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Top Sleep Questions Answered by Sleep Expert, Dr. Shelby Harris

Are the effects of insomnia wearing you down? Clinical psychologist, Dr. Shelby Harris has the answer.

Working with adults and children to provide comprehensive treatments for insomnia and tackle other sleep challenges, Dr. Harris specializes in Cognitive Behavioral Therapy as a solution.

Hammering home the importance of lifestyle changes and hormonal patterns, Dr. Harris is confident that everyone can get a good night’s sleep if they put their mind to it.

Read on to discover Dr. Shelby Harris’ top answers to the big questions about sleep.

What is this Dr. Shelby Harris Podcast All About?

Dr. Shelby Harris has a BA with honors in Psychology and Music, Brown University and received her PsyD in Clinical Psychology, Ferkauf Graduate School of Psychology at Yeshiva University. She is the former director of the behavioral sleep medicine program at Montefiore Medical Center, and author of The Women’s Guide to Overcoming Insomnia.

Joining the Untangle podcast, Dr. Harris talks extensively about what’s really going on when you sleep and what you can do to improve it.

Answering some of the most common questions about sleep, Dr. Harris includes actionable steps that you can take to get better shuteye every night.

Keep reading to learn about Dr. Harris’ approach to treating insomnia and other sleep disorders to learn how to get a restful sleep.

7 Pressing Sleep Questions Answered by Dr. Shelby Harris

Is insomnia plaguing your life? Are you dying to sleep better at night? Dr. Shelby Harris answers the most common questions on why you’re sleeping badly.

If you need new tactics to help you drift off, here’s your answers.

1. Why are you so sleepless?

A lack of sleep impacts your whole life.

According to Dr. Harris, if you have no underlying medical issues, there are several major lifestyle factors that could make you feel sleepless.

Firstly, there’s your inability to just call it a day.

As Dr. Harris puts it:

“[Americans] are a stressed society. We just don’t know how to put an end to the day anymore. Some days we are going, going, going…”

This is a problem because it causes you to treat sleep like it’s an on/off switch, where you’re hitting the hay to simply ‘crash.

Dr. Harris warns that if you treat bedtime like crash-time, that’s not a good sign.

“Sleep is not an on/off switch. If you think you can just turn the light switch off and go right to sleep, you likely are a sleep deprived person. […] It should be like a process of a dimmer switch where you’re slowly dimming your body, your brain, to wind itself down to land the plane gently so you can then glide into sleep.”

No more crash landings!

The other major factor is the problem of smart devices.

As Dr. Shelby Harris explains:

“We have our phones on us non-stop and we think we can just put things down and crash.”

While Dr. Harris supports using a screen before bed to do something like a guided meditation, intentional staring into the screen should be avoided for a couple biological reasons.

First off, screens inhibit melatonin production big time.

“Your brain reads the light from the screen just like it’s the sun and our brains do not like the sun to be able to go to sleep. So, we have this thing called melatonin in our brains, we call it the hormone of darkness, and it makes us sleepy […] Melatonin comes out when the light goes out or the sun goes down. If you’re staring at a screen, your brain thinks the sun is still out. So, you’re making your sleepiness hormone melatonin suppressed. It can actually take an hour longer for people to fall asleep.”

Dr. Harris goes on to explain that not only can it take you longer to drift off, but prolonged exposure to blue-light after the sun goes down can also negatively affect the quality of your sleep as well.

What’s more, interacting with your phone stimulates the brain, keeping you awake.

The dopamine rush and the engaging content stops your brain from switching off.

Another major reason you’re sleepless is due to hormones. This is especially true for women.

Hormonal fluctuations can cause all sorts of sleep disturbances from mildly irritating sleeplessness to downright insomnia.

2. How much sleep do you need?

When looking at her patients in general, Dr. Harris finds that most people need between 6-9 hours of sleep a night.

Dr. Harris first explains that to answer this, you have to define “need”. From her perspective, you can tell how much sleep you need from how you feel during the day.

To Dr. Harris, you’re probably getting enough sleep if you feel pretty refreshed an hour after waking, you don’t feel like you need a nap during the day, and you’re not passing out on the train as soon as you finish work.

While the numbers make things easy to aim for, Dr. Harris points out that, as a sleep psychologist, she’s mainly concerned with sleep quality, rather than quantity of sleep.

“Let’s get you quality sleep over the quantity first. I have insomnia patients that come to me saying I have to get 8 hours, I have to get 8 hours. All you’re doing now is worrying about how to get those 8 hours that are painted in gold and put on a pedestal. That makes It worse. So, let’s focus on getting 5 hours but 5 hours that aren’t broken, 5 hours that feel better and then we can slowly work to get more.”

3. What is a normal sleep pattern?

While you sleep every night of your life, you’ve probably never thought about what’s actually going on during those sleeping hours? What does your pattern of sleep look like?

