Ep063: The Thin Line Between Chronic Pain and Sleep Disorder - with Dr. Baughn
WHAT WILL WE LEARN
04:09 Sleep disorders experienced by people with chronic pain and excess body weight
06:46 Chronic Pain: It's all in the mind
09:40 How pain can interfere with one's sleep habit
15:32 Control what you can and accept what you can't
17:22 Understanding what your mind is saying
19:23 Try different kinds of techniques that works best for you
21:32 How to deal with sleep disorder if you have excess body weight
24:17 Reduce daytime napping
26:16 Changing your environment
27:35 Pacing technique and its importance
32:55 Good mood management is good pain management
34:20 The difference between fatigue and sleepiness
TODAY’S GUEST
Dr. Daniel Baughn is a Pain and Sleep Specialist who has a private practice in Tampa, Florida. Dr. Baughn specializes in treating patients who have excessive body weight and chronic pain. He completed his training at some of the best medical centers in the country including UF Health, VCU Health, VA Palo Alto, Stanford University, VA San Francisco, and the University of California - San Francisco.
“I kind of like to introduce the concept of what we're trying to do in any work together, whether it's pain or with sleep, or with these other pieces, is recognizing that you want to be able to kind of control what you can and accept what you can't.” - Dr. Daniel Baughn
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Transcripts
Dr. Yishan Xu 0:00
Hey, welcome to deep into sleep Episode 063. I hope you all had a wonderful holiday last week. During this week, I sit in my living room quite a lot. And unfortunately, I did not have a very good chair to support my back. So after sitting there for quite several days and long hours each day, I started feeling a lot of back pain and shoulder pain. I can even feel those pains at night while I sleep. How interesting it is for human beings, when we don't have pain, everything seems fine. But when some parts of our body start feeling painful, everything, every movement, every sensation reminds us of that pain. Remind us how inconvenient it is. Especially when I tried to sleep. If I feel the soreness of my back, my shoulder, it's just so annoying, and sometimes definitely gets into my way of falling asleep. Fortunately, for me, it's not chronic pain. And I can solve the problem by buying a much better chair, which I did so far. But think about if you are suffering from something like chronic pain? If it has been a problem for you for a long time. What can you do? How can you feel so painful at night, but still manage to sleep better and sleep okay with it? Is it possible for us to co-exist to live with the pain we feel physically and let it not interfere with our sleep quality as much as it has been? So today we have a pain and sleep specialist Dr. Daniel Baughn who has a private practice in Tampa, Florida. He has a lot of training in primary care settings and pre-surgical settings. And he specialized in treating patients who have excessive body weight and chronic pain. How they can manage these life challenges. And while sleeping better at night. Welcome, Dr. Baughn to deep into sleep podcast.
Dr. Daniel Baughn 2:33
Thank you so much for having me. I'm excited to be here today and to join you guys and to talk about all things sleep and weight loss and pain-related. So since these are all interactive.
Dr. Yishan Xu 2:42
That's awesome. I'm really excited because I know you are a clinical psychologist who specialized with sleep and many other conditions for patients and you have a lot of training in different areas. Do you want to share with the audience? What are your specialties and what kind of population do you work with most?
Dr. Daniel Baughn 3:05
Yes, of course, thank you so much. So yes, I'm, again, I'm a licensed psychologist here in Florida. But my background really is in health psychology. And that all started for me back in graduate school. And that continued on through into internship and then postdoc after that. And what I really work with is the majority of my clients actually are individuals who are living with excess body weight in some capacity. And then on top of that, also living with sleep-related issues or pain-related issues. And I would say I also see individuals who are just one of those areas that usually most of my clients are living with all three and some way or another. And that's really kind of how I kind of got into this area was really primarily because of working with individuals who are seeking weight loss surgery and graduate school. But then really also just seeing how these pieces, especially as it, relates to sleep. And also as it relates to pain really impacts your behavior. Like it really impacts the things that you do and how you respond to stuff. And that's how I kind of got to where I am today.
Dr. Yishan Xu 4:06
Great. So that's very interesting people with pain or people with body weight challenges. What kind of sleep difficulties you have noticed among patients like this kind of population.
