New Approach to Insomnia and Sleep Issues?

Dr. Cooper

How’d you sleep last night? Does one night really matter? Has the attention on sleep in the past few years been a good thing or is it produced anxiety about yet one more thing outside of our control? Is sleep actually out of our control? Welcome to the latest episode of the Catalyst Health, Wellness, and Performance Coaching Podcast. I’m your host, Dr. Bradford Cooper of the Catalyst Coaching Institute. And these are all questions we brought up to today’s guest, Dr. Colleen Carney. Dr. Carney is an associate professor and director of the sleep and depression laboratory at Ryerson university in Toronto, Canada. She’s the current president of the association for behavior and cognitive therapies, insomnia and other sleep disorders, special interest group. She has previously been on faculty at duke university medical center where she was the recipient of the prestigious national sleep foundations, Pickwick fellowship. If you think this is just another discussion about sleep hygiene, you’re in for a big surprise. Two quick highlights for those looking to pursue your NBHWC approved coaching certification. Our June program filled up really early, but registration for our August program is now open. And for those of you who are already coaches, you do not want to miss the coaching event of the year. And I’m being completely serious here. The Rocky Mountain coaching retreat and symposium on September 17th through the 19th, we will all be back together in beautiful Estes park, Colorado this year and registrations they are already at the time of recording this at an all time record. We still have three months to go until the actual event. So don’t miss this one. All the details at CatalystCoachingInstitute.com or feel free to reach out to us anytime Results@CatalystCoachingInstitute.com. Now let’s tap into the insights from sleep expert, extraordinary Dr. Colleen Carney on the latest episode of the Catalyst Health, Wellness, and Performance Coaching Podcast. All right well, Dr. Carney, sleep is such a big topic for folks that are listening here on the Catalyst Health, Wellness and Performance Coaching Podcast. So we are thrilled to have you join us today. Thanks for jumping in.

Dr. Colleen Carney

No problem.

Dr. Cooper

So right out of the gate, we’ve had, I was doing a lot of pre-interview prep the last week. You take a little different approach than we’ve heard from some of the other sleep experts we’ve had here on the show like Dr. Meeta Singh. What are some of the key differences between your recommendations from maybe what our audience has heard or read in the past?

Dr. Colleen Carney

Well, I I’m, I don’t know, cause there’s so much information out there and, and there’s also a lot of misinformation out there, so I’m not sure how I’m, I’m different. I don’t think, um, I think that I represent sort of the, the average cognitive behavioral therapist. So for those of you who know what cognitive behavioral therapy, it’s an approach to changing your behavior and thoughts as a way of leveraging your sleep system and getting rid of things like chronic insomnia. And I think one thing that’s probably different is I guess, eight years ago, a student of mine researched what is the number one disseminated, sleep advice on the internet? You know, she kind of did it just out of interest at first and then we turned it into a paper and, um, and the number one bit of sleep advice was something called sleep hygiene. And we asked docs, like we asked family physicians and well, we asked, um, psychiatrists, we asked psychologists, we asked people who a lot of our, um, the people that we asked were members of the association for behavioral and cognitive therapies. So I mean, like they are CBT therapists, maybe not in sleep, hopefully not in sleep, but they were, you know, experts in CBT and other areas, sleep hygiene. And when we asked about what else do you do for chronic insomnia? The recommendations that are actually the most effective and the ones that actually have evidence on their own are things like they called stimulus control, which I can explain in a minute. And one that’s time in bed restriction. That’s another one that’s really effective. And they were at the end of the recommendations. Those ones are on their own effective on their own. And, and they are the core pieces of a cognitive behavioral package. What is this sleep hygiene?

Dr. Colleen Carney

So we became really interested in this because sleep hygiene is, um, is not recommended. It doesn’t have evidence on its own. It’s the thing on somebody’s website. And, um, and what we found is a couple of interesting things. One is that what somebody, what somebody calls, sleep hygiene, one place, maybe different than what somebody posts in another place and sleep hygiene is one of those things that seems to have morphed over time. And people kind of like pick and choose and add things as they go, even throwing in one piece of advice, like no napping, which is part of stimulus control, like throwing it in there as if it’s part of sleep hygiene and it’s not. So then it removes it from the rationale and from that component that actually is effective and throwing it into sleep hygiene. So you might think like what’s the big deal, but the big deal is, is that when I do a clinical trial, um, I need a control therapy. I know I need something that is going to be believable, credible, but something that I know won’t work, right. I use sleep hygiene as that condition. In fact, we all do in clinical trials. So as, as a control, meaning that we know it won’t work. And so it’s very upsetting to know that people are getting flogged with this, not only on the internet, but actually when they see a provider, because then these poor people are diligently engaging in their sleep hygiene and wondering why their chronic insomnia is not going away. It’s like, they’re getting blamed for it. You know? Um, like their doctor’s like, well, you know, I told you to quit smoking well, smoking cessation actually makes insomnia worse. So it’s, it’s incredibly unkind. Uh, and not evidence-based to be pushing sleep hygiene. Now sleep hygiene can be part of cognitive behavior therapy in that um, if somebody, I find it almost insulting, it’s almost like, you know, somebody wouldn’t know that drinking coffee before bed would stimulate before bed might not be a great thing. You know?

Dr. Cooper

You’d be surprised.

