Ep 297: Can’t Sleep During Pregnancy or Postpartum? Here’s What Actually Helps with Behavioral Sleep Medicine Specialist Dr. Daniella Marchetti

Dr. Nicole (00:00.31)

If you're struggling to sleep during pregnancy or postpartum, you are definitely not alone and it's not just about being tired. In this episode, I'm joined by clinical psychologist and sleep specialist, Dr. Daniella Marchetti, to break down why sleep can feel so elusive in motherhood and what you can do about it. We're talking real strategies, the truth about things like melatonin and Benadryl and why sleep when the baby sleeps, just don't cut it.

Tune in, this episode might just change your nights.

Dr. Nicole (00:39.512)

Welcome to the Birth with Power podcast where knowledge is power and power transforms birth. I'm Dr. Nicole Callaway-Rankins, mom of two and practicing board certified OB-GYN with over 20 years of experience and nearly 2000 births attended. I've seen firsthand how the hospital system can leave women feeling unheard and uncertain, but that doesn't have to be your story.

Here, you'll get the knowledge, support, and strategies to take charge of your birth experience so you can walk into the hospital feeling calm, confident, and empowered. Note, this podcast is for educational purposes only and it's not a substitute for medical advice. See the full disclaimer at drncolmargains.com forward slash disclaimer. Now let's get to it.

Hello there, welcome to another episode of the podcast. This is episode number 297. Whether this is your first time listening or you've been here before, I'm grateful you're spending some time with me today. Today we're diving into a topic that so many of us face, but we don't talk about it enough. And that is insomnia and sleep struggles during pregnancy and the postpartum period. I'm joined by Dr. Daniella Marchetti, a clinical psychologist and health psychologist

with a specialization in behavioral sleep medicine. She holds two master's degrees and a PhD from the University of Miami. And in addition to working in a hospital, she runs a private practice focused entirely on sleep issues, from insomnia and nightmares to sleep apnea and sleep training. In our conversation, we explore what really causes insomnia during pregnancy and how it's different from just having a tough night.

We also talk about why that typical advice like sleep when the baby sleeps falls real flat and how cognitive behavioral therapy for insomnia, that's CBTI, can be a game changer. If you've ever felt overwhelmed, exhausted, or unsure of where to start with your sleep, this episode is for you. So let's get into our conversation with Dr. Daniella Marchetti.

Dr. Nicole (02:58.914)

Thank you so much, Dr. Marketti for coming on to the podcast. Y'all before we started, I just totally mispronounced her name. So I'm glad that we got that together. So I am excited to talk about this topic of particularly insomnia in pregnancy and postpartum. So thank you for coming. So why don't you start off a bit by telling us about who you are, the work you do and your family, if you'd like.

That's my pleasure.

Dr. Daniella Marchetti (03:23.416)

Sure. I'm a clinical psychologist. My background is in health psychology in particular, so helping folks at that intersection of mental and physical health. I specialize in behavioral sleep medicine, so the bread and butter of what I do is insomnia treatment. And I am based out of South Florida. I have three kids, so I am particularly passionate about helping young families with their sleep. And in fact, I just welcomed my latest, you know, not even two months ago.

Oh my goodness, wow. So you are still like in the fourth Charmester. I am. figuring things out and yes. yeah. And how old are your other two?

So I'm a six year old, a three year old, and now my newborn. Absolutely.

So you have a full house. Well, good. Well, it's important. You talked a little bit about your background, but I also want you to say maybe in a little bit more detail your training because it's important for to me for my listeners to know the background and training that people are basing their recommendations on, especially I think in the wild, wild west of the Internet and social media where anybody pops on and says anything and not that there's not some value to personal experience, of course, but I also

like to hear people's training and backgrounds. So what's your training to do what you do?

