Sleep Health and Psychology on Lockdown—Yelena Blank, Ph.D.—Clinical Psychologist and Sleep Expert

Richard Jacobs: Hello this is Richard Jacobs with the Finding Genius podcast. My guest today is Yelena Blank. She goes by, Elaine, is a clinical psychologist in the San Francisco Bay area. She provides therapy in Palo Alto and Mountain View as well as online events in California. And literally nowadays of Covid-19 crap it’s all online. Use the evidence-based practices combined with what she says is a warm, nonjudgmental, one collaborative approach to help you with sleep problems, trauma, PTSD, depression, anxiety, which she mentioned offline a lot more people are experiencing. So thanks for coming. How are you doing?

Yelena Blank: I’m doing great. Thanks for having me.

Richard Jacobs: Well what got you into working with people that have sleep issues?

Yelena Blank: It was actually totally accidental at first. I graduated from college with a degree in psychology, but as anybody who has an undergraduate degree in psychology knows there’s not a whole lot you can actually add in it. And so I took some time off, two years off just to figure out what I wanted to do with myself. And by sheer luck, got a job as a research assistant at the San Francisco Veterans Affairs, VA, working with vets who had post-traumatic stress and sleep issues and discovered that I was fascinated by both those things. The fact that sleep important and sleep were so prevalent, not just in PTSD but in anybody we talked, all mental health disorders, healthy folks who don’t have any other diagnoses, often had sleep. It was just something that I, as like a young 22-year old had never really thought about as particularly because I hadn’t had an issue with it and suddenly was super aware of like, yeah, this is a problem.

Richard Jacobs: Well, as I say, when you’re young, nothing bothers you. I remember for many years I had laid down, next thing I know I was waking up, never woke up, none of that stuff. And as you get older, you wake up to pee and you worry about things, a family and kids and all that stuff and life gets different.

Yelena Blank: You suddenly realize I’m not 20 anymore. If I stay up half the night, my next day doesn’t actually feel that great.

Richard Jacobs: Yeah, exactly. You can’t just shake it off, have coffee or do whatever and you’re fine. What’s the avatar of the people you work with? Is it surprising or is it your typical 40 plus person? Who are they?

Yelena Blank: I tend to work within twenties primarily. That’s not necessarily like, Oh, that’s the only population I work with, but it just so happens where I am in the Bay area that’s moved my populate. I end up working a lot of folks in the tech industry. So I would say I’m about half and half male and female and a few trans and non-binary folks. Mostly like I said, late twenties or leafing gym outside that I deal with some somewhat.

Richard Jacobs: Oh, I’m surprised that they’re so young. But you think it’s where you are is because you’re in San Francisco Bay area that maybe the tech is so much check that people are stressing out earlier?

Yelena Blank: I think so. And I think so part of it I think is negative in the sense that the only high-pressure job part of it I think is positive in that the big companies Google, Facebook, Apple and other smaller than the area are actually good job of focusing on mental health care and we’ll just seek and partnering with the companies that do like employee assistance programs for mental health.

Richard Jacobs: Within your treatment is it like CBTI, cognitive behavioral therapy for insomnia or is it a different flavor? Like what is your treatment look like?

Yelena Blank: Yeah, so if we have issues, my primary is CBT. It’s the gold standard for insomnia. It has a ton of research behind it which I love. The other thing I really love about it, it’s not a set protocol like do this session, do this and stuff, but it’s a series of evidence based module where there’s different strategies based on what specific issues my clients are presenting. And then so that’s sleep specific or really insomnia specific. For everything else I use CBT based approaches. And then it just depends on what the exact issue is. I also bring in a mindfulness. I also bring in pieces of something called act acceptance therapy, which basically like very short version is, Hey, you’re dealing with tough things and struggling with them isn’t helping for you. How can we work with you to accept that can’t change and then identify.

Richard Jacobs: So okay, so insomnia I could see would be probably an overarching issue for a lot of people. What else is it about their sleep that is not insomnia that bothers them? It is just wake up feeling not rested or like what do you hear from clients? How do they express their problem with sleep?

Yelena Blank: Other than insomnia and things I see are something called circadian rhythm or like shift disorder. So not even necessarily for people who are working, but for folks who are, maybe very much night owls but are having to come time and having to, in a world that doesn’t necessarily adjust their schedule. So having to wake up when they’re not feeling rested when their circadian rhythm is actually at a low instead of sending out those. So I see some of that a fair bit. I see sleep apnea fair bit, and that’s not something that I can treat as far as the apnea itself, but something I work with on is helping them using a C-PAP machine adjust to like what this might look like with that troubleshoot in ways that medical providers don’t necessarily have the time or expertise.

Richard Jacobs: So people that are night owls I’ve noticed that the whole world kind of make some wrong judgments about people that stay up late and especially it’s like the early bird gets the worm early to rise and it makes a person wealthy and wise, et cetera. Do you find that people deal with that and that colors their perception? Do they feel like a bad person because they’re a night owl? Let’s say?

