Putting Sleep Back on the Agenda

Today we take a deep dive into sleep with the first CEO of the Sleep Health Foundation, Moira Junge, whose focus is firmly on raising awareness of the importance of ‘valuing sleep’ as part of a healthy lifestyle alongside regular exercise, a sensible diet, moderation in alcohol intake and smoking cessation.

Moira has more than 20 years’ experience working in clinical practice as a psychologist, has been on the Board of the Sleep Health Foundation for more than five years and has worked extensively with media outlets to promote the importance of sleep health. 

She was also part of the team that successfully advocated for a Parliamentary inquiry into sleep health. 

Regarded as one of Australia’s leading proponents into all things sleep. 

To find out more about how a better night's sleep can assist your overall health and wellbeing visit www.sleep.hif.com.au

Transcript

 HIF acknowledges the traditional owners and custodians of the land on which this podcast is produced. We pay our respects to Elders past, present and emerging, and to all Aboriginal and Torres Strait Islander peoples. The following episode contains general information and discussion about sleep treatments and advice and is intended for informational purposes. 

The individual variation within sleep is really significant and people need to really be aware of that.  That there's an individual, even your response to caffeine, you know, your response to light, your response to stress  and how it affects your sleep. So it's, it's multifactorial, it's complex. But the other good news in the pitch is that it's there's simple solutions available. 

And the biggest And the best one with that is that, you know, give it a priority and, you know, allow plenty of time for sleep.  Welcome to Sleep Easy with HIF. I'm your host Guy Rowlison. Glad you could join us.  In this episode, we speak with Moira Junger, the very first CEO of the Sleep Health Foundation. 

Moira has more than 20 years experience working in clinical practice as a psychologist. She's been on the board of the Sleep Health Foundation for more than five years and worked extensively with media outlets to promote the importance of sleep health.  She's also part of the team that successfully advocated for a parliamentary inquiry into sleep health. 

Regarded as one of Australia's leading proponents into all things sleep, I'm pleased to say she joins us today. Moira, welcome to the podcast. Hello Guy, well thank you very much for having me. I'm excited.  When you and I spoke the other day, you highlighted the importance of good sleep health and the uniqueness of sleep patterns. 

What was it that ignited your passion for advocating good sleep health and where did that stem from?  Yeah, it was a long story and I'll keep it short, but it was back in the day when I was actually a nurse first, back in my career in the late 80s to late 90s. And then during that time in 1994,  the Alfred Hospital opened their  first sleep disorder center.

So I started working there part time. It was a very much just a part time gig while I was studying to be a psychologist. And I fell in love with the field. I actually, when I was wiring people up to do their sleep studies. I had good chats with them and I realized the debilitation of people who weren't sleeping well.

And it was okay if they had obstructive sleep apnea because there was plenty of great medical doctors for that and sleep apnea, et cetera. But those that had other sort of sleep disorders like insomnia, nightmares, hypersomnia.  I realize and they realize  there was not really any behavioral treatments or there was just medication and a lot of doctors didn't know much about all those other things.

So I sort of had it in my mind then to start with my psychology career to specialize in sleep, which I did. And then maybe 10, 15 years into my career as a psychologist, I realized, well, clinical disorders is not the only thing I want to do. I actually want to get down the line or upstream, downstream, whatever, both to actually advocate for around awareness and education and prevention because that's and that's what I'll do for the next, you know, 10, 20 years, whatever I have left in my energy box in terms of, of my working career. 

So let's fast forward. Um, what led you to become CEO of the Sleep Health Foundation and why did they decide that? The time was right for a CEO. Yeah. Well, I was on the board, as you just said, I was on the board from about 2016 and really loving that sort of advocacy work.  And then there was discussions in 2021 around bringing in a CEO.

And I did think to myself, I'm, I'm going to put my hat in the ring. I was, I was a bit burnt out from psychology and that, and that the tsunami of stuff. I thought, I don't think I can, I could work 17 hours every day and not, not. not be impactful. I thought I could have a bigger impact.  So, you know, got the job, but the foundation at that time had just recognized, I think, on the back of Parliamentary Inquiry, which we'll talk about in a minute.

Um, just, there was just a momentum that we thought we have to get people on the ground because until that point, we were just a operational board  with maybe a, you know, some secretaries, one person, three days a week in  and the rest of us working very much full time in our daytime jobs. In the sleep field, either is, um, professors of medicine, professors of research, psychologists, et cetera.

