082: Dr. Brian Curtis, Clinical Psychologist, Sleep Specialist & Founder of Honest Sleep LLC: Chronic Sleep Disruption & Its Direct Link To Mental Health

Welcome to the sleep is a skilled 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 is a skilled podcast. My guest today is Brian Curtis PhD, and is a clinical psychologist and the founder of honest sleep, LLC, a telehealth based clinical practice specializing in the S. Assessment and treatment of chronic insomnia and nightmare disorder. He has over 12 years of research experience in the field of sleep medicine and is a member of the American academy of sleep medicine and society of behavioral sleep medicine.

Dr. Curtis received a PhD in clinical psychology and Ms. In human genetics from the university of Utah, Dr. Curtis's work includes targeting co. Sleep disruption for individuals diagnosed with borderline personality disorder, post traumatic stress disorder, anxiety disorders, and depression as sleep.

Disruption is trans diagnostic across most mental health concerns. Dr. Curtis is particularly interested in helping. Fellow therapists increase their competence in the assessment and treatment of sleep related difficulties with their clients. Really, really helpful conversation that we get into today.

And a lot of practical tips and takeaways. He even does an exercise with us. Right in the podcast. So please engage in that, you know, of course, if you're not driving or what have you, but I think you're gonna really, really get some immediate takeaways and some new strategies and ways to look at this world of sleep and how to really gain power in this area.

So I get a lot of questions around sleep supplements, and I'm very hesitant to just throw out a whole laundry list of possibilities. One, I don't think it's the most responsible thing to do. I really do believe in testing to see what types of supplements make sense for you. And two, because I really truly believe that most of the things that you can do to improve your sleep are behavioral, psychological environmental in nature, and often don't cost a.

However, there is one supplement that I personally take every day and that I do feel quite comfortable with suggesting for most individuals to experiment with because of a couple of reasons. It's high safety profile and high rates of deficiencies in our modern society. Some put the numbers as somewhere around 80% of the population being deficient in this one area.

And that is magnesium. So magnesium has been called the calming mineral and some report that magnesium can increase GABA, which encourages relaxation on a cellular level, which is critical for sleep. Magnesium also plays a key role in regulating our body's stress response system. Those with magnesium deficiency usually have higher anxiety and stress levels, which negatively impacts sleep as.

Now before you go out and buy a magnesium supplement, it's important to understand that most magnesium products out there either synthetic or they only have one to two forms of magnesium. When in reality, your body needs all seven forms of this essential sleep mineral. So that's why I recommend a product for my friends over at bio optimizers, they have created something called the magnesium breakthrough and taking this magnesium before bed helps you relax and wake up, refresh and energized.

And while we don't recommend that you go two nuts on looking at all the sleep stage classifications on all your wearables. I will share anecdotally that many clients have reported improvements in their deep sleep trend numbers. Again, I don't want you going nuts on the sleep stage classification numbers on your wearables, but I do wanna let you know about that because I know that many of you do reach out on questions of how to improve your deep sleep.

So I also love that bio optimizers offers free shipping on select orders and they offer a 365 day money back guarantee on all their products. Plus they have a customer satisfaction rating of 99.3%. Very impressive. And you can get 10% off magnesium breakthrough. Again, this is the same magnesium that I use every single night.

And finally, you can get 10% off magnesium breakthrough. Again, that's the magnesium supplement that I use every single night by going to www dot mag ag. So mag breakthrough.com/sleep is a skill and be sure to use the code. Sleep is a skill for 10% off. And welcome to the sleep is a skill podcast. Uh, Dr.

Brian Curtis, I'm really happy to have you here today. This is really a, a pleasure. I know we got connected on a panel that we have done, uh, around mental health and sleep a while back. So to be able to have the opportunity to go in deeper, uh, with your knowledge is really just an honor. So thank you so much for being.

I am honored to be here. I've been looking forward to it. Thank you, Molly. Oh, awesome. We had an opportunity to speak a bit before we hit record. And one of the, or a couple of things that we spoke to that we're hoping to hit on today is the big topic of anxiety and. Sleep and potentially some tools or strategies of how to approach that, but I know you've really made it your business to explore that in depth, both, it sounds like in your own life and then with the many, many patients that you've worked with on this topic.

So I'm gonna, uh, kind of put it onto you to share a little bit about maybe your background and how you found yourself really specializing, particularly in that area of mental health anxiety. Yeah, thanks. And so  the way I found myself. It was really, it was almost by accident. So this topic of, you know, sleep, I've struggled with chronic insomnia, um, for 21 years, I mean, at least since the age of 10, I was the, the kid at the sleepover awake at.

Two o'clock in the morning, just watching my friends sleep. You know, sometimes the memories of walking home with my blanket, just super sad, not being able to sleep. Yes. And just lifelong what we would call generalized anxiety, uh, which is the flavor of anxiety that it's not. It's not a phobia. It's not, I can't go in elevators.

I'm afraid of dogs. It's that kind of constant chatter for me in the mind, it's planning, it's worrying. And I would later find out this just runs in my family. So my mother, my three older brothers, this is our flavor. It's planning, it's perfectionism, it's anxiety. And it happens to be chronic insomnia too.

And so this has been with me for the majority of my life. And I stumbled into this field of sleep medicine that I knew nothing about. I was in college and I wanted to shift from this kind of daytime corporate day job that I had. And there was a position for a research assistant at our local university sleep center.

And I almost didn't do it. The medical director, Dr. Chris Jones, he's a sleep neurologist. He left a message on my voicemail and I listened to it. And he's, you know, this is. Dr. Jones and very somber and buddy mentioned the term circadian rhythm. And that brought up an REM song that I liked called day sleeper.

That talks about circadian rhythms. I'm like, I don't know what those are, but I like that band. And so , that gave me the prompt to call him back. And then I got introduced to this whole field of sleep medicine. And then I could reflect on, Hey, this has been my whole life. And I had no idea. You know, the gold standard evidence based treatments for what I was struggling with.

