083: Dr. Shelby Harris, Bestselling Author, Clinical Psychologist & Sleep Specialist: “A Firestorm For Insomnia”: A Complete Guide To Why Women Have Sleep Issues

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.

And welcome to the Sleep as a Skilled Podcast. My guest today is Dr. Shelby Harris, a clinical psychologist and sleep specialist in private practice in New York. She is board certified in behavioral sleep medicine and treats a wide variety of. Sleep, anxiety and depression issues using evidence based non-medication treatments.

Her self-help book the Women's Guide to Overcoming Insomnia. Get a Good Night's Sleep without Relying on Medication. Was published in 2019. Before going into private practice, she was the longstanding director of the behavioral sleep medicine program at the Sleep Awake Disorder Center, and she is a clinical Associate professor of neurology and psychiatry at the Albert Einstein College of Medicine in New York City.

Dr. Harris has been an invited columnist for the New York Times consults blog and is frequently quoted in the media, including The New Yorker, Washington Post, and New York Times on. The on parenting column, she has appeared on the Today Show. Good Morning America and CBS Mornings. Dr. Harris can also be found on Instagram at Sleep Doc Shelby, where she provides evidence based information about sleep, wellness and sleep disorders.

Quick callout, highly recommend following her Instagram. She's got lots of great content that I think you'll really enjoy. Be able to have some bite size information around improving your sleep. So without further ado, let's jump into the podcast. 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 well.

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They have created something called the Magnesium Breakthrough, and taking this magnesium before bed helps you relax and wake up, refresh and energize. 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. 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 m a g.

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. Today we are here with Dr. Shelby Harris. Shelby, thank you so much for taking the time to do this in the midst of, uh, what sounds like a hailstorm over where you are in lots of activities.

So thank you for taking the time. Thank you. It's my pleasure to be here. Thanks for having me. Oh, fantastic. Well, one, I have been a huge fan of your content for quite some time. You've got a fantastic social media presence, which is really rare in this realm of sleep help and sleep support, and certainly qualified sleep support.

So really thank you for all the work that you do as well as your book. You are kind enough to send that over a while back, and I loved it so well written. I also had the opportunity to connect with you at Sleep 2022 in person, which is a rarity nowadays. So just a big fan and excited to learn more from you today and to share your wisdom with our community.

So thank you for being here. And I just wanna kind of kick it off with. Almost the beginning. How did you find yourself in this realm of, uh, you know, helping to support people with their sleep and particularly having a bit of this niche as well as for women with their sleep? Not exclusively, but you know, having that knowledge base in women and their sleep.

So I initially was always interested in sleep and a kind of bizarre way cause I was a horrible sleep walker. So yes. Oh, sleep walker. Okay. I had an element of that. I was gonna say, certainly with the sleep piece, I'm with you. I had a bit of the sleepwalk element, but I didn't know this. Okay. So yeah, share.

Share. I haven't talked about. Maybe I'll do that on Instagram and day, but I, when. 5, 6, 7, 8, I would get out of my bed, tried to leave my house a few times. I always had to have the bottom bunk sleepaway camp and the stories that people would tell me of things that I would do in the house when I was a kid.

I had no recollection of it. So it was always just so interesting to me in a weird way of like, Why do I do. Yeah. And I had no understanding of it, so I was just fascinated with sleep in general. Sure. But I think that to make a career out of it, when I went to college grad, right after I had graduated, I was working in addiction studies cuz I was debating actually whether to go into becoming a professional musician or going to graduate school for psychology.

Cause I'm a, I'm a basis, so I debated between the two and I just worked in. Research and they put me on a study in addictions where I was going to a rehab and for alcoholism, and we were actually treating people with alcohol issues in early recovery, like first think first month. Sure. And we were treating them at that time with Trazodone, which is an antidepressant, but also sedating.

And the theory was if we help people sleep better early on in their recovery, their relapse rates would actually. And risk of relapse. And actually that has been shown over and over again in research with medication and now with behavioral treatments. And it just set this light bulb off into my brain that said, if we can get someone sleeping better, think about how many other areas of their lives, if it helps with addiction rates, how many other areas of their lives can this help?

And in just short sessions. So that made me, when I went to graduate school, find, I found a grad school that had, um, a sleep focus, and then it's just kind of all fallen in line from. Fantastic. Oh wow. Okay. So this has been a long time coming with the interest and fascination around sleep. Uh, a bit of a personal element of just why is this happening for me even at a young age, and then evolving into these multiple pathways of how much sleep can really affect your health and wellbeing, and certainly with substances and other paths that can all take, Yeah.

Wow. Okay. And women's stuff to answer that question. Yeah, please. Yeah. Aspect, I was, so when I first started practicing, I actually have, I had been at the Montefiore Sleep Wake Disorder Center running their behavioral sleep medicine program since Oh wow. For like years. So that's where I started and I started to notice, That a lot of my patients were women and were women in the perimenopause stage.

