The People, Process, & Progress Podcast - How to Optimize Your Sleep | KEV Talks #2

Episode Date: October 4, 2022

Sleep is critical for the mind, body and some say spirit to heal and maintain function. In this episode I'll help the listener understand the principles of Cognitive Behavioral Therapy for Insomnia (CBT-I) and share what worked for me when I had a bout of insomnia.Key Components Discussed:CBT-I vs. MedicationHow much sleep do we need?Multi-Component elements of CBT-ICognitiveBehavioralPsychoeducationalKey CBT-I ElementsStimulus ControlSleep Restriction & CompressionRelaxation TrainingReferences:https://www.sleepfoundation.org/insomnia/treatment/cognitive-behavioral-therapy-insomniahttps://health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/get-enough-sleephttps://www.cdc.gov/sleep/about_sleep/how_much_sleep.html

cue superhero landing I gotta tell you I'm glad I take krill oil and glucosamine because those superhero landings are tough thanks everybody for coming back to the KevTalks podcast episode two got sleep well if you're joining me today the plan for this episode is to put you to sleep or at least help you to get to sleep, stay asleep, get back to sleep because sleep is important. It's important to heal our minds and our bodies. Some would say our souls. So let's talk about that. So first, how much sleep do we need? There's probably a range that we've all heard of. Let's use the CDC. They say if you're 13 to 18 years old, you need eight to 10 hours of sleep. Between 18 and 60 years old, 7 or more hours of sleep.

And then older than 60, it fluctuates between 7 to 9 or 7 to 8 hours of sleep. So that's the ideal hours of sleep that we need to help our bodies be healthy, our minds get some rest. And it really is critical, right? Because our mind repairs like our body does. And that's a big deal. get some rest. And it really is critical, right? Because our mind repairs like our body does. And that's a big deal. So what I'm going to talk about today is cognitive behavioral therapy for insomnia. And this is a way to improve your sleep to address insomnia without drugs. In fact, cognitive behavioral therapy for insomnia or CBT-I has been shown to be more effective than benzodiazepines like

Valium or Xanax and non-benzodiazepines like Ambien or Trazodone, which is also given for sleep. And it's more durable because you're changing the way you think about things. You're changing your actions. You're changing the environment around you. And we'll get into this, of course, and my reference, I want to mention the CDC, but I'm going to talk about an article the Sleep Foundation used. And I referenced when I was having some insomnia the past few months and really made a big difference in getting some good sleep and changing my mind around sleep. Have you ever not slept well and you're just down about it all day and then it's time to go to bed and you're like, man, I hope I sleep tonight. And you overthink it and you can get in a cycle and maybe you don't sleep as good that night either. So CBTI is what that's all about is fixing it. So it is really looking at the connection between your thoughts, your actions, and your behaviors, how we sleep.

You can do this with a therapist or with someone, a psychiatrist trained in CBTI, probably the ideal method between six to eight sessions. And again, I'll share this link to the Sleep Foundation article. And there's a great YouTube video too. I'll share the link to that that goes through this whole PowerPoint presentation that covers the same stuff we will. But if you want to see it from a pro, from a sleep expert, that's cool. I'll link to that in the show notes. But it says between six to eight sessions or with your primary care physician, maybe two. I don't know what the disparity is there. I think it just depends on how well you adapt.

I know I didn't have any sessions in particular other than talking about maybe supplements or even some non-benzodiazepine. And I say non because benzodiazepines, if you've ever been on them or if you know about them, I don't think I've ever been on them before other than maybe before surgery to kind of show you out that shot they give you. But they're very addictive. You may sleep, but your sleep cycle is not great. Still kind of in the background, but they're very addictive, right? Because it works or they feel good or all these different things. So it's bad for you. You can kind of get addicted to non-adventive as it means too. But at any rate, so the CBTI is what we want to do. We want to

change what we do. And so the main components are there. It's a multi-component approach, and it's looking at our cognitive interventions, our behavioral interventions, go figure CBT, right? And our psychoeducational interventions. And so really the cognitive piece of that is going to look at the inaccurate or unhelpful thoughts that we're having about sleep. Like I'm anxious about sleep. Some people have sleep anxiety. I had that after I had a panic attack, right? I was nervous to go to bed because it happened at night. I sprung up. I didn't feel good. I was breathing hard. So going to sleep was a challenge for me because I was afraid to go to sleep. And a lot of people have that. I see it on the Reddit boards with anxiety and other places. And so that alone can be an issue. So addressing that helps with

