Well Wisconsin Radio

Interviewer:

Hello and welcome to Well, Wisconsin Radio, a podcast discussing health and well-being topics with experts from all around the state of Wisconsin. I’m your host, Alexis Krause, and today my guest is Dr. Daniel Dixon. Daniel Dickson completed his PhD at Loyola University Chicago, his pre-doctoral internship at the University of Wisconsin School of Medicine and Public Health, and a two-year postdoctoral fellowship with the University of Wisconsin Madison School of Medicine and Public Health in collaboration with the Wisconsin Sleep Center. He is currently a clinical assistant professor in the Department of Psychiatry at UW-Madison where he treats insomnia, circadian rhythm sleep disorders, anxiety, and depressive disorders with cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT). That’s a mouthful Dr. Dixon!

Guest:

That’s a lot of stuff.

Interviewer:

Yeah! Help me out here. How are you doing today?

Guest:

I’m doing very well. Thanks for having me here.

Interviewer:

Good. Well, I’m excited to talk to you about sleep. I know this is a topic a lot of people are curious about. So I was just wondering if you could start us off with what happens to our bodies when we sleep?

Guest:

Yeah. Um, well, I’ll use a lot of metaphors today. So if you have a questions here, please feel free to interrupt. But, um, how I like to talk to my clients about sleep and what it does for us is think of, I use a metaphor of my office, I have my little dinky office I have in my clinic, where in the winter time we get a lot of like salt on the floor from people, you know, coming in and out from outside. I have papers everywhere that need to be filed or shredded. Um, but think of like your whole body is my office getting a little bit cluttered. It gets salt, gets messy, stuff gets moved around, papers everywhere. And when we sleep, what your brain basically does is cleans up and vacuums all the gunk. Gets your custodial stuff. It, like, will file papers away for you. So think of that from short term to long term memory. Think about shredding things you don’t need. Say, ope, this paper’s gotta get thrown away. And so, basically what your brain is doing is treating your pain, your inflammation, clearing out some of the gunk in your brain, making space for new memories, new information be held in there. And if, if you think about it. I like to tell people is imagine your custodial staff only has 15 minutes to clean the whole space. They’re going to be rushed and they’re going to miss stuff. But if you give them an hour and a half, two hours, there’s plenty of time to clean things up. And so basically if we shorten sleep, we don’t get all that stuff. And if we have that time, basically our brain can be cleaned up and more orderly. Um, also there’s more opportunity for our brain to actually kind of take in information because when we’re sleepy, I don’t know about anybody else, but I don’t feel good when I don’t sleep.

Interviewer:

Yeah, I definitely don’t. I know we were talking before here; we’re both lacking a little bit of sleep today. So what happens when we don’t get the sleep we need?

Guest:

What I think about is Like when we don’t sleep well, our brain doesn’t work as well. Uh, I actually saw a colleague do a talk recently talking about what happens, why do we sleep?

Because if you really think about it evolutionarily, sleep doesn’t really make much sense. We’re very vulnerable, we’re not awake, we’re not alert, predators can come get us. Um, so what really happens? And what they say is, I’m using another metaphor, if anybody’s a runner out there, if you go running for a long period of time, you’ll have maybe knee inflammation, right? And in order to help run the next day, you have to ice your knees or give it some rest. Same thing applies to our brain. The more we use certain areas of our brain, it gets really active, it gets what we might call saturated with activity. And basically what your brain does when it sleeps is it’s icing your brain and calming down those regions so they can be used again. So if you don’t have time to ice, then you won’t be able to run as long or as far. And so, also if you don’t get good sleep, our mood gets worse. We actually see difficulty regulating our appetite or how much of the food we eat. Uh, we see difficulty concentrating, focusing, irritability. Uh, thinking about attention, memory, retrieving memories, building new memories. Our brain gets really foggy and it’s really hard to do much of anything if we don’t sleep well. Um, so yeah, that’s what happens.

Interviewer:

Yeah, that’s not great is it?

