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How Therapists Can Help Clients Finally Sleep: An Interview with Jessica Fink, LCSW-S

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How Therapists Can Help Clients Finally Sleep: An Interview with Jessica Fink, LCSW-S

Curt and Katie chat with Jessica Fink, LCSW-S, about what therapists get wrong about sleep, how to spot real sleep disorders, and what actually works when clients can’t sleep. We dig into CBT-I, nighttime anxiety, “tired vs. sleepy,” the myth of sleep hygiene as treatment, screens and blue light, circadian rhythm issues, and what to do when clients wake up at 3 a.m. replaying work problems.

Transcript

Click here to scroll to the podcast transcript.

(Show notes provided in collaboration with Otter.ai and ChatGPT.)

About Our Guest: Jessica Fink, LCSW-S

Jessica Fink, LCSW-S, is a compassionate and results-oriented therapist committed to guiding clients toward clarity and relief from debilitating sleep issues, chronic pain, OCD, PTSD, and overcontrol. With a strong belief that “talking alone isn’t enough,” Jessica integrates science, data, and creativity to foster lasting change. Jessica’s approach is rooted in CBT principles, emphasizing structured, planful, and evidence-based methods while remaining adaptable to individual needs.

A Master of Social Work graduate from Texas State University-San Marcos (2007), Jessica has specialized training in treating a range of complex issues, including sleep disorders (insomnia, nightmares, circadian rhythm disorders), PTSD, OCD, RODBT, and chronic pain. Prior experience in a hospital setting further enriches Jessica’s clinical perspective. Jessica is passionate about fostering client independence, aiming to help individuals develop their own tools and coping strategies for long-term well-being. When not working with clients, Jessica enjoys musical theater, watching The Golden Girls, and listening to 90s alternative rock, embodying a lifelong love for learning that informs her therapeutic practice. Jessica’s 100% online practice provides accessible support to all Texans.

In this podcast episode: Helping Therapists Understand Evidence-Based Sleep Treatment

Curt and Katie interview sleep specialist Jessica Fink, LCSW-S, who provides clear, practical, and myth-busting education about behavioral sleep treatment. We explore the limitations of sleep hygiene, the behavioral nature of sleep disorders, how therapists can assess and intervene, and what to do when clients’ insomnia becomes entrenched.

Key Takeaways for Therapists: Sleep Interventions, Insomnia, and Behavioral Strategies

“Sleep doesn’t reward effort, and the harder you’re trying to sleep, the less likely you are to fall asleep.” – Jessica Fink

Sleep hygiene is preventive—not treatment. It’s brushing and flossing, not filling the cavity.
Insomnia becomes its own disorder when it lasts 3+ nights/week, for 3+ months—even if it started secondary to anxiety or depression.
CBT-I is counterintuitive:
- Don’t get in bed until sleepy (not tired).
- If awake more than ~20–30 minutes, get out of bed.
- Go back only when sleepy.
Behavioral sleep treatments often outperform medication long-term.
“Screens” aren’t the enemy. Blue light is over-vilified unless you’re treating circadian rhythm disorders.
Wearables can worsen anxiety and create “orthosomnia”—perfectionistic sleep optimization that harms sleep.
Consistent wake time matters more than bedtime. Keep it within one hour every day.
Therapists play a critical role even when sleep disorders have medical components—especially with CPAP adherence, motivation, routines, and anxiety management.
Nighttime anxiety needs daytime scheduling. Use constructive worry periods to reduce 3 a.m. spirals.

“It’s better to get a smaller amount of good sleep than a lot of crappy sleep.” – Jessica Fink

Resources on Sleep Disorders, Insomnia, and Behavioral Sleep Treatment

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Jessica’s Website & Blog
https://www.jessicafinktherapy.com

Jessica’s YouTube Channel
Jessica Fink Therapy on YouTube

Referenced Tools & Concepts

CBT-I (Cognitive Behavioral Therapy for Insomnia)
Constructive Worry Worksheet
Epworth Sleepiness Scale
Circadian Rhythm Disorders
CPAP Adherence Motivational Strategies

Relevant Episodes of MTSG Podcast

Meet the Hosts: Curt Widhalm & Katie Vernoy

Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Katie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Join the Modern Therapist Community:

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Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements)

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back, modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about the things that we do in our practices, the ways that we help clients. And in this episode, we’re diving into one place that therapists and clients alike struggle to find peace, and that’s the bedroom. No, not, not like that. We’re talking about the holy grail of self care. Katie and I talk about self care a lot. We’re talking about sleep. And so if you’ve ever had clients who are locked into a nightly battle with their pillows, we are joined by Jessica Fink, LCSW-S to talk about helping clients out without necessarily focusing just on the medication end of things, but some of the behavioral stuff they could do. So thank you very much for joining us.

Jessica Fink 1:04
Thank you. Glad to be here.

