Latest / ADHD with Confidence | Overcome Anxiety & Self-Doubt, Christian ADHD Coach, ADHD in Women / 163 // How to Improve Your Sleep, with Dr. Aric Prather

Transcript

163 // How to Improve Your Sleep, with Dr. Aric Prather · ADHD with Confidence | Overcome Anxiety & Self-Doubt, Christian ADHD Coach, ADHD in Women

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I want to start off by saying if you are struggling with sleep, there is hope.
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Make sure you stick around for today's episode where I had the privilege of
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interviewing Dr. Eric Prather.
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He is a sleep expert, the author of the book The Sleep Prescription,
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which was incredibly helpful, and he's a professor of psychiatry and behavioral sciences.
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There are so many tips in today's episode. I will link the book below,
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and I really hope that you find something encouraging, hopeful,
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and helpful in today's episode.
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Hey friends, welcome to the ADHD with Confidence podcast. I'm your host,
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Kelsey Spronk, and I am so excited for today's episode. We're going to be talking
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all about sleep with Dr. Eric Prather. Eric, welcome.
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Thank you. Yeah, thank you for having me. I'm so excited to be here.
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Yeah, thanks for being here. I know that my audience and myself are very excited
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to learn all about how we can improve our sleep and then improve our well-being.
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But before we get started into that, can you just tell us a little bit about
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yourself and the research that you do?
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Yeah, absolutely. So I am a professor here in the Department of Psychiatry and
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Behavioral Sciences at the University of California, San Francisco.
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I'm a clinical psychologist.
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And, you know, over the last, I don't know,
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two decades. We've kind of been running a research program around sleep and
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how it's related to stress and what that means for our health,
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both our mental health, but also we've done a lot of work on kind of physical health.
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So my interest has been in the immune system and trying to understand how when
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people don't get the sleep they need, like do they get sick?
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You know, how does that affect different kind of biological processes that might
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be related to aging and those sorts of things.
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But then we've also become, you know, more and more interested in interventions
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and how we can get people sleeping better.
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And so kind of in the other part of my life, I helped direct clinic here at
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UCSF focused on treating people with insomnia using kind of the gold standard.
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Kind of first line treatment, which is cognitive behavioral therapy for insomnia,
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which is, you know, amazing.
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And so, and then, yeah, the rest of my time is trying to talk to people about
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sleep and getting them excited about kind of how important it is for kind of
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our health and well-being.
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So, so excited to do that here.
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Well, we are honored to have you because I don't know if I've ever met anybody
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who doesn't struggle with sleep in some capacity, and especially within in the
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ADHD population. It is a very popular topic.
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I want to start off. So first of all, your book, The Sleep Prescription, really great book.
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I loved it. After I read it, I decided I needed to reach out to ask you questions about it.
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But can you talk to us about the importance of sleep? Because I think for a
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lot of, well, I'll speak for myself, for myself, sometimes I just,
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I can't be bothered with doing the things that I need to do that I know I need to do to get a good sleep.
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But how important is sleep for those who are starting on this journey saying,
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hey, do I need to make some of these lifestyle changes?
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Do I need to do things differently? Do I need to work on this?
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How important is sleep for us? Yeah, it's such a good point.
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You know, first, I mean, you know, like everyone sleeps.
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Everybody probably wishes they slept a little bit better.
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Sleep changes as we age, right? So like that's also part of it.
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You know, you're never going to probably sleep as well as you did the decade
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before as you move on to the next decade.
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But it is like I think of it as really kind of, you know, central to health.
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I think of it. I think of sleep as kind of the glue that holds our life together.
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And, you know, the research really supports this. I mean, you know,
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there's now, you know, piles and piles of empirical papers that show that when
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people are getting kind of insufficient amounts of sleep chronically,
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they're at increased risk for kind of a whole host of negative health outcomes.
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I mean, you know, sleep and insomnia is associated with increased risk for things
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like depression and anxiety disorders, you know, cardiovascular disease.
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Cardiometabolic conditions like type 2 diabetes.
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And there's kind of growing interest and concern around kind of the role that
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sleep or lack thereof plays and kind of the development of neurodegenerative
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diseases. So like Alzheimer's and myocognitive impairment, things like that.
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And then, you know, we've done a lot of work on kind of sleep and the immune
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system and say susceptibility to infectious illness. So, you know,
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when people don't get the sleep they need and then they're kind of exposed to
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a virus, they're more likely to take it up and maybe get sick from it. So, you know, sleep is.
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You know is not just kind of like a laptop where you kind of close it and and
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then you're gone to the world i mean there's lots of important biological things
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that happen while you're sleeping and some of which only happen when you're sleeping,
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and so you know it is absolutely something that people can invest in i think
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you know i hear you and i hear it all the time from people that you know look,
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like like we have so many obligations we our lives are so busy and we're kind
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of constantly making these trade-offs around, you know, what we do and what we don't do.
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And it's completely understandable that sometimes it just, it seems like a bridge
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too far to make changes for your sleep.
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I think the thing that people don't often recognize is kind of the return on
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that investment can be enormous. So...
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You know, I always tell people that, you know, all of the research suggests
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that when people are getting the
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sleep they need, they're kind of the best version of themselves, right?
