Up All Night: How Drugs, Alcohol, and Recovery Disrupt Sleep—and How to Fix It

Sleep doesn’t break because you forgot how to close your eyes. It breaks when anxiety trains your brain to stay on guard, and when quick fixes like alcohol, cannabis, or OTC sleep aids sedate you without restoring you. We team up with Australian psychologist and author Helen Dugdale to unpack how insomnia forms, why 3 a.m. wakeups become a habit loop, and the practical, evidence‑based steps that rebuild real rest—especially for people in recovery.

Helen shares how anxiety sits at the core of most sleep problems and why the brain’s plasticity is our greatest ally. We dig into Cognitive Behavioral Therapy for Insomnia (CBT‑I) basics—aligning with circadian rhythm, setting simple pre‑bed routines, and replacing catastrophic thoughts with repeatable behaviors—and explore how Eye Movement Desensitization and Reprocessing (EMDR) calms trauma so sleep skills can finally land. Expect concrete tactics: caffeine cutoffs tied to bedtime, screen boundaries that don’t feel punitive, mantras that redirect attention, breathing and counting that occupy mental space, and progressive muscle relaxation you can run anywhere, even in a noisy room with the lights on.

We also address the realities people with addiction face: unstable housing, tight budgets, caregiving, and long days that drain executive function. You’ll hear how to build micro‑habits that fit into crowded lives—thirty seconds while the kettle boils, one minute before starting the car, seven minutes as “0.5% of your day.” We talk timelines for progress, what to do on rough days when HALT hits, and how to bounce back from relapse without shame. The throughline is hope: you are worth the effort, and repetition rewires nights. If you’re ready to trade quick fixes for deep, durable rest, this conversation gives you a blueprint you can start tonight.

Subscribe, share with a friend who needs better sleep, and leave a review with the one habit you’ll try first. Your feedback helps others find the show.

To learn more about Helen's work: https://australianbraincoaching.com.au

To contact Dr. Grover: ammadeeasy@fastmail.com

Transcript

Welcome And Why Sleep Matters

SPEAKER_01 0:00

Welcome to the Addiction Medicine Made Easy podcast. Hey there, I'm Dr. Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years, I worked in the emergency department, seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. Thanks for tuning in. Let's get started.

Meet Helen: From Science To Sleep Therapy

SPEAKER_01 0:40

Today's episode is much overdue. We will be talking about sleep. Sleep comes up all the time when I am treating addiction. People often use downers like alcohol and cannabis to help them get to sleep, but it turns out that these substances actually make the quality of sleep worse. In fact, alcohol is the number one substance people use in the US to help them sleep, even though it makes the sleep worse. And when people are getting sober, disrupted sleep can be a very common symptom, particularly for those coming off of Downers. So I wanted to talk to an expert about sleep. This is an interview with Helen Dugdale, a psychologist in Australia with an expertise in anxiety and sleep. She's the author of the book, Put Insomnia to Sleep. And we combined her expertise in insomnia and anxiety with my expertise in addiction for this episode. I will put a link to her website in the show notes if you'd like to learn more about her work. And with that, here we go. All right. Happy Friday, your time. Happy Thursday, my time. I am so glad to have you join the podcast. Let's start with who you are and what you do.

SPEAKER_02 1:57

Thanks very much for having me, Casey. And I'm excited to be part of your podcast and hope I can bring some tips to your listeners about the importance of sleep with whatever they're going through. So my background is I've got a science background way back starting in the 70s. And then I got another qualification and I taught science at secondary schools. And then I was in scientific research for 20 or 30 years. And then I started up my own business running personal development workshops, that is, communication skills, leadership skills, goal setting, all those types of things. And I thought I should really go back to university and study psychology because there's so much psychology in whatever we do. And I'm so glad I did it. And I graduated with the postgraduate diploma of psychology on my 62nd birthday. So to anyone, you're never too old to try new things and to stick with it because it was so rewarding. And then I started up my business as a psychotherapist, helping people with anxiety and sleep problems and phobias and different things