Katie Vernoy 1:06
We are so excited to have you. And I was telling you before we hit record, both Curt and I probably can use some help. So some of these questions might be a bit personal or, quote, unquote, for a friend. So…

Jessica Fink 1:19
Got it, bring it.

Katie Vernoy 1:20
But before we get started, we’re going to ask you the question we asked all our guests, which is, who are you and what are you putting out into the world?

Jessica Fink 1:27
All right, so I would consider myself is I’m a therapist for anxious rule followers with a death grip on life. That’s kind of this, like slogan I’m playing around with. So each of my specialties really involves holding life too tightly in some capacity, and sleep is no exception. So the people who aren’t sleeping, are trying really hard to sleep, and they’re thinking about it all the time. And the people who are sleeping, they are not trying. They don’t care. They think nothing of it. They just sleep. And there really is something to that. And then as far as what I’m putting out into the world, unfortunately, there’s a lot of bad information, or just misleading information about about sleep out there. And so I’m trying to put out into the world credible information and stuff that actually works.

Curt Widhalm 2:19
So what is the bad information that’s out there. What do therapists usually get wrong in helping their clients with sleep challenges?

Jessica Fink 2:26
So two, really, two things that I see. So one, and I think we’ll probably be delving into this a little bit more as we go as well, but recommending sleep hygiene for everything, anytime somebody has a sleep complaint. So, sleep hygiene is about, I’ll define it really quickly. It’s about having a bedroom environment and daily habits that are conducive to sleep. So sleep hygiene is all the stuff like make sure your bedrooms dark and do some gentle stretching before bed, stuff like that. And I did the same thing before I became like a sleep specialist, but sleep hygiene is really preventive care. So if you’re on average, a good sleeper who has the occasional, like, bad night that we all have, sleep hygiene might be all that you need. So it’s, I was told to think of it like brushing and flossing. Like it’s good to brush and floss. Everyone needs to be brushing and flossing. But if you have a sleep disorder, like, let’s say, insomnia. It’s like you have a cavity. So in that case, you need treatment, not just hygiene. And then once the cavity is treated, your dentist is going to say, please brush and floss to prevent future cavities. And similarly, when I treat someone’s insomnia, once we’ve kind of got it on track and the sleep is where they want it to be, we will put sleep hygiene in place, once, so for once, their insomnia has resolved. So if you have insomnia, sleep hygiene is not going to fix it. You really need CBT for insomnia, which is not a specialty, which there’s people over the country that are trained in it. So really the first error is not understanding the purchase of sleep hygiene, and then its place in the broader context of treating sleep disorders. And then the other is, and that’s part of like why I wanted to come on the show today, is believing that sleep is just purely a medical issue, and then it can only be helped by a physician, which I also believed before I became a sleep person. So sleep is so much more behavioral than a lot of people think, depending on the sleep disorder. So some sleep disorders like insomnia and nightmares; purely behavioral. So there are medications for those things, but like sustainable change in insomnia or nightmares, that really comes from a behavioral intervention. And then circadian rhythm disorders, it’s another type of sleep disorders, those are mostly behavioral. So generally, those are treated with a combination of properly timed light exposure, properly timed melatonin. But even sleep disorders that do require more medical intervention like, say, sleep apnea or hypersomnia disorders like narcolepsy, they still have a behavioral component, so like wearing a CPAP, that’s a behavior change. And we as therapists, I think, have a really important role to play in helping people wear their CPAP using things like motivational interviewing, empathic listening, like, if you just tell someone wear this thing, because I said so. And the thing is, like, weird and uncomfortable people aren’t going to wear it. And CPAP, if you’re in space, are really poor. But we know from research that if you actually take the time and really listen to someone’s objections to wearing the CPAP, explain to them what’s going on and why they’re being asked to do it. People were a lot more amenable to wearing the CPAP. That’s sleep apnea. Let me just touch on the other thing I mentioned, which is narcolepsy. There’s a group of sleep disorders called hypersomnia disorders, and that includes narcolepsy one, narcolepsy two, and there’s something called idiopathic hypersomnia. So like sleep apnea, you do need a physician to diagnose. You do need a physician to prescribe the treatment. But we’ve also learned through research that even if these people who have these hypersomnia disorders are properly medicated, so standard care is usually a stimulant, they still have quality of life issues, like they don’t know how to socialize or date with these disorders, they don’t know how to ask for accommodations at work. They don’t know how to manage their energy during the day. And so again, therapists really have something to offer here.