These are skills based. They're not pills based. And so, so much of my life was trying to find that kind of quick fix, right? The sleep meds, antihistamines alcohol was one that I didn't even realize that I was using for both sleep and anxiety. And so that really. This whole path to then being trained in neuroscience and genetics with the research we were doing, and then ultimately to this field of clinical psychology and being a specialist in what's known as behavioral sleep medicine.

And that's all about the skills based tools. For how do we deal with an optimized sleep without the use of, of medication? Although those can be useful as well, which we can talk about. Sure. Wow. Well, thank you for that background. And then, I mean, just, I'm so glad that you liked that band and that you had that kind of.

Connection. It's all, it's all about RM. That's my whole life story I owe which Michael said. Thanks. Fantastic. Love that. Okay. So that's kind of the, the background, and I know you're particularly passionate to, and to your point of what you've shared, how it's worked into your own life and then how you've been able to make this connection for the patients that you're working with.

So if we just start at the beginning and kinda the ABCs for. People listening. Presumably if they're listening to this podcast, they're either struggling with their sleep or looking to up level their sleep. So if you can kind of walk us through how anxiety and sleep might be interconnected or anything, we need to really know, kinda start us at the beginning.

Yeah. And so anxiety is one thing we talk about, but anything that has this flavor of what we can call hyper arousal. Yeah. Which is our stress is just high. And so if you find that during the day you have elevated stress and a lot of people I work with it's that pre sleep period where the mind starts racing with anxiety.

But also if you have a trauma history, Post-traumatic stress disorder. This can be just your kind of baseline is that hyper arousal state. And so anxiety, chronic stress, these things they do, what's called masking sleepiness, which is they kind of sit on top of underlying sleepiness, kind of like a mask on our face.

And so. A primary tool that we want to think about when we have high anxiety, that's not often covered. When we talk about treating something like insomnia, are these evidence based tools for how do we manage ongoing chronic stress? Right. And so how do we unmask this underlying sleepiness to even give our brain a chance to recognize.

That we have this sleepiness. Okay. And so there's a number of evidence based tools to do that. And we can walk through a few of 'em, but that's one of the primary drivers is if you're dealing with anxiety, if you're dealing with trauma, you know, low mood does this as well. It's kind of  sleep is what's called a trans diagnostic factor.

Meaning that if you're struggling with your mental health, chances are sleep kind of comes along for the. And a really important research finding is unless you target the sleep disruption directly, it's unlikely to go away. Even if you successfully treat the other mental health difficulties, the anxiety, even PTSD sleep tends to break off and become its own little monster that requires its own direct inter.

Mm. Well, thank you for clarifying that too, and providing a bit of that kind of vocabulary and ways to understand this. Just quick check in, uh, for anyone that might be listening and certainly anxiety. I'm so glad we're discussing this because anxiety and sleep disturbances, as we know, often go hand in hand, just wanna underscore.

Your sense of the future for someone dealing with this, if you can just help us kind of share that while it might be like that for someone right now, if you can then walk us through some of these tools and also provide us with the, the comfort that there are things that we can do about this, because I think so many of us, and certainly, you know, I think, you know, my backstory.

That I went through my own period of difficulty with my sleep. And one of the biggest things I was often looking for just, you know, kind of the, the success stories of showing that people can work through these things. And while, you know, you might have a, um, proclivity to certain ways of being and certain patterns that there are a lot of things that we can do.

So just the underscoring and checking in, and so that people are committed as they listen to all these tools that they're not just kind of like surviving it, that they can thrive throughout. Are you saying that my, my previous answers were just a bummer moment. Is that what you're saying?  no. So we'll, and now we'll shift to the whole, definitely not  to underscore that's right.

This is really, really important though. And this is why in the work that I do. It almost sounds to a lot of people almost too good to be true. And so we'll talk about the tools and when we're talking about, let's say insomnia, Which is difficulty falling asleep or difficulty staying asleep or difficulty waking up earlier than you want to.

And it's hard to get back to sleep. The gold standard treatment is something called cognitive behavioral therapy for insomnia or C B T I, and it's this multi component treatment. One of those components is let's target hyper arousal and anxiety, but this tends to work on. Average from four to eight weekly treatment sessions.

And so, yeah, I've seen people who have come to me and they've been struggling with this like me for 20 plus years. And within a matter of, I mean, really six weekly sessions after I meet with them, they're sleeping on, on their own. This isn't, you know, they've been on, let's say sleep meds for years, if not decades.

And once their sleep schedule is S. We can gradually taper those down in coordination with their medication prescriber. And so a real benefit to this treatment is it tends to be highly effective and it tends to work very quickly. And that's with saying though, an important factor here is why is the insomnia happening and making sure it's not some.

Sleep complaint. I know you've talked about sleep apnea on the podcast before circadian rhythm disorders. And so making sure this is what we're looking at, let's say in this case, insomnia, there's definitely hope it's highly effective, but we really want to make sure we know exactly what we're treating.

Yeah. Ah, well, thank you so much for framing it that way. And also being thorough in the fact that sleep is not, you know, top five tips type of article or something it's really, to your point requires that really leveled and layer. Thinking to get at what are we dealing with here, but certainly coming from that place that there's so much we can do and the high effectiveness or the way of approaching it, certainly with some of the results for C, B T I looking really, really promising.

So without further ado, yes. Please share with us some of those tools that you've found to be effective through that lens. Yeah. So one of 'em that is great. And we have it because we're always doing it focuses on our breath. Okay, this is with anxiety. This is with chronic stress. And so for the listener, we're gonna have to do this verbally.

Molly, you can see me if you take your index finger, go ahead. And just in kind of the middle of your neck, on the side, kind of between your chin and your jaw, go down and find your pulse there on your carotid artery. If you can feel that yep. Kind of heartbeat, you got it. Got it. And so we're not gonna change anything that we're doing.

Just breathe normally and just become aware of what your heartbeat is like in this moment. Okay. So that's the heartbeat at rest. And now what I want us to do, there's no fancy counting of breathing, but just breathe normally through your nose. And then on the out breath, just try to elongate the out breath slightly longer than the in breath.

