Think Differently. Solve the Impossible.

Show Notes

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Transcript

My guest today is Tracy Hannigan.

She's a sleep therapist recognized by the Society for Behavioural Sleep Medicine.

She helps people learn how to sleep well, no matter how long they've had insomnia, regardless if they are in pain or prairie menopausal.

Using evidence-based approaches such as CBTI, ACTI, and other methods, she helps adults regain restorative sleep and develop sleep resilience that lasts a lifetime.

Welcome to my show, Tracy.

Hey, thank you very much for having me.

So to start, how did you end up being a sleep therapist?

That's not everybody's job.

Tell me that story.

I stumbled into it a little bit as a result of my own personal experience with insomnia.

My professional background.

I used to work in community mental health in California.

And obviously, there's quite an intersection between mental health issues and particularly anxiety disorders and sleeping issues.

When people don't sleep well, they can be more prone to anxiety.

And if you're anxious, you're more prone to sleeping difficulties.

So I saw a lot in that context.

When I moved to the UK, my degree didn't transfer, so I had to retrain.

I actually retrained as an osteopath and worked.

Where did you move from?

America?

Yeah.

Yeah.

So I grew up in New Hampshire, spent most of my adult life in California, and then moved to the UK via Sweden.

Kind of long story.

But when I got here, I trained as an osteopath and worked in pain settings.

Obviously, lots of intersection between people who have longstanding pain and sleeping issues.

And through that journey, having had my own sleeping issues, decided I was going to do a little bit more training.

And evidence-based approaches have always been my particular slant.

And so I trained and became qualified as a sleep therapist.

And shortly before the pandemic began doing that work, kind of more full-time than I had previously.

And then, of course, when everything closed down, there were lots of sleeping issues people were having.

And so it just took off from there.

Nice.

Does everybody need a common question?

Does everybody need eight hours of sleep to be healthy and happy and whatnot?

No.

I call that the eight-hour myth.

And a person's sleep need is genetically determined.

Some people need less, some people need more.

The way a person knows, by the way, how much sleep they need is enough sleep to allow them to fall asleep within, say, 15 or 20 minutes, but no faster than five minutes.

And people might wake a couple of times in the night long enough to remember it.

We actually wake up many, many times at night, but a couple of times long enough to remember it, and then fall back to sleep relatively quickly.

And then when a person wakes up and begins their day, after they get going, because some people are a little slower to get going than others, they have enough energy, focus and concentration to do what they want to do with their day.

Whatever that number looks like is the number for that particular person.

It could be six and a half hours, it could be nine hours, it's quite variable.

I was going to say four.

It happens to fall between seven and nine, and so everybody tends to think, oh, I need eight hours or all these terrible things are going to happen to me, and it's-

Oh, the scientists are averaging it, like a lot of things.

Here's a, keep it simple, here's the average.

Yeah, the middle of the bell curve is seven to nine hours, but it doesn't necessarily mean that a little bit more, a little bit less than that is quote unquote abnormal, or necessarily unhealthy.

It's a very individual thing.

If a person needs nine hours, nine and a half hours, like myself, I need quite, I need about nine, makes me really happy.

And I were getting five, for example, that wouldn't be enough for me.

But because of this emphasis on eight hours, people who need six and a half or seven, particularly now that we can track our sleep, you know, for better or for worse with lots of different devices and apps and things, if they're trying really hard to get eight because they've heard eight is the magic number, they can actually make their sleep worse over time.

Or it sounds like if you can get down to half, half what feels good for you before you're really tired and you should have slept more, if six or seven, six and a half is good for me, I shouldn't panic if I only get five one night.

On one night, yeah.

I mean, long-term, we don't want to be getting less than we do.

But we're all, including myself, with a big basket of tools to help with other people with their sleep and myself with sleep.

I still have rough patches of sleep.

And that simply is showing me that my sleep system's working exactly the way that it should.

Because we were not meant to be able to sleep well if we feel under threat, under high stress or very anxious or excited about something.

That is simply an arousal system response that tells our brain at its most basic level, you're being chased by a tiger.

And it wouldn't be very adaptive if we would have evolved to sleep while we were being chased by tigers.

So what are your top three pointers for helping people improve their sleep?

Right.

If a person isn't sleeping well, those pointers will be a little different than if a person is sleeping well.

But if a person is not sleeping well, a lot of people are going to tune in onto this, probably listening if they're not sleeping well, or they may remember it in the future.

I would say ditching the apps and tracking devices and watches because they are not necessarily accurate.

They're getting better, but they promote a hyper-fixation on sleep.

That anxiousness about what the data says actually can worsen people's sleep over time, because they become very fixated on these numbers, which again are not accurate.

It's like taking a magnifying glass to a problem, and not in a helpful way.

That would be tip number one.

Well, if I had the data too, I'd be like, what do I do with the data?

That's exactly right.

And this is why it's a double-edged sword.

Yes, they're not super accurate.

Even if they were 100 percent accurate, and you had the best device on the market, most people wouldn't know what the data meant.

People fixate on sleep stages, and they say, I didn't get enough deep sleep.

And say this person is 35 years old, I only got 20 percent deep sleep.

You know, what's wrong?

20 percent deep sleep would be normal for a human.

We spend most of our night in light sleep.

So we misinterpret things just because we don't know, and that raises our anxiety, which then makes sleep problematic.

I would say I just don't know why, but I feel tired when I woke up.

So I must have not got enough sleep.

Yeah.

The right quality of sleep or the length, something in between.

Yeah.

That's another reason.