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They're like better parents, better partners, more creative,
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more productive, better able to kind of cope with like all of the hard things
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that we have no control over, right?
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But we can have sleep on board to regulate our emotions in a way that might,
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get easier to make better decisions, better choices.
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We have better food preferences when we get sleep we need. We're more likely
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to go to the gym or get outside when we get the sleep we need,
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when we have the energy to expand.
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And so all of those things are central to kind of living a full and restorative
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life. And, you know, sleep is at the center of it.
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And I, you know, I just try to implore people to do some behavioral experiments
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so that they can see that that makes such a big difference. The spillover effects
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of sleep are, you know, very tangible.
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And that's such an important place to start because I don't know about for other
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people, But there's been times where I've said, you know, I have too much work
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I need to get done or I want to enjoy my, you know, my evening.
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Maybe if you have little kids in the evening, bedtime procrastination kind of
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thing, you don't want to go to sleep.
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But recognizing the fact, like you said, that spillover in a positive way of,
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getting that restorative sleep, that better sleep is then going to improve.
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Like you said, not just well-being, fighting off sickness, preventing yourself
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from getting sick, but your relationships, your creativity.
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I imagine as well it would help with mood and focus as well.
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Absolutely. I mean, yeah, I mean, I think kind of these, you know,
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the best examples of kind of the costs of kind of acute sleep loss.
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Are really around kind of like attention, right? Like it's really hard to maintain
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focus and attention when people have acute sleep loss.
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And I think that, so one of the things that I think is so interesting about
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these studies are that, so they've done these studies where they kind of deprive
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people of sleep kind of partially for multiple nights in a row.
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And as they do that, kind of people get worse and worse at these kind of attentional
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tasks, right? Like it kind of builds up.
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But as they continue to do these kind of partial sleep loss nights,
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people's subjective experience of how sleepy or impaired they are kind of plateaus.
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So that despite the fact that objectively, there are these decrements that accrue
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over time from lack of sleep, people begin to not notice any longer,
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and this is partly why you know people go through the world and not really appreciating
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how impaired they might be because there's kind of this disconnection between
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what they're doing and how it feels
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and i think that's that's one of the challenges that we have in kind of getting
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people sleep back on track is there are people walking around the world in the
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world thinking that they're doing fine,
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but they they kind of lost the sense of kind of what how how well they could be performing um.
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And whether it's an attention attention task or something else if they had got
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gotten more sleep and then you're also right about the mood piece i mean when we have done,
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kind of studies where we've like serially measured people's sleep and kind of
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their mood and their stress level and stuff over day after day after day we
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find that when When people get less sleep than they typically do.
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You know, they just are more reactive to the things that go on in their lives,
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right? It's like little things feel like big things.
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And obviously, we're kind of a social network of community.
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And, you know, it only takes one person to have the short on sleep for things to kind of go awry.
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And now if you kind of like, you know, extrapolate that out to like,
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large groups of people where everybody or many people are kind of short on sleep it's no surprise that,
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you know there are communities or societies or whatnot where there's a little
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bit more friction than maybe there should be because of this sort of kind of constant,
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shortness on on sleep you know the debt that we all carry around,
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and that so that lack of sleep that you're talking about how it affects people,
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how we become more agitated on edge.
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I know I've definitely experienced that, you know, with little kids and you're
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not sleeping through the night.
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And then the next day, they drop the bowl of Cheerios or whatever it is.
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And you're just, you know, jumping. Does that have to do with the sympathetic
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nervous system then that fight, flight, or freeze?
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Yeah, yeah, no, absolutely. So, you know, when,
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so when people are short on sleep, and this has been done kind of in experimental
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studies, or just kind of when you measure people's sleep in general,
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and then you expose them to a task, like a stressor task, we do find that they may be more reactive.
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So this is kind of like activated, like blood pressure spikes,
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you know, they might have elevated cortisol compared to people who sleep more,
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or have better sleep overall.
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And then on top of that, it's not just kind of the acute change.
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It's also like how quickly people recover from that, right? Like how long does
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it take for the sympathetic nervous system to come down?
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You know, and there, you know, there's been studies looking at the brain.
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And so there's a, you know, there's a part of the brain that is kind of more threat sensitive.
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It's, it's for, you know, also activated to novelty, but kind of thought of
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this threat center, the amygdala.
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And you know in these paradigms where people will kind of be deprived of sleep
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or and compared to a night when they're not and then they're on the night on
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both nights they're exposed to kind of like
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angry faces or emotional faces that are threat provoking you'll see this kind
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of exaggerated activation on the nights where on the days after a night where
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they got kind of insufficient amounts of sleep or it was they were sleep deprived and so you
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know the idea that we're kind of more threat sensitive.
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And it's both the activation of that part of the brain, but also what regulates it.
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So our prefrontal cortex is sort of kind of the executive function center and
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kind of down regulates that.
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And that seems to be kind of offline or less aged.
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And so it's kind of this experience of when people are short on sleep or deprived
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of sleep, they're kind of all gas and like no brakes right like it's like you know which which is,
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sort of reasonable and probably adaptive in some times right like if you talk
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about you know when you have a new baby or something like it's really important that,
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people can stay up, right? That we can kind of maintain alertness and vigilance,
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under threat or like under survival.
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But what happens is like, that's often not the case, right?
