192: Dr. Jennifer Giordano, Tapering Sleep Medications (Like Benzos & Z-drugs): A Psychiatrist’s Guide to Thoughtful and Safe Deprescribing

 Welcome to the sleep as a skill podcast. My name is Mollie Eastman. I am the founder of sleep as a skill, a company that optimizes sleep through technology, accountability, and behavioral change as an ex sleep sufferer turned sleep course creator. I am on a mission to transform the way the world. thinks about sleep.

‍

Each week I'll be interviewing world class experts ranging from researchers, doctors, innovators, and thought leaders to give actionable tips and strategies that you can implement to become a more skillful sleeper. Ultimately, I believe that living a circadian aligned lifestyle is going to be one of the biggest trends in wellness.

‍

And I'm committed to keeping you up to date on all the things that you can do today to transform your circadian health and by extension, allowing you to sleep and live better than ever before.

‍

Welcome to today's episode of sleep is a skill podcast. Today's topic is near and dear to my heart. I watch close family members suffer getting off of benzos and in my own experience with my sleep, even getting off of benzos after a short term period of time was still a really challenging period of my own life.

‍

So this is why we're going to explore how we can thoughtfully and. safely taper off of sleep medications, of course, with the help of professionals. So to help us unpack this, we're joined by Dr. Jennifer Giordano or as her patients lovingly call her Dr. G. She's a psychiatrist with a heart for holistic mental health and has dedicated her work to empowering people who want to take back control of their wellbeing by reducing or coming off of psychiatric medications altogether.

‍

So Dr. G saw a huge gap in the medical world when it came to helping patients. Safely taper off medications, and she made it her mission to change that over the years. She's worked closely with hundreds of people, guiding them through the process with care and compassion. In this episode, we'll talk about what tapering actually looks like, why going too fast can be risky and how to find the right professionals to support you along the way.

‍

If you or someone you love has been thinking about tapering off of sleep medications, this episode is here to offer insights, practical tips, and most importantly, hope. Now let's get into the podcast, but first a few words from our sponsors. And again, these sponsors really do keep this podcast alive. So please check out their offerings.

‍

Important question. Can you see the hand in front of your face in your bedroom? If so, you need to hear about our sponsor who is revolutionizing the blackout shade space and finally making it easy and affordable to get a truly blacked out bedroom. So challenging in the past, right? So introducing you block out the ultimate solution for creating the perfect sleep environment, ensuring total darkness, comfort and control.

‍

So why you block out in particular? Well, 100 percent blackout guarantee comes with this product provides temperature comfort all year round. So you keep your room warmer in the winter and cooler in the summer. You block out helps in enhancing your sleep quality by maintaining a comfortable temperature regardless of the season.

‍

Acoustic noise reduction. Enjoy a quieter sleeping environment with uBlockout shades designed to minimize external sounds that can disrupt your peace. Ideal for urban dwellers or anyone looking to reduce noise pollution. Customizable and easy to install. Tailored to fit your space with a simple 30 minute installation process, uBlockout makes it hassle free to achieve the perfect sleep setting, ensuring your bedroom is a sanctuary for sleep and for listeners of the sleep is a skill podcast.

‍

Use the code sleep is a skill for exclusive 10 percent off and embark on the journey to unparalleled sleep quality. Remember, light is the number one external factor affecting our sleep. With you block out, you're not just investing in a blackout shade. You're investing in your health, wellbeing, and quality of life.

‍

So again, go to you block out spelled the letter you. block out and use code sleep as a skill for a discount  and welcome to the sleep is a skill podcast. Wow. This is going to be a big, big topic. I have a real personal, I guess you could put it as a personal mission to get the information out for people around.

‍

What do we do when we're thinking about tapering or curious around tapering medication specifically for sleep? How do we set ourselves up powerfully? Who are the people that we align with? How do we think about this in a thoughtful manner? It's a big topic, big one, and we really want to set people up for success.

‍

So we are really, really grateful to have our guest on the podcast today. Thank you so much for taking the time to be here. My pleasure. Thank you so much for having me today. I appreciate it. Oh, well, I know before we even hit record, we had all kinds of things to, that we were connecting on. So really excited to get in this conversation with you today, but maybe you can share a little bit of a background on you and how you came to be really finding yourself with this level of expertise around, you know, many areas in your field, but also in the world of tapering medications.

