What is a Sleep Divorce?

Pre-show banter and sponsor intro 0:00

All right, it's a new show. That means it is time for pre-cals. What's going on, gentlemen? Well, Jerry, we have Dr. Wendy Troxell coming on today. She's a clinical psychologist and a sleep researcher. she's been on some TV, done some Ted talks. I think she is going to be really interesting. Her focus is couples and sleep and does a little work on there's adolescence and asleep well, but she has become very popular because of her work around couples. And so, yeah, it's going be fun to talk to her today and hear a lot about what her thoughts are on how maybe some of us can do a little bit better at home at night in our relationships.

You know, it's amazing how comprehensive sleep is becoming. You now, we've all been sort of hyper-focused on sleep apnea, sleep, apneas, and now it becoming, you know maybe it because of technology with all the wearables and some of the, serious technology like the endotyping and phenotypping that's out there. But, to have someone treat couples, you know, specifically. This is going to be a super interesting conversation and I look forward to hearing, uh, her perspective on this because I know we all who are married have our own challenges, I'm assuming, occasionally as it relates to sleep and whether either one of us gets a good night of sleep, and how that might impact our day the next day.

I want to say one thing, you mentioned two words, endotyping and phenotypping. How about we all take a shot every time we hear Emerson say that in the episode. You know, that's one of his favorite, those are some of the favorite terms. It is. Let's play a little game. Folks out there, let's count how many times he said it and then put it in comments. That's right. All right, awesome. On to the show. Now a word from our sponsor, MedBridge Healthcare. Medbridge Healthcare is a leading provider of sleep lab management services and home sleep apnea testing.

MedBridge partners with hospitals, healthcare systems, and medical academic institutions to offer comprehensive, fully integrated services for sleep disorders.

Introducing Dr. Wendy Troxel 2:34

Sleep Tech Talk is brought to you by Fisher & Paykel. Fisher and Paykel Healthcare is a leader in CPAP masks design and innovation for over 20 years. Their unique technologies have benefited millions of OSA patients through their top CPAC masks. These advancements continue to further enhance patient experience and outcomes. Welcome everyone once again to another episode of Sleep Tech Talk, the Sleep Podcast with your hosts and friends, Emerson Kerr, Robert Miller, and me, Dr. Gerald George Monikerode.

Folks, thank you so much. As you know, we've crossed a hundred episodes and we just continue to grow, but that's thanks to you. Huge shout out to each and every one of you, Thank you for your support. Please continue the like to share and subscribe. We really, really love the shares that you've been doing and the constant engagement. And huge shout out to our sponsors, without whom we couldn't do this either. And be sure to check out the sponsors in the links below. With that being said, Aaron Emerson, what's going on today?

Thanks Jerry, we are so lucky. We have Dr. Wendy Troxell with us today. She is an internationally recognized sleep expert and senior behavioral scientist at the Rand Corporation, a licensed clinical psychologist and certified behavioral sleep medicine specialist with over 20 years of experience. She is also the adjunct professor at the University of Pittsburgh and University Of Utah. Her research funded by the National Institutes of Health and Department of Defense and private corporations focuses on how sleep impacts health, relationships and performance.

She served on the NIH Sleep Disorders Research Advisory Board and the American Academy of Sleep Medicine Task Force and is among the top cited sleep researchers globally. Dr. Troxell authored the book, Sharing the Covers, Every Couple's Guide to Better Sleep, which was recognized by the New York Times as essential reading. Dr Troxtell's TEDx talk on teen sleep has garnered over 2 million views. Her insights have featured in major media outlets, including CNN, BBC, NPR, and The New Ariana Huffington named her one of the five most influential people in sleep, recognizing her unique ability to translate complex science into actionable wisdom that changes lives, relationships, and policies.

Dr. Troxel, what a pleasure to have you on with us today. You know, one of the things that we love to do is just take a couple of minutes and ask how you got into sleep because you clearly had a wide range of opportunities with your psychology background. What drew you into Sleep Medicine? Yes, well thank you so much for having you here today gentlemen and congratulations on your hundredth episode that's really exciting. And I love to answer this question about what drew me into sleep. It actually began during my graduate school training towards the end of getting my PhD when I was working on my dissertation.