CBTI or unhelpful thoughts. Again, that I didn't get enough sleep, so I'm not going to sleep again tomorrow. So I'm going to think real hard about sleep so that I'm not going to sleep as well. And you get in this cycle where eventually you have to start accepting that, yes, I'm tired. Yes, I didn't sleep good. Tonight, I'm going to have good sleep hygiene, and we'll go over that. And I'm just going to accept what I accept. I'm going to get through the day. And it's amazing. And again, this is a perspective that particularly the past few months after I read Man's Search for Meaning, and I'll mention that probably a lot on this podcast and in posts that I've done because it's a life-changing book. It was written by Viktor Frankl.

It was from his standpoint of being in Nazi concentration camps, like three or four different camps. His family was killed. Of course, millions of Jews were killed and other folks were killed in the concentration camps. His family was killed. Of course, millions of Jews were killed and other folks were killed in the concentration camps. And the big takeaway, of course, is, you know, if you, if you have your why, you can figure out how. So if your why is that you're going to keep going, you're going to, you know, work through this insomnia, you have a family, you have a baby, you have a job, you have a sport, whatever it is, you can figure out how to do it. And we can do amazing things exhausted. I mean, examples from that book, Man's Search for Meaning, is little to no sleep, little to no clothes, in freezing cold weather where your shoes are all busted up.

There's, you know, let's say a number might be off 100 people in a space where normally there would be 25. And if you've seen any of the pictures from there, so just, you know, sleeping on those racks, no pads, no blankets. So if you're in a decent place with heat, with air conditioning, with a bed, you're already better off than a lot of other folks. And if you didn't have a good night's sleep, it is awful. It feels horrible, but it could be worse. So keep that mantra. It could be worse. Keep pushing through, be tired, and let's use some of these CBT-I skills and get you all sleeping better

like it helped me sleep better. It really made a big difference. So cognitively, we need to change our thoughts, our, you know, what we think about sleep and what, you know, those unhelpful thoughts that we're not gonna sleep and oh, this impact and it doesn't hurt me. We can go pretty long without sleep.

The other big thing obviously is behavioral. So that's what we'll dive into. Relaxation training, stimulus control, sleep sleep restriction which i'll go into they help promote relaxation and eventually it gets your body to the point where it's like all right i have to go to sleep your body and your mind right because it's a it's a partnership there and then the psychoeducational interventions that they mentioned that's the word they use on the sleep foundation site and again i'll link to that is really talking about that connection between your thoughts, feelings, behaviors, and sleep. And a lot of that is like the cognitive behavioral therapy plus the insomnia focus. But when you do CBT or if you've done it,

that's a big thing that your thoughts aren't necessarily reality. These feelings that you have aren't necessarily reality. And so it's kind of how to help manage that. And they have some really good tools like one is cognitive restructuring right you don't want to reinforce those dysfunctional thoughts that you have about sleep that you can't sleep that it's hard to sleep you know negative thoughts breed like other negative thoughts there's another good saying I can't remember for it right positive thoughts or accepting thoughts help you start to not, you know, stew on that kind of thing. And you restructure it and you help adjust the anxiety and you're going to be

tired during the day, but you know, you can't dwell on it constantly. One of the actions that we'll get into kind of less on the cognitive and let's get to the actionable pieces, right? We're about eight minutes in almost, is stimulus control. So this is huge and a problem today, right? Because we have access to so much, any kind of movie, TV show, music, right? So just the short of it is if you watch an action movie, a gory horror movie, something that keeps your mind racing, or you keep reading work emails, or looking at your phone, you are stimulating your brain, you're not sending it in a relaxation mode. So the stimulus control is that you need to not watch those things, right? For some folks that you have PTSD, or anxiety about

a certain thing, but you're watching a movie about it, or you're depressed, and you're watching sad or gory, scary movies, that's not going help your mindset anyway, let alone when you wanna go to sleep. The other thing is for stimulus control is that in your bedroom, and there's some great videos, again, I'll link to these for Therapy in a Nutshell, a whole bunch, which is great. I found so many great resources

over the past few months out there, is you only use your bedroom for two things, sleep and sex, that's it. Maybe reading a book if you have a space, but the key is your bed, right? You don't associate your bed with doing work emails, with listening to heavy metal, to watching scary movies. And I did that. My wife and I liked watching TV in bed and hanging out in bed. Now I have the TV on in my bedroom sometimes when I'm folding laundry or something, but don't associate your bed or you have to break that association with your bed.