Dr. Daniel Baughn 4:25
So another good question. And I would say it really depends. It can be multiple different things. For a lot of the individuals who are living with excess body weight, there can be usually a sleep apnea of some kind. And then also usually some type of insomnia related kind of condition can kind of develop or symptoms of insomnia. And so for those individuals, one part that we work on a lot is helping them to really kind of understand how what they're doing during the day is going to really impact what their sleep is going to look like at night since insomnia truly is kind of a 24 hour problem. It's not just what you're doing and the night for those individuals, it was all about helping them understand their behavior. And then usually, there's often as it relates to chronic pain, we know that when pain flares up, and also fatigue. I would say I work with a lot of individuals with fatigue too, when either one of those two things kind of flare-up, good sleep can go out of the window pretty quickly. And usually, because of the combination of a few things, number one is just what you're feeling like in the night in terms of your body, if you're laying in one position for too long, or if there's a particular type of injury that might get aggravated by a bed position. But it's also what you do, maybe in anticipation of your sleep for that night, and how you respond to pain flare-ups during the day too. So really, it just kind of comes down to understanding what their experiences individually and what their pain experiences, as well as what kind of living with that body weight has been making that either helpful or maybe less than helpful. And then kind of go on from there. So fundamentally, it's all about behavior, from my perspective, behavior and how your mind interprets that behavior.
Dr. Yishan Xu 6:04
That's a great point. I really liked the point you mentioned, sleep is not only a nighttime thing, it's a 24-hour thing. A lot of our audience, a lot of us may sometimes ignore that or forget about that, like daytime behaviors may impact nighttime sleep, that's behavioral. But also how we interpret sleep plays a big role and how we interpret pain, I guess. Because I know, for chronic pain especially, a lot of time people not only need to see a medical doctor. Consider others like rehabilitation treatment or medication. They also need to see a psychologist. Why psychologists? They can help with chronic pain, right? Is that something to do with their perception of the pain?
Dr. Daniel Baughn 6:54
This is a great question. I feel like I've said that a lot so far today. But these are all really good questions. And I would say I get this particular one a lot from clients, if they're like, look like why don't want to see a psychologist, are you telling me that it's like you know that the pain is in my head? And I would absolutely say no, it's not your pain, not your head, your pain is legitimate, it's authentic. But what we do know is that your mind can either amplify the pain kind of signal and pain experience that you get. But it can also begin to kind of minimize it or reduce it, it can't necessarily turn off the pain mechanism per se. But what we can definitely know is that it can definitely make the pain that's already there a lot worse. And it can make the pain that's there and maybe a little bit less worse, depending on what our mind does with that pain. So it's really how you experience pain and how you respond to pain, that very much is shaped by your mind and how you respond to it.
Dr. Yishan Xu 7:48
That's cool. The way you explain that really makes me feel like it's parallel with how we think about sleep. Right? Similarly, how do we experience sleep? How do we think about sleep? Because I know why people with sleep disorders need to see a sleep psychologist, also. They still have sleep symptoms. But the expectation like you mentioned is the expectation of sleep and how they deal with it, and how they think about it. It can be a big gap in between.
Dr. Daniel Baughn 8:24
You got it. And I think you kind of highlight a good point that I want to make sure that I kind of reiterate is that for the majority of my clients, they usually have already seen a medical provider. But I would say medical care is absolutely crucial from this perspective. You know, you really want everyone to have seen a solid kind of had a solid medical workup first, to really evaluate everything that's there, and that's happening. And then to really kind of identify that, yes, no, but looks like there are some really behavioral pieces of this, whether it's for pain, or whether it's for sleep, or whether it's kind of emotions related to the kind of living with excess body weight and those types of things. Because really wanting to jump instantly into the fix. And I would say a lot of clients that contact me, they're like, look, can you just make my sleep better. And like one or two sessions, and I would say it sounds like you're really interested in sleep hygiene, which is not necessarily bad per se. But also really doesn't necessarily work either. In terms of helpful suggestions. And I would say for some people, they can be really good things to try. In fact, I encourage all my clients to try them. But really kind of figuring out how you're responding to number one, what started the difficulty that you're experiencing, can be very different than what's actually maintaining it right now. So that's true, very true for sleep and insomnia, but absolutely critical for pain and how you respond to pain.