Now I'm seeing a lot more just having had babies and it was the area, it was before people were talking about, we were talking like 2006, 2005, before people were talking about perimenopause is a big issue and really thinking about gender differences. So that's when my interest in it really started to peak and then led to the book even.

Oh, fantastic. Okay. And so with that, when did you write the book? So just so people know, we're talking about the Women's Guide to Overcoming Insomnia. Really just such a helpful kind of guidebook for women that might be struggling with this. So one, maybe we can break down the vocabulary. So that insomnia piece, if we can just get ourselves rooted and begin there.

If you can help educate us from that perspective. So insomnia. I think people just use it as like this kind of term catch all or something. Insomnia. When we talk about real true diagnostic insomnia, the diagnosis for it is three or more nights of poor sleep a week. So what does poor sleep mean? So the definition some, some books use the definition of 30 or more minutes awake at night.

Some actually don't give a time cutoff. It's more about just annoyance. So annoyed. So it's trouble falling. Staying asleep or awakening too early, earlier than three or more nights a week. Now we add on top of that, it has to happen for at least one month to be short term insomnia, acute insomnia, as we call it, and at least three months to be.

Chronic insomnia. So what does that definition mean to me? And it also has to create a problem for you also. Yeah, that's thing. So if you just are awake at night, but you're not bothered by it, or you're not tired during the day, or annoyed, you actually don't meet the criteria, believe it or not. Mm. But what does that mean?

That all means that it is normal. To have a bad night here and there. Right. Please underscore that to anyone listening. I think that can be a sigh of relief for a lot of those people seeking perfectionism and Yeah, exactly. Think about three or more nights a week for months on end. So if you have a occasional night or two here and there a week, you actually school or within normal limit.

I tell everyone I work with, I don't sleep perfect every single night. Yeah. But you wanna aim for five nights a week where you are content with your sleep. Yeah. That's the key. Mm. So that's the difference between occasional bad nights here and there, and actually having chronic insomnia. Okay, well one, thank you for kind of breaking that down, but two, also providing what I hope can be a side relief for some of those individuals that are really overly obsessing or fine tuning on some of these elements of trying to achieve some level of perfection.

Uh, I think just even that permission to know that some of those nights are gonna happen is really, really helpful. So thank you for sharing that. And assuming people are listening, they say, Okay, well I meet that criteria. Can you. Guide us to understand, you know, how do you deal with people when they come to you and they are meeting that level of criteria and certainly also the cautionary tales so that they don't go down these other paths that might be problematic.

So, For all the patients that I've seen over the years, they're usually coming, well, they usually come to me because they want behavioral treatments, but that being said, yeah. When I was at Monte running the sleep center for well over a decade, I was the first line treatment for anyone who had insomnia.

So whether they wanted medication or not, they were still coming to me first. Got it. So a choice. So the really, the way we try to treat insomnia in the field of sleep medicine is we tr I, I think of it as like a tiered approach. Okay. You always, you always wanna make sure sleep hygiene is on point, right?

If you're drinking a two liter bottle of soda before bed, of course you're gonna have like trouble with sleep. Yeah. But for the majority, the vast majority of people with chronic insomnia, the sleep hygiene stuff doesn't.  I must hear every day from patients. I don't drink caffeine. I don't, you know, eat late at night and I still can't sleep.

Yeah, that because sleep hygiene is that thing. You have to have as a basics, but it's not gonna treat chronic insomnia. So then we start thinking about cognitive behavior therapy for insomnia or kind of similar offshoots where use more mindfulness, but we try those very evidence based treatments without medication.

So it's changing. Bed times changing wake times. I have people use sleep diaries to track their sleep, changing what they're doing in bed, out of bed, wind down routines. And we also, for some people who are very cognitively, like have a lot of cognitive arousal at night. Yeah, work on their thoughts and changing their thoughts about sleep, the pressure they put on themselves.

C BT for insomnia is a very short term treat. Four to 12 sessions for most people, it can be on the longer end if you're tapering off of medications or you have other MA major complications. If that's not working, then we move to medication based treatments and there's all different types of effective medications out there, and you'd wanna talk with an MD sleep doctor to make sure that you're getting appropriate treatment for that.

And then we might move to other things such as that, have a little less evidence or a lot less, depending upon what the treatment is. Acupuncture, other types of treatments that just haven't been studied as much. So, and then the other thing we always do at the first appointment is we make sure there's nothing else medically going on that could be impacting their sleep, like rest the SL at night or sleep apnea.

Those are all things that could cause insomnia that people don't always think about either. Absolutely. Okay, so then with that one, is there a recommendation that you have people go through with this path where one you are consistently then testing them for some of these other variabilities or screening them for, whether it's sleep apnea or one of the many other sleep disorders that are out there that we might forget about?

Is there certain protocol that you have people go to and also. Just how do people even get to you? Cuz I think that that is a question that a lot of people have because, you know, there's millions of us even in the US alone, and yet there's a kind of shortage in a lot of ways of the availability or what feels like the availability or access to train professionals like yourself.

