Insomnia & Sleep Solutions with guest Dr. Daniella Marchetti

Do you struggle to fall asleep, stay asleep, or wake up feeling rested? If so, then you won’t want to miss this information-packed episode of the Brainy Moms podcast with health psychologist Dr. Daniella Marchetti who specializes in behavioral sleep medicine. In this conversation with Dr. Amy and Sandy, Dr. Marchetti shares the truth about melatonin, nightmares, room temperature, white noise machines, sleep trackers, and even mattresses! Learn how to improve your sleep without getting a sleep study. If you think you know all there is to know about sleep, tune in for this interview with a sleep medicine expert who is “in the know” about how to wake up feeling rested. 

ABOUT DR. DANIELLA MARCHETTI:

Dr. Daniella obtained two master’s and PhD from the University of Miami in Clinical Psychology. As a trained Health Psychologist, her specialty is in behavioral sleep medicine, which she uses to help treat insomnia, nightmares, hypersomnolence, and sleep apnea across the lifespan. She currently works in a hospital setting as well as her private practice devoted to the treatment of sleep disorders.

ABOUT US: 

Brainy Moms is a parenting podcast hosted by cognitive psychologist Dr. Amy Moore. Dr. Amy and her rotating co-hosts bring listeners conversations with experts on topics in parenting, child development, education, psychology, mental health, and neuroscience. Listeners leave with tips and helpful advice for helping moms and kids thrive in life, learning, and relationships. This episode is co-hosted by Sandy Zamalis.

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Transcript

DR. AMY: Hi, smart moms and dads. Welcome to another episode of the Brainy Moms podcast brought to you today by LearningRx Cognitive Skills Training Centers. I'm your host, Dr. Amy Moore, here with my co-host, Sandy Zamalis, and we are excited to have a conversation today with our guest, Dr. Daniella Marchetti. Dr. Marchetti obtained two master's degrees and a PhD from the University of Miami in clinical psychology. As a trained health psychologist, her specialty is in behavioral sleep medicine, which she uses to help treat insomnia, nightmares, hypersomnolence, and sleep apnea across the lifespan. In both a hospital setting as well as in private practice, Dr. Marchetti is devoted to the treatment of sleep disorders. She's here today to talk to us about insomnia and other sleep problems and some solutions. Welcome, DR. DANIELLA.  

DR. DANIELLA: Thank you for having me.  

SANDY: We're so glad you're here. We like to start every episode by having our guests talk about how they got interested in their specific topic. So of all the psychology specialties, why are you passionate about sleep? 

DR. DANIELLA: That's a great question. So I actually decided. I discovered behavioral sleep medicine around the same time that I became a mother. And so in those early postpartum months when my own sleep was interrupted and going through rapid changes following the lack of circadian rhythm of my baby, I found CBTI, this treatment for insomnia, and I was learning how to implement it and when, and I always knew on paper how effective it was.

You know, I could see the effect sizes, I've, I've read the research, but when I started self-implementing some of the strategies and saw the change in my own life, I was sold. You know, at that point, I realized, you know, more parents should know about this. Everyone should know about this, but especially parents should know about this. So from there on out, I was, you know, committed to the treatment of sleep disorders.  

DR. AMY: So, we absolutely want to hear about CBTI and some other ways that we can help, but let's back up a little bit and just talk about some basics. So, how do you define insomnia? What does that mean? From, is it just hard to fall asleep? Is it just hard to stay asleep? Are there specific metrics or parameters that define insomnia? Or is this subjective?

DR. DANIELLA: Yeah. So, there are metrics and it's important to know them because oftentimes I think we use the term insomnia or insomniac, like colloquially, but there are distinctions. So, in order to have full -ledged insomnia, you need to have some kind of sleep disturbance for at least three days a week or over the course of three months. And when I say sleep disturbance, I mean either difficulty falling asleep, difficulty staying asleep or even problems waking up too early. So, if your alarm, for example, is set at 7, but you chronically get up at 6:30, and you don't know why your body can't just take you that remaining half hour, that still counts as a sleep disturbance. If you've had these issues for a month, we could call that acute insomnia, and that's kind of like our yellow flag of, you know, let's go start getting some help. But three months is the absolute cutoff. At that point, it's clinical insomnia. 

DR. AMY: So how long should it take the average person to fall asleep? Because let me just tell you why I say this. My husband takes forever to fall asleep and I take 3.2 seconds. And so I can sleep on command. If you tell me, “DR. AMY, fall asleep right now,” I will go to sleep right now. And if it takes me more than two or three minutes to fall asleep once I'm ready to go to sleep, then I’m a wreck, right? I’m like, “What is wrong with me? I've got insomnia,” which obviously taking more than 3.2 seconds to fall asleep cannot be the metric. So, what, how do we define how long it should take to fall asleep?

