0:06

Chopin bank . Hello

0:26

and welcome to another episode

0:29

of Mental HealthTheBullshit . I'm your

0:31

host , james , and once

0:33

again we have one of my favorite guests

0:35

back . Go ahead and let the listeners

0:37

hear your voice again .

0:40

Hi , it's me , I'm back . It's

0:42

Angela Knoss , lmft , specializing

0:44

in PTSD and trauma .

0:47

Thank you , angela . You had emailed

0:49

me prior to the episode

0:52

and had wanted to talk about mental

0:54

health and fatigue . I

0:56

found it really interesting that you brought this up because it's a

0:58

very common thing for people in

1:00

our space to talk about . A lot of our clients

1:02

come to us with some level of

1:04

burnout , fatigue , exhaustion , feeling

1:07

tired , unmotivated or feeling like

1:09

something is fucking off and they can't figure

1:11

out what . And it was

1:13

surprising that I never thought to talk

1:15

about this , probably because for

1:17

me it's so common and there's

1:19

a lot of content out about

1:21

fatigue and what to do about

1:23

it . But I love the idea

1:26

because I've never put

1:28

any type of public content regarding

1:30

this particular topic of mental health and fatigue . I've

1:33

never done a presentation or blog

1:35

about it or really anything

1:37

on the podcast has actually touched it . So

1:39

thank you so much for bringing this up . A

1:42

lot of people deal with this . This is very common

1:44

. If you and I see this at least

1:47

several times a week , if not more

1:49

, it sparks what

1:51

a lot of people start counseling for in therapy

1:53

and mental health treatment is fatigue

1:56

. So before we get into

1:58

deep diving about mental health and fatigue

2:01

, let's define it From your

2:03

perspective what is fatigue

2:05

, and how does that impact a person's mental health

2:08

?

2:09

So I draw a line between and researchers

2:11

do too between fatigue and sleepiness

2:13

. So sleepiness is the

2:15

term for when you're falling asleep in

2:17

a place and a time you don't mean to . I

2:20

don't know if this has ever happened to you . You're sitting in class

2:22

or you're driving , and then fatigue

2:24

is that feeling like you're moving

2:27

through mud , like your body is tired

2:29

, not necessarily that you want to

2:31

fall asleep , but you don't have the

2:33

energy that you usually do . Does

2:35

that make sense ?

2:37

Yeah , I've actually experienced both . So

2:39

in 2018 , I did

2:41

not know , but I was undiagnosed

2:43

diabetic and I was super

2:46

tired . My glucose levels

2:48

were through the roof , I

2:51

thought , and at the same time , I had

2:53

a herniated disc I was trying to deal with and it was

2:55

pinching my sciatic nerve . So I was going through

2:57

just an incredible amount of like nerve pain

2:59

that was basically never ending and

3:02

I wasn't sleeping because I felt like

3:04

shit . So then throughout the day

3:06

, randomly , like I would fall asleep and

3:09

I thought I was just tired , I

3:11

was effectively dying from like

3:14

not being on diabetic medication and

3:16

I was fighting off . A diabetic

3:18

coma is what really it was . It was a combination

3:21

of both me being sleepy because

3:23

I was not getting good sleep because I was in so much pain

3:25

, and then also my undiagnosed

3:27

diabetes was causing

3:30

fatigue as well . So

3:32

I had a healthy dose of

3:35

both in 2018 , prior

3:37

to me getting my back fixed and

3:39

getting on medication . Since

3:42

then , I've been able to tell the

3:44

difference between being

3:47

sleepy and being fatigued , because me being a

3:49

diabetic and eating really shitty food is

3:51

different than me like lacking sleep

3:53

or not getting restful sleep , and

3:55

it is . There is a difference . You're absolutely

3:58

right , and it doesn't feel

4:00

the same . But the response

4:02

is the same . You kind of just start losing consciousness

4:04

regardless . One

4:06

just doesn't make sense Right

4:09

, being fatigued and just like kind of passing

4:11

out throughout the day or feeling like you're going to feels

4:13

different and

4:15

you can't make sense of it , whereas if you know

4:17

you don't sleep well , like you have ADHD

4:20

or you have like a sleep disorder or

4:22

you know you were just really strong out

4:24

and just like couldn't fall asleep , it kind of makes sense

4:26

but it doesn't feel the same

4:28

like caffeine will fix that . When you're fatigued , like

4:31

you like . That needs to be checked out

4:33

on a more professional level if it's like chronic

4:35

, if it's ongoing and consistent . So

4:39

one thing

4:41

I like to talk about one because my clients

4:43

bring this up to me is I

4:45

have poor sleep . I'm

4:48

not sure why , like what are your thoughts

4:50

? And I always preface it . I'm not

4:52

a medical professional . I'm not a sleep

4:54

expert . Mental health does impact

4:56

sleep , but I don't know anything

4:58

about the medical side . I encourage you , if

5:00

you don't , if you haven't already , you

5:03

know , find a professional on the medical side

5:05

and get yourself checked out for a

5:07

myriad of things . What

5:10

do you want to talk about ? I

5:12

want to start there .