Dr. Daniella Marchetti (04:39.224)

Sure, yeah, I definitely agree with you. It can be a little buyer beware on the internet. So I myself, have two master's degrees in psychology and counseling. And then I received my doctorate at the University of Miami on a health psychology track. And so that exposed me to a lot of different modalities, working in medical settings and doing outpatient therapy with folks that might be contending with a number of different conditions. So things like...

chronic pain, diabetes, adjusting to new diagnoses, and then of course, behavioral things, behavioral health items like weight management and sleep. And when I was exposed to behavioral sleep medicine work, I decided that was the area where I really wanted to specialize. And so I completed hundreds of hours, supervised hours in behavioral sleep medicine, did a lot of extra CEs and additional.

trainings and CBTI and then other other modalities as well like image rehearsal therapy for nightmares, etc. So that I could sit for the diplomat in behavioral sleep medicine. And so I was boarded, which basically means that I have I'm more than proficient to deal with a number of different sleep issues. It is the highest accreditation that you can get in this particular field.

Okay, yes, I love it. it, again, not to discount other people's experiences, but I think there's something to when people when someone puts some effort into really learning about something, it makes a difference. And obviously, you have put some effort into learning about sleep. So you're the perfect person to talk about it today. Yes. So why don't we start with the basics and

What exactly is insomnia and how is that different than just having like maybe a tough night of sleep?

Dr. Daniella Marchetti (06:34.05)

Yes, and this is a great question because I feel like insomnia gets tossed around colloquially very often. Now, everyone has had a rough patch of sleep and may know what that feels like. But insomnia in particular is when you've had an issue with either falling asleep, staying asleep, or even issues waking up too early. And these are pervasive. So they happen at least three times a week and they've been happening for about three months or so.

Right? that now it's more of a chronic condition and you just haven't been able to get back to maybe what your baseline sleep was.

Gotcha, gotcha. Okay. So then, actually three months feels like a long time, but also you also want to make sure that, I don't know, that it's going on for enough and not just sort of here and there kind of thing before you call it something. But three months does seem like a long time to be worried about.

Can I tell you, I wish that folks would come to me at three months because usually my patients have had insomnia for years. Really? I've had patients that have had insomnia for decades before they find me.

Heel-

Dr. Nicole (07:41.582)

they just think it's normal? Like that's just how they sleep or whatever.

Exactly. Yeah. A lot of folks think that, you know, it's par for the course. This is just what life is. And, for being honest, you know, the CBTI, which I'm sure we'll dig into, I feel like just has less of a marketing team than maybe other solutions for Enzami.

Yeah, gotcha, gotcha. Okay. So then how often do you see pregnant women and new moms have insomnia?

So in my private practice, I like to think that I specialize in this area, again, with young families. But statistically, one in four women have insomnia in the first trimester, in early pregnancy. And that number jumps up to 80 % by the end of the third trimester. And then afterwards, it really actually stays with women. I think about eight weeks, which I'm around the corner of.

those numbers still peak at around 60 % and it remains elevated at 41%, you know, even two years later.

Dr. Nicole (08:43.446)

I think as an OBGYN, I didn't know this, which is kind of embarrassing, but I think it's because we don't ask and we don't really talk about it. So I think it's important to know that this is, and for people to hear that this is actually pretty common. Yeah.

Right. And yeah, I think that's the double-edged sword, right? Because it's so common. It's like, yeah, okay, you're not sleeping. Big surprise there. But then sometimes there's that need that just isn't met then with maybe a clinical intervention.

Gotcha, yep, yep, yep. So do we know what causes insomnia either during pregnancy or in that postpartum period?

Absolutely. So there's a number of things. In both the pregnancy and postpartum period, there's lots of hormonal changes. So during pregnancy, we have these increases in estrogen and progesterone, which can contribute to insomnia through multiple avenues, either increasing cortisol, so if we're feeling stress, or even having swelling, congestion, these things can just drop sleep.

progesterone, which ironically is supposed to make you feel really sleepy during the day, it actually leads to more nocturnal sleep fragmentation. that getting up in the middle of the night and then maybe not being able to fall back asleep. And it can disrupt sleep cycles and even the amount of REM sleep that people can get. So these things happen during pregnancy along with the obvious physical discomforts, right? Like we're getting heartburn, back pain, increased need to use

Dr. Daniella Marchetti (10:20.318)

the restroom in the middle of the night. So you're having all these awakenings. And then you're also more likely to develop sleep apnea and restless leg syndrome. And sleep apnea is one that, forgive the pun, a lot of people are sleeping on. Because it actually has huge impacts, not only for maternal health, but also for baby's health. And nobody's really talking about that.

Bye.

