You Probably Have Insomnia... Here's What to Do About It
You probably have insomnia… and you probably don’t even know it. In this episode, we dive into one of the most relatable struggles out there: not being able to fall asleep, stay asleep, or stop stressing about sleep. We’re joined by Dr. Michelle Jonelis, a sleep medicine specialist who explains why your sleep tracker might be lying to you, why optimizing your sleep setup might backfire, and what actually works to fix your sleep (spoiler: it’s not melatonin). Dr. Jonelis breaks down the gold-standard treatment for insomnia and why so many of us are going about it the wrong way. If your brain won’t shut off at night, this one’s for you—or at least the 75% of us in the same boat.
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Juna: So we get a lot of emails in our inbox.
Eddie: Yes. We love the emails from our listeners. Keep sending them. We also get a lot from agents pitching their clients to be on the show,
Juna: but to be honest, we don't allow a lot of people who are like pitching their clients on the show, you guys, because honestly we have a very high bar for who comes on the show.
But I did get an email from someone recently that I was like, wait a minute. This person seems, seems really cool. We cannot pass
Eddie: this person up.
Juna: Yeah, no, she seemed. Awesome. Her name was Dr. Michelle Joan Ellis, and she was emailing us about our episode on sleep and saying that we really needed to do an episode on Insomnia.
And I said, sure, but how many people have insomnia, right? I mean, it's like a niche
Eddie: thing you told me, right? Like, like, uh, no one's gonna be listening, guys. I
Juna: thought it was like 5% of the population, maybe no insomnia. I.
Eddie: Higher,
Juna: apparently, as you're gonna learn today's episode, apparently approximately 75% of the population by some estimates, have some sort of insomnia.
That is insane.
Eddie: So this might be one of our more popular episodes. Know I.
Juna: I know. So if you're listening to this and you're in the lucky 25%, I guess you don't have to listen, but you probably do know a loved one that does need to listen. So you should hear it just for their sake. And if you're in the 75% where maybe you struggle with your sleep, maybe you get anxious about your sleep, maybe they should play
Eddie: this and it'll put them to sleep.
Juna: Yes. Exactly. You should listen to this as you're trying to go to sleep, but today we are talking about all the things that have to do with insomnia, not being able to sleep well, getting stressed about your sleep, getting woken up in the middle of the night and not knowing what to do. Very annoying roommates who wake you up a million times a night.
I wonder who that's about. So if you're interested in any of those things, this is the episode for you. I am Yuna Gata,
Eddie: and I'm Dr. Eddie Phillips, associate professor at Harvard Medical School,
Juna: and you're listening to food. We need to talk the only health podcast that has been scientifically proven by sleep medicine researchers to be the best thing to listen to when you can't fall asleep at night.
First, let's start by shouting out one of our favorite reviews of the week, and that review is going to be read by the wonderful Mr. Edward M. Phillips.
Eddie: So this is called Science and Grace. Kinda nice tone to it. It sounds like we can have a whole show called Science and Grace. Um, and it comes from, turns out I'm a cat person.
Juna: Oh my God. Love the username.
Eddie: Yuna and Eddie share science-backed health information with humor and kindness. No shame, no blame. Want to be healthier and happier You. These two want that for themselves and for their listeners. I'm a better me for listening, learning, and applying the information that they and their guests share.
Juna: Aw, that was so sweet. Thank you. Thank you. It turns out
Eddie: I'm a cat person. Oh my gosh.
Juna: Thank you. Turns out I'm a cat person. Remember guys, leaving the reviews not only makes us feel good, it also helps other people find the show.
Eddie: And one last thing, we have a newsletter. You're gonna be listening to this episode.
There is a lot of information coming really quickly. What if you had a chance to write it all down? Well, no, you're gardening and you're driving and you're trying to fall asleep while you're listening to us. So we put together a lovely newsletter and you could subscribe to it simply by writing to food.
We need to talk.com/email. We will not spam you. We will not put an advertisement. We will simply. Summarize what you've heard, and you can share that with your friends, with your neighbors, with your loved ones.
Juna: And now to the episode. Today we are joined by Dr. Michelle Jonis. She's the founder and medical director of Lifestyle Sleep, a lifestyle focused sleep medicine clinic in the San Francisco Bay Area.
She is board certified in sleep medicine and lifestyle medicine with specialized training in behavioral sleep medicine. And she focuses on non-pharmacological treatments for sleep disorders using cognitive behavioral therapy for insomnia. Dr. Janis, thank you so much for coming on food. We need to talk.
Thank you. I'm so happy to be here. Well, we are so happy to have you because you know, I'm obsessed with sleep and,
Eddie: and I just wanna repeat that the theme of the show, although there's like gazillion listeners and we're really happy. The show is about unit and what she needs. So, so right. With your help, we're going to, um, if appropriate, diagnose, uh, unit today with or without insomnia.
No, but we brought in an expert unit, yes.
Juna: But I, I do wanna make it clear this episode is for anybody who. Has any struggles with their sleep. Okay, so you don't have to have diagnosis for insomnia 'cause I do not currently, although I may soon. But for anybody that does struggle falling asleep, if you stress out about your sleep, if you like, think of yourself as a very light sleeper and you get woken up a lot and then you stress out about falling back asleep, we're gonna be talking about all those things today.
So the first thing I want to talk about is how you define insomnia, because like I thought insomnia was a very, very severe. Diagnosis, like you'd have to like, you know, only sleep two hours a day for like at least 10 days or something insane like that. But I actually have no idea. I've actually like never looked up the definition.
Dr. Jonelis: So I would say you are confused because it's a little bit confusing. There is the clinical diag. Yeah, there's the clinical diagnosis of insomnia, which is used basically for research studies. Like if you wanna be in a drug trial for Ambien, right? Mm-hmm. They're trying Ambien. How well does it work? Are you eligible for that study?