There's a whole range of sleep experts, mostly on the board.  And then we've realized we've had to, you know, yeah, start having that dedicated staff to actually grow our foundation, to increase our visibility, to increase our impact, to increase the messaging and our reach. And so I was so privileged to, to be the inaugural CEO, which is coming up to nearly two years now that I've been in the role. 

Which leads me for those that don't know, uh, can you perhaps talk me through your role as CEO and that. more widely of the foundation. Yeah, so we are, what we say we are, you know, we are community facing in that we want to go direct to the public to say, hey, you know, do you know sleep's important?  Do you know there are some solutions?

We've got some resources. We want to do political and community advocacy. And we want to join up with the other people who are doing, we can't do the research ourselves, but collaborate and help with translation of dissemination of findings. So that's what we, that's what we do. And our very close organization we work closely with is the Australasian Sleep Association.

Which is the peak body for the professionals that work in sleep. You know, the doctors, the nurses, the researchers, the scientists  who, and I've been a member of ASA, a proud member and been very active with them as well. Since 1994, I was, I've been a member for that long. They've been around say 30 years and Sleep Health Foundation's been around, say, you know, nearly 14, like 2010.

So we were born out of them.  Um, and that's what, so they are sort of, but we have a bit of overlap, of course, and that's where we collaborate together and work, you know, we go to parliament together. We do submissions together, but they are, you know, we are, we have a different board, different funding sources, different constitution.

And, um, yeah, that, that we, we say that we're community facing, they're more sort of professional issues, guidelines, all that sort of stuff.  You were also heavily involved in the Parliamentary Inquiry, as we mentioned, into sleep health back in 2019, I think it was. Can you talk me through the push for that?

Yeah, well that was very much a joint effort of both organisations, a great example of where we work together. So both the Australasian Sleep Association and the Sleep Health Foundation. In about 2017, we went to Parliament House to launch this report that we had done, the Deloitte Access Economics had done.

And we Sleep Health Foundation commissioned them to do this report called a sleep on the job. And it was looking at, um, the, the productivity costs, I guess, of, you know, what, what's the, what's the financial cost? What are the, what's the impact on Australians in one year? It was 2016 to 2017. What's the cost?

You know, what's the cost of poor, inadequate sleep in Australia? And the number was mind boggling. It was 66. 3.  billion dollars in one year alone back in 2016 17 that we're talking well before COVID before we even knew that that was coming  and it was a staggering staggering amount of you know of money and that was a combination of well being costs both health health and well being costs like direct and indirect and um. 

You know, uh, productivity, loss of productivity costs and calculated on, you know, days off work and years of health and all those sort of complex things that I, I can't go into, but the report is very much available, you know, on our website, uh, and probably on Deloitte Access Economics website too, like, you know, call to sleep on the job.

So that, that, so then we launched that at Parliament House. I was part of the group. We went up there in 2017. Greg Hunt was the minister at the time.  And I was so convinced we were going to get our millions in, because he was really impressed. He launched it for us. He was very articulate. He was very concerned. 

Um, and that was 2017. But on the back of that, he did at least, he said, well, I think this is a serious issue. We're going to launch a parliamentary inquiry. It's like bipartisan, you know, parliamentary led.  Trent Zimmerman was the chair of that parliamentary inquiry.  So in 2018 and 2019, they sort of heard submissions, 130 or so people put submissions in around the country,  which is pretty good for, you know, back, back then too.

Like when sleep was, it's sort of an unknown thing, but obviously it's got a lot of traction at the moment.  And then in 2019, there was this, you know, The, the response was there from the, um,  they, they called it bedtime reading and it's, uh, that's, that's the parliamentary, it's, it's on the parliamentary inquiry website federally.

And there was 11 recommendations. So, so from that, there was 11 recommendations. And so, but so that, so the parliamentary inquiry was launched or was sort of stimulated by this Deloitte's access economics report that we, that we'd commissioned.  And then the. You know, there's 11 recommendations on the, wow,  this is it.

Like, you know, we're probably nearly 10 years in now with our advocacy and our work and both organizations and, and other organizations too and other, you know, Sleep Disorders Australia, which is a, you know,  a peer support, some patient support kind of group and many other individuals and other put, put submissions in.

But then of course, in 2020, when COVID hit  every single health person, state and federally had to just Drop everything and focus on that response, rightly so.  And then we haven't had any kind of traction or anything on sleep  until last year in say, I think it was August of 2023. We did have a response. 

