Transcript of Road Home Program: The Podcast, Episode 17
Obtaining healthy sleep is important for both physical and mental health, improving productivity and overall quality of life. Everyone can benefit from better sleep, and sleep hygiene can play a key part in achieving that goal.
Will Beiersdorf, Executive Director at The Road Home Program at Rush: Good day, everybody. My name is Will Beiersdorf. And I’m the Executive Director of the Road Home Program here at Rush University Medical Center. And this is the Road Home Podcast, the podcast we like to talk about so. So again, if you’re just joining us, you know, for the Road Home Podcast, The Road Home Program is a veteran and Family Center, we also take care of service members who are maybe in the National Guard or, or reserve or even active duty who are struggling with what we always say, the invisible wounds of war in life, post-traumatic stress disorder, you know, people refer to it as PTSD, military sexual trauma, you know, you’ll hear us me, so occasionally referred to it as MST or other challenges that people might face. And the other thing too, as you’re listening to this particular podcast today, is that we also take care of families, families are an integral part. So, and usually, you know, many times are the bridge, you know, as we connect with our veteran or a service member, you know, individuals. So today, you know, we’re very fortunate to have Dr. Monica De Iorio, you got it. And I’m going to let you know, Monica, can you tell folks a little bit about yourself and what you do here at the road home program?
Dr. Monica De Iorio, Neuropsychology Postdoctoral Fellow at The Road Home Program at Rush: Absolutely. So, I am a neuropsychology postdoctoral fellow here at Road Home. And so that means I’m a psychologist who is specialized in brain and behavior relationships. So, I do a lot of work with people who have problems with attention and memory, and other thinking abilities. And I’ve also taken an interest in sleep, which is why I’m really here today. So many of the people that I work with have problems falling asleep, staying asleep, and sleep problems for years and years. So, I thought it was really important that I understand how to help those people and support getting better, healthier sleep. So here at Road Home, I am involved in our Intensive Outpatient Program, running a couple of groups. I do a sleep group where I teach some of the strategies to support sleep, as well as a group on some of those thinking abilities. And I can meet with people one on one also to do a more kind of personalized information-giving session about how to promote their sleep or their thinking abilities and things like that.
Will Beiersdorf: Good. Great. And again, you know, you know, Monica just talked about some things about the IOP. So, the Road Home Program has a couple of different programs. We have an outpatient program, for folks that live locally, you know, here in Illinois, again, where we’re located here in Chicago. And we also have folks that come from Indiana or other places, but pretty much local. And then we have what Monica referred to is the IOP, the Intensive Outpatient Program, and that’s a two-week program, where we have veterans come in for, you know, an Intensive Outpatient Program, you know, centered around CPT, that’s cognitive processing therapy, and a variety of other things. You know, Monica, talk a little bit about that. But those are the things we do here. And then we’ve got a whole host of other programs, which we’ll touch upon. But today we’re going to be talking about sleep hygiene, right? So, you know, what I’ve heard, and what people have asked, is we kind of prepared for this podcast was, you know, you know, veterans are always like, there are some problems sleeping, right? And it’s, again, it’s not just veterans, it’s many people, it crosses all the way to the civilian community. But, the first question always is like, so what you said, is sleep hygiene? So, what is sleep hygiene? And how it can help me? And that’s one of the questions that we get asked a lot. So, how would you answer that?
Dr. Monica De Iorio: Yeah, that’s a great question. You know, sleep hygiene gets kind of thrown around a lot. And it’s a group of strategies that people can use to support better, healthier, and more restful sleep. A variety of sleep hygiene strategies are things like setting up the environment to support sleep, as well as how to get a good sleep routine in place and tools that you can use to help like I said, get that better, more restful sleep. A lot of the sleep hygiene, specific strategies, so things like having a dark room, cooler temperature tends to support sleep. Quiet or white noise. A lot of people have a hard time with complete silence around sleep, but some white noise machines or a fan going can be really helpful. Those strategies in particular can be good for maintaining healthy sleep. And some of the strategies around getting a good sleep routine are going to be great for addressing some of the underlying difficulties with chronic sleep problems like insomnia.