You can almost kind of imagining emptying your lungs, not to the point of where it's uncomfortable and then a normal breath in and the slower breath out. And as we do this, Molly and dear listeners just be interested in, does the heartbeat change? Does it get slower? Does it get faster? And is it on the in breath or the out breath?

And I don't know, I'll rely on you, Molly, whenever you notice anything, does anything, is anything coming up for you? Yeah, I really appreciated the kind of general instructions to extend the Outre versus the specifics of. Count to this, do this. Cause I think for a lot of us that can run more anxious, the strategy of getting it right.

Can take over. Yes. So instead of that, I really appreciated that. I did just see that naturalized kind of elongation of the process of how long that took to for the pulse, right. To kind of slow. So that was very nice. And like you're mentioning with anxiety and with people who are really high achievers, I want to do this, right?

Yeah. Counting can be very stressful and they notice their heart rate increases when they focus on breathing. And so the mechanism here is if you're wired up, like I would expect you to be as a human, our in breath is paired with a branch of our automatic or autonomic nervous system called the sympathetic nervous.

Which increases heart rate, the out breath is paired to that kind of break pedal the parasympathetic, and that slows the heart rate down. And so if you're noticing you're anxious, especially around that pre sleep period, taking a few deep breaths and especially elongating the out breath. That can put you in more of that sleep promoting state and this just isn't for sleep.

This is during the day too, if you're anxious, if you're worried, that's one evidence based tool, we can call it, paste, breathing, or diaphragmatic breathing. And that, that can be something that clinically we use all the time because you're breathing anyway. And so now, knowing the mechanism of what is kind of driving that can be useful for anxiety.

So breathing is one strategy. Questions about that. We locked in. We good? Yeah. That was great. Thank you for kind of starting there. Cause it's one of the arguably one of the most important places to begin. So thank you. Nice. And so a second one is for a lot of people where worries start to come up, our anxiety start to come up.

And I definitely noticed this in my life, which is I would be kind of nodding off on the couch before bed. I had a lot of sleepiness, but as soon as I started heading towards. The bedroom right in bedtime. That's when the heart rate increased. And that's when the thinking started over and over that rumination right of the thinking.

And so one way to approach this there's multiple ways. But one way is to actually before bedtime an hour or two, before bedtime is to get a piece of the paper in a pen or type it out if you want to, but actually write out all of these worries, these things that you're lost in the future planning about.

And so we're getting them out of our mind. Onto paper and then engage in some problem. Can anything be done about this? Hey, this is my schedule tomorrow. I'm gonna be meeting with Molly. Is that stressful? Well, not really. I like Molly, but is there something I need to prep for?  yeah, there is actually, I want to get my thoughts together.

And so if those thoughts come up in the middle of the night, not right before I'm sleeping, cuz that can be stressful. But an hour or two before we're writing these worries down we're problem solving. And so that way in the middle of the night, when we have those worrisome thoughts, we actually have already written it down and we can give ourself permission to kinda let go of problem solving during the nighttime.

And we can remind ourself, Hey, we're probably gonna be more effective after a solid night of sleep than at three o'clock in the morning. Anyway, so we have breathing. We have writing out stressors, which can be, you know, useful. You can also keep a little notepad by the side of the bed to jot things down.

So a related point here is if you find yourself ruminating, tossing, and turning, and it's hard, you know, the, the sheets are getting warm. A real evidence based tool is when you notice that effort to sleep, the clinical term here is sleep effort is just physically getting up and out of. Okay, breaking that learned pattern of the bed in the bedroom are now the place for worry and stress versus relaxation and restoration.

And then once you're outta bed, you can engage in maybe some paced, breathing, maybe some meditation, maybe some gentle stretching or yoga, whatever it is to get that heart rate down, back in that sleep promoting state. And then you try. Back to bed. We're not, we don't have that effort. The, you know, pillows cool down kind of hitting the reset button.

That's another evidence based strategy for how to deal with this kind of chronic cycle of anxiety induced, sleep disruption. Excellent. Do you have any advice for people when they discuss the fact that, um, they find themselves now hypervigilant of how long they've been up starting to assess? Am I sleepy?

Am I not? Is this working, does this make sense to go back the frustration that comes all of this kind of inner chatter, any way to kind of work. Yes. And so the general guideline we can say in sleep medicine, like if after 15 or 20 minutes, you're not falling asleep, getting up and outta bed. The problem with the patients I work with with anxiety is, well, now I've got a laser beam on the clock and oh, it's only been 13 minutes and the anxiety is up.

That was me. And so very. Was that you? Oh yeah, that was, that really tripped me up that one. . And so I have an idea. Did you I'll just ask what actually worked for you then if you were watching the clock, what was useful for you? So one of the, and this was quite a journey, a number of things came in, so it was very layered, but eventually one of the things that started to make a difference was the linking up that.

During this time, wasn't just totally wasted that there was even in that kind of restful state of laying horizontally, there was different ways that I went through this, but eventually getting that I was getting some sort of restoration in a particular way. That started to bit lower the anxiety and over time with many, many other tools, I started to like loosen the grip of the trying that all that efforting.

So it was a kind of internal shift in the narrative and, and thought process, but that some other things that happened  perfect. But that, that shift is so critical because often the way I'll frame this, there's a number of skills in. C B T I, but when you combine these together, it can end up that, well, maybe you're going to bed a little bit later.

Mm-hmm  than you normally would to build up that sleepiness. And right. If you're maybe not watching the clock for some people actually have 'em turn it around or move it across the room, and we're just gonna rely on the physiological signal of sleepiness. And differentiating that from something like tiredness or fatigue, but so we're using our body's signal to guide when we get in bed.

But even if we do that a couple of times a night, let's say we get up and outta bed. It takes 10 minutes now to feel sleepy again, 15 minutes, we go back to bed. Hey, it's happening again? Right. And I'll, I'll have patients say, but what if this happens two or three times this dovetails with the critically important tool of monitoring our sleep.