And so then you would have to fulfill specific criteria, which would be something like difficulty falling. Or staying asleep at least, you know, three nights per week for at least three months. Right. Something like that. Okay. So that's like a DSM diagnosis or, um, you know, the, sort of the clinical diagnostic criteria.
Mm-hmm. But more and more we are just thinking from a practical standpoint of insomnia as. Anybody who has difficulty sleeping despite sufficient opportunity for sleep. So if you're a shift worker and you only have four hours to sleep and you're only getting four hours of sleep, right? And like you're not getting sufficient sleep, but it's because you have restricted opportunity, that would not be insomnia.
Mm-hmm. But even, let's say you're the same shift worker, you only have a four hour sleep opportunity. Oh, you're working multiple jobs. Um, you only have a four hour sleep opportunity, but you can't sleep in that four hours. Right. Like you're only able to get. Two hours that would still actually qualify as insomnia.
Mm-hmm. Kind of difficulty sleeping despite sufficient opportunity. Mm-hmm. And so if you use those criteria for insomnia, like you have the opportunity to sleep, you'll wanna sleep, but you can't sleep, then the incidents of insomnia. Oh by, so by the first. The clinical criteria, it's like 10, 15% of the population.
Mm-hmm. By this more expanded criteria, it's really like 50 plus percent. Oh my God. Population.
Eddie: Jesus. Yeah. So you know, you're not alone. I told,
Juna: I told you episode. No, that makes me feel so much better.
Dr. Jonelis: Well, okay, and I'm gonna throw in one other definition, which I use. It's not always part of it, but also I would throw in there, if you're somebody who is using or dependent on a medication or substance for sleep, I'd say at least, you know, one day a week.
Yes. Then. I would say that also qualifies. Or maybe you take a sleeping pill chronically and you sleep well. You're on Trazodone, chronically, you sleep well. But if you don't take it, then you can't sleep. Yes. I would say that still qualifies you as having insomnia. Okay. And if we go to that criteria, yeah, we are up to 75% of the population.
I kid you not, oh my God. 75% of the population. This is an American Academy of Sleep Medicine survey. Oh my God. From 2020. Three 75% of the population takes a medication or supplement for sleep on that. Is terrify on an occasional or regular basis? Yeah.
Juna: Terrify. That's so crazy. 'cause I was gonna say, I actually have a couple friends, they're my age or younger, actually.
One of them is 24, who literally every single night take a sleeping pill to sleep. Yeah. And they sleep like 10 hours. It's like. Like they had knocked out for 10 hours and like, I don't think they're even sleeping that well because they, they're still so tired. What?
Eddie: All right. What if it's, um, self-imposed?
And the example I'll give would be someone who, uh, you just doesn't turn off their computer after they're 10 o'clock at night. They, well, they're scrolling or they're answering emails or. They could be writing, uh, lectures. Um hmm. Are you asking
Juna: for a friend? I'm just asking.
Eddie: Um, you know, and then it's like, oh, you, you know, like, uh, the blue light special, like I, I'm all jazzed up here.
Is that just sort of self-imposed,
Dr. Jonelis: self-imposed insomnia.
Eddie: Self. SII.
Dr. Jonelis: So, okay, so if we say 75% of the population has some difficulty sleeping, right. They're not, all those people are at least three nights a week, at least, you know, for the past months. Mm-hmm. It's just again, some difficulty sleeping. Mm-hmm. Is what I would say the causes of that.
There's gonna be many different causes.
Juna: Ah, got it, got it.
Dr. Jonelis: And some of them would be what we call idiopathic insomnia. Right? Like we sort of don't know the cause, uh, but most of it there are going to be contributors, environmental factors contributing. And that's actually more and more how we're. Thinking about sleep and sleep difficulties is really that sleep is just this byproduct.
Like we talk about good sleep is so essential, we have to have good sleep. But the truth is sleep is this very primitive biologic process. Like if an embryo is developing and it doesn't have an intact sleep wake system, it doesn't. Develop. Wow. Like, I don't know what phase of development it would, you know, not go past, but probably like this first dividing cells, right?
Like from the time the little embryo is developing its cells have like a more quiescent state mm-hmm. And a more active state. Um, and so. You cannot be born without a functioning sleep wake system. So everybody comes out knowing how to sleep. It's this process we all know how to do, but it's responsive to the environment.
Like our, like our breathing adapts, right? If we're running, we're breathing faster than if we're sitting or if we're sleeping, we're, you know, we're breathing in a different way. So with sleep, it's the same thing. If the sleep is not good, if we're having difficulty sleeping, it means that one of the.
Inputs to the sleep wake system is wrong. And it could be that we're stressed. It could be that we are trying to sleep at a weird time. You know, we're a shift worker. It could be we're dedicating too long to sleep. We'll talk about that. Uh, it could be blue light, it could be not getting outdoors enough during the day.
Right? But so it's this sign that like, hey, something is. Something is wrong with the system, but it doesn't mean that it's a primary sleep problem there. There in order for there to be something. Ah, got it. Actually wrong with the sleep system. Like that's exceedingly rare. There's like extremely rare genetic disorders where there can be something off.
But again, even in those cases, like there is some function of the sleep-wake system, otherwise they wouldn't be alive.
Juna: So can you go through some of the most common causes of people having trouble sleeping today?
Dr. Jonelis: Yeah. So one of the big concepts with not just people with sleep disturbances, but of course also with just metabolic disturbances in general, is this whole idea of environmental mismatch, right?
So it's this idea that our ancestors evolved, our physiology evolved in this very different world, the hunter gatherer world, basically, I bring in the hunter gatherers. Yes, bring them in. But so, you know, we evolved in this time when we hunted and gathered for our food. We were outdoors right all the time.