‍

Happy to do that. So yeah, my name is Dr. Jennifer Giordano. Um, I'm a psychiatrist and I am someone who specializes in deeper, de prescribing psychiatric medications. So that means tapering or coming off psychiatric medications. So I'm meeting people at the other end of some of their entrance into the mental health.

‍

stream or system.  Um, how did I get into this?  I've always, I've always been interested in  minimizing medications. Um, that's just kind of my natural  outlook on life. I've been just more of a natural kind of person. I've always liked to keep it, you know,  a little bit on the, um, minimalist side of things. So, and it started in residency.

‍

I think when I started to notice, you know, our education was very medication centric. You know, we learned all about those kinds of interventions  with a disproportionate amount of time spent on any other kind of interventions that can be done to help somebody. And I think intuitively,  most people  Want to avoid medications when possible.

‍

Yeah. Um, so that was kind of my outlook from the very beginning. And then,  you know, going throughout my career, kind of having that kind of same adage and for myself, helping myself, you know, with my own mental health throughout.  major stress times, you know, residency, medical school, all that kind of stuff.

‍

And in that process, also learning about  what worked and what didn't work, um, and then,  and so having that outlook from the very beginning,  and then it came to my awareness about four years ago that there was a  quiet, but building movement around.  discontinuing or tapering psychiatric medications.  And then I took a personal deep dive of educating myself about that.

‍

Um, and learned a lot about what was happening with people out there in the world and their struggles to get off medications. I knew plenty about helping people get on medications and doses and classes and all that kind of stuff. We certainly learn all about that in medical training and psychiatric training.

‍

And we learned extremely little about what it was like for people to come off these medications.  And so think, I mean, thanks to the advent of the internet and then the online peer based support communities that have evolved and developed out of people basically just raising their voices in their own experience of trying psychoactive, psychotropic, psychiatric medications.

‍

It's not what we thought, I think is what I would say. It's not what we're telling people, I can tell you that. I mean, true informed consent is sadly quite  rare. Yeah. Almost impossible based on what you're taught in medical school and residency.  You know, we aren't talked about protracted withdrawal, which means long term withdrawal symptoms that can last for a long period of time after stopping a medication.

‍

We're given terms like discontinuation syndrome. Yes. Like it's in your head or something, or yes.  It sounds so benign, right? Yeah. And really it's just kind of a, a watered down way of saying withdrawal. Yes. And we, we recognize that we tend to recognize withdrawal. for medications. I mean, certainly we understand for,  you know,  street drugs, okay?

‍

You know, medications or drugs or substances that people are addicted to and are abusing. We seem to kind of know, okay, well, if you abruptly stop those, yeah, you can go into withdrawal. If you abruptly stop drinking alcohol, you know, when you've been using it for a long time and daily and increasing amounts, you can have severe life threatening withdrawal symptoms.

‍

So psychoactive substances like that, we understand, um, even opiates now we kind of, and I think more and more understanding about the benzodiazepines, that there's, there's definite, you know, withdrawal potential.  Well, I would say my experience, particularly after the last four years through personally working with probably, you know, a few hundred people, and then there, you don't have to go far at all.

‍

To find on the internet about the struggles that people are having about it in coming off the other classes of  medications as well, the ones that we would typically deem not,  you know, without having the risk of dependence, we would typically deem them as, Oh, yeah, that's the ones that we say, Oh, you could have a discontinuation syndrome.

‍

I would now propose  very strongly that Any psychoactive substance that you are taking on a daily basis  has the  clear possibility of creating a physiological dependence in your body, which basically means if you then try to stop it abruptly or change the dose abruptly, that you'll suffer from withdrawal symptoms.

‍

So that was,  that, that was kind of how things evolved for me. And it was kind of accidental too, because I was also working in a,  a framework where it was more of a holistic approach to psychiatry. Well, naturally when people start doing the holistic approach, they start getting better and they start wanting to, to decrease their medications or come off.

‍

So it also kind of dovetailed with this certain approach too, that I was  kind of taking  Just more methodically and then naturally you're trying to help people come off and you start to see these.  So it's been a fascinating,  eye opening,  you know, career changing kind of, um,  experience. It's actually made me  enjoy being a psychiatrist in really helping people find true freedom.

