Science of Sleep: The Intersection of Chronic Pain, Serious Mental Illness, and Trauma on Sleep


Cathy Cave: Hello, everyone. My name is Cathy Cave, and welcome to our
webinar. Today’s conversation is a further discussion
on the science of sleep. The disclaimer that I’d like to share with
you all is that the views expressed in this training do not necessarily represent the
views, policies, and physicians of the Center for Mental Health Services, or just CMHS,
and the Substance Abuse and Mental Health Services Administration, which is SAMHSA,
or the US Department of Health and Human Services, which is HHS. We’re going to be talking about, as I said,
the science of sleep, and this is our second module. We had, our first module was last week. And this module is on the intersection of
chronic pain, serious mental illness, and trauma on sleep, and what are some things
that we can do about it. During our module today, these are some things
that we’ll be talking about, and hopefully the outcomes will be that you’ll be able to
identify some of the conditions that can cause chronic pain and interfere with sleep. That you’ll be able to recognize some of the
ways that trauma can impact sleep participation, and you’ll be able to identify strategies
for falling asleep and staying asleep, despite these challenges that are present. We have some additional materials from the
SAMHSA’s Program to Achieve Wellness that will be available as part of this webinar
today, and those are being made available to you as we speak. And just a brief note about those materials. The first is a cognitive behavioral therapy
treatment for insomnia, or CBTI, and there’s fact sheet about what that is, and what CBT
is, how it can be helpful, and the ways that … some of the goals of what CBT actually
are, and some things that we can think about in terms of what might be helpful for people
who have sleep challenges. In the fact sheet about CBTI, there’s some
further resources, there’s some information about what it is, and how it can be helpful. Some of the goals would be to change thoughts
and behaviors that actually contribute to the disruption of sleep. So, that would be really useful for folks
that are either participating in our webinar today, or if you are working with someone
who’s experiencing some difficulties with sleep. The next resource that we’re making available
to you also is a resource to help with sleep disturbance, and its Interpersonal and Social
Rhythm Therapy. It’s, again, a fact sheet. Some elements of social rhythm therapy. Help regulate daily routines, and emphasize
the link between mood and our ability to sleep, and really to focus in on that, and to help
us think about ways to manage mood, and to educate around habits and resources that might
be more helpful for folks who are struggling with sleep. And then our third resource is Healthy Coping
and Sleep Strategies to Promote Restful sleep for Those Who Experienced Trauma. And it’s actually more of a worksheet that
can be helpful as folks are trying to manage and navigate, and really think about what
is currently happening, and then develop some strategies and habits that can improve sleep. Those resources are made available to you. You’ll be able to download them. And if you have any questions, we’ll have
some time at the end where we’ll talk about any questions that you all have, any additional
resources for sharing. I would also invite everyone during the webinar
to please use your chat box. And you can send us questions, you can add
… if you have resources, you can type them in, so that this is a sharing community that
we’re creating. There are resources available for everyone. Again, my name is Cathy Cave, I am the co-director
of SAMHSA’s Program to Achieve Wellness, and we’re going to talk a little bit more about
the science of sleep. One of the things we wanted to focus on in
today’s conversation is really the impact of trauma on sleep, and what are some strategies
that we can use to help each other get a better night’s sleep, feel better about the habits
that we have and the way that we are working to improve our sleep. When we talk about the impact of trauma, we
really want to think about that in addition to post-traumatic stress disorder, which many
of us are familiar with. It’s a term that’s common as something that
happens, or experiences that folks have after a traumatic event or traumatic experiences. And that in addition to post-traumatic stress
disorder, there are many responses to trauma, and that some of those responses to trauma
can include not being able to sleep, can include alcohol and substance use, other substance
use, having suicidal thoughts. I want to make sure that we pause to think
for a moment about how resilient people can be, and that this isn’t all just about the
struggle that folks have, but it is common that when you’ve had traumatic experiences,
there are ways that we respond, in terms of our emotional and social well-being, in terms
of our physical health, that could be impacted. So, when we think about this range of mental
health challenges that are possible, that in addition to that, in addition to the things
that are struggles, and in addition to having eating disorders, and in addition to having
ways that make it hard for folks to navigate every day, that disrupted sleep can also be
a part of that. I wanted to bring the trauma conversation
to this larger conversation that we’ve been having about sleep, and the science of sleep. To define trauma: Individual trauma results
from an event, series of events, or set of circumstances experienced by an individual
