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Episode 10: You Are What You Sleep with Josh Tal, PhD.
86 Plays5 years ago
Sleep expert Josh Tal, PhD joins us to discuss some common sleep issues and treatment options for insomnia. We were delighted to hear about his boot camp approach, which incorporates CBT-I to effectively improve sleepless nights.
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Transcript
Introduction to Mental Health and Sleep
00:00:05
Speaker
Everybody knows somebody who's a bad sleeper. Thank you for joining us on doorknob comments, a podcast that we created to discuss all things involving mental health. We take the view that psychiatry is not just about the absence of illness, but rather the positive qualities, presence of health and strong relationships and all the wonderful things that make life worth living. I'm Dr. Farah White. And I'm Dr. Grant Brenner.
00:00:29
Speaker
Sleep is such an important thing and I was glad we had a chance to talk to a sleep expert.
Challenges and Treatments for Sleep Issues
00:00:35
Speaker
Josh Tall is a psychologist and the interview with him, it's a fun interview and it's about a serious topic, especially with COVID. People's sleep is all off. One thing I like is that as a clinician, he's really laser focused on sleep.
00:00:50
Speaker
Yeah, he has a real expertise in that way and a knowledge of like the latest therapies. Kind of wanted to put out there that I think we were talking, you know, about things that are pretty standard in our field. For example, the use of medications for different things. And I want to make sure that I didn't come off as like flippant about certain things, specifically sleep medications or medications that people would use to interfere with their sleep.
00:01:17
Speaker
I didn't mention it in our conversation, but it's a really dangerous thing to use or misuse medicines and use libel to lead to a lot of problems. What I like about this is we're offering different ways to help treat insomnia and other non-pharmacological things, interventions that are much less harmful.
00:01:40
Speaker
I think you raise a good point. And it's an interesting subject because there's a sense that a lot of times in psychiatry, maybe people are prescribed medications too quickly or too readily. And that medications, you know, can alleviate symptoms, but generally they shouldn't be prescribed as a fix for a more complex problem. Doctors sometimes will use humor defensively just as everyone else can.
00:02:08
Speaker
And so, you know, maybe there's some discomfort around the way some sleep medications are prescribed very broadly and often, you know, without really understanding what's happening on a more fine grained level. And that's one of the things that that the interview with Josh highlights is how important it is to slow down and look at the behaviors around sleep and maladaptive cognitions, you know, ways of thinking about sleep.
00:02:36
Speaker
because his approach is fundamentally a cognitive behavioral therapy insomnia approach, or CBTI. I so appreciate that. I think a lot of the work that he does is to help people get off of these medications, which can be a really difficult thing to do.
Joshua Tall's Background in Sleep Science
00:02:55
Speaker
I don't know. I guess I just wanted to put that disclaimer out there.
00:02:58
Speaker
Well, we cover a lot of territory. It's not meant as a comprehensive guide to sleep problems, but we also think it's a fun conversation to listen to. And then the other thing is, if people have questions on this topic, they can always email us, hello at doorknapcomments.com. We can see if we can have Josh back on again. Yeah, absolutely. And if you have any questions, comments, or requests, email us and let us know. Okay, great. Enjoy.
00:03:27
Speaker
Dr. Joshua Tal, you're a psychologist right on private practice to the Upper West Side of Manhattan. Good afternoon. Thank you, Josh, so much for being here and agreeing to do this. I've wanted to interview you for a really long time, actually. Yeah, because I have some questions, some lingering questions, and Grant, you're more than welcome to jump in, but I feel sleep is
00:03:52
Speaker
kind of a mystery to me. And I'm wondering how you sort of like got into it and how the field has like evolved and changed. Well, actually I got into sleep work. Uh, when I was in college, my parents opened a sleep
Understanding Sleep Apnea and Its Impacts
00:04:06
Speaker
center. Wow. It's a good entryway into sleep science. Well, it's a place for disordered sleeping. So it's there to diagnose, you know, sleep apnea to look at a,
00:04:19
Speaker
Other issues, teeth grinding, restless leg syndrome. A lot of people have those issues and medications obviously can cause them too. Antidepressants can cause teeth grinding and so on. A lot of people have these issues. Alcohol actually increases the prevalence of sleep apnea by fourfold. It can cause a lot of issues breathing at nighttime and
00:04:44
Speaker
In general, sleep apnea is undiagnosed, about 85% of people who have it don't know that they have it. What is sleep apnea? Sleep apnea is where essentially when someone is sleeping, they're lying backwards on their back and the muscle in your throat basically blocks, covers your throat, causing you to hold your breath for
00:05:09
Speaker
10 seconds or longer, causing you to sort of cough yourself awake and to breathe normally again. So it's very scary. It's very common. So someone who has like a severe sleep apnea and diagnosis, those events are happening 30 to 40 times an hour, right? So it's not just, it's normal to have up to five an hour, but usually you'll see someone with 10 or 15. I've seen someone with a hundred an hour, barely even breathing normally.