DR. DANIELLA: Yeah. So right now, I suppose a good or normal sleeper is somebody who can fall asleep within 10 to 20 minutes of getting in bed. So if it's been more than 20 minutes and you haven't been able to fall asleep, you know, I wouldn't, I wouldn't start thinking about it because that can make it matters worse. But, um, anything more than 20 minutes would be considered kind of a long sleep onset. And while we're talking about, you know, what's normal, just getting to the sleep maintenance piece, the staying asleep piece, it is normal to get up, you know, once, maybe even two times, depending how old you are, in the night to maybe use the restroom. Everyone has some, like, micro arousals. But if you're getting up, and it's taking you forever to fall back asleep, or you're having very fragmented sleep, that's when it's considered an issue.  

DR. AMY: And is this the same for children and adults? Oh, I'm sorry, Sandy.

SANDY: Yeah. That's okay. I was going to ask the same question.

DR. AMY: Oh, okay.  

DR. DANIELLA: Yes, that's, so there are, there are differences. Because children, you know, their circadian patterns are changing throughout their lifespan. So if you take a newborn infant, you know, they're actually born with what we call an ultradian pattern, which means no pattern whatsoever. You know, there, there've been researchers that have put ActiGraphs on newborns. And if you look at them, each ActiGraph is different. So having multiple awakenings in the night doesn't mean that your newborn has insomnia. It just means they're a newborn. But around, you know, three to four months, circadian patterns start to develop, and so then more predictable sleep schedules are expected. After six months, there is the physical possibility of sleeping through the night, because their pineal gland isn't fully formed when they're born. And the pineal gland is actually what produces melatonin, which is that sleep promoting hormone. And without the pineal gland and without melatonin, you know, we know that we're going to have some issues sleeping through the night. So there are differences between, you know, children, depending what age and stage they're in, and adults, certainly.  

DR. AMY: And the length of time that it takes a child to fall asleep, can that vary as well? Or should that land in that same 10- to 20-minute metric?  

DR. DANIELLA: Yeah, so when we talk about sleep onset for children, you know, this doesn't count like the bedtime routine. So there is the time that you get in bed and then there's the lights out time. So with children, sometimes that's a little bit different. You know, adults might get into bed and it's lights out. With children, sometimes there's more of a routine. You know, parents may like read a story, engage in like a night prayer, do something to kind of help the child wind down. So that doesn't count towards your like sleep onset time. But once it's lights out, good night, and you walk out, yes, the expectation is that they should fall asleep within those 30 minutes. 

DR. AMY: And then how does melatonin release play into that process? So how does the body know, “Let me release melatonin now.”

DR. DANIELLA: Yeah. So, one of the processes that regulate our sleep and the determines when and how we fall asleep is our circadian pattern, which relies really heavily on our cues to lightness and darkness. So like right now in the summer months, we have extended daylight, and so it may take longer for our bodies to actually produce melatonin. Whereas we might usually start producing melatonin, maybe around 8 p.m. at night, if we're still getting a lot of sunlight, if there's sunlight at 7:30 p.m., your melatonin might start being produced a little bit later, which then might push your bedtime a little bit later. And so it's heavily dependent on your exposures to light and dark, but there are other things as well,  because your body isn't just one circadian clock, it's a lot of clocks. So every organ in your body has a clock, like your kidney, your pancreas, your skin, and it's all regulated by one master clock in your brain. But that means that the timing of your meals, if and when you exercise, and a lot of environmental cues do play a role in getting you regulated and on a consistent pattern. So depending on when that child might eat their meals, how much activity they have, how much of it is outside, these are all things that will have implications for when their melatonin naturally begins to produce. 

SANDY: So how much sleep do we actually need?  

DR. DANIELLA: So that's a great question. So there are differences across development, right? For adults, I know everyone's probably heard that magic number is like somewhere between seven and eight, but the real answer is that it depends. Anything within six to ten hours can be considered normal if that person is functioning well during the day. But some people are naturally short sleepers, which means they can have six hours and they feel great. They're good to go. You know, they're, they're feeling well and doing well during the day. And then there are folks that are considered long sleepers that may need 10 to 12 hours in order to feel their best. So that number is going to vary person to person.  

DR. AMY: And for kids too?  

DR. DANIELLA: So for children, we have, we do have guidelines, but there is a little bit of flexibility, right? So in that newborn stage, like 16 to 18 hours. Adolescents can vary, because adolescents are also going through circadian changes. They tend to have what we call a delayed sleep phase. So they tend to go to bed later, want to rise later. But they're like within, you know, seven to 10 hours would be considered normal. So as you know, you know, sleep is important for growth. And so we need a lot more of it when we're young.

And as we get older, we spend less time sleeping and also just less time in slow-wave sleep, which is that, you know, part where that is so, has many implications for development, and even less REM sleep. So babies, when they, when they go to sleep, they actually jump into REM first, and half the time they spend asleep is in REM. And adults, we might only spend 25 percent of the night in REM, and I'm sorry, 25%, yeah, only 25 percent of the night in REM, and we don't start there.  

DR. AMY: Right, it takes several cycles to get to that point, right? Like it's towards the later half of the night.  

DR. DANIELLA: Yeah, that's right. So, we typically spend more time in REM in the second half of the night. So, in like those early hours of the morning, and that's why you usually only remember the dreams that happen maybe at like 4 or 5 a. m., maybe like right before you woke up.  

