Sleep Health and Tips to Restful Sleep with Annie Miller

Today's guest is Annie Miller, licensed therapist and former chronic pain sufferer.  Annie works with her clients to reprogram their behaviors around sleep.  

Do you find your mind is preoccupied with anxious thoughts, or you are replaying old experiences, unable to let go?

If you’re dealing with symptoms of anxiety or you’re having trouble moving past a traumatic event, our therapy will help you develop healthy habits and responses. Therapies backed by research, like EMDR and CBT are clinically proven to help symptoms of anxiety and trauma.

Therapy is about learning and growing, but it’s also about a connection to your therapist. 

Connect with Annie online at: https://dcmetrotherapy.com

Transcript

Magic Barclay: 1:01

Welcome back to a magical life. I'm your host, magic Barclay. And today any Miller joins me and we're talking sleep and chronic pain. Any Miller is a licensed psychotherapist in private practice in the Washington DC area in the U S she is the owner and founder of DC Metro sleep. and psychotherapy, and he specializes in working with sleep disorders, chronic pain and trauma, and he uses a wide variety of evidence based techniques, including CBTI for insomnia, EMDR for trauma. CBT for anxiety disorders and PRT, which is pain reprocessing therapy for chronic pain. Annie received her BA from the University of Pennsylvania and her MSW from the University of Chicago. Annie is a licensed clinical social worker in Maryland, the District of Columbia and Virginia. She has training from the University of Pennsylvania in CBT for insomnia. And he is also trained in EMDR, which is eye movement, desensitization and reprocessing, and is one of a select group of therapists in pain reprocessing therapy. Welcome Annie.

Annie Millier: 2:24

Thank you so much for

Magic Barclay: 2:26

having me. My pleasure. Now I want to get straight into this because I've really been looking forward to an episode. Around sleep health. I think it's just so, so important. And I've spoken before to the listeners about the importance of a great morning routine to set up for a great night of restful sleep. But I think we really need to target the issue because so many people sleep so poorly.

Annie Millier: 2:57

Yes, that's definitely true. I agree with you.

Magic Barclay: 3:00

Great. So, look, I asked the same three questions of all of my guests. Everyone gives me a different answer. And the first one is what can your expertise do to accelerate health, not just physical health, but also emotional and spiritual health. Yeah. So,

Annie Millier: 3:18

I really specialize in teaching people how to manage difficult emotions and difficult conditions. And I'm I'm In a way that's different from how people are used to thinking about them. So helping people understand conditions like insomnia and chronic pain and relating it to the brain and how the brain works. Because, you know, the way that I see it, we are so used to being uncomfortable and immediately seeking relief. and in my opinion, getting to a healthier place is about learning how to tolerate. discomfort and reduce fear around difficult sensations or emotions. so for instance, when I talk to clients, I see about sleep. The biggest kind of piece of advice I have is talking to them about letting go of fear and worry about not sleeping. And it's a similar approach with pain. So the overall message is. to shift your mindset and work on, approaching things that may cause you discomfort differently and changing your brain in this way can create more healthy responses.

Magic Barclay: 4:38

Very much so. And I know personally, I found And nights that I struggled to get to sleep, definitely lying in bed, going, I can't get to sleep, make things a lot worse.

Annie Millier: 4:50

Yes, that is exactly right. So that's one of the things that we can talk about is. You know, and that one of the things I teach my clients is lying in bed, trying to sleep and gives your brain this wide open space to worry. And so changing your habits and thoughts around sleep is essential to

Magic Barclay: 5:11

getting better sleep. Definitely. Now we talk about wealth here as well, and people think that's just financial wealth. And I guess it is. Tied in, but also personal and emotional wealth. So what are your top three tips to creating wealth?