Dr. Colleen Carney

But, um, so it might be necessary to give that information and to say, I know now I, whenever I said, I’m tempted to drink my coffee, I cannot resist, but it’s almost like, okay, well, yeah, I mean, we probably have to tell, and I need to tell teens, you know, teens do need, they have a copious amounts of caffeine throughout their day, hidden sources of caffeine. So it’s not like I would never do it. It’s not like it’s never necessary to bring it up, but it is never sufficient. Um, and in fact, um, one thing that the American academy of sleep medicine did this year, um, I was part of this work group is we came out in the most, I think, bold statements so far. Like we previously we’ve said it doesn’t work, but now we actually recommended against it as a standalone treatment because in fact we’ve called for research to see if it’s harmful, even because it delays treatment for people. And you know, this isn’t, that, isn’t what CBT is. And it’s, it’s unfair. It’s unfair for people. So I think that’s one big difference is, is that you’re never going to hear me pushing sleep hygiene. We can get into why and why doesn’t it work and what is it? But I think that is one, one big difference.

Dr. Cooper

Oh, wow. What a way to start? So let’s take a step back. So some folks are saying, wait, CBT, cognitive behavioral therapy. I’ve heard that term. I don’t, could you explain that in a basic sense for folks that are maybe thinking I kind of know, but I don’t really understand what she’s talking about.

Dr. Colleen Carney

Yeah, absolutely. So cognitive behavior therapy is really a, um, it is a generic term. So we can use this approach to many different types of conditions. When, when I’m saying CBT, I mean specifically for chronic insomnia and it’s a, it’s an incredibly brief package. Um, so in its brief form, that’s just behavior therapy has only two sessions. And in its full version, it’s actually only about four sessions. I’ve seen it as long as eight in group format. So it’s incredibly brief is an evidence-based program in which you research what causes and maintains a disorder. And then you apply, um, learning principles, learning theory, and cognitive theory strategies to impact the, the, the symptoms that are primary in that disorder and what’s causing it. And the key part about CBT is that you are, um, you don’t do something that doesn’t work. So you’re, it’s, it’s incumbent on you to show that the package works, uh, not only in strict, um, clinical trials, but you also have to show that it works in a way that’s effective outside of the laboratory. So in, in clinics and with people who are not sleep experts, that that, that others can deliver it, that, um, and, and so it’s, it’s a, it’s a ever changing, ever refining treatment. And I think one of the biggest misconception is when, when people say, oh, you’re changing behavior and changing thoughts. I think one of the biggest misconceptions of it is that your behavior or your thinking is wrong. To me, that’s that in the beginning, I think that that’s how CBT was packaged, but that, that is completely inconsistent with how most of us see it. I actually see it, like when I meet somebody who I want to work with, we’re going to collaborate together and we’re going to become an expert on your particular sleep and your sleep patterns. And I have several tricks up my sleeve. And the reason why is that I’m a sleep expert. So I know about how sleep systems work. And, um, I know that the information out there about our sleep systems is not accurate most of the time.

Dr. Colleen Carney

So for example, we think that the way that our body makes up for lost sleep is by producing more sleep. That’s not true at all. In fact, when our body wants to make up for lost sleep, it actually makes up by producing deeper sleep. And you would never know this from the public health, you know, get eight hours getting, I was getting eight hours. That’s a myth. We don’t all eat need eight hours. We need how much our body tells us it needs. And for some people, eight hours is far too few. And for some people that would be far too much. So we teach people these tricks to leverage their own sleep systems and, and get their sleep mechanistics like their balancing system for making up sleep, their body clock, how to get it work for them so that they can then get rid of the sleep problem. It’s nothing they’re doing wrong. There’s no difference between a, with insomnia and a good sleeper in terms of their habits. So this finger waving at people about habits is, is, is unfair. It’s inaccurate. It’s not true. It’s just that the person has a condition that actually creates a different physiologic environment. And so now the only way to get out of it is to do something different. So it’s not like they did something wrong. They didn’t. One of the primary things that happens in insomnia is called conditioned arousal. And it’s a consequence of having an insomnia. And so to blame someone and say that, oh, well, you got to do, you’ve got to clean up your habits. You got to clean up your sleep hygiene. That’s that’s crap. Like that’s not what that’s not true. It’s unfair. It’s just that, why don’t you leverage a sleep expert for 4-8 weeks and, and you can make a difference in the way that you sleep. And that’s really what cognitive behavior therapy is.

Dr. Cooper

Yeah. You’ve used the term chronic insomnia. What point does it become chronic? Is it if it’s happening twice a week and that’s just life, it has to be seven days in a row. At what point do we say now it’s time.

