How to Sleep Better with Michelle Drerup, PsyD

Podcast Transcript

Speaker 1: There's so much health advice out there, lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health questions so you get the answers you need. This is the Health Essentials podcast, brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Annie Zaleski: Hello, and thank you for joining us for this episode of the Health Essentials podcast. I'm your host, Annie Zaleski, and today we're talking with sleep expert, Dr. Michelle Drerup to discuss things you can do to fall asleep faster.

If you find that your brain starts revving up as soon as your head hits the pillow or your prone to tossing and turning at night, you're not alone. Stress and anxiety can make your ZZZ’s feel very far away. So can certain sleep disorders which might impact your quality and amount of sleep. At other times, our daily habits such as using our phones can have an impact on our shut-eye. Dr. Drerup is here to discuss why we have trouble sleeping, things we can use to make our bedtime routines smoother and easy lifestyle changes we can make today. Dr. Drerup, thanks so much for being here.

Dr. Michelle Drerup: Thank you for having me.

Annie Zaleski: So I'd like to start off by having you tell us a little bit about your work here at Cleveland Clinic, what kind of research and clinical work do you do?

Dr. Michelle Drerup: Sure. I'm Director of Behavioral Sleep Medicine here at the Cleveland Clinic Sleep Disorders Center. I see patients who have sleep disorders and treat them with nonpharmacological interventions, so I see a lot of patients with insomnia. My research also falls in that line as well, in looking at the effectiveness of treatments, including both in person, one-on-one, as well as digital cognitive behavioral therapy for insomnia.

Annie Zaleski: So walk us through what it's like when the body's falling asleep, what changes are happening that make us wind down the day?

Dr. Michelle Drerup: So there's something called the two-process model of sleep regulation. So thinking about it in a simple term that we have a sleep drive that builds up the longer we're awake and so by the end of the day, that sleep drive or pressure for sleep is high, but we also have more of an internal sleep rhythm. People know this as our circadian rhythm that also varies for people. Some people might identify themselves as more night owls and they don't get sleepy until much later, other people are more early, and so this internal rhythm influences when we start to feel sleepy as well. It's really both the body, as well as mind starting to relax and quiet down.

Annie Zaleski: So how long does it generally take people to fall asleep? Is there a normal range or a typical range that you see?

Dr. Michelle Drerup: Yeah. Most people, if they don't have any sleep difficulties, probably fall asleep within 10 to 20 minutes. It varies as well. If it takes someone 45 minutes to fall asleep and that's normal for them and they allow enough time, it's not necessarily a problem. People don't typically fall asleep immediately. That suggests they're probably sleep deprived and not getting enough sleep.

Annie Zaleski: I was going to ask that, how common is it then that people would have trouble getting to sleep or might have trouble staying asleep during the night?

Dr. Michelle Drerup: Yeah. About 30% of adults have symptoms of insomnia, and of that about 10% of adults have it severe enough where it's causing daytime consequences, and that we would actually diagnose them with insomnia disorder.

Annie Zaleski: So obviously stress is something that people would very much report is keeping them up at night. They're worried about something that might have happened during the day or something they're doing maybe the following day. So what are some other common reasons that we might have trouble sleeping or factors that affect our sleep?

Dr. Michelle Drerup: Yeah. So commonly it might be having an irregular schedule, that they're waking at different times in the morning, they may have some poor sleep habits that contribute, and I think we'll talk about those as we get into the podcast. Oftentimes insomnia and sleep difficulties can be part of a mental health disorder, like anxiety or depression, physical illnesses and pain, impacts of medications. Other sleep disorders can actually cause insomnia symptoms as well. By far, stress tends to be the most commonly reported but there's a wide gamut of different factors that can contribute.

Annie Zaleski: So with something like diet, can that also affect your sleeping habits?

Dr. Michelle Drerup: Potentially, sure. The obvious one we think of is caffeine because that is a stimulant and so it can keep people up. But heavy meals can cause digestion late which then is more of an activating process.

