Change Your Brain Every Day - How to Break the Cycle of Sleep Deprivation, with Dr. Shane Creado

Episode Date: June 22, 2020

It’s clear that the pandemic has been devastating to many peoples’ sleep health, because we had a huge response to the recent series on sleep issues with Dr. Shane Creado. So we invited Dr. Creado back to address some more sleep topics that we didn’t get to last time. This episode discusses the cycle of sleep deprivation, and why it’s so important to break it. For more on Dr. Creado's new book, "Peak Sleep Performance for Athletes" visit: https://www.amazon.com/Peak-Sleep-Performance-Athletes-Cutting-edge-ebook/dp/B085YFP9YW For more on Dr. Creado's online course, "Overcoming Insomnia", visit: https://brainmd.com/overcoming-insomnia-course

Welcome to the Brain Warriors Way podcast. I'm Dr. Daniel Amen. And I'm Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body. The Brain Warriors Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain spec imaging to personalize treatment to your brain. For more information, visit amenclinics.com. The Brain Warriors Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com. Back by popular demand is Dr. Shane Criotto, our sleep doctor. Dr. Criotto is a board certified psychiatrist and sleep medicine physician. He was wildly popular the last time he was on.

He did his undergraduate degree in physical therapy and then went on to do his medical degree, graduating at the top of his class, received the gold medal for obtaining honors in every subject in medical school. He has clinical experience with veterans, with college mental health, exercise, prescriptions and mental health, comorbid psychiatric and sleep problems, which he does for us, CBT, insomnia, cognitive behavior therapy for insomnia, alcohol recovery groups, mindfulness-based stress reduction, administrative psychiatry. He's got loads of experience, couples therapy, regressive hypnosis, which I think is just really fun and awesome. He is also the creator of the Amon University course, Overcoming Insomnia. He's the author of a new book, Peak Sleep Performance, the cutting edge sleep science

that will guarantee a competitive advantage, which debuted at number one new release on Amazon and Sports Medicine in March 2020. So Shane, we are so grateful you're back. He's one of our lead physicians in our Chicago area clinic. Yeah, I'm really excited to have you. This is always one of my favorite guests and it's one of my favorite topics because it's just such an important one. And I know our community, especially I know my community for sure, really struggles with this. And because we are at that age, we are female and at that age. And we're going to talk about some great topics today, but I would love for our community, if you would, please post not only what the struggles have been going through all this, you know, with the pandemic and the riots and the fear, post what your struggles have been,

your questions, your concerns, but also tell us what you learned because Dr. Criato is just masterful. And I, he's taught me so much. And I thought I had researched a lot on sleep. It's not even close. So it's really interesting. We would love to hear from you. And if you would take a screenshot of us and send it to us that'd be awesome um so and tag us in it please so thank you and welcome so cute you're so cute you want the screenshot and dr criado is so cute yeah so thank you and pleased and welcome dr criado thank you so much for that generous uh. And it's good to see you both again. Well, life is becoming a Zoom experience, video conferencing.

And, you know, I hate the term social distancing because it's a bad term because we should be socially more connected than ever so we don't get depressed. But physically distancing just makes so much sense so we don't empower the coronavirus to keep spreading and doing damage around the world. One of the big things that's happening with the pandemic is people are not sleeping. Their nightmares have gone up. They're afraid. and the incidence of post-traumatic stress disorder is going up as well. And the riots, I think, are adding to that. Not the protesting, but when it gets violent, I think people are afraid. Well, and then, of course, that's where their news is going to focus on whatever bad things happening. They're going to focus on that, making it seem like something that is local is global. And whenever you see something terrible as global, your anxiety skyrockets. So from a sleep perspective and also

working with us at Amen Clinics, what are you seeing, Shane? We're seeing that anxiety levels are skyrocketing. Even people whose other psychiatric disorders were well-controlled, they're having more frequent episodes, severe episodes as well as mood symptoms. And because if they're in danger mode, they're anxious, they're worried, they're on edge, their sleep will be affected. The Dalai Lama once said that sleep is the best meditation. And if you're in danger mode, your brain is obligated to protect you. Sleep is the most vulnerable thing we do. So you will be more likely to be awake, on guard, on edge, and your sleep will definitely suffer. The problem is if your sleep is devastated, if your sleep is fragmented, you're more likely to have manic episodes, more likely to have severe depression.