Annie Millier: 5:26

Yeah. The way I see this can tie into some of the other things. so I think the 1st thing I would really recommend is patience. so anytime we put pressure on something to happen right now, right away, quick fix. it's going to make the situation much less likely to happen. So, approaching changing your situation, whether it's financial or, you know, another kind of wealth. with a sense of ease and peace and without pressure with more patients is really important. And it's similar to how I think about sleep as well. And the 2nd thing I would suggest is to find within yourself a sense of confidence. so I think it's really important to believe that you're capable and to feel like you really believe in what you're doing and your worth. like, that you have something important to share and to really dig in and find that self belief. Because if that's not there, it's going to be really hard to be successful. And the 3rd thing that I would suggest is resilience. so the path to creating success is going to have ups and downs. It always does. You know, life is complicated. And so it's really important to be able to weather the successes and failures. And to pick yourself up and learn from each bump that you face, because. that's how we create resilience. So, resilience is a really important, thing that you need to have in order to really be successful.

Magic Barclay: 7:15

Fantastic. And our final standard question, and I know you mentioned to me off air that you're not comfortable with this question. We do talk about weight loss. So all I'm going to say is from a scientific standpoint is a big link between weight issues and sleep health. Have you come across any kind of link like that in practice? Yes.

Annie Millier: 7:41

and you know, I just, I personally am not a specialist. You know, there's a lot of therapists out there who focus on weight and body image and eating and that's not one of my specialties. but I do think that there are a lot of overlaps with trouble sleeping and even with chronic pain and, weight issues or, over focus on eating, and eating related issues. And so I do think there's overlaps. a lot of research shows that poor sleep is linked. To, you know, weight gain, in addition, chronic pain is linked to weight gain, but generally speaking, you know, I view this topic in a similar way that I view, you know, sleep and chronic pain is that the more pressure we put on it, the more focus we have on it. the harder it's going to be to change.

Magic Barclay: 8:39

Definitely. Well, that's our standard three questions, Annie. Now I really want to open up the floor to everything that you do in practice. So tell us what it's like working with sleep and, and I guess, how did you get into working in this field?

Annie Millier: 8:58

Yeah, great. so I had kind of stumbled into this field. So, particularly with sleep. I was always interested in in sleep because, I kind of joke that I come from a family of 4 sleepers. so, you know, my. Knowledge of sleep and just kind of seeing this play out difficulty sleeping, was there, you know, in childhood from watching family members go through this. and so when I became a therapist, I started out as a, just to talk therapist. and. I took a CBT for insomnia course, and it was just, I really connected with the material, and it kind of snowballed from there and then CBT. I is this really evidence based. Treatment for insomnia. That works really well. And so when you start working with clients and seeing them get better, it's kind of like, you know, amazing as a therapist, because you have this therapy that works really well, and you can really help people with their sleep. so I was kind of hooked on working with sleep from there.

Magic Barclay: 10:13

So how do you quantify good sleep or restful sleep? Look, what are people looking for? Are they looking for feeling refreshed in the morning or are they looking for, you know, feeling mentally refreshed? Like what are the goals of restful sleep? And I guess, how much sleep do we need to get?

Annie Millier: 10:34

you know, these are good questions because, there are a lot of people out there who view their sleep as being bad or not restful. but when we actually look at it, it's. You know, they're doing pretty well. All things considered. So, you know, I really base how restful sleep is on how someone's feeling, keeping in mind that there's a lot of factors that go into, like, feeling tired, for instance. It's not just about the sleep. but what C. B. T. I. Does that helps refine your habits and thoughts to make it a lot easier to get restful sleep. and in terms of the, the number of hours, this is a really good question. and I think it's actually 1 of the common misconceptions about sleep that people have. You know, most people out there think we need 8 hours of sleep, right? And, for you, right? You're working in nutrition, functional nutrition, right? And if we all needed to eat the same foods, that wouldn't make sense, right? it can't be true that every single person needs the same amount of sleep. So eight hours has sort of become this standard, and some people do need but I would say most healthy adults need somewhere between six and nine hours. for some people, six is great and then there are short sleepers who actually need more like five hours and that's, that's a more unusual. but they're out there and what their biggest struggle is, is that they're trying to get 8 hours and so they're lying there for this extra 3 hours trying to make it work when it's not what their body needs. So, you know, the overall goal is not to meet certain standard that you think you need to meet. It's to kind of see what works for your body, typically thinking of that six to nine hour range.

