Episode Transcript
[00:00:00] Speaker A: Welcome to the Art of the Referral podcast where we explore the nuances of mental health referrals to better serve our patients and our communities.
I'm your host, Anna o', Brien, a practicing licensed professional counselor and co founder of Be well Private Practice Communities and theravera Care Connection Technologies.
I am passionate about creating a stronger professional community that works together to reduce provider burnout, increase continuity of care and ultimately improve the lives of people living with mental health challenges.
Each week we dive into a different specialty or supportive tool, bringing you expert interviews, practical advice and inspiring stories to help you master the art and ethics of referrals. Join us as we navigate the complexities of patient care, enhance our professional skills and build a more connected health conscious community.
Let's get started.
[00:00:57] Speaker B: Foreign.
[00:01:02] Speaker C: Welcome to this episode of Art of the Referral. I'm so pleased to be here with Dr. Funke Brown, who is a medical doctor and a specialist in sleep. She practices out of Horsham and online and helps families with sleep. And I'm going to turn it over to her because she'll do a much better job talking about all of her specialties and training.
Thank you so much for being here, Dr. Brown.
[00:01:29] Speaker B: Thank you so much for having me and I'm really excited. I'm looking forward to this conversation.
[00:01:36] Speaker C: Absolutely.
So tell me a little bit like how did you, as a medical doctor, how did you get into the world of sleep? What kind of drew you to this specialty?
[00:01:47] Speaker B: Yeah, no, that's a, that's a question I often get asked and it just takes me back to my own experience with sleep or lack thereof. I was someone who struggled throughout my training and you know, medical school training is very intense. That's just putting it very mildly. And so you talk about burning the candle on both ends, literally and figuratively. And so I was already burnt out even before I knew there was such a term.
And so fast forward to doing my residency and my fellowship training. This was something I struggled with.
And then the kids showed up and they didn't know better and all they thought was, well, just cater to us regardless. And so they also weren't sleeping. And so I really feel like I, I hit that wall people talk about and I just, I was just such, at such a loss and really didn't feel like this was something that I wanted my life to look at. Constantly running on empty and so, you know, kind of looked at what were things within my control and what was something that I knew I was very, very sensitive to and that was lack of sleep. So I started to, you know, change some habits, because that's. I mean, sleep is something you do every day. So I felt like, okay, this is something I could. I could at least work on in aggressively. And so setting boundaries, starting to work on healthy habits, and really intensely looking at how I could improve my sleep. And I started to see my mood was better, my energy was better, I was yelling less, I was more present, I was a better doctor. And, you know, as a busy professional woman, it was. It was just like, okay, this is a truth that I cannot unsee. And so that motivated and inspired me to really get additional training to now start doing it, using it as part of my practice, because I also am. I have a background in pediatrics. I have a background in pediatric pulmonology. And I was incorporating it into the things I was doing.
And then I got to a point where I said, no, no, no, I want to go all in here, because this is definitely something where there is a need.
And so I started my.
About two years ago. So prior to that, I was in academia doing all the things, but I really wanted to create a bigger impact, focusing on sleep as a foundation to families, health, to healthy women, to helping children.
And so this has really enabled me to achieve that.
[00:04:11] Speaker C: That's so interesting to learn about. You know, I grew up just thinking about sleep medicine as, like, Lunesta or Ambien, right. And you hear often the negative side effects of that. And also in. In the training as a therapist, you learn about the impact of sleep. Like, I know a lot of the suicide prevention trainings they talk about is like, one of the first questions you should be asking is, how is your sleep? Because that's one of the biggest risk factors.
So we know that this is so big of a deal. It's like a third of our lives, and yet it's something that often we kind of see as a luxury in our culture.
Um, so it's really interesting to. To chat with you about this, because every therapist. You know, the point of this podcast is to talk to therapists about, like, how to talk to your clients about things that may not be your specialty, how to kind of educate on the importance of it and how to know when maybe something is crossing into a threshold of wow, this. This may be specialty work that. That I need to refer to, and. And kind of knowing the treatments that are out there, not just the dated ones that we may have thought about from 20 years ago.
So it's exciting to have you here. And, you know, what I heard you saying is that you Were noticing cognitive impact of sleep when you were not getting well rested, emotional and physical. Can you share with us a little more about like some of the research or data that, that at the intersection of mental health and well being and sleep and how these play out together?