Guest:

No, not good.

Interviewer:

Could you tell us a bit about when we’re analyzing our sleep and thinking more about this, um, there’s sleep studies versus sleep logs and how are these two things different?

Guest:

Yeah, so sleep studies, a lot of times I should get referrals from primary care physicians or other physicians saying, ‘hey, this client has difficulty with sleep. Send them to Wisconsin sleep.’ And Wisconsin sleep will have a physician to evaluate them to determine what’s going on. Essentially what sleep most sleep studies do is you think about if you’ve ever seen one before, they’ll plug your head in with a bunch of electrodes, they’ll put different things, respirators around you, you’ll have a nasal cannula, an oximeter on your finger. There’s a lot of the day that goes into a sleep study, and that is actually to mostly assess for sleep apnea. There are a couple different forms of sleep apnea, but think about his interruptions in your breathing. Or as I tell people, imagine your sleep like a submarine. We want deep sleep. Just like if submarines meant to go deep, when you have sleep apnea, your sleep can basically bob at the top because of this pauses while you’re breathing, that causes you to wake up. And so what sleep, what sleep studies will do is evaluate is are you experiencing these apnea events, or we might think of it as a snoring sound from our partners, or even just simple pausing when you’re breathing. Um, other disorders they’ll evaluate are what we call periodic limb movement disorders. So imagine when you’re going through REM sleep, your body wants to put you in lockdown, hold you in place, because that’s when you’re dreaming. And if it forgets to lock you down, you will act out. A lot of times I ask people the question, periodic limb movement questions, and they’ll say, well how do I know? And like, your partner will tell you, or your sheets will be across your, across the room. Because you have moved quite a bit. Think of it as you’ll act out your gym’s punch and kick. These aren’t very, kind of, focused, targeted behaviors. You know, it’s more grandiose, arm swinging, kicking, maybe even acting out or yelling. Um, they’ll also assess restless leg, which is that feeling of creepy crawly or sensation in your legs as you’re about to go to sleep. Um, basically what your body will say is, get up and walk around. And it might make it feel better. And as soon as you sit back down, guess what comes back? That creepy crawly sensation again. And it can make it really hard to fall asleep. Um, let’s see what else I might evaluate. Those are the big ones. Of course, other parasomnias might exist. Night terrors, things like that. But in general, we don’t need, for people who have insomnia concerns, we actually don’t recommend a sleep study. Mostly because they cost, it can cost you about $900, even if you have insurance. So it can be expensive to do that. And in reality, Thankfully, we can actually do most of the evaluation for sleep logs. Can actually you can evaluate insomnia by simply using a few sheets of paper and a few moments of your time. And so thankfully, it’s pretty easy to identify insomnia or circadian rhythm sleep disorder simply using pens and paper. We don’t need to have a night sleeping underground with a bunch of electrodes on your head. It’s a really uncomfortable hotel. They do a great job, but it’s not the most comfortable space to be sleeping in.

Interviewer:

Yeah, I’m glad that’s not required because I need to know a little bit more about my sleep along with I’m sure a lot of people here are curious about their own too. So how can you diagnose insomnia or the circadian rhythm disorders that you were talking about.

Guest:

Yeah, the good news is it is really sitting down and actually asking a few questions. Actually, I brought a questionnaire to share with our audience today. Um, but there’s actually a, I believe it’s a seven item questionnaire you can take that can pretty reliably tell you if you have insomnia or not. Um, oftentimes I can diagnose circadian rhythm sleep disorders by having you track your sleep for a period of about two weeks. And I can actually tell you from there well, I think you might have a circadian rhythm sleep disorder. Um, of course, that’s ruling out other factors might be playing into it. Um, sometimes when people might have, again, delayed sleep phase could be contributed by restless leg or other, like, shift work, things like that. Um, but realistically, it does not require you to, you know, spend a couple of months meeting with a physician, waiting a couple of months to get in this in lab sleep, plus the co pay of an in lab sleep study. It can be done a little bit quicker.