Magic Barclay: 12:44

I know for myself, pre menopause, I was the short sleeper, five hours, four, four and a half to five was the sweet spot. And then when menopause hit, I became pretty much 7. 2. So, you know, going to bed at 10 PM and then waking up at about quarter past five in the morning, you know, even without an alarm clock, that's just the way it went after menopause. So definitely, There is no set number that I've found for people like try and get eight hours for me at any point in my hormonal life just

13:21

won't

Annie Millier: 13:22

work. It's really interesting. No, I appreciate you sharing that because it's, I think that's really helpful. Because it's, for a lot of people, they're feeling frustrated and thinking that they're doing it wrong. but we're all different. We all have different needs. And just as you shared with your own experience, our needs change over time. So, if it's 1 thing now, it may not be set that way, and, you know, going through different experiences, you know, like, becoming a new parent, for instance. other big milestones in life sometimes change sleep. So yeah, it's important to, to have a broader perspective on it.

Magic Barclay: 14:06

Definitely. Now, what are some important things that you would like to talk to the listeners

Annie Millier: 14:11

about, would it be helpful for me to kind of give you an overview of how I work with clients, uh, doing CBTI?

Magic Barclay: 14:21

Definitely. I'm sure many people haven't heard of what it is.

Annie Millier: 14:24

Yeah, so C. B. T. I again is C. B. T. for insomnia and a lot of listeners may have heard of C. B. T. which is cognitive behavioral therapy. C. B. T. for insomnia is actually different and it's its own thing. So. What it's based on is changing thoughts and habits around sleep, and it's a really evidence based treatment, meaning that there's a lot of research out there that's been done looking at how effective it is, and it's really amazing. I mean, most of the research shows that it's between 70 and 80 percent effective, which is. so that's what it is. and then it's really about, you know, these specific strategies that can impact what's called your sleep drive. So what sleep drive is, is it's that innate need that your body has to sleep. so we want to increase your sleep drive. And in order to do that, I have clients keep a sleep diary that has pretty specific questions to track their sleep. And then once I can see what their habits are and what their patterns are, I'll have them follow a set of rules. And specifically, we're doing no clocks in the bedroom. So that's the 1st thing I want them to do and for some people that no clocks is kind of a funny thing and it feels weird. But that connection, how much longer do I have to sleep the checking and the attention to it is not helping with sleep. the next thing that I have people do is to make sure that they're using the bed only for sleep. So, this involves, like, no reading, no watching TV, no looking at your phone in bed. So, most people think that this therapy is going to be about restricting screens. But it's really just about, paying attention to what you're looking at and where so if you're looking at something upsetting before bed in bed, that's, you know, a big no, no, and that's not going to help. So, we are careful about the content and. But specifically trying to develop a strong what we call conditioned response to the bed being for sleep. So if we use the bed only for sleep, you know, we start to have more of that conditioned response. I also make sure that what people are doing, if they can't sleep is to get up and get out of bed. So this is what we, like, touched on a little bit before if you're lying in bed, trying to sleep, your brain has this wide open space to worry, think about everything you didn't do. And we don't want that. So if you can't sleep, get up, get out of bed, go do something quiet and come back into bed. When you feel sleepy, I encourage people and this is a really important thing, even though it's not the most popular. of these rules. Is to wake up at the same time every day, no matter what 7 days a week and to go to bed at about the same time or later. So we're not going to bed early and there's a component of this. That is called sleep restriction. Um, where we're setting a window of time to sleep within that window. You don't want to get in bed early and you don't want to sleep late. And then there's a couple other things we work on. So, another role is not to nap during the day. And if you do need a nap, a short nap, 15 to 20 minutes. Um, and then giving yourself a buffer zone before bed, just time to relax. So we don't want to be working, working right up until it's time to bet to go to bed and then expect just to be able to have our brains, you know, relax, because that's not typically the way it works. Um, and then, you know, there are the thoughts about sleep too. So that's the, the cognitive component is the thoughts. you know, if I need this amount of sleep in order to feel okay, and so that's CBT EI. I

Magic Barclay: 19:06

think there's some great points in there and I certainly found. For myself, you know, I, I used to love watching YouTube in bed before I went to sleep and particularly love the true crime things or, uh, you know, the, the cemetery stories and things like that. And it, it took me quite a while to realize that was actually stopping me from getting to sleep. So definitely. I love the tip of the bed is just for sleeping. That's. You know, that's what you do. That's a great takeaway.