Dr. Nicole (10:44.994)

that is a really important point. Certainly more talk about that within our community that we're not looking enough for sleep apnea and how it contributes to things like preterm labor and baby not growing as well. So it's definitely something that's really important to bring up. So I'm glad you brought that topic up. So let's talk about, and we'll get into some of the like therapies and strategies and things like that. But I want to talk about a few maybe like myth busting or help people to kind of figure some things out.

Some women might feel like, what is wrong with me? Like, why can't I sleep? Especially when they're already tired. What am I doing wrong? What is happening? So what do you tell women or what have you seen them think around? Like, why is it that I can't sleep even though I feel so physically tired?

Right. And you actually bring up a very important distinction. You can't sleep even when you're tired. That's how you know it's insomnia and not just sleep deprivation, which can also happen with pregnant women and women in the fourth trimester. Sure. Sure. Initially, there might be some sleep deprivation because you're up at all hours. But when there is opportunity to sleep, if you cannot fall asleep, that is insomnia.

Gotcha.

But what I would say is, insomnia is very different from other health behaviors. And this is why I was actually really interested in studying it, because we can't force this behavior. We have some control over whether or not we can exercise, some control again over the foods that we eat and how much water we drink, but when it comes to sleep, we can't just shut off. All we can do is promote good sleep and invite it in.

Dr. Nicole (12:27.618)

Right.

Dr. Daniella Marchetti (12:33.602)

but it's something that needs to unfold naturally. So there is an element that is a bit out of your control. It's not that you're doing something wrong. It's that over the course of years, maybe this was a behavior that was learned. There is usually predisposing factors like your sleep chronotype. Are you more of a morning lark or do you have more of a night owl tendency and there's a mismatch with your day's work and...

what you want to be doing at night. Or their childhood customs that might have colored the way that you approach sleep. And precipitating factors. Did you have a job transition, a divorce, a loss, a new addition to the family? These things often precipitate insomnia. And then the part you can control are what are the things that you're doing to perpetuate it now? And that's where treatment comes in.

Gotcha, gotcha. And then let's go ahead and tackle the infamous advice of when you have a new baby to sleep when your baby sleeps. Why doesn't this work for so many women? Why is this kind of like trashy advice?

I internally cringe a little bit when I hear this one because firstly, not everyone can sleep on command or on another person's schedule. I myself never been able to nap, just not in my biology. so for me, that was never on the table. But really consider the new mom archetype in 2025. She has...

many things she's juggling. She's going to be prioritizing chores, probably, things she hasn't gone around to. She may have other children. She may be working. And she may want to be doing other things that nourish her on other levels. So if you've always exercised, you might use that 30, 45 minutes to jump on your peloton or to go for a walk or to do something or to read or even the most common ones, just stay.

Dr. Nicole (14:38.274)

See you.

Right? So there's a lot of things that compete for time.

Right. Nowadays. Okay. Okay. Gotcha. Gotcha. And you know what? Another question that just popped up before we get into some strategies is why is sleep even important? I remember way back in medical school, we had a professor and she would just, you her response was kind of like, well, you have to sleep because if you don't sleep, then it just hurts your health. Like you have to sleep because you have to. like, can you kind of expand upon like what happens if you don't sleep and what are the...

benefits, why do we need sleep, period, as humans?

Yeah, so sleep serves actually a lot of different functions. So there is that, you know, the low hanging fruit is, you know, the immune, the immunity piece, right? So when we're in our slow wave sleep, we have human growth hormone that's being released. And that's not just something that helps little kids develop. It's something that helps, you know, tissue and muscle repair, you know, so that keeps us going. But then there's also the cognitive piece, right? We get our memories and we move them from short term into long term.

Dr. Daniella Marchetti (15:45.71)

when we're in slow wave sleep. It helps us with our reflexes so that, God forbid, you need to make a quick turn when you're on the road, you're able to stay safe. So there's the cognitive function, the immune piece, our ability to also just not get things like the flu or the cold. So there's so many different things.

Definitely. And then what is the difference between, like, why is REM sleep important? How much are you supposed to get for that?

