Have you ever felt like you're trudging through mud, energy zapped, yet sleep just doesn't cut it? This enigma of fatigue is dissected with returning guest Angela Nauss, LMFT, as we traverse the often murky waters of mental health and its impact on our sleep cycles. We go beyond the surface-level symptoms to question the deep-seated connections between the two, sharing not only my own struggle with undiagnosed diabetes and debilitating back pain but also the broader implications of conflating physical symptoms with psychological issues without proper medical consultation.
Sleep isn't just a nightly routine; it's a gateway to overall well-being, especially for those with ADHD or shift work schedules. Our conversation shifts focus to the practical, as Angela and I spotlight the marvels of Cognitive Behavioral Therapy for Insomnia (CBTI), considering a fresh rebrand to 'neuro brain insomnia treatment' to capture its essence and deserved attention. We share an arsenal of tools, from sleep diaries to specialized apps, aimed to arm you with the strategies you need for a rejuvenating slumber. With evidence-based success stories, this therapy isn't just a passing mention; it's a cornerstone for those seeking to reclaim their night's peace.
Wrapping up, we confront the elephant in the room – the technical gremlins that snatched away a portion of our audio. In a pledge to uphold the integrity and quality you've come to expect, I extend my heartfelt apologies and commit to fortifying our future episodes against such mishaps. Remember, whether it's combating fatigue, fine-tuning sleep routines, or understanding the nuanced dance between mental health and sleep, we're here to journey with you toward a brighter, more rested tomorrow.
More about Angela Nauss, LMFT
More about James Marrugo, LPC:
https://morningcoffeecounseling.com/
If there are questions you want answered or topics you want me to cover, send me an email at
James.Marrugo@MorningCoffeeCounseling.com
Music by AlexGrohl from Pixabay
Have you ever felt like you're trudging through mud, energy zapped, yet sleep just doesn't cut it? This enigma of fatigue is dissected with returning guest Angela Nauss, LMFT, as we traverse the often murky waters of mental health and its impact on our sleep cycles. We go beyond the surface-level symptoms to question the deep-seated connections between the two, sharing not only my own struggle with undiagnosed diabetes and debilitating back pain but also the broader implications of conflating physical symptoms with psychological issues without proper medical consultation.
Sleep isn't just a nightly routine; it's a gateway to overall well-being, especially for those with ADHD or shift work schedules. Our conversation shifts focus to the practical, as Angela and I spotlight the marvels of Cognitive Behavioral Therapy for Insomnia (CBTI), considering a fresh rebrand to 'neuro brain insomnia treatment' to capture its essence and deserved attention. We share an arsenal of tools, from sleep diaries to specialized apps, aimed to arm you with the strategies you need for a rejuvenating slumber. With evidence-based success stories, this therapy isn't just a passing mention; it's a cornerstone for those seeking to reclaim their night's peace.
Wrapping up, we confront the elephant in the room – the technical gremlins that snatched away a portion of our audio. In a pledge to uphold the integrity and quality you've come to expect, I extend my heartfelt apologies and commit to fortifying our future episodes against such mishaps. Remember, whether it's combating fatigue, fine-tuning sleep routines, or understanding the nuanced dance between mental health and sleep, we're here to journey with you toward a brighter, more rested tomorrow.
More about Angela Nauss, LMFT
More about James Marrugo, LPC:
https://morningcoffeecounseling.com/
If there are questions you want answered or topics you want me to cover, send me an email at
James.Marrugo@MorningCoffeeCounseling.com
Music by AlexGrohl from Pixabay
Chopin bank. Hello and welcome to another episode of Mental HealthTheBullshit. I'm your host, james, and once again we have one of my favorite guests back. Go ahead and let the listeners hear your voice again.
Speaker 2:Hi, it's me, I'm back. It's Angela Knoss, lmft, specializing in PTSD and trauma.
Speaker 1:Thank you, angela. You had emailed me prior to the episode and had wanted to talk about mental health and fatigue. I found it really interesting that you brought this up because it's a very common thing for people in our space to talk about. A lot of our clients come to us with some level of burnout, fatigue, exhaustion, feeling tired, unmotivated or feeling like something is fucking off and they can't figure out what. And it was surprising that I never thought to talk about this, probably because for me it's so common and there's a lot of content out about fatigue and what to do about it. But I love the idea because I've never put any type of public content regarding this particular topic of mental health and fatigue. I've never done a presentation or blog about it or really anything on the podcast has actually touched it. So thank you so much for bringing this up.
