physical wellbeing

Naturopathic Sleep Tips

Dr. Trevor Cates: Welcome to The Spa Dr. Podcast. I am Dr. Trevor Cates. Today we are talking about how to reset your sleep habits for physical and emotional wellbeing. My guest is Dr. Catherine Darley, who is internationally recognized as a leader in naturopathic sleep medicine. She is the director of the Institute of Naturopathic sleep medicine in Seattle.

Dr. Trevor Cates: Her clinical work focused on the treatment of sleep disorders in both children and adults using behavioral and naturopathic medicine. She also trains corporate employees and emergency personnel on a variety of sleep performance and safety issues. She also is adjunct faculty at Bastyr University and National University of natural medicine. Dr. Darley’s volunteer efforts have focused on starting school later.

Dr. Trevor Cates: This program is both in Seattle and nationally, and she has served on the board of the Washington association of Naturopathic physicians. In today’s interview, we discuss how poor sleep impacts your physical, emotional, and social wellbeing.

Dr. Trevor Cates: Not only does it affect you physically and the way you feel, but also how you appear, how you look and your emotional health and your ability to interact well with others. Dr. Darley shares how to know you have gotten the right amount of sleep and tips to set you up to design a sleep healthy lifestyle. So please enjoy this interview.

Dr. Trevor Cates: Catherine is so great to have you on The Spa Dr. Podcast. Welcome.

Dr. Catherine Darley: Great, thanks. Glad to be here.

Dr. Trevor Cates: So we are talking about sleep today and sleep is so important, especially when we’re stressed and then when we’re stressed, we have harder time with sleep. And so we definitely want to figure out how we can sleep better, but first, before we talk about ways to improve our sleep, let’s talk about the real issue of what lack of sleep does to us.

Dr. Catherine Darley: Yeah. I would like to dive into that. I think about it in five domains, Trevor, that you have your physical health and your mental health. In adequate sleep raises blood pressure, it makes inflammation worse, on that physical route. We have the emotional piece, anxiety, depression, worse with sleep problems.

Dr. Catherine Darley: Then I think about the two domains of performance, our physical performance and our cognitive performance, everything from simple memory, remembering someone’s name through really more complex problem solving, what am I going to do about this challenging situation that the whole broad range of cognitive performance is impaired. Then of course, physical performance. Typically we think about drowsy driving, right?

Dr. Catherine Darley: Many of us drive, and if we are not getting adequate sleep, we are more at risk. Then the domain that I want to focus on the most today is how sleep impacts our emotional intelligence and our ability to get along well with others, which is such a key part of our quality of life and sleep can really have a big impact on that.

Dr. Trevor Cates: Yeah, it’s so true. I think all of us have experienced those days where we don’t get enough sleep and we tend to be a little bit more irritable, a little less patient. We may notice it while we are driving or we notice it with our kids or with our partners or at work.

Dr. Trevor Cates: Certainly it is not something that we know that it’s not our best self that is showing up. Let’s talk about more of this and absolutely physical health is an important part of sleep, but right now we’re focusing really on the emotional aspect of it.

Dr. Trevor Cates: I am wondering what are the warning signs that you typically tell people to look for and knowing that this is definitely an issue for you?

Dr. Catherine Darley: I think what you shared about the experience that many of us have had, we haven’t slept well and we can tell we are just a little bit more irritable. The research really actually plays that out and there is a lot of a growing area of evidence. One of the things that happens is that if I’m sleep deprived and I look at your face, Trevor, I can’t tell if you’re happy or angry.

Dr. Catherine Darley: Think about how that is going to manifest then, if I can’t tell if you are happy or angry, I can’t necessarily respond appropriately. And so that is going to have a negative effect on relationships and just your overall wellness.

Dr. Catherine Darley: The other thing that we know is decision making gets much more rule-based so a person isn’t able to necessarily take in the nuances of the situation. They’re just like X equals Y and that’s it, there’s no A, B or C that we are going to take into consideration. We also find that when people aren’t getting adequate sleep, they rate their bad experiences as much worse and their good experiences as ho hum. Just even your enjoyment of life gets worse.

Dr. Catherine Darley: You asked about red flags. I think if you are feeling irritable, if you find yourself snapping or having an out of character, negative reaction, like flying off the handle, that would be something, if you’re finding you feel that Eeyore feeling like nothing’s good. Think about that Winnie the Pooh character, Eeyore, those would be some red flags.