That's another reason the numbers are not necessarily the most important thing, because sleep quality is difficult to quantify.

It should be measured based on how we feel.

Oh, there you go.

What some number tells us.

And we have nothing to measure how you feel unless you take a survey with the same sleep device, which it probably is, but again, then you're still complicating things.

You really need to go to an expert like yourself, and just get help and not try to.

It's kind of like a doctor.

Sometimes you just need to go to a doctor.

Yeah, sometimes you do.

But I think the keep it simple principle is really important.

Do you not feel great in the morning?

Maybe your sleep quality wasn't as ideal as it could be, but hyperfixating on all the details and the numbers and the percent of the numbers of minutes in different sleep stages is, it's a hiding to nothing, as I would say, and it's just gonna cause more problems.

And the same goes for tip number two, which is checking the time at night.

Nobody is excited to wake up at three o'clock in the morning and not be able to fall back to sleep.

And there's nothing you can do with that information at three o'clock to change the situation.

It just gives us a place to hang sleep anxiety.

What's number three?

Number three would be if you're having some wobbly sleep, it would be to focus particularly on making sure that you get up at the same time every day, not necessarily forever, but for the short term.

A lot of people say, well, I go to bed at the same time every night, and I get up at the same time every morning, but it takes me two hours to fall asleep.

I would suggest keeping that morning wake up time, but not going to bed until you're actually sleepy.

There's no point in going to bed and then laying there awake for two hours.

And that can actually make sleep worse over time as well.

You know, a lot of people have real common sense, you know, quote unquote helpful advice saying, you know, if you're having difficulty, you know, go to bed early.

And often that makes sleep a little bit more problematic.

If you're tired, go to sleep early.

If you're tired.

If you're sleepy, go to sleep.

Keep that fixed morning wake up time.

But don't go to bed and lay there.

It seems like when your recommendation on waking up at the same time, like if you were traveling to a different time zone, that's the way you get, force yourself to adapt to the new time.

Yeah, that is where people think about the sleep cycle as starting when we're getting kind of getting ready to wind down for bed.

And really, the sleep cycle starts from when we get up in the morning and we begin moving, we begin getting light, we begin getting food, because those three things stimulate systems that are not supposed to be stimulated when we are asleep.

So they're very important for anchoring the circadian rhythm and also very important for the consistent build up of sleep drive.

So you say those things are important.

You say there are three main kinds of insomnia and each one has a bit of a different fix.

What are the three types of insomnia in the in one fix?

There's probably different fixes for like a simple fix for each.

Yeah, you do a whole show just on each individual piece.

But in short, falling asleep is one variety.

Staying asleep is another variety.

And difficulty with staying asleep, but having an early morning awakening.

So if somebody sleeps, but they wake up at four o'clock in the morning and then they're up for the rest of the day.

So difficulty with falling asleep, difficulty with staying asleep, and then difficulty staying asleep, but having an early morning awakening.

Those three variables.

I think I got all three.

They do blend together.

Usually people at some point end up with a variation on some of those themes all lumped together.

I stay up late, of course.

Oh, this is something we're going to speak about because you have a good tip on this.

I stay up late, but because I'm not falling asleep, I'm working on my computer.

And then I work and work and work until I'm so tired, I'm falling asleep.

And then I get good sleep and then I wake up at three or four in the morning and I literally don't go back to sleep.

So you were telling me earlier when I was speaking to you before the show, that one of your tips is to shut all that stuff off, read a book or something like that, right?

Instead, tell listeners about that tip.

But how do you fall asleep?

Falling asleep better.

So falling asleep better is dependent on primarily on sleep drive.

So going back to that waking up at consistent time in the morning, and waiting until people are sleepy enough to fall asleep is going to help with the speed of falling asleep.

If you go to bed early and lay there, you have a slower trajectory into sleep and it's going to take longer if that's what your difficulty is.

So don't just get into bed at a certain time and sit there.

Absolutely.

Don't do it, you know, if I'm supposed to get eight hours and I have to get up at six o'clock, don't just get into bed at 10 for the heck of it and then lay there.

You wait until you're tired.

Until you're sleepy.

I'm sleepy, okay.

Wait until you're sleepy.

Now there are variations on that with individuals.

So some individuals will have such high levels of what we call hyperarousal that they don't get sleepy feelings.

But that's a very specific subset of people.

But in general, sooner or later, it seems you're just going to pass out from.

Eventually, it catches up.

The brain gets what it needs.

For people who are really scared about not getting enough sleep, the brain prioritizes the sleep that it needs.

And if it needs REM sleep, it will get REM sleep.

If it needs deep sleep, it will get deep sleep.

If it needs light sleep, it will get light sleep.

Eventually, it will get what it needs.

It's just not always comfortable for us, and it might not feel like it's enough, but it's smarter than we are.

We try to control it.

We try to control sleep.

But sleep is one of the few things in this world.

That the harder you try to make it better, the worse it's going to get.

Yeah.

So there's the racing brain thing.

Like I get into bed, I was a little felt tired, but now I'm not.

What do you recommend the strategy is to actually then stay in bed and fall asleep instead of get out of bed?

Because I felt sleepy, I got into bed, but then I didn't fall asleep right away.

Yeah.

Often this happens when people have spent a lot of time in bed awake with a busy brain.

So before this kind of pattern arises, the bed is associated with sleepy feelings.

Bed, sleep, bed, sleep, bed, sleep.

It's really common after a while for a person to feel sleepy, get into bed, and then their brain switches on.

And often that's a conditioned response.