Annie Zaleski: Well, let's dive into some of the most common remedies and major things people use to help them sleep better. So I think one of the major things that people might want to reach for, first and foremost, is sleeping pills or other medications. So talk a little bit about this as an effect and whether you should take them and what people should know.

Dr. Michelle Drerup: Yeah. When they're taken by healthy adults, sleep aids usually can be safe for short term use as long as they're used as prescribed or directed. However, there's a potential for side-effects, so obviously it's always safest to do this under the guidance of your physician or healthcare professional. Really no sleep aid is the magic bullet and there's not one best sleep aid for everyone.

Problems with sleep aids is that ideally people use them temporarily but they can become dependent on them. So ideally we recommend trying alternative strategies aside from sleep medications first. That's our guidelines from the American College of Family Physicians and The American Academy of Sleep Medicine, are really that behavioral strategies should be first line treatment for insomnia versus medications.

Annie Zaleski: Well, there were also some FDA warnings a few years ago as well, that people really need to be careful and talk to their doctor about before they go down this route.

Dr. Michelle Drerup: Right. The common side effects of prescription sleep medications are really because it has a sedative effect it's not like it just works only when you're sleeping that if they wake up they may feel drowsy, groggy, have slowed thinking when they want to be alert — obviously concerning for people who drive in the morning. There are also incidents of abnormal behaviors after taking some sleep aids, doing things without awareness, sleep-eating, there's even been incidents of sleep-driving related to a sleep-walking type impact of sleep medications. So they're not with side effects.

Annie Zaleski: So one of the other common remedies I think people also reach for is melatonin? So talk to me a little bit about why that's a sleep remedy and what it does and what people should look out for.

Dr. Michelle Drerup: Yeah. Melatonin is sold over the counter in a range of doses so I think it's confusing for consumers, it can be from as low as 0.5 milligrams to 10 milligrams and higher. And oftentimes we think, well, higher doses are going to be better or work better, and that's not really the case with melatonin. The right dosage can vary a lot from person to person, as well as what sleep disorder we're treating.

Sometimes we use it as a sedative to make people feel more sleepy so then they might take it about a half hour or an hour before bedtime. But melatonin really works best for people who have a delayed circadian rhythm, so someone who's a night owl, who just their internal clock prefers going to bed later and waking up later but maybe they have to wake up early for work or for school or other commitments and so it really works much more. We have much more data on using it as a circadian rhythm shifter.

Annie Zaleski: You mentioned that sleeping pills, people can be addicted to them, can melatonin have a similar effect?

Dr. Michelle Drerup: Not physiologically. As with anything people take tends to be more that they'll have a psychological dependence on it. It may not really be helping, but if they don't take it they feel like they don't sleep at all, and it's because they have really this association that “this helps me sleep and so I start to relax when I take it.” So there's not a risk of physiological dependence. It's not that you stop producing melatonin if you're taking melatonin for a period of time, but it's much more psychological dependence. And as with any sleep aids, we recommend people use them for the shortest possible period of time.

Annie Zaleski: So one of the other things that people deal with these days is using your phone. Everyone is tied to their phone and it’s usually there when they get up in the morning to when they go to sleep at night. But limiting phone and screen time is one of the biggest remedies for trying to be able to get to sleep better and getting to sleep faster. So talk a little bit about this, why it's so important to limit phone and screen time.

Dr. Michelle Drerup: Yeah. This advice is all over the place in terms of what we recommend. "Oh, you shouldn't use it an hour before bedtime, two hours before time," and most of the research on this issue has really been done in children, which we have strong evidence for its impact of media use and technology before bed and poor sleep. But adults see more mixed effects actually. Studies actually indicate that potentially more passive use of technology, such as “I'm watching TV and I'm far away from the screen, it's not a very stimulating or distressing show,” or “I'm listening to my music on a device” don't really effect sleep compared to active use, like “I'm texting, I'm on social media.” So the content is actually probably more impactful than the impact of blue light from the screens. So I think there probably are people that might be more sensitive to it, but it's really much more about what you're doing on those devices. We can use our devices to actually promote sleep by listening to something that's relaxing or doing something that takes our mind off other things.

