Think of Gratitude and More for Remarkably Great Sleep

In this episode of Thursday Tea with Sami, I sit down with Dr. Heather Martarella, a clinical psychologist specializing in sleep and gratitude. We explore what really happens in your brain and body during sleep, how modern life interferes with rest, and the powerful connection between gratitude practices and better sleep. Dr. Martarella shares insights from her clinical work, practical tools you can use tonight, and the science behind why a few minutes of reflection can make a big difference in your well-being.

To learn more or get in touch with Dr. Martarella, visit: https://oasispainrelief.com

Transcript

Samia (00:06)
Welcome to Thursday Tea with Sami, your sip of wellness and mental health. I'm Samia Estrada and I'm so glad that you're here. This podcast is all about living a healthy, balanced life mentally, physically, and emotionally. Every other week we'll explore simple, practical ways to improve your well-being, we'll hear from experts, and we will learn together. Grab your cup of tea, take a deep breath, and let's dive in.

Samia Estrada, PsyD (00:38)
Hi, and welcome to Thursday Tea with Sami We are so excited today to have Dr. Heather Martarella with us. She, among other things, is an expert in sleep and gratitude. And today I'm so excited to learn from her and to hear everything that she has to say. So welcome, Dr. Martarella, so happy to have you here.

Heather Martarella, PsyD (01:00)
Thanks, I've been excited, looking forward to talking with you, as usual.

Samia Estrada, PsyD (01:03)
⁓

thanks. I'm so excited. Can you share a little bit about your background and what led you to focus on sleep in your clinical work?

Heather Martarella, PsyD (01:12)
Yeah, so was

actually just working with people with chronic pain. And as I was working with folks with chronic pain, I kept discovering again and again and again that so many of them were struggling with their sleep. And I hadn't really thought about it as being connected in that way until I kept seeing this evidence of it again and again and again. And then I started looking at some of the research and going, oh, there's a little bit of something out there. This is back in 2012, 2013. So it wasn't until 2014, 2015, something like that, that I started seeing a little bit more about it. And it was just...

coming up so frequently in the sessions that we just had to start integrating it, right? It just had to be part of the treatment. So I went back and got more of the CBTI training and incorporated that.

Samia Estrada, PsyD (01:52)
I definitely see it in chronic pain patients, but I think that overall, a lot of people just are not sleeping well. And that's something that I see so often. Yes.

Heather Martarella, PsyD (02:00)
Oh, yeah. Yeah. Oh, no,

I don't want to imply that it's just people with chronic pain. It's just in that population, having been more of a generalist prior to that, I was used to hearing about, you know, sleep being a problem. We talk about sleep with people with anxiety and depression, but it wasn't until I was seeing this particular population that I was seeing so consistently, you know, it felt like more than 50 percent of the people I was seeing were really having these pain struggles.

Samia Estrada, PsyD (02:07)
Right.

Yeah.

Heather Martarella, PsyD (02:27)
Well, all of them are having pain struggles, but more than 50 % of them are also having the sleep with it. And I didn't really know at that time how strong that bi-directional relationship was. And to hear people talk about it is always that pain caused their sleep or anxiety caused their sleep. And it turns out that the actual, the stronger one is the sleep problems actually cause more pain and cause more anxiety and emotion dysregulation, right? Than the other way around, but it's a bi-directional relationship. Yeah.

Samia Estrada, PsyD (02:53)
Yeah, that's super interesting. Yes.

Yeah, so interesting. And it's true, right? Sometimes it's hard to tell which came first, the chicken or the egg. Yeah.

Heather Martarella, PsyD (02:58)
Totally.

Exactly.

And do we even really need to know what we need to know is what's disrupting your functioning and impairing your quality of life, right? And then we dive in.

Samia Estrada, PsyD (03:12)
definitely. Okay, and I know that gratitude is a big part of your practice too. What sparked your interest in gratitude to begin with?

