← UNRULY WITH SHELAH MARIE
UNRULY WITH SHELAH MARIE
35: The Science of Sleep: Why Black Women Deserve Better Rest ft. Dr. Angela Holliday-Bell
00:49:09
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- [00:02]
A
Welcome to Unruly. I'm your host, Sheila Marie. I'm an author, a fierce advocate for black women, and the founder of the curvy curly conscious movement in this space. I'm sharing what I've learned on my own journey while sitting down with some amazing women who are all navigating their own paths to healing. Because there's no better time than now to get a little unruly. Hey there, beautiful people. Welcome back to another episode of Unruly. You know, we talk about rest all the time. I think there's at least four episodes, if not dedicated to how important rest is, they mention it in a significant way. We all agree. Yes. Okay. Rest is resistance. Rest is important. Rest is necessary for our healing. But today we're gonna go deeper because we wanna know how, how do we get that rest that we truly need? My guest today is Angela Holiday Bell, a board certified physician. Y' all hear that? Credentials, honey. She gonna come with the facts and the research today?
- [01:07]
B
Always.
- [01:09]
A
She's a certified sleep specialist and the founder of the Solution is Sleep. She's been featured in the New York Times, NBC News well and Good Essence and more, where she's known for her no nonsense, deeply compassionate approach to helping people, especially black women, get the rest that they deserve. We are so excited for this conversation. I've already polled my audience. They had so many questions for you. And so I think we should just get right into it.
- [01:37]
B
Okay, let's do it.
- [01:39]
A
Because the girls are tired. That's what they told me. Okay. So I'm going to start with kind of like a little rapid fire icebreaker questions. Okay.
- [01:48]
B
Yep.
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A
All right. So what's the strangest sleep advice you've ever heard?
- [01:53]
B
Oh, the strangest sleep advice I ever heard. That's a good question. Strangest. I don't have that much strange, I guess. So some people have recommended sleeping in chunks. So, like, there was. He's actually a professor of something, but he went through this experiment where he was sleeping in like two hour chunks throughout the day as opposed to like a full thing overnight. And there was supposed to be this benefit to polyphasic sleep, and it turns out there there was no benefit and he was just tired and performing poorly afterwards. Yeah. So some people do believe that you should sleep in kind of these smaller segments throughout the day as opposed to one larger chunk, but I. I would not recommend.
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A
Okay. Period. Got it. Why do people talk in their sleep?
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B
Oh, so we don't know exactly why it is. It's one of those things like sleep walking Sleep talking. Some people do it, some people don't. There's tends to be a genetic predisp. So if you have family members who do it, you're more likely to do it. We know that things like not getting enough sleep, having sleep disturbers like alcohol can make you do it more. But we have not uncovered exactly why some people do it and why some people don't.
- [03:10]
A
Can you train yourself to be a morning person?
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B
Yes and no. So that's actually a great question. I am naturally a night owl and I've definitely tried this. First of all, your circadian rhythm, your chronotype is genetic. It is in your DNA. There's nothing you can do about it. It's written in there. However, there are.
- [03:27]
A
What was that word?
- [03:27]
B
You. Chronotype. Chronotype. So when we think about night owl, early bird, those are chronotypes. And it literally, if your parents are night owls, you're more likely to be a night owl. It's written in your DNA. But there are things you can do to make it easier for you to get sleepy earlier and wake up earlier. The best thing to do is stick to a consistent early schedule. So going to sleep early, waking up early. But what I always tell people as a fellow night owl, mornings will never be my peak time. I'm never like at my best in the mornings because that is just not when my body genetically wants to be awake. But I can do things to make it easier.
- [04:04]
A
You know what I've discovered for myself is that I'm not a morning person in the sense that I want to get up early. But the hours, like two to three hours from when I first wake up are always going to be my like those are my power hours.
- [04:19]
B
Okay. You know, very interesting. Get on.
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A
Cause I feel like I'm a morning person, but my morning is not. My morning is like nine o' clock. You know what I'm saying?
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B
Yes, yes. And what a lot of people don't realize is there are, we say morning, early bird and night owl, there are actually several chronotypes in between. So you're probably more of like a bear. Like there are ones that like you get your peak a little bit later. Whereas early birds are usually that 6, 7 o' clock type of time.
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A
Definitely not me. Ever, ever.
- [04:46]
B
Same.
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A
And I feel so sorry for mothers. Cause I know a lot of my friends who were like that and they had kids and they're like, they' early like 6am and they want to start talking. Mommy, what's this? Mommy, what's this? I I saw a post on X the other day, and it was like, did I just say X? I've never said X. I always say Twitter. And now I say, oh, my God. But she. This lady was like, girl, it's 6am and my son just asked me, do I have kids? I don't have time for this. I was like, I feel you.
- [05:20]
B
That's hilarious.
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A
Okay, so let's get into you. So you said that sleep bec your obsession. After struggling with it yourself, what was it that your body was communicating? What did you discover about sleep?
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B
Yeah, so I. I went through this bout of insomnia during my professional training during residency. And it started with me not having time to sleep because I was working so much. But then it became me not being able to sleep even when my schedule was clear on the weekends. Um, and so I wasn't getting much sleep at all, no matter how hard I tried. And it actually affected every single aspect of my life. So I was way more stressed. I was irritable. I was on ed. It affected my relationship with my husband. I didn't enjoy leisure time as much. Like, even if I was out with friends, it wasn't as enjoyable because I was so exhausted all the time. And I think what really did it for me was that I wasn't even being the doctor I wanted to be. I knew I wasn't showing up fully in my role because I was so exhausted and so drained. So I was just trying to get by every day. And that's when I realized I had to make a change. And in the process of just like, okay, how do I fix this for myself? I realized that, oh, sleep is more than just feeling rested. Like, it truly is the fabric and foundation for everything that you do in life. And as I started to fix my sleep, I was like, oh, my gosh, this is. I'm a new person. And I knew that I had to help other people do the same.