Dr. Colleen Carney

Great question. So, I mean, this changes over time. Whenever there’s a diagnosis, it’s always about some, some consensus, but if you want to know right now, what it is, it’s about, um, half or more nights of the week, and it’s been going on consistently for three months or more. So it it’s changed over time. It used to be, you know, six months or more, um, at one point it was one month or more. So I think the number of months has changed, but this idea that it’s at least half the nights of the week. So you can pretty much count on it 50% of the time or greater that you’re going to have a bad night that tells us that your body is kind of kicked into this chronic way of being that requires some adjustment to get out of it. And like I said, some of the adjustments that your body makes are, are really to protect yourself. So I want to give you a good example. So one of the things that’s really weird in the acute phases of insomnia, you still have something called sleepiness and sleepiness is the propensity to fall asleep quickly. So even like, you know, during the day you might kind of doze off or you’ll be able to nap people with insomnia as exhausted as they are. They’re tired, but wired. Okay. So they are like, they should be falling asleep constantly all through the day, but most of them are not. And it’s because of something called hyper arousal, hyper arousal, the upregulation of all these physiologic symptoms is in some ways, a nice thing your body does so that you can function, but then how are you supposed to sleep now? Because it’s 24 hours. So it’s a, you know, metabolism, cortical, HPA axis, every single one of your systems is upregulated. It’s like a car whose engine is too high? You know, it always sounds like it’s rubbing and there’s no purpose. I mean, the purpose is to help you function, but now what are you going to do to be able to sleep? So we have techniques to reverse hyper arousal. And it’s just things like that. It’s not about you being naughty and bad with your habits. It’s not at all like that. And I wish people would stop presenting, presenting it like that because it’s shaming people for something that they have no, like they haven’t done anything wrong.

Dr. Cooper

You said it requires adjustments to get out of. Now, I pulled up the one of you have several sleep diaries. I’ve got version II that I pulled here, uh, from your website. And folks we’ll include a link to her website. So you can pull this up. Are there certain aspects of this? How is this utilized, this question seemed, you’re not gonna be surprised by the questions that are on here. They make sense. They, to some extent, seem to, related to sleep hygiene in some ways, um, where, where does this come into play? How do you utilize this? How might this be different than someone who’s done something similar to this in the past? Or how would it be utilized differently? Even if maybe the information is, is overlapping in some way?

Dr. Colleen Carney

Yeah. So what I would say is, um, we use that information from your sleep diary. First of all, the sleep diary, a lot of times people will be, um, a little bit hesitant to complete it because they want to do something like a Fitbit, right? So that the idea here is that somebody else’s, uh, impression of my sleep is more important than my own. But interestingly insomnia is actually a disorder of experience and complaint. So we don’t actually object. We don’t objectively assess, and there’s no, um, quantitative criteria for this disorder. So it’s like, it feels like it takes hours to fall asleep. If it doesn’t take you hours to fall asleep and that’s your perception, then that’s what I want to work on. Um, so it, it,

Dr. Cooper

Meaning it provides this data, but the diary provides this data. So you are actually combining those two in terms of your analysis.

Dr. Colleen Carney

No, we don’t at all. So Fitbit’s, um, well, let’s, let’s call motion trackers. So I don’t actually, um, follow fitbit, but whatever the problem is, not in the device, the problem, um, because the device actually measures movement and there’s nothing wrong with that. The, the issue is that um, it’s the construct, it’s the idea that, that sleep has something to do with movement that the trickiness of that is that it doesn’t right. So people with insomnia are not laying there, flapping around.

Dr. Cooper

Those, listening on the podcast, you’ve got to pull the video up to see her dance here.

Dr. Colleen Carney

Uh, it’s like, um, you know, at the, uh, issue when they have the, the wind. Yeah. So, um, so that’s not what is happening in insomnia. And so that’s why, um, the, um, Fitbits have so much error associated. Or not Fitbit but the motion detectors, it’s the algorithm. It has nothing to do with the device itself. The device is sound and it’s, and it’s actually a great way of looking at, uh, when you’re in the bed and out of bed, um, and movement and activity and counting steps and all those sorts of things, because those are all movement based. And so, so they’re excellent appropriate for that. But as far as the experience of sleep, I need to understand what your experience is. So I need that diary. So what do we do in, in CBT? Well, I want to know how efficient your body is at producing sleep during the time of which you’re in bed. So that’s the core thing I want to know. So we express this as something called sleep efficiency. So what’s the proportion of time that you are asleep while you’re in bed. And for some people, the interesting thing is, is that they have and often unbeknownst to them, they actually have a, uh, quite a lot of time in bed in the 24 hour period. And it’s not really a mystery why that’s happened. I mean, if you’re tired all the time, and if you listen, I mean, even like mom’s advice, it’s like better go to bed early. You know, you got a big day tomorrow. It’s and, um, why don’t you, why don’t you sleep in a little bit, catch up on your sleep? Um, feel tired, have a nap. All of that translate to extra time in bed.

Dr. Colleen Carney

Now, sometimes insomnia is an artifact of too much time in bed. And so you can discover that together by looking at the efficiency, right? So if you’re, if you’re in bed for 10 hours to produce eight, that’s extremely inefficient. You’ve got two hours of wakefulness in bed. That’s artificially creating insomnia because you’re creating two hours of wakefulness, which then is wasted time. So sometimes it’s a matter of just tweaking and some people don’t spend enough time in bed and the general public, and that’s where we get the eight hour push. So the, the idea that we all need eight hours is because there is in society, the opposite problem as well. So people who think there’s time for sleep when I’m dead, right. Uh, and if you’re, you know, and, and some people who want to function at a really high level, they’ve decided to try all these wacky kind of ways to decrease sleep in the 24 hour period. And they miss, um, misconstrue coping with it as being I’ve adapted to it physiologically speaking. And you’re not, I mean, you’re, you’re going to be in an early grave, fine that you get to go through your day with a little bit extra time, but that doesn’t mean that you’re not going to be in trouble with, from a cardiovascular, even dementia, all those negative things. So, and, and these people not only put, uh, put themselves at risk from health, uh, for health purposes, they they’re a drain on, on, um, you know, uh, health system. So certainly in Canada, we have in our health system, that would be a real difficult thing. And they create car crashes that are more fatal than drunk drivers because they’re sleeping while it’s happening. And so there’s been a push over the years to gotta to get 8 hours. And it’s really directed at those people, but unfortunately, it’s really only people with insomnia who listened to those messages. And so they are always striving and exerting effort to produce eight hours when they’re maybe are not an eight hour sleeper, or they are getting seven and a half hours. And they increase their time in bed trying to get that elusive eight hours to 10 and 11 hours in bed. And then, um, at our, or the insomnia is getting worse and worse and worse when they’re a seven and a half hours sleeper optimally. So, um, it’s just, it’s, it’s tricky because we have, we have information up there that’s meant for certain groups that is always picked up by the groups that we don’t really want to target. And so I always say we’re always throwing people insomnia under the bus with our public health information, because I don’t disagree that people should be prioritizing sleep, but with insomnia, it’s a preoccupation over, over prioritizing sleep, everything is sleep, sleep, you know,

