 Welcome to Happiness Isn't Brain Surgery with Doc Snipes. This podcast was created to provide you the information and tools Doc Snipes gives our clients so that you too can start living happier. Our website, docsknipes.com, has even more resources, videos and handouts and even interactive sessions with Doc Snipes to help you apply what you learn. Go to docsknipes.com to learn more. Welcome to Happiness Isn't Brain Surgery with Doc Snipes, practical tools to improve your mood and quality of life. Today we're going to be talking about sleep and why it's important and how it really is one of our greatest vulnerabilities for depression, anxiety and irritability. We're going to start by learning about the function of sleep. Talk about those sleep cycles that everyone talks about, REM sleep, deep sleep, this kind of sleep. What are they? We're going to talk about how much is enough and you might be surprised at how much or how little you actually need. And then we'll talk about how sleep contributes to feelings of depression, anxiety and irritability. Once you've learned all that, you might be motivated to figure out how to improve your sleep. I know I was. Sleep is the time for your body to rest and restore. Adequate sleep improves your memory and learning, increases attention and creativity and aids in concentration and decision making. So all of those things, if you look at them, well, maybe not memory and learning, but your concentration and your decision making and your energy levels, all of those things are actually symptoms of depression as well as lack of sufficient sleep. So lack of quality sleep, and I'm going to keep using the word quality, is really important in understanding maybe why you're feeling a certain way. Feelings that accumulate in the brain are thought to be cleared out during sleep. So, you know, if you haven't slept well and you get up and you're kind of foggy in the morning, that might be one of the reasons. Healing and repair of cells also takes place during sleep. So it's important to get this good quality sleep. And sleep also helps to maintain the balance of hormones in the body, including ghrelin and leptin, which regulate your feelings of hunger and fullness. So if you're not getting really good sleep, you may feel like you want to eat all the time, or likewise, you may have no appetite at all. But more often than not, people tend to be more hungry or more apt to want to eat and not know if they're hungry or not. Insulin, which is responsible for the regulation of glucose in the blood, is also affected when you don't get enough sleep, which is why it's really important if you have hypoglycemia or any type of diabetes or prediabetes to make sure you're getting enough sleep so your body can effectively regulate your insulin levels. Sleep deficiency is also linked to a higher risk of cardiovascular disease, stroke, diabetes, kidney disease, difficulty concentrating, irritability, fatigue, and loss of energy. Now, if you think about when you haven't had enough sleep and if it goes on for a long time, long periods of sleep deprivation, you know, when my children were younger, there were several months there. I didn't get good quality sleep for a while. And during those periods, I definitely felt a lot more symptomatic of, you know, no energy, irritability, difficulty concentrating. And this extra stress on the body from not getting enough sleep is generally what causes some of the problems, the physical health problems, that result from lack of sleep, because over time, the body starts to break down, which is, again, why it's important, nip it in the bud, get as much quality sleep as you can. Stage one, or non-rem sleep, is when you drift in and out of light sleep and can be easily awakened. It's kind of like when you nap on the couch. Stage two, non-rem sleep, brain waves slow with intermittent bursts of rapid brain waves, your eyes stop moving, your body temperature drops, and your heart rate begins to slow down. This usually lasts for about 20 minutes. Now, don't hold me to these numbers because everybody's a little bit different, which is why I say it usually lasts for that long. So now we're into, you know, 30, 40 minutes after you think you've fallen asleep. Stage three, non-rem sleep, also known as deep sleep or delta sleep, is marked by very slow delta brain waves. There's no voluntary movement, and you're very difficult to awaken. Think about a time, you know, if you've got kids, you've probably experienced this, or if you've got dogs, when you have been in a deep sleep, not dreaming in a deep, deep sleep, and somebody has awakened you, and it's taken you a minute to figure out, okay, where am I? Who are you? What's going on? Okay, got it. Let's proceed. You were probably in your deep sleep at that point in time. This stage usually lasts for about 30 minutes. The largest percentage of deep sleep comes in the early part of the total night's sleep pattern. Now, that's in normal sleep people. If you have depression, if you have high levels of anxiety, or if you are drinking alcohol or caffeine prior to bed, then your deep sleep may not come at the beginning of the night. It'll be when those substances wear off or when you calm down. And sometimes with depression, people have difficulty getting any deep sleep. So it's important to not look if you've got a activity tracker and look at your monitor and go, well, my deep sleep's coming at the end. If it is, you might want to ask yourself, well, when did I have caffeine last? Because caffeine stays