So if a person spent a lot of time in bed worrying, planning, thinking about things, being upset about not falling asleep, that's what the brain says.

Oh, I was sleepy on the sofa, but now this is where I worry about everything.

So if you read online, there's a rule of thumb that says, don't stay in bed if you're in that space.

But the reality is we're all going to spend time awake at night in bed, and we don't want to pathologize that.

I think it's really important to change our arousal level while we are in bed.

And it's easier said than done, particularly if you have an anxiety disorder.

But there are lots and lots of different approaches to bring arousal down.

Breathwork is helpful for some people.

Meditation is helpful for other people.

There's a whole host of different techniques for managing racing brain that actually start during the day, instead of this is what I do at night.

If we can lower the arousal association while we are awake in bed, over time that accumulates so that the brain starts to say, oh, I get in bed and I bring these sleepy feelings and most of them stay.

And then over more time, the brain says, oh, I bring these sleepy feelings to bed and then I fall asleep because the arousal association is lower than it had been before.

So, how do I do that?

Every person is different.

Do you like breath work?

That's a great way to do it.

If you like to read, that's absolutely fine.

I have no problem with people reading in bed.

As long as they're doing it because they enjoy it, not because they're trying to force themselves back to sleep.

I'm doing giant air quotes with my fingers.

Oh, yeah, yeah.

You were telling me about that.

The harder we try to make ourselves sleep, especially for doing things we don't like.

We're sending a bunch of messages to the brain that says things like, being awake is a punishment.

We have to do all of these things we don't like to make ourselves sleep because otherwise we're in danger.

What happens then is the brain says, look, they are trying really hard to get to sleep.

So there must be something really scary about being awake, so I better be on guard for the tiger that's going to be coming into the room because it's dangerous to be awake at night.

And it continues to feed that cycle.

So when people say, what do I do at night?

Do what you like doing.

And actually, if we want to go into myth busting mode, if people like scrolling on their phone and looking at Instagram before they fall asleep, there is absolutely no evidence that says you shouldn't do that.

Phones and tablets don't emit enough light to affect melatonin onset.

Laptops do.

So laptops are a little bit different.

You turn the brightness down, though.

You can turn the brightness down, but what's really interesting is over the course of the last 10, 15 years when they've been doing this research, they've been looking at things like if you use a laptop for five hours before bed, because they used five hours because you want to pick up before the usual dim light melatonin onset for somebody.

They said, yes, it delays the melatonin onset by an hour and a half or something along those lines.

But they didn't actually study, did that shorten or lengthen how long it took a person to fall asleep.

So they looked at the melatonin onset and said, oh, it delays it, so it must delay people falling asleep.

So nobody should be doing this at night.

But actually, the more recent studies look at melatonin onset and did it make a difference in how long it took that person to fall asleep?

Well, those groups of people to fall asleep.

And you're looking at an average of six minutes, eight minutes.

So it's really not very significant.

So if we want to look at the evening time as a time to wind down for bed, if we fill it full of rules that say, you can't look at your cat videos and you can't do this and you can't do that and you have to do this and you have to do that, you're still sending a message to the brain saying, oh, this is dangerous.

And then you add the shame on, boy, a lot of clients come to me and they're, oh, I know I shouldn't look at my phone before for two hours before my bedtime.

And I'm like, why?

There's no evidence for it.

And why make yourself sound bad?

But why make yourself feel bad?

Life is short.

So let's do things we enjoy doing.

So as long as it's something you enjoy, and maybe a phone is better than a tablet because there's less light.

What about spooky movies?

Like that cause that kind of a stress arousal thing.

For me, I'm sensitive to spooky movies, so you wouldn't catch me doing it.

I think each individual probably has something that might kind of tickle like zombie movies or whatever.

But they actually have done studies looking at people playing video games.

And versus, I can't remember what about, watching documentaries.

So you have a bunch of young people playing first shooter, kind of exciting video games, and you have the people watching documentaries, there was still very little difference in how long it took the video game group to fall asleep compared to the documentary group.

Because that's what they're used to.

For me, for me and you, it would maybe cause some problems.

But for people, that's what they do, and they enjoy it then.

Yeah, I mean, I don't enjoy it, so it would fall into that category of things I wouldn't do.

That's not my bag.

What the biggest impact is for things like video games, like because people get into them, whatever you're getting into, is if you're using them after your bedtime, they're obviously impacting your sleep.

Because you're not sleeping, you're playing video games instead.

So that is really the impact, rather than the light or the arousal.

I'm going to keep playing because I enjoy it and keep playing and I'm sleepy, but come on.

Yeah, it becomes a sleep procrastination thing, right?

Which obviously results in less sleep.

But if you're playing a video game and the content is particularly personally upsetting to you, that might be something that then gives you nightmares or disturbs your sleep.

Tell me about that word, sleep procrastination.

Sleep procrastination is a situation where people could sleep if they went to bed, but they don't.

They stay up or they get up early in order to do other things.

Sometimes people call it revenge bedtime procrastination.

Basically, using that time to get chores done, do projects, get up and do workouts, and they're sacrificing sleep that they could be getting.

And not because they have trouble falling asleep and they don't want to go through that frustration, but just because they want to use the time for something else?

Yeah.

Both of those things can coexist.

Absolutely.

In order to work on the having difficulty falling asleep piece, we need to look at what is that person engaging in for sleep procrastination and can we shift things?

Can we shift things earlier?

If work is particularly exciting, that might not be the best thing to do right before bed, right?

Especially if you don't enjoy it.

But you're trying to catch up.