Will Beiersdorf: You know, you’re talking about that so bit, you know so one of the things we do is set up a schedule, right? Some type of a schedule. You know, one of the things I always hear and again, I’m not, you know, a good proponent of this, I always kind of break this. But, you know, no, no caffeine or alcohol, right? Or nicotine before you, you try to go to bed, right? Because that’ll, that’ll keep you up, as well. And I know there’s some, probably some other things, but how can – this next question would be, how can one develop that program, you know, or, you know that schedule, you know, for sleep hygiene?
Dr. Monica De Iorio: Yeah. I’m going to address some of the kind of alcohol and caffeine things first, and then talk about routines specifically. I think a lot of the time, especially around alcohol, sometimes when I’m working with people, they, they’re surprised that alcohol interferes with sleep, because it does have a sedating effect where you can get kind of sleepy and get knocked out in a sense, and maybe fall asleep faster. And that’s true. But the problem is that the type of sleep you get after having alcohol is more disrupted. So, it’s not really a restful and restorative sleep. And a lot of people, once you start talking about it can identify with that, right? If you fall asleep after having alcohol, you usually don’t wake up feeling awesome and ready to take on the day, right? And caffeine, it stays in your system for a very long time. So, I think that’s an important thing for people to understand, as well. That it can be having an effect on you even 10 hours, sometimes after you take in caffeine. So, really being careful about how much caffeine you have, and how late in the day you’re having it.
Will Beiersdorf: You’re hitting on some, like, help, you know, kind of like, you know, trying to, you know, prepare yourself, right? And in some healthy, healthy sleep habits. You know, one of the things you know, again, with COVID, you know, as we kind of move, hopefully, in a post COVID environment here, this particular date, you know, moving forward, you know, people have been siloed in their homes, right? You know, and so, you know, I mean, some folks might not have a big place, right? So, their bedroom might be the biggest place in the, in the room. So, you know, one of the things I’ve always heard is people use, you know, their bedroom for so many different things. So, so you know, the one thing, too, is try to, you know, leave the bedroom if you could, as the room you sleep in, right? Not, that’s where you hang out, the TV room, activity, or whatever it is. Because that’s one of the things I hear from, you know, vets or other individuals about the fact that I don’t really have, you know, a lot of places to go. So what do I, what do I do in that situation?
Dr. Monica De Iorio: Yeah, that’s a good question. And that, you’re right, especially now with COVID and being home so much more. For a lot of people, that is a big issue. Sometimes you can make even subtle differences. So, the idea would be, right, keeping the bedroom for only sleep. If you are lying in bed and not sleeping, like, you’re trying to get to sleep, getting out of bed and doing something that’s kind of relaxing and calming in a different room. Then once you start to feel sleepy again, trying to go back to bed. If you’re not able to, like you’re saying, if you’re not able to leave the room, you can set up some kind of different atmospheres within the same room. If you can have kind of a corner of the room with a chair in it or something where you can engage in things like work or watching Netflix, either a relaxing or a focus space, but keep that bed area for sleep. That would be ideal. Even more subtle than that. Sometimes people have even found benefit to keep in one side of their bed for sleep and the other side of the bed where they kind of sit up and read or do something that’s more alert. And even that subtle difference from the kind of, side and the position of the bed can make a little difference. It’s not ideal, but you got to work with you’ve got.
Will Beiersdorf: No, I totally understand. So again, if you’re just joining us, and Will Beiersdorf, the Executive Director here at the Road Home Program, and you’re listening to the podcast, the Road Home Podcast here at the Road Home Program, which again, takes care of veterans and family members who may be struggling with the invisible wounds of war and life. And I’m talking with Dr. Monica De Iorio, who is one of our post, wait, hold on a second, Neuropsychology Postdoc Fellow.
Dr. Monica De Iorio: That’s right.
Will Beiersdorf: Sorry, anyways. But worked, and again, we’re talking about sleep hygiene. You know, one of the things I also wanted to ask you, too is, again, you know, how important is again, nutrition and exercise again, you know, for sleep? We don’t, we don’t, kind of, a lot of times we take that for granted but you know, how important you know, does it mean to have good sleep if you need to exercise or have a have at least a decent diet right or try to get close to one?
