Guest Episode
March 25, 2023
Episode 80:
Sleep issues, Pain and Trauma
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Annie Miller is a licensed psychotherapist in private practice in the Washington DC area. She is the owner and founder of DC Metro Sleep and Psychotherapy.
Annie specializes in working with sleep disorders, chronic pain, and trauma. Annie uses various evidence-based techniques, including CBT-i for insomnia, EMDR for trauma, CBT for anxiety disorders, and PRT (pain reprocessing therapy) for chronic pain.
Annie received her BA from the University of Pennsylvania and her MSW from the University of Chicago. Annie is a licensed clinical social worker in Maryland, the District of Columbia and Virginia.
Today we will discuss the connection between sleep issues, pain and trauma.
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okay good morning Annie welcome to True Hope cast thank you so much for joining
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me today very interested to learn about what it is that you do sleep Psychotherapy trauma pain huge big
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topics but how are you today what is going well I am doing great thank you so much for
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having me um I'm really happy to chat with you um and so I'm in the DC area Washington
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DC area and it's beautiful and actually not hot
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um here today which is a rare occurrence for you know mid-august so I'm really pleased about that and that's going
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really well wonderful yeah it's nice to have the weather that's not too hot not too cold and you know it's nice to get those
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little those little breaks within the year when definitely When You're Expecting super hot weather you know it's a nice little relief for sure yeah
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so why don't you kick us off with a little little background on you what it is that you do who are you like I'd love
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to just get that information please sure so yeah my name is Annie and I'm a
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therapist so I'm actually a clinical social worker um and I am licensed as a therapist
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um I run a small group practice Private Practice in um right outside Washington
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DC and our practice focuses primarily on
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treating insomnia chronic pain and Trauma through Psychotherapy
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um and therapy-based strategies Grant it's called DC Metro sleep and
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Psychotherapy correct that's correct yeah and how whether this clinic but how
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did it start like I mean there's an interesting connection insomnia chronic pain people and Trauma people might not
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connect those things and also throwing Psychotherapy in there I think most people when they think about going
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somewhere to sort their sleep out they might be getting something like maybe a new bed or maybe some supplements or you
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know some other things to help them sleep so how do we connect insomnia pain and Trauma like what comes
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first like how do you how do most people come in and explain and display the
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issues that they're experiencing yeah no this is a good question and it's a really good point
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um that a lot of times people are seeking a product or a you know medical
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treatment for you know particularly for both pain and sleep
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and so you know we really focus on evidence-based treatments so treatments
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that are proven you know have some research behind them that are shown to work
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um for these you know for these conditions that people are dealing with
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um and just a little bit about it um so I started out doing regular talk therapy
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like a lot of other therapists do and I um you know I had a struggle with
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chronic pain myself and so part of this is me learning how
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this all works through a little trial and error myself um I also I think it's helpful to share
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this I come from a family of poor sleepers so
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um we I've known and been around poor sleepers and
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um so you know this stuff is kind of part of has been part of my life and so
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when I discovered these treatments that are not medicine and not you know
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medical model based it was it was like amazing you know and and so now I'm
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really really passionate about treating these things through therapy because it
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can it can really work and so back to your other question about well what's the
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kind of relationship between these things and the way that I see it is it's
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all based on the brain um so it's how our brain is working and
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sometimes the symptom of insomnia shows up for instance
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um as it's a symptom of the overactive nervous system response so to be more
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specific the brain being stuck in that fight or flight response in stress mode
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um and insomnia and chronic pain are just some of the ways that that shows up
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um you know physically in our body interesting what are some of the like
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go-to's when it comes to like um pharmaceutical medication if somebody
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has got sleep issues because I think a lot of people I think most people unfortunately are going to go to their
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doctor if they've got sleep problems or pain or trauma um which no they can be very helpful
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with that situation but when we're talking about like the practice that you have and you're working with Psychotherapy and you're working with
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kind of getting to the to the root cause of these issues because you know as you say like if somebody is constantly
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engaged in their sympathetic fight or flight nervous system because of you know if there's so many different factors that might engage engage that
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constant kind of response and even if you were to take really good quality supplements you're not really getting to
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the root cause of that you might be assisting your body to come out of that into a rest and digest situation for a
