Introduction and Sleep in Relationships

Dr. Wells here again for Sleep

Deep: New Ways To Treat Insomnia And Sleep Apnea. And today I'm talking with Dr. Kavetha Sun, who is a relationship expert, as well as being a double boarded psychiatrist.

Welcome, Dr. Sun. It's a pleasure to see you. Thank you so much. It's a pleasure to be here. Very excited. So we're going to talk about sleep in the bedroom and having relationships despite sleep problems.

And I always like to tell my patients that I am not a marriage counselor. But a lot of times in the clinic visit, the couple can kind of bring up some issues that are caused by sleep.

And I wonder if you have experience with that as well. I'm not directly I haven't directly worked with somebody who comes to me specifically because they are trying to figure out how to talk about, you know, like a sleep machine or such.

What I have seen, though, is the effect of having different sleep schedules. First of all, on a relationship and also the effect of insomnia and a sleep deficit on your what I call the window of tolerance emotionally.

And how then that impacts the relationship. Not to mention, I mean, I think of it as emotional regulation. Then there is the memory attention piece that then impacts the relationship.

And then there is just the logistics of never going to bed at the same time. And, you know, all the all the stuff around having different needs for sleep, whether it's a zip up machine, but also if you're just like a night owl versus a morning person, how that alone can impact relationships.

I've seen it in those respects for sure. And, you know, one of the funny things about sleep is that the newer part of our brain, the frontal lobe, is inhibiting the emotional brain in the middle.

But with sleep deprivation, sleep loss or sleep interruption, you kind of lose that inhibition. And then the internal toddler comes out to play. And that doesn't always work in a couple.

That's right. The internal toddler, I think of the internal child as having as all of us do, the the joyful side in the shadow side. Right. So this joyful side, which actually includes creativity and play and thinking outside the box and energy and all of that.

But the downside. The dark side of the shadows. side, is that we become, as you said, very irritable.

Sleep Loss, Emotional Regulation, and the Window of Tolerance

We have a hard time managing our capacity to put ourselves in somebody else's shoes, which is a frontal lobe, taking perspective, empathy, pausing before reacting.

Also, the intent. I've seen people who have a sleep deficit as assuming negative intent in somebody else because you are almost cruising at just below surface level in terms of irritability and anxiety.

So I think all of that makes the inner child really hard to deal with for the partner. You mentioned something before which intrigued me. You mentioned the emotional tolerance.

And I want to give you a chance to explain that, because it sounds like there's sort of a boundary there that might be recognized. Yeah, that's a great question.

So the window of tolerance is a well-known concept, but basically what we're talking about is our nervous systems capacity to keep ourselves in or around what we call the ventral one of the parasympathetic response, which means that we're a little bit more relaxed, we have a little bit more perspective and three dimensional, more nuance in when we listen to something or we don't get the response that we like.

That parasympathetic ventral vagal response when you have a larger window of tolerance, even when shit is happening, sorry, when stuff is happening, the when life gets hard as it does sometimes, and seasons come and go.

Stress sometimes, you know, your stress bucket is heavy. Sometimes. And if your window of tolerance is narrow, even what would be easy for someone with a larger window of tolerance becomes unbearable for you.

And I would imagine that's directly affected to how much sleep is in your gas tank. Yes, stress. When I think of stress like a backpack or a bucket. Right.

And some parts of the bucket you're born with, there's your genetics. There's a trauma that you experienced, you know, things like that. But there is other stuff that we pour into the bucket or allow into the bucket and their internal stuff.

And there's external stuff. The internal stuff is many things, but sleep is a big part of your internal what how you modulate internally and what you bring to your stress bucket.

I'm curious to know how you help people to get to know themselves, have more awareness about this. One of the one of the things that I like to talk about is one's relationship with themselves as they're lying down to sleep.

So you're away from all the distractions. There's very little stimuli coming in and your ability to sleep can be affected by your relations. Chip with yourself. Do you agree? 100%.