So what does even the path to get there, and if their doctor isn't recommending this, can they really fight for this? What, what does that. Yeah, If your doctor, First of all, if your primary care doctor has never even heard of CBT for insomnia, you wanna find a different specialist to talk with about your sleep, since it is the frontline at first primary care.

So they should know that standard and many. Yeah. So the best place to go if you're looking for a behavioral specialist is this Society of Behavioral Sleep Medicine. Yeah. I think it's behavioral sleep.org. And if you go there, they have a whole. Sting of people who are very well trained. If you're looking for someone who knows even more than just insomnia, such as myself, Yeah, you can look at the credentials DB SM so that you have a diplomat and behavioral sleep medicine.

So that's someone who's gone even beyond just insomnia training. So I can treat a whole, I can screen for a lot of different sleep disorders, just absolutely. Cause I've worked in a. For years. Yeah, but you wanna start with someone who at least is on that site. That's a great place to go. But there's also, you know, like if you just have some insomnia, you don't necessarily know if you have other sleep issues.

You can talk to your doctor just to make sure that there's no app near other stuff going on. But you can still, at the same time, work on your insomnia for many people. So you could do, there's great apps out there. So Sorut is one app. There's sleepio, there's C B T I coach. There's many really great apps.

There's books like Buy. But if you're on medications or you kind of want that extra guidance to help you know, with the nuance aspect, then you should find someone like, Absolutely. And I know this is a big topic, but just wanted to touch on it briefly, the medications aspect. Now so many people will message us around and it's certainly outside of, far outside of the scope of what we're looking to, We're in very much a distinct category of that optimization piece.

And you know, you and I have chatted about that very, very different worlds and, and so when people are messaging and they will say, I'm on many, many different. Uh, prescriptions, how to think about this, how to approach this. Can you share just certain kind of, uh, rules of them or tips that people might wanna think about in just some of the most common sleep medications that they might have, or if they're in conversation?

Oh, I don't wanna be on these long term, how to think about all this. I mean, there's so many different sleep aids out there right now. Yes. So the one that everyone talks about is Ambien. Yes. So Ambien is, it's just super popular. It works for a lot of people, but the reality is that also, like you can, a lot of times people are in, and I totally get it, they're in distress.

Yeah. Onto their doctor, and the doc wants to help them in that moment because they're kind. Yeah. And it's, You gotta wait a little while to start C B T I. Yeah. Which does take a little time. They're prescribing a medication to help them with their distress. But the thing is to consider is, are you being put on the max dose of things?

Cause oftentimes people are just put on the higher doses of some of these meds. Yeah. And actually a lower dose would've just been as appropriate. So sometimes, you know, Ambien, there's Lu Nesta, there's there. Oh my gosh, there's there's so many out there. Yeah. And then there's also like we or Sonata's, another one in that class.

Then there's also antidepressants that we use a lot. Like we were talking about Trazodone. Um, Reran is another one. Uh, Amitriptyline, we use so many different medications for their side effects because they're sleep inducing. And then there's all the newer ones. So there's like dago, there's a lot of different, or Ssam.

There's um, not dago, but there's Bessamer. There's a whole bunch of them out there. I mean, it's really. A big game, and it's a game changer for many people. But what we try to do is a lot of times is try the lower dose. If the behavioral stuff isn't working, initially, try the lower doses first and combine that with behavioral issue or behavioral treatments.

And then slowly taper people off or get them sleeping better on the lowest amount of medication possible. So tips and tricks. There's really, it's really hard to give specific trips because there's such different medications. Like some people will take certain medications in the middle of the night, like, um, intra for example, when they're waking up in the middle of the night.

So they'll take something like that. Or they'll take beginning of the night, but it might have a much, much longer halflife than or other medications. So it's hard to be like get in bed at this time. It sometimes it's better to work with the person who really fully understands those meds. Yeah. I don't prescribe, but I work with prescribers all the time as a team.

I get someone on the right dose or off a certain dose while combining it with behavioral stuff to get them stable and then we slowly change the dosage if we need. And how about for people listening that have been on some of these drugs for decades and they really, really want to explore options to taper down or off.

Do you have recommendations for people to, of how to find someone specifically skilled in that conversation who can support them with. So if you're gonna go and look for someone like myself, right at the society, behavioral sleep medicine, when you, you know, just because you call someone doesn't mean that you can't ask questions too.

They're gonna ask you questions about your sleep, but I always consider it a conversation back and forth. So ask that person, what sort of training have you had with. Things besides just c BT for insomnia. Have you worked to get people off of medication? How do you work with the other prescribers? So if my primary care doctor is prescribing it, how do you wanna work with that person to help get me off of that medication?

It is very doable for many people, Not everyone. The goal is to get you sleeping on the least amount of medication possible. Yes. It works for a lot. I mean, I've worked to get people on lower meds or off meds many, many, many, many times in my career and it is very doable. But the thing you have to realize is that you're also gonna have to tolerate some bad nights here and there.