And of course, PTSD and sleep are very closely related to one another. So you'll be worrying, your brain won't be able to shut off, then you will be catastrophizing, even the worst case scenario. And then when that happens, you're going to get poor sleep, you're going to recover very poorly the next day, it's going to set you up for failure. And we see that on the SPECT images as well. The rational part of the brain shuts down, the emotional circuits are overloaded and in danger mode. And then just sets up a vicious cycle because the more anxious you are, the less sleep you get. And then the more anxiety you get, the less sleep you get. So with PTSD, post-traumatic stress disorder,

where people have experienced a really traumatic event or they've witnessed it, the danger mode in the brain is really a significant factor that devastates people's sleep. The other thing, of course, is nightmares, where they have a strong negative emotional response accompanied by an awakening. If you are sleep deprived, your brain needs to drink as much dream sleep as possible to catch up. So inadvertently, you end up getting more nightmares because you are sleep deprived because of the anxiety and PTSD. It's called REM rebound in sleep medicine. People with PTSD are also more at risk of sleep apnea, obstructive sleep apnea, leg and arm twitches, which lead to further sleep fragmentation.

They're afraid of going to sleep, especially if trauma has occurred around the bedroom or at night. So they will want to do perimeter checks to make sure things are okay. They may avoid the bed because of the nightmares and the trauma associated with the bedroom. That again causes sleep disruptions. And medications, of course, can affect your ability to fall asleep. Medications that treat anxiety disorders like PTSD can worsen sleep apnea like benzodiazepines. Here at Amen Clinics, we know that benzodiazepines are maybe medications of last resort because of all the damage it can cause to the brain. So those are the ways in which PTSD can really impact your sleep. What are things people can do about it?

So if they have had PTSD before, robbed, raped, in a fire, grew up in a traumatic environment, have been molested. And what we see on scans is their emotional brain is heightened. And so they can't stop thinking about the traumas from the past, which will interfere with sleep. What are some of the strategies that could help them? So there's psychiatric strategies and there's sleep strategies. We know that we recommend trauma-focused CBT, we recommend EMDR therapy, certain medications for the psychiatric component. As far as the sleep component is concerned, for the hypervigilance, for the danger mode, calming strategies, progressive relaxation, scheduling a worry time earlier in the evening, identifying negative thoughts that are unreasonable or irrational, and working on those through cognitive behavioral components. In the Overcoming Insomnia video series, we touch on some of those strategies to calm the busy brain

down. So that's as far as the relaxation, the hypervigilance is concerned. The other piece is to avoid the urge to constantly look for danger at nighttime. So for patients who perform safety checks all the time, refraining from doing so will initially increase their anxiety. But over time, the anxiety will reduce, the checking behavior will be extinguished, and sleep will improve. She's kicking me. No, you're hitting me under the table. I don't see how that's going to make people who need to check feel more secure. Well, let me give you an example of this. Maybe we need a little therapy here. No, we don't.

This is about them. This is about them. She was actually doing really great. The quarantine was fine. During the first part of the pandemic. She was, because she's a prepper. She's prepared. And I felt empowered. And I felt empowered.

And she felt empowered. But when the social upheaval started, she began to unravel a little bit. Now she's checking and she was actually during the beginning, I was watching the news more, you know, I turned that off. And so when the whole george floyd killing and the riots and all of that um i had trained myself to stop checking and now she's checking and all of a sudden we're moving which goes to show you but that goes to show you for everybody listening or something yeah well it goes to show it to a bunker somewhere. Yeah.

