It’s clear that the pandemic has been devastating to many peoples’ sleep health, because we had a huge response to the recent series on sleep issues with Dr. Shane Creado. So we invited Dr. Creado back to address some more sleep topics that we didn’t get to last time. This episode discusses the cycle of sleep deprivation, and why it’s so important to break it.
For more on Dr. Creado’s new book, “Peak Sleep Performance for Athletes” visit: https://www.amazon.com/Peak-Sleep-Performance-Athletes-Cutting-edge-ebook/dp/B085YFP9YW
For more on Dr. Creado’s online course, “Overcoming Insomnia”, visit: https://brainmd.com/overcoming-insomnia-course
Daniel Amen, MD:
Welcome to the Brain Warrior’s Way podcast. I’m Dr. Daniel. Amen.
Tana Amen, BSN RN:
And I’m Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
The Brain Warrior’s Way podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain SPECT imaging to personalize treatment to your brain. For more information, visit amenclinics.com.
The Brain Warrior’s Way podcast is also brought to you by BrainMD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to brainmd.com.
Back by popular demand is Dr. Shane Creado, our sleep doctor. Dr. Creado is a board certified psychiatrist and sleep medicine physician. He was wildly popular on the last time he was on. He did his undergraduate degree in physical therapy and then went on to do his medical degree graduating in at the top of his class, received the gold medal for obtaining honors in every subject in medical school. He has clinical experience with veterans, with college mental health, exercise, prescriptions and mental health, comorbid psychiatric and sleep problems which he does for us, CBT, insomnia, cognitive behavior therapy for insomnia, alcohol recovery groups, mindfulness based stress reduction, ministrative psychiatry. He’s got loads of experience.
Couples therapy, regressive hypnosis, which I think is just really fun and awesome. He is also the creator of the Amen University course Overcoming Insomnia. He’s the author of the new book, Peak Sleep Performance: The Cutting-edge Sleep Science That Will Guarantee a Competitive Advantage, which debuted at number one new release on Amazon in sports medicine in March 2020. So Shane, we are so grateful you’re back. He’s one of our lead physicians in our Chicago area clinic.
Yeah, and I’m really excited to have you. This is always one of my favorite guests and is one of my favorite topics, because it’s just such an important one. I know our community especially [inaudible [00:02:49] community for sure really struggles with this, and because we are at that age, we are female and at that age, and we’re going to talk about some great topics today, but I would for our community, if you would please post not only what the struggles have been going through all this, with the pandemic and the riots and the fear, post what your struggles have been, your questions, your concerns, but also tell us what you learned, because Dr. Creado is just masterful. He’s taught me so much and I thought I had researched a lot on sleep. It’s not even close. So, it’s really interesting. We would love to hear from you, and if you would, take a screenshot of us and send it to us, that’d be awesome. Tag us in it, please. So, thank you and welcome.
Are you saying I’m so cute?
You’re so cute.
You wanted a screenshot?
And Dr. Creado is so cute.
And Dr. Creado?
Yeah. So, thank you and please, and welcome Dr. Creado.
Shane Creado, MD:
Thank you so much for that generous welcome. It’s good to see you both again.
Well, life is becoming a Zoom experience, video conferencing, and I hate the term social distancing because it’s a bad term because we should be socially more connected than ever so we don’t get depressed, but physically distancing just makes so much sense, so we don’t empower the coronavirus to keep spreading and doing damage around the world. One of the big things that’s happening with the pandemic is people are not sleeping. Their nightmares have gone up. They’re afraid and the incidents of posttraumatic stress disorder is going up as well.
The riots I think are adding to that. Not that not the protesting, but when it gets violent, I think people are afraid.
Well and then of course that’s where their news is going to focus on whatever bad things happening they’re going to focus on that. Making it seem like something that is local is global. Whenever you see something terrible as global, your anxiety skyrockets. So from a sleep perspective and also working with us at Amen Clinics, what are you seeing, Shane?
