Improving Your Sleep with Dr. Brigitta Ziemba
Show Notes:
Trouble falling asleep? Feeling tired all day and awake all night? These are frequent experiences of post-concussion and brain injury survivors. Many struggle with finding the right balance and knowing where to start with improving your sleep. Many lean towards melatonin, so listen in to learn more about why that may not be the best option for you.
Join us today for a talk on why your sleep can be affected post-concussion and what you can do about it. We walk through things from sleep habits, sleep medications, and natural options with today's incredible guest Dr. Brigitta Ziemba a board certified Naturopathic Doctor.
Key Points From This Episode:
[00:02:02] Dr. Brigitta explains what led to her interest in concussions
[00:03:51] Dr. Brigitta explains why we may struggle with sleep after a concussion.
[00:07:03] Bella shares some of her struggles with managing a sleep cycle.
[00:08:29] Dr. Brigitta gives tips for improving your sleep.
[00:10:38] How caffeine affects your sleep.
[00:12:06] Bella's best recommendation for getting up in the morning.
[00:13:16] How melatonin works in the body.
[00:17:36] Discussing the use of sleep medications and other options.
[00:26:41] Dr. Brigitta shares some natural sleep solutions.
Follow Dr. Brigitta on IG @naturally_neuro
Get in touch https://drbrigitta.com
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[00:00:03] Bella: Hi everyone. I'm your host Bella Page, and after suffering from post-concussion syndrome for years, it was time to do something about it. So welcome to the Post-concussion podcast where we dig deep into life When it doesn't go back to normal, be sure to share the podcast and join our support network.
Concussion Connect. Let's make this invisible injury become visible. The Post-concussion podcast is strictly an information podcast about concussions and post-concussion syndrome. It does not provide nor substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast. The opinions expressed in this podcast are simply intended to spark discussion about concussions and post-concussion syndrome.
Welcome to episode number 92 of the Post-Concussion Podcast with my myself, bell Page and today's guest, Dr. Brigitta Ziemba. I know last week was missed due to me being in the Mayo Clinic in Rochester, Minnesota, getting diagnosed with four chronic illnesses. Three, which are likely from my concussion experience, which I'll be sharing soon on Concussion Connect.
Now, let's get. Dr. Brigitta is a board certified naturopathic doctor and former primary care paramedic of 10 years, as well as a quantum energy healer and medical intuitive who focuses on helping individuals, brave and concussion recovery, chronic pain, mental and cognitive decline, reclaim and optimize the resilient brains naturally.
Welcome to the show, Dr. Brigitta.
[00:01:59] Dr. Brigitta: Thank you so much, Bella. It's great to be here.
[00:02:02] Bella: So to start, do you wanna kind of talk about what created your interest into concussions?
[00:02:08] Dr. Brigitta: Absolutely. So I worked as a paramedic for 10 years on the frontline, and while I was a paramedic, I was also going through a naturopathic medical school, and that was around the time that Rowan's law came into effect in Ontario.
So there was a lot more awareness around concussions. There was a lot more research being done as well. And so here I was as a paramedic on the frontline, seeing the lack of concussion care after the initial, big red flags had been ruled out. And then from the naturopathic medical side, I was seeing all these beautiful tools we had to actually support people with brain injury and brain health as a whole.
And so I, I basically saw the gap that existed and every time it came around to doing a research project or anything, I just, I kept digging deeper into concussions and then started mentoring with, some clinicians and started getting into cranial sacro therapy work and everything. My interest always kept coming back to concussions.
Every time I veered away a little bit, I was like, Ooh. But I love, I love all the stuff about concussions. So it wasn't one particular thing, but it just seemed like everything kind of interplayed over the years.
[00:03:21] Bella: Yeah, that's great. And yeah, I'm also, in Ontario, so it's always interesting to hear that cause some people don't know what Rowan's Law is.
Mm-hmm. . But it's great to be brought up cuz it's really important. You see it in all the schools. They have like, all the concussion posters kind, especially in gyms and things. And so today's topic is really about sleep. Mm-hmm. , because I can't count how many times I've gotten the request for sleep and asking like, I can't sleep or I sleep too much, or all these things.