DR. AMY: So, speaking of dreams, let's talk about nightmares and how, well, first of all, why do we have them and how did they impact our sleep quality and our sleep hygiene in general? 

DR. DANIELLA: Yeah, so that's a great question. So dreams are just a typical part of our sleep experience, right? It's a product of us replaying events during the day, even consolidating memories. But sometimes when some of those dreams have themes that are disturbing to us so much so that we wake up and we're a little bit in a panic or we're disturbed. And sometimes the content itself doesn't need to be scary. You could be, I don't know, chopping onions in your kitchen, but if you have that intense feeling of fear, it could still count as a nightmare. Sometimes some of those dreams happen, and they may wake us up, they may not wake us up, and they do impair our sleep quality. If you're having nightmares, again, three times a week for an extended period of time between like that one- to three-month mark, then you'd even be considered, you know, having a nightmare disorder. So it's certainly not something that should be happening very often. The most common cause for nightmares is having actually PTSD or some other kind of mood condition. So some depression, anxiety, these things kind of go together.  

DR. AMY: So I notice that if the temperature in my bedroom is too hot that I am more likely to have a nightmare than if it's cool. And so am I just an outlier or have you seen that pattern?  

DR. DANIELLA: Yeah, you know, I can't say I've seen any, any research related to nightmares and room temperature. But we do know that there is an optimal temperature for sleep. So if you were to sleep in your room, the ideal temperature would be around in the sixties. Anything above 75 degrees would be considered, like, actually, like, probably impairing your sleep. But you just, you would need to be somewhere in the 60s to be comfortable, typically. So maybe what's happening is you're having these awakenings because it's a little bit more warm in the room. And, you know, they could, it could just be pairing with a nightmare.  

DR. AMY: So what is the science behind needing to sleep in a room with a temperature in the 60s? Because I can hear our listeners now going, that's expensive, right? So why should, why should cost not be a variable in deciding our nighttime temperature?  

DR. DANIELLA: Yes. Yeah. So, that's, so that's a good question. So we've kind of settled on this 60s number because research has shown that that's just the most consistent temperature that was correlated with optimal sleep. But we do know that going back to your circadian rhythm, in order for you to fall asleep, your body temperature actually has to drop. So having an ambient temperature that supports that body temperature dropping just tends to move things along better. Because our, our body temperature drops in order for us to fall asleep and it reaches its lowest point around 3 a. m., which is a very common wake up time for people in the middle of the night. And that's just one way that our circadian cycle kind of functions. 

DR. AMY: Fascinating. 

SANDY: So do you have like a never do this list for your clients, you know, like don't drink coffee past a certain time or no technology or, you know, do quiet things before you go to bed. Do you have like a list of things to kind of help clients get into like a sleep pattern? 

DR. DANIELLA: I do, I do. So I certainly encourage a lot of sunlight to help establish your circadian rhythm. So I know, you know, depending on where you are in the country, you know, this may be more accessible to some than others. But getting sunlight as soon as you wake up to kind of help set your rhythm. Something that is a real, like, you must, you must not do this, and this is especially for my remote workers, is spending too much time in bed when you're not sleeping. So, our brain, you know, we, we're conditioned, we make relationships naturally, and we want to make sure that there is a relationship between our bed and sleepiness. So if we spend a lot of time in our bed working, eating, stressing out, worrying, like doing other things other than sleeping, we lose a little bit of that automaticity that we want at night, right? We want to go to bed and fall asleep in 3.2 seconds flat. Like, that is the ideal. And if that happens for you, that means that your relationship with bed and sleepiness is probably pretty strong. But if it doesn't happen, then we do different things. We modify our schedules so that we can strengthen that relationship. And one of them is only being in bed when you're actually asleep. There are exceptions to that. 

DR. AMY: There's some what? I'm sorry, I interrupted you. 

DR. DANIELLA: The only exception to that is having, like, intercourse with your partner. Like, that's the only thing that sleep psychologists say, okay. That's like the one thing you can do other than sleep.

DR. AMY: Sleep and sex, got it. 

DR. DANIELLA: Yeah.  

DR. AMY: So what about blue light? There's so much information about not being exposed to blue light, you know, within a certain number of hours before bed or, you know, what's the science say?  

DR. DANIELLA: Yeah, so that's, so that's a very good point. So blue light suppresses your body's release of melatonin. So I mentioned that, you know, with light and dark, melatonin is produced or it's inhibited. And that blue light signals to your brain that it's, that it's like the daytime. So, this has a lot of implications, especially if you're on like a handheld device or something that you're holding really close to your face, like a cell phone or a tablet. And so it does impede our body's ability to release melatonin because we get these mixed signals. You know, our body and our sleep hunger, this other drive that regulates sleep, is telling us we're tired and we're sleepy and we want to go to bed. But then, you know, these, where the light transmitters that we're getting is telling us, “No, it's daytime, stay awake.” So we want to make sure that we're avoiding blue light late at night because it can influence circadian rhythm, your alertness, your heart rate, all those things. And not just through the light, but, you know, these devices are very stimulating. You know, so if you're scrolling and clicking, it's really activating because you're probably thinking about things. Maybe it's the news, maybe it's your personal life. And it can be hard to wind down when your mind is kind of going, you know, 70 miles a minute. 