Dr. Yishan Xu 9:38
Right. So now I'm very curious to ask you, if a patient with quite a lot of pain and they've been having medical workup and they are taking medications, they're doing whatever the medical doctor tells them to do. But they are very uncomfortable, very annoyed by the pain, and very frustrated in the middle of the night, possibly very common for people who come to see you. I just cannot sleep. If you say it's gonna take a while and it cannot be rushed. Is there anything they can do? I can imagine if we apply some of the CBT for insomnia technique to them, there may be some pushback. They're like, well, I'm laying on the bed, it's too painful, I cannot get up. I cannot get off the bed, I have to be there, you don't understand my pain is too much. Right? Whatever suggestion you gave me, I don't think I can take it. What do you do?
Dr. Daniel Baughn 10:35
So another kind of helpful piece that comes up with this. And this is crucial from an insomnia perspective. But I think also for pain as well, is that fundamentally what we're working with is how people respond to and interpret the signals that they kind of interpret to be kind of danger that they interpret to be kind of like, something's wrong with me, or something's the matter with me in some way. And what we're wanting to do is kind of to create a place in mindfulness is a great example of where this comes in. You're wanting to create ways to essentially de arouse or to turn down the volume knob if you want to use that as a good kind of metaphor, you're finding ways to turn down the volume knob when you hit a bump in the road, whether that bump in the road be kind of waking up in the middle of the night, or whether the bump in the road being like pain flaring up. And the same kind of strategies, whether it be you know, the deep breathing, or the visualization, or some mindfulness kind of exercises. I'm a huge proponent of self-compassion myself, I actually love self-compassion, and compassion, focus therapy interventions. Because I think they dovetail so nicely, they're very integrative from this perspective of number one, recognizing that when your body is in this kind of danger, response mode, the way that you respond to things can be very different than when your body is in a more kind of calm, more relaxed, more kind of centered kind of zone. So to kind of answer your question earlier of what happens with your experience of pain and develop it, if it's interfering with your sleep? Well, the first thing that we'll want to do is we want to understand how we are responding to the pain in the middle of the night? So what are you doing with both your body but also your mind? And this is one thing that I see a lot for my sleep clients is that we truly underestimate how quickly our mind can kind of crank right back up. When you wake up in the middle of the night there come misconceptions. You think that because you didn't turn on you know the lights, or you didn't check your phone for that long, or you didn't do these things that somehow your brain but still be you know, and it's kind of low status, so to speak. And what we absolutely know is that your mind can roll back up fairly quickly, depending on what's going through it. And a lot of times, that kind of initial reaction, when you wake up in the night because of pain is the kind of a negative reaction, we almost think of like, oh, gosh, there it is, again, my pains back. And it means I'm having another like four hours of uncomfortable on and off again, type of sleep, and wake up the next day and go to work, and I'm just gonna feel horrible. And so it's really kind of using these same strategies to first create a sense of, kind of homeostasis, again, a more kind of a deeper sense of felt safety in those moments. So that you can then choose how you're going to respond to these things if that makes sense.
Dr. Yishan Xu 13:14
Right. So definitely, when we understand ourselves, first how we think how we interpret things. And then think about what are some good strategies we can do. I'm sure for different people, even they have the same type of pain, or even the same pain level, based on how they think differently, strategies, what can be helpful to them possibly can look very different.
Dr. Daniel Baughn 13:43
Definitely, and I would say, it depends too on where the pain is coming from. So if it's pain as a result of an injury, then or a past injury that maybe just has moved past, you know, the acute phase of chronic pain and kind of moved into something that's a little bit longer. So meaning that you've been living with it for six months or so. And the pain is not necessarily going down at that point. Those types of responses to that might actually be more physical related. So for example, shifting a position in bed, or also acknowledging to and this happens a lot with sleep, in general, is that recognizing that most people wake up several times in the middle of the night. So waking up is not really the challenge. It is what you do after you're woken and how you respond to that to help your mind and your body go back into that sleep. That's I would say the biggest kind of hurdle to jump over first, especially if you're talking about, the waking up in the middle of the night after sleep is already on set is this idea of how do I calm myself back down to re-enter into that rest, instead of really getting pulled into a cycle that focuses on Gosh, my pain is back or it's worse or you name it, you can fill in the blank, so to speak, to talk a little bit more thoroughly to on more diffuse and they can be a little bit different. And so that's because when you're waking up and there's kind of a diffuse pain really. The goal in those types of instances can just be what I can do right now just to lower my overall level of arousal. And this is where again, I would always encourage everyone to consult with your medical prescriber, your medical doctor in general. Because if there are medications that maybe you need to be taking, or if there are other things that need to be kind of happening at that time too, that's one of those things, you want to make sure that you're doing as prescribed, and as recommended by your doctors, not just kind of thinking that if I do a deep breathing exercise, that somehow it's all going to be better, so to speak.