So two things, you sleep in the bed, you have sex in the bed. That's it. One of the videos I saw is maybe reading, but even that, like I have a chair in my room, I have a decent sized bedroom, which is good. And I'll read in that or I'll read in my living room. But that's something that's great to do. And again, I do my best not to be on my phone an hour before I go to bed and not to really watch TV an hour or two. I've gotten a little worse at that lately. Just some good shows that I've

wanted to watch. But again, the blue light on your eyes and just the stimulation of having a screen makes a big difference. So at least an hour, let's go with an hour for now, right? So an hour before bed, no phone. And phones. I use an iPhone. They have a sleep mode too. So it starts, it turns the screen dark on the whole phone and on applications that have a night mode, which is great. So if you have to look at your phone, you're also not getting hit up with bright light. But you can also put it in sleep focus. So you don't get the alarms and any alerts that you would normally get during the day. So again, your stimulus control is working really good. But the big thing here is if you're watching things that stimulate your

brain, listening to things that do that long before, or even exercising like an hour before bed, that gets you going, right? That's why I work out in the morning. You could work out maybe at like two or three in the afternoon. Some folks work out at four or five, but if you work out at like eight o'clock and you go to bed at nine or 10, you know, that might not be great. But so that's where we look at stimulus control, sleep restriction and compression. And this was one that was really hard for me as hard for most people. So if you have insomnia or just having trouble sleeping and you're going to try the sleep restriction, maybe check in with your doctor if you have medical conditions. So here's the example, just straight from sleep foundations website. They say you have medical conditions. So here's the example just straight from Sleep Foundation's website.

They say it better than me. So, quote, for example, if a person is trying to sleep eight hours a night but only getting five hours, they start by adjusting their bedtime to spend five hours and 30 minutes in bed. Once a person spends the majority of their time in bed sleeping, they can begin gradually increasing their time in bed, end quote. So you're going to go from being in bed for eight hours to being in bed for five hours and 30 minutes. The difference is you're going to get up at the same time. So a lot of the videos, reading I've done, get up at the same time. So still set your alarm for whatever time you normally get up, but you're going to go to bed way later, right? So two and a half hours later, it's tough. You're going to be tired. But

by the time you get to bed, you're going to, you're going to sleep in your mind and your body. You're going to want to sleep. It's not going to be perfect. You might be exhausted a few days, but your body and your mind are going to be like, okay, okay, we have to go to sleep now. And it's going to work. Um, it's going to take a little bit of time. Again, it could take a few days. It could take a week. But again, check in with your doctor if you need to or try it on a weekend. It works really well. So I'll give you my example.

Doing this sleep restriction plus stimulus control really was the key for me. Plus, I did take some supplements. I took a thing called Trazodone, which the docs gave me. They give it to a lot of folks. It's primarily for depression, but they give it off-label, which is why I was taking it for sleep. I didn't like the way it made me feel, so I tried that. So my kind of winning combo now is a couple hours before bed, I'll take melatonin, either Oli Sleep or Oli Sleep with Immunity and get that in the system. I also take magnesium glycinate.

There's a whole podcast and list and maybe I'll do a supplement episode. But I'll link to actually Andrew Huberman's kind of sleep stack kind of thing. But to me, those are the two things that work really good. They're more natural. I know we don't need melatonin all the time. There's a whole bunch of things, but that works for me. So a couple of two hours before bed, right? Well before bed.