Speaker 1:A lot of people deal with this. This is very common. If you and I see this at least several times a week, if not more, it sparks what a lot of people start counseling for in therapy and mental health treatment is fatigue. So before we get into deep diving about mental health and fatigue, let's define it From your perspective what is fatigue, and how does that impact a person's mental health?
Speaker 2:So I draw a line between and researchers do too between fatigue and sleepiness. So sleepiness is the term for when you're falling asleep in a place and a time you don't mean to. I don't know if this has ever happened to you. You're sitting in class or you're driving, and then fatigue is that feeling like you're moving through mud, like your body is tired, not necessarily that you want to fall asleep, but you don't have the energy that you usually do. Does that make sense?
Speaker 1:Yeah, I've actually experienced both. So in 2018, I did not know, but I was undiagnosed diabetic and I was super tired. My glucose levels were through the roof, I thought, and at the same time, I had a herniated disc I was trying to deal with and it was pinching my sciatic nerve. So I was going through just an incredible amount of like nerve pain that was basically never ending and I wasn't sleeping because I felt like shit. So then throughout the day, randomly, like I would fall asleep and I thought I was just tired, I was effectively dying from like not being on diabetic medication and I was fighting off. A diabetic coma is what really it was. It was a combination of both me being sleepy because I was not getting good sleep because I was in so much pain, and then also my undiagnosed diabetes was causing fatigue as well. So I had a healthy dose of both in 2018, prior to me getting my back fixed and getting on medication.
Speaker 1:Since then, I've been able to tell the difference between being sleepy and being fatigued, because me being a diabetic and eating really shitty food is different than me like lacking sleep or not getting restful sleep, and it is. There is a difference. You're absolutely right, and it doesn't feel the same. But the response is the same. You kind of just start losing consciousness regardless. One just doesn't make sense Right, being fatigued and just like kind of passing out throughout the day or feeling like you're going to feels different and you can't make sense of it, whereas if you know you don't sleep well, like you have ADHD or you have like a sleep disorder or you know you were just really strong out and just like couldn't fall asleep, it kind of makes sense but it doesn't feel the same like caffeine will fix that. When you're fatigued, like you like. That needs to be checked out on a more professional level if it's like chronic, if it's ongoing and consistent.
Speaker 1:So one thing I like to talk about one because my clients bring this up to me is I have poor sleep. I'm not sure why, like what are your thoughts? And I always preface it. I'm not a medical professional. I'm not a sleep expert. Mental health does impact sleep, but I don't know anything about the medical side. I encourage you, if you don't, if you haven't already, you know, find a professional on the medical side and get yourself checked out for a myriad of things. What do you want to talk about? I want to start there.
Speaker 2:So you know, we talked in a previous episode about how the trend in psychology over the past hundred years has come full circle and therapists are now back to seeing things in a very literal sense. So for a while we were talking about, like you know, maybe you have a stomach ache. Metaphorically, the stomach ache is like caused by your depression or trauma, whatever trauma symptoms, and we are now literally back to like 1925. The trauma resides in your stomach and you need a stomach intervention to cure your PTSD, which you can guess, for me, giggling, I think is complete garbage. I think you know 1925 should stay in 1925. That being said, there are 100% therapists you could go to today and you could be like I'm having trouble sleeping, like you could give them your diabetic symptoms, and the therapist would be like you need PTSD therapy. I bet EMDR would fix this.
Speaker 2:The first place you need to start is go to your doctor and I tell people that I work a lot with conversion disorders. It just comes with the territory of trauma. Conversion disorders is when you have physical symptoms, somatic symptoms that are not explainable by any medical condition, and I need a doctor to diagnose that. So in 1925, you know, Fritz Pearls, Sigma Freud, all those wonderful boys. They all had MDs so they could diagnose in their office. I don't and I have had this backfire on. It's never backfired, but it's happened to me where someone comes in just like you and they're like man I'm so tired, Do you think I'm depressed and it turns out they're on the verge of a diabetic coma or they have an organ that's shutting down, or they have an endocrine dysfunction. I'm like go to the doctor. And it's happened so many times to me that I just don't play anymore. I'm like go to the doctor. I'm like I'm not. I'm not even going to diagnose you until a doctor has ruled this out. I've had clients have everything in the book. So that's really where you need to start. I need a doctor to rule out.
Speaker 2:We know that mental illness and sleepiness sleep disorders are bi-directional. This is new research that's just come out. So what that means is that when you have a mental illness, it makes your sleep worse, but sleeping worse also makes your mental illness worse. So sleep dysfunction is an element in, like I'd say, probably most of the mental illness disorders in the DSM that you could have.