‍

Because something intuitively also, you start to know, you know, when you're, when you're focused solely on just the medications as the intervention.  There's something that you intuitively kind of start to realize, like, is this really getting at the root issue? Is this the really, is this really the long term solution?

‍

And you would see time and time again that it, you know. It wouldn't, it wouldn't be. Right. People's medications poop out. There's,  yeah, it's, it would become a never, never ending, you know, kind of  puzzle trying to figure out, okay, which concoction of,  of, you know,  medications were going to work. And it's,  yeah, it was definitely a fascinating kind of pivot.

‍

And then. Um, the other key  piece of the puzzle for me was to finally listen to and believe the people I was working with.  Yeah. There's something about the medical scenario where, and I only know this because I used to do it. Yeah. Right. So, you know, so I'm not trying to throw shade, but it's, yeah,  the, the way medical education is imparted.

‍

in the West is it's very, very,  it's very authoritarian. Sure. It's very, like, almost like a dogma. Like, this is the only way it is. This is the only way it can be. Yes. And the assertion of, and it is this way for you, rather than the true openness to listening to, wait a minute, what is this individual's actual life experience?

‍

And then believing them, you know, and that was the other piece of the puzzle to actually believing that that could actually happen was  total change in my experience of being experience and practice of being in the role of a. Psychiatrist. Wow. Well, I'm so grateful that you made that pivot and because that's one of the things that we've seen for people when they, they found themselves in a situation where they're taking something and they've been taking it for a long enough period of time where now there's, you know, maybe fear or concern of what would happen if they're to embark on tapering off of these, but who to go to, to do that and to guide them and to get it and to be thoughtful about it.

‍

I think maybe that could potentially be a place for us to begin is in the conversation, at least around sleep and medications. What are some of the medications that you're finding people coming to you with that they've been taking specifically for sleep and now have that question of what to do? How do we get off of these?

‍

And what are some of the common ones that you see? And how do you help people think about this? I mean, we've had people come our way, you know, we always refer out to different individuals that can help them mindfully and thoughtfully just create a plan for this. And as we know that some of these plans can be a long time.

‍

And so we really want to set ourselves up for success here. But unfortunately, we see people coming our way that have tried going to some of these. You know, fly by the night clinics and they get off of some of these very strong, powerful drugs in a short period of time. So what is the right way to think about this?

‍

Or what do we know at the moment? And what are some of the common drugs that you see people coming your way with around sleep? Yeah, this is a great question. Excellent question.  Just kind of start for in the area where you ended the duration of tapers of these kinds of medications  is way longer  than your traditional doctor will warn you about or guide you through.

‍

That's the sad state of affairs that we're presently in, I feel, in this country, is that  for many people abrupt changes, decreases, or, or God forbid cold turkeying,  medications,  can be extremely, extremely,  potentially dangerous. Yeah. And or,  if not that, severely debilitating. Yes. So, um,  and  tapers, like to give you an example, I mean, and I've only been doing this work for almost four years.

‍

I've now seen many people complete many tapers. Yeah. And I will tell you, time frame, years. Yes. Not weeks. Not cut it in half for a couple of weeks and cut it in half again.  Not months. I wish it was. I wish I was doing out like plans and schedules for people of like, hey Yeah, a few months. Awesome. Let's celebrate.

‍

No, it's it is years.  So, like, for example, you're asking about medications, something like Klonopin. Tapering, tapering one milligram of Klonopin commonly takes over a year. One  milligram. Yeah. Um, it depends on the person. It depends on how long they've been on it. It depends on their history of how, of how many other medications and for how long they've been on those.

‍

Other things, their own personal health, whatever they're going through in their. you know, life personally as well, you know, how much stress they're under.  But that's not an uncommon time frame, if not potentially longer, independent, again, you know, depending on duration of exposure to the medication. The longer a person has been on a medication or exposed to it, the longer a taper takes.

‍

So somebody who's been on, you know, a benzodiazepine for a year, it's different than the taper who, than someone who's been on it for 20 or 30 years. Yeah, so you slow it every so what you do is slowing everything down. That's how  The brain seems to be able to adjust to these changes  because we can't go into a live human brain and open it up and dissect it and understand what's going on with the neurons and all that stuff, you know, I think we tried animal studies and tried to understand these things, you know, via whatever studies we could do, but I think we've reached a time in our history where we've now had so many people use these medications.