[00:05:40] Speaker B: Yes, this is huge actually. And you know, we are seeing it almost as a bidirectional relationship. Right. If you not getting enough sleep, then there's a higher likelihood of anxiety, depression, suicidality, all of those things. But if you are not sleeping, if you have those risk factors or those conditions already, it impacts sleep as well. And so emotional regulation occurs during sleep, especially stages like REM sleep or rapid eye movement sleep. So when you're not getting either sufficient sleep or you're getting poor quality sleep, it's really not giving your brain that ability to have that emotional reset. And so this is where you start to find the irritability, the, you know, impulsivity, the sort of ADHD like symptoms that we sometimes see in kids and adults. We also see things like impaired executive function and decision making. And so when you think about our teenagers and some of the risk taking behaviors, it's a lot of times, I mean it's not all the time, but all the times these kids are just sleep deprived. They are.
So, you know, things like that, it really broadly impacts, you know, decision making is also another one where I see even for people who maybe for instance, you're trying to adopt healthy habits like lose weight and eat healthy and go to the gym, your brain craves energy when you've not gotten enough sleep and it doesn't care where that source of energy is from, either a carrot or a carrot cake. It is just looking to say, where can I get sugar so that I could keep functioning. And also that ability to make that distinction between okay, this is probably not an healthy, not a healthy option for me, let me go for the more healthy option. That's all impaired. And so we start to see increased risk again in our bodies of, you know, increased weight gain, difficulty losing weight, lack of motivation to go to the gym. What does that do to our self esteem and our self confidence? It erodes it. And so it becomes this vicious cycle. And so this is why it is so tightly wound, that concept of, you know, healthy sleep and mental health.
[00:08:06] Speaker C: Absolutely. What are some of the questions that therapists might want to engage and I think simultaneously some of the symptoms that might indicate that sleep is bad. Besides someone just saying I'm not sleeping well. What are some of the questions that we should be asking to learn More to see if this is something that we should be addressing.
[00:08:26] Speaker B: Yeah, that's a great question. So I think to start with, like you said, someone comes to you, maybe they say they're overwhelmed or you've been seeing them for a while, they're anxious. I think the first basic thing is an open ended question like, how is your sleep? I think that is helpful because it really then opens the opportunity to now have dialogue that can help you now determine what your next questions would be. Oh my goodness, my sleep is awful. Right, okay. What does awful actually mean? Right. Okay. Well, I have a hard time falling asleep.
I have a hard time staying asleep. So then you can start to ask questions around that.
And so I would say generally you want to start off with, well, how much sleep are you getting? I think that's a very basic, fundamental question. Right. Adults are supposed to get anywhere from seven to nine hours of sleep. Teenagers eight to 11, eight to 10 hours of sleep, and our younger kids about nine to 11.
So when they tell you quantity, they may say, well, I'm getting about, you know, the normal number of hours, but I'm waking up tired.
Then that might suggest to you like a quality issue. So you can start to ask things like, is it that it's hard for you to fall asleep or is it hard to stay asleep?
So when they're saying things like that, your mind will start to lead you into, okay, something is making sleep difficult at the onset of the night, or something is making sleep difficult when it comes to the sleep maintenance. And typically that's a symptom of insomnia, which we see a lot. Right. So you can start to. Then you can see now we're starting to tease things about. We've gone from like the quantity of sleep to like, okay, what's going on? To the quality and maintenance of sleep. So when they now start to tell you, well, you know, it could be insomnia where I just have a hard time shutting my mind off.
I just have a hard time where I wake up to use the bathroom in the middle of the night, falling back asleep. And then that sort of leads you down the path of maybe insomnia is going on. But before we sort of completely put them in that insomnia bracket, this is something that I do as a sleep specialist is make sure that you're also maybe asking a couple of questions to rule out an organic sleep disorder like sleep apnea. Sleep apnea is actually more common in people who have depression.