So do you wanna talk a little bit of why concussion survivors do have sleep trouble after their concussion?
[00:03:58] Dr. Brigitta: Absolutely. So, and a lot of people do one way or the other. So I think the best place to start is really why we sleep. And so there's a number of reasons why we sleep, but when we actually look at the brain and what it does and what it means, so most of our growth hormone is actually made while we sleep.
So growth hormone is responsible for repairing and rebuilding tissues, brain cells, all those beautiful things. and also our glymphatic system, which is the drainage and detox pathway of the brain is most active when we sleep. So, we have our lymphatic system in the body, and then we have the lymphatic system in the brain.
So that is most, most active. And so when we're looking at an increased need for sleep post-concussion, it's a combination of things. So because there was an, because there was a physical injury in that metabolic cascade of injury, the glymphatic system is actually looking to get rid of all that metabolic waste.
So it's actually trying to cleanse the brain and from the growth hormone side, it's also trying to repair the brain. There's also an energy deficit that happens, a post-concussion as well. So the brain has that. There's decreased energy, so it recharges by going to sleep and supporting that. So that's the increased need for sleep.
When we're looking at the opposite side, which a lot of people get really, or a lot of patients survivors get really frustrated with because they're like, I'm tired, my brain's tired. I just wanna sleep, but I can't sleep. What is going on? So that's where we dive into the nervous system. And so when we break it down to a simplistic way of looking at it. We have the sympathetic nervous system and the parasympathetic, so the sympathetic is our fight or flight response. Basically, the way I explain it is your body feels like it's being chased by a bear. It's a reaction meant to keep us safe and alive and our rest and digest or our parasympathetic is really that it's when we rest, digest, and repair.
And when a trauma comes into the body, whether it's physical, mental, emotional, the body will go into that sympathetic reaction state, which is meant to keep us alive. What often happens in trauma survivors is that becomes a hypervigilant state, so that becomes a chronic state for a lot of people and so when we think, okay, if my body is prepared to run from a bear at all times, it's not gonna be worried about sleeping, it's not gonna be worried about repairing the tissues, right? So it's going to be hyper-vigilant, hyper alert, so sleep is gonna be difficult. Digestion is not gonna be working optimally.
When we look at light sensitivity and noise sensitivity. So those are the pieces that can often come from that sympathetic nervous system activation as well. Even things like the feelings of anxiety and nausea, those will come in as well. So those are all impacted by the nervous system and that is often why post-concussion, patient survivors, they struggle to sleep even though there is an increased need for sleep.
[00:07:03] Bella: I always used to get really frustrated, kind of like you said. Mm-hmm. where I would be so tired all the time like doing things like reading or trying to do schoolwork would make me, I was exhausted from like small tasks like cooking, which is why we really start cookbook to help people with that and like it's really important, but.
It's so tough because then at night I also had the problem where like I would kind of sleep too much in the day. Mm-hmm. and then because I was so exhausted, but then at night I'd be awake all night. So like trying to find a balance took me a long time on finding like, okay, you have to make yourself stay awake.
Like I know you're tired but you have to, cause otherwise your sleep cycle's off. Mm-hmm. And then other problem was I had like the extreme problem with fatigue, where like I would sleep for like, I think when my headaches were really bad, I also slept to avoid the pain. Mm-hmm. was one of the problems. Like if the headaches were really bad, but I could sleep for 20 hours.
And then like wake up exhausted and I'm like, how does that work? ? I know insomnia is something a lot of people deal with. and they're always like, I can't fall asleep, or I'm really restless, or, you know, I got my eight hours, but I woke up tired. Like, how does that work? Or whatever. Recommended sleep you wanna go off of now
So do you have any tips for improving life around sleep as a survivor?
[00:08:29] Dr. Brigitta: Yeah. So you brought up a really, really great point there, right? In the disruption of a sleep wake cycle, and that really is when we talk about sleep and getting people back to a sleep schedule and optimizing sleep and circadian rhythm, which is our 24 hour clock.