Okay. So if they're doing a sleep diary or a sleep log, which they absolutely will,  when they work with me, it's the golden ticket, a sleep medicine. Yeah. We can actually look and say, well, based on your last week, it looks like you're kind of awake for like two and a half hours. To fall asleep or during the night.

And so that shift of it comes from viewing this as a drag, and I'm gonna be, at least I'm laying down to rest when I'm in bed. Well, if you're resting, but still trying to sleep, we're still learning this connection that the bed and the bedroom is a place for trying something instead of allowing sleep to happen.

And so part of the way I describe this sometimes is like, we're giving you the gift of an hour and a half of time that you didn't have. And so what would you like to do during that. If we're staying up a bit later and now they're engaged in some values based activities. Maybe it is relaxation. Maybe it's journaling.

Maybe it's some light reading, but it's not in the bed. It's not in that space. So yeah, that kind of shift that happened for you with multiple things. That is a really big part of treatment is viewing this as something we need to keep doing and adding to eventually that's what makes this so challenging with anxiety?

And insomnia. It's why meditation is so hard is it's actually about skillfully doing less, not about adding a whole more, but it takes learning skills to do it counterintuitively. Absolutely. Interestingly for me, a bit of a fringe element in that. One of the things that did help make a difference was if you're familiar with a C T I acceptance commitment therapy for insomnia, kind of using some of those kind of practices, because I was actually starting to get so fixated on the whole fact of, I can't be in the bed unless I'm only sleeping and the sleep and sex element.

And oddly counterintuitively, after all that hype, to be able to kind of just get that there was an element there could be time and place. Also be in the bed to relax and do some of this kind of breath work and calming practices. So much of that over strategizing very much the hyper vigilance that you're speaking to.

So I just appreciate that you're walking us through this because it's not so cut and dry, and there are oftentimes where you're gonna try and bring in number of these things and compound them over time and you will get better and better at these things. And I love that. You're saying that because oftentimes, you know, people have been handed a handout that says sleep hygiene.

And it's kind of like the it's etched on tablets that thou shall not have caffeine or alcohol after this time, you know, it's these rules, but what you're pointing to is this flexibility. So if people getting up and out of bed is stressful. What I care about as your sleep clinician is I care about what works.

Yeah. And so we're going to make this highly individualized. And so for Molly getting up and outta bed might not be the most useful tool. It can, it has evidence that it can be useful. But we're looking for what works for you. And so yeah, having that, that act acceptance and commitment therapy. Maybe we do this while we're in bed, but we're tracking it.

And so we know that's useful for you. And that's the really fun part about doing this work is it's so highly individualized based on people's backgrounds, their treatment goals. And that's the process of discovery to make sure it's not just, we're gonna go from step one to two to three, but it's gonna be about you as a person and.

Working with the specific things that are getting in the way of that restorative sleep that you, we also desperately need. Absolutely. Well, and thank you for sharing to that element of the personalization. In my case, some of the, the peak stressors were happening while I was traveling. So I might be in different types of Airbnbs or hotels or what have you.

And. So I would just be doing such odd things. Like I'd be getting out of the bed and going kind of at this like little section, but not a proper second room and overthinking is this okay? You know, just all of this silliness. And I say silliness, because now I can say that, but at the time, yeah, it was so real.

And so. So just, uh, just fear based. So thank you for walking through that. Mm-hmm  and also kind of calling out that there might be specific ways we address this for different individuals. So to continue on, I'd love to hear from you to share more. What else you see for people that are dealing with this big umbrella of anxiety?

And of course, I know you had broken that down to many other things that might be happening for individuals under that umbrella. Mm-hmm  but yeah, if you wanna just kind of share some other ways that you might steer this. Yeah, totally. And this dovetails with, when you mention acceptance and commitment therapy, we also can talk about mindfulness, which is a component of, of act, which is just being aware in the moment without judgment, but importantly, this element of control  okay.

We see this in anxiety. We see it in trauma. We see this all over the place and in sleep. One of the most common things I'll hear is Brian. I just can't shut my mind. I can't turn my brain off. Yeah. And when I hear that, I mean, what I'm thinking inside is good. Stop trying to do that because so another exercise we can play around with is we won't take too much time, but so for the next 60 seconds and audience members, you play along Molly, if you will, to, so you can think of anything that you want to think of.

Okay. Anything at all for the next 60 seconds, but just don't think about a purple cow. Okay. Anything you want is fine. We're not gonna do anything. And all our job is just to observe what comes up. Okay. All right. Any questions? No. Okay. That's clear. I'm gonna hit begin after 60 seconds. We'll hear a little alarm and we'll see how this plays over a podcast, but all right.

60 seconds and begin. Whoa. So that was a minute. Molly. What did you observe? Lots of pinging ponging to the purple cow. And then back again, lots of that. Okay. And how many purple cows were you thinking about before we did that exercise? No. Purple cows whatsoever.  and so, but when, when we think about what we make of this.

Okay. And it's really because we're holding a rule in our mind that we're trying to control thinking. And a lot of the skills here, when you think about mindfulness and the center of the bullseye is really just recognizing a thought as a. And when you do this work, you can come to the understanding that, oh, these things just arise, right.

They just kind of like a wave where clouds in the sky, right. When we watch these pass by. But the moment we have a rule and we try to control them, I can't have any thoughts at night. I'm getting in bed. I need to not, it's fine to think about things, but not about my insomnia or whatever. That's the purple.

And the more we try to control thinking it actually not only is it not useful, it tends to have the opposite effect of having more of those thoughts come up. It's this phenomenon that is very well known. It's called thought suppression. The more we try to suppress it, the more it tends to come out. And so the alternative, just like you said, with, with act and what you came to is just being able to step back and notice these thoughts are rising.

and so the shift can be the goal from, I need to turn off my mind. I need to shut off my thoughts. It can be, I need to be able to recognize when I'm having these thoughts come up and then once you can do that, that is a skill that so few people have to be able to recognize the thought and not be lost in it.

But then you can ask yourself the question. Well, is this useful? Mmm. And so if the thought comes up about, oh no, I haven't prepared for Molly. That can be really useful because that might motivate me to then write some stuff down. Sure. But if it's three in the morning and it's like, did I, what was happening there?