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period of time but there's underlying things happening in primarily your brain
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that are causing you to get into that fight or flight and that you know if you're in a stress response and you think you're going to be eaten by a lion
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there's no way your body's going to put you in a state for good quality sleep but what are the like if most people go
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to the doctor with sleep issues what are like the some of the primary medications that that people get put on like is
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let's step one sure no and I just I wanna you know kind of acknowledge how like right on you are
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is and I appreciate that because I think not that many people really understand that the supplements and medications
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they can really help they can and especially on a temporary basis and
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they're amazing but it it isn't going to fix the mechanism that's happening in
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the brain and then and so we do need to kind of retrain that from a therapy
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behavioral based perspective because if we don't it's going to keep happening and while the medication does and you
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know supplements they do really help there's still this missing piece for a lot of people
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um but you had asked what kind of medications are people taking um for sleep
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it's there's a whole range of things out there you know typically people do things like Ambien
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um and you know sometimes people that take things like Xanax you know there's a really common one that we see here is
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is trazodone um you know there's a whole range of things
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out there and again those things can help um but what I find the most often is the
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people they help initially or not at all sometimes but if they help
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they help initially and then people kind of start to get back into their old habits and are you know the stress
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response is overriding the medication or supplement and most people who come and see you is
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it more common that they have actually gone through that type of experience with the medications before
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they come and see you and they recognize that maybe it doesn't work for them or it doesn't do what it used to do or are
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people coming to you who um you know like the idea of using
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therapy as well it's just it doesn't seem super common to me that people would be like oh I've got sleep issues chronic pain and Trauma maybe I should
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go and see a psychotherapist or sort those things out that doesn't say I mean I do because I you know I feel like
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that that's where I am in my life now I'd like to look at those type of therapies that are going to get to the
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to the root cause and a practitioner like yourself are going to understand like the the full rounded effects of
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like what is going to influence my sleep so most people coming through your door have they experience this like
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conventional approach first and then they're coming to you for I'd like better help
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yeah you know um often that's the case um particularly when it comes to pain
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I don't see very many people trying a therapeutic based approach first so I
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would say almost all the time with chronic pain people have been through the ringer with it and and they've tried everything
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with sleep you know it's a big range um most people have tried something
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medically um they've gone to the doctor um maybe they've done a sleep study you
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know there's a whole range of things maybe some people don't want to take sleep medication
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um but I mean I have people who've had you know sleep problems since getting coveted for instance and it's been like
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you know six months or I've had people who've you know have to sleep apartments for 30 years so it's
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it depends on the person um more and more people are
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understanding the therapy I use for insomnia called CBT for insomnia and so
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more and more people are doing you know learning about that and I think that's good and that's part
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of why I like talking to people about it is because it's so helpful to know what's out there and with this kind of like Trifecta of
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sleep chronic pain and Trauma um is the goal to
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work work with that trauma to improve sleep to reduce the pain is that kind of
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the if I missed that if I mix that up or is it different from different people so um you know some people are coming in
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with just insomnia right and so we start by working on just the insomnia
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um and through that process getting to know them a little bit better we uncover wall
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actually there's a lot of you know historical trauma in there um that would be helpful to work on so
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you know typically I think people come in with one area of focus to work on and
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thinking about it you know they they kind of see one thing as their biggest issue or the biggest obstacle that
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they're dealing with and then me you know some people only have that one thing of I see most
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commonly that there's definitely these overlaps um with other areas but you know it just
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it depends it depends on the person and when when someone's coming in with any kind of sleep related problem
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I like to focus on that first um the sleep first because it's more
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shorter term we can I think we you can get sleep in a better place more quickly
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um then you can some of the other things and so I I tip that's my go-to is just
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start working on the Sleep one sleep is a little better it's easier to focus on the other things when people start putting your
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recommendations or all the practices that you recommend them to take home because obviously they're coming to the clinic with you and you know they're