5:13

So you know , we talked in a

5:15

previous episode about how the trend in

5:17

psychology over the past hundred years

5:19

has come full circle and therapists

5:22

are now back to seeing things in

5:24

a very literal sense . So for

5:26

a while we were talking about , like you

5:28

know , maybe you have a stomach ache . Metaphorically

5:32

, the stomach ache is like caused by your depression

5:34

or trauma , whatever trauma

5:36

symptoms , and we are now literally back

5:38

to like 1925 . The

5:41

trauma resides in your stomach and

5:43

you need a stomach intervention to cure

5:45

your PTSD , which you can guess , for me

5:48

, giggling , I think is complete garbage . I

5:50

think you know 1925 should stay

5:53

in 1925 . That being said , there are

5:55

100% therapists you could

5:57

go to today and you could be like

5:59

I'm having trouble sleeping , like you

6:01

could give them your diabetic symptoms , and the therapist

6:03

would be like you need

6:06

PTSD therapy . I bet EMDR

6:08

would fix this . The first place

6:10

you need to start is go to your doctor and

6:12

I tell people that I work a lot with conversion

6:15

disorders . It just comes with the territory

6:17

of trauma . Conversion disorders is

6:19

when you have physical symptoms , somatic

6:22

symptoms that are not explainable by any medical

6:24

condition , and I need a doctor to diagnose

6:26

that . So in 1925 , you

6:29

know , Fritz Pearls , Sigma Freud , all

6:31

those wonderful boys . They all had MDs

6:33

so they could diagnose in their office . I don't and

6:36

I have had this backfire on

6:38

. It's never backfired , but it's happened to me where

6:40

someone comes in just like you and they're like man

6:42

I'm so tired , Do you think I'm depressed and it

6:44

turns out they're on the verge of a diabetic coma

6:46

or they have an organ that's shutting down , or

6:49

they have an endocrine dysfunction

6:51

. I'm like go to the doctor . And it's happened

6:53

so many times to me that I just don't

6:56

play anymore . I'm like go to

6:58

the doctor . I'm like I'm not . I'm not even going to

7:00

diagnose you until a doctor has ruled this out . I've

7:02

had clients have everything in the

7:04

book . So that's really where you need

7:06

to start . I need a doctor to rule

7:08

out . We know that mental

7:11

illness and sleepiness sleep

7:13

disorders are bi-directional . This

7:16

is new research that's just come out . So

7:18

what that means is that when you have a mental

7:20

illness , it makes your sleep worse , but

7:23

sleeping worse also makes

7:26

your mental illness worse . So

7:28

sleep dysfunction is an element

7:31

in , like I'd say , probably most of

7:33

the mental illness disorders in the DSM

7:35

that you could have . I did

7:37

the deep dive on this earlier this year

7:39

. There's a technique like

7:41

it . In terms of actual

7:43

research , we've cracked insomnia . We

7:47

figured that one out . There's a technique called

7:49

CBTI . It's extremely effective for

7:51

sleep dysfunction and usually that

7:54

works . I say usually because if it

7:56

doesn't work , what do you do ? So we could get

7:58

more into what

8:00

does sleep dysfunction look like for different

8:03

disorders . We could talk more about CBTI

8:06

, the meat and potatoes . How do you fix it ? Or

8:09

, if you want , which is my favorite , we

8:11

could talk about difficult

8:14

to fix sleep disorders . I recently

8:16

went to a convention and , as part of my

8:18

work , I shake down researchers

8:20

for research that I don't have access

8:22

to , and I got the

8:25

most recent guidelines for shift

8:27

work sleep disorder .

8:29

So wherever you want to start , James , yeah

8:32

, let's start with your favorite , because a lot of these

8:34

sleep disorders right , if you go to a doctor , get

8:36

a referral for an expert a

8:38

lot of the times that whatever's going on

8:41

there , they can fix and cure and your mental

8:43

health will improve when you

8:45

have impactful and restful sleep . But

8:47

the big issues that I've encountered

8:49

with some of my clients is

8:52

they present with depression

8:54

but the doctors can't find anything , but

8:56

they're not sleeping . I help them with

8:58

their depression but they're still not sleeping . So

9:00

then I'm just like OK , someone

9:03

needs to get your referral for a

9:05

specialist , Because you're obviously depressed

9:08

and I can see it , but you're also never

9:10

sleeping and your sleep's all fucked

9:12

up . Let's go down that route

9:14

of the recent research

9:16

you've been able to shake down and let's target

9:19

the individuals

9:21

who just cannot find something and let's hope

9:23

that what we talk about gives them some

9:25

sense of direction .

