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#75 How College Students Can Sleep Better: Expert Strategies from Dr. Colleen Ehrnstrom · College Is Fine, Everything's Fine

College Is Fine Podcast (00:50) Hi everybody and welcome to the Colleges Fine podcast. We're so excited to have a guest on today because we quite a while ago did some things on sleep. ⁓ But I went to a conference, I know I'm kind of a geek for conferences and I saw this remarkable ⁓ psychologist, doctor, sleep expert and also college mental health expert speaking about sleep in a new way that I thought had a much I had a really a realistic feel to me in terms of what college students expect when it comes to mental health. So I will let you introduce yourself. Colleen (01:28) Great, thank you. That was a really lovely introduction, thank you. So I am Colleen Ernstrom. I'm working out of Boulder, Colorado. So I work at the University of Colorado at Boulder. ⁓ I work in the Counseling and Psychiatric Services. People typically know that as CAHPS. And then within that, for the last... five years we've been one of the universities across the country working on creating these embedded programs where we assign therapists to go in and work within the colleges and the dorms to kind of break down barriers and increase our understanding of what unique challenges there are for specific colleges like engineering versus law versus business. College Is Fine Podcast (02:10) I love that. All right. Very, very cool. Liz (02:12) Yeah, that's wonderful. Colleen (02:14) There's just an article that came out this morning in the New York Times about the embedded programs and what's going on with them. College Is Fine Podcast (02:21) I want to read it. I will definitely link it. That's, that's fascinating. I also noticed that we say, people say UC Boulder, but they actually called see you. Is that because you said, why is that? Colleen (02:33) That is to avoid confusion with the California schools. So it changed several decades ago, more recently than you would think, because people were constantly confused between UC and CU. So it is a little weird, but it's CU Boulder. College Is Fine Podcast (02:47) But you're the first person to give me that explanation because I have family actually that live in Boulder and I was constantly thinking, what in the heck? And also as somebody who's from UT, I mean, sorry. And also as somebody who's from Tennessee, so many people are like, oh, UT and think University of Texas. And I'm like, hello, there's another T. So interesting. All right. But I think we'd have to fight it out. be like some sort of civil war over which one had TU and which one got UT. So we'll just let it lie for now. Liz (02:47) You Colleen (03:02) Right. Yeah. Exactly. Liz (03:12) You College Is Fine Podcast (03:15) ⁓ So you work full time at the university counseling center and it means you help students with all kinds of things, but what percentage of the college students do you see who come in because they struggle with sleep? I think I know the answer, but let's just make it really clear. Colleen (03:30) Yeah, you know, it's an interesting response because I rarely see anybody come into my office that has really healthy, consistent sleep because sleep is such a piece of all. mental health stressors. It's really sort of listed on just about everyone as a symptom. But rarely do people come to me specifically for sleep problems. When they have sleep problems, they typically head towards their doctor's office. So I will get referrals from our behavioral health team who supports our medical system. But typically people will come to me for other things. But we always ask how sleep is. so invariably that becomes a topic of conversation. Liz (04:11) Right. I mean, I tell a lot of my patients, and I truly believe this, that I feel like I would lose 50 % of my practice if people slept better, like they ate consistently, had well nourished. College Is Fine Podcast (04:24) Yeah. Liz (04:26) and we're moving more effectively, right? In terms of the impact it has on emotion regulation. And of course, not to oversimplify the ease at which to do that. And definitely in a collegial environment, I mean, it's really pulling for a lot of different reasons to not get ⁓ quality sleep. ⁓ But ⁓ what would you say is like the typical range of poor and consistent sleep for a college student? Like when you actually would get concerned. as somebody like my patients joke with me because I always ask whether sleep in every session. They're like, are you like, why are you so obsessed with sleep? So sometimes we have interviewed a college student about sleep. And when they told me like what they're sleeping, I like almost fainted, right? Because it really at this stage of my life, it really just seems like it's getting a little out of control in terms of