Why We Can’t Sleep & How to Fix It with Dr. Shelby Harris
July 9, 2024
Hey Glennon, why were you late?
Glennon Doyle:
Because I don’t know if I can say this, it’s so gross, the children have stolen all of my underwear, so I am wearing a bathing suit under my clothes right now. Look at this. I am wearing a bathing suit because it was either this or commando. So that’s my life. All my underwear’s gone. I’m also wearing a bra from college. Maybe we could buy ourselves new bras one day. Let’s just record. But I am, you guys, wearing a bathing suit. This is all real what happened to me this morning.
Dr. Shelby Harris:
Bathing suits are uncomfortable.
Glennon Doyle:
Hi everybody. Welcome to We Can Do Hard Things. Today’s going to be a challenge of whether we can in fact do hard things, because the hard thing we’re talking about today is sleep.
Abby Wambach:
Yes.
Glennon Doyle:
Abby’s so excited. I am trepidatious. Sleep is a word that brings up a lot of feelings for me because it’s been a challenge. The word sleep even makes me feel a little bit, I think it’s like an achy loneliness because, oh gosh, when I am trying to sleep and I can’t sleep and everyone’s asleep and I feel so … Anyway, I’m going to stay here. We are going to nail this. We’re going to figure out how the hell to sleep.
Today we have Dr. Shelby Harris, who is a psychologist and sleep specialist who treats a wide variety of sleep, anxiety and depression issues. Oh girl, you are in the right place. She is a columnist for the New York Times. She is author of the book, The Women’s Guide to Overcoming Insomnia. Dr. Harris can be found on Instagram @SleepdocShelby, where she provides evidence-based information. Ooh, that’s nice, about sleep wellness and sleep disorders. Welcome, Dr. Shelby.
Dr. Shelby Harris:
Oh, thank you for having me. It is such a pleasure to be here. Thank you.
Glennon Doyle:
Your work is focused on “realistic wellness.”
Dr. Shelby Harris:
Yes.
Glennon Doyle:
Which I just like that already. I just like adding the realistic in there. My first question to you is how much sleep wellness is realistic for women? Is it not much? This is going to be a short episode, y’all.
Dr. Shelby Harris:
That is a wonderful question, and I think the problem in the field is that for years we were very focused in sleep medicine on sleep disorders. So people would come to us when they had issues with chronic insomnia, sleep apnea, narcolepsy, whatever it might be, that it was really making a big problem in their lives. And then we still do the sleep disorder stuff. It has taken the shift in the past five to eight years towards this wellness idea, and I think it’s almost overshot the mark too much where it’s giving people this idea of perfection.
I mean there are some people out there who are giving these sleep tips. Their wake up times must be, they’re routines, must be two hours long. And I’m thinking, “Who the heck has time to do this, to view the light at certain ways and certain times and to do all these things.” That is just not realistic for many people.
Glennon Doyle:
That’s so good.
Dr. Shelby Harris:
So it’s about doing certain things to help where you feel well rested and refreshed most of the day, as often as you can, and trying to make little gains wherever you can so that you can then kind of work towards improving your sleep longer term.
Glennon Doyle:
Do you see being a woman as a preexisting condition-
Dr. Shelby Harris:
100% yes.
Glennon Doyle:
… for not getting enough sleep? I mean, I’m just going to start this by telling you, and I’m not talking shit about Craig. We laugh about this story all the time, but I’ll never forget being at the little neighborhood thing when the kids were very little. I was just dripping with them. They were probably five, three and one, and I was listening to Craig talk to our neighbors, and one of the neighbors said, “How are you guys sleeping?” And Craig said, “Well, you know what? I’m just really lucky because Glennon just doesn’t need that much sleep.”
Dr. Shelby Harris:
Oh my gosh.
Glennon Doyle:
I thought, “Oh, that’s what they think.” Okay.
Dr. Shelby Harris:
But it’s interesting. Actually, when we look at research with women, women actually need a little bit more sleep, and we’re not talking hours more, but they need a little bit more sleep than men, and the sleep they get when they do actually sleep, because then we have insomnia and all this stuff on top of it, it’s actually deeper than men. So this idea of women don’t need as much, no, it’s just because we’re functioning on all different levels all throughout the night 24/7. And you said it was being a woman of preexisting condition in a way, and it kind of is. So there’s hormone changes that happen and we see for in kids the rates of insomnia especially, or trouble sleeping for boys and girls is exactly the same until they hit puberty.
Glennon Doyle:
Okay, thank you for that.
Dr. Shelby Harris:
Once they hit puberty, then it starts to become an issue. And so it can be around your period. Some women will start noticing that they’re either having trouble with sleep or they’re excessively sleepy, the opposite can happen. Then we talk about pregnancy, trying to get pregnant. There are a lot of people who are taking various hormones for fertility issues. That can impact sleep. Then once you’re pregnant, there can be sleep issues. Then the baby comes, and then if you’re breastfeeding there can be issues. Then we didn’t even talk about perimenopause and menopause.
So at various stages throughout the life for women, we do notice there are a lot of sleep issues. And then you throw on top of that two other big factors. So one is that we do notice there’s more anxiety and depression in some women, and then finally there’s social and psychological stress, or social stresses more so. Women are often having kids later in life and they’re working more than they had before. So there’s work, they’re having kids later, so they’re taking care of little kids, and then there’s aging parents and family that they’re taking care of. So it’s a nonstop kind of firestorm of hormonal, psychological and social issues that really do factor in for women.
Glennon Doyle:
Yeah, and I’ve noticed, I want you to take us away from this, sister, because I promise I’m not just going to complain this whole time, but Dr. Shelby now that I have you here, I’ve also recently noticed that I’ve always had sleep issues, and we’ll get to that, but the little kid time, you don’t sleep for 10 years. But then I’ve been unpleasantly surprised by the fact that then when they become teenagers, I didn’t realize then they just stay up so late or stay out so late. So then you’re still up half the night. We just got married seven years ago, so she stays up now with them because I’m like, “You missed the early years, so now this is your time to shine.”
Abby Wambach:
And actually I think it’s really interesting, because I think Glennon has lack of sleep PTSD from the time that she was dripping with kids when they were really, really young. So she becomes an angry elf in the middle of the night times, if in fact she does wake up, because I think she has so much anxiety around sleep, because she missed it so much. I don’t know if that’s something that you found.
Dr. Shelby Harris:
Totally a thing. It’s not an actual diagnostic term, but I would say it’s more like a sleep anxiety. And I see this, because I work with women so frequently that there’s almost like, “I don’t want to go back to where I was. I don’t want to go back to that.” And so they almost become super, I mean not saying you are, but some women start become hyper-focused on their wind down routines, very rigid about I have to have my arm in a certain way. The pillows have to be a certain way. All these things. And then if they wake up in the middle of the night, “You’re breathing too loud, why do you do these things?” And then it’s this focus on anything that could be a potential threat to their sleep. So it’s almost too rigid for some people.
Abby Wambach:
Yep. Do you have a fix for that?
Glennon Doyle:
Okay, we’ll get to that. Sissy, go for it. We promised not to use it as marriage therapy. Go ahead, sissy.
Amanda Doyle:
Well, all of that is basically like a survival instinct, right?
Dr. Shelby Harris:
Yes.
Amanda Doyle:
If you are deprived, then you are like, “This is a threat to my health and survival. I would love to dig into that, because I think a lot of us think sleep is about not being tired when you’re awake, and that sleep is for the purpose of not being tired. But evolution doesn’t give a shit about us being tired. Evolution cares about our body’s restoration and preservation, because all of those things you just discussed about hormones, okay, so when we’re 11 we get our period suddenly first surprise, you’re fucked up now.