Interviewer:

Okay. Well, that’s encouraging to hear. How can someone determine how much sleep they actually need? I know there’s different numbers out there that I’ve heard, but what do you think is the right way to go about that?

Guest:

The way I often talk to people about sleep need is if anyone If you’ve all been to the grocery store, look at the back nutrition facts. It says based on a 2, 000 calorie diet. And I don’t know about you, many of us probably have different varying amounts of caloric needs. I usually joke my 6 and almost 7 year old son, if I gave him 2, 000 calories, he’d be pretty plump, pretty round. He wouldn’t, it’s probably more than he needs. Uh, I’m a pretty big dude if I, I’m pretty active. If I have 2, 000 calories, I’ll lose weight quickly. So is a 2, 000 calorie diet for everybody? Or is it for just some people? Um, so I use that as a metaphor, a parallel of the recommendation, everyone needs 7 to 9 hours of sleep. It’s probably most people do, probably say 60 to maybe 70, 80 percent of the population might need that amount of sleep. But think of your sleep need as your own unique calorie count. And not only that, it’s dynamic over the course of life’s lifespan. Um, think about that with newborns. How much do they sleep? They sleep probably, my kids not enough, but other people’s kids, you know, 14 to 18 hours in a day. As we get older, we sleep less and less, and not only how much we sleep, but when we sleep also changes. Think of adolescents, they want to sleep in later. They experience delayed sleep phase. And so our sleep is very dynamic over the lifespan, and it can change. Because I’ll have clients say, ‘hey, I’m not sleeping as much as I was when I was 20.’ I’m like, well, now you’re 60. It’s going to be different. If we follow the same routine, it’s not going to work the same because your sleep need is different. Um, so there are a lot of different ways to figure out your unique sleep need. But typically if you track your sleep for two weeks and see how much you sleep on average over the course of two weeks, assuming you’ve given yourself adequate opportunity for sleep, so not waking up early or staying up too late for some other, other reason, uh, you can get a rough estimate of how much sleep your body uniquely needs.

Interviewer:

I like that analogy of caloric need because you can kind of clearly picture that and it’s changing throughout your life. Yeah, I love that.

And now we’ll just take a quick break to hear about some of Well, Wisconsin’s program offerings.

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Interviewer:

And now we’ll head back to the Well Wisconsin radio interview.

How common is it for people to suffer from sleep disturbances or insomnia?

Guest:

Very common. It’s actually probably one of the most common disorders we see, I think it’s, gosh, there’s so many different ways you can look at insomnia. It’s like people who experience a period of insomnia, people who meet criteria for insomnia disorder, people who have difficulty sleeping one night. And the numbers range quite a bit. I think it’s between 5 -10 percent of the population have an insomnia disorder. Uh, and actually we see that it’s interestingly enough, it’s becoming more common. Uh, there’s a lot of research that shows that actually insomnia is a man-made disorder. Um, to give you some background, these, the study done, I can’t remember how long ago it was, but they, uh, they gave these hunter gatherer communities in, I think it was South America and Africa, these, like, Fitbits on steroids. And they can like track your sunlight, they actually pre accurately capture your sleep, they tell you how active you are. And they found in both cultures, they woke up with the sun, they’re pretty active till about noon, then they had siestas in both cultures, then they got active, and then their activity tailed off as they got dark. And the researchers were curious, they said, ‘well, what do you do when you get insomnia?’ And the interpreters for both cultures said, ‘they don’t have a word for that.’ And so we come to the conclusion is that, Our lighting, our demands of our life, more modern world of course are impacting our sleep. But it doesn’t mean we should get rid of our lights. But it’s of course that we get thrown off because of the more modern things we have here. Um, I think in this study, they might have alluded to one guy one time having a hard time sleeping, but it wasn’t like we have our insomnia disorder here in our culture.