Dr. Harris explains that a normal sleep pattern looks like this:

There are basically five types of sleep that your body cycles through in a night.

Stage 1 – Light Sleep: This is the in-between wakefulness and sleep period.

Stage 2 – Medium Sleep: “About 60% of your sleep is middle level sleep”

Stage 3/4 – Deep Sleep: This is the deepest level of sleep and usually occurs shortly after you actually fall asleep. This is when your brain really shuts off and rests. A lot of people think they want to be deep sleeping all night, but, in reality, that’s not normal.

REM sleep –  Shot for ‘rapid eye movement, this phase of sleep gets the most attention because it’s where the majority of your dreaming takes place. “Your eyes actually move together and apart, together and apart […] your brain is very active during REM sleep — you tend to dream the most, it’s memory storage, memory consolidation, mood regulation, all happen during REM sleep. It’s like your filing cabinet is working overdrive during that time.”

If everything is going according to plan, your body goes through 4-7 cycles per night in a pretty predictable pattern.

“We want to see that kind of sleep architecture – deep sleep, light sleep, REM – and then more REM as the night goes on.”

Dr. Harris also explains that between each cycle, there is a brief moment of wakefulness that you almost never remember and that’s totally normal and just part of the cycle.

Just before you wake up for the day is typically when you will have the most REM sleep. This is why you remember your dreams so vividly when that alarm goes off.

4. How can Cognitive Behavioral Therapy (CBT) help insomnia?

As a sleep psychologist focusing on sleep disorders, Dr. Harris spends the majority of her time working with Cognitive Behavioral Therapy for insomnia (CBT-I) and other milder sleep issues.

The cognitive part of the therapy is about working through your anxious thoughts, rather than suppressing them. This helps you to rationalize the anxiety and worry that contribute to your sleep issues.

As Dr. Shelby Harris explains,

“The rational part of your brain is usually not there at 2:00 in the morning. And then [we look at] how to challenge those thoughts, not always in a positive way but in a realistic manner. It’s about realizing those challenges to help bring down your anxiety and bring down the pressure you’re putting on your sleep.”

Cognitive behavioral treatments are becoming more widely available as an alternative to medication or other sleep aids.

“It’s been around for 20 years and over the past 5-10 years it’s really been used as the gold standard treatment for insomnia, above medication. In the field of primary care and sleep medicine, it is in the guidelines that it is the first line treatment for insomnia. Physicians should be giving prescriptions for CBT for insomnia to see people like myself before giving medication, in many cases. The problem is there aren’t many people who do what I do or specialists in it, that’s the issue.”

In the eyes of many sleep specialists like Dr. Harris and British sleep expert, Dr. Guy Meadows, meditation is a particularly effective cognitive treatment.

In relation to sleep therapy, Dr. Harris says,

“I teach patients how to meditate during the day or even an hour before bed, to help them become more aware of their anxious thoughts and let them pass so that when they get in bed they don’t get stuck on the anxious thoughts as much – they can let them pass to let sleep then happen. That’s the cognitive aspect.”

When it comes to the behavioral aspect, Dr. Harris focuses on sleep hygiene and stimulus control to promote healthy sleep behaviors.

Sleep hygiene is about doing all the common-sense things that you often hear about and brush aside — limit caffeine, no screens in bed, eat healthy, and exercise etc.

One really actionable tip that Dr. Harris suggests is about what you should do when you’re lying in bed for hours unable to fall asleep:

“If you’re not sleeping, don’t lay in bed, get up and go sit somewhere else. The bed is only for sleep and sex […] Lay there for a little while, about 20 minutes — don’t look at a clock just guestimate — if you don’t fall asleep, get up, go sit somewhere else, read, meditate, do something else. When you’re sleepy again, go back to bed. And you keep teaching your body that bed is only a place for sleep not a place to lay awake tossing and turning.”

This training of your brain to associate the bed with sleep is one of the key parts of the behavioral side of CBT.

Another point Dr. Harris makes is about spending too much time in bed. That’s not good either.

“The final part of CBT is limiting time in bed. A lot of people with insomnia spend too much time in bed.”

If you struggle too hard to get those elusive eight hours, you’ll end up stressing yourself out just lying in bed.

When it comes to a timeline for making these changes, Dr. Harris explains that,

“You don’t have to do it all at once, but you can’t expect your sleep to just magically improve, you have to adjust change your expectations.”

With her patients, she will usually introduce one thing at a time until the goal has been met, rather than trying to change everything at once.

5. What if you see a clinical psychologist, follow all the guidelines, and it still doesn’t work? Can hormones override it all?

Dr. Harris makes it clear that if you’re experiencing serious issues, you should absolutely see your doctor.

She goes on to explain that everyone is different and there isn’t a magic bullet for fixing sleep issues but hormones certainly play a significant role in many people’s sleeplessness.