00:05:37
Speaker
What is the end result of that? Are they just like more tired during the day? Do they have trouble falling asleep? Exactly. More tired during the day. You have cognitive issues performing using your memory, using concentration. You have a lot of people who have increased risk of diabetes and hypertension and all these different things. It's horrible. Metabolic syndrome.
00:06:04
Speaker
But I noticed also, so when I was working, I used to help the clients when they came and set them up with all these electrodes. And then I'd have to make sure that they were comfortable at nighttime and that they didn't get tangled up in the wires, you know.
00:06:20
Speaker
And so I had to ruin my sleep staying up all night to help their sleep. Shift work. Did you work there growing up? Did you work there as a teenager? No, they only opened it when I was in college. So I helped them when they started it. And I worked there when I was home for the summers. I had worked there. And I would manage projects from afar as well. It
Medication Misuse in Sleep Treatment
00:06:44
Speaker
was fun. It was fun because it was an interesting field.
00:06:48
Speaker
And I also noticed that people that had insomnia or issues with a circadian rhythm issue were largely sort of ignored. They were told to take a pill. That just didn't fly with you. That didn't fly with me. Yeah. You were not down with that. I was not down with that. I was outraged.
00:07:10
Speaker
I'm there with you. I mean, people come in and our culture is kind of, you know, take a pill and, you know, I'm a psychiatrist. I prescribe medications, but I'm fairly conservative. I try to be thorough and it's very easy to make a judgment call too fast. I thought even with people with sleep apnea, they have trouble concentrating. I bet a lot of people come in and they think they have ADHD.
00:07:36
Speaker
And you're like, well, how's your sleep? Probably stimulants, they probably improve sleep quality or make it worse? What's your experience? Well, it depends on timing, right? Simulants have a longer, a longer than average half-life, right? Who wants to stay in the bloodstream a long time? Stay in the bloodstream a long time. So I will sometimes get clients who will come to see me and they'll say, something's wrong with my sleep. Well, yeah. And then I take my last Adderall dose at five o'clock.
00:08:05
Speaker
I'm like, well, there's the issue. That's the culprit, the Adderall XR at five o'clock. A lot of people work at night though, so they're like, well, what do you do if you do have ADHD? Exactly. You don't want to take a pill to come down off the Adderall. Exactly. Like you were saying also, when we're talking about anti-anxiety medicine, benzodiazepines, those are really bad for a sleep apnea.
00:08:33
Speaker
What do they do to sleep? Number one, you'll see more relaxed muscles. So you'll see more more sleep apnea events like with alcohol. Like with alcohol. Yeah. Number two, you'll see that there's an increased incidence of anxiety and depression as a result of the apnea that when you're taking the benzodiazepines, you also see
00:08:56
Speaker
that there's like increased sleep spindles in the sleep architecture, what are called beta intrusion, meaning it's like you'll see wakefulness intrusion within the sleep waves.
00:09:06
Speaker
It's like the brain is not fully asleep at night. Not fully asleep, yeah, exactly. Dolphins do that, don't they? Like, I heard that half a dolphin's brain is awake and half is asleep. Is that true? That's what I hear, yeah. People don't do
The Science of Sleep and Disorders
00:09:20
Speaker
that, though. We just don't sleep right, and then you wake up tired, and then you can't function, and then you get depressed. Yeah, exactly, yeah. And you're irritable. You can't deal with your emotions. You need to eat carbs just to get through the day. Yeah.
00:09:33
Speaker
It's really bad. How do people usually get to you? Because my experiences, as you were saying, a lot of times there's different kinds of sleep apnea. There's a lot of different sleep disorders. Apnea is a common one. And a lot of times it isn't picked up. Like how would they know? That's a great question. There are some telltale signs that I look for that I can teach you now.