Yeah. Because changing some medication, some people think that it's like, I'm just gonna, now that they're seeing me, I'm gonna like snap my fingers and they'll never have a bad night. No. There's physical tolerance, psychological tolerance, and. Changing that. So you have to be willing to do, put up with that for a little bit, put up and put in the work, but eventually you will get over that hump for many people and be able to sleep on less medication.

That's not the only thing that you have to do is medication. Yeah. And on that medication piece. Just, yeah. One last question. Do you advise for people when they're, so maybe they have, uh, acquired this particular relationship to these drugs for sometimes a very long time, years, decades, et cetera. Do you aim to have them set up life to be able to actually embark on this journey and you know, maybe minimize certain things or stressors or other things to set them up powerfully for that kind of journey?

Or how do you kind of prepare them for that? It really is where they are in that process. Yeah. So they're fully motivated. I have to like talk, you know, and we'll, we'll just go at, we'll just do it. Yeah. But for other people, they're more concerned. So then it's thinking about how is it gonna, It's really just playing through what their worst case scenario and their fears are of, if I don't take these meds or I lower the dose, what's gonna happen?

How will I function if I can't sleep? Yeah. So it's really about, like you said, setting up their life around it, but also showing people. You can have a bad night here and there. Yeah. And it's in the parameters of the solid wake time and the things that we're talking about. Yep. You get through that hump.

So yeah, it's about, we call it motivational interviewing, so it's really helping the person where they are and getting them to the point where they're willing to make the decision to change the medication. Yeah. I love that and I love that you mentioned that kind of worst case scenario. What is that for them?

You know, talking that through and then actually experiencing Okay. And, uh, what would be the worst case scenario? Often when you even put words to that, they become less scary. Kind of lose its power. So love that. Exactly. You picture yourself coping with the worst case scenario and when you picture yourself coping it, like you said, becomes less scary.

Mm, yeah. So important, so happy to. Here are you speaking into this? Cuz I think this is very common for a lot of people that are really struggling this, but they don't quite know where to go or who to speak with or concerned that it's just gonna be another doctor to put them on more medications or, you know, a lot of narratives that kind of get created.

And that doesn't have to be at all the realities. So thank you for that. And as far as the piece on women, so wanna just open that up. Why specifically women, What does that look like? Their relationship to sleep. Why do we wanna think about this differently? So, like I was saying, when I started working at the Sleep Center, oh 5 0 6, I can't remember anymore.

Many of my patients were women. Yeah. And it, like I was saying, we just weren't talking about it and I had so many women coming to me and back then too, hormone replacement or mhts are calling now. It was not. Really, it was still thought of, and for many people as being as tab more taboo than it now we, It's recommended for a lot of people.

Yeah. So there's women coming to me like, I feel like I need to do this. Like whispering. Yeah. And they didn't feel like they had anyone to talk to and just a safe kind of environment. They felt like they were the only ones suffering. And women, the reality is what we know now is. There's three reasons why women have sleep issues, more, especially insomnia.

They have it at a higher rate than men because of biological issues. So there's the hormonal changes, but it's not just at perimenopause. So right before they have their cycle, some women are either excessively sleepy for four or five days. Or they have insomnia, then pregnancy, their sleep changes.

Obviously throughout pregnancy at different stages. Once the baby comes, there's sleep disruption. Yeah. Sometimes, this is a big area of my practice now, is that once the baby sleeps better, women's continue to not sleep well because they've conditioned themselves to listen for the baby. Yeah. And then perimenopause.

So we know biological is one big area. Then there's also, um, psychological, so women tend to have more anxiety and depression than than men. And then also, Social issues. So women are taking care of families a lot of times working more than ever, and it's just a multitude of stressors. And also women are having babies later.

So a lot of times women are taking care of their kids. Working and taking care of aging parents. So you put all those three areas together and it's like a firestorm? forSo. Oh, absolutely. Okay, got it. So you're seeing all of that, and are you also seeing differences for them around certain markers for some of these sleep disorders, like sleep apnea, different kind of hallmarks for them to be aware of that you might not see for men, for example?

So the other thing that I see a lot with women that gets missed really fast, I, people who just aren't as familiar with the area is so restless leg. I am a sufferer of restless leg myself. Ugh. I'd love to hear more about that too and how you're dealing with that. Yeah, I started with it. It's very hormonal for some people.

I started, it's very common in women. I started having it when I was pregnant.  both times, and now I just kind of get it. Especially I'm, I run a lot, so if I've worked out a lot more, my legs are like, really? So as the night comes closer, your legs and it can be your arms too. Mm. It everyone describes it different.

I just have to keep stretching, like I can't stay still. Yeah. So people will describe it as feeling anxious. And then they get misdiagnosed as having insomnia or And anxiety disorder. Yeah. But it has to get worse as the night gets closer and it's this inability to kind of stay still in movement, helps to relieve it.