I think insomnia is is a very emotional regulation issue in many ways, because when we are only with ourselves and there's no external stimulation, I'm not just talking about other people and things that we're doing, but even visually and sensory wise, there's just less stimulation.

And so you're left with your thoughts, right? And depending on your attachment style, you may have anxious thoughts about the past in the future, or you may have ruminative thoughts about what another person is doing to encroach on you, whatever.

Wherever it goes, it impacts you and you get negative feedback. It feels so uncomfortable that then you postpone sleep. You postpone sleep, or you pull out one of these guys and kind of indulge in a lot of scrolling and kind of hypnotism with your phone.

Yes, 100%. Oh, my God. This is something that I'm noticing more and more in. The clients that come to us is either they themselves admit to using. I mean, distraction is a useful technique, right?

Sometimes your window of tolerance has been breached.

Attachment Styles and Communication at Night

You're too overwhelmed, but you can't really process it in the moment and you don't want to let it out. Maybe you or a team meeting or something. And so distraction is a useful technique, but when it becomes your only technique, it's like holding a beach ball under the water right the minute you let go.

It's like rebounding. I totally agree. And you know, when when you're kind of at that place of having low reserves, it can be difficult to communicate to your partner.

I wonder if you can give some tips for how you might say that this is not a good time for me. Oh, such a good question. So I'll go back to I'm pretty relational in the way of there is no perfect communication.

Basically, people often come to me and they say, we have miscommunication, I need communication scripts. How do I? And I often say there is no magic script.

What you need to understand is what your needs are and what your core sort of fears are, where your story goes when you are disappointed or hurt, and the same for the person that you are in relationship with, whether this is your spouse or your mom.

Right. So let's say you are wanting to postpone a conversation. Someone's coming at you, right? As the how do I say? If your spouse or the loved one has an anxious attachment, their core fear is going to be if I say no, they're going to feel abandoned, rejected and feel like they are not prioritized or wanted.

Right? If I know that about my spouse or my loved one, the first thing I want to do is actually evade and go around poking that core fear. So I want to start with saying, hey, honey, I really miss you, too.

I'm we're in this together. I can't think very clearly right now. And I want to be fully present. Can we talk about this tomorrow? Those are really powerful words and simple, too.

I like that. Yes. And so the magic is not actually in the script. The magic is in you knowing that that is the wound that's going to be provoked in the other person versus if your loved one is, they avoid it, right?

Then if you say no, what, they will take that to mean. Often or where they might will go is I'm not good enough. I've done something wrong. You want to bypass that in that person?

I'm wondering for people who may not be familiar with anxious and avoidant attachment styles, can you nutshell what those two terms mean? Absolutely. So attachment, just in brief, was something that John Bowlby, who is known as the father of attachment science, came up with.

And then Mary Ainsworth was someone who did a bunch of studies a few decades ago to look into the different kinds of attachment. Attachment basically is the nature and quality of the emotional bond between a child and their primary caregiver.

Okay, so there are different kinds of attachment styles, but overarching there is secure and there's insecure. Secure attachment is in that dyad between you and your primary caregiver.

There was enough security and give and take and emotional attunement that you have now taken that feeling of security and you have absorbed into your body such that even when you're not in the presence of that parent, you carry along that feeling of security in you wherever you go.

So such people tend to trust the world a little bit more, have a lot of self-respect, can be flexible in their thinking, can hold boundaries without becoming harsh things that were quite foreign to me for many, many years.

Okay. The other side is insecure. Attachment and insecure is actually of three types. There is the anxious, preoccupied, and that basically means that your attachment style with your primary caregiver was such that you had to you were worried that you would lose connection.

And so you would anxiously try to cry, cling, have panic, maybe even exaggerate the things that you're feeling in order to get a response. You had to do that in order to get a response.

And so you learned that and your model for the world is people will leave and you almost expect that. And you might have emotion disregulation and maybe exaggerate of your emotional response because, you know, that is the only way to maintain connection.