9:27

Right . So CBTI it's called

9:29

CBT for insomnia is

9:31

extremely unattractive to mainstream

9:33

practitioners because it has CBT in the title

9:35

. If I put brain or neuro

9:38

in the title , everyone would do it , so we're going

9:40

to call this neuro brain

9:42

insomnia treatment instead . That

9:44

way I can convince people to do it . It's so

9:47

easy and you can find

9:49

manuals free online Like

9:51

you can literally Google CBTI manual

9:53

and it comes up Like the biggest group

9:56

that uses this is the VA , and the VA

9:58

I love because they put

10:00

all their training videos online for free . You

10:02

don't need to be on Tricara or the VA panel , you

10:04

just go do it . So the way CBTI works

10:07

is it's too prompt . One is behavioral

10:09

and then the other one is cognitive

10:11

, challenging anxiety and that kind of stuff

10:13

which I want you to talk about

10:15

. But the behavioral stuff it

10:17

usually begins with doing a sleep diary

10:19

, and I'm going to generalize . You

10:22

write down . The most important things usually

10:24

end up being what time you went to sleep

10:26

, like went into bed , how

10:29

long it took you to fall asleep and then how many

10:31

times you woke up during the night and what

10:33

you find is that most people who have insomnia

10:35

are spending more time in bed than

10:37

they are sleeping A tale as

10:39

old as time is . I get into bed at 8

10:41

o'clock , I go on my phone , I goof off

10:43

, I play with the cats . Finally at 10 , I

10:45

turn off the lights , I toss and turn

10:48

in anguish until 1

10:50

o'clock in the morning . So if you

10:52

get into bed at 8 and

10:54

you don't go to sleep until 1 in the morning , let

10:56

me do some quick math here . You're spending four

10:59

hours in bed not sleeping , and

11:01

the way CBTI works is we need

11:03

to train you that the bed is a sleep place

11:05

, so you decrease the time spent in

11:07

bed until it's so . If you

11:09

only sleep five hours a night now , you're only

11:11

allowed to spend five hours in bed

11:13

. So the first couple weeks

11:16

are like you can do all the being on your

11:18

phone and playing with the cats , but not in bed . You're

11:20

not allowed to get into bed until

11:22

1 o'clock in the morning . You do this

11:24

gradually . You don't fall off a cliff , it's

11:26

like OK , we'll decrease by an hour every night . So

11:29

it's excruciating for a little bit and

11:31

people are very tired . If you have a

11:33

job that involves driving or operating

11:36

heavy machinery , this is not an intervention

11:38

for you . What organization

11:41

was it ? Let's

11:43

see the US National Highway

11:46

Traffic Safety Administration estimates

11:48

that drowsy driving

11:50

hurts an average of 40,000 people a year

11:52

and costs up to 1,500 deaths . So

11:55

again , you don't want to be a part of that statistic . So

11:57

if driving is part of your job , this is not

12:00

for you . But assuming you can do this

12:02

, you decrease the time you

12:04

spend in bed and what this does is it trains

12:06

you that bed is now only for sleep

12:08

, and this works like gangbusters

12:10

. It's money Like I have

12:12

extremely high success

12:14

rates just doing this intervention with people

12:17

and then they're able to get into bed and

12:19

they fall asleep almost immediately

12:22

. This also fixes usually and

12:24

fixes the general term the waking up

12:26

in the middle of the night problem , because

12:29

then you need the sleep so bad . What

12:31

you've done is you've built up their sleep

12:33

debt . That's a clinical term for

12:36

if you need 7 to 8

12:38

hours of sleep per day , which research

12:41

says it's between 7 and 9 for most adults

12:43

you owe your body

12:45

, like a student loan , 7 hours

12:47

of sleep a night and if you get 6 , you're in debt

12:49

one hour . So you're

12:52

building up the sleep debt by making them so

12:54

tired because they can't get into bed . It

12:56

usually fixes most problems . Now

12:58

, of course , if you work in a job that has

13:01

an odd shift , like if you work

13:03

at a bakery or a factory or a refinery

13:05

or somewhere where you have to wake up in the morning , nurses

13:08

are listening to this , going like , ok , fix

13:10

my schedule . I have a different shift

13:12

every five days

13:15

, and so I went to

13:17

the ABCT

13:19

conference this year , which is the conference for

13:21

the CBT people , and I listened

13:23

to the sleep researchers and I didn't shake

13:26

them down . They're actually very nice . You can

13:28

literally just email researchers . I

13:30

need a copy of your paper and they'll give it

13:32

to you . You can email them . I

13:34

need a solution for shift workers

13:36

and they'll tell you what it is , and that's what they did

13:39

. So they sent me the advanced . This

13:41

has just come out . This year they had researchers

13:44

in Australia put their heads together

13:46

and figure out what the new sleep guidelines

13:48

for shift workers should be . You can't do

13:50

CBTI because you can't be

13:53

working at a power plant

13:55

and be in the two-week phase

13:57

of CBTI where you're decreasing sleep . That's

13:59

not going to work . You operate heavy

14:01

machinery , it's your job . Same thing with nurses

14:03

. Also , most

14:05

of the sleep hygiene guidelines don't apply

14:08

. Like don't take naps and

14:10

keep a strict schedule Isn't

14:13

applicable to a shift worker , and

14:15

so the Australian researchers did this whole

14:17

progress and they put together 18

14:19

new guidelines , and the new guidelines

14:21

include you should take naps

14:24

, sleep opportunity , so

14:27

find seven hours

14:29

of sleep opportunities . That could

14:31

be two , three and a half hour blocks

14:33

, or whatever they

14:35

say 90 minutes , or

14:38

you should either sleep 15 to 20

14:40

minutes as a nap or you should sleep

14:42

90 minutes . Don't do the in-between . So

14:44

if you can get 90-minute increments of sleep

14:46

, then you could make up seven

14:48

hours of sleep in a day . There's more

14:51

to it than that , but I'm like , if

14:53

you're listening to this and you have sleep problems , that's where you

14:55

should start , my opinion .

14:59

I fucking love your brain and how you operate

15:01

. You look at these things , because every time

15:03

I have you on a podcast I feel like

15:05

I just became a more educated

15:08

professional , more efficiently

15:10

than fucking being a grad student ever

15:12

did for me , because so much

15:15

stuff is going through my head and I know we have limited

15:17

time to go and this is such a huge

15:19

topic Like what we're talking about

15:21

is probably the tip of the iceberg of fucking sleep

15:23

and science and all this stuff

15:25

. So one of the questions I have

15:28

several of my clients

15:30

have ADHD and it's always fucked up their sleep

15:32

and I'm not treating them for ADHD

15:34

because I'm not a specialist in it , but it

15:36

is a part of their mental health , which is why they're seeing

15:38

me . Has any of the research you've

15:40

done regarding fatigue and sleep

15:42

? Does this same technique

15:45

work for people with ADHD ? Because

15:47

part of their problem is they struggle to fall

15:49

asleep because they have ADHD and

15:51

medication often wears off by then

15:53

. They don't like taking sleep meds because then

15:55

it fucks up their whole day the next day

15:58

and that's not efficient and some of them can't

16:00

their jobs . They need to be alert

16:02

and awake and they can't have that groggy sensation

16:05

and then also they struggle

16:07

to stay asleep . So that whole thing of they

16:09

wake up at fucking 1 , 2 , 3

16:11

in the morning and their brain just won't

16:14

shut off . I have one more question

16:16

after that . This is something my wife and I do , but

16:18

it's more important that we talk about our potential

16:20

clients and people struggling . I'm

16:23

not one of them , so let's focus on has

16:25

your research brought up this ADHD

16:28

in this technique ?