DR. AMY: All right. So full disclosure here.  My husband and I made a decision about 10 years ago that we did not want a television in our bedroom, and so we don't have a television in our bedroom. But what has happened is we both go to bed with our tablets, and so I watch something on my tablet and he watches something on his tablet. And so it kind of defeats the purpose of not having the television in the bedroom, but it's just this pattern that we have found ourselves in. So what I'm hearing you say is that because the proximity of the tablet to our faces, it makes a difference in our sleep quality or our release of melatonin or our circadian rhythm. And so it might be better to have a television on the other side of the room after all, or should we not have anything in the bedroom? 

DR. DANIELLA: Yeah, I would probably argue the latter, right? We should avoid screen time right before bed. So in those 30 minutes to maybe an hour, depending on, you know, how you're doing, I would limit any electronic usage. I'm totally on board with you with not having a TV in the bedroom. And having that in a different area of your room. Because let's be honest, if you put it in your bedroom, like, it's not gonna be there for decoration. You're gonna watch it. And the same thing goes for tablets. You can still have some of your tablet time, but maybe moving it to a different room and maybe just moving it a little bit earlier in your day or in your night schedule. So you don't have to do away with the things that you love entirely, but just finding maybe one other thing to do between tablet time and bedtime to help you transition. 

SANDY: So you've talked a lot about circadian rhythms, right? Let's talk about circadian rhythm disorders. I'm sure there are lots of things that can throw that off. You've talked about sunlight exposure and, you know, we've talked about blue light, all those kinds of things. But how do you help people whose biological clock is thrown off by like night shift work, for example. New moms, you mentioned at the very beginning where your sleep patterns are just thrown all out of whack, or excessive travel. How do you help those individuals?  

DR. DANIELLA: Yeah, so that's a great question. So when it comes to circadian rhythm disorders, it really depends on what's in front of me, right? So sometimes, let's say I have a teenager who has a delayed sleep phase disorder. And they have it because, you know, maybe they already had some pre-existing insomnia. It was brought on by puberty and there are these very real hormonal changes that are just shifting their sleep backwards, or back in the night. So what we want to do is advance that sleep forward, right? So that it makes more sense with like their school schedule. And so some of the things that we would do is we would probably still implement the same CBTI principles, right, these cognitive behavioral principles, the sleep hygiene. But we would also like to start implementing things like light therapy or chronotherapy, where we start shifting that sleep back little by little until we're at our desired bedtime. Now we do this with actually being out in the sunlight first thing in the morning, or if that's not a possibility, let's say, you know, just on unrealistic, you live in an unsafe neighborhood or the weather is not permitting, there are light boxes. And so getting a light box that has at least 10,000 Lux can help. It needs to be very, very strong light, and spending at least 30 minutes in that light. And then in the evening, actually supplementing with half a milligram of melatonin. And I, you know, melatonin is a very hot, hot topic. And for the record, I do not recommend it for everyone or everything because there are definitely misuses to it, or incorrect usage, you know, in our, in our society. But for circadian rhythm disorders, melatonin does have a place, because it does help shift that sleep forward, which is what it's intended for. It's intended to help shift your sleep forward, not put you out to sleep, if that makes sense.  

DR. AMY: All right, so can you talk a little bit more about melatonin? Because a lot of people use it?  

DR. DANIELLA: Yeah, yeah, absolutely. And I think a lot of folks take it thinking it's going to make me fall asleep, but it's not a hypnotic drug. It's not something like Trazodone or Ambien. It's like a chronohypnotic. It's something that we use to bring your sleep forward, but it doesn't work instantaneously. So, for, let's say, let's say you're traveling and you're in a time zone that's six hours ahead of what you're used to, we'd want you to take that melatonin. And when I say melatonin I mean like a milligram or less, three hours before you intend to be asleep. So we want to take it well ahead of time. We don't want to take it right at bedtime, and we definitely don't want to take more than a milligram. Naturally your brain produces about half a milligram on its own, and that is technically sufficient to put you to sleep. But what we see now is that there's a lot of, you know, a lot of companies that are making these five milligram gummies, even these 10 milligram gummies, and that's just too much. Now, there is no addictive quality to melatonin. Maybe in like a psychological sense, we can become a little dependent, you know, if we think, “I can only go to sleep if I take my melatonin.” You know, and that's a little bit of a placebo effect. So there's that. But we don't want to be taking too much because then we might feel nauseous, you know, the next day we may feel groggy. It just wouldn't work the way we would want it to.  

DR. AMY: Does it impact our pineal glands ability to regulate our own melatonin production? Does it have any impact on that?  