00:09:56
Speaker
in my insomnia practice around almost 30% who think they have insomnia actually have a sleep apnea. It's very high. The signs that you want to look out for. So someone tells you that they have broken, interrupted sleep and that they sleep eight or nine hours, but they really don't feel rested. And to the point that they're falling asleep in meetings or when, when they're a passenger in a car or something like that, you know, and then you'll also hear someone with sleep apnea say that
00:10:25
Speaker
They snore and they've woken themselves up snoring or that someone has their partner says that they've, that they wake themselves up. They choke in the middle of the night. That's one that so many times, like they'll tell it, they'll say it out loud.
00:10:42
Speaker
and like laugh it off and I'm so shocked. Like they'll be like, yeah, I remember that time that he almost choked and we thought he was dead. Yeah. Wasn't that hilarious? And they're saying it out loud. And I'm like, like, hello, do you hear what you just said? Like, uh, you know, they need it. They need to, they have to come to the provider and say it in front of the provider to, to realize that it's a reality, you know? Yeah. Those are usually the signs. Maybe also not remembering your dreams. That's one too. If you feel like, yeah. Uh-oh.
00:11:12
Speaker
Like you haven't dreamt for a long time. It's not like every case is that, but that's a sign.
Treating Sleep Apnea with CPAP
00:11:20
Speaker
Like because people don't get into a deep enough state of sleep. Yeah. Well, REM sleep actually your muscle tone turns off. So there's very high incidences of apnea during REM sleep. That's usually when it's the highest.
00:11:33
Speaker
at nighttime. Yeah. And then sometimes you'll see, I wake up at two o'clock every day and then I sleep very lightly from two to five. Cause that's usually when there's the highest incidence of REM sleep is in the last third of the night. Well, I definitely have apnea. And so obviously that, you know, the treatment for that is different, you know, from the treatment that you do, right?
00:12:01
Speaker
Yeah, so the treatment for apnea, there are a few avenues. I don't do any of them. So the first one would be CPAP, continuous positive airway pressure, which is a machine that has a very high-tech, actually, machine, air-blowing machine with these super comfy masks that are light as a feather, like a pillow. It's like a pillow that's resting on their nose. It's just so light.
00:12:31
Speaker
It's so light and feathery and comfortable. No, I'll tell you. They actually are really high tech, the machines. They really try to make it as comfortable as possible. And then with a few tweaks, like getting the right kind of pillow or a couple of different things, you can make it really comfortable, the right kind of mask. It can be life changing for people in a very positive way. It can be so life changing.
Cognitive Behavioral Therapy for Insomnia
00:12:57
Speaker
I've had people tell me like, oh my God,
00:13:00
Speaker
I like, I used to drink four cups of coffee a day and now I drink only one and like, I feel so alert and like it's insane. And what's amazing about it is that sleep apnea is one of the only chronic illnesses that has a treatment that's a hundred percent efficacious. Like, can you think about that for a second? Anyone who uses a CPEP and uses it correctly, and they literally, they have ones that auto titrate that make sure that
00:13:26
Speaker
They're giving you the exact right amount of air based on how well you're breathing. And it will get rid of 100% of the events. You will have perfect, amazing sleep. Isn't that crazy? That's amazing. That's like a lock pick. Yeah. Yeah. That's crazy. But it's just really uncomfortable. It has low compliance. So it's like,
00:13:47
Speaker
40% of people with a CPAP machine will use it for four hours or more. That's the metric they had to use was four hours to even just get, to even get the compliance, like even, even to a respectable. And then, but there are also now that, you know, there are mouth devices for moderate insomnia, for moderate apnea. And then there's also, there's like a heart make, uh, like a pacemaker device.
00:14:12
Speaker
for severance of apnea. So there's, there are options. There are different options. Well, the CPAP machine is, what is that, continuous positive airway pressure? Yes. Yeah. So, so like essentially it, it blows air under pressure. So it keeps, it keeps the throat inflated, right? Exactly. They're very adaptive. So when you breathe out, it can tell that you're breathing out. So it won't, it won't, it won't blow air when you're breathing out, but then it will blow air.