How Anxiety Fuels Insomnia

SPEAKER_02 3:15

like that. And then during COVID, I thought there's so many sleep problems around the world. And in Western societies like America and Australia, it's about 40% of the population have sleep problems. And I was thinking, why is that so when there's so much information available to help people with their sleep and people still have problems? And then my clients were getting success. I'm thinking, what's going on? Why are so many other people having problems with sleep? So I delved into it. And a lot of sleep problems stem from anxiety. It could be your physical environment or physical aches and pains. Most of it is an emotional trigger. And what happens with sleep problems is your brain gets into the habit of staying awake. Oh, three o'clock in the morning, I'm awake now. I'll think about all the thousand things under the sun. And then they get stressed about not getting enough sleep. So then that's a double whammy. Because of the stress of not being able to sleep, it's building up the cortisol in your body. So you're even less likely to go to sleep. So then with lack of sleep, it causes all sorts of problems the next day in your brain and your body. So when you think about it, it's not just your looks like waking up with bags under your eyes, but you could be grumpy. So it's affecting your emotion regulation. It could be affecting your decision-making skills. Like you're so tired you'll reach for that energy drink, or you're so tired you'll reach for that alcohol, or you're so tired that you don't feel like going to the gym when you know you should be, or you might be so tired you're making mistakes at work, let alone your relationship. So sleep has a big influence on our daily lives. And so I wrote a book about it, about sleep. And I'm um I've got lots of tips and guides in the book, different chapters on different things that will upset your sleep and what you can do about it.

SPEAKER_01 5:31

Yeah. A lot of my patients struggle with their sleep, whether it's they can't sleep so they drink alcohol, or they drink alcohol and then they can't sleep, or then they're newly in recovery and their brain chemistry is rebalancing and they can't sleep.

Alcohol’s False Promise Of Rest

SPEAKER_01 5:44

Let's start with just what substances do to our sleep. What does alcohol do to our sleep?

SPEAKER_02 5:49

You're right. Some people say, Oh, I need the alcohol to help me get to sleep. That might be true. Some people say it puts them to sleep, but they don't get good quality sleep. And they could be waking up because they need to go to the toilet, or they could be waking up because they've got a headache, because alcohol dehydrates the membranes of your brain. So you get it, that's how you get a headache. And it also reduces the quality of your sleep if you're drinking alcohol right on bedtime. Alcohol early in the evening, a small amount is okay because you've probably digested it by the time you're going to bed. But I've had clients that drank 10 units of alcohol each evening, and they say, Oh, but I need it to go to sleep. But they're not getting the quality sleep or they're waking up. And then there's all the problems the next day.

SPEAKER_01 6:44

How do you measure quality of sleep?

SPEAKER_02 6:47

Deep sleep and REM sleep. And an easy way to measure it is you if you wake up refreshed. Because we do cycle through our there's sleep cycles during the night. They go for 90 minutes and then you go through the next cycle, deep sleep, slow wave sleep, rem sleep, and then you go through another cycle. So it's when you're going through the lightest sleep that can tend to wake you up if there's any noise or light or a dream that might wake you up. But usually, if you're getting good quality sleep, you're able to get back to sleep.

Cannabis, OTC Aids, And Tolerance

SPEAKER_01 7:27

How about cannabis? A number of my patients use cannabis, either THC or CBD. How does cannabis affect sleep?

SPEAKER_02 7:35

Uh, I haven't really gone into the drug side of things, except for over-the-counter drugs. But cannabis is known to relax you and to get you to sleep. I'm not sure how it affects the quality of your sleep.

SPEAKER_01 7:52

My understanding is that cannabis and alcohol are fairly similar and that they cause drowsiness, but that's not associated with an increased quality of sleep.

SPEAKER_02 8:02

But the danger is that you your body gets used to it to get the same effect, and then you might need more of it to get the same effect.

SPEAKER_01 8:12

You mentioned over-the-counter medicines. Are you talking about antihistamines?

SPEAKER_02 8:17

Yes. And a lot of people say to me that they might take one or two sleeping tablets and that to help them get to sleep, but then after a week or two, they might find their sleep is going backwards again. So they'll take an extra sleeping tablet, and that will work for a while, and then their sleep goes backwards again, and so they'll take another sleeping tablet. So you can see event gradually they're taking a lot of sleeping tablets to get the same effect. And there's a danger of overdosing. So even on the label of the sleeping tablets, it says aren't for short-term use.

SPEAKER_01 8:58

My understanding about insomnia is that there's sleep onset insomnia, which is where it's hard to fall asleep, and sleep latency insomnia where it's hard to stay asleep. Yes. Does alcohol and some of these over-the-counter sleep aids affect both of them?

SPEAKER_02 9:14

Yes. Usually you'll be able to get to sleep with alcohol and the sleep aids, but it's staying asleep that is the issue. Do you know why that is? I think your brain is just used to waking up after a few hours. It's got into that habit of waking up no matter what you've taken, whether you're woken up by a headache or the need to go to the toilet or the drug has worn off a bit, and your brain gets used to being awake at two or three o'clock in the morning.

SPEAKER_01 9:44

In other words, these medications that make us drowsy don't actually fix the sleep. It's still the same problem.

SPEAKER_02 9:51

Yes, that's right. And our brain likes habits. We get into a habit, and because our brain has got plasticity, you can change those habits, but it needs practice over and over again. So your brain has got into the habit of waking up during the night. We have to stop that habit somehow.

