August 28, 2024 • 40 mins
In this episode of the Sleep Edit podcast, we welcome Dr. Shelby Harris, a leading expert in behavioral sleep medicine. Often, parents are struggling even after their kid's sleep problems are addressed. We talk about the common sleep challenges faced by parents focusing on the impact of stress, hormonal changes, and modern technology on sleep quality. Dr. Harris provides insights into the diagnosis and treatment of insomnia, emphasizing cognitive behavioral therapy for insomnia (CBTI) and its effectiveness over medication for long-term improvement. The conversation also explores the practicalities of sleep hygiene, sleep restriction, and the influence of consumer sleep tracking technologies.
Links:
- Dr. Harris’ website
- Dr. Harris' on Instagram
- The Women's Guide to Overcoming Insomnia: Get a Good Night's Sleep Without Relying on Medication (affilate link)
- Room sharing recommendation in 2024
- Directory of providers at the Society of Behavioral Sleep Medicine
- University of Pennsylvania CBT-i Provider Directory
- Orthosomnia
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Craig Canapari MD (00:02):
Welcome to the Sleep Edit, a podcast devoted to helping
tired kids and parents sleep better.
We focus on actionable evidence-basedsleep advice, so everyone in your
home can sleep through the night.
Now, a quick disclaimer, this podcastis for general informational purposes
only and does not constitute thepractice of medicine, nursing, or
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(00:27):
No doctor patient relationship is formed.
The use of this information andthe materials linked to this
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The content on the show is not intendedto be a substitute for professional
medical advice, diagnosis, or treatment.
Users should not disregard ordelay obtaining medical help for
(00:50):
any medical condition they have.
Or that their children may have,they should seek the assistance
of their healthcare professionalsfor any such conditions.
Nothing stated here reflectsthe views of our employers or
the employees of our guests.
Enjoy the show.
welcome back to the ThemeEdit podcast, where we provide
(01:11):
evidence-based information forparents and kids everywhere.
I am Dr.
Craig, Canapari.
Arielle Greenleaf (01:17):
Ariel Greenleaf.
Craig Canapari MD (01:21):
Today we are pleased to welcome the one and only Dr.
Shelby Harris to talk aboutimproving sleep in grownups.
Dr.
Harris has a doctorate in psychology fromYeshiva University and extensive training
in the behavioral treatment of insomnia.
She's board certified in behavioralsleep medicine, one of the few
providers in the northeast UnitedStates holding that designation.
(01:42):
She's a clinical associate professorin the departments of neurology and
psychiatry at Albert Einstein Collegeof Medicine and sees patients in
person and via telehealth in New York.
She also has extensive social media.
Following Under the Handle Sleep DocShelby has been featured prominently
in the media and publications such asThe New York Times and The New Yorker.
(02:02):
She's also the author of The Women's Guideto Overcoming Insomnia, get a Good Night's
Sleep Without Relying on Medication.
Shelby, it is a pleasure tohave you today on our podcast
Shelby Harris PhD (02:12):
I am so happy to be here.
Thanks for having me.
Craig Canapari MD (02:17):
I think it's a real truism in the world of pediatric sleep
is that even the kids that are sleepingpoorly tend to be doing pretty okay
during the day, compared with theirparents, especially younger children.
little kids, they can nap in the car seat.
They can nap in the stroller.
but even if they wake up and go backto sleep quickly at night, parents
do not, I would imagine a lot of thepatients you see are parents, and I was
(02:43):
wondering if you could speak a littleto the struggles that parents face,
when they become parents and throughoutchildhood in terms of their sleep.
Shelby Harris PhD (02:51):
So, this is something I see a lot and it's funny, you know,
we talk a lot now, at least in socialmedia and online, about perimenopause and
menopause being stressors for insomnia.
But a lot of the patients that I talk to,say, oh, it's worse now, but it started
when I had my kids So I think there's alot of things that set it off for parents,
talking about if you're carrying a baby,
(03:13):
right?
There's all the pregnancy stuff,there's a lot of just that firestorm
happening during that time.
Then once the baby comes, the parents,whoever's really there as the caregiver,
they're waking up at varying times.
And then with all the.
Tech that we have now, they'rejust listening out and there's
all these little things.
Whether it could be things that they'vehad for over the years with the alarms
(03:34):
that have false alarms or any noise ormonitor can really make them be on edge.
And then once the babystarts sleeping better.
the parents just keep listening outfor any potential threats, because if I
fall asleep now, maybe the baby's gonnawake up in an hour or two later, and
it just continues from there it becomesvery hard for parents, especially moms
(03:55):
to let go and ease into sleep becausethey're always listening out for the
next threat that could get in the way ofthem actually falling and staying asleep.
Craig Canapari MD (04:03):
Either when is my child gonna wake up again,
or especially when they're really little.
I don't hear them.
Is everything okay?
Shelby Harris PhD (04:11):
Yep.
Arielle Greenleaf (04:12):
Or it also, is waking when they just stir.
I mean, any little
noise.
And we have, so like you're talkingabout the technology and it's like, oh,
this is so great, but it's actually not,I see so many moms in particular who
are just so glued to their smartmonitor of some sort They just
(04:32):
can't, it's almost like an obsession.
They just cannot back away
from it, and it has such anegative impact on their sleep.
Shelby Harris PhD (04:41):
Yeah, I just saw parents that I've been seeing on and off
throughout the years for, various issuesand the mom said to me, is the goal to
really have my child sleep through thenight and not have any noise or anything?
I said, no, that's.
Not the goal noises happen.
We all just kind of make a noisehere and there and The mom is
like looking at the monitor.
Listening to the monitor full volume.
And the dad is a stereotype.
(05:02):
I know, but the dad's likesleeping through the whole thing.
not noticing
any of it.
Arielle Greenleaf (05:05):
me in my house.
Shelby Harris PhD (05:06):
It was like, you're making it harder for
you to sleep.
So we, turn that monitordown a little bit, maybe.
Craig Canapari MD (05:12):
it's this perception that your vigilance is
what's keeping your child alive, thisis especially true in the era of the
room sharing recommendation, whichI think it's been around since 2013,
but was really strengthened in 2016.
I think that makes it harder.
babies make noise during the night.
some parents, especially with theirfirst child, feel like they need to do
(05:33):
something, they need to rush over, givethat kid the pacifier, do something
and, and sometimes you just need to let achild work through something a little bit.
Shelby Harris PhD (05:42):
Yeah.
And I love the point of the roomsharing recommendations, right?
So when it was a year, especially, Ihave so many parents that would just,
their insomnia was worsened as thebaby would be in there 7, 8, 9 months.
And there's a point where you have to alsothink about your own sleep because it's
not getting better A lot of the times.
Craig Canapari MD (06:01):
I think there was, one of the rationale for
the room sharing recommendationit does seem to reduce the risk.
Of
SIDS.
And there's some pretty good evidence for
Shelby Harris PhD (06:09):
Yeah.
Craig Canapari MD (06:10):
I think the counterfactual is, there was a
large study, and I'll throw in theshow notes of a number of nurses.
They, that was their profession.
They were nurses and they found thatin the context of the room sharing
recommendation, a subset of those parentswhose kids were up frequently, ended up
making pretty unsafe sleep decisions.
they're up with their kid, then they'refalling asleep in a chair or on a couch,
(06:32):
which we know is much more dangerousin terms of, entrapment or suffocation.
And that I, you know, I encouragefamilies that are really struggling
with this recommendation andeveryone's sleeping poorly to really
talk about their pediatrician tofeel what is the safest context.
I mean, we, we really.
We ask a lot of parents, right?
(06:53):
It's not like generations ago wherethere be multiple family members.
We're supposed to, you know, in theera of attachment parenting, never let
our kids fuss, nurse them on demand,carry them, have them in our bedroom.
Arielle Greenleaf (07:05):
return to work,
Craig Canapari MD (07:06):
really hard.
Shelby Harris PhD (07:08):
well there you go.
Arielle Greenleaf (07:09):
we need to return to work and do all those things.
how does one even function?
Shelby Harris PhD (07:13):
we're expecting like super
superpowers.
Craig Canapari MD (07:16):
I'm kind of wondering too, because certainly in the US a lot of
our listeners, they may be, professionals,A lot of them may be having their children
a little bit older than people a couplegenerations ago, say in their thirties or
even their forties versus their twenties.
How does that prime them to bemore vulnerable to insomnia?
Shelby Harris PhD (07:37):
that's an excellent point.
When I was talking about perimenopausesymptoms, I'm often seeing
women who are having children.
I had my second child at 38.
there are a lot of women inthat stage who are starting to
have perimenopause symptoms too.
So you, it's like you have hot flashes,you're having other, and it doesn't
mean you can't get pregnant, youcan still have kids, but there's a
lot of hormonal firestorm going on.
(07:57):
then you're taking on higher level,jobs that people are going back to.
Sometimes people already havea kid or two at that point.
And then the other big stressoron top of that is with work and
more things going on, there canbe more anxiety, more depression.
But then also the thing that we don'toften think about is that if we're having
kids later, we often have our own parents
and family that's aging.
(08:17):
So a lot of people are taking careof elderly parents on top of their
own kids, on top of trying to figureout what to do in school and all
these other things for their kidsand having a baby on top of that.
Craig Canapari MD (08:30):
I think too, and my wife said this to me, my oldest is gonna
be a senior in high school this year.
when he was born, mywife a year in actually.
was like, I don't know if I'mgonna ever sleep well again.
it was just that sort of anxiety beinglike, how are they doing in school?
What's with their extracurriculars?
What's going on with global warming?
all the very specific to very.
(08:51):
Kind of global anxiety.
'cause you are looking atthings not just through your own
wellbeing, but that of your child.
And, I think that is just kindof the nature of anxiety, right?
like worrying about a lotof stuff you can't control.
Shelby Harris PhD (09:04):
I think it's interesting, a lot of people
will be like, oh, I just wantmy kids to sleep better when
they're little.
it gets hard too when they get olderI have a ninth grader, he's going to
ninth grade and he goes to bed laterthan I do, and I'm already worrying
about high school college, and thenwhat's he doing once I go to sleep?
the.
Tech, all that stuff there's varying typesof anxiety happening worrying about things
you cannot control is the big crux of it.
(09:26):
when you add in the perimenopause symptomsfor some women, that's the 3:00 AM the
4:00 AM awakenings, and their brain isjust racing about a lot of this stuff.
Craig Canapari MD (09:36):
God, you make it sound like I'm in perimenopause.