Annie Zaleski: That's really interesting. Do doctors know why that is? Why it's about the content and not necessarily about the light coming in that it's making you stay awake longer? Or maybe it's keeping you awake longer?

Dr. Michelle Drerup: Yeah. I think it's activating our brain. Anything that is activating our brain as we're trying to wind down can keep us going. The effect of light, the studies that have really shown support for its impact on sleep onset and melatonin production are much more like people using screens for two hours straight prior to bedtime versus is there any harm and I'm going to, an hour before bed, check to make sure I don't have any messages I need to respond to, look over my next day and then put it aside and do something to relax.

Annie Zaleski: So you mentioned that people might want to listen to music, and so noise machines are another thing or apps that produce noise are another very popular thing now for people. So can white noise help you sleep?

Dr. Michelle Drerup: Yeah. So that consistency of white noise or a sound machine creates a masking effect so it can block out any sudden changes in noises. So say a bed partner snoring, or the dog barking or something outside, so that might cause you to wake up, so it tunes your auditory focus to that constant sound. So people can find this to be soothing as well and help them fall asleep or fall back asleep after waking.

Annie Zaleski: So there's also something called pink noise, what is this and why does this help you sleep?

Dr. Michelle Drerup: Yeah. So there are all different colors of noise, and pink noise is described as white noise with the base turned up. So white noise is perfectly balanced across all frequency, whereas pink noise, the higher frequencies are actually turned down. So pink noise sounds lower pitch than white noise.

Annie Zaleski: So what are some examples of pink noise then? It's interesting that it's up the base because it almost seems counterintuitive. It seems like that would make you keep you awake rather than make you fall asleep.

Dr. Michelle Drerup: Right. So the best comparison is probably pink noise is the sound of a waterfall. White noise is more static. And there actually was a study a few years ago that found that pink noise actually enhanced deep sleep in older adults and improved cognitive performance. So pink noises or white noise or any type of sound is generally safe for anyone to use. People with hearing loss or sensitivity to sounds might find it a bit annoying or frustrating, but if someone wants to try it out it's typically not a concern just to see how it works for them.

Annie Zaleski: So you mentioned calming music, what other types of noise might help you sleep better? Is there any type of noise that is not good for you or not good for your sleep habits?

Dr. Michelle Drerup: Yeah, it really is individual. If someone might prefer a fan, the sound machine, the different apps that are out there, nature sounds, it's really more the consistency and that it's this ambient sound that's predictable and consistent. Those are the qualities that help best. I once had a patient that liked techno music, that that beat helped them fall asleep, and I think most people would probably find that to be odd but the consistency of the beat was something they focused on and helped them relax.

Annie Zaleski: That's really interesting. That doesn't surprise me though, people fall asleep at concerts all the time and so you wonder how that happens. Exactly.

Dr. Michelle Drerup: Yeah, people think a lot about classical music or something like that because it is very calm and soothing, not a lot of variations, but it is very individual.

Annie Zaleski: So one of the other common things people recommend is practicing meditation or relaxation techniques before bed. What are some common ones and what does this sort of look like?

Dr. Michelle Drerup: Yeah. So the common ones include mindfulness meditation, in particular, has shown to improve sleep quality, decrease daytime disturbance in people with chronic insomnia. Different types of relaxation, like progressive muscle relaxation, guided imagery, they bring about a relaxed state of mind that is more conducive to falling to sleep. We're trying to bring on the relaxation response, which is the opposite of the stress response. When people initially start to try this, I tell them to do it during the day and not to start at night, it's something novel, just to see how they respond to it. Again, it doesn't necessarily make you fall asleep. It's more to get in a better relaxed state to help you fall asleep.