There's a higher likelihood. Yes. So this is something that most people are not aware of. So middle aged in men, in women, in perimenopause and menopause, those are very common places where we tend to see it. So you can ask things like, do you snore? Or does anybody ever tell you that you snore? Do you move a lot in your sleep? Do you feel like your sleep is restless when you hear? Yes. For any of those, my high recommendation is have them to be, have them seen by either their primary doctor or even better still, a sleep doctor, so that we can then kind of evaluate for that. Now they may still have insomnia. So you still want to try to probe a little bit more and start to talk through, well, what are things that are going on as you're falling asleep, do you have a lot of worries? And then, you know, sometimes we'll start to talk around, you know, cognitive behavioral therapy for insomnia and managing sleep related anxiety and things like that. So again, you start off sort of broadly and then as the patient or as your client is speaking, they might start to say some words which will help you to figure out where. And they may tell you, well, I'm not getting enough sleep. I only get five hours of sleep. Okay, why is that? Well, I'm taking the kids all over the town, I'm running errands, I'm in so many committees. And then we start to talk more around sleep hygiene and time management and, you know, things like that. So it's, it's, it opens up so many opportunities for dialog, you know, just from asking those questions.
[00:12:16] Speaker C: Yeah, that's fascinating to learn about. And I'm curious, with the sleep apnea thing, is it chicken or egg, do we know? Or is it kind of a vicious cycle? Does it, does the depression cause someone to be more likely to develop sleep apnea because of the, you know, biological effects of depression? Or do we find that when people are not breathing well at night it can lead to depression? Do we know much about that?
[00:12:39] Speaker B: Yes, I think specifically for sleep apnea, it's more of the fact that your brain is waking up multiple times at night because you're not breathing, such that you're waking up feeling tired and so you're waking up fatigued, and so you know what's going on. Before you know it, you know, you may start to feel just overwhelmed and then the symptoms of depression are exacerbated. So it's not necessarily that it causes depression, but if you're already somebody who might be at risk definitely exacerbates it.
[00:13:13] Speaker C: That's wonderful to know so much knowledge out there.
So what about, you know, what we should be doing as therapists? If, you know, maybe we're not sure, like we've been working with someone, they're starting to bring up some sleep issues. We're not sure if it's.
They're in need of a referral. We'd like to try to do some things in session to see if we can start to improve things when it comes to having conversations around sleep hygiene or what have you. What are some things that a therapist can start to integrate and you know, when may not cover it all, but also ideas around training or books that they can read if they want to do further research.
[00:13:50] Speaker B: Yeah. So I think even if they don't bring up specific questions around sleep, knowing how tightly related is our mental health is to our sleep, it is a fundamental. The same way we say, you know, eat healthy, exercise, we have to bring up enough some sleep hygiene as a foundation, just as part of our routine care. You could take out two minutes and just go over some of the basics. Like I would encourage you to do that at every single interaction.
I think we can find two minutes to say, hey, let's just go over some basics, make sure you're doing all those things. You know, of course, eventually it may sound redundant, but it's like, oh, just a checkbox just to make sure. Because if sometimes when we get into habits, sometimes we just forget and then we start to take those things for granted. So I made, I have an acronym that I recommend. I think that's very easy and that's why I said two minutes. It's fast. You could get it done very quickly in your interaction with your clients.
And it's create C R E A C E. So how do we create healthy sleep habits or sleep hygiene?
So C stands for consistency.
So making sure they have a consistent bedtime and wake up time. And that's a whole podcast episode around our circadian rhythm and consistency, all of that. But just that consistency is very important.
R is the routine. So having a bedtime routine, it is critical, especially for someone who has maybe anxiety or, you know, they have a lot of anxious thoughts.
A routine serves as almost like a buffer between your day and night and it helps to sort of welcome the nighttime. And so two or three pleasant activities that are heading in the direction of the bedroom. Then E is the environment. So that environment, you want to make sure your bedroom is cool. Cool. It is dark, it is noise free. Or maybe you use like a white noise machine, something like that you just really want to make sure your bedroom environment is optimized. I tell you, all kinds of things go on in certain bedrooms. So you just want to check in on that.
A is assign the bed for sleep, meaning that you shouldn't really be bringing work into bed with you. Your phone, the tv, all of that. The bed is just for sleeping. And then C is tackle technology. And we all know that blue light sometimes can suppress the brain melatonin and makes it hard for us to sleep. So you really want to talk through device management and.