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A
What were some of those early steps that you took to fix your sleep?
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B
So I started with literally reading every book there was about sleep. I started with a book written by the founder of the sleep stages, so the person who discovered the sleep stages. And then it just was captivating to me. So I read every single book after that. Anything I could get my hands on. I started to volunteer in the sleep clinic in my hospital just to get some, like, hands on experience. Experience what other people were struggling with in their sleep. I actually did some trainings in cognitive behavioral therapy for insomnia. And so it was literally like piecemeal doing my own research, and as I was learning these things, applying them to my life. Wow.
- [07:20]
A
I'd love to hear any insights from your work in cognitive behavioral therapy with insomnia.
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B
Yeah, so that is actually mostly what I do now when I'm working with individuals who have sleep issues. It's generally chronic insomnia. And the thing that sets us apart. Some people struggle with sleep and are told, okay, go to bed at the same time, have a bedtime routine. And that is important. But when you're at the point that you're struggling with chronic insomnia, which is difficulty falling asleep, staying asleep, or waking up earlier than intended, at least three nights or days per week for at least three months, it is much different. We're past the keep a consistent bedtime space. Usually you've built up an anxiety with sleep. There's a sleep anxiety. Right. So this sleep relationship is broken. So with cognitive behavioral therapy for insomnia, we have to retrain your brain to establish a healthy relationship with sleep, to get rid of that stress and anxiety that's around sleep itself and make it more of this natural restorative process that it was meant to be.
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A
How do you begin to repair that relationship? Or reframe it, I should say. Yeah.
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B
Yeah. So first of all, we uncover the underlying reasons that you're struggling to sleep. Right. So for me, again, initially started with me not being able to sleep because I was so busy. I was working 80 hours a week. But also I was falling into bad habits. And the more I struggled to sleep, the more bad habits I fell into. And so I was, you know, staying up late, I was trying to catch up on the weekends. I was spending way too much time in bed on the weekends, thinking that if I just was in bed longer, then it increased my chances of getting sleep. And so then I'd end up being refreshed, not realizing that I was further breaking relationship, because I was actually teaching myself that being in bed meant being awake. So doing awake activities, stressing, tossing and turning. Yeah. And so I had to first uncover those reasons, Right. Like, this is what has led to this. And then I had to reestablish my healthy relationship with sleep. So I had to identify the negative thoughts I had around sleep. So when I would get into bed, I would be, like, instantly stressed. Like, oh, there's another night when it's been tossing and turning stressed. I'm gonna be so exhausted tomorrow. And all that did was make me more anxious and stress. So I had to identify those thoughts and replace them with better Thoughts that supported my rest. And then there are also therapeutic techniques called stimulus control and sleep restriction, actually, where we restrict time in bed. Sounds counterintuitive, but it works to re establish a relationship between bed and sleep only and not all of these other activities and takes advantage of the sleep drive. So it's a process. For most people, it takes four to six weeks to really get going. But it is the longest lasting sleep treatment. Longer than prescription medications gives you? Yeah, yeah. The most benefit because we're. We're uncovering that underlying cause. We're not putting a band aid on it. We're fixing it at the root.
- [10:11]
A
So have you encountered people who were like, taking medications to sleep and then worked with you and now can fall asleep without those medications?
- [10:20]
B
Absolutely. So I work with people who have been prescribed prescription sleep medications all the time. I am personally not a fan, not a proponent. Me neither. I would never prescribe. Prescribe them. What I will say is there are some rare cases where prescription sleep medications can be helpful, but for the vast majority of people, they're not gonna be helpful. They tend to cover up the underlying cause. Or putting a band aid on it. People never learn healthy sleep habits. They just take something, then knock them out. They end up building tolerance to it, meaning they need higher and higher doses to get the same effect. There are side effects from it. So they're generally not a great idea for most people. So when I work with people who are on these medications, we have like a tailored plan to we them off of it slowly. Because it's also usually not a great idea to just stop it completely while we're doing the cognitive behavioral therapy for insomnia. So we're building up their healthy sleep habits, getting them off the medications, and then they're usually able to sleep independently.
- [11:13]
A
Am I right in saying, is CBT like exposure? Like, is there. Is there some. Am I. Am I thinking of that?
- [11:20]
B
Right? So it's a little different. So there's exposure therapy. So let's say you were afraid to fly. Exposure therapy is like, we're gonna put you on a plane and just like face that fear. You're afraid of dogs. We're gonna put you in a room with a couple dogs to face that cbt. Cognitive behavioral therapy is the cognitive part. So where we are identifying those thoughts. Behavioral. We are working on the subsequent behaviors that are typically maladaptive because of the thoughts and then working on the end result.
- [11:48]
A
Okay. Okay. Wow. So is some of this. Guess I'm like, I'm not a certified. I did not Go to nobody med school. So I'm like, is this some of this, like, psychological. Do you also work with, for example? I'll give you an example for myself. My mom worked nights. And so when I was with nights, I was always with other people, like either my stepdad or babysitters. And because of that, I have a trouble feeling safe when I sleep at night. Like, I didn't know that. I realized that in therapy when I got older. But the reason I'm asking is that's something I discovered in therapy that, oh, my gosh, my insomnia is maybe related to that. And so I was wondering, does that come up in your work too, where some of this is. Is related to trauma? Yeah.