some. of the sleep patterns, but what would you say is an area of concern? Colleen (05:20) Yeah, yeah, yeah, no, it is pretty alarming. ⁓ Now the good news is at that age, they're more resilient, they can tolerate a little bit more, ⁓ but that actually makes it so that they deprioritize it. I heard in one of your other podcasts, it was fabulous about how it's one of the first things to go when they're having to choose, do I study, do I sleep, do I socialize? It's the first to go. So I think ⁓ we know across the board, young adults, middle adults, seven is really not enough, but seven is something that people think Liz (05:26) Right. Colleen (05:49) they can function on a fair amount. But at seven, and this is you know on average over a week, but at seven we're already seeing an impact on concentration, focus, mood, the way that we can recover from you know if you're working out your physical recovery. But as you've heard the range is you know it gets much lower and it's wild that you know some of these kids are getting by, young adults excuse me, on four to five hours. I think where it turns into a really Liz (06:07) Mm-hmm. Colleen (06:19) important conversation is a lot of daytime impairment or when you're hearing that this is the pattern that's going on for weeks and weeks and weeks. So we know that there's a lot of lost sleep around finals. We remember that during our years at college. That's very different than this is happening for months and months and months. And when you really hear about how much it's impacting their quality of life, their ability to function, that's when the conversation shifts. College Is Fine Podcast (06:32) Mm-hmm. Liz (06:36) Right. College Is Fine Podcast (06:45) Well, what do you think are the common hurdles that get them to that place of weeks and weeks and weeks without consistent sleep? Colleen (06:54) Where do we begin? It's such a hard time to be a student right now. I really have a lot of compassion. I think about what the hurdles were for us and they're all there too. Back in the day, ⁓ living situations, you're sharing space. You're sharing these tiny spaces where you've got hardly any room and there's a lot of noise around you that you certainly can't control, whether it's in the dorm or an apartment. That's not new. Liz (07:11) Right. Colleen (07:24) schedules so you know you could have an 8 a.m. one day and then a 12 o'clock the next day and you know sort of navigating when you do your work when you do your sleep I mean that's that's also something I think another piece that is often missed at this age that I really want to talk about is really recognizing the difference between insomnia and a circadian rhythm disorder think the circadian rhythm disorders are ⁓ a huge part of our work with college students because they're identifying that they want to work on their sleep. They're having some struggles. They're really conceptualizing it and even being told by some of their caregivers that they need to, you know, sort of work on being able to promote falling asleep. They're having trouble falling asleep. But what's actually happening is that they have a circadian rhythm that's later in the night and that they aren't actually ⁓ ready to go to sleep at the time that their world or their ⁓ class schedule needs them to. And that's really important because it's a different disorder with a different intervention. And so they're really frustrated because the current intervention. Liz (08:18) Mm-hmm. College Is Fine Podcast (08:26) Is it same as night owl? Colleen (08:29) It is exactly the same as night owl except that there is a disconnect or a challenge in what the world around you needs. So if you're a night owl and you don't have classes until noon, you don't have a problem. But if you're a night owl and you have 8 a.m.s and you're trying to go to sleep but you're having trouble asleep and then you're having all this grogginess when you're waking up, then you're thinking, I must have insomnia when really what you have is this circadian rhythm that needs to be Liz (08:42) Right. College Is Fine Podcast (08:43) Right. Colleen (08:59) able to move to a different time so that you can get up and function for your 8 a.m.s. That's exactly it. College Is Fine Podcast (09:05) gotcha. Okay. So it sounds like there is a way to get it shifted as opposed to, well, hope you just have a lot of good noon classes. Sometimes those choosing your classes, it's like a whole matrix, right? It's not always in your control. Colleen (09:14) Yeah, yeah. Exactly, yeah, and I think it's an obstacle because I think, you know, this generation of traditional college students are really savvy, they're really interested, they're listening to these podcasts, they're wanting to figure things out, and so they're frustrated when they're trying to, you know, sort of sleep at a