Dr. Catherine Darley: You find in the workplace, there is lots of evidence that when people aren’t getting good sleep, either sufficient sleep or they have sleep disorders, they’re not able to regulate their interactions. They are more likely to write an email that is not appropriate, or sit at their desk and yes, they are physically at their work station, but they are just not getting their work done.

Dr. Trevor Cates: Yeah, absolutely. Then there is the occasional difficulty getting a good night’s sleep and then there are chronic sleep problems. Even one night’s sleep, even one of those can make a difference in your day, but if you’re having an ongoing basis, it becomes a chronic problem. Anything that you want to talk about as far as that’s concerned, and then the other question I have just to kind of play into that is what is a good night’s sleep?

Dr. Catherine Darley: Yeah. A good night’s sleep can be elusive for many people. And that’s a great question. What makes a good night’s sleep? I think falling asleep within about 30 minutes or less, is one of the features of a good night’s sleep.

Dr. Catherine Darley: Sleeping through the night we think of as a good night’s sleep, with the exception of maybe one bathroom break, but it shouldn’t be more than one, regardless of your age actually.

Dr. Catherine Darley: Then waking up feeling refreshed and restored and ready for your day. Because of our circadian rhythm, it is typical that a person would have a little dip in their alertness about one to three o’clock in the afternoon, but otherwise your energy should be pretty good until close to bedtime.

Dr. Trevor Cates: Right? For people who say, I have to take a nap in the afternoon, that’s not a good sign.

Dr. Catherine Darley: Right. I think that there are certainly situations where a person may develop a nap lifestyle where they are regularly taking a nap. Maybe they have to get up super early for work, four o’clock, five o’clock in the morning for work. And they are getting off early in the afternoon. In that case, having a nap lifestyle may make sense. It’s when people say they have to, or they are falling asleep unintentionally, those are more red flags for us.

Dr. Trevor Cates: And so then that other part of what I was talking about is that we occasionally will have these difficulties with a night’s sleep, but then there are the people who basically every night they are struggling with one or all of those things that you mentioned. In particular, that key part is that how you feel when you wake up, you might be, Oh, I slept through the night, but I still wake up feeling terrible.

Dr. Catherine Darley: Yeah. We really encourage people, if they have had sleep difficulties for a month, then it’s time to get help. One of the things that we see in the literature is that often people will wait sometimes years to get help from a professional for their sleep.

Dr. Catherine Darley: I encourage you, if you do see that you are having this problem, even if it hasn’t been years go and get help from your primary care physician, from a sleep specialist, from some licensed healthcare professional. Just so that it doesn’t linger on and on. Unfortunately people’s baseline of awareness of how impaired they are by sleep can decline.

Dr. Catherine Darley: If you are sleep deprived or have a sleep disruption for very many days in a row, the first couple of days you are aware of, I don’t feel good. I’m not cognitively snappy. I’m a danger on the road, but after about three nights of not sleeping, well, your baseline gets adjusted down.

Dr. Catherine Darley: You just lose the sensitivity and you suddenly think, Oh, well I guess I’m doing okay on this amount of sleep. But really if we measure your performance, you are impaired. I think of it kind of as similar to alcohol, right? The first drink, the second drink, you might be sensitive to how it’s affecting you, but after the third or fourth drink, many people lose their awareness of how impaired they are.

Dr. Trevor Cates: And how much sleep do you think people need?

Dr. Catherine Darley: I think that adults need somewhere between six and 10. It’s a bell curve where we think most adults need somewhere around eight, three to four percent of adults need only six. Then one to two percent of healthy, normal adults need 10 hours. It is really important for a person to calibrate to how much sleep they need.

Dr. Catherine Darley: If you are someone who needs nine hours and you’re getting eight, it may sound like you are getting plenty to your friends and family, but that means you are an hour sleep deprived every night. And having all those performance and emotional intelligence problems because of that.

Dr. Trevor Cates: Also it can change your physical appearance too. If you are not getting a good night’s sleep.

Dr. Catherine Darley: It really does. There’s been some really interesting studies where they ask people to look at photographs of folks when they are well rested and when they are sleep deprived. And interestingly enough, when a person is sleep deprived, raters will say that they are less intelligent, they are less attractive and they look tired.