Dr. Cooper

If someone’s listening to this and they’re saying, well, wow, maybe I am a seven instead of an eight or a seven and a half, whatever, do you sense that through your, okay, I got seven last night and I’m doing good today. Like, I’m alert, do you need to do that for, I mean, one day is not the, you know, we’re not controlling for enough variables when we say, oh, I got it for one day. And so I’m good to go. But what do you advise with that? Because one of the other things that I want to get into my beliefs about sleep and the construction of worry instructions, super fascinating on a personal level, I’ll just admit upfront because I’m one of those people that believes sleep is super important. And I know it messes me up as I read that, I was just like, oh my gosh, she’s talking to me. This is amazing. So how does somebody know that they are seven and eight and nine? What are some general guidelines along those lines before we jump into these other beliefs?

Dr. Colleen Carney

Yeah. Well, I mean, the first thing was, it, it stems from your really good question about the sleep diary. So, um, and, and by the way that sleep diary you got from my website, I now have a free, um, app version of that. And it will, it is, is now out. So I will, I’m updating my website right now, but, but, um, and it will calculate sleep efficiency for you. So let me, let me tell you how to do this. So if you were creating, if you’re completing a diary, ideally do it for two weeks. Why? Because there’s a study out there that says how many nights are enough to, and the answer is two weeks. Um, so yeah, so if you were to collect a sleep diary for two weeks, what you want to do is you want to look at what the average total sleep time is. Um, how much sleep do you typically produce night after night after night? Now the tricky thing about this is, um, if you’re somebody who believes there’s, you know, time for sleeping, when I’m dead, actually those people are never going to be, they’re not going to be listening to this podcast and they’re not going to be doing the diary. So I I’ve put that aside. So I’m going to say for people who, what I want you to do is look at the average total sleep time. So if, if you see it’s about seven and a half, for example, and when you extend your time in bed, so the night it’s like eight, eight and a half, you don’t really fill up much of that time. And certainly not on a consistent basis. You have your answer right now. Now the thing about this is that sleep length has a very tiny genetic component to it. It is mainly situational, how much sleep we produce is really governed, um, or is, is related to part of your body. That’s just a balancing system, a homeostatic system. And what it does is it, it measures, keeps track of how much activity and how much rest you have in a 24 hour period. So under conditions in which you’ve, you’ve had a, you know, a good run that day, then what we usually will see is increased deep sleep. So we’ll see greater depth and more proportion. So it’s more about deep sleep than it is about total sleep time. But that has an impact on total sleep time, because the deeper you sleep, then the less prone you are to wake ups. Okay. Now, how do we know this? We know this because first of all, that’s where all your growth hormone gets secreted, right? And growth hormone is what restores your tissues, right? And so we know that when people are less at rest in a 24 hour period, we see greater amounts of growth, hormone production. We can measure it in serum and the metabolite. Um, and we can see,

Dr. Cooper

Wait, wait, say that again when they’re less at rest. So you mean when you’re more active during the day?

Dr. Colleen Carney

Yeah. And I, I said it that way because, um, there’s, um, it’s tricky. We do not have a good equation for what activity is, um, is needed to generate this.

Dr. Cooper

Okay. So there’s no magical 10,000 steps, x intensity of heart rate, et cetera, et cetera.

Dr. Colleen Carney

No. And I work a lot with people with depression and chronic pain and so on and their word that they’re never going to get deep sleep. Now that does underlie a lot of their deep sleep problems, their decreased activity. So what we’ll do is we’ll try and, and find a manageable schedule during the day of less rest. But that’s the way we put it, right? So we’re like, or active rest, right? So like you’re doing something and you want to take a break. Can you, um, take a break in a way that doesn’t mean like laying down on the couch, could you take a break mentally doing something enjoyable or going out for a walk or something that’s low impact. But so, so yes, it is activity for sure, but even people in comas do produce trace amounts of slow wave sleep. Um, so they do maintain a, a rest activity activity, mental. So depending on the nature of the coma, so on. So, so we don’t know, we know that at a bare minimum, we like to track time in bed and out of bed. There’s your sleep diary again and again, that app will track that for you. So when it will tell you how much time do I spend in the 24 hour period in bed, you want to look at that because if it looks more like a school kids diary, if you see like nine, 10 hours in bed, don’t, don’t feel ashamed about it. It’s something that happens in insomnia insidiously. So it creeps in because you go to bed a little early and you hit the snooze bar a little bit more on the, on the other end and then a nap. And so you often will lose track, but it would be expecting your body to fill up 10 hours in bed with sleep night after night is kind of like going to a shoe store and saying, I’m a size six, but give me a size 10. I want bigger feet. It’s it, it makes my feet look bigger, but, but it doesn’t work functionally, right? So it’s, it’s, it’s, you’re, you’re not getting the return for it. And I think that’s what you want to, so you can track for two weeks, I’m asleep. Do I look at your total sleep and look at the average, then you also want to look at sleep efficiency, because if you’re looking at the average, the sleep efficiency is not in a healthy range.