00:14:39
Speaker
When you're breathing in, you know? Yeah. No, no, it's remarkable. I'm laughing because I'm having flashbacks to when I was a general surgical resident. We had to manage ventilators in the intensive care unit and CPAP machine sort of like a ventilator though. There was a little bit of a debacle about that early on in COVID, you know, because
00:15:00
Speaker
some of the ventilators were actually CPAP machines, if you remember that, but it is very technologically sophisticated. If properly managed, right, can be a game changer. But you're saying that even under the best of circumstances, people don't use them as much as they maybe they ought to. It's true. It's very true. But there are options, so never give up. I have worked with clients who've had
00:15:30
Speaker
like sort of claustrophobia with the masks and we've done desensitization work.
00:15:36
Speaker
Like little by little, getting used to it. Yeah, exactly. Yeah. But that's not your main thing. What are the main things that you treat? I usually treat insomnia. That's what people usually see me for. I use cognitive behavioral therapy for insomnia as my vehicle. What does that look like? Like if I were to come in and say, you know, I'm having a lot of trouble, I'm having anxiety and a lot of trouble falling asleep at night.
00:16:06
Speaker
you know, where would, where would you start with? Yeah. So, so usually someone with insomnia, what happens is, and they come to see me, they say, you know, they have, they've had a bunch of nights where they can't sleep. And so they start to worry about their sleep. And then that compounds the issue.
00:16:26
Speaker
They're worrying about sleep, and then it becomes a self-fulfilling prophecy because the worrying about sleep keeps you awake. When you worry about anything, it keeps you awake. So I'm like, oh no, this is going to be another one of those nights where I just toss and turn. Yeah. So how many times a day would
00:16:49
Speaker
Does the average person think about sleep? Maybe once or twice. How many times did you think Farrah, did you think today about your sleep? You know? I don't know, a couple of times. Right. Regular sleep or beauty sleep? Beauty sleep. For me, sleep serves a lot of different purposes. So I do think about it like,
00:17:16
Speaker
Yeah, just here and there. I take your point. I don't worry how I'm going to sleep tonight most of the time. With insomnia,
Pandemic's Effect on Sleep Disorders
00:17:25
Speaker
someone will come to me and they'll say, I think about it all day, like over a hundred times a day, right? Where in the morning I'll think about how did I do last night? What were the issues? Like what can I
00:17:39
Speaker
Like, how is it going to affect me? And then that night, I'll be thinking, towards the evening, I'll be thinking about what's my next night going to be like? Like all those kinds of questions. Imagine that. People get nervous about like illnesses. And then they used to call it hypochondria. Now it's called illness anxiety disorder. It sounds almost like you could have an insomnia anxiety disorder. Oh, it's worse than that because the mere thought
00:18:08
Speaker
I might not sleep tonight or I have an insomnia disorder becomes an automatic self-fulfilling prophecy once you ask it enough times. Right. It's inevitable. There's no other solution basically. It causes the problem you're trying to solve. Do people get scared to go to sleep? Oh yeah, totally. That's not common. I'd say that's more rare. And even without trauma, I mean, let's definitely with trauma, you'll have like,
00:18:36
Speaker
scared of the nighttime and a sort of vigilance build up. But I have people that are actually just developed such a bad, bad experience with sleep. It's just a nightmare. And they actually fear it. They actually, as the nighttime comes, the stress builds up as if it was a catastrophe. It's like a form of torment. Oh, yeah. Yeah, yeah.
00:19:04
Speaker
How do you go about managing it? So then, right, the other piece of the puzzle is imagine an experience where somebody is sitting and tormenting over something over and over and over and over again in bed, right? Not only that, like everyone and their mother are telling you to do things, to try something. Sleeping issues are low stigma mental illness that you can talk about. Yeah.
Impact of Phone Usage and Motivation on Sleep
00:19:30
Speaker
Right? So everyone talks about sleeping issues.
00:19:33
Speaker
Everyone knows someone that has it and everyone recommends something. Oh, you have to try magnesium. Oh, you have to try melatonin. Oh, you have to try going to bed earlier. Quick fix. Does that bother you? No, it doesn't bother me because usually the people that come to see me, how the hell have I? I wish it worked more often than people wouldn't need to see me. And then I could move on to something more complicated.
00:19:59
Speaker
Like, uh, a little sexier. Yeah. Yeah. Yeah. That's what I was saying. Like, uh, but no, it doesn't work. And then it reinforces this idea that like my sleep is broken. Like I have an insomnia disorder.