Dr. Catherine Darley: We do see that because of an increase in inflammation. Actually not getting sufficient sleep or having disrupted sleep causes an increase in inflammation, which can result in reddened skin. It can result in black circles under the eyes, bloodshot eyes. We also see that our appetite is very sensitive to sleep deprivation and it’ll actually change our appetite hormones.

Dr. Catherine Darley: So we eat more calories. Women will tend to eat about 320 more calories a day if they are sleep deprived and men a little bit less around 280 calories more each day when they are sleep deprived. That can have a cumulative effect. Many people are struggling with their weight and sleep could be one piece of the solution there.

Dr. Trevor Cates: Right. It certainly affects us socially too. This is particularly a concern right now because of all the stress that we have on our lives and the limited social interactions. But then having to go back to some of that. Anything else you want to mention about that?

Dr. Catherine Darley: Yeah. I want to mention that there is an emerging body of knowledge about sleep and loneliness. When we are lonely, we do not sleep as well. Years ago, when I was first in my practice, a couple of years into my practice with patients, I came home one day and I said I was going to change the name of my business. The family was really curious about that.

Dr. Catherine Darley: And I said, I was going to change it from sleep center to sleep and dating center. Which is obviously not true, it was a facetious comment. What I had observed is that when we were talking about people’s sleep problems, and I would ask what are you thinking about at night or what’s troubling you at night, many times people had those really big questions about social connections.

Dr. Catherine Darley: Am I ever going to find a partner? Will I ever have children? How can I find people who just really clicked with me? And a couple of years after I made the observation, there started to be this research coming out, showing that when people say that they are lonely, they don’t sleep well, it is correlated with insomnia symptoms.

Dr. Catherine Darley: Even right now in this pandemic, there is some new research looking at the sleep of healthcare providers in China. And those who say that they have high levels of social capital social connection actually sleep better than those people who are healthcare providers.

Dr. Catherine Darley: They are very stressed. They have high demands right now, worries with this pandemic and the ones who don’t have high rates of social connection and social capital are actually sleeping worse than those who do.

Dr. Trevor Cates: Yeah. I think it becomes such a big problem for us. We definitely want to improve our sleep. So many people struggle with sleep. Let’s talk about the solution to this. What are some of the things that people can do? Obviously, this is a problem. So let’s talk about the solution right now.

Dr. Catherine Darley: Yeah. No use talking about a problem if you are not going to get to a solution. The most common sleep disorder, there are many. There are six main classes of sleep disorders. The main sleep disorder that we see most commonly is actually insufficient sleep. Even just in the first quarter of 2020, we see that the percent of people, adults in America getting sufficient sleep has actually declined by 5% currently.

Dr. Catherine Darley: We are at about 49% of adult Americans getting seven to eight hours, which is considered really the very minimum for most people. That means over half of us are not getting the sleep that we need. I would like to suggest to your viewers that they do an optimal sleep challenge. What I mean by that is simply back to a time that you were really well rested.

Dr. Catherine Darley: And those five domains that I talked about, physical, mental health, cognitive, and physical performance and emotional intelligence, all of those five domains were going really well for you. And come up with your ideal sleep number, how much sleep do you really do best? And you’re at the top of your game. Then try to get that amount of sleep for 10 nights in a row and see how it pays out for you. And if it’s worth it.

Dr. Catherine Darley: I think many people can tell you if you ask them, they can say, well, I think I do best with X number of hours. Maybe they do best with nine hours of hours of sleep at night, which would not be unusual. The other part of the coin that I think people don’t necessarily think about, is if you’re programmed for nine hours of sleep at night, that means you’ve got 15 hours in the day.

Dr. Catherine Darley: So if you are going to go from being sleep deprived by an hour or two every night, and you are going to increase your sleep to what you need, that means you are going to have to shorten down your day of commitments. You are going to have to intentionally decide not to do some things that you have been spending your time on.

Dr. Catherine Darley: You will have to maybe delegate some tasks to other family members or people in your life. It is going to have to be well thought out to be able to shrink your daytime commitments, to enlarge your sleep, to the amount that you need.

Dr. Trevor Cates: Yeah. That makes sense. I think that making that adjustment and planning your schedule around that does make sense. And of course there is going to be some time of adjustment, but then in the long run, it is going to provide some great benefits.