‍

We have their reported experiences, which. Right. You know, I would love to see that turned into data. Yes. So that we can help truly understand what's the reality of the human usage of these medications? How does that actually go in, in the, in real life? Um, so,  so benzodiazepines, of course, is a big one that I see.

‍

People get it on them for all kinds of reasons, sleep, anxiety, which can also affect sleep and all that kind of stuff. Um, so things like, you know, Ativan, Xanax, Klonopin, Valium, Restoril, all those.  Um, yeah, and like I mentioned, those tapers can be years.  And the best way to do, um, the best way to do really any taper is to  use  thoughtful percentages  for the reduction.

‍

Um, and then the other key piece is listen to that person's body.  The body will tell you,  it will tell you. And what it appears to me is.  That the brain is an adaptable, you know, it's an adaptable organ,  but it's timeframe for adaptation is longer than we give it credit for. And if you think of it like a TBI, like a traumatic brain injury.

‍

Yeah. And if you think about that, we understand that recovery from those  is more on those kinds of timescales, you know, years, and that if you've had a concussion in your history, like, be careful with the brain, right?  We're throwing out these, these chemicals. that are psychoactive, affect the brain directly, and we're doing it like as if it's just we can like put them on, put them off.

‍

Yeah. Move them all around, shuffle them around. The brain is not happy with that, in my observation, like my experience of observing this for  this long. Oh, yeah.  Gentleness, slow,  the whole adage. Gentle and slow. And listen, listen to the human mechanism that's going through it. That was such a big shift for me, honestly, like, personally, as a psychiatrist.

‍

Because it was always like, you know, you're kind of trained to put in the position of, okay, that person comes in, I'm going to tell them what to do. I'm the authority. Sure. And for me, the big switch was  No, we're both authorities  in that, like, okay, yeah, I have all this knowledge, you know, and all the experience and all that stuff.

‍

And the patient is by far, of course, the authority in their own body mind.  What a paradigm shift.  Huge life altering paradigm shift for me and has made it.  Day and night in terms of my personal satisfaction as working as a physician, I cannot even tell you like it's so much more fulfilling,  fun, empowering to us both to come to the table is okay.

‍

I hear you. You hear me. Let's put our minds together  and come up with a sensical plan and let's listen to your body. Let's stay in touch. Let's stay in tune.  And then, I mean, that, that to me is the secret sauce. That was kind of, and then, you know, figuring out that, yeah, you shouldn't make 50 percent reductions, you should make 5 percent reductions, or maybe 10%, depending on the person and the scenario and the situation.

‍

Um, other sleep meds, Ambien, of course, is a big one.  Trazodone, Remeron. On  the scale of things, The more forgiving ones. Yeah. Trazodone, Remeron.  Um,  oh, further down that scale, Ambien,  a little more forgiving. The Benzos, not forgiving. Not forgiving. Yes. Not at all. Oh my gosh. Not at all. Today I want to talk to you about something that often flies under the radar but is absolutely crucial for great sleep.

‍

minerals. Now you've heard me talk about circadian rhythms, light exposure, temperature control and more. But let's dive into the foundational elements that fuel our body's ability to sleep deeply and restoratively, specifically minerals. Our modern lifestyle with its processed foods and environmental stressors can leave us depleted of essential minerals.

‍

This depletion can mess with our sleep quality leading to issues like restless legs, poor sleep initiation and waking up in the middle of the night. Enter beam minerals. Beam minerals are designed to replenish your body's essential mineral levels, providing the building blocks your body needs for optimal health.

‍

And this includes better sleep. What I love about beam is that they use a hundred percent bioavailable liquid minerals, which means your body can actually absorb and utilize them instantly without any fillers or additives. Magnesium, for example, is known as nature's relaxant, helping to calm the nervous system, support muscle relaxation, and some argue by extension can promote deep, restful sleep.

‍

Beam's magnesium is sourced in a way that ensures maximum absorption and effectiveness, making it a key part of my sleep routine. But beam doesn't stop there. They've created a comprehensive blend that includes other vital minerals like potassium, calcium, and trace minerals that work synergistically to support your overall health.