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B
Yeah. So we don't. We. We don't typically, like, delve into trauma. Like, okay, let's. Let's figure out your traumas that have led to this. But just in the process of exploring those underlying reasons and those cognitions related to sleep, we often do end up uncovering some of those things. And it usually is so buried that people don't even realize that that is why they have these issues. And so it's taking them through the practices, like I said, to uncover those. Excuse me, those thoughts, because that's really what it starts with. But then we engage in all these behaviors to try to make up for it that again, we lose that initial kind of spark or initial underlying reason. For instance, for some people, they went through the death of a family member, and it's normal during a time of grief to struggle sleeping. But then they engage in all these behaviors to try to overcome that. And even when that period of acute grief is gone, now they're stuck in this. This cycle of these maladaptive behaviors. But then we still have to trace it back to that original thing that kind of set it off. So we do end up uncovering things like the trauma, the grief, the loss, you know, moving life changes that initially triggered this. That we then have to work on restructuring those thoughts.
- [13:41]
A
So if you encountered someone who was struggling with insomnia, and let's say, obviously working with you is best case scenario, if they can't work with you, if they're not in a position to do that, what would you recommend to them to start getting to the better sleep?
- [13:56]
B
Yeah, so. So first of all, seeking help in general, right there. Unfortunately, there are not a lot of practitioners who do CBT I. Cognitive behavior therapy for insomnia definitely needs to be more. Unfortunately, there's not. But I always say, tell people if you're struggling with sleep, ask for help. Just like if you were struggling with any other medical condition that affected your life, you wouldn't just go on being like, I guess I gotta just deal with these. You would just seek help. So seek help. There are psychologists who do it, other sleep specialists, sleep medic, you know, providers. So I would start with talking to your medical provider about it. You can kind of go the hands on, figure it out yourself route like I did. That's just my personality. If there's a problem, I'm gonna fix it. Luckily, there's a lot of good information out there. There are even online programs for cbti. It's of course better if you can work individually with a practitioner, but if you can't, these have also been shown and researched to be helpful. And then my number one thing for people really who are struggling with sleep, whether it's chronic insomnia or just bad sleep happens, is to start with prioritizing sleep. For the longest time, I did not make sleep a priority. My priority was work and, you know, this hustle mentality. I'll sleep when I die. I don't have time for this. I don't wanna be lazy. And that just led to so many negative downstream consequences. And once I started to say, okay, no, sleep has to be a priority, everything else actually fell into place so much better. And I was so much better in every other role. So literally start making sleep a priority and then take the steps necessary to improve your sleep.
- [15:27]
A
You mentioned lazy. And I'm so glad you brought that up because I feel that so many black women struggle with like, lazy is like. Is it A4 let L A Z? No, no. Okay. Okay. I was gonna say, okay, it's a four letter is bad word. Like you don't want to be called or associated with being lazy. And I find like, I know so many. I mean, growing college, especially in those like, periods of intense like, like work you're doing are like pride themselves in how little sleep we can get and how much we can still do. What? How did you begin to reframe, like, the word lazy? Like, no, no, no. Sleep is something that is good for me and that I actually need.
- [16:07]
B
Yeah, it took some time. So it took me being in a broken place, honestly, at a place that I was like, I am not me. I'm not. This version of me is not who I want to be. And I knew it was as a direct result of my insufficient sleep. And I knew I was trying, I was working hard, I was in residency, you know, medical training. And doing all these things. So it wasn't that I wasn't working hard, but I wasn't working smart. And I wasn't working efficiently because I wasn't getting sleep. And as I started to prioritize that, I realized that that's actually the smartest thing that you can do, is to work on prioritizing your sleep. And it doesn't make you lazy. It doesn't make you less of a hustler. It doesn't make you less of a go getter. It actually makes you someone who's prioritizing not just your sleep, but your health, your mental health, your physical health. And for me, obviously, it's always been important. I'm speaking with patients about prioritizing their health, but I wasn't doing the same thing. And so once I started to see the changes in my life and how I literally became better at everything I was doing everything, everything changed for the better. And it would restructure my mind to say, I literally start my day with sleep in mind. And that's what I tell other people to do. Instead of thinking of sleep as the ending of your day, start thinking about it as a beginning of your tomorrow. So what I know is, yeah, right.
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A
That's.
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B
I need nine hours of sleep. I set aside nine hours that I'm sleeping, and then everything else of the day has to follow around that as opposed to have all these long lists of things to do. And then whatever time is left over for that is when I sleep.
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A
Okay, so you sleep nine hours. That's like. That's the amount of sleep you need?
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B
Yes.
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A
And do you take naps? How do you feel about naps?
- [17:35]
B
Oh, yeah. So I like. And I'm gonna say I'm also expecting right now. You guys can't tell.
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A
Congratulations.
- [17:41]
B
Thank you very. At the very tail end. So I'm actually sleeping a lot more than nine hours now, but my typical sleep need is nine hours. I love napping. I say napping is one of the best things you can do, but you do have to nap responsibly, right? So there is a right and a wrong way to nap. First of all, it's a right and.
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A
A wrong way to nap somebody.
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B
Okay, so overnight sleep is gonna be the most important sleep. That is when all the goodness of the things happen for your body and your mind. A strategic power nap can be helpful in improving your energy, mental clarity, mood, and creativity. But it's no replacement for overnight sleep. So it's like the cherry on the Sunday, but shouldn't be anything that impedes or replaces overnight sleep.
- [18:27]
A
Oops, sorry.