Same with pregnancy, same with babies, same with perimenopause and menopause. So we’re just on this hamster wheel of constantly being screwed up, and we learned to live with that, but we really need to take account of, it’s not just about us being miserable and tired. Can you say the things that happen during sleep about keeping us well and alive and the bad things that happen to our health when we don’t get it, because it’s bigger than not being tired?
Dr. Shelby Harris:
Yeah, and I think what you were just saying about sleep being a function to help us be not tired and not being sleepy during the day is such an important thing. And I have patients that are taking all these sleep aids, not that that’s necessarily bad thing if you have tried other things that’s not working, but I have patients taking things and they’re so sleepy during the day because of these sedating medications. Then I’m like, “Well, what’s the point? You’re sleeping at night just so you turn your brain off, but if it’s not helping to improve the quality of your life, is it really doing that much at this point?”
Glennon Doyle:
You think they’re using it just to avoid the scared loneliness?
Dr. Shelby Harris:
Potentially. Some people do, they just want-
Glennon Doyle:
I’d almost rather put myself out and skip over that scary lonely part of trying to fall asleep and feel like shit all the time than deal with that.
Dr. Shelby Harris:
So you don’t have to be with the thoughts or whatever it is, that visceral feeling that it brings you back to. But sleep is that thing that I always say we talk a lot about the pillars of health in our society, diet, exercise, sleep being one of them. I argue that sleep is the bedrock for health more so than being another pillar, because what we find is when it comes to all the areas of functioning really, sleep is the thing that keeps things going. When we think about our memory, our mood, our quality of life overall, we think about cardiovascular risk, we think about diabetes, metabolic syndrome, how we heal from exercise, from the daily stresses of life.
For kids, it’s super important for cognition, mental growth and physical growth. It really does inform so many things that we’re doing in our lives. And if you’re just focusing on say diet and exercise to kind of live a healthier life and you’re not focusing on sleep, or at least trying to improve whatever sleep you have, then you’re missing out on a big component of that, because it’s definitely going to impact all these other things.
And even things like sleep gets missed a lot when people are in treatment, let’s say for depression and anxiety, or even any medical issues. If you’re not sleeping well, we know when it comes to outcomes for depression and anxiety treatment especially that sleep helps to bolster those other treatments. So I argue for some people that if you’re feeling depression and anxiety, and you’re having trouble with your sleep, let’s walk on your sleep first, because it might actually give you better benefits with some of the other treatments that you’re doing in your life.
Speaker X:
That’s interesting.
Amanda Doyle:
I just think it’s so important. We live in such a hyper productive, in order to value anything, I have to know how I’m going to net out on it. And I think just understanding our bodies of when you are sleeping and certain types of sleep, your body is actually mending the cells. You are repairing yourself. It’s like putting your computer to sleep and it runs the updates. That is time that is productive and necessary for yourself to be asleep. And also there’s this huge correlation with people who don’t get enough sleep do not have the same level of those super cancer fighting things in our body-
Speaker X:
Cells.
Amanda Doyle:
… as people who do get sleep. It’s doing a thing, y’all. You need it.
Dr. Shelby Harris:
So it’s always a fine line, right? Because we don’t want to fear-monger either, because Glennon with you-
Glennon Doyle:
I feel scared now. I’m like, “Oh, my little cancer fighting thing.”
Dr. Shelby Harris:
I think sleep is an important thing, but we have to also think about are we taking some of these things that we’re finding and we’re making it so broad and generalized, like to say you’re going to get cancer because you’re not sleeping or you’re definitely going to get Alzheimer’s, which is one of the things, yes, they definitely put us at greater risk, but it doesn’t necessarily mean that other things you’re not doing in life are doing aren’t going to, it all kind of mixes together.
But there are things like your immunity to certain things. We do find that people who are sleep-deprived, even for one night might have more of a risk of getting a cold, or might end up longer term developing certain kinds of cancer. So for example, people who work shift work aren’t getting enough sleep. Some people who work shifts really struggle with that. We know that there’s higher rates, for example, of breast cancer, and we see those rates, but it’s not all cancers.
So you have to be careful with that. But there are things that not getting enough sleep definitely impacts. So when you were talking about sleep staging, there’s another thing. So when you go to sleep at night, we cycle through different stages of sleep. You have deep sleep, light sleep, and then you awaken. And the different stages are, we call it stage three, which is this deep sleep, and then there’s this middle level, stage two, that happens for a good 65% of the night or so. And then we cycle with REM sleep throughout the night too.
So a lot of people will say, “I’ve got to get that deep sleep all night long.” But the reality is you should actually have different percentages of the different stages throughout the night. So REM sleep is really important for emotion processing. We find that, for example, teenagers talking about teens in that late night when they have to get up really early to go to school, they’re cutting off a lot of that REM sleep. So a lot of that emotion processing that teens really need just to get through and to develop, that’s being cut off with early school start times for some of these districts.
Amanda Doyle:
We should let our kids sleep, we should let our teenagers sleep. The next time your kids are being an asshole, just send them back to bed.
Dr. Shelby Harris:
Yes.
Amanda Doyle:
Back to bed.
Dr. Shelby Harris:
You need to get more REM. And then the other thing is that deep sleep. That’s when you are repairing your muscles from exercise. That’s when kids tend to grow more. So it’s really, it’s a smattering of different stages throughout the night as opposed to being focused on you have to get more REM sleep or deep sleep or whatever it might be.
Glennon Doyle:
It feels like such a beautiful focus that you’re doing this. It just feels like-
Dr. Shelby Harris:
Thank you.
Glennon Doyle:
… in the world of women’s health and wellness, why is there not a lot of focus here, but all of our focus on diet and exercise? Because those things are tied to how a woman appears. They’re tied to our worth.
Amanda Doyle:
And shit she can buy.
Glennon Doyle:
Right. And sleep is about how we are actually, how we are, which the world cares a lot less about for women.
Dr. Shelby Harris:
Yeah. There’s the idea of you have to just kind of fake it for years on end and then at some point kids or whatever will be grown and then you’ll have time and you’ll make it up later. But I also hear people say, “Well, you’ll sleep when you’re dead.”
Glennon Doyle:
Oh my gosh you just said that.
Dr. Shelby Harris:
That might happen sooner if you’re going to sleep deprive yourself for years on end. But then like I was saying at the beginning, there’s this kind of overshooting the mark of you have to be perfect with it seven nights a week. And I think for some people that actually makes their sleep anxiety worse that they’re now actually getting less sleep because they’re so worried about the perfection’s the enemy of good essentially.
Amanda Doyle:
Can we talk about that sleep anxiety? Because this is something I had never heard. You talk about how the gold standard, like all the research shows that cognitive behavioral therapy is the gold standard for treating insomnia, which is fascinating to me, because the way you speak about it makes it seem to me like it’s a lot mental, that insomnia is basically sleep problems that are caused by anxiety, about sleep problems in some ways.
I know that’s a crazy oversimplification, but can you talk us through that? Is all of this, or a portion of all of these problems that we face, are they essentially an oversimplified anxiety disorder in a way? Because if cognitive behavioral therapy is going to help you with it, it suggests it’s not a purely physiological thing that is arbitrarily assigned to you.