Speaker 2:I did the deep dive on this earlier this year. There's a technique like it. In terms of actual research, we've cracked insomnia. We figured that one out. There's a technique called CBTI. It's extremely effective for sleep dysfunction and usually that works. I say usually because if it doesn't work, what do you do? So we could get more into what does sleep dysfunction look like for different disorders. We could talk more about CBTI, the meat and potatoes. How do you fix it? Or, if you want, which is my favorite, we could talk about difficult to fix sleep disorders. I recently went to a convention and, as part of my work, I shake down researchers for research that I don't have access to, and I got the most recent guidelines for shift work sleep disorder.
Speaker 1:So wherever you want to start, James, yeah, let's start with your favorite, because a lot of these sleep disorders right, if you go to a doctor, get a referral for an expert a lot of the times that whatever's going on there, they can fix and cure and your mental health will improve when you have impactful and restful sleep. But the big issues that I've encountered with some of my clients is they present with depression but the doctors can't find anything, but they're not sleeping. I help them with their depression but they're still not sleeping. So then I'm just like OK, someone needs to get your referral for a specialist, Because you're obviously depressed and I can see it, but you're also never sleeping and your sleep's all fucked up. Let's go down that route of the recent research you've been able to shake down and let's target the individuals who just cannot find something and let's hope that what we talk about gives them some sense of direction.
Speaker 2:Right. So CBTI it's called CBT for insomnia is extremely unattractive to mainstream practitioners because it has CBT in the title. If I put brain or neuro in the title, everyone would do it, so we're going to call this neuro brain insomnia treatment instead. That way I can convince people to do it. It's so easy and you can find manuals free online Like you can literally Google CBTI manual and it comes up Like the biggest group that uses this is the VA, and the VA I love because they put all their training videos online for free.
Speaker 2:You don't need to be on Tricara or the VA panel, you just go do it. So the way CBTI works is it's too prompt. One is behavioral and then the other one is cognitive, challenging anxiety and that kind of stuff which I want you to talk about. But the behavioral stuff it usually begins with doing a sleep diary, and I'm going to generalize. You write down. The most important things usually end up being what time you went to sleep, like went into bed, how long it took you to fall asleep and then how many times you woke up during the night and what you find is that most people who have insomnia are spending more time in bed than they are sleeping A tale as old as time is. I get into bed at 8 o'clock, I go on my phone, I goof off, I play with the cats. Finally at 10, I turn off the lights, I toss and turn in anguish until 1 o'clock in the morning. So if you get into bed at 8 and you don't go to sleep until 1 in the morning, let me do some quick math here. You're spending four hours in bed not sleeping, and the way CBTI works is we need to train you that the bed is a sleep place, so you decrease the time spent in bed until it's so. If you only sleep five hours a night now, you're only allowed to spend five hours in bed. So the first couple weeks are like you can do all the being on your phone and playing with the cats, but not in bed. You're not allowed to get into bed until 1 o'clock in the morning. You do this gradually. You don't fall off a cliff, it's like OK, we'll decrease by an hour every night. So it's excruciating for a little bit and people are very tired.
Speaker 2:If you have a job that involves driving or operating heavy machinery, this is not an intervention for you. What organization was it? Let's see the US National Highway Traffic Safety Administration estimates that drowsy driving hurts an average of 40,000 people a year and costs up to 1,500 deaths. So again, you don't want to be a part of that statistic. So if driving is part of your job, this is not for you. But assuming you can do this, you decrease the time you spend in bed and what this does is it trains you that bed is now only for sleep, and this works like gangbusters. It's money Like I have extremely high success rates just doing this intervention with people and then they're able to get into bed and they fall asleep almost immediately.
Speaker 2:This also fixes usually and fixes the general term the waking up in the middle of the night problem, because then you need the sleep so bad. What you've done is you've built up their sleep debt. That's a clinical term for if you need 7 to 8 hours of sleep per day, which research says it's between 7 and 9 for most adults you owe your body, like a student loan, 7 hours of sleep a night and if you get 6, you're in debt one hour. So you're building up the sleep debt by making them so tired because they can't get into bed. It usually fixes most problems. Now, of course, if you work in a job that has an odd shift, like if you work at a bakery or a factory or a refinery or somewhere where you have to wake up in the morning, nurses are listening to this, going like, ok, fix my schedule. I have a different shift every five days, and so I went to the ABCT conference this year, which is the conference for the CBT people, and I listened to the sleep researchers and I didn't shake them down. They're actually very nice. You can literally just email researchers. I need a copy of your paper and they'll give it to you. You can email them. I need a solution for shift workers and they'll tell you what it is, and that's what they did. So they sent me the advanced. This has just come out.