Interviewer:

Yeah. That’s a lot to process. I’m thinking about all the things in my life that are impacting me right now too. What’s the difference between insomnia as a symptom and insomnia disorder as a diagnosed condition?

Guest:

Yes, so people can have insomnia and non-insomnia disorder, and it might sound like we’re splitting hairs, but there are a lot of times I see people who can’t sleep, but the reason they can’t sleep can be very different. So I think we’ll talk about a little bit of how people can be very worried and have difficulty sleeping, or a period of grief and have difficulty sleeping. And it’s not due to purely your body won’t let you sleep, it’s something else that’s contributing to your body’s difficulty sleeping. Um, a lot of times we’ll see people even misdiagnosed with insomnia when they have a circadian rhythm sleep disorder. They’re basically their body wants to go to bed later and wake up later. So when they want to go to bed at the recommended time, everyone says pick a bedtime every night at the same time. When they, they follow that they won’t sleep very well because their body is not on the same page. We also see the cost of emotional disorders that insomnia is a symptom. If you look, if any of you have read the DSM 5 lately, which I’m sure is by your nightstands. If you look at the DSM 5, you’ll see almost multiple disorders, we’ll say. sleep difficulties, or insomnia, or difficulty initiating or maintaining sleep. And so it’s a transdiagnostic feature, so simply relying on sleep as a difficulty to diagnose, you can kind of, there’s many disorders it could fit under. Uh, which an insomnia disorder is difficulty initiating or maintaining sleep, four to seven days a week, um, that actually adversely impacts your functioning during the day. Um, and typically it’s not better explained by another disorder, which is one of the caveats to using the self-report measure I brought in today is that we can’t purely rely on that because we also want to take into account other factors that can be contributing to your sleep disorder.

Interviewer:

Okay. So there’s a little bit more that goes into it than just a couple of factors.

Guest:

Yes.

Interviewer:

What are some of the most common sleep disturbances? I know you talked a little bit about some of them, but I know there’s quite a few that you have in your hat to talk about.

Guest:

Yeah, so the most common ones I see in my work, I’ll see a lot of people, individual generalized anxiety disorder, which is a, think of it as chronic long standing, difficult to control worry about multiple areas of your life. Usually goes for six months or more; associated with, um, difficulty focusing attention, sleep disturbance, irritability, feeling on edge, or tense. Um, but a lot of times individuals will have sleep difficulties, but where, where I would treat them with what I use might not work because essentially with this symptom, it’s actually worry, is what’s driving the difficulty sleeping, not your body will again won’t let you sleep. Um, we also see in depression that of course individuals will spend more time in bed. Essentially, what I’d like to describe is, uh, if anyone likes pizza, I’ll use a pizza metaphor. Imagine, like, your sleep amount is, like, a medium sized ball of pizza dough. And imagine though, you’re like, well, I want to feed a lot of people, so I’m going to spread it out over an extra large pizza pan. Your dough will get thin, it will get holes in it, it will get gaps, and it won’t have full coverage, and you’ll lose your toppings. Um, what that basically, how it relates to sleep is that people with depression can extend their time in bed and get thin crust sleep, or holes in their sleep. And they’ll say, I’m not sleeping well, but it’s also partially contributed to depression.

The good news is both of those issues, uh, we actually see that treating sleep first can actually improve outcomes in both. Um, it can improve anxiety and depression. Again, going back to kind of what happens when we don’t sleep well. If your brain isn’t feeling good from sleep, it won’t do well trying to treat these other areas. So we actually, there’s a lot of research coming out saying treat sleep first. That might help treat them next. Um, this is of course different than something like PTSD, which often times I get referrals where people, not that their body can’t sleep, it’s their body is afraid to sleep. As I mentioned earlier, like sleep is a vulnerable space and again our brain, when we have trauma, your brain says, this is vulnerable, this is scary, this is threatening, stay awake. Most commonly I’ll see that where I’ll see someone sleeping only for three to four hours a night and I go, oh, it looks like your body is afraid to sleep and will only sleep once your body is shutting down.