Yelena Blank: There’s definitely the sense of, well, everyone quote un-quote can get up at this time and I can’t what’s wrong with them? And so part of what I do, even just in the initial session, you know when I’m doing assessment, is try to provide some education around, Hey, like you are normal. Here are the solution. You are an outlier when we look at a normal curve, but you are by far not the only one and this is an actual part of how you’re wired. It’s not a moral judge.

Richard Jacobs: What do you think people come into you with that bias in their mind or do a lot of people that sleep those hours? Just think, well that’s just me.

Yelena Blank: I think a fair bit of, even with that bias where they’re like, I really want to change, not because I personally think it would be better, but because the world is telling them,

Richard Jacobs: Oh okay, is there a certain, a degree of night owl illness that really is a problem for people. Like how late is late?

Yelena Blank: I think most of the problem comes from mismatch. The biology log and world expect, so it’s actually interesting be here in the tech world for a lot of people what might be a problem for others it isn’t a problem because there is more flexibility. So for example, somebody goes to bed normally around morning and gets up around 9 to 10 in the morning. Here is actually not a huge deal necessarily even with flexible hours, but somebody who naturally in a bed at four, five in the morning and then waking up at like 1:00 PM that’s going to be problematic because most companies, unless they’re really working from home on their own, they’re not going to be able to make that kind of adjustment. Company is not going to be able to and the rest of the world doesn’t function on that schedule. If you’re somebody who’s having a hard time getting up before say 1:00 PM while you’re missing out on a whole day of being able to, or a half day of being able to go to doctors or the bank, et cetera.

Richard Jacobs: Well, what happens with people that are on that like ultra-lazy schedule? Is there reasons that, do they really get their best sleep doing that or is there something psychological going on?

Yelena Blank: Their best sleep is such that they’re having their wake signal much later on, you know, probably at 10 or 11:00 PM or actually if they’re going to bed at four, they’re probably getting in the wake of theirs going to let around two or 3:00 AM. And so they can’t fall asleep for that. We do a lot of work on gradually shifted wake timer, which is the thing that helps shift their bedtime earlier, but it’s something that they have to be very consistent with and it tends to feel unpleasant, so it takes a lot of mode to be able.

Richard Jacobs: When anything changing recently, not literally in the past, you know, week or so because of the damn virus, but over the past year or so, do you see any new things happening?

Yelena Blank: The past year? I’d say I’ve definitely seen people are moved to online. Obviously, like you said in the past week, everything has gone online, but even before that, more people starting to shift towards that. And some of it has been by preference. Well some of it has been my personal preference or like, Oh this is lenient. Like it’s nice to be from my home or from an office room I reserved. Some of it I think has been maybe a little bit less good in the sense that easier till the end of the day. But it also means that there may be prioritizing dizziness over self-care alone.

Richard Jacobs: And what about now? What do you think the fallout from the virus, you know, quarantine type stuff will be like how are people reacting to you right now and what do you think there’ll be reacting like in a few months hopefully when the song is over?

Yelena Blank: Yeah. So of course this past week we’ve all been in position and I would say that 95% of my session focused on helping folks figure out what like now because if you don’t have a good routine, that’s not good for you, that’s not good for depression. If that’s what they’re struggling, it’s often not good for anxiety because there’s not predictability in your schedule, your day life. And so people are just having such an uptick of symptoms right onto that. It’s hard to tell what’s going to happen in the long run. But one of the things I’ve been to a lot of my clients about is how can you all time as potentially of, Hey, here are things now that maybe don’t work as well, but also here things now that might be better. Can you identify those things, hold on to them and then try to carry them over into reality when we go back to normal?

Richard Jacobs: Yeah, it makes sense. I mean, in a way, if we think about it right. Hopefully for some people that could be a time of reflection. Just like maybe over the Christmas holidays where you have a few days or a week to make your plans for the coming year. Well, maybe this can be like that for people and they can think and make their plans going forward on how they can improve stuff and was this really necessary, et cetera. How to adjust and make things better.

Yelena Blank: Exactly. And right now there’s this very enforced change. But one of the potential upsides of that is it shifts you out of what you choose that may be well enough but wasn’t necessarily and gives you the opportunity to ask, Hey, would this be better if I change?

Richard Jacobs: Well that makes sense. So there are new ideas that have come to you with your therapies? Are you going to be doing things in a different way? What do you think would be most helpful to your people at this moment?

Yelena Blank: I think I’m going well. After all this is over, I think I’m going to online me than I have been. Like I said, I’ve been doing it already, but I’ve been part of and now that I’m getting more comfortable with it, as you know, 100% of my case load right now, I actually think that that’s something more proactively offered to clients as well. I also think that people are going to become aware of sleep as a health thing because right now that’s one of the things that’s been interesting is people who’ve actually, a lot of my folks have been able to get more sleep because they’re not commuting or their jobs aren’t expecting them to be on quite as tight a schedule. And so they’re suddenly seeing, Oh Hey, I feel a fair bit better despite all of this anxiety because I’ve been able to get that extra hour of sleep. And so I’m predicting that’s something I’m going to bring on even with folks who are not specifically presenting direct.