Dr. Monica De Iorio: Yeah, it’s absolutely important. One of the main things that helps us regulate our sleep is called our circadian rhythm. And that’s kind of an internal body clock that can tell you when to be sleepy and when to be awake. And it’s really sensitive to routine. So, not only your sleep routine, but also your nutrition routine, you know, eating kind of on a schedule, and exercising regularly, as well. A couple of things that can get in the way for sleep in that realm of diet and exercise, is if you’re eating a large meal, especially close to sleep, that can either give you more energy, particularly if you have a lot of sugar or things that kind of wake you up. Or it can disrupt sleep because of digestion. Or if you have some acid reflux, things like that. So, trying to keep a regular schedule for when you’re eating and eating kind of early enough in the evening to give you time to start digesting, kind of settle your stomach, those sorts of things can be helpful. You also don’t want to go to bed hungry. So, having a small snack right before dinner can be okay. Things like that. Exercise is also sort of tricky. So, I’ve worked with veterans who, when we talked about the idea of getting out of bed when you can’t sleep, sometimes people try to then exercise during that time. I can’t sleep, so I’m going to burn off my energy and exercise right now. And that makes sense, right? You think, oh, I can’t sleep, so I’m going to wear myself out. The problem is when you exercise, it activates your body. So afterwards, there is a period of time where you feel more alert and more awake. And so, your body then needs to wind down from that. And your body temperature also needs to cool off. When your body temperature rises, it can interfere with sleep. So, with exercise, you want to do it early enough in the day, usually at least three hours before sleep or earlier than that, to give yourself time to, yes, expend the energy Get that activity level during the day. Exercise is great for so many things. But not too close to sleep where it might make you feel awake and interfere with you falling asleep.
Will Beiersdorf: Got it. Good. Good. Those are good things. What else when we talk about sleep hygiene? Is there anything else? I mean, I asked you some questions, and again, these are things that veterans and others have asked us, and I’ve heard people ask about these, but is there anything else that, you know, veterans or other family members, right? Should know, you know, about both sleep hygiene and the importance, you know, really of sleep?
Dr. Monica De Iorio: Yeah. Sleep is important for so many things. And I think because the problems are so, they’re everywhere, right? So many people have sleep problems, and especially in the veteran community. Some of those insomnia symptoms are actually two to three times more common in the veteran and service member community. So, it’s so important to learn about and to work on. One of the things I want to make sure we touch on, going back to establishing that routine for sleep, is really setting a regular wake time and getting out of bed at that same time every day consistently. No matter how much sleep you actually got. And no matter what day of the week it is, right? If it’s a weekday or a weekend, trying to keep that as consistent as possible. That wake time is kind of the most important thing for regulating that circadian rhythm that I mentioned before. And so, along with that, the bedtime routine can look a little different. So, sometimes there is a lot of focus around keeping a regular bedtime. And that can be good. Routine is helpful in general. But the problem with just a set bedtime is, let’s say, you decide it’s 11 o’clock. Sounds like a good time for your lifestyle. Great. 11 o’clock is when you want to be going to bed. But if 11 o’clock rolls around and the person is not feeling tired, and they are they say, “Well, I’m trying this. You know, Dr. De Iorio says routine is important. I’m going to go to bed at 11 o’clock”, even though they’re not feeling tired. What’s going to end up happening is they’re not going to sleep because they’re not tired. So, you might lay in bed thinking, worrying, going on your phone, doing a number of other things. And so that goes back to that recommendation of keeping the bed only for sleep. All of a sudden, you’re spending all of this time trying to force yourself to sleep, worrying about not being able to sleep, staring at the clock, those sorts of things. And the bed becomes associated with all sorts of things besides sleep. And that’s what you want to kind of work around and strengthen instead, that connection between bed and sleep. So, if you start to do those two things together, keep the bed only for sleep and get up at the same time every single day, that’s going to help, kind of, these two systems work together where your body is telling you, “Okay, this is about the time where I get sleepy. This is about the time that I start to feel awake and take on the day.” And when you get a few nights of poor, slight asleep, especially at the beginning, when you’re starting to put the routine into place, it does take time. And so, you might feel extra tired at the beginning. But that actually can be helpful in promoting you falling asleep faster. So, it starts to even out. And that’s an important thing for people to know, as well, is that when unfortunately, as you start to make changes to your sleep, it doesn’t happen right away. You can start to implement some of these strategies and not really notice much difference or notice that you’re more tired. But keeping at it, oftentimes for at least two weeks, give something a try for at least two weeks before you decide maybe this isn’t the strategy for me. I think that’s important for people to know.