Dr. Shelby Harris:
Right. It’s a little multifaceted. And when we talk about cognitive behavior therapy for insomnia, CBTI for the insomnia part, currently as we’re recording this now, there’s a big uproar in Europe right now, in England, because the new standards for menopause care have come out, and one of the recommendations they have in there is CBT. And people are saying, “Well then you’re saying all of menopause issues are all in their head and that therapy is going to fix it all.” And I think there’s a big misnomer there.
So when it comes to insomnia treatment with CBT, there’s a piece of it, the cognitive part, we might work with some people on that perfection, that anxiety, like, “If I’m only going to bed for seven hours, I have to fall asleep fast because I need to get those seven hours, otherwise X, Y, Z won’t happen or will happen tomorrow and I won’t be able to function.” That’s a piece of it for some people.
But for other people, there are learned behaviors. I’ll sometimes say it becomes an issue of common sense where they’re going to bed either too early or they’re trying to sleep in. A lot of parents aren’t able to sleep in, but if they can or get the ability to, or they take a nap, and then some people start using alcohol or they’ll use certain over-the-counter medications or prescription medications, or I don’t know, THC, whatever it might be to help them sleep, that some of those behaviors or what they’re doing in bed in the middle of the night, maybe on their phones, those are all things that are actually worsening it.
So sometimes it can be more of an anxiety issue. For some people, it’s literally just no matter how hard I try, I can’t sleep more than four hours a night. So it’s changing some of the bedtimes and wake times and some of the behaviors they’re doing, where it’s really not as much cognitively focused.
Amanda Doyle:
Okay, that’s helpful. So is the dovetailing of the cognitive with the behavioral-
Dr. Shelby Harris:
Yes.
Amanda Doyle:
… is where the magic happens?
Dr. Shelby Harris:
Exactly.
Amanda Doyle:
That cognitive piece I feel like happens in people, like I don’t suffer from insomnia. Thank you baby Jesus. But I still have that thing where if I’m not falling asleep, I do that in my head. I’m like, “Okay, so seven hours has now become six. Oh gosh, now it’s five. Oh gosh, now it’s four.” Now I’m up for the rest of the night because I’m counting down and I’m so fixated on what I’m not doing that it’s gone now.
Dr. Shelby Harris:
Mental math at night, the clock is just not good. I always tell people get rid of your clock, or at least have it for an alarm, but turn it around, because looking at the clock just adds an extra level of someone’s watching me and I’ve got extra pressure and it’s not going to make the time pass any different. It’s not going to change the outcome of the night. All it can do is really make you put more pressure on yourself and when you put more pressure on yourself, you get more tense and that actually is what can worsen sleep for a lot of people.
So it’s some of the behavioral stuff and then it’s also looking at, have you ever noticed that if you have a bad night, it’s not always a disaster the next day?
Speaker X:
Yeah, I’ve noticed that.
Dr. Shelby Harris:
And then sometimes when you have a good night, you still feel crummy the next day. So it’s not always a perfect prediction of what’s going to happen either, but we automatically go to the worst possible outcome at 2:00 in the morning, which doesn’t help.
Glennon Doyle:
Were there any other surprising findings to you in that new study that just came out about menopause?
Dr. Shelby Harris:
Well, the recommendations are all pretty good. I mean, they’re pretty, along the lines of what we have here in North America, and it was just a draft, it hasn’t even been finalized yet, but the outcry of so many very well-known menopause physicians saying therapy shouldn’t be one of the recommendations. I don’t understand. Hormones work for a lot of people, but they don’t work for everyone. So why not give another evidence-based that we have actually good data on, evidence-based option to help people sleep better and help with their mood.
But people are just, “It’s all in your head.” And then there’s this stigma of going to therapy. For insomnia stuff, I see people typically two to eight sessions. That’s generally what I do and it’s not even weekly. So people often think too when they hear therapy or CBT, they think this is going to be something that’s months if not years on end when you think of therapy. It’s a very, very short term thing.
Glennon Doyle:
So what do you do that’s most helpful? If someone’s listening right now and they can’t get to CBT therapy for many reasons, what is most helpful for somebody who’s suffering from insomnia, besides the get rid of your phone? I need something besides get rid of your phone and caffeine and booze. I want just something else.
Dr. Shelby Harris:
Okay, so that’s actually a really good point, Glennon, that you’re bringing up is that sleep hygiene, so one of my colleagues, Rachel Manber always talks about sleep hygiene, which I love. She says it’s like dental hygiene. So you’re going to brush and floss every single day and that will help prevent a cavity, but it doesn’t-
Glennon Doyle:
Are you, Dr. Shelby? Are you going to floss every day?
Dr. Shelby Harris:
I try. I try. I try. But the idea is that it helps prevent insomnia, but if you do limiting the caffeine, limiting screens, all that sort of stuff. But once you get a cavity, A, you’re not going to stop brushing, but you can’t really brush a cavity away. Correct? You can’t. Same thing with sleep hygiene. So you want to limit alcohol, limit the caffeine close to bed. All that stuff, they’re good sleep habits. But once it now tips from once in a while a bad night to routinely having bad nights, no amount of limiting screens is going to necessarily help fix that problem.
Glennon Doyle:
Exactly.
Dr. Shelby Harris:
And that’s the thing that gets put out there more often than not. And the media and in books, a lot of people are like, “Well, you have to limit this and do this.” And that’s actually not evidence-based care for insomnia. So when you’re asking what do we do, so sleep hygiene is important, but it’s not going to solve the problem. If you’re drinking a two-liter bottle of soda before bed that’s got caffeine, good luck. I mean you got to fix those things.
But one of the biggest things I usually say to people is limit the time in bed and come up with a more consistent sleep/wake time. It’s not perfect, but do it as often as you can five nights a week. If you’re only sleeping, let’s just be generous here, you’re sleeping six and a half hours a night, but you’re in bed for eight hours, maybe limit yourself to about seven hours. It’s more about quality over quantity, because we get very fixated on that you have to get seven or eight hours a night or else all these things are going to happen.
I’d rather someone at first start getting six hours where they’re falling asleep a little faster and fall back asleep faster than in bed for eight hours with kind of chunks throughout the night. So limit and then try and be a little bit more consistent with the bed and wake time. And sometimes it’s kind of weird, but sometimes it goes, if you’re someone who tends to have a very busy brain, if you spend a little less time in bed, you might fall asleep a little faster because you’re going to bed later, and you might fall back asleep faster because your body is learning that has less time in bed so that you actually get into a deeper sleep once you fall back asleep.
Glennon Doyle:
Whenever I hear the sleep thing and people are just like, “Just stop drinking caffeine,” it makes me feel like it’s equivalent to people giving women financial advice where they’re like, “Just stop having your latte.” It’s like no matter what a woman’s problem is, the answer is just stop drinking coffee. It’s the one thing that we live for that keeps us going. It’s like when I was in elementary school, I would come to the clinic and be like, “My stomach hurts.”
And they’d be like, “Here’s your ice pack.” It’s like stop drinking coffee is the, “Here’s your ice pack for women.” But really when I have historically been laying in bed, it’s because I feel like I have the weight of the world in my brain. It feels like other people could sleep because they’re not spinning the mental load of the entire world. Is there some parts of this sleep problem that is about gender inequality?
Dr. Shelby Harris:
Oh, a huge piece of it, a huge piece. And I think that’s also what’s getting missed as well in the discussion. I think there are a lot of men out there who are writing about sleep who don’t necessarily have the same perspective. Not to say that it’s not a valid perspective on their end, but it doesn’t speak to a lot of people, and it doesn’t speak to a lot of the patients that I work with. And I think the spinning brain and that kind of mental load that a lot of women take on, it’s very hard to let go of in the middle of the night.