Dr. Yishan Xu 15:31
Right. I definitely notice sometimes if people use whatever tools they get either psychological tools or medical tools, they think this is going to be the magical thing to help me go back to sleep, then that actually won't work very well. I really like what you mentioned, it feels like, if you can accept more like, I have pain, I can live with it, I can still go back to sleep with it, I just need to calm down my mind it will happen. It may happen, like quicker. But if we think that's the enemy, we refuse to face it or accept it, say oh, you come again, I don't like you, I really want to get rid of you. You'll be destroying my life again, you're destroying my life. I can imagine those people possibly going to have a really hard time going back to sleep.
Dr. Daniel Baughn 16:24
Yes, absolutely. And then and I would say really, this is where I kind of like to introduce the concept of what we're trying to do kind of in any work together, whether it's pain or with sleep, or with these other pieces, is recognizing that you want to be able to kind of control what you can and accept what you can't. And kind of recognizing what parts of this can fall into the bucket where stuff I have direct control over. And stuff that I don't have control over. Right. And so it's recognizing that you'll need different strategies for which pieces are falling into which bucket if that makes sense.
Dr. Yishan Xu 16:58
Yes, I love that. That's a very important thing to keep in mind when we talk about how to change our mindset, how to change our perspective. Really separate what we are able to control, what we are not able to control, and really put the energy, direct our energy more to the things we can control, and that something can really empower ourselves.
Dr. Daniel Baughn 17:22
Definitely. Another piece that I encourage a lot of my pain clients. But also the sleep ones that I work with, as well as that. I'll say this with the caveat, it always depends on what you're doing and the moment I write. But generally speaking, when you're waking up in the middle of the night, you typically want to focus on more strategies that are going to help to calm you and kind of help you to re-enter that kind of restful sleep experience, rather than the more kind of proactive kind of more, more deeper mind ones, which are ones like you know, cognitive restructuring or thinking about where my thoughts going right now, not because they're not valid. I mean, I think there's value to doing kind of, you know, a thought record and understanding what your mind is saying, and what's the belief behind them. But that really in the middle of the night, or when you're kind of wanting to re-enter into that rest is that you want to do as many things as you can that are, the arousing or things that are soothing. And so that can be something as simple as just, you know, putting a hand over your heart or some other position that you know, feels comforting for you. Just speaking some words of you know, calm and comforting, that says, it could be something as simple as you know, I can get through this or just give myself what I need right now at this moment. Right now I just want to breathe. So let me just focus on breathing air in, and then breathing out and doing those types of activities versus some of the other ones which are a little bit more like, okay, let me bust out a piece of paper in the middle of the night and do some other types of more active types of things. But again, I say that with a caveat. It really depends on if this is just someone waking up and it's a more and more kind of mild awakening, or if it's someone who is wide awake, and then you'd use different strategies at that point.
Dr. Yishan Xu 18:56
Right. It's a very general suggestion, but I still really love it, there's a lot of good points coming out of it. In the middle of the night, we really don't want our brain to work too hard. A lot of people say like, heavy cognitive work actually can be quite exhausting, or they have to think really hard. A lot of people find this gasm aroused, it's really difficult to calm it down. So I really like what you emphasize in the middle of the night. There are other strategies you can use, you don't have to force yourself to think so hard to analyze everything in the middle of the night. The soothing strategies you mentioned really feel like they come from what you like: the self-compassion roles that reminded me of a lot of great self-compassion techniques. Put your hands on your belly or your heart and say those nice things to yourself and remind yourself suffering is common and give yourself some hope. Those are I think very valuable suggestions and if people are trying them sometimes, maybe some people may really like it, they try different things, right, you may find what, whatever works best for you.
