[JOE SANOK] This is the Practice of the Practice Podcast with Joe Sanok, session number 760. I’m Joe Sanok, your host, and welcome to the Practice of the Practice podcast. I hope your summer is going awesome. Can you believe it’s already August? Some of you may already have kids going back to school or things like that. Maybe you’re planning for the fall. You know in the fall, in September and October we’re going to be doing, we don’t have the dates at the time of this recording, so we’ll let you know but we’re doing Level Up Week where it’s going to be a week where if you haven’t joined Next Level practice, then you can join Next Level Practice. If you’re in Next Level practice, you level up to Group Practice Launch where you’re adding clinicians to your practice and if you’re in Group Practice Launch, you jump into Group Practice Boss, so, doing it all at once. We have more details over at Practice of the Practice, right on the main page there by the time this episode goes live, as to exactly what date that is. We record a little bit ahead of time when we’re doing these types of shows. I am so excited today to be talking about sleep. Shantha Gowda, Dr. Gowda has trained as a clinical fellow at the Stanford Sleep Medicine Center and built the first sleep and circadian health program for the Marine Corps Special Ops Command. Dr. Gowda is a Licensed Clinical Health Psychologist who is board certified in behavioral sleep medicine. She consults for a variety of groups, including the FBI, Special Operations command providers, first responders, and collegiate sports teams. Dr. Gowda, welcome to the Practice of the Practice Podcast. So glad that you’re here today. [DR. SHANTHA GOWDA] Thanks, Joe. Yes, it’s a pleasure to be here. [JOE] I mean, that’s quite a resume there. Special ops, FBI, Sleep Specialists. I think we’re going to have some fun today. [DR. GOWDA] I think so too. Anytime we’re talking about sleep, it’s a great time. [JOE] Well, how’d you get into sleep, how did that become a specialty for you? [DR. GOWDA] It was pretty early on actually. I drank the sleep Kool-Aid, as they say in graduate school. I did a lot of work in behavior change and diet, healthy lifestyles and it turns out people don’t necessarily want to change their drinking habits or their diet, but I’ve never met someone who doesn’t want to get a good night of sleep. [JOE] Yes, yes, so it’s a pretty easy sell. [DR. GOWDA] Yes, so I think the reaction from patients, some clients when they could really improve their sleep and they realized that it’s not actually that challenging to do so I think that was so rewarding that I stuck with it and I haven’t looked back. [JOE] Well, maybe take us through some of the basics of sleep that every human should know, but then also maybe even diving into what clinicians should know. [DR. GOWDA] Absolutely. I think that’s one of my goals as a clinician. I really think there’s a lot of misinformation about sleep out there and it’s not useful for people to have unhelpful beliefs about sleep because the more that you’re thinking about sleep, the worse sleep you’re going to get. I think one of the biggest things that I see, and that a lot of clinicians see of course, is individuals who have difficulty with sleep, so falling asleep, staying asleep, what we call insomnia. I think one of the biggest myths I come across is that a lot of just general tips and tricks can cure insomnia, like the sleep hygiene tips that you sort of hear; maybe avoiding caffeine or alcohol or just trying to be consistent is going to improve sleep. I think for clinicians and for patients when they’re trying that or they’re recommending that and they’re not seeing change, it can be really discouraging. So I think the biggest myth that I like to bust is that if you really do have insomnia, if you have this strong difficulty with sleep, then sleep hygiene or these general tips and tricks aren’t really going to cut it and you want to want to seek something that’s going to actually treat your insomnia. [JOE] So what are some of those things that, because to me, I would think, okay, maybe not insomnia, but if I’m having trouble sleeping that I should not look at screens before bed, I should maybe cut off my caffeine earlier in the day. What are maybe just things that everyone should do? Then maybe we can talk more about the clinical, like if someone has more insomnia, what they should do? But what would you say, if I’m just showing up, I’m a single dad, I’ve got kids that wake up early every morning, I want to get a little bit better sleep. What are some habits that I can start doing to just optimize my brain a little bit more for sleep? [DR. GOWDA] Absolutely. I think you said a couple of great ones, but I would say to start really just prioritizing your sleep. Sleep tends to be that one behavior that we don’t really schedule, we just let it happen when we have time and given our busy lives sometimes there’s so many other things that take priority. I would say first, prioritizing your sleep, making sure that you’re allowing yourself sufficient sleep at night or during the day, whenever you have the time to sleep. Then really giving yourself a great bedroom environment, making sure that it’s like a comfortable space for you, that you don’t overheat so that it’s cool, it’s dark, it’s quiet enough. There’s so many ways that we can problem solve these things with blackout curtains or white noise machine, just really making sure that at night you feel really comfortable when you’re going to bed. [JOE] What are things that maybe, like I heard