‍

And of course your sleep, the result, you wake up feeling more refreshed, more balanced. and ready to take on the day. So if you've been struggling with sleep and feel like you've tried everything, it might be time to look at what's happening on a cellular level. B minerals can help fill in those gaps and give your body the support it needs for truly restorative sleep.

‍

So head on over to B minerals spelled B E A M today and use the code sleep as a skill all one word at checkout to get a special discount on your order. Your body and your sleep will thank you.  On the Benzo topic. Yeah, we've had Benzo Information Coalition on the podcast, who's been helpful and really trying to get, you know, this message out, but also getting resources and kind of creating a network of people like yourself that can speak this language and be, you know, Benzo literate, if you will.

‍

So we've had them on. We've had Dr. Anna Lemke, who wrote Dopamine Nation out of Stanford, um, is calling the benzo use in the United States what she's calling the silent epidemic and really seems to echo so much of what you're sharing. And I'm curious. you know, because I've been in this for a while and we only have, I only have a few places to point people that are established.

‍

So I'm curious, when you started doing that research for yourself, were there places that you can point to for people that you feel gives some qualified and reliable and thoughtful information? Or is it more piecemeal? We're just kind of trying to put this together as we're going. What have you seen there?

‍

And of course, I'm assuming to the Ashton manual may or may not be part of what you might point people to, but I'm curious if there are places that you would send people to research this for themselves in addition to finding themselves a qualified practitioner. Yeah, it's slow coming to fruition. Like the resources.

‍

I mean, there's a huge, it's, it's a good size movement that is, you know, sure. Happening. So  things that I learned from and, or that I, you know,  either find people find me through them or I refer them to, to these resources. I think one of the first one was, um, intercompass initiative.  Fantastic, uh, nonprofit organization founded by Laura Delano, someone who personally went through  psychiatric medication  merry go round and got out the other side, came off the meds and said, Hey, I want to shine the light for others so that they don't have to go through this.

‍

Horrible experience that she did and, um, intercompass initiative again, um, just they put out good, I think responsibly done information surviving antidepressants was a big one that helps me in the beginning so much there. Yeah, a big platform. And they've really done a lot of work to try to help raise awareness, give, you know, give a basic guide.

‍

I mean, the thing is, is people are desperate out there, right? Human beings and massive kind of,  we're getting organized, like how we do as human beings. Slowly, slowly organize ourselves so that it comes out as a coherent message, you know, in the society or in the community. And it's, it's happening through, you know, these kinds of organizations more and more.

‍

Or platforms, uh, Medicating Normal, that's a big one, the documentary. Yes. You know, tons of people actually with them. Madden America.  And they have directories. Madden America has a directory, Medicating Normal.  Um, I don't know, I don't think that intercompass does, but  I'll have to be honest, it's, it's hard to find a practitioner.

‍

There's a handful of us  doctors who are kind of  speaking up and kind of really identifying ourselves as like, Hey, I de prescribe  who've kind of done the deep dive. research into understanding, you know, how,  how to help make that happen for people. Um, but it's, it's few and far between because of state regulations and all that stuff, it becomes even harder because you have to be for certain, I mean, you've got to be licensed, um, in the states where you prescribe.

‍

It's it's it's tricky. Yeah, I can't sugarcoat that one. Absolutely. Well, and thank you for those resources. We'll make sure to put those in the show notes to to have just additional things and places for people to go because I think sometimes they might, for lack of a better term, maybe deal with unintentional gaslighting, maybe, you know, going to going to certain resources, even if it's just a quick Google or what have you just maybe some of what now as we're speaking about.

‍

concerning information around the expectation or speed by which people might be able to get off of these and at the bare minimum, as you're pointing to, it's likely much longer than has been advertised. So thank you for providing that information. And real quick, I'm wondering the term or thinking around rebound insomnia, anything to share there or ways that you help maybe people that might have concerns around that, how to navigate that.

‍

I know it's a big topic, but any thoughts there? Or do you feel like part of it is about setting up the way that we're navigating this tapering process to minimize some of those experiences? Or how do you think about rebound insomnia? So like rebound insomnia in the context of  Medication tapering. Yes.

‍

Yes. Yeah. So, I mean,  Tapering,  you know, any psychiatric medication, including the sleep ones,  one of the number one side effects is sleep disturbance  because these medications affect how your brain functions, you know, the, how your brain waves change throughout the day and dropping into, you know, restful states and sleep, not to mention the regulation of your nervous system.