I just feel like nowadays, Iwake up at three or four in the
morning and sometimes I'm just kind of
sweating a little bit, I don't knowif you wanna speak at all to the,
I know Ariel had a question hereabout hormones, specifically, I
Shelby Harris PhD (09:52):
So
Craig Canapari MD: wanna elaborate on that, (09:52):
undefined
Arielle Greenleaf (09:53):
I've obviously, I follow along, on your social media and I
know that you post like we're discussingperimenopause, but also I feel like
there has to be some sort of connection.
Postpartum with hormones.
Of course we have the smart monitors andthe baby and all that, but is there also
some sort of driving, biological forceis causing women to sleep at poorly?
Shelby Harris PhD (10:21):
Yeah.
Oh for sure.
Oh, for sure.
There it's, I keep saying afirestorm, your hormones are just not.
Regulating themselves.
it's all over the place.
The first few months.
Once you have a child if you arebreastfeeding that can impact,
hormone swings that are happening.
A lot of temperature control,temperature regulation in the middle
night, issues that are happening.
And then you throw on top of thatanxiety all the things that we were
(10:43):
talking about too, with having a youngbaby at home and worrying about just
keeping your child alive and, and allthe things that can happen with that,
that they all kind of feed on each other.
But yes, there's a lot of hormonalchanges that are happening in the first
few months that can be really hardfor women to settle down to sleep to
begin
Arielle Greenleaf (11:00):
what sort of treatment would you provide for, is
it situational insomnia what are thedifferent scales or, dimensions of
insomnia and how do you diagnose that?
Shelby Harris PhD: That's a great question. (11:14):
undefined
when we're talking about insomnia,we think about certain areas.
So are you having trouble fallingasleep, staying asleep or awakening
earlier than you'd like to?
And how often is that happening?
is that happening threeor more nights a week?
for an insomnia diagnosis some peopleargue for a certain amount of time,
some people say it's about 30 minutes.
(11:36):
I don't like that cutoff because whatdoes 29 versus 31 minutes mean that
you now qualify for insomnia?
So a lot of times it's really perception.
I like to think about perception andhow annoyed or bothered you are by it.
And then also what is it doing?
For you, right?
or it's not helping you with.
So are you, how is itbothering you in your life?
Is it annoying to you?
Are you feeling, like we were talkingabout earlier, that dragging feeling?
(11:57):
Are you feeling sleepy?
Are you having trouble with concentration?
Is it making you feel more anxious?
So if these are things happening atleast three or more times a week, and
then short term is a month, long termis three months, then you're gonna
meet the criteria for insomnia somehow.
Now, let's talk aboutwhen you're postpartum.
First few months.
We know that there's a good amount ofdata that suggests that protecting at
(12:20):
least four hours for the mom, especiallyif you've had, preexisting depression or
anxiety issues before having your baby,
Can help be a preventative againstdeveloping any sort of, postpartum
depression or anxiety issues.
So I try to be realistic about it.
I'm one of those people that sometimes,like people who are about to have a
baby, they're always talking aboutbaby sleep, which I totally appreciate.
(12:42):
I've been there, but they're not reallytalking with their significant other,
or with their, OB, GYN or midwifeabout a plan for their own sleep.
Once
the baby comes, right?
So let's try and figure out supportfor you, so that we can try and
at least get that four hours.
if they're still struggling with beingable to sleep a four hour chunk then
(13:02):
we will start to do some modified.
CBT for insomnia.
But we have to be realistic, right?
I'm not expecting someone to restrictthem to five hours in bed and
not have any awakenings at night.
I know that there's going to be a babythat's possibly gonna wake them up,
so we try to modify some behaviorsaround there with giving them a.
solid chunk of when to sleep, maybecoming up with a nap schedule, coming
(13:23):
up with plans to get help when we can,to then have them be able to protect
a certain amount of time for sleep.
And then as baby starts to get a bitolder, then we might modify that.
Craig Canapari MD (13:32):
can you speak in general to, How insomnia starts and
then what perpetuates it in people.
Shelby Harris PhD (13:40):
Yeah.
So there, can be a number of thingsthat can start it for people.
there are people that I work withwho say, I've had it my whole life.
I have no idea what started it.
other people, it can be familyhistory, but you can have a
family history for insomnia.
It doesn't mean thatyou're gonna develop it.
oftentimes what can happen is some sortof stressor a biological stressor could
be development of, cancer, fibromyalgia,some sort of medical illness I'm seeing
(14:03):
a lot of people over the years with Covidwho've maybe have some sleep issues.
Some people do, some people don't.
there can be some biologicalstressor that could happen.
then there could be apsychological stressor.
people often think of stressas being bad stress, right?
Like there was a job thatended or something, but there
can also be good stressors.
I've had patients over the years thatare about to get married and they're
(14:25):
super happy about it, but they stilldevelop insomnia because of this
anticipatory anxiety or even good stressthen there can also be social stressors.
So a new job or having a baby,sometimes it could even be working.
having a significant otherwho has a different schedule
from you can continue it.
So like you might be with, you mightbe having one schedule, but your
significant other might that yousleep with might have shift work
(14:48):
and that can throw it off or have a.
Phone that goes off in themiddle of the night for work.
So then what happens is once youstart having some trouble sleeping
because of one of those stressors thenwhat we often find happen are these
perpetuating factors that build in.
So people will start doingthings, and I always say it's
like an issue with common sense.
when you start not sleepingwell, I'll start to say, maybe I
should take a nap more routinely.
(15:08):
Maybe I'll go to bed a littleearlier, sleep in if I can.
sometimes people will rely on, over thecounter medications, NyQuil, whatever
it might be, or start worrying moreabout sleep or start using medication or
alcohol or more caffeine during the day.
Those are all the things that we findthat even though something else might have
started the insomnia, those are the thingsthat continue it in the longer term.
And that's where we really tryto focus a lot of the treatment.
Craig Canapari MD (15:33):
In your practice?
what are the most common unforcederrors that you see people making
when they're trying to fix theirown sleep before they come to you?
what are the common mistakesthat people are making?
Shelby Harris PhD (15:43):
there's a few of them.
the first one is trying to catch sleepwhen they can so they lose track of.
A consistent sleep wake schedule.
people always ask me, what do you thinkis the number one thing that's the
most important when it comes to sleep?
And I say around thesame wake time every day.
'cause that really helps to kindof set that rhythm so people
will start to push that a bit onthe days when they can, they'll.
(16:06):
Sleep a little bit lateror go to bed earlier.
Just following their body'scues, which are actually giving
them probably prettyinaccurate cues at times.
So that's one of them.
The other thing that people are doingis they're trying to overthink sleep.
So when we're not sleeping well, we startthinking like, why am I not sleeping?
I have to sleep.
And some people get to the point wherethey become so rigid about their sleep
(16:27):
wake schedule I know I'm saying to keepa sleep wake schedule, but they start.
Like having these long drawn out routinesbefore bed with the hope that magically
it's going to help them to sleep.
So that sleep wake kind of pressurethey're putting on themselves.
If I don't sleep tonight, x,y Z's gonna happen tomorrow.
That is a really big issue.
And then the last thing I seea lot of people do is they
start picking and choosing.
(16:48):
Supplements, whatever medications.
It's a lot of supplement use.
They're just kind of, oh,I'll use this for a few days.
This seemed to work.
And then it stops working, sothen they grab another thing.
So there's a lot of random supplementchoosing that they're doing as well.
Arielle Greenleaf (16:59):
I see that regularly among family and friends.
Shelby Harris PhD (17:02):
Pediatrics too.
Arielle Greenleaf (17:03):
in my personal life, I see it all the time.
I think it's true it becomes like anobsession when it comes to pediatric
sleep, I can easily see how that wouldtranslate into adult sleep Well, my
partner definitely struggles with sleepand he is an offender of trying the
supplements, taking it one night andsaying, oh, that didn't work, so I'm
(17:24):
not gonna use that, or reading that,
tart cherry juice and bananas can helpwith sleep It's like, dude, this has been
going on for so many years that a banana
at night is not going tofix your sleep problems.
Shelby Harris PhD (17:39):
But that's where I think social media has made
it worse since the pandemic, sinceInstagram has taken off more, which
is one of the reasons why I started mysocial media account was just to try
to get a little bit more of like a.
More evidence-based approach to itis there are people out there who are
these millions of followers who arejust like, use this one supplement.
It's gonna fix everything.
Do this one thing, have this reallyelaborate wake up routine, and they're
(18:03):
not really talking to the peoplewho have real entrenched insomnia.
patients with insomnia, that'sthat mismatch that we're finding a
lot of times, yes, sometimes thesethings can help, but they're not
usually helping the people with real
entrenched insomnia
Arielle Greenleaf (18:15):
my question is.
Just from my own experience, evenas a child, I had some sort of
anticipatory insomnia going on.
If I wasn't falling asleep, I'dbe looking at the clock and it's
nine o'clock, it's 10 o'clock.
Oh my gosh, I'm gonna feel so awfulin the morning, sort of thing.
and then as, as I grew older,I was diagnosed, as insomnia
(18:39):
and I was given medication.
And now it seems that the firststop is CBT cognitive behavioral
therapy when it comes to insomnia.
And as someone who has had been toCBT for, anxiety and depression,
I'm skeptical about CBT as somethingthat's really gonna cure insomnia.
I wanna know how it works.
(18:59):
I really do.
I'm really curious
about it.
Because it.
is real.
Absolutely.
I just
wanna know more.
Shelby Harris PhD (19:06):
another thing that can get mixed up is the term CBT for insomnia.
as someone who did fellowship trainingin CBT for anxiety and depression, I
think that C-B-T-I-C-B-T for insomnia.
Is a bit of a different animalthan the other types of CBT.
So, and there's a reason whymany people who do CBT aren't
(19:27):
specialized in insomnia because itis a different kind of treatment.
for CBTI, the biggest bangfor your buck in all of it.
It's, it's different treatment modulesessentially put together into one package.
So we have the cognitive part,we have the behavioral part.
Therapy for insomnia.
So the behavioral part has the mostbang for your buck, in my opinion.
what that consists of is.
(19:48):
sleep hygiene.
Let's start with sleep hygiene.
That's the stuff you hear about allthe time on the news and in social
media that's like, you know, limitcaffeine, limit these things and nine
times outta 10 my patients have cometo me and be like, I tried all those
things, but it didn't do anything.
Yes, that stuff typically is the controlgroup for most insomnia treatments.
But the reality is you stillneed to do them routinely.
(20:08):
To make sure you're gonna get themost benefit from the other modules.