Dr. Daniel Baughn 20:10
This is another piece. And this is true for pain, for weight loss and I think for sleep too. Is that there's a really strong desire, I would say, in almost every one of my clients, and I think this is pretty human, is that you always want the magical solution, right? Like you want, you want, whether it's a pill, or whether it's a technique, or whether it's all these things? And the answer is, is that it truly depends on the individual, like what combination of different sets of techniques together, are going to be most helpful. It's really kind of practicing that gentle curiosity about Okay, let me try this, let me see if this plus this plus that. And I know I tried the other thing the other night, that one didn't work. But let me maybe try it again another night. And you just kind of give yourself that creative kind of flexibility, to try out a combination of different things, all of them with the goal of helping you to kind of soothe your body soothe yourself to kind of reenter that sleep, or start sleep if you haven't been able to get through.
Dr. Yishan Xu 21:06
Right. Build up your psychological toolbox, right. And you can use these tools to apply to different scenarios. And so it sounds like for people with chronic pain, working on and understanding, adjusting your own perspective, how you think, and then guide, what you do is quite important, then, for the other population, you mentioned those weights, excessive body weight. And for them, I can imagine this dilemma that it might be very hard for them to move. But you also mentioned for them, daytime, what they do during the daytime also matters. What can they do, if it's very hard for them to move?
Dr. Daniel Baughn 21:51
This one comes up a lot because I would say one of the more common recommendations is activity specifically kind of cardiovascular activity, right of the idea of you know, burning exercise to help kind of increase your sleep pressure, which on its own phenomenal activity, a great thing to do more of a shift kind of be doing that and adding that in. But when you're living with excess body weight, and when you're living with chronic pain, it makes movement incredibly difficult. And so this is why I would always say one of my excellent go twos and referrals is always number one, have you seen a physical therapist recently, because we absolutely want to help you to establish a safe movement regimen. And that movement can be things as even as simple as maybe some chair exercises, or even some kind of stretching. The real goal being is that eventually, we can move over towards trying to just explore other types of activities. Usually, aquatic exercise is one of the better ones, mainly because it reduces pressure on the joints and those types of things. But even if it's just some type of movement, and this piece in the research is really kind of interesting about what's called non-sedentary activity, so there's exercise and then there's kind of non-sedentary activity. And then there's really sedentary activity, which is what I would say a lot of individuals kind of fall more into the like when you're watching Netflix, or you're kind of watching TV, that's more of the sedentary piece. But even non-sedentary activities have benefits, you don't necessarily get an amazing cardiovascular workout from them. But there is value to just getting up and moving around. Even if that movement is small, you just want to make sure that you're moving in a way that's safe for you. And in a way that isn't going to exacerbate any type of injury or pain from that perspective and this is where pacing kind of comes in, especially as it relates to pain, but I will go into that in a moment.
Dr. Yishan Xu 23:37
Yes, I absolutely love that I think that gives people a lot of hope that you don't have to put yourself in a framework to a high standard like all other people's daytime activities like that. If I cannot do that, I won't be able to help myself. No. It sounds like if you even do a little bit within your own capability, whatever your doctors, your treatment team recommends you, even a tiny bit, it still counts it still can be helpful.
Dr. Daniel Baughn 24:09
You got it. This comes back to that idea too of building up sleep pressure by just engaging in activities, and ideally to another common one is to try and reduce or completely cut out daytime napping. Because any of that is always going to kind of steal some of that sleep pressure that ideally should be building up throughout the day for you. So if you can combine even some non-sedentary activities with some light stretching, maybe some aquatics, maybe some gym equipment or exercise equipment that again is low impact. So that could be like an elliptical machine. Could be a recumbent bicycle where you're seated. That could even be, on Amazon, they sell these small pedal machines where you kind of sit on your couch and just move your feet while you're watching, you know, a TV show. Any one of those. It's not that those are things that are going to you know, be phenomenal, but again, it's about small steps. So it's small pieces, that when you combine them together, they help to increase that sleep pressure, which has helped to improve your sleep in the night. But also help increase your heart rate and just honestly add more activity to your day.
Dr. Yishan Xu 25:14
Right. So it reminds me, my parents are from China, they don't want to do a lot of exercises, and my dad actually is a little bit overweight. So they are talking about some kind of equipment in China that you really just need to stand on some kind of silicone thing, and you just shake your body, just standing there. And doing something real like, you don't have to even change your position, but you are like shaking your whole body. And they said it's advertised to be really helpful. So I was really suspicious about that. But now after you mentioned, I was thinking it’s possibly better than nothing.