And having that sort of accountability system where you're not constantly consuming content before bed. And then the final E is eliminate. So looking at your diet or things that you're feeding yourself, either in your mind or in your body, I might get into the way of sleep. So caffeine, alcohol, heavy meals before bed are a no, no. So when you kind of run through that, but sort of mentally, you're reminding your client to take you sort of, you know, check those basics off. And here's what I would say. If they're doing all those basics, they're doing all the right things you're telling them to do, and you notice that they're still struggling. You know, of course, working through some of the mind, the thoughts right around sleep or worries and things like that is. I think it's definitely within the jurisdiction of a therapist. But if doing those things and they're like, I'm doing it all, I'm getting enough sleep, I'm doing all my sleep hygiene, I am still tired, I would recommend that they get evaluated.
[00:17:18] Speaker C: That's so helpful to know. So when you are working, if you get a referral from a therapist, what are some of the ways in which you might be collaborating with a therapist so that, you know, they're able to kind of continue on the work on a weekly basis to support the work that you're doing as well.
[00:17:35] Speaker B: Oh, yes. I mean, I work. I think it's the most dynamic and incredible collaboration working with therapists, because I am not a therapist. I'm a sleep doctor. Right. So. But I know how tightly wound, like I have. You know, I had a patient recently who has profound anxiety. Right. Which we've been trying to manage around bedtime, but there's anxiety all through the day. So speaking with the therapist, I was able to learn the strategies she'd been using to help with managing. And guess what? We were able to use then adapt some of those strategies within my cognitive behavioral therapy for insomnia. Right. Specifically. So how Are we managing those thoughts during the day? What are we doing to relax during the day? And then we, you know, we then sort of create a protocol for the nighttime. So. And it's vice versa. So sometimes also, you know, there might be things that they've been asked to do during the day, which I think, you know what, I want them activated. But being too activated in the evening might impact their sleep. And so we're having this back and forth dialogue and every single therapist that I work with either gets a phone call from me or an email to say, hey, this is what we're working on. Just of course, of course we accept. We, we obtain patient release information, you know, agreement first. But really, I think it's just very dynamic. It's a healthy. And the patients love it because now they feel, oh my goodness, I have a team that's working on this with me on this journey and it's really enriching. And I've had patients too, who, you know, they've been working with therapies for a while and the therapist sends them to me and we realize, oh my goodness, they've been dealing with sleep apnea for years. And so giving that feedback already also to the therapies where they're like, oh, now I understand that constant fatigue, that constant exhaustion was not just their depression, it was sleep apnea or restless leg syndrome. So we're constantly also educating each other and things like that.
[00:19:35] Speaker C: Wow, that must really feel like you get your life back, you know, after you've been struggling with something and then you're like, oh, this is actually something that can be treated with a cpap and what that must feel like to have that first night of restful sleep and wake up, you know?
[00:19:50] Speaker B: Yeah, yeah, absolutely. And I would say this too. I've had people say, you know what, just, you know, check, let me just send the patient to the sleep doctor. And sometimes we check. And it's, it's really not necessarily a sleep disorder. It is just the anxiety. So sometimes I'm able to say, okay, you've done your due diligence. This is all, you know, anxiety related. I recommend that you continue to follow up with your therapist. I think this is great that we've worked like this together. So it's, it's just, it's great to know because that way now they can really focus on the exact care that they need.
[00:20:26] Speaker C: Absolutely. Yeah. I used to work in the hospital and we'd have folks that are more often complaining of not getting sleep or they, they felt like they didn't sleep at all. And yet with checks happening every 15 minutes, we could indicate that, that they were asleep. So it is true that sometimes people, you know, do get under the, the anxious loop of, of kind of obsessing about sleep. But certainly if we aren't taking it seriously, then that's only going to exacerbate the anxiety and, and making someone feel not heard. So with that, I'm curious your. Your take and ideas around some of the wearable devices that people are using in terms of are they healthy? Are you feeling that people are starting to obsess a bit?
What would your suggestion be now that so many people are wearing watches and whatnot that are monitoring sleep, what are your thoughts around that?
[00:21:16] Speaker B: Here's mine.
So I also use them. I have an aura ring, but I'm not affiliated with them at all. But here's the thing. I think it's the intention.
Wearables are here to stay. And I think we within the sleep community were like, initially we were just saying, you know what, there's no point. Don't track it, leave it alone. But it's literally like rolling uphill. People will track whatever it is they want to track.