Some people massage. Sitting on a cold floor can help. Getting up and just moving around is helpful. So that happens a lot for women. It happens at any time, but can happen more so in pregnancy and also, During hormonal times and impair menopause, their rates go up and the other big thing I see that gets missed a lot is sleep apnea.

Mm-hmm. . So you can have, the thing is you can have insomnia and sleep apnea at the same time. We call it  so you can have them at the same time, but the, if you sleep more with insomnia treatment, but the quality of it's crummy because you're snoring. You missed half the treatment. So women get misdiagnosed as being depressed a lot more, or you're just, you know, you have a busy life, you're stressed.

Yeah. Stress, anxious, all that. Yeah, exactly. And a lot of times there's that misnomer that women have to be over. Wait, snoring super loud, falling asleep during the day in order to have sleep apnea, and that couldn't be further from the truth. I have had many very healthy fit young women who just, it's the way that their jaw and their airway is built that they, they have sleep apnea, so if you feel like something's off, if you wake up with a dry mouth, if you wake up to urinate a lot at night, if you have any pauses in your breathing, it doesn't have to be overt loud, snoring, right.

Notice it. Record yourself. If you have to ask a bed partner, get that evaluated as well, because once you hit perimenopause and during pregnancy, two, the rates go up a lot and they're actually more equal between men and women at that age. Absolutely. And it doesn't have to be a arduous thing. Are you often doing at home tests for people?

What does that look? I'm sure's certainly during the pandemic. No, I just don't actually say I work with the, I mean, I could do it, but I haven't done it. I send to, I work with MDs because I can't prescribe for the PS because I'm a PhD. Sure. But I work with them all the time. Like Mount Sinai is a big hospital in the city that I deal with all the.

And they use, which I love, they use the watch pad, so I'll just have people, Yes, and it's numbers. Home sleep studies are not as in depth. It's important stretch. Yeah. So if you're thrashing at night, if you're sleepwalking, if you're having more unusual symptoms and in lab study's probably gonna happen.

Yeah. But screeners, they're great screeners at home. So the watch hat is literally a watch with a pulse sock on it. I mean, come on. That's amazing. Yeah. And you use your home for a night or two. Then there's ones that are chest bands with little oxygen sensor and um, oxygen sensor. They're really not so bad at all.

So a screener at home is better than doing any or not doing anything about it. Got it. Okay. And question around while we're talking about check. How do you feel about, do you have women coming your way that are saying, I'm wearing X, Y, or z a watch a ring, this or that? What do you, how do you help them in that regard?

So tricky. So I, I love tech. I mean, I'm an exercise junkie. I love, like, I love just seeing stats, right? Yeah. But there's a fine line between when it becomes obsessive. Yeah. Help, it doesn't help you as much anymore, right? Yeah. So for people with insomnia, I see people just, cause I'm in New York, it's like the trendy thing right now is the aura ring.

Like yes, everybody has the aura ring and I think it's, it's adorable and I don't think there's anything wrong with it. Yes. But if you have insomnia, what does it do? It just makes you more critical of your sleep. Yeah. Actually makes it worse. So we call that Ortho Sonia. That's a a di They came up, they coined the term Kelly.

Clean the term in like some literature a few years ago, and it's yes, genius. So what we find in research is it actually worsens their sleep. So I actually tell people when they come, some people used to come for years with like, instead of doing my paper sleep diary with just like screenshots from their phone of what their ring said or whatever else.

I'm like, no. Yeah. All I care about is what you think happened. Mm. Very hard for some people to let go, but insomnia is really a diagnosis of perception. That's why I love, Yeah, that's the important, They don't have like strict, like 30 versus 31 minutes for a lot of the diagnosis really about what do you feel like happened?

So I just wanna see someone's perception on their home sleep diary that they write by hand or you can do it on a phone. I just want to see their perception of I was up for two hours, start to become 30 minutes. I would rather that than what a ring says. Yeah. And so with that perception, are you working through, are you finding things like the conversation around paradoxical insomnia and helping to kind of break that down?

Is that something to kind of work through with them? For sure, for sure. And it's, you know, there's. There's a lot of like little funky little tests that you can do too. Right? So like those, the paradox, So paradox, insomnia. So sleep state misperception, you think you're awake, but you're actually asleep. You know?

That's a fun, It's a funky sleep disorder because we really don't have very good understanding of it. Yeah. And one of the treatments is honestly giving ambient because it creates an amnesia for the night for a lot of people. . Mm. Yeah. So there's funky little tests that you can do though, like the spoon and the tray.

So essentially someone falls, you just have them lay next to the bed for a long time holding onto a spoon, and when it falls and hits the tray, you know you fell asleep. So there are different things you can do to kind of test it a little bit without having to rely on tech, but it's really about what's the function of sleep.