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with you and you know you're discussing things but then they go home and they're spending a significant amount of time
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away from you um which you know for some people can be difficult to get motivated motivated at
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home when you're surrounded by you know all the familiar things that you know make us behave in predictable ways I
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suppose is it um do people find it difficult to take those practices home or is it like a you
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know is it is it a constant having to like really work with you on like a frequent basis to really start
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implementing these behavioral changes because we know like humans aren't brilliant at changing those like learned
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behaviors and when we're talking about something like long-term pain or insomnia or trauma you know we're
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talking about things that have been within someone's life for decades in some cases so that's really hard to
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crack through that like really solidified um neural network of you know of
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thoughts feelings and behaviors that that lead to these traumatic this trauma and this pain and then ultimately like a
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big lack of sleep and we obviously know a lack of good quality sleep is going to have a large effect on pretty much every
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system in your body so do people find it difficult to make these changes and when they do start to
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make the changes on a consistent basis do they find results quickly from the Sleep perspective
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um it's it's actually easier because of the way the therapy is set up so it's it's kind of like a program so
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what I have them do is start with a sleep diary so they're tracking their sleep
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um so like that is a way for them to be accountable actually
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um and generally speaking you know I don't
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outside of the CBT for insomnia I don't I'm not a huge fan of sleep tracking because I think it calls attention to
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sleep it puts your focus on it sometimes in a negative way and that can be counterproductive but
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for the purposes of what we're doing and if I have the Sleep Diaries set up a certain way so they can't really focus
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on it or it's just they do it and it's they don't see the information um
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but that creates some accountability um so plus it's it's very structured you
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know you do this you do that and you know there's kind of a step-by-step process to
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um or a set of rules and guidelines to follow and so most people
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you know are able to follow it to some degree there's things that are some things are harder than others for people
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to follow but generally speaking this kind of therapy is actually
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relatively straightforward to follow it's a habit change so there's resistance you know we Face resistance
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trying something new that we don't feel great about sometimes but um
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for like many many people it's actually pretty straightforward that's great I I feel that most people
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who probably come through your door and um work with you they're pretty self-motivated to make changes and and
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to do that because you say like a lot of them have gone through a conventional system and they recognize that that's not really worked for them and they
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really genuinely want to sleep better and have less pain and and you know work
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through the traumatic events that they might not necessarily consciously connect with those issues so this probably works well that you
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know people are really looking to change their self-motivated and you know it's now's the Now's the Time for them to
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start making these changes that are going to lead to those those outcomes that they're looking for when you talk about tracking sleep what type of things
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are you looking at what's the what information are you looking for there so I'm looking at um how long it's
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taking them to fall asleep so um that's that's what we call it sleep latency so the amount of time it takes
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from when you get in bed to when you're falling asleep and it's just an estimate that people are making because we never
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really know how long that takes it's based on like what we think is happening
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um you know how much they're awake in the middle of the night um and you know if they're waking up
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early in the morning let's say earlier than they intend to but I also am interested in overall like one of the
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big things that we're tracking is how much time are they spending in bed because we don't want to be spending
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time in bed unless we're asleep so that's very clear with us
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um so that's a big one and then overall just what their habits look like so when they do wake up what do they do do they
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lie there and try to sleep do they get up um what are what's their typical routine
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around sleep looking like what do you think about like the Sleep apps and smart watches and things like
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that and the information from there is there any is there any helpful information with that that we can take
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you know um generally I recommend not using it for
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Sleep um and you know they're they're okay at
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tracking sleep um they're you know they have give you a a general picture but they can't really
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you know they're they're tracking your heart rate they're not looking at what's going on in your brain you know if you
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go to a sleep lab it's a whole different setup you know you you have they're really tracking it and they can really
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see at a sleep lab so um I think that what I've seen with with
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sleep trackers is sometimes people will wear their you know Smart Watch to bed and then you know kind of obsess about
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the data and oh did I get this it's saying that I didn't get this and that