Our sleep environments were, were communal. We had communal sleep environments, you know, not these soft protected, temperature controlled nest that we have nowadays. And you know, our diet was different, our exercise, everything. And that's kind of what this responsiveness of the sleep wake system reacted to.
Mm. So now if you've fast forward to modern times, there has been some change in our physiology. Since hunter gatherer times, but the speed with which we evolve has not kept pace with all of the changes in the modern world. So now we're indoors most of the time. Again, we have temperature controlled bedrooms.
Uh, we don't have anything disrupting our sleep, which actually puts a lot of pressure on the sleep for a hunter gatherer. Mm-hmm. They're awake. During the night, first of all, they have disruption to their sleep. Like there's a bed partner kicking them, or there's coyotes or there's, you know, whatever. Like they have these interruptions and we're sort of supposed to be somewhat resilient to those.
Now you take all of that away, you're awake in the middle of the night. There's nothing to do. You can't gaze at the stars. You can't snuggle with a bed partner. You can't listen to the nature sounds, right? Like it's just you alone with your thoughts in this dark bedroom. Um, and that, that puts a lot of pressure on the.
Sleep system. So I mean, on a, on a societal level, we all sleep poorly because of like all of these unhealthy lifestyle factors that we have, which you guys are so nicely tried to help us, uh, correct. Um, but I would say a major contributor nowadays is these. Media messages about sleep that have been perpetuated and that are making us all crazy like that.
We all eight hours of sleep. That's right. So the thing is, if you go back to the nineties, there was like an epidemic of insufficient opportunity for sleep. Right? Like people didn't value sleep. They thought it was this waste of time. The CEOs were like, I'll sleep when I die, you know, I only sleep four hours a night.
All of that. Mm-hmm. Yeah. And so then there was this big. Interest in sleep research and like people who looked at sleep were like, no, you guys, this is really important, right? Like you can't sleep when you're dead. You need to sleep when you're alive so you can actually live, right? Like you're not living if you're not sleeping.
And so we realized sleep was really important. We did all these studies like, look at all the adverse effects of sleep deprivation, right? All these people function so poorly and look how much better they do if they get more sleep. And the media kind of went crazy with that messaging. And so it, and. Like with many things, they kind of overdid it.
So there's all this emphasis nowadays on sleep is so important. If you even, you know, have one disrupted night of sleep. Mm-hmm. Or one truncated night of sleep, like this is a travesty and you're gonna get dementia and infections and all this stuff. When in reality, if you think about hunter gatherers like.
They're not having perfect nights of sleep every single night. Mm-hmm. Like what matters is the average. And this also this idea of eight hours or how much sleep we need has also kind of been misportrayed by the media and that's making us crazy. So, so yeah. So my specialty is in insomnia. That's like mostly what I see in my practice and now.
I've had different types of practices in the past. Right now I have a cash pay practice, and it's mostly affluent, highly educated people that I see who are very, very healthy. And the people that I see, there's actually nothing wrong with their sleep. They sleep completely. Normally, they just think that the sleep is supposed to look different than it actually does.
Mm. So they'll say like, you know. I, I'm so stressed about my sleep. I only sleep six hours or six and a half hours. That's what my Fitbit or my Aura ring or you know, whatever tells me or what I think I sleep, but I need eight hours, right? Like I'm not getting the eight hours. How can I get the eight hours?
If I take a sleeping pill? Maybe I get seven, but it's still not eight. I'm gonna get dementia, I'm gonna have all this stuff. And my job is basically just kind of. Reprogramming, like, like sorting through all that messaging. I call it deprogramming and then like reeducating, uh, and sort of teaching 'em, no, you know, you've been misled and just alleviating their anxiety, but it's tragic because there's literally nothing wrong with their sleep.
Eddie: So I've got loads of questions from what you just said. So first off, what are the hours of your practice? You start around 10:00 PM and
Dr. Jonelis: No, no. Yeah, so luckily as a sleep medicine physician, we keep daytime hours, we do uhtraining. Good. I I, so there's like a sleep laboratory you can send people to where there's sleep techs who work overnight.
I actually really try to minimize that because of the shift work, right? Like shift work is not good for us and I don't want to have people working for me who are shift workers. So they do exist at, sometimes it is necessary to do an overnight study, but mostly we're just seeing people regular daytime hours.
Eddie: All right. So you're seeing them in the light day. Yes. There was something you said before that I had never really thought about before, which are the, I guess you'd call them the, the natural disruptors to sleep. Yep. Yeah. In other words, like I'm not a big one for camping.
Dr. Jonelis: Yeah.
Eddie: Um, and even if I end up in a hotel, I.
The first night is always weird because the noises are different, right? First is
Dr. Jonelis: called the first night effect. Yes.
Eddie: First night effect. Okay. It's nothing to do with New Year's, right? It's, no,
Dr. Jonelis: it's like, it's like when you bring people into the sleep lab for a research sleep study and you wanna look at their sleep.
You always do one to two acclimation nights, they're called to get to account for the first night effect. So when we're in an unusual environment, especially in the sleep laboratory, you have all this equipment glued to you, which is not comfortable. It's normal and natural for the sleep to be lighter and more disrupted you to have more awareness of what's around you.
Right. With camping, it's like your body is trying to figure out how not to get, you know, a bruise from the rocks that are underneath your pad or you know, the, you're worried about the bear attacking you, right? Like the first night it kind of is. Yeah, hyper aware of all of the potential threats to you, be it positional or environmental.
And then it kind of does that work, figures it out, and the second night you're like, ah, you know, now I can relax. And you'll typically sleep a little bit more deeply. Sometimes it can take more than two nights, but typically, yeah.
Eddie: I think this is a great time for us to take a little break, but don't go anywhere.
Don't
Juna: fall asleep.
Eddie: We'll be right back with more sleep talk.