Throughout my graduate school, my doctoral training, I've always been interested in why relationships are so important, not only for our mental health

How relationships led Troxel into sleep research 5:44

and well being, but also for our physical health. So I had been doing a lot of work up to my dissertation and through my dissertations on the role of marriage and marital quality as it relates to cardiovascular disease risk. And what we know from my early work and others is that being married confers health benefits. particularly for men, that married men tend to live longer, happier and healthier lives than their unmarried counterparts. It is also true for women, but that relationship between marital status and health outcomes is actually somewhat less consistent for woman.

And from that, I started to look at, well, maybe it's not just being married that matters, for, women it is particularly important to see the quality of relationships. Because a high quality, supportive relationship should confer health benefits for a woman, and it does. But a strained or stressful relationship may actually be a profound source of stress, particularly for women, which could confer health risks. And that's actually exactly what we found in my early work. From that original line of research, I wanted to unpack why it is that being married and particularly being in a good quality marriage or marriage-like relationship, why that matters for these really protracted disease outcomes like heart disease risk.

that's really where I stumbled upon sleep. This was about 20 years ago when sleep was really blossoming and emerging in epidemiologic research where we were starting to show these really robust associations between the duration and quality of sleep and your risk for all sorts of health outcomes including heart disease risk. So I got to thinking Well, sleep matters for cardiovascular disease risk. Relationships matter for Cardiovascular disease, risk and most couples. In fact, about 61% of adults share a bed with a partner.

So most adults. sleep with a partner. And yet no one really in the sleep field at the time was looking at sleep in a context in which it occurs for most adults, which is in couple sense. So that's really where I embarked on my journey into sleep from this relational perspective. That's where my career has always kind of had this relational or social context lens to sleep, whether it be the couple or the family or neighborhoods in which we live, or even the public policies under which you live. All of that can influence our sleep.

Well, that's a great answer. I was looking at your website today, and I highly recommend anyone listening to go on it. We'll have it in the show notes so you can click the link. But something that you brought in there that was really fascinating was how the impact of the relationship on sleep differs between men and women. So if a guy, three of us being guys, this definitely applies to us. If we have poor sleep, it affects our relationship, whereas it's the converse, it is the way it sounds with women.

So can you take us through that and explain why this is so different? Because it almost sounds like a catch-22 for so many people when sleep and relationship are both off. You're absolutely right. It can be a catch-22 or a vicious cycle where poor sleep leads to poor relationship functioning and so on. But I like to think of wherever there is the potential for a viscous cycle, there's also an opportunity for virtuous one because it means we can intervene either on the relationships or the sleep and have a positive impact on both domains.

And that work you referred to was actually some of my early work conducted with Dr. Bram Hassler at the University of Pittsburgh. And what we did was we had a, I think it was a 10-day study where we measured people's sleep on a nightly basis using actigraphy and sleep diaries.

Sleep and relationship dynamics in couples 9:54

We also measured their relationship quality using daily diarys on daily basis throughout that period. As you said, for men we found a strong relationship between how well or not well he slept at night. That predicted his relationship quality the next day. So when a guy had a bad night of sleep, the day he reported poor relationship satisfaction. What was so interesting was that for women, it was the opposite direction. So for women, we found that if she reported sort of negative relationship dynamics during the day, that impacted both her sleep and her partner's sleep that night.

In other words, if, she's not happy, no one's sleeping particularly well. And so it's really interesting to show these, you know, sex differences as well as these bi-directional associations between relationship quality and sleep. And it really, again, suggests an important and innovative opportunity for interventions, either at the side of the relationships or at side the sleep, or in my work, what we're doing now is we are merging them both by trying to treat sleep disorders within couples. Dr.

Troxel, I don't know if you coined the term sleep divorce, but it sounds like we're headed toward that particular topic. So can you cover sleep, divorce for us? And I know that it's been, you've been able to be on multiple programs to talk about that. And, uh, and our audience would love to hear more about the sleep. Absolutely. Well, not take credit. I did not coin the turn. sleep divorce because it has such negative connotations. And it really reflects the stigma we have in society against couples sleeping apart.

Yet this stigma is actually not science-based at all. Because as I said, in the early days of my research, really no one was studying sleep in a context of couples. So we really have very limited data on the benefits or consequences of sleeping together or apart, And what we do know, however, from my work and others, is that sleep is critically important for the quality of your relationship. So this concept of sleep divorce, again, all it refers to is couples who choose to sleep apart. There's actually no data to suggest that simply the decision to sleeping apart has any negative impact on relationships.