Breaking The 3 A.M. Awake Habit

SPEAKER_02 10:12

And it can't, it is possible. Some people say, Oh, I've always been like that, but it is still possible. I've had clients that have only had two or three hours a night for 30 or 40 years. So imagine what that is like. And then we've got them to reduce their emotions. Why is that emotion keeping them awake? And then re-change their habits so that they're uh they're changing the plasticity of their brain and being able to get back to sleep quickly. And it will take practice, and what it is is being able to relax enough for sleep to come on. So rather than lying there getting stressed about the amount of sleep you're getting, don't even mention the word sleep. Just be relaxed, tell yourself you're calm, tell you tell yourself something calming, and that will create a new habit in your brain of being calm and relaxed. So you're not even mentioning the word sleep. So eventually that will happen.

SPEAKER_01 11:22

What you're saying is basically the pattern of being anxious about sleeping, using a substance, not sleeping well, waking up, you've essentially cued the brain for that series of behaviors to happen. Exactly. That's right. I've never had anyone explain it that way.

SPEAKER_02 11:38

Yeah. So if you can change all those habits, get yourself into a nice relaxing sleep hygiene routine before bed, and this is where the circadian rhythm comes into it. You're not fighting that that natural rhythm where your body is closing down, relaxing in the evening. Instead of fighting that, you're going with it. And then putting in all these relaxing routines that

Routines, Circadian Rhythm, And Mantras

SPEAKER_02 12:03

tells your brain it's evening now, it's nighttime, it's time to rest. And your body starts to shut down and get ready for sleep. So then in the middle of the night, if you do wake up, instead of getting anxious about it, you can bring in your relaxation techniques. And what works for one person might not work for another. So there's all different sorts of techniques that you can use. Find one that suits you. A good one that a lot of my clients like is having a mantra. It's something over and over again, like I am relaxed, or I deserve to have a restful sleep, a peaceful night, or I deserve to wake up refreshed, or something that's going to relax them. Another one is deep breathing and counting. And our psychology lectures said while you're deep breathing and counting, your cognitive resources are taken up with those things, not with the thousand other things that's worrying you that's going through your head. So if you can concentrate on the deep breathing and the counting, that will help you relax as well.

SPEAKER_01 13:15

One follow-up to what we talked about earlier. I just pulled up an article in the National Library of Medicine. And yes, cannabis, again, is like alcohol. It helps with drowsiness, but it's not actually associated with good quality sleep. So a number of my patients have had horribly traumatic lives, and that's what leads them to addiction. A lot of them gravitate towards downers because it makes the intensity of the anxiety from their PTSD less intense, or they gravitate towards uppers because they can be so up and thinking of other things that they don't have to worry about their trauma. Let's imagine a case where, let's say, a 35-year-old woman was abused as a child and comes to you drinking alcohol with PTSD, can't sleep. Is your work any different with that person compared to somebody who just says, I've never slept well?

SPEAKER_02 14:03

What I'd do is it, because it's easier to say something than do it. It's it's not easy to give up a lifetime of habits and way of thinking. I know it's not easy. But what I would do is help her with her emotions to start with. And I get people to start valuing themselves. What are their good points? Instead of people dwelling on negative things or unhelpful thoughts, I would get people to think of what is good about them. What are some helpful things they could say to themselves and remind themselves of all their good points so that when they are feeling anxious and upset, go back to what are your good points? What do you like about yourself? And I know sometimes that's hard to do, but get into the habit of thinking well of yourself, of valuing yourself. So I'd start with that. Try

Trauma, PTSD, And Readiness To Change

SPEAKER_02 15:00

and balance the emotions. So instead of the emotions taking over our thought, we want to be in control of our thoughts, not our emotions controlling us.

SPEAKER_01 15:12

So it sounds like in some ways your work when people are using a substance to sleep is similar to my work, which is I have to assess how ready are you to change. And it sounds like if someone comes to you again, this hypothetical case, 35-year-old female, PTSD using alcohol to sleep, you have to assess are you ready to change? Yes.

SPEAKER_02 15:34

Yeah, yeah. So it's baby steps to start with, and get her to feel confident about herself, and then get her to start having some helpful habits. For example, looking after herself, which might be a good routine before bed, or it might be doing something enjoyable that doesn't include alcohol. So she's rewarding herself in other ways. And I know that's easier to say, but we'll just we'll keep working on that, keep valuing herself. And what sort of things does she like to do that makes her feel good? And it could be gardening, or it could be talking with friends, or it could be craft work, or it could be being with children. Everyone is different, but something that's not alcohol that still makes her feel good.

SPEAKER_01 16:29

So my patients come from all backgrounds. I have lawyers, physicians, CEOs, and then I have people that are homeless on the street, in jail. A lot of what we think is the best ideal circumstance involves people who have resources, a home, a safe place to stay, the finances to say garden. How would your approach differ for somebody who's got unstable housing or doesn't have a lot of financial resources?