So there's sleep hygiene.
Then there's somethingcalled sleep restriction.
So my mentor Michael Thorpy, was onone of the original studies looking at
sleep restriction in the late eighties.
And that idea is that, and this iswhere it's different from all the
anxiety and depression treatments,we actually look at the amount of
sleep someone's getting on average andrestrict them to what they're getting
(20:33):
on average for the past week or two.
if someone's coming to me spending eighthours in bed every night, but I'm keeping
a consistent sleep wake schedule, butthey're only getting five and a half hours
on average, I'm gonna restrict that personto a five and a half to six hour window.
And what we find is they fallasleep faster and they tend to
stay asleep or wake up, but go backto sleep faster in that window.
(20:53):
we teach them ways tocalculate, sleep efficiency.
How efficient and consolidatedtheir sleep is at night.
then we slowly increase their totalsleep time quality first, then quantity.
So that's something that youdon't really get in, all the
other anxiety It's just different.
And like that's why I find, honestly,sleep restriction is where I almost
always start with patients if I can.
And that's where you, like I saidearlier, you tend to get the most
(21:15):
bang for your buck.
Arielle Greenleaf (21:16):
like positive reinforcement because you get them
falling asleep easily, and then they'reable to fall back to sleep easily.
So they're like, oh wait, I can
sleep.
And then you slowly add on tothe amount of sleep if they're
still tired, you add on to
that start time gets alittle earlier and earlier.
Shelby Harris PhD (21:36):
And a lot of it is not easy to do in theory, it's easy
in practice, but getting someone to
do it is really tough.
working with someone on how to stayawake, like the people who don't have
trouble falling asleep at the beginningof the night, but wake up early in
the morning, they're harder becausenow I'm making them stay up later when
they're already sleepy to begin with.
So it's a lot of problemsolving ways to get someone to.
Stay awake until I need them tobuilding in a nap if we have to.
(21:59):
doing all of that is really wherethe skill in my opinion, comes in
and tailoring it to the patient tosee what their specific, issues are.
And then the one other piece of thebehavioral treatment is stimulus control.
So everyone hears if you haven'tfallen asleep in 20 minutes,
get up and go outta the bed.
I don't love the 20 minutes.
'cause it makes you look at a clock whenwe say, don't look at a clock at night.
one of my friends Michael Perlis usedto always say Just go by annoyance.
(22:22):
If you start noticing your brain's on fireand you're annoyed, just get outta bed.
And that's usually around 20 minutes.
So if someone's just restingtheir brain's not on fire, they're
possibly in and out of sleep.
But if they're really anxious andtrying to force sleep to happen,
that's when I have them get out of bed.
that's the behavioral stuff.
the cognitive part of CBTI is a littlebit more flexible with the patient.
So.
Sometimes for some patients I'll needto challenge the thoughts they're having
(22:45):
about trying to force sleep what willhappen if sleep doesn't come that night?
Also, I'm a huge believer in addingin mindfulness-based therapy for this.
Sometimes relaxation that'smore behavioral, but an
acceptance and commitment wemight add a little bit there.
Those fall under the Cpart of CBTI, so that.
Is more standard when wethink about cognitive therapy
for depression and anxiety.
(23:05):
But the behavioral stuff isactually very different and for
many people it works in about two to
12 sessions.
one person said to me, well, my doctortold me it should work in two months.
And I said, well, you're on alot of different medication.
So it also depends on the patient.
Sometimes we need to taper them
down on medication and getthem to where we need to be.
So it's not a one size fits all kindof amount, but it's definitely a
Arielle Greenleaf (23:25):
That's what I always say about adults.
people find out I help children sleepand they're like, oh, can you help
me?
And I'm like, adults have somany different things going on.
Medications, anxiety,depression, any of that.
I feel like it's muchmore complicated, but.
That is so interesting and itmakes so much sense to me the
sleep restriction piece andthen, adding in the other things.
(23:48):
so thank you.
That was really helpful.
Shelby Harris PhD (23:49):
You are welcome.
But to your point earlier about it beingmore of a medication in the past, I mean
still a lot of people use medication.
I have no issue if we've gone throughthe risks and benefits and figured
out what treatments have they tried.
but CBTI, although it's harder at thebeginning, has more lasting power.
if you take the medication awayfrom someone, a lot of times
(24:10):
they haven't learned strategiesor tools to sleep better.
This will give them something tofall back on if they have a, a
almost their, you know, to ever saythat someone's cured from insomnia,
think is unrealistic.
But if it starts to come back, theyknow what to do to get back on track.
Whereas medication makes it harder.
But like I said, it's not aone size fits all approach.
We just try to start with CBTIbecause it tends to have the least
(24:32):
amount of side effects and risks
Arielle Greenleaf (24:33):
That is so helpful.
Craig Canapari MD (24:35):
Is there anyone you'd say is not a good candidate for CBTi?
Arielle Greenleaf (24:38):
Hmm.
Shelby Harris PhD (24:39):
I sometimes get, patients that will come to me
and say, where can I get the pill?
If they have zero motivation despite.
education on my end, that'snot an ideal patient.
If someone has a lot of significantanxiety or depression, it doesn't
mean they can't do CBTI, but ifit's gonna get in the way of them
being even remotely consistentwith what I'm asking them to do.
They might not be an ideal patientbut I think many people can start with
(25:02):
it, even if they're on medications.
You just have to modify the treatment.
I think you might not be ideal forone of the apps, but we can always
modify it to try it with patients.
Craig Canapari MD (25:11):
we struggle a little bit in our adolescent
population, especially kids that aremultiple psychiatric medications.
They're already working with a therapist.
Otherwise, there's, there's the insurance
layer that sometimes you can't getcoverage for two psychologists at once.
If nothing is workingwell, where do you start?
I have patients with mood disorder,narcolepsy, terrible sleep
(25:33):
hygiene, and it's kind of like
Shelby Harris PhD (25:35):
Yep.
Craig Canapari MD (25:36):
sometimes we're sort of just trying to figure
out like, where do we even begin?
Another domain I've seen a lot of,especially since the pandemic, are
kids with school avoidance, kidswho are just not attending school
and they come to sleep clinic.
'cause they're like, oh, they'resleeping all day and that's
why they're going to school.
And I'm like, no, theydon't want to go to school.
(25:57):
And that, that, that is thenthey've stopped going to school
and then start sleeping all day.
it's not that hard to fix a circadianor body clock problem if some, even
if someone's split their dates andnights, all the adolescents did
this during the pandemic, and mostof them we could switch it right
back when they went back to school.
it's just the kids where there's alot of anxiety and behaviors about
(26:17):
avoiding things that they need todo, that are perpetuating these
really maladaptive sleep problems.
Shelby Harris PhD (26:24):
one of the things with the circadian stuff that I see
a lot is even with adults, if theysay, I just wanna have a normal sleep
schedule, but they don't have an actualreason to get up by a certain time,
that's someone that I find is gonnabe more challenging to treat because
they don't have that, external reason
to have to get up for a certain time.
Exactly, exactly.
(26:44):
But I do think when I was saying likedepression, anxiety, if someone's
coming to me, even though I work asa general therapist, CBT stuff, I
don't always take on cases weekly.
I don't always have the room,so I do mostly sleep stuff.
So if people are coming to me, they'relike, I don't know where to start.
Do I start with the sleep?
Do I start with the depression?
I'm one of those people that just says,you know what, let's start with a few
(27:05):
focused sessions of CBT for insomniaor working on whatever sleep issue
behaviorally that we're going to.
And sometimes what we see is ifsomeone's sleeping better, it helps
with their coping mechanisms tohelp with whatever other treatments
they're gonna be doing so you get more
bang for your buck.
I keep saying that, I really do find that.
When it comes to this sort of stuff,if someone's trying, they can't
stay up until the time I'm asking tobecause they just wanna get in bed to
(27:27):
avoid whatever thoughts that they'rehaving or to put an end to the day.
If there's a big depression componentthat's making it harder, then I
might argue first, starting withthe depression treatment first.
Craig Canapari MD (27:36):
Yeah.
if someone is listening tothis and they're like, I'm
really struggling with sleep.
I wanna find a provider forCBTI, where should they look?
Because I know this is.
Surprisingly difficult a lot of the time.
I mean, it, it took me in the lastyear we hired a psychologist in
our clinic, and it took years andyears for us to make this happen.
Shelby Harris PhD (28:00):
Yep.
Craig Canapari MD (28:01):
where should people look if they're looking to find a Dr.
Shelby, or someone with similarskills, how do they start that search?
Shelby Harris PhD (28:10):
I think the first place is you have to think about.
what level of qualificationsyou're looking for?
when I refer for any sort of behavioralsleep medicine issue, the first place
I tend to go to is someone who hasbeen board certified in behavioral
sleep medicine, someone who hassomething called a DBSM and that way
you know that they have fulfilled theamount of training that's necessary.
(28:33):
They've taken the exam, they'vehad the supervision that you
know what you're getting.
For for sure.
And they've got that gold stamp on there.
you can go to the Society ofBehavioral Sleep Medicine and they
will have a, listing throughout theworld of people who have, different
credentials, but they'll have alsopeople who have the DBSM designation.
Then if you don't need someone, I mean,you don't have to have a DBSM, there's,
it's a lot of extra training, you don'thave to have that to be good at, say CBTI.
(28:58):
if you're looking for that, the Societyof Behavioral Sleep Medicine, but you
don't have someone who's DBSM, you know,you're probably gonna get someone that
actually is in the know about the fieldthat they're even going to have their name
listed on this website.
Penn Medicine has a.
CBTI provider directory as well.
And those are people who have taken,Michael Perlis's training if you're
not sure if the person has justtaken a training, I always say to
(29:20):
patients like you're the consumerwhen you call to have an initial
consultation, talk with this person.
Ask them how many cases,roughly have you maybe seen how.
Have you been supervised by anyone?
Like Michael Perlis will be the firstperson to say like, if you've taken
my training for a few weekends, Istill think you should have some
supervision by someone who has a DBSM.
So like those varyinglevels are really helpful.
(29:41):
There are a lot of people who say theydo CBTI on Psychology Today but they
honestly are just giving someone sleephygiene treatment recommendations.
That's not CBTI.
So I think going through itin that way is a much more
standardized way to think about it.
Craig Canapari MD (29:54):
One thing I think is, uh, interesting is the
importance of tracking sleep, right?
Yeah.
sleep is so subjective.
if I said I'll give you a milliondollars, tell me the exact time
you fell asleep last night.
Like, nobody can do that.
It's just, it's just not how it works.