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Like our lives make it feel like we're under threat or,
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you know, our brains, because we have these big brains, can,
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you know, create this, we can get stuck in loops and we can.
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Have all of these things that kind of activate our sympathetic nervous system
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as if we're under real threat when in fact it's more our anxieties our worries
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about the future our worries about things that will never happen in in reality
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right and it's i mean it's even extra,
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relevant because like when we're in the middle of the night like for some reason
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like it's never that our brain just populates with like the best things that
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have ever happened right it's almost like it's like very specific to these terrible things that,
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you know, that seem really small in the morning, but in the middle of the night
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take on such a loud volume and feel so large.
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And so when all of those things are kind of compounded on each other,
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it's no surprise that so many people have problems sleeping and their mood suffers as a consequence.
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And I'm excited to dive into how we can improve that.
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I think we talked a lot right now about the effects of a lack of sleep or poor
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sleep, not enough sleep yeah i want to i want to give people hope as well but
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i wanted to touch on something you said it's like.
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All gas and no brakes that's very relevant to the adhd audience in the sense
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that there is a term calling adhd it's like we have a ferrari brain with bicycle brakes
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the brakes are also yeah so the brakes are already something that we need to
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strengthen and i think it's a good reminder of the fact that,
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sleep is so incredibly important like you said for the prefrontal cortex.
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This is going to be important. So now that we know that it's important.
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Is there hope for people who are struggling with their sleep?
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Oh, my gosh, there is absolutely hope.
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I mean, I think, yeah, you know, like they I so I as I mentioned,
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I like help run this clinic.
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And, you know, we've been doing now it's been doing it for 10 years in this
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clinic. And, you know, I can't even think of an example where I was like,
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you know what? I think your sleep is just broken.
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Like, that really is terrible.
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Sorry. No, I mean, I think the good news is that sleep is something that has
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been, you know, conserved across
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all organisms that we've studied do something that looks like sleep.
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And it's been across millennia, right? Like, it's so fundamental to our being as humans.
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It's like built into our genetic code and like there are like fundamental biological
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processes that help regulate it right like and it's often the case that you
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know a lot of the challenge that people get into.
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Are our behaviors that kind of get in our own way.
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And the hope is that we can identify these behavioral strategies and and implement
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them in a way that will allow sleep to happen more predictably,
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so that there's like less effort that people need to put into it. I mean, I think,
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I always say that, you know, sleep is something that we never even wonder how
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it works until it stops working.
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And then when it stops working, you just become so hyper-focused,
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understandably, because it's like something that you never had to think about
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and you feel it when it doesn't work.
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And so people get really hyper-focused. They get really anxious because sleep
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becomes really feeling really unpredictable, right? And kind of you feel like you need to catch it.
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But sleep isn't something that you make happen. It's something that like happens
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to you. It's something that washes over you.
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And, you know, absolutely, you know, folks with ADHD, it's it's more challenging,
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right? Like it's like neurochemically more challenging.
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Like that's, you know, and like, thankfully, we have like this tapestry of kind
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of differences in in how our brains are made up.
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And and, you know, but one of the challenges is around sleep.
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And so, but all of the principles of how to try to improve someone's sleep stand
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regardless of kind of like how your brain is wired, right?
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Because these are like these very basic fundamental processes that regulate your human sleep.
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And so we can take advantage of that. That was something in the book that I
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really appreciated was how accessible this all is.
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We don't need to start off by, you know, going into a clinic and having different
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medications handed out or anything like that.
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These are things that are accessible to the common consumer.
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And I really appreciated how you made it so accessible and easy to access,
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even breaking it down into seven days to unlocking your best rest.
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I wanted to so we will in a second get into where people can start with improving
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their sleep but what do you find typically gets in the way of good sleep because
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I think a lot of times we feel like it's out of our control,
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there's something else affecting us we can't do anything about it we start to
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panic we feel like there's nothing that we can do so what would you say typically
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gets in the way of good sleep for people.
18:37
Yeah, no, I mean, and just to kind of like underscore that it like my experience
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is like when when people are having really bad sleep, and maybe they're developed
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insomnia, it feels like something's happening to you.
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Right? It's like, I don't know what this is. Like, all of a sudden,
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this is how I am. And I am kind of lost and scared.
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And you know, that is a really tough place to be. So I want to kind of like,
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be sure that like that is that is really, really hard.
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And, you know, I think the things that people do that get in the way.
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You know, they might start out as harmless, or they might be things that make
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tons of sense in the moment.
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You know, like, I think when people are already in a position where their sleep
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is really disturbed, you know, they're kind of just on kind of emergency,
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kind of like, just survival mode, right?
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And it's like, every night, it's about like, oh, my gosh, like,
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what is going to happen tonight? Like, what do I need to do?
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You know, it starts really starting putting sleep kind of on this pedestal becomes
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this very precious thing. Like I need to be at this place. I need to be wearing this.
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I need to kind of like have the room set up this way.
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And that just puts a lot of mental effort and pressure on the system.
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And, you know, no surprise, like oftentimes it kind of spirals out of control
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because you're like so anxious about getting it wrong.
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I mean, from the most basic sense, there are like these basic things that,
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you know, if people are just having,
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sleep problems and, you know, they've, you know, for whatever reason,
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never heard these kind of like basic sleep hygiene things, like you want to
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make sure those are checked off first, right?