And there are things that we try to do, meditation being one thing, not in the middle of the night. I actually have people meditate during the day to help get a little bit better at recognizing, because sometimes people get so deep in the hole of doing it in the middle of the night, it’s hard for them to recognize that they started going in the hole. That if you can just kind of start to be a little bit better at saying, “Nope, not now, that’s for tomorrow,” and by doing daytime meditation can make it a little bit easier to softly kind of change the focus. It’s just finding five minutes during the day for some people can be really a challenge.
Glennon Doyle:
If I were a psychologist, if I was a marriage therapist, I know everyone’s trying to figure out how do we actually transfer the mental load? People have finally figured out that it’s not fair in a couple for one person to be carrying all the mental load, but everyone’s trying to figure out then how do we actually pass half of it over? I would suggest that every time the person who carries the mental load is trying to fall asleep and they’re thinking of all the things, that they just constantly wake up the other person and then they go, “Also this.” And then the other person’s like, “Oh, that’s our …” and then they keep going, “Also this,” just like all night forever until the mental load is evenly distributed. That would work. Correct?
Amanda Doyle:
I think that’s part of it. It feels so overwhelming to carry it and then 2X overwhelming to get it out of your head and to make the invisible visible. And so I think that’s a really good strategy, actually-
Glennon Doyle:
I do too.
Amanda Doyle:
… Glennon. It doesn’t just have to be at night. I think anytime putting in the extra work at the beginning to make that invisible visible, I mean if you have a whiteboard in your house-
Glennon Doyle:
Yes, huge whiteboard.
Amanda Doyle:
If you have a piece of paper on the refrigerator and every time that something comes to you, you’re writing it down.
Abby Wambach:
You can create a shared reminder and notes app on your phones that you literally have a tally-
Amanda Doyle:
You’re so high tech.
Abby Wambach:
… of shit.
Dr. Shelby Harris:
You hit the nail on the head.
Abby Wambach:
It’s the best. I haven’t done it with Glennon yet. I’ve just started to do the reminder app myself.
Glennon Doyle:
I just scream things from the basement, “And also don’t forget.”
Dr. Shelby Harris:
But that’s a big thing. I’m a huge fan of just to-do lists or things that have to get done. I love the shared app too. I will use various different apps for that sort of thing with families and with couples, because it helps to share that load. But also a to-do list in general can be something like, what has to get done tomorrow, because these are other things that we’re thinking about prioritizing, what has to get done tomorrow, what would we like to get done tomorrow? What do others want us to do tomorrow, to really think about it and really get a little bit granular with it so that it’s not just spinning and, “Oh well,” but just share it a bit. I wouldn’t recommend waking up the other person routinely because then you’re both going to suffer with insomnia and then that’s not going to be good.
Amanda Doyle:
Unless they’re noncompliant. Yes. If they’re non-compliant, that’s what they get. All right?
Dr. Shelby Harris:
There you go.
Amanda Doyle:
You’re spinning with me brother.
Glennon Doyle:
This is why I’m not a therapist.
Amanda Doyle:
But that it gives it a home. It doesn’t have to swirl in my head because now it lives on that list that will exist tomorrow. And similarly, the reason the meditation is happening during the day you say is to build that muscle so that when it comes up at night and you can remind it, “It’s okay, love. You’re doing such a great job carrying all the things. Thank you for that. And also that thing you just said, it exists already in that list, but thank you for reminding. Now I’m going to write it down on that list, and now you can go in the cloud bubble and float away.”
Glennon Doyle:
I get that. That makes sense to me because that is a skill that has to be practiced. That I’d buy because during the day when I’m meditating, I am learning how everything can be ridiculous and there can be so many things going on to do and I still am able to put that aside for this time. That is a skill that is required for sleep that you can practice in meditation.
Dr. Shelby Harris:
Because more so with women, but not always. Some people come to me and they just say, “I can’t turn the volume down on my brain.” It’s just out to a 10 it feels like it’s an 11. So it’s just they can’t turn it down. And that’s where meditation really is useful. And a lot of people use meditation. They’ll use these apps and they’ll listen to someone that’s talking very quietly and then they’ll try to fall asleep to it. And that’s fine for some people, but you’re not actually meditating, you’re not getting the skill. It’s like going to the gym and doing a bench press and falling asleep in the middle of it. You’re not getting the work out of it.
So doing that work during the day will make it easier to soften in the middle of the night because the stakes are just, they feel so much higher in the middle of the night. So do it in a lower pressure environment during the day and it can actually really, really help. But it’s the sort of thing where some people will be like limit caffeine. Okay, stop. You might notice a difference after two days. Meditation unfortunately doesn’t work that fast, so you have to be patient with it to put the work in.
Speaker X:
Is it four days?
Dr. Shelby Harris:
Four days? I wish.
Glennon Doyle:
No, but seriously how long?
Dr. Shelby Harris:
I usually tell people when it comes to the sleep stuff, I usually tell them to really commit to it for a good month at least. It’s a skill. And the thing too is that some people, I have so many patients that just want to learn meditation from the apps that are out there and they’re like 10 minutes long, and I’m like, “Why are you doing 10 minutes?” And the goal is not to focus the whole time. The goal is recognizing when your brain’s wandering and saying, “Back on track, back on track.”
Speaker X:
A million times.
Dr. Shelby Harris:
[inaudible 00:30:39] minutes, don’t do 10. And then slowly build yourself up to whatever you have time for. People say, “What’s the ideal amount of time to meditate for?” It’s whatever you have the ability to do, because it shouldn’t be adding extra stress to your life. But I would argue if you cannot find five minutes in your day to meditate and to just sit and even be with your breath, then we need to really think about where you’re losing that time in other parts during your day.Abby Wambach:
Meditation is like a sleep workout. So I’m a huge proponent of sleep. I have all the gadgets and gizmos of plenty, and I’ve tracked my sleep, I’ve been doing it for years and I find it to be super helpful, because I’ve been tracking so much of my bodily heart rates, et cetera, for 20 years. And what’s interesting for you, every day that you meditate, you have a good night’s sleep.
Glennon Doyle:
I hate to freaking admit that that is probably right, but I’m sure that’s probably true.
Abby Wambach:
But it’s interesting because you’re kind of opposed, and I don’t think that the sleep tracking devices are for everybody. And I totally agree and understand that, but I kind of track your sleep.
Glennon Doyle:
I know you do. I don’t want to know the scores though because I feel like I’m too impressionable. So if my score says you’re not ready for the world, I’ll be like, “Oh, I’m out.”
Abby Wambach:
Yeah. But I guess my question is, especially talking about insomnia and some sort of sleep anxiety, would you recommend sleep devices or aids in this way to those kinds of folks? Because I do think that the world is trying to sell us, I buy into it, it really helps me personally and the personality that I am. But would you recommend that to patients that come in that you see?
Dr. Shelby Harris:
No.
Glennon Doyle:
[inaudible 00:32:28].Dr. Shelby Harris:
There is some research that’s by my colleague, Kelly Glaser Barron, who coined the term orthosomnia a few years ago. It’s a legit thing that I see in my practice all the time. When someone’s coming to see me, I am old school. I have a paper sleep diary that I’ve been using for over 20 years now in my practice and I just want someone not to look at the clock just to guesstimate. That’s all I want. So how do you think you slept? How many hours do you think you were up for last night? And some people will not even pay attention to that and just send me their ring or watch data, that’s it.
And I said, “No, no, no, I don’t want that.” Because then, like you were saying, Glennon, you’re very impressionable. So even if you think you slept okay, if some watch tells you you didn’t or you didn’t get a certain stage of sleep, which we even know that those trackers are good for amount of sleep, but not so great for staging as we’d like in comparison to a sleep study, it still can make you then put extra stress on you.