And when we look at our circadian rhythm, everything else is tied to our circadian rhythm. So oftentimes, patients will also report, digestive issues in hormonal complaints and all those other things, and all our hormones are tied to our circadian rhythm. So once again, it all comes back to our sleep and our sleep regulation.
So when we look at the tools, we talk a lot about sleep hygiene and what we can do to prepare for bed. But sleep hygiene really begins in the morning, right? So if we're sleeping in, then that's gonna impact the whole day. And like you said, it's gonna be way harder to fall asleep at night if you're sleeping in.
So one of the things I talk about, not just what we're doing before bed, but what are we doing way early in the morning to actually prepare ourselves for bed? So morning sunshine, and having also a set morning wake up time is hugely important as well. And when we lie in bed and we just kind of, when we lie there, what happens is often our body isn't sure if we're gonna get up or not.
And cortisols are stress hormone and it's normally supposed to spike in the morning. So if we actually put our feet on the ground and stand up, yeah, it might take a couple minutes for, you know, our body to be like there's that sleep inertia moment where you're wandering around and you're like, I don't know if I'm here or if I'm still in dream world or what's going on , but actually getting up will signal to your body too. Like, okay, it's time to spike my cortisol, which naturally is supposed to spike in the morning. And then that also helps set the tone for the whole day. Whereas if we linger in bed, then the body's not sure of what's going on and then it doesn't really spike.
And then sometimes it spikes later in the day, which then depending, on each individual's, rhythm may actually start to impact sleep later in the day because you might still have more cortisol, which is our stress hormone later in the day. So then it's not gonna be as easy to go to sleep.
The other big one I talk about too is caffeine because people will use it, for headaches, but oftentimes, you know, it's our quick go-to when we're sleep deprived. The issue with caffeine is the halflife of it. So the halflife is how long it actually takes to break down half of it, and we're looking at five to six hours and it can take easily up to 10 hours to metabolize completely in some people's bodies.
Some people are slower metabolizers, so that it might take even longer. So the afternoon coffee, or if now you're having coffee even later in the morning, that could also impact your sleep later on in the evening. Yeah, so there's a lot of pieces to look out for earlier in the day, and then as well as we're getting into the later hours and closer to sleep.
[00:11:25] Bella: Yeah. Well, I'll talk about the morning ones first. Mm-hmm. I like the idea of that, I've never really thought about like what I did in the morning would impact, what I do that night. I'm a very inconsistent sleeper. I've never, I'm like a, oh, I work till four in the morning and then I screw up my sleep schedule for four days to get it back.
Mm-hmm. And I'm, uh, you know, like this morning my girlfriend messaged me at 7:00am saying, oh, I've been up since 6:30am and like, my alarm's gonna go off and I'm gonna be so tired and I'm like, I've been up since 5:00am. I was like, but I'm still in bed cause I'm like hoping that I'll fall back asleep.
Right. And it's hard cause it's like, do you just get up or do you stay in bed?
I know something I do recommend a lot here is not so much when your body wakes up in the middle of the night like mine does. Mm-hmm. But when it wakes up like closer to when you wanna get up is to just get up. Absolutely. It would make it harder to get up, like if I woke up a half an hour before an alarm. It's easier to get up then than to let your body fall back asleep and then get up when the alarm goes off. And I think people without concussions feel this way too. But when you do have a concussion, like everything in your body is so much more sensitive to everything you do when you eat, how you eat, when you get out of bed, when you go to sleep, all these things.
It is really important to think about your whole day, and I really like that aspect of sleeping about, thinking about the morning and caffeine isn't something, I don't take caffeine. Mm-hmm. , uh, I don't drink it because, I had such bad headaches, uh, when I was younger. And then when all of my friends started drinking caffeine, it was like, well, I already have a headache every single day.
I don't need to give myself another reason to have a headache, cause all of them would be like, oh, I didn't have my morning coffee. And I was like, I have enough issues. So I never started. But that is really important. And so do you have any tips for the other half, like going to bed?