And we're back with Dr. Michelle Ellis. So to avoid insomnia, my wife and I have tried to create an oasis, right? Which is quiet, which is comfortable. We put down the temperature in the house so that we're sleeping. Cool. Oh, it's so lovely. And the bedding is soft enough, but not too soft, and it's certainly quiet.
And if not, we've got earplugs and eye patches and noisemakers. Well, like are we going the wrong direction? And this natural sleep. Disruption, like the fact that I snore it, that that should be helping my wife. Is that, is that what you're telling me? Yeah. Okay. Well, the
Dr. Jonelis: snoring is a separate issue. Issue that we could get into, but Oh, okay.
All right. We'll get there. But no, I mean, so, so the stuff that you were talking about is sleep hygiene, that's what we call it. So, you know, turn off your devices two hours before bed. Keep the bedroom. Cool. Keep it dark, keep it quiet. Right. Have a soft. Comfortable mattress. These are things that definitely do reduce the, they increase what's called the sleep efficiency, right?
So they reduce the wakefulness. Mm-hmm. Sleep efficiency is the, the percent of the night that you're asleep. Um, it turns out that wakefulness, mm-hmm, is actually a normal, essential, healthy part of sleep. But for most adults in our modern sleep. Sleep environments, the percent that we're awake, it depends on your age, but it's gonna be somewhere between like 10 and 20% of the night you're awake.
So let's say you even think you're like a super deep sleeper. You sleep through the night, right? You have no sleep problems whatsoever. Mm-hmm. Still your brainwaves are gonna show that 10% of the night you are awake, um, you just aren't aware of it. Mm-hmm. You know, it's sort of these brief awakenings you roll over and go into the next sleep cycle.
Doing all that stuff to your environment is, is fine. It just, it allows the sleep to be more efficient compared to if you look at hunter gatherer sleep, they're awake 30 to 40% of the night because they have all of this environment disruption.
Juna: Oh, what?
Dr. Jonelis: Yeah. But the thing is with the environmental disruption, like for me, I am, I bed shared with my son until he was like six years old.
Maybe that tells you something about me, but in any event, I. Thought when I was sharing the bed with him, I slept well. Like I liked it. It was cozy. I was like, I get to see how kids sleep. Right? Like, I thought it was this interesting thing. I was happy he was happy, but I
Eddie: You made it an experiment.
Dr. Jonelis: Kind of.
But I, but I, but I thought I was a nine hour sleeper, right? Like, I thought I needed nine hours of sleep, but then as soon as he left the bedroom, all of a sudden I'm like a seven hour sleeper, right? So what was happening is during night there was more, if you looked at my sleep efficiency, it would've been lower.
Ah, but because the environment was. Otherwise, well, like I was actually still, as long as I spent longer in bed, I was able to kind of get what I needed. Mm-hmm. Like, it wasn't like I was functioning poorly 'cause I spent nine hours in bed every night. Um, but now I don't have to spend nine hours in bed anymore.
Juna: Wait, so I have a question for you. So my sisters always make fun of me because they say that like, I've optimized my sleep situation so much that now. I'm a giant baby and like, I like, like, okay. Okay. I'll, I'll explain. So like my room set, set up the scene for, yeah. I have blackout shades, right? Yep.
Because like light is very disruptive, so I, I do have blackout shades and then like I turn on the red lights, which I actually like. That's not even just for sleep. I actually just like. Turning them on at like 8:00 PM because it's just like nice and like dark and nice. But anyways, so that's not the biggest disturbance to me.
It's when I go to other places and like it's very bright in the room because obviously like nobody has blackout shades. So whenever we go to Airbnbs or stuff like that, or even like when I was staying with my cousin last year. She literally was like watching tiktoks in the room next door and I could hear them and of course my sister next to me like passes out and I'm like awake the entire time while she's scrolling.
Tiktoks and my sisters both say it's because I have like babied myself into this, like needing this like specific environment and now I can't sleep anywhere. Whereas they can sleep until like, you know, noon. Even though it's broad daylight, like as soon as like the sun starts coming out, I start to wake up.
So anyways, that's what I'm saying. Did I do it to myself? Flash. Should I like let more light into my room to be less disrupted when I travel or should I No, no. Keep it off. No. So I
Dr. Jonelis: think having a great sleep environment at home, if you're able to sleep, you know you have the opportunity, you're able to sleep in that environment is great.
There's no problem with that. But I think understanding that what matters from a sleep health perspective is really how we sleep on average. And that if on average you get really good sleep, if there's a night or two or three that are disrupted for some reason, like you're gonna be fine. And then also when I travel, you know, I do things.
To try to improve that sleep quality. And that's okay. Like I am am going to Scandinavia this summer. I'm gonna bring an eye mask 'cause I don't know what kind of shades they're gonna have. Mm-hmm. So bring an eye mask. I use white noise when I'm in hotels. The other thing I do, which I think you will like, you know, is I bring, I have like this orange colored book light, um, that I bring.
'cause in the Oh yeah. Because in the hotels they always have these cool colored LED lights. It that like that's all you can use. And I don't like to have that before bed 'cause it does reduce sleep quality and it's just alerting and unpleasant. Yeah. So I use my orange colored light, but the thing is, because I sort of understand sleep is this resilient system and like if one of these things goes wrong, I, it's not a travesty, right?
Like I'm still gonna be fine. And the more relaxed, yeah, the more relaxed you are about it, I think you'll find it's less disruptive. But I would say the getting up at the same time every day, that's a sign of a healthy clock. So I definitely wouldn't feel bad about that.
Juna: Okay, great. And then, okay, another question I have for you is like, so I think the reason like you probably diagnosed me from afar as like potentially having insomnia is because just listening to the podcast, yes.