Mark Butler and his team, the Federal Health Department,  did a response and posted it though, posted it quietly on the  Parliamentary Inquiry website. So we didn't have any fanfare or any media, you know, press releases or anything about it, but we did notice there was a response there, which we're very grateful for,  um, because the Parliamentary Inquiry, you know, there was 11 recommendations, but the Biggest number one recommendation was, you know, the committee recommended that the Australian government prioritise sleep health as a national priority and recognise its importance to health alongside fitness, or we, we would say, you know, physical activity and nutrition.

So that's huge. We all know that anecdotally, but for that to be in writing and then supported, that's huge for as a field to think, wow, this is what we wanted. We wanted recognition alongside the importance of nutrition and physical. Activity  for as a foundational sort of core pillar of health, because that's what we all know.

Everyone knows that everyone knows  from their children or from their own experience, such as how important sleep is, but we just haven't had it yet  in policy or legislation or, or, or funding, you know, in terms of, you know, public health campaigns.  The final report was held as a defining moment for patients, clinicians and health experts.

What were some of the key findings there?  Yeah, so that's the key one, which I've already mentioned, was just that it was recognised that was so, so, so well received. And another, the other ones were really relating to understanding that, you know, Safe Work Australia and the like, all industries relating to shift work, for instance, um, that they, Recognize it has to be unified or, you know, optimal shift structures, um, and to promote alertness, safety and productivity.

So there were things along the lines of that around, um, perhaps. And the other thing around the workplace safety was recommendation saying that should be nationally consistent because anyone listening who might know about, you know,  most things in this country that they're not necessarily nationally consistent, like things like within health and within, um, road safety, everything, guidelines for various things that do relate to the sleep field.

It's a sort of, very much a state approach. So that's been tricky. Um, the other key findings were, um,  access to treatments, particularly CPAP, like the, the, the, that all pensioner and healthcare card holders. with moderate to obstructive sleep apnea.  Regardless of their location, should have a free trial of CPAP, which is the Continuous Positive Airways Pressure.

Um, and that they should have free ongoing CPAP, because that's a huge issue.  Anyone listening who knows about CPAP, um, it's one of the, it is a common treatment for sleep apnea. But it costs around about 2, 000, or it used to. And a lot of, you know, a lot of people don't have access to that. Um, so that's been a good, it's another recommendation that's been accepted as well as a recommendation.

Um, and that other key findings were, one of my favorite ones is that there should be a recommendation eight, for instance, was that they should, they recommend that this, you know, the Parliamentary Enquirer recommended that.  Um, the Australian government in partnership with the states, territories and key stakeholder groups work to develop and implement implement a national sleep health awareness campaign.

So we haven't seen that yet. Have like if you think back to say, life being in a, um, slip, slop, slap, like the equivalent of those sorts of things we haven't had yet for sleep. So that's a recommendation. That's sort of the key findings with those sorts of things. I won't go into them all, but they're the key ones.

Um, plus we, I mean, I should probably shouldn't say they're the key ones because all 11 recommendations were, are important. Um, but that's just a snapshot of them all.  This episode of Sleep Easy with HIF is brought to you by the Health Insurance Fund of Australia. What if your health insurer gave you the freedom to choose? 

I know you mentioned that things were paused, rightly so, due to the pandemic. So where are things now? Because I was shocked to read that I think it was around 26 percent of workplace injuries are also attributable to inadequate sleep.  Oh yeah, absolutely. I know, isn't it? Isn't that extraordinary? And the road toll too, like things like, um, we know that  more than one person every day apparently, you know, falls,  dies on the road due to inadequate sleep. 

So,  um, so where things are at now is that although we've had a response saying that these sort of, we agree that these things are important and these recommendations are supported in principle,  there is, so we're still at a bit of a, uh,  nothing's changed yet,  but.  We have, I think that we have increased  our voice and we've increased our visibility as a field and that we will continue to advocate for, for these changes to happen across the board within sleep, not just with clinical sleep disorders or not just with road safety or workplace safety with, with the general kind of awareness as well, but the education and awareness and a preventative arm. 

So that's where we're at. So we're hoping like we will continue to do like pre budget submissions. We will submit another one and asking, asking for, for money and for grants and for collaboration to implement these things now, because none of them have yet been implemented, but really, you know, really optimistic and even having conversations like this and getting this out to your members, um, and people listening can just, and we can all just have shared optimism  because it won't just, because the thing about sleep, it's not just a health issue.

It's not, it's actually, it's about, it's social, it's emotional.  It's, it's in the preventative space, it's financial, you know, it's, it's health equity as well. There's so many things within sleep that it shouldn't just be in the portfolio of the health department.  It's kind of a, it's a very much a shared thing. 