It's about daytime performance for most people. So we really, I focus on the daytime performance for them more than anything. Like, how are you feeling during the day? Let's forget about what happened at night. Let's actually look at the data for the day. Because a lot of times the bed partners like you were snoring all night long and you wanna wake as much as you think.

So, yes. Yeah. And just reminding that they actually were sleeping and we're not, and certainly not settling for that and not saying, Well carry on with your life as it is, cuz clearly something's wrong, but reminding them that sleep is happen. It's tricky. The ones that are more sign, like serious that I see, and you can usually plot it immediately is on my sleep diary.

They and patients with this issue have written this for years. They'll just write no sleep across the whole thing. Yeah. So that's when I know immediately, okay, there's something going on. Yeah. But it also, you know, some doctors can be a little dismissive of it. Sure. To be like, Here's your sleep study. You slept all night long.

It's all on your head. I think there's more behind it. There's something that's not turning off mentally. Yeah. When you're, But we don't know enough of that. So you wanna work with someone who actually is empathic who really gets it because the more you're shamed about it, it just makes the whole problem worse.

A hundred percent. Yeah. Absolutely. And that's one of the beauties of sleep is that you have this wonderful, like you pointed to that amnesia effect and the sense of. Delineation between how yesterday was and how today's gonna be. And that cannot be something that we are consistently having night after night.

So, uh, appreciate you drawing that distinction and also having that empathy. Cause that is, can be really maddening to have that night after night. Yep. And everyone tells you, you're sleeping, you're sleeping, but you don't perceive it. There's something going on. We just don't, I always say sleep is the lack of conscious a.

Mm. So you don't have a thought process going on, then just assume asleep. Cause a lot of people with insomnia assume awake. When they're in and out as opposed to, was I sleeping? So let's flip the script on it a little bit. Love that. Awesome. Sounds like you're certainly getting into a lot of the kind of therapeutic element of this and just how much, kind of pulling apart, what are these thoughts, how are you thinking of this and really helping to empower them from that place?

And then more to the point of women. Are there any other things that as, as women are listening in particular, To be mindful of kind of age brackets that we wanna be on the alert for, or certain things that we wanna make sure they're, they're getting in this conversation. Yeah. So if you are younger and you're noticing that maybe there's, you're having some like cycles of insomnia.

Yeah. I always encourage people to track your, track, your period. Yes. So track your period and track your sleep. So you can use all the app trackers if you want, or you can just do it old school on like a diary like I have on my website. Yeah. So track it because you might find that there's a very cyclical pattern to.

That it's happening before you get your period every month. Yes. So if that's an issue, then I would definitely talk to a gynecologist because there are treatments that can be done to help with hormones and it, there's all these different things that you can try. If you are pregnant, then you think about what are the things that are disrupting your sleep?

So is it discomfort? So pillows can be your best friend. I loved my wedge pillow, and then it became full body pillow when I was really pregnant. If it's sleeping because you're too hot at night, there's great products like chili, sleep, there's all these great things to cool your body down, and then, you know, thinking about quiet, dark, cool, comfortable.

And also ra. You know, you shouldn't put up with horrible insomnia when you're pregnant, but there are things you can do, whether it's changing your bedtime wake time, there's other things that you can do to modify it as well. And then perimenopause. So you think about the hot flashes again, there's moisture wicking sheets, moisture wicking, tech.

You know, you, you talk about this stuff all the time, right? Sure. There's so much stuff to help cool. And takes and to really wick. Sweat. So, and then you think about the mattress cooler toppers, I mean, chilly, sleep, all that sort of stuff are fantastic. If your spouse has a different internal temperature than you get two different blankets, right?

Sometimes we have to do that. It might not look as pretty. But there's all different things to think about with temperature regulation at night and then if it's really not working, like just some of the basic stuff, talk to your doctor about, um, mhd, any sort of hormonal replacement. There are a lot of people who are afraid of it.

It is not as people thought it was. There are many guidelines with how people can use it safely, and it really does help many people. And then if though that's not enough or you're not a candidate for it, then we'll talk about things like antidepressants. Sometimes we'll use certain supplements. Yoga has been shown in some studies to help acupuncture has been shown.

So there's definitely a whole array of things that we can try. Excellent. Okay. So likely anyone listening is gonna say, All right, she knows so much about sleep. What is she doing for her sleep? So I wanna get into a little bit about how you're managing things, and I'm sure things evolve, shift your, you know, if you're traveling, if you're in other location, whatever is happening for you.

I'm sure there's gonna be variability. We wanna see what we can learn from how you're managing things. So the first question is, what is your nightly sleep routine looking like right now? How do you think about that? So I have a 12 year old and a six year old. Granted the 12 year old's at Sleep Boy Camp right now, but, and he's starting to go to bed later than me, which is kinda, Yeah.

But I have always been a stickler with getting them to bed before me and on a routine time, because if you're a parent, especially, Your bedtime can be so variable if your kids are not going to bed well. So I've always made that a real point for me to get them on a really good sleep routine themselves.