Everybody's blessed enough in their life to do stuff that they love doing, but not everybody is.

But it might be you need the time, like for work, you're overloaded with work and you're trying to scratch some extra time out and you're using your sleep time for that.

But you can't have your cake and eat it too.

That might be a personal choice that you're making for the short term, because you've got a project that needs to be done and you need to put in those extra hours.

But at the same time, you can't say, I need to get those hours with sleep because you're choosing to spend that time doing something else.

We all have done that.

We've all gotten up early to do work on things, or we've stayed up late, or.

You don't need an expert like Tracy to tell you, don't do that, you know better.

Not necessary.

No, because those things come down to personal choice.

One of the things that I think you specialize in when you talk about evidence-based therapy, what is cognitive behavioral therapy for insomnia, the CBTI?

Right.

CBTI has the longest track record in terms of the evidence.

If you look it up on PubMed, which is where all the medical evidence tends to be kept, we're looking at an evolution of what they now call CBTI, which includes a few different pillars.

It's not like CBT exclusively.

So people might have heard of cognitive behavioral therapy for anxiety or for depression or for pain.

CBTI is specific to insomnia because it includes sleep-specific interventions.

So there's a CBT element looking at how we think about sleep.

For example, the eight-hour myth.

If a person is satisfied with seven and they're panicking because they're not getting eight, how can we dissect that to take the fear out of it?

So there is a cognitive restructuring element like there would be with any CBT.

But there's also looking at a person's sleep diary and sleep scheduling.

Are they spending 15 hours in bed but sleeping for only five and a half or six?

And how can interventions be put in place to change that?

It looks at that psychobiological relationship to the bed.

Is panic and fear of not sleeping associated with the bed or are sleepy, relaxed, content, safe feelings associated with the bed?

And how can we kind of transform those fearful feelings into something a little bit different?

Would you make the bed more comfortable and change the color of the sheets or things like that?

You can.

You can.

There's nothing wrong with making a bed and a bedroom environment more pleasant.

But when we're talking about those sorts of things, it's almost a little bit of like sleep hygiene, like making the room dark and cool and making the bed comfortable.

Those deal with the external inputs.

What about quiet?

Yeah, or quiet.

People have different levels of sensitivity to quiet and to light and to comfort.

Those deal with outside influences on sleep, things that might wake you up like headlights coming in the window.

They don't address the fear of not sleeping, which is what creates longer-term insomnia.

It doesn't deal with the insides.

It's the difference between pulling the blinds, so that the headlights don't come in and disturb your sleep, versus taping the blinds to the wall to keep every photon of light out, because they're scared the light's going to keep you awake.

There's a fear of not sleeping that is fueling the not sleeping.

That's the tiger, right?

That is the person's brain saying, if I don't sleep, all these terrible things are going to happen, or I'm going to feel bad tomorrow.

How do you address that?

What's a true story or a true example?

Oh my goodness.

Of making the fix.

Somebody had a problem.

That was an example, taping the blinds.

Oh, really?

Kind of.

I know there's people out there probably do that.

Aluminum foil, duct tape, whatever, I'm going to close them down.

Yeah.

Have you ever seen somebody sleeping in the park in broad daylight?

Darkness isn't actually required.

I can do that.

I pull a hat over my face so I don't get sunburn.

Yeah.

So it's like it's not necessarily the light that is the issue.

It's the fear of not sleeping in that particular environment that tends to become that issue.

So talking it through, and some of this is eyebrows up stuff, like having those kinds of revelations.

Or somebody saying, I ask somebody, what's the worst possible thing that could happen if you didn't sleep tonight?

And some people have a long cascade of all these things that could potentially happen.

Another person might say, well, I feel really bad tomorrow.

Okay.

When else have you ever felt really bad when you've gotten up?

You know, when you know when my cat died, when there's other situations, when sleep becomes the whole focus, that makes the problem worse.

So looking at other times, putting it into perspective, other times that you woke up and felt terrible, maybe it was jet lag, maybe it was you had a curry and you were up with reflux all night, maybe it was relationship issue.

Once you identify that, how does that help just knowing about it?

So if just knowing about some of these things, if you put them in perspective and then like the light bulb goes off and that helps.

But for a lot of people who've been dealing with this for a long time, it's not as simple as just changing thinking.

It has to be a bit more experiential.

So conscious exposure to things like, so for example, this is a really common one.

Somebody wakes up in the middle of the night and they feel really tempted to take another sleepy time tea or a dose of medication or something like that, because you're afraid they're not going to fall back to sleep.

The glass of wine.

Yeah.

I'll have another glass of wine, put myself back to sleep.

Allowing that person to have the skills and tools and safety to feel the discomfort of not doing the rescue behaviour can teach the brain to not be afraid.

So it's a little bit of exposure therapy, like when people are afraid of snakes or spiders.

You know, you go through this process of gradually having a person be closer and closer to a spider or snake.

You might have seen these things on TV where over the course of several hours, they go from vomiting when they think about a snake to having a snake on them because they have slowly showed their brain that they are not in danger.

So there are different ways of doing this by allowing people to consciously expose themselves to the fear of being awake without resorting to what we call safety, but without resorting to the rescue.

Is there a problem with a glass of wine?

Like say I'm having a hard time falling asleep and I get a glass of wine.

Is that a...

It's soporific.

It's soporific.

It can help you relax.

You're not going to be thinking or worrying quite so much, but it disturbs sleep later on.

And there are obviously other reasons why you shouldn't necessarily use a habituating substance to help you get to sleep for other health and mental health reasons.