SPEAKER_02 16:56

Is there a public garden they could sit in? What is free that they could use? Is it just uh birdwatch could be something that someone enjoys? They're free libraries that they could go to. They're talking to friends around the streets or whatever. I would keep delving until I found something that they like. So it's not like me telling them what I think they should do. I would get it out of them what they feel comfortable doing.

SPEAKER_01 17:29

It's just trying to see whatever works within the resources that a person has. That makes perfect sense to me.

SPEAKER_02 17:36

Yeah. And I even get pe some people tell me, say to me, Oh, just tell me what to do. Even though it's tempting to tell someone what I think they should do, I don't really know what their life is like. I don't really know what will work for them. So I will get it out of them what they would like to do, what they feel comfortable doing, and what they know will fit well with their lifestyle.

SPEAKER_01 18:01

So we'll come back to my fictitious 35-year-old with PTSD

Low‑Cost Self‑Care And Resource Gaps

SPEAKER_01 18:05

who's drinking alcohol. She's not quite ready to give up alcohol and she says to you, Helen, I know what I'm gonna do. I'm gonna just watch Netflix instead of drinking alcohol. What are your thoughts on using screens around bedtime?

SPEAKER_02 18:17

TV across the room is okay because it's not right in your face, as long as it's not a scary movie or something that's going to stimulate your brain, because you don't want your brain stimulated right on bedtime. But a screen right here, like an iPad or a phone, is not that great because that's going to stimulate your all your nervous system behind your eyes and everything. So at least an hour before bed, put the screens down. And maybe that's when she could spend time on herself valuing herself, whether it's a warm bath or hand cream or meditating or gentle exercise, those sorts of things, something that she enjoys doing. Not that and I will get it out of her what she enjoys doing and what will make her feel good about herself.

SPEAKER_01 19:10

How about books? Is reading a book before bed a good thing?

SPEAKER_02 19:14

Yep. Reading a book is a good thing, as again, as long as it's not going to stimulate your brain. Like you you might not want to read a book about politics and then get all upset about that on bedtime.

SPEAKER_01 19:27

In in America's current political climate, that has definitely happened to me.

SPEAKER_02 19:31

Yes, yes.

SPEAKER_01 19:32

Okay, so I I add another layer of complexity. I feel like I keep throwing you things to try to explain to me. This same 35-year-old female says, You know what, Helen, I really can't. I'm too busy to do any self-care. I've got three kids. When you get the I'm too busy, where do you go with that?

SPEAKER_02 19:47

Yes, yes. I've had that before. Even we start with one minute. You've got one minute to text, or you've got one minute to scroll, you've got one minute to spend on yourself to value yourself. So I would help them with are you worth it? Are you worth one minute? Are you worth five minutes? And and then I I've got another um, I was going to say a trick, but a tip. In in in 24 hours in a day, there's 1,440

Screens, Books, And Evening Wind‑Down

SPEAKER_02 20:19

minutes. 1% of that time is 14 minutes. So when people say I'm too busy, I say if you got 1% of your time, you've still got 99% of your day to do everything else you have to do. Have you got 1% to spend on yourself? Which is 14 minutes? And if they say I haven't even got 14 minutes, have you got 0.5%, which is seven minutes? And when they see that, oh, 99.5% of my day I can spend doing everything else, yeah. I've got 0.5% of my day I could spend on myself. So when they see it like that, they can carve out seven minutes.

SPEAKER_01 21:04

So you're essentially helping them change their perspective. And it sounds like a lot of this is some form of motivational interviewing.

SPEAKER_02 21:10

Yes, yes. And and creating a new habit over and over again. Are you worth it? Keep telling yourself all these positive things and and establishing new habits. And Aristotle said it 2,000 years ago that we are what we repeatedly do. So this isn't something new age. And if you think about it, we are what we repeatedly do. Like an easy example is someone who keeps saying, I'm bad at maths. You've heard that. I'm bad at maths, I'm never any good, I'll never be any good. And guess what? They're no good at maths because they keep telling themselves that. What if you told yourself something positive, something reinforcing over and over again? Yes, I am a capable. Person. Yes, I am worth doing this sleep hygiene for seven minutes. Or I am worth going for a walk for seven minutes. Just start with that.

SPEAKER_01 22:14

So I'm going to bring my coffee cup over here. I don't know if you can see my prescription coffee cup. Uh, I can't read the words. I can see coffee. It's a joke mug that has a prescription for caffeine. So again, we'll come back to our potential patient here. So you've convinced her to do some self-care. She's willing to try. You're working on some routines and hygiene at bedtime. And she's not sleeping well as she's getting through the first parts of it. But now she's consuming coffee and energy drinks throughout the

The “Too Busy” Barrier And Micro‑Habits

SPEAKER_01 22:45

day. And she comes back to you and says, Helen, I can't sleep. I'm having to use caffeine all day. What are your thoughts on caffeine as it relates to that?