recently how people may feel like they’re getting good quality sleep, but they’re actually not giving the depth think. What are some, maybe I don’t want to call them warning signs, but the average sleeper, they maybe aren’t getting the best quality sleeps. What might be triggers or reminders or things that would show you like, hey, I heard recently, if you’re getting up to go to the bathroom three or four times a night, you’re probably not getting the best quality of sleep. Are those things true or what are some other things that might be indicators that you’re not getting as good of a quality of sleep as you think you are? [DR. GOWDA] Yes, I think the best indicator would be really assessing how you feel during the day. So if you’re someone who you feel like I’m getting the amount of sleep that I believe I need, or that I’ve typically needed, and I know the amount of sleep that we need varies for adults, it’s somewhere in the range of, seven to nine tends to be the average. But if you feel like I’m getting the amount of sleep that I believe I need or that I’ve typically needed, but I’m feeling pretty sluggish during the day, or if you catch yourself dozing off during the day, or if you put your head on the pillow and you can fall asleep within seconds or if you’re reaching for extra caffeine throughout the day, I would say that’s a really strong indicator that, hmm, maybe I’m either not getting the quantity that I need or the quality that I need is really suffering. In terms of getting up to go to the bathroom and sort of nighttime awakenings, I think one, it’s definitely normal to wake up at night. That varies person to person. Waking up and then falling back to sleep relatively quickly is not concerning but if you’re yes, going to the bathroom an excessive amount of time or if you just feel like your awakenings have increased, then something more could be going on that’s disrupting your quality of sleep. [JOE] Well, tell us a little bit more about why good quality sleep really is important. I know what I learned in grad school or the things I picked up from TED Talks and things like that, but what are the reasons that really good quality sleep is important? I mean, I imagine it’s important if the FBI and Special Ops want you to help them with it. Why does it matter in our brains to get really good quality sleep as well as quantity sleep? [DR. GOWDA] I think you know it, the answer that immediately comes to mind is literally everything, Joe. Everything is impacted when we’re sleeping and so good quality and quantity sleep consistently over time, it affects every organ system in our body; I like to say from our appetite to the way that our brain sort of removes waste, just our, even our immunity, our ability to catch a cold, which is with Covid around even more relevant our heart, our mood. So it affects so much that we don’t necessarily realize on a day to day basis you’re not really thinking how are my organs sort of functioning? A lot of what we do notice day to day is our daytime cognitive functioning; so our attention, our concentration, our reaction time, problem solving, logic and reasoning. All of these things are impacted. So you can imagine anyone in any field would really benefit from sort of honing in these skills, whether that’s athletes who are trying to get a little bit more precise or accurate in their sport or someone who has such a high level job that requires their utmost attention. Improving sleep is one of the easiest ways to sort of improve your overall functioning. [JOE] Now, what should clinicians in private practice notice, ask, assess in regards to sleep, whether it’s their intakes or even just looking at behavior, things like that in their practice? [DR. GOWDA] I would say the first step would be definitely addressing it. I don’t know if everyone asks about sleep, but that’s definitely important. Just like we ask about anything else in an intake definitely ask how the person is sleeping, maybe quantity, just get their sense of sort of their view on how their sleep is. Quantity is one aspect, how many hours of sleep they’re getting. Is their sleep consistent night to night? consistency is really important, so are they sleeping relatively similar times each day? Definitely getting a sense of whether they’re more of sort of a morning type or an evening type. Sometimes people who have more evening types they call themselves night owls and they’re up late. They might have different considerations than someone who is really an early morning person. Then if that person does share concern about sleep, making sure that they get the right resources so that they can focus to improve their sleep, especially because we know that sleep is so closely related with almost every mental health diagnosis and for your physical health for that matter. [JOE] Yes. When you’re saying get them the resources, so if someone is having sleep issues, obviously there could be sleep specialists or referrals like that, the average clinicians’ not going to do a full sleep intervention, but what are things that, or maybe a few steps beyond just talking about sleep hygiene or things like that? Or is it, you really should refer out as soon as you see these types of things? When does it become refer out? What are some of those stepped up resources that someone can talk about? [DR. GOWDA] Definitely, I would say if the patient or client is generally not reporting too many symptoms of sleep problems, then sort of reviewing general sleep hygiene is a great first step. Things like you mentioned, talking about