But even one glass of wine, for some people, it completely wrecks your deep sleep.

It takes that stage three sleep and chops it up into lots of little pieces.

And it also suppresses REM sleep.

And so what happens is...

Yeah, and so what happens is if people have done that for a while, they fall asleep quickly, but they wake up in the night and they've got palpitations, and they might be really anxious, very difficult to manage kind of anxiety.

So we have another glass.

And some people will do that.

Then you're really exhausted, you wake up in the morning, you drink coffee all day, you're even more anxious, and then you feel, wow, I'm really not going to fall asleep, so I'm going to have two glasses of wine.

And it just kind of cycles on itself.

And for people who do that long term, just stopping the alcohol use doesn't necessarily fix the sleeping problem.

It can take a lot longer once that disruption has kind of set in, but it destroys people's sleep quality.

Most people would be better off spending longer falling asleep and then sleeping, then having a glass of wine or two or three, and then having their sleep disturbed later on.

And maybe instead of the glass of wine, if they had started one of your strategies, fall asleep, better like read a book, don't use the laptop to avoid the light, use the phone is okay.

If they had taken one of those tips to start with, they might have not needed the glass of wine or the alcohol.

Potentially, potentially.

I think people who resort to wine for sleep, I would again go back to the beginning of the sleep cycle, which is the start of the day and look at how they compartmentalize the categories of their life and the stresses in their life, because usually these things accumulate.

Again, when we look at sleep, we don't want to just look at like the couple of hours before bedtime.

We want to look at it quite holistically.

Is that person, when they have a rough time sleeping, once they fall asleep, do they then sleep until nine o'clock?

Do they start working from home and not going into the office so that they can make meetings later and then they can grab more sleep in the morning?

That is all going to have a knock-on effect on people who have challenges, particularly with falling asleep, but also for people who have challenges with waking up in the middle of the night.

It is pretty holistic.

That's much deeper than I would have thought, which is as simple like, this is probably why the app and the data on your watch tracking your sleep doesn't do any good.

It's not take into account any of that.

It doesn't.

A lot of people drag stuff through the day and into the night.

And there are ways that people can practice creating compartments for the different kind of stressors of life, you know, creating rituals, for example, really good one.

Your person who has really difficult kind of emotional times when you wake up in the morning after a bad night of sleep, create a ritual where you close that off.

You get ready to exit your bedroom, you open the door, you take a deep breath, you walk through that door, you close it behind you, you turn around and you set an emotional intention for the rest of your day, and then you focus on what's the next thing I got to do, what's the next thing.

Don't let your head go back into what happened the night before.

It sounds overly simplistic, but if you do these things regularly, it helps create a compartment.

The sleep experience, positive or negative, happens in this block of time.

And then you have the experience before work.

Sorry, yeah, and you can make it very concrete, yeah.

You like walking through a threshold, doing things to change your physiology as you walk through that threshold.

You walk through that threshold and take like three really long, slow, deep breaths.

Of course, then I gotta go back and open the door to go back to sleep the next evening, and I'll be afraid to open the door again.

Yeah, but with practice doing this compartmentalizing in the daytime, at least you're not dragging that whole experience with you.

And then we can look at how do I create a different relationship with the bed so that I'm not terrified of going into the war zone.

And name, how about if I name my bed?

Is that a name the bed?

Like, you like your dog or cat, I'm gonna name the bed something I'm comfortable with.

Yeah, and you can also name that voice in your head that's saying, oh gosh, I gotta go to bed, and what's gonna happen tonight, and tomorrow's gonna be difficult, or I have to get to sleep, I have to get sleep or else.

That's a voice in our head, that's our safety brain talking to us to try to get us to act to avoid the tiger.

The tiger brain.

I would call it tiger brain.

Hey, tiger brain.

Yeah, some people call it the monkey mind.

But if you give it a name, it automatically separates you from the content.

Absolutely.

We can create compartments that we can relate to that voice differently instead of automatically buying into everything it tells us, which is where we get into trouble.

We believe it and it tries to encourage us to believe it by generating physical responses and fear and emotion.

It becomes very convincing.

But if we can separate ourselves from it a little bit, we can create a relationship with that voice that says, I hear you, because if we try to squash it, it doesn't matter.

I will tell a tiger brain or monkey brain, hey, leave me a voice message.

I'll get back to you tomorrow in the daytime.

That's literally, absolutely.

And we can do this throughout the day as well.

You literally make a, you acknowledge that.

You say, thank you very much.

Appreciate you're trying to help me.

You're trying to save me from the tiger.

But I recognize with my human brain that this is not being chased by a tiger situation.

So I've heard you, I'm going to deal with you tomorrow, and now I'm going to go to bed.

It's one of those strategies I use in business.

If I got someone who's a high maintenance client, who you can't please and I'm busy, I'm like, how about we talk, you know, I'm busy.

I'll talk tomorrow with the tiger brain during the day.

So the nap, when you mentioned, can you fall asleep in a park?

And I said, yes.

Is there a problem with taking a nap in the middle of the day?

For most people who are sleeping well, absolutely not.

I like to find a nap gap in my diary in the afternoon.

I could consider it quite a luxurious, decadent little things, just a little block of my diary where I don't have anything to do, where I could grab a 20-minute nap.

I really like that, but I don't have difficulty sleeping.

If people are having difficulty sleeping, particularly falling asleep, naps are risky because it takes a dent out of the chemistry that we need to build to its maximum for sleep.

Now, there's exceptions to this.

People should take a nap if they feel so sleepy that they feel in danger.