Yeah, so I love talking about this because I feel like folks really feel that REM is the important one. And actually, so there's those three stages, stage one, two, three, and then REM. Okay. And I would say the most important stage is stage three, where we're that slow wave sleep. That's that deep restorative sleep. Okay. REM is deep as well, and that's where 95 % of our dreaming happens. But I'm more interested in stage three because that's where my memories...

are going into into that long-term memory bank. That's when my tissues and muscles are repairing. And that's where we're going to feel the most

Got you. Got you. Okay. All right. That's good to know. Good to know. All right. So let's talk about strategies and I'm guessing there are different strategies for falling asleep versus staying asleep. Is that true? And so let's talk about, and maybe there is, maybe it isn't, we can talk about it. So what are like two or three strategies that can help with falling asleep and then also with staying asleep and then may differ pregnant versus postpartum. So let's do it all.

Dr. Daniella Marchetti (17:22.27)

Yeah, so with sleep onset, know good sleep really starts in the morning and the average person it takes them about 14 to 16 hours to feel sleepy enough to actually fall asleep So one of the big things is actually not sleeping during the day trying to eliminate naps Now in pregnant women or postpartum women, you know, I would say that's that's where there's an exception there because now you're also in sleep deprivation territory show

And this also goes for folks that maybe contend with chronic illness. If you're struggling with insomnia, yes, we usually say, no, don't take any naps. But if you are in one of these groups, naps can be helpful at the beginning of the day, 30 minutes, make sure that they're not happening too late into the day. And the reason why we cap them at 30 minutes is so that we actually prevent ourselves from getting into those deeper stages of sleep. Because if you do, maybe take a two or three hour nap.

Gotch.

Then you're going to wake up disoriented and groggy and may not feel so good. So making sure that you're tired enough or sleepy enough at your bedtime is important to help with sleep onset. Filling your day with activities, with sunshine, with movement, and just maintaining a regular schedule. So every day rising at the same time, eating more or less at the same time, moving more or less at the same time.

These things that you do during the day are going to set you up to have an easier time at night.

Dr. Nicole (18:50.882)

Gotcha. All right. Anything else that helps with staying asleep or falling asleep?

So with staying asleep, one of the most important things is actually getting out of bed when you're unable to. And there's two reasons for this. Okay. Yeah. And I know this one is the one that usually we struggle to get by and on because I know the knee jerk reaction is how am going to sleep more if I'm not in bed? if you're in bed and you're tossing and turning or you're worrying,

Yeah, well.

Dr. Daniella Marchetti (19:25.888)

or you're planning or you're just unable to fall asleep. We're starting to build this association of wakefulness with our bed. Okay. So one prong is we want to get out of bed when we're not sleeping so that we can have a strong association of our bed with sleepiness. Okay. So that means staying out of bed when you're awake, right? And that goes for during the day and at night. So making sure that you're not eating in bed, watching TV in bed, scrolling in bed, even reading in bed. Okay.

And that's a tough one for postpartum women because oftentimes you're with newborn baby and where are you going to set up camp, right?

Probably.

You know, so making sure that you have a designated space for daytime rest that isn't sleep is really important so that you're not creating that association of wakefulness with your bed. And then the second prong is we don't want you to be tossing and turning in the middle of the night in bed because now you might be getting frustrated. You know, if you wake up and you see that clock and it's three a.m. or worse, like an hour before you're actually supposed to be awake for work.

Okay, that is like the, I hate it when that happens. Yes.

Dr. Daniella Marchetti (20:37.898)

Now, see, so that's a problem waking up too early. if that happens to you, now you're mad, you're frustrated. Maybe you've had a knee-jerk reaction of like, this is never going to get any better. that's going to keep you awake too. So the more that you stay in bed fighting and trying hard to sleep, the more that it's going to elude you.

So getting out of bed and doing something in dim light, something to distract yourself that's going to induce sleepiness is preferable because now you're not giving time to some of those frustrated thoughts and you're doing something else that is going to help bring that sleepiness on, whether it's reading somewhere else or listening to a meditation, a relaxation exercise. I've heard it all. Some people, you know,

Yeah.

Dr. Daniella Marchetti (21:28.91)

pray, some people work on Lego sets. You have to find the right activity for you. And then you just come back to bed once sleepiness comes back on.

So at two o'clock in the morning, if you wake up, ideally, if you're tossing and turning, then it's better for you to get up, go to another place, do something that helps you to get sleepy, and then go back to bed. Correct. I did not know that.