Dr. Colleen Carney

I’m going to give you some numbers. So generally speaking, we should be asleep about 85% of the time that we’re in bed. Once it gets above 90%, we actually consider that too sleepy because it means, and this is another problem in insomnia is that there people with insomnia have a, have a tendency to marry somebody with sleep apnea. And they’re like, oh, well my husband, his head hits the pillow and he’s out like that. And he’s dead to the world on it. And that’s their, that’s their, um, sleep goals. And I said, you know, that that’s really scary. You’re cause that’s, you have a goal of something that actually is healthy it, and it’s, it’s worse than that. I mean, I mean, sleep apnea is a disorder that is associated with so many disorders downstream and early death. So unlike insomnia. So we don’t want to set that as a goal. So if your, if your sleep efficiency is above 90% on average, then when you look at that total sleep time, what I want you to consider is I want you to prioritize putting an extra half an hour, if you can in bed and see if your body fills it up. And if your body fills it up and your efficiency comes down more into the normal range, you know, somewhere like 90, um, even even 80 to 90% would be okay then great. If you fill up that time and your sleep efficiency is still above 90%. And if you’re being honest with yourself, you’re always keeping busy to keep yourself from falling asleep. I would consider talking to your doctor about that because if sleep extension doesn’t work for you, they may actually just ask you to extend again and see what happens. There, there are people who are called long sleepers and long sleepers is exactly what it sounds like. It is a clinical group who require more sleep than average. And, uh, some people convince themselves they’re long sleepers, but really what it is is that several times a week, they like to oversleep. And then the rest of the week, they actually sleep normal amounts and it throws them off. So we’re looking for people who on a regular basis can produce 10 hours, 10 hours, 10 hours. And if they don’t get, if they get 10 hours they’re great, if they can’t, then they’re sleepy during the day and have a lot of difficulty. So the diary can tell you a lot and it can help you make some adjustments and with a sleep medicine, a behavioral sleep medicine person, they can do little experiments with you and tweak things and tell you’re feeling at your best.

Dr. Cooper

Let’s talk about the middle of the night thing. This seems to be a common problem, especially I’m 55. So especially for men, 40 mid forties, plus, you’re going to wake up regardless. There’s nothing that’s going to change with that, but the falling back asleep is, and I’ll just personally, that’s where I really struggle. I’ll wake up at 2:30 and I’m not going back to sleep like sometimes for hours. And so I’m trying to follow the typical advice and maybe this is a sleep hygiene thing of, okay, it’s been more than 20 minutes. Get out of bed, read a boring book or journal or something, stay, you know, keep it quiet. Don’t look at your phone, don’t pull up the computer, all those kinds of things. And sometimes that works. And a lot of times it doesn’t any guidance for the folks that are saying, oh my gosh. Yes, that’s me too.

Dr. Colleen Carney

Um, so a couple of things I would think about, first of all, I’m curious why you have to do boring things and why you can’t look at your phone.

Dr. Cooper

Well, it comes back to the sleep hygiene things. So yes, I probably don’t follow the boring things concept. Usually I pull out my journal and just start putting down everything into my head so I can stop ruminating on it if I’m doing the cycle thing. Um, but I do try to avoid the phone with the whole blue light thing. And is that going to spark the melatonin? And again, I think I’m going to get a good, interesting, uh, insight into what you say next, but, um, I think I’m less concerned about that piece because certainly that wouldn’t help me to add those things, but is there something else going on and maybe it comes back to, and I’ve got your, my beliefs about sleep thing and folks, you got to pull this up. This is so interesting. It probably ties into that in some way. Cause I, I am one of those people that says, oh man, my day is going to be brutal. I just, I didn’t sleep well. It’s, you know, I’m having trouble for my sleep. Now it’s 4:00 AM and I need to get up in another hour. Um, so anyway, I’ll stop blabbering. And uh, any tips, not necessarily for me, specifically, for people in general that are struggling with that middle of the night thing,