[00:13:16] Dr. Brigitta: Absolutely, so when we're looking at what we're doing, winding down at night our light is a major impact on, so melatonin is our night signal. People often mistake if we're kind of like our natural, like sleep medication but what it is is a dark hormone, a dark signal, right? So what it tells us is as the light decreases our melatonin increases, and so artificial light at night really disrupts that whole process. So being very mindful of how we're using lights and obviously as we're in the winter months and it's a little bit darker, we're gonna turn on lights when the sun sets, you know, depending where you are here, sometimes it's 2:30 in the afternoon. Some places it's 4:30, right? So you're, gonna mess with that circadian rhythm a little bit because we're not trying to go to bed that early.
But just being very mindful of the lights as well and the color of the light bulbs as well. So some people will actually switch out their lights to red light bulbs to actually help increase the melatonin production, as well, a lot of phones now will have blue light filters. So you can put your phone on night shift mode a couple hours before.
The other thing with, phones and electronics, it's not just the light, but it's the way the screens actually work. So it's a strobe light. So it's being very mindful of that actual stimulus that's coming in. What else? The temperature of the room, the light in the room, all those things can impact sleep as well.
And then having a way to actually, I think just as much as we have a morning routine, what that routine looks like at night. So for some people it's reading, some people it's stretching, a cup of tea, meditating, mindfulness. Yeah! Whatever works for you.
[00:14:56] Bella: I think most of the world, it's TikTok right now, right?
Most of the world is scrolling through their phone before they go to bed.
[00:15:03] Dr. Brigitta: Which is the exact opposite of what we recommend.
[00:15:06] Bella: Yeah. Post Concussion Inc, has TikTok, but I don't go on TikTok cuz I know what it's like. Like you just scroll, you're like, oh, I wanna go to bed in a half hour. Oh, it's been two like that's not a good system for trying to fall asleep. But I really like those. And I really like the idea of the red lights. I know I have, uh, like that yellow light. Like, you know how when you go to the store and there's like yellow to blue? Yes. I always pick the yellow. Cause I find the softer light in the house is nicer than like that big blue light and I find like this is my house. It doesn't need to be that bright. Absolutely. I like natural light. I'm a huge meditation person before going to sleep, so Headspace is like my go-to. I really like the app cause it kind of walks you through it. And I also find doing that in the morning sometimes helps.
I find like I will go in waves like this week has been a bad sleep week, so I will start doing it again. And get in the habit of like meditating before I go to bed and then getting up, cause then I'm not staring at my phone right. for like the last half hour, hour before I go to sleep. Cause I don't think that's the best method, but I know that's what most people do.
So that's really great and I like that you mentioned melatonin, but we are gonna talk a little bit about sleep medications after our break.
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[00:17:29] Bella: Welcome back to the Post-Concussion podcast with my South Bella page and today's guest, Dr. Brigitta Ziemba.
So what I really wanted to get into is sleep medication, because I've been put on sleep medication just the other day. My girlfriend asked well, have you tried sleep meds? And I don't like them cause they make me feel really cognitively fatigued or really off the next day I find I don't wake up. Like my body is affected too much, but some people really like them. I know I've gotten pretty weird side effects from them, but do you wanna talk a little bit about all that and also melatonin, because people seem like that is the answer and I don't know if that's exactly it.
[00:18:11] Dr. Brigitta: Yeah. So let's start with melatonin, cause I think that's the most common one that people reach for. Right? So as briefly mentioned, because it's a natural hormone that's made in our body a lot of people are like, oh, it's like a natural sleep medication replacement, but it's not. It's what it is, it's a dark hormone. So all those things we talked about as far as sleep hygiene, it's not like you can stay up till two in the morning on your phone, music blasting and then all of a sudden take melatonin and you're knocked out. Right? Like it doesn't work that way. So we still need to support the body in secreting its own melatonin, and we do that through the sleep hygiene that we talked about. And then we can support with melatonin as well if we need to and there's many benefits of it. It's also, neuro anti-inflammatory, neuro antioxidant. So it has benefits outside of it, which is also why our brain, our body makes it as well.
and that can be used in a couple different ways. And really it just depends what's most appropriate for each person. So we can dose it in multiple different ways. There's shorter release, there's longer release, and it really depends on what's going on with the person's sleep. So that can also individually be tailored. When it comes to sleep medication, the over-the-counter ones.