‍

Um, it's significant. And certainly when I see people who a lot of times if they, if they come in in crisis or they've, you know, made a big jump, um, it's,  it's challenging, you know,  and it depends on the, the individual person for each person that I see, I do do a whole plan for them.  So not just about the taper, you know, so there's all the, the tapering guidance and the schedule, you know, we work on it.

‍

The schedule or plan for them,  which everybody's different and it's always dynamic. There's not actually a schedule. It's making up as we go along as they're coming down.  But also amidst all of that, as you give recommendations for the other aspects of things, you know, diet, nutrition, supplements, exercise, stress reduction, holistic practices, you know, good sleep hygiene tips.

‍

Um, and  it's in all of that together.  Yes, that where we kind of help get the assistance and support. That's where I'm and I'm sure you, you know, know extremely well better than me about all of the different various things that a person can do to help support their sleep. That's non medication.  Sometimes.

‍

You got to look into the medication piece and see if you need to, you know, updose or reinstate based on where they're at in their particular place in their journey, you know.  So that is a piece of the puzzle. But with,  in, in the whole, the whole aim is in the whole adage we're working around is stability.

‍

Yeah. Once a person is in a stable zone, and it does not mean perfect, it doesn't mean that things are all, you know. Hunky dory or rainbows, unicorns. It means  baseline stability or stable.  From there, you know, we can,  you know, that's the best place to taper from.  And then we're always, we're always trying to support that in various ways.

‍

Right. You know, making sure, do you have a support person or people?  What else do you need? You know, what are you eating? When are you eating? What are you consuming? What's, what other substances are you putting in your body? Yeah. When we look at the whole. picture,  things go a lot better.  I wish I could say like, Oh, well, it's this supplement.

‍

That's right. It's It's an amalgamation of a bunch of things that,  and each person is like, we're like a snowflake, like every person is different. It's a different, but we can kind of, we can, you know, put things together and tweak it and explore that. And generally  when we take that approach, the genuinely holistic one, we're able to, things, you know, we can figure it out.

‍

Things will smooth out. Oh, well, I think that's a perfect potential segue because I hope that while we're also sharing as you know, so if anyone's listening, if they're dealing with this or know someone kind of in this situation that I hope we're relaying both the empathy and understanding and sharing of really.

‍

hoping to get their experience, but also share that there's hope and that there's a light at the end of the tunnel. And it's worth this exploring and setting yourself up for success, because on the other side of this, there's a whole other life available, I think could be pointed to. And I'm assuming that you are in that camp.

‍

It sounds like you have now seen so many people on the other side after those long periods of time and getting to see what their lives look like. So, For you, is there anything else that we, I know this is a big topic and we only just scratched the surface, but is there anything else that we left out in this conversation around sleep and tapering that we want to hit on before we shift over to how you're managing your own sleep?

‍

Well, I love what you said about hope. Yeah. You know, there is hope. A lot of people feel trapped, very trapped and very alone. Yes. It can be, it can be,  a person can feel desperately alone  in, in, in being on a medication and suffering  and feeling like they cannot find support.  They may go to their doctor who may not understand why cutting their particular medication in half.

‍

is not tolerable. Yes. But intuitively, if you have a feeling and if you know that, wait a minute, I really think, I really think that this could be done. I really do think I could live and sleep.  Without a medication and or at least I want to try.  Hang in there. Do your research. Yes. Poke around the nose around for people like me and people like you and  because there is information and and support out there if you if you just look for it.

‍

And then once you're clear that that's what you want to do. It's just just patience. Hold on, you know, doing the gradual gradual reductions. It's just. You can do it. It is possible. And you're not alone.  It may feel like it, but you're actually not. And  you, it is very much possible.  So important. Yeah, just to share from my own personal experience, if people have tuned in before, they may have heard me share how that was part of my story was part of the rock bottom period of my life was this period of insomnia, then getting prescriptions for different benzos and Z drugs.

‍

And thankfully. Based on some of the people in my circle and the research and the places that I found myself, I was able to set myself up to get off of those, but I think it really dodged a bull and it could have very easily, I feel, gone a different way and become a very long term problem. But I've also shared about.