Heather Martarella, PsyD (03:22)
You know, it was around that same

time, unrelated to the sleep with chronic pain though. It was that, I mean, I'd had an interest in it personally prior to that. I've been exposed to some work that I thought was interesting about it. And I knew I had fallen into kind of negativity cycles at times and I didn't like that. So I wanted to change some of that. So I started doing gratitude practices myself. And then when I started working at that pain clinic, I started recognizing I wanted to have a gift that I would give patients at the end of their, you know, the graduation ceremony.

and so I wanted to do gratitude journals, so I needed to teach people how to do a gratitude practice. And then later, it was years later, that I started seeing all of the more research coming out at that point. I don't even think there had been any at that point when I was looking then about gratitude and sleep and how much it helped with sleep and pain, but mostly with the sleep is what the research was about. Yeah, that just intensified my interest in using it with.

with patients, right? So I started hearing anecdotally from folks that it was helpful for them, but the research really made me want to do it more and more. So that's when I just wanted to incorporate it into our whole program.

Samia Estrada, PsyD (04:25)
Yeah, yeah. And I know that years ago, you gave me one of those five year gratitude journals, and it was one of the best gifts that anybody has given me. ⁓ I wrote on that consistently. And it's so nice because I can go back and look at it any day if I'm having a bad day or, you know, or if I just want a little pick me up, I go back and I look and there's so many things that I was grateful for that I can just enjoy again by looking at it and reading what I wrote down many years ago.

Heather Martarella, PsyD (04:34)
us.

That's thing we know about gratitude research too though, right? Is that the added on piece of savoring it. So going back and reflecting on the things that you have written or the things that you are recalling and savoring that thing again, we're going to get a big boost from it now, even though that thing didn't happen today, right? So I remember there were times when you, a couple of times, maybe a few times even, that you would send me a text message because you were doing your gratitude journal and you had seen something from the year before or two years before. And you said like, on this day I was grateful for something.

related to me, right? And it was just, yeah, it just boosted my day, like gave me a big extra dose of Samia sunshine in my day. And I loved it. Just like, wow, it felt like the gift that keeps on giving, you know, that was just really mutually beneficial. And I loved that you then shared that with me. So it was just fabulous.

Samia Estrada, PsyD (05:35)
Yes.

It was a

Heather Martarella, PsyD (05:42)
Yeah.

For sure.

Samia Estrada, PsyD (05:43)
Yeah. So just for the sake

of it, is there anything that you're grateful for this morning just to add a little fun to our segment?

Heather Martarella, PsyD (05:51)
Well, you, first of all, I've been looking forward to this just because anytime I get an opportunity to interact with you, I'm

happy about

I just enjoy it.

Samia Estrada, PsyD (05:58)
You're so sweet, thank you.

Heather Martarella, PsyD (06:01)
was grateful yesterday. I was grateful for a lot of the sun and I woke up this morning and I saw it was just all gray and dreary where I am. And I thought, no, dreary is the first thing that popped in my mind. And I was like, no, no, this is nice and cooling and it's comfortable. And I had the windows open and just felt like a more of a crisp morning. So it actually was.

nice, but I had to get that like mind shift into like, oh, oh, right. So I'm grateful for my brain being able to do that shift and not being stuck in that rigid, oh no, I'm going to stick with this instead, can I shift it a bit? So I was grateful for my brain and for the weather at that point. So there's like three, how about that?

Samia Estrada, PsyD (06:23)
Right.

Yeah.

Yes,

And what a difference it makes when you make that shift for sure Well, I want to kind of shift back to sleep for a minute and then we'll talk more about gratitude. But can you tell us what actually happens in your brain and in your body when we sleep?

Heather Martarella, PsyD (06:50)
I mean, it's a complicated process really, but to make it as simple as possible is that we, I believe, it's kind of like a reboot. It's not just a, sometimes people think it's unconsciousness. It's just I'm completely out like a coma or something. That's not it. I like to think about it as a reboot, kind of like

iPhone. My mom will message me like, oh, my iPhone is not working. It's doing all these glitchy things, you know, whatever. I'm like, okay, mom, when's the last time you shut it off? I don't know when I bought it like months ago.