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kind of creates its own issue actually yeah um so they're great at heart rate
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movement and and there's so amazing things about them but overall I find them more unhelpful when it comes to
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sleep yeah I think they can become yeah wait just just putting way too much
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focus and energy on that information as you say like it's just trying to tracking heart rate and that varies between individuals and it's not
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super super accurate when it comes to the like the full data that you would
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get let's say in the morning um I used to I used to have one that I I got like that very very quickly I was
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like really into the app looking at the the ups and downs and I just I didn't like the idea of my this watch being on
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me talking to my phone all night while I'm trying to sleep you know like I don't know the ins and outs of that
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connectivity and how that you know that messes with the frequency of like what is necessary for my brain to sleep I'm
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not quite sure about that I don't know but I just didn't like the idea of this watch being kind of like on me on my
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person um always on and like you know going I didn't like the idea of that to be
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honest but um is is it common for psychotherapists to work with sleep or do you have kind of like a unique
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approach to you know what you're doing in your practice that's a good question too
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um there is a field um and it's it's new so there aren't that many people working in this field
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but it's called um behavioral sleep medicine so it's it's actually
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um I'm a social worker but there's more psychologists who are in that field than any other type of Provider
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um but but more and more social workers I mean I think you know anyone who
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experiences like if as a therapist when you see someone change and you can
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see it pretty quickly it's it's amazing and and you feel like oh my gosh I can
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really impact people in this amazing way and so it's growing it's a growing field
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because CBT for insomnia is a very highly researched
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um therapy and the outcomes are really positive so like 70 to 80 percent of
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people get better which is really amazing wow so
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is it really common no it's it still needs we need more people doing this
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um but you know there's places like the VA for instance that are starting to to
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really use cbti um and other kind of big uh agencies
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that are starting to implement this more so and really roll out training
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um for this but it's still you know not that widely known
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with the with the pain issues that people come in they're they're like is there a common type of pain in like a in
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a part of the body or the actual pain itself whether that's like
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I kind of I kind of think of like pain and discomfort on different scales rather than like a scale of pain I feel
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like I've got this like discomfort pain like how much mind discomfort and then and then pains a different section for me
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um but are people coming in with like like are there patterns of the pain that people are coming in with and is that
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like connected to insomnia in some kind of way um I mean I see them occur together
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really really frequently um but with pain
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um I think probably the most common type of pain I see is back pain um I don't know from a statistical
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standpoint what you know um terms of like chronic pain what most people are suffering with but I would
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say back pain migraines for sure um is a big one and then like neck
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shoulder pain like that kind of like you know overuse pain
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um those are probably the most common things that I see um but there are others I mean you know
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some of the therapy that I use for chronic pain is called pain reprocessing therapy and I think about also symptoms
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like GI issues for instance or you know like stomach pain or even
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other types of GI issues as being related all related to the same
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um you know kind of underlying issue that the brain is experiencing right so or even something like fatigue
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unexplained fatigue so if someone comes in with a symptom like that like I'm looking at it in the
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same way and I you know as long as they've ruled out you know they've they've been through testing and they've
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ruled out other problems um and in some cases you know from a
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pain standpoint if they have like like a bulging disc or something like that I
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see that differently because typically bulging just don't cause pain but
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they're being treated for it right so um it depends on the diagnosis we you
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know um we kind of have to look at it critically yeah of course yeah everyone's going to
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be different and as you say everyone's um everyone's perspective on their own pain
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can be very different from other people I think that we also like learn to deal with quite a large amount of discomfort
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or pain that we just end up kind of like dealing with and that's just like our normal and we get used to it and so that
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can really kind of distort how bad something might be for somebody are
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there any complementary like practices or other therapies that you that you work closely with or you might recommend
23:03
somebody try along with the therapies that you're going with like Chiropractic or acupuncture for example massage do do
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you refer people out to these type of practices um I do sometimes yeah and