Katie Vernoy 6:35
Sleep seems like such an important part of our lives, and I have clients who, for whatever reason, are not sleeping, I feel like there’s almost nothing I can do to help them, because everything is very overwhelming. Everything is emotional, is almost impossible. There’s there’s so much that that goes into it and it’s and what I’m hearing you say is that there’s a lot of behavioral change that can can shift some of these things. And I definitely have been somebody that’s talked about sleep hygiene, so I’m very interested to hear more about this. But it it feels pretty daunting when you’re sitting in a room with a client and they’re they’re not sleeping, and if we’re saying, hey, behavioral change is required and they’re not sleeping, the behavior changes seem even harder to do. And so where do you start with that? Where do you start with whether it’s, you know, CBT for insomnia, or whatever, like, what are the things that you do, how do you, I guess, how do you assess and then what do you do as kind of initial interventions to try to help shift this? Because I feel like it’s that deficit of I’m depressed and I can’t do anything, but activation is going to help me be less depressed. It’s it feels like an uphill battle that feels very daunting.

Jessica Fink 7:51
I spend a lot of time going into the rationale. So I love I love teaching. I just, I love teaching, and so I really like to spend a lot of time just educating people about about sleep and about what are the biological processes that have an impact on what your sleep looks like. And then we get into here’s how this affects it, or this doesn’t affect it. I spend a lot of time going into rationale like because the stuff that we ask people to do in CBTI is really counterintuitive. One of the things we ask is, spend less time in bed. Cut time in bed. Basically, if you’re not sleeping, you’re not in bed, you’re not going to go to bed until you feel ready to fall asleep. You’re going to get out of bed if you’re not sleeping, you’re still going to get out of bed at the same time every day, even if you slept like crap. We’re cutting time in bed. And most people with insomnia, I find they start spending more time in bed. They’re like, oh, I need to cast a big, wide net. Let me just, you know, make sure I’m maximizing my opportunity for sleep. And the way that you build the drive for sleep is to be up and out of bed and moving around. And so that’s kind of my I spend a ton of time talking about, here’s what I’m going to ask you to do, and here’s why. Because if I just tell you don’t spend time in bed, people are being like, that’s stupid. Why are you asking me to do that? And all of CBTI is like, it’s the other thing I tell people is basically quit trying so hard to sleep. Like, like, I tell people, like, I want you to not care. I want to get you to be a place where you don’t care if you get sleep, because good sleepers, and I always ask, who are the good sleepers in your life? You know, you’re married to one or, you know, one? I’m like, do they worry about sleep? Do they care? What do they do to sleep? And they’re like, they don’t do anything. They just sleep. I’m like, exactly, and what are you doing? And they’re like, Well, I drink my tea at nine, and then I do yoga for 20 minutes at 10:30 and I do this and I do this, and I do that whole last list of things, and I’m like, and none of it’s working, because you’re bringing so much like pressure and intensity and stress and striving, and of course, you’re not going to fall asleep, because sleep doesn’t reward effort, and the harder you’re trying to sleep, please sleep like a cat. Explain what I mean by that. If you’ve ever had a cat, you know how cats pets are kind of like, they love you on their own terms, like cats, they like you or they don’t like you. Dogs tend to be like, I love everybody. Hooray. You’re my friend. Cats are like, I don’t know. I’m gonna hang out over here. I’m not gonna pay you much attention. And as soon as she like, if you try to, like, pursue the cat and be like, Come cuddle with me. It’s like, No, get away from me. But a lot of the time, if you just, so, you know, let the cat. Ignore the cat. Don’t do anything with the cat. The cat will come to you on, on its own terms. Sleep is like that. So it’s sleep like a cat.

Curt Widhalm 10:46
So it sounds like we’re talking to people about, hey, we want you to think a lot about this thing. But with don’t think about it too much.

Jessica Fink 10:55
Yes, the treatments, it’s full of contradicts, full of contradictions. I also, like people keep a detailed sleep diary. And I’m also, I’m also saying, like, Hey, don’t think about it. Don’t care. Don’t worry. Also, please keep this detailed diary so I can see what’s going on.

… 11:10
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Curt Widhalm 11:11
What is the initial reaction like? And I know that you’re talking about giving people a lot of psycho education about why all of this stuff is important, but my experience with people who are having sleep difficulties is this feels like too much work to be able to get out of what seemingly is almost pathologically habitual and just kind of stuck in momentum. And how do you really get this, the sales on people being able to do this, because I imagine a lot of people are wanting immediate relief.