DR. DANIELLA: You know, there's no research indicating that right now. I know with other hormones, like with estrogen, like there's some research that's, you know, indicating, you know, if you start taking some of those things, then your body may stop producing. With melatonin, we're not quite there yet. You know, so no definitive statements. You know, the side effects are mild. Worst-case scenario is that you're taking too much and just not feeling your best and just not getting the effects that you want. And so what often happens, or like the case of the children that ate like a whole bottle of gummies because they thought it was candy, right? So,  you know, we want to, you just want to approach it, have a measured approach, and just try to do what we know through science is effective for improving your sleep. Melatonin can be used, and again, if you have like shift-work disorder, delayed sleep phase, even for jet lag, but it's not meant for chronic use. So if you've been taking it for more than two weeks every night, then I would say, and you're still having like sleep problems, I would say your melatonin probably isn't working the way that you want it to. And let's try something different.  

DR. AMY: Can you talk about nightlights for kids?  

DR. DANIELLA: Oh yes, I'm sorry, nightlights? 

DR. AMY: Nightlights. Let's talk about nightlights for kids.  

DR. DANIELLA: Okay. Yeah, so there are these nightlights now that are using this red light instead of blue light. So those are the ones that are being like, promoted now as, you know, things that can help, like, for example, if your child needs to get up and use the restroom in the middle of the night, it can help, like, light the path. And those, you know, they don't signal for the release of melanopsin, which is that, which is the one that counteracts melatonin. Melanopsin tells you, “Hey, it's daytime.” Melatonin is, “Hey, it's time to go to sleep.” So as far as nightlights, I'm not opposed to them, but if you want to optimize your use, I would use the ones that have more of like a red light instead of the blue light. 

SANDY: Funny story, so we got this night, this alarm clock, a digital alarm clock when we opened up a checking account moons ago. But it had red digital numbers on it, and we have kept on to that clock forever because it, when you go to shop for digital clocks anymore, they always have the blue light and it’s jarring. And so we have kept this ancient alarm clock just because of the red numbers on it for that purpose. It's just, it's very soothing it that you can look at the clock when you wake up and see the time and go right back to sleep. It's not glaring at you. So that's my two cents for if you can find a digital clock that has red digital numbers on it. You'll be so thankful. 

DR. DANIELLA: Yeah. Well, the, the hues of red, orange, and yellow are just better for preparing the mind and body for sleep. So if you found something that works for you, then that's great.  

SANDY: So you had mentioned CBTI. Correct? When we were talking a little bit about sleep disorders, what is that? What does that look like? Is that a common place practice for people who struggle with sleep issues? Tell us more about that. 

DR. DANIELLA: Yeah. So CBTI stands for cognitive behavioral treatment of insomnia. And it's, a treatment that's implemented through a mental health provider. It's actually considered gold-standard treatment for insomnia. So even physicians know, you know, I should prescribe CBT before I prescribe a sleeping pill. Now what I've found in my work is, you know, if you're not in psychology, like you don't know this exists, you know? It just doesn't get the same marketing, you know, as some of these like sleeping pill options, but it has been found to be more effective because if we're being honest, you know, and there's nothing wrong with medication, there's a time and place for everything. But medications are treating the symptoms of insomnia, they're not necessarily treating the causes. And what CBTI does is it works at the very root of the cause to help improve your sleep. And the skills that you learn are lifelong. And so maybe I help you through this rough patch of sleep, you know, in these like six to eight sessions, but let's say six months from now you run into another rough patch, as we all do. Because we all, you know, either get sick or travel or, you know, have chronic stress, now you have all these tools in your pocket and you can implement them yourself and you can keep your rough patch of sleep from becoming a month, three months, or even longer. And so, as the name implies, we do behavioral approaches, so what you're doing around your sleep, what is your routine, how regular is it, and there's cognitive approaches, so a lot of cognitive therapy. You know, do you have any sleep related anxiety? Do you have any sleep related thoughts that are impeding your ability to fall asleep? Do you get in bed, are you sleepy on the couch, and then you get in bed, and now your mind is racing, and you don't know why your sleepiness just disappeared. So, working with those kinds of strategies to help improve your sleep. And we know it works because we measure your sleep week in and week out. So, there is a little bit of homework. All clients have to like fill out a sleep log and just closely monitor week to week when they're going to bed, when they're falling asleep. And with that we can identify patterns, issues that come up. It just gives us so much data to pull from and this number called your sleep efficiency.  And that number, what that tells us is like basically how good you are at sleeping. So let's say I spend 10 hours in bed, but I'm only asleep for 5 of them, my sleep efficiency is 50%. Okay, so it's a very simple math, but, and then we make modifications, and ideally we get you to 85 percent or, or above. Because that would put you in that normal to like good sleeper range.  

DR. AMY: And would you do CBTI with children and adults?  

DR. DANIELLA: Absolutely. Yeah. Yeah, absolutely. You can do CBTI with children and adults. Now, with kids, you know, sometimes there's other things that come up, you know, like bedtime departures, like wanting to like leave your bed. You know, there's nightmares, there's enuresis, or like wetting the bed. There's lots of like other things that come up with kids, so you do need to have that kind of toolbox to be able to work with, you know, a client that also might be afraid of the dark or think there's like a boogeyman under the bed. So, there's a little bit more involved with children, because you're working with them and their parents. But yes, this is for, for children and adults.  