caffeine, the bedroom environment, consistency just increasing physical activity and your exposure to sunlight, really relaxing before bedtime, some of those general tips that are great for anyone to help maintain good sleep. But if they do really struggle with falling asleep or staying asleep or they’ve sort of described some sort of unusual behavior at night, what we call parasomnias, so really distressing nightmares or irregular movements at night, then I would say referring to a sleep specialist is probably the best thing that you could do at that point, because diagnosing the right problem in sleep is critical to to getting the right treatment. Mostly problems present the same way. They usually present, “Hey, I have difficulty falling asleep, or I can fall asleep, but I really struggle to stay asleep throughout the night.” Then the third bucket that’s the most common would be, “I sleep, but I feel pretty miserable during the day.” Everything presents in those three buckets, I would say, but there could be a number of reasons for that, a number of different diagnoses that would require different treatment and so that’s why getting to the right specialist who can diagnose and treat appropriately is really important. [JOE] I would love to take some time for you to do a sleep assessment of me to just see, I mean, I have this expert on the podcast, might as well, just have your brain help my brain. What would, why don’t you go ahead and just ask me questions and then maybe we can come up with a plan if I need to adjust my sleep? [DR. GOWDA] Yes, that sounds great. That would probably be helpful for people to think about things that they do or maybe that they ask their own patients. [JOE] All right. [DR. GOWDA] All right, Joe, so tell me a little bit about your sleep on an average day. What time do you typically get into bed and wake up? Maybe go over your schedule a little bit with me. [JOE] Yes. So I would say I’m probably in bed between 11:00 and 11:30, and then my alarm goes off at 7:10. I usually wake up a few minutes before the alarm and then I take my daughters, their clothes and I hit snooze and then take them their clothes and if they get their clothes on, then they can come cuddle with me. We do a couple snoozes just to have some cuddle time before the day starts, get ready for school, usually have a cup of green tea and then after that I’ll have a cup of coffee or two, probably more likely two. I try to wrap up my coffee by noon, but I’d say on workday, so Tuesday, Wednesday, Thursday are usually my big work days and especially Tuesday, Wednesday, it’s back to back. I may, like after this podcast, I’m pretty sure I’m going to make a cup of coffee. It’ll be a smaller one, maybe like six ounces but just like to have that final push and then pick up the girls from school around four. Then, I mean, it’s really busy as most families are. Then they go to bed usually around 8:30. Then I’d say I can straighten up the house and do things like that. I’ll usually watch maybe 45 minutes of Netflix or something like that, have a glass of wine or two before bed, and then might play some a game on my phone or something. Then we’re back to the 11 o’clock. [DR. GOWDA] Yes. Well, it sounds like you’ve got a great schedule. Do you have any difficulty falling asleep or sort of maintaining sleep throughout the night? [JOE] I’d say so. I usually take five milligrams of melatonin, I’d say at least five nights a week, if not seven. I think, especially during the last year and a half of uncoupling there was just so much going on in my brain that that really helped to kick things off. I haven’t really experimented to not use the melatonin right before bed. Actually when I was on vacation two weeks ago in New Orleans, I didn’t take any the whole time and I fell right asleep. So it’s, I’m guessing maybe that’s more just like the life stuff in my brain but usually I’d say I fall asleep within five to 10 minutes of laying down. [DR. GOWDA] Great. Falling asleep within about 30 minutes is definitely healthy. I would be interested if you were to experiment with removing the melatonin and seeing how your sleep is, because typically it becomes a habit that people take and they may not need it and they notice that when they’re sort of traveling or if they forget to take it or something like that. So I’d be curious if that’s something that wanted to experiment with. I’d love to hear back if you noticed change without the melatonin. [JOE] Yes, I could totally see doing that on nights that are before a non-work day, just because if it were a work day and then it doesn’t work and I’m just exhausted, it’s just going to make that day a lot more difficult. But I could totally see doing like a Thursday, Friday, Saturday, Sunday night thing, trying off and then just observing that. [DR. GOWDA] Yes. I’m glad you mentioned that because that is typically the sort of pattern we see. Our sleep is always a little bit more disrupted when we’re sort of slightly anxious about our sleep or anticipate getting poor sleep or worried about getting quality sleep because we have so much going on the next day. So oftentimes when people are experimenting with medication or with over-the-counter supplements like melatonin or magnesium, et cetera, they tend to not try it for a day and then they feel that anxiety and they maybe didn’t get good quality sleep, and so then they get back to it. So I usually tell people when they’re, when they’re ready to experiment, commit to two weeks of sort of pulling the bandaid off to see over the course of two weeks how is your