Somewhere between, yeah, if you feel like it's been 20 or 30 minutes, I would say, okay, at that point, get out of bed. And don't look at the clock. Don't be looking at the clock. Just use your gut. We tend to know when sleep is on the table and when it's not. So just use your intuition for when it's time.

Okay. And probably definitely don't get on your phone.

There's multiple reasons, right? Yes, yes. Not just the blue light, but our phones are so stimulating. All that short form content.

Dr. Nicole (22:27.646)

Mm-hmm, for sure, for sure. Okay. Now, what about things like melatonin or Benadryl or even something like Ambien to help with insomnia?

Yeah, so melatonin is actually not meant for insomnia. It's really meant for short-term use. And I feel like I need to say that because there's so many people that are just taking melatonin constantly or they're taking teas that are infused melatonin. And that's just not how it's meant to be taken. So in behavioral sleep medicine, we recommend it when there are circadian rhythm issues because melatonin is not hypnotic. We treat it as what we call a chronobiotic.

draw sleep forward. So if you're someone with a delayed sleep phase, like you repeatedly fall asleep at 3 a.m. and you're trying to fall asleep at 10 or 11, and your circadian rhythm is out of sync, then we can talk about short-term melatonin use and other strategies to help shift your sleep. But for insomnia, it's really not recommended. Okay. Okay. And Benadryl. So Benadryl is a...

is an antihistamine and we know that histamine is an alerting chemical in the brain. So it does work to make you fall asleep, but the issue is that there's side effects. You can build up a tolerance over time. So also really not a long-term solution. It can have that hangover effect, right? In children, let's not even talk about it. It can have an opposite effect in kids where it makes them agitated and hyperactive.

know, pregnant women usually encounter, you know, antihistamines in, in Bongesta, right? So in those anti-nausea medications, it's unisome. It's not quite what's used in Benadryl, but it does create that sleepiness effect.

Dr. Nicole (24:22.606)

which is why we say take it at night to start,

Exactly. they might also notice that initially when they start using Fongesta, yes, they're sleepy, they're sleeping great in that first trimester, and then eventually it wears off because like all things, we build a tolerance. So just not a long-term solution. And then when you try to get off it, there are withdrawal effects. So like feeling like a really itchy nose, what you would expect from getting off an allergy medication.

Sure. And then what about prescription things like Ambien?

Yeah, so Ambien is a hypnotic, right? It's a sedative. And so because of the short half-life, I know that it is helpful for some folks. It does also have side effects, right? Just like anything, like dry mouth, feeling dizzy, constipation, nausea, like those kinds of things. But it doesn't really hold a candle to long-term solutions like CBTI, right? I mean, there's always the option of trying to get a higher dose.

or an extended release version. But if your kind of insomnia is the one where you're waking up in the middle of the night and not able to go back to sleep, it's not as effective. So, you know, I always tell my patients, you know, if you want to take a sleeping medication, you can do that, you know, in addition to, you know, our CBT-I treatment, but know what kind of insomnia you have so that you can talk to your prescriber so that they give you something that's more effective.

Dr. Nicole (25:51.747)

you

Because if something is a shorter half-life, it may help you in that beginning part of the night. If it's a longer half-life than the next day, you might also feel like you're going through molasses a little bit. So, be able to speak to your prescriber in a way that gets you something that's more effective. But yeah, so good for short-term relief, but just not as durable as CBTI. And I know that Ambien or zolpidem, it can suppress deep sleep or REM sleep, which we know, again, are...

Sure. Got it.

Dr. Daniella Marchetti (26:22.156)

restorative parts of the evening.

Gotcha. Now let's talk about CBTI. What is CBTI? What does that stand for? And how does it work to help treat insomnia?

Yeah, so it stands for cognitive behavioral treatment of insomnia. And so as the name suggests, we focus on our behaviors. So what you're doing around your sleep and your cognitions, how you're thinking and feeling about your sleep in order to create change. And so again, it's a very behaviorist approach. So what we want to do is build associations with our bed and sleepiness. And we want to, you

project.

Dr. Daniella Marchetti (26:58.572)

We want to work on anything that can be getting in the way of that. So if you're having racing thoughts at night, what can we do about those thoughts? There's so many interventions. Do we need to be reframing? Do we need to be creating some time during the day for our anxiety that's popping up at night? And so it allows for the treatment to be very tailored to the patient because if I have an anxiety-driven insomnia, I'm going to focus more on cognitive interventions.