Okay, all right. It needs a reboot, right? Like it needs to be shut off and turned back on and then it's gonna function better. And I think the same is true for our bodies. But when we fall asleep, we have different stages of sleep. So we have wakefulness, right? I'm awake. Then we have stage one sleep where it's kind of like someone can be watching something on TV, let's say for example, right? And you're kind of paying attention to it.

Samia Estrada, PsyD (07:18)
You

Heather Martarella, PsyD (07:40)
And then maybe someone walks in the room and says, hey, are you watching this? Can I change the channel? It looks like you're like fading out or something. And you're like, no, no, I'm watching this. And you have some idea of what's going on. You may recognize though that maybe it's further along and you're not as with it as you thought you were. So maybe you've had some kind of micro sleep, right? Some stage one, oh, I'm kind of falling out. Am I really here? No, I'm pretty sure I'm awake. But even feeling like you're awake, could be actually stage one sleep. Stage two sleep is a bit, well, I would just call it stage one or.

Samia Estrada, PsyD (07:55)
Yes.

Okay.

Heather Martarella, PsyD (08:07)
early, right? And then you're actually falling asleep. ⁓ And so falling asleep is stage two, or someone's kind of coming along and saying, Hey, it looks like you fell asleep. Can I watch this thing? And you're like, what? No, I'm watching. And you look and it's a whole different show that's on, right? You actually missed something. So you were asleep at some point, but you may have that no, I'm here. Stage three, that slow brainwave deep sleep, someone comes along and has to kind of shake you or say your name loudly, there's some noise, something that wakes you up. You're uncomfortable in this situation you're in the

position you're in and so you wake up to move around a bit. That would be stage three sleep and that's that deep slow brainwave sleep where a body restores itself, cellularly, physically, right? Then we're going to have, and that's earlier in the evening or the earlier on the night when you fall asleep, the first three hours or so of sleep, which is about two full sleep cycles where you're getting most of that deep sleep. And then it's those latter hours of sleep where we get REM, the rapid eye movement, the I'm dreaming state. And that's where emotion regulation happens.

And so you cycle through these and then you start having that REM sleep. So a good restorative, restful night of sleep,

yourself physically, cellularly, also emotionally, mentally.

Samia Estrada, PsyD (09:17)
let's talk a little bit more about that mental and emotional piece. Why is sleep critical for emotional and mental health

Heather Martarella, PsyD (09:25)
Well, we get better at kind of filtering out the emotional noise, right? All of these stressors come

And we can just manage those better. We're more resilient, less reactive. We regulate our mood better. We respond with more psychological flexibility instead of a mental rigidity. So we're less likely to get stuck in those downward spirals or the people say, you know, like I'm spinning out anxiety, maybe amping up, right? Maybe spinning up.

and others like I'm spiraling down and depression like, okay, got it. So how was your sleep? So it does really help regulate our mood in those ways. It's also just better for our gut. And we know gut works as a, like a second brain. and it impacts all connected. So if our Garolin and lectin is thrown off, we're just not going to feel very satisfied with our food that day. We're more likely to overeat. it just messes with our whole microbiome, our gut.

Yeah, so.

Samia Estrada, PsyD (10:16)
God,

yeah, definitely. And I personally get a lot of people who say they have all kinds of disruptions at night, whether it's that they have a hard time falling asleep because they're thinking too much or they wake up in the middle of the night. But what are some of the most common sleep disruptors that you see?

Heather Martarella, PsyD (10:35)
Well, because of the population

I work with primarily, is chronic pain, but many people with chronic pain also have a lot of anxiety about the pain, but about other things in life as well, right? It starts becoming part of that pattern, that fear pattern. So anxiety would probably be the biggest one. And then chronic pain, second to that. I don't see it with the depression so much because that usually is looking more like hypersomnia. So it is a sleep problem, right? We need to address, but...

or early morning waking, early morning waking and the hypersomnia really associated with depression and difficulty falling asleep and interrupted sleep where we wake during the night and can't fall back to sleep easily in under 20 minutes that those two are associated more with anxiety. So there's that. I think the brain is an association machine, right? So anything we associate with it becomes this repeated pattern. And so I think the things I see again are the anxiety and chronic pain, but

Samia Estrada, PsyD (11:22)
Yes.