16:28

overall , my research

16:30

might , deep diving and shaking down sleep

16:32

researchers . So we know that

16:35

people with ADHD have a higher rate

16:37

of sleep apnea and restless leg syndrome

16:39

. If you want , you can screen yourself

16:41

online and that'll tell you whether you need

16:43

to go to a doctor . You know me , I'm always

16:46

team go to your doctor anyway . But

16:48

sleep progress , sleep problems

16:50

, can aggravate the reduced attention

16:52

span and behavior problems associated with ADHD

16:54

. So CBTI works

16:56

like money for ADHD

16:59

people at least my ADHD clients

17:01

For two reasons . Number

17:03

one , a huge part of sleep hygiene

17:05

, and we know sleep hygiene doesn't fix sleep

17:08

problems but it does help behavioral

17:10

interventions . So , going through the list

17:13

of sleep hygiene , you can Google this like keep

17:15

the room quiet , don't do bright

17:17

lights before you go to bed , don't eat a big meal

17:19

, etc . Those

17:22

things are money . You take that straight to

17:24

the bank . Part of creating a routine

17:26

is also great for ADHD

17:28

people . They love that . They're like yes , give

17:30

me the same thing to do every day and

17:33

then I can just train myself to do

17:35

it and do this repeatedly . So you should

17:37

have a sleep routine that ideally starts

17:39

an hour before you go to sleep . The

17:41

pie in the sky is there's no electronics

17:44

, no bright light and only calming activities

17:46

. But I know plenty of people , my

17:48

clients included , who are like if I

17:50

put the TV on , I'll fall asleep while watching

17:52

it . Great , do that . People are like

17:55

if I watch tick-tock videos , I will

17:57

pass out while watching them again . If it works

17:59

for you , just do it same thing

18:01

with the waking up in the middle of the night problem . Training

18:04

yourself to limit the amount of time

18:06

you spend in bed seems to be very

18:08

effective for ADHD people . My

18:10

observation Wonderful

18:13

man .

18:14

So my wife and I have this habit . We

18:16

have a TV in our bedroom and we often

18:19

just fucking laying bed watch TV . Is

18:21

that technically fucking up our whole

18:23

like sleep routine ?

18:24

No , if it works for you , do it . Do

18:27

you fall asleep while watching it ?

18:29

Sometimes I mean depends on what it's like

18:32

. If she likes like these

18:34

reality Romance things , those

18:36

things will put me to fucking sleep because I think they're boring

18:38

. But for watching like a Marvel movie , like I'm

18:40

staying up . So it depends on what

18:42

it is . I Don't

18:45

have problems like falling asleep . I

18:48

show the wake up , but that's like how I've been

18:50

my whole life . But I just found

18:52

it interesting that you can effectively train

18:55

yourself through the CBTI , I

18:57

Guess perspective of

18:59

modality to have a better

19:01

sleep routine . That is so impactful

19:04

. After the show

19:06

, I definitely want you to email me those

19:08

resources Because I have several people

19:10

that have been struggling to just like have

19:12

better sleep routines . They do sleep

19:14

hygiene , they do all that . They

19:17

have other misleadings going on and they

19:19

still struggle sleep and sometimes

19:21

around the holidays , like they're worse right now , like

19:23

their mental health is worse , they're fucking sleep

19:25

is worse . So after the show

19:27

, like please email me that because I'm gonna start using

19:29

it .

19:30

If it's that simple , I'm gonna start using it and

19:33

if you're listening to this , but one

19:35

of the researchers I shook down . First of all , they

19:37

are so nice and if you

19:39

have a client who has absolutely bizarre

19:42

sleep patterns , reach out to them

19:44

. They know the cure . One of them is Daniel

19:46

J Taylor and he made a website

19:49

called CBTI web and it

19:51

has like all the manuals on there like

19:53

for free and all

19:55

of the research for free . He's like I don't know

19:57

why . He's like I just made this . You

19:59

know people can use it if they want . I'm like Daniel

20:02

. The people need to know my

20:04

, my sweet , sweet boy . They need

20:06

to know it's free .

20:09

The other one .

20:13

Yeah , I'll give you like the other one

20:15

again . I didn't shake anyone down , actually , there

20:17

they're so nice Was

20:20

Jessica Deitch , and she is

20:22

working on a shift work man

20:24

like app and she's studying

20:26

nurses right now and they're

20:29

literally , literally . She's in the

20:31

field , like talking to nurses and observing

20:33

their sleep schedules to make an app that will just

20:35

tell you how to change your

20:37

shift , like when you should drink coffee

20:39

. There's an app for this kind of now time shifter

20:41

, but this one's gonna be more research

20:44

based about like specific

20:46

interventions for how to go from

20:48

shift to shift without like

20:51

Experiencing major

20:53

sleep disruption , because we know that , ironically

20:55

, insomnia is a huge problem for shift

20:57

workers , even though you're working

21:00

18 hours a day and I have clients like this

21:02

you know they'll come home and they

21:04

won't be able to sleep , but they'll be exhausted

21:06

, and so , again , the researchers

21:08

have cracked this there . They're like , please

21:10

, like , share our work .