SPEAKER_02 22:52

Yes. Yes. I've done a lot of research on that too. Caffeine's okay in the mornings. It's a stimulant. It stays around in your body for about 10 hours. So if you want to go to sleep at 10 o'clock at night, don't have caffeine after midday.

SPEAKER_01 23:10

Looks like I'm not going to sleep well tonight. I just had a cup of coffee at three of the afternoon.

SPEAKER_02 23:15

Some people need it. Like every now and then it's okay. But if it's a regular habit, like an evening habit, that and if you've got sleep problems, that's going to upset your your body homeostasis, the balance in your body. Although everyone's different. And I have had someone who says they have to have a cup of coffee at nighttime. And that and they don't have any sleep problems. But that's good for them. But people with sleep problems, they're going to be it's going to be upset by having caffeine in their system. Or a stimulant like the energy drinks.

SPEAKER_01 23:51

How much is the work that you do, like cognitive behavioral therapy for insomnia, also known as CBTI?

SPEAKER_02 23:58

Yes, yeah. I incorporate that and I also use EMDR, the eye movement dissociation and resetting, and that is really good because it's balancing the left and right side of the brain, left and right hemisphere.

SPEAKER_01 24:14

So imagine I know nothing about sleep and I'm seeing you as a patient, as a new patient today. Can you explain to me what CBTI is?

SPEAKER_02 24:23

See, it's cognitive behavior

Caffeine Timing And Sleep Quality

SPEAKER_02 24:25

therapy for insomnia, and that is where you're repeating positive behavior. We'll, as I was saying before, we'll we'll we'll identify what you want to do and what will fit with your lifestyle, and we'll incorporate that into your daily life, your daily habit, and that's the positive behavior over and over again. It's a bit like if you've got a phobia about, say, walking on cracks in the footpath. If to get over it, you practice seeing cracks on a screen, or then you practice trying to step on it in real life and knowing that nothing bad is going to happen. So it's practicing positive behavior over and over again to develop these new pathways in your brain.

SPEAKER_01 25:15

My understanding is that CBTI is some of the most effective treatment for insomnia.

SPEAKER_02 25:20

Yes, yeah. Although it is very effective, you have sometimes you have to get to the heart of the problem. If you haven't identified what the original trigger is, that might keep coming out from your the back of your brain, from your amygdala where your emotional memories are stored, and when times of stress, that will come to the fore and will take over your logical thinking. So we have to get to the bottom of why you're like that in the first place. And this is EMDR will help, I my method will help you identify where does this come from? And then

CBT‑I Explained And Why It Works

SPEAKER_02 26:00

do the EMDR and then do the CBT to reinforce new positive habits. I wasn't aware of EMDR for insomnia. Can you elaborate? Oh, I use EMDR for the trauma and for regulating emotions. Then I use the CBT.

SPEAKER_01 26:19

Makes sense.

SPEAKER_02 26:20

So we need to regulate emotions to get people to make good decisions for themselves.

SPEAKER_01 26:28

Yeah, it makes perfect sense. Coming back to our fictitious patient, she's given up the caffeine, she's given up the alcohol, she's now really ready, again, in those stages of change. She's in the action stage. How long does it actually take with this sort of work to see a meaningful difference and sleep better?

SPEAKER_02 26:47

You should be able to see a difference in a week, but again, it's you've got to incorporate these positive habits over and over again. Like they might have had years of these unhelpful habits. It's a lot to get over to change the your way of thinking. I would say three or four weeks of these new positive habits, you have to do it in a meaningful way. You really have to lean into your new habits, not just it's training any part of your body. You have to do it in a meaningful way to get the results.

SPEAKER_01 27:27

And what is that three to four-week period like for people? Do they have to take time off of work? Do they need help parenting?

SPEAKER_02 27:37

The habits I will help help her with are things she can do while she's waiting for the kettle to boil, while she's before she gets out of the car, or just to repeat her own mantra over and over again and to fit in with her lifestyle. So take 30 seconds, take a minute to do it every now and then, all through the day. And then in the evening, once everyone else has gone to sleep, then she can really concentrate

EMDR For Trauma Regulating Sleep

SPEAKER_02 28:05

on her positive habits, her new routine.

SPEAKER_01 28:10

It's interesting. I was on a podcast and I was asked as the expert on the podcast, Casey, what's the biggest predictor of someone's success in getting sober? And my response was a willingness to tolerate discomfort and be vulnerable. And I'm listening to you and realizing if you're willing to tackle insomnia, there's some pain to make gains. Is that right? Yes.