Jessica Fink 11:47
Yes, yes. And I do tell people that it’s going to take, it’s not going to take a lot of time. It’s six to eight sessions is the typical length of CBTI. But I do tell people it’s, it’s not going to fix it tonight. It’s not going to fix it tomorrow night. I’ll talk about how, if you plot, if you could plot efficacy on a graph of so like sleeping medicines, a lot of people come to me, they’re on sleeping medicines, and they would like to go off of them, but I’ll say, Hey, if you were to sleep tonight, take a sleeping medicine, it’ll most likely work. It’ll get you to sleep. But if we plot the efficacy over time of sleeping medicines, they tend to be effective right away, but the efficacy will typically decline after a while. Behavioral Intervention is like the opposite. It would make an X so behavioral it’s not going to work. It’s not going to help at first. It’s not going to help you sleep tonight, probably not going to help you sleep tomorrow night, but give it a few nights, especially, give it a week or two, you will start to see benefit. And we know that that benefit is so much more. We’ve studied people as far as 10 years out from doing CBT for insomnia, and so we know that the changes hold at least as far as as 10 years out, and just a lot of validation that this is hard. I’m like, I’m like, you’ve got the hard end of the deal. I’m like, it’s easy for me. It’s straightforward. I can tell you what to do. I know where we’re going. It’s, it’s, I’ve got the easy job here, you’ve got the hard job. I’ve even told people, like, if you’re awake in the middle of the night and you’re getting out of bed and you’re pissed off because you don’t want to get out of bed, because no one ever wants to get out of bed. I’m like, you know you could, you could send me an email, now I will be asleep. I won’t get it, but if you want to send me an email, that’s like, this sucks. I hate it. F you, or leave me a voicemail, because, you know, don’t, don’t worry not bothered me. I will be asleep, but if you’re just frustrated, if you want it, you’re like, Damn you, Jessica, you know what do? No one’s taken me up on that, but I always, I always offer it because I’m like, it’s going to be two in the morning and you’re going to be so frustrated because you don’t want to get out of bed, and I’m making you get out of bed.

Katie Vernoy 13:59
So one of the things that sounds like you’re if, if you’re asleep, you’re in bed. If you’re not asleep, you’re not in bed. But I think there’s some gradations there, right? Because there’s a certain amount of time it takes to fall asleep when you get into bed. And then there’s also like, Hey, I drank water before I went to sleep, and now I have to get up and go pee and I come back. And there’s this element of, how long do you wait until you determine, like, I got to get out of bed?

Jessica Fink 14:23
Yeah. Great question. So there’s a there’s a little bit of variation, but typically 15 to 30 minutes is kind of the, so as far as how long it takes you to fall asleep, 10 to 30 minutes is considered normal. So that’s also another piece of it, is some people have this idea that they should fall asleep in five minutes and and I’ll actually say, you know, normal sleep latency 10 minutes to 30 minutes, so you can go up to 30, but 15, I think 15 to 20 is also kind of a good but definitely no more than 30, so definitely no more than 30 minutes in bed, not sleeping. And also it’s normal to wake up over the course of the night, we tend to use 30 minutes as the cut off there. So being awake for short periods of time, even up to about 30 minutes, that’s normal. A lot of it is letting people know, hey, this is normal. Like you’re not supposed to fall asleep in two seconds, be in deep sleep the whole night, and then bounce out of bed ready to go, like nobody does, nobody does that. So somewhere 10 minutes, 15 minutes, 20 minutes, but definitely no more than 30 minutes.

Katie Vernoy 15:29
And so you get out of bed and what do you do?

Jessica Fink 15:31
Yeah, great question, because we changed the guidance on this, so it used to be and a lot of what why this works is you’re giving up the effort. You’re also, we’re trying to pair bed with sleep, so that’s part of it, but you’re also giving up that sleep effort. So you’re like, Okay, it’s not working. I can’t sleep. I’m gonna get up and do something else. The guidance used to be do something like boring or not too stimulating, like don’t do something that’s gonna wake you up. But we’re starting to see that that guidance is like, kind of a Trojan horse for sleep effort, which you I’ll probably be talking about that a lot. That’s like one of the biggest culprits in poor sleep. People are like, okay, what can I do? What’s the right thing to do? What’s the wrong thing to do? I can’t do that because it’s too stimulating. And now they’re all wound up over: I don’t want to choose the wrong thing and mess it up. Yeah. And so we’ve started telling people do whatever you want, do, seriously, watch a movie like, try to be a person who doesn’t care about sleep. If you didn’t care about sleep, what would you be doing? You’d be doing whatever you do something fun, because then that’s going to incentivize you to get out of bed. I mean, my God, if you’re like, I have to get like a knife to do something boring. And, you know, I used to tell people to watch C-Span.

Katie Vernoy 16:50
I don’t think that would be boring right now, especially in the middle of the night when they’re trying to pass stuff that nobody wants to know about.

Jessica Fink 16:56
It’s not even work anymore. So, so, yeah, do whatever you want. Do not go back to bed until you feel sleepy. And I want to talk about the difference between tired and sleepy, because that’s really important. Sleepy is high likelihood that you’re going to fall asleep. If you’re sleepy, you’re going to fall asleep. That’s eyelids heavy. Head is nodding forward. Lapses is in concentration. That’s sleepy. Tired is like fatigued Dragon, cranky, irritable. People with insomnia don’t tend to be very sleepy. They’re better described as tired but wired. And so if I say go back to bed when you’re tired, then people will want tired after five minutes, I’m going to go right. To go right back to bed. No, no, don’t go back to bed until you’re sleepy, meaning you are reasonably sure that you’re ready to fall asleep. And that comes up just constantly. I’m like, Are you tired or are you sleepy? Because if you’re sleepy you should go to bed. If you’re sleepy, you should take a nap. But tired is different. And you can be tired and not be sleepy, not fall asleep. So you go back to bed when you’re sleepy.