in your body for 12 hours. That aside, it's important to know that when it comes, when you get your deep sleep, it usually only lasts for about 30 minutes at a shot. So you're going to cycle in and out of it throughout the night. After deep sleep is your REM sleep, which is characterized by temporary paralysis of the voluntary muscles and fast irregular breathing, inability to regulate body temperature, faster brain waves, resembling the activity of a person that is awake. Most dreams occur during your REM sleep. So if you wake up and you're sweaty, you've kicked off all the covers or something like that, you've probably been out of your REM sleep for a little bit of time. But it's important to understand you're not regulating your body temperature really well, which is why you may wake up and feel sweaty and throw the covers off. REM sleep is what most people think about as deep sleep. And while it's good, it is not the deep restorative sleep that you need in order for your body to rest and rebalance. So how much do you need? Well, the hour requirement is a little bit loosey-goosey, because if you're not getting the deep sleep, then you may need more sleep than what's recommended here. So I'm just going to skip ahead to us adults here. And they say we typically need between 7.5 and 9 hours of sleep. And you may be laughing to yourself going, I can't remember the last time I got more than 6. Something to consider that may be contributing to irritability, fatigue, and foggy-headedness. Now, some people get a lot of deep sleep in six hours, and that's fine. Deep sleep needed for adults is between 1.5 and 1.8 hours. And, you know, again, if you use a fitness tracker, not an actual sleep study monitor, it measures your, quote, deep sleep in terms of how much movement you have. And we know that there are two different phases of sleep where you are not having voluntary muscle movement, so your movement's going to be a lot slower. For a rough estimate for myself, I take whatever it says in terms of how many hours of deep sleep I got, and I divide it in two, because I figure probably only half of that was the actual deep restorative sleep. So I aim for between 3.5 and 4 hours of, quote, deep sleep, according to my fitness tracker each night. Obviously, you're going to need to do what feels best for you. Some people, if they sleep more than 8 hours, they just don't feel like they can get started. Other people don't feel like they can get started unless they've had at least 8 hours. If you're sleeping a lot and you're not feeling rested, it would be interesting to get a sleep tracker of some sort and Fitbit, Garmin, there's bunches of them out there. And see how much deep sleep you're getting. But at the end of this presentation, we're also going to talk about things you can do right now to start improving your sleep and just keep a sleep journal of I slept this many hours and when I woke up, I felt rested or not rested. How did you feel at noon time and how did you feel at bedtime? So you know if that sleep is enduring and you're actually maintaining your energy throughout the day. Estrogen usually improves the quality of sleep, reduces the time to fall asleep and increases the amount of REM sleep. Now too much estrogen can keep you up, but too little estrogen as you see in people who are going through menopause can also keep you up and mess with your ability to control your temperature and those sorts of things. Too little or too much testosterone may also affect overall sleep quality. So your sex hormones actually do play a part in what kind of sleep you're getting. So if you're finding that you're having some depressive symptoms, you're having some sleep problems, you may want to have your doctor evaluate your hormone levels. Cortisol is your stress hormone and it prevents restful sleep. When you've got cortisol going through your system, it's telling your body there's a threat somewhere and you can't afford to go into a deep sleep because you need to be able to respond as soon as I tell you to. And we know you're not going to if you're in deep sleep. So if you have high levels of stress and anxiety and you have ongoing cortisol pretty much throughout the day, you keep it up because of your anxious thoughts and things like that, then you most likely will not get restful sleep. So it's important to start addressing some of those thoughts and issues in your life that are keeping your stress levels high consistently where you feel like you're burning the candle at both ends. And thyroid hormones, which are too high, can also cause insomnia and too low can cause fatigue and lethargy. Again, this is one of those your doctor can measure and tell you, yes, it's in the normal range. This is probably not causing your problem or identify that there is a problem. So when you're going for your physical, if you're having symptoms of fatigue, foggyheadedness, depression, irritability, it might be worth talking to him or her about getting a full blood workup done. Nutrition, tryptophan is used to make serotonin. Serotonin is used to make melatonin, melatonin functions to help you feel sleepy. Well, tryptophan is a protein and it's found in most of your meats. Your body cannot make it. So if you don't eat a good diet, your body can't make the neurochemicals needed to help you feel sleepy. Some people will try to take melatonin supplements. That works for some people, for other people. It is awful. They wake up, they may feel good for 30 minutes, and then they're groggy the rest of the day. That