They have to drive somewhere, for example, safety first.

But in general, avoiding naps.

But if you have to take a nap, keep it short, 20 minutes or less.

Keep it as early in the day as possible, and then stay up a little bit later to make up for it if you can.

So basically, if you are a listener having trouble sleeping, insomnia, whatnot, a nap is not a good idea at this point in your treatment.

Very tempting for people who can nap.

Not everybody can nap because their arousal, their fear response is so high that it makes it difficult for them to nap.

Avoiding a nap is ideal.

I always get kicked back like, well, I'll sleep if I want to.

Okay, you can.

That's absolutely fine.

You can sleep four hours in the middle of the day if you like, but you can't complain about not falling asleep.

And probably also another myth buster possibly, because maybe somebody else feels great taking naps, and they get good sleep, and they're trying to help you.

But you know what your problem is?

You just need a nap.

I take a nap and I feel great.

It puts me to sleep, so you're falling into that trap, perhaps?

When people do have the ability to sleep, I always suggest that they sleep in their bed.

So if it's a 20-minute nap, and this person is capable of taking a 20-minute nap, setting an alarm so they don't oversleep, anything to pair that sleepy feeling with the bed, we want to encourage that.

Some therapists disagree with that, saying we want to encourage sleep at night.

No sleeping in the park then, that's not the strategy.

Under a tree in the park in a...

What's interesting about sleeping in other places, not a problem if people don't have issues, but what can happen is if somebody's having difficulty sleeping in bed, and then they kind of, they give up, and they go out and they sit on the sofa, and because they've given up, they fall asleep because their arousal has dropped, they're no longer trying to sleep, they're sitting up and they're reading or whatever, so they start to get sleepy and they sleep on the sofa.

What happens over time is the sofa becomes associated with, oh, it's relaxing here, there's no stress here, and I sleep here, which is fine.

But that person's not gotten over this stress and anxiety about not being able to sleep in bed.

This actually has happened with my mother.

I hadn't gone home for a very long time to where I grew up.

My mother sleeps on the sofa, and she doesn't mind me telling this story, by the way, because that is the place that she's associated with sleep.

Now, it works for her and her relationship, but it wouldn't work for everybody.

And what happens is if you want to then go back to sleeping in your bed, you have to overcome the drama around sleeping in bed.

At the same time, you have to resist sleeping on the sofa.

So although it feels really good in the short term to get some sleep on the sofa, in the long term, doing that regularly is a problem if you want to go back and sleep in your bed.

Yeah, when I've done that sometimes, in its temperature, so I'm in a two-story condo, in the summertime, it's cooler downstairs and warmer upstairs.

Yeah, yep.

It'll work for one or two nights and then sleeping on the couch doesn't do it anymore.

What else can I do to, couch is not fixed.

It was for the first night or two, but it's not working now.

Yeah, but what's the common denominator here between the bed and the sofa?

Well, it's me.

So what about ACTI?

What is ACTI?

Yeah, treatment.

It's another evidence based approach called acceptance and commitment therapy for insomnia.

Again, there are insomnia specific elements.

I like ACT, ACTI from a mindfulness based angle.

And I think a big takeaway to simplify what ACT is all about is creating that space so that you're not getting sucked into the fearful thinking around sleep.

And despite how you feel, you might feel really shattered.

But if you start giving up work and start giving up your friends and start giving up your hobbies so that the only thing that fills the frame of your life is fixing your sleeping problem, you're creating more problems.

So in ACT, there's this concept of values-based action, taking action toward the thing that you know is best for you, that you really want, like to hang out with your friends, to go out for that dinner, to go on this trip, whatever it is.

And doing that despite the fact that you feel tired, it's sort of like the, there was a meme that I saw on social media the other day that kind of sums this up saying, you know, I want to do this, but I'm scared.

And then the reply was, well, then do it scared.

And that kind of sums up the values based action, because keeping our attention focused on the things that are really important to us, is A, going to make the journey a lot better and a lot more meaningful, because we're going to be engaged in things that we love to do.

It's going to take the focus off of sleep and it's going to take the power away from sleeplessness that we historically typically have given it.

We've said, I had a bad sleep, so I can't do whatever, or I'm afraid I'm not going to sleep, so I can't do this, or I had to do that, I had to take a sleeping, but I had to do this.

We disempower ourselves with our language around sleep a lot.

But values based action is saying, yes, I feel this way, but I'm going to choose what I'm going to do.

And it might be to take a nap, or it might be to not take a nap, go out with a friend instead.

But it puts that person who's using that different language back in the driver's seat instead of giving all the power to the sleeping situation.

And what about sleeping medication?

I think that falls into our alcohol, but there are probably people who the doctor has prescribed sleeping medication for sleep therapy.

And we don't, I'm not a doctor, and I try not to step on other professionals' toes.

What do you think about the medication though versus these other treatments?

Well, if you look at the treatment algorithms for the management of chronic insomnia across all major medical associations worldwide, across all sleep associations worldwide, medications are not the first suggested alternative.

But they're often the first thing given simply because it's easier to deliver than sleep therapy is to deliver.

And again, I'm not a doctor or a prescriber.

People come to me and they say, you know, should I be taking this?

Should I not be taking it?

I can't answer that question.

But most people come to me and they are in a position where their sleeping medication has side effects that they do not want.

They don't want to be on it.

Or it's not helping their sleep sufficiently.

And I can work with people, even if they are on sleeping medication.

Or if they want to taper off first and then work with me, that's absolutely fine as well.