In fact, the term I have coined is called a sleep alliance. because that really has a more positive focus. And it's really what I encourage couples to do is to really work on building an alliance and using open and honest communication to discuss the sleeping arrangement that's going to serve them as a couple best. Because really the ultimate goal is for both partners to sleep well, given that the science does show that sleeping well can benefit relationships. So that may look different in different couples.

There truly is no one size fits all sleeping strategy that's going to work for all couples and, you know, for the couples out there who are choosing to sleep apart. Again, I can tell you that simply the decision to do so does not necessarily mean that there are problems in the relationship. In fact, for many couples who choose to sleep apart, they will swear that it's the key to the relationships satisfaction because they're finally both sleeping better.

Sleep divorce and sleeping apart 13:42

So again, it no one size fits all strategy. It is not a term I've coined. I do get asked to comment on it quite a bit. But what I encourage couples to is to open the conversation about their shared sleep. And if it's working for them, great. Many couples really do benefit from the experience of shared sleeping. There's also some potential physiological benefits of sharing a bed. But if crosses a threshold where your partner is for whatever reason, disrupting your sleep to such an extent that even if it feels good psychologically to share a bed, that might reach a point where your asleep is so disrupted that sleeping apart even occasionally might have some benefits for you.

So, Doc, what are some of the reasons where people would sleep separately? I mean, typically, we always think of snoring, and that's the pain in the side because the bed partner is elbowing them in their ribs. That's why they go to the sleep center. But we all know there's a whole lot more than just the snorring. What other reasons could cause this need to separate bedtimes or beds, for that matter? Absolutely. Yeah, there's lots of reasons why couples may choose to sleep apart, either in separate beds or even separate rooms.

Snoring is the one that absolutely gets the most attention. And by the way, I like what you said, which is important. It's another reason why I study sleep in couples, particularly in the context of apnea, because guess what? Partners are often the primary motivator to get the patient with sleep apnea into the sleep lab in the first place. So that's a really powerful measure of social control, we would call it in social psychology. And it's actually one of the benefits of being in a relationship that you have a partner saying you better get to the Sleep Lab to see what's going on because it is affecting both of us.

But beyond sleep apnea and snoring, there are many other reasons why couples may choose to sleep apart. Maybe they have different sleep schedules, either due to work schedules or their intrinsic chronotypes. She's a lark. He's an owl. And, you know, so, one is ready for bed at 10 p.m., where the other one, is simply not at all sleepy. The owl is not going to be sleepy at ten p m. So that may be a reason. Children, particularly young children who like to weasel their way into the bedroom at night may sort of lead to at least a temporary sleep separation for couples who are just trying to get any sleep they can.

Different sleep habits. Whether one partner likes to bring their iPad or iPhone into bed and the other partner is really trying to be very strict about good sleep hygiene. Maybe one part tosses and turns or insomnia in one or both partners, which simply means that their threshold for being disturbed by the partner might just be lower. And so they might be looking for strategies to optimize their sleep, including testing out sleeping apart. Fisher & Paykel Solo is the world's first autofit CPAP mask.

It simplifies setup with its revolutionary auto-lock technology. Simply stretch to fit, touch to adjust. Go to fphcare.com forward slash solo. Are you a sleep tech looking for new opportunities? Well, MedBridge Healthcare is one of the largest employers of sleep technologists and they are growing. If you are a Sleep Technologist interested in a new position, potential paid relocation, or looking for a career advancement, consider a Career with MidBridge Healthcare. Now back to the show. Dr. Troxel, I appreciate the approach and certainly it's a way to restore marriages.

I think if you can fix the sleep problem between couples, but a question for you, is there a time where you potentially have to separate the husband and the wife to deal with specific issues that are individual to them? We've talked on our show with a few of our guests about the complexities sometimes of women and sleep issues. And I remember one of our conversations with Dr. Valerie Caccio, she talked about that sometimes she had to deal with hormonal things and other types of issues for women specifically before she could deal the sleep apnea that may be an underlying issue as well.

So what's your approach to individually, I guess, correcting the issues related to sleep, but then bring those back together so that they can have a harmonious night of sleep between the husband and the wife.

Why couples sleep separately 18:18

What's very interesting that you bring this up and I see this clinically all the time. You know, my clinical practice is predominantly focused on insomnia and it's a very common scenario where I will have a couple come in to see me, primarily led by the wife who is struggling with sleep and sort of wants my support and guidance in helping them to find sleep strategies, including permission to sleep apart. And again, while I'm absolutely not prescriptive about how couples should sleep together or apart, and I really wanna work with couples to the find the strategies that work best for them, often in our exploration of what's going on, she might be adamant that it's entirely her partner that is causing her sleep disruption.