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um I like to work with Fighters that really understand what I'm doing um so like for instance in in the DC
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area there's some great physical therapists who really understand the brain perspective and understand how the
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the role the brain and the nervous system play in the in you know kind of creating and perpetuating pain so I
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think any one of those type of providers can be complimentary if they see it the
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same way so let's say we have a provider like that who doesn't see it the same way and they
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kind of you know feel around in someone's back and they're like uh oh this looks bad that's going to kind of
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counteract what I'm trying to work on so I want to be mindful I want to connect with them and make sure hey look do we
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do you see it this way um because I have actually had that happen with clients I'm working with and
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the whole goal of pain reprocessing therapy or PRT is to separate fear
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from the physical sensation and if someone's reinforcing that it's going to be unhelpful so
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um I think you kind of understand what I'm saying as long as as long as they're like-minded yes absolutely it can be
24:36
helpful yeah that's great I think one of the greatest things for I mean I'm I'm 38 now and I didn't really have a
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relationship with pain rather than like no sock injuries but I'm 38 now I've got two small kids
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and like the my first kid is three he's three now but he'd like messed my back up my body was not used to carrying a
24:57
child around and I was probably quite unconscious I was carrying him on one side and now and like for a good good
25:03
five six months my like back would be in you know in bits in quite a lot of discomfort and I had to do quite a lot
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of work to to help that out you know like warm baths and stretching but one of the
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best things that I did for it was using my meditative practice to actually just like sit and like rather than
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really wanting the pain to like go away or do something to just get rid of it I
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was kind of talking to it and connecting with it and really like feeling it I I definitely do that a lot when I'm in bed
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and I'm asleep and I'm like still and it's dark and I can I've got the the sensory overload of like the world is
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not quite there and I feel the pain and it's it's very interesting because you once you put
25:48
your energy into something like that I genuinely feel like you can make a diff
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have a different relationship and a different connection with what that pain means to you because I I think little
25:58
messages I think that there's you know my my back pain is a connection that I need to be more aware of my posture I
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need to be more aware of like you know how I'm holding my shoulders back and I'm standing up in my desk today you
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know and I'm trying to stand up straight and I think they're all just like little messages here and I just wonder like when you speak to
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um your clients about pain what's the type of approach you have to it because like you know if you're going to go to I
26:22
just want to say a bad chiropractor all they want to do is just try and manipulate you to just like relieve some
26:27
of that pressure to reduce the pain a little bit um which you know might be very helpful for somebody who's in significant
26:34
discomfort but at the end of the day like it's a Band-Aid that Pain's coming back because someone's going back into the car they're going back to their
26:40
office they're going to sit down on the sofa they're going to do all the things that created that pain in the first place and it's just not you're not
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creating an understanding of why that pain is there and what that pain means so what's the type of approach you have
26:52
with your clients when it comes to understanding their own pain yeah um no it's a it's this is a good point
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and I I really appreciate what you just said because you kind of nailed it um it's that's what it you know that's
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what perpetuates pain so sometimes pain can start from an actual injury right so
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it can if it can begin with like a broken foot and then you're what happens
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is your brain starts to develop what's called these conditioned responses like it learns that when I step down I feel
27:23
pain I step down I feel pain and so then it starts to kind of take on a course of
27:28
its own based on your brain's habits and patterns right so you know holding your
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your child may have kind of been that initial Kickstarter but then the learned
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responses start to kick in that your brain has so unwinding the way that
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works and a big part of it is sitting with the discomfort so that sensation is
27:54
there I feel it but it's not alarming nothing's terrible is happening I'm
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feeling that and I can tolerate that because it's just a sensation it's not
28:05
dangerous and so that fact and that you know kind of point is
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a big overarching theme in this pain reprocessing therapy yeah and we have these beautiful when
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you look at the biology of the body you know it's all Pathways it's all communication whether that's
28:22
um within your cells using hormones you you're using neurotransmitters using electricity using chemicals and if I've
28:29
got pain in my lower back you know that's just like that message traveling up all the way up through my you know
28:35
peripheral nervous system to my central nervous system communicating with the brain letting me know that you know I need to put some attention to that area
28:40
and I think if we have a a bit more of an understanding of yellow what that pain is how it's getting to my
28:47
brain like that I just think we can just start creating a softer more compassionate understanding about like
28:53
what's actually going on in your body and yeah the fact that we like go straight for painkillers or
28:59
anti-inflammatories or we like you know just do as much as we can to just like ignore it or to just like take it away
29:07
right away yeah it's not the it's just not going to have a lot there's no gonna be no long-term benefits of that type of
29:13
approach and that's why I'm so thankful that you know practice is like yours and um therapies like yours are out there you
29:20
know supporting people to get them back to kind of connecting and understanding their own brain and body a little bit better and you know how they can serve
29:27
themselves um going forward in many different aspects of their lives you know if you start getting connected more of your
29:32
mind and your body and you want to start understanding that you're very powerful then you can you can do many different things and you just got this bigger
