140: Victoria Bangieva, PhD Clinical Psychologist: Unlocking Better Sleep: Democratizing CBT-I w/DocBotic's Affordable Text-Based Solution

 Welcome to the sleep as a skill podcast. My name is Mollie McGlocklin and I own a company that optimizes sleep through technology, accountability, and behavioral change. Each week I'll be interviewing world class experts ranging from doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper.

Let's jump into your dose of practical sleep training.

Welcome to the. sleep as a skill podcast. Our episode today is all about CBTI and how to democratize it. So many people would like to test it out, but they don't necessarily have access or the funds available to dive in on this topic. So how about texting? Which is why you might be interested in this new company, DocBotic, that is looking to help At a really affordable rate, give you access to a text messaging bot that will guide you through some of the key components of CBTI right to your own phone, a text based sleep improvement program.

So our guest is Victoria Bangieva, PhD, and is a licensed clinical psychiatrist who is passionate about improving access to evidence based mental health treatment by leveraging data and technology. She specializes in clinical product design by bridging clinical Science with digital product development.

Additionally, she focuses on translating evidence based behavior, change principles into impactful digital health solutions. She is currently the fractional clinical product director at DocBotic, a health technology company that has developed a 40 day text based sleep improvement program. Additionally, she maintains a small private practice and is a ad hoc reviewer for several professional journals.

Now we're going to jump right into the podcast, but first we have a few words from our sponsors. The CDC reports that more than one in three Americans are sleep deprived, and it's estimated that sleep related issues like trouble falling asleep, staying asleep, and sleep disorders affect around 50 to 70 million Americans.

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com forward slash sleep is a skill. I will also include this in the show notes as well. And welcome to the sleep is a skill podcast. My guest today, Victoria, thank you so much for taking the time to be here. Hi, thank you so much, Molly. It's great to talk with you today. Oh, excellent. We are going to be diving into a few different topics today, but first, where to begin but the beginning.

How did you find yourself in this area, line of work, and how it relates with sleep? Yeah, well, you know, initially, honestly, it kind of all started for me through more of like an intellectual academic perspective. You know, I was studying pre med in undergrad, was planning to go to medical school. And in my early experiences, um, whether in clinics, you know, shadowing, volunteering, um, I started to kind of realize that I was less interested in the Actual like biology of diseases and the labs and the numbers, the medication that are prescribed, but really more interested in, you know, who are these people that are struggling?

What personality or behavioral, um, you know, perspectives really? Differentiate with how people cope and manage, you know, whatever diseases they're at. So really started to kind of get more interested in the psychology of what happens in within health. And that's what actually brought me to this discipline of health psychology.

And, um, sleep medicine is a specialty within that. But health psychology, um, more broadly is. Just the intersection of emotional and physical health. So as a health psychologist, I focus on, um, helping people better manage and cope with whatever health conditions they might have. And of course, insomnia or sleep issues tend to be under that umbrella as well.

So, um, throughout my graduate training, I trained in several sleep clinics. I'm, um, trained in cognitive behavioral therapy for insomnia, or C B T I, which is the gold standard treatment for insomnia. So, um, yeah, that's kind of what brought me into the so world of, um, Of sleep and behavioral, uh, behavioral sleep medicine.

And, you know, I've done kind of had this other transition into the world of health technology and now, you know, so much that's been done around. Improving or enhancing how it is that we've historically thought about addressing health conditions through the use now of tech and data. And so in around what, 2017, as I was finishing my my graduate training, really stepped into this world.

And my career has largely focused on working in. Digital mental health companies where I act as a clinical subject matter expert. A lot of the work that I do involves, um, applying or translating clinical science into, um, viable and effective digital health tools and products. And so, you know, that's. Kind of my journey overall, but more recently I've been working on a new and exciting, uh, product called sleep bot, which, um, we've been working on through, um, With, uh, the doc bot team.