20:15
So it's like, okay, like, guess what? Like caffeine keeps you awake, right?
20:21
Like caffeine is incredibly effective for alertness, but it absolutely is in
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your system for a long time.
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And so you know, the half life of caffeine is around six hours.
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So that's like how long it takes for half of it to still be left in your system.
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And so if you consume like a double espresso at 4pm, like at 10pm,
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you have a single espresso in your bloodstream. So like, you know,
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shocker, like it might impact your ability to fall asleep. It's not true for everyone.
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But you know, that's something you should consider.
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Alcohol and other other kind of substances near bedtime definitely affect your
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brain and sleep is generated in the brain.
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So that can make it harder to stay asleep. I mean, alcohol helps people fall
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asleep. It's relaxing, but it.
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It impacts kind of the architecture of people's sleep in a way that can make
21:09
it more disturbing, right?
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The bedroom, like making sure that people have, you know, that it's dark,
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that it's quiet, that the temperature is cooler, all of those things help support sleep.
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So, you know, when people aren't doing those things, like those are like kind
21:24
of the obvious things to jump into to rectify them.
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But when people have like, I guess the last thing I'll say, when people have,
21:33
really disturbed sleep and they might have insomnia, the thing that they often
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do that gets in the way is they spend a very long time in bed, not sleeping.
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And this is an example of where it makes so much sense, right?
21:50
That when sleep is so unpredictable, you want to be in the right place at the right time, right?
21:57
People say, like, you know, I'm only getting four hours of sleep so like i get
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in bed at 8 p.m because like what what if it's in what if it's from like nine,
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nine to whatever nine to one you know and and so,
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you know they're but when they do that they ensure that they're just going to
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have a lot of time awake kind of stewing in this like angstiness
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around not sleeping right like your body can only generate so much sleep right
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and And this idea that everyone needs eight hours is probably not accurate.
22:30
Like we're learning more and more that there's much more of a distribution.
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And, you know, the Academy, American Academy of Sleep Medicine,
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I think the Canadian Sleep Society, we all kind of have these recommendations
22:40
of at least seven hours of sleep for optimal health for an adult.
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It's not a one size fits all thing. And, you know, if so, if you're a seven
22:48
hour sleeper, and you're giving yourself 10 hours in bed, that you're ensuring
22:52
on the best night, three hours awake, right?
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And like, you don't get to choose when that is. And it turns out that when people,
22:59
kind of extend their kind of sleep window, it often also kind of,
23:04
kind of like lightens that sleep, too.
23:07
And so it's, it's, you know, it ends up being like really fragmented.
23:10
And so from all the sleep science, we know that,
23:13
kind of when sleep is fragmented like that,
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even if you get the same amount that you always get but it's all broken up it
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just feels worse like you like you know your subjective experience of sleep
23:25
is just you just don't feel as restored and you know,
23:29
like often as much as you know sleep is so important for our health and well-being
23:33
and all these other things.
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For like biological reasons it's also you know really important for like how
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you feel during the day and like being able to do things you want to do and
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being happy and, you know, you know, to relate well with others,
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all those sorts of things.
23:47
And it seems like that fragmented part of it seems to undermine that a little bit.
23:52
So those are all the things that people do to get in their way,
23:55
you know, among other things. But a couple of things that stand out and what
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you just said, there was a quote you had in the book, page 155.
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It said, there's no such thing as perfect sleep.
24:07
And I think that's a really important reminder because so often you said we
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don't think much about sleep until we are lacking sleep
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and then we can become obsessed with it we can worry about it we can become
24:18
really anxious which as you talked about in the book sometimes it's that anxiety
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about sleep that's actually preventing us in part from being able to sleep because
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the more we worry about it,
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the harder it's going to be to fall into that sleep i know for me that used to be the case
24:34
before i read your book and and years ago i would be up in the middle of the
24:38
night and i would get frustrated i would just you know maybe if i lay really
24:42
still maybe if i you know do this that and the other thing and so i i thought
24:45
that was important that you address the fact that it's
24:49
it's okay and it's good to get out of your bed,
24:51
to wait until you're tired again and then get back in your bed so that your
24:55
bed is associated in your mind with that sleep yeah,
25:00
another piece that Sorry, go ahead. Did you have something to add?
25:02
Oh, I was just, I was going to say, I mean, like one of the things that I've noticed that.
25:07
Working with people that have, you know, really chronic insomnia is they,
25:10
and maybe, and I actually, it resonates for me and me for you is you have once
25:14
in a while, you'll have this like exceptional night of sleep, right?
25:18
Where you like go to sleep, you, you know, you, you wake up and then same position
25:23
you started, like, you're just like, you feel great.
25:26
And like, you're like, Oh my gosh, like that, that's what I want.
25:31
And for people that often have insomnia, they've had that experience.
25:35
And for whatever reason that becomes their reference for what sleep should be,
25:40
right that they like and and so that's what they're striving often striving for.
25:46
But rather than seeing that as like that is good enough or like a normal night's
25:50
sleep, it's like this exceptional thing that's really for savoring,
25:53
right? Like it's this very unique experience.