And like, if we want someone toget better at fitness, we're like,
okay, run a mile and then runtwo miles, then run three miles.
(30:14):
I know you run marathons andstuff like that in sleep.
It's like, it's like trying to control it
more actually make, can make it worse.
Shelby Harris PhD (30:22):
Yep.
Craig Canapari MD (30:23):
About the role of, consumer technology in tracking sleep.
pros and cons because likeI, I wear an over ring.
I find it useful.
I've had friends whose kids were like,you need to stop wearing the ring because
you're being really weird about it.
Like this sort of classic orthosomnia
thing, which is wheresomeone's obsessing about their
(30:44):
sleep tracker and they can't sleep.
where do you see the kindof role of these consumer.
Which are honestly as goodas the medical technology
acti we use.
but they do have some potential downside
Shelby Harris PhD (30:57):
Yeah.
so I think they have a really stronguse for people who don't make sleep
the biggest priority in their life,and they're just interested in how
they can, optimize their sleep.
Like what does alcohol, do to my sleep?
What does the caffeine do?
And in regular sleep breakschedule, am I getting enough sleep?
Because we know they're prettyaccurate with telling us how much
sleep someone's getting on average.
(31:17):
The sleep staging can be a little funkybased on, the device and in general.
for people burning the candleat both ends and just wanna
see how to improve their sleep.
I think for the peoplewho have chronic insomnia.
Really think a lot about their sleep.
I think it is, like you said, orthosomnia, I think it's the A recipe
for disaster because they know theydon't need something to tell them
they're not sleeping well already.
(31:39):
And then if they had a night wherethey thought they slept well, but
the device said they didn't sleepwell, then that oftentimes will.
gauge how their day is going to go.
So I have had plenty of patients,I'll say, get rid of the device.
I just wanna see on averagehow you think you're doing.
And if you start thinking thatyour sleep is getting better,
that's all I really care about.
I do use the devices, actually,I'm using them more and more.
for, circadian rhythm disorders.
(32:00):
for tracking, sleep, wake timing,I'm using those a lot in my practice.
Arielle Greenleaf (32:04):
I feel like I know a lot of people who are like, oh my gosh,
I only got this amount of deep sleeplast night, and I'm like, how do you even
know people think that they need ninehours of deep sleep in order to be well
rested the next day, andthat's just not a fact.
you get these devices, butyou're not told how to read
the stuff that's coming out of them.
Shelby Harris PhD (32:23):
I think that we get very fixed on like, I need
that REM sleep.
I need that deep sleep.
they don't really think aboutthe percentages that you're
supposed to get throughout the night.
people don't think about other things thatimpact sleep staging throughout the night.
Psychiatric medications youmight be taking, other things can
definitely impact that, that thosedevices aren't necessarily telling
you about.
there's more to the story than just whata printout or a screenshot might tell you.
Craig Canapari MD (32:47):
Yeah.
You know, I,
I, I'm, I'm very conflictedabout this stuff.
'cause on the, on the one handit's can be very useful when
families bring this in.
And, the flip side is in the pediatricrealm, sometimes it can create some
conflict, especially between teenagers and
parents.
Families with a high level of achievement.
They're wanting to optimizeeverything in their kid,
(33:08):
and I'm like, maybe you don't.
need to hold on quite so tightly
Arielle Greenleaf (33:13):
I always tell that to parents as
well.
We can't force people to sleep.
We can't force their sleep stages.
it just is what it is.
At some point, I mean,you we're not robots.
Shelby Harris PhD (33:26):
but it feels a little bit like, like
you said, policing in a way.
Like they're just watching,are you getting up in the
middle, what's happening?
And just that level of control.
it's creating more stress aroundthe idea of sleep, which is what
makes it worse for the whole family.
Craig Canapari MD (33:39):
I think it is A funny phenomenon as the owner of two adolescent
boys, it is a funny thing when, like
they're going to bed later than you are,you don't quite know what they're doing.
I, I tell them, 'cause you know, ifthey, if they wake me up out of that
slow wave sleep, when they're rattlingaround the bathroom or something
like that, like I, I am up for
(34:01):
like an hour and I'm like, lookguys, I'm leaving the door open.
'cause the air conditioning's on.
Can you brush your teeth andstuff before I go to bed?
Because they're just running up and down
stairs, slamming doors.
it's crazy.
Shelby Harris PhD (34:14):
I know my son likes to make homemade pasta,
Arielle Greenleaf (34:16):
Oh God.
Shelby Harris PhD (34:16):
11 o'clock at night.
I'm like, really?
do, we need to be doing that right now?
It's so
Craig Canapari MD (34:21):
like
fire alarms going off and.
It's crazy.
So listen, we, we thoughtthis would be fun.
I mean, I thought of this, don't know ifArielle thinks this is fun or not, having
guests on to talk about a sleep hackand a sleep confession, things that you
might find helpful and things that youdo that you know are not best practice.
I, can go first.
(34:42):
my sleep hack is.
I love a sleep mask, I only started acouple years ago and I'm like, why have
I not been doing this my whole life?
I'm light sensitive.
I like the pressure on my face.
Now my 16-year-old loves it.
He went to scout camp with a sleep mask.
It's just really funny.
Um, my confession is I take acouple of supplements every night.
(35:03):
I take a tiny bit of melatonin,I take some magnesium, and
I take some L-theanine.
And I've actually used my Oura ringto be like what actually works.
I've tried a bunch of supplements.
I'm like, this seems to help the most.
So yeah, I will say I'veplayed around with it, but
I don't know if I'd recommend thisto everybody, I was talking to Sujay.
He's like, there's not a lotof evidence for magnesium.
(35:24):
I'm like, I do feel better when I take it.
Shelby Harris PhD (35:27):
I'm gonna like, Exactly.
There's not a lot of evidence for it,but if it helps you and there's not
really any downside to it, just besidesspending the money on it and you find
it's helping, then you, I always say
that.
Craig Canapari MD (35:38):
Do you want to,
Arielle Greenleaf (35:39):
my sleep hack You said you're light sensitive.
I am very noise sensitive.
I always have been.
even in college, I had white noise.
I lived in Boston, it was loud.
I believe in white noise forpeople that are sensitive to it.
A lot of times parents will say,well, I don't want my child to get.
Used to white noise.
But I also say, in my opinion, it feelslike you either sensitive to noise or
(36:01):
you're not, and your baby can't tell you.
it doesn't hurt to use it.
And then if they tell you laterwhen they have the ability to do so,
they don't like it, take it away.
for me
it really helps a lot.
my confession is that I've been onsleeping medication for years and
my mom thinks it's hilarious that I
help people with pediatric sleep.
(36:22):
She said I didn't sleep throughthe night till I was four.
So, I mean, I
think my body is just, you know, it.
And the crazy thing isthat I need a lot of sleep.
if I don't get
sleep, I feel.
Physically ill, and I think that'sultimately why I have stayed on
medication for so long because itreally affects my life when I don't
Shelby Harris PhD (36:44):
yeah, And you
found something that's workingfor you, so there you go.
Um.
Craig Canapari MD (36:49):
do you wanna out yourself for sleeping
with a TV on all night or
Shelby Harris PhD (36:52):
Oh, so my hack, is that I like to keep my bedroom really cold.
I actually get too cold at thebeginning of the night, so I sleep with
Big fuzzy socks.
for me that helps to keep the room cold.
My kids don't seem to
care at all.
My husband's fine with it, so itkeeps it nice and cold, but my
feet aren't shivering and freezing.
then I throw the socks offin the middle of the night.
And that actually for some womendoes, or some people does help with
(37:13):
sleep when temperature regulations.
So that's what I do.
mask on an eye mask.
I cannot do that.
I have so many patients who loveto do it and I cannot do it.
and then for my confession, I've.
Two confessions.
So one is that I absolutelyhate the smell of lavender.
people ask me all the timewithout lavender, and I'm
like, I cannot be near it.
It gives me a migraine.
But if you like it, go ahead.
(37:35):
the other thing for me is that Iactually grew up, my parents hate
it when I admit this, but I grewup with a TV in my bedroom that was
the thing that I watched every nightto soothe myself to go to sleep
And it's just one of those things that I.
Still have a TV in my room.
Do I watch it every singlenight right before I go to bed?
No, but I watch it.
I watch like a relaxingshow that I like to watch.
sometimes it's something I've seen10 times already, but sometimes I
(37:56):
watch that right before bed and I'mgood about turning it off and then
saying it's time to go to sleep.
So I have a TV in my room and yes,I do watch it before bed sometimes.
Arielle Greenleaf (38:04):
Yeah.
I have that same thing,
Shelby Harris PhD (38:08):
Yeah.
Craig Canapari MD (38:08):
Rules are meant to be broken, you
know?
Shelby Harris PhD (38:10):
I'm not a hard and fast get rid of all screens right before bed.
some people can actually toleratethem a little bit better, so
Craig Canapari MD (38:15):
I take a TV in someone's room over
them staring at their phone
any day.
It's just not as engaging.
Arielle Greenleaf (38:21):
passive.
Craig Canapari MD (38:22):
it's, yeah.
Shelby Harris PhD (38:23):
But getting people to actually get a TV to put in their
room is harder and harder nowadays.
Craig Canapari MD (38:29):
So Shelby, I have the link to your website and
your book.
is there anything else that you wouldlike to plug here, for our audience?
Shelby Harris PhD (38:37):
I think it's just the Instagram account and then my
website and book would be great.
Thank
Craig Canapari MD (38:41):
Awesome.
Well, thanks so much for coming.
This was super fun.
I learned a
lot and, I think the takehome for me is for parents is
like, take care of your sleep.
there's a reason your body wants tospend a third of your life doing it.
It's very important.
Shelby Harris PhD (38:55):
don't assume the number of people on social media, they're
like, oh, once you have kids, your
sleep is done.
that's
not the case.
You can work on your sleep andwork on your kids as well, because
you both need that for yourselves
to develop.
Craig Canapari MD (39:07):
Absolutely.
thank you so much.
Shelby Harris PhD (39:09):
Thank
you.
guys.
I will talk to
you later and, have a
Arielle Greenleaf (39:13):
You too.
Craig Canapari MD (39:18):
Thanks so much for listening to the Sleep edit.
You can find transcripts atthe web address Sleeped show.
You can also find video of theepisodes at that address as
well as in my YouTube channel.
You can find me at Dr.
Craig canna perry.com and on allsocial media at D-R-C-A-N-A-P-A-R-I.
(39:39):
You can find Ariel atInstagram at Ariel Greenleaf.