Heather Martarella, PsyD (11:28)
Anytime someone is worrying in their bed and that becomes a place that we have arguments with their significant other or that they are paying their taxes, paying their bills, whatever dealing with anything other than sleep, sex, and maybe some gentle stretching, we end up associating the bed with those things. So if you're laying in bed worrying about, I going to fall asleep? This isn't going to happen for me. I'm so uncomfortable. Let me move around.

Samia Estrada, PsyD (11:31)
Yes.

Heather Martarella, PsyD (11:50)
All of those things, what's going on in my brain, the worry machine is big on catastrophizing about tomorrow's to-do list, right? no, it's worry o'clock, I can't do this. But you say, no, today's going to be great. I'm feeling so relaxed and sit on the couch or I'm talking with a friend or I'm doing something. I do my bedtime routine and I go and get in bed and suddenly I'm wide awake. That's a really good indicator. Your brain has associated your bed with something, some worries, some strength from something, right? You have evidence for yourself then. Like, okay.

Samia Estrada, PsyD (11:56)
Yes. Right?

Mm-hmm.

Heather Martarella, PsyD (12:17)
So the brain can make these associations. It can also make new, healthier, more safe, comfortable ones. So there's hope in it, right? It's like, yeah, we'll be able to go this route, but we can not unlearn it. We can retrain it to do it differently.

Samia Estrada, PsyD (12:24)
Yes.

⁓ wonderful. I know that sometimes people don't necessarily know or understand the big impact that sleep has in our life. There's also sometimes misconceptions. Do you ever find that people have certain myths or misconceptions about sleep? And if so, what are some of those misconceptions?

Heather Martarella, PsyD (12:49)
think the big one is that I need to get eight hours of sleep. So I'll be people saying, I'm only getting six to seven hours of sleep. I'm like, okay, is that what's been your norm, right? Throughout your life? And yeah, I've always had this problem. Well, it may be that six to seven hours is actually what your body, your brain needs, right? So it's somewhere in the five to 10 range, actually. I mean, ideally we're looking around the six to eight range, but there are folks for whom biologically it works for them to get a little more than five hours sleep.

⁓ That is not good for the vast majority of people. If we have too much sleep, we're getting more than 10 hours sleep, and this is not for children. For children, we want lot more sleep than that, ⁓ and for adolescents as well. There's different needs, different stages of sleep. work almost exclusively, and actually exclusively now for a number of years, only with adults. This is what my answers are related to.

Samia Estrada, PsyD (13:26)
Yes.

Okay.

Yes.

Heather Martarella, PsyD (13:41)
that five to 10 range. And for some people, it's when you can think back to a time that was ⁓ you felt you were getting good restful restorative sleep, waking up feeling rested, not having daytime sleepiness. You could function well, no kind of brain fog. Pain was well managed if that was part of your condition. Moods were better regulated. How much sleep were you getting at that time? That helps us give some of the goal of what we're looking for for you rather than this like eight hour thing that was really

brought about more by like mattress companies and such, right? And then the other big sleep myth would be like, I have sleep debt and I can catch up on the weekend, ⁓ I just have to blast through this week for work or whatever else it is. And I'm going to catch up on the weekend. And it really doesn't work like that. It's like skipping all of your meals during the week and then trying to binge eat on Saturday and Sunday. Like that just doesn't work.

Samia Estrada, PsyD (14:11)
Absolutely.

No.

Heather Martarella, PsyD (14:31)
Your

metabolism doesn't work that way. Your circadian rhythms don't work that way. It's just not how the system works. So there's that. And then one I see very commonly is waking up at night, bad. actually not. That's actually part of a sleep cycle. Like they should be about 90 to 110 minutes. So if you're waking up every 90 to 110 minutes, I'm not concerned about that unless you're waking up and you can't fall back to sleep in under 20 minutes. Takes you longer than 20 minutes. We're looking at potentially.

sleep maintenance insomnia, interrupted sleep that's a problem. And there's a whole criteria to meet

But really it's just how it was impacting your functioning and your

those are the big

Samia Estrada, PsyD (15:08)
and

I think people feel busier than ever and ⁓ trying to fit so much more into their day. And, you know, aside from being busier, I know there's a lot of factors. How do you think some of our modern lifestyle ⁓ choices or just our modern lifestyle in general interferes with sleep?