Interviewer:

Okay, so I think we may have touched on this one a little bit, but just want to open this up a little bit. So how can things like generalized anxiety disorder and depression actually impact someone’s sleep? Is it preventing them? Is it waking them up? Is it a combination of those things?

Guest:

Yeah, uh, so how I think for generalized anxiety disorder is I think of, uh, I’m going to spin it this way, but oftentimes think of worry as kind of like a mental habit. Our brain like does it and can’t stop doing it. That’s why it’s such a hard thing to control. Uh, no different than like doom scrolling or other activities like that. And so what happens though is just because it gets dark doesn’t mean our brain breaks the habit. And so we talk, I talk to clients a lot about is how do we then treat the daytime habit so it’s not impacting your nighttime routine. Because when we have worry, you can’t just flip a switch. If it was that easy, I wouldn’t have a job. And I would be totally happy with that because I’d work probably at Costco or something like that. But the main idea is that the habit of worry can get in the way of falling and staying asleep. And there I’d say it’s not insomnia, it’s, it is insomnia, but it’s not an insomnia disorder. And so the treatment might be different where I’d say, let’s treat the worry during the day so it’s not invading on your nighttime. Um, and I think for in terms for depression, it goes back to the idea of that extending his time of sleep. Um, there is also this really, the one of the seminal studies in sleep was done in the seventies, uh, where they basically found that people with insomnia spend time in bed and their brain forgets that the bed is a place to sleep. So one of the things I’ll ask people, we might do intakes, I’ll say, well, do you ever feel sleepy somewhere else in your house, but as soon as you get into bed, you feel wide awake. That’s one of the hallmarks I see in insomnia disorders is because their brain forgets that bed is for sleep. So if you’ve ever heard the recommendation only use a bed for sleep or for sex, that’s the main idea is that your brain can unlearn that sleep bed association, and then it learns to just be awake and says, ‘hey, you were here awake last night. Guess what I’m gonna do tonight? Keep you awake.’

Interviewer:

Wow. That’s really interesting. I definitely fall into that group. I saw a couple of people in the audience nodding too that that can happen. What are some of the initial steps or recommendations for someone who might be experiencing some of these sleep disturbances?

Guest:

Yeah. Uh, well, I usually tell, I, my initial treatment visit, I almost do very similar recommendations for most clients, uh, because a lot of times the simplest ones actually are the most effective ones. Um, I find that sometimes we get too. Complicated. Again, I’ve joked earlier before this that my wife will watch the Today Show and get recommendations on sleep and this feels very complicated because what is it? What do I need to do? Is it I need to wind down better? I need to get out of bed. What do I need to do or go to bed the same time every night? Um, a lot of times people get very surprised to hear this, but I actually say the time going to bed, is important, but not the most important. I usually tell people it’s waking up at the same time is more important. A lot of times we get very focused on bedtime, but a lot of clients I see, I go, are you sleepy at the same time every night? Most people aren’t always. I can share and hope people in Wisconsin don’t mind, but I’m a 49ers fan. Last year I watched the super bowl. The game went up kind of late. I couldn’t fall asleep because my brain says, ‘ope, it’s your bedtime.’ But you’re too excited, or actually despondent, because we lost, and you won’t be able to fall asleep. And so I often tell people is, you can’t control when your body’s ready for sleep, but what you can do is by setting your wake-up time more consistently, your bedtime will fall into line. Um, another kind of wrinkle to add with that is people often get very focused on, well, I need this amount of sleep every night. Um, I’ll share, I’m about a seven to seven and a half hour sleep need person. But don’t think of it as you just need seven and a half hours of sleep. Think of it as you need, do my math here in my head, 16 and a half hours of wakefulness before your body’s ready to go back to sleep. I think I did my math right there. And the idea for that is that it takes an amount of time for your body ready to sleep. So if you shift your wake up times, you will shift your bedtimes. And so I often tell clients, the more consistent you are with your wake up times, naturally your bedtime will fall into line.