Thanks.

Or if I have conditioned insomnia like so many postpartum women have, know, insomnia by repetition, then we work on behavioral pieces. And so what's nice about this work, besides that it's tailored to the patient or the client, is that it's also intended to be short-term treatment for long-term effects.

Got it. Okay. So how long does that treatment typically take?

It's usually between six to eight sessions. Yeah, I was going to say in the psychology world, there are folks that could be in treatment for things for months, years. So six to eight sessions is pretty good.

Dr. Nicole (27:50.83)

No, that's not bad. I mean, that's not a lot.

Dr. Nicole (28:03.822)

agree, yes. I don't know why I was thinking you were gonna say like six months or something like that.

Yeah. Okay. Yeah. So it's meant to be short term and that I like especially for young families and new mothers just because you don't have a lot of time. And therapy can often be the first thing to kind of fall off the to-do list because so many parents are in the service of their families and sometimes self-care takes a backseat. Definitely.

Yeah, definitely.

Dr. Daniella Marchetti (28:35.79)

could allow for it to fit into your schedule if you can at least tolerate it for a short-term period.

Gotcha, gotcha. That's really good to know. then when, okay, so if someone is like struggling with insomnia, what, is there kind of a stepwise approach to it? And then when does a professional come into the picture?

I usually tell people if it's been two weeks where you've implemented sleep hygiene, which is different from CBTI, and you're still struggling, then I would say start looking for a provider. If it's been two weeks and it's not getting better, then that might be your first warning sign. But after a month, I would say you should have a provider picked out and a consultation call at least. Because after one month, it's acute insomnia. Three months is chronic, but you don't have to wait.

you know, until it gets really bad to get help.

Gotcha. And then what, what do even search for? Like, what are you looking for for what type of professional?

Dr. Daniella Marchetti (29:33.472)

Yeah, so a behavioral sleep medicine specialist. On the behavioral sleep medicine website, there is a list of folks that have been boarded. Now, granted, you can find someone, you can find a psychologist or a therapist who can do CBTI and they don't necessarily need to be board certified. They can be proficient at CBTI without the board certification. But I always like to recommend taking a look at that list of folks that are boarded just because

What if your insomnia is at the intersection of a circadian issue? Or what if you have sleep apnea? And now it's a little bit more complicated and you want to find someone that's going to be well equipped for all kinds of permutations with your sleep.

Gotcha, gotcha. And then, you you mentioned sleep hygiene. I think it's worth saying, how is that different? Like what is sleep hygiene also? Let's go ahead and touch on that.

Yeah, so sleep hygiene are things like, okay, what are you eating around bedtime? When are you exercising? What's the temperature and environment of your room? Things like that. CBTI, there's monitoring week to week of your sleep. So you're completing sleep logs and then there's something called sleep efficiency training. Okay. And that's something that needs to be done with a provider just because

the provider puts it into their calculator and they're able to tell you your efficiency score and then modify your time in bed window based off of how you're trending, the needs of your life, et cetera. So sleep hygiene, is all the things that if you Google sleep hygiene, they're probably gonna come up.

Dr. Nicole (31:11.406)

I mean, this is really, I had no idea there was so much depth into trying to help people have better sleep. I mean, I kind of knew, but like when you just said the calculator and all this, my goodness, this is a lot, which is helpful. It's good to know. And then, know, one more thing. What do you think about, you know, I'm wearing it now, like some sort of device that's helping track your sleep. Does that play into, does that help? Does that hurt? Like, what are your thoughts on that?

I'd say it really depends on on who you are now with with the wearables It can be helpful because we know that in health behavior change When you start monitoring a behavior, that's the first step in changing it, right? We can't know how poorly we're sleeping without knowing how poorly we're sleeping

Gotcha.

But sometimes it can make us fixate on the health behavior. So a lot of folks might get obsessive about sleep scores. it can create anxiety as well. So if you're someone that's prone to just being a little bit more nervous and anxious about your sleep, would say you can still track your sleep. Do so maybe paper pencil.

