ADHD and Sleep – Episode 3 ‘ADHD, A Young Person’s Guide’

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Hosted by Dr. Blandine French, this podcast series focuses on attention-deficit/hyperactivity disorders (ADHD) and is designed to help young people and their families. We are delighted to produce this podcast series in partnership with Clinical Partners, the UK’s largest private mental health partnership.

This episode focuses on ADHD and sleep, and Blandine is joined by Emily El-Bahrawy, a young person with lived experience of ADHD, and Helen Tracey, a sleep practitioner with Parenting Special Children.

Helen begins by providing insight into the connection between ADHD and sleep, including why sleep is such a problem, and whether it is just bad sleep onset or if there is also an element of unsettled/poor quality sleep as well. Emily then shares her own experience of how her sleep is affected by ADHD.

Helen also expands a little bit about how poor sleep can exacerbate ADHD symptoms, and Emily shares how sleep difficulties and poor sleep has affected herself the day after a poor night’s sleep, including difficulties concentrating.

Helen and Blandine then discusses what the difference is between the sleep schedule of someone with ADHD, comments on how we can work with ADHD to both sleep better and wake up better, as well as shares tips on how to cope and adjust for times when we know we’re not going to get a good night’s sleep.

Furthermore, Emily and Helen each share three key takeaways to improving sleep with ADHD.

This podcast series for young people is supported by Clinical Partners. With the UK’s largest network of senior mental health professionals, Clinical Partners can help ensure your child has fast-tracked the right diagnosis and optimized treatment plan. For further information and advice for families and carers, search for Clinical Partners ADHD or visit their website.

Subscribe to ACAMH mental health podcasts on your preferred streaming platform. Just search for ACAMH on; SoundCloudSpotifyCastBoxDeezerGoogle Podcasts, Podcastaddict, JioSaavn, Listen notesRadio Public, and Radio.com (not available in the EU). Plus we are on Apple Podcasts visit the link or click on the icon, or scan the QR code.

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Other episodes in the series

Getting the Right Support – Episode 1 ‘ADHD, A Young Person’s Guide’

Adjusting to Change – Episode 2 ‘ADHD, A Young Person’s Guide’

Women and ADHD – Episode 4 ‘ADHD, A Young Person’s Guide’

Women and ADHD: Diagnosis & Management – Episode 5 ‘ADHD, A Young Person’s Guide’

Managing Impulsive and Risky Behaviour – Episode 6 ‘ADHD, A Young Person’s Guide’

Dr. Blandine French
Dr. Blandine French

Blandine has worked with parents of children with ADHD and adult patients for the last 8 years. She also received a diagnosis of ADHD as an adult which enabled her to go back to university to gain a degree in child psychology. Blandine’s main research interest in neurodevelopmental disorders, most specifically ADHD and Dyspraxia. Bio and image via The Institute of Mental Health Nottingham

Helen Tracey
Helen Tracey

Helen Tracey is a sleep practitioner with Parenting Special Children, a charity based in Berkshire. During this time, Helen has been involved in facilitating sleep courses for parents of children and young people, including teenagers who have neurodiversity, including ADHD. Helen has been involved in one-to-one sleep clinics with young people with neurodiversity, including ADHD. Helen also works part time as a Social Worker in a Short Breaks Service for disabled children. Helen is also a parent of a young adult who has ADHD, autism, and anxiety. Bio and image via Parenting Special Children

Emily El-Bahrawy
Emily El-Bahrawy

Hi, I’m Emily and I’m 22. I’m currently in a gap year doing volunteering before starting psychological and behavioural science at Durham University. I was first diagnosed with ADHD in November of 2021 during college studies, and I also have a diagnosis of PTSD and experience with child and adult mental health services.

Transcript

[00:00:30.360] Dr. Blandine French: Hello and welcome to ADHD, A Young Person’s Guide. This podcast series focuses on attention-deficit/hyperactivity disorders referred to as ADHD, and is designed to help young people and their families. Do please subscribe to this series of podcasts. All the episodes include, Adjusting to Change, Risky and Impulsive Behaviour, Getting the Right Support, and a two-part special on women and girls.