So Jenna, the founder and CEO of the company, she and I worked previously together, and when I heard what she was working on, I got really excited about that, um, sleep bot is, um, A more of a, you know, there's so many different health apps out there, right? And so we really wanted to do something different in actually, um, delivering care through a way that would be much more accessible to people, to people.

So it's a treatment program that's delivered via SMS and WhatsApp. Um, it is a 40 day program that really delivers, um, personalized. Um, interventions and different strategies for improving sleep. So, happy to kind of talk more about SleepBud and, uh, Yeah, please. Because what are some of the pain points around CBT I and the ability to get these, this message out to the masses, implement it consistently over, you know, night after night?

Morning after morning, how people can still stay connected and committed, what do people struggle with, and how might something like the SleepBot kind of fill that gap or void or address some of those challenges? You know, there's a few different challenges. I think first, it's the accessibility and perspective from how do people even find a provider that is trained or that would be able to, um, really help them around sleep.

So, you know, there's. Very few professionals out there that are actually trained in CBTI and finding those people not to mention the financial costs involved, um, certainly a lot of barriers. But then the program itself can be quite challenging for people and we do see, you know, pretty large dropout rates.

One of the components of the treatment involves actually reducing the number Uh, the amount of sleep, which can be quite challenging for people, so that tends to be, you know, just a difficult, um, program for people to really kind of go through, um, not to mention the stigma around sleep odd and, uh, or the stigma around, um, you know, just seeking out mental health.

So. Um, the benefit from a lot of the digital health solutions out there is the accessibility perspective, and I think we've seen a, you know, a lot of great apps out there. But what we also know from the data and research that's been done with these apps is over time, um, people just don't really stick with them.

You know, we see significant drop off rates within a few weeks. What the benefit of SleepBot is, is it's The treatment is delivered to you via text, something that, you know, just about everybody has access to as long as they have a phone. And so that is what we took as an approach to really improve the way in which this treatment can be delivered.

So for someone that's like, oh, okay, interesting, what would I be getting myself into with the text message? Like, what do they look like?

Is it a very time consuming thing or kind of walk us through what the experience might look like? Yeah, well, it's a 40 day treatment program, as I mentioned. Um, when someone first signs up, they complete pretty brief. Uh, questionnaire just for us to understand, you know, what your daily routines look like, what are the things that you're struggling with?

What have been some of the challenges you've been experiencing with sleep? And through that assessment, we develop a customized, um, Program that involves daily messages that you receive. Sometimes it's not just sometimes you might be asking a bit more information around your day to day. Um, that really help us to target specifically the challenges that you're having.

Um, so that you can. All with the goal of helping you improve your sleep. Um, in terms of the number of, uh, messages, it really can range, but you know, we try not to overwhelm people with the number of messages. Um, and they tend to be very brief and, um, you know, not very Very helpful in nature, but also just not laden with all of this health jargon.

So we've really done a lot to keep us as user friendly as possible. In addition to making it accessible. And for those people that aren't as familiar with CBT I, what are some of those things that the texting can help support, whether through awareness of certain elements or reflection, like is it kind of long form response or is it more than the numbers of, I went to bed at this time, I woke up at this time, like what might they kind of be learning about themselves in that process?

Yeah, well, one of the aspects of our program is actually a daily sleep, uh, diary, which is, you know, what you would expect in any kind of, um, you know, treatment, uh, CBTI focused treatment. So the day starts with just asking you a few questions about your last night's sleep. Um, the general components of CBT, I one, there's some psycho education or just general information about sleep.

You know, it's, it's interesting, right? Like, we don't really think about sleep until we have to until we're, we have some kind, you know. a difficulty or a challenge around sleep. And so just even learning about the different processes of sleep, um, what tends to help us sleep better and what might be getting in the way, understanding our own sleep, you know, that's all part of that education that goes, goes into it.