Annie Zaleski: So we mentioned this briefly but I think a lot of people want to know whether changing their diet can help them sleep better. What do doctors know?

Dr. Michelle Drerup: Yeah. What we eat might impact our sleep quality, sleep duration. Like we said, caffeine is notorious, and that stimulating effect we recommend for avoiding caffeine and there's hidden caffeine in things like chocolate. The half-life of caffeine is about five to seven hours, so for most people avoiding it in the early afternoon is best. Some people are more sensitive, so if you're one of those people you need to be more careful.

Eating a diet that's high in sugar, saturated fat, processed carbohydrates can disrupt your sleep. While eating more plants, fiber, foods rich in unsaturated fats seems to have the opposite effect. The foods that are good for our overall health tend to be better for our sleep health.

Another thing that can contribute to sleep difficulties, specific types of foods, are eating spicy foods. That can cause heartburn when you lie down. That might exacerbate acid reflux with spicy food, so that can be difficult for people.

A food that’s not food would be alcohol. Alcohol, people oftentimes associate with helping them fall asleep more quickly because they feel more relaxed, but that's its initial impact. However, when alcohol wears off it can wake people up in more of the restorative stages of sleep, it can worsen sleep apnea symptoms, it can cause sleep-walking, sleep-talking, worsened nightmares. So it can have a lot of detrimental effects to sleep.

Annie Zaleski: Is there a general rule that you should stop eating or drinking X amount of hours before you go to sleep? Is there an optimal range?

Dr. Michelle Drerup: Again, this varies for people. A small snack prior to bedtime isn't probably going to be disruptive. Typically, with alcohol earlier is better and so avoiding alcohol within the last couple of hours before bedtime is better in timing of that. But large meals, large heavy meals late are really what we're most concerned about.

Annie Zaleski: So everyone knows exercise is good for you for dozens of reasons, so can getting more exercise, or a regular regimen of exercise, can that help you sleep better?

Dr. Michelle Drerup: Yeah. Sleep and exercise, like a lot of things with sleep, have a bidirectional relationship, which means that proper exercise and regular exercise can improve sleep. And when we get better sleep, we're more likely to exercise. People can get caught in a vicious cycle where “I'm too tired to exercise so I don't exercise and then my sleep worsens further.”

So in terms of specific to improving sleep, moderate to more strenuous exercise can increase sleep quality for adults, decreasing the time it takes to fall asleep, decreasing that wakefulness during the night and it might also help with daytime sleepiness. So instead of feeling like, "OK, I'm going to rest and take a nap because I'm tired," getting out and taking a walk has an exponential effect because I'm not napping during the daytime that might decrease that sleep drive but also gives me a boost to increase that sleep quality.

Annie Zaleski: What I like about that too is that it's very short. You don't necessarily need to throw on your sneakers and go for an hour long run. Just a little bit of movement and a little bit of exercise can make a difference.

Dr. Michelle Drerup: Absolutely. Yep.

Annie Zaleski: So one of the other things that I think people are always striving for is a comfortable sleeping environment. So can your mattress, or pillows, or even your sheets affect your sleep and are there things people can change?

Dr. Michelle Drerup: Yeah. It's really hard to find the right mattress or pillow for someone because it all varies on sleep position. Are they a side sleeper? A back sleeper? The firmness they desire? So there's a lot of factors when it comes into figuring out what's the best mattress for me. I tell people, "Well, if your mattress is 10 years old or more you probably should look into getting a new mattress," but there's not one size that fits all. Same thing with pillows, a pillow ideally should keep your head neck and shoulders aligned with your spine, and so depending on your sleeping position it varies for each person.

Annie Zaleski: So I think another popular thing people turn to sometimes is weighted blankets, do they work and what is their role in helping you sleep better?

Dr. Michelle Drerup: Yeah, there was a study done in I think it was 2020 that did find weighted blankets improved self-reported sleep in people with psychiatric issues, like major depressive disorder, generalized anxiety and ADHD. So it seems to help really with that anxiety component for people. So there are a few small sample studies that have found benefit with weighted blankets in having that calming effect.