Dr. Catherine Darley: Yes. Right. So then there are other components of a sleep healthy lifestyle. That’s how I think of it. If you want to design a sleep healthy lifestyle. One of the things that’s really different for us in modern culture is our light exposure. I like people to really think about our ancestors 150, 200 years ago.

Dr. Catherine Darley: How much light were they getting during the day? How much darkness were they getting at night? I think we kind of can take for granted, how very different our light exposure is to what people lived with throughout most of human history.

Dr. Catherine Darley: What I would say the modern light experience is we get a little bit of light during the day, and we get a little bit of light during the night instead of getting a lot of light during the day and tiny little bit of light, maybe a candle light at night.

Dr. Catherine Darley: That really actually makes a huge difference in your sleep because of your physiology. If there is enough light that you can hold your hand out, arms length and see your fingers wiggling, that is enough light to suppress your melatonin. Melatonin is a sleeping hormone that we want to have increasing, even before we hit the sheets, in that sunset period. Our melatonin will start to rise so that we are sleepy when we get to that.

Dr. Trevor Cates: That is a great one. I have never heard that one before, but that’s great. And then of course, no extra lights on. A lot of people will have their TV or the alarm clock or various things throughout the room that have little bits of light emitting, that can add up.

Dr. Catherine Darley: They really do add up. And a hack that people can easily do is you can look up a Lux meter on your phone. It is just a free app on your phone that you can easily download called Lux meter and it uses your phone to measure light levels. And so you can check how light it is in my bedroom. We want it to be three luxs or less at night.

Dr. Trevor Cates: Interesting. I think it’s hard for people who live in cities because it never gets really dark at night. Even in Park City, Utah, I have lived here for 11 years now. When I first moved here at night, you could see the stars. It was really, really dark. And now I absolutely have to pull my curtains closed, because in the neighborhood and nearby businesses, the lights are still on.

Dr. Trevor Cates: So it just creates more light outdoors. And so we don’t see the stars as much as we did here. I think it’s something to be aware of, how dark is it naturally where you live?

Dr. Catherine Darley: Yeah. Then the other thing to think about is how much light are you getting in the morning? We want people to get at least 20 minutes of bright outside light, as soon as they can, after they get up. Using light in that way, actually causes kind of a Teeter totter effect on your melatonin.

Dr. Catherine Darley: By that, I mean, when you first wake up, your melatonin is still a little bit elevated and that bright light will suppress it. And as it’s suppressing your melatonin in the morning, it’s also going to cause a higher pulse of melatonin at night and a little bit earlier, which is going to help you feel sleepy at bedtime.

Dr. Catherine Darley: So daytime light exposure is also equally as important as getting darkness at night. Then you want to be getting pulses of bright outside light every two to three hours, at least 10 minutes.

Dr. Catherine Darley: Some research has looked at office workers and their sleep. The office workers who are in a room that doesn’t have any windows and has a relatively dim indoor light. They don’t sleep as well as their colleagues who are next to a window or go outside on their breaks.

Dr. Trevor Cates: Right. That is a great tip for people who work indoors primarily, to get outdoors. Especially if you don’t have windows in your office. Or a school, allowing kids to get outdoors and get some sunlight too.

Dr. Catherine Darley: Yes. The other thing that I want to say, is during this time, when many of us are working from home and space might be crowded, it is best to insulate your bedroom as a place just for sleep. That can be challenging. I know even in our household, we now have four out of five people who are a hundred percent working from home all the time.

Dr. Catherine Darley: And it is challenging to have enough space to separate work areas and sleep areas. One thing that you can do, if you need to have a work area in your bedroom is to have maybe a decorative cloth or something that you put over your workstation when you are done with it. Just as a visual cue that you are off duty. That is important.

Dr. Catherine Darley: Then the other challenge that people are having at this time is that our routines are off. We have talked about sleep. The other aspect that feeds into our sleep health is the circadian rhythm.

Dr. Catherine Darley: Having your meal times at a regular time and getting up at the same time every day, and having your main task of the day, whether it’s homemaking or work or school or whatever it is that you’re focused on. Having that happen at the same time each day is really going to help your sleep and mental health.

Dr. Trevor Cates: Do you have other suggested adjustments for different times of the year? I think when we talk of days being shorter, longer, do you suggest people adjust depending upon how much light there is outside?