SPEAKER_02 28:32

Yes. Because we'll, it's easy to reach for the quick fixes, but that's not going to help in the long term. And you're so used to grabbing whatever it was you used to have, it's hard to give that up. So there, there is a bit of pain to start with. And we think, oh, do I really have to count my breaths? But it will help. And all these new habits of spoil, like spoiling yourself before you go to sleep. But not in a way where it includes screens or alcohol or over-the-counter drugs.

SPEAKER_01 29:09

Sounds like your work and mine are not that dissimilar.

SPEAKER_00 29:12

Yeah.

SPEAKER_01 29:12

Let's say somebody is not in their home environment. So let's say my patient has a rock bottom, they're ready to go to rehabilitation program, they get into the program, it's not their bed, it's they've got a roommate, they're snoring, the environment's out of their control. Do your techniques still help?

SPEAKER_02 29:33

That will be really difficult, especially if there's noise and light and there's the environment's not comfortable. That would be really hard. Again, go back to valuing yourself. Are you valuing yourself when you're getting stressed? Just bring in your calming thoughts again. Try and do whatever you can with your bathroom routine before bed. Maybe do some gentle exercise. You

Timelines: Discomfort, Practice, And Gains

SPEAKER_02 30:00

if you should be able to do that in even if you're not in your own environment. The snoring person, it's not much you can do unless you've got your own noise-cancelling earphones. Yes, that might just be a temporary blip.

SPEAKER_01 30:15

Almost what I'm seeing in my world in addiction is we might use a sleep aid for that artificial environment. And then when the sleep environment is better, take the time to work on the techniques that you've been talking about.

SPEAKER_02 30:27

Yeah.

SPEAKER_01 30:27

Yeah, that makes sense.

SPEAKER_02 30:28

Yeah. That's things that are in your control.

SPEAKER_01 30:32

So let's say you're treating a patient without addiction who has severe anxiety, because those are also my patients, right? Yes. Alcohol is a downer. It gives the illusion that the anxiety is better. Talk about how you work with someone who has severe anxiety to help them improve their sleep quality. Because I've often heard insomnia described as anxiety about not sleeping.

SPEAKER_02 30:53

Yes. Oh, exactly. It's anxiety upon anxiety. And they even start saying it in the mornings. Oh, I bet I don't sleep well tonight. And then I won't be able to work properly the next day. And then they say, then I'll make mistakes and then I might lose my job. And they catastrophize because they think they're not going to sleep well. And because they think that, they probably won't sleep well. Getting back to overcoming anxieties, I would talk to them and find out when this started, what was the original cause of the anxiety that has developed into anxiety about sleep. So we'd go back through their history, when has this started, and then we'll work on that, resolving that issue, that original issue.

SPEAKER_01 31:41

In other words, you're screening to see if it's not PTSD manifesting as anxiety. Could be.

SPEAKER_02 31:46

And sometimes it doesn't even have to be anything really bad. It's just that at that time it started their brain thinking in that way. I had a client who, when she was a child, thought that something bad had happened to her father, and she thought she was never going to see him again, even though

Sleep In Tough Environments

SPEAKER_02 32:10

it turned out all right. But because of that original fright, she developed anxiety. And so we worked on that. And once she realized that yeah, nothing happened bad that happened, but that's how her brain reacted, and it got into the habit of reacting that way. So we dealt with that. And so she kept expecting something bad to happen for the rest of her life until we we sorted that out and we we got her back into resolve that original problem, then developed some new good sleeping routines and reducing the anxiety, and she slept nine hours the next night. And but she didn't realize that was the original trigger. She just kept thinking something bad was going to happen all the time, and that was what was keeping her awake.

SPEAKER_01 33:07

I absolutely love my patients, and I preface that because I'm going to talk about the struggle or one of the struggles with addiction, which is that the way I think of addiction is it's a disease of the executive functioning, keeping a calendar, staying organized, being motivated. One of, let's say a patient comes to you, they've got a graduate degree, they've been successful, they're motivated, they can keep to a schedule. How do you change your approach for somebody who's newly in recovery, has been using heavily for 10 years and just doesn't have that same level of executive function?

SPEAKER_02 33:40

Yes, that's where the anxiety is taking over their logical thinking. And so we will get them again, I would get them to tell me all their good points. They are a logical person. They can, they've proven they're a logical, rational person in every other part of their life, except for this. So why is it? I get to the bottom of it. Why are they like that? Why are they doing this to themselves when they know that they are a logical person? So again, it's the emotions taking over from their logical

Anxiety About Sleep And Catastrophizing

SPEAKER_02 34:12

thinking.

SPEAKER_01 34:13

So you're almost trying to in the moment refocus them away from the anxiety which increases their fight or flight and brings down their executive functioning and trying to activate their prefrontal cortex to allow them to problem solve. Oh, that's fascinating. Can I just ask, what does that actually look like? How do you do that?