Annie Millier: 19:41

yeah. And if we, think about this in terms of the idea of conditioning, so most people may remember conditioning from like a psychology class that they took, where we learned about Pavlov and the dogs. And so, basically, what we learned through that is we can start to condition ourselves to have a response. And with Pavlov, he would ring a bell and then feed dogs. And he did that consistently to the point where they would salivate and expect food. After they heard the bell and so we want to get in bed and have this very clear association. The bed is her sleep and this is much more powerful than people realize. It is the way our mission responses. So we want a really clear.

Magic Barclay: 20:39

much so now something I found with sleep is certainly in my clinical practice, a lot of people have cortisol issues. So whether their cortisol awakening response is off, whether, you know, their, their cortisol is kind of. Switched around and so it's highest at the evening rather than the morning. So what are some ways that you help people stop that cortisol cycling response that's keeping them awake?

Annie Millier: 21:13

Yeah, it's a good point. I would say most people that I see have some level of this problem. many, many people have they're more awake at night. Switched. They kind of have that cortisol push at night when it's really supposed to be that our body is releasing melatonin to make us feel sleepy, but it ends up being that our circadian rhythm gets shifted off. and, you know, a lot of that's due to stress and anxiety and, you know, the fear about sleep and stress around, you know, bedtime can put our brain into that state as well. So. Um, what I do with people is to I mentioned this a little bit before, but it's to try to increase sleep drive. So getting your sleep drive higher, basically is you're, so sleepy, when you start to do some of this stuff that. You need to sleep and it starts to shift your circadian rhythm back to, you know, the natural normal way that it's supposed to function it's a little bit like ripping a bandaid off sometimes because we have to kind of go through a little bit of a tough. point to get to, having more functional sleep, having more sleep drive. So, it can be a little uncomfortable sometimes to do this, but if you keep your wake time the same, so that's the starting point that I would recommend is what happens with most people is that when you feel more awake at night, you stay up later and then to compensate. You sleep later, because, you know, the thought is, well, I, I can't function if I don't get X amount of sleep and so we just end up pushing it and then it becomes a cycle that's repeating. So, if you pick a week time, no matter what time you go to bed. And you keep doing that the same time every day, eventually, you're going to be really, really sleepy. So, even if you get a very small amount of sleep, you know, especially that 1st night, 2nd night. You're going to get through the day, you're going to be okay, and you're going to be sleepy and that's what we want and that's kind of the process behind this and I do it a little more with based on like the, what I'm seeing, you know, from the person who's tracking their sleep and the sleep diary and that part of it's important too.

Magic Barclay: 23:44

So, when setting the bedroom up for good sleep or for healthy sleep, what are some tips that you have, like block out blinds. No light, you know, what, what are some things that you find you're suggesting?

Annie Millier: 24:04

Yeah. So, um, having the room be dark is important. Having it be cool. Is also important, um, you know, the thing I mentioned before about not having clocks in the room. That's incredibly important as well. So, you know, we don't want to have access to, even if you keep, like, if you sleep with your phone right next to your bed and you wake up and your habit is just to pull up the phone, you're going to see what time it is. We don't want to do that. So you can set an alarm. You can either turn the clock around. Or put something over it, like, we just don't want to have access to see the time. Um, you know, those are some of the basic things I think, um, you know, it's much more about, like, the habits and routines. It does really help to have a dark room with no clocks. But what we're doing around sleep, I think is even more important.

Magic Barclay: 25:06

So there's a lot of talk about no screen time for two hours before sleep. What are your thoughts on that? And for the people that, you know, watch TV leading up to sleep, is there a time buffer there that they should be considering?