Without that, it feels like death. Right. The other one is dismissive. Avoid it. This is the diametrically opposite of anxious, preoccupied, where basically you see the world as you had a relationship with your primary caregiver where you felt intruded upon.

Okay. So instead of them disappearing, they will constantly maybe reading your diary and telling you what to think and telling you which friends are good for you and which are not, and checking up on every single thing that you do and putting themselves into your life so much that you started withdrawing and maybe not sharing as much about your life, maybe lying, maybe emotionally shutting down.

We also might have come from a dynamic where even though there was intrusion, there was no real emotional sharing. So you don't have a vocabulary often for emotions at all.

All you have is the sense of icky overwhelm when someone tries to come too close to you. So that's a business avoided and people with that style often will say, you know, you're exaggerating.

Why are you so emotional? Back off, deal with your own emotions. Not my problem. Stop bugging me. Right. They fear that they're going to be swallowed whole by this other person.

And the last one is fearful, avoidant or this disorganized, which is you sort of got the short end of the stick on both sides. Your parents sometimes will present, sometimes a volatile, sometimes were absent.

And you just didn't have any strategy that actually worked. So you just bounced all over the place trying to find something that works. And as an adult, it comes across as your conflict testing your spouse or partner or loved one.

When they do respond, you don't quite trusted. You're like, you don't mean it and you reject it and you tell them to try again. And this is push for push pull.

I think what strikes me about these descriptions is how old the programing is. This is sort of fundamental patterns that were established in childhood and they kind of come out to play in the night or when a person is sleep deprived.

I wonder, can people improve from their attachment styles and what does that look like? As such a good question. So this is sort of been my lifelong journey myself and something that I really passionate about helping people achieve.

It's you can in short, it's called earned security, right? You wasn't given to you. You're earning it as an adult. And there are many ways to get there.

There is no set time limit. Right. I'm not going to say if you start on Tuesday, by Tuesday of next week, you'll be at this point. What it requires is, one, the awareness that something is off, which is actually much harder to see, then it sounds like, because it is the water use women.

So like fish don't even know this. And such a thing called water, right? Like that. We don't know that we have any patterns. It just feels like life to us.

So even recognizing that often takes time, especially because our loved ones and family of origin is the system we came from. So they mirroring this as well in some ways.

And the second thing, and the easiest way to start your journey towards UN security is actually spending a lot of time with people who are security attached.

Mm hmm. Where do you find those people? I know, right? Where are they hiding? Yeah, actually, I will say that there is nobody who is secure all the time.

Yeah. Okay. But there are people who can catch themselves, come back, repair, take ownership, draw boundaries gently. Right. They may not be able to do it in the moment.

And even a securely attached person in certain relationships can lean towards anxious or avoid it. Right. But more often than not, they don't spend decades in that relationship just pushing and pulling.

They can catch themselves a little easier. The second way to recognize a security attached person is that they can take a note without pouting. Mm hmm.

That's a skill, I think. Yes. That's something that's very valuable. Yeah. So, you know, sharing a bed is one of the most intimate things that you can do with someone.

Building Secure Attachment and Repairing Conflict

And, you know, not just from a sexual point of view, but also because, you know, I've always appreciated how vulnerable we are when we sleep. And that's something that I keep in mind when I order sleep studies, for example, because, you know, people are unconscious when they're asleep.

So I wonder if you can talk about the friction that can occur in the bedroom and give us some solutions for what might help? Absolutely. So just as a clarifying question, when you say friction, do you mean do you mean in the relationship because of the fact that you're being that vulnerable in that space or is that something else?

I think what I'm getting at is that I see patients who have a spouse that they and they have bruised ribs because of snoring. You know, there's that that irritation that happens.

I see couples that separate and go to sleep in separate spaces. I see people who really subscribe to the notion that you should not go to bed angry and then they kind of push through because they that's a belief.

So that's the kind of friction that I'd like to hear more about. That makes a lot of sense. So if you are someone that you're in partnership with, has that belief that we have to talk through something because I feel uncomfortable.