- [18:28]
B
Go ahead. I was gonna say. So napping responsibly means limiting it to no more than 10 to 30 minutes. Because if you nap for. Yeah, if you nap for too long, you run the risk of falling in the deep stages of sleep is number one. And when you're awakened from a deep stage of sleep, you're more likely to suffer from what we call sleep inertia. So that's that groggy, disoriented feeling that can take a couple hours to recover from. So some people say I don't nap because I feel worse after I nap than before. And that's usually because they've napped for too long. And then you wanna do it early than roughly 3pm for most people, because as soon as you open your eyes in the morning, you're building up this sleep drive that directs you towards sleep. It's a pressure to sleep. If you nap for too long or too late, you steal from that sleep drive and make it harder to sleep overnight. So again, napping can be great, but if it interferes with your ability to sleep overnight, it's not something we recommend.
- [19:17]
A
So 10 to 30 minutes, that's what you used to just when I nap, my friends used to do micro naps. She used to be like, I'm taking a 15 and I'm like, Like, I feel like that makes me so angry if I think about that. I'm like, I'm gonna lay down and close my eyes and be 15 minutes later.
- [19:32]
B
No, they show in research, they show naps as short as six minutes can actually give you a lot of the same benefits I talked about. So you don't have to nap for long to get a lot of the benefits. And if you nap for too long, then you negate a lot of the benefits.
- [19:44]
A
Sabrina, you were right. I'm here to tell you you were right, friend. I'm gonna text her after this episode and tell her because she was like, girl, I swear by like 10, like you were saying she would take these. She's a mom of three. She's like, I just little naps whenever. And I'm like, that doesn't do anything. I was wrong. There we go.
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B
That's perfect.
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A
So let's talk about cortisol hormones, right? I think this is me in my whole journey to health, you know, like, trying to get healthy, stay healthy, trying to conceive all the things. One thing I'm paying so much attention to is my hormones. And one thing I've discovered is how much sleep affects our hormones.
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B
Absolutely.
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A
So talk to us about women. Cortisol, stress and sleep.
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B
Yeah. So cortisol plays a big role in. Well, I should say sleep deficiency plays a big role when we think about cortisol. First of all, when you're not getting enough sleep, you actually trigger your body's fight or flight stress response system. Right. We know that the sympathetic nervous system, if you see a bear in the woods, it's like fight or flight. You trigger your body to go into that mode because your body is saying, if we are not participating in this very important, very beneficial restorative process, clearly we're under some sort of danger or threat. So let's go ahead and kick up the cortisol so we be ready to respond in case we need to. And when that cortisol is on long term, because you're chronically not getting sleep, that affects every single area of your overall health. It weakens your blood vessels, increasing your risk of high blood pressure. It puts strain on your heart, increasing your risk of heart disease. Cortisol decreases your body's sensitivity to insulin, increasing your risk of type 2 diabetes and all the things. Right, so you are literally telling your body we're under some sort of danger or threatening when you're not getting enough sleep. Yeah, I know.
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A
That's how life feels. It's always something. Right. There's a bear around every corner.
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B
Yes. And that's what it feels like. And then conversely, even if you're going through your day, really obviously we're gonna encounter stressors and anxieties through our day. It's just, that's life. Right. But if you don't deal with those things, I say you take this increased stress load to bed with you. Again, that cortisol, that elevated cortisol that's been high all day is telling your brain it's not safe to fall asleep, because what if something happens and we need to act? So it is literally causing you to in a high alert state, a high vigilant state is what a lot of people especially have chronic insomnia are in. And your body doesn't feel safe to fall asleep in that state. So it's just this cycle.
- [22:08]
A
I was just gonna say it sounds like this cycle. So how do you get out of the cycle? The less sleep you get, the more cortisol, the more cortisol, the less sleep.
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B
Yeah, yeah. So. So first of all, you really have to learn how to manage those daily stresses and anxieties. Like I said, we're going to encounter them it's not realistic to say that you're not gonna have any, but there are some things you can do proactively to manage it, especially before you go. One of the most underrated ways to deal with this that as adults a lot of people don't do, is just have a bedtime routine, have something that you do that signals to your brain that it's time to go to bed and helps you to come down from this high adrenaline state of the day to the calmness and relaxation that you need to transition to sleep. You need to signal to your brain that it's now safe and it's okay to fall asleep. In addition, prioritize sleep and meet your sleep needs so that you're not triggering this high cortisol when you wake up. So then we're kind of, we're breaking that cycle.
- [23:03]
A
And how do you, as a clinician, is that the correct term? Yeah. Yes, A clinician differentiate between stress related sleep issues and like a diagnosable sleep disorder?
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B
That's a great question. Sometimes it's hard and sometimes it's both. Right. So someone who has a sleep disorder often has stress related to not being able to fall asleep. And so they engage in these behaviors to compensate for the sleep disorder. So there are a lot of people who have, let's say obstructive sleep apnea who also have chronic insomnia because their sleep apnea has led to sleep anxieties and so on. But the first thing we do when I work with anyone, we go through a very deep dive in depth intake questionnaire that tries to parse out whether or not there is an increased risk for sleep disorders. Because if you have, let's say, obstructive sleep apnea, restless leg syndrome, we can do all the work in the world that we wanna do and there may be some improvement, but you're not gonna get the quality sleep that you need until that underlying disorder is fixed. So it often comes down to symptoms, to habits. So you know, snoring is a big one. If you're snoring every single night, if you are waking up gasping for air, for some people, especially women, we don't have that. We don't present classically with obstructive sleep apnea. Right. So people think of a overweight middle aged man who snores every night, but women may not even snore at all. So I say if you are, are doing the things you feel that you're supposed to be doing for sleep, but you're waking up either not feeling refreshed having poor sleep quality, then I always say to get assessed because oftentimes there is some underlying sleep disorder, like obstructive sleep apnea that we're just not picking up on. And then we can work on the cognitive behavioral stuff after that is taken care of.