Um, another component of CBTI is the cognitive components, right? Like we might have Certain beliefs or thoughts about sleep that might not actually be serving us and might be getting in the way so addressing that as part of the treatment is important and then lastly is the behavioral components. Um, and there's a few different parts to that.

One is what we call stimulus control, which is how can we work on. Enhancing that relationship between feeling sleepy or actually sleeping when we're in bed or in our sleep environment. And then another is sleep restriction, which is, um, maximizing the. Amount of time that we're actually asleep while we are in bed.

So there's a few different, um, parts to that treatment, but what you might expect to see in through our sleep program is perhaps something like encouraging you to eat during, um, you know. Same times throughout the day, or perhaps that is finding the right time where you might exercise. Um, there are even reminders for when you should start starts to wind down before your bedtime and what you might want to incorporate into your wind down routine.

We have some recommendations. for various relaxation techniques to really help you feel more relaxed and start to feel sleepy before actually getting into bed. So the program kind of walks you through all of those different aspects that are really designed to, um, help you. Enhance and improve your overall sleep and do you find then that the ability for people to stick with this is heightened when they're just getting those prompts versus they have a rough night and they kind of throw the baby out with the bath water or drop off that instead there's a way for us to still stay in the game by having those kind of show up automatically each day.

Yeah, exactly. Right. I mean, we're reducing the additional step that someone would have to take by physically opening up an app or, you know, opening up a program and kind of interacting with it. We are coming right to you through our messages. And, um, the goal there is that you don't even have to think about it.

Like we will show up. Throughout the day for you, so that really, you know, we've seen great, um, results, um, through our trials, um, in terms of engagement, we've seen as many as 80 percent of our participants interact with, uh, the program at least four times throughout the week, and as many as 70 of our participants continue on with, uh, sleep, but even after the program ends, so there is something that really, I think, um, Engages people and just pulls them in, uh, through this kind of a nudging and messaging, um, interface that we use nice.

And would this still be complimentary if people are using wearables right now, a lot of our listeners might have some sort of sleep tracker of some sort kind of can go hand in hand. Yeah, it can certainly go hand in hand. You can pull in, you know, we've gotten a lot of requests from our users so far to find a way to merge the wearable with the program, which we are looking into.

Of course, that'll be, um. You know, ideal state for us, but in the meantime, you can certainly pull in whatever data you're gathering through your wearables into our program to get even more, um, you know, specific or more customized, um, recommendations based on the data that you're receiving through the wearables.

But, you know, hopefully, some point in the near term, we'll be able to pull that data and automatically and incorporate that into our program. Got it. And the four weeks, what you're finding is that within that four weeks, that's a long enough time that you're seeing the, those real measurable changes and through just having that technology piece without even having to hire someone or interact at that possibly more pricey and time consuming level.

Yes, we are. So, you know, we actually started out, uh, we thought that You know, we would, the initial program was actually designed as an eight week program and based off of what traditional CBT therapy, you know, typically tends to be somewhere between 68 sessions. So we designed it based off of what we know works in just the, you know, the typical clinic.

Um, but through just the research that we've done and the trials that we've ran, we've actually been seeing an effect and a significant and significant improvements in our, um, participants sleep much earlier than that. And so we formulated the program around those results and. given that we are seeing improvement as soon as four weeks.

Uh, that's the overall program, but certainly participants can continue to use the program past the four weeks. Yeah, and on your site it's pointing to on average users can feel more awake. 72 percent of participants feel more awake, 63 percent function better, 45 percent fall asleep faster, 92 percent feel less anxious.

Is that all? Captured correctly. Yeah, absolutely. You know, in addition to just measuring sleep and outcomes related to sleep, we are also looking at just general mood and symptoms of depression. Anxiety is part of that. And what we are seeing is through improving sleep, which we are seeing significant improvements around, you know, symptoms of.

Just challenges with sleep, our members are also improving overall symptoms of depression and anxiety. And this is something that has been shown in, you know, the literature and in the research time and time again, that sleep is just so closely connected to all these other mental health processes that by improving our sleep, we can actually influence our mood.