But that being said, I think the trackers are wonderful for people who just have a curiosity, or the flip side who just don’t make sleep a priority. They could sleep fine or sleep more, but they’re burning the candle at both ends or they’re up watching TV all night or they’re having a lot of alcohol, and they just want to see what the actual data says and where they might be able to make changes. But a lot of times the changes that it’s recommending for someone with insomnia aren’t things that aren’t going to help it typically for a lot of people.
So it just may makes the focus on it worse. So I would actually say get a paper sleep diary. I have one on my website. You can get them, consensus sleep diary. You can get them anywhere online. I have one in my book, just paper and pencil.
Glennon Doyle:
I love it.
Dr. Shelby Harris:
Try to meditate during the day and then wake up in the morning and say, “How do I think I slept last night?” And that can be your data. It doesn’t have to be an exact science.
Glennon Doyle:
And it feels human. It feels human. I would like to keep this thing that I’m wanting to make my life to be more human, I would like to keep that human. I would like to avoid finding myself in a sleep cult, and once again looking at numbers and buying things and waking up and now I’m in sleep rehab because I’m addicted to sleep whatever. I mean I’m kind of joking, but not really. When you say wellness can be just another fricking fundamentalist religion.
Dr. Shelby Harris:
Yeah, agreed. And I think there’s something to be said for the fact that we were able to sleep for many years before any of these trackers existed.
Abby Wambach:
Right. I’m curious though, just by listening to you, knowing that women are having harder times sleeping than men for all of these reasons, it feels like there has to be some underlying issue or something that we haven’t researched yet. Is there more research being done now that will uncover, I don’t know, a silver bullet sort of fix for what issues we see with women sleeping?
Dr. Shelby Harris:
Insomnia is one of those things where it really can vary based on the person. So with women specifically, talk about women and taking on too much, I was nine months pregnant when I signed my book deal because I was like, “Oh, I’ll have time to write it on maternity leave. It’s my second. I know what I’m doing.” Stupid.
Glennon Doyle:
Sleep when the baby sleeps, you’re just going to write when the baby writes.
Dr. Shelby Harris:
I mean it’s just ridiculous. We all do these things, right? I should have known better, but I didn’t. So I think when I was writing the book in 2015, there was not that much research being done on women in sleep. There were a few studies out looking at CBT for insomnia as one treatment for women who were going through perimenopause, and some modifications for women who had just had babies or during pregnancy, but there really wasn’t much. So they’re starting to research it more, look at different ways.
There’s been more research coming out with a mindfulness-based approach to insomnia. So kind of building on the CBT stuff, but using more mindfulness. There’s been more stuff now looking at hormones for women at various stages. It’s just been an area where looking at sex differences hasn’t been something that they’ve done very much unfortunately.
We’re also looking a lot at couples sleep too. There’s some really great researchers out there who are looking at when should you sleep together versus when should you actually just say, “We’ve done everything we can. Should we just sleep apart at this point to kind of value, look at the relationship.”
Glennon Doyle:
This is sleep divorce situation.
Dr. Shelby Harris:
Yes.
Glennon Doyle:
Can you talk to us about sleep divorce? And I’ll tell you to set you up that this is a very personal thing for us, is that we are really struggling with this. I think that sleep is probably our biggest challenge. I just want to tell you what we do. We have a bed. We have a bed, all right? On my side of the bed-
Dr. Shelby Harris:
So far so good. [inaudible 00:37:15].
Glennon Doyle:
… every night I have a fan that is blasting in my face for the noise and the whatever. I have earplugs that I put in my ear. I have an eye mask that I put over … I feel like I’m a robot that’s shutting herself down one sense at a time. Abby on her side has this white noise that is so loud, so we have two white noises going. We zigzag, which means every night we’re like, “Are you zigzagging or am I?”
Abby Wambach:
My head is at the foot of the bed or [inaudible 00:37:45] head is at the [inaudible 00:37:45].
Glennon Doyle:
We keep our heads at different sides-
Abby Wambach:
Of the zigzag.
Speaker X:
Wait, why do you do that?
Glennon Doyle:
Because then the snoring will be further from my head.
Dr. Shelby Harris:
Oh.
Glennon Doyle:
Okay. It’s very emotional. We don’t want to be in separate beds because that feels so scary. That feels like the beginning of something or it’s a slippery slope and Abby feels really strongly about not, but it’s very hard. Every night for someone who already has a hard time going to sleep, worrying about snoring, the actual snoring, the worrying about the snoring being probably worse than the actual snoring.
Abby Wambach:
Yes. I have a lazy tongue, so I’m trying to sort that out. I’m working out my tongue.
Glennon Doyle:
She literally does. One night-
Dr. Shelby Harris:
[inaudible 00:38:26] functional therapy and stuff. Yeah.Glennon Doyle:
I mean one night she had tape over her mouth. She’s tried every TikTok answer, she’s taped her mouth shut. So I’m like, “Goodnight honey.” She’s like, “Goodnight.”
Amanda Doyle:
Just for folks who think that Glennon is instituting abuse with the tape over the mouth, this is like a thing, the mouth breathing versus the nose breathing. Nose breathing is way preferable to the mouth breathing. This is not.
Glennon Doyle:
The tape wasn’t my idea.
Abby Wambach:
Glennon hasn’t come up with any of this. I’m doing all of this.
Dr. Shelby Harris:
I’m doing a bunch of things. So where do I start? So the mouth taping thing, in sleep medicine, more standard care, we don’t recommend it right off the bat, because unless you have been fully evaluated, because a lot of people are doing that and they have sleep apnea or some sort of sub-threshold or upper airway resistance issue, they’re actually not helping the problem and could be making it even worse.
So we always say you have to get evaluated, potentially do a sleep study, which can be at home a lot of times. It doesn’t have to be in a lab. So people often think they have to get wired up right off the bat. They don’t. So we always try to do that first. But if someone’s snoring a lot at night, I want to make sure that that person has been evaluated and they’re doing everything that they can to try and help with the snoring. That’s going to help not hurt.
But then the other side of it is also sometimes, like you were saying, Glennon, is that sometimes you might be more sensitive to the idea of it being an actual issue than it actually is an issue. So sometimes there is more of an underlying insomnia that if we just get you sleeping a little bit deeper and having fewer awakenings in the middle of the night, sometimes working on that person’s insomnia can make them sleep through those issues a little bit more.
And then if you’ve both worked on those issues and you’ve really done as much as you can, that’s when that idea of sleep divorce, so my colleague, Wendy Troxel has done a lot of research over the past 10, 15 years in this area. And really what we do find is that when people are making a, she calls it, and I love this term, a sleep alliance, because that term divorce-
Speaker X:
See that’s better.
Speaker X:
I hate the term sleep divorce.
Speaker X:
That feels better.
Amanda Doyle:
It’s so much better.
Dr. Shelby Harris:
Oh, it’s terrible, sleep divorce, because it just has that connotation that it’s going to ruin your marriage, when in research we actually find and just working with patients, it actually brings them closer together because you’re valuing one another’s health, and if you allow for fair and separate sleep environments, so it’s not like one person’s getting relegated to the couch and has a horrible night of sleep. You have separate areas that you sleep in where you’re comfortable, but you spend time having intimacy. You do whatever you want to do to cuddle or whatever, have sex before bed. That’s the time that’s really key.