Katie Vernoy 18:12
One of the things that I’ve seen a lot, and this is, I think, with the executives I work with, especially that have, you know, big deadlines or very high pressure things happening, they wake up and they’re still working on the problem, and they can’t get back to sleep. And so I guess I’m asking for approval on this, because I don’t know if this has been good advice, but I tell them to get out of bed and do the thing and get them, get their self to a place where they kind of, you know, they write down the thing they need to know for tomorrow morning, or they kind of get it so they’re not kind of rehearsing it in their head while they continue to sleep and figure out, what is it? Do they just need to write the email and set it to go out in the morning? Do they need to write down all the plans they’ve been thinking about and dreaming about and then, then when they’re sleepy, I guess, and not tired again, but when they’re sleepy, they go back to sleep and they’re able to say, Hey, I’ve resolved that. So they don’t keep ruminating, they don’t keep staying up. And I think, I guess, my question is, is that okay advice? And then the other thing is, what is your advice when folks wake up or can’t sleep because they’re anxious and thinking through whatever stressing them, stressing them out.

Jessica Fink 19:25
So I don’t think that, like, I’m it’s not a hard and fast like, no, they, they shouldn’t, like, those executives, I would say, like, do they do they even have like, complaints about their sleep, or do they feel like they’re bumping Okay, okay, okay, okay. So, I mean, one of the things I like to tell people is if, if it’s possible to try to and sometimes it’s a time management issue, like, sometimes it’s like, time hasn’t been managed well during the day, and so it’s stolen over into the night. That’s one thing I’ll kind of, I’ll get into. But I also there’s a tool that I share with people. It’s just. NRL is called the constructive worry worksheet. And I’ll tell people I’m like, have a just a different time where you do your worrying or your planning, or whatever it is, pick a time. And so this is for like, the people that are like worrying and perseverating, choose the time is some time during the day, maybe in the early evening. Try not to have to have it be too close to bedtime, but write down, what is this thing that I think is going to keep me awake? Write it down, and then write down, what is the very next step to address? It doesn’t have to be the last step. Probably won’t be that like you’re going to get overwhelmed if you try to think about all the steps, what’s the very next step? So maybe the very next step is like something towards solving the problem. Or maybe the next step is, I don’t know what to do, I need to ask for help. Or maybe the next step is, there’s nothing I can do. I’m just gonna have to live with it, or I’m just gonna have to blow off it when it comes that’s the next step. So whatever the next step is, problem next step, problem next step, take about 15 minutes. Problem next step, and then put it away, fold it, put it on your nightstand. Don’t think about it. When you get to bedtime, if those worry thoughts start to creep in, you can tell yourself, I’ve already worried about it. Already worried about it. I’ve already made a decision. It’s right over there. And then, similarly, like if you wake up in the middle of the night, I’ve already worried about it. I’m already and also think it’s if it’s just going to be a few minutes, and if you can hop up and get it out of your brain and then go back, like waking up in the middle of the night is not, it’s not the it’s not the end of the world. It’s normal to be there’s this theory that humans actually used to be biphasic sleepers. We used to sleep in like two chunks. Being awake in the middle of the night is not especially if it’s like, less than 30 minutes, I’m usually not going to be too concerned about it if it goes beyond 30 minutes, or the person is, like, really distressed about it. And then we’ll try to shift that too, because it’s like your brain’s trying to work out this problem. And like, I had somebody who he would just send himself an email at the end of the work day. And that was his version of it. And it was like everything that he kind of just, everything that he had going on, he just sent himself an email thing. And that did because he was waking up at three in the morning and just perseverating about work, and so he would, he took the worry worksheet, but sent himself an email at the end of the day. And that was his, his version of that.

Katie Vernoy 22:22
I like that because it puts a specific spot during the day before you’re sleeping to kind of plan ahead. It’s, it’s, it’s those things that kind of come out of the blue because you’ve been sleeping that I think is a little bit harder, but it sounds like, Get up, do a quick like, what is my next step, and then go back to bed.

Jessica Fink 22:40
Sure, and then go back to bed. Yeah, perfect.

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Curt Widhalm 22:44
How do you assess for primary sleep disorders versus something that’s secondary to anxiety, depression, trauma, something else completely? And is there a treatment difference in how you approach each of those?