Heather Martarella, PsyD (15:28)
Yeah, so it's what I think, but it's also what research indicates and even anecdotally hearing from clients is that they're spending more hours than they think their parents did generations prior to them being indoors and working environments. And yeah, so a lot of them are working inside with these fluorescent lights or the LED lights and we're not getting as much natural light, which is what manages our circadian rhythms is natural lighting.

So if you're not getting outside as much, if you're someone who works indoors and you're spending a lot of time indoors and you're being sedentary on top of it, that we are seated and doing a lot more things on the computer these days when our previous generations didn't have computers. My parents didn't grow computers. It was like a life for them, right? ⁓ So yeah, it's very different in those generations and how much time we now spend in buildings away from natural light.

Samia Estrada, PsyD (16:07)
Right.

Yeah.

Heather Martarella, PsyD (16:18)
We're often needing to answer emails or getting Slack messages or Teams messages or text messages or whatever related to work. We're alert working longer hours. We're having less downtime and less recovery time,

Samia Estrada, PsyD (16:31)
Yeah.

And that's not even talking about shift work and people who work overnight and, you know, all that.

Heather Martarella, PsyD (16:35)
No.

yeah, that's a whole nother significant issue. I find that it in the clients that I see, that's not common. I don't have many shift workers, but it is a significant one. So I'm glad you mentioned it for those particular folks. Things look a little bit different treatments, even a little bit different.

Samia Estrada, PsyD (16:57)
I know that you work mostly with chronic pain patients. And

one

the things that I've noticed with chronic pain is a lot of times you have patients with chronic pain who also have

do you feel that trauma affects sleep?

Heather Martarella, PsyD (17:10)
well, pretty significantly. We can get really wrapped up in kind of replaying the trauma so we can get re-traumatized by reliving it. We can have flashbacks, nightmares, or night terrors ⁓ related to that. trauma can play a pretty significant role. If I'm gonna be treating sleep, will often treat trauma first ⁓ because it's gonna be harder to be beneficial to sleep. And often people are avoidant of sleep at that point.

Samia Estrada, PsyD (17:15)
Yeah.

Okay.

Heather Martarella, PsyD (17:33)
There's anticipatory dread. I don't want to fall asleep because I'm start having these nightmares, right? Maybe having flashbacks during the day, those may increase at bedtime when there's not other distractions through the course of your day. You're kind of sitting with your thoughts and those things may come up even more. There may even be related triggers to going to sleep. And then we have the actual sleep itself where you may be having the nightmares. And so people want to avoid those commonly. So we do need to address the trauma first.

Samia Estrada, PsyD (17:37)
Yeah. ⁓

Yeah. Okay.

Heather Martarella, PsyD (18:00)
I think this is all our nervous system doing its job though, when we do have the anxiety and depression and trauma kind of coming up related to it. So we want to acknowledge that the traumatized body scans for danger all the time. our systems gonna, flatten our circadian rhythms. That doesn't work well. ⁓

Samia Estrada, PsyD (18:08)
Yeah.

Right.

Yes,

What about, do you ever see any differences like within age groups or genders or even like a stage of life, know, if somebody's caregiving versus somebody who's maybe going through menopause or, you know, things like that?

Heather Martarella, PsyD (18:31)
Exactly. You nailed it. So some of the big ones, right? Right. So yeah, if someone is breastfeeding, they've got to get up multiple times during the night or they just have a baby. Maybe they're not even breastfeeding, but they have a small child who just needs them or they have a dependent adult. They're a caregiver. So it doesn't even have to be a child that they're caring for. It can be, you know, their elderly parent or something. Yeah, that can be pretty significant disruption. And we're going to have to work with that differently because we can't say, don't get up during the night. Right. You have to be able to get it.