Will Beiersdorf: No, those are good things. And again, you know, if you’re just joining us, it’s the podcast here, the Road Home Program with Dr. Monica De Iorio. And then, I’m Will Beiersdorf, the Executive Director here at the Road Home Program. And again, we’re talking about sleep hygiene. So, you know, you know, one of the things that we you know, the, the whole core of our programming kind of focuses on PTSD, PTSD, Post Traumatic Stress Disorder. We also, you know, care for folks with military sexual trauma, MST, or other challenges people might face right around depression, anxiety, or other types of invisible challenges. But, you know, again, PTSD and sleep, right? I mean, usually, if someone has, you know, post-traumatic stress disorder, the, you know, do they, do they always struggle with sleep issues? Or is it, just does it depend, I mean, I’m actually asking that for myself. I’m just, you know, does it always, are they always together? Are they always kind of related?
Dr. Monica De Iorio: Not always? It’s a good question. They’re, they’re kind of interrelated in some ways. So, to answer this question, I want to talk about kind of three points in time. So, before a trauma has happened around the time of a trauma, and then kind of chronically after that. So, before a trauma has happened, if someone already has some disrupted sleep or sleep difficulty, or maybe they don’t really have sleep difficulty, but there’s not really a consistent sleep routine. And so, if we think about kind of our active-duty service members or veterans in general, it’s pretty common for people to have maybe less opportunity for sleep or inconsistent schedule because of some demands of their job. And so not having a consistent sleep schedule, or really strong sleep might increase some risk for developing PTSD later on after a trauma. So, that’s one way that they’re court sort of related. And then after a trauma has happened, and right around that trauma, there’s a couple of symptoms of PTSD that are very interrelated with sleep. So, we can think about PTSD has kind of a cluster of symptom experiences related to what we call hyperarousal. So, this idea that you have kind of an alerting system or a threat system, if you will, that’s overactive. And so, you’re kind of looking out for things that might be going wrong and, kind of, on the protective end of things. That over arousal is going to start to interfere with sleep, right? That state of being physiologically doesn’t support, relaxing and resting. So, that’s one way that PTSD can interfere with sleep. And then the re-experiencing symptoms of trauma, as well, where the kind of memories of the trauma can intrude into your life and into your sleep. So, that’s where you get distressing dreams or nightmares which may be directly related to the trauma or maybe not as clearly directly related, but having those dreams, which can, of course, wake you up out of sleep, and then cause distress around sleep. Especially if you commonly have nightmares, there becomes this fear of, if I go to sleep, I’m going to have another nightmare. So, I don’t want to go to sleep. And so, then people kind of can stay up longer and get less sleep, and then their sleep is interrupted because of the nightmare, more irritable during the day, and the cycle kind of continues. So, those are some ways that PTSD and sleep problems are very interrelated. They can kind of diverge, as well. So, especially as time goes on, oftentimes, the stressor or the trauma can be kind of this activating event that can bring on some insomnia. But what makes the sleep problems and the insomnia continue might be kind of different than the PTSD. So, it starts to be some of the things that people do to try to get better sleep, which makes sense intuitively, but actually can interfere with sleep and perpetuate sleep problems. So, things like some of the things we’ve already talked about, like spending more time in bed. Sometimes people think, “Oh, well, at least I’m resting. If I’m not sleeping, I’m laying in bed.” But again, you’re not sleeping. So, you’re not strengthening that bed sleep connection. Things like alcohol use, again, as we talked about before can disrupt sleep. And things like napping, again, very intuitive, you think, “Well, I can’t sleep. I’m not getting sleep during the night. So, I have to sleep whenever I can. If I can nap, I’m going to take the chance.” The problem is, if you then nap during the day, your, we call it sleep drive, your need to sleep at night will likely be weaker. So, you will maybe stay up later and struggle to fall asleep again, get less sleep, be more tired the next day, take another nap and again, kind of continues the cycle. So, I know this is a long answer to your question. But.