And then when it’s actually time to roll over and go to sleep, you go to your separate environments. And some people, it’s not even just the snoring or moving a lot at night or whatever it might be. Some people have just different sleep schedules that they … some people are a night owl and the other’s an early bird. It can cause more resentment in the relationship. So if you make an alliance and a plan together, it can really actually help people in the long run. But I always encourage people to try various things first. And it can also be, I would, if you haven’t done it, see about in your house, sleeping apart a few days here and there. Do you still sleep as well? Glennon, do you still wake up and listen for other things?
Glennon Doyle:
No.
Dr. Shelby Harris:
Okay, so it’s time.
Glennon Doyle:
When we do sleep in different places, we sleep really well. She sleeps so much better because she’s so the most thoughtful person on earth. So she’s constantly worried about me and she’s waking herself up-
Abby Wambach:
Constantly jamming a pillow under my jaw to close my mouth. Yeah, I like the sleep alliance phraseology. I’m such a fear of abandonment person. And so it feels like such a scary process to even begin with. But just listening to her talk makes me feel like maybe you’re just a sleep alone kind of person.
Glennon Doyle:
100% I’m a sleep alone kind of person.
Dr. Shelby Harris:
Some people are, some people are.
Abby Wambach:
Wow, okay. Okay.
Dr. Shelby Harris:
And then another way that some people, instead of making this hard and fast rule that we’re going to sleep separate or we’ll sleep together, it could be just a few days a week, you could have a schedule so you know that this might be a little bit of an easier night for me versus another night. But then you feel like you’ve kind of met in the middle a little bit. But it really, come up with a plan together can really make it a lot more freeing and let go of some of the resentment that some couples feel.
Abby Wambach:
This is very interesting.
Glennon Doyle:
When she’s talking and saying the sleep alliance thing, and I can feel in my body like you listening to her and shifting your thoughts about it, the relief it’s bringing me is so real. When we watch The Crown and Queen Elizabeth goes to her own bed and then she just tucks herself in at night and then the king leaves, I’m so jealous of Queen Elizabeth.
Dr. Shelby Harris:
It’s that idea. I mean I love that show, but it’s the idea of sleeping together is the benchmark of a relationship in some weird way. We didn’t always sleep together either, right? There were many-
Speaker X:
It’s new.
Dr. Shelby Harris:
It’s a newer-
Speaker X:
It’s kind of a new phenomenon.
Dr. Shelby Harris:
It’s a newer phenomenon and people slept together often because of just limited resources or because of heat, when you’re thinking about many hundreds of years ago. And then it was considered to be almost something that people who had a lot of wealth would sleep apart because they had the extra rooms, they had the extra space.
Speaker X:
Queen Elizabeth.
Dr. Shelby Harris:
And they would do that. And then sleeping together has now become this thing again of that’s the benchmark of where you are in your relationship. But there are plenty of couples that are not happy that are sleeping together and there are plenty of couples that are super happy that are sleeping apart. And I think there’s also this idea in psychology that’s not necessarily always practicing evidence-based medicine where we just say you have to sleep together.
I’ve had debates with old supervisors and graduate training who said, “You have to have your couples sleep together.” And I would say, “Why? Based on what?” And like I was saying earlier, we know from the research that if you make an alliance and you choose to sleep apart on whatever that means, few nights a week, whatever, it actually can bring people closer together.
Abby Wambach:
I would say this, I am happy to explore this route, but one thing that would feel important to me is for me not to be the one that always left.
Glennon Doyle:
Totally.
Abby Wambach:
That I got to sleep in bed a couple of nights.
Glennon Doyle:
That’s funny. I don’t even picture it that way. When I picture it, not that I’ve ever pictured it, Dr. Shelby, but if I were to have pictured it, I always picture myself not being in there.
Abby Wambach:
That’s weird.
Glennon Doyle:
I know. Maybe it’s because I always feel like I’m the one who would need it, so I would … But just so you know, I don’t picture it that way.
Abby Wambach:
We also have a French bulldog, which is also very snorty. So me and Honey go down to the basement.
Glennon Doyle:
I didn’t bring her up to Dr. Shelby, because I don’t want anyone telling us not to sleep with Honey. And I know that’s the first most obvious option.
Dr. Shelby Harris:
Well, the pet thing is a mixed bag. I grew up with dogs. If your pet, if you love your pet and your pet is not causing any issues for you in the middle of the night and you’re not bothered by it, fine. But bulldogs, bulldogs, sleep apnea and snoring bulldogs, if it’s causing an issue for you and you really want to do something about it, then you got to think about that.
Abby Wambach:
She’s only going to be alive for five more years. So I’m just like, this is my little baby years.
Amanda Doyle:
Have you tried taping her mouth?
Abby Wambach:
I actually have to put my finger in her mouth to move her tongue around a little bit.
Amanda Doyle:
Oh, you both have lazy tongues.
Abby Wambach:
We do.
Amanda Doyle:
It’s so cute.
Glennon Doyle:
I don’t want to not talk about revenge scrolling, because this is something my sister does. I don’t know. Do you still do this, sissy? Is this a thing for you, revenge bedtime?
Abby Wambach:
No. What is revenge scrolling.
Amanda Doyle:
I have changed my habits. It’s revenge nighttime procrastination where you’re stealing your day back out of resentment that you have no part of your day that is just yours, and using it to scroll at night for several hours and feel really shitty about yourself after.
Glennon Doyle:
Is that what a lot of us are doing? A lot of us are doing that, right?
Dr. Shelby Harris:
Oh, yeah.
Glennon Doyle:
We feel like it’s the only time we have.
Dr. Shelby Harris:
I talk about The Crown, right? They gave us what, three episodes? So generous.
Glennon Doyle:
I binged the whole thing.
Dr. Shelby Harris:
So generous. It was very hard for me to stop watching those three episodes and go to bed because I got sucked into it. So revenge bedtime procrastination, it’s a newer term for an age-old problem. I wrote about it in my book, I called it Momsomnia because it was a women’s kind of book, but it’s an issue that we’ve had for years. And the idea is that you’re so busy during the day that you just want to steal back some time for yourself before going to bed.
And it’s a hard thing for some people to overcome. But we do know that if you’re really sleep depriving yourself more times than not, then you’re spinning the wheels more often during the day, and you’re actually less effective at doing the things you need to do during the day that then you feel like you need to steal back even more time at night.
So I encourage people, one of the simplest tips that I encourage people to do is if you’re watching shows like I did and I hadn’t turned it off on my phone yet, it’s like a Netflix or any of the autostream or the streaming services, they usually have autoplay. So if you turn off that function, it makes you make a conscious decision as to whether you’re going to then go into the next episode of The Crown or you’re just going to let it automatically start for you, because then once it’s already started, you’re sucked in. So something-
Amanda Doyle:
Who am I to stop this? Who am I?
Dr. Shelby Harris:
So something simple like that to just give you that little pause to say, “Okay, am I choosing sleep or am I choosing to actually just watch another show that I really like?” And the thing is, once in a while, doing these things is fine. If you’ve had a really hard day and you’re up really late, you’re doing a million things, like right now with all the activities for my kids, a lot of us are just sucked into all that stuff, that once in a while it’s nice to get home and to just catch up on something and just kind of decompress.
Speaker X:
Fun. Yeah.
Dr. Shelby Harris:
Just don’t make it the exception, not the norm. But it’s also thinking about what are you consuming? Some people are just like doom scrolling on their phone all night long. That’s not helpful. So putting an alarm on your phone. For some people who really struggle with it, there are apps that will shut everything off on your phone, and that can be really effective for some people. You really have to be thoughtful about how you’re consuming the media.