But once we get into the work together and I do a thorough sleep history. You know we discover, oh, well, she has underlying insomnia that far you know preceded any issues that she had with sharing a bed, or we might discover this. you know, an experimental process because often, you now, if I have a couple who comes in to see me and one partner is really motivated to try separate sleeping arrangements and the other partner's resistant, I often deal with that resistance by saying, why don't you guys experiment?

Why don' you try it out for a weekend and see what it's like to sleep apart just for the weekend or maybe two days during the week and then return to the shared bed. And from that experiment, a couple of things might be revealed. Number one, the individual who's super motivated to sleep apart because she swears that it's her partner that's causing her sleep disruption might find, oh, it not actually all about him. I didn't sleep so well even while sleeping alone. And that a great strategy for us to then say, great, we're going to dive in with your treatment of insomnia.

On the other hand, sometimes the partner who feels very resistant to the idea of sleeping apart in part because again, there's a lot tied to The Marital Bed in terms of the meaning and the impact and people fear, oh my gosh, it's going to mean the loss of intimacy, the lost of closeness. So that partner is facing some resistance in the context of this just experimental approach, which is not permanent. They can say, Well, wait, you know, that was two nights and we, it didn't kill our sex life. We were able to sort of go about our normal life, we felt just as close as before.

So that experimental strategy, kind of removes that pressure from both partners. And again, as you said, It allows us to identify where there are dyadic influences. That is, that the partner is in fact disrupting your sleep, for instance, at the beginning of the night. But it's not entirely him. So it gives us multi-level strategies to improve sleep. Which is again, sort of, the focus of all of my work is that there's often, you know, individual approaches matter. They're quite effective. but often we can boost our treatment effectiveness by incorporating different levels of the social environment, be it incorporating the bed partner or

Treating sleep issues within the couple 21:30

at broader social context, intervening in neighborhoods or communities or on public policy. Dr. Troxell, one of the things we get to talk about on here is things that are new and exciting. And we've only recently learned that the study of just women in sleep is relatively new. It's amazing that I think women and just medical research is really only the last 30 years. So as you kind of are looking at the frontier of what your research and we think about endotypes and phenotypes, and kind what's next, what is next on the radar for you and what do you see in the world of couples and just these features that we're talking about of endotyping and phenotyp.

Where does that fit into your future work as a clinical psychologist? Yeah. Well, and I consider myself a clinical psychologist and a sleep researcher, but also a women's health researcher because that's always been a focus of my work. So I'm really happy to see this sort of increasing awareness that women are not just little men, that our sleep is different. The factors that influence our asleep are different across the lifespan. And again, we can't effectively address and identify women's sleep issues simply by following a male model.

So in my work, I'm doing a number of things that I think are really driven by this lens of trying to better understand the experience of sleep among women, particularly as we age. And understanding the social context, which relates to all of my works, is critically important. For instance, when I have a number of studies happening right now that I'm really excited about that are actually treating sleep apnea in the couple level context. That is we are helping patients hopefully better adhere to CPAC treatment by incorporating the bed partner in a very systematic way and also kind of giving something to the bed partner as well so that they're not just along for the ride, we actually incorporate into this behavioral treatment both CPAP adherence strategies, but also sleep quality improvement strategies for both partners.

And what we're finding is that this approach seems to be very motivating for female patients. In fact, disproportionately, We are seeing greater success in our clinical trials in terms of recruiting women with apnea than in other larger trials. And again, I think it's because we are really viewing sleep and sleep disorders in the lens that women experience it. You cannot disentangle the experience of sleep apnia or using CPAP from the relational context. And for women in particular, there's lots of barriers or perceived barriers to treating sleep apnea because of concerns about the impact on intimacy or sexiness or appearance.

And so we're really trying to target that head on by having a very relationship centric approach, which I think, you know, does actually really appeal to women. And more generally, my work is really, and one of the reasons why I'm so excited to be on this podcast. and the science of women's sleep, because there's a lot of voices out there about sleep. And sleep has definitely become a hot topic right now. But it can be predominated, no offense to those in the room, but by a bro science perspective.

So we do need more voices that can speak to the unique experiences of woman throughout the lifespan as it relates to our sleep and so I'm really happy to contribute to that. Doc, thank you so much. It's been a really, really nice conversation so far, but we are out of time. Is there anything else you want to add where people can find you or get more information about you?