- [24:50]
A
So snoring is not normal.
- [24:53]
B
Snoring is not normal. Oh, that is. Yeah. Snoring is not normal. So even if you don't have a diagnosable disorder, snoring is not normal. Snoring means there's turbulence in your airway. So you think about it when you breathe in, either through your nose, for most people, through your nose or through your mouth. It's supposed to be an in and out process that is smooth. You don't hear anything. When there's turbulence in the airway from something obstructing it, it leads to the sound of snoring. So at no point is snoring normal. There means that there's turbulence in the airway. Now, is that turbulence just some congestion because you're sick? Is it because of something else? Like, it doesn't mean it's a sleep disorder, but it does. It should raise a flag that something is going on in your airway that's leading to sounded this morning.
- [25:33]
A
Oh, I did not know that. I did not know that. This is. This is such an enlightening conversation. There's so much about sleep you don't know.
- [25:41]
B
So much.
- [25:42]
A
All right, I want to ask you about sleep aids like melatonin, cbd, thc, CBD gummies. What's your take on those? You know, they got all the things now.
- [25:52]
B
All the stuff, all the things. So many things. So let's start with melatonin, because I think that's the most widely used sleep supplement. Melatonin can be helpful if also used the right way. And many people don't tend to use it in the correct way. So melatonin is a naturally produced hormone. We naturally produce it in our brains. It is a hormone of darkness. So as we get closer to our bedtime, and as primitively speaking, as we evolve, the sun would set. That would trigger our melatonin to be released and set the stage for sleep. So there are things we can do to increase our natural melatonin release, like dimming the lights before bed, using a red light before bed instead of blue light. Getting natural light exposure in the mornings actually helps, helps our melatonin release at night if your circadian rhythm is thrown off for other reasons. So let's say you're traveling across Time zones. And now your sleep schedule is very different from what it just was a day ago. Or we're doing the time change daylight savings time. Or let's say you're naturally a night owl who has been on vacation living your best night owl life and now you have to transition to an earlier schedule for your typical schedule. A short course. Short course low dose 1-3mg is all you need of melatonin can be helpful to get things back on track. Track. But it's not meant to be used as a nightly sleeping pill as many people do or in these super high doses like 10, 20, 30 milligrams. Not at all. Short term low dose course can be helpful when your circadian rhythm is thrown off.
- [27:21]
A
Okay. And what about the CBD's THC's gummies?
- [27:25]
B
So the hat becomes a little grayer. So because these things are not fully regulated in newer on the market. First of all, we don't have a whole lot of research that supports these use in sleep. Some people find it to be helpful in sleep, but we're finding in some research that it actually can worsen sleep quality. It's not something that I recommend just because we don't have enough information to support its use. If people are using it for other medically approved reasons and it does help your sleep, sure, use it for that. Take it close to bedtime. But it's something that has not been shown to consistently improve sleep and in some cases may harm it. So we just need more research on it, proper dosing, proper timing and all those things. So it's not something that I typically will recommend. Recommend.
- [28:09]
A
Okay, great. You are so needed. We know so little about sleep. I'm realizing what's your take on sleep tracking apps?
- [28:19]
B
So they can be great and they can be not great for some people. So first of all, I think it's fine to track your sleep. I love that there's now so much emphasis on sleep. Right. On people just understanding that you should be sleeping and how much sleep are you getting and are you falling asleep but at the same time is your sleep quality. I think that the fact that they actually cause people to think about their sleep more is excellent. The potential issue is that there are some people who have this sleep anxiety that I talked about and that anxiety can be worsened when you have all of my.
- [28:47]
A
That's what happened to me.
- [28:48]
B
That might happen to me. Yeah. About your sleep and you're like oh fudge.
- [28:51]
A
I started to obsess over it.
- [28:53]
B
Yes. Some people started to obsess and like, I only slept this much and now what am I gonna do? And I gotta try to shift this. And you wake up and the first thing you do is look at your sleep app. There has actually been studies that have shown, it's been experimental studies where they have people use a sleep tracker, they sleep, and they change the results of the sleep tracker to say that they sleep slept poorly, even if they slept well. And people actually felt more tired during the day if their sleep tracker said they slept poorly, even if they slept well. And so when we get into those kind of things, it's like, we gotta take a pause. It's not the best for everyone. And also, they're not great at actually identifying the sleep stages. So people are like, oh, I didn't get enough REM sleep last night, or I didn't get enough deep sleep. We have no idea. The sleep tribes are not great at that. So I say use it for global trends. If you're like, okay, I'm just trying to go to bed at the same time each day. Did. Was I successful at that? At the end of the week, great. Or I had alcohol, it made me sleepy. But now I am seeing that my sleep quality was poor because of my sleep tracker. Okay, I probably shouldn't have alcohol before bed. Those things are great. The little details of minutia, not so much. And if it makes you more anxious, I just recommend not using it.
- [30:01]
A
You said sleep quality. How. How do you know that you're getting good quality sleep?