Jessica Fink 23:00
Like, I’ll say so i’ll speak for because I feel like insomnia is kind of the, maybe the main one that gets attributed to, like, Oh, it’s just secondary to depression, if we treat the depression. So insomnia, if you are having trouble sleeping, if it’s at least three nights a week for at least three months, just the DSM criteria for insomnia, if it’s at least three nights a week for at least three months, that’s its own problem. Insomnia has become its own problem. It needs its own treatment. There’s this idea that if you just treat the depression, the insomnia will go away. Just treat the anxiety, the insomnia will go away. Well, if it’s become an entrenched problem, no, it’s not going to go away. It’s become its own thing. A lot of the time, insomnia will it can start as a secondary you know, I’m not sleeping because I’m stressed at work. I’m not sleeping because I’m depressed. But after a certain point, in three months, is the cut off that we use, after a certain point, it has developed a life of its own. And even if you treat the depression, the anxiety, the insomnia, is still and what’s interesting is sometimes, if you treat the insomnia, you can actually make a pretty big deal. I’ve had people who we treat the insomnia, and their anxiety goes away because all their anxiety was about sleep. They weren’t really anxious about anything else. They were just they were just worried about sleep. And so I’m probably also just biased, because sleep is sleep is my specialty. But I think once you, like, once you’ve met the diagnostic criteria for a sleep disorder, then that disorder needs, it needs to be addressed as its own issue. And every sleep disorder has a treatment. A lot of them are behavioral treatments, or some of them are more medical but like, once you’ve been, once you’ve met the criteria, I think it’s its own thing, and it needs its own treatment.

Curt Widhalm 24:49
I want to go back to a sleep hygiene question that we didn’t really ask, because I think that one thing we haven’t talked about is how often we say, Don’t go to blue lights. You know, don’t get on your phone. Don’t get Yeah, earlier you were talking about, go ahead, watch a movie. This is another seeming contradiction that…

Jessica Fink 25:08
Yes.

Curt Widhalm 25:09
…you’re talking about here,

Jessica Fink 25:10
The screens have gotten overly vilified in in my opinion.

Curt Widhalm 25:15
Don’t, don’t tell my kids that.

Jessica Fink 25:18
Right? You’re gonna cut that out just for for that reason, a lot. Yeah, the screens have really gotten overly, overly vilified. So I do ever since I got trained in sleep and it became my specialty. I actually do monthly consultation with somebody who is kind of a pretty high like expert in the sleep world, and he does consultation with clinicians, and brought it up in consultation with with him, because I was like, I see what the phone then the screens and the this and the that. And I said, I feel like they’ve gotten overly vilified, but tell me if I’m right or I’m wrong about that. And he said, so here’s the deal, the way that so that, you know, the research that comes out that’s like, blue light shift had this impact, or had that impact. The way they do the research about that stuff is really interesting. So it’s called a constant routine, and it’s the same where participants are kept in like, dim light for 26 hours, there’s like lying on their bellies. I get prone in supine I get those confused. They’re either lying on their backs or their bellies the whole time. They’re they’re not really like eating much. They’re only drinking clear liquids. They’re having very not a lot of activity. It’s this really. I don’t know how they get anyone to fall into volunteer for these studies, but…

Curt Widhalm 26:43
It also seems super representative of everyday life.

Jessica Fink 26:47
And this is what I’m telling all my clients. I’m like, So tell me, you spend 26 hours a day in low light, only drinking. It’s, it’s because they, I think, because they want you to be as like light neutral as some people. So these people are getting, like, no light exposure during the day. So then you introduce a little bit of light, and it’s going to have a big shift. But most of us are not, we’re having light I’ve got four windows in this room. I mean, I’ve got tons of light exposure going on right now. Most of us are getting more light exposure during the day than what they’re getting in a lot of those studies that are like, light does this and light does that. So it just it doesn’t make as big of an impact given what most of our lives look unless you’re spending your whole day in like a cave or something like that.

Katie Vernoy 27:35
Gamers pay attention to this.

Jessica Fink 27:39
The only time that I’m concerned about the blue light is if I’m working with somebody who has a circadian rhythm disorder, particularly, there’s a there is there’s one called phase delayed, and it looks a lot like insomnia. But these are people because the circadian rhythm is very sensitive to light. So if the circadian rhythm is real, those are the people that I’m telling to get, like, the blue blocker glasses and but insomnia, like, the reason you’re not sleeping is probably it’s probably not the blue light. It’s probably that you’re spending too much time in bed and you’re trying too hard to sleep.

Katie Vernoy 28:12
So when I think about the advice you’ve given so far, don’t stay in bed unless you’re sleeping. And the way that I learned sleep hygiene was sleep is or your bed is for sleep and sex. So, you know, keep it very specific. Don’t try so hard if you if you can’t sleep, do whatever you want.

Jessica Fink 28:30
Yeah, yeah.

Katie Vernoy 28:31
Until you get sleepy. Are there other piece of pieces of advice or behavioral changes that are consistent for folks who are having sleep disorders?