Speaker 2:This year they had researchers in Australia put their heads together and figure out what the new sleep guidelines for shift workers should be. You can't do CBTI because you can't be working at a power plant and be in the two-week phase of CBTI where you're decreasing sleep. That's not going to work. You operate heavy machinery, it's your job. Same thing with nurses. Also, most of the sleep hygiene guidelines don't apply.
Speaker 2:Like don't take naps and keep a strict schedule Isn't applicable to a shift worker, and so the Australian researchers did this whole progress and they put together 18 new guidelines, and the new guidelines include you should take naps, sleep opportunity, so find seven hours of sleep opportunities. That could be two, three and a half hour blocks, or whatever they say 90 minutes, or you should either sleep 15 to 20 minutes as a nap or you should sleep 90 minutes. Don't do the in-between. So if you can get 90-minute increments of sleep, then you could make up seven hours of sleep in a day. There's more to it than that, but I'm like, if you're listening to this and you have sleep problems, that's where you should start, my opinion.
Speaker 1:I fucking love your brain and how you operate. You look at these things, because every time I have you on a podcast I feel like I just became a more educated professional, more efficiently than fucking being a grad student ever did for me, because so much stuff is going through my head and I know we have limited time to go and this is such a huge topic Like what we're talking about is probably the tip of the iceberg of fucking sleep and science and all this stuff. So one of the questions I have several of my clients have ADHD and it's always fucked up their sleep and I'm not treating them for ADHD because I'm not a specialist in it, but it is a part of their mental health, which is why they're seeing me. Has any of the research you've done regarding fatigue and sleep?
Speaker 1:Does this same technique work for people with ADHD? Because part of their problem is they struggle to fall asleep because they have ADHD and medication often wears off by then. They don't like taking sleep meds because then it fucks up their whole day the next day and that's not efficient and some of them can't their jobs. They need to be alert and awake and they can't have that groggy sensation and then also they struggle to stay asleep. So that whole thing of they wake up at fucking 1, 2, 3 in the morning and their brain just won't shut off. I have one more question after that. This is something my wife and I do, but it's more important that we talk about our potential clients and people struggling. I'm not one of them, so let's focus on has your research brought up this ADHD in this technique?
Speaker 2:overall, my research might, deep diving and shaking down sleep researchers. So we know that people with ADHD have a higher rate of sleep apnea and restless leg syndrome. If you want, you can screen yourself online and that'll tell you whether you need to go to a doctor. You know me, I'm always team go to your doctor anyway. But sleep progress, sleep problems, can aggravate the reduced attention span and behavior problems associated with ADHD. So CBTI works like money for ADHD people at least my ADHD clients For two reasons. Number one, a huge part of sleep hygiene, and we know sleep hygiene doesn't fix sleep problems but it does help behavioral interventions. So, going through the list of sleep hygiene, you can Google this like keep the room quiet, don't do bright lights before you go to bed, don't eat a big meal, etc. Those things are money. You take that straight to the bank.
Speaker 2:Part of creating a routine is also great for ADHD people. They love that. They're like yes, give me the same thing to do every day and then I can just train myself to do it and do this repeatedly. So you should have a sleep routine that ideally starts an hour before you go to sleep. The pie in the sky is there's no electronics, no bright light and only calming activities. But I know plenty of people, my clients included, who are like if I put the TV on, I'll fall asleep while watching it. Great, do that. People are like if I watch tick-tock videos, I will pass out while watching them again. If it works for you, just do it same thing with the waking up in the middle of the night problem. Training yourself to limit the amount of time you spend in bed seems to be very effective for ADHD people. My observation Wonderful man.
Speaker 1:So my wife and I have this habit. We have a TV in our bedroom and we often just fucking laying bed watch TV. Is that technically fucking up our whole like sleep routine?
Speaker 2:No, if it works for you, do it. Do you fall asleep while watching it?
Speaker 1:Sometimes I mean depends on what it's like. If she likes like these reality Romance things, those things will put me to fucking sleep because I think they're boring. But for watching like a Marvel movie, like I'm staying up. So it depends on what it is. I Don't have problems like falling asleep. I show the wake up, but that's like how I've been my whole life. But I just found it interesting that you can effectively train yourself through the CBTI, I Guess perspective of modality to have a better sleep routine. That is so impactful. After the show, I definitely want you to email me those resources Because I have several people that have been struggling to just like have better sleep routines. They do sleep hygiene, they do all that. They have other misleadings going on and they still struggle sleep and sometimes around the holidays, like they're worse right now, like their mental health is worse, they're fucking sleep is worse. So after the show, like please email me that because I'm gonna start using it.