Because once that those cards are in place, then I can really focus on my own bedtime routine. So for me it sometimes it can, it's 20 minutes, sometimes it's an hour. Depends on what I have that night. Yeah. I if like a typical night of 20, 30 minutes, I, um, I do a lot of, like, I go into the bathroom, I'll brush my teeth, I'll put my pajamas on, I'll wash my face, do all that sort of stuff.

And it's a ritual for me. Like I really like skin care. That is nice. Calming routine. Yeah. And then I go and do a lot of stretchings. That's something I tried to make as a, um, a goal for myself during the pandemic. So I had, I used to use, I'd have a video far away, use that just to learn it, and now I know the routine, so I spend nice 10 minutes doing stretches.

You could do gentle yoga, whatever you want. And then I get in bed and I read a magazine or something for like five, 10 minutes and then I go to, I turn out the lights and go. I don't think it. Lot of it. I love that. And the simplicity of that and the stretching, did that come about with the restless legs?

And I appreciate you called out the arms element. Yeah. Is that part of that or no? It wasn't, but no, it, it can help. No, I'm not usually doing it for that reason. It's because I run marathons, so my legs are, have. Marathon horribly tight over the years and oh man, runners hate to stretch. So that was my, that was my biggest thing, was like, okay, I need to do this during the pandemic.

So I started it and now it hit two and a half years in, has become a routine of mine at night, so. Got it. And I appreciate you, uh, mentioning that too, of how active you are, because some people might, again, for restless leg, uh, assume. That's something that, um, exercise is helping to alleviate, but that's not always the case.

Sometimes it's on the other side of the spectrum. A lot of exercise bringing about that. So, uh, really great call out there. And what, in turn, what does your morning quote unquote, sleep routine look like? So my morning is I go to bed early. I go to bed at like 9, 9 30 most nights. Nice. Nine 30 is pushing it.

I get up at about 5, 5, 5 30 and that's when I do my running and strength training in spinning. Nice. So I try to do it and I have it in my basement a lot. I'm very fortunate in that respect. Yeah. I run in my basement, I turn all the lights on and my treadmill or bike are in front of a window, so I try to at least get some natural light that way.

And that's how I wake up. I have all my clothes laid out at night. That's actually part of my routine too, So I get up, I don't have to put any thought into it. I go downstairs and I work out. 45 minutes to an hour, and then I have my coffee, and then I start my day. I get my kids and start my day. That is so perfect, and I love how one, that's also starting a bit in the evening and you're setting yourself up so that you have everything available.

It's not a big question mark, and it sounds like there's such routine nature to that, that you're not reinventing the wheel every single morning. You just kind of have that laid out. And the fact that we see certain studies pointing to the fact that that can help with your sleep in the evening by phase advancing.

Fantastic. So you do that consistently. And then as far as what we might see in your space, so what might we see on your nighttime bedstand or proverbial bedstand or you know, nightstand if you're traveling, gadgets, gizmos, anything to be aware of. So for me, when I, um, my, my nightstand has a little bit of clutter on it cuz I was just traveling.

Yes. But typically , typically it is a lamp, a book or a few magazines. I'm working on reading more, but I, I love magazines even though they're like, Going with the dinosaurs . Um, I love magazine. And then honestly, I have a, my old school alarm clock that I had when I was in high school, I used the exact same alarm clock and it's still more, I use that atlo, Sony, the Sony Dream machine, and it, I have it go off at the same time every morning, although I'm so used to my sleep wake schedule is so routine.

Yeah. Usually wake up five minutes before and I don't even need it, but I always use it. So I do that. My kids have hatch alarms because they like the light and all that sort of stuff. Mm-hmm. , But I. School and my husband has actually is from a college or high school on his nightstand. So some Oh, a match, man in heaven,  people.

And then when I travel, I always bring a white noise machine with me. Yes. I, um, have that and I'll have that like right, right under the bed or somewhere near the door if I, depending on the room. That's great. Do you have a travel size one or the full size? I have the full size one just. I do that too actually.

matter. Oh, I've done some of the travel size, I don't know, just feels not as, um, significant. So I like that. Yeah. And then the apps, I've tried apps for me, I can detect a little difference in the, the way it sounds. I'm just certain to the old school white noise machine that I just, I, I take that one with me and that's it.

Fantastic. Okay. And then the last question would be, what has made the biggest change to your sleep game, or biggest kinda aha moment in the relationship to your own sleep? So for me, it wasn't necessarily exercising. I didn't start running or really exercising until I was 30. Okay. That's when I really started in marathon.

So I didn't start early on, but what the game changer was for me, I, I didn't have kids at that point, but I was still not sleeping great A lot of the times. Even though I was working out a lot at, when I was 30 training for my first marathon, I joined a run club on the weekend and I would run with them on the weekends and we always ran at the same time that I would wake up and run in the middle of the week.