Dr. Catherine Darley: We do see that melatonin levels are somewhat higher during the winter. Some people find that they need a little bit more sleep. Otherwise, no main adjustments. As you get further North, you are not necessarily going to be able to get bright light outside right when you wake up. And then in that season, you might consider using a light box at home in the morning. That is if you find that you are really benefiting from the light.

Dr. Trevor Cates: Yep. Great.

Dr. Catherine Darley: I would like to end this Trevor with a strategy to put your thoughts to rest. So the tip that I would like to leave your listeners with is for people who are ruminating at night, thinking things through. Which is a really common problem for people to have thoughts that are intrusive.

Dr. Catherine Darley: The first step with this is to really think about your daytime and your nighttime as very different purposes. And give yourself permission to be off duty at night. We have a lot of roles and responsibilities, doctor, mother, friend, daughter, community member.

Dr. Catherine Darley: To really think, okay, well, I’m going to take care of these roles and responsibilities during daytime and night sleep hours are going to just be for restoring and being ready for the next day, ready to be my best the next day. I think that is a novel idea for people that you don’t have to take your roles to bed with you.

Dr. Catherine Darley: The second thing to help with that is to spend 10 minutes, about an hour or two before bed, just dumping those thoughts onto paper. Whether it is a narrative full sentence diary type journal, or if it’s just problem solving, brainstorming or a to do list, or whatever you need to do, put your thoughts onto the paper and then put those thoughts to bed and you are done with those thoughts.

Dr. Catherine Darley: Then if you start thinking in the night, you tell yourself, I already thought about that? I will have time tomorrow. Now’s my time to rest. Which is a limit setting skill that we can use with ourselves. I encourage people if they are thinking about stuff in the middle of the night to do this practice for 30 days, it’s a skill and like any skill you get better with time.

Dr. Catherine Darley: I think that will be really helpful. Some of the strategies people sometimes hear about is to keep a pencil and paper at your bedside and in the middle of the night, jot your thoughts down.

Dr. Catherine Darley: I’m actually not a fan of that because it’s reinforcing that you should be thinking things through in the middle of the night. What you really want to do is make enough time in the middle of the day or in the evening to think things through and say, okay, I’m going to sleep now. I’m not going to be vigilant to my thoughts.

Dr. Trevor Cates: Yeah. I agree with that. I have done it some. I have a journal beside my bed anyway. And there have been a couple of times I have woken up and then thought, I don’t know that I’m going to remember tomorrow, so I will write it down. But typically when I wake up and I have a thought, I think if it’s really that important, I’m going to remember it tomorrow, right now is my time to sleep and I’m going to do better tomorrow. Getting that thing done.

Dr. Catherine Darley: That’s perfect self-talk to get yourself back to sleep. Prioritize your sleep as the restorative effects you have.

Dr. Trevor Cates: Well, these are really fantastic tips. I do love that you talk about getting a reset and that you have to follow these things for 30 days to really train yourself how to sleep, because we forget, we just get busy and with all the electronics and the lights and the busyness and especially with what has been happening with people working and doing their school at home. We have lost this sense of rhythm and respect for boundaries and routine, and to give yourself 30 days to get a reprogram, I think is a great idea.

Dr. Catherine Darley: Yeah. I think that sleep is one of those things that increases your happiness. And I think it’s worth doing therefore.

Dr. Trevor Cates: Yeah, absolutely. Happiness and of course, health too.

Dr. Trevor Cates: Catherine, It has been so great having you on the podcast. Will you tell everybody where they can learn more about you and follow up with you if they want to reconnect.

Dr. Catherine Darley: Yes. So my website is, naturalsleepmedicine.net. That is a great way to just learn more about my work. I’m on Twitter at naturalsleepdr and Facebook.

Dr. Trevor Cates: All right. Well, thanks again, Catherine, for coming on. So appreciate it.

Dr. Catherine Darley: Yeah. Great. Thank you very much Dr. Cates, and it was a pleasure to talk with everybody.

Dr. Trevor Cates: I hope you enjoyed this interview today with Dr. Catherine Darley. To learn more about her or to get the links to her clinic, you can go to thespadr.com, go to the podcast page with her interview and you’ll find the information and links there. And while you’re there, I invite you to join The Spa Dr. Community. So you don’t miss any of our upcoming shows and information. And since the skin is an outer reflection of inner health, it’s important to know what’s behind that.

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