That's A-R-I-E-L-L-E-G-R-E-E-N-L-E-A.
If you like the flavor of the advice here.
Please check out my book.
It's Never Too Late to Sleep.
Train the Low Stress Way to high QualitySleep for babies, kids, and parents.
(40:01):
It's available whereverfine books are sold.
If you found this useful, pleasesubscribe at Spotify or Apple Podcast
and share it with your friends.
It really helps as we're tryingto get the show off the ground.
Thanks.
Welcome to the Sleep Edit, a podcast devoted to helping
tired kids and parents sleep better.
We focus on actionable evidence-basedsleep advice, so everyone in your
home can sleep through the night.
Now, a quick disclaimer, this podcastis for general informational purposes
only and does not constitute thepractice of medicine, nursing, or
other professional healthcare services,including the giving of medical advice.
(00:27):
No doctor patient relationship is formed.
The use of this information andthe materials linked to this
podcast and any associated videocontent are at the user's own risk.
The content on the show is not intendedto be a substitute for professional
medical advice, diagnosis, or treatment.
Users should not disregard ordelay obtaining medical help for
(00:50):
any medical condition they have.
Or that their children may have,they should seek the assistance
of their healthcare professionalsfor any such conditions.
Nothing stated here reflectsthe views of our employers or
the employees of our guests.
Enjoy the show.
welcome back to the ThemeEdit podcast, where we provide
(01:11):
evidence-based information forparents and kids everywhere.
I am Dr.
Craig, Canapari.
Arielle Greenleaf (01:17):
Ariel Greenleaf.
Craig Canapari MD (01:21):
Today we are pleased to welcome the one and only Dr.
Shelby Harris to talk aboutimproving sleep in grownups.
Dr.
Harris has a doctorate in psychology fromYeshiva University and extensive training
in the behavioral treatment of insomnia.
She's board certified in behavioralsleep medicine, one of the few
providers in the northeast UnitedStates holding that designation.
(01:42):
She's a clinical associate professorin the departments of neurology and
psychiatry at Albert Einstein Collegeof Medicine and sees patients in
person and via telehealth in New York.
She also has extensive social media.
Following Under the Handle Sleep DocShelby has been featured prominently
in the media and publications such asThe New York Times and The New Yorker.
(02:02):
She's also the author of The Women's Guideto Overcoming Insomnia, get a Good Night's
Sleep Without Relying on Medication.
Shelby, it is a pleasure tohave you today on our podcast
Shelby Harris PhD (02:12):
I am so happy to be here.
Thanks for having me.
Craig Canapari MD (02:17):
I think it's a real truism in the world of pediatric sleep
is that even the kids that are sleepingpoorly tend to be doing pretty okay
during the day, compared with theirparents, especially younger children.
little kids, they can nap in the car seat.
They can nap in the stroller.
but even if they wake up and go backto sleep quickly at night, parents
do not, I would imagine a lot of thepatients you see are parents, and I was
(02:43):
wondering if you could speak a littleto the struggles that parents face,
when they become parents and throughoutchildhood in terms of their sleep.
Shelby Harris PhD (02:51):
So, this is something I see a lot and it's funny, you know,
we talk a lot now, at least in socialmedia and online, about perimenopause and
menopause being stressors for insomnia.
But a lot of the patients that I talk to,say, oh, it's worse now, but it started
when I had my kids So I think there's alot of things that set it off for parents,
talking about if you're carrying a baby,
(03:13):
right?
There's all the pregnancy stuff,there's a lot of just that firestorm
happening during that time.
Then once the baby comes, the parents,whoever's really there as the caregiver,
they're waking up at varying times.
And then with all the.
Tech that we have now, they'rejust listening out and there's
all these little things.
Whether it could be things that they'vehad for over the years with the alarms
(03:34):
that have false alarms or any noise ormonitor can really make them be on edge.
And then once the babystarts sleeping better.
the parents just keep listening outfor any potential threats, because if I
fall asleep now, maybe the baby's gonnawake up in an hour or two later, and
it just continues from there it becomesvery hard for parents, especially moms
(03:55):
to let go and ease into sleep becausethey're always listening out for the
next threat that could get in the way ofthem actually falling and staying asleep.
Craig Canapari MD (04:03):
Either when is my child gonna wake up again,
or especially when they're really little.
I don't hear them.
Is everything okay?
Shelby Harris PhD (04:11):
Yep.
Arielle Greenleaf (04:12):
Or it also, is waking when they just stir.
I mean, any little
noise.
And we have, so like you're talkingabout the technology and it's like, oh,
this is so great, but it's actually not,I see so many moms in particular who
are just so glued to their smartmonitor of some sort They just
(04:32):
can't, it's almost like an obsession.
They just cannot back away
from it, and it has such anegative impact on their sleep.
Shelby Harris PhD (04:41):
Yeah, I just saw parents that I've been seeing on and off
throughout the years for, various issuesand the mom said to me, is the goal to
really have my child sleep through thenight and not have any noise or anything?
I said, no, that's.
Not the goal noises happen.
We all just kind of make a noisehere and there and The mom is
like looking at the monitor.
Listening to the monitor full volume.
And the dad is a stereotype.
(05:02):
I know, but the dad's likesleeping through the whole thing.
not noticing
any of it.
Arielle Greenleaf (05:05):
me in my house.
Shelby Harris PhD (05:06):
It was like, you're making it harder for
you to sleep.
So we, turn that monitordown a little bit, maybe.
Craig Canapari MD (05:12):
it's this perception that your vigilance is
what's keeping your child alive, thisis especially true in the era of the
room sharing recommendation, whichI think it's been around since 2013,
but was really strengthened in 2016.
I think that makes it harder.
babies make noise during the night.
some parents, especially with theirfirst child, feel like they need to do
(05:33):
something, they need to rush over, givethat kid the pacifier, do something
and, and sometimes you just need to let achild work through something a little bit.
Shelby Harris PhD (05:42):
Yeah.
And I love the point of the roomsharing recommendations, right?
So when it was a year, especially, Ihave so many parents that would just,
their insomnia was worsened as thebaby would be in there 7, 8, 9 months.
And there's a point where you have to alsothink about your own sleep because it's
not getting better A lot of the times.
Craig Canapari MD (06:01):
I think there was, one of the rationale for
the room sharing recommendationit does seem to reduce the risk.
Of
SIDS.
And there's some pretty good evidence for
Shelby Harris PhD (06:09):
Yeah.
Craig Canapari MD (06:10):
I think the counterfactual is, there was a
large study, and I'll throw in theshow notes of a number of nurses.
They, that was their profession.
They were nurses and they found thatin the context of the room sharing
recommendation, a subset of those parentswhose kids were up frequently, ended up
making pretty unsafe sleep decisions.
they're up with their kid, then they'refalling asleep in a chair or on a couch,
(06:32):
which we know is much more dangerousin terms of, entrapment or suffocation.
And that I, you know, I encouragefamilies that are really struggling
with this recommendation andeveryone's sleeping poorly to really
talk about their pediatrician tofeel what is the safest context.
I mean, we, we really.
We ask a lot of parents, right?
(06:53):
It's not like generations ago wherethere be multiple family members.
We're supposed to, you know, in theera of attachment parenting, never let
our kids fuss, nurse them on demand,carry them, have them in our bedroom.
Arielle Greenleaf (07:05):
return to work,
Craig Canapari MD (07:06):
really hard.
Shelby Harris PhD (07:08):
well there you go.
Arielle Greenleaf (07:09):
we need to return to work and do all those things.
how does one even function?
Shelby Harris PhD (07:13):
we're expecting like super
superpowers.
Craig Canapari MD (07:16):
I'm kind of wondering too, because certainly in the US a lot of
our listeners, they may be, professionals,A lot of them may be having their children
a little bit older than people a couplegenerations ago, say in their thirties or
even their forties versus their twenties.
How does that prime them to bemore vulnerable to insomnia?
Shelby Harris PhD (07:37):
that's an excellent point.
When I was talking about perimenopausesymptoms, I'm often seeing
women who are having children.
I had my second child at 38.
there are a lot of women inthat stage who are starting to
have perimenopause symptoms too.
So you, it's like you have hot flashes,you're having other, and it doesn't
mean you can't get pregnant, youcan still have kids, but there's a
lot of hormonal firestorm going on.
(07:57):
then you're taking on higher level,jobs that people are going back to.
Sometimes people already havea kid or two at that point.
And then the other big stressoron top of that is with work and
more things going on, there canbe more anxiety, more depression.
But then also the thing that we don'toften think about is that if we're having
kids later, we often have our own parents
and family that's aging.
(08:17):
So a lot of people are taking careof elderly parents on top of their
own kids, on top of trying to figureout what to do in school and all
these other things for their kidsand having a baby on top of that.
Craig Canapari MD (08:30):
I think too, and my wife said this to me, my oldest is gonna
be a senior in high school this year.
when he was born, mywife a year in actually.
was like, I don't know if I'mgonna ever sleep well again.
it was just that sort of anxiety beinglike, how are they doing in school?
What's with their extracurriculars?
What's going on with global warming?
all the very specific to very.
(08:51):
Kind of global anxiety.
'cause you are looking atthings not just through your own
wellbeing, but that of your child.
And, I think that is just kindof the nature of anxiety, right?
like worrying about a lotof stuff you can't control.
Shelby Harris PhD (09:04):
I think it's interesting, a lot of people
will be like, oh, I just wantmy kids to sleep better when
they're little.
it gets hard too when they get olderI have a ninth grader, he's going to
ninth grade and he goes to bed laterthan I do, and I'm already worrying
about high school college, and thenwhat's he doing once I go to sleep?
the.
Tech, all that stuff there's varying typesof anxiety happening worrying about things
you cannot control is the big crux of it.
(09:26):
when you add in the perimenopause symptomsfor some women, that's the 3:00 AM the
4:00 AM awakenings, and their brain isjust racing about a lot of this stuff.
Craig Canapari MD (09:36):
God, you make it sound like I'm in perimenopause.
I just feel like nowadays, Iwake up at three or four in the
morning and sometimes I'm just kind of
sweating a little bit, I don't knowif you wanna speak at all to the,
I know Ariel had a question hereabout hormones, specifically, I
Shelby Harris PhD (09:52):
So
Craig Canapari MD: wanna elaborate on that, (09:52):
undefined
Arielle Greenleaf (09:53):
I've obviously, I follow along, on your social media and I
know that you post like we're discussingperimenopause, but also I feel like
there has to be some sort of connection.
Postpartum with hormones.