Maybe do I need to. If that's not useful. Well, now you have the superpower of just being able to notice it without necessarily needing to control it. Mm. And so for anxiety and for so many other, you know, with, when we talk about thoughts that shift alone and building those skills, cuz that is a skill mindfulness.

Yes. Is a huge skill and it. It's like learning an instrument. It requires practice. But once you can do that, that shift alone can be a game changer for so many of the people I work with when that kind of cycle of, you know, just thinking over and over and never moving past, that can be a very useful tool.

Oh, fantastic. Is a purple cow, a nod to Seth go. And his, uh, it is actually fantastic. Love that. That's amazing that you, yes. Um, I think like a yellow Jeep, you can also use, you can use anything, but yes, for me, I just get an internal smile when I think about, so Seth go author of this is marketing and he's very aligned with values based, you know, Seth was a big influence on setting up honest sleep.

You know, my practice when we did it really? Oh yeah, yeah, yeah. I listened to it's. I was gonna say I read, but I, I have him read me his books.  audio books. Yeah. One high point of my life was meeting with him at a wedding and I happened, he, you know, asked, uh, what I do and what have you. And I shared about sleep as a skill.

And he said, that's a great name. And that from a marketing. Master was like, all right, we've made it.  I, I, I always have a smile and I love that we live in the world when we have Seth gardens and people like that. It's it's great. Yes. Oh, fantastic. Well, very, I didn't mean to sidetrack us, but loved, uh, a mutual, uh, love and admiration.

So that's great. So thank you for sharing that. And you might have already touched on this, but I just wanted to underscore, cause I actually have. A client in mind, as you were sharing some of this who often will speak to has, uh, quite a narrative that she cannot meditate. She cannot think of those thoughts.

She cannot sit with that. She needs to have TV, audio books, all the things to cuz the moment she starts doing that she gets more anxious. This is her narrative. And you know, I think you might have addressed a little bit. But I just wanted to super underscore that. What would you say from the vantage point that you're speaking to from C B T I act cetera, to address that.

Yeah. So  the, the comment I can't meditate. Yes. Yes. Well then the question is, well, what do you mean by meditation? Yeah. Okay. And very often people will say, well, I can't clear my mind and now we're talking about, okay, well, let's, let's talk about what meditation and especially what mindfulness is, which isn't about doing.

We're not changing anything. Sure. We're just noticing what's already arising anyway. And so if then you tell me, well, I can't do that when I don't have a distraction. I just notice these things are coming up very often. That is the first sign that, yeah, you're meditating. Like you're becoming aware of what is just happening automatically when we're on autopilot.

Thoughts are just arising and there's a lot of them. And then they lead to emotions and then they lead to urges to do things. And if we can just step back as the observer and just notice that we're gonna be awareness, not the contents of consciousness that can bring this freedom of, oh, I'm not really implicated in.

and so I'll do an exercise called urge surfing, which if you think about surfing these things, you can view 'em as a wave. Okay. There's an urge to act when we have a thought of, oh no. Did I lock the door? Well, the urges, I need to go check it. What would it be like to, instead of acting on it, just noticing that I'll have people do this.

We won't do it here, but I'll take three minutes, five minutes and say we're gonna commit to not moving a single. Muscle. Mm. For this amount of time, we can still breathe. But if you have an itch, I want you to notice that urge to scratch it. Okay. If you have anxiety come up, what is the urge that that's prompting you to do?

And you can actually learn. And none of this is to be believed for the listeners. This is all to be tested. If you have an itch, just notice what happens if you don't scratch it, does it keep increasing? Does the wave, how long does that last? Does it shift and go to some other sensation or does it kind of peak, and then it naturally goes down on its own.

You explore this and then you can come to the curious question of, oh, everything kind of has this characteristic to it. So to that person, I would experiment with it. I wouldn't try to convince her at all. It's like, let's test this stuff out. And how interesting. Yeah, there's a lot going on in the mind.

There's a ton going on and that is really anxiety provoking. What does that anxiety feel like? Mm. How do you know that's anxiety and not fear? How do you know? It's not shame and now we're talking about, oh, there's muscle tension. Well, where is it? It's in my chest.  and so, yeah, you're, we're kind curious, stepping back, back anyway.

Yeah. Being very curious, being very open, but that's a common thing that I hear is I just can't meditate. Yes. And then it's about, well, what is the goal? And if the goal is to eliminate thinking, I can't do that either. And when I try it's. It's a nightmare. It's very counterproductive. No pun intended with the nightmare star.

Yes, exactly. I love that. Fantastic. So thank you for, for walking us through that and for giving so many of those tools. Are there any other tools or, uh, things that you'd wanna make sure that you share about when you and I, I know this is certainly, uh, thin slicing all of your, uh, wisdom in this area, but anything else that you wanna make sure that you address when it comes to anxiety and.

Yeah. If there is one tool that we have in the sleep, you know, the, the toolbox that we have, when we talk about anxiety, we talk about insomnia, which is people will talk about a stable sleep schedule. We want stability and consistency. I really want to emphasize a consistent and stable wake time. Yes. Okay.

So when I'm working clinically, one of the first things we'll do is yes, we're gonna start tracking your sleep, but let's pick a wake time that it doesn't feel punishing. You're not swearing at me in your mind that I'm making you wake up two hours earlier, but what is the latest wake time that you will feel comfortable?

Ideally, if you work. On work days and on nonwork days, but to have that set wait time. And then when I ask people, will they say, why wouldn't I do that for my bedtime too? And I don't know if you have thoughts on that. Why would it be not advisable to let's say schedule a preset bedtime as well as a wait time.

Yes. Oh, I'm so glad you're addressing this. And this is one of my favorites too. I. Certainly, especially in this conversation of anxiety, that the structure and the, the thought that can go into this when you don't achieve what can almost go into the realm of performance and certainly get kind of collapsed with, Ugh, I already failed, you know, it was supposed to be 11 and now it's.