Yeah. So the consistency of waking up that time seven days a week and for me, having the accountability of friends in a run club waiting for me, yeah, it kept me on a consistent sleep work schedule seven days a week and that was a game changer. Uh, actually you're inspiring me because I just moved to Austin, just sharing that with you and looking to set up a couple, you know, kind of consistent schedules and workout routines and you're inspiring me to take a look at, are there any REN clubs in my area?

So, thank you, . You're welcome. Yeah, so really that for me was a big game changer. So a hundred percent. I mean, that alone for so many individuals, if they get nothing else outta what we're speaking about, just the concept of what life would really look like. To have that consistent wake up schedule seven days a week can just be such a game changer and also create some real kind of leadership in their own life because what would you have to do to manage.

A schedule like that would you have to kind of end certain things at certain times, set up your calendar in a particular way. So I think that's really important. And quick call out, cause I'm sure you've got opportunities and things happening at, uh, throughout the course of your life. How are you managing that when you have to stay at a little bit later?

There's a wedding, there's an event. What would you say for people for that? You know, I think if, if you can, you know, if they sleep in like an hour, hour and a half in the morning is okay. Yeah. If you can get, The reality is for a lot of people have kids, it's not an option. Yeah, exactly. My kids are getting older.

They can go and entertain themselves. Yeah. But sleep an hour later if you want. But if you start sleeping 2, 3, 4 hours later, it can impact the next night. So that. Like a little nap if you had a really, really late night. So a little nap for 20 minutes can be beneficial cuz then it doesn't in earlier in the day, like before two or three.

Yeah. Doesn't tend to impact the night as much. So if you do those things like a little nap as opposed to sleeping in a lot, and then coffee. Judiciously earlier in the day, or caffeine, a lot of water to hydrate yourself light exposure. Those are all things to help and to know that one night of a little less sleep.

If you don't have chronic insomnia, guess what? The next night go to bed a little earlier if you want, if you're super tired. But really, I try to get people waking up at the same time every single day. Yes. Cause I think if you, you can go to bed a little earlier, but if you sleep in, it just then tends to impact the next night and the next night.

So that's really the key is not sleeping in too. Oh, fantastic. Okay, so we've spoken about a lot of things today. Was there anything that we left out that you wanna make sure you underscore or let people know about or, uh, kind of any important things that we did not touch on? Yeah, I think we did a lot. I think, you know, social media to, it's the wild, wild west out there, so, There can be a lot of misinformation.

Just really don't, don't take everything at first, you know, glance and say, This is what I need to do. Yes. Like all the supplement stuff, you know, there's a lot of stuff out there. Do your research, talk to people who are really in the know before you necessarily start taking things. There are supplements that we use for certain people, but I really do think that people shouldn't just automatically see something online and try it all.

And I know when you're not sleeping well, people tend to get desperate. Yeah. But you know, there, there are really good treatments out there. It's just, you know, To kind of do your due diligence a little bit first. Yes. Very important. Call out. And you know, I really just wanna underscore that I so appreciate you and the work that you're doing and also making this accessible to the masses.

And so anyone listening, I absolutely. Recommend that you check out, uh, Dr. Harris's different platform. She's on, available in multiple platforms, but I want you to share for sure, how do you ensure that people stay connected with all the work that you're doing, uh, the various different pathways or access to you.

Yeah, so I have a website. It's just Dr like doctor, dr shelby harris.com. You can always message me through there. That's where my practice is. So I see patients virtually and in person a little bit, but mostly virtually in New York. But soon that's gonna be changing, that I'll be able to see people hopefully in other states too.

Yes. Um, I know it's, the licensure laws have been very sticky for years, but te. Changed it. So there's that plus um, you can find info about my book on my website. And then the bigger thing, honestly, is Instagram. So it's Sleep Doc Shelby, so you can find me there. People message me there all the time. I put up random sleep information and just random stuff about me and my life there, and people seem to really like it.

I'm. Deciding whether to start TikTok. I'm, I'm scared. Oh my God. I'm a little scared. Right. But I been trying to get me to join it, so We'll, we'll see. So that might be in the future. Mm. All right. Stay tuned. A little cliff hanger. I'm gonna definitely wanna follow you in TikTok if that happens. And I. Really do recommend following her for sure on Instagram as well.

I love that. You make it fun. You've got your office, you know, I've definitely have bonded with you over your love of the office. Big fan of that . Awesome. Yeah, no, and it just, it's, it's so important too, because it doesn't have to be drudgery or. Boring or you know, some of these things that had been how people had related to sleep.

I'm throwing out silly words because of course, you know, can also, I'm not touching on how frustrating and upsetting and many, many different emotional states that people can go through. But certainly at the bare minimum, you're also helping to make it accessible, which is just so, so important. So really appreciate that and definitely checking out that book as well.

Real tons of information, the Women's Guide to Overcoming Insomnia. So thank you just so much for taking the time and for the work that you're doing for so many people. It's my pleasure. Thank you so much for all your, your work as well. I really appreciate it. Thank you. Oh, 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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