as physically or emotionally harmful or life-threatening, with lasting adverse effects on the individual’s
function, and mental, physical, social, emotional, or spiritual well-being. This definition comes to us from SAMHSA, and
the work of many folks involved in the conversation over decades, and really thinking about what
is trauma, and what’s trauma’s impact, and again, ways that we can think about how people
are impacted, and that that’s a common experience. So, when people have adverse events, it is
common that there is disruption of functioning, and that we have struggles and challenges. To talk a little bit more about those struggles
and challenges related to sleep, it’s that trauma can make it difficult to fall asleep,
or to stay asleep. Can make it difficult to get relaxed enough,
settled down enough, and comfortable enough to get a good night’s sleep. Some of the things that interfere with good
sleep are traumatic reminders. Those are the things that could be sights,
or sounds, or smells, or intrusive memories. The things that stop us in that moment from
being fully present, from being able to settle down, from being able to relax and prepare
for sleep in a way that contributes to getting a good night’s sleep for the full night. Sometimes there’s a response trauma, that
we need to stay, or people who are having experiences, need to stay vigilant, and stay
alert, and stay aware, and that this can lead to a hyperawareness. It’s thinking about, again, how are these
different experiences interrupting or disrupting sleep? If someone’s feeling very anxious and restless,
again, it’s hard to settle down, hard to feel safe, hard to feel comfortable, and settle
in, and say, “Okay, this is good. I can rest.” And often depression, which can be part of
a trauma response, also may make it difficult to have a good night’s sleep. What studies will tell us is that there are
ways that the experience of trauma disrupt people’s ability to comfortably settle in,
to feel safe, to feel supported, to fall asleep, and to stay asleep. And again, just a reminder to folks, if anyone
… just to invite you to use the chat box, and if you have experiences or examples of
how trauma can disrupt sleep, please share that. Adverse childhood events, or ACEs, have been
associated with some self-reported sleep challenges in adulthood. In some studies, what we’re learning is that
individuals who have had childhood trauma have often reported later on having difficulty
sleeping, and that some of those challenges are related to … Again, 33 percent of people
said they have difficulty falling asleep, and then 24 percent reported feeling tired
even after sleeping. So, even if you fall asleep and can stay asleep,
for many folks, there’s no guarantee that having that sleep restores you, and feels
like you’ve rested, and when you wake up, you feel as if you’re energized and ready
for the day. The experiences of childhood and trauma in
this particular study was the focus, but I would also invite people to think about that
there are adverse events that happen in adulthood, related to interpersonal violence, or related
to community violence. Things that people experience in the day-to-day
as adults that also interrupt the ability to sleep, to fall asleep, to stay asleep,
and to wake up feeling refreshed from sleep. Again, just to summarize that research does
show a link between trauma and sleep disturbance, and that exposure to trauma causes general
dysregulation or disruption of our circadian rhythms, and thereby disrupts sleep regulation
in adulthood. All that to say that our body rhythms that
let us know it’s time for rest, it’s time to sleep, and they’re influenced by light,
may be influenced by the time of day, may be influenced by some outside forces, but
in general, they help regulate our body’s ability to sleep. Let us know, it’s getting late, it’s time
for bed, let’s go to sleep. But that disruption may mean that in our minds
we’re thinking, “It’s time to go to bed,” and then not be able to go to sleep, or get
in bed and go to sleep, but can’t stay asleep. So, as we’re thinking about the impact of
both adverse events that happened in childhood, and traumatic experiences that happen in adulthood,
there is a direct impact on our ability to fall asleep and stay asleep. And some of what that might look like is that
sleep disturbances can include insomnia. Again, I would invite folks, if you have examples
of what either you’ve experienced, or folks that you’re working with have experienced,
in terms of sleep disturbance, I welcome you to type in and add to the conversation, and
use the chat box. That insomnia, or that ability to settle down
enough to go to sleep, and be able to … Folks have shared, “I can’t go to sleep. I’ve been up for two, three days.” That kind of insomnia keeps you going, keeps
you awake, but also helps make it so that you’re not as alert as you want to be, or
don’t feel as clear and direct as you want to be, and don’t feel solid, able to connect
to other people, able to do your work, able to show up in the ways that we want to show
up. When we have been up for days at a time-that
can cause folks to feel unable to work and show up in the ways that they want to do that. That interrupted sleep can also keep us groggy
and edgy and disconnected. Having nightmares, that waking up in the middle
of the night with dreams that are startling and terrorizing, that may feel as if they’re
real and happening in the moment, or sleep paralysis, where there’s literally an inability
to move parts of your body when you first wake up or as you’re going to sleep. It’s thinking about when there’s this overall