Speaker 2:If it's that simple, I'm gonna start using it and if you're listening to this, but one of the researchers I shook down. First of all, they are so nice and if you have a client who has absolutely bizarre sleep patterns, reach out to them. They know the cure. One of them is Daniel J Taylor and he made a website called CBTI web and it has like all the manuals on there like for free and all of the research for free. He's like I don't know why. He's like I just made this. You know people can use it if they want. I'm like Daniel. The people need to know my, my sweet, sweet boy. They need to know it's free.
Speaker 1:The other one.
Speaker 2:Yeah, I'll give you like the other one again. I didn't shake anyone down, actually, there they're so nice Was Jessica Deitch, and she is working on a shift work man like app and she's studying nurses right now and they're literally, literally. She's in the field, like talking to nurses and observing their sleep schedules to make an app that will just tell you how to change your shift, like when you should drink coffee. There's an app for this kind of now time shifter, but this one's gonna be more research based about like specific interventions for how to go from shift to shift without like Experiencing major sleep disruption, because we know that, ironically, insomnia is a huge problem for shift workers, even though you're working 18 hours a day and I have clients like this you know they'll come home and they won't be able to sleep, but they'll be exhausted, and so, again, the researchers have cracked this there. They're like, please, like, share our work.
Speaker 1:That's amazing. I'm so glad you found this is. I literally have a A current nurse on my case load and she, she, her, her shift again like changes every every so many days from like day to nights and, you know, depending on what's happening in her field, within her specialty, like it's this all over the fucking place and sometimes she'll have to like reschedule with me. She's like, well, I'm working. You know, the night shifts a day before, like weren't you just in a day shift, like two days ago? Like how the fuck you function, and her shifts are like 12 hour shifts or more. I'm like man, like when you have time to like be normal as a nurse like I don't think it's a thing and.
Speaker 2:This is my frustration with, like, our reversion to 1925. Therapy is Genuinely right now today. I could go on psychology today and I could find a therapist who would be willing to do EMDR on my sleep problem. If I had one, which, like I, have absolutely zero faith in that there there's zero research showing that does anything, I'm sure I could still find or a somatic practitioner that's like oh well, you must be storing the trauma in your hypothalamus and that's why you have sleep disruption like CBT.
Speaker 2:I, like CBT in general has so thoroughly cracked sleep dysfunction. I could and I'll send this to you if you want. The VA has a free I'm not even kidding Excel spreadsheet and you can use this if you're just like a client this is not even just for therapists where you can track your daily sleep log and the Excel sheet will automatically Calculate your time spent in bed, what's called your time, your sleep efficiency, which is time spent in bed versus time sleeping. Like. It'll just do all the math for you and then it'll tell you, based on that, when you should be going to sleep, based on what your sleep schedule is. So, like, these tools are out there. They exist. Like. Please don't do some weird alternative treatment about this.
Speaker 1:Yeah, send me that as well, because that that's something I would even use personally.
Speaker 2:Yes, send me all this stuff, so okay so my favorite sleep tool I know I know you want to talk about the other thing is there's a quiz I found in one of it's buried in one of the tricare trainings and it's called. You guys can look it up. It's free. The morning, this evening, this questionnaire and it you fill it out and it will tell you whether you're a morning person or an evening person.
Speaker 1:Send me that, Like I'm pretty sure I'm an evening person man.
Speaker 2:You'd be surprised. You'd be surprised.
Speaker 1:OK, love it, send me that. Because all of this stuff I'm thinking of all the clients that I have that struggle sleep or even inconsistently struggle sleep and I always tell them go talk to an expert. This is like I can help you with mental health and that can improve your sleep and we can do things there from a habit-forming sense. But if there's something going on with your fucking brain or your body, there's experts for that. I'll talk to them, I'll work with them. I don't fucking know what I'm doing because this is beyond my scope. Another thing we wanted to talk about, and that you had brought up as well, is mental health and sleep and fatigue, and let's start off with the most common one depression.