When we do therapy and you're monitoring sleep from week to week, we use paper pencil and that's gold standard. The wearables are fun though, and they can give you some good insights, but they're also sometimes inaccurate. They might overestimate time of sleep because if you're laying in bed and you're fully awake but not moving, it means you're asleep. Or worse, it might underestimate because what if you're someone who moves around a lot in your sleep and now it thinks you're awake? So there are limitations.

Dr. Nicole (32:46.918)

Gotcha. Okay. Okay. Okay. Well, then as we wrap up, and these are questions that I ask all my guests, what would you say is the most frustrating part of your work?

Well, and most people don't think about it this way, but I think that poor sleep is also very much a social justice issue.

please expand upon that.

I often encounter people who, for example, can't give up their night shifts because they're lucrative or because of the kind of work that they're in. Or folks who live in studio apartments or those with dense housing, those who live in areas with more noise or light pollution. We know that certain ethnic groups are more likely to have insomnia because of socioeconomic factors.

So there are very real macro level environmental things that get in the way of sleep that I cannot fix in a session. There are things I can advocate for, but as soon as I see that there are environmental constrictions, I know that at that point, I'm going to focus on harm reduction, then I'm going to be focusing on optimization.

Dr. Daniella Marchetti (33:59.02)

But now I'm facing these very real things that are going to be difficult to work around. So it's frustrating when I find that on multiple levels. Because one, I would like for them not to be in that situation, too, because it will make the work a bit more challenging. And so that I would think is the most frustrating.

Yes, yeah, definitely. And I think that's probably not probably it is true for a lot of health care how you realize that so much that happens outside of what we do impacts what we do. So yeah, yeah. And then on the flip side, what's the most rewarding part of your work?

Yes, how quickly it works. So, know, myself as a provider, there's a little bit of self-interest in me and I like to see when my patients get better and I like to feel like I'm making a difference. And, you know, I provide a lot of different kinds of care. I've provided, you know, care for anxiety and depression and the whole gamut. And sometimes progress is slow. And as a provider, you hope that you're creating change in your patients. But with CBTI,

I can see it. I see it week to week as I'm measuring your sleep with these logs, as I'm looking at your sleep efficiency, I see it in the numbers, and the patient knows when they're done. They can say, you know what, we've met the goal. And that usually happens in those six to eight sessions. So I enjoy feeling like I can make a change myself and I enjoy how quickly it can happen for folks.

Okay, we're done.

Dr. Nicole (35:32.29)

Yeah, yeah, I can imagine that's that's quite rewarding. Is this typically covered by insurance or does it depend?

It does depend. There are some providers that take insurance, but I have to say right now you're most likely going to find some self-pay options in the private sector. And I don't know that so many hospitals have sleeve clinics. So this is an area that I think is quickly growing and people are starting to see the need and they're starting to see the research on CBTI. And so I do think that this work you're going to see more in

about it and hear more about it in the upcoming years. Because there's also just not that many of us that do it. As far as folks that are actually on the BSM list, I think there's only a couple hundred in the whole country. Yeah. you can find both. There are some folks out there that take insurance, definitely. In fact, I only do it virtually.

Yeah, that's not a lot.

Dr. Nicole (36:28.755)

Can it be done virtually?

Dr. Nicole (36:33.006)

Well, there you go. Good, good, good. then for anyone who's listening, for the mom that's listening, or pregnant woman or person who's utterly exhausted or feeling overwhelmed, unsure where to start, what would you tell them to do right now?

I would say take it one night at a time. The overwhelm can add a layer that you don't need. Poor sleep is hard enough. Starting to create a mythology around your sleep can make it tougher. So instead of looking at sleep as a health behavior and something you need to check off your list, think of it more as a relationship. We want to think about sleep as something that we're inviting but not smothering.

I like that. That's a really great way to think of it. Yes. Yes. And then if you had any like other, is there any other like favorite piece of advice that you would give to an expectant mom? Period. About anything. It doesn't have to be sleep, but your favorite piece of advice.

Well, for expected moms, would say seek the help before you think you need it.

I'm like, can we say that again? There's nothing worse than sitting at three o'clock in the morning trying to figure something out.

Dr. Daniella Marchetti (37:40.845)

is it?