different time and it's not working. So I think being able to really assess carefully what's going on and then intervene accordingly can really increase, you know, sort of their ability to fix things. Liz (09:50) So, I mean, a lot of college students I work with, I feel like their biggest complaint is that they're tired all the time, right? I think it's really normalized to have a lack of sleep in college, right? It's probably something that someone says to you at least once during the day that they're exhausted. Do college students seem concerned at all about their lack of sleep? Is this something that you're hearing about? ⁓ And do you think that there is a learning curve to how much they really should prioritize it? Colleen (10:20) ⁓ yeah, great questions. I feel like I want to hear your answers as well, given your work. would say, yeah, you know, and I think this is a common conversation too, like the difference between fatigue and sleepiness. you know, fatigue can be seen in a lot of ways to be an indicator that I'm trying my best, that I'm working really hard. I couldn't possibly be doing any more. And again, you know, we've got this generation that are high achieving. They're really interested in functioning. so, you College Is Fine Podcast (10:25) I Liz (10:42) Mm-hmm. Colleen (10:50) to be able to tease apart are you feeling sort of a heaviness, a fatigue versus could you actually fall asleep during the day, which is sleepiness. And really recognizing when the intervention is to increase your sleep window or your opportunity for sleep versus when is it to do other types of stress management interventions because sometimes people are very sleep deprived but they're also struggling to fall asleep because they're so activated and wired. And I think really Liz (10:58) Right. Right. Colleen (11:19) know teasing that out is pretty important. College Is Fine Podcast (11:24) It's so fascinating that you said fatigue could be a sign that you're really trying your best. think about the word burnout and I think about how every single time someone comes in and they say, I'm tired. I think, okay, we're going to talk, you know, first we're going to talk about concrete sleep and we're also going to think through our, what are, what is your mood like? Are you feeling sad? That can make you tired. Are you feeling like you have ADHD and you're constantly trying to hone your attention? Well, that can make you feel fatigue. So I love that idea between sleepiness versus fatigue, because fatigue is like, it's sort of like a non symptom in a way, or it's sort of like a catch all for so many different potential things. I'm feeling fatigue right now because I have a cold, as you can probably tell from my delicious deep voice. Excuse me while I cough. ⁓ So with all the things that college students have going on, I found that when I was first, Liz (12:05) Mm-hmm. You College Is Fine Podcast (12:21) kind of maybe a younger therapist working with people on sleep, then there's so much research out there about good sleep habits, good sleep hygiene, and they include things like getting a consistent sleep schedule every single day. So going to bed at the same time, waking up at the same time, et cetera, et cetera. Do you find that some of those typical sleep hygiene methods are effective for college students? Colleen (12:46) Yeah, well, this is another great question. think there's two layers on there. The one is our relationship with students and what they're going through developmentally, because developmentally, they're learning by living. They're learning by experimenting, by deciding for themselves. And there's a certain amount of really appropriate pushback on when we tell students to do something. I mean, all we have to do is think back to when we were college students. Like, I think about my relationship with sleep now versus when I was 18, 19, 20. It's not the same and you I'm sure people were telling me to prioritize sleep back then. So I think there's this piece around, know, sort of how do you have a message that feels really flexible without, you know, kind of getting that pushback? I think the other piece ⁓ is our society's relationship with sleep hygiene. And this is something that, you know, if you've ever heard me talk, I get really, I get really on my soapbox about it because So the way that I explain it, which I think is worth our time, is that sleep hygiene is like oral hygiene. So oral hygiene would be your flossing, your brushing, you're using fluoride, perhaps, perhaps not, you're going to your dentist. You're really doing that to promote good care of your gums and teeth. Over time, we also have genetics that influence that, so you could be doing everything right. You go to the dentist, you're still gonna have cavity. But your dentist doesn't say, ⁓ I'm gonna floss away this cavity. Your