would be something I would strongly encourage you to talk with your doctor about. The other reason for that is that a lot of the over-the-counter supplements are significantly higher than what the American Sleep Foundation recommends for melatonin supplementation. So before you take any supplements, always talk with your doctor. But if you eat a good diet, or make sure you eat a good diet, so your body can help you make the neurotransmitters you need to get sleepy. Caffeine is a stimulant and it has a six-hour half-life, which means it's not out of your body for 12 hours. So if you drink a espresso at noon, it is still impacting you at midnight. Just keep that in mind. If you're having sleep issues, you may want to stop ingesting caffeine at like 10 a.m., and then some people may be like, oh my gosh, I couldn't get through the day without it. You may consider weaning down slowly, going first to half and half, and then 25% caffeine after 10 in the morning or something, so you don't get that jolt. But when you're taking in caffeine, you're causing your body to run more intensely, hotter than normal, if you will, burn up more energy than it really has. You're artificially burning up energy. So you're going to be tired and it creates sort of a vicious cycle of needing more caffeine to keep going. As you wean, and I've done it myself, I went from three pots of coffee a day to two cups in the morning, and I feel a lot better. I don't feel like I need to have caffeine throughout the day. But be aware that as you wean down, you may start to get headaches and drink plenty of water, et cetera, and take it slow. You don't want to make it so miserable that you just throw in the towel. Nicotine is also a stimulant with a two-hour half-life, which means half of it is out of your body in two hours. It doesn't completely get out of your body for four hours. So if you're smoking right before bed, that will impact your sleep. Decongestants like pseudofed are also stimulants with a two-hour half-life. So be aware, if you've got a cold, you may need to take them so you can breathe. When you're laying down trying to get to sleep, I know for me, when I get a head cold, I don't sleep well with or without the decongestants, because I can't stand it if I can't breathe through my nose. So you may feel like you need to take the decongestants, and that's totally cool, but understand that it will keep you from getting the deep restorative sleep, most likely. Antihistamines, which are the ingredient in most over-the-counter sleep aids, like Benadryl, make you drowsy, but contribute to poor quality sleep. So if you take antihistamines, just be aware or sleep aids, be aware that you may fall asleep faster and sleep for longer, but it may not be quality sleep. Alcohol blocks REM sleep and can cause sleep apnea, so people who drink before bed may not get into deep sleep, because they keep waking themselves up as their respiration slows down and they start snoring harder. Alcohol, decongestants, antihistamines, caffeine, and nicotine are all things that if you can avoid them, it would be ideal, or minimize them so they can get out of your system and you can get a good night's sleep. Like I said, eating a high protein dinner, high in tryptophan in the body is really good, chicken is good, beef is good, eggs are okay. You can Google food sources of tryptophan and find something that works for you. Not everybody eats meat or animal-based products. Make sure you're getting enough selenium, vitamin D, calcium, vitamin A, magnesium, and zinc. All of these are needed to help you sleep, and you're probably going, I have no clue where those come from if I'm getting enough. Most of us don't. Thankfully there are apps that you can get on your mobile device, and most all of them will calculate your nutrient intake, so you can figure out if you keep a diary on your mobile device. You can figure out if you're getting enough of these vitamins and minerals, or if you need a multivitamin. Again, before taking any supplements, talk to your doctor. So sleep hygiene. Create a wind-down ritual, just like we did with kids when they were infants. They would eat dinner, or if they were toddlers, they would come home from preschool, they would play, they would eat dinner, they would take a bath, because usually they were filthy after eating. We'd read them a story, kiss them on the cheek, and put them to bed, and that cued their body in. As soon as they started eating dinner, the body's like, okay, wait a minute, I know, in an hour and a half or so, it's going to be time for sleep. So then it starts the process of making the melatonin available. So do that for yourself. Create two or three things that you do every night before bed. You know, work backwards from what you already do. You already brush your teeth. So all right, you brush your teeth before bed. What do you do before that? And so your body has a clue. For me, I play checkers on my mobile device. And anytime I start playing checkers now, my body seems to think it's time to go to bed, and I start getting sleepy. So if your body starts to associate a certain activity with almost time for bed, it will help you calm down. Reduce or eliminate exposure to blue lights one hour before bed. Now blue lights are things that come from computer monitors, TVs, cell phones, and some of your not soft white bulbs. So try to minimize how much light's coming in. Your circadian rhythms are partly set by light levels. So when the sun goes down, you're supposed to go to sleep. But if you