Annie Zaleski: So how do you know if maybe your sleeping setup isn't working for you? Is it the fact that maybe you're tired during the day? Or are there any signs that people might know or recognize that something is maybe not the best for them?

Dr. Michelle Drerup: In terms of that environment... Because it may not be the environment. That's the thing we hope it is because then I can go buy something and that's an easy fix, but it may be because they have a undiagnosed sleep disorder that that's why they're waking up not refreshed. But a real cue for people is if they're waking up and they feel body pain, that they're feeling like, "Gosh, that should have been restorative and I actually feel more physically tense and uncomfortable," that they might not have a good sleep environment.

The other things to think about too in terms of that sleep environment are people with allergies. So certain materials tend to accumulate more allergens like dust mites so there might be different materials that would be better for them if they're finding that they're having more difficulties with their allergies acting up at night.

Annie Zaleski: So a lot of the things we've been talking about are wrapped into sleep hygiene, which is a broad term people might have heard used to describe maintaining healthy sleep habits. So how does sleep hygiene fit into sleeping better?

Dr. Michelle Drerup: Yeah. So this is the most common non-pharmacological intervention that we use for insomnia, and I think it's just like dental hygiene. So dental hygiene and brushing your teeth twice a day, flossing, getting your teeth cleaned by the dental hygienist, these are all good dental hygiene practices that promote good sleep for people who aren't sleeping well. It's these daily behaviors.

Unfortunately, sleep hygiene isn't effective when you have insomnia when it's implemented on its own. So sleep hygiene is a very small component of a much broader, bigger treatment approach called cognitive behavioral therapy for insomnia. That's like going to the dentist, that's actually addressing the cavity or the disorder. So I think people oftentimes will get a little bit too wrapped up in making sure everything is right with sleep hygiene and they're like, "I'm still not sleeping better," and my response is, "That's not surprising," because these are good sleep habits to maintain good sleep and it's not necessarily addressing issues that are maintaining the difficulty.

Annie Zaleski: I really like that analogy because when you think about dental hygiene, you can brush your teeth every day and floss every day and yet you can go to the dentist and still have a cavity. Sometimes there are things that are out of your control or you can be as good as you possibly can and you might still have a little bit of gum decay. It's just one of those things.

Dr. Michelle Drerup: Yep. Absolutely.

Annie Zaleski: So sleep apps and sleep tracking programs, I think especially over the last few years, have become very popular for people, can these help you sleep faster? Are there some better than others? What role can they help in terms of helping you develop good sleep habits?

Dr. Michelle Drerup: Yeah. There are thousands of apps out there that call themselves sleep apps but a lot of these apps do very different things. So some sleep apps are more offering a sound machine relaxing sound, doing relaxation or guided meditations for sleepers to listen to as they fall asleep. Other sleep apps or alarm clocks, or they track sleep, they track your sleep data. So there's a great variety and I think it's hard to navigate as a consumer what are the best. We don't have any comparison trials to say what works best in these, so the research on the efficacy of sleep apps is still underway.

And the sleep apps that are used for sleep tracking, so they're maybe on your watch or another personal device that's tracking movements during sleep. These are convenient, they're affordable, but we don't have a lot of good data on how they compare to our traditional sleep study and what we're measuring with sleep. So we're moving in that direction to study them more to try to get an idea of how accurate they are.

But another difficulty with sleep apps a lot of times is if it's tracking my sleep now I know what my sleep pattern's like but it's not really telling me what to do. So it might motivate me, "OK, I'm only getting five hours of sleep a night. I need to try to increase my sleep window." But if you have sleep difficulties, it's not telling you what's wrong or what you can do to address that.

Annie Zaleski: Yeah, that makes sense. You have all this data and then it's like, "OK, well, what's next? What is my next step? What is my action plan?" That's when you bring that to your doctor and say, "All right, help. What does this mean?