21:13

That's amazing . I'm so glad you found

21:15

this is . I literally have a A

21:18

current nurse on my case load

21:20

and she , she , her

21:22

, her shift again like changes every every

21:24

so many days from like day to nights

21:26

and , you know , depending

21:28

on what's happening in her field , within her specialty

21:30

, like it's this all over the fucking place and sometimes

21:33

she'll have to like reschedule

21:35

with me . She's like , well , I'm working . You know , the night

21:37

shifts a day before , like weren't you just in a day shift

21:39

, like two days ago ? Like how the fuck you function

21:42

, and her shifts are like 12 hour

21:44

shifts or more . I'm like man

21:46

, like when you have time

21:48

to like be normal as a

21:50

nurse like I don't think it's a thing and .

21:53

This is my frustration with , like , our

21:55

reversion to 1925 . Therapy

21:57

is Genuinely right

21:59

now today . I could go on psychology

22:02

today and I could find a therapist

22:04

who would be willing to do EMDR on my sleep

22:06

problem . If I had one , which , like

22:08

I , have absolutely zero faith in that

22:10

there there's zero research showing that

22:13

does anything , I'm sure I could still find or

22:15

a somatic practitioner that's like oh

22:17

well , you must be storing the trauma

22:20

in your hypothalamus and that's

22:22

why you have sleep disruption like CBT

22:24

. I , like CBT in general

22:26

has so thoroughly cracked sleep

22:29

dysfunction . I could and I'll send this

22:31

to you if you want . The VA has a free

22:33

I'm not even kidding Excel spreadsheet

22:35

and you can use this if you're just like a client

22:37

this is not even just for therapists where

22:40

you can track your daily sleep

22:42

log and the Excel sheet will

22:44

automatically Calculate your time

22:46

spent in bed , what's called your time

22:48

, your sleep efficiency , which

22:51

is time spent in bed versus time sleeping

22:53

. Like . It'll just do all the math

22:55

for you and then it'll tell you , based

22:57

on that , when you should be

22:59

going to sleep , based on what your sleep schedule

23:01

is . So , like , these tools are out there

23:04

. They exist . Like . Please

23:06

don't do some weird alternative treatment about

23:08

this .

23:09

Yeah , send me that as well , because that

23:11

that's something I would even use personally .

23:14

Yes , send me all this stuff , so okay

23:16

so my favorite sleep tool I

23:19

know I know you want to talk about the other thing is

23:21

there's a quiz I found in one

23:23

of it's buried in one of the tricare

23:25

trainings and it's called . You guys can look

23:27

it up . It's free . The morning , this evening

23:30

, this questionnaire and it you fill

23:32

it out and it will tell you whether

23:34

you're a morning person or an evening person

23:36

.

23:37

Send me that , Like I'm pretty sure I'm

23:40

an evening person man

23:42

.

23:42

You'd be surprised . You'd be surprised

23:44

.

23:45

OK , love it , send me that . Because all

23:48

of this stuff I'm thinking of all the clients that

23:50

I have that struggle sleep or even

23:52

inconsistently struggle sleep and I

23:55

always tell them go talk to an expert

23:57

. This is like I can help you with mental health and that

23:59

can improve your sleep and we can do things

24:01

there from a habit-forming

24:03

sense . But if there's something going on with your fucking

24:06

brain or your body , there's

24:08

experts for that . I'll

24:10

talk to them , I'll work with them . I don't fucking know what

24:12

I'm doing because this is beyond my scope . Another

24:15

thing we wanted to talk about

24:17

, and that you had brought up as well , is mental health

24:19

and sleep and fatigue , and

24:22

let's start off with the most common one

24:24

depression .

24:26

Right . So we know that 75%

24:28

of people with depression also have insomnia

24:30

, and this is according to the National Sleep Foundation

24:32

, which the sleep

24:34

researchers sent me , so I trust them . So

24:37

, because of the bi-directional relationship between

24:39

mental illness and sleep , for

24:41

some people improving

24:44

sleep may actually improve

24:46

your depression . So , according to the UCLA

24:49

Sleep Center , people with depression have been shown

24:51

to have abnormal deep sleep and

24:53

dream sleep patterns Fascinating

24:55

what does that mean ? I have no idea . You

24:58

have to look it up . I didn't go that far into

25:00

the deep dive . However , improving

25:02

and regulating your sleep could alleviate

25:05

some of your mood symptoms . We know this is especially

25:07

true for more severe

25:10

mood disorders like bipolar disorder

25:12

. If you have bipolar disorder or you have a client

25:14

who has bipolar , you know that regulating

25:17

sleep is an absolute must . I

25:20

don't know if this has happened to you , james .