quality of poor sleep, the ways that our bodies and minds are impacted, and the ways that
we’re not able to actually function the way that we want. When we talk about the importance of sleep,
there’s thinking about all of these things that happen that keep us awake, and some of
that’s related to trauma. There’s also thinking about that the lack
of sleep may be impacting our ability to be well, to be healthy, to not just work in the
ways that we want, or be connected to other people in the way that we want, but also it
may impact our ways of being able to keep going, to practice good self-care, even when
we have really good intentions about that. The things that keep us well, keep us focused
on our well-being, and the well-being of others that we care about, having poor sleep gets
in the way of all of that. Sometimes when people who have lived through
traumatic experiences are coping with those experiences, some of the ways or strategies
that people have to help support their coping may interrupt sleep. There’s environmental things that someone
might do who’s lived through a traumatic event. I may, for example, want to keep the lights
on. I may want to keep the television on. I was working with someone who had three TVs
in her apartment, and she had them all on all the time. That was helpful and soothing in those moments
where she needed to feel like she wasn’t alone, but also may have kept her from getting a
good night’s sleep, because the lights are always on, and several TVs are always on. Just sharing an example of the things people
may do, and may need to do in order to feel safe, physically safe and emotionally safe
in the moment. The ways that folks may, for example, keep
their cell phones next to the bed, so that will feel safe. If you’re feeling scared in the middle of
the night, or startled in the middle of the night, you can easily reach someone. That strategy may be the same thing where
those lights keep you from being able to go to sleep and stay asleep. And then, alcohol and substance abuse. For example, with alcohol, many folks have
talked about how in being alone, and coping, and thinking through what’s happening, also
thinking through not having … All day long, reminders of previous events, and not having
a startle to sights and scents and smells, and body sensations. The things that may be trauma reminders. Seeing someone who reminds you of someone
who was harmful. All of those kinds of things may call upon
a person to do something that helps cope and get through those moments. One of those resources may be alcohol or other
drugs, and one of our challenges is that while those strategies may work in the moment, they
may also keep you from getting a solid night’s sleep. Often, folks will talk about that it helped
to have a drink before bed, that maybe that felt good, or relaxing and helpful. But then they were wide awake in an hour,
an hour and a half. It’s really thinking through that some of
the ways that folks cope with both ongoing traumatic stress and adverse childhood experiences,
the things that cause us to be feeling at alarm, and constantly on alert, that the ways
that humans cope with some of that, the strategies that people have for coping, can also be problematic
in terms of getting a good night’s sleep, going to sleep and staying asleep. I wanted to share a comment from the chat
box, and thank you for adding to this. Someone shared that, “I had a concussion and
was unable to sleep for three days. I was able to exercise and meditate, which
ultimately led to being able to relax and fall asleep.” It’s a good example of having different strategies,
and thank you for sharing that. There are different strategies that we can
use, and we’ll talk a little more about those. When there are strategies that we’re currently
using to cope and kind of get through the experiences, or being able to navigate in
a world that’s a very scary place, some of the strategies that we use for that, we can
find new strategies that may not interfere with sleep. That takes support. It takes information. It takes persistence. And it takes actually feeling safe. It’s really thinking through, what are ways
that we can help with that? Thank you for your comment. The impact of chronic pain on sleep: When
we think about, there’s a close relation between chronic pain and inflammation, and that it
also impacts sleep. As an example, I’m someone who has chronic
pain. It’s something that I’ve had as part of my
life over the last decade or more, and there’s a link that’s been talked about in studies
between inflammation, chronic pain, and feeling sleep deprived, and being sleep deprived. Inflammation can increase when people have
not had enough sleep. So, for all the reasons that we’ve been talking
about, all the things that can impact sleep, whether it’s insomnia, or disrupted sleep,
or having nightmares, or having trauma reminders, that all of those things, when we’re sleep
deprived, can increase inflammation in our bodies, and then sleep loss can also lead
to generalized pain. And if chronic pain is already a condition,
there are links between more inflammation, less sleep, leads to more inflammation, and
more sleep loss. And then sleep loss and chronic pain are connected. It’s really thinking through, again, that
when we’re working with folks who have said, “I have chronic pain conditions,” are there
strategies, are there tools that we can offer, resources that we can offer to work on strategies
for managing chronic pain, work on strategies to increase better sleep, and really, thinking