And the other thing about sleep, I'm sorry to go, it's, it's the other thing too, is that it's, it's across the lifespan. Like it's the eight day old person  and their family, and it's the 88 year old person and their family that are very much impacted day to day.  By the amount of sleep that's been  received. 

And we all know that we're in the, in the midst of a mental health pandemic.  What's the relationship then between sleep and mental health? Uh, it's a bit of a chicken and egg scenario, isn't it? Absolutely. Yeah, it is very much. And we call it, yeah, it's got a bi directional relationship, but often, you know, colloquially we say, let's.

Chicken and egg that it's, it can be either, it can be both.  And until sort of the nineties and even more record, maybe more recently in the last, maybe last 10 years,  always being thought particularly that what I got taught in nursing school and psychology school and what medical doctors were taught, there was very much a perception and understanding.

That anyone with a sleep problem was pretty much just a manifestation of their mental state, like either their anxiety or their bipolar or their depression or, and that's why they've got sleep problems. But there's been very clear data from the 90s and as they more recently really just backed up all the time, it's very, very unequivocal that sometimes it could be that the  poor sleep itself  Is the trigger or the antecedent that, that, that precedes the first ever episode of mental health problems. 

So in that sense, it's chicken and egg, like, you know, some, and people know like in my long standing career as a clinician, and I'd see people like, you know, guy might come in for his first session and I talk about it with you and you would know, I'd actually say to you, what do you think came first? And you have a good sense.

You say, look, you know what? It was actually my anxiety. I think it's my anxiety. I'm a very anxious person, always have been, and I can see the relationship with my sleep when it goes off the boil.  Other people say, um, or, or, the other thing can be too, it's a very good triggering thing. Like people know when my sleep doesn't go so well, when I don't sleep well, I feel, I know that I'm about to actually drop into a bit of a different state.

So it can be a good litmus test for people with long standing mental health conditions, that their sleep is a bit, a barometer for them.  There's other people who say, you know what, I just. Yeah, I didn't sleep well, didn't sleep well, didn't sleep well from my teen years onwards. I just didn't think much of it.

I went to uni,  but then, you know, it sort of hit me. I started having quite significant depression, anxiety, you know, 10 years later, and I realized it was probably an accumulation of lack of sleep. And there's good data from that too, like long standing, um, looking, you know, long standing longitudinal studies looking at, um, particularly, say, this group of women.

It's a very famous, a good study that was done in Australia.  I think it was 10, 000 women looking at them in the year 2000 and then catching up with them every three years. And the people who didn't sleep well initially, but didn't have any mental health, you know, didn't score highly on mental health stuff.

But. but did tick the box. I didn't sleep well.  10 years later, they were so, so, you know, you know, five times more likely or there was, I should know the stats, but it was at least at least a big, big increase in likelihood of having anxiety or depression.  So we do know that it can work in that way. That sort of either it's, it can be a very much a risk factor for and a consequence of mental health problems. 

So what's the key thing you would say to people to get them to pay attention? to sleep, or necessarily, what would be your sleep pitch?  Yeah, well, yeah,  the sleep, the good, yeah, the, the, the summary of the sleep pitch is that,  A, do you, do you understand it's important, like, do you recognize it's, have this awareness, it's really important for your health? 

But the next thing to that is saying, but do you understand it's a lot of nuance too? There's a lot of individual variation, so please don't panic if you're a five or six hour sleeper.  You might be a good sleeper.  Oh, really? So yeah, you could be, but you, but you might be a nine or 10 or 11 hour sleeper and, and not be very healthy as well.

So there's this whole range, we know that range, a range of sleep, say six to 10 or so is considered normal healthy sleep,  but it's not really about duration either. There's a lot of focus on duration, but the sleep thing about sleep is really. the quality of it and the consistency of it, the regularity, the timing.

That, so I'd say to people there's a lot of all the fields I've been across in my health career.  The individual variation within sleep is really significant and people need to really be aware of that.  That there's an individual, even at your response to caffeine, you know, your response to light, your response to stress.

And how it affects your sleep. So it's, it's multifactorial, it's complex. The other good news in the pitch is that it's simple, there's simple solutions available.  And the biggest one with that is that, you know, give it a priority and, you know, allow plenty of time for sleep, but if you're not sleeping well. 

Don't panic. You know, give yourself the odd bad couple of nights bad sleep a week is probably okay. But if it's a consistent problem where it's interfering your quality of life, that you really feel like, I'm actually really distressed about my sleep. I feel like I can't function very well. Then you must.

you know, you must get some, get some support for that. And it might not, it might not end up being medication, might not end up being a machine, it might end up not being, you might actually just have some lifestyle  changes that can just be like little tiny tweaks around regularity of getting up for a certain time or what you're eating or cutting back on your caffeine, cutting back on your stress.