25:23

No , so I don't have any . I've

25:25

never had clients and at

25:27

least I know currently I'm a case-loaded big diagnosis

25:29

bipolar that I'm aware of or

25:31

have a history . I have spoken with

25:33

people on a professional

25:36

level regarding bipolar because it

25:38

comes into my case-loaded every once

25:40

in a while and I refer out because I don't

25:42

know enough . That's something they've talked about

25:44

is sleep

25:47

for individuals with bipolar ? It's

25:50

non-existent , it's fucking intangible and

25:52

I'm like , well , that's shitty because you

25:54

have bipolar and that's already annoying

25:57

to fucking miserable to deal with at the best of times

25:59

anyway . And understanding how that

26:01

fucks up your sleep probably just exacerbates

26:03

all of the fucking things you have to deal with , and

26:06

that's the norm for anyone . If you have zero

26:08

mental health disorders or any issues , poor

26:11

sleep will fucking cause problems

26:14

and that anyone for

26:16

anywhere in your life's sleep is super

26:18

fucking important . So

26:20

I love that you talk about

26:22

how it's bi-directional , because a lot

26:24

of my clients who have been diagnosed

26:26

with a major depressive disorder

26:29

and they're going through a lot of stuff and

26:31

they're struggling to sleep . I always

26:33

tell them there's

26:35

two pathways here . One is just

26:37

like your behavior around sleep routine

26:39

and sleep hygiene and those are things that we

26:41

can mechanically attack . The other thing is

26:44

your mental health , your psychology

26:46

, like the emotions

26:48

that you're having and when you're having them and

26:50

what you're doing with them , both

26:52

impact the other . If

26:55

you have poor sleep , you become more depressed . If you're

26:57

depressed , it also you lose sleep , and

26:59

so it's a really nasty cycle as well . I tell

27:01

my clients , and when they explore like

27:03

well , how do I get out of it ? I'm like when

27:05

you get to this point , you attack both sides . I don't

27:07

fucking care . We need you to sleep . We

27:09

also need you to be less depressed so you can

27:12

sleep . Because , in order to improve

27:14

, your mental health 100%

27:16

.

27:17

OK . So there are three times a year

27:19

for me that my caseload of

27:22

depressed people spikes , and

27:24

they coincide with religious

27:26

holidays . There is a Muslim

27:28

holiday that involves fasting

27:31

, there's a Jewish holiday that involves

27:33

fasting , and then some Catholics fast

27:35

for Lent and you get people who

27:37

come in and they're like man , I've never

27:39

been depressed before but this because

27:42

of this like I have . No , it's usually not

27:44

connected to the fasting , they'll just be like God . I'm

27:46

so depressed . What's going on ? And you ask

27:48

them like OK , tell me what's changed in your

27:50

schedule ? And I have a lot of clients who will be like

27:52

because of the rules of these religious

27:54

holidays , they're not eating all day . They eat

27:56

after sundown a big meal and

27:59

then they can't sleep . We know that going to

28:01

bed hungry is also not advised

28:03

. That can mess up your sleep . And so

28:05

all of a sudden , these people aren't sleeping . The

28:07

first week is usually OK and then

28:09

the second week you get all these people calling

28:12

you . In the middle of this religious fasting

28:14

holiday , sleep is so

28:16

important and amazingly for

28:18

most of these folks , after the fasting

28:20

stops , they just get better . They're

28:23

like Angela , you cured me . I'm

28:25

like no , I actually didn't do anything , your sleep is just normal

28:27

again .

28:28

So sleep is so crucial

28:30

, so important 100%

28:34

, and it's so interesting that a

28:37

lot of people don't fully acknowledge

28:39

how your mental health and your

28:41

sleep are directly connected

28:44

at times , and another

28:47

thing that I'm seeing a lot recently is

28:50

seasonal affective disorder and how

28:52

that impacts people's sleep . What

28:55

deep dives have you done regarding this

28:57

?

28:59

Two things I found . I found that it could be

29:01

a disorder of circadian rhythm patterns which

29:03

, as we know , you know the changing light

29:06

exposure messes up Like

29:08

. So let me back up . I'm backtracking

29:10

. Okay , your sleep is affected by two things

29:13

. First is the circadian rhythm

29:15

. You've heard that that's like the sun is

29:17

out . Your light goes

29:19

into your eyes . You know that makes you want to be awake

29:21

. The second is the

29:23

need for sleep within your body . So

29:25

you need seven to nine hours

29:28

of sleep per 24 hours

29:30

for an adult , and that need

29:32

for sleep builds up from the

29:34

time you wake up throughout the day

29:36

. That's why taking a nap decreases

29:38

the need for sleep . We talked about sleep debt . So

29:40

that'll make you . If you take a nap that's

29:43

long enough , it could make you have a harder

29:45

time falling asleep later on . Circadian

29:47

rhythm can get thrown off . When the days

29:49

get shorter , you're seeing less light , shift

29:52

workers especially . What do you do when

29:54

you work a shift ? That you wake

29:56

up and it's dark . You're inside all day

29:59

and when you go to sleep it's dark again . So

30:01

for shift workers , the advice in the new

30:03

guidelines is go outside , look at the sun

30:06

. If it's possible

30:08

during your work hours , get

30:10

the sunlight into your face

30:12

so that your body can set to

30:14

like okay , it is in fact light outside

30:17

, I should be awake . They sell

30:19

light treatments which are good for

30:21

that . The other thing is treating

30:23

it similar to PMDD , where , if you know

30:25

it's going to happen , you should have a plan in place . The

30:28

seasons are going to change , you're going to get depressed

30:30

. What is our coping skills plan , similar

30:33

to the CBTI ? You know you're going to get anxious

30:35

before you go to bed . What are

30:37

the things we can do ? One intervention

30:39

I didn't mention and this is part of CBTI

30:41

is they recommend that for people who

30:43

have problem waking up in the middle of the night which

30:46

can be very common with seasonal affective

30:48

disorder because you're dysregulated is

30:50

, if you're awake for more than 15 minutes

30:52

, get up and get out of bed . This does

30:54

two things Number one , it tends

30:56

to shut off the racing anxiety

30:58

that's in your brain and number two , it makes

31:01

it easier to fall asleep . Right

31:03

, because we're training your body that

31:05

your bed is only for sleeping . So

31:08

if you're not sleeping , if you're wrestling

31:10

with a pit of anxiety , you

31:12

know locks in the prison of your own despair

31:14

inside your head get out

31:17

of

31:19

bed .