dentist says, we have a different intervention. Liz (13:44) you Mm-hmm. Colleen (14:13) we're going to do a filling, and we still want you to keep doing this hygiene because it's promoting ⁓ overall good health. And sleep hygiene is like that. So, you know, your relationship with your screens, your relationship with stimulants, it's all in service of promoting healthy sleep, but you can still have problems. And when you have problems, we don't expect sleep hygiene to fix it any more than we would expect that to fix the cavity. There's got to be a separate intervention, which we know we use ACT, we use CBT for. And I think the problem is that a lot of our ⁓ medical providers are only trained in sleep hygiene, and they're really taught that it is an intervention or a fix. And so people go to their providers, they say they're not sleeping, and they're told to use these hygiene interventions, and then they're frustrated when it Liz (14:36) Hmm. Colleen (15:01) fix it. So I think it's really important to think about, know, what are we doing to promote healthy sleep in addition to what do we do if it gets derailed? And I think when students think about it that way, ⁓ they're really insightful about their relationship with their screens, their, you know, willingness to have a sleep window, to have any kind of consistency, but it shifts away from this sort of rigid you have to or else into a longer-term conversation. College Is Fine Podcast (15:02) Right. I love that idea because I find too with certain aspects of sleep hygiene and sort of the rules around that, it can feel so frustrating when you're like, yeah, that'd be great. I can't pull it off. I don't know what to tell you. And you feel stuck. Like, I guess I'll just have to be exhausted. I'm not asking this just because you live in Boulder, but speaking of sleep interventions, the relationship that you find to your students, marijuana use and sleep, other sort of drug use and sleep. Liz (15:30) Right. Colleen (15:41) Yes. Liz (15:42) Right. College Is Fine Podcast (15:59) and what's real and what's not. Colleen (16:03) yeah, yeah, that is a great question. The good news about Boulder is not only are we a place where, you know, people like to utilize and experiment, but we also have great researchers. So there's a lot of great researchers around in the Denver, know, Boulder corridor that are also looking at trying to understand that. And I think, I think from a, from a scientific perspective, what we've come to understand is it's really personal based on somebody's genetic predisposition that there is College Is Fine Podcast (16:14) You Yeah. Colleen (16:33) a gold standard statement that it's all good or bad, that we have found that some people really find CBD or CBN without THC to be a really important navigator in helping sleep, but for other people it creates a very different reaction. So I think it's difficult and it's valuable that they're looking at that and I don't think that we can say it's all good or all bad. The way that I talk about it with my clients Liz (16:36) Right. Colleen (17:03) is to think about it the way we would think about any prescription. So if somebody was giving you a prescription of melatonin or sleep medications, you would follow the prescription. And so thinking about if you're using or experimenting with THC, CBD, CBN, to really think about it in terms of what is the right dosage, how do I titrate, and really paying attention to it and thinking about that ⁓ functionally so that it's supporting you in that way. ⁓ Liz (17:31) I find that a lot of the suggestions I make with college students around sleep are quickly shot down. Like for example, yesterday I was talking to someone and they told me they took a nap. from three to six p.m. and then they a really bad night's sleep. So for example, like maybe we decrease daytime napping, right? And they're like, oh my gosh, never. Like that's like my favorite time of the day. Like I love napping. What are a few tips that are... palatable that you have found to college students around their sleep. Colleen (18:05) Yeah, yeah, you nailed it. That's one of the, you know, sort of most difficult things to do is to find that place where, you know, it feels workable. And I, you know, I see that resistance in ACT. talk a lot about resistance being a posture, not a problem. And so I think, you know, I'm sure you do the same thing of really kind of looking at the function of that resistance and, know, that person saying, you know, that that's my happy time and being right. And I'm not giving that up. And, you know, really, I think that the bigger conversation Liz (18:29) Yeah. Right. Colleen (18:35) about making hard choices every day about what you prioritize and what you give up and that that might be, that might continue to be that student's choice and being able to