SPEAKER_02 34:32

Oh, again with the EMDR, but we we will get we'll get them to identify why they're like that. And the more they think about their anxiety, the more they're going to be anxious. So it's people who I've had people say, I have to sleep, I have to sleep, I have to sleep, or why can't I sleep? Why can't I sleep? And because all they're thinking about is sleep, that's not going to happen. Because they're getting worked up. So we've got to reduce that, that executive person that you're talking about, the logical, rational person. Reduce that anxiety by not even acknowledge it and that's it. Don't let it take over. So I would again, I would concentrate on all their good points. What are they like about themselves? What are they good at? What they've proven they are good at some things in most things in their life.

SPEAKER_01 35:26

I'm going to make a bad analogy here. I'm almost positive, but let me try this out. So let's imagine that you and I are in battle and we've got 10 guns, and our opponent, we're going to try to do whatever to defend ourselves. When a person has anxiety, it's like most of their guns are going the wrong direction towards the anxiety and not towards the goal. And what you're trying to do is get them to focus their firepower on the executive functioning. Was that a horrible analogy, or does that make sense?

SPEAKER_02 35:58

It makes sense, but it made me think of another analogy. I saw a driving teacher, a person, a driving instructor with the young person driving a car. They were in a paddock in a field, no, no other traffic, no other cars, no danger. There was one tree, one little tree in the paddock. And the driving instructor is saying, Don't hit the tree, don't hit the tree, don't hit the tree. So the learner driver is all uptight because they're learning to drive a car. What do they do? They're only thinking of the tree. So they go and hit the tree. This little sapling that so that's what they were concentrating on is what they were leaning towards. And it's like your gun's firing towards the anxiety, or it should be aiming at the logic. Interesting. It's a bit like a golfer. I've got a few clients who are golfers, and a few of them have said that they want to play well, right? But they're losing their concentration. And they say to a couple of them said they say to themselves, don't hit the rough, don't

Executive Function, Focus, And Reframing

SPEAKER_02 37:10

hit the rough, the rough on the side of the golf. Don't hit the rough, don't hit the rough, don't hit the rough. Guess where their ball goes? Into the rough. So I get them to change their thinking, calm down, concentrate, all the things you know you should be doing at golf. And then they started hitting straight down the fairway. Because they weren't going, they weren't thinking about the rough. They were thinking about the fairway and the green at the end.

SPEAKER_01 37:39

It's funny because I coach tennis and it's the exact same way in tennis. When people hit their second serve, all they think about is don't double fault. It just occurred to me, Helen, while we were speaking, you're not actually focused on anxiety specifically. You're helping people change in a positive way that could apply to anything. Sleep has a particularly high weight in people's minds and therefore generates more anxiety. Wow. Very cool.

SPEAKER_02 38:04

So I get them to, as you said, take away their concentration on their anxiety or their sleep and focus on something else that they like about themselves or something they're good at or something they want to be, like they want to be more relaxed, more calm. Concentrate on that. There's another, there is another one, the muscle relaxation technique, the progressive muscle. And I've got clients after working with me, that's what they like to do. And they say they they don't even get to their shoulders and they've gone to sleep. It's morning. And they've fallen asleep while they've done the progressive muscle relaxation. Or the people who are deep breathing and counting, they say the next thing they know it's morning because they're so relaxed that they've gone to sleep.

SPEAKER_01 38:56

In other words, they've focused their brain on something that is productive and the brain doesn't have time to focus on the anxiety. That's right. Wow.

SPEAKER_02 39:03

It's really and you try I've even had a client sitting in an office with sleep problems, and I've got her to do the mantra, the deep breathing, the counting, sitting on a chair in a well-lit office, and then she started to her shoulders dropped because she was relaxed. Then she started to lean off the chair because she was falling asleep. So again, you have to lean into it.

SPEAKER_01 39:31

So in the world of addiction, we think about good days and bad days. Let's somebody's let's say somebody's six months sober. They're past some of that early healing, they're starting to do better with cravings and triggers. And I mean you've heard of halts, hunger, anger, loneliness, tiredness, and then sick or being like ill. Yeah. Just your emotional resilience doesn't have as much that day. Is it the same with insomnia that people have to prepare for bad days where they're more stressed and they're gonna have to do more work to get to sleep?

SPEAKER_02 40:03

Yep. Good point. Because they think, oh, I'm so tired, I don't feel like healthy food, or I'm so tired, I don't feel like doing exercise, or I'm so tired, I'll just stay in bed and not go to work. You know, it's not productive, not useful. You could say that

Relaxation Tools That Actually Stick

SPEAKER_02 40:25

just take it easy that day. Go easy on yourself rather than give in to your emotions. Just take it easy that day, knowing that tonight the next day will be better. As long as you don't get yourself worked up.