Jessica Fink 28:41
Yeah, getting out of bed at the same time every day. I can’t remember if I’ve mentioned that one’s real and that one is really, I mean, honestly, I think we all probably need to be, whether you have a sleep disorder or not, getting out of bed at a consistent time, consistent meaning within an hour. So it doesn’t have to be like to the second, but within an hour, trying to keep it, don’t bury it by more than an hour. We say the hour because Daylight Saving Time is an hour, and we know that has that shift has an impact on people, so that’s why we say don’t bury it. So whatever time you’re getting out during the week, if you want to sleep in on weekends, don’t go beyond an hour. So getting up at the same time every day is the thing that really because the time you get out of bed determines the timing of when you eat and when you have light exposure, when you do all the other stuff you need during the day, and your circadian rhythm is the thing that determines the timing of when you’re asleep and when you’re awake. So if you’re getting up at wildly different times throughout the week, you might as well be flying like, from California to New York like every other day and just constantly, it’s jet lag. You’re giving yourself jet lag. We call it social jet lag. And so your circadian rhythm is like, I don’t understand. My human is going to bed at these weird times. I don’t know. Is it day? Is it night? Should I be awake? Should I be asleep? I don’t know. And it throws something out, and then people are like, sleepy at weird times and awake at weird times. So pretty much, no matter what the problem, or even if you don’t have a sleep disorder, getting out of bed at the same time, within an hour every morning has a huge impact. And then the other thing I’ll share that I don’t think I’ve shared yet is don’t get into bed until you feel sleepy or until you feel like, reasonably like, try not to go to bed based on the time. Go to bed based on Okay, I feel like I could fall asleep if I got into bed. Because you’re the two things that determine what your sleep looks like are your sleep drive and your circadian rhythm, your sleep drive, is only related to how much is built up in the system. So if you’re not sleepy, so if you’re not falling asleep, you’re not sleepy. So if you go to bed too early, what ends up happening is you’re not falling asleep. And then people have all this anxiety about, why am I not falling asleep? What’s wrong with me? And it’s really better to get, like, a smaller amount of good sleep than a lot of crappy sleep. And so going to bed later can actually be a people like, I have to go to bed early. No, don’t go to bed if you’re not going to fall asleep till midnight. Don’t go to bed at 10. You’re going to lay there for two hours and stress and worry about, go to bed at midnight, because then you’re going to fall asleep fast, you’re probably gonna sleep better. So that’s kind of the other thing I’ll tell people, is, don’t get into bed until you actually feel like, okay, I think I could fall asleep now.

Curt Widhalm 31:31
What’s your opinion on wearables and the information? I kind of figured that your response would be something like that. But, you know, I don’t have one of the fancy watches, but I check my app every so often, and it’s like, use you got a 60 as your sleep score. So tell me what your reaction is.

Jessica Fink 31:55
Those consumer wearables are the bane of my existence. I’ll be totally honest, really, mostly in, just in the case of so, like people with insomnia, people who develop insomnia tend to be people that are already more anxious. They’re already more health conscious. And so they’re tracking, they’re tracking everything. One we don’t, we do not know how acurate those are because, you know, because the companies that make them their algorithms, and the way they calculate them is it, it’s a trace, you know, understandably, like, full information, they’re not going to put it out to the world. Hey, this was how we calculate our stuff, so we can’t speak to [unintelligible]. The other thing I’ve seen is people will get so obsessed with the data, they’ll wake up in the morning and they’ll feel okay, they’ll feel they’ll feel okay. And then that watch tells them they slept like crap. And now they have anxiety. Now they’re like, oh my god, I thought I slept okay, but it turns out I didn’t, and my perception is all wrong. It’s like, the the device is like, inducing this, and the other thing people get so focused on, like optimizing, I have to optimize my sleep. There’s actually a term at orthosomnia.

Katie Vernoy 33:09
Oh, wow.

Jessica Fink 33:11
If you’ve heard Orthorexia. Yeah, it’s like orthorexia, but for sleep. So these are people that really need on paper, their sleep looks okay. They really don’t have they’re sleeping okay, but they’re so worried. They’re so worried a lot of the time because they have unrealistic expectations about what their sleep looks like, or they’re just so it’s like the data has created this. They’re so fixated on the data and every little thing. And we all have bad nights. Bad nights are normal. But yeah, that’s I have people keep a paper sleep log. And they’re like, I have a watch. I’m like, Cool, please keep the paper sleep log. Keep wearing your watch. I’m not going to take your watch away. But I have had people like, I’m not wearing my watch anymore. This thing’s stressing me out. And I’m like, yeah, it is.

Katie Vernoy 33:59
So there’s there’s also sleep studies, and it seems like some folks want to jump to that. Some folks are trying to avoid it like the plague. Who should do sleep studies and who shouldn’t?