25:57
And that's some of the cognitive shift that people have to make around like,
26:01
what, you know, what am I shooting for? Like, how will I know that it's successful?
26:05
You know, because a lot of trying to help people with their sleep is somewhat
26:10
about building resilience.
26:12
And kind of showing people that like, you know, not every night's going to be
26:16
great and it's never about tonight, right?
26:19
Like it's like trying to get people to shift to the idea that like do these
26:23
things and on average your sleep will be better, but there are so many things
26:27
in the world that we can't control.
26:29
And, you know, like take, you know, what if your kid gets up in the middle of
26:32
the night and wakes you up, right?
26:33
Like you can't control that and that's good. You want to be able to kind of
26:37
do that, but you should also be confident in yourself that like,
26:41
you know, for every bad night that you have, that usually means that the next
26:45
night's going to be better because your body will compensate because it's so,
26:49
like biologically based, right? To make sure that your body will take care of you.
26:56
And, you know, keeping that in mind can be helpful and kind of relieving some
26:59
of that anxiety night to night.
27:02
And ironically, when you talk about the fact that there's a lot of things that we can't control,
27:07
yes we can control the factors around helping us to sleep better but we can't
27:11
control that sleep and it's,
27:13
excuse me it's letting go of that control that is more likely to help us to
27:17
actually fall into sleep absolutely absolutely,
27:22
one other thing that i wanted to touch on you talk about in the book rumination
27:26
and rumination is common within adhd.
27:31
What would you suggest? How does that affect sleep and what can we do about it?
27:36
Yeah, I mean, you know, like rumination is, you know, completely natural,
27:40
right? I mean, it's, you know, it's getting stuck in, in some of these loops and thinking.
27:47
And, you know, it's often kind of like negatively valenced thinking.
27:51
And it can be challenging. And it certainly gets in the way of sleeping,
27:57
you know, happens, you know, maybe before you go to bed or the middle of the
28:00
night, and you're kind of just going, kind of taken for a ride on this like thought train.
28:06
And it's really hard to get off. And so, you know, there are like a couple different
28:12
strategies that that we recommend or I recommend.
28:15
And I mean, you know, in the moment, usually, what seems to be most effective
28:20
is kind of removing yourself from the situation.
28:22
So in this case, if, if you're kind of spending, this is happening in bed,
28:26
and you're noticing that your kind of mind is, is going down that path.
28:31
And you've had experience of like not being able to get out of it and fall back asleep.
28:35
Usually, the best strategy is to kind of get out of bed, go somewhere quiet,
28:40
pick an activity that is kind of sleep supportive, but also distracting as a
28:45
way to try to redirect your mind.
28:48
There's lots of different, you know, different techniques. I mean,
28:50
this is, I, you know, I often say that, Like, you know, sleep is universal,
28:54
but it's also kind of personal, like both in like our life experience around
28:58
sleep and what we think sleep should be, but also what works for us.
29:02
Right. I mean, I used to think like, oh, reading, reading's the thing.
29:06
Like, you know, for me, it's like I read two pages and I'm like,
29:09
oh, my gosh, like I have to reread it all, you know.
29:13
But, you know, I ran into all like all of these, you know, multiple patients
29:16
that were kind of like super bookworms.
29:19
And like they would just like read just they would just like devour books.
29:22
And I'd be like, how are you sleeping?
29:25
And they're like, well, I'm not sleeping any better. But like,
29:27
I read like three books this week. And I'm like, oh, my God,
29:29
like, this is not not what I intended. And so, you know, that was like a great
29:34
learning experience for me.
29:35
And and so, you know, maybe it's something else. Like, you know,
29:38
some people, they can just like watch kind of light TV.
29:42
That, you know, I always recommend like something that they've seen before so
29:45
they don't have to like know what's going to happen you know you don't want
29:47
to kind of like binge watch a series or something like that but like you know
29:50
something that's like light and and and i i guess always shooting for like,
29:55
positive slightly positive and calming is like the zone that we want to try
29:59
to get people into because we know that also supports kind of our parasympathetic
30:04
nervous system so the the the,
30:06
opposite of the sympathetic nervous system kind of the that this rest and digest
30:10
system that is critical for helping people to kind of wind down and get sleepy again.
30:14
For other people, it's stretching or like, you know, doing a meditation or kind
30:17
of tracking their breath.
30:19
You know, I mean, that's the same, you know, these kind of like four,
30:22
seven, eight breathing techniques or box breathing or any of that kind of stuff
30:26
is, or progressive muscle relaxation, all of those things, you know,
30:30
help engage that system.
30:33
And, you know, and it's good to have kind of a toolkit of things that you can
30:36
try. I mean, listening to podcasts are often helpful for people.
30:40
You know, I think there's so much content that people can engage in that they
30:43
can find something that works for them.
30:45
But the goal, I think importantly, is to kind of focus your mind on it away
30:49
from the ruminating thought.
30:51
And it's also, I think the other thing that's important is that.
30:55
Like having the frame of mind that this time that you're spending is not about being productive.
31:02
Right. It's not like, oh, well, I'm up, so I guess I'll do this.
31:05
It's like, no, like we're working towards trying to retrain your brain so that
31:11
you don't run into this rumination pattern kind of every night.
31:15
Right. And so then once you begin to feel sleepy again, you get back in bed.