We can influence, um, Okay. Uh, you know, these other symptoms that you might might not, you know, be able to or even know that you need to treat directly, but just through, you know, different enhancements to sleep, it can certainly influence how it is that you're feeling in these other areas of life. So great.

So important. So with this, I'm sure people are going to want to know, well, how are you managing your own sleep? Did you go through the app program? The whole world of it. So we'll ask you a couple questions around what we can learn about someone like yourself that is sleep. in the weeds on this topic day in day out.

People just love, love, love to understand what can they kind of glean from how you're managing things. So our first question that we do ask everyone is, what is your nightly sleep routine look like? And I just put on a little addendum of, or the add on of, is it something that you went through the program ongoingly?

What did that look like for you? Was that part of your nightly routine? If you did do that, Cheryl? Yeah, well, you know, I'm someone that has been sleeping, thinking about sleep for quite a long time. Yes. And I've been through my own sleep journey. I mean, not proud to admit, but throughout my graduate training years, I mean, there were times.

Sleeping four to five hours a night. And that was kind of the norm. And, you know, over time, of course, that caught up with me. Um, so there was a point in time where I really kind of, you know, I had to start to prioritize my own sleep. Um, I did go through the program myself, but I've, I would say even before going through the sleep app program, um, have put a variety of different.

just practices in place to really support my own sleep habits. Some of that for me involves, um, really going to bed and waking up at the same time every day. Um, you know, I try to just keep my daily routine as consistent as possible around when I eat. You know, the times that I do my work in when I exercise, I think that consistency is just really important.

Um, we know that lights and temperature are the primary drivers of our circadian cycle. So I really focus on that when it comes to my own sleep. For example, um, You know, blackout shades is really important. I keep my, uh, my bedroom as, you know, dark as possible. Um, I use a sound machine. I live in a, in a city where there's a lot of, you know, noise even at night.

So that becomes really important. And, um, yeah, and just generally keep a pretty comfortable, you know, bedroom environment, but yeah. And then you had gone through, or I guess I should check, were you one of the participants that went through this program, too, just to see the experience, not that you need to partake in it, but, and if so, was that something that was part of your evening routine, so you get like a little text and then answer that, or what might we see there?

Yeah, I did go through the program, even though I was, you know, helping design it. Yeah. But going through the program, you know, helped me understand our product better and just what it might be like the user experience, but there were actually some takeaways for me personally, which, you know, I, I would say was pretty helpful.

Um, one of the things that I would say I've really found it to. You know, I've really found it helpful, uh, some, you know, as a business owner and busy with a busy schedule, we might not always stick to those consistent times that we might really kind of try to. So what I've really found helpful going through the sleep by program is the constant reminders.

And, and that has really actually helped me be more consistent. So I've really appreciated that part of it. Um, which, you know, as someone who just generally thinks, Hey, I have pretty good sleep habits in place. Um, it was nice to get that additional nudge of, um, Totally. Just start to wind down now. Yeah, right.

Isn't it so wild when those things prompt and come right in and oh wow, I didn't even realize it was that time or what have you. It just can really help dial you in. That's great. Okay, and then what might we see in your morning sleep routine? And that could certainly involve during the time when you were going through the program, what you might see there as well.

Mhm. You know, I think in the morning, like I said, I generally try to get up at the same time every morning. I'm a big, um, I'm big on getting my exercise in the morning. Uh, just kind of knowing that if I don't get it in in the morning, then, uh, it'll be very difficult to actually squeeze. Later on in the day, as the day goes by, um, I try to get outside as early as possible again to really, um, increase kind of my exposure to light and it really helps me kind of feel more awake and get my day started.

Um, I also like to start the day with just, you know, a healthy nutritious breakfast and that helps me get going as well. Um, but, you know, I, I'm also someone that tends to. Really be affected by stress. My sleep really gets affected by stress or anxiety. So something that you know, my personal life that might be weighing heavy on me.