Dr. Michelle Drerup: Yeah. Yeah, for people within insomnia they can be really problematic because someone will... In terms of accuracy, someone will come to me and say, well, "Oh, my sleep tracker is telling me I sleep so much worse than I thought. I was thinking I was waking up two or three times a night but the sleep tracker's telling me I wake up eight times a night," and so it can cause more anxiety about their sleep. It's not necessarily helpful for those folks. Now, technology has come a long way in the past few years and I think as we work more with sleep scientists and researchers, with tech companies in a more collaborative manner, that we'll have more validated ways to track this and to help people.

Annie Zaleski: So the Cleveland Clinic itself offers a couple of proprietary apps and programs, including Sleep by Cleveland Clinic and also the Go! to Sleep program. So can you tell us a little bit about each?

Dr. Michelle Drerup: Sure. Yeah. Sleep by Cleveland Clinics, a free smart for app, it's created by our Cleveland Clinic sleep experts and it's really more of a sleep assessment tool that can calculate one's risk of the four most common sleep disorders that affect sleep patterns and sleep quality. So those being obstructive sleep apnea, insomnia, shift work sleep disorder and insufficient sleep syndrome. So you take validated sleep questionnaires to calculate your risk for some of these common sleep disorders and you get your scores immediately, along with an explanation of your risk level for each disorder, more information about specific disorders and treatment options and some tips and strategies for improving your sleep.

But Go! to Sleep app, on the other hand, if you've been identified as having insomnia or insufficient sleep, this is more of a digital treatment program that might be recommended. So it's an online tool that was developed by Cleveland Clinic sleep experts, including myself, and it's really helpful for patients that have limited access to traditional in-person cognitive behavioral therapy for insomnia because of maybe geographic limitations, financial barriers, things that might keep them from following up.

Now, with COVID, and we have telehealth, this treatment is much more available than it had in the past when people would have to come into the clinic to see a provider. But the Go! to Sleep program is really taking what we do with people one-on-one, myself as the therapist and the patient, and guiding them through that. It's self-guided where they're doing different lessons that provide education about sleep and strategies to enhance sleep. They track their sleep online that helps them determine sleep plans and what strategies are going to be most beneficial for them.

Annie Zaleski: What I really like about that is that it's meeting people where they are and really sort of saying, "Hey, we have a plan and we have that extra support system."

Dr. Michelle Drerup: Yeah. And for really motivated people, they can go through those lessons and the practice and implement strategies, and we've done several research trials showing its benefit in improving insomnia symptoms. And also when we improve sleep, the benefit is we tend to see some improvement in mood and depression as well. So we have some studies showing that both in patients with chronic insomnia, but as well in populations with more complex presentations where we often see insomnia, so patients with MS and insomnia symptoms, patients with Parkinson's and insomnia symptoms, and so not only for those who have really just insomnia as their only problem but also that other people with more complex presentations can benefit.

Annie Zaleski: So what other tips do you have for people who might want to fall asleep faster?

Dr. Michelle Drerup: The biggest thing that I think is hard for people to understand is to stop trying to sleep. So if you think about someone who sleeps well, they probably don't think about sleep at all. They just listen to their body when they feel sleepy and that's when they go to bed. They don't have these rules or they don't have any real thoughts about sleep. It's just, this is what I do.

When someone has sleep difficulties, they get anxious about sleep. They start to dread going to bed. The harder you try to sleep, the least successful you're going to be. So it's in a sense, letting go of it and trying to get back to what naturally my body wants to do. We have that sleep drive, we have that internal clock and things we do to make up for lack of sleep, things that we... "If I had a bad night, well, I'm going to take a nap. I'm going to have more caffeine." These things we do to compensate oftentimes exacerbate and make sleep worse again the following night.

Annie Zaleski: That is so difficult because you're right, sometimes people stay up past their bed time reading or watching a movie, or they have to get something done so they feel like they can't listen to their body. It can get out of whack pretty easily.