- [30:06]
B
Yeah. So that is. So when, when it comes to sleep, we have quantity and we have quality. Right? So your sleep need is your quantity. For me, that's nine hours of sleep. Well, let's say I slept from, you know, 10:00pm to 7:00am and I wake up and I'm unrefreshed. It's hard for me to get through my day. I'm tired, I don't have a lot of energy. That means that most likely my sleep quality was poor. And when it comes to sleep, actually quality is more important than quantity. So that's things like your continuity of sleep. Are you remaining sleep for most of the night? Are you getting into the full, like, deep stages of sleep and cycling through the normal sleep architecture? Because if you're not, even if you're getting a lot of hours of sleep, you're not gonna feel refreshed and restored. And so for some people who have sleep apnea, for instance, they may say, I sleep eight hours a night, but I'm always so tired. And that's because they're, they're getting a decrease in oxygen that's triggering them to wake up so often throughout the night that they don't make it into those deeper stages of sleep like they should. So it's not restorative and refreshing even if the number of hours should be enough.
- [31:12]
A
Wow. So do you have any maybe hacks or rituals for let's say as a sleep deprived girl somewhere listening to this? And she's just trying, she, she's like, I'm just trying to get some good sleep. Is there any quick tips or hacks that we can give her?
- [31:29]
B
Definitely. So the best thing you can do for your sleep quality that most people are not aware of is actually wake up at the same time. And every day the best thing that you can do for your sleep quality and by the same time, within an hour, from day to day, because we have this circadian rhythm that's that roughly 24 hour cycle that dictates when you feel awake and alert in the mornings, when you feel tired at night. And we have to train it or teach it to send those signals at the time that we want it to. But if you're waking up at 6, some days, 8, some days, 9, some days, 10, it, it's confusing, it doesn't know when to send those signals. And that can impact your sleep quality. So literally start by waking up at the same time every day. One of the best things you can do for your sleep, the next best thing you can do for your sleep is to actually get natural light exposure within an hour of waking in the morning. This is interesting because when most people think about sleep, they only think about what you do at night. So once I get to my bedtime, what should I be doing? But sleep is a 24 hour process. If you're waiting until nighttime, you're well behind the ball. You've missed so many things that impact your sleep. Getting natural light exposure helps to shut off your melatonin release, which we want that during the day increases serotonin production, which is not only the feel good hormone, but also is needed for melatonin production at night. And then it helps to stabilize the release of melatonin at night. So there's so many good benefits that come from literally getting natural light exposure. And then the third thing I would say is a consistent relaxing bedtime routine. Doesn't have to be anything extravagant, but something that helps you to come down again from the high stress state of the day. A meditation is great reading, taking a warm shower, just things that signal to your brain that you are safe, you're in relaxation mode. And you can find just doing those three things for most people who don't struggle with chronic insomnia will actually make a huge difference in their sleep.
- [33:14]
A
Mm. And so what would you say to maybe moms like your mother or a mother to be. And I, I'm not a mother, but I, I know a lot of moms and, and like a lot of them don't have control over their sleep patterns. Maybe their baby is very young or maybe their child might be have nightmares or get up in the middle of the night and some of them simply can't stop thinking. There's so many things to worry about. So what advice would you have for maybe a mom who doesn't necessarily have the all control over her sleep schedule?
- [33:47]
B
Yeah, it's tough. It's tough for mom starting from conception, let me tell you. It gets tough from the beginning, but they're definitely. So first of all, I will say a lot of moms have more control over their sleep than they think that they do. That's number one for the first three months of that baby's life. It is difficult. There is only some, like biologically, they're waking up to feed every three hours. There's only so much you can do if you have support from a partner. Not everyone does share the load, take shifts so that you're being woken up less, but you're truly in survival mode at that point. But beyond that, what I tell moms is one of the most important things, one of the best things you can do for your kids is to equip them with healthy, independent sleep habits from a young age. Because what happens with moms is we have this war time of the first few months, but then they fall into these habits that are not great for their sleep. And then they don't necessarily teach their kids how to sleep independently too. So their kids are used to needing them in the middle of the night and they're used to responding in the middle of the night. So now I'm sleeping in the lighter stages of sleep because I'm used to that being a time that I am doing things as opposed to sleeping. And it takes a lot of retraining after that first few months for your body to feel safe and feel like it's okay to sleep. But a lot of that is going to come down to how you teach your kids to manage their wake ups in the middle of the night. Now, with that being said, there are gonna be times that a kid is sick that A kid has nightmares. And absolutely, you're a mom, you're gonna step in and take care of them. But also what happens is your kid is sick. You, you know, give them some Tylenol in the middle of the night. Then you pick up your phone and you scroll through social media. We're gonna turn on Netflix real quick because I just need to, to wind down after this. And all those things tell your brain that you wanna be awake and alert. It's not I need to tend to the needs of my kids. It's like these are things that are further relaying to your brain that, yeah, you wanna be awake. So it's about handling whatever business you need to handle in the middle of the night. Like, I personally wake up no less than five or six times to urinate in the middle of the night now. But I keep the lights low. I never grab my phone. I don't look at the time. Like, I don't, I don't make those nighttime wakings worse and it's easier for me to fall back asleep. But when you look at your phone, you look at the time. When you do all those things, you're telling your brain you wanna be up in a week. So it's about how you hand handle those things.
- [36:04]
A
So don't pick up that phone and scroll on TikTok.
- [36:06]
B
Okay? Don't look at the time. One of the worst things you can do when you wake up in the middle of the night is look at the time. Why? Because it, it causes a countdown anxiety, we call it, right? So you wake up, you're like, oh, shoot. I'm like, what time is it? Oh, it's 3:00am okay, so I gotta wake up at 7. Okay. So I have four more hours to sleep. Let me try to hurry up and go back to sleep so I can get four hours. And then you're up. You're like, shoot, let me see what time? Okay, it's four. Okay. Okay. Three more hours of sleep. Let me just close my eyes really tight so I can fall back asleep. And you cause yourself to be more anxious and stressed and it actually makes it harder to fall back asleep. So if your alarm has not gone, gone off, it's not time to wake up. Do not look at the phone. Just if you're, if you're stressed or anxious, have. You can listen to an audiobook, listen to music. You can. There are things like cognitive shuffle that helps to distract your thoughts, but do something else. Until you're able to fall back asleep, do not look at the time.