Speaker 2:Right. So we know that 75% of people with depression also have insomnia, and this is according to the National Sleep Foundation, which the sleep researchers sent me, so I trust them. So, because of the bi-directional relationship between mental illness and sleep, for some people improving sleep may actually improve your depression. So, according to the UCLA Sleep Center, people with depression have been shown to have abnormal deep sleep and dream sleep patterns Fascinating what does that mean? I have no idea. You have to look it up. I didn't go that far into the deep dive. However, improving and regulating your sleep could alleviate some of your mood symptoms. We know this is especially true for more severe mood disorders like bipolar disorder. If you have bipolar disorder or you have a client who has bipolar, you know that regulating sleep is an absolute must. I don't know if this has happened to you, james.
Speaker 1:No, so I don't have any. I've never had clients and at least I know currently I'm a case-loaded big diagnosis bipolar that I'm aware of or have a history. I have spoken with people on a professional level regarding bipolar because it comes into my case-loaded every once in a while and I refer out because I don't know enough. That's something they've talked about is sleep for individuals with bipolar? It's non-existent, it's fucking intangible and I'm like, well, that's shitty because you have bipolar and that's already annoying to fucking miserable to deal with at the best of times anyway. And understanding how that fucks up your sleep probably just exacerbates all of the fucking things you have to deal with, and that's the norm for anyone. If you have zero mental health disorders or any issues, poor sleep will fucking cause problems and that anyone for anywhere in your life's sleep is super fucking important. So I love that you talk about how it's bi-directional, because a lot of my clients who have been diagnosed with a major depressive disorder and they're going through a lot of stuff and they're struggling to sleep.
Speaker 1:I always tell them there's two pathways here. One is just like your behavior around sleep routine and sleep hygiene and those are things that we can mechanically attack. The other thing is your mental health, your psychology, like the emotions that you're having and when you're having them and what you're doing with them, both impact the other. If you have poor sleep, you become more depressed. If you're depressed, it also you lose sleep, and so it's a really nasty cycle as well. I tell my clients, and when they explore like well, how do I get out of it? I'm like when you get to this point, you attack both sides. I don't fucking care. We need you to sleep. We also need you to be less depressed so you can sleep. Because, in order to improve, your mental health 100%.
Speaker 2:OK. So there are three times a year for me that my caseload of depressed people spikes, and they coincide with religious holidays. There is a Muslim holiday that involves fasting, there's a Jewish holiday that involves fasting, and then some Catholics fast for Lent and you get people who come in and they're like man, I've never been depressed before but this because of this like I have. No, it's usually not connected to the fasting, they'll just be like God. I'm so depressed. What's going on? And you ask them like OK, tell me what's changed in your schedule?
Speaker 2:And I have a lot of clients who will be like because of the rules of these religious holidays, they're not eating all day. They eat after sundown a big meal and then they can't sleep. We know that going to bed hungry is also not advised. That can mess up your sleep. And so all of a sudden, these people aren't sleeping. The first week is usually OK and then the second week you get all these people calling you. In the middle of this religious fasting holiday, sleep is so important and amazingly for most of these folks, after the fasting stops, they just get better. They're like Angela, you cured me. I'm like no, I actually didn't do anything, your sleep is just normal again.
Speaker 1:So sleep is so crucial, so important 100%, and it's so interesting that a lot of people don't fully acknowledge how your mental health and your sleep are directly connected at times, and another thing that I'm seeing a lot recently is seasonal affective disorder and how that impacts people's sleep. What deep dives have you done regarding this?
Speaker 2:Two things I found. I found that it could be a disorder of circadian rhythm patterns which, as we know, you know the changing light exposure messes up Like. So let me back up. I'm backtracking.
Speaker 2:Okay, your sleep is affected by two things. First is the circadian rhythm. You've heard that that's like the sun is out. Your light goes into your eyes. You know that makes you want to be awake. The second is the need for sleep within your body. So you need seven to nine hours of sleep per 24 hours for an adult, and that need for sleep builds up from the time you wake up throughout the day. That's why taking a nap decreases the need for sleep. We talked about sleep debt. So that'll make you. If you take a nap that's long enough, it could make you have a harder time falling asleep later on.
Speaker 2:Circadian rhythm can get thrown off. When the days get shorter, you're seeing less light, shift workers especially. What do you do when you work a shift? That you wake up and it's dark. You're inside all day and when you go to sleep it's dark again. So for shift workers, the advice in the new guidelines is go outside, look at the sun. If it's possible during your work hours, get the sunlight into your face so that your body can set to like okay, it is in fact light outside, I should be awake. They sell light treatments which are good for that.