about that that connection exists, and we can do more together with the resources that
we have. When we talk about the impact, and when we
talk about what kind of strategies we can develop together, I’d really like to invite
folks, again, to add some more information in the chat box, if you have strategies for
that. Whether it’s strategies that help with chronic
pain, or strategies that help with inflammation, or strategies that help with that intersection
of pain and sleep. Please, you’re welcome to share. When research shows that there’s a link between
trauma and chronic pain conditions, part of what we need to think about, then, is are
there some strategies for self-care that we can adapt, that can help support our ability
to sleep, and our ability to navigate trauma and chronic pain. As we think further about self-care and self-care
strategies, let’s just keep in the back of our minds this notion of the connection between
pain and sleep and trauma. When we talk about strategies, here’s a few
things to support getting better sleep. Thinking creatively, on your own or with others
who have experienced trauma, about sleep tips and tools. We know, for example, that peer support is
a useful tool, and a useful strategy, connecting with others around for support, and to think
about ways to increase feeling safe and comfortable. Thinking about ways to shape our environments. Think about ways to pay attention to our own
needs for both physical and emotional safety, and that these are topics to bring to peer
support conversations, or to bring to other kinds of support groups, and to bring to all
of the environments as we’re working together in clinical practice, for example. Put this on the table for talking about, because
there are strategies, and there are resources. Again, in your tips and tools that we shared
in the beginning, and we’ll share them again in a little bit, to really think through,
how do we bring these conversations to the table? Let’s talk about achieving a nurturing sleep
environment. Let’s put that on the table for discussion. And what are some of the strategies that folks
have? Are we thinking about ways to fall asleep,
stay asleep? Are we thinking about ways to attend to safety? And what might that mean? For example, the example I shared earlier
about someone who might need to keep all the TVs on in an apartment, are there other ways
to bring in that level of sound that feels supportive, that helps to increase safety,
but maybe is more supportive of getting good sleep? Is a sound machine helpful? Are there different kinds of sounds that might
be helpful? We’ll explore in a moment a few more strategies,
but the idea here is to really think through that the goals are nurturing sleep, creating
an environment that actually does nurture our sleep, and then attending to the need
for safety at the same time. And again, I would invite folks to share ideas,
and how do we think more about our sleep habits, and promoting good sleep habits? Again, pay attention to the fact that trauma
happens, that chronic pain happens, and that these are real conditions where folks are
really struggling. There were a few suggestions from module one
on creating a healthy sleep environment, and I just wanted to touch back on those for a
moment, in terms of sensory factors like noise and smells, really thinking about touch, and
thinking about lighting. I’m someone who is particularly sensitive
to smells, so there are some essential oils, for example, that really do help me go to
sleep. So, it might be a lavender, or a eucalyptus,
or rosemary. Things that, those scents are soothing, that
help create a sense of safety and support in my environment, as an example. When we think about touch, in terms of who
are we sleeping near, and where are we? All of our sleep spaces are not always in
bedrooms. We have people who really struggle with homelessness,
who may not be sleeping in a room that is their own, that might not be a bedroom. Someone may be sleeping on couches, or sleeping
in a shelter. Are there ways to bring some of these strategies
to deal with noise, and smells, and touch, and lights, and really think about that in
terms of the sensory environment that people are in? Are there ways to give more control over the
sensory environment? And are there ways to create options and choices? In my own home, I can choose to have my pets
sleep with me. I have two cats and a dog, and they’re all
in the bed, and that’s where we sleep, and it’s where we all sleep every night, and there’s
a sense of safety and comfort in that. But if folks can’t do that, then what are
some other options? Are there textures that feel good to touch? To manage the sounds, are there ways to share
that folks can have, headphones? Are there ways to talk about whether or not
that feels safe or not? It’s really adding to the conversation about
the realities of people’s lives, and their ability to control the sensory factors, or
to create them, or add to them. I wonder, is it possible to expand the tools
that you have for coping, or tools that you have for sharing with others, as resources
to improve sleep. Again, I would wonder, invite folks to use
the chat box. Just to share a couple of thoughts that have
come up, someone said, “Using essential oils every night to promote sleep.” And then another person shared that, “I know
white noise is helpful for many people, including myself. Having a fan running drowns out the thoughts
in your head, and really can support better sleep.” Thank you for sharing those, and I really
appreciate that folks are thinking about ways that you can shape the environment with what