29:39
connection with yourself where you are in the world and what you can do and I think I think that's only
29:45
going to benefit people um going forward I've got a question about like myths about sleep like what
29:51
do people misunderstanding about like sleep and what it means I've got an example of
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um so I'm a holistic nutritionist and you know I did that for many years before I started working with true hope and one of my questions based around
30:04
sleep was you know like how how quickly do you does it take for you to fall asleep you know as we spoke about before
30:10
that's an important question and a lot of people who are coming to me with
30:15
pain and inflammation they were telling me Oh my sleep's awesome I like lie down on the bed and I
30:21
I pass out like immediately and I think a lot of people you can correct me if I'm wrong here this is just my
30:26
understanding of it but people associate that with having a good sleep pattern I
30:31
understand like there should be this period of maybe like five to fifteen minutes where we actually like fall
30:37
asleep rather than just like passing out through exhaustion I'm sure there's a genetic component and some people just
30:43
like have the ability to just kind of pass out but there's a there's a big difference between like falling asleep
30:49
and then just like crashing out can you talk to us a little bit about that yeah
30:55
um you know so part of the therapy that I do for sleep is so there's a piece of it
31:01
that's um called Sleep restriction so we're actually restricting sleep to some degree
31:09
um to in order to make people feel very sleepy so at the beginning of therapy
31:14
that's the goal is to fall asleep faster for some people I mean I have people who it takes them two hours you know they
31:20
come in and they're up for two hours just lying there and um so what what we say is really
31:27
anything under 20 minutes is our goal so if it's between 5 and 15 minutes that's
31:33
great I'm not concerned if someone's falling asleep really fast I would I would be
31:39
interested to see how tired are they during the day so if this person's really really tired and sleepy all day
31:46
then you know that's another piece that we would look at if they're
31:52
fine all day or you know reporting that they're fine and they're falling asleep that quickly well it's not too much of a
31:59
concern um but you would ask you know what are we getting wrong about sleep and
32:05
there's there's a bunch of these that may surprise you that I think maybe will be helpful for people I'm hoping they
32:11
will be um but this whole eight hours thing is
32:17
really a big myth that everybody needs eight hours and you as a holistic
32:22
nutritionist can probably relate to the analogy I use for this which is it's like saying every single person needs to
32:29
be on the same diet right yeah that doesn't work that's not the way we're not all the exact same so generally most
32:38
people need between six and nine hours some people really do great with six hours that's what their body needs
32:45
um there are short sleepers who need less than six and those are you know people who typically have this genetic
32:51
kind of short sleep um condition and but it's not bad that's
32:57
what their body needs so it's more about listening to your body rather than trying to meet a goal
33:06
um so that's one thing and generally the idea that more sleep
33:11
is better over you know overall um tends to be the way people see it so
33:17
if I'm tired I'll just get in bed early but the problem with that is it creates
33:23
this like inconsistent sleep patterns either I'll get in bed early or just try to
33:28
sleep late I'm just trying to sleep when I can but if we have more consistency so I go
33:34
to bed at a certain time or later and getting up at the same time every day no matter what is more helpful for
33:42
regulating sleep than just trying to sleep when you can
33:48
um the other thing that I think people focus on and it is it's so common to
33:56
read about this is that lack of sleep causes so many issues and so we know
34:04
that not sleeping well is not good you feel tired but we don't want to start to associate
34:11
oh no if I don't sleep then all this bad stuff is going to happen right because
34:18
how do you really separate stress from sleep and anxiety from sleep
34:24
if you're you know it's really hard to do that so oftentimes the worry about
34:29
sleep just exacerbates the whole problem and so it's not the it's often not the sleep
34:37
alone in isolation it's all like the worrying and the emphasis we're putting
34:44
on it I needed to look this way because as you know you have two young
34:49
kids right new parents aren't you know kind of having heart attacks all the time or all
34:56
the scary things that we read about it's if we have short-term
35:02
sleep loss because that's what happens with new parents right it's you're tired it's not fun you feel
35:10
foggy but you're not having the typically you're not a you're not like
35:16
afraid of not sleeping in the same way because you're just desperate for it
35:22
uh like no that makes total sense because you know you I also feel like you know when you're about to become a
35:28
new power and your body recognize that that's going to happen and it's going to start you know biochemically changing
35:33
changing things for you so you can get through that time but yeah like especially the first the first six
35:40
months to a year of you know new kids is absolutely wild and then once you get
35:46
through that bit and you can reflect on the fact that you've achieved accomplished so much and you've kept this human alive for 12 months you can
35:53
be oh my gosh I can do so much on quite little sleep and you can actually you know do quite a bit but it's obviously
35:59
you know I like to think of these things it's just going to be a phase and then you know things will change because sleep is very important to me
36:06
um but yeah it's uh it's it's a serious business like having young kids and like that whole sleep deprivation thing and
36:13
do you have a lot of like new parents that that come in like really worried about the the fact that their whole
36:19
sleep routine is completely flipped upside down yes that is it's a common time
36:25
um for people you know to to experience sleep issues is you know Parenthood
36:31
um also you know another one is like retirement because there's all of a sudden a lack of structure
36:36
and you know the consistency and routine you used to have is not there and then kovid you know brought this up for
36:43
people too so there's these like these typical things I see when we have a
36:48
shift in our change or routine like travel or health issues or you know there's these common things that throw
36:54
sleep off um but you know typically with new parents it's it's a process you know and
37:02
and you you kind of get used to sleeping with like you know a lighter sleep right
37:08
because you got to be aware of it's a different it's a different
37:14
um type of sleep here than you were doing before because you if they cry you have to be you know aware of it but it's
37:22
not um like it's temporary and you can change
37:28
it you can work with kids on their sleep you can start to um you know do behavioral things for
37:34
kids so there there are things that really help um and
37:39
it's a good lesson to learn because the the parents that I see tend to be like a
37:46
little more flexible with their thinking I know I don't need eight hours every night because I just went through six
37:52
months of that you know um and so if you can let go of what you
37:58
think it needs to look like it's easier to make progress yeah I think uh especially with like the
38:04
of how we how we change this as people when we become parents or you know we get let me move in with
38:11
somebody you know like those those patterns are all going to change and we we're going to evolve and we're going to
38:16
adapt and the body is like really good at being able to do that and yeah having the you know having the mindset and the