SPEAKER_01 40:41

Almost like the mantra in addiction of one day at a time.

SPEAKER_02 40:44

Yes.

SPEAKER_01 40:45

I'll be darned. I had no idea insomnia management and addiction management were so similar.

SPEAKER_02 40:50

Yes, yeah. And people some people are addicted to insomnia.

SPEAKER_01 40:55

What do you mean by that?

SPEAKER_02 40:56

They're used to being woken up, and some people even say, Oh, you only got four hours last night, and they're a bit proud of it, even though it's having an effect on their body that and their reactions during the day. So the you really need to look after your body, and your body will look after your brain and your system and your breathing, and even your um your gut biome is affected by lack of sleep. That's getting on to another topic.

SPEAKER_01 41:26

Yeah, yeah. Coming back to our fictitious patient, 35, post-traumatic stress disorder, alcohol. You work with her for a few weeks, she's doing better, her sleep improves, six, several months go by, something bad happens, she stops seeing you, goes back to alcohol. Does she have to start over again with the same process? Does she need to see you again, or can she do some techniques on her own, or what does that look like?

SPEAKER_02 41:50

If she feels confident enough to do the techniques again, that will be good. Sometimes you need another chat with me, and I can get you back on track. That, you know, the reasons why you slipped up, but also you are worth getting back on track. You are worth the effort. So get her back onto track that way. So that just because she slipped up once doesn't mean she's all of a sudden a bad person. Get her to think well of herself, value herself.

SPEAKER_01 42:25

So, clinician to clinician, you know how this works, right? You go in, you're doing your examination, you're talking to the client, and certain things go off in your mind that make you think, oh man, this one's gonna be tough to treat. In my world, it's family history, length of time using, comorbid mental illness, homelessness, incarceration, legal consequences. What's that look like on your list? What are the things that you look at and go, I'm gonna have to put in extra work with this client because their insomnia is gonna be harder to treat?

SPEAKER_02 42:56

Yes. And a lot of cases it's influence from another person in their life that's really difficult. If they've got to deal with the difficult person and with their own addiction and or their own

Bad Days, HALT, And Resilience

SPEAKER_02 43:10

anxieties, that's hard. So that takes extra work from me. And really, poor self-esteem is the heart of a lot of it. So I've really got to work on their self-esteem. That would be the main thing. Are they worth the effort? And that's what I'd be asking them. Are you worth the effort?

SPEAKER_01 43:32

Yeah. So, Helen, I've been asking all you the questions. I don't think I've given you a chance to add in other scenarios that you wanted to talk about or some of your other tips and techniques. What have we not covered yet in our conversation?

SPEAKER_02 43:44

The main one that we covered that I want to give people hope that your brain does have plasticity. You can change your way of thinking and change your habits. That don't give up hope. You can change. That's the main thing. But it will take Persistence over and over again. I've mentioned the deep breathing techniques, the mantra, valuing yourself, reminding yourself of all your good points. Most of us have more good points than bad points. So I would just keep rein reinforcing that. So that's the main things I wanted to say about that there is always hope. And tell us about your book. The Put Insomnia to Sleep. It's available on Amazon. And I've also got a one-page PDF that I've distilled all over the world. What I think the top bad habits to give up and the top good habits to start incorporating. So I've got that on a one-pager if you'd like that, or if people want to go on my website and they can request that. There's heaps of references, technical references in the book. So I haven't just said things that I've made up. I've wanted to back it up with science and research, plus the case studies I've put in here. And I hopefully it people find it easy to read and pick up some good tips. And they don't have to read the whole book from start to finish. They can just go to the table of contents and look at the different chapters and think, oh, that interests me. I'll read that bit or I'll read

Relapse, Recovery, And Self‑Worth

SPEAKER_02 45:20

that bit. So it's pretty easy to follow.

SPEAKER_01 45:23

Yeah, my my love language, if you will, as a doctor is buying people books. I love to be able to buy my patients books. It's almost like I give them homework because they only see me once a week or once every few weeks. I will add this to my list of books that I will be buying for my patients.

SPEAKER_02 45:37

Oh, great. Thank you. Yeah. And I'm happy to have a chat with people over Zoom if they wanted to. And I won't charge, there's no charge for that, but because I like talking and I like helping people. So if anyone wants to have a chat with me, I'm happy to talk to them over Zoom.

SPEAKER_01 45:55

Any last thoughts as we wrap up on pearls of wisdom around sleep or any messages of hope? I know you've given some, but just anything you want to wrap up with.

SPEAKER_02 46:05

Just remember that we are what we repeatedly do. And if we keep repeating good things to ourselves or for ourselves, that's how we will be.

SPEAKER_01 46:58

Together, we can make it happen. Thanks for listening. And remember, treating addiction saves lives.