And even if it's 2:00 in the morning because you're not supposed to go to bed angry, it's probably an anxiously attached person. Right. They literally feel like I'm crumbling here.

You have to come and help me hold it together, which is why they keep saying let's talk. No, no, no. It's still not making her. So if you or your spouse does not first recognize that it's coming from something outside of just it's a habit for that person to always want to talk about it.

It's coming from something outside of that. If you can see it that way, then you can actually find help for that and help that anxiously attached person as well and reassure them, which will help you be able to have the talk at a time when both of you are actually online mentally.

The second thing you mentioned is the fact that we're so vulnerable and that we may have different ideas of when to go to sleep, how to go to sleep, what time to go to sleep, all of these things, and I've seen that quite a bit.

What I will say is you said a day poignantly, it's a you are actually unconscious when you're sleeping. In my mind I see sleep as almost like a and I, I don't mean to be morose, but almost like a mini death.

Right? You're you're out. You're out of this world completely. Mm hmm. And so whether we recognize it or not, the times when we are mini death unconscious and the times we're waking up from that are pretty vulnerable times both night and morning.

So if you have that idea, then you can make sure this is my route. I always am like my clients to make sure that they connect before that time of sleep.

Even if one of them tends to go to bed later. Mm. What does that connection look like? Give me a menu of what's available. Yeah. So the number one thing is to if you can not talk about your relationship struggles.

Not at night. Not at night, because you both are not in a calm, safe space. You're not thinking clearly. You're already exhausted. You're already sort of like anxious about the next day's activities.

Right. So it just is not going to go well. The second reason, though, is because what's more important is to feel like I have somebody who can who has my back and I have their back against the world out there.

And if you don't provide that for each other, research has shown that even if your relationship does get better, eventually it will sort of crumble because outside stress needs both of you to feel like you're on the same sort of on each other side in order to combat.

So all of this to say that nighttime routine should have something to do with affection and something to do with processing outside stressors and the listener just being on your spouse's side, you know, problem solving, you're not telling them how they could have handled it better, even if you're sure that you know that you could have done it better.

Your job is just to say, Yeah, that sucks. Fuck that. Okay, I'm on your side. Right. Unless they ask for specific advice. So I always recommend my clients to just touch base for a few minutes, have a moment of affection.

Right. Touch, affection, laughter. That kind of thing. And then just ask, how was your day? And let that person see whatever and let them know that you're on their side.

That's so important. And you know, one thing that I see a lot as a sleep medicine physician is that couples choose deliberately to sleep in different bedrooms.

So having that coming together, that reliable connection before one or both retires for the night is a great anchor point to help the relationship stay strong.

100% you will lose your weight even if you're not having a lot of arguing. We know that the second wave of divorce comes with roommate marriages. Right. This is what ends up happening.

Sleep and the difference in sleep schedules is a big reason that people then end up in disconnected marriages and wait till the children are in high school or college and then separate.

Yeah, I think it's too bad because, you know, marriage is supposed to be beneficial for both people in it. So it does take work to invest in the marriage and kind of a sense that you're willing to show up authentically, be who you are.

Be as flexible as you can. But whenever there's a backdrop of sleep issue going on, that can be especially difficult. One thing I wanted to ask you about is, you know, if a couple is going through a period of strain, you mention that not talking about their relationship issues at night is a no brainer, but how would that get brought up earlier in the day?

Can you give us some questions? What a great question. So what I always recommend for my clients is to have a set time for that. The reason being, one, if we don't have a set time, if one partner is more anxiously preoccupied, they are constantly thinking about what is wrong in the relationship.

They're looking for problems to solve. And, you know, whatever you look for, you find. So you're always thinking about, you know, or he came late or she did this or whatever.

Bedroom Friction, Sleep Apnea, and CPAP

So when you have that rolling on your head all the time and you don't have a set time to talk about it all end up happening as you'll bring it up all the time.