reflect that that is their choice and the consequence of that is that the student's not likely to ⁓ sort of shift or change. So I think that's a big one. And I'm with you on that because I say this a lot. Liz (18:52) Mm-hmm. Colleen (19:02) sleep work happens during the day. It's about the way you're managing your day. And what we do at night is a lot more of an acceptance and a sort of rolling with it kind of experience. We don't get to control how well we sleep any given night, but we can increase the likelihood of a healthy sleep pattern if we're really thinking about how we do things during the day. So I do come back to that again and again. And I also am, you know, I think we do a lot of that makes sense that's your choice now, if that changes. Liz (19:15) Mm-hmm. Colleen (19:32) you feel that your current status quo is no longer tolerable, let's go back and revisit them. Yeah. Liz (19:32) Right. College Is Fine Podcast (19:40) Yeah. So some things that they could do during the day. it sounds like potentially setting yourself up for success could include not necessarily napping away the day and then assuming you'll be able to sleep at night, for instance, or ⁓ not having a lot of caffeine at a certain point. Are there certain daytime easily used strategies for how to set yourself up for success during the day? Colleen (20:05) So, yes and no. So, yes, and I'm very aware that you're, I have to shout out to your other podcast guests on podcast 22 and 23, because they were fabulous. And they talk about a lot of these daytime strategies and they're exactly accurate. And, you know, I think this is something that, you know, brought us together at the conference that the problem with thinking in that way is that the strategy then, the subtext there is I can do something now to control my sleep tonight. College Is Fine Podcast (20:16) Yeah. Colleen (20:35) And that really is a very dangerous paradigm because it's not true. Sleep is like appetite, it's like mood we can promote, but there's gonna be natural variations. And so we really wanna think more about. ⁓ Liz (20:39) Right. Colleen (20:48) you know, how can we think about it during a week? Like we, you know, we do better when we say, how well have I done with eating my vegetables this week? Maybe not today, but overall have I more days than not gotten my vegetables? And that's really important. ⁓ You know, a great way that I think is just a very immediate way to connect, but also give a lot of flexibility is to really think about treating sleep like a friend. A friend is someone that you have a give and take. Liz (20:52) Yeah. Colleen (21:18) You don't expect that you're going to be controlling the narrative the entire time. It's more about consistency and really thinking about follow through reliability and really thinking about the choices that you're making during the day as a way to sort of how would you treat a friend? If you said you were going to go to the gym and then you just didn't go, that person would be disappointed. And so really thinking about it in those terms, I think, can be pretty effective. Liz (21:45) I like that. I like that. College Is Fine Podcast (21:47) I love that. It's a bit more flexible. And I think what you're saying is almost like in a complete paradigm shift in how you think about sleep, you know, especially for something in college where it feels, I'm sure a lot of people listening feel like, ⁓ it'd be so great if I could, you know, I like having control. It makes me feel comfortable to have control. I want to be certain about sleep, but that might be, that might come back to bite you when you get so overly focused on getting that perfect night or going to sleep at a certain time. Colleen (22:17) Exactly. And what I think, you know, there's at the heart of sleep work during the day and during the night is consistency. And that's not something that is really ⁓ easy to do at any age, but especially. College Is Fine Podcast (22:32) Right, right. Colleen (22:34) But especially during college when your environment is very inconsistent and chaotic. And so I think we have to have a little bit of compassion for that. think also this is not something you hear in later adulthood, but in early adulthood, there is something really beneficial about reminding students about the value of one good night's sleep. You know, that sense when the world is feeling so awful and overwhelming and just like, let's go get some extra sleep and waking up and feeling refreshed, there is power in that. College Is Fine Podcast (22:40) Right. Liz (22:58) Right. Colleen (23:04) And students can really respond to that. It's the same, I think you have HALT in a couple of your podcasts, like wait, we need to eat, we need to rest. And that reset button is a huge one that I think it's very immediate and accessible for students. Liz (23:18) Mm-hmm. College Is Fine Podcast (23:19) I think I had to use one of those last week where I was like, just, at some point I'll, I'll, I'll get that good night's sleep and then, and then I will feel better. I don't know when that's going to come, but I know that it'll reset me. ⁓ so I think I definitely needed to incorporate that when I'd, you know, done some similar stuff that I'm sure college students do, right? It's like, I'd put, just put, I packed too much in. was exciting stuff. I didn't want to miss it. And the consequence was I, at the end of the Liz (23:32) ⁓ Right. College Is Fine Podcast (23:48) The weaker weekend, just, I was depleted, but I wouldn't have given it up for the world. Liz (23:52) you ⁓ Colleen (23:52) Yeah, exactly. And I think you're really highlighting such an important thing. There's two very distinct groups. There's a group of students who are figuring out how to balance life like we all are. And at some point, there is a deficit that then you go and you look forward to catching up on sleep, but you feel like you have the capacity to sleep. And then we've got this other group where they're really struggling to, they're wanting to prioritize sleep and they're really struggling to make sleep happen for themselves. Liz (24:12) Yeah. Hmm. Colleen (24:22) So I think those are two distinct conversations. College Is Fine Podcast (24:29) So this is kind of a therapists confess question or guests confess, right? Because as we know, we all like to say, we know a lot about psychology, et cetera, but everybody is also human ⁓ on this podcast and coming in and we've all been there. So do you practice what you preach or do you also struggle occasionally with wanting to control sleep? or falling into some poor, I don't want to say habits necessarily, but yeah, do you practice what you preach? Colleen (24:58) yeah. ⁓ I think you could say it. think we're all human. ⁓ You know, and I think that the sort of human answer is sometimes. You know, I think ⁓ when I first started doing this work about 20 years ago and I was learning about the protocol, I did each and every protocol because I thought, how can I possibly ask my clients to get out of bed at 2 a.m. if I'm not willing to do it? And it's hard. You know, that really intense behavioral program is very difficult. ⁓ And I'm very grateful Liz (25:22) Yeah. Colleen (25:30) that I don't have chronic sleep problems. I'm also grateful that I feel like I know what I need to do when I need to do it. I think there's other domains in our lives where like, please tell me I don't know what to do. And I think that's where this conversation is so valuable. ⁓ But no, I'm not perfect at all. And I think that's why I have so much compassion when people and students tell us it's really hard to figure this out, because it is. College Is Fine Podcast (26:00) And I know just for our listeners, might not know that one of the most common things people say to do when you're not able to sleep is to get out of bed, do something else, try not to fight so much for sleep and so that you're not sort of sitting and stewing and getting more anxious in your bed. And so I can also say that I very rarely, I have a hard time with that. to your point about finding some balance, I will open up. Liz (26:22) Get out. College Is Fine Podcast (26:29) you know, a book or try to do something else. Like I don't, I'm like, okay, it's too cold for me to get out of bed. So that's a no, but I am able to start an audio book and just listen to that. And if I listen to the whole thing, well, which, ⁓ I think that idea of giving up the struggle was really refreshing for me. ⁓ and so I know that's a lot of what you talk about in your work is just, you know, kind of let go of the rope, give up the struggle. You ultimately in the long run, we'll have a better relationship to sleep. Colleen (26:45) Yes. College Is Fine Podcast (26:57) as opposed to that kind of fight to get sleep in a perfect way this night. You'll just have a better relationship to sleep. And probably that would, I imagine, spill over into other aspects of your life as well, nutrition, et cetera. So I just thought your message was so important for college students to hear. And those folks at CU Boulder, not UC, are lucky to have you. Colleen (27:20) Well, thank you. And I love that you guys are getting the word out about everything about college and what's happening and how to help students. It's really great what you guys are doing. College Is Fine Podcast (27:31) Well, we'll have you back on for another topic at some point soon, because it sounds like you're not, you know, know sleep, but I'm sure I have a feeling you have some other tips for some other areas of life. So thanks so much for coming on. Liz (27:34) Yes. Yeah Colleen (27:41) would love to. Yeah, thank you. Liz (27:44) Thank you so much, Colleen.