But like, is Dr. Janis
Eddie: Gotcha. Like, I, I
Juna: have to say it's been the worst in the past two years because I have a roommate who wakes up at 5:30 AM every day and who goes to the bathroom at like one or 2:00 AM every day and the bathroom is right next to my bedroom. And so. There's just been like periods of time where I've been woken up every single night, like multiple times a night, and I literally just won't fall back asleep.
If she wakes me up at 1:00 AM I like, won't fall back asleep till four and then she wakes up at five 30. And so this has happened many times. And so I think like the real problem is that after it happened, once I become so stressed about the potential of it happening again, that when she does wake me up at 1:00 AM my body, like I can literally feel.
I don't know if it's cortisol or what, but I can literally feel a hormone that like, like shoots through my body and my entire body is awake and my heart is racing. The second I get woken up. Yes. Because I'm so worried about her doing that. Absolutely. And so like. Somebody's sleep problems are because of something like that where it's like you're so worried about somebody disrupting your sleep because they have in the past, like, what do you do to fix that?
Because I've tried like breathing exercises and then I tried this thing that like Navy seals do apparently to like sleep faster. I don't even know. And then it's just like, it's not working. I don't know. Right. So this.
Dr. Jonelis: Things that you read online, this trick will put you to sleep a hundred percent of the time, right?
Yeah. Those only work for people who don't have insomnia. Right? Like if somebody is in a relaxed state and they do that, it will put them to sleep. Anything will put them to sleep. Right? Counting sheep will put them to sleep. Yeah. Yeah. Yeah. If you can't sleep and you have the expectation that it's gonna put you to sleep, it just stresses you out more.
'cause you're like, oh, why is it this working and that cortisol? Yeah. So, okay. So the insomnia cycle nowadays is mostly this. So what happens is there's some kind of stressor that disrupts the sleep system. It could be an infection, it could be menopausal hormone changes. It could be a roommate who's waking you up, right?
But um, then we mount what's called the sleep stress response, where our sympathetic nervous system activates at night and. What's supposed to happen when there's an environmental threat is our sleep is supposed to be lighter and we're supposed to sleep a little bit less. You can think about it like if for a hunter gatherers, right?
If there were wildfires in the area or a neighboring tribe was attacking, or there was a lion that was coming and attacking people in the tribe at night, right? The last thing you wanna be is the poor sucker who sleeps through it all and gets killed. So we have this. Capability as humans to when we don't feel safe in our environment at night, we will, again, we'll have more awareness during the night.
We'll wake up more frequently. You can see all of this on sleep studies when you do them in the sleep lab, and then there's a little less sleep overall. So that's the normal response. So we're stressed about something, we have that, but now because of our fixation on sleep and all this messaging, like, oh my God, you did sleep.
All these bad things are gonna happen. You say, oh crap, and now you're not stressed about. Whatever was stressing you out and making you feel unsafe at night, but you're stressed about the sleep itself and it becomes this fear. Insomnia becomes a fear of not sleeping, and now you have that fear of not sleeping, which mounts that same sleep stress response, so it actually interfere.
Fears with the sleep itself. And the way that you can deal with that is, first of all, just by understanding, right, like your brain, if it doesn't feel safe at night, which it doesn't 'cause you're worried that you're gonna get interrupted, um, yeah, then it's not going to feel relaxed. And so you can do things like white noise, you know, I would definitely recommend in that situation.
Uh, and then when, mm-hmm it does happen, the deep breathing. You focus on, um, you have to kind of change the way you think of the night from. The night is a time just for sleep to the night is a time for rest and or sleep, right? And certain nights there's gonna be a higher percentage of rest. Certain nights there's gonna be a higher percentage of sleep.
And just remember for our ancestors that they did have a lot of wakefulness during the night and they were just fine. So. If there's some nights that have a little bit more wakefulness, it's not the end of the world. But what is not gonna be helpful is if you're stressed. If you're spending the night stressed out and activating that sympathetic nervous system.
So focus the deep breathing. You know, it's not a bad idea, but you wanna kind of focus it on, you're just gonna rest, right? Like you're not, you're not using it as a tool to try to get to sleep.
Eddie: So there's a listener someplace, maybe many of them who are getting stressed by learning about the sleep stress cycle and, and, and, you know, they're now like making sure that they've got the melatonin and or.
Ambien and other sleep aids, you know, at the ready. So just run us through why that's not the best option and what, what the better advice is.
Juna: Or are they good options for who are they not good options for it. Yeah.
Dr. Jonelis: And should they ever be used chronically? Right. Okay. So if you think about, again, what I said at the beginning, which is that sleep is this primitive biologic function where.
All capable of doing, but it's responsive to these external inputs. And if the sleep is not good, it means that there's something wrong with one of the inputs. So how would sleeping medications fit into that? So first of all, calling them sleeping pills is kind of a misnomer. There's no. Substance out there, be it prescription over the counter, herbal, cannabis, whatever.
Pick your poison. There's nothing out there right now that produces the same type of sleep that your body naturally produces. They might enhance one stage of sleep or one neurotransmitter during sleep. Right. But the picture, the sleep that it's producing is going to be distorted. So it's not a sleeping pill.
It is a. Sedative or for melatonin, it's kind of, it increases our body's natural darkness hormone melatonin is our body's natural darkness hormone. And so it's not gonna produce a natural sleep. So you have to get that out of your mind. And then the thing is, let's say your sleep is disrupted from, you know, your roommate is taking a sleeping pill, going to fix.
That. Like, is it gonna do anything to the roommate? No, it's not. So it's not addressing the underlying cause and let's say the problem that you're experiencing, like, this happened to me the other day, I hurt my foot. Right? And like the first night, if you ever have one of these injuries, it was so painful, right?