might be readily available. Again, I have challenges about being able
to control where I sleep and when I sleep that can make it really difficult to feel
that … Lots of the suggestions might apply to me. Are there ways that, if I’m sleeping in someone
else’s space, that I can feel supported, and really work to create a sense of safety, and
support, and peace, and welcoming? That says, yeah, I can go to sleep, and I
can stay asleep right now. We’re going to hear from Matt Canuteson, who
is someone that I’ve had the pleasure of working with for many things. Matt is a project associate at Policy Research
Associates, and combined with professional and lived experience with substance use, mental
illness, homelessness, and with criminal justice involvement, he provides technical assistance
and support at the federal, state, and local levels. A person in long-term recovery, Matt provides
a unique perspective on how government, private organizations, and local communities can work
together to make recovery a possibility for everyone. I’d like to invite Matt to share some thoughts
with us, and Matt, if you could speak to your experience with sleep, and getting good sleep,
and any tools and coping resources that you have to share with us, that would be great. Welcome, Matt. Matt Canuteson: Thank you, Cathy, and I’m
really excited to be here today, talking to all of you. Sleep is one of my favorite topics. People that are in my life will … I talk
about sleep often. First, and I’ll explain a little bit about
why that is, but first, just about myself. Like Cathy said, I’m a person in long-term
recovery. What that means for me is, I haven’t used
any substances, illicit substances, in about 16 years, now. My past to where I am now also included other
behavior health issues, such as depression, anxiety, and I also have a trauma history
that comes from a number of different places. We don’t have the time to really describe
them, but just to say that I have a trauma history. My story involves being pushed along, and
being involved in a number of different settings, including sometimes homeless. A little bit of time street homeless. Rehabs, hospitals, and then also a fairly
extensive incarceration history. And I say that those places, and I bring up
the settings, just so that the listeners understand that some of those settings are the places
that really were the root of my trauma. Mostly the incarcerations. My life ended up working out, through peer
support, mostly, which was other people who had lived experience who had found recovery
came across my path. My life turned around, and I was able to do
all of the things that somebody in society would want to do. I went on with my education, career. Now I spend most of my career working to help
improve the lives of individuals who have pasts like me, who are currently living in
those situations. I did struggle with sleep early on in my recovery
process. I think, like we already talked about a little
bit, a lot of reoccurring memories. A little on the drug dreams, dreaming of using
substances early on. But mostly just thinking of different situations
that I had been in in my past, different settings, and that would make it hard for me to sleep. Early on, I also found, and really believe,
and just found in my own personal life, that my functioning wasn’t as high the next day,
which is obvious, if you’re not sleeping right. That meant that I would be more irritable. That meant that it affected relationships
with people around me, whether that be my significant other, or whether that be my kids. Now it’s my kids. I’m a parent, so I know I’m going to be spending
the next day with my kids all day, I am extra, extra careful to make sure that I get enough
sleep, just because I feel like I owe it to them to be in the best mood possible, and
to be able to be present for them. That’s why I say I always talk about sleep. I’m very careful, I think, is the word I like
to use about my sleep, and I’m going to talk a little bit about some of the techniques
that I use to make sure. One, I’m glad somebody brought up smell, and
that’s funny, because I didn’t think that anybody was going to. But smell is super-important for me. Whether or not it be scented candles, or the
diffusers, or whatever people are using nowadays, essential oils. I have this one scent, it’s a lavender essential
oil that I use, that is helpful to me. And it’s also habit-building, so there’s sort
of a ritual of getting ready for sleep that I feel is very important. There’s certain things that I do. I light a candle next to my bed every night
right before I go to sleep, because I feel like it creates this psychological ritual
that I’m going to be getting ready for sleep. And I do a little reading right before sleep,
and then I do. That’s the other thing, is to create this
little ritual. I feel like other things that are important
is, I don’t drink any caffeine past about 3:00 in the afternoon. Not because I felt like there’s been a huge
problem with it in the past, but I just got that advice a while ago, and then always just
really try to not drink caffeine then. As we know, most of the different areas of
wellness that we talk about are connected to one another. Exercise is actually beneficial to us for
a whole bunch of different reasons, but one of them, it ties back to sleep. If I’m exercising, it makes it so much easier
for me to feel more relaxed at the end of the day, and be able to find that place where
my body and my brain is going to be in a place where I’m going to be able to sleep. Now, diet is also extremely important, and