Dr. Colleen Carney

I’ll start with you specifically in the sense that you, um, you already have some insight into what’s going on. Um, and so, um, a lot of times what we’re doing in CBT is playing detective. And if, if you’ve already identified that when it happens to you middle of the night, it’s like, there’s what we call arousal. So, and it’s called conditioned arousal, right? So, so now there’s like this, this added element to kind of get over the first half of the night. It think of it like a relay race. The first half of the night is all that mechanism that makes up for lost sleep. So it’s whether or not you’ve generated enough sleep, drive, deep sleep drive, activity, time out of bed to be able to sustain you through the first half of the night. And then the Baton gets passed to the body clock for the second half of the night. Okay. So what we, what happens to us in middle-age is sometimes we don’t have enough sleep drive to, um, sustain us to that, to the handoff. And so we’ve got to lay there awake until the handoff happens, and if we’re anxious or annoyed, then, then it’s going to delay. It’s going to interfere a little bit here. So a couple of things to keep in mind, one is I always like to look to see if anybody’s going to bed too early. Um, so I wanna make sure that they fall asleep because what can happen is, uh, there can be the first cycle can be more like a really efficient nap, right? So, um, so we, we want to look at that and then we want to make sure also that they’ve been sufficiently active during the day. Sometimes that’s a problem in middle-aged because a lot of us have sedentary jobs. Like we sit. But once it happens, you know, stimulus control really start was, you know, made it’s debut in insomnia, uh, around 1970. And we didn’t have phones and, and all this stuff, but we for safety and it, cause if this started with older adults, we started this treatment with older adults, not for, not for, um, middle-aged adults. And we, we certainly wanted them to turn lights on for safety, right? Because you know, you don’t want them to fall, right? That’s like the worst possible scenario for them. And, and we would encourage them to do something to only to, to follow rule number one of stimulus control, which is to wait until sleepiness returns. And so there was no, there was no effort or attachment to falling back getting, or trying to get back into bed. As soon as you could, what you do was accepting that your body wasn’t ready for sleep and let’s do something.

Dr. Colleen Carney

Um, preferably the thing that you were doing before you, that when you got sleepy and got into bed. And so that’s part of the problem right now is that this idea, it’s not that the blue light research is not good research. It is, but it is very specific. So in order to get the results that you see in the media, we use a dim light paradigm and we recruit young people like undergrads because they’re light sensitive. The closer you are to puberty, then you are actually photo sensitive. Okay. I hate to break it to you because we’re about the same age, but our eyes are a little bit different. Um, so we are not light sensitive in any way. In fact, our pupils are narrowing. Um, there are many structural changes that happen that blue light is less meaningful. Meaningful for us our lenses yellow actually over time. So yellow plus blue equals green, which is not an a phase shift or at all a Greenlight is inefficient that way. Also melatonin is so poorly understood. Um, one of my favorite studies, um, comes out of rush that showed us that melatonin, the effects of melatonin are completely dependent on when it is given in the 24 hour period for that person. So when you give melatonin, when melatonin is present, as it is in the middle of the night, uh, as it is at bedtime, when people take melatonin as a sleeping pill, it is not a sleeping pill at all ineffective pill, or even taking an hour before when melatonin is already there, it has no effect at all because the, the brain already knows that’s there. It’s like the bat signal. Okay. Right. So commissioner Gordon, he senses something’s up. He puts the bat signal up in the sky. All right. Batman looks at, it says, oh, I gotta, I gotta do this. Right. So he’s like the melatonin where he’s like, oh, here’s the signal. It means I have to decrease my alerting signal. And many hours later, I’m going to go to sleep. It has nothing to do with putting you to sleep, but it sets the stage. Okay, well, it’s like you put up the bat signal one day and maybe the bulb isn’t as bright. Okay. Batman, doesn’t look at that and say, well, maybe I shouldn’t go. Right? Because the bat signal looks a little weaker today. He’s still going to go. It’s still a signal. It’s like, it’s either you either ring that bell or you don’t ring that bell. So the idea that if we put blue light in the middle of the night, that we are going to have an effect on melatonin in the middle of the night is not accurate. And, and, and so what anyway, and so this treatment was tested many years ago and we all, we had people watching TV, reading a book, doing whatever it is that we were the idea behind. It was give up the effort to sleep because it’s the effort to sleep. It’s the idea that I need to make this happen or else, you know, and then whatever disaster scenario you want to spend, or you become a master mathematician, right. Like, okay. If I fall asleep now.

Dr. Cooper

Exactly, minus 30 minutes plus six, uh, throw in a nap. I’m good. Okay.

Dr. Colleen Carney

And the thing is, is that, um, well, wait a minute, you, you were, you were watching television before you went to bed and became sleepy and got into bed and had no trouble. So why is it a disaster all of a sudden to watch TV in the middle of the night? What is this blue light business? This is not, that’s not helpful. There is no, um, there’s no research going on right now in terms of blue light and people with chronic insomnia. So all of this idea about walking around with goggles on and so on, that is all extremely premature. And it’s also ill informed is not the way that melatonin works. So, um, I would say, um, I would find something engaging to truly engage you so that you’re not thinking about the next day and then separate from that and making sure that you’re not getting into bed too early and that you’re generating a good sleep drive and that you’re not laying in, in the morning, like beyond a certain time. But then on top of that, then I would start to look at some of your disaster scenarios because when I meet somebody with insomnia, I am almost, it’s almost, I mean, I can’t think of a lot of exceptions. I’m so impressed by the resources that people with insomnia have. Most people go a decade or more without effective treatment and they manage all that time. So the idea that, that these people are poor copers during the day is not true. They’re incredible. They have, they’re very resilient and that we do have hyperarousal to help us through our day.