Dr. Daniel Baughn 25:54
Yes, I would say, and again, it falls into this range of non-sedentary activity, which is I'm going to be clear does not have the same outcomes that exercise does. But meaning that non-sedentary activity is going to give you all these other things that we know exercise does like boost your mood, you know, improve your sleep at night, do all these other things. But we do know that it's better than just being sedentary. Honestly, even changing the environment of where you're at, can have a huge impact on, how you feel as you go throughout the day and what you feel like you're able to do so, just even physically changing what you're seeing what you're looking at, and have a really big impact on you as a human being.
Dr. Yishan Xu 26:31
Yes, even myself, I totally agree. I have that feeling like if I’m stuck in the house the whole time throughout the day, it just sometimes feels like it's too much. I already haven't seen anyone. And I don't even get to be outside. But if I just pull a chair to sit outside even a little bit, sometimes I purposely carve out like half an hour, one hour, just read the books, outside my door with a chair. And that already makes me feel a little way better.
Dr. Daniel Baughn 27:01
You got it. And I love what I heard you say just a few months ago, outdoor sunlight or actual natural sunlight, it's phenomenal. It's great from a sleep perspective, just because you want to make sure that you get exposure to that I mean light, in general, can be helpful. But really, it does seem like outdoor light or sunlight itself has a really kind of centering effect on your body and on your brain. And can really just have a lot of benefits from that perspective.
Dr. Yishan Xu 27:29
Right. And I also know for chronic pain and sleep, especially for pains, there's a pacing technique, right, that is quite classical. And you mentioned that a little bit, do you want to introduce what that is more?
Dr. Daniel Baughn 27:43
Yes, so pacing is really kind of, this idea that its a combination of a few different ideas, the kind of core premise of it is this idea that you really want to learn how you can work smarter, not necessarily harder when it comes to your pain experience, and the level of energy that you have because pacing works similarly for individuals who are kind of living with fatigue in some way as well, where you have, you know, a limited amount of energy. And then oftentimes what can happen when you have a limited amount of energy is it's kind of like you're like a kid in a candy shop, and you're like, Oh my gosh, I have energy, let me get as many things done right now as I can. Or likewise for my clients with pain, when they have a day where their pain is not flaring up. Ah, they're like, Oh my gosh, like my pain is not horrible. Let me go and try and do as many things as you know, as I can do right now. And the real kind of challenge with that is that it can lead you to then do things that are kind of the opposite of what might be kind of the best, you can kind of go into this boom and bust kind of cycle where instead of kind of recognizing that your energy is limited, and before pain flares up, and that you're fatigued, your level of energy before fatigue kind of sets on also is limited. You want to find ways to kind of engage in activity that really keeps you below your nervous system from kind of sounding the alarm bells or sounding kind of the warning bells. And for you know a lot of people the hardest part of pacing is learning how to recognize like, what's your level, what's your level of activity that you engage in before your nervous system starts flaring up and starts kicking back those warning signals you're like, they're like, Danger, danger, like I'm engaging in too much activity. You know, one of the kinds of classic examples that I use, and this one's not meant to be, it's just really meant for illustrative purposes, but it's just to compare two people. So one is Joe and then the other one is Mary and we'll say that Joe, you know, doesn't do any pacing, and you know, has woken up in the day. And Joe's day is his pain ratings, maybe a four out of 10 and which is good for him because it's usually a maybe like a seven out of 10. And Joe's like great, I'm gonna work hard, and he works hard for our one and then for our two and then for hours three, four, or five and six, he's in pain. And that's mainly because he just kind of, you know, took advantage of that time and the experience of saying Hey, my pain is not flaring up on me, let me get as much accomplished right now as I can. And then intuitively sounds right intuitively, you're like, Oh, yeah, like that kind of makes sense. Except when you're living with a chronic health condition like pain, or chronic fatigue, or some other situation, life is a little bit