Will Beiersdorf: No, this is all good. And again, this is helpful. And as we kind of put this podcast out this, this is good information. And I’m going to kind of wrap things up here, you know. And just again, if people want to learn more, you know about the Road Home Program, they can go to Road Home Program, that’s all one word roadhomeprogram.org. If you’re in Chicago, or even if you’re not, and you want to learn more, you can also call us at 312-942-8387 or 312 942 VETS. So, if you want to learn more, and you can, again, the website’s great. There’s a lot of good information there. But is there any last, you know, parting thoughts? You know, about sleep hygiene and things? And, you know, any other thoughts as we kind of wrap things up? From your perspective? Again, this is a really important topic because yeah, I mean, its sleep is critical, right? To your, to your long-term health. And so, you need the, whatever it is people always say, “I only need like three hours of sleep” I can get, you but, you know what, yeah, maybe. You know, but you know, pay me now or pay me later.
Dr. Monica De Iorio: Yeah.
Will Beiersdorf: You do need, you know, at least the six or seven hours or maybe eight hours, whatever, whatever it is, but, but it does make a difference long term. But is there any other, you know, like last minute or last thoughts that you have, you know, as we kind of wrap things up and begin to, you know, encourage folks, you know, if they are having challenges, you know, you know, what they should do, more importantly, they should call us, right? Or reach out to us.
Dr. Monica De Iorio: Right. And I think that’s kind of the parting thought maybe I’ll leave off is that there is, there’s a lot of these strategies that you can try out on your own, and I encourage people to do so. But it can be really helpful to work with someone. Especially if you’ve been struggling with sleep for, you know, 10 years or two years or whatever, a long time, right? That can be particularly helpful. You know, you can call us. Sometimes I work with people on an outpatient side, as well, to work with things like sleep. There’s a treatment called Cognitive Behavioral Therapy for insomnia. It’s short term and we do a lot of the things that we talked about here in this podcast. It’s very personalized and we go, kind of, step by step to find what’s going to work for you. And I will say, you know, as frustrating as sleep problems can be, they can get better, and a lot of these strategies have been very well researched and studied and we know that they are helpful for people. So, you know, try things out on your own and if you’re having difficulties reach out and get help from us or someone else. You know that help is out there.
Will Beiersdorf: Exactly. No, it’s good stuff. Good stuff. Well, Monica, I want to thank you again, for the time today. I think it’s great information again for folks to hear. And again, it’s you know, we’re, this is the Road Home Podcast, if you want to learn more about the Road Home Program, rode home program all one word .org. Or you can call us at 312 942 8387. 312 942 VETS. And yeah, that wraps things up for this podcast today. So, you know, thanks, Monica. I appreciate, you know, you and all the work you do here. I mean, you know, and please, again, folks, take some time to learn about us, you know. And if you’re a family member or friend of a veteran, or you know, someone who’s struggling with this, you know, highly encourage you to, you know, get online, and check us out or call us. So, thanks, Monica.
Dr. Monica De Iorio: Thank you so much for having me.
Will Beiersdorf: You’re welcome.
About Road Home Program: The Podcast
Veterans have served our country, now it’s our turn to serve them. Road Home’s Will Beiersdorf talks with veterans and their families about their journeys transitioning to civilian life. During every episode you’ll hear from subject matter experts, like Rush clinicians, staff and community partners, discussing resources and services available to veterans to help them heal from the invisible wounds of war. Subscribe, download, or listen to other Road Home Program podcast episodes.
The Road Home Program provides mental health care and wellness to veterans of all eras, service members, and their families at no cost and regardless of discharge status. If you or a loved one needs help, call us at (312) 942-8387 (VETS) or fill out the Get Care form.