have it right as noon time in your bedroom, your brain's not going to get the clue. You can get different filters, different apps that'll put a filter over your mobile devices, whether it's a tablet or a phone or whatever. So the blue lights are not available and it has sort of a red hue to it, which is supposed to help you not jolt out of that wind down routine. Try to go to bed at roughly the same time each night. Now that doesn't mean you have to do it every single night. Just roughly the same time for me. It's within an hour window, most nights. Every once in a while I'll get wild and crazy and stay up until 10 o'clock. But whatever works for you, but if you can try to keep on a consistent schedule, you'll find that it helps you a lot. Eliminate as much light as possible in your room, including considering a sleep mask if you have lights coming in from street lights or whatever. Eliminate as much noise as possible. If you feel comfortable, you might try putting on earplugs or getting a white noise device. Don't exercise or take a hot bath within two hours of bed because your body actually needs to be cool to go to sleep. Keeping the room cool 72 degrees is ideal is great, but it's really expensive most of the year. Regardless, try to keep yourself as cool as possible with having a fan on. Consider getting a cooling pillow and a mattress topper that doesn't hold heat. A lot of the old fashioned foam mattress toppers that are supposed to conform to your body are great, but they conform to your body by virtue of as they heat up, they become more malleable and they hold that heat. Some of the new generation mattress toppers don't do that, so you want to look for a mattress topper that's going to help you maintain your body temperature. Try to avoid anything that might get you upset at night, such as social media or the news or whatever it is that tends to get you all fired up because as soon as you kick off that stress response, then you're going to kind of have to start all over again at the beginning of the wind down. Reducer, eliminate caffeine at least six, preferably 12 hours before bed. Drink the majority of fluids during the day. I am guilty of waiting till dinner time and drinking too much many times and then you have to get up in the middle of the night to go to the bathroom. If you have to get up in the middle of the night to go to the bathroom, try to have a flashlight that has a red light on it or have a night light in the bathroom that has a red light on it so you don't trick your body into thinking it's almost time to get up. Keep an air purifier in the room if you have allergies, keep animals off the bed. This is one of the things I'm guilty of. You may not be able to do all these things, but if you start improving your sleep hygiene in two or three different areas, you're probably going to see an improvement in your sleep. Make the bedroom a place of relaxation and sleep, not where you pay your bills, not where you fight with your spouse. Try to have it be a place that you can go and just let your hair down so to speak. Keep a red light flashlight and a notepad by your bed to write down anything that pops into your head that you, quote, need to remember. I've had nights that I've mulled over. I need to remember to get X and so at the grocery, and it's kept me from going to sleep as easily because I keep getting stressed out that I'm going to forget that I need to remember to get that. So just keep a tablet by your bed, a notepad and write down things as you think of them so you can rest comfortably and know that they're going to be there for you in the morning. And finally, weighted blankets can help some people get to sleep easier because they give you a feeling of being secured. You can order them offline, you can make your own, you can go on YouTube and find videos on how to make your own weighted blankets for cheaper than you can buy them. If this is something that might be helpful to you, if you like to be under something heavy when you sleep, then that would be something to consider. Keep daytime naps to under 45 minutes. Once you pass that 45 minute mark, then you start confusing your brain about whether this is a nap or it's supposed to go into deep sleep. Consider diffusing essential oils that can help you relax. Lavender, chamomile, patchouli and catnip are all known to have sedative properties to them and calming properties to them. And select the right pillow. If your neck is all out of whack, if it's not an ergonomic situation, you may have difficulty getting to sleep and you may wake up the next morning with a kink in your neck. So getting a good pillow is really worth the investment. Insufficient quality sleep contributes to fatigue, difficulty concentrating, reduced reaction time and apathy. During deep sleep is when researchers think the brain kind of resets and rebalances. And over time sleep deprivation can cause changes in neurotransmitter levels and immune system functioning. Most people could benefit from auditing their sleep quality and doing things as simple as reducing light and noises, reducing the number of trips to the bathroom, reducing wakeups because of allergies, coughing or being too hot, and cutting back on their caffeine six, preferably 12 hours before bed. If you're only willing to change one thing this month to start being happier, more energetic and clear-headed, sleep is probably a great place to start. If you like this podcast, please subscribe on your favorite podcast app. You can join our Facebook group at