Speaker 2:The other thing is treating it similar to PMDD, where, if you know it's going to happen, you should have a plan in place. The seasons are going to change, you're going to get depressed. What is our coping skills plan, similar to the CBTI? You know you're going to get anxious before you go to bed. What are the things we can do? One intervention I didn't mention and this is part of CBTI is they recommend that for people who have problem waking up in the middle of the night which can be very common with seasonal affective disorder because you're dysregulated is, if you're awake for more than 15 minutes, get up and get out of bed. This does two things Number one, it tends to shut off the racing anxiety that's in your brain and number two, it makes it easier to fall asleep. Right, because we're training your body that your bed is only for sleeping. So if you're not sleeping, if you're wrestling with a pit of anxiety, you know locks in the prison of your own despair inside your head get out of bed.
Speaker 1:I actually came down with this as a grad student when I was learning basic counseling techniques. I was convinced I was fucking horrible at this and I developed like a lot of anxiety and I was not sleeping. My solution was to read more books and to take extra classes that were not just prescribed to me by my curriculum, to just be a better therapist for my future. It did work. It took a couple of months and it paid off because I actually did very well in my performance review.
Speaker 1:My thought process like I'm lying in bed, not sleeping, because I'm scared that I suck at this.
Speaker 1:So I was like I might as well just fucking, you know, use the energy I have and like I guess go get better being a therapist and I've told a lot of my clients the same thing. Like if you wake up and you're fucking anxious and like you know you're trying to go back to sleep, but it's been like an hour and like at that point like you're fucked, like you might as well just get up and like do something with it and then feel productive, even though you're going to be tired, because at least you have a reason for it. Like I was up, you know, getting something important done or making improvements to my life and you know whatever, and I did something with it. For me, I would fall back asleep eventually after I did like an hour or two of reading or rehearsing a clinical technique, because I was just like physically, mentally exhausted and I was like now now, like I literally cannot stay awake, I'm falling asleep in my chair. A lot of clients give me pushback Like no, because if I get up I never go back to sleep. You're not fucking sleeping anyway.
Speaker 2:See, and that's such a crucial part of CBTI. So we talked about the behavioral part. Train yourself that bed is only for sleep. The other part is looking at maladaptive thoughts around sleep and then challenging them. So people with insomnia or sleep disorder should be waking up in the middle of the night, want to often have thoughts like what you just said. They're catastrophizing black and white thinking. If I wake up, I'm not going to go back to sleep. If I don't get a good night of sleep, my entire day will be ruined. Like I'm not going to sleep, no matter what. My whole life is ruined.
Speaker 2:And they'll tell us to you like you just said and like it's a fact. And you have to tell them. No, it's not a fact. There are things we can do. And if you believe it's hopeless, it's going to be hopeless. So we have to have some hope here. Like maybe you will have less sleep than you want. Will your next day be ruined? Will it be garbage? Should you just quit your job? Obviously not. Like that's so intense. You know you got to unpack this with people.
Speaker 2:It also helps if you have a coping skills plan. So like if you know you're going to get. You know the scary thoughts about this is hopeless. You have like a mantra that you say to yourself. Like it's not hopeless, I'm doing the thing again. Jesus, whatever you know, same thing. The sleeper searchers say that 15 minutes you should get out of bed. If you're awake for 15 minutes, don't like obsessively look at the clock. That's going to make it worse. But if you happen to glance at the clock or feel it's 15 minutes and get out of bed, they say do something not stressful. I do have clients who are like I'm having racing thoughts and I need to like keep it to do this next to my bed. It's almost always a bad idea. It's much better to just like wake up and do something soothing until you get tired enough you can go back to bed.
Speaker 1:I love that. Yeah, it's, it's, I've, I've, I've. Some of my clients I've struggled with, just like, if you're awake and you can't fall back to sleep, then you might also just get up and you know, do something, go try to relax or watch TV or get that thing done. That's the reason why you're fucking awake. Is because you get too strong out, like like laying there isn't going to solve it, you're just going to get more angry. And then you're going to just like get sad or anxious about not sleeping and then you're really not going to ever fall back asleep, because now you're just emotionally pent up and you, you're not letting yourself release it either. You're just like lying in bed, forcing yourself not to move, with the expectation of if I sit still long enough, I'll pass out.
Speaker 1:It's like, no, that's, that's not a people aren't completely still in a sleep anyway. Like that's not an actual thing. A lot of people move around a bit and they're like they're asleep, they're unconscious. It's it's it's neurological, it's your psychology, it's you. You acting like you're petrified isn't going to make you tired. If that was the fucking case, like a lot of us would just stop moving and fall, fall over. Like that's not how this works.