So it goes to show you where that everyone is sort of triggered by something different. Clearly the illness was more of a concern for you, but we've all got our own issues. Things trigger us differently, right? So traumatic and violent things are what triggered me far more. I'm a nurse. And so like being able to kick into my nursing mode, I'm like, Oh, I got this. But but I didn't got it for the other thing. And I'm like, I don't have an answer for this. This is not I feel out of my element. And I think a lot of people are experiencing that one or the other they can handle both is like tilt overload. Right, exactly. And and if it's not affecting your ability to fall asleep, then that's going

to be something that that's okay for you. But if it's not affecting your ability to fall asleep, then that's going to be something that's okay for you. But if it affects your ability to function and fall asleep, then it's a problem. And I did notice, I did notice, to credit to what you're saying, immediately when I forced myself to not look at the news, I'm not going to say I didn't do perimeter checks, but when I stopped watching the news and started making my mind focus on positive things that are meaningful to me, like my church services, like my brain went to a totally different place and I slept like a baby. In the next podcast, we're going to talk about the impact of pain on your sleep. But in the last minute, Shane, can you just give people, if they've had emotional trauma, I know there's a medication, Prazosin, that we use sometimes to help decrease nightmares, and you use that a lot,

but give us like just two or three strategies. If you've had PTSD or you're struggling with it now, what are the most important things you can do to help improve your sleep? Well, for the nightmare component, there's a few really helpful strategies. In addition to the calming the brain down, stopping the perimeter checks, one is a grounding technique. So when you awaken from a nightmare, it's associated with confusion. So grounding techniques might include looking at a calendar upon waking up to reorient yourself, holding a special object that is now, and you've got to break that cycle, that thread of thinking. That's really going to be helpful for people to break that aspect of functioning. If you are waking up in a panic, don't stay in bed. Get out of bed. Listen to calming meditation. We have some great ones on Brain Fit Life or other strategies. Once you calm down, then go back to the bed. Otherwise, you're lying in bed worrying, associating the bread with that trauma, and eventually the bed will be a traumatic place for you to be in.

So some people with PTSD, they come to a clinic in Chicago from other parts of the world and other parts of the country, and they say, I slept the best I've slept in years. Because it often happens that their bedroom or the bed is now associated with the trauma. So break the cycle, grounding techniques, relaxation, recalibration. And then you and I created a pretty cool supplement called Put Me to Sleep, which is what people want. They want to go to sleep. And it is just like sold out, but now it's back in stock, thankfully. Talk about put me to

sleep and why that is one thing that can be part of a good sleep regimen. It's a beautifully balanced supplement. And we worked in it for a couple of years. And it has low dose melatonin, so it doesn't knock you out. It helps your brain drift into sleepiness very gently. It has GABA to calm those basal ganglia down, which are your dangerous stress circuits. It has 5-HTP to help boost a little serotonin to help you with stress tolerance. B6, and generally what it does

is it allows the brain to calm down gently. Take it 30 to 60 minutes before a desired bedtime. Give a nice wind down routine. And it just helps embolden and strengthen your natural biological circadian rhythm to function more effectively. So it's beautiful. It's very well tolerated. My patients, none of them have woken up with a hangover or tiredness. They wake up feeling good.

The quality of sleep has improved. Yeah, no, it's so effective. All right, when we come back, we're going to talk about pain and sleep. So important. Stay with us. If you're enjoying the Brain Warriors Way podcast, please don't forget to subscribe so you'll always know when there's a new episode. And while you're at it, feel free to give us a review or five-star rating as that helps others find the podcast. If you're considering coming to Amen Clinics or trying some of the brain healthy supplements from BrainMD, you can use the code podcast10 to get a 10% discount on a full evaluation at amenclinics.com or a 10% discount on all supplements at brainmdhealth.com.

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