Dr. Michelle Drerup: Yeah. And when we have these changes, like for some people the stress we saw a definite increase in sleep issue with the pandemic, not only because of increased stress but, "Well, now my schedule's changed completely. I'm not as active as I was. If I'm staying home more I'm literally just walking to the bathroom and to my desk. And that's all I'm doing during the day. I can stay in bed and sleep later because I don't have to drive to the office." So this change in routine and lack of schedule actually can exacerbate sleep issues too.

Annie Zaleski: So when does someone know that their sleeping habits are causing a problem? I think excessive sleepiness during the day is one thing that's come up but what are some other signs?

Dr. Michelle Drerup: Yeah. So depending on the sleep disorder, when we're speaking specifically of chronic insomnia, it's where it's happening at least three times a week that you're having this difficulty and that it's causing daytime impairment. So that might be daytime sleepiness, it might be feeling like, "I just don't have any energy. I feel like I'm not able to focus." When it's become something that now I'm thinking about it during the daytime as like, "Oh, this is because I didn't sleep well last night," those are definite signs that someone should seek assistance.

Annie Zaleski: So if you are having trouble sleeping then what is your best first step? When should you call your doctor and what should you bring to that appointment to tell them?

Dr. Michelle Drerup: Yeah, so making sure that you have that conversation. I think a lot of patients are hesitant to bring it up with, say, their family doctor, their primary care physician, because it's like, "Well, everybody isn't sleeping well." But just really if you can give them, thinking about like, "OK, what is my typical pattern? Is it that I'm trying to fall asleep and I'm just lying there for several hours? Is it that I'm waking up a lot during the night?" So it can be really helpful for someone to track their sleep for a week or so to give the provider a picture of what's going on with their sleep pattern so that they can get them connected to the right treatment.

Annie Zaleski: So is there anything else you want to add?

Dr. Michelle Drerup: Gosh, we've talked about a lot, but I think most importantly, when we're thinking about someone who has chronic insomnia, so that means that they're having difficulty either initially falling asleep, they're waking up and having difficulty getting back to sleep, or they may wake up early and then can't return back to sleep, that sleep hygiene isn't necessarily going to resolve that. That those are necessary but not sufficient strategies and that cognitive behavioral therapy for insomnia is our gold standard treatment. First line treatment for insomnia tends to have much better outcomes long term when we compare it to using a sleep aid or a sleep medication. And that now that we have the digital programs, we have telehealth, there's a lot more access and that it's not a long term treatment. It's typically brief. On average, we might follow someone four to six sessions and they see progress pretty quickly. So it's not traditional talk therapy where people think I'm in counseling and I see someone once a week and we talk about the stressors. That's not CBTI. CBTI is very focused on behaviors and thoughts that are disruptive and perpetuating that insomnia issue.

Annie Zaleski: Yeah, when someone is having treatment and they're seeing results quickly and see tangible results, it's always very gratifying because then you feel like what I'm doing is working and I'm going to feel better soon.

Dr. Michelle Drerup: Yeah, and that's why I love working in this field because when we improve someone's sleep, we can do it relatively quickly. And not only are they feeling that their sleep is better at night, but it oftentimes impacts their whole life and how they're functioning during the daytime and just have such significant benefit in other areas of their life. So it's a really rewarding position that I'm in in terms of my work with patients.

Annie Zaleski: That's great. Dr. Drerup, thank you so much for being here today. This has been really interesting. I think it's going to help a lot of people.

Dr. Michelle Drerup: Yeah. I'm shocked at how much we got covered in that time so I hope it's helpful, and it was my pleasure.

Annie Zaleski: If you're having trouble sleeping, a sleep specialist can help you figure out what's going on and determine the best next steps so you could once again have a good night's sleep. Call Cleveland Clinic Sleep Disorder Center at 216-636-5860 or visit clevelandclinic.org/sleep.

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