And my sleep was so disrupted, right? Mm-hmm. Like all night, all I can think about is, oh my God, my foot's in pain. And then of course you think about, oh no, now I'm not gonna be able to run. And you know, ah, why did I do this? Right? Like all of these things. Mm-hmm. You're spiraling through that. But I just kind of wrote it out and the next day I was.
Tired because I was in pain all night, but like the night after I slept really deeply. Uh, and what if I had thrown a sleeping pill into the mix on that night? I mean, it might've resulted in me injuring my foot more because I might've gone into a position. Mm-hmm. Mm-hmm. Mm-hmm. Part of why my brain was keeping me awake was so I didn't injure my foot more so I, you know, protected it and, and didn't put it in a position that caused even more pain.
So when we're not sleeping, there's some reason our brain is trying to tell us something. It doesn't want us to sleep, and it's our job to figure it out, and the medications prevent us from doing that.
Eddie: That's a great way to look at it differently than. You know, I'm damaged. It's our, it's a, it's a natural thing.
We need to feel safe.
Dr. Jonelis: I have this slide that I show to my patients when I do these insomnia sessions, which says, like the problem with the sleeping pill, even a placebo. So a placebo has, you know, no, it's just a sugar pill. Mm-hmm. It has no actual effect on the sleep. But if you take a placebo for sleep, what you're doing is you're teaching your brain that it needs to rely on something for sleep, and you're preventing it from using these more.
Adaptive skills, like accepting that not every night of sleep needs to be perfect. Um, in these tools to help us feel more calm and safe at night to manipulate our sleep schedule, which is something we also should talk about because we can manipulate our sleep schedule to make the sleep deeper or to make it a little bit more spread out and more fragmented.
Eddie: Maybe go on that you've mentioned in terms of schedule, like getting up at the same time. Yeah. Is something that we have some control over. And, and, and the regularity helps. But what, what constitutes. The best sleep schedule to reduce the incidents or the chance of insomnia,
Dr. Jonelis: right? So the sleep wake system again, is this responsive system and it responds to the input that we have and one of those inputs to the sleep wake system is how long we spend in bed.
And there are these experiments from like. You know, the fifties, sixties, I don't know, early days, maybe even the eighties, but uh, early days of sleep research where they took people and they put them in bed for like one hour a night every night or like two hours, three hours, right? Like they just like wanted to see what would happen.
And what happens is when you only give people, and keep in mind, these experiments are always done on college students, right? They're done on college and like new college grads, which I think is relevant 'cause sleep changes as we age. But in that population you give them. You know, four hours of sleep opportunity per night.
And what you see is after a couple nights, the sleep becomes very efficient. That 10% of the night that was asleep goes down to like, you know, by like the third or fourth night, like 2% of the night is awake. Yeah. Um, and so, you know, it's really the sleep sort of fills in. If you do the opposite, you give them, you know, eight hours sleep opportunity, nine hour sleep opportunity, 12 hours, sleep opportunity, 16 hours of sleep opportunity.
You feel bad for these poor people. What you see happens is that the sleep spreads out and you have more wakefulness during the night. Oh, lord. So you can only, our brains and bodies only need a certain amount of sleep. And if you spend longer than that in bed. It just that gets filled up with wakefulness.
So one thing that happens is that because of these myths about how much sleep we all need, many of us who have sleep disruption are spending too long in bed. And when we have sleep disruption, it worsens the problem. 'cause we think, oh my God, I'm sleeping poorly. Let's say we have, we've activated that sleep stress response.
So your sleep was lighter, it was more fragmented. You had, you know, a really disrupted night of sleep and you think, oh my God, I better sleep. Stay in, you know, bed longer. I better sleep in in the morning to make up for the poor sleep quality. And then the next night I better go to bed earlier. But you end up.
Just worsening the whole sleep wake system overall by sort of spending overly long in bed. So it doesn't, the reason you were sleeping less had nothing to do with spending too little time in bed. It was just that, you know, you were stressed. And so spending longer in bed only makes it worse because now you have more wakefulness and you've weakened your sleep wake drive overall.
Eddie: So it sounds like we've come around to. Uh, define the treatment, which is cognitive behavioral therapy for insomnia. Correct. Tell us how CBTI works.
Dr. Jonelis: So, so it was discovered actually back in the eighties, the late eighties or like the earliest papers on cognitive behavioral therapy for insomnia. And there's this nice picture showing what I just showed you, right?
Where there's the sleep stress response, the person starts sleeping less, then they expand their time in bed, their sleep opportunity, and then like there's all this wakefulness during the night and they're stressed about the sleep. And what the diagram then shows is that this is. Beman 1987 if you wanna look it up.
But um, but then what it shows is that if you give the person less time in bed, you reduce their sleep opportunity, the sleep starts to fill in. So they discovered this in the early days. They used to call it sleep restriction therapy. Now it's kind of been rebranded. We call it sleep compression therapy with my patients.
I call it sleep recalibration, which I think is a better characterization of what it is, right? We're recalibrating the sleep wake system. We're kind of strengthening it, and it's a recalibration, so it's not going on forever, right? Like you, you recalibrate, it falls out of place again, you recalibrate again, right?
It's kind of this dynamic process. But what you do is in its basic form, you say, how long do you think you sleep every night? And the person says like, I don't know, you know, four hours. And then you. The old fashioned 1980s style was, okay, well then you only get four hours in bed. Right? And after a few nights, things fell.
Yeah. Now we know, like for my patients that I see, it's, I'm. Almost never even having 'em spend fewer than seven hours in bed. Sometimes I'll do six hours, some people are just shorter sleepers, but I say, Hey, mm-hmm for a week let's just spend seven hours in bed, or sometimes eight hours in bed. Like they're spending, you know, 10 hours in bed.
Um, maybe they have Fitbit data. It shows that they sleep seven and a half hours. So I say, let's just reduce the sleep opportunity to seven and a half hours, or sometimes even eight hours. For a week keep the wake time really regular 'cause the, the regular wake time really sets our body clock for the day and sets the sleep wake system up to be stronger.