Limit what I'm watching or turn the TV off. And then an hour before bed, phone away, not looking at that, and then read a book, right? And usually for me, that starts at 8. So my two hours starts at 8. My goal is go to bed at 10, get up at 6. So what I started doing was start this process at nine or 10, probably nine, and then go to bed later at 11 or 11 something, because I still wanted to get up at either five something or six. And yeah, I was tired nights, I didn't sleep all through the night. But gradually,

I started being able to sleep more and more, I'd sleep for like five, six hour chunks before I would wake up, either have to go to the bathroom or just, you know, wake up, I have to put myself back to sleep or walk around because I couldn't sleep. And I would walk around and I didn't mention this in the sleep stimulus control rather is so not only during the day when you're just doing stuff, do you not want to use your bed for things other than sleep or sex? Even if you sleep during the day, it's short naps, like usually before three o'clock, no longer than like 30 minutes. But also at night, if you lay in bed for longer than like 10 or 15 minutes, you need to get up and walk around or go read a book. Don't turn super bright lights

on. Just kind of go somewhere where you can chill out, focus your mind because you're not sleeping. And again, if you lay there, your mind's going to associate restlessness with not sleeping and it's going to keep that cycle going. So during the day, don't use your bed. And then at night, if you get up, get up and walk around. Don't look at the clocks. That makes it worse too. Then you're like, oh, I only have three hours or four hours or an hour. Just kind of walk around and do your thing and read a book or do a task that's not too stimulating. And then when you're tired, go back to sleep. And again, when you're restricting your sleep and this happens, it's very hard to do. You're going to have days you're tired. So just be smart. If you have to

drive on a trip the next day, don't do this sleep restriction. It could be worse than your insomnia, who knows, but do this. And when you keep doing it, it will help. There's trackers for this, apps for this too, that help calculate what time you should go to bed, which I use. I actually have a great one from the VA for veterans in particular, because for PTSD, sleep is a problem. Insomnia is a big problem. A lot of times when we go to sleep, we think of stuff we don't want to or first responders or really anybody that's had a traumatic event, right? And then relaxation training is kind of the next tool that we talked about or that I mentioned or if I didn't mention it, I'm mentioning it now.

That's part of the CBTI. And there's breathing exercise. There's so many different ways to do breathing exercise. There's box breathing where you like breathe in for four, hold for four, breathe out for four, hold for four. That's really relaxing. And other kind of numbered breathing systems that equal seconds that you hold or breathe. There's progressive muscle relaxation and that's a good one. So think about, you know, flexing your toes were hard and let that go. Then your calves, then up your legs, basically each of the big muscles up to your head and then you relax them. That's a big help in relaxing. Um, that's not really one of my favorites. Um,

the, the box breathing is good. And there's some other things on the website I'm just not as familiar with, uh, like autogenic training where you focus on different parts of the body, biofeedback, where you look at like brainwaves heart rate breathing hypnosis which i have never done meditation i do very regularly and kind of mindfulness so each day i'll do or most days at least 10 minutes where it's just me in meditation and it's guided and i use headspace i've mentioned that before headspace is awesome it's the best app that i've used again Again, no plug there, no kickbacks from them, but just keeping it real. That's one that I use. So you can set two. Do I want to do five, 10, 15 minutes, 30 minutes? You can really go a long time. I've found 10 minutes is pretty good. It helps you get your brain to be able to

calm itself down. So if you're anxious at night or you can't sleep, to be able to kind of take those breaths, to do that box breathing, to focus on something else. There's also great on Spotify or other online streaming things like night or sleep hypnosis or sleep meditations. You just have to try some out, what works for you, what doesn't. But that's the other kind of tools that we can use to help us go to sleep as far as relaxation.

They work really good. One that I've used a lot too was white noise. There was a, you know, it's interesting when you get anxious at night before I get anxious, before I had a panic attack, I wanted dead silent, pitch black. And then I was really nervous and I actually wanted a little bit of light and some noise. I think it helped me feel a little safer. And then as I gradually kind of was able to reprogram and recalibrate and just kind of come down off that anxiety. Now I'm kind of back to, I want it really dark. But if it's going to be loud, maybe around you or something like that, there's white noise. There's white noise in that Headspace app. There's a great one that's like a fan noise.