Mm hmm. Right. And we know that research has shown that even in the middle of an argument right. Marriages that are doing okay, the even in the middle of an argument, that's a 5 to 1 ratio for good, safe connection, whether that's just an eye contact, nodding while they're talking, saying, I can see your point.

Fair enough. Or just putting your hand on the other person's knee or saying, wait a minute, you know, I just want to get some water. Would you like some little things that are safety signals?

Is 5 to 1 in the middle of an argument. Outside of an argument as 20 is to one. Oh, my goodness. Wow. Okay. However, when we don't have a set time, when we're constantly bringing up little, little, little, little, little things.

Right. It really erodes that 21 sometimes I've seen it opposite. It's like one, two, 20. Mm hmm. Right. And that can really damage your relationship. So the first thing is actually set aside a time.

It also helps the anxiously preoccupied person know that there is a time, because part of why they keep bringing it up everywhere is because they don't feel like they'll ever be heard.

So set aside a time I usually recommend once a week to start off with where you have like an hour or half an hour actually meeting. And one of the things that I recommend is start with sinking your calendars, because that alone causes so much unnecessary conflict, misunderstandings and feeling of frustration.

Right. So sinking your calendar for this coming week. What do you have? What do I have? Who gets the car? Who's dropping Gianni off? Blah, blah, blah.

Right, sinking your calendar and then talking about it's like the sandwich approach for giving feedback, right? Sync your calendar. Start with what went well this week in the relationship.

Then share something that you need to process that maybe hurt your feelings or you felt confused about, or you need some support on whatever it is. And then ending with this question, which I love, is What can I do to make you feel more loved this coming week?

I think that's an amazing question. And, you know, there's there's really just one way to receive that, which is with, you know, with gratitude and love.

Absolutely right. What a question to be asked or to. And also it inspires the other person to want to meet you when he's. Going that way. Yeah. One thing I see a lot with people who have insomnia is some component of the motivational triad.

So health, wealth and relationships and that relationship with the person that you share a bed is critical. I want to talk about sleep apnea for a second because there's kind of this life cycle that happens.

So one spouse might be worried about the snoring and the pauses and breathing. I often see reluctance on the part of my patient to go through with getting tested and then if there is sleep apnea and they decide to treat it with CPAP, now there's a machine in the bedroom which is, you know, it's different.

And I think when you bring a machine into your home, there is a psychological component there. I wonder sometimes about people who are more adherent to CPAP treatment versus less adherent.

There seems to be a correlation with their spouse or their bed partner kind of reinforcing the idea that this is for health. Is there any tips that you can give people as they navigate that kind of chronic disease and treatment?

Great question. I have seen this a couple of times, even in my family members and a couple of times peripherally with the clients that we work with, with the machine, as you as you mentioned, it's almost like a third entity in the bedroom, right?

Especially the size and the noise of the seatbelt machine. The number one thing really is recognizing the integral role of sleep. Agree. Right. Many, many of us, myself included.

Sometimes I lose track of that and then I start noticing two or three days into that sleep deficit that I'm a little bit a little bit tiny, bit shorter, a little bit more prone to forget the little things that people mention, not register.

Right. It's a cue for me that even half an hour deficit every single day catches up to you pretty fast. So first, recognizing that and making it a mainstay of your conversation of the sort of the values of your home.

The other thing that I often recommend that we do in our home that I found really helpful is we insist that everybody put their devices into a basket that we leave outside of the bedrooms.

Great plan. Yeah. Especially for teenagers. Oh, yes. There's really an underestimation of how much these electronic devices affect sleep and even effect relationship, because, you know, you're checked out when you're in your phone, you're putting your emotional attention somewhere else and it's giving you the signal that it's time to be awake.

So all of those are vectors pointed in the wrong direction. Wrong direction. That's right. So first, recognizing the sleep is important, making it a mainstay of the basic hygiene of a family.

Right. Setting up rituals for that. And then the third thing I've heard from people with sleep apnea needing a machine is the feeling of feeling less attractive in some way.