Richard Jacobs: Yeah, that’s interesting. I guess in some places the average person may save a couple of hours of community, so that would be a big boon to them to sleep later, you know, maybe roll out of bed in a second later behind the computer that works with no commute. So hopefully it’s a good thing. There’s always two sides to every coin. So, hopefully there’s a lot of good things that you can point out to people or they’ll point out to you and improve what’s going on.

Yelena Blank: And I’ve joked in the past that sometimes the side effect of insomnia treatment is people change. Not because I’m specifically pushing them to, but because when we talk about things like sleep opportunity, they suddenly discover with my life the way it is right now, there’s no way I can get enough sleep.

Richard Jacobs: Oh really? People tell you that way, I don’t know, they feel like their life is out of control to the point where they just can’t get enough sleep?

Yelena Blank: Well, it’s certainly an area that a lot of people have and sometimes when we start breaking that down, it’s like, Oh yeah, there’s in your schedule, there is no given the code to actually allow more time for sleep.

Richard Jacobs: Yeah. That’s terrible.

Yelena Blank: I’m not a fan of this solution and yet housing and prices and that’s a challenge.

Richard Jacobs: I guess one or two more questions. You said you were doing very few online consults and it sounds like you didn’t really prefer to do them. Why? What is it about? What did you feel was missing from online consults?

Yelena Blank: I think the thing that’s hard about them is the body language because I mean video is much better than, but even with video you’re still only seeing part of their face and not combination. It’s also the case that then you’re potentially battling with technology. I have a system that works pretty well and that has worked pretty well, but it’s still dependent on the internet working and I’ve had random times where my internet has just stopped or clients have had times where their internet got over and so you’re spending some of the session monitoring the technology rather than actually the person, that said, I think the benefits of it in many times can outweigh the cause. And I think that’s what I’m noticing right now where it’s like, yeah, it’s harder in these ways, but it’s so much better than not having anything at all. And for some of my clients it really does make more accessible. That’s what I think I’ll be moved to that.

Richard Jacobs: Any tricks of the trade that you can learn about online sessions to make them more effective?

Yelena Blank: That’s a good question, I think, well for me, the things that I’ve been noticing over this week, making sure that I have for sure like a really comfortable desk. And also something that I can look at that isn’t just the camera. So I keep my notes on the side because when you’re in the face to face with a person, you’re not constantly staring at their eyes. You’re sort of, there’s other stimulus on the computer. Weird, right? You’d be a little bit creepy. We’re directly staring at their eyes the whole time. So having like my note up on the side of the screen kind of helps go back and forth and regulate some of that.

Richard Jacobs: Okay, great. What about setting up maybe like an extra camera and maybe you have like, I don’t know another thing, you know, you can tell the person to sit on something or you can move to another location, then you sit somewhere else and you move around during the consult. Maybe that would help.

Yelena Blank: Yeah. Being able to like shift a little bit instead of being frozen in front of the camera.

Richard Jacobs: Yeah.

Yelena Blank: Well the other thing that’s actually been really fun about doing this past week is most of my clients are at home because of the shelter endures that world under. So I’ve been getting to most pets. That’s been really cute. There’s been like puppies and cats just popping into the picture and that’s kind of charming.

Richard Jacobs: How have people been responding to the shelter in place? Are they listening? Are they going out for food? Like what are they doing?

Yelena Blank: My folks have been very conscientious about it, so like not really leaving the house except food grocery. Then they’re trying to do if possible. Going on walks for exercise, but make her to stay far away from people.

Richard Jacobs: Hmm. All right. Well very good. What’s the best way, now that you’re doing virtual work? I mean, pretty much anyone can see you. What does that look like? Is it like a fixed number of sessions or what’s your recommendation?

Yelena Blank: So let me actually start over. I don’t do a fixed number of sessions really hard to predict ahead of time what that looks like. Insomnia specific to ten straight session. If folks are having other anxiety, et cetera, back in bunker, PG trauma, a lot more complexity thereof. For me, I tend to actually pull every other, I find that that’s more helpful, gives us more time for them to make char session and to really get into new patterns. Cause that’s what CBT, insomnia into patterns. With folks more of them like that, I tend to see them if it’s fever schedule. And then from a logistics standpoint, I can only see clients who are from California because I’m licensed in California. So even though the online thing can be accessible to anybody, the laws around that haven’t caught up yet. I think they would have the next, I would say probably two to five years, but they’re not quick.

Richard Jacobs: Okay. That makes sense. Well, very good. What’s the best way for people to get in touch? You have a website address or what should they do?

Yelena Blank: Yeah, the website is the easiest. All my contact information there. My website is yelenablankphd.com.

Richard Jacobs: Well, very good. Well, Elena, thanks for coming and it’s been a good call and I appreciate you being here.

Yelena Blank: Thank you so much for having me. It’s been great to talk to you.