31:22

I actually came down with this as

31:25

a grad student when

31:27

I was learning basic counseling techniques . I was

31:29

convinced I was fucking horrible at this and I

31:31

developed like a lot of anxiety and I was

31:33

not sleeping . My solution

31:36

was to read more books and

31:38

to take extra classes that were not just

31:40

prescribed to me by my curriculum

31:42

, to just be a better therapist

31:44

for my future . It did

31:46

work . It took a couple of months and it

31:48

paid off because I actually did very

31:50

well in my performance review . My

31:53

thought process like I'm lying

31:55

in bed , not sleeping , because

31:57

I'm scared that I suck at this . So

32:00

I was like I might as well just fucking , you

32:02

know , use the energy I have and like I guess

32:04

go get better being a therapist and

32:07

I've told a lot of my clients the same thing . Like if you

32:09

wake up and you're fucking anxious and like

32:11

you know you're trying to go back to sleep , but it's

32:13

been like an hour and like at that

32:15

point like you're fucked , like you might as well just get up

32:17

and like do something with it and then feel productive

32:20

, even though you're going to be tired , because at least you

32:22

have a reason for it . Like I was up , you know

32:24

, getting something important done or

32:26

making improvements to my life and you

32:28

know whatever , and I did something

32:30

with it . For me , I would

32:32

fall back asleep eventually after I did

32:35

like an hour or two of reading or rehearsing

32:37

a clinical technique , because

32:39

I was just like physically , mentally

32:41

exhausted and I was like now

32:43

now , like I literally cannot stay awake

32:45

, I'm falling asleep in my chair . A lot

32:47

of clients give me pushback Like no

32:50

, because if I get up I never go back to sleep

32:52

. You're not fucking sleeping anyway .

32:53

See , and that's such a crucial part

32:55

of CBTI . So we talked about the behavioral

32:58

part . Train yourself that bed is only for sleep

33:00

. The other part is looking at

33:02

maladaptive thoughts around

33:04

sleep and then challenging them . So

33:06

people with insomnia or sleep disorder should

33:09

be waking up in the middle of the night , want to often have

33:11

thoughts like what you just said . They're

33:13

catastrophizing black and white thinking . If

33:15

I wake up , I'm not going to go back to sleep . If

33:17

I don't get a good night of sleep , my entire

33:19

day will be ruined . Like I'm not

33:21

going to sleep , no matter what . My whole life is

33:23

ruined . And they'll tell us to you like you

33:26

just said and like it's a

33:28

fact . And you have to tell them . No , it's

33:30

not a fact . There are things

33:32

we can do . And if you believe it's

33:34

hopeless , it's going to be hopeless . So we have

33:36

to have some hope here . Like maybe

33:39

you will have less sleep than you

33:41

want . Will your next day be ruined

33:44

? Will it be garbage

33:46

? Should you just quit your job ? Obviously not

33:48

. Like that's so intense . You know you got to unpack

33:51

this with people . It also helps if

33:53

you have a coping skills plan . So

33:55

like if you know you're going to get . You

33:57

know the scary thoughts about this is hopeless

33:59

. You have like a mantra that you say to yourself

34:02

. Like it's not hopeless , I'm doing the

34:04

thing again . Jesus , whatever you

34:06

know , same thing . The sleeper

34:08

searchers say that 15

34:10

minutes you should get out of bed . If you're awake for

34:12

15 minutes , don't like obsessively look at the

34:14

clock . That's going to make it worse . But if

34:16

you happen to glance at the clock or

34:19

feel it's 15 minutes and get out of bed , they

34:21

say do something not stressful

34:23

. I do have clients who are like

34:25

I'm having racing thoughts and I need

34:27

to like keep it to do this next to my bed . It's

34:30

almost always a bad idea

34:32

. It's much better to just like wake

34:34

up and do something soothing until

34:36

you get tired enough you can go back to bed .

34:40

I love that . Yeah , it's

34:42

, it's , I've , I've , I've . Some of

34:44

my clients I've struggled with , just like , if

34:46

you're awake and you can't fall back to sleep , then

34:49

you might also just get up and you know , do

34:51

something , go try to relax

34:54

or watch TV or get that thing

34:56

done . That's the reason why you're fucking awake

34:58

. Is because you get too strong out , like like

35:00

laying there isn't going to solve it , you're just going to get

35:02

more angry . And then you're going to just like get sad

35:05

or anxious about not sleeping and then you're really

35:07

not going to ever fall back asleep , because now

35:09

you're just emotionally pent up

35:11

and you , you're not letting yourself release it

35:13

either . You're just like lying in bed

35:15

, forcing yourself not to move , with the expectation

35:18

of if I sit still long enough , I'll pass out . It's

35:20

like , no , that's , that's not

35:22

a people aren't completely still

35:24

in a sleep anyway . Like that's not an actual thing

35:26

. A lot of people move around a bit and

35:28

they're like they're asleep , they're unconscious . It's it's

35:31

it's neurological , it's your psychology

35:33

, it's you . You acting

35:35

like you're petrified isn't going to make you tired

35:38

. If that was the fucking case

35:40

, like a lot of us would just stop moving and fall , fall

35:43

over . Like that's not how this works .