We’re seeing that anxiety levels are skyrocketing. Even people whose other psychiatric disorders were well-controlled, they’re having more frequent episodes, severe episodes as well as mood symptoms. Because if you’re they’re in danger mode, they’re anxious, they’re worried, they’re on edge. Their sleep will be affected. The Dalai Lama once said that sleep is the best meditation. If you’re injure mode, your brain is obligated to protect you. Sleep is the most vulnerable thing we do. So, you will be more likely to be awake, on guard, on edge and your sleep will definitely suffer.
The problem is if your sleep is devastated, if your is fragmented, you’re more likely to have manic episodes, more likely to have severe depression. Of course, PTSD and sleep are very closely related to one another. So, you’ll be worrying, your brain won’t be able to shut off. Then you will be catastrophizing about the worst case scenario. Then when that happens, you’re going to get poor sleep. You’re going to recover very poorly the next day. That’s going to set you up for failure. We see that on the SPECT images as well. The rational part of the brain shuts down. The emotional circuits are overloaded and in danger mode and it just sets up a vicious cycle because the more anxious you are, the less sleep you get. Then the more anxiety you get, the less sleep you get. So, with PTSD, posttraumatic stress disorder, where people have experienced a really traumatic event or they’ve witnessed it, the danger mode in the brain is really significant factor that devastates people’s sleep.
The other thing of course is nightmares, where they have a strong negative emotional response accompanied by an awakening. If you are sleep deprived, your brain needs to drink as much dream sleep as possible to catch up. So, inadvertently you end up getting more nightmares simply because you are sleep deprived because of the anxiety and PTSD. It’s called REM rebound in sleep medicine, people with [inaudible [00:07:30] so more at risk of sleep apnea, obstructive sleep apnea, leg and arm twitches, which lead to further sleep fragmentation. They’re afraid of going to sleep, especially if trauma has occurred around the bedroom or at tonight. So, they will want to do perimeter checks to make sure things are okay. They may avoid the bed because of the nightmares and the trauma associated with the bedroom. That again causes sleep disruptions.
Medications of course can affect your ability to fall asleep. Medications that treat anxiety disorders like PTSD can worsen sleep apnea like benzodiazepines. Here at Amen Clinics, we know that benzodiazepines are maybe medications of last resort, because because of all the damage that can cause to the brain. So, those are the ways in which PTSD can really impact your sleep.
What are things people can do about it? So, if they have had PTSD before, robbed, raped, in a fire, grew up in a traumatic environment, had been molested, and what we see on scans is their emotional brain is heightened. So, they can’t stop thinking about the traumas from the past, which will interfere with sleep. What are some of the strategies that could help them?
So, there’s psychiatric strategies and there’s sleep strategies. We know that we recommend trauma focused CBT. We recommend EMDR therapy, certain medications for the psychiatric component. As far as the sleep component is concerned, for the hypervigilance, for the danger mode, calming strategies, progressive relaxation, scheduling a worry time earlier in the evening, identifying negative thoughts that are unreasonable or irrational and working on those through cognitive behavioral components. In the overcoming insomnia video series, we touched on some of those strategies to calm the busy brain down. So, that’s as far as the relaxation, the hypervigilance is concerned.
The other piece is to avoid the urge to constantly look for danger at nighttime. So, for patients who perform safety checks all the time, refraining from doing so will initially increase their anxiety, but over time, the anxiety will reduce, the checking behavior will be extinguished and sleep will improve.
She’s kicking me under the table.
Stop. No, you’re hitting me under the table. I don’t how that’s going to make people who need to check with [inaudible [00:10:27]
Well, let me give you an example of this.
[crosstalk [00:10:30] a little therapy here.
No, we don’t. This is about him.
This is about him.
She was actually doing really great-
The quarantine is fine.
… during the first part of the pandemic. She was … cause she’s a prepper. She’s prepared-
And I felt empowered.
… and she felt empowered, but when the social upheavals started, she began to unravel.
I wanted a bunker.
So bad. Now, she’s checking. She was actually … During the beginning, I was watching the news more. I turned that off. So, when the whole George Floyd killing and the riots and all of that, I had trained myself to stop checking. Now, she’s checking and all of a sudden we’re moving.