There's going to be some really simple things that make enormous differences.  The simple pitch is going to be hopefully like Slip, Slop, Slap,  that we'll have Moira Young and we'll not spend five minutes on the short pitch. It'll be a quick little, we can have  public awareness that's much more succinct than what I just went through, that recognizes that it's about the consistency.

It's about, there's a lot of individual differences,  but that it's highly important.  As someone deeply involved in sleep advocacy, I'd like to finish up perhaps  what's the most interesting or unexpected thing you've discovered about sleep throughout your career?  Yeah, probably what has surprised me the most,  um, is the, is that individual differences like that. 

And particularly if I could, the differences between someone with a sleep disorder already  and the difference between the public health messaging.  So if we say to someone,  um, hey, you need to go to bed at the same time, you understand, you know that the consistency is important.  Someone with insomnia already, they've got the condition insomnia, like it's diagnosable, it's been there for months, if not years.

I would not say to that person, go to bed at the same time every night. I would say to you, I would say, make sure that you go to bed when you're sleeping and tired, no matter what the clock says.  So it's very interesting. It's a really tricky thing that so much nuance is required  in that sleep is very different depending on whether you've already got a sleep problem. 

or not. So if someone has an eating disorder and it's been quite significant and debilitating for them and they went and saw someone about it, they'd be pretty disappointed if that person gave them a sheet of the healthy food pyramid.  They think, oh, I think I'm a bit beyond that. So that's a similar thing.

Sometimes people who have got a quite significant sleep problem,  And they go on Google and they look for some support and they get the equivalent of, they get some of those lists of do this, don't do that, some basic kind of sleep hygiene tips.  They're not going to cut the mustard if you're already down the track quite a bit.

So that's a surprise to me. And I think that's a surprise to everyone else to think, Oh, that's actually really helpful to know that, that I don't, I can't just. Google the millions of, you know, when you put in how to sleep well,  that's, so you have to actually understand that's quite a specialized thing,  but, you know, but in general terms, of course, you know, general basic common sense sleep hygiene tips are really good, but please don't, you know, keep sort of banging your head against a brick wall, doing those sorts of regularity, rigidity things, because once you've got a sleep problem and it's particularly if it's insomnia,  the thing you need to do is take pressure off yourself and ironically you sit up a bit later.

Not, not sort of give away the rules and throw the, and that's it. So that's a surprise to everyone. Often people used to wait maybe, you know, a few months to see me as a clinician and the first session they say, what you're telling me that  they're getting to bed at 10 o'clock at night because they want to maximize their opportunity for sleep and they want to improve their life.

And they've been, they've been really debilitated for years. And the sleep person tells them to get up, you know, to stay up till one o'clock. And if they're in bed awake to get up and go back to the lounge room, all these things are there. This is crazy. You're telling me to get less sleep. I say, yeah, in the short term, what we're going to do is change all that and make sure that every time you're in bed, it's a good experience and you're sleeping.

And if you're not, then you're out of there. And you do your worrying or you do your thinking or you do your reading, do it all out of the bed and you only come into bed for sleep, for sleep and really have that conditioned response that it becomes a really good, a good, healthy, safe haven.  If people want to find out more information or simply want to be a little bit, uh, educated about the Sleep Health Foundation, where can they, where can they go? 

I would love them to come to our website, which is sleephealthfoundation.  org. au and to look at our different range of sleep, um, healthy sleep topics and also sleep disorder topics. And to just to sign up to our newsletter, keep involved what we're doing, be part of the, part of the campaign, I guess, like to, you know, to be interested in what we're doing and, um, follow us, follow us on social media as well. 

And yeah, because the more. people we have behind us or the more people that are coming to the website that sort of helps us with our advocacy as well to, you know, to say that we have this sort of amount of reach and hopefully we can have more funding over time  to, to develop really good sophisticated programs along the lines I was talking about with, you know, identifying that nuance that's required. 

Best of luck with the work you and the Sleep Health Foundation are currently engaged with. And thank you not only for your insights, uh, but the time you've taken away from your busy schedule to spend with us on Sleep Easy.  My pleasure. Thank you so much for the opportunity, Guy.  The content provided on this podcast is not intended as a substitute for professional medical advice, diagnosis, or treatment.

If you have any sleep related concerns or questions, we encourage you to seek advice from a licensed healthcare professional or sleep specialist based on your specific circumstances.