I really now kind of know that I need to attend to that and take more steps to um, whether it is just wind down or relax from the day or make sure that throughout the day. Thank you. I am, you know, doing what I need to, to really minimize or manage the stress so that I'm not feeling so overwhelmed by the time the day is over.

So also knowing, you know, what happens in your day to day and how that might influence or affect your sleep is crucial. Um. So I think that was also just a learning that I've kind of had throughout, um, the program and just noticing how it is that my, um, sleep is affected by stressors and perhaps even like levels of anxiety.

Mm. So good. And then the third question would be what might we visually see on your nightstand or if you're traveling proverbial nightstand that can include ambience, you know, things in your environment. Yeah. Well, you know, like I said, I am a big proponent of having a very comfortable sleeping environment.

Yes. Blackout shades, sound machine, all, all of that. And then one of the things that my husband and I invested in a few years ago is the Chili Pad. Yes. So good. Oh, amazing. It's been a game changer. Um, it's just You know, so nice to like keep you keeps you cool throughout the night and obviously, you know, temperature, like I said, is another big driver of um, our circadian rhythms and cycle.

So that is another gadget that, you know, we also huge. The sleep out program and, um, you know, ways in which that that has been helpful to me. And I usually don't have my phone in the room, but, um, while I was participating in that program, I was on my nightstand, but of course, face turned down so that I could just get those reminders.

And, um, sure. That's great. Oh, the chili. It's, isn't it so challenging when you go like travel away from it? Oh, gosh. I know that is a stressor of actually like, yeah, the one part of travel that is not fun is being away from the chili. Oh my God. It's such a great testimonial for them. Oh gosh. And then the last question would be, what would you say has made the biggest change to your sleep game or said another way, maybe biggest aha moment in managing your own sleep?

There have been a few through the years, but I would say one is actually just how important Sleep is to me, you know, I always thought I was someone that could function and get away with not sleeping all that much. Like I said, four or five hours is what I used to get consistently. Um, but I started to feel like I just.

Can't continue on like that, and it started to show up in my relationships and just my overall productivity. So actually making the time to sleep and, um, and really focusing on my overall sleep quality has been a major. You know, aha moment. So it's really nothing specific, I guess, but just the general, you know, and, and I'm someone right, like I help other people with managing their sleep, but it took me some time to really kind of get to understand how important it is for me as well.

Oh, so important that prioritization. Yeah, that's one of the things it's like if we might know all these things and the knowing is really great and yet the prioritization to actually take the steps to leave the party at what, you know, every time and to then have the commitment to on Saturday still get up at around the same time or what have you all of those things.

It's that kind of where the rubber meets the road. So I love that you're begin with your kind of why and the reason that's important to you. Was there anything along the way that you felt was really important that strengthen that? Why was there, you know, from a mental health perspective or for longevity or cognition or productivity or just the whole just knowing all the things that it does for you.

Is there anything in particular that really hit home for you? I would say generally it was all of those things, but I think one one in particular was just how I would feel when I. When I wasn't, you know, well rested, whether it was around my mood and just feeling kind of sluggish and, um, you know, not as motivated, um, but also just not as sharp.

A lot of the times, you know, not feeling like. Like, hey, I know I can do better and is it just about my sleep and if it is, then my God, like, let's, let's improve that, right? Like, let me in a little, you know, just even an hour and a half to, uh, how much I'm sleeping and I started to really notice that that began to make a huge difference again and how I was feeling from an emotional and just the cognitive standpoint and I, Okay.

Started to see results right away once I started to add in a little bit more time to my, um, you know, sleep, sleep time that I was a much better coworker, a much better partner, friend, right? Like I was more available to other people because. I had just more to give as a result of um, just getting more sleep and feeling a bit more alive.