DR. AMY: All right, so we need to take a break. Oh, sorry. Do we not want to take a break? No, I'll take a break. Okay. All right. Let's take a quick break. Let Sandy read a word from our sponsor. And when we come back, I want to get your opinion on noise machines, white noise machines, when we come back. 

SANDY: Throughout her life, Aubrey's doctors had told her that she had cognitive issues, which affected her academic performance, confidence, and socialization. Her mom says, “We spent so many evenings at the kitchen table with her crying. Her friends were out playing and she wasn't able to go because she had so much homework.” Her mom enrolled Aubrey in a cognitive skills training program at LearningRx. Very soon, Aubrey was no longer bringing homework home because she had completed it at school. After graduating from LearningRx, her test anxiety disappeared and she is thriving now. While your child may or may not achieve these same results, LearningRx would be happy to work with you to get answers about your child's struggles with learning. Get started at LearningRx.com or head to our show notes for links for more helpful resources.  

DR. AMY: Okay, so we are continuing our conversation with health psychologist, Dr. DR. DANIELLA Marchetti, about sleep problems, sleep disorders, common solutions. But I want to talk a little bit about white noise machines. I know several people who swear they cannot sleep without white noise in the background. But I also know that some white noise machines operate on a frequency that can actually activate the sympathetic nervous system, which I would think would make sleep even harder. So give us your take on white noise machines. What you got?  

DR. DANIELLA: Yeah. So the jury's still out on, on white noise machines, right? So we definitely need more research, um, to confirm whether white noise actually improves sleep. So we have found that it can help newborn babies fall asleep faster. So that is something that the research has found. But you're right, it can be disturbing to a lot of people. And so it's very case by case. For folks that, let's say, prefer to have, like, the TV going on all night in the background because they feel like they need something or it's too quiet, I often find that those are the patients or clients that might benefit from maybe replacing that TV with a white noise machine. But then there are some folks that, like, it's super disturbing to them, they can't sleep with it, and they maybe would benefit more from earplugs, you know, if there are other things that are waking them up in the night. But we primarily recommend when there are things in the sleep environment that are waking them up maybe in the middle of the night. Whether it's like a pet or if they live in an urban area and there's like a lot of street noise, you know, rowdy neighbors, or if you're in an apartment building, sometimes that white noise can mask some of these other things that could rouse you if you're going through that stage one or stage two of sleep. So we might recommend it in those cases, as well as in the cases of those who might have tinnitus, because tinnitus can be really disturbing when you're trying to fall asleep. And so if you can put some white noise on, it can help because they're, it's like they're focusing on a different noise other than, you know, the ringing in their ear. And then that's preferable. So yeah, the jury's out. It can be beneficial for some people, it can be harmful for others. So I tend to take a, you know, case by case approach when it comes to making that recommendation.  

SANDY: I know my son would always  listen to books on tape, but it always had to be books on tape he knew already so that he wasn't really following the story. It was just sort of this white noise or background noise and if he fell asleep, it wasn't a big deal. He didn't miss anything. What's going to happen next. But he, from the get go, when he was a kid, always needed to have music or something going on in the background. Is there a reason why is that something, you know, for some people, the brain just needs that extra task or attentional piece to help quiet or focus into that sleep space?

DR. DANIELLA: It's funny that you mention that about the book also. I just want to mention, because usually it's the TV people are putting on programs are already familiar with too, right? They're not putting on a movie they really want to watch. It's just, you know, background noise. And so the theory is, is that sometimes, you know, some folks can benefit from white noise because they think that it could synchronize brain waves. But, you know, that's something, again, that's just a theory. Nothing has been proven yet. We just know that there's some people that have a propensity for needing something else  to be almost like a little bit soothing or maybe a distraction from thoughts or something to focus on. And other folks need it to be pin quiet. 

SANDY: That's both of my children. I got the yin and the yang. 

DR. AMY: Well, it's funny because my husband—

SANDY: I'm like, DR. AMY. I'm like DR. AMY. I'm asleep. The minute my head hits the pillow. I'm out. 

DR. AMY: My husband, he will … He loves the sound of rain and, or the sound of the ocean on instead of plain white noise. Like that's the type of background sounds that he prefers to listen to. But it actually stirs me up. And so, but I also have misophonia. So hearing noises  can set off a fight-or-flight response. So maybe again, I'm an outlier there as well. Do you have a recommendation on mattress firmness? The types of pillows that would maximize sleep, or again, is this subjective? 