Yes, definitely. And also, you know, if someone doesn't have a single bed partner, if they're on the dating scene or whatever, there can be this real reluctance to let somebody into their bedroom.

I like to say it's it's an opportunity to be authentic and kind of establish health as a topic in the relationship from the beginning. What's your take on it?

I completely agree. I think I understand. Like, how do I say this? I think vulnerability is a wonderful, wonderful quality. And I think people have to earn your vulnerability with them.

So it's not a matter of am I vulnerable or not? It's a matter of who am I vulnerable with, to what extent? Right. So when you're initially dating, I understand if somebody is not ready yet to be that vulnerable.

What is I think more important is to talk about this concept of emotional intimacy and vulnerability as a concept so that whether it's a slip up, whether it's that you want to tell that person eventually that, you know, you were abused as a child or you have some other something, right?

Maybe you smoked for ten years and you're embarrassed about that. There are many things that we are hesitant to be vulnerable about. So I think talking about how do we what do you think about emotional intimacy and vulnerability and how that lands and is received in relationships is the thing that you want to start with.

Great point.

Sex, Intimacy, and Where to Learn More

And you know, when when people are kind of navigating this, it can be it can feel tricky and people can feel a little bit hesitant. So I think just having that frank discussion is really useful.

There's also, you know, when I advise people who are struggling with insomnia to they there's such a thing called stimulus control, which is where they remove things from the bed except for sleep and sex and want to talk about sex because sleeping together and sex often go hand in hand.

You mentioned the roommate relationship before, and I think there's something to be explored there too. Yeah. So I've seen roommate relationships actually in two ways.

One is where there is no emotional intimacy or sexual intimacy. And the second is where there is no sexual intimacy. But there is a sort of a baseline friendship.

Mm hmm. If you will. So it's not that you dislike that person. It might be, but it often is that you're just sort of like the block. Right. It's like living with a friend.

So all this to say, I think sexual attraction, talking about sex, I mean, there's so many studies that show that it's not the frequency of sex or even the quality of sex that has people rate their sex lives as satisfactory.

It is literally how often and how openly they're able to talk about sex. Mm hmm. Okay. So but a lot of us, you know, I know for me, this is true. And many of us were raised in homes where talk of sex is taboo.

Right. My parents certainly never would talk to about sex from their parents. And it was considered almost like, you know, it happens somewhere over there and nobody talks about it.

Right. So I think learning to talk about sex is the important thing. And intimacy. Intimacy is basically, as you mentioned, authenticity. It is. I like to say it is into me, you see.

Right. Is showing your revealing. And if part of it is I'm feeling less attractive myself, I'm being less attracted to you or I'm having some sexual, I don't know, fantasies, things that I want to try out.

Right. All of these things because we don't know how to talk about it. We squash. And then on top of that, there is just life and the fact that we don't know how to get through differences in parenting or money or how to deal with external family members and all.

So all of that comes together and the partners decide that there's no point, quote unquote, in talking about it because they don't know how to talk about it.

And that leads to the just let's just coexist. So I think intimacy, sex is such an important part, but it's actually the talking about sex. Agree. That's intimacy.

And that can be a big challenge for people who are struggling. You know, I think this is a really great discussion. I so appreciate your insight into, you know, a person's attachment, a person's relation with their partner and also how sleep disorders may play into all of their responses, including anger, worry and insomnia and sleep apnea.

It's been a great discussion. I wonder if people want to work with you. How does that look? So thank you. First of all, I really enjoyed it too. I always learn something when I speak with you and I'm so it's so cool to see you doing this and see you out in the world and sharing your expertize and genius.

Thank you for having me. So people, if they want to work with us or find us and talk about look at what we're doing on my website is healyourrelationships.com We also have free Facebook group called Heal Your Relationships.

So and we also have a podcast also called Heal Your Relationships. So easy way to find us. That's amazing. Thank you so much, Dr. Sun. It's been a pleasure. Thank you so much.

Take care.

Kavetha Sundaramoorthy, MD

Your Spouse’s Insomnia: A Guide To Coexisting