Glennon Doyle:
I like that. Just something that shuts it all down after your bedtime. You have lost your privileges to make decisions about this after 9:00 PM.
Dr. Shelby Harris:
But I do caution because some of that stuff will use a password and then I’ll have someone give the password that they don’t know to a significant other. And then it creates this tension where you’re the one who can unlock my phone. Don’t do that. Don’t go down that road.
Amanda Doyle:
Do you know my solution to that, which I found very helpful, is because I agree with you. It’s not just the amount of minutes or hours you’re doing it. It’s the substance of what you’re consuming. And then I’ve seen three horrendous crises that have happened and people, and now I’m thinking about those people who have been, and so what I have switched it to, but I like my little treat. Allison on our team would call it a TR. I really like a little TR at the night that’s just for me.
And so I have switched it to now I do the New York Times game section at the end of every night. But I intentionally don’t subscribe to the, you can have as many games as you want, because then I’d be doing 15 Wordle’s. So now I just do, there’s the little mini daily cross crossword, the Wordle thing, the connections-
Speaker X:
Wonderful.
Amanda Doyle:
… and whatever. The one where you make the words in the box, and that takes me, I don’t know however many minutes that takes me. And I’m like, “Well, it’s all gone now. Goodnight Moon.”
Glennon Doyle:
That’s amazing. I didn’t know you did that.
Amanda Doyle:
It feels like a little treat.
Dr. Shelby Harris:
You finished your Sunday.
Glennon Doyle:
That’s so great. How long does it take you? How long does it take you?
Amanda Doyle:
I don’t know.
Glennon Doyle:
That’s only on Sundays? Or is that every day?
Amanda Doyle:
Every day.
Glennon Doyle:
That’s so great. I don’t know.
Amanda Doyle:
It’s like a matter of minutes.
Glennon Doyle:
I’m delighted. I did not know that about you.
Amanda Doyle:
He’s really good at games. Really good at games so it takes me just a couple of minutes.
Dr. Shelby Harris:
See for me, I would get more frustrated.
Glennon Doyle:
Me too.
Dr. Shelby Harris:
It’s a little trial and error too. People always ask, “What’s the ideal wind down time or the thing that I should be doing?” It’s like it varies based on every single person.
Glennon Doyle:
Yes.
Dr. Shelby Harris:
So if games and puzzles do it for you and you don’t get sucked into it and you can have a nice limit for yourself, all for it. Yeah, it’s fine what works for you.
Glennon Doyle:
To me, that sounds like, let me just real quick give myself five more problems before I go to bed.
Dr. Shelby Harris:
Yeah.
Amanda Doyle:
So is social media. That’s giving you 27,000 more problems because now you’re worried about why does my kitchen look like shit and hers looks so good, and why are those people dying and what can we do about it and what is the … it’s all problems.
Dr. Shelby Harris:
But I think what we’re talking about here too, not even just revenge bedtime stuff, but it’s really about too, people villainize the blue light. It’s not great, but it’s not as bad of an issue as everyone makes it sound like. So you want to try and stay away from your phones and your screens within ideally an hour before bed. But I mean the reality is that I want to go on my phone once in a while, and so you have to be thoughtful about what you’re consuming. I stay away from social media. I stay away from when all these things are, I mean, there’s always bad stuff going on in the world, but I try to be thoughtful about saying, “Okay, is this going to change what I’m learning about right now or is it still going to be an issue in the morning that I can learn about?”
Glennon Doyle:
Yes.
Dr. Shelby Harris:
So try to be thoughtful. I have all these 20 year olds that want to watch The Office right now, right before bed or Friends.
Glennon Doyle:
Oh, really?
Dr. Shelby Harris:
Those two shows, they just want to watch.
Glennon Doyle:
That’s great. [inaudible 00:51:54] Creek. It’s not going to upset you. A baking show. I love a baking show.
Abby Wambach:
What do you guys look at on social media? My social media is lovely.
Glennon Doyle:
She just has pictures of dogs.
Abby Wambach:
I have puppy videos. I’ve got-
Amanda Doyle:
That’s the real answer. That’s the real answer, folks, to all of our life problems. You asked about the silver bullet? It’s dog videos.
Dr. Shelby Harris:
What is the algorithm feeding you?
Abby Wambach:
Exactly. I’m watching these inspiring stories and these puppy videos
Glennon Doyle:
It’s because you’re a genius. It’s the rich get richer and the anxious get more anxious because of algorithms. If you are an anxious person, you are looking at things that bring you anxiety and then your entire algorithm is things that make you … if your folks look, seek and you shall find.
Abby Wambach:
I seek good.
Glennon Doyle:
I know you seek fainting goats and shit.
Abby Wambach:
I love the fainting goats. Oh my gosh, goat yoga. Those are my faves. Or puppy yoga. Get out of here.
Dr. Shelby Harris:
I need to start looking at that so I can feed the algorithm.
Abby Wambach:
Yeah, just look at one or two of those videos early on in your session like three times in a row and then it just sets you up for success.
Dr. Shelby Harris:
I mean, like we were saying, [inaudible 00:52:58]-
Amanda Doyle:
Compounding interest on fainting goats.
Dr. Shelby Harris:
Mine goes between sleep stuff, insomnia and whatever other sleep stuff and Great British bake-off kind of videos, just goes back and forth. But be thoughtful about if your feed is not giving you that stuff, it’s probably not … And the problem with social media is it’s meant to be addictive, so it’s just scrolling endlessly. So it’s not actually giving you a stop point, because it wants you on there longer. So you have to be thoughtful about that too.
Abby Wambach:
Yeah, everybody who has a phone right now, just speak into it. Highland mini cows.
Glennon Doyle:
Oh my gosh, you guys, the cows.
Abby Wambach:
Highland mini cows.
Glennon Doyle:
If we had one extra room in this house, we would own a Highland mini cow.
Abby Wambach:
Cutest animal alive.
Glennon Doyle:
Sissy, what were you going to say?
Amanda Doyle:
I would help you with your sleep to have a wild animal in your house.
Abby Wambach:
Oh my gosh, I want to farm.
Amanda Doyle:
I would love to get to some super practical things for people in the last period here where obviously if you have insomnia, you are aware of it. There is no getting around this, but what are the three ways that people would be able to notice signs in their lives? If you’re just not getting enough sleep, how would you notice it in your life?
Dr. Shelby Harris:
So is it not getting enough sleep because of a sleep disorder? And then one other thing we didn’t even mention is sleep apnea in women gets underdiagnosed and misdiagnosed so often, and things like restless legs during pregnancy and perimenopause. I have that horribly myself. These things just get missed because there’s this idea that you have to be this older man who’s overweight and snoring really loud, and women, it’s not usually snoring really loud that’s happening. So there’s a lot of these things that can really influence sleep.
So if you’re not getting enough sleep, is it because of you burning the candle and not getting enough, or is it something else that’s getting in the way? So that’s always the first thing that I like people to try and figure out. If you’re doing everything you can and it’s just not working, that’s when you want to go see a sleep specialist for sure. There’s other things though could be signs that you’re not getting enough sleep and you’re just not making time for it or you’re not making it a priority. And that could be one of the biggest things is how fast do you fall asleep at night? And this is something that usually surprises most people, but it should take you at least five minutes or so to fall asleep.
Glennon Doyle:
I can’t believe people can fall asleep in five minutes. That’s insanity. I’m so jealous.
Abby Wambach:
She’s saying at least five minutes.