this is just for me. I feel like sugar and different things like
that, I try to limit them anyway, but definitely before bed. I usually try to eat a little bit so that
I’m not hungry in the middle of the night, but I just eat a healthy snack, and it’s usually
better for me to eat something that is not protein-based, so I pick a carb more than
… In my diet, I eat oatmeal every day, so I eat a bowl of oatmeal before bed every night,
and that’s something that helps me. It makes my stomach full, and again, it’s
a part of this ritual that I do to be able to have sleep. Those are really the things that I would say. I would also point, something that we didn’t
talk about really a lot, I feel like more of a priority needs to be on it, because like
I said, in my recovery process, we hear the world “HALT,” which is an acronym, “hungry,
angry, lonely, tired.” If you’re ever one of those specific things,
you need to do something to pull you out of that, so that you can be in a more balanced
place. Those things are all interrelated for me. It’s easier for me to get angry when I’m tired. It’s easier for me to feel depressed or not
very good when I’m tired. And again, it goes back to the eating. All these things are part of a bigger picture,
a collage of what makes us well. So, those were generally the different things
that I use. I think that we owe it to ourselves. I feel like I’m also the type of person that
believes that we should pamper ourselves. It’s important to really take the time to
think about what is going to work for you. It’s going to be different for everybody,
in terms of what smells might work for you. Maybe some people like flannel sheets, maybe
some people like the more shiny silk ones. It’s going to be up to you to decide what
works for you, but really, if you have never in your life, or you don’t do it enough, take
the time to really do it, because you deserve it, and everybody’s special, and it’s important. Thank you for the opportunity, Cathy, and
I am available for questions when you say people can give me questions. Cathy Cave: Thanks, Matt. Really appreciate you. I really also wanted to thank you for your
thoughts around, and examples of, habits and rituals. And when we think about, again, trauma, one
of the things that is important in our rituals and habits is to think through things that
help you feel physically safe, in terms of your rituals. For example, before going to bed, actually
checking the locks, actually checking the lights. Is there a routine that you have that actually
checks on the physical safety things, or the challenges and issues and concerns, that are
concrete things to do? And then for emotional safety, an example
might be, I text with a family member every night before I go to sleep. Matt gave us some ideas for rituals that get
you centered and calm, but there also might be a need to say, to tell someone else, “I’m
good, I’m settled. Have a good night.” And really using peer support in that way,
or family support, or friends. Next week, we’re going to talk some more about
… In our third module, rather, we’ll talk about habits and rituals, but to really think
today about the things that are really happening for people, and what can we do in this moment,
again, related to trauma and chronic pain? When we opened up and asked people to add
to the chat box, someone shared, a warm bath before bed. Now, it’s soothing and helpful, but it also
might help with and address chronic pain, actually soothing those muscles and directly
attending to what’s happening in the body in that moment. There was a recommendation for a book called
“Treating Sleep Problems: A Trans Diagnostic Approach.” I wanted to share some of the resources that
folks have added, and certainly, we’ll make those available. Wanted to also comment on a suggestion for
a sleep study that was done to screen for sleep apnea. Again, looking for the physical things that
are happening that might be keeping us up at night, or preventing us from staying asleep. And then, someone asked the question around
when folks are not able to sleep in a safe space. What does that look like? What does it feel like? I think, when we talk about getting restful
sleep, it’s easy to forget that we all have very different lives, and these are some really
good ideas. It’s really talking with individuals about
the rituals that you have control over, that you can add to, that you can either use to
support getting better sleep, or if you have ideas that might support someone else. But the life realities are really important
for us to keep in mind, so I really thank you all for that reminder, as well. When we talk about the need for safety and
sleep in the same context, we’re recognizing that people’s lives are unique, and the challenges
are real. Some things that you can do if you have access. These are some ideas for getting restful sleep. Setting a timer for a television that can
shut off at a certain time, rather than leaving everything on all night long. Now, if the channel changes, or the show changes,
rather, something new comes on, or commercials might be loud, is there a way to have a little
bit of that and not have it go all night long? And we already talked about incorporating
comforting sounds and scents. Again, a matter of what we can control in
our environments that can support us and add to good sleep, and are there ways to … Following
up with Matt’s suggestion on physical safety, or on physical activity, rather, just before
we talk about safety … Again, think about what’s possible and doable. You might not live in a community where you’re