Totally. Ugh. So we work with a lot of high stakes poker players in particular and for them that ability to be in that heightened state throughout the entire course of their time at the table, which sometimes can be like 12 hours or what have you, and to be have that edge can spell the difference between millions.

gained or lost. And so to be able to maintain that level of performance to utilize sleep and its advantages, it's, you know, just one example of how much not only from the cognition standpoint, but from emotional regulation and their ability to manage their response instead of being overly aggressive at the wrong times, or, you know, kind of taking these swings or getting really messed with that they're able to.

manage their emotional state with a bit more granularity. So, so well said, so important. And did we leave anything out, would you say, before we share for people of how they can take these next steps? Was there anything that we missed, would you say, that is important on this whole topic of sleep and how to do it well?

Um, you know, I, I generally would say I think it's important to remember that it's not a one solution fits all kind of thing when it comes to sleep. And I talk about this with my own clients all the time and any kind of, you know, digital solution that I'm involved in designing. I always see it through that lens as well.

There we need to have. Some customization in place, right? And if it's ourselves that we're talking about, like customize it to your own unique needs. Um, there's a lot out there now around sleep and different strategies. And sometimes what I see is people feel kind of like overwhelmed with. Yeah, that's out there.

And I think it's okay to try different strategies or tools or products. But in the end, if something is just not working for you, if it's actually not helping, there's no need to continue on to use it. So, and just because it's working for a slew of other people doesn't mean that there's something wrong with you if you're not actually benefiting from just always encourage people to.

You know, you can try what's out there, but in the end, it's just important to know what works for you and sticking with that. So, you know, be your own advocate, know what, know what works for you and what you need. And, um, you know, similar goes with the sleeper program. We've had a number of, you know, now 3000 participants go through our program.

Many of them have, you know, absolutely loved it. But we've also, you know, heard from people like, yeah, here are the parts that didn't work for me. And that's totally fine. Right? Like, not everyone is expected to like everything that's out there. So, you know, my just overall message is don't feel pressured.

And, um, the goal here is not to feel overwhelmed, but actually benefit from the stuff that's out there that you would find helpful. That's so well said and it's so great. They've had it run 3000 people and for those certain group of people that it didn't quite fit for them. It was only what 20 a month or something 20, right?

20 bucks or so. So, yeah, right. Yep. The program is 20, but we are offering offering a promotional code for 25 percent off. So if you're interested, you can go through the program for just 15 and. You know, if anything, it could be, you know, something new that you learn about yourself or your sleep and hopefully benefit from.

Oh, absolutely. I think it's so important to kind of democratize great sleep. And so that it's not kind of only reserved for people that can afford to get the one on ones and the data that like to have this available at a relatively affordable rate. really important. So I love the work you're doing and what are the best ways for people to check it out and to give it a spin themselves?

Yeah, well, um, you can sign up and just overall learn more about the program on our website. If you go to sleep. dogbotic. care for that 25 percent off code that I mentioned, um, the code is sleepbot25. Great. So good. Amazing. And I'm sure there's more to come. It sounds like you're in the midst of different trials and just kind of gathering more information.

So I'm sure people can continue to follow that progress and you're on different social media platforms and all the things too to stay abreast of the latest. Yep, absolutely. So we are actually just finalized our trials and are in the process of publishing our results. Woohoo! And, uh, yeah, you can certainly find, um, Doc Botic on Instagram and other social media platforms.

So just follow along with, uh, what we're doing so good. Uh, well, thank you so much for taking the time. I know you're juggling a bunch of things, so means the world and keep up the amazing work in getting this message out in. different platforms and mediums instead of just how it's always been to shake things up and allow for different generations and across generations to be able to have access to something like this is really, really, you know, outstanding.

So I appreciate it. Thank you so much. I appreciate it. Thank you. You've been listening to the sleep is a skill podcast, the number one podcast for people who want to take their sleep skills to the next level. Every Monday, I send out something that I call Molly's Monday obsessions containing everything that I'm obsessing over in the world of sleep, head on over to sleep as a skill.

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