Dr. Colleen Carney

So I think trying to curb some of our disaster scenarios and looking at our strength and our resilience, and instead using some fatigue management strategies during the day, rather than say, oh my God, I’m screwed tomorrow. Looking at it. Like, you know what? I’m actually incredibly resilient and tomorrow might be a crappy day. So what I’m going to do is I’m going to make sure here’s my plan for self-compassion tomorrow, right? Like, first of all, um, some of these perfectionist and goals I’ve got for myself tomorrow are going out the window. Um, I’m going to focus on making sure that I don’t spend too much time in bed tomorrow because tomorrow should be recovery night for me, physiologically speaking, as long as they don’t circumvent it by getting into, by laying in, in the morning, like sleeping in or going to bed early tomorrow, I can, I can really use that build up of sleep drive tomorrow and recover naturally. And I’m going to focus on making sure I have lots of light exposure during the day to help me feel alert. That’s the one thing about blue light is that it gives us a, it gives us a, a momentary while you’re out there, helpful little increase in alertness. And so, you know, that that’s actually helpful for us from a, from a fatigue management standpoint movement helps us, uh, staying hydrated helps us focusing on healthy eating that doesn’t spike and then crash your blood sugar, doing something enjoyable, rewarding yourself. These are all good fatigue management strategies taking breaks when you’re bored, rather than rubbing your eyes and like staring harder at the screen. These are all strategies that are far more helpful. You know, cause caffeination is, is, is fine. It does help with sleepiness, but then you’re chasing caffeine withdrawal symptoms for the rest of the day. Cause every six hours, the withdrawal is the opposite of the drug. So you’re going to have increased fatigue. Um, so, uh, you know, it’s so, so those are some of the things that I would be thinking about, you know, just in an oversimplified way, because obviously there’d be a lot more to it. Right?

Dr. Cooper

So one of the things you mentioned is, Hey, knock yourself out and you wake up at three in the morning, are you saying, Hey, you want to work at three in the morning, work at three in the morning and just get after it. And, but in the back of my mind, and I just need to try it. If that’s your recommendation back of my mind, I’m thinking, well, once I’m in like I’m in, like, I love my job. And so I might go three, four hours and go, oh my gosh, it’s seven o’clock now I’m really hung. Or are you saying, no, you’re not, no, you’re going to be tired that day. And you’re going to sleep deeper that night and it’s going to balance itself out.

Dr. Colleen Carney

I think both are true. I think that, um, I think when somebody says that they want to do work in the middle of the night, um, I’m a little bit suspicious for that. Cause I’m like, that sounds a little perfectionistic. And so, and perfectionism is kind of like the enemy of insomnia, right. So I would want to know why, but in theory I have no problem with that, right? Like in theory, you can do whatever you want and then just bank it. And then, and then go ahead. Um, what, I don’t want to, people lying in bed tossing and turning and being frustrated and trying and trying and trying to fall asleep. If you don’t believe me, try it and see what result you get. Really. I don’t have a lot of rules for what people want to do during the night. If they’re going to do something that specifically keeps them up. I’m curious why. So my teens always pick things that they know will be engaging. Uh, and so I want to know why, and it’s usually that they kind of have, um, a lower sleep IQ than I want. Like I want them to have more of an understanding of, of, you know, that’s a health behavior. If you’re doing work to try to tire yourself out or bore yourself, I don’t love that. Um, cause then you that’s sleep effort. And if you’re doing work to again, it’s like perfectionism, it’s just kind of keeping yourself wired. Like, oh, I’ve got to get more and more done. I don’t love that. But if it’s something that you enjoy doing, I mean, like during the middle of the night, or usually where I have all my guilty pleasures, if I wake up, then I’m going to reward myself with something that I don’t usually watch. And because the irony is I won’t get very far into it because I’m like, I’m no longer thinking about, well, what if I don’t fall asleep? Or what if, or like, oh, I only have four hours. It’s like, oh look like star wars is on. And then out you go, I don’t have a lot of rules for that.

Dr. Cooper

Yeah. Because I’m thinking that worked for me be okay, I’m going to be a little more fatigued, but if I could knock out two hours here and get some good things done, then I could have more self-compassion as it goes on. Or I could take that nap. Maybe we need to talk about naps because I’m basically coming into the day ahead of the game. I I’ve gotten a chance to start three hours earlier than I usually would or something like that.

Dr. Colleen Carney

Yeah. I mean, so the, yeah, the only, the only sort of good thing about a bad night is, um, there is a, there’s a physiologic recovery. If we don’t get an, an in our body’s way, the next night, it may not be in total sleep though. It might be inefficiency. And, um, but taking a nap, it’s almost like thinking like this, it’s like you have to build, it’s almost like you have to blow up a balloon every day. So, and you blow up your balloon by, um, expanding energy. And that’s what fills up the balloon. And you want your balloon to be nice and full and talk by the time you get in the bed and the letting go of the balloon is associated with the production of deep sleep and growth hormone. Um, if you take a nap, you’re letting go of the balloon. So, so the, you are inhibiting the, um, the recovery that night to some extent. So, um, naps are really good outside of the, um, outside of the context of insomnia. So for somebody who is sleepy or who has somebody something to do post nap from a performance point of view, whether it be a speech or, Hey, absolutely. Like that’s a performance enhancer and, and good sleepers can do that because the hit that you take at night, most good sleepers don’t notice the loss of slow-wave sleep. They get that night because we’re not that attuned, but for somebody with insomnia, it’s probably gonna be a difference between being awake for hours or not. So I say naps, natural, like cupcakes, nothing wrong with a cupcake, but it takes in the context of diabetes takes on a different, so that’s why naps in the context of insomnia. No, no, um, naps any other than maybe it’s a cost benefit analysis. And for people who are sleep deprived, like shift, work, sleep apnea, whatever, during the day, very important to use them when they feel sleepy. And, and, and you can think of them as a performance enhancer for people, if you’re just an average sleeper, um, you always nap for sleepiness to get rid of the feeling of sleepiness. You never nap for sleep because naps are never good for sleep. But again, like if I had to do give a, an evening talk, I would always have to, because I’m, I’m an early bird. So giving a talk in evenings hard for me.