And so I think our role is to partner with them, to figure out what it's doing for them, and also to help them sort of separate who they are from what their data is showing.
So that's that unhealthy obsession most people have with their devices. I have people who, I ask them, I say, how long did it take you to fall asleep? Which is a very important question I ask in my practice. And they'll say, well, it took me 45 minutes. And I'm like, did it take you 45 minutes or did your tracker say it took you 45 minutes? Well, I feel like it took me just five minutes, but my tracker said 45. So I say no. Over the next two weeks, I don't want you to listen to your tracker. I want to just hear what your take is. Because sometimes, first of all, a lot of the algorithms for these trackers are proprietary, so we don't even know what they're using. And when we compare them to the gold standard sleep studies, they just not as accurate. Because with the sleep study, you actually can measure brainwaves and things like that. But if you're looking at trends, right, I made a change. I used to drink iced tea for dinner. Now I stopped drinking iced tea. Now I want to see how long does it take me to fall asleep? What does my sleep look like versus before I started making that change to now and it's beautiful to observe and say, wow, that was great. Now let me try and add on another healthy behavior. So when you're using it from a place of observation rather than the gospel truth, I think it's okay. But if you start to find out that you're perseverating and you have to be true to yourself, how do you feel when you wake up? Are you grabbing your phone right away to see what, how you did, like you scored in a test?
It's time to let go of that device. Right. So I think it's really. There has to be a balance.
[00:23:24] Speaker C: Very helpful. Yeah, I totally agree with you. These are here to stay. And you know, knowledge can be power. You know, it's just framing it around, you know, it's validity. So when, you know. I'm embarrassed to admit, but I did not know about CBTI until years into my training that there is actually cognitive behavioral therapy for insomnia. I'm curious about your experience with that. If you've worked with people, you know what your thoughts are around CBTI and its effectiveness.
[00:24:00] Speaker B: Absolutely. So CBT I, or cognitive behavioral therapy for insomnia, has become the, the gold standard really for treatment of insomnia, chronic insomnia in adults and actually I would say even in teenagers.
So we actually use the core principles of CBTI in our practice. We have an insomnia comprehensive insomnia program.
And I think that's where it makes things a little different. With the standard cbti, there are, you know, these are strategies that address thoughts around sleep, behaviors around sleep and help you to maintain or to get healthy sleep. And it includes five principles. There is psychoeducation, which is really educating the person about what their sleep looks like. What does sleep drive look like? What are healthy sleep habits?
There is what we call stimulus control. And these are just some strategies to help to decrease that association. Most people with insomnia tell you their mind is racing. So how do you decrease those mind racing? How do you decrease that sort of, you know, increased heart rate that you might get when you get into bed?
There's also what we call sleep restriction, I like to call it bedtime restriction, which is really about consolidating your sleep and improving your sleep efficiency. And you tend to use what we call a sleep diary for those things.
And then there is, you know, the standard sleep hygiene. So I mean, if you're drinking alcohol in bed and scrolling on your phone, well, no wonder you have insomnia. So we're still Making sure we cover those basics as well.
And then there is also what we call cognitive restructuring. And I think this is a big part of cbti. It's around what, what does it mean that you don't get good sleep? Do you catastrophize? How do we change all those negative thoughts into more sleep enhancing thoughts? And then finally we, we do some relaxation techniques which is really around, you know, mindfulness based practices, breath work, meditation, all of those things to help decrease cognitive arousal. So it's a whole usually about a six to eight week program where we're really working on different goals, using the sleep diary to track your sleep and then making sure that you go from the place of poor sleep to a place where you feel confident in your body's ability to sleep.
With our practice, we're looking at it holistically. There are lots of micronutrient deficiencies, again, sleep disorders that might contribute to sleep issues. So it's not just cbt. I, it's really first, let's rule out any organic sleep issue because if you have sleep apnea and that's why you're waking up, well, the CBTI is not going to fix it. So we're really working on everything comprehensively.
[00:27:00] Speaker C: Yeah.
It's so neat that we've made it so far into this podcast and haven't even needed to explore the medical intervention in terms of medication. There are so many options before medication.
I am curious. Yeah. What do you find in terms of how often you are finding that people are in needs of medication or how you're using it these days that might have differed from the training or advice 20 years ago before you really knew the impacts of some of these medications.