Jessica Fink 34:09
Sure. Yeah, great question. So for sure, if you suspect sleep apnea. So sleep apnea is where you you stop breathing in the middle of the night. So what makes you know, so when might you suspect sleep apnea? So look for excessive sleepiness during the day. So that’s why I make the distinction between tired and sleepy. People with untreated sleep apnea tend to be very like they tend they’re falling asleep. These are the people that are falling asleep in the movie theater, in the car. They’re falling asleep when they don’t want to fall asleep. And there’s a tool it’s very easy to find online, called the Epworth sleepiness scale that you can give to people, and it’ll you can score it, and you don’t have to be a doctor. You just ask them the questions for it, and if it’s over a 10, then I would recommend you refer them to a doctor or sleep medicine specialist to get a sleep study because they most likely have sleep apnea. That’s probably it. Sleep apnea, where sleep, a sleep study is if you suspect narcolepsy. Narcolepsy is pretty rare. I don’t know how many people listening science. With narcolepsy, they’re also excessively sleepy. During the day, they’re again, they’re falling asleep, and they don’t want to be falling asleep. But with insomnia, a sleep study, if you only suspect insomnia, a sleep study is not going to tell you anything useful. So I think it’s just important to know what a sleep study can measure and what it can’t measure. So there’s two ways of objectively measuring sleep, polysomnography, and then actigraphy. Actigraphy is what all the smart watches are doing. Actigraphy uses movement as a proxy for sleep, and so it kind of says, Okay, if you’re moving, you’re awake. If you’re not moving, you’re asleep. Polysomnography is what they’re doing in the lab. There’s different levels of it, but it’s it tends to measure stuff like brain waves, eye movement, what your muscles are doing, your heart rate, your breathing, so it can tell you, do you stop breathing at night? How many times do you stop breathing at night? And with narcolepsy, they’re trying to see like how quickly somebody goes into REM sleep, which is why they’re measuring the eye movements. But insomnia is a learned behavior that’s become a habit. You don’t have insomnia because of your you know, because of what your brain waves are doing, or because of what your eyes or your heart rate, you have insomnia because you because you have chronic insomnia because you’re doing stuff trying to fix it that’s not working, like you’ve learned this habit, and then you’re doing stuff to try to fix it. People with just suspect insomnia, they don’t tend to get anything useful. Sometimes they end up sleeping better in the lab because they’re so worried they want their sleep to look as bad as possible, to help diagnose that they’re like, hoping it’s bad. And the funny thing that happens is, when you quit trying to sleep, you sleep, but they sleep right? And then the doctor’s like, Oh, you’re good news, nothing is wrong. And they’re like, something’s insomnia, subjective, like insomnia is also I’m not sleeping and I’m distressed about the fact that I’m worried about the fact that I’m not sleeping. So insomnia, or a sleep study, can’t tell you that you’re spending too much time in bed or that you’re getting up at erratic times. It just can’t measure the kind of stuff, same with nightmares or circadian rhythm disorders, those are diagnosed with a clinical interview and sleep logs. So really it’s sleep apnea or narcolepsy. There’s a couple of other sleep disorders that are getting kind of like way in the weeds. There’s something called REM behavior disorder, where you act out your dreams. So if you’re acting, if you’re punching and picking while you’re dreaming, go get a sleep study. But yeah, those are kind of sleep apnea, narcolepsy, REM behavior disorder. Sleep study is helpful. It’s going to give you useful information. Insomnia, no, nightmares, circadian rhythm disorders, it’s not going to tell you anything useful.

Katie Vernoy 38:02
It seems like there’s a big crossover here with a lot of medical stuff. I’m just thinking about medicines that can make you tired or make you less sleepy or give you insomnia. So it seems like there would be a need to understand someone’s medical history and potentially even be part of a team working with your client, to understand how all those things interact.

Jessica Fink 38:25
Yeah, sleep is really multi disciplinary. I guess maybe everything’s multi disciplinary for sleep, for sleep for sure, for sleep for sure is it’s stay both medical and behavioral, and depending on the disorder, it’s more medical or more behavioral.

Curt Widhalm 38:40
Where can people find out more about you and your practice?

Jessica Fink 38:44
Yes, so I will. I’ll start with my website, which is www.JessicaFinktherapy, which is my name, and then the word therapy license in Texas. So if you live in Texas and you need sleep help, you can contact me through my website about becoming a client. I also have a blog on my website. I write about all my specialties, but most of the contents about sleep. I send a monthly email newsletter. You can sign up for that on my website, there’s links. I put links pretty, pretty much all over the site. I think they’re hard to miss. And finally, I have this. I have a small YouTube channel, so similar to my blog, I blog about my specialties, but again, like most of the content is about sleep and it’s just It’s Jessica Fink therapy on on YouTube.

Curt Widhalm 39:32
And we will include links to those in our show notes over at mtsgpodcast.com and follow us on our social media, join our Facebook group, the Modern Therapist’s Group, to continue on with this and other conversations, and until next time, I’m Curt Widhalm with Katie Vernoy and Jessica Fink.

… 39:50
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