So this is one that, we talk about quite a bit. So diphenhydramine. , which can also be known F used for allergies, but then also is branded for sleep medication because it crosses the blood-brain barrier. So it will actually have that sedating effect. But along with that sedating effect also comes a whole bunch of other side effects.
So what it is is an anticholinergic effects. It has anticholinergic effects. So choline makes a subtle choline. A subtle choline is responsible for memory formation. So a lot of people find they're on sleep medication and then their memory's impacted because it also has anticholinergic. It'll cause dilation of the pupils.
The pupils will not be as responsive to light. So then people will end up with blurred vision. It also impacts the gut, so it decreases motility. So then we end up with constipation potentially, also dry mouth, agitation. So there's other side effects that come with it as well. And so then from a clinical standpoint, we need to tease out is this post-concussion side effects or is this medication side effects? Right? And that's where it can become a little bit tricky because the last thing I wanna be doing as a naturopathic doctor is treating or recommending supplements for side effects of a medication that someone took for sleep , right? It is far easier for me to try and just support the sleep to begin with, then trying to do the other pieces in between.
So that's one of the big ones and especially when it's over the counter and as we come into the spring and allergy season, also people being very mindful that if they are using, both as an over-the-counter sleep medication and then also an antihistamine, then they can actually be doubling up on the medication depending on, what they're taking.
So the labeling of it as well is also very important. So they're not double dosing things like that, because then we'll see those side effects come on even stronger, potentially. They can also increase heart rate and hyperthermia as well. So they'll cause a body temperature to rise. So, once again, when we're looking at things like exercise intolerance, even sensations of anxiety, right?
If your heart rate's elevated by 30 to 40 beats a minute, most of us are gonna feel pretty anxious and pretty uncomfortable. So once again it's teasing out, okay, is this a medication side effect or what's actually belonging to the post-concussion, side effects. And then when it comes to actually prescription, sleep aids, most of them are addictive.
So then the challenge always becomes, yes, we wanna help people sleep and then on the same token, when we start to remove that or wean that off, it's also supporting the sleep as well in the first place. So if we can support it more naturally, that's always my preferred root because then there's less weaning, less side effects generally.
So like you mentioned too, you're like, you know, I just feel groggy and there's been some interesting research about medication, medication dosing as well. When we look at the lot of the research, it has not been done in women. So when we look at a lot of the studies, usually they're on young, healthy males in their twenties.
And so when we look at the weight and the size of most of those males compared to females, if we're dosing at the same, some females might only need about half the amount compared to a male, right? So no wonder they're feeling groggy. And there's been some interesting research to show, like it could potentially be contributing to car accidents in the next day and things like that because, , women are being overdosed potentially based on their size.
[00:23:04] Bella: You know, that makes a lot of sense because I actually got put on a medication in a few months ago. Uh, I didn't stay on it cause it actually as we're talking about sleep. Made me wanna sleep all day. I would get up, stare at the computer for an hour and then go for a nap and I was like, okay, can't function like this, but
I like that you kind of mentioned like the addiction side to a lot of these meds, and that's with all medication. And I always like to say, you don't have to have an addictive personality to be addicted because sometimes your body is addicted, but your brain isn't. And like I know that doesn't always make sense until you've been addicted to something.
Mm-hmm. But for example, I got addicted to a narcotic once and I'd say my body was addicted. My brain wasn't like, it wasn't an addiction in a sense that I was like, I'm taking more than I need. It was that getting off of it was really hard. Like I felt like I was going through drug withdrawals and all these things and it was like, and then there's part of you that's like, you know, if you just take it, that goes away.