Which goes to show you, but that goes to show you, for everybody listening-
To Montana or something.
Yeah. So, it goes to show … to a bunker somewhere, yeah. So, it goes to show you that everyone is sort of triggered by something different. Clearly, the illness was more of a concern for you, but we’ve all got our own issues. Things trigger us differently. Right? So, traumatic and violent things are what triggered me far more. I’m a nurse. Like being able to kick in to my nursing mode, I’m like, “Oh, I got this.” but I didn’t got it for the other thing and I’m like, “Wait, I don’t have an answer for this. This is not … I feel out of my element.” I think a lot of people are experiencing that. One or the other they can handle, both is like tilt overload.
Right. Exactly, Tana. If it’s not affecting your ability to fall asleep, then that’s going to be something that that’s okay for you, but if it affects your ability to function and fall asleep, then it’s a problem.
I did notice, I did notice to accredit to what you’re saying. Immediately when I force myself to not look at the news, I’m not going to say the new perimeter checks, but when I stopped watching the news and started making my mind focus on positive things that are meaningful to me like my church services, like my brain went to a totally different place and I slept like a baby.
In the next podcast, we’re going to talk about the impact of pain on your sleep, but in the last minute, Shane, can you just give people, if they’ve had emotional trauma, I know there’s a medication, prazosin, that we use sometimes to help decrease nightmares and you use that a lot, but give us just two or three strategies if you’ve had PTSD or you’re struggling with it now, what are the most important things you can do to help improve your sleep?
Well, for the nightmare component, there’s a few really helpful strategies. In addition to the calming the brain down, stopping the perimeter checks, one is a grounding techniques. So, when you awaken from a nightmare, it’s associated with confusion. So, rounding techniques might include looking at a calendar upon waking up to reorient yourself, holding a special object that has emotional significance for you, so you get back to the moment and you realize that that was a nightmare and this is now, and you’ve got to break that cycle, that thread of thinking. That’s really going to be helpful for people to break that aspect of functioning.
If you are waking up in a panic, don’t stay in bed. Get out of bed, listen to a calming meditation. We have some great ones on BrainFitLife or other strategies. Once you calm down, then go back to the bed. Otherwise, you’re lying in bed worrying, associating the bread with that trauma and eventually the bed will be a traumatic place for you to be in. So, some people with PTSD, they come to our clinic in Chicago from other parts of the world and other parts of the country. They say, “I slept the best I’ve slept in years.” because it often happens that their bedroom or the bed is now associated with the trauma. So, break the cycle. Grounding techniques, relaxation, recalibration.
Then you and I created a pretty cool supplement called Put Me To Sleep, which is what people want. They want to go to sleep. It like sold out, but now it’s back in stock thankfully. Talk about Put Me To Sleep and why that is one thing that can be part of a good sleep regimen.
It’s a beautifully balanced supplement. We worked in it for a couple of years, and it has low dose melatonin so it doesn’t knock you out. It helps your brain drift into sleepiness very gently. It has GABA to calm this basal ganglia down, which are your danger stress circuits. There’s 5-HTP to help boost a little serotonin to help you with stress tolerance, B6, and generally what it does is it allows the brain to calm down gently, to get 30 to 60 minutes before desired bedtime, you have a nice wind down routine and it just helps embolden and strengthened your natural biological circadian rhythm to function more effectively. So, it’s beautiful. It’s very well tolerated. My patients, none of them have woken up with a hangover or tiredness. They’ll wake up feeling good. The quality of sleep has improved.
Yeah, no, it’s so effective. All right. When we come back, we’re going to talk about pain and sleep. So important. Stay with us.
If you’re enjoying the Brain Warrior’s Way podcast, please don’t forget to subscribe so you’ll always know when there’s a new episode, and while you’re at it, feel free to give us a review or five star rating as that helps others find the podcast.
If you’re considering coming to Amen Clinics or trying some of the brain healthy supplements from BrainMD, you can use the code podcast 10 to get a 10% discount on a full evaluation at amenclinics.com or a 10% discount on all supplements at brainmdhealth.com. For more information, give us a call at 855-978-1363.