It is produced by the mental health charity, the Association for Child and Adolescent Mental Health, ACAMH for short, in partnership with Clinical Partners, the UK’s largest private mental health partnership. Search for Clinical Partners ADHD or visit www.clinical-partners.co.uk for more information. I’m Dr. Blandine French. I am a researcher at Mindtech at the University of Nottingham. My main research interests are on neurodevelopmental disorders, but more specifically ADHD and dyspraxia. I work with young people and parents of children with ADHD, and I myself received a diagnosis of ADHD as an adult, which helped me make sense of my life as a child and adolescence, and helped me go to university and put the right support in place. This podcast will focus on ADHD and sleep.

Sleep has a huge effect on mental health, and many of us with ADHD can have sleep issues. An estimated 25% to 50% of people with ADHD experience sleep problems, ranging from difficulty falling asleep, waking up multiple times, prone to insomnia. You might experience hyperfocus, with racing thoughts and burst of energy that makes it difficult to settle down for sleep. And it can lead to a disrupted sleep-wake schedule. Those of us with ADHD can experience being tired during the day as a result of poor sleep, whilst other experience restlessness, non-refreshing sleep with multiple awakenings. And these can affect cognitive functioning as well during the day.

We’ll be looking at some of these problems with tips, advice, and strategies that can help you and your family. And today, I am delighted to be joined by Emily El-Bahrawy and Helen Tracey to talk about sleep and ADHD. Emily, can you start with a brief introduction of who you are and what you do, please.

[00:02:46.230] Emily El-Bahrawy: I’m Emily. I’m 22. And I am currently taking a gap year, but I plan to study psychological and behavioural science.

[00:02:54.690] Dr. Blandine French: Brilliant, thank you. And Helen, could you give us a brief introduction of who you are and what you do?

[00:02:59.580] Helen Tracey: Hi, I’m Helen Tracey. I’m a sleep practitioner with Parenting Special Children, a charity-based in Berkshire. And during this time, I’ve been involved in facilitating sleep courses for parents of children and young people, including teenagers who have neurodiversity, including ADHD. I’ve also been involved in one-to-one sleep clinics with young people with neurodiversity, including ADHD. I did my training through Southampton University Sleep Disorder Service. And I’ve since undertaken further training with the sleep charity and Cerebra. I’m also a parent of a young adult. He has ADHD, autism, and anxiety.

[00:03:45.090] Dr. Blandine French: To start with, Helen, can you tell us a bit more about the connection between ADHD and sleep? Why is it such a problem?

[00:03:53.050] Helen Tracey: So, the connection between sleep and ADHD is highly complex. And I would say that more research is needed to discover exactly why certain sleep disorders are associated with ADHD. But there is some evidence that the body’s sleep-wake cycle, is also known as the circadian or circadian rhythm, plays a really big role. Sleep-wake cycle essentially tells us when to go to sleep and when to wake up. This sleep cycle is delayed in some people with ADHD, so they’re naturally more inclined to go to bed later and wake up later. There is some research linked to this that indicates that the production of melatonin, which is the hormone that helps to regulate our sleep-wake cycle, that this is delayed, the release of melatonin is delayed in those with ADHD, hence why there’s this delay in settling to sleep.

[00:04:51.753] Dr. Blandine French: Emily, can you please tell us how is sleep affected by your ADHD?

[00:04:56.112] Emily El-Bahrawy: I think following on from what Helen said, a lot of it tends to be just never being able to get to sleep at the time where I need to be or where I want to be. I often end up staying up a lot later than I should do. It sort of ends up as a vicious cycle, because then I end up waking up quite early for whatever I have to do for the day, and so I haven’t had enough sleep. And often that just exacerbates the difficulties I have because of ADHD, if I was already struggling to concentrate.

I suppose in terms of actually getting to sleep in the evenings as well, I would say, sometimes I find I have this kind of nervous energy. And I think that energy seems to persist exactly when I don’t want it to. That’s probably quite a psychological thing. But yeah, it definitely just keeps me awake at the times where I don’t want to be.

[00:05:53.633] Dr. Blandine French: Thank you, Emily. And it’s quite interesting as well to see not just an issue with sleeping, is a knock-on effect it has the next day on your ADHD symptoms. And sleep deprivation and ADHD, have got a lot in common. It’s very similar symptoms. So, it’s really not a great mix at all. Helen, I’m just thinking, is it just a bad sleep onset, or is there also an element of waking up through the night and unsettled sleep, poor quality sleep, as well?