12, and here we go. And then we can start kind of, um, negotiating and a number of things can happen. And then you might think that it makes all the sense in the world to then push out that wake up time. Cause you already missed the first thing. So you're already behind. And what have you, so thank you. Yeah, it's share more about that.

No that's that you've hit it on. You know, that that is the center of the bullseye, which is if people focus on, I need to be in bed by whatever time it is, normal people, quote, unquote, sleep by 11 o'clock, but you might not be biologically tired until midnight or, or even if it is 11 o'clock now you've set up that you have to strive to now will yourself unconscious by this predetermined time, we're watching the clock, we're getting stressed.

And so by focusing on wait time, if we can consistently do. And the important thing is regardless of how much sleep you got that night. Yeah. People, this can be very counterintuitive, but even if you get five hours of sleep, four and a half, that one night, if you hold that wake up time, well, now you have the whole rest of the day to continue to build up.

That daytime sleepiness, you know, in the brain adenine that primary molecule. And we can now apply that to the next night. And we're going to be letting your biological sleep drive dictate when you're getting into bed, rather than that preset time with the exception of if there's a trauma history and there's that really high hyper arousal that might be masking the sleepiness.

And so even if you don't experience it, The suggestion might be okay. Well, let's just try for this time, even if you don't experience sleepiness and then if you're not falling asleep and you're efforting, you know, there's that sleep effort, then get up and out. But. Set wait time, if you can do it, it helps to be working with somebody to kind of hold you accountable, cuz it's tough to do, but this is what I did right.

When I was doing for my own insomnia. Sure. I basically had to become a sleep specialist to, you know, get over my chronic insomnia and it's been over seven years now, but that one recommendation alone can really do the trick for people. Ah, so good. I'm so glad you addressed that. And uh, just one quick thing that you made me think.

Paradoxical insomnia and anxious patients. Ha anything to say about that? As far as the perception of the amount of sleep that you're getting and any things to be aware of, or kind of fact checking the thought of, oh, I didn't sleep a wink and that maybe there was some sleep that was happening throughout the course of the night and just kind of questioning our own narrative.

Yeah, it's tough. And so when we do a sleep log, like that's a subjective report that you do, you wake up, Hey, what's your best recall of when you were asleep, when you were awake? This notion of paradoxical insomnia and they've done studies where people EEG on their scalp, they are sleeping, but their subjective report is, Hey, I did not sleep.

I was, you know, awake during the night and there's actually some evidence. Some people yeah, they're in those lighter stages of sleep. Sure. They might report, Hey, I heard that car alarm go off at two 30 and there was a car alarm mm-hmm  but they were in these lighter stages. And so clinically how I work with that is let's go with your daytime functioning level.

So. If there is that still hyper vigilance, hyper arousal and anxiety. And maybe I was asleep. I don't remember waking up or maybe there's a disconnect. Well, I'm really going to lean into the stress reduction, right? Elements of this decreasing hyper arousal. And I don't often go to other tools like trackers, cuz when you go to sleep stages, a lot of people, oh they're, you know, notorious, some can.

Yeah, they can be good for sleep duration and timing. Yes. But a lot of people I work with actually counter, not counterintuitively, but by them actually taking off the external commercial device they have now they're not worried so much about the sleep stages. Mm-hmm,  what we really focus on is, well, how do you feel in the morning?

And so we're monitoring their level of restoration. And we're tracking sleepiness versus fatigue. And if we still see that kind of high, then we're going to adjust and say, okay, did we miss anything? We should still be having that go down. But yeah, that can be complicated when there's that mismatch.

Especially if it's a subjective report, we're relying on. Sure. Absolutely. Thank you for distinguishing that. And as far as the trackers too, because I know a lot of people listening, cuz we do make a particular emphasis around technology and kind of data tracking. So for anyone that's listening, one of the important things that we like to really underscore is that a.

All the data that you're getting out of. A lot of consumer grade trackers, the least accurate is the sleep stage classification. So we actually advise people to really not spend a lot of time looking at that if at all, and actually avoiding that entire section. And if anything, utilizing that for a couple other reasons, one kind of just the auto logging, the automaticity of when did I fall asleep around, when did I wake up around?

But we also look quite a lot at more of these kind of quote unquote. Indicators to pull from certain trackers. So looking at heart rate, heart rate variabilities, as far as a stress response, and then a bit of body temperature, certainly for women and their INFR rhythms and how that plays a role in their sleep and then respiratory rates.

And some of the things that we can learn about through that end, you're so tute to pull out the point that sometimes there can be a time and a place for all of these things. Mm-hmm  and there might. Absolutely be benefits to taking a breather from all of this awareness. Maybe we're too aware. So I appreciate that call out.

And the, the center of the bullseye we can do is when we talk instead of what should I, or shouldn't I do just gimme some tips, gimme some hot tricks. It's really about we'll test it out and find out what works. If for you, your sleep tracker is useful. We're gonna use that. And trust me, it's been useful.

But if there's that, like you're saying if we're way maybe over focused on it. Yeah. Well, we're not gonna say take it off and don't use it and throw it away. We're gonna say, what would it be like for this week? Yeah. To maybe take that off and they get an anxiety spike and it's like, well, let's talk about that.

Right. What would it be like not to have that data and to rely on this is mindfulness to rely on those own cues and signals. And again, we're just being flexible in doing what works. Fantastic. Okay. So from that place we wanna dive into what is it that you're doing for your sleep? Because you've so generously shared that you've worked through a lot of things and had some real triumphs in your own sleep.

So people often wanna say, well, what are they. So we have four questions that we ask everyone that comes on. So the first one is looking at what does your nightly sleep routine look like right now? And I'm sure it's evolved and changed and travel or whatever might adjust it. But what we, we see now. Yeah.

So a really, really, really big thing that I used to really struggle with until I realized how counterproductive it was is I try to finish work at least an hour before I typically get in. Currently, I'm getting into bed about 11:00 PM. I really try 10:00 PM. If not earlier, to get the actual work done, not to be emailing, not to be otherwise engaged.