‍

close family members who I've seen go through the ringer and just also going down a path that we do not want to set up for people of cold turkey and high doses of benzos and all the things that we're trying to make sure we're getting the message out around that it doesn't have to go like that. So I still appreciate people like yourself getting this message out because you're right like when for me when I went through this period I remember vividly I was living in New York City and googling and like why is there no AA for sleep and for you know tapering and all of these conversations and so because it can feel so alone and like you're just the only weirdo dealing with these things and it's not the case so so appreciate you sharing these topics and I'm curious as we shift gears to how you're managing your own.

‍

sleep, knowing all that, you know, we do ask everyone four questions. And the first one is, how are you managing your nightly sleep routine right now? Uh, nightly sleep routine.  Yeah. How am I managing it? That's a great question.  I, I should be, I should be better about the screen before I go to sleep for sure.

‍

And it's funny because we were just. I was coming back from vacation and there was, I was just reading a book before bed every night.  Okay. And so I want to get back into that vacation mindset mode and get back to the book thing because I can clearly feel the nervous system stimulation of being on the screen, even close to bedtime.

‍

So, you know, I just need to, otherwise, um, I mean, knock on wood, I come from a family of good sleepers. Oh, nice. Yeah. Um, I,  I, I, and I've always been that, you know, kind of the natural health kind of person. Yeah. And so I've, I think I've over time probably done things in my overall health regime that help. I don't do caffeine.

‍

I don't, you know, it's,  um, stimulating stuff.  And yeah, that's, so  keeping the bedroom cool. That is one too. I learned that kind of recently, keeping the bedroom cool. But yeah, that's, it's not, um, it's probably been something that's evolved over years for the small little things that I either, you know, do or don't do for my overall health.

‍

I slept like.  Doodoo in residency in med school. Oh, right. Yes. So that it's also a function, I think, too, of, you know, the ambient stress during the day. Yeah. Oh, well, that perfectly segues us to your morning sleep routine, quote unquote, of with the argument that how we. start our day or set up our day can impact our sleep.

And I love what you said there, because I think we've seen that that can sometimes relieve some of the pressure for people. If we shift the focus from, you know, a stranglehold on the nights and instead started, how are we managing our days? And you know, in the light of day, what might we be able to do to support that nervous system regulation?

‍

But what is your morning sleep routine look like? Morning, waking up.  I used to do hours of yoga and meditation in the morning, actually. And now my husband and I are doing this thing together where we're going to sit silently and then either read a little book passage or listen to a little, um, talk by a particular, some teachers that we like.

‍

And so that's kind of the morning thing we're doing to set. The tone of the nervous system and kind of the mental perspective for the day. That's  that's and then a big glass of water.  I love that. What a great primer for the day. That sounds amazing. So cool. And then what might we visually see in your sleep environment?

‍

You know, on your nightstand or maybe in the ambiance, if you will. Yeah, I'm definitely, I do like to keep the bedroom neat  overall, just visually, so I don't feel like stressed by clutter. I wish I could say that for my office, but I can't for the bedroom. I do keep that just minimal, a few nice decorations, things that make my heart smile.

‍

And then, um, the nightstand, you know, a few books. My husband just moved out my phone for, I was charging it at night. At the bedside, which I know is not ideal, but he moved it here, so I charge it in my office during the day, and I don't,  yeah, I don't have it charging there by me, but yeah, we keep it cool.

‍

and minimal. I love it. You know, we've seen a through line of often people that have shared that their sleep is, you know, really working. Often there is more of a minimalist kind of, it's almost, we've seen the other side of it too, where people have. Nine million things and they're like, Oh yeah, I'm still struggling with my sleep and I slept horribly and whatever.

‍

So I like that. The last question is so far to date What would you say has made the biggest change to your sleep game or said another way maybe biggest aha moment in managing your sleep? This might seem weird but being true to myself  Oh say more very cool So, you know, I think my like the I mentioned like my experience of medical school and residency It  was in many ways horrifying to my own mental health.

‍

I had GERD, I had  sleep disruption, I mean, bad sleep, anxiety through the roof. And I feel like I was forcing myself through something that was really painful.  After that, having done that. Aligning my day and life to my values, what I value, like well being and peace and, you know, having balance, just having balance in my life between, you know, the hours that I spend actively working and the hours I spend doing other stuff.