38:22
understanding to like take back and rationally think about okay this this huge thing's happened it's now in my
38:28
life you know like a lot of my energy and focus is now on this things are going to be different it's my sleep and all these other types of routines are
38:35
going to be different but you know we can adapt to that and we can certainly do different practices to kind of help
38:41
along the way and I think yeah putting some of those practices into you know young children to be able to you know
38:47
work with work with them as individuals and what they what they might need and yourself then you can certainly get
38:54
through quite seemingly very difficult times you mentioned about some of the like evidence-based therapies that you
39:01
use can you give us some examples of of that like what's been like you know what's really got solid science science
39:08
and evidence behind behind it when it comes to improving sleep and reducing
39:13
chronic pain yeah so there's two main therapies that I have kind of touched on is for Sleep
39:21
um what I use is is cognitive behavioral therapy for insomnia cbti
39:27
and it's um yeah the research is really great so it shows I think
39:35
um like average is something like 70 to 80 percent of people of
39:40
um of people get better so that's really high for therapy you know and typically we're talking about between four to
39:47
eight sessions so it's really short term and just to give you like a little overview of what cbti looks like is
39:57
um so we have people keep the Sleep diary as I had mentioned and then there's a set of rules and I can just give you
40:03
like a quick overview if that would be helpful certainly please um so the kind of things we're talking
40:09
about are not having a clock in the bedroom um
40:15
so that helps to detach like that thought process of how long do I have
40:20
and we don't if we set an alarm and we have it somewhere else when you can't see it we'll still wake up at the same
40:26
time but we don't need the marker of time um making sure that we use the bed only
40:33
for sleep so that means no reading watching TV in bed so we're not opposed
40:39
to those things before bed um just not in bed so we're trying to create an association the bed is for
40:45
sleep um and then the idea of um if you can't sleep get up and get out
40:52
of bed so lying in bed is kind of the worst thing you can do when it comes to sleep
40:58
you wanna have as little time in bed a week that
41:05
um that you can manage so you know give yourself 15 to 20 minutes of trying to sleep
41:12
um but that's it that's the maximum um waking up at the same time every day no matter what
41:18
um and going to bed at approximately the same time or later so we're not like when I work with people I set a window
41:25
and that's their window and they can go to bed later but they still have to wake up at the same time and if they get less
41:31
sleep they get less sleep um yeah sorry just a quick question there when
41:37
you when you recommend people not to it makes title sense to me now I've never really thought about it but obviously
41:43
the longer you stay that you lie there looking at the ceiling the more frustrating you're gonna get and if there's a clock in the room as well it's
41:49
just gonna you know send that into overdrive but what would you recommend people do then if they're
41:55
like 15 20 minutes and they can't get to sleep they're lying in bed like what would you what would you recommend they go and do
42:00
so I'm you know pretty open with this I mean any kind of quiet activity so
42:07
um there's a couple of things that aren't helpful like work like if you're working it just kind of tends to you
42:12
know kind of spin your brain up um in a more negative way or you know
42:18
anything that's more um like stimulating is not ideal but like any quiet activity
42:24
reading even watching TV as long as it's like a light easy um something that's light and easy
42:32
um you know sometimes people like to like knit or you know something do a puzzle stuff like that
42:39
um it's kind of individual but really it could be anything as long as it's not a
42:45
stressor like don't pay bills right because you can get really stressed yeah
42:51
um but I think a lot of things that people might not think are okay are
42:59
actually okay the the difference is you don't want to do those things in bed so find somewhere else
43:05
that is separate from the bed kind of its own little space yeah it's
43:10
like what you know what type of nervous system do you want to be really using before bed you know you're going to go
43:15
watch a thriller or you're gonna go and watch David Attenborough talk about fish yeah yeah like what's gonna be more
43:22
beneficial for you and you know I think about transitions in in my day like I like to have a transition from Breakfast
43:28
family time in the morning to coming down into my office to you know get focused into work you know because it's
43:35
only going to benefit me to get the best out of my time when I when I can do that so I have like a coffee and I'd spend a
43:42
few minutes like breathing and just like when I come downstairs and I'm in this mode and then the same when I finish up
43:47
and I want to go upstairs I transition yeah and I feel like I'm pretty lazy with this because
43:52
I get into when I get into a show I'm not really into it and I won't watch anything for like five months so I'm
43:58
into a show at the moment so I'm like my kids are going to bed pretty asleep by like eight o'clock and then like I like
44:04
to watch watch a couple of shows but I don't like doing that because I know that it affects my sleep and it affects my day the next day so I'm trying to cut
44:10
it out so I'm trying to transition using you know like different things like my wife and I will read books we'll talk
44:16
about different stuff or you know just sit there have maybe a glass of wine look at the mountains you know like it's so did you recommend these like
44:22
transitional periods rather than like going from you know your day straight
44:28
into like straight into sleep or is it the same when you wake up like this bit more of like a a little bit more of a
44:35
dance into the next phase of your day I I really love that and in particular
44:40
one of the cbti um rules is to have a buffer zone one to two houses yeah
44:46
um and in the I think it helps in the morning that's not you know that doesn't have to be part of cbti but yeah it you
44:52
know especially in the morning um what can help also is getting sunlight you know direct sunlight and kind of that cue for your brain hey it's
44:59
light it's time to be awake um but you know I I do think that those
45:06
transitions are really important because I see a lot of people who are you know really you know hard workers and they're
45:13
working working until 11 o'clock and then they're you know like why can't I fall asleep at 11 30. well you know
45:19
that's a that's a big ask for your brain to just stop and then put that away so
45:25
we do need that I think we need that um you know I think the one thing a lot of
45:30
people do also think though is TV is not good before bed
45:36
and you know what I really think is it well it depends right because
45:41
um a nature documentary just like what you were saying is is really relaxing for some people and if that can help you
45:49
to kind of let go of your day in a in a way where you know just sitting there
45:54
quietly doesn't um do that because you know sometimes if
46:00
you're trying to sit there quietly you can get more and more frustrated it depends on the person and on the day but
46:06
you know I think something like that actually can be helpful
46:11
um again as long as you're not doing it in bed um and you know having that separation but you know I
46:18
really do think some certain types of things can be helpful
46:25
in winding down like that yeah I think for me it's a compounding effect like
46:30
you know if I if I'm doing that every night or five nights a week like it's compounding my brain is
46:35
confused and it's you know it's having to get used to that that that transition that I'm choosing for those five days