[00:06:26.160] Helen Tracey: I think beginning around puberty, young people with ADHD, they’re more likely to experience either shorter sleep time, so have less sleep, problems falling asleep, staying asleep. They are also at high risk unfortunately of developing a sleep disorder. And young people with ADHD often experience more restless sleep, including restless legs syndrome. According to the Sleep Foundation, 50% of adults with ADHD experience restless legs syndrome, which is where you have an overwhelming urge to move your legs. It can only be relieved by movement. And some young people have reported to me that it feels like they’ve got creepy crawlies going up and down their legs. But also, young people with ADHD can struggle with waking up in the morning, often because they’ve struggled to settle to sleep. And intrusive sleep where they lose interest in an activity, their nervous system then disengages in search of something more interesting.

Sometimes this disengagement is so abrupt that it can induce sudden extreme drowsiness, even to the point of falling asleep. So, they’re trying to contend with lots of different sleep issues. For many young people, part of the problem with having ADHD is that ability to switch off at the end of the day, and allowing their minds and body to unwind and relax, and then settle into sleep. And this is particularly difficult for people with ADHD. And we always say that ADHD doesn’t disappear at night. It affects the whole 24-hour period.

[00:08:14.413] Dr. Blandine French: Thank you, Helen. That’s really interesting. I’m just curious about one thing I picked up on. Emily, you said that it takes a long time to sleep, and Helen, you have echoed that as well. So, is it similar if you wake up through the night? If you wake up in the middle of the night for whatever reason, Emily, does it take a long time to go back to sleep then as well?

[00:08:34.470] Emily El-Bahrawy: In all honesty, I think at the moment, I’ve sort of agreed with myself to admit defeat when it comes to waking up. Because if I am awake, it does depend. I feel like there’s sort of a short period. It’s almost like if I wake up and manage to get back to sleep within like a certain amount of time, then it tends to be OK. But any longer than that, and it’s like I’m awake. That’s it. I’m alert. I’m awake. And getting back to sleep is so hard. And often, I just end up getting quite frustrated if I try and force myself to settle down. Yeah, that’s not great because then often I’m not getting enough hours of sleep. I suppose as soon as you try and force yourself to sleep, it becomes next to impossible to do it, so.

[00:09:20.275] Dr. Blandine French: Helen, I wonder if you could expand a little bit about how does poor sleep exacerbate ADHD symptoms?

[00:09:27.660] Helen Tracey: The symptoms of ADHD can make it really difficult to sleep. And poor sleep can then, as Emily said earlier, impact on ADHD symptoms during the day. So, we know poor sleep, as I said, can affect concentration, focus, make us prone to illness, affect our mood and our emotional regulation. It can make us more irritable, more accident prone, and can present symptoms that are similar to ADHD. So, if you have ADHD and you’re sleep deprived, then it can just exacerbate all of these symptoms, making it incredibly difficult to fall sleep.

You also touched, Blandine, about mental health, there’s lots of research that indicates that poor sleep can adversely affect mental health. And certainly, we see quite a high number of young people who have ADHD but also struggle with their mental health. So, they may have anxiety. They may have low mood or depression. And obviously, that lack of sleep again exacerbates those difficulties is the sleep deprivation impacting on the ADHD symptoms.

[00:10:46.315] Dr. Blandine French: Emily, again you mentioned briefly that you have difficulty concentrating if you have a poor night’s sleep. Is there anything else you would like to add and how sleep difficulties and poor sleep can affect you the next day?

[00:10:58.700] Emily El-Bahrawy: I think in terms of my mental health as well, I think I can relate quite strongly to that in terms of how the sleep– well, I mean, I suppose overall the fact that it exacerbates the ADHD symptoms means that it made worse the feelings I had towards myself, I suppose in a sense. Like in terms of– if I felt like I wasn’t getting things done properly, or if I didn’t have the concentration to get my work done and stuff like that, then often that just results in a lot of negative thought patterns.