sleep. Because you’ll definitely notice a couple of days of disruption and you don’t want that to be blamed on the supplement. It’s most likely the change that you’re doing. [JOE] So you would recommend doing like two full weeks of no melatonin and just seeing, maybe starting like a Thursday when I know I’m not working the next day, but then even the next week when I’m working just stick with no melatonin? [DR. GOWDA] Exactly, exactly. The sort of general suggestion I give about supplements is if people find them to be really helpful and, you know it’s a supplement that we know there’s no strong negative effect, then great keep taking it. But I always, if people are not really interested in taking it and they feel like they need it, then I encourage them to really experiment and try the two weeks without it because it’s very likely that over, with practice you can clean up your sleep without the need of the supplements. [PILLARS OF PRACTICE] We brought together all of our checklists, videos, and other free things in one spot so you don’t have to opt-in all over the place just to get another checklist. We’ve put it all together over at pillarsofpractice.com. Whether you’re just getting started or have an established group therapy practice, we have a free e-course for you as well. We have eight-minute experts, which are short eight-minute videos around specific topics completely free. So if you want to take your practice to the next level, head on over to pillarsofpractice.com to get access to our free e-courses. Again, that’s pillarsofpractice.com to get all of those free e-courses. [JOE SANOK] Anything else you would adjust in my schedule or habits? [DR. GOWDA] Yes, it sounds like before bed for about 45 minutes you’re watching some Netflix, what do you usually watch? [JOE] I usually will watch something intense and then I’ll have a chaser. For example, I might watch Ozark, I might watch Ozark, which I just wrapped up the final season of, but something like that’s maybe more intense, but then I’ll watch a comedy thing for even just like 10 minutes to just clean out my brain as a chaser. [DR. GOWDA] Yes, that’s perfect. The general, the gist is that however much time you can offer I really like to recommend about an hour, but I know that our lives, not everyone can realistically devote an hour to sort of winding down, but sometime before bed you really want to sort of evoke as much positive emotion and relaxation as possible. Sometimes when we’re, even though we love the show, if we’re watching something really intense that can carry with us when we go to bed so I’m glad that you throw in a comedy at the end. That’s a great strategy. [JOE] Yes, I just don’t want to have cartel things and drug dealing in my brain going into, I’ve always been a really active dreamer. Even as a kid on Saturday mornings, my parents would get their cup of coffee and be like, what’d you dream about? They’d just sit there for like an hour and I’d tell them all my dreams and it was like a TV show for them. So I’ve always, they joke that I’m Joseph the Dreamer [DR. GOWDA] Yes. A lot of times you can dream about, you definitely carry what you’ve just been doing or watching to bed with you. Comedies are great, anything that evokes positive emotions, you really want to sort of wind down your nervous system. And I encourage this with anyone. It sounds like you have a pretty great routine and fairly good sleep. So you don’t really, there’s no need for change, but just for suggestions sort of to carry through the rest of your life if sleep becomes a problem putting in more activities in that last hour in addition to TV, like sort of some deep breathing or maybe just looking away from the TV and maybe playing some sort of game or puzzle, anything with mild focus, but really just letting your nervous system sort of relax and get ready for bed. [JOE] Okay, awesome. Well, before we wrap up the interview, I want to hear about how do you get consulting with the FBI and with Special Ops and what work do you do with them that you’re allowed to disclose? [DR. GOWDA] My background, I did a lot of my training with veterans in the VA system and so I definitely have an interest in working with the military and I realized that sleep is just, sleep problems are just so prevalent. A lot of my work was with shift workers and you can imagine in the military with deployments and traveling and depending on the job you have, you have to be awake or asleep throughout the day and then not just be awake, but sort of be on your A game or your best performance, on command sometimes. So there’s so much that can be done. I can give just some examples, but really optimizing your personal preferences, so like whether you’re a morning person or an evening person, really knowing what part of the day you’re sort of at your best energy or highest focus, least fatigue can be really useful when you’re sort of matching someone to a shift that could work well for them. Just in general, improving overall sleep from the burden of shift work when you’re sort of rotating shifts you can only envision, I don’t know if you Joe, have ever been a shift worker, but I’m sure anyone — [JOE] Oh yes, I did overnights throughout all of grad school at a runway shelter. [DR. GOWDA] Yes, and people have different resiliencies. Some people can do it and they’re great, but I think the biggest reality is that as you age, your ability to adjust to that shift really declines. So really helping people, even though they may not have a problem adjusting to shifts, really making sure that they