Samia Estrada, PsyD (18:39)
Yes.

Right.

Heather Martarella, PsyD (18:59)
and I can do the caregiving that needs to happen. Then we have the hormonal things. You mentioned menopause and it starts in perimenopause So for women, we're looking at gender differences. Those who have a uterus or ovaries, even if the uterus has been removed from the ovaries, your body's still cycling through. Even if you've had a complete hysterectomy, your body is still cycling in these ways, Or if you're dealing with HRT, the hormone replacement therapy, that can help sleep sometimes, but for others it can be a bit...

Samia Estrada, PsyD (19:01)
Thank you.

Yes.

Yeah.

Heather Martarella, PsyD (19:27)
even more disruptive. So it's different for different people. But just

Samia Estrada, PsyD (19:29)
Right?

Heather Martarella, PsyD (19:33)
and menopause, both are, they are sleep disruptors. So we do have to address those. But we also know that insomnia occurs more commonly in women. And I think that's the hugest part of it is about that hormone piece. Also, We know that they're more likely to seek help for anxiety.

Samia Estrada, PsyD (19:37)
Yeah.

Heather Martarella, PsyD (19:47)
⁓ so there's, that component too, the people who are more likely to seek help for their sleep, maybe female, ⁓ and have anxiety, but also in perimenopause or menopause it's pretty significant.

Samia Estrada, PsyD (19:57)
That's good to know. And we were talking about gratitude. So let's bring that into the sleep area. What does the research say about gratitude in relation to sleep?

Heather Martarella, PsyD (20:04)
Okay.

You know, there was a cool study

end of 2024. So it's a pretty new

I like. it was over 400 people. was like 430 people. And they did this community study with folks.

if they do a gratitude practice before bed, they were basically, they broke people up into different groups and people who were having more positive thoughts, more optimistic.

grateful thoughts, thinking about things that matter to them in the day, moments that matter to them in the day. They had easier time falling asleep, staying asleep, and they felt more rested the next day. So I thought that was kind cool. had, oh, fewer daytime slumps too. So, well, but that goes without saying. If you're better rested you're gonna have fewer daytime slumps. So I thought that was pretty cool. The biggest kind of takeaway from this though was that it's about that not...

Samia Estrada, PsyD (20:44)
Okay.

Heather Martarella, PsyD (20:51)
gratitude throughout the day really, it's about the pre-sleep. What's going on in your brain those 15 to 30 minutes before bed is gonna help prime what's gonna happen while you are sleeping. So it's specifically about doing kind of a gratitude practice at night, which is why I ask people to do it as part of their bedtime wind down routine, because that's really priming your brain not to be on the, tomorrow I have to remember to do this. What's my schedule like for tomorrow? You know, going through all those things that are common.

Samia Estrada, PsyD (21:00)
Yeah.

Yes.

Yeah.

Heather Martarella, PsyD (21:16)
So when they looked at that it was the folks who had more anxiety and so I've been since that research came out telling folks about imagining this couple that you have this couple and they're both in bed and one of them is is worrying about what's coming the next day and what they've got coming up and Just worry lists right and then you have the other person who's doing their gratitude practice and this person's gonna fall asleep quickly and this person's gonna stay awake and start getting frustrated My partner is able to fall asleep. Why not me?

If I don't fall asleep now, all of those anxious thoughts just build on what they're already thinking about the anxious thoughts and it just becomes this vicious cycle. And so now they're awake and getting more frustrated. The more frustrated you get, the less likely you are to fall asleep. So I thought it was cool

group of people.

Samia Estrada, PsyD (21:59)
love that

visual. can picture it perfectly and I want to be the person who's doing the gratitude practice.

Heather Martarella, PsyD (22:07)
Right. Teaching

your significant other who's in bed with you, or significant or not, whatever. But hey, if you try to spread it to your friends, right? Can you just tell them about some things that went well in your day? What were some special moments or something? Try to help them get out of those worries in their mind too, potentially. But, you know, self-care comes first. Put on your own oxygen mask and get to sleep. And then maybe the next day, help them with some of those. Here's what works for me, right?