So again, I really prioritize that pre sleep buffer period. So I try to complete work and by the way, sometimes I slip up, but I know what I'm doing. Right. I know that's setting me up and then I'm increasing. These other things, which is I will do so many of these relaxation techniques I have over on the external monitor.

I have my daily word document. I know what today's gonna be before. After I see patients today, I'm going to know what tomorrow is. If I have any worries, I'll write those out and try to problem solve it. Because that cognitive thinking piece was huge for me. So I will do that. And then in terms of relaxation, a meditation practice has been for the past seven years.

It's just a daily practice that I have. It's incredibly useful for me, sometimes a hot bath. You know, that when we talk about core body temperature, when we get out. Dumps that core temperature to the environment, core temperature decreases. That's useful. I'll often do stretching. I hold a lot of tension in my neck and my shoulders.

Yeah. And so I'll just, I'm doing it now. It's, I'm aware it's all stretch, but it can be really interesting how it seems like. These little interventions of stretching and I'll do this paced breathing. And often too, it's funny, Megan, my wife she'll see me either meditating out back or during the day and I'll just have my finger on my neck.

Oh, that's great. And she's like, oh, are you doing your pace breathing? I'm like, yeah, you know what I'm doing? But just to get that feedback of, Hey, my heart rate, I'm slowing it down. So I'll do that. And one thing we haven't talked about, but it's been a staple for me for so long is I use a white noise. Ah, every night.

Yeah. And that has been really, really useful. There will be days where I don't have it and I can still, luckily not luckily, I mean, it's been a process. I don't necessarily need it to sleep, but it's part of my routine is I'll just click that on. And I have that, that helps with thinking for me. For some people, it doesn't, it's useful.

And then always when I'm in bed, if I have that sleep effort, I'm getting up, I'm getting out of bed, I'm doing the relaxation tools and I'm getting back in bed. I don't even think about it anymore. It's just so natural that I've done this for seven plus years. Now. This is just what I do. If I have that sleep effort, that's basically the.

Oh, so great. And the meditation piece, any callouts there as far as, so some people discuss benefits or callouts around doing it right before sleep. Like if you fall asleep and it's almost like giving you second wind, or do you find that that's not the case and it just kind of calms you and gets you prepared for sleep?

What's your take there? I would say again, I'm gonna default to. Test it out and let's try it out for me. Same. Yeah. Yeah. I'll do in that pre sleep period, it's useful. And I've really transitioned from what we can call a formal meditation. Like we kind of did, you know, for a couple minutes here where we're sitting down eyes closed or open and really having this just be more of this informal.

This is how I kind of am. Like, I'm doing it right now. I'm aware of you. I'm aware of the surroundings, but when I notice I'm lost in thought, or I notice these emotions.  that's kind of a mindfulness alarm of okay. What's happening. And so I would say for people just getting used to this, just try it out. I have a couple of apps that I usually recommend 10% happier is great.

Dan Harris, the free trial, right. Waking up with Sam Harris is my favorite. So good. Just cuz he has the evidence based neuroscience, mindfulness and all of that background. Calm is good. Just test it out. But I would say. You know, none of this is again to be believed. Does it, is it useful for you and then figuring out what times of day it's, especially around sleep, it's working for you and yeah.

See for yourself. Yeah, I love that Andrew Huberman has kind of popularized that whole, uh, nons sleep, deep breast protocol as he's coined it, which I appreciate is just kind of a container to put a lot of things that might calm the nervous system and kind of put the breaks on that stress response and sympathetic response.

So it might look like different things to different people, yoga nidra. It might be HYP. That might be deep breathing, yoga, whatever. So the fact that we can pull out all those into your point, get curious, and practice and experiment for ourselves is really empowering. And just one thing there is we haven't talked about nightmares and, you know, we don't have time to do that today, but part of the nightmare protocol is actually doing these relaxation exercises while you're in.

After you do some of the imagery rescripting and all of that work for nightmares. When you're in bed, now you're doing progressive muscle relaxation. Now you're doing the breathing. So again, no hard and fast rule that it's just like you said, sleep and sex. Yeah. Those have a lot of evidence, but test this out and see maybe it is in bed right before sleep.

And a lot of the patients I work with on trauma related nightmares, they start doing it. And before they know it, they're waking up in the morning and they have no memory of what happened. It's. Ah, that's incredible. I mean, I know I'm kind of biased, but that's just such an example of how life changing something like this can be when someone begins to entrain themselves, to be really sometimes terrified to go to sleep and how it relates to their bed and, and to recreate that is just huge.

So yeah. Thank you for that. So the second question that we've recently added in is what is your morning sleep routine? And I think you certainly alluded to the fact that we know, uh, most likely yours is gonna. Consistent. And it's gonna be around the same time that you're waking up, which is fantastic.

And it's kind of step one in a lot of ways. So anything you wanna share about what your morning routine looks like and how you see that relating to your results with your sleep? Yeah. And so before I would say before having kids, I used an alarm for the set morning. Wake time. Yeah. We have four, you know, there's we have a seven year old, a five year old, a three year old and a one year.

Which has been fun during a pandemic. It's been great. It's been amazing. Yeah. But 7:00 AM, regardless of whether I want that or not, is the latest I'm ever getting up because they're jumping on the bed.  yeah. And they're there. Totally. And so a consistent morning, wait time, it doesn't matter what day it is.

That's when I'm going to be getting up. If it wasn't for them, I would set an alarm. And for me, it used to be, I had the coffee pre-programmed in the morning as kind of that emphasis to get up and out of bed quickly. Now I have the tea, you know, the kettle kind of ready. I can do that. Right. For a lot of people I work with having something that's motivating you to get up and outta bed, whether it is a certain beverage or whether it's a certain activity I wanna read by the window.

That's really useful for me to know. There's that set thing to look forward to and then just so happens. I'm a creature of habit. A lot of my morning routine is. Very very locked in about making breakfast for the kids, making breakfast for me taking a shower, like there's an order to it and a predictability that again, it's kind of outta my hands now.