Interviewer:

I like that. And that almost seems like a more doable goal because you can’t always control what’s happening in the evenings every time things will change, 49ers might be on kind of thing, but yeah, waking up at the same time seems a little more doable. Well, as we’re wrapping up here, Dr. Dixon, are there any final words of advice for our listeners who might be considering changing their sleep habits?

Guest:

Uh, there’s a great book, title, the title is relevant, I’m not going to actually push the book for anyone to buy, but it’s called End the Insomnia Struggle. Uh, one of the things I teach my clients quite a bit as I tell them the story of growing up. I had this dog. His name was Rocky. He was the sweetest dog you ever met. But he had this thing where he got out the front door and he would run and run and run. And I would chase after him. And my dad sees me doing this and says, ‘Daniel, what are you doing? You’re not going to catch this dog.’ Because every time I ran after him, he would. Kind of look at me shimmy a little bit and sprint the other way. And my dad says come here. He hands me a can of fancy feast cat food and says whistle three times. I whistled three times and here comes this dog, tail between his legs ears all pinned back all ashamed. He eats the can of cat food and goes inside the house. And every client goes what the heck does that have to do is sleep? And I go do you ever notice when you try to sleep it runs away from you. So stop chasing it. But what do we do? And so sometimes I’ll tell clients, like, stop chasing it. You know that feeling, you’re in bed going, Ah, it’s not going to happen, not tonight, right? Flipping the covers over, tossing and turning, elbowing your partner, not looking at anybody in particular here. But it’s the idea is, let’s stop chasing after our sleep. Go to another room, do something light. I actually do recommend to my clients, like, did you ever watch Everybody Loves Raymond? I’m like, yeah, like, turn on some TV, watch that for about 20 minutes. If you’re ready to go back to sleep, go ahead. You want something that’s about 20 to 25 minutes because then you get a chasing after sleep. Maybe you let sleep kind of catch back up to you. Uh, people usually get very scared. I say, you told me to watch TV. I’m like, yeah. It’s more of what’s on TV, not What, not the fact you’re watching television. I’ve had clients say, I’ll watch World War II documentaries. I go, please don’t do that. That will keep you awake at night. Don’t watch the news either. Stay away from that. But it’s, what do we need to do to help sleep kind of come back and catch up to us again? Um, I also recommend reading, uh, I even joke with clients, I will not read psychology articles that get too excited. So I recommend reading something very light hearted, something that is mildly interesting that can hold your attention because you want sleep to kind of sneak back up to you.

Not you chase after it.

Interviewer:

That’s really great. Thank you so much, Dr. Dixon for being here with us today. We really appreciate it.

Guest:

Thank you.

Interviewer:

Thanks for listening to Well, Wisconsin radio. I hope you enjoyed this show. You can find our survey in the Well Wisconsin portal and our transcripts and previous episodes all at www.webmdhealthservices.com/WellWisconsinRadio. If you’re listening to this podcast on your platform of choice, be sure to subscribe so you can never miss an episode.

 

In this episode, we sit down with Daniel Dickson, PhD who is a clinical psychologist. We discuss the complexities of sleep from insomnia to common sleep disturbances and mental health conditions, such as anxiety and depression, that can impact one’s sleep. Dr. Dickson also shares practical advice for those looking to improve their sleep habits and overall well-being.

Talk to a health coach individually or sign up for group coaching today by calling 800-821-6591

Sign up for MeQ at www.webmdhealth.com/wellwisconsin and complete a short questionnaire to begin your personalized experience.

Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR)

End the Insomnia Struggle: A Step-by-Step Guide to Help You Get to Sleep and Stay Asleep by Colleen Ehrnstrom PhD ABPP

The information in this podcast does not provide medical advice, diagnosis, or treatment. It should not be used as a substitution for healthcare from a licensed healthcare professional. Consult with your healthcare provider for individualized treatment or before beginning any new program.