And yeah, I definitely feel like in terms of anxiety, like that, I mean, already, there’s that nervous energy I get with ADHD, or the kind of feeling of being on edge a lot of the time. And without sleep, it was– I don’t know, it just tends to be just a million times worse. It’s almost like your body just cannot manage to deal with even the smallest of stimuli. Everything just feels very overwhelming. Or you feel like you want to just– I don’t know, I guess shut down, or maybe– not sure exactly what phrasing I would use, but it’s like I’m too exhausted to think about anything, but then I’m also so on edge that I’m thinking about everything. I don’t know how that’s possible simultaneously. But that’s what it feels like.

[00:12:21.073] Dr. Blandine French: Thank you, Emily. I can highly relate to that. I know exactly what you mean. I don’t know if the listeners will relate to that. Helen, what is a difference between a sleep schedule of someone with ADHD?

[00:12:33.000] Helen Tracey: I think we have touched on it. And I think it is very similar to sleep schedules for everybody. The ideal temperature for your room is between 16 and 18 Celsius, which is actually a lot lower than you’d expect. And the reason for that, and the reason people say have a bath half an hour before bed, is because by submerging your body in warm water, you raise your core body temperature. When you get out of the bath, your body temperature then starts to drop. That drop is linked to the release of our melatonin. So that’s why they suggest a cool bedroom as well because of that.

But I think there are some key things, I think there are some differences, certainly visuals and prompts can be really helpful. So, I’ve known a number of young people who’ve used alarms, whether it’s on smart speaker so that they’ve got a little alarm to tell them when it’s maybe time to start winding down or thinking about bedtime.

And visuals, just prompt, so it doesn’t mean pictures necessarily, but even just bullet point list of things that they need to do in that build up towards the bedtime routine. What we strongly suggest is one to two hours without gadgets before bed. And the reason for that is because the blue light that is emitted from gadgets, and gadgets will be televisions, laptops, mobile phones, Xboxes, games consoles, things like that, it impacts on the release of our melatonin. So, if we’ve already heard that there is this delay in the production of melatonin in young people with ADHD, really, they need all the help that they can get in terms of helping with that production of melatonin. And gadgets just don’t– they hinder the release of melatonin, melatonin being our hormone that helps to regulate our sleep-wake cycle. However, I’m always very conscious that’s easier said than done.

And the other thing I was just going to mention was music. So often, generally our sleep advice may be in a darkened quiet room. What I found with a lot of the young people who have ADHD that I’ve supported over the years, that doesn’t work for them. Because often it can become distracted by what is going on in the rest of the house. So, what we’ve found that has worked in the past is music. So, this is music possibly on a Wi-Fi speaker, or a Bluetooth speaker, because you don’t want to– if you’ve got the gadget in the room, you may be distracted and want to go on it and read messages, et cetera. Get something that plays music for 8 to 12 hours, so I’m thinking YouTube or something like that. So that is just playing on a loop. And the reason for that is– and I’ve wanted to pick it up because of what Emily said earlier, so we all partially wake, perfectly typical. Everybody does it. This is we’re coming out of our one full sleep cycle going into another, we come into partial waking. What generally happens in good sleepers is we roll over, we might mess about with our pillow, and we go back to sleep. But for people who struggle with their sleep, what happens is they come into their partial waking, and then they’re more likely to fully wake at this time.

And just a couple of examples, if you change the environment, this is likely to happen. So, if you go to bed listening to music, but it’s like switches off after an hour, when you come into your partial waking, the environment has changed so you’re more likely to fully awake at that time. So, what we suggest is keeping the environment as consistent as possible throughout the night. So that when you come into the partial waking, there’s more chance that you just rouse and then settle back to sleep.

[00:16:33.303] Dr. Blandine French: Thank you, Helen. And I’d like to add on that. As well as music, I mean, in a very similar way, I know a lot of the strategies that worked with adults is the white noise. So, whether it’s a river, or the rain, or whatever, I know some people get distracted by the melody of music. It just too distracting. But white noise is a bit more neutral than just a background noise that also works very well. Emily, have you got any things that work for you that you can have?

[00:17:03.130] Emily El-Bahrawy: I know for me, my sleep problems were a combination of obviously ADHD, which really explains why it started so early on, but I also experienced a lot of nightmares growing up as well. And I think that in itself is very difficult because especially in that time when you wake up. If you wake up from a nightmare, occasionally, you’ve got quite a lot of anxiety or adrenaline because of that stress if it’s a scary experience. And for me, in the evening, I find if anything that drinking a cup of coffee does not keep me awake actually makes me really quite tired, sort of act as a stimulant, but then also it lasts and then runs out a lot quicker than natural stimulants in your body. It is very bizarre the way that it works.