Dr. Shelby Harris:
At least five minutes. So a lot of people I work with will say, “Well, my significant other, the minute that my bed partner, their head hits the pillow, they’re out cold.” That actually is not always a great thing. It should take a few minutes to fall asleep, because that would suggest I’m not getting enough sleep or the quality of it’s not great. Are you always sleeping in more than two hours on the days off that you can or on the weekends? If you’re doing that, then that suggests that you probably need more sleep. So those are two of the bigger signs that I like to have people kind of point to.
Abby Wambach:
Yeah, my sleep latency, that’s the word for the time that it takes you to fall asleep, sometimes it’s 30 minutes. You can tell when I go into my sleep breath. I actually give Glennon a 45-minute headstart. So she goes to sleep and I sit on my phone for 45 minutes.
Glennon Doyle:
She watches cow videos.
Abby Wambach:
Highland cow baby videos, and then I’ll go to sleep. Sometimes she hasn’t even fallen asleep yet, but it sometimes takes me 30 minutes. So it’s like I think you also have sleep jealousy.
Glennon Doyle:
I do. I have sleep bitterness, sleep jealousy, sleep anxiety. What about menopause? The night sweats, what the hell is that? And also did you just say restless leg syndrome is part of perimenopause? Because my legs hurt all the time.
Dr. Shelby Harris:
It can happen more during that time. We see it a lot during pregnancy and we see it a lot more during just hormonal changes in women. So that is something, and I’ve noticed I’ve gotten deeper into perimenopause. My legs are just on fire some nights and it can make it harder for you to fall asleep and it doesn’t have to be … the name can be a misnomer. So it doesn’t have to be just your legs, it can be your limbs, so it can be your arms. Some people just feel their trunks, they’re just restless and the only way you feel better is by getting up and moving around.
Sometimes it’s as simple as just an iron deficiency and getting tested for that can really help. And then you take supplements if your doctor’s okay with it. And then sometimes there are other treatments that will do, but it gets missed a lot. And women I think often just are told, “You’re just anxious-“
Glennon Doyle:
Yeah, of course.
Dr. Shelby Harris:
“That’s your problem. You’re just hormonal. Don’t worry about it.” But there are actually legit issues that can be treated. So what were you asking about perimenopause in general?
Glennon Doyle:
Well, when they go to their doctors, so right now they’ve listened to this hour, they feel like there’s something that should be done or could be done about their sleep issues. What do they say to their doctors so that they’re not just dismissed as anxious women?
Dr. Shelby Harris:
Yeah, you are the expert on yourself. You know if there is a change or if it just doesn’t feel, as if your sleep doesn’t feel restorative. If you are feeling like you’re just not getting enough sleep and you’re dragging through the day, you are the person who knows yourself best. And if your doctor doesn’t ask you simple questions like, “Well, what time are you going to bed? What time are you waking up? What happens in the middle of the night? Do you snore?”
If they’re not asking you any of those questions and they’re just quick to say it’s anxiety or just write you a prescription, I would urge you to find a different doctor who’s going to take it seriously. Because we have so many wonderful treatments for sleep disorders, whether it’s behavioral, medication, psychiatric, when it comes to anxiety, there are so many areas, hormone treatments, there are so many areas that we have that you should not suffer in silence. And that’s what I think a lot of women are doing. It’s starting to change, but you shouldn’t have to fight to get a sleep study if you think you’re snoring or you’re having any pauses in your breathing throughout the night and you’re falling asleep.
Abby Wambach:
In terms of blood work or genetic methylation tests, do you recommend any kind of testing for anybody who’s having any sleep disorder issues?
Dr. Shelby Harris:
When it comes to some of the genetic tests, there’s not so much that we would do with it that would be any different than if we know that you have a sleep disorder. So the gold standard for most people is if you feel like something is off, you would go and see a sleep specialist. And if it’s say, if they suspect any sort of apnea or thrashing in the middle of the night, then they’re going to do a sleep study. A sleep study will usually give us most of the information that we need based on … it can be other things. There can be REM behavior disorder, people acting out their dreams in the middle of the night and not even knowing it.
So a sleep study is usually the thing that will tell us. And like I was saying, depending upon the issue that you’re presenting with, sometimes it can be a simple home sleep study. I mean people are really scared to go to a sleep center, but some of the sleep centers, like here in New York, there’s a few sleep centers that use something called a watch pad, which is wonderful. It’s literally a watch with a pulse ox on it and that’s the general sleep study. It’s looking more at your breathing, but if we think that there’s more going on, then you might have to sleep in a lab that has an EEG on it and other stuff so we can look at it on a more holistic scale.
Amanda Doyle:
I have a question and it is, you’ve mentioned how this eight hour thing gets drilled into us so much that it gives us anxiety. Is it true that each person has their sleep need that is specific to them? Is it true that some people, their optimal amount of sleep for their function is five hours and other people it’s 11 hours? And if that’s true, how do we find out-
Abby Wambach:
What that number is.
Dr. Shelby Harris:
What the number?
Amanda Doyle:
… what I need?
Dr. Shelby Harris:
Yes. I can’t remember what colleague of mine says this, but they say it’s like sleep need is like shoe size. So everyone has a different shoe size, but we all tend to vary or kind of congregate around similar kind of areas. That’s where that seven to nine comes from. That’s why people say eight. It’s because it’s literally in between seven to nine, most people are between seven to nine. But that being said, there’s some people that do a little bit better with less. There are some people who do better and need more. I actually am closer to eight and a half, sometimes even nine hours, and my husband needs less than I do to really feel … He can’t even sleep more if he tries.
Now to figure out what that number is, there’s two different ways that I recommend people to do it. One is a little bit easier than the other, but one way that’s really great is if you have a week off and you don’t have to get up for any reason, you can go on a vacation or do whatever in your house, go to bed at your usual time, and this is where a paper sleep tracker is great. So you go to bed at your usual time and then you go to sleep and you just record the time that you naturally wake up without an alarm clock in the morning and do that for ideally a week.
And then look at days four, five, six, seven, and see what you were naturally getting on those days. The first few days we usually use as a throwaway because you’re probably a little sleep-deprived that you’re catching up. So average it out four, five, six, seven, those days, that’s probably if you felt well rested and refreshed most of the day, you have a dip here and there, that’s probably your sleep need.
The other way to do it is to kind of come up with your routine that you’re already doing and then every few days increase either your wake time or your bedtime by about five, 10 minutes. And then when you start to notice things fall apart, that’s probably where you got a little too greedy and you kind of go back to whatever the number was and that’s probably your sleep need.
Glennon Doyle:
Cool. So I was listening to my friend Adrian Marie Brown talking on her podcast recently and she was talking about her sister and she said that whenever she thinks about her sister or any of the women in her life that she loves so much, her blessing or wish from them is always just let her rest, just more sleep. Just let her sleep, let her sleep. I actually turned it off and just sat with that for a minute because that is so true. That’s what we want for each other. It means so much. It’s literal, it’s a metaphor, it’s everything.
Speaker X:
So much.
Glennon Doyle:
But that is my wish for everyone listening to the podcast right now. All of you, I just wish you more sleep and more rest, and I thank you, Dr. Shelby, for being part of this sleep revolution-
Dr. Shelby Harris:
Thank you.
Glennon Doyle:
… for people and women. Thank you for this hour. You can do hard things and we’ll see you back here next time. Bye. If this podcast means something to you, it would mean so much to us. If you’d be willing to take 30 seconds to do these three things. First, can you please follow or subscribe to We Can Do Hard Things? Following the pod helps you because you’ll never miss an episode, and it helps us because you’ll never miss an episode.