DR. DANIELLA: Yeah, so there, there is some research on the ergonomics of sleep. And so, and there's like a whole field of folks devoted to this. And so I've had the privilege of attending one or two seminars on the subject and I do feel pretty strongly about it. The truth is that most people sleep well with an intermediate mattress. So folks who need it to be too firm or too soft, those are definitely, like, outliers and might be folks that might have like, chronic conditions, back pain, you know, other things to consider. But what can be really beneficial is getting a cooling mattress. So there's a lot of technology now. You know, I mentioned the importance of temperature, right, for helping you fall asleep and how we need, you know, it to be a little bit cooler when we're falling asleep. And so having, you know, mattresses and comforters that are, you know, responding to that, responsive to cooling in your environment, cause, especially depending where you live, you know, sometimes whatever's going on outside will seep in to your house, no matter how well controlled your AC is. So having a mattress with cooling technology is great as far as like pillows, there is like an optimal angle depending on your body type, for like how like tall or firm your neck pillow should be. You would have to go into some of these stores and actually get an assessment and they could tell you. But as a rule of thumb, you want that your sleeping position to mimic your posture standing up, okay, as much as you can. Now, I know that some of us are side sleepers, some of us sleep on our stomachs, you know, so there's different positions you might be in, but generally you want your posture sleeping to parallel what it would be like standing up. So, play around with different pillows and see which one gets you closest to what that would be like.  

DR. AMY: Yeah, I love the cooling pillows and the cooling mattress. covers and, but you know, I'm also in my fifties. And so there's a hormonal aspect to that as well, I would think. But again, we talk about optimal body temperature, right? And so if that can help get us there, then why not use those external supports?  

DR. DANIELLA: Yeah, I will say this. I often find, like, a lot of my patients, you know, have already, like, invested in really expensive mattresses, you know, hoping that that's a sleep solution. And so all of this, like, stuff on the periphery, like your sleep environment, it is important, and it's very much like an insurance policy. But I always, you know, I tell folks, you know, there's no mattress or pillow that's going to solve your sleep problem. If you have clinical insomnia and more than just like a rough patch, then you really need to do some different kind of work.  

DR. AMY: Absolutely. So what about sleep trackers? We see the Oura ring. We see, you know, the, the sleep apps on our Apple watches. Is there a benefit to, to tracking sleep using those types of devices?  

DR. DANIELLA: Yeah. So, there is a place for trackers. I'll say a few different things. Sleep trackers are great if you are, like, trying to figure out, you know, maybe when you're, when you're falling asleep. The thing is, is that right now where the technology is at, it's a little, they're a little bit inaccurate. So depending what you're using, it's probably underestimating your sleep stages because, you know, it's not an EEG. It's not connected to your brainwaves, right? So it might not be totally accurate in that regard, and it may, it may overestimate how many, how many times you're awake because there's some of us that move around in our sleep. And so if you're wearing a Fitbit and you're moving around in your sleep, now it thinks that you woke up. You know, it might think that you're awake. And so if you look at your tracker, you might see a lot of little arousals, you know, around like 3 or 4 or 5 a. m. But maybe you were asleep the whole time and you were just moving around.

So they're not totally accurate. And sleep scores, you know, I've seen people who've gotten 100 on their sleep score, but they really didn't sleep well the night before, so sometimes they don't line up really well. Believe it or not, the best way to track your sleep is a paper pencil method, just a sleep log and writing things down as best you can. Obviously we can't tell when we fall asleep exactly because we've fallen asleep and we probably shouldn't be looking at clocks in the middle of the night. But guesstimating and writing paper pencil is how we do it in the sleep world, you know? I don't tell my patients like go get an Oura ring or any of these things. Because one, they're expensive and they're not totally necessary for treatment, you know? The log is enough. Now, are they fun to use? Yeah, they're fun. Like, I, like, I would love to have an Oura ring just so that I could, you know, know. And the Oura ring is recommended, I think, as, like the best overall sleep tracker at this point because it's also really lightweight, you know, it's just a ring. And so folks who might wear, like a Fitbit or even an Apple Watch, if you're wearing that when you sleep and you're moving around, it might wake you up, it could be bulky. There's a lot of different kinds out there. There's trackers that you can lie flat, like right under your sheet, so it detects you when you're on the bed. You know, there are some that you wear as like a visor. So there's a lot of different options out there. Yeah, but I, I don't think that they're necessary if you're trying to change your sleep. 

DR. AMY: So what I'm hearing you say is that movement doesn't necessarily correlate to sleep quality. 

DR. DANIELLA: No, no, it doesn't. Some of us move a lot. Some of us don't move at all. Some of us act out our dreams. Some of us don't. You know, if the movement is now hampering, let's say, like, if you have a bed partner, then that's a different issue, right? And then we have to like work around that. Or if your movement is now getting to a place where it's like unsafe because you're falling off the bed, and that's something else too. But if you move around in your sleep and you feel really great when you wake up, then it may not necessarily be an issue.  

DR. AMY: All right, so to clarify, what you're saying is your partner's movement might impede your sleep quality, but your movement is not correlated with your sleep quality.  

DR. DANIELLA: Yeah, that's very true. So sleep is often a dyadic process, right? A lot of us sleep with a bed partner and we underestimate how important that other partner's role is in our own sleep. You know, as I'm sure you've probably observed in your own lives, like what they do matters, you know. If they're falling asleep earlier than you or after you, or if they're having insomnia and you don't have insomnia, their insomnia could start waking you up and start giving you problems. So it's often very much a group effort to try to get, you know, sleep at a good place for both people.  