31:18
And what that is doing is is kind of trying to, you know, use a little classical
31:23
conditioning, track, you know, hack to, to kind of pair the bed with this sleepiness
31:28
feeling so that the bed itself becomes more supportive of sleep.
31:31
So that's, that's something that people can do in the middle of the night.
31:35
The other thing that often is helpful is trying to get out in front of it during
31:39
the day, right? So a lot of times the ruminations that we have or the worries
31:44
or whatever kind of thought loop we end up getting into, those things are predictable.
31:49
Like a lot of them don't come out of the blue, like, oh my gosh,
31:51
I can't believe I'm thinking about this.
31:52
Like, where did that come from? Like, you know, it's, it's often things that
31:55
are relevant to our daily life or like stressors that we're constantly dealing
31:59
with or things about tomorrow or, you know, whatever, like things that are on your plate.
32:03
And, and so like giving yourself time, like scheduled time to actually work on those things.
32:10
We talk, talk about it like as scheduled worry where people can,
32:14
you know, write down, you know, you know, pick a time in your day,
32:17
say 10 minutes, 20 minutes, whatever you can do where you are intentional about.
32:24
Worrying about those things, like letting your mind do its thing and ideally
32:29
writing it down because then there's something about language that is helpful.
32:33
It also provides a little bit more clarity around what's going on through your mind.
32:40
But then having it scheduled and then having a stop time. And when it stops, you stop.
32:44
And then you can keep it, say, by the bedside or something like that.
32:48
But, you know, at the very least, if it starts cropping up in the middle of
32:52
the night or when you're going to bed, you say, no, look, I did that already.
32:56
I already scheduled and I have it scheduled for tomorrow.
32:59
Like I can, you know, deal with it then. And when people make that a practice,
33:04
it can be really helpful. I mean, it might feel kind of funny in the moment.
33:08
And in the early days, it might be, you know, you're like, this is not making a huge difference.
33:12
But as you begin to make it a practice, it will begin to kind of quiet the mind,
33:20
and increase the chances that it doesn't crop up when people have wakenings,
33:24
which is totally normal to awaken during the night.
33:27
I appreciate the fact that instead of just saying, you know,
33:31
don't ruminate, don't worry about that, telling people not to experience,
33:35
have that human experience, recognizing that it is normal to worry about things
33:40
and scheduling that time in.
33:43
I think it is incredibly helpful to even within ADHD, there's that piece of
33:47
rejection sensitivity that can also then lead to rumination about the rejection,
33:54
the perceived rejection or failure.
33:56
And I think, too, I talked about this the other day, the importance of going
34:00
through it, experiencing it. And it's kind of what you're talking about here
34:03
is scheduling that time to worry, but also having a stop time.
34:07
I think part of it, too, is recognizing for those of us, myself included,
34:11
who do like being productive, we don't like to, you know, waste time, so to speak,
34:16
is recognizing that without scheduling this time in, chances are I'm going to
34:20
spend a lot more time worrying, ruminating, thinking about this during the day.
34:26
And potentially in the middle of the night. And so having that,
34:30
time set aside, something else you talked about, speaking of time set aside,
34:33
is scheduling rest breaks throughout your day, having time for you to
34:39
be relaxed, go for a walk, something that's calming during the day instead of
34:43
expecting yourself, like you said, you're not a computer, you can't just shut
34:46
down to go, go, go all day and then all of a sudden flip a switch and fall asleep.
34:52
Yeah, I mean, it's, yeah. I mean, the more that I like think about this.
34:59
I think one of the challenges has been that,
35:02
historically we have focused on improving people's sleep and we kind of focus
35:08
narrowly on that like nighttime period right like as if there's some clear way to demarcate,
35:17
like daytime life nighttime life like this is a nighttime problem,
35:22
but you know it's a 24-hour experience right and I think it it should be treated that way.
35:28
And I mean, the good news is that what that means is like, you have ample opportunity
35:34
to try to improve your sleep throughout the day, right?
35:36
These are all things that we can do that I think will also have just like direct
35:40
benefits to your day, even if your sleep isn't problematic, right?
35:44
Like I think scheduling and breaks anyway is a great idea, right?
35:48
Getting outside, like, you know, enjoying the sunshine and like the,
35:54
you know, the extent that you can be around kind of nature all like there's
35:57
just more and more evidence to support those those kind of benefits for health
36:01
and well-being and so you know,
36:03
but if you can't do that just like take some time for yourself i think you know
36:07
you mentioned in the beginning you know bedtime procrastination.
36:12
And that's like such a fascinating thing that people do regularly because we've
36:18
we've sort of lost that autonomy that control of our time and so as a consequence,
36:22
you know, people kind of take advantage of it at the night at the expense of sleep.
36:27
Possibly it's it's it's not a nighttime problem that's like a daytime problem
36:32
right that's a thing where you know maybe by,
36:36
kind of taking some ownership where you can and not everyone can i get that
36:40
you know like that's those are the challenge those are like societal challenges,
36:43
but to the extent that you can even briefly,
36:47
that that that that is likely nourishing in a way that will have benefits come bedtime.
36:56
Yeah. Instead of blaming yourself for adding shame onto the struggle you're
37:00
probably already having, recognizing that this could be a legitimate need.