And then the sleep kind of fills in. So if you have that sleep stress response, rather than saying, I'm gonna spend longer in bed, I'm gonna sleep in, I had that disrupted sleep. What you actually wanna do is get up at your regular time and if you're still stressed, maybe stay up a little later. The next couple nights.
Paradoxically still get up at that regular time or sometimes even a little earlier until things kind of self-correct and at the same time, hopefully work. On managing whatever caused that stress where I talked to the roommate, implement the white noise, you know? Mm-hmm. Other things that you can do to address the problem, to make your brain feel safe at night.
Juna: So you're moving the times, like instead of moving the wake time earlier, you think keep the wake time the same and like go to bed later, and then start moving your sleep time up as you get better at the sleep efficiency.
Dr. Jonelis: So it's gonna depend what the person is doing at baseline, right? So if the person's.
Say there are people out there will then naturally wake up at five 30, but they don't get out of the bed till eight. Maybe they have like a little dozing after that. I mean, we see this, right? I'm an insomnia doctor, so that's what I see. So for that person, I'd say, why don't we get up at six? Right. Um, for other people, they, you know, they have difficulty falling asleep, right?
In which case we just move their wake time later. Like we say, don't go to bed till you fall asleep. Basically, if that's your primary issue that you have difficulty falling asleep, just stay up mm-hmm. Till the time that you normally fall asleep. Still get up at the same time, and you can, you can shift people's schedule.
Like we try one manipulation and then you see how they respond to it. You know how they like it. It's, it's sort of an ongoing adjustment. That's why it's a recalibration.
Juna: So if my roommates always wake me up at like 6:00 AM should I just like get up at 6:00 AM instead of like, because I, I'll like wake up and then be kind of pissed, but then I'll just like fall back asleep and I'll wake up at eight, you know?
Dr. Jonelis: Yeah. So it's gonna depend what your goals are. I mean, first of all, the less pissed you are, the easier it's gonna be to fall back. Right? It's true. Right? It, I'm pissed. Why are they so loud? Right? So you're gonna put on the white noise, right? And you're gonna just do some deep breathing and be like. I have two choices, right?
I could get up at six with the roommates or I could, you know, keep my regular eight o'clock wake up time. I'm choosing the eight o'clock wake up time, so I know they're gonna wake me up. I'm just gonna do some, I like the 4, 7, 8 breathing if you know that, that technique. And you know, I'm just gonna rest.
Have a few thoughts and drift back to sleep. If instead you're like awake for an, you know, an hour and a half and you're just falling back asleep at seven 30. Mm-hmm. Like that, I wouldn't do. So you just kind of have to decide and you wanna pick one time or another. We think just for sleep health overall, it's ideal not to vary your wake up time by more than an hour over a month.
Right. So within a month, yeah. You kind of wanna stay in that hour window. You can have more flexibility in the bedtime, a little more, maybe like two hours. But the wait time's gotta be pretty regular.
Juna: Okay. I think I fall asleep in like a minute. Honestly. I just think I like that minute. I'm so, I'm like so awake.
'cause I'm like, what the heck? Yeah. But then I feel like I literally like pass out like a minute later or something. Yeah. Then I wouldn't worry about it. Just reassure
Dr. Jonelis: yourself.
Eddie: So, um, asking for a close friend who I've shared a bed with for decades. What, um. If we, she misses kind of that go to sleep window somewhere between like 10 30 and stays up like past 11, then a greater chance of waking up early in the morning.
Yeah. What's the physiology? Or is that the sleep stress thing going on? It's the sleep stress response.
Dr. Jonelis: You're exactly right. So the more relaxed you are about it, the less that's gonna happen. Right? But you think like, oh my God, now I'm staying up later. Plus sleep restriction is a stressor, right? So if you stay up really late, like your body interprets that as it doesn't know why the sleep was restricted.
Wow. But it interprets that as a stressor, and so it can activate that sleep stress response. But I do wanna talk about. Sleep apnea, just very briefly. Yeah, please, please. Yes, let's do it. Sleep apnea is this problem where the throat collapses during the night blocking the airflow, and your lungs try to pull in air.
They can't. They try harder and they do eventually pull in air, but your throat will keep collapsing. You'll stop breathing, you know, hundreds, sometimes hundreds of times throughout the night, and there's a range of severity. Oh my God. There's a mild sleep apnea where it happens. You know, infrequently throughout the night or severe sleep apnea where it's happening, you know, every 30 seconds you're stopping breathing, but it is a cause of sleep disruption.
And how can you tell if you have sleep apnea? It tends to be weight associated, but it's also jaw structure associated. So some people who are quite thin, if they have a small jaw structure, but you can't always tell, sometimes it's internal. You can be at risk for sleep apnea. And some people who are quite large, if they have a very.
Large jaw, like it doesn't cause a lot of problems. They don't have a lot of compression. So it's not just the weight, but if you're told that you snore loudly, if you snore and stop breathing, you definitely have sleep apnea. That combination of snoring plus pauses and breathing is a hundred percent specific for sleep apnea.
My God. Yeah, and really, and we think it takes a toll on health overall. So it's if you do think you have sleep apnea, you snore, you snore loudly, maybe you're. Sleep. You feel like you sleep. Oh my God. But you're not feeling rested then You should definitely just see a regular sleep doctor. You don't need an insomnia specialist.
But they can do a sleep study. That's
Juna: my dad. There you go. I, I'm like 99% sure. My dad has sleep apnea. He has the craziest snoring and they'll just be like a pause and like a crazy snore. Nice. Like, oh my God. So that's sleep
Dr. Jonelis: apnea. Definitely. Okay. And he can just get a sleep test. So is the only treatment CPAP?