00:20:13
Speaker
It becomes a pathology. It becomes like an identity. Oh yeah, it's a narrative. It's an ego. Oh, I see. There's a masochistic element. So what I hear you saying is that sleep problems take on a life of their own for people and almost like hijacks their life.
00:20:37
Speaker
It's very sad. There's this feeling like even a baby can sleep. Yeah. I can't sleep. It's so basic. So what are some of the basic things that do it? What I do, I call it
Functions of Sleep and Listener Engagement
00:20:50
Speaker
sleep bootcamp. You know, whip your sleep into shape. First of all, the treatment's hard. So I want to desensitize people. Like I say to them, this is not a...
00:21:01
Speaker
This is a hard treatment. Short-term pain, long-term gain. Five to eight sessions. It's a horrible business model because everyone keeps getting better. It's like about 85 to 90% of clients will get at least an hour of sleep or more. That's in the research. In my practice, it's been the same thing. They set a goal for themselves in the beginning. I want to increase the quality of my sleep and feel more rested most nights.
00:21:31
Speaker
85% are reaching their goal. It's amazing. It's an amazing treatment. Well, what makes it so hard? What are the pain points? Part of the bootcamp is what's called sleep restriction, which is a horrible name.
00:21:45
Speaker
So people, essentially, they reduce the amount that they sleep in order to do what? So it goes back to Pavlov, classical conditioning. It goes back to the idea that you're spending a lot of time in bed not sleeping. Your body learns
00:22:03
Speaker
that the bed is a place not to sleep. Yeah, I usually look at spreadsheets in bed. You're right. No, I'm serious. People do that. Yeah, totally. I'm kidding, but it's true. It's true, no. People do it. Because you have laptops and you've got phones. Yeah. And so what ends up happening is that the bed becomes a place that's associated with staying awake. So we cannot have a situation where we're in bed and we're anxious. We're really doing anything besides sleeping.
00:22:33
Speaker
So it's a bootcamp where we're really just retraining the bed just from a pure stimulus perspective. We want to see an increase in the percentage of time that you're in bed. When you're in bed, you're sleeping. Done. And if you're not sleeping, then you're not in bed.
00:22:51
Speaker
I see that's why you call it bootcamp because there's a kind of a discipline that's required to make it work. There's a discipline itself. So, and that's another thing that scares people about it is that they think, well, you know, I'm going to have to change my sleep forever and always do this. And that's not the case. I call it a bootcamp because it's a discreet period of time. I'm going to do the bootcamp and then I'm going to, I'm going to go back to living. And that's how the sleep treatment is as well. You do this, the sleep treatment, and then,
00:23:21
Speaker
you can reintroduce all the quote unquote bad behaviors and see what affects your sleep and what doesn't affect your sleep. It almost sounds like a reboot. Exactly. But if it were that simple, people could do it themselves. And we know that people have difficulty doing it. That's why they need your help, right? I'll tell you what it is. It's actually it's working with a provider. Part of what I do is just I'm just there to say, no, no, no, that's normal. You're OK.
00:23:49
Speaker
You know, that's it. That's part of a part of my job because what ends up happening, there are times where you all of a sudden have a bad night and it's really scary. And you're like, what the heck is happening right now? Like I thought I was doing well. And now I'm in that you can spiral so many different ways. So I'm there to help help tweak the sleeve and the protocol matches the experience. And then the rest, that's what's amazing about the treatment as an exposure, you know? So for example, when you're doing like, let's say,
00:24:17
Speaker
an exposure treatment for spiders, arachnophobia, fear of spiders. You could have a situation where the spider ends up like biting the person and it's really scary, you know? It's sort of like, don't panic, but, you know, obviously much more subtle and sophisticated because, okay, you're going to feel some anxiety, but that's okay. Oh, that's the thing. Yeah.
00:24:37
Speaker
Well, with sleep, there's a fear that I'm going to have insomnia forever and like, I'm never going to fall asleep. I'm going to be tired and it's going to ruin everything. And that's just not physically possible because you always, always will fall asleep eventually. And if it's positioned and it's framed correctly, you can use that as a moment of strength to then reclaim your sleep so that you can now integrate it into your life where it's not the center of your life. You sleep to live, right? Not live to sleep.
00:25:07
Speaker
You've shrunk it down to proportion. This idea that reassurance is a really important part of it. I'm also wondering, especially now with the pandemic, have you seen a change in sleep disorders? Or has it become harder or easier to treat? You said the new term, is it COVID-somnia? Yeah, that's what they're calling it.