able to go outside at night before bed. Are there things that you can do inside that
feel possible, and also support physical and emotional safety? When we talk about the use of peer support,
when we talk about creating rituals that make sense, it’s what makes sense for you, or what
makes sense for the person that you’re working with, so that we can just raise the awareness,
going back to one of Matt’s other points, that there’s not enough awareness in our conversations
about what impacts our sleep. So, raising awareness raises opportunities
for different kinds of strategies that might be helpful. Getting a pet has certainly been helpful for
lots of folks, if that’s possible and doable in the space that you’re in. Really thinking through how pets can be helpful. They can manage sensitivity to noise, and
they can help soothe that heightened sense of awareness, but also can be aware with you. It’s acknowledging that trauma can lead to
this heightened sense of not feeling safe emotionally or physical, and that support
animals can be helpful, again, if that’s possible. And having a match for you and your life,
and your lifestyle, and your events. What kind of support and comfort animal can
you have with you? It’s thinking about what’s possible in this
moment. What have your coping strategies been? Are there things you can do differently? Are there things that you’re doing that are
not supporting your sleep? Are there things that could better support
sleep? It’s opening the conversation, again, around
here’s what I do. And again, one of the handouts, or supplemental
materials that’s part of this webinar, there’s a worksheet that can help support this reflecting,
and you can also bring that to conversations with others. So, it’s sharing it either with a clinician
or in peer support, around, this is what I do that works. These are some ideas that I might have that
I’ve thought about, but if I can’t have an animal, for example, then what can I do? Where else can I get support? How else can I get support? How else can I think about what will support
my sleep? In our work together, again, whether it’s
with clinicians or with peer support, it’s really thinking through the idea of, there
may be one small thing we can do that can enhance our sleep, and therefore better enhance
our lives. Someone put in the chat box, in response to
Matt, “Oatmeal, great idea. Hadn’t thought about that before.” So, let’s think about some strategies. There’s a strategy that was offered in the
chat box for earplugs. Someone found that to be helpful. Someone else added, having a journal of sleep
rituals that did not work, but also some that work, so that when we’re talking about our
ideas, and someone says, “Did you try this? Did you try that?” Having some reflection, a place to reflect
on, these are the things that I have tried, and this is what did work, and this is what
was not helpful. I did want to pause for a moment to see if
there are any questions or comments that folks have that we did not get to in our time together. One of our questions is, “I have a history
of chronic, severe abuse as a child. Now I’m 55, and about to get a sleep study
for sleep apnea. This webinar presents another possibility,
for I sleep 10 hours a night, but not rested. I wake up with a headache.” And there’s some more, here. “Wake up with a headache,” and I can’t see
the rest. Just to speak to what is here, and thank you
for the person who brought this to our attention, that it’s also being able to prepare for the
sleep study. So, really, if you have questions about what
that process will be, in terms of maintaining a sense of feeling both physically and emotionally
safe, really talking with the person who’s going to do your sleep study about what the
process is, and is this something that can happen at home, or do you have to go to a
sleep center? People have experienced both. Lots of questions to ask about what it will
be like, what will it mean, what the results mean, how long do you keep the monitors on,
how do they fit? There’s great questions that can actually
help the process of getting a sleep study feel more comfortable. And it makes sense that given life experience,
many of us do struggle with feeling rested after sleeping, or not having enough sleep. Teeth grinding is really common. Many folks experience that who have had some
hard experiences, or traumatic experiences as children or as adults. So, thank you for bringing us back to that. And then, another question is, “What are some
of the sleep practices you employed when on the street or in a shelter dwelling, and how
was it transitioning to being housed?” Matt, I think that question is for you, so
I’m going to turn that over to you, if you would like to respond. Matt Canuteson: Yeah, I mean, I saw the question
come in earlier. It’s an interesting question, and a hard one
to answer. I think, like anybody, I tried to make my
surroundings as comfortable as possible. What I did, and I’m just talking about me,
but obviously this is a predicament that nobody ever wants to find themselves in. I would go off the beaten path. I lived, somewhat, at the time, in a city. I would walk to a part of the city, almost
in the outskirts, that was not very populated. And I would sleep at this baseball park in
the dugout, was my main go-to at that time in my life, because it was covered, it was
quiet, there wasn’t really anybody around. Sometimes I would be with another person,
which was somewhat beneficial, as well. But that’s what I did, just so there weren’t
really people around, it was a little bit more quiet. But that’s not a situation I would hope anybody