No. So you CPAP is still the best. It's kinda like the gold standard treatment. And for CPA, especially if you don't know if your symptoms, like say you have mild sleep apnea and you're feeling fatigued, CCP a's gonna be a really great way to tell if it's the sleep apnea are not 'cause it, it will, once you get used to it, it a hundred percent treats the sleep apnea.
But if you don't wanna use CPAP, um, you know, you have sleep apnea, you really don't wanna do the CP Pap. There are other treatments out there now. They're not, they're still not as effective as CPA, but if we combine them, some of them are pretty good. And if you combine multiple different modalities, sometimes you can get a pretty good treatment outcome.
And again, even if it's really bad, even a 50% reduction or 30% reduction is gonna be better than nothing. Jesus God. So Jesus, don't be scared by the C ccp. A P can be great and if you have the right mask, if you have, you know, the right pressure settings, like it really can be this life changing treatment.
And definitely something worth trying, but if you don't want to, don't be scared by that. Like still go see somebody. There's other things that you can do and other things you can try.
Juna: Mm-hmm.
Dr. Jonelis: I just wanna add one more thing about cognitive behavioral therapy for insomnia. So cognitive behavioral therapy for insomnia is the gold standard recommended treatment for insomnia.
What has happened is that the American Academy of. Fleet medicine, the American Academy of Internal Medicine, right? Like all of the major medical organizations, periodically, they try to create these guidelines for treatment of whatever medical condition you have. And when they look at insomnia, they review all the evidence supporting cognitive behavioral therapy for insomnia.
Medications for insomnia, and all of these organizations have independently come to the same conclusion, which is that cognitive behavioral therapy for insomnia is more effective and more safe than medications for insomnia. Mm-hmm. The evidence supporting any medication for insomnia, you can look at these guidelines, but it says like, you know, Ambien, uh uh, Trazodone, you know, all these things.
The evidence supporting any of those for chronic insomnia is. Actually weak, right? That's the quality of the evidence that we save versus the evidence for cognitive behavioral therapy for insomnia and some similar spinoffs that exist nowadays is strong. So that's why yeah, is considered the gold standard treatment.
And if you are suffering from insomnia, that's like the big message that I want from coming on the podcast is seek out cognitive behavioral therapy for insomnia. And there are you, if you Google it, you can find provider databases where you can find someone in your. Area who does it. There are also now, mm-hmm.
A lot of digital options, some of which are completely free. There's something called Insomnia Coach or CBTI coach to similar apps that were developed by the VA and are offered completely free of charge. Oh, cool. Yeah, you can start that today. There's also. Books that offer CBTI. And if you tried cognitive behavioral therapy for insomnia and it didn't work for you, just know there are different styles and there's now something called acceptance and commitment therapy for insomnia.
So it's still that type of treatment is most effective. But you know, with every type of therapy do, sometimes it's not a good fit. Sometimes it wasn't implemented in a way that worked for you. So find a different provider. Try again. Find like maybe somebody who does a spinoff, one of these spinoffs, and try again with them.
But that is the recommended treatment. And if you do take medication for sleep, you're not alone, right? You're with 75% of the population. So that's not something to feel bad about. Like of course you're taking medication. Thought sleep was important. You were understood all the messaging, that it was important.
You were trying to improve your sleep, right? You're taking action. It's a great sign. It means you understand sleep is important, but know that it's not the best strategy. And so you wanna do that cognitive behavioral therapy for insomnia or do some digging about like what's really causing the sleep problem.
You know, try to address that. And then with the medications, you don't wanna just. Stop because our brains become dependent on the medication, but you can wean off mm-hmm. Over time. So you wanna work with your provider, get on a stable dose and then, you know, slowly wean while you do cognitive behavioral therapy for insomnia or addressing whatever, whatever the cause is.
Eddie: And we can put all of those resources in the show notes for this episode so that
Juna: Absolutely. Well. This has been so incredible. I want to talk to, you wanna wake up, huh? I know. Lit. Literally, yes. Ah, I'm so glad you emailed us. I'm so glad I saw the email. We want to talk about aging and what happens to your sleep as you age, and what do you do when you actually like wake up in the middle of the night and you can't fall back asleep?
Like should we read. Yeah. Should we scroll on TikTok? Yeah. Should we watch a movie Go with TikTok? We wanna talk all about that on our bonus episode. But for this episode, thank you so much for joining us. I'm sure it helped so, so, so many people, including myself and my family members who I'm sending this to, and I just really appreciate you coming on.
Thank you. Yeah,
Dr. Jonelis: no, I'm so happy. So happy to come on.
Juna: Thank you so much to Dr. Jonelle for joining us. On today's episode, we will link to her work and the studies that she's mentioned on our website. If you want to hear the rest of our bonus episode where we talked all about what happens to sleep as you get older, do you still need a lot of sleep when you're older or do you need less sleep?
What happens when you go through menopause? What do you do if you wake up in the middle of. The night and
Eddie: how do you balance your sleep with all of the other lifestyle behaviors that we're pushing so hard, like getting enough exercise? I really
Juna: don't know. That's a great question. You can go to food. We need to talk.com/membership or you can click the link in our show notes.
You can find us at food. We need to talk on Instagram, and you can find me at the official UNA on Instagram and Una Jada on YouTube and TikTok. You can find Eddie.
Eddie: Try not to stress about sleep.
Juna: Oh my God. That's where you can find me too. That's what I need to do. Food. We Need To Talk is produced by Rebecca SEL and is distributed by PRX.
Eddie: Our mix engineer is Rebecca sel.
Juna: We were co-created by Kerry Goldberg, George Hicks, Eddie Phillips, and me.
Eddie: For any personal health questions, please consult your health provider. To find out more, go to food. We need to talk.com. Thanks for listening. Thanks for listening.
Juna: Go to sleep.