Of course we have the smart monitors andthe baby and all that, but is there also
some sort of driving, biological forceis causing women to sleep at poorly?
Shelby Harris PhD (10:21):
Yeah.
Oh for sure.
Oh, for sure.
There it's, I keep saying afirestorm, your hormones are just not.
Regulating themselves.
it's all over the place.
The first few months.
Once you have a child if you arebreastfeeding that can impact,
hormone swings that are happening.
A lot of temperature control,temperature regulation in the middle
night, issues that are happening.
And then you throw on top of thatanxiety all the things that we were
(10:43):
talking about too, with having a youngbaby at home and worrying about just
keeping your child alive and, and allthe things that can happen with that,
that they all kind of feed on each other.
But yes, there's a lot of hormonalchanges that are happening in the first
few months that can be really hardfor women to settle down to sleep to
begin
Arielle Greenleaf (11:00):
what sort of treatment would you provide for, is
it situational insomnia what are thedifferent scales or, dimensions of
insomnia and how do you diagnose that?
Shelby Harris PhD: That's a great question. (11:14):
undefined
when we're talking about insomnia,we think about certain areas.
So are you having trouble fallingasleep, staying asleep or awakening
earlier than you'd like to?
And how often is that happening?
is that happening threeor more nights a week?
for an insomnia diagnosis some peopleargue for a certain amount of time,
some people say it's about 30 minutes.
(11:36):
I don't like that cutoff because whatdoes 29 versus 31 minutes mean that
you now qualify for insomnia?
So a lot of times it's really perception.
I like to think about perception andhow annoyed or bothered you are by it.
And then also what is it doing?
For you, right?
or it's not helping you with.
So are you, how is itbothering you in your life?
Is it annoying to you?
Are you feeling, like we were talkingabout earlier, that dragging feeling?
(11:57):
Are you feeling sleepy?
Are you having trouble with concentration?
Is it making you feel more anxious?
So if these are things happening atleast three or more times a week, and
then short term is a month, long termis three months, then you're gonna
meet the criteria for insomnia somehow.
Now, let's talk aboutwhen you're postpartum.
First few months.
We know that there's a good amount ofdata that suggests that protecting at
(12:20):
least four hours for the mom, especiallyif you've had, preexisting depression or
anxiety issues before having your baby,
Can help be a preventative againstdeveloping any sort of, postpartum
depression or anxiety issues.
So I try to be realistic about it.
I'm one of those people that sometimes,like people who are about to have a
baby, they're always talking aboutbaby sleep, which I totally appreciate.
(12:42):
I've been there, but they're not reallytalking with their significant other,
or with their, OB, GYN or midwifeabout a plan for their own sleep.
Once
the baby comes, right?
So let's try and figure out supportfor you, so that we can try and
at least get that four hours.
if they're still struggling with beingable to sleep a four hour chunk then
(13:02):
we will start to do some modified.
CBT for insomnia.
But we have to be realistic, right?
I'm not expecting someone to restrictthem to five hours in bed and
not have any awakenings at night.
I know that there's going to be a babythat's possibly gonna wake them up,
so we try to modify some behaviorsaround there with giving them a.
solid chunk of when to sleep, maybecoming up with a nap schedule, coming
(13:23):
up with plans to get help when we can,to then have them be able to protect
a certain amount of time for sleep.
And then as baby starts to get a bitolder, then we might modify that.
Craig Canapari MD (13:32):
can you speak in general to, How insomnia starts and
then what perpetuates it in people.
Shelby Harris PhD (13:40):
Yeah.
So there, can be a number of thingsthat can start it for people.
there are people that I work withwho say, I've had it my whole life.
I have no idea what started it.
other people, it can be familyhistory, but you can have a
family history for insomnia.
It doesn't mean thatyou're gonna develop it.
oftentimes what can happen is some sortof stressor a biological stressor could
be development of, cancer, fibromyalgia,some sort of medical illness I'm seeing
(14:03):
a lot of people over the years with Covidwho've maybe have some sleep issues.
Some people do, some people don't.
there can be some biologicalstressor that could happen.
then there could be apsychological stressor.
people often think of stressas being bad stress, right?
Like there was a job thatended or something, but there
can also be good stressors.
I've had patients over the years thatare about to get married and they're
(14:25):
super happy about it, but they stilldevelop insomnia because of this
anticipatory anxiety or even good stressthen there can also be social stressors.
So a new job or having a baby,sometimes it could even be working.
having a significant otherwho has a different schedule
from you can continue it.
So like you might be with, you mightbe having one schedule, but your
significant other might that yousleep with might have shift work
(14:48):
and that can throw it off or have a.
Phone that goes off in themiddle of the night for work.
So then what happens is once youstart having some trouble sleeping
because of one of those stressors thenwhat we often find happen are these
perpetuating factors that build in.
So people will start doingthings, and I always say it's
like an issue with common sense.
when you start not sleepingwell, I'll start to say, maybe I
should take a nap more routinely.
(15:08):
Maybe I'll go to bed a littleearlier, sleep in if I can.
sometimes people will rely on, over thecounter medications, NyQuil, whatever
it might be, or start worrying moreabout sleep or start using medication or
alcohol or more caffeine during the day.
Those are all the things that we findthat even though something else might have
started the insomnia, those are the thingsthat continue it in the longer term.
And that's where we really tryto focus a lot of the treatment.
Craig Canapari MD (15:33):
In your practice?
what are the most common unforcederrors that you see people making
when they're trying to fix theirown sleep before they come to you?
what are the common mistakesthat people are making?
Shelby Harris PhD (15:43):
there's a few of them.
the first one is trying to catch sleepwhen they can so they lose track of.
A consistent sleep wake schedule.
people always ask me, what do you thinkis the number one thing that's the
most important when it comes to sleep?
And I say around thesame wake time every day.
'cause that really helps to kindof set that rhythm so people
will start to push that a bit onthe days when they can, they'll.
(16:06):
Sleep a little bit lateror go to bed earlier.
Just following their body'scues, which are actually giving
them probably prettyinaccurate cues at times.
So that's one of them.
The other thing that people are doingis they're trying to overthink sleep.
So when we're not sleeping well, we startthinking like, why am I not sleeping?
I have to sleep.
And some people get to the point wherethey become so rigid about their sleep
(16:27):
wake schedule I know I'm saying to keepa sleep wake schedule, but they start.
Like having these long drawn out routinesbefore bed with the hope that magically
it's going to help them to sleep.
So that sleep wake kind of pressurethey're putting on themselves.
If I don't sleep tonight, x,y Z's gonna happen tomorrow.
That is a really big issue.
And then the last thing I seea lot of people do is they
start picking and choosing.
(16:48):
Supplements, whatever medications.
It's a lot of supplement use.
They're just kind of, oh,I'll use this for a few days.
This seemed to work.
And then it stops working, sothen they grab another thing.
So there's a lot of random supplementchoosing that they're doing as well.
Arielle Greenleaf (16:59):
I see that regularly among family and friends.
Shelby Harris PhD (17:02):
Pediatrics too.
Arielle Greenleaf (17:03):
in my personal life, I see it all the time.
I think it's true it becomes like anobsession when it comes to pediatric
sleep, I can easily see how that wouldtranslate into adult sleep Well, my
partner definitely struggles with sleepand he is an offender of trying the
supplements, taking it one night andsaying, oh, that didn't work, so I'm
(17:24):
not gonna use that, or reading that,
tart cherry juice and bananas can helpwith sleep It's like, dude, this has been
going on for so many years that a banana
at night is not going tofix your sleep problems.
Shelby Harris PhD (17:39):
But that's where I think social media has made
it worse since the pandemic, sinceInstagram has taken off more, which
is one of the reasons why I started mysocial media account was just to try
to get a little bit more of like a.
More evidence-based approach to itis there are people out there who are
these millions of followers who arejust like, use this one supplement.
It's gonna fix everything.
Do this one thing, have this reallyelaborate wake up routine, and they're
(18:03):
not really talking to the peoplewho have real entrenched insomnia.
patients with insomnia, that'sthat mismatch that we're finding a
lot of times, yes, sometimes thesethings can help, but they're not
usually helping the people with real
entrenched insomnia
Arielle Greenleaf (18:15):
my question is.
Just from my own experience, evenas a child, I had some sort of
anticipatory insomnia going on.
If I wasn't falling asleep, I'dbe looking at the clock and it's
nine o'clock, it's 10 o'clock.
Oh my gosh, I'm gonna feel so awfulin the morning, sort of thing.
and then as, as I grew older,I was diagnosed, as insomnia
(18:39):
and I was given medication.
And now it seems that the firststop is CBT cognitive behavioral
therapy when it comes to insomnia.
And as someone who has had been toCBT for, anxiety and depression,
I'm skeptical about CBT as somethingthat's really gonna cure insomnia.
I wanna know how it works.
(18:59):
I really do.
I'm really curious
about it.
Because it.
is real.
Absolutely.
I just
wanna know more.
Shelby Harris PhD (19:06):
another thing that can get mixed up is the term CBT for insomnia.
as someone who did fellowship trainingin CBT for anxiety and depression, I
think that C-B-T-I-C-B-T for insomnia.
Is a bit of a different animalthan the other types of CBT.
So, and there's a reason whymany people who do CBT aren't
(19:27):
specialized in insomnia because itis a different kind of treatment.
for CBTI, the biggest bangfor your buck in all of it.
It's, it's different treatment modulesessentially put together into one package.
So we have the cognitive part,we have the behavioral part.
Therapy for insomnia.
So the behavioral part has the mostbang for your buck, in my opinion.
what that consists of is.
(19:48):
sleep hygiene.
Let's start with sleep hygiene.
That's the stuff you hear about allthe time on the news and in social
media that's like, you know, limitcaffeine, limit these things and nine
times outta 10 my patients have cometo me and be like, I tried all those
things, but it didn't do anything.
Yes, that stuff typically is the controlgroup for most insomnia treatments.
But the reality is you stillneed to do them routinely.
(20:08):
To make sure you're gonna get themost benefit from the other modules.
So there's sleep hygiene.
Then there's somethingcalled sleep restriction.
So my mentor Michael Thorpy, was onone of the original studies looking at
sleep restriction in the late eighties.
And that idea is that, and this iswhere it's different from all the
anxiety and depression treatments,we actually look at the amount of
sleep someone's getting on average andrestrict them to what they're getting
(20:33):
on average for the past week or two.
if someone's coming to me spending eighthours in bed every night, but I'm keeping
a consistent sleep wake schedule, butthey're only getting five and a half hours
on average, I'm gonna restrict that personto a five and a half to six hour window.