37:04
Maybe you missed out on social connection during the day. Maybe you missed out
37:08
on kind of a fundamental, a core need of creativity or learning,
37:12
or maybe, you know, for those of us, myself included, bookworms.
37:15
When I read that in your book, I thought, nope, that's not me.
37:18
I would be the one who had read three books by the end of the week.
37:22
But finding time to be able to do that during the day and recognizing that that's
37:27
not selfish, that's necessary, and that's part of who we are and part of building
37:32
that, fulfilling that meaningful life. And then it's also going to help us with our sleep.
37:37
Before we go, where should we start if somebody is struggling with sleep? Sorry again.
37:43
If somebody is struggling with sleep, of course, I have a cough today.
37:47
Where should they start, what would be a few of the basics that you would start them off with?
37:52
Yeah. So, you know, ironically, the first place that I always have people start is when they wake up.
38:00
And so as much as people don't love this suggestion, it is to maintain a stable
38:07
wake up time seven days a week.
38:10
This is a course for people that are having sleep problems. So,
38:12
you know, I'm not like the enemy of like sleeping in on the weekend.
38:15
And like, in some cases that can
38:16
be really helpful because if people sleep debt and stuff like that, but.
38:20
You know, I talked about these like biological processes that regulate sleep.
38:23
And one of them is your circadian rhythm. And so this is kind of your internal clock.
38:28
And one of the best ways to entrain that clock to ensure that it's stable is
38:35
by stabilizing someone's wake time so that they wake up the same time your body
38:39
kind of starts moving around the same time, you get sunlight in your eyes,
38:41
all those sorts of things.
38:43
But it also helps anchor your other biological process, which is called your
38:47
homeostatic sleep drive or just sleep drive.
38:50
And basically that's the idea that kind of like the longer you're awake,
38:53
the sleepier you get. And I talk about it like a balloon. Like,
38:57
so you kind of wake up in the morning and your balloon is flat.
38:59
And then like you go throughout the day and it kind of builds up and builds
39:02
up and builds up with sleepiness.
39:03
And then when you go to sleep, it kind of drains out that out of that balloon.
39:06
And, and so when you stabilize someone's wake time, it, and you keep it consistent,
39:11
it's, you know, it both It entrains your circadian rhythm and it starts the
39:16
filling of that balloon at the same time.
39:18
And so, you know, eventually when you keep it consistent, people will begin
39:21
to get sleepy around the same time at night, right?
39:23
So rather than giving someone a prescribed bedtime, which can be really anxiety
39:27
producing for someone with insomnia, you let kind of biology do the work.
39:31
And when the circadian rhythm and the sleep drive are kind of well aligned,
39:36
that creates a more predictable and kind of robust sleep experience.
39:43
And so that's always where I have people start. And we talked about some of
39:47
the other things that people can do during the day.
39:50
I mean, I think the other thing that I find really important is that people
39:55
kind of create a wind down for themselves that they can keep consistently.
39:59
So, you know, our brain is like a predicting machine, like it's like doing so
40:04
much work trying to take in all this information from the environment to kind
40:07
of know what's supposed to happen next.
40:09
And the more predictable those things can be, like the better the outcomes are.
40:14
And so, you know, you know, it's just so
40:17
important to kind of create some kind of transition time from your kind of working,
40:23
busy life to like letting your body know like, no, this we're moving into nighttime
40:28
and sleep and all the restoration that comes with it.
40:31
And so whether it's one hour before or two hours before or 30 minutes before,
40:34
like whatever you can do to ensure that you can set that set kind of bookend
40:39
the night or the day with this like next chapter of, of, uh,
40:43
of bedtime can be really helpful.
40:45
And, and so, you know, this is the idea of like having these rituals or these
40:51
cues so that your body knows what to do.
40:53
I mean, if you think about kids and like they're stuffed animals,
40:55
right? Like this, like feeling of safety, but also like something that they,
40:58
that helps their body know, like, okay, like this is where we go to bed and
41:01
we, you know, we start that transition process.
41:03
Humans have it too, whether it's brushing your teeth or stretching or like getting
41:07
your favorite pajamas or, you know, and then I think along those lines,
41:11
making your bedroom a shrine to sleep, right?
41:14
So I always say that like, you know, sleep and sex, like everything else like
41:18
stays out of the bed. Like ideally you're not watching TV in bed.
41:21
You're not doing other things. I mean, again, if you're working on your sleep,
41:24
like if you're sleeping fine and that's working for you, great.
41:28
I do always have a caveat that like, if you're doing something that is very
41:33
specific, and if you go somewhere else and you don't have it,
41:37
and then you can't sleep, like you should kind of examine that, right?
41:40
Like, so if you sleep with the TV on, and you know, that's your life,
41:44
and then you go somewhere, they don't have that, and all of a sudden you have
41:46
insomnia, like, maybe we should work on that.
41:49
But otherwise, like, try to keep things out of the bed, and don't get in bed until you're sleepy.
41:55
So again, kind of trying to build that relationship of like sleepiness in the
41:58
bed so that it kind of helps support that experience and that transition moving
42:02
forward. So I mean, those are the things that I would start with for sure.
42:05
So that those routines of waking up consistently
42:09
at the same time and then having a bit of a wind down with the understanding
42:15
that when we create that predictability, it helps train our bodies to to do
42:20
the work without us having to consciously think about it.