DR. AMY: Okay, so let's go back to CBTI, if our listeners are recognizing that, “Hey, I might actually have a sleep issue here.” Where would they search out a provider of CBTI?

DR. DANIELLA: Sure, so they would look for a behavioral sleep medicine specialist. So you can always go to the BSM directory online if you're trying to find someone in your area. I, myself, you know, I see patients across 42 states now. So I'm PSYPACT certified and so if you're in one of those states and you want to work with me, then they can always find me at my website, DR. DANIELLAmarchetti.com. But if they'd like to work with someone else or if it's a state where I'm not offering services, then certainly a BSM directory would help you find somebody that has spent, you know, a significant amount of hours in this work, someone that's done the correct amount of CEs, that would be the best way to find someone.

DR. AMY: So I'm hearing you say that it's available, you offer it through teletherapy so they don't actually have to live near you to come see you. 

DR. DANIELLA: That's right. Yes, I offer teletherapy. So I find that it helps make it accessible to folks cause I can offer weekend hours and night hours and for folks at work or have children, you know, oftentimes that's what really works best. I like the flexibility, I guess. 

DR. AMY: Do people have to have a sleep study first, or is this based on self-reported symptoms and behavioral patterns?  

DR. DANIELLA: Yeah, they do not need a sleep study because as long as they meet the criteria, like the DSM criteria for clinical insomnia, which we indicated earlier in the session, they can be treated for insomnia. Now what might happen is, let's say we start seeing each other and if they, tell me about other symptoms, like they're snoring or having interrupted breathing in the night or they have restless leg. If they have other things happening, I might say, “Hey, it might be a good idea for you to get a sleep study just so we can rule out some other sleep disorders as well.” And then I would give a referral to, you know, to someone that would do a sleep study.  But you don't need it for CBTI.

SANDY: Is that the first stop? Do you recommend CBT as the first initial phase, or would a sleep study be the first initial phase? That's kind of what he knew, I think was driving. You don't need one or the other. But if someone is just getting into this journey, cause you mentioned at the very beginning that, you know, if it's been going on for about a month or longer, it's probably time to start thinking about getting some help. So, what would be the first phase? 

DR. DANIELLA: Yeah, I think the first step is to get a consultation with a BSM specialist, right? So conducting an intake and then going from there, because the truth is that sleep studies are pretty costly. They might set you back a thousand dollars and there may not be a reason for it. And it is a little invasive, you know, oftentimes, you know, all children have to do a sleep study in lab, in a hospital. That’s what the ASM recommends. Adults can do sometimes their sleep study at home or in a hospital. But you know, it's very labor intensive. They're connected to all these wires. It's uncomfortable. And it, again—

SANDY: Which is weird because you're not going to get a normal night's sleep that way. Like from a diagnostic perspective, that's so strange. 

DR. DANIELLA: Yeah, it makes it very challenging. So just because it is so costly and again, it may not be necessary. It's not a first stop.  I would say a consultation first and then go from there. Because if there is a need for a sleep study, no one's going to hesitate to send you.  

DR. AMY: So is there anything you'd like to leave our listeners with that you haven't gotten to say today?  

DR. DANIELLA: Yeah, you know, it would be that, you know, as soon as you start having, you know, any kind of sleep issue, you know, talk about it. Because I think that poor sleep is something that's normalized in our culture, you know, we're very productivity centered, and I feel like mothers in particular are often told that that's the norm. You know, as soon as they have children, it's like, “Oh, you'll never sleep again.” You know, but it's not. Just because it's common doesn't mean that we should settle. And so anyone who is having any subpar sleep, if they're not getting what they need, if it's not restorative, you know, please make sure that you seek out help, whoever it may be, because it is foundational for your health. Not only your like physical health, but your cognitive health. Because we know that insomnia does predict hypertension, diabetes, dementia, Alzheimer's, you know, later on in life. And so, and the number one thing that predicts that is how regular your sleep is. So maintaining a steady bedtime and a steady wake time is probably the number one thing that you can do to make sure that you have good sleep health. So I encourage you all to, you know, seek help when you need it and talk about it and let people know that there are options. It doesn't have to be insomnia or a sleeping pill. There can be other options too.  

DR. AMY: Awesome. Dr. Daniela Marchetti, thank you so much for joining us today to share your wisdom on sleep. Listeners, if you would like to connect with Dr. Marchetti, you can visit her website, drdaniellamarchetti.com, which is M A R C H E T T I. She's on Instagram at @DrDaniellaMarchetti. We will put those links in our show notes as well. So you don't have to remember how to spell it at the moment.  So thank you so much for listening today. If you liked our show, we would love it if you would leave us a five-star rating and review on Apple podcasts. Please follow us on social media at the brainy moms. You can also find Sandy on TikTok at the Brain Trainer Lady. And if you would rather see our faces, we are also on YouTube at the Brainy Moms. That is all the smart stuff that we have for you today. So we're going to catch you next time.  

DR. DANIELLA: Thank you.