different. And so because of that, you want to actually learn how to be a little bit smarter with that. So if you look at Joe, he used that six-hour period of time, his pain, in the beginning, was four out of 10, his pain at the end, it was a 10 out of 10 like Joe worked for two solid hours, but then he was in pain for four hours. And then we just want to take Joe and then compare Joe to kind of Mary. And Mary uses pacing. So the way that Mary approaches this is Mary wakes up in the morning, she's like, ooh, I feel like my pain is doing good today, I've got some energy. So Mary says, you know what, instead of doing, the non-pacing way, she's gonna try this pacing way, which she tries working for 30 minutes, and then really resting for 30 minutes, and working for 30 minutes resting for 30 minutes working for 30 resting for 30. And again, the exact amount actually just kind of depends on again, knowing your level of activity, and you want to keep that below those alarm warning bells. But what's really kind of interesting is that Mary and Joe have the same six-hour period of time. And then Mary's pain rating, you know, in the beginning, was four to 10. But at the end was also four of the 10. But here's the real kicker, Mary actually accomplished more work, she was able to work for three hours worth of time, versus Joe, who only worked for two hours worth of time. And Mary also spent three of those six hours resting, versus Joe spent four of those six hours and pain with his pain kind of flared up if that kind of makes sense. And so again, these are kind of figurative examples here. But what's helpful about them is that they can show you the idea that if you can approach your level of activity, especially when you have you know, a day with low pain, or a day where your fatigue is not as intense, with recognizing that you still need to take care of yourself. And what I mean by that is alternating periods of activity with periods of rest, that you can actually get more done. And at the end of the day, not be in pain. So that's the key difference to Mary, at the end of the six hours for pain level was a four to 10. Joe, at the end of the six hours, his pain level was a 10 out of 10. So a lot more significant, if that makes sense.
Dr. Yishan Xu 32:15
Well, I love these examples, because I think if I'm Joe, not only within that day, I did not accomplish enough and I was in pain for too long, that's directly going to decide for the next day. I may not want to move at all. And in the future, I may be scared, I may want to rest much, much more possibly to an unhealthy level. But if I’m Mary, I feel encouraged, I feel hope I feel like I can keep on working like this, or the next day or the next week or the next month.
Dr. Daniel Baughn 32:50
You're absolutely right. And I love what you kind of hit on with that last piece to have good mood management is good pain management. And I would say the same happens for sleep too. And I see this most often come up for my clients that have really been kind of living with sleep problems for I would say a solid decade or more is that you really develop this identity that goes with you know really kind of disrupted sleep or really fragmented sleep. And what happens for a lot of these clients is that you really get wrapped up into the kind of the word that we use as a psychologist is that catastrophizing piece, what can kind of happen is that its kind of like a cascade of fact, that happens. As soon as we recognize things like, oh, gosh, there's again, a point of friction or a point of something that feels uncomfortable pain about the sleeve, then I'll send it kind of spiraling out of control. And really the goal is learning how to, again, be calm and kind to yourself because you are suffering if you have poor sleep and you are suffering when your pain flares up like you're legitimately experiencing conditions that are impacting your life like otherwise, you wouldn't be reaching out to work with someone to kind of get help on them. So it's kind of learning how to be calm and compassionate to yourself while also looking at what your behaviors are doing. So that you can kind of make some consistent changes there.
Dr. Yishan Xu 34:11
Right, a lot of self-awareness with a lot of self-love. That's a wonderful combination. A very powerful one, near the end, just wants to ask one more thing you mentioned earlier is about fatigue and napping, then a lot of people have the question. We may not need to go into detail, but I just noticed there are a lot of people with chronic disease chronic conditions. Fatigue is something they talk about a lot. And from a sleep perspective, we know fatigue is not equal to sleepiness, right. But a lot of people when they feel tired during the day, they tend to rest and end up taking a nap. What do you think about this?