What's tricky is if people take things sometimes, depending on how they feel, because again, that gives power to the sleeplessness.

But I can work with people across that entire spectrum.

I think the most, it's not just sleeping medication, people can become psychologically dependent on anything.

The special sleeping mask, heaven forbid, you lose your special sleeping mask.

Or the ritual, like the eight things I have to do before I go to sleep so that I sleep better.

Well, if those things worked, you wouldn't be coming to see me, right?

Even for people who know their sleeping medication is not actually helping their sleep, they become afraid to not take it.

So that is the element that I can work with.

I can help people with the conversation around medication with their practitioner and help them come to a decision about how to safely biologically, medically come off of medication.

But I help a lot with that psychological side.

Again, that exists with medication, with lots of other things too.

An interesting thing I discovered, I don't take it to fall asleep, but I think I had a, he was taking it and being an engineer, I was kind of like, I wonder how it works.

And I learned that the over-the-counter stuff, you don't need a prescription for that makes you fall asleep.

It's actually the allergy medication that they saw as a side effect makes people sleepy, but it's actually the medication that would give you if you have allergies, and they have no idea why it makes you sleepy.

Yeah.

Yeah.

It depends on the particular receptors being blocked or not, or facilitated depending on what the medication is.

What's interesting about antihistamines, in older people, they increase falls risk.

So there are additional risks for taking that kind of class of medication.

And also, if you look at some of the studies that have been done, the actual effect of the antihistamine itself on sedation tends to wear off relatively quickly.

So if somebody says, I've been taking fill in the blank antihistamine, and I've been taking it for three years, and every night it puts me to sleep in five minutes, I say the placebo effect.

Oh, not right.

Same thing with melatonin.

Melatonin people swear by it.

I take it, and I fall asleep in five minutes.

But A, that's not how it works.

Yeah, it's a hormone.

It's not available over the counter in the UK.

It's a prescription medication here.

It's available over the counter in a lot of countries.

But buyer beware, you don't always get what's on the bottle.

Sometimes you get a lot less, sometimes you get a lot more.

Sometimes you get other things because in most countries, if it's not on prescription, it's also not regulated.

They have no need to prove there's a certain amount of anything in it.

But people say, I take it and I fall asleep in five minutes.

That is the power of the brain because that is not how melatonin functions.

What happens is people take it, they take it and they go, oh, I don't have to worry about sleeping tonight.

And then voila, they sleep.

Nothing wrong with a good placebo effect, but it creates dependence, it creates a psychological dependence that isn't warranted in that situation.

And what came to mind is if I had a partner who was having trouble sleeping and I felt bad for them, I don't want them to take all these pills all the time.

I could swap them out for pills that are the same color and shape, placebo, sugar pills, and probably still work.

I wouldn't obviously suggest anybody do that.

The mind is really powerful.

And if we look at long-standing insomnia from the most established model of how it comes about, if we reduce the fear of not sleeping, people could sleep better.

Yeah, I've heard you say that a lot.

So that for me is an interesting takeaway.

That it all a lot or what I'm hearing is the fear of not falling asleep is a big factor.

Yeah.

And the more we put pressure on ourselves to sleep, the more we're sending a message to that brain that says, oh, there's danger here and we can't sleep if we feel like we're in danger.

So we get caught in this loop, this kind of fear loop where the anxiety about not sleeping increases and then the sleep gets worse and then the anxiety gets worse and then the sleep gets worse.

And soon we're kind of circling that drain of trying harder, harder and harder.

Does it work as a strategy just to, for me anyhow, to try is next time I have a hard time falling asleep, instead of trying so hard, go, I don't care.

What's worse can happen and I don't fall asleep tonight.

I've got to fall asleep sometime just.

Yeah.

Reducing the fear of not sleeping, really considering how rational, how big are the consequences that I am deeming are going to happen if I don't sleep and looking at those more objectively.

With CBTI, for example, again, the longest like 30 years of evidence behind it.

There are some interventions within CBTI that are not appropriate for certain people with certain health conditions in certain situations.

Those are more the sleep structuring types of things.

Even if you take those away because people can't do those because it's not safe, working on how people think and feel about their sleep is a game changer.

So I just thought of a real example when I was in college, an engineer, and I'm working full time.

I work till 11 p.m.

I've got a calculus test at 7 a.m.

in the morning.

Yeah.

I've got to get up, drive, and then ride my bicycle to get to class and cram.

I'm panicky.

That's why I am afraid I must fall asleep.

If I don't get four hours of sleep, two hours of sleep, some sleep, there's no way I can take this exam.

Walk me through quickly.

I've heard it all, but it sounds, how am I going to not be panicky?

Yeah.

Practice is the answer.

It's difficult with one-off situations.

Okay.

Because obviously we know that we perform better if we have better sleep.

But the reality is if we let ourselves panic about it, we're not going to sleep and then we will perform more poorly as a result.

And that's why it takes practice and exposure to those circumstances.

A little bit different example with kind of a performance type of situation.

I've worked with athletes who have a lot of difficulty the night before a big event, or the couple of nights before the big event.

One person, his approach was to, or even big training events where they're with other people, and so they feel a bit self-conscious about their performance.

This one gentleman decided to do the full exposure route by essentially scheduling as many training events as he could put into his diary.

So he went through it again and again, gave himself opportunities to practice, to look at these kinds of thoughts, to allow himself to feel uncomfortable and go and do it anyway, and just did it over and over and over and over again.

I kind of lost it.

Actually the brain stopped panicking about it.

Do you mean he was training himself to fall asleep?

No, he was training.

