I think it's.

Dr Liz White 59:08

There is something isn't there about any sort of group uh intervention. Is that you're coming together with people who experience similar issues? Um, and there's. That can be just transformative in itself, can't it?

Dr Maja Schaedel 59:22

yeah, absolutely, and you know, we know that from the NHS, like those group interventions can be so powerful. But to encourage people to do them in a private world, I think is a bit harder, because I think you know there's all sorts of uh concerns people have about sharing that sort of, you know, their personal stuff. But I think the way that I I think this is in a way it's it's a, it's a great way of being able to access it because they're not required to kind of go into any uh depth of their own personal difficulties and it really is a kind of learning environment, um.

Dr Maja Schaedel 59:56

So, yeah, I'm, uh, I'm really, and there's a real range of ages as well, you know. Um, so again, we have people in their late 20s up to sort of people in their um, late 60s, 17. So there's a real age range, um, but, yeah, I'm, uh, I'm, I'm, I quite like the idea of also, as a psychologist, being able to branch out and do different things by folks like you, liz, you know, doing the podcast and yeah, and for me, like just being able to have another string to my bow, um, you know, because I really I love the patient work and I do lots of one-to-one work in the NHS and in my private work, but actually it's really nice to to actually do something a bit different as well, and I've been really, I've been really enjoying it, you know how are you fitting it all in?

Dr Liz White 1:00:39

I mean, you work in the NHS and you have a private clinic and you do sleep with you. That's a lot.

Dr Maja Schaedel 1:00:44

I know it is, isn't it? I mean, I don't know how do we all do it? I?

Dr Liz White 1:00:47

it's um.

Dr Maja Schaedel 1:00:48

I think I do get to points where I think I've taken on too much and then I have to sort of scale it back a little bit. Sure, one thing that I've, um, yeah, I've done a little bit more of recently, as I'm I've got some more associates that work at the good sleep clinic now, so I'm I'm trying to take on a little bit less um one-to-one clinical work privately now. Um, but yeah, it's um, yeah, it's tough to fit it all in.

Dr Liz White 1:01:11

You know, I don't know it's.

Dr Maja Schaedel 1:01:13

Sometimes I get it right, sometimes I definitely don't yeah well.

Dr Liz White 1:01:17

Maya, thank you so much for your time today.

Sleep Retreats and Professional Passion

Dr Maja Schaedel 1:01:19

It's been great talking to you yeah, and you, liz, thanks so much for having me on. I've really enjoyed it. It's been lovely you're welcome.

Dr Liz White 1:01:27

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