[00:17:55.630] Helen Tracey: I heard that before, Emily. I’ve got a colleague who has ADHD, and she can have a coffee at bedtime and it helps, whereas I’d be– yeah, I wouldn’t sleep if I had coffee at bedtime.

[00:18:10.127] Emily El-Bahrawy: I think obviously I still have issues, but that’s more down to the fact that I really struggle with being more strict with myself when it comes to actually doing these things. But I do know that they help. And predominantly, when you were talking about listening to things, I was thinking about ASMR, which isn’t a hugely talked about topic as of yet. Although it’s– I mean, in terms of the online community, it’s become phenomenally huge since I first discovered it when I was about 14.

And I suppose it’s just an alternative type of sound. But the idea of ASMR is that it stimulates this very relaxing feeling in your body, which a lot people get when people play with their hair, or when they get a massage, or things like that. It’s a very interesting– the science behind it is very confusing and not something I could explain, but it is just a very relaxing feeling. And the fact that there are sounds that you can listen to that can trigger that same response, I found that to be infinitely helpful. Often my challenge is purely just getting myself to lie down and listen to it.

[00:19:18.333] Dr. Blandine French: Thank you, Emily. So, we talked about how can we work with ADHD to sleep better. Helen, what can we do to wake up better?

[00:19:26.360] Helen Tracey: There are some things that overlap. And taken into account what Emily was saying about, it is really difficult. You know what you need to do, but it’s not always easy to do it. We talked a lot about routine. That includes a bedtime routine at night, but I would say that it needs to be flexible in the sense that there are certain things you have to do, but the order you do it for somebody with ADHD might be different each night so that they can get those tasks done. So, I think sometimes being too prescriptive backfires, and makes it incredibly difficult for people with ADHD to follow through with the routine.

The other key thing is the wake-up time. We know that young people and young adults with ADHD can really struggle to wake up. And the other piece of advice we give is to try and get up at the same time each day. If you’re really struggling and you’re trying to make changes to your sleep, that would include weekends and holidays.

Once you’ve embedded a good routine and things have improved, it could be that you could have a short lie in. The problem is, we often see– and I’ve seen this personally within my own household, they’re so early during the week, at the weekend, they’re so exhausted that they then stay in bed half the day. The problem with that is you then take away some of that sleep pressure, so the need to sleep at a particular time that following night. So, we do try to suggest, routine is really important. And that waking up and going to sleep at the same time every day is really important.

There’s been some studies that say that morning light, they’re going outside in the morning, whether it’s a short walk, or even in some natural daylight in the morning can really help reset our circadian rhythm, our body clock ready for the evening. And obviously, exercise or physical activity– again, not everybody finds exercise and activity easy, but there’s lots of research, as I’m sure you’re aware, that the positive impact not just on sleep, but on emotional well-being as well. So, trying to be as active as possible during the day can really help.

[00:21:46.033] Dr. Blandine French: Thank you, Helen. How can we cope and adjust for times when we know we’re not going to get a good night’s sleep, such as sleeping at someone else’s house, which has loads of different stimuli? When we know we’re not going to get a good night’s sleep, what can we do?

[00:22:00.540] Helen Tracey: Unfortunately, we can’t make up for lost sleep, hence why we say about not lying in. So, what I would say is we do live in the real world, and late nights occasionally because you’re going out and holidays, and what we say is sleep routine is really helpful. However, there are going to be times when that does go out the window. Don’t beat yourself up. I think it’s really important, and I think Emily touched on this earlier, about getting annoyed with yourself because you’re not sleeping properly. And it just adds to the pressure. So, take the pressure off. Accept that this is going to be, things are out of sync tonight. I’m going to get back on it. I’m going to deal with tonight. I’m going to have some fun. I’m going to relax and enjoy myself. And then the following night, I’m going to try and get back into some sort of routine.

[00:22:49.478] Dr. Blandine French: I think there’s also an important element that if you know you’re going to have a disturbed night, if it’s planned and you know that on Saturday night I’m not going to sleep well, it’s going to take some time to recover, what I find very useful is to make sure I don’t plan anything important the next couple of days. Because I know that the next day after a bad night’s sleep, I won’t be able to function properly. I thought that was very helpful for me to make sure even in terms of work, or studying, or my family, when I know something is going to happen, I’m going to get a full night’s sleep, the next day is cleared out.