And what we find is they fallasleep faster and they tend to
stay asleep or wake up, but go backto sleep faster in that window.
(20:53):
we teach them ways tocalculate, sleep efficiency.
How efficient and consolidatedtheir sleep is at night.
then we slowly increase their totalsleep time quality first, then quantity.
So that's something that youdon't really get in, all the
other anxiety It's just different.
And like that's why I find, honestly,sleep restriction is where I almost
always start with patients if I can.
And that's where you, like I saidearlier, you tend to get the most
(21:15):
bang for your buck.
Arielle Greenleaf (21:16):
like positive reinforcement because you get them
falling asleep easily, and then they'reable to fall back to sleep easily.
So they're like, oh wait, I can
sleep.
And then you slowly add on tothe amount of sleep if they're
still tired, you add on to
that start time gets alittle earlier and earlier.
Shelby Harris PhD (21:36):
And a lot of it is not easy to do in theory, it's easy
in practice, but getting someone to
do it is really tough.
working with someone on how to stayawake, like the people who don't have
trouble falling asleep at the beginningof the night, but wake up early in
the morning, they're harder becausenow I'm making them stay up later when
they're already sleepy to begin with.
So it's a lot of problemsolving ways to get someone to.
Stay awake until I need them tobuilding in a nap if we have to.
(21:59):
doing all of that is really wherethe skill in my opinion, comes in
and tailoring it to the patient tosee what their specific, issues are.
And then the one other piece of thebehavioral treatment is stimulus control.
So everyone hears if you haven'tfallen asleep in 20 minutes,
get up and go outta the bed.
I don't love the 20 minutes.
'cause it makes you look at a clock whenwe say, don't look at a clock at night.
one of my friends Michael Perlis usedto always say Just go by annoyance.
(22:22):
If you start noticing your brain's on fireand you're annoyed, just get outta bed.
And that's usually around 20 minutes.
So if someone's just restingtheir brain's not on fire, they're
possibly in and out of sleep.
But if they're really anxious andtrying to force sleep to happen,
that's when I have them get out of bed.
that's the behavioral stuff.
the cognitive part of CBTI is a littlebit more flexible with the patient.
So.
Sometimes for some patients I'll needto challenge the thoughts they're having
(22:45):
about trying to force sleep what willhappen if sleep doesn't come that night?
Also, I'm a huge believer in addingin mindfulness-based therapy for this.
Sometimes relaxation that'smore behavioral, but an
acceptance and commitment wemight add a little bit there.
Those fall under the Cpart of CBTI, so that.
Is more standard when wethink about cognitive therapy
for depression and anxiety.
(23:05):
But the behavioral stuff isactually very different and for
many people it works in about two to
12 sessions.
one person said to me, well, my doctortold me it should work in two months.
And I said, well, you're on alot of different medication.
So it also depends on the patient.
Sometimes we need to taper them
down on medication and getthem to where we need to be.
So it's not a one size fits all kindof amount, but it's definitely a
Arielle Greenleaf (23:25):
That's what I always say about adults.
people find out I help children sleepand they're like, oh, can you help
me?
And I'm like, adults have somany different things going on.
Medications, anxiety,depression, any of that.
I feel like it's muchmore complicated, but.
That is so interesting and itmakes so much sense to me the
sleep restriction piece andthen, adding in the other things.
(23:48):
so thank you.
That was really helpful.
Shelby Harris PhD (23:49):
You are welcome.
But to your point earlier about it beingmore of a medication in the past, I mean
still a lot of people use medication.
I have no issue if we've gone throughthe risks and benefits and figured
out what treatments have they tried.
but CBTI, although it's harder at thebeginning, has more lasting power.
if you take the medication awayfrom someone, a lot of times
(24:10):
they haven't learned strategiesor tools to sleep better.
This will give them something tofall back on if they have a, a
almost their, you know, to ever saythat someone's cured from insomnia,
think is unrealistic.
But if it starts to come back, theyknow what to do to get back on track.
Whereas medication makes it harder.
But like I said, it's not aone size fits all approach.
We just try to start with CBTIbecause it tends to have the least
(24:32):
amount of side effects and risks
Arielle Greenleaf (24:33):
That is so helpful.
Craig Canapari MD (24:35):
Is there anyone you'd say is not a good candidate for CBTi?
Arielle Greenleaf (24:38):
Hmm.
Shelby Harris PhD (24:39):
I sometimes get, patients that will come to me
and say, where can I get the pill?
If they have zero motivation despite.
education on my end, that'snot an ideal patient.
If someone has a lot of significantanxiety or depression, it doesn't
mean they can't do CBTI, but ifit's gonna get in the way of them
being even remotely consistentwith what I'm asking them to do.
They might not be an ideal patientbut I think many people can start with
(25:02):
it, even if they're on medications.
You just have to modify the treatment.
I think you might not be ideal forone of the apps, but we can always
modify it to try it with patients.
Craig Canapari MD (25:11):
we struggle a little bit in our adolescent
population, especially kids that aremultiple psychiatric medications.
They're already working with a therapist.
Otherwise, there's, there's the insurance
layer that sometimes you can't getcoverage for two psychologists at once.
If nothing is workingwell, where do you start?
I have patients with mood disorder,narcolepsy, terrible sleep
(25:33):
hygiene, and it's kind of like
Shelby Harris PhD (25:35):
Yep.
Craig Canapari MD (25:36):
sometimes we're sort of just trying to figure
out like, where do we even begin?
Another domain I've seen a lot of,especially since the pandemic, are
kids with school avoidance, kidswho are just not attending school
and they come to sleep clinic.
'cause they're like, oh, they'resleeping all day and that's
why they're going to school.
And I'm like, no, theydon't want to go to school.
(25:57):
And that, that, that is thenthey've stopped going to school
and then start sleeping all day.
it's not that hard to fix a circadianor body clock problem if some, even
if someone's split their dates andnights, all the adolescents did
this during the pandemic, and mostof them we could switch it right
back when they went back to school.
it's just the kids where there's alot of anxiety and behaviors about
(26:17):
avoiding things that they need todo, that are perpetuating these
really maladaptive sleep problems.
Shelby Harris PhD (26:24):
one of the things with the circadian stuff that I see
a lot is even with adults, if theysay, I just wanna have a normal sleep
schedule, but they don't have an actualreason to get up by a certain time,
that's someone that I find is gonnabe more challenging to treat because
they don't have that, external reason
to have to get up for a certain time.
Exactly, exactly.
(26:44):
But I do think when I was saying likedepression, anxiety, if someone's
coming to me, even though I work asa general therapist, CBT stuff, I
don't always take on cases weekly.
I don't always have the room,so I do mostly sleep stuff.
So if people are coming to me, they'relike, I don't know where to start.
Do I start with the sleep?
Do I start with the depression?
I'm one of those people that just says,you know what, let's start with a few
(27:05):
focused sessions of CBT for insomniaor working on whatever sleep issue
behaviorally that we're going to.
And sometimes what we see is ifsomeone's sleeping better, it helps
with their coping mechanisms tohelp with whatever other treatments
they're gonna be doing so you get more
bang for your buck.
I keep saying that, I really do find that.
When it comes to this sort of stuff,if someone's trying, they can't
stay up until the time I'm asking tobecause they just wanna get in bed to
(27:27):
avoid whatever thoughts that they'rehaving or to put an end to the day.
If there's a big depression componentthat's making it harder, then I
might argue first, starting withthe depression treatment first.
Craig Canapari MD (27:36):
Yeah.
if someone is listening tothis and they're like, I'm
really struggling with sleep.
I wanna find a provider forCBTI, where should they look?
Because I know this is.
Surprisingly difficult a lot of the time.
I mean, it, it took me in the lastyear we hired a psychologist in
our clinic, and it took years andyears for us to make this happen.
Shelby Harris PhD (28:00):
Yep.
Craig Canapari MD (28:01):
where should people look if they're looking to find a Dr.
Shelby, or someone with similarskills, how do they start that search?
Shelby Harris PhD (28:10):
I think the first place is you have to think about.
what level of qualificationsyou're looking for?
when I refer for any sort of behavioralsleep medicine issue, the first place
I tend to go to is someone who hasbeen board certified in behavioral
sleep medicine, someone who hassomething called a DBSM and that way
you know that they have fulfilled theamount of training that's necessary.
(28:33):
They've taken the exam, they'vehad the supervision that you
know what you're getting.
For for sure.
And they've got that gold stamp on there.
you can go to the Society ofBehavioral Sleep Medicine and they
will have a, listing throughout theworld of people who have, different
credentials, but they'll have alsopeople who have the DBSM designation.
Then if you don't need someone, I mean,you don't have to have a DBSM, there's,
it's a lot of extra training, you don'thave to have that to be good at, say CBTI.
(28:58):
if you're looking for that, the Societyof Behavioral Sleep Medicine, but you
don't have someone who's DBSM, you know,you're probably gonna get someone that
actually is in the know about the fieldthat they're even going to have their name
listed on this website.
Penn Medicine has a.
CBTI provider directory as well.
And those are people who have taken,Michael Perlis's training if you're
not sure if the person has justtaken a training, I always say to
(29:20):
patients like you're the consumerwhen you call to have an initial
consultation, talk with this person.
Ask them how many cases,roughly have you maybe seen how.
Have you been supervised by anyone?
Like Michael Perlis will be the firstperson to say like, if you've taken
my training for a few weekends, Istill think you should have some
supervision by someone who has a DBSM.
So like those varyinglevels are really helpful.
(29:41):
There are a lot of people who say theydo CBTI on Psychology Today but they
honestly are just giving someone sleephygiene treatment recommendations.
That's not CBTI.
So I think going through itin that way is a much more
standardized way to think about it.
Craig Canapari MD (29:54):
One thing I think is, uh, interesting is the
importance of tracking sleep, right?
Yeah.
sleep is so subjective.
if I said I'll give you a milliondollars, tell me the exact time
you fell asleep last night.
Like, nobody can do that.
It's just, it's just not how it works.
And like, if we want someone toget better at fitness, we're like,
okay, run a mile and then runtwo miles, then run three miles.
(30:14):
I know you run marathons andstuff like that in sleep.
It's like, it's like trying to control it
more actually make, can make it worse.
Shelby Harris PhD (30:22):
Yep.
Craig Canapari MD (30:23):
About the role of, consumer technology in tracking sleep.
pros and cons because likeI, I wear an over ring.
I find it useful.