Dr. Daniella Marchetti (37:45.812)

Just get the help before you need it because prevention is so much better than having to put out a fire later. We prepare for the breastfeeding journey. We make sure that we get our pumps through our providers or we get formula or childcare. We plan for all of these pieces of the pregnancy and postpartum period and sleep should be no different. We should be planning for those changes that are going to be happening because of our lifestyle, because of

hormones and physical changes and psychological changes too. So set yourself up for success and get all the things and seek all the people before you think you need them.

Gotcha, gotcha, love it. So where can people find you, find more information about what you do or on social media or anything like that?

Sure. So I am based out of Florida, but I am CIPAC certified so I can provide care across 42 states. Okay. So if anyone would like to work with me, they're welcome to check out my website, which is danielamarquetti.com. Thank you.

And it's very beautiful, by the way. it's very soothing. was like, this is what a sleep person's website should look like.

Dr. Daniella Marchetti (38:54.622)

Yes, yes. So yes, go onto the website and you can schedule a free consultation, see if we'd be a good fit for each other. If not, I'm always happy to give referrals for folks that are licensed in your area. And if you'd like to follow on Instagram, I'm always posting little tips and tidbits here and there for a number of different sleep concerns. And I'm happy to have you follow and just contribute to the conversation. I always like to meet people where they're at and see what people want to see more of.

Awesome. And you're on Instagram with your Instagram handle. Okay, awesome. Thank you. Well, thank you so much for agreeing to come on to the podcast. This is a really important topic. I know I learned a lot myself and I'm sure the listeners did.

It's at Dr. Daniella Marghetti.

Dr. Daniella Marchetti (39:36.814)

Thank you. Thank you for having me. It's been a pleasure.

Dr. Nicole (39:46.09)

Wasn't that an informative episode? You know, after every episode when I have a guest come on, I do something called Dr. Nicole's notes where I talk about my top takeaways from the conversation. Here are my Dr. Nicole's notes from my conversation with Dr. Marchetti. One is it's important for you to understand that insomnia is more than just a bad night's sleep. We throw around the term insomnia kind of loosely, but clinically it actually means trouble falling or staying asleep.

at least three times a week for over three months. And it's not just about being tired. It's a chronic condition that truly deserves attention. Up to 80 % of women may experience insomnia about the third trimester and many continue to struggle even two years postpartum. So if you are having trouble, then seek help. Number two, you cannot force sleep, but you can support it.

Sleep is not like exercise or hydration. It's not something that you can just make happen through willpower. It's more of a relationship, not a task to be completed. You have to more so invite sleep. You can't just demand it. And that's why understanding your behaviors and your thought patterns, like what cognitive behavioral therapy can address, can make such a huge difference. So again, if you're having trouble,

do seek that help so you can better support your sleep. Number three, and this is so, so, so important, control what you can control. This is the exact same thing I say about birth. You can't plan your birth. You can't control every aspect of your birth, but there are so many aspects that you can control. So from your sleep environment to your routines,

to what you believe about sleep and how you respond when sleep is hard, there is a lot that is really within your power. And just like birth, that mindset shift of understanding and taking control of the things that you can control can be truly, truly empowering.

Dr. Nicole (42:04.93)

And then the last thing I'll say is that the whole sleep when the baby sleeps, it doesn't work for most people. Okay. Like it's just kind of trashy advice and the advice may come from a good place. Of course it does, but it really doesn't fit everyone's or even most people's reality. Your body may not be able to nap on command. know I can't nap on command. You may have other kids, you may have other responsibilities. So it's

much more helpful and appropriate to create a plan that honors your needs, your capacity, not someone else's idea of what you quote unquote should do. All right, that is it for this episode. If you found it helpful, share it with a friend. Every pregnant woman deserves to feel informed and empowered and also subscribe to the podcast so you never miss an episode.

And if you love the show, I'd really appreciate you leaving a quick review in Apple Podcast. That is one of the best things you can do for me to help show your support for my work. Plus, it helps more moms to be found birth with power and step into birth with confidence, just like you. And come on over and join me on the Gram at Instagram. I'm on Instagram at Dr. Nicole Rankins. I really do love hearing from you.

And if something from this episode or any episode resonated or you just want to say hi, please come into my DMs. I read them all and I love, love, love connecting with you. And then of course, please do me one more favor and come on back next week and remember to trust your power and take charge of your birth.