[00:23:23.400] Helen Tracey: And in some situations, a nap can help, it’s just been really mindful with naps about how long you’re going to have a nap for. I mean, we usually say if you have a 20-minute nap, it’s like a power nap. Because you’re not going into deep sleep. You’re more likely to go into just your stage two sleep. So maybe a power nap might refresh you enough to counter the late night. But just have it earlier in the day, so not late in the day because it will affect obviously settling to sleep that night.

[00:23:54.780] Dr. Blandine French: Thank you, Helen. So just to summarize, what are the three key takeaways to improving sleep with ADHD? If I start with you, Emily.

[00:24:04.790] Emily El-Bahrawy: Firstly, it would be to not– well, we’ve briefly gone over it, but just not stressing yourself out too much over the whole situation. Because becoming frustrated, or annoyed, or feeling disappointed, all of that just makes it far worse to try and manage. I would say then moving on from that, I guess is just regularity, even if it’s just one or two things that you definitely do every night around the same time. I find having a daily routine to be immensely boring. So, I can’t do the same thing every day. But there are a select couple of things that maybe I will do in the evening, that– like, say, brushing my teeth at a specific time. And that I guess– again, the science behind it, I couldn’t explain. But I guess that kind of gives me that feeling of, OK, it’s kind of bedtime now, without putting too much pressure on myself.

And yeah, I think as the last thing, maybe allowing yourself to take a step back in terms of– for me, I find if we spoke a bit about how it becomes quite a vicious cycle with having bad sleep, and often because I’ve got lots of other things that I need to be getting done, like studying or need to get the groceries, or there’s all this stuff I’ve got to do in a week, it starts to become like a second thing, or it’s just perhaps not in my list of priorities. So, I guess all I would say is sometimes it’s OK to just be like, actually, I’m going to cancel everything I had planned to do today. Because otherwise, this is just going to continue. And I suppose giving yourself that opportunity to reset sometimes, and again, not being annoyed at yourself because you’ve come out of rhythm again, or something, because it happens. So yeah.

[00:26:02.200] Dr. Blandine French: Helen, what are your key three messages?

[00:26:04.750] Helen Tracey: So, I think, and I know this goes against what Emily said in some respects, a routine, but it is what I was trying to say about a flexible routine. I think there is a need for some level of routine. And I think your teeth brushing is brilliant because that is like a sleep association. So, you associate brushing your teeth with going to bed, so at least some routine that works for you as an individual.

My next one would be relaxation. And I think this is linked to what Emily was saying about taking the pressure off. Because I think pressure– that pressure to sleep just really counteracts wanting to go to sleep and being able to get sleep. So, I think it’s just some time in the hour before you go to bed when hopefully you’re not on your gadgets. And that might be some self-care time. It might be some mindfulness or a relaxation technique that you particularly like, maybe some journaling if you like journaling, or positive thinking. Just whatever works for you.

And then my other one was the turning off the tech, which I know isn’t going to go down well with everybody. But we know the impact tech has on us. Because it isn’t just the blue light, although I talked about the blue light earlier. It is about– it can be highly stimulating, but it can also raise anxiety. I’m very conscious that people have got access to you 24/7 with our mobile phones, and that can be quite anxiety provoking. So yeah, if you can turn off the tech an hour before bed, it can be really beneficial both emotionally, but also for your sleep.

[00:27:51.028] Dr. Blandine French: Thank you very much. Thank you very much, Helen and Emily, for joining us today. That was extremely informative. Thank you for sharing your experience on this really problematic issue. Once again, our thanks go to Clinical Partners for supporting this ADHD podcast series. With the UK’s largest network of senior mental health professionals, Clinical Partners can help ensure your child is fast tracked the right diagnosis and optimized treatment plan. For further information and advice for families and carers, search for Clinical Partners ADHD, or visit www.clinical-partners.co.uk. For more details on ACAMH, please visit the ACAMH website, www.acamh.org, and twitter @acamh, ACAMH. And don’t forget to follow us on your preferred streaming platform. Let us know if you enjoyed the podcast with a rating or review, and do share with friends and colleagues.

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