It's just automated at nighttime and at the morning. So that's consistent. Wait time is the center of the bullseye for sure. Fantastic. I like that. Consistent wake time. And then you're also getting that consistent meal timing in there, which is fantastic also for entrainment of our, uh, circadian rhythm.

So really good stuff there. And then the next question would be, what might we see on your nightstand or maybe your proverbial nightstand, if you're traveling, anything that you would often ensure is around you? I know you mentioned the sound machine, but if there's anything else.  that is my primary one.

Okay. So it's fantastic. It's the sound machine. And that literally is on my, not just proverbial. That is on my literal nightstand  uh, that I have there. Um, and I, yeah, I silenced the phone. I actually turn the screen down, which is if I get a message or anything, of course it's on silent, but I don't like any light, any distractions.

We have a ceiling fan. I. Temperature is cool for us. We've settled on like 69 to 70 degrees, but temperature is huge. Not exactly on the nightstand, but that's something we prioritize, but yeah, kind of a minimalist. I don't have too much there for, but the nighttime routine leading up to it is, is kind of the central driver for me.

Yeah. Oh, fantastic. Okay. And then the last question would be what has made the biggest change to your sleep game or the biggest kinda aha moment that you've had with your sleep? And I know you've already kinda shared a bit of your journey, but if there's anything that sticks out that we didn't discuss.

Yeah, for me,  the biggest aha moment was there is actually a field that's devoted to sleep medicine and treatment. Yeah. I had never heard of any of this stuff that we're talking about. And for me, when I learned of it, I had been. Just, I mean, trying so many things again, it was ambient, it was Benadryl, it was alcohol.

It was like NyQuil. It was whatever I could do. And when I talked to my general practitioner, it was just, well, here's some meds, here's some sleep hygiene and so on kind of accident again. Thanks REM for getting into an eyeopening, you know, opening my eyes to this field, just learning about the evidence and that this actually is the gold standard treatment.

And sleep is a skill. These are skills that can be learned and that can be practiced. And very importantly, that can be individualized. If you're frustrated by trying the 29 things that people have been recommending to you. Yeah. Maybe only two of those are gonna be useful for you. And so giving yourself permission to focus on what works and maybe not to focus so much on all of the things you're hearing.

But that was the biggest game changer for me is those four letters, C B T I, it completely changed my life. And I mean, my career trajectory is what it is because of it. It was so incredible. And that's why I'm so passionate about this work, as I know just how life changing this can be. And I really appreciate you this podcast because you know, that that really is a barrier is just getting the word out and having people to become aware of.

Not to be hopeless. And there is so much science behind this and getting started can often be the hardest part. So, yeah, that was the biggest thing for me. Ah, so great. Well, thank you so much for sharing your wisdom. Yeah. I was really struck by your. Knowledge, but also just what felt like that real genuine passion when we had connected on the panel that we're on.

So excited to continue to collaborate with you in whatever way possible to kind of get this word out. And I appreciate too, that you do speak openly about the mental health piece, because sometimes we can glaze over that, but that is just. Can be such a huge component and we've only scratch a surface I know today, but really appreciate you sharing all this.

So for anyone that's listening, they say, oh my gosh, I need to kind of follow Brian's work or work with you. What are some of the best ways to get connected or stay connected? Yeah, I would say the website is just honest, sleep.com, H O N E SST, S L E E P.com. And whether or not you decide to work with me, whether or not you have questions, please feel free to reach out to me.

I love getting those emails about, Hey, this has been happening. What do you think? Cuz again, getting people on that. Can be such a critical step. And so Brian B R I a n@honestsleep.com do not be shy. Please feel free to reach out to me with questions or anything else. And you now have a sleep specialist in your back pocket.

And I, I genuinely sincerely would love to hear from you. So don't hesitate. If, if this sounds like something that would be useful for you. Well, anyone listening, absolutely take advantage of that. You don't hear that every single day. And then to that point, I just wanted to check in too. I love what you said about getting people on that path.

If people are just beginning they're, they're curious, or maybe they're, um, on the spectrum of, uh, desperate, wherever they might be falling wanted to hear. Do you have any other first steps that you often recommend as far as books? Um, Places for people to begin. Cause I know you said C B T I for you really made such that difference.

I just wanted to check in if you had any, uh, resources that you really recommend there. Yeah, I would say a really, really great one is the society of behavioral sleep medicine and their website. It's behavioral sleep.org. Okay. That has really like an overview of what this field is about. It'll talk about C, B T I it'll talk about nightmare disorder.

It'll talk about circadian rhythm disorders. If you have sleep apnea and you can't stand wearing that mask, or you have claustrophobia or a trauma history. A big evidence based thing you can do is to work with, uh, you know, a behavioral specialist to be able to get used to that and habituate to it. And so that can be a resource to kind of explore around in terms of books.

I don't have it in front of me. It's calling Carney. And this is for clinicians too. I would say it's called treatment plans and interventions for insomnia, that book alone, it really walks you through kind of the nuts and bolts. If you wanted a deep dive into sleep treatment. And I would say if somebody just wants to get started, let's say insomnia feels like.

Kind of the, the flavor of what they might have. The VA has put out the C B T I coach app. Yes. Sure. And so you can, you can just go and type in C, B, T I coach and download that. And it'll actually kind of walk you through, this is what C B T I looks like here's some of the components, so you can start testing some of this out for yourself.

Well, thank you for answering that question. I've been playing with adding that to a fifth question that we ask everyone as far as kind of their most recommended or resources and places to begin for people. But absolutely. I don't wanna step over the fact that you're offering to be able to kind of help people along on this process.

If they do have anything specific to reach out to you, please take him up on. Very cool offering. And I just thank you for your time and your attention, and just generously giving this information to all of us, which as you've shared, I completely agree can be completely life changing. So thank you for what you're doing and looking forward, uh, to more

Well, thanks so much, Molly. Honestly, truly a pleasure of mine and thanks for all the amazing work that you're doing and thanks to everybody for listening. Ah, fantastic. Thank you. You've been listening to the sleep is a skilled podcast. The number one podcast for people who wanna 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 is a skill.com to sign up.

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