docsnives.com slash Facebook. Subscribe to our YouTube channel at youtube.com slash all CEU's education or join our community and access additional resources at doc. Welcome to this week's book review. Each week I review a book that I believe would be helpful to the general public and or clinicians. I'm never paid to do the reviews. However, in some instances, I may receive a small commission if you purchase the item which helps defray the cost of our podcast and providing the free educational videos. The cost to you, however, remains the same. Today, we're going to be talking about self-esteem. And this is the fourth edition. I actually started out using this book when it was back in the third edition. And I absolutely love it. It's a very comprehensive guide to helping people improve their self-esteem. In the book, you're going to learn how to uncover and analyze negative self-statements. So talking about that internal critic, create new, more objective and positive self-statements. Let go of judgmental self-attacking thoughts and act in accordance with what matters to you most. So the book is 300 and some odd pages and it goes on for a while. But what it does is walk you through step by step understanding what self-esteem is because it's kind of one of those terms that we talk about, but we may not really know what it is. And why just telling yourself that you're okay may not work? Well, the key is you have to believe it. So he starts talking about why people don't believe they're okay even if they tell themselves they are. Then he introduces you to the pathological critic and encourages you to explore why you listen to it and learn how to disarm it. It moves on from that point to creating a balanced self-description, accepting weaknesses and embracing strengths, recognizing that we're not perfect, but nobody's perfect. So embracing yourself and cherishing yourself as you are. He moves on from there to identifying and combating cognitive distortions that keep you feeling bad because a lot of times when we start looking at our weaknesses, we magnify them. And when we look at our strengths, we minimize them. And that keeps us feeling bad about ourselves. So McKay goes into great detail about how to combat some of those cognitive errors or thinking errors. He encourages you to explore your thoughts about compassion and developing self-compassion. One of the reasons that many people have difficulty developing self-esteem and being kind to themselves is because somewhere along the way they were taught that having compassion for themselves or being kind can be seen as weakness or failure or something negative. So he really challenges you to look at your beliefs about self-compassion and self-acceptance. He explores how to reframe mistakes and accept fallibility. Because again, even though we know we've got strengths and weaknesses, we're also going to make mistakes. So accepting those and learning from them and not turning them into something huge but accepting that everybody makes mistakes. Then he talks about what to do with the constructive and destructive criticism that you receive sometimes on a daily basis to help you respond in a meaningful way. And basically it boils down to a bunch of techniques that will help you learn how to take what's useful and leave the rest, accepting that sometimes criticism is not as much about you as about that other person's stuff. And then he ends with helping you clarify what you want and need and using your skills to get those needs met more effectively. So creating win-win situations and learning how to assertively communicate with the people that are important to you. This book is written in really plain language with practical tools which is one thing that I love about it. You can read three or four pages, get something really useful and insightful and work with that for a while, then come back the next day or the next week and read another three or four pages. So it can be really useful for self-help or as a tool to guide individual or group therapy sessions. Visual learning clients like to have it as a reference to review markup and bring for discussion in the next session. So a lot of times when I do self-esteem groups, I'll have each client get a copy of this book. We go through it page by page, activity by activity. We do them sometimes in class, sometimes as homework. And then we talk about what they learned and then they can go back and review over the week between sessions what we talked about and get those visual cues that help them remember the important skills. I hope you've enjoyed this book review and please feel free to log on. It's self-esteem by Matthew McKay. It does have a Google preview so you can read a little bit more about what's in it and see for yourself and see if it resonates with you as a good tool for self-improvement. Thanks for tuning into happiness isn't brain surgery with Doc Snipes. Our mission is to make practical tools for living the happiest life affordable and accessible to everyone. We record the podcast during a Facebook live broadcast each week. Join us free at docsnipes.com slash Facebook or subscribe to the podcast on your favorite podcast player. And remember DocSnipes.com has even more resources, members only videos, handouts, and workbooks to help you apply what you learn. If you like this podcast and want to support the work we are doing for as little as $3.99 per month, you can become a supporter at docsnipes.com slash join. Again, thank you for joining us and let us know how we can help you.