00:25:31
Speaker
They're seeing, I don't know if there's any actual research on it, but... What is COVID-somnia? I believe that we're seeing increased incidences of disturbed sleeping that can be traced back to the COVID period or something related to COVID-19. Because we know that, in general, when there's an active stressor,
00:25:55
Speaker
It's hard to sleep, right? Because your sympathetic nervous system's activated. Your body says, I need to deal with this imminent danger. I can't sleep. And so COVID is just a chronic, imminent danger. It can really tax the
00:26:12
Speaker
the anxiety insomnia system. It doesn't make sense to go to sleep because I got to stay awake in case something happens. I should be prepared, vigilant, but it's a chronic stress. With the political crises too, same thing. There's a fair amount of apocalyptic thinking, both in terms of politics and disease as well. Is the treatment for that any different?
00:26:39
Speaker
Well, it's hard because if somebody is going through an active COVID related emergency, I wouldn't recommend doing the active treatments. There will be an increase in disturbed sleeping as a sort of initial side effect of the treatment. And so you don't want it to ever
00:27:01
Speaker
right, coincide with like a known upcoming stressor, that kind of thing. So you have to time it. Do you tell people like, hey, after your wedding and then we'll- Yeah, or they're exactly, or if there's a vacation, same kind of thing, because you want to treat the sleep when it's the normal conditions. But also with COVID related fears, there's a general shift where you say, you know, it's true. It is a dangerous time.
00:27:31
Speaker
And has it made your job a little tougher or more complicated? I don't think so. That's the good thing about cognitive behavioral therapy for insomnia is that it usually works no matter what, no matter the cause or if it's happening at the same time as another diagnosis. Great. I mean, I think it's super interesting. We had just wanted to chat with you a little bit just casually about some of like the
00:28:00
Speaker
I don't know, are there any sleep myths that come to mind that you like wanted to spell? That it's important to prioritize sleep. It's not that they've shown that you can't catch up on the weekends. If you're, you know, having bad sleep every night during the week, you know, just not leaving enough time for sleep, then it can lead to some long term issues.
00:28:23
Speaker
the nights where I'm not sleeping well, there's actually important stuff on my mind. And I don't always follow good sleep hygiene and kind of wait quietly till I'm tired. Though, I mean, fundamentally, that's what I'll do. But I'll often take that opportunity to journal or to really figure out kind of what's on my mind.
00:28:43
Speaker
That's a good idea. But it often means being up for later and longer than maybe if I just, you know, sat quietly until I got tired again. Yeah. Just make sure you're journaling outside the bed, right? Yeah. Yeah. Yeah. Because we don't want to associate the journaling with a sleep experience, you know? Yeah, definitely. Like what do you do with people who are like hooked on their phones and texting late at night or
00:29:12
Speaker
you know, scrolling Instagram. You know, it's a, it's a matter of a motivation, right? Someone wants to change their sleep.
00:29:20
Speaker
Then that's a place you can start. You have people that come to you for treatment, but they're still unable to put the phone down. Well, people also use their phone as a sleep aid, I think. They'll listen to binaural beats or a meditation tape. What do you think about these things like blue light and ways to mitigate it for people who can't practice abstinence?
00:29:45
Speaker
So if you have a circadian rhythm issue, meaning your timing is off, your sleep timing. They're sleeping enough but at the wrong time of day? The wrong time, yeah, exactly. So that's when you would want to be really careful about blue light. So you'd want to make sure to block it in the evening time.
00:30:03
Speaker
I see. So their sleep clock is not thrown off by the light exposure when people say they can't sleep. But when you start to talk to them, you know, it's like they actually don't want to go to sleep. Exactly. Right. But not because they're like they have fear of insomnia, you know, or nightmares or anything like that. But they like staying up. They like staying up for, you know, lots of different reasons. Also, I've had people that feel guilty and they want that they like don't deserve sleep.
00:30:32
Speaker
Can you say more about that? It's a privilege to sleep and because they have a lot of things to do and they have to finish all their duties and maybe they didn't finish everything and you don't deserve to sleep so you have to sort of push it off until later and get less sleep. But not necessarily like actively punishing oneself. No, it's like passive. It's like unconsciously passive, like that kind of thing.