I've had friends whose kids were like,you need to stop wearing the ring because
you're being really weird about it.
Like this sort of classic orthosomnia
thing, which is wheresomeone's obsessing about their
(30:44):
sleep tracker and they can't sleep.
where do you see the kindof role of these consumer.
Which are honestly as goodas the medical technology
acti we use.
but they do have some potential downside
Shelby Harris PhD (30:57):
Yeah.
so I think they have a really stronguse for people who don't make sleep
the biggest priority in their life,and they're just interested in how
they can, optimize their sleep.
Like what does alcohol, do to my sleep?
What does the caffeine do?
And in regular sleep breakschedule, am I getting enough sleep?
Because we know they're prettyaccurate with telling us how much
sleep someone's getting on average.
(31:17):
The sleep staging can be a little funkybased on, the device and in general.
for people burning the candleat both ends and just wanna
see how to improve their sleep.
I think for the peoplewho have chronic insomnia.
Really think a lot about their sleep.
I think it is, like you said, orthosomnia, I think it's the A recipe
for disaster because they know theydon't need something to tell them
they're not sleeping well already.
(31:39):
And then if they had a night wherethey thought they slept well, but
the device said they didn't sleepwell, then that oftentimes will.
gauge how their day is going to go.
So I have had plenty of patients,I'll say, get rid of the device.
I just wanna see on averagehow you think you're doing.
And if you start thinking thatyour sleep is getting better,
that's all I really care about.
I do use the devices, actually,I'm using them more and more.
for, circadian rhythm disorders.
(32:00):
for tracking, sleep, wake timing,I'm using those a lot in my practice.
Arielle Greenleaf (32:04):
I feel like I know a lot of people who are like, oh my gosh,
I only got this amount of deep sleeplast night, and I'm like, how do you even
know people think that they need ninehours of deep sleep in order to be well
rested the next day, andthat's just not a fact.
you get these devices, butyou're not told how to read
the stuff that's coming out of them.
Shelby Harris PhD (32:23):
I think that we get very fixed on like, I need
that REM sleep.
I need that deep sleep.
they don't really think aboutthe percentages that you're
supposed to get throughout the night.
people don't think about other things thatimpact sleep staging throughout the night.
Psychiatric medications youmight be taking, other things can
definitely impact that, that thosedevices aren't necessarily telling
you about.
there's more to the story than just whata printout or a screenshot might tell you.
Craig Canapari MD (32:47):
Yeah.
You know, I,
I, I'm, I'm very conflictedabout this stuff.
'cause on the, on the one handit's can be very useful when
families bring this in.
And, the flip side is in the pediatricrealm, sometimes it can create some
conflict, especially between teenagers and
parents.
Families with a high level of achievement.
They're wanting to optimizeeverything in their kid,
(33:08):
and I'm like, maybe you don't.
need to hold on quite so tightly
Arielle Greenleaf (33:13):
I always tell that to parents as
well.
We can't force people to sleep.
We can't force their sleep stages.
it just is what it is.
At some point, I mean,you we're not robots.
Shelby Harris PhD (33:26):
but it feels a little bit like, like
you said, policing in a way.
Like they're just watching,are you getting up in the
middle, what's happening?
And just that level of control.
it's creating more stress aroundthe idea of sleep, which is what
makes it worse for the whole family.
Craig Canapari MD (33:39):
I think it is A funny phenomenon as the owner of two adolescent
boys, it is a funny thing when, like
they're going to bed later than you are,you don't quite know what they're doing.
I, I tell them, 'cause you know, ifthey, if they wake me up out of that
slow wave sleep, when they're rattlingaround the bathroom or something
like that, like I, I am up for
(34:01):
like an hour and I'm like, lookguys, I'm leaving the door open.
'cause the air conditioning's on.
Can you brush your teeth andstuff before I go to bed?
Because they're just running up and down
stairs, slamming doors.
it's crazy.
Shelby Harris PhD (34:14):
I know my son likes to make homemade pasta,
Arielle Greenleaf (34:16):
Oh God.
Shelby Harris PhD (34:16):
11 o'clock at night.
I'm like, really?
do, we need to be doing that right now?
It's so
Craig Canapari MD (34:21):
like
fire alarms going off and.
It's crazy.
So listen, we, we thoughtthis would be fun.
I mean, I thought of this, don't know ifArielle thinks this is fun or not, having
guests on to talk about a sleep hackand a sleep confession, things that you
might find helpful and things that youdo that you know are not best practice.
I, can go first.
(34:42):
my sleep hack is.
I love a sleep mask, I only started acouple years ago and I'm like, why have
I not been doing this my whole life?
I'm light sensitive.
I like the pressure on my face.
Now my 16-year-old loves it.
He went to scout camp with a sleep mask.
It's just really funny.
Um, my confession is I take acouple of supplements every night.
(35:03):
I take a tiny bit of melatonin,I take some magnesium, and
I take some L-theanine.
And I've actually used my Oura ringto be like what actually works.
I've tried a bunch of supplements.
I'm like, this seems to help the most.
So yeah, I will say I'veplayed around with it, but
I don't know if I'd recommend thisto everybody, I was talking to Sujay.
He's like, there's not a lotof evidence for magnesium.
(35:24):
I'm like, I do feel better when I take it.
Shelby Harris PhD (35:27):
I'm gonna like, Exactly.
There's not a lot of evidence for it,but if it helps you and there's not
really any downside to it, just besidesspending the money on it and you find
it's helping, then you, I always say
that.
Craig Canapari MD (35:38):
Do you want to,
Arielle Greenleaf (35:39):
my sleep hack You said you're light sensitive.
I am very noise sensitive.
I always have been.
even in college, I had white noise.
I lived in Boston, it was loud.
I believe in white noise forpeople that are sensitive to it.
A lot of times parents will say,well, I don't want my child to get.
Used to white noise.
But I also say, in my opinion, it feelslike you either sensitive to noise or
(36:01):
you're not, and your baby can't tell you.
it doesn't hurt to use it.
And then if they tell you laterwhen they have the ability to do so,
they don't like it, take it away.
for me
it really helps a lot.
my confession is that I've been onsleeping medication for years and
my mom thinks it's hilarious that I
help people with pediatric sleep.
(36:22):
She said I didn't sleep throughthe night till I was four.
So, I mean, I
think my body is just, you know, it.
And the crazy thing isthat I need a lot of sleep.
if I don't get
sleep, I feel.
Physically ill, and I think that'sultimately why I have stayed on
medication for so long because itreally affects my life when I don't
Shelby Harris PhD (36:44):
yeah, And you
found something that's workingfor you, so there you go.
Um.
Craig Canapari MD (36:49):
do you wanna out yourself for sleeping
with a TV on all night or
Shelby Harris PhD (36:52):
Oh, so my hack, is that I like to keep my bedroom really cold.
I actually get too cold at thebeginning of the night, so I sleep with
Big fuzzy socks.
for me that helps to keep the room cold.
My kids don't seem to
care at all.
My husband's fine with it, so itkeeps it nice and cold, but my
feet aren't shivering and freezing.
then I throw the socks offin the middle of the night.
And that actually for some womendoes, or some people does help with
(37:13):
sleep when temperature regulations.
So that's what I do.
mask on an eye mask.
I cannot do that.
I have so many patients who loveto do it and I cannot do it.
and then for my confession, I've.
Two confessions.
So one is that I absolutelyhate the smell of lavender.
people ask me all the timewithout lavender, and I'm
like, I cannot be near it.
It gives me a migraine.
But if you like it, go ahead.
(37:35):
the other thing for me is that Iactually grew up, my parents hate
it when I admit this, but I grewup with a TV in my bedroom that was
the thing that I watched every nightto soothe myself to go to sleep
And it's just one of those things that I.
Still have a TV in my room.
Do I watch it every singlenight right before I go to bed?
No, but I watch it.
I watch like a relaxingshow that I like to watch.
sometimes it's something I've seen10 times already, but sometimes I
(37:56):
watch that right before bed and I'mgood about turning it off and then
saying it's time to go to sleep.
So I have a TV in my room and yes,I do watch it before bed sometimes.
Arielle Greenleaf (38:04):
Yeah.
I have that same thing,
Shelby Harris PhD (38:08):
Yeah.
Craig Canapari MD (38:08):
Rules are meant to be broken, you
know?
Shelby Harris PhD (38:10):
I'm not a hard and fast get rid of all screens right before bed.
some people can actually toleratethem a little bit better, so
Craig Canapari MD (38:15):
I take a TV in someone's room over
them staring at their phone
any day.
It's just not as engaging.
Arielle Greenleaf (38:21):
passive.
Craig Canapari MD (38:22):
it's, yeah.
Shelby Harris PhD (38:23):
But getting people to actually get a TV to put in their
room is harder and harder nowadays.
Craig Canapari MD (38:29):
So Shelby, I have the link to your website and
your book.
is there anything else that you wouldlike to plug here, for our audience?
Shelby Harris PhD (38:37):
I think it's just the Instagram account and then my
website and book would be great.
Thank
Craig Canapari MD (38:41):
Awesome.
Well, thanks so much for coming.
This was super fun.
I learned a
lot and, I think the takehome for me is for parents is
like, take care of your sleep.
there's a reason your body wants tospend a third of your life doing it.
It's very important.
Shelby Harris PhD (38:55):
don't assume the number of people on social media, they're
like, oh, once you have kids, your
sleep is done.
that's
not the case.
You can work on your sleep andwork on your kids as well, because
you both need that for yourselves
to develop.
Craig Canapari MD (39:07):
Absolutely.
thank you so much.
Shelby Harris PhD (39:09):
Thank
you.
guys.
I will talk to
you later and, have a
Arielle Greenleaf (39:13):
You too.
Craig Canapari MD (39:18):
Thanks so much for listening to the Sleep edit.
You can find transcripts atthe web address Sleeped show.
You can also find video of theepisodes at that address as
well as in my YouTube channel.
You can find me at Dr.
Craig canna perry.com and on allsocial media at D-R-C-A-N-A-P-A-R-I.
(39:39):
You can find Ariel atInstagram at Ariel Greenleaf.
That's A-R-I-E-L-L-E-G-R-E-E-N-L-E-A.
If you like the flavor of the advice here.
Please check out my book.
It's Never Too Late to Sleep.
Train the Low Stress Way to high QualitySleep for babies, kids, and parents.
(40:01):
It's available whereverfine books are sold.
If you found this useful, pleasesubscribe at Spotify or Apple Podcast
and share it with your friends.
It really helps as we're tryingto get the show off the ground.
Thanks.
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