Womenu2019s sleep research and future directions 25:48

Well, I'm really thrilled to get to talk to you all today. Thank you for the time and for interest in my work. I am on social media, on LinkedIn, Dr. Wendy Troxell, also on Instagram. My website is wendytroxel.com. Of course, there's my book, Sharing the Covers, Every Couple's Guide to Better Sleep, which sort of runs the gamut of all the existing research and some of my clinical experience related to couples and sleep really across the lifespan. So please check it out. And of course there are my TED Talks.

I have two of them, one on couples in sleep and one adolescent sleep, and the conflict with early school start times. Awesome, thank you so much, Doc, it's been a pleasure. You all as well, Thank you. And folks out there, thank you so much for joining us. It's been an absolute pleasure with you all as well. We thank so you much the likes. Thank you for the subscriptions. And most importantly, we thank for sharing the podcast with all your friends, all Sleep Professionals, fellow Sleep professionals, and most important, Sleep Curious, trying to understand what's going on out in this world.

Please continue to support our sponsors. Until next time, lights on. Alright, another show in the books. That means it's time for post-cows. What do you guys think? You know, one of the things that stood out to me, Jerry, was how long Dr. Troxell is feeding, is really treating the family. And it reminds me a lot of our episode with Dr Aflobi Brown and what she does with pediatrics. She takes care of parents and the whole family, and it is just really fascinating when you think of that kind of approach to medicine, that the whole couple could be treated, the family could treated is really just fascinating to me.

Because if we think about some of the things that are a hindrance to success, I had a doctor I used to call on here in Alabama as a successful boarded sleep pulmonary physician, fantastic guy, and his wife wouldn't even let him have a CPAP in the bedroom. And so when you think about it in that kind of context of that lack of support, because maybe the feng shui was thrown off, it really speaks to the importance of having the whole family involved. So it was really beautiful to hear that today from Dr.

Troxel. I'm just enamored by the fact that you said Feng Shui. So I'll just tell you that. You know, I've brushed up on my vocabulary just a little bit. There's multiple things that play here today. I mean, number one, we got to hear, you know this sort of approach to treating different sleep disorders. And by the way, as a sleep tech, did you ever do a asleep study and you, maybe the spouse or significant other stayed over in the room and at some point during the night you hear snoring on the intercom, but it's not coming from the patient that is having the sleep study.

That happened a lot actually. Yes. So we know that this is definitely an issue for couples. She did use the term bro-science. I'm going to have to figure out another place in my life to be able to insert that particular phrase. You hear it a lot in the gym, bro science. Bro science, all right. Well, you know, but you think about it, I learned this just when we were at sleep in Seattle just a couple of weeks ago, is that research on women in medicine didn't really start till, I think, 1993. It's terrible.

So when you think about this, it's awful to think. And then just in sleep, probably in the last 20 years, less than that, that we've seen that.

Closing remarks and post-show discussion 29:38

Seeing this focus on couples really is fantastic because it does affect everyone. As Robert pointed out, It could be the other partner. But if you about some of the things we're learning about women in And we focus on the guy and his snoring and how heavy that is. But if she's having periodic limb movements and she is having some upper resistance and things like that, she could be just as disruptive to sleep as her partner is, so I think it's really fascinating that we see this holistic approach.

And it is just, like I said before, a beautiful approach to what sleep medicine can be. I can 100% confirm, by the way, that if my wife has a bad night of sleep, then it's going to result in a day potentially for me. If mom is not happy, nobody's happy. I just want to say this about what you just said, Robert. Congratulations. Happy anniversary. How many years is it? The recording of this episode, robert is celebrating his anniversary, Yeah, 35 years. Congratulations. That is fantastic. God bless.

Beautiful family. Yeah. Well, folks, thank you all so much. Gentlemen, I think it's a good time to call it, right? Awesome. And if you did pay attention, please put in the comments how many times Emerson did say phenotype and endotype. We really want to see that. All right, guys, until next time. Cheers. Before we go, we would like to thank our sponsor, MedBridge Healthcare. Medbridge Healthcare is developing innovative inpatient post-discharge and population health programs to screen comorbid conditions, diagnose and treat sleep disorders.

Learn more about their innovative solutions and career opportunities at medbridgehealthcare.com. Once again, you can learn more about their innovative solutions and career opportunities at medbridgehealthcare.com. Our clinical sponsor, Sleep Review Magazine. More details in show notes.