00:30:58
Speaker
So they'll just do another Netflix and just sort of zone out, dissociate, or guilt about sleeping in. I see that one a lot. Like being unproductive. Yeah, being unproductive. I'm just like my dad. Yeah, I had some other thoughts. I was trying to catch a hold of something to do with the staying up late because I think so many people want to stay up late.
00:31:21
Speaker
I wonder how you would address that because so sometimes when I've used more cognitive behavioral approaches, I've reached a point where it gets into another area, which is sort of like, like we said, I kind of want to stay awake. And so, you know, someone comes to you and they're like, help me sleep. But as you were saying, maybe there's like a feeling like I'm quote unquote, being naughty. OK, so growing up, you know, I didn't want to go to bed. I didn't listen to my parents.
00:31:49
Speaker
I stayed up all late at night. What are the obstacles that you run into when you try to treat insomnia with a more structured approach? It's always a measure of motivation, right? If they're saying, I have no desire to change, then you have to wait until that desire comes. You can't cause the desire.
00:32:11
Speaker
like necessity is the mother of invention. And a lot of people's lifestyle and habits sort of corner them into hitting some kind of bottom where they have to change. Do you use motivational interviewing? Yes, exactly. That's not the main area. Sometimes it's hard because it's very non-directive and it takes a long time. But usually that's one of the nice things
00:32:39
Speaker
about having a private practice that does not take insurance, right? Where most of the clients I see are gonna be highly motivated and highly invested in the treatment just like they're monetarily investing in it. So they're also gonna be emotionally invested. So usually the people that come to see me, they've tried everything. They do not have any ambivalence about changing. They just wanna,
00:33:07
Speaker
they want to change their sleep. So I don't really need to do very much motivation on their beyond. But I could see if you're a generalist or working with trauma and then a sleep issue comes, it can probably be hard to build up that interest in making changes with medication or things like that.
00:33:26
Speaker
Yeah, I see what you mean. It's a different context. I'm curious. I'm sure it's always interesting to people. What does actually sleep do? I mean, why do we need sleep? No one's actually clear on exactly why we sleep. Like we know what happens if you don't sleep. So we know that, for example, as we use energy, our body has this byproduct called adenosine. And when we have a large buildup of adenosine,
00:33:56
Speaker
become more tired, more drowsy. And then when we sleep, the adenosine gets lowered, and the drive to sleep lowers. So the more you sleep, the more your adenosine lowers. That is one reason we sleep is to clear out this sort of waste byproduct of expending energy. We also know that our temperature goes, gets lowered. They've done studies to show that the body
00:34:24
Speaker
cools down during sleep in order to make sure it doesn't overheat during the daytime. That's one of the means of staying at the right temperature and that we regulate our temperature. We also know that sleep is important for memory consolidation. We know that sleep is important for
00:34:46
Speaker
your muscle, muscle recovery. It's good for the body too. Not just the body. Right. Yeah. It's we just, it's, we know it's good for a whole host of different things. Thank you. Was there anything that you wanted to talk about that we didn't ask you about or? No, this was great guys. I'm so happy you're covering sleep, you know, like recently, recently, a couple of years ago,
00:35:09
Speaker
the American Academy of Physicians changed the first line recommendation for presentation of insomnia is no longer sleeping pills. It's CBT for insomnia, but not enough doctors know about it and sleeping pills are still routinely given.
00:35:29
Speaker
I agree, and culturally, it's a big part of self-care. Sleep is one of the most important things, sleep, nutrition, exercise. When you go to the drugstore, there's tons of sleep aids. They're homeopathic and Benadryl, and they don't necessarily give you good quality sleep. But we should definitely say a couple of words about our guest today. Thank you, Dr. Joshua Tall.
00:35:53
Speaker
Dr. Tall can be found at drjoshuatall.com. Are you doing virtual therapy now? Yeah, only virtual now due to the pandemic. But maybe one day, soon I'll be back in the office. That would be
00:36:09
Speaker
That would be really nice. Yeah, it's hard on everyone. Some folks more than others, but definitely if you're having trouble sleeping and you're ready to change, Dr. Tal's sleep bootcamp has a very high success rate, and he would be happy to speak with you for a free 10-minute phone consultation. And again, you can find him at drjoshuatal.com. Yes. Be in touch, everyone. Let's get you sleeping again.
00:36:39
Speaker
This news, you win. We'll have a good one, guys. Thanks for having me. Thank you. We'll talk soon. Thanks. Okay. All right. Bye. Bye.