The training was for the event.

So instead of doing an event a week to train for this final event that he was having, he decided he's gonna schedule four every single week all the way until the main event.

So he had four opportunities every single week to go through this drama that he went through on the night before one of these events.

And he showed, he had opportunities to practice showing his brain, he wasn't gonna die because he didn't sleep well the night before.

And also to say, actually, I performed okay.

We tend to be a lot more resilient than we think we are, but we get stuck in this cycle of, I've got this big thing tomorrow and it's gonna be a disaster if I don't sleep.

So we believe that it's gonna be a disaster, which is problem number one.

And so we believe that voice because the voice is saying, it's gonna be a disaster, so you better get some sleep.

Unfortunately, that doesn't help us get any sleep, it makes things worse.

So lots of repeated exposure and practice to that is eventually how he dropped his fear.

It's easy to do it just from our eyebrows up and say, oh, don't worry about it.

It's harder in practice.

Well, it's a little easier if you're an athlete and you're a professional athlete, you have resources, people to help you.

If you're in college and your student is like, I could take my final exam.

You can't really get to practice that too much.

You get thrown into the middle of the pond without your life jacket.

Just do the, you know what it is, what it is.

And we're saying, don't worry about it.

What's worse that can happen?

I fail, fail.

Yeah, and most people don't, because we are much more resilient than we believe we are.

The problem is that it's more uncomfortable.

So if you look at people's performance, say cycling, I think there was a study on cycling.

You can't quote me on that, but I believe it was cycling.

And they looked at groups of people who slept well and people who didn't, and they had them do trials and lab.

Both groups did equally well.

The group that didn't sleep very well, their perception of their effort was a lot higher.

So it felt harder for them to achieve what ended up being the same result as the other group.

And that's where this intolerance for discomfort within us creates problems because we think, well, if it's hard, then I shouldn't do it or I can't do it.

We equate discomfort with fear or discomfort with, oh, I can't do that.

And that's where ACT is useful.

It says, well, you might be uncomfortable, but you can choose to do it anyway.

And people say, how did you get through your bouts of insomnia?

My first one in particular.

And it was, I didn't realize how I got through it until after I got through my second one.

I stopped focusing on sleep.

I kind of gave up trying to fix it, and I got back to living my life despite feeling crappy, to be honest.

And that changed the game.

It really changed the game, you know?

If I stayed stuck in comparisonitis and said, well, I'm not going to be as much fun as I used to be, or I'm not going to be as much fun as I know I could be.

Well, I just wouldn't have done anything.

I'd have just been paralyzed by the comparisonitis.

I got so tired of the drama and the fight and the struggle, that it wasn't really a mental thing.

It was sort of like a full experience giving up of it.

Of the drama and the struggle.

And yes, it was still uncomfortable because for a while, I was still not sleeping well, but at least I was re-engaged with my life.

And I was doing things that were important to me.

And then I started sleeping better because I was not engaged in the drama.

Some people have ongoing drama, you know, perimenopause and waking up with hot flushes and that sort of thing.

That's a biological thing that is going to affect half the population.

And if they get to the age where they're going to experience that, there's a difference between waking up with a hot flush and then calming back down, going back to bed and falling asleep, or waking up with a hot flush and then panicking about being awake and everything that's going to happen.

So although actually the studies show that those symptoms decrease when people do CBTI as well, the sleep improves but also the symptoms improve.

If we have a level that is the pain of not sleeping, we add on this additional level of the suffering of our relationship with not sleeping, and we can fix that piece if it's insomnia for sure.

There's 85 different sleep disorders.

If it's something else, it's a different approach.

But when it's insomnia, we can make our daily life a lot more meaningful to us and valuable to us if we're willing to put up with a little bit of discomfort along the way, and that really helps people sleep better over time.

Nice.

So is there anything I haven't asked you, I haven't talked about, you feel it's real important for people to know?

Oh my gosh, I could talk about this stuff for hours.

You can.

I didn't realize there was so much to sleep.

We could unpack each of those questions for a long time.

I think we hit a lot of the big points, a lot of the points that connect all these things together.

I think that the only thing I would mention is, I touched on it just now, is that there are over 85 different sleeping disorders, and it's really important to get a diagnosis to be screened for other sleep disorders, because this psychobiological element that is insomnia specific would not be the approach for sleep apnea or restless leg syndrome or periodic limb movement disorder or a REM behaviour disorder.

There's a whole hope or circadian rhythm disorder.

Now, you can have those other conditions and have insomnia.

For example, someone with sleep apnea wakes a lot, but then they might be awake for a long time.

So the frequent waking might be the sleep apnea, but the long awakening and the worrying would be the insomnia piece.

Those other things need to be intervened with appropriately, and these approaches wouldn't fix those problems, right?

So that's important.

So Tracy's website is tracethesleepcoach.co.uk.

It'll be in the show notes.

You can go there to get resources.

He has a sleep recovery course.

People can take it on their own, right Tracy?

Yeah.

You can also book a one-on-one session to be coached by her one-on-one using one of her sleep therapy coaching programs.

And she also has a YouTube channel.

It'll be in the show notes too.

Yeah.

Thanks.

And if anybody wants to just see if my interventions and support would be appropriate, I offer a free 20-minute chat.

Nice.

I'll take you up on it when I'm trying to fall asleep some night.

This is a good time to book a session.

Thanks so much for being on my show, Tracy.

This has been real informative.

A lot of great tips.

Yeah.

Thank you so much for having me.

Thank you.

Good night.

I wish you the best and a good night's sleep.