42:23
That's right. Exactly. And I mean, yeah, and like, I guess emphasizing that
42:27
if you're having sleeping problems, you know, really ideally wait until you
42:32
feel actually sleepy before getting in bed.
42:35
Because I so often I meet people where they say, you know, I was like feeling
42:40
sleepy, then I got in bed and like my brain woke up.
42:43
You know, and that that's, you know, that's that's very classic, a classic experience.
42:49
And that's is likely like a conditioned arousal that like the bed itself has
42:54
been kind of, you know, you had so many bad nights of sleep.
42:56
Like now it's like a trigger, right? Like it's like, oh, now we're gonna have
43:00
another in those nights.
43:01
And they experience that. And then, you know, this is where you kind of,
43:05
if you feel that, then that's where you need to actually remove yourself,
43:09
wait until you feel sleepy and then kind of get back. And, you know,
43:11
eventually it will, it'll start to repair itself.
43:14
But, you know, you definitely don't want to get in bed and just like lay there.
43:17
And I think that's a myth that I think a lot of us have believed about sleep
43:21
is that the more, you know, you get out of bed, the more awake you're going
43:26
to be and the harder it's going to be to fall asleep.
43:29
So I think that was an important piece that I learned is that it's counterintuitive
43:35
to what we believe, but it's better to get out of bed.
43:38
And you talked about that with as far as rumination, but even just waking up
43:41
in the night is to get up, to go do something calming, like you said,
43:45
whether it's because of those negative loops.
43:49
Thoughts or whether it's because we simply can't fall back asleep instead of
43:52
laying in bed and associating our bed with not being able to sleep and then
43:56
increasing our anxiety and frustration around sleep yeah,
44:01
i think i think the only thing i would add to that is that's all true i also
44:07
you know like i think the only exception is like when people wake up like one
44:10
hour before their alarm or something like that like basically you know your
44:14
sleep drive in a sleep balloon has kind of like drained out most of it.
44:18
And so, you know, and then the likelihood that people like get out of bed and
44:23
then they get sleepy enough to get to get like that last 20 minutes or whatever,
44:26
is and so the way that I deal with that is, you know, giving people kind of
44:30
the grace of like, just enjoy resting, right?
44:34
Like it's, you may fall asleep, fall back asleep, you may not.
44:37
But as long as you're not getting anxious about the fact that you have this
44:41
one hour left, like that's I mean, you just want to remove anxiety out of the bed.
44:44
But if you just want to kind of like enjoy you know hearing the birds or enjoy
44:50
kind of like that last bit of rest before the day starts and your brain isn't
44:54
like getting all revved up,
44:56
that's totally fine too right because we want to like like oftentimes when people
45:01
do do that sort of rest they often will kind of fall like into light sleep,
45:06
you know they'll say oh i was awake for an hour but they're like i don't remember
45:08
an hour like sure went by fast it's like yeah,
45:12
probably because you weren't awake for an hour yeah and And,
45:15
you know, so I just, you know, I always want to make sure people know that because it's like I.
45:18
That that is a common a common experience, especially when people have stress
45:22
in their lives. They often like wake up, you know, a little bit earlier than
45:25
they want to. And it's just hard to get back to sleep.
45:27
Right. That is a very good point. You're not wanting to get up and walk around
45:31
expecting yourself to build enough need for sleep to fall back.
45:35
That is a very good point. That is something that is common for me is waking
45:40
up earlier than I'd like to. But then I do. I enjoy that peaceful,
45:44
restful time before my kids, you know, come in and jump on me.
45:47
Kind of a magic time exactly before their little grill clock son wakes up and
45:53
they're allowed to you know come and wrestle and who knows what they've probably
45:57
been up for a while i remember that,
46:00
so on to the last question here where can we go to learn more about you and
46:06
about the work that you're doing oh gosh you know i should do a better job with this,
46:12
uh well you know the internet is a great place. I'm all over it.
46:16
Good thing my name is a pretty unique and at least in its spelling.
46:21
And so that comes up. And then, you know, I like my book that I've had,
46:26
you know, so lucky and fortunate to be able to share.
46:31
And it's it's kind of like the most amazing experience in my career that I never
46:37
thought I would have. And so I'm so grateful for that. That's available wherever you find books.
46:43
I mean, bookstores, there's probably one, but...
46:47
I will link it below. I will link it below. I have linked it in previous episodes
46:51
and had people asking about it.
46:53
And I will link it again. And then I will put a link to your website as well,
46:58
in case people want to go and find out more. Is there anything else that you want to add before we go?
47:04
No, I mean, you know, I think this has been great. I think, you know,
47:09
sleep is something that everyone has the opportunity to improve.
47:13
So when it feels like it's really hard, know that like, you know, it's not about tonight.
47:19
Like there are more nights in store to make little changes and those can add
47:24
up to big, big improvements.
47:27
And so I hope that people kind of take on that challenge and I'm happy to help in any way I can.
47:33
Amazing. Well, we appreciate the hope that you're providing that we can improve
47:37
sleep, the reminders of why it's so incredibly important, and then also the
47:42
tips that you gave us today. So thank you so much for taking the time to be
47:45
with us here today. Yeah, absolutely. Thank you.