46:42
but when it's like just a couple of days a week with a cut you know with like two or three days in between it's very very
46:48
different because now you were touching on like you said uh people are working till 11 o'clock at night and then they
46:54
expect to fall asleep at 11 30. we have to be thinking about what the what the body is doing and what it has to do to
47:00
to to put you in that different nervous system you know it's the you know it's having to actually you know reduce and
47:07
break down a lot of hormones and neurotransmitters that are you know flooding around the body then it has to
47:12
start ramping up the production of other ones which has to go around the body you know and it's not like it's not obviously not like a light switch these
47:19
things have to have time to be able to manufacture and if you're somebody that does like work a lot till quite late you
47:25
know you it's going to be difficult for your body to be able to like shut that down and say you've got like the screens going on like until quite late at night
47:31
and yeah it's it's just a tricky thing for the body to do I was going to ask you just kind of just kind of coming up to
47:37
like the 50 minute Point here and I I don't want to there's so many questions I've got about sleep I think we should just get you back on so we don't miss
47:43
out on any other things but I want to talk to you about like sunlight and exposing your face your eyes your body
47:49
to sunlight to help um your brain and your body like regulate
47:56
kind of like with the sun and the moon and the Darkness to help you sleep better
48:02
yeah so I post to be able to do that that's look
48:08
at the Circadian rhythm right like the cues that your body has um that it's it should be starting to
48:14
get sleepy like so at night as the sun goes down and it gets darker we're
48:20
supposed to you know release more melatonin at that time which gives you that cue hey it's it's time for Sleep
48:27
um you know and for a lot of people with insomnia that's not happening so well at night
48:33
um so mourning you know getting outside getting that direct sunlight does help
48:40
it does really give your brain that cue you know even as little as like 15 minutes in the morning to you know just
48:48
give yourself that you know reminder it's daytime um I'm supposed to be awake it's okay
48:53
even if you're really tired you can sleep great that still helps so the more
48:59
that you can do that you know keep your wake time consistent get a little you know light in the morning it's helpful
49:05
it's important yeah there's some super strong research in regards to getting outside like within the first hour of waking up I
49:12
know for me after listening to a really cool podcast about that that exact thing okay and you know I live in a part of
49:18
the world where like at 6am for the last month and a half it's been like you know beautiful sunshine outside and blue
49:23
skies so when my son decides to get up at like 5 55 or 6 a.m or whatever we just like go straight outside
49:30
pretty much get naked and say hi to the Sun and do some stretching and just like be out there for like you know 10 to 15
49:36
minutes just to like begin begin the day with that type of exposure and it just makes me think obviously that would have been a very normal situation for you
49:44
know humans 100 200 000 years ago um so yeah I think that's a really powerful for really powerful practice
49:51
and it's again it's a good transition it's like hello to the day and it's just spending that five ten fifty minute
49:56
period allowing your body to you know gently go from being you know
50:01
kind of unconscious in darkness to you know waking up in the morning getting prepared for the day I after doing that
50:07
for like a week and a half I def I felt like a 30 increase in my energy throughout the day like it was I felt it
50:14
real quick and there was no doubt that it was that early exposure that was was really doing it for me
50:20
um yeah I have so many questions in regards to chronic pain as well and like what's important to not I think we
50:26
should get you back on and talk about that because I don't I don't want to rush it it's such an important point because so many people are suffering
50:32
from chronic pain and I think it would be really good to crack down on what
50:37
people should know about their pain and what they when they should be looking at like emergency care or when they could
50:43
be really looking to work with a psychotherapist to talk about you know traumas and pain and how how and sleep
50:49
and how that's all connected I don't want to rush that because that's a very very um important valuable topic so we'll get
50:56
you back on to talk about that so where can people connect with you and learn more about your awesome work in DC
51:05
um yeah they can they can go to my website dcmetrotherapy.com
51:10
and um you know we're a dc-based practice um you know D.C Maryland Virginia
51:17
um you know some of us are working in other places as well so it's worth asking
51:23
um and then more recently it created like an online course um for chronic pain for people to engage
51:31
that don't you know can't access therapy um and I'm gonna be working on one for
51:36
sleep too so I'm excited about that um as well so for people who you know aren't necessarily able to get therapy
51:44
or aren't in that area do you work remotely with people can people have sessions with you on the
51:50
internet so yes but um because there's I'm a licensed
51:57
therapist so there's licensing guidelines um from state to state so there's
52:04
usually when somebody if somebody contacts us we just try to do a little research on those the where they are
52:11
located and the licensing rules so sometimes in other places but yes we do a big a large chunk of what myself and
52:20
the other therapists do is is teletherapy okay awesome well that's great well I'm going to make sure that
52:26
um people can connect with you in the show notes are you on social media as well is there a place I can send people
52:31
um yes so Instagram umdc.metro dot therapy
52:38
um is a good one um Facebook I'm not as active but it's there too
52:45
um Instagram is more active yeah I feel that's the same for a lot of people these days Instagram is where it's that
52:51
um well any if honestly thank you so much for coming on and talking to us about all those amazing topics so
52:57
important everybody sleeps everyone's got a relationship with pain and Trauma is kind of you know everyone's got a
53:04
relationship with trauma as well so I think what we've spoken about today is relatable to everyone on the planet so I
53:10
really appreciate you coming on talk to me on the show and just what you do out there like I I think these type of
53:15
therapies the connection with the sleep for trauma I had a really interesting conversation with another psychotherapist last week who is talking
53:22
more about like critical therapy and talking to talk just taking the
53:27
Psychotherapy just just evolving it changing it like making it more like about the embodied person and their
53:33
whole experience rather than like a narrow focus on one particular aspect so happy that you're pulling all of these
53:40
really important aspects together it's awesome so yeah thank you very much for being on the show I really appreciate your time Annie thank you so much for
53:47
having me and I'm be really excited to come back excellent yeah we'll certainly get you back on the show there's no
53:52
doubt about that um but yeah that's it for this episode um on true Hope cast the official
53:57
podcast of true hope Canada I'll make sure that there are links in the show notes so you can connect with Annie and
54:03
uh and uh see and learn a little bit more about about what she's doing over there in DC DC Metro sleep and
54:09
psychotherapy but that's it leave us a review on iTunes if you're listening to on that but thank you very much for listening this is true hopecast the
54:15
official podcast which you hope Canada we'll see you next week foreign [Music]
54:20
[Applause] that was awesome oh good I'm good yeah