‍

I think. Centering my life around what I feel is true to me  has brought the hugest stress relief  and feeling of ease and peace  that I could have ever longed for. Ugh. It's the adage of follow your enthusiasm as well, you know, so, and then also the, the,  the way I get to spend my time in the work is I find this work extremely meaningful.

‍

Extremely fulfilling, and then kind of my system settled down and it was easier to sleep at night. There's still times, of course, things happen or hormones change or whatever. But  overall, feeling at peace with my daytime life, I think helped me also then have peace in my  nighttime sleep. Oh, I love that.

‍

That is so wise. That might be one of the more  wise responses we've had. And I think we're I don't know what we're pushing. One hundred and seventy or something episodes. But yeah, I feel like that's kind of the whole game, right? Like. I was just sharing with someone else how, just as one use case or one example of people that we do find coming our way, just happening to be some retirees, for example, not the only people, but a particular group of struggling with their sleep after they have now left and closed this chapter on.

‍

a career or a body of work where they had some sort of purpose or reason to get up each day. And it just, what you shared makes me think of that group just from the difference, the dramatic difference that we'll often see once there's not that calling or that sense of meaning, like you were pointing to and that, you know, sense of purpose or greater.

‍

use for your life where we can see people start to get a little Unbalanced when that's missing and the power of really harnessing that that's incredible. Love it amazing That sounds fascinating, by the way Yeah, we fascinating we see that a lot. It's really interesting, especially um, what's been so cool now is so You know, the primary wearable that we use here is with Oura Ring, and they've been out now since 2015.

‍

And so we have almost a decade of many long time users, so they might come in with whatever, nine years worth of data, eight years, something along those lines. And so we get to see this whole history of them. Now, is it, Medical grade. No, it's consumer tech, but it's a breadth of data. And we do get some pretty good information just around their generalized habits.

‍

And then also you could extrapolate some information around their nervous system with their heart rate, their HRV, their body temperature, their respiratory rate. So we can see kind of a diary of them emerge. And there's Definitely interesting through line that seems to happen for people when there is that missing of what's next, a reason to get up in the morning just to have that consistency.

‍

It's a very interesting thing to see and then for people to navigate, like how to deal with that. So. Love that you're having that focus on the day. That's beautiful. So having said that, was there anything that we missed before we share how people can follow you and connect with you if they or someone that they know might be dealing with and needing someone like yourself with your expertise?

‍

Was there anything we missed before we get there? Nope. Okay. Beautiful. Yay. I know. Big topics. So appreciate that. So how can people work with you, follow you and beyond? Yep. Wonderful. Yes. I am accepting new patients. Probably easiest way is through our website. It's true you psychiatry and wellness or true you psych.

‍

We have a live chat, you can give us a call, um, give us an email,  um, and we're on social media, Instagram and Facebook.  Not as diligent, I think, in keeping up with that stuff, but certainly directly just right through our website. Give us a call. Happy to hear from you. Beautiful. Well, we need more people like you.

‍

That is fantastic. So appreciate that. Oh, and you did mention to a few states in particular that are quite complimentary for you to potentially work with. Were there any call outs on those? Yeah. States I'm licensed in Michigan, California, New York, Florida. Georgia, Arizona, and Virginia. Did I say that? I'm sorry.

‍

There's seven of them. And it's on my website. And it's on the website. That's the brilliant part. You just gotta go to the website, people. Totally. And you're so knowledgeable in this area, too. And so once people are listening to this, if you're booked up or something. One, I'm sure you probably have a waitlist and two, can help support people in resources and directions if they're in different states or something.

‍

Yeah, absolutely. Okay, fantastic. Ah, well, thank you so much for taking the time. I so appreciate it. I feel that passion and purpose from you, and just so grateful there's people like yourself out there. I've sent clients to you, and I'm so grateful, and there's all, you know, people have had just incredible experiences with you, so if you're listening to this, check her out.

‍

It can be really life changing, so really appreciate the time. Thank you so much. Awesome. Thank you.  You've been listening to the sleep as a skill podcast, the top podcast for people who want to take their sleep skills to the next level. Every Monday I send out the sleep obsessions newsletter, which aims to be one of the most obsessive newsletters on the planet.

‍

Fun fact, I've never missed a Monday for over five years and counting. And it contains everything that you need to know in the fascinating world of sleep. Head on over to sleep as a skill. com forward slash newsletter to sign up.