[00:27:30] Speaker B: Yeah. So I end up taking people off more than putting them on medication because usually, which is why I really love working with therapists as well, because by the time they've been come to me, some of these patients who maybe they've already seen a doctor that's been prescribing them 20 years worth of medications and now nothing is working. Right. So medications have a role. They help with insomnia on the short term.
They were never created for long term treatment or chronic insomnia. And I think that's where the struggle is, that people use it, they start using it over time, their bodies stop responding and then they go on a higher dose. That tired dose isn't working. Then they add, increase the, increase the dose or they add another medication. And what that message just ends up sending, especially when you get to that point where you're quote unquote dependent on medications is just telling you, well, your sleep system is broken and you need something to fix it, which is sort of almost like what we're trying to empower you with with CBT I to say you can, your sleep is not broken. Let's empower you. So most times I can. I sometimes will use medications, but before I even get to medications, I'm looking at micronutrients. I'm using those supplements to make sure we optimize your supplement level. First we're doing CBT I. And then in some situations there might be patients who may need like a low dose, something to take them off the edge. And so sometimes we're using that as a bridge until we can get you on standard and effective therapy.
[00:29:05] Speaker C: Okay, put.
I could go on forever. I could literally go through the night, which I know you would not recommend because we need to sleep schedule. But I would love to, like, do this again with you and even discuss. I know another one of your specialties which is family, like, well, being family. Sleep right. Because there are so many things in terms of patterns we can change and then there are just times of life where everything goes out the window with a baby. So it's exciting to know that you're there to support at the Restful Sleep place in Horsham and also online.
And I'm going to brag for you for a second. You didn't even tell me this, but I saw you had 85, five star reviews on Google.
[00:29:46] Speaker B: That is remarkable.
[00:29:48] Speaker C: So it really speaks well and I'm not surprised after talking with you.
But it's been an honor to have you here. And if therapists want to learn more about the work that you do, do you have any suggestions about how they can reach you?
[00:30:02] Speaker B: Yeah, no, you can email me directly. That's the other thing about. I try to make access to, you know, other healthcare providers and patients, of course, as easy as possible. You can either email me, Dr. Brown restfulsleepmd.com you can go to our website.
It has a whole lot of stuff. So our website is therestfulsleepplace.com that's therestfulsleepplace dot com or you could call our practice 215-607-8297. I'm big on meeting people in person, which was why I was really looking forward to seeing you at the grand opening. So. But if you're ever like in the area, you want to stop by the office to say hi, you want to meet up for coffee, or brunch. I'm always open to that. I love meeting people and just talking about sleep and other ways we can support each other.
[00:30:52] Speaker C: Well, absolutely. And so that we don't flood your call line as well if people are watching outside of the state of Pennsylvania, are you licensed outside of the state or do you just treat people within Pennsylvania?
[00:31:05] Speaker B: So we treat people in Pennsylvania, New Jersey and California from in terms of our medical practice now we also offer coaching. So I do a lot of so sleep training, cbti, you know, working with high achieving professionals to optimize their sleep. We do it across all the states. And so on our website you could, you could also actually schedule a discovery call. We usually have a 15 minute free complimentary call to learn about your needs. And then, and here's the thing, even if I cannot help you, I will tell you right away and I will help connect you with, you know, someone that can.
And I should also mention we're on social media, so we're on LinkedIn, we're on Instagram, it's @Red Flag Restful Sleep MD.
So that's where I share all kinds of nuggets, fun nuggets about sleep as well.
[00:31:55] Speaker C: Well, wonderful. Thank you so much. I feel like I learned a lot and I'm looking forward to bedtime tonight to try.
[00:32:01] Speaker B: That's awesome.
[00:32:04] Speaker C: So thanks again, Dr. Brown. It's been an honor to have you and you really educated us so much.
[00:32:12] Speaker B: Thank you so much for having me and I'm looking forward to next time.
Absolutely.
[00:32:19] Speaker A: Thank you for tuning in to the Art of the Referral podcast. We hope you found today's episode insightful and valuable.
Don't forget to subscribe and leave a review to help us reach more providers and clinicians like you.
Follow us on social media and visit our website for additional resources and updates on upcoming episodes. Until next time, keep mastering the art of referrals and making a difference in patient care. Goodbye.