Dr. Daniel Baughn 34:53
Yes, great question. And I see this a lot too. I see a lot of people who are tired but not necessarily sleeping. Or another common one is that with fatigue, you can literally just say that I need some rest. And I'm gonna say rest, I mean, like physical rest, not necessarily like sleep, rest, per se. And what happens oftentimes is people kind of confuse those two things with saying, Oh, I need some sleep right now. And so it's really kind of recognizing that when you are experiencing fatigue, number one, you definitely wanna make sure that you're engaging in some pacing to kind of get yourself throughout the day. And which means taking periods of activity and periods of rest. But then number two is recognizing that when you are tired, are you tired? Or are you actually sleepy? And if it's during the day, you want to do activities that are for that tiredness, that are non-activities for sleep-related kinds of things, if that kind of makes sense. So it could be like, activities that you normally, might not do, or might not feel as compelled to do them. But maybe you're like, Oh, yeah, I need to go like, fold some laundry, or I need to go, get my friend a phone call or do something like those types of activities, rather than actually trying to sleep. That being said, full caveat and full disclosure are that it's incredibly hard, especially when you have years, if not decades of adjusting to living with chronic fatigue, to then say, Oh, wait, you're just telling me, I got to stop taking sleepy times, or nap times in the day, but I spend like, four hours every afternoon on my couch. My goal from that perspective is number one is to recognize like, Okay, that makes sense. I can tell that for you. This was you trying to get through the day trying to get through, a lived experience for you. That's so incredibly challenging. And this is how you've been coping. And then kind of also highlighting and what has that, how's that really impacted you? Yes, you get four hours of rest on the couch in the afternoon. But what does your sleep look like at three o'clock in the morning? And at three o'clock in the morning to like, Oh, yeah, you're right. Like I'm, maybe it's not as good as the night time. And so it's kind of again, finding those ways to recognize yourself. Are you tired? versus sleepy? Because there is a difference between the two.
Dr. Yishan Xu 37:04
Right. I love your approach, always trying to use some real-life experience, stories to really help people think instead of just telling them theories, hey, these two are different, right?
Dr. Daniel Baughn 37:16
Yes. And yes, no, you're absolutely right. I would say as a psychologist, I'm fully guilty of, myself of diving deeper into like, what's the model here at work, like what's happening. But at the end of the day, the person that's sitting across from me, like in a chair over a video screen right now, because it's all over video tell, they want to get better. They want to have better sleep, they want to have pain relief, they want to be able to manage the weight better. And so it's coming from that fundamental place of saying, Okay, I get that you're wanting something different. And the ways that you're coping with it right now, maybe they aren't working as well for you. So we want to find some ways to create new, more workable kinds of solutions to that.
Dr. Yishan Xu 37:57
Yes, totally. I love how you combine all these different areas of experienced knowledge together and deliver this kind of high-quality care to the patients. If our audience has questions or challenges in their own life, or they have family members, friends, living with chronic conditions, and also have some sleep difficulties. Do you have practice? How, if they want to get your service? How can they find you?
Dr. Daniel Baughn 38:25
Great question. So I would say the internet is the best way to find me right now. So they can find me on my website. So my website is my full name.com. So that's danielbaughn.com. And that's Daniel and Baughn. But you can also find me on Twitter, Instagram, my handle is at danielbaughnphd, Google is always your friend too. But definitely reach out. My goal in general is just to be a helpful source of information for people. So even if people decided not to work with me is that maybe I know someone that's near them that maybe they can get connected to and kind of go from there.
Dr. Yishan Xu 39:00
I really hope you will have your books in the future or your classes, I think that can benefit you and more people.
Dr. Daniel Baughn 39:09
I would love to do that. I've thought about doing that. And I would say it's one of those backburner ideas of finding more ways to kind of spread the message of like, look like the things that got you to where you're at right now are not your fault. you've responded to some situations in some ways that maybe didn't work so well for you. And it's understandable like as human beings we do that right? instead of blaming ourselves and getting really negative on ourselves and harshing ourselves really bad. Let's find ways to find more workable solutions to that stuff.
Dr. Yishan Xu 39:41
Thank you so much Dr.Baughn for coming to the show and sharing all this wonderful information to our audience and bringing hope to a lot of people. Well, my conversation with Dr.Baughn definitely brings some hope to me. I've been experiencing a lot of shoulder pain recently because of my crappy chair. While I'm still waiting for the new chair to be delivered, I think I definitely can use his suggestion to cope with my pain when I try to sleep. I will start with some meditation practice tonight. How about you? If there's anything you find useful and want to try, please let me know later whether it helps you and what have you tried that you find very helpful to you. If you want to find more about Dr. Baughn's service, you can go to danielbaughn.com to find his website and his service. I will also put his information on our show notes at deepintosleep.co. Thank you for listening. I will see you next week.
40:43
Sleep is an individual thing we all sleep differently. And there is so much we can do to improve sleep quality. Keep hope and carry on. This podcast is for general informational purposes only and does not include the practice of medicine or other health professional services. The usage of the information we share is that the listeners own risk. And our content does not intend to be a substitute for any medical and professional services, diagnosis, and treatment. please seek professional health services as needed.