Dr. Cooper

So knock yourself out, do whatever you want. Uh, don’t don’t limit yourself to the 20 minute rule or whatever, just do it. And when you’re sleepy go back to bed and if that’s three hours, it’s three hours. But probably that night you’ll, you’ll recycle if it’s 20 minutes. Awesome. But don’t force it is, is a big part of your point.

Dr. Colleen Carney

Yeah, yeah. Beautifully put. And I, and I, I always put it down to sleep effort, right. So if I asked the difference between a good sleeper and a poor sleeper, it’s all about effort. So if I ask good, good sleeper, I want you to teach me how to sleep. Well, they’ll laugh. And they’ll say, I’m like, shut your eyes. Um, but a poor sleeper will give me a long list of like, well, you get your sleep mask out. And then you like have your blackout blinds and whales that are singing to each other on a CD and you’ve taken your melatonin. Right. And it’s like, okay, but like, you’re, you’re a crappy sleep or so how, how has that we don’t, sleep is effortless. Right? And so it’s really about having good habits that set the stage from a health perspective. Right. And it’s the, you know, this is the same thing in terms of eating and, and all, all of those sorts of things. It’s like when we get into extremes, um, we, we get into trouble, right? So it’s, it’s really, let’s get back to basics here. For little kids, we make sure that they have enough outside time, um, that they’re active. They have a regular schedule and they have a wind down before bed. I couldn’t give you more perfect advice than that. And it works for kids, but we think we outgrow it. And we, we get in the way and sleep effort is one of the main things that gets in the way.

Dr. Cooper

I think my wife called you before this interview, um, she’s going to miss those really cool sleep, blue light blocking glasses that I wear every night. She’s like, those are so sexy, honey, you gotta, you gotta keep wearing those even if they don’t work.

Dr. Colleen Carney

Well, maybe you shouldn’t that, I mean, you know, I mean, it’s just to keep the spice alive.

Dr. Cooper

All right. All right. There are a thousand other things we need to talk about and everyone listening is going, wait, don’t stop yet. Is there any, but we’re up against the time here. We’ve got just a few minutes left. Is there anything that you’d like to throw out there? Something I haven’t asked about something that people are really confused about that we haven’t brought up in the conversation you’ve covered so many great things here, but I don’t want to tie a ribbon on without you getting a chance to stick your finger into the ribbon before we tie it.

Dr. Colleen Carney

Well, I mean, I, I liked that we were able to talk about of, um, you know, thinking like a little kid about sleep. But what I, what I will say though, is, um, for those of you who are suffering from chronic insomnia, so you heard yourself in our definition earlier that, um, that there is absolutely help out there. So there’s different ways of doing it. There, there are, um, CBT books that are helpful and, and, and, and digital therapy. Um, but, uh, but there’s also, um, for those of you who want to Google the society for behavioral sleep medicine, there are provider lists of people who do this. Um, there’s a, you might be able to find, um, a coach in your, uh, in your area, if you do a search for CBT in your area. Um, because a lot of us work in training people to be able to deliver this.

Dr. Colleen Carney

So I don’t want people to think that they can’t, um, they can’t get treatment. Also, if you’re somebody who has another sleep disorder, like sleep apnea or narcolepsy, and you could use help adjusting to the treatments, the medical treatments that are associated with those disorders, that people like me can help you adjust. Um, so, um, whether it be getting a different type of device or working with you on, on some of your beliefs about, oh my God, I feel like Darth Vader mask, and no one’s ever going to want to sleep with me or whatever, that, that somebody like me who works in behavioral sleep medicine would be, um, uh, happy and, and qualified to work with you. So there is help out there.

Dr. Cooper

Beautiful, beautiful. And everyone just to clarify, it’s CBT not CBD, we’re going to have a lot of people like cool. I’m getting my cannabis going now. I love it. Love it. Dr. Carney. Fantastic job. Thank you so much for your insights. This is, this is wonderful.

Dr. Colleen Carney

You’re most welcome.

Dr. Cooper

Okay. I’ll admit it. Consistent high quality of sleep is one of those things that I just, I try to make it a priority. And yet I really struggle. So this was when I had started my calendar. Since we got it scheduled, I hope you found some nuggets in there for yourself. Thanks for tuning into the number one podcast for health and wellness coaching. Next week’s episode features Stanford’s Dr. Tina Seelig whose super fascinating insights on the realities of luck and risk-taking are something you’re definitely going to want to hear. If you’re on Facebook, we’d love to have you join us over at the health and wellness coaching forum group. We’ll include a link to that below, or drop us a note Results@CatalystCoachingInstitute.com. We can send over the link you need to join. It’s a great spot to share ideas, encouragement, and so much more in the field of coaching. Now it’s time to be a catalyst, to be a catalyst on this journey of life, the chance to make a positive difference in the world while simultaneously improving our own lives, which is the essence of being a catalyst. This is Dr. Bradford Cooper, of the Catalyst Coaching Institute, make it a great rest of your week, and I’ll speak with you soon on the next episode of the Catalyst Health, Wellness, and Performance Coaching Podcast, or maybe over on the YouTube coaching channel.