Mm-hmm. , but it's like, but you know that you don't wanna take it. And that's like the addiction side and it's not hard, , to go through that and I mean, like it's not hard for it to happen because you're on this medication that's helping you sleep. And then some medications like going cold turkey off medications I've done.
And sometimes it's like a, ooh, you have a week where you're like, not okay, and then you can bounce back. But that week is long. And the dosage side, when I mentioned that medication, I got put on I remember, I was on like half a pill of a regular small pill my doctor's like, you're small, like look like you have to think of like your weight and all these things.
But sometimes we don't think about that when we're taking over the counter meds when they're not prescribed. And you're like, oh, well it says like, for an adult, take this well, an adults, like you said, can be a very different size, adult height, weight, gender. There's so many things to really think about.
So when you are taking medication, that's why it's important, even if it's over the counter, especially when you're trying to like, kind of self-treat things. Talk to your doctor, talk to a specialist that knows what they're talking about so that you're not risking yourself even more, with a lot of those types of things.
So really like that. And I like that you mentioned to be aware of the medications for allergies because I take Benadryl, which wipes you out. Like even the daytime one makes you sleepy, but the nighttime one, like you are out, like usually you wake up and you're like, oh. , the day was gone.
But if you're taking that regularly and sleep medication, uh, it's definitely likely doubling up. So thank you so much for all that. I think it's really important to really be aware of the different types of medications you can take and the risks that come along with them. And the benefits of course, maybe they do help you sleep and you don't get a ton of side effects. I always like to mention that too, why it's important to try things because for myself I've been on the same medication as someone else that I know and they didn't get any side effects and they had doubled the dose and so it doesn't always matter.
So it's important to remember that. And we have talked a lot about so many things about sleep and kind of like a quick course on how to help your sleep after concussion recovery, and hopefully it helps all these brain injury survivors who listen to this show. So is there anything else you'd like to add before we end today's episode?
[00:26:25] Dr. Brigitta: Yeah, I think just touching on, and those are brilliant points that you shared as well and sharing your story as well. And that's hugely helpful and relatable to a lot of people, so thank you for doing that as well. I think people, so melatonin we touched on is often the go-to when people think like natural sleep solutions, right?
And there are some other ones that people, may not be considering, so I'll just share some of them. And then once again, talk to your care provider because some of them do have interactions with, different medications as well. So it's just being mindful of things. But, lavender, essential oil can actually be really, really beneficial.
So both diffused, it could be put on the soles of the feet, so we have a lot of, pores on the bottom of our feet, so they absorb very, very well there. And if you're using a therapeutic grade one, you can actually take it internally in a capsule as well, or make it into a tea. When it comes to teas, there are some sleepy time or some sleep teas as well that can support sleep.
So chamomiles is often a go-to for a lot of people that they think of and that could be tied in with that nighttime routine, right? Having a cup of tea and whining down. When we're looking at some other things, passion, flower, lemon balm, and valerian are some other really, really great ones.
There's some, once again, they're in teas, but there's also in some combo formulas. And then we have things like altheine and gaba, which are also dubbed nature's chill pills. So those can help, calm the brain and the brain waves down and help us get into those, those states where we're primed to actually sleep.
So there's a lot of different options other than melatonin out there for people.
[00:28:02] Bella: Yeah. That's great. Well, thank you so much. And I like that you also mentioned about connecting your symptoms, like am I treating you or am I treating what you're taking? Which is why every time you walk into a doctor's office it's like, what do you take?
And that includes your non-prescription medications. I know some people are like, oh, well I just take like this. I'm just like, yeah, but that still matters, so don't forget those things. And I just wanna thank you so much for sharing some of your insights on sleep.
[00:28:31] Dr. Brigitta: Oh my absolute joy. Thank you so much for having me on the show.
Need more than just this podcast. Be sure to check out our website, post-concussion inc.com to see how we can help you in your post-concussion life. From a support network to one-on-one coaching, I believe life can get better because I've lived through it. Make sure you take it one day at a time.
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