- [36:55]
A
Okay. That's very, that's very good advice. And the second sleep countdown is so real. That is if I look at my phone, I'm already thinking about, oh, okay, three and a half. Okay. So I'm gonna feel it's like yeah, automatically. I have some questions from the audience for you. Okay. I told them I was going to speak to a sleep expert and they were like, I had all the questions. So these are directly. These are not questions in my words. Okay. Just letting you know, how can I get some good ass sleep with no scary drink dreams? I told you.
- [37:29]
B
I like it. We just straight to the point. Okay, so that's actually a great point to bring up. Some people do have nightmares and there are people who have like occasional nightmares and people have nightmare syndrome. So there's consistent nightmares that wake you up, that put you in this state of fear that makes it harder to fall back asleep. First of all, understanding that when it comes to any sleep disturbance, like as I sleep walking, sleep talking, nightmare disorder, not getting enough sleep, sleep is more likely to trigger it or sleep disruptors. So if you're drinking alcohol before a bed, if you have caffeine too late in the day, if you're going to sleep late and not meeting your sleep need, you're making it more likely that you're going to experience these things. So really focusing on prioritizing your sleep. But if you have a nightmare disorder, there's something called nightmare rehearsal therapy and you can see like a provider for this. There are resources online for this, but it basically is where you, you kind of play out the nightmare that's happening and you train yourself to have an ending that's not so scary. So you basically have some control over it so that it's not causing you to get to this point.
- [38:33]
A
Is this lucid dreamy?
- [38:35]
B
It's not lucid dreamy. So it's not why. It's, it's, it's something you do while you're awake that you're training yourself, you're rehearsing the nightmare over and over. But you get to the point that you are, you are fabricating this ending in your conscious state so that in the asleep state it's more likely to end in that way. No. Yeah. Extinguishes that fear component that's actually waking you up.
- [38:57]
A
So you take a dream. I'm sorry, that you have at night, that's stressful. And then you rehearse it in your waking hours in the hopes that when you're sleeping it'll end like you rehearse it in your waking hours.
- [39:09]
B
Exactly, exactly. And so you kind of take back control over that. You take away that fear component that's impacting your sleep and make it more likely that either you don't wake up or the nightmare doesn't recur, or you're able to fall back asleep quickly while also making sure you're getting enough sleep. Prioritizing sleep, limiting the things that can disrupt your sleep.
- [39:26]
A
That's really good. All right, and the next one is, are there any natural sleep aids that actually work? Mm.
- [39:34]
B
It's a good question. So actually work. Everyone is different, right? Especially when it comes to natural sleep aids. So there are some that will work great for some. There's not one sleep aid that across the board is gonna work for everyone. But what I will say is my absolute favorite sleep supplement, I say that because it's just a great thing to take and it happens to help with your sleep, but it's just healthy in general, is magnesium glycinate. I take it every single night, personally. Magnesium is a naturally occurring mineral that we need in our body. It's used in over 300 neurological processes. It helps to relax the muscles, relax the brain, kind of slow everything down, and sets the stage for better quality sleep. It's not gonna knock you out, but it definitely helps to get you in a better space. You can get it from your diet, from things like legumes and green leafy vegetables that most of us are just not. Our diets are not super rich in. So taking it in supplemental form can be helpful. And there are different stages in your life, especially as a woman, when you're going through pregnancy, when you're going through menopause, that your magnesium needs are actually higher. So focusing on getting an adequate amount of that is helpful for a lot of people to sleep. That is my number one supplement that I recommend. Recommend.
- [40:40]
A
Love that. Okay. Myth or fact, going to sleep after midnight equates to worse sleep.
- [40:47]
B
Myth, myth, myth, myth. I hate that people say that. It's a myth and it is a myth because some people are, like, naturally night owls. So if you could live your life according to your natural chronotype. So let's say society was not against night owls and you could just. You could wake up later, stay up later. It's actually better to live your life according to your natural chronotype schedule. So for me, that would actually be going to sleep around 1, waking up at 10am If I could live my life that way, I'd be more productive, more creative during my waking hours. And all those things, life distance will work that way. But that also means that I would never be going to sleep before midnight. And there is nothing magical about pre midnight, post midnight sleep that makes it better or worse. The problem is when you're not getting enough sleep, when you're not getting that sleep consistently. So it's more important to have a consistent schedule. If that's 1am to 9am and you're getting that every single day, it's actually more important than whether or not you're going to sleep after 12. Not, it's not really a thing.
- [41:44]
A
Okay, what's up with mouth tape?
- [41:47]
B
Oh, everybody loves mouth taping right now. So as I said, snoring is never normal, right? It doesn't mean this is a disorder. It's never normal. People feel that snoring, breathing through your mouth, it's a bad thing. So let me take my mouth closed, it caused me to breathe through my nose and it's better. Breathing through your nose in general is better than breathing through your mouth. However, if you're breathing through your mouth, why are you? It is more important to figure out the underlying cause and reason than it is to just again put a band aid or some mouth tape over it and call it a day. For most people it's not going to be harmful. For some people, they find it helpful, but sometimes it can cause you to aspirate so like the contents of your stomach coming up your esophagus and you swallow it because your mouth is taped closed. For some people it can be harmful truly if they have a reason they need to be breathing out of their mouth and now they're obstructing and not allowing themselves to do so. So it is more important to be assess and understand why you're breathing from your mouth, why you're snoring than putting mouth tape on.