“For young women who really have significant insomnia related to menstruation, it’s that drop in estrogen that happens and the beginning of menstruation that can set off the insomnia cycle. That, for some people, is so significant that they are willing to go on a birth control pill.”

For older women in the perimenopausal period, there are other issues in hormone shifts that can disrupt your sleep.

Dr. Harris mentions hormonal treatments that women can undergo but also gives some great suggestions for non-hormonal natural remedies for falling asleep, namely black cohosh and evening primrose oil.

She underscores all of this with the reminder that you should not undergo any treatment without first discussing possible side effects or interactions with your gynecologist or primary care doctor. Just because a treatment is not medication or hormonal doesn’t mean that it’s 100% safe for everyone.

Dr. Harris also explains that there are natural causes of sleeplessness in everyone’s lives. For example, right after a baby is born, there’s just not a whole lot new parents can do. Sometimes you’ll just have to ride it out.

6. When, if ever, is medication called for?

Dr. Harris’s review of sleep medicine is not all bad. She agrees that sometimes, the best option is medication, but it’s usually not the first option. What she prefers to do, and what is standard in the field now, is to first try CBT and if that is unsuccessful, she will recommend medication.

“I think there is definitely a role for medication. It’s just that we got a to a point 10 years ago where it was just too easy to prescribe it and we didn’t think about the longer-term consequences of it. And now we are starting to see more and more data come out, for some people, especially older adults. We see it cause a lot of cognitive issues and falls…eight sessions of CBT is not as fast as taking a pill but if it works, we would much rather do that nowadays than medication.”

CBT doesn’t work for everyone or it can have a mild effect. In these cases, Dr. Harris uses a combination of medication and therapy. The really positive thing about the combined effort is that the patient can be on a much lower dose.

7. What are some techniques or at-home treatments you can do right now to release negative thoughts regarding sleep?

First, Dr. Harris makes it clear that treatment of sleep issues is about releasing negative thoughts. This doesn’t mean positive thinking — it means thinking realistically.

“It’s about talking yourself through it in a realistic and rational way to help bring your anxiety down. It’s not positive thinking, it’s realistic thinking.”

She suggests getting something called a ‘Thought Log’.

When you have a negative thought about sleep or feel pressure to sleep, write it down. Then there are several questions that will prompt you to reframe how you think about that negativity.

The goal is to reframe how you react to those thoughts in the future.

Another practice Dr. Harris suggests is something called ‘worry time’.

“We can do things like worry time, it’s just setting aside time early in the day or evening and you say I’m just going to worry the heck out of everything for 20 minutes. And you set a timer for twenty minutes, this is a very standard cognitive technique.”

If a worry about sleep comes up outside of that prescribed time, you tell yourself not to just stop worrying, but to remind yourself that there is time set aside later to worry as much as you want about it.

“Worry time says not now, but I WILL think about it tomorrow during my set 20 minutes so you’re allowing it, just not 24/7. It helps rein it in a little bit.”

You should write down your worries during that twenty minutes and when your time is up, you can review each one in a calm setting and find rational solutions to each.

The third immediate thing you can do to help release negative thoughts is to get out a pen and paper and write down a good old fashioned ‘To Do’ list an hour before bed.

You think that if you just keep it top of mind, you won’t forget it. The problem with trying to remember your to-do list all the time means your brain can never relax. If you write the things down, you won’t spend hours lying in bed trying not to forget everything you have to do tomorrow.

What are Dr. Shelby Harris’ biggest take-aways?

If you take anything away from Dr. Shelby Harris, remember these crucial things.

1. Consistency

“We are meant to go to bed at the same time and wake up at the same time, seven days a week. We do not have a different alarm for the weekdays vs. weekends. If you are having trouble sleeping, consistency every day as much as possible is key.”

2. Room environment

Make it a place you want to be. “Make it quiet, dark, comfortable, and cool.”

3. Limit Caffeine

It can disrupt the quality of your sleep so make sure you try and cut it off by 2PM.

4. Exercise

“Just get yourself out there, if you can move a little bit you are using your battery so you’ll help recharge it more at night. But exercise right before bed is not ideal. It can actually interfere with sleep even more. [Exercise] any time during the day, just not within 3 hours before bed.”

5. Meditation

“It will help to quiet your brain and be aware of the anxious thoughts before you go to bed and to let go of them to be able to get a better night’s sleep.”

In Short…

As Dr. Shelby Harris sees it, good quality sleep relies on a calm mind. Rather than beating yourself up about getting eight hours of sleep, you should focus on relieving anxiety to get good quality sleep.

If you’re finding yourself struggling with insomnia, try relaxation exercises, calming activities, and CBT.

Most importantly Dr. Harris says, “Don’t suffer, there are so many effective ways to fight this. It’s a very treatable disorder and you really shouldn’t just be suffering.”

If you’re a woman suffering from sleeplessness and you’d like to learn more about Dr. Harris’ treatments for insomnia, check out her extremely helpful book.