know what strategies are really going to put them in the best place. A lot of strategies are related to when you have exposure to sunlight making sure your caffeine timing is really important, physical activity and really managing your sort of your nervous system to wind down at the right time. So those kinds of things are relevant for anyone, but you can imagine how important it would be for someone who really has to perform at their peak most of the time. A lot of us rely on that. [JOE] I feel like I would be nervous partnering with the military about sleep in that, I mean, this is all based on movies, when there’s sleep deprivation in Guantanamo Bay or things like that, the ethical side of using this knowledge in a military way. But I mean, I imagine that you have a very clear contract as to what you’re consulting you’re doing. [DR. GOWDA] Yes, the consulting that I’m doing is very much, a lot of it is not just for the whole consulting not just for sort of the organization or agency as a whole, but more individuals who have problems with sleep or common themes throughout different groups that they could improve on and also a lot of just education with providers and staff to make sure that they’re also promoting healthy sleep science for everyone that they work with. [JOE] Yes, I can imagine how if you’re not doing that, especially if you’re Special Ops or FBI and you’re not getting good sleep or it’s not restful how that could really affect the end outcomes. [DR. GOWDA] Absolutely, absolutely. So that’s why, I mean, I really love focusing on sleep. A lot of people ask me, don’t you get bored of doing like the same thing? You’re helping people sleep every day. But someone could be an average 30-year-old who is really just not able to get good quality sleep and then you could be someone with really complex psychiatric diagnoses that could have problems with sleep and just an average FBI agent who really just wants to make sure that they’re getting the healthy sleep that they need to perform at their best during the day or during the night. So anyone could really benefit from general strategies to help improve their sleep. [JOE] Well, the last question I always ask is, if every private practitioner in the world were listening right now, what would you want them to know? [DR. GOWDA] I would say, I would want to know, I would want to share, and I wish that I had known to really have patience and trust in the skills set that you have. Because eventually those, eventually your skill set will come to light and serve you really well. So having patience and really trust in the skill set that you have can take you a long way. [JOE] So awesome. Shantha, if people want to connect with you, learn more about your work what’s the best way for them to connect? [DR. GOWDA] Yes, absolutely, you can visit my website at www.thinksleep.org. I also share a lot of useful tips, strategies education on sleep on my Instagram, which is think.sleep, and my email and phone number and all my contact info is on my Instagram and my website. So if anyone is interested in learning more about sleep or resources for someone who could really benefit from a sleep specialist, they can find all of that at those locations. [JOE] So wonderful. Thank you so much for being on the Practice of the Practice podcast. [DR. GOWDA] Thanks, Joe. [JOE] I love sleep so much and I love hearing about this. My grandma used to always joke, she’d say like, “Why is it that when it’s time to go to sleep, I don’t want to go to sleep and when I want to wake up I don’t want to wake up?” I just think that she was just so fully present, she just was loving life no matter what was going on. It’s so interesting to see just the different, just ways that my two daughters even sleep. My seven year old is like a teenager. She slept until 10:00 AM the other Saturday and just keeps on sleeping. Whereas my 10 year old, oh my gosh she wakes up between 7:10 and 7:12 every morning no matter what, whether there’s an alarm or not. It’s just interesting to see that difference between them. Well, we couldn’t do our show without our sponsors and this week, or today because we had to do four shows a week, our sponsors is us, our Pillars of Practice e-course. It’s a totally free course, whether you’re starting a practice or growing a practice. There’s two different tracks within it. You get all of our PDFs, all of our resources that we’ve given away for years as individual opt-ins. It’s all in one place. As well, we have a bunch of videos in there that we call eight-minute experts, where we interview all sorts of experts that are going to help you start and grow your private practice so that you can do it quickly. It’s just eight-minute videos super pointed. I set a timer with the person and say, “All right, let’s talk websites, let’s talk finances, let’s talk bookkeeping.” Super, super practical. You can access that totally free over at pillarsofpractice.com. Again, that’s pillarsofpractice.com, our free e-course that you get full access to just for being a listener. Thanks so much for letting me into your ears and into your brain. Have an amazing day. I’ll talk to you soon. [JOE] Special thanks to the band Silence is Sexy for your intro music. This podcast is designed to provide accurate and authoritative information in regard to the subject matter covered. This is given with the understanding that neither the host, the producers, the publishers, or the guests are rendering legal, accounting, clinical, or other professional information. If you want a professional, you should find one.