- [42:48]
A
How do you know how many hours of sleep you actually need?
- [42:51]
B
Oh, that's a great question. Because most people just go on the average, right? Oh, we need seven to eight hours of sleep, but again, I need nine. So seven doesn't cut it for me. I'm exhausted.
- [43:01]
A
If I do, I need nine also.
- [43:02]
B
Oh yeah, and a lot more people need more than eight than they realize. So my favorite way to go about understanding your sleep need if you don't know is to take what I call a sleep case. So it is a vacation that's based 100% on your sleep. So you take a time, five to seven days, ideally where you have no other daily time constraints. So not having to get up for work, childcare duties. Allow yourself to fall asleep naturally. Allow yourself to wake up naturally as well. Without an alarm clock. For the first few days, you'll be paying off what we call sleep debt. So that's the amount of sleep that you have built up through the week that you have it, that has accumulated. So if your sleep need is 8 hours, you on sub 6, you built up 2 hours of sleep debt. Your body will try to pay that off to some extent, but after a few nights you'll find that you're falling into this rhythm or you're falling asleep, waking up at roughly the same time getting the same amount of sleep, feeling refreshed and energized. And that is gonna be reflective of your sleep need.
- [43:56]
A
Oh, that's great advice. Do you have any tips for sleep apnea?
- [44:01]
B
Yeah, so definitely, if you know that you have sleep apnea, that means you've been assessed, which is great. It is not something that's like an at home remedy type of thing. There are many medical options. So first of all, understand your options. The CPAP continuous pressure, continuous positive airway pressure machine that most people are aware of that goes over your nose or your mouth or both is gonna be the gold standard. So that will keep your airway open so you're not obstructing overnight. But there are dental appliances, there are like implants that will actually move your tongue out of the way. There's actually a new medication that was recently approved for people with sleep apnea. So there are other options. A lot of people get scared by the CPAP mask, but there are other options, especially if your sleep apnea is mild. So I would say your options, but absolutely, get it treated. 100% get it treated. Because sleep apnea is actually so dangerous, it can cause so many significant health consequences and outcomes down the line. So get it treated first and then move on to any other sleep issues you might have.
- [45:02]
A
And last audience question is, why does sleep change during perimenopause?
- [45:07]
B
Oh, because we just saw Lucky as women that we.
- [45:12]
A
Yeah, I love it here.
- [45:15]
B
Anytime you have significant hormonal changes, particularly in progesterone. Progesterone is a very important hormone for sleep, but estrogen plays a role too. So even throughout puberty, for a lot of women surrounding their menstrual cycle, they'll have insomnia. Pregnancy can lead to insomnia and then menopause is a huge one because you have a significant drop in these very important hormones that help to stabilize your sleep. So it's very Common just because those hormones are very important. But again, there are options. There's hormone replacement therapy, there are alternatives to hormone replacement therapy that can help stabilize things a little bit more. And then it's so important during that time period that you're even more vigilant about your sleep, your sleep schedule, setting up a sleep space that's conducive, keeping it nice and cool to combat hot flashes and all of those things. But it's a significant drops in the hormones that are important for sleep that cause you to have sleep disruptions.
- [46:05]
A
Oh, man. It just keeps getting better and better, huh? But I. I appreciate this conversation so much. As someone who struggled with sleep issues pretty much my whole life, this was so enlightening. And I wish I would have talked to you 20 years ago, but now that we're here, we're here. And since you're here, I want. We have an unruly toolkit, and it's this big toolbox, and every guest puts a tool in there. So if you were gonna put a sleep tool in that unruly toolkit, what would it be?
- [46:38]
B
You know, it's gonna sound maybe cliche, but honestly, a lot of sleep and sleep issues comes down to mindset and how you think about your sleep. So understanding first of all that sleep is important. Prioritizing sleep. But one quote I told you earlier about thinking of sleep as the beginning of a tomorrow. But one quote that really, really stuck with me during my sleep struggles is instead of asking myself, have I worked hard enough to deserve to rest? I've started asking myself, have I rested enough to do my best work? And when you think about it that way and rest as a tool for your work and being your best self and showing up, then you understand like, okay, this is why this is important. It helps to reframe those thoughts and at least get you on the right path towards better sleep.
- [47:20]
A
That is amazing. Dr. Angela Holiday. Bill, thank you so much for this reminder today of how important sleep is and how. And all the tips for how we can get the rest that we need. So if you're listening to this, whether you're dealing with insomnia, you're wired at night, you have constant fog or exhaustion. I hope that this episode made you feel seen, affirmed, and gave you some tools. Doctor, where can people find you? Work with you, Find out about everything you have going?
- [47:48]
B
Yeah, the best place will be my website. The solution is sleep.com. you can find out my services there. Connect with me on social media. My book, a link to my book is there. That's kind of the best kind of hub to get in contact with me.
- [48:03]
A
Awesome. And thank you so much for joining us. We really appreciate you. I wish you a safe and happy and healthy delivery and I hope all the girls follow you and work with you and get great, great sleep.
- [48:15]
B
Thank you. Thank you so much.
- [48:19]
A
If you have something on your mind, a question or something you want me to answer, just send in a voice note@speakpipe.com unruly I can't wait to hear from you. Thank you so much for listening. Be sure to follow or subscribe so you never ever ever ever miss an episode of Unruly.
- [48:40]
B
SA.
- [49:09]
C
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