Annie Millier: 25:23

Yeah. You know, I think this is something that a lot of people wonder about, um, and ask about and Thank you. The way that I see this is maybe different than some other people and the way they see it, but, um, there are some people out there who have. Uh, what's called circadian rhythm issues where, like, they're, up really, really late or even they, they're going to bed really, really early. And if that's the case, sometimes light and screens can impact the circadian rhythm. It can and it can have an impact. Most of us aren't as sensitive to it. So let's say you're what you had mentioned about watching the true crime kind of stuff. particularly in bed and I know it's tempting and a lot of people do this. Right? So, I totally understand why. and many people out there are doing that. But crime and true crime, even though it's very appealing, it can get you kind of worked up and it can put your brain into a place of stress because you're thinking about difficult things. And so I think sometimes those things aren't helpful. Watching a horror movie before bed is not helpful. but if it is relaxing to watch TV before bed, I'm all for it, you know, watching like a light, easy show. One of the, the things like the examples I give is something like a nature documentary because it's, you can turn it off pretty easily. It's not too engaging, and for many people they find it really relaxing. So something like that, a nature documentary, as long as you're not watching it in bed. I personally feel like I support that. Terrific.

Magic Barclay: 27:18

What about sounds in the bedroom? So I know, you know, some people like to have the relaxation music going, or, you know, the car map or something like that. Is that helpful in getting to sleep? And more so is it helpful in staying

Annie Millier: 27:35

asleep? you know, something like a white noise machine, I think can be really helpful because it helps to drown out background noises. So it makes it less likely that you'll wake up and hear something, or that sounds will disrupt sleep. So something like that, I, I do recommend, but, you know, like the calm app, and other meditation apps. I love them. I'm a huge, huge, fan of meditation for everyone. I think that the problem with doing that before bed is that we start to think, especially some, some people more than others will start to think, well, I really need to fall asleep by the end of this meditation. And then you're preoccupied with thinking about that during the meditation and you're worrying about what happens if I don't fall asleep. Am I going to start another 1? What am I going to do then? And then it, it ends up becoming kind of a stressor and it defeats the purpose of meditation. So I recommend meditation before. And if people really feel connected to it, it's okay to listen to it. I just, we're, we're aiming for 15 to 20 minutes of lying in bed, trying to sleep. And if if it's not working at that point, you're going to get up and get out of bed. So, as long as you kind of have this in mind. And work within that framework, I think, you know, you can use some of these tools

Magic Barclay: 29:07

terrific. Now we've covered quite a few points here. Is there anything else that you feel? The listeners need to hear?

Annie Millier: 29:16

Yeah. I mean, I, I generally want people to know that. More sleep is not necessarily better. so if you've ever had this experience where you have not such a great night, typically, the next night is better because of what we talked about before, which is sleep drive. so not thinking about more as being better, it's more about trying to establish good patterns and routines. And it's so important to let go of the worry and the fear, because that's just creating more of a problem of insomnia.

Magic Barclay: 29:56

Great. Now, Annie, people can find you on Instagram at dc. metro. therapy. You're on LinkedIn, Annie Miller, MSW. LCSW, C L I C S W, and then B 4 8 5 9 4 2 4. You're also on Facebook at DC Metro Sleep and Psychotherapy. Before I let you go, we love freebies here. So what can you offer the listeners and where can they find it?

Annie Millier: 30:33

yeah, I mean, there's a lot of information on my website, D. C. Metro therapy dot com. So there's, there's a blog. and I also, I mean, I have an online course on there for chronic pain, which hopefully some people will be interested in, but my Instagram, I think, is probably the best source of information. There's. Videos and posts, and a lot of helpful tips and information that I give on there. So hopefully that'll be helpful.

Magic Barclay: 31:06

Wonderful. Annie, thank you so much for joining us.

Annie Millier: 31:10

Thank you so much for having me.

Magic Barclay: 31:13

And listeners, thank you for your time. Go on ahead to Spotify, Apple, wherever you listen to this podcast. Please leave us a review. We certainly do appreciate all of your feedback. And for now, go forth and create your magical life.