35:45

No , literally . I don't like telling people

35:47

to do work in the middle of the night , because

35:49

I find that reinforces the

35:52

idea that work is a danger

35:54

or that they're weird triggers

35:56

Like oh God . I gotta send this email . It's valid

35:58

. I never want to reinforce that , so

36:01

I'm going to be like I

36:03

no , that's not on the list of things to do . Read

36:05

a book , sit , pet the cats , walk

36:07

around . One of the sleep guidelines the

36:10

newest ones they say no nicotine

36:13

or limit nicotine six hours before

36:15

you go to sleep and then limit , obviously

36:17

, big meals before you go to bed You've heard that

36:19

one and limit fluid

36:21

intake so you don't have to wake up to go to the bathroom

36:24

. I love the human

36:26

beings . As a species , I feel

36:28

like everyone's different . I've been

36:30

doing the CPTI interventions for

36:32

like a pride , started a steep dive

36:34

, like earlier this year , and I've already

36:36

met people who have exceptions to

36:39

every single one of the guidelines . I had a client

36:41

who was like I drink a cup of coffee an hour before

36:43

I go to bed . I'm like why do you do that ? They're

36:45

like makes me go to sleep .

36:48

I find people tell me that and I don't

36:50

fucking get that . I'm like that's like

36:53

how , like how does

36:55

it make you fall asleep ? You're gonna

36:57

wake up at some point , like your body's gonna process

36:59

that caffeine , and you're gonna be fucking up . I don't

37:01

get it .

37:03

Dude . For this person it worked , it

37:05

was legit and that wasn't even one of

37:07

, like their sleep problems . They were like I wake up

37:09

to go to the bathroom . I'm like , do you think it's

37:11

the cup of coffee you're drinking ?

37:16

Interesting , interesting . One

37:19

of the things I want to ask you about PTSD

37:23

in sleep because this is where you're more of an expert

37:25

in regards to the mental health side of things is

37:28

trauma in sleep

37:30

. Educate us .

37:31

So legally I can't call

37:34

myself an expert . It's

37:36

a . It's like a legal thing . I'm not

37:38

an expert . I do a lot of research

37:41

on my own time about PTSD . Here's

37:43

some facts about it . So we know at least

37:45

90% of veterans this

37:48

. There was a study just on . Veterans with

37:50

PTSD have insomnia . We

37:53

know that they have more sleep dysfunction than

37:55

that , the most often ones I hear

37:57

like racing thoughts , memories of past

37:59

traumatic events . So this is pretty

38:02

common . One of the most common treatments

38:04

for PTSD symptoms

38:06

is a drug called prososin , which

38:09

almost always just

38:11

takes away nightmares . That's what it's for . There

38:13

are recent guidelines from the VA

38:15

DoD that have to reinforce that

38:17

. Prososin does not make PTSD better

38:19

, it's just a nightmare treatment Like . Do you see the difference

38:22

between those two claims ? And

38:24

this is pretty common . There's no drug

38:26

that will treat PTSD , but there are plenty

38:28

of drugs that treat the symptoms . For example

38:30

, you could use anti-depressants to like treat

38:32

the depressed symptoms , but it's not going to make your

38:35

PTSD go away . So , similarly

38:37

, sleep interventions can make

38:39

PTSD symptoms much better

38:41

, kind of like depression . It will not

38:43

make your PTSD go away . The opposite

38:46

is also true . If you experience sleep

38:48

dysfunction , your PTSD

38:50

symptoms will almost certainly I

38:53

can almost promise they're going to get worse

38:55

. You will have more flashbacks , you'll

38:57

be more on edge , more irritable , more angry

38:59

, feel more hopeless . I

39:02

love using CBTI . At

39:05

the conference I went to actually Daniel

39:08

, who I'm obsessed with , the sleep researcher who's so nice

39:10

. He did a presentation about using

39:12

CBTI interventions along

39:14

with well , as part of this

39:16

research , along with interventions for

39:18

PTSD for veterans , and it was interesting

39:21

that in the feedback a lot of the people in the audience

39:23

were like this is something we already do . So

39:25

one of the most established treatments for PTSD

39:28

is CPT , which you probably haven't

39:30

heard of if you're not a veteran because it doesn't

39:32

have the word brain or neuro in the title

39:34

. We'll just call it brain neuro CPT

39:37

, which is very effective and has a lot of research

39:39

behind it . It does not officially

39:41

have a protocol for sleep

39:43

in it , but you

39:45

can add CBTI to it . I

39:48

add CBTI to prolonged exposure

39:50

, which is my weapon of choice . It's

39:53

again . You just block off like five or ten minutes

39:55

at the beginning of the session to go over a

39:57

sleep diary with somebody . Interestingly

40:00

, this is a good place to add this , just because substance

40:02

abuse overlaps with PTSD

40:04

. So often is that people

40:07

will come to me and they'll say I use

40:09

sleep medication to go to sleep or I smoke

40:11

weed or I drink alcohol . Now we

40:14

know that alcohol before you go to sleep

40:16

is not a good choice . It's not actually

40:18

going to make your sleep better and for most

40:20

people , the symptoms they get when

40:23

they drink before they go to sleep is something called sleep

40:25

inertia , which is what researchers call

40:27

groggyness , like when you wake

40:29

up and you're still tired for like twenty minutes

40:32

. It can last twenty minutes , it can last two hours

40:34

and we know that alcohol makes

40:36

that work .

40:38

Listeners . It is at this point that the

40:40

audio file for this episode

40:43

got damaged and there was another twenty

40:45

minutes of recorded audio that just didn't

40:47

make it to the final product . For

40:50

those of you who found this topic really interesting

40:52

and really wanted to hear more about what we

40:54

were talking about , I'm so sorry . I'm

40:57

definitely going to make sure to correct this issue

40:59

before the next time I upload an episode

41:01

and see if there's something better I can do for you

41:03

guys . I want to keep my

41:05

podcast real and authentic

41:07

, and that means sometimes having technical issues

41:10

that kind of make things lame

41:12

. For those of you who stuck around

41:14

all the way to this point , thank you and

41:16

I'll catch you next time .