Speaker 2:No, literally. I don't like telling people to do work in the middle of the night, because I find that reinforces the idea that work is a danger or that they're weird triggers Like oh God.
Speaker 2:I gotta send this email. It's valid. I never want to reinforce that, so I'm going to be like I no, that's not on the list of things to do. Read a book, sit, pet the cats, walk around. One of the sleep guidelines the newest ones they say no nicotine or limit nicotine six hours before you go to sleep and then limit, obviously, big meals before you go to bed You've heard that one and limit fluid intake so you don't have to wake up to go to the bathroom. I love the human beings. As a species, I feel like everyone's different. I've been doing the CPTI interventions for like a pride, started a steep dive, like earlier this year, and I've already met people who have exceptions to every single one of the guidelines. I had a client who was like I drink a cup of coffee an hour before I go to bed. I'm like why do you do that? They're like makes me go to sleep.
Speaker 1:I find people tell me that and I don't fucking get that. I'm like that's like how, like how does it make you fall asleep? You're gonna wake up at some point, like your body's gonna process that caffeine, and you're gonna be fucking up. I don't get it.
Speaker 2:Dude. For this person it worked, it was legit and that wasn't even one of, like their sleep problems. They were like I wake up to go to the bathroom. I'm like, do you think it's the cup of coffee you're drinking?
Speaker 1:Interesting, interesting. One of the things I want to ask you about PTSD in sleep because this is where you're more of an expert in regards to the mental health side of things is trauma in sleep. Educate us.
Speaker 2:So legally I can't call myself an expert. It's a. It's like a legal thing. I'm not an expert. I do a lot of research on my own time about PTSD. Here's some facts about it. So we know at least 90% of veterans this. There was a study just on. Veterans with PTSD have insomnia. We know that they have more sleep dysfunction than that, the most often ones I hear like racing thoughts, memories of past traumatic events. So this is pretty common. One of the most common treatments for PTSD symptoms is a drug called prososin, which almost always just takes away nightmares. That's what it's for. There are recent guidelines from the VA DoD that have to reinforce that. Prososin does not make PTSD better, it's just a nightmare treatment Like. Do you see the difference between those two claims?
Speaker 2:And this is pretty common. There's no drug that will treat PTSD, but there are plenty of drugs that treat the symptoms. For example, you could use anti-depressants to like treat the depressed symptoms, but it's not going to make your PTSD go away. So, similarly, sleep interventions can make PTSD symptoms much better, kind of like depression. It will not make your PTSD go away. The opposite is also true. If you experience sleep dysfunction, your PTSD symptoms will almost certainly I can almost promise they're going to get worse. You will have more flashbacks, you'll be more on edge, more irritable, more angry, feel more hopeless.
Speaker 2:I love using CBTI. At the conference I went to actually Daniel, who I'm obsessed with, the sleep researcher who's so nice. He did a presentation about using CBTI interventions along with well, as part of this research, along with interventions for PTSD for veterans, and it was interesting that in the feedback a lot of the people in the audience were like this is something we already do. So one of the most established treatments for PTSD is CPT, which you probably haven't heard of if you're not a veteran because it doesn't have the word brain or neuro in the title. We'll just call it brain neuro CPT, which is very effective and has a lot of research behind it. It does not officially have a protocol for sleep in it, but you can add CBTI to it.
Speaker 2:I add CBTI to prolonged exposure, which is my weapon of choice. It's again. You just block off like five or ten minutes at the beginning of the session to go over a sleep diary with somebody. Interestingly, this is a good place to add this, just because substance abuse overlaps with PTSD. So often is that people will come to me and they'll say I use sleep medication to go to sleep or I smoke weed or I drink alcohol. Now we know that alcohol before you go to sleep is not a good choice. It's not actually going to make your sleep better and for most people, the symptoms they get when they drink before they go to sleep is something called sleep inertia, which is what researchers call groggyness, like when you wake up and you're still tired for like twenty minutes. It can last twenty minutes, it can last two hours and we know that alcohol makes that work.
Speaker 1:Listeners. It is at this point that the audio file for this episode got damaged and there was another twenty minutes of recorded audio that just didn't make it to the final product. For those of you who found this topic really interesting and really wanted to hear more about what we were talking about, I'm so sorry. I'm definitely going to make sure to correct this issue before the next time I upload an episode and see if there's something better I can do for you guys. I want to keep my podcast real and authentic, and that means sometimes having technical issues that kind of make things lame. For those of you who stuck around all the way to this point, thank you and I'll catch you next time.