has to do, but we know that a whole bunch of Americans do have to deal with that. And then, honestly, being in settings such
as a shelter, or a drug rehab, or a jail, or any of those, it’s extremely hard to have
your sleep be regulated, mostly because of the safety. Sometimes I was in dorms, so it wasn’t like
… I was in a room with up to 50 complete strangers, and you’re sleeping at night in
a room with 50 complete strangers. So, that was kind of hard, and that was jail,
rehabs, and whatever, as well. I think that that’s one of the reasons why,
I think, now, that I’m so, it’s so important to me to find sleep in the way that I do,
and I’m very careful about it, is because there were times in my life that that wasn’t
really an option. I didn’t really have the choice on how I was
going to sleep. But it’s funny, because I was also just thinking
about, to me it’s not this stressful thing, like I’m stressed about sleep, and I make
it this thing that’s not fun, or whatever. And I’ve kind of passed that on to my kids. My three boys, they all love sleep, even the
three-year-old. The other night, he sighed and said that he
wanted to go night-night, because I have this whole … It’s kind of the same with him. He has his little stars that show up on the
ceiling. He has his little stuffed animals. It’s very dark. All the different things, and it’s kind of
like a ritual again. And then my two older kids, who are seven
and eight, it’s the same thing. They actually say, “I love going to sleep,”
just because it’s this nice little time that we have, and I’ve made them … They make
their own decisions a little bit about what it is that’s going to make them feel comfortable. So, that’s my answer. Cathy Cave: Well, thank you. And I appreciate your thoughts about making
sleep rituals fun. There can be joy in thinking about, how do
I change my space? How do I make the space I’m in, what do I
have control over? If I do have control, how do I make the space
feel soothing? How do I make the light work for me? I have two windows, for example, in the room
where I sleep. One of them, we keep the blind down all the
time, and the other one, the blind is open all day long, and then closed at night. And closing that at night is one of the rituals
that we have. So, it’s really thinking through what works. I wanted to respond to another question around,
“How do you escape the pain, when pain wakes you up?” One of my challenges is both pain that is
pervasive and ongoing, all the time, with very little relief. Strategies that were helpful to me was acupuncture,
acupressure, and massage. Those were things that I was able to build
into my regular practice that are helpful, and reduce the amount of time I was in pain,
and reduce the amount of pain I was in for short periods of time. That was actually helpful. I think, one of the other things that would
happen, and I was often woken in the middle of the night with cramps in my legs. A simple solution was pushing my bed closer
to the wall, the outside wall of our house, and if I put my foot against the wall, that
would help relieve the pain really quickly from a cramp, and I was able to go back to
sleep. It’s like, where this suggestion came from
was probably from a friend of a friend, and I heard about it, and it happened to be something
that worked. It’s really thinking about strategies that
you could try. One is to think about the thread for managing
pain, which may include some alternative kinds of approaches for pain management. Again, massage worked for me, acupressure
worked for me, acupuncture worked for me. There may be other strategies that other folks
have that work for them. There’s that thread of pain management that
was not going to cause me further harm. And then, also working on strategies that
were more related to rituals. Checking for physical safety in my environment,
and then having peer support at night. Just, again, texting a friend, saying, “Have
a good night. I’m going to sleep.” That kept the connection going, that I’m not
alone. And also, having pets was something I could
do, was something I could control in my environment. The interesting thing about that is that the
pets also made me exercise more, so that’s helpful, actually moving more. Often when people have chronic pain, we move
less, so moving more was a useful strategy, and really helpful. I don’t run marathons, but I certainly can
take a walk. Those are some things that were helpful in
really realizing the impact of pain, and what I could do about it. I think we have answered, or responded to
all of the questions in the chat box. I wanted to put up a reminder for next week,
as I mentioned. Next week is putting it all together, talking
more about sleep habits, and rituals, and routines for health and wellness, and that
will be with Doctor Peggy Swarbrick of Rutgers University, who is also a senior consultant
for SAMHSA’s Program to Achieve Wellness. I would also ask everyone to please complete
the survey that’s available when you exit the webinar. The feedback is helpful for us. It also gives us an opportunity to think about
if there’s something in addition that we wanted to talk about with sleep, we can make sure
that we put that into our conversation for our next module. Thank you all for spending your time today. Here’s our contacts from SAMHSA. And if you have any other information that
you would like from SAMHSA’s Program to Achieve Wellness, please let us know, and the contact
information is here. Thank you all so much for your time and attention,
and have a great day.

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