So if you just have that going in the background, it can also help drown out other noise. Like if you live in the city or somewhere it's loud, white noise is a great thing. There's also white noise machines and all these others. You just got to figure out what environment do I like. Once you've already done the stimulus control, once you're doing your sleep restriction, you're relaxed, then you're kind of fine-tuning your sleep environment. And it really does make a big difference.

And Sleep Diary is one of the last things they mention here as far as kind of homework. And so you program, and this is one thing I do each morning is like a to-do list that's kind of like the the Savers program I've mentioned here. That's part of the Miracle Morning, Hal Elrod's deal, which is awesome, which is where you're at each morning for 10 minutes each. You do some silence. You listen to affirmations. You look at a vision board. You do exercise. You read and you scribe or journal. Well, this one is a sleep diary. So each morning I would write how I slept as part of my scribing the night before. And then I stopped doing that because I started kind of getting in that cycle of overanalyzing it. And like I talked about earlier in this episode, that's kind of one of the negatives, but it was good to track. Did this help? Did that help? You know, the different

supplements I took for sleep or the actions I took or, you know, something like that. So again, CBTI, cognitive behavioral therapy for insomnia, works better than most any or all medications really, and it's more durable. Here's another quote just right from the Sleep Foundation. When these techniques are used together, meaning what we talked about, sleep restriction, stimulus control, some of the other stuff, used together as multi-component CBTI, as many as 70% to 80% of patients with primary insomnia experience improvements, right? Includes less time to fall asleep, more time spent asleep, and waking up less during sleep. And these results are maintained over time, end quote. That's the thing about looking for a quick fix in the pills.

It may be short-term you might need that if you just had a traumatic event or you're just having a bad short-term thing. That's between you and your doctor. So it could help you get maybe a quick, maybe you haven't slept already for four days and you're just, you know, dragging and you just need to be knocked out. But CBTI is going to help fix the problem more long-term, more naturally. It will, by getting better sleep, help you get sick less often. It actually will help you have a healthier weight, lower your risk for things like diabetes and heart disease, reduce your stress, improve your mood, think more clearly,

get along better with people, make better decisions. And this is just a list from, uh, health.gov. Again, I'll share this link as well, but a quick summary, if you didn't listen to the first part of this episode and happened to jump to the 20 minute and 15 second episode or a timestamp is if you're not sleeping well, cognitive behavioral therapy for insomnia or CBTI is a natural, no drugs way where you're going to change how you think about sleep, how you control the environment that you sleep in. You're going to not watch scary or gory movies. You're not going to be on your phone right up

until you go to sleep. You're going to only use your bed for sleep or sex. You're going to not hang out in your bedroom if you're not tired during the day. If you're going to shut down their stimulus an hour before bedtime, you'll read a book before you get to bed. Only go to bed when you're ready to sleep. If you're having trouble, that's where we got to look at sleep restriction, where if you're laying in bed for eight hours, you're only sleeping five. Go to bed two and a half hours later and stay in the bed for five and a half hours. When you start sleeping actually that whole time, then start adding half an hour and try relaxation techniques. Learn some breathing treatments, breathing

therapies, meditation, yoga. There's a whole bunch of relaxation techniques. I'll link to some of those as well. But sleep is critical. It is a vital thing. It helps us just be better humans, both for ourselves and those around us. And again, I'm so thankful that I found CBTI. It changed my life. It changed those around me's life. Not sleeping is hard, but you can make it through there. Just like Viktor Frankl, find why you want to push through your insomnia and CBTI will help be the how you're going to do it. Thank you all for listening to the KevTalks podcast. If this is your first visit, your first play, I appreciate you clicking on the logo and listen to this one, Got Sleep, episode two. If you listen to the People Process Progress podcast, the previous name of the show, thanks so much for being here.

Go back and listen to some of the great interviews. The last one I had was with Dr. Tracy Marks. A lot of anxiety, other mental health resources there. And as I mentioned on the last podcast, coming up, we got some great interviews, one with a good buddy of mine. We're gonna talk about substance abuse and public safety and gonna talk with an author about mindfulness for first responders, for warriors as she calls them. And so really excited for those podcasts,

really excited to see what the show does. Thank you so much out there. Remember, have a plan, stay informed and get involved. For now, I've gotta fly.