Samia Estrada, PsyD (22:10)
Right? Yes. Yes.

Yes.

Yes, exactly. Yeah,

yeah, definitely. Speaking of doing this before bed, what would be ⁓ an easy gratitude practice that somebody can do before bed that you would recommend?

Heather Martarella, PsyD (22:34)
Cool.

Yeah, so I generally recommend just thinking about three things, right? Three moments that occurred during your day, three things that are relevant to that particular day. So sometimes people say, that there's a roof over my head. I'm like, that's great. And the roof is over your head on a regular basis, I'm assuming. If not, then today is the day, then wonderful. But what's specific and three somethings that came up in the course of your day today, So,

went out to get a coffee or tea or something and a dog wagged its tail at me and that felt good. Great. You got a text from a friend saying, thinking about you or I remember when, Doesn't that just brighten the day? All sorts of things like that. You really enjoyed a good meal. It can be something really subtle. I appreciate that plant that I have that's looking well or whatever. I look at the plants. Whatever it can be, really something that seems quite small or it could be something that inspired awe.

Samia Estrada, PsyD (23:13)
Yeah.

Yes.

Yeah.

Heather Martarella, PsyD (23:30)
but just what were moments in your day. It could even be something about yourself, right? I really appreciated this about myself. That's why I wanted to include that one about my morning this morning when I looked out and saw the gloominess. I thought, it's gloomy, it's dreary, it's whatever. And I appreciated that my brain had that psychological flexibility and it's able to go like, let's reframe this. What's the good part about it? you know what? I really did appreciate that it's got that nice, cool, crisp morning and the air is clean and fresh smelling and all of that.

Samia Estrada, PsyD (23:41)
Yeah.

Yes.

Yeah, and I love to hear that personal story. I'm wondering if you can share without names, of course, any client stories of people that have benefited with their mental health or their chronic pain from doing gratitude, a gratitude practice.

Heather Martarella, PsyD (24:16)
Yeah, you know, it's always, it's hard to pick apart because there's always a combination of things that people are doing. It's really just one variable that we shift. If I was doing a rigorous research study, I'd say we just changed this one thing, which is like what that 2024 study did, right? But I think because we're doing multiple things, I can't say that I have someone who just the gratitude practice is what did it for them. But I have had plenty of people say that's one of the tools in their toolbox.

Samia Estrada, PsyD (24:22)
Yeah.

Heather Martarella, PsyD (24:42)
that they find really works for them. And we know it helps retrain the brain away from negativity loops, From that rumination, catastrophizing, all of that, to worst case scenarios, to being able to get to like, okay, there were some things that went okay in this day. Even if I thought the day was like a, I don't know, a trash fire or something, right? Like a whole burning fire of nothingness. And then I look at it go, well, okay.

Samia Estrada, PsyD (25:03)
Yeah.

Heather Martarella, PsyD (25:08)
Yeah, the dog did wag's tail. Yeah, I did, you know, have this thing about my thinking. I was able to redirect myself in this positive way, or I made this healthy choice for myself, or just someone reached out and said hello, Or gave me a genuine compliment or anything like that. Yeah, I've had people who have said those things have been quite helpful for them in shifting their emotional state. And when your emotional state's in that way, then they're able to fall asleep. I've had clients who've told me they're able to fall asleep more easily.

Samia Estrada, PsyD (25:26)
So, yeah.

And to be able to make that shift when you're having a bad day and to be able to say, it was a bad day or it was a day where a lot of things happened that I wish hadn't happened, but there were also these good things that happened. That's huge. You know, be able to notice that. ⁓

Heather Martarella, PsyD (25:45)
Yeah.

Yeah,

that is. So I think that doing that like three part practice is really good, but you can also do like a gratitude practice of a body scan. A lot of people will do that as one of their bedtime routines. So some people say, I don't want to write things down. I'm like, okay, you don't want to. mean, ideally you do because handwriting rather than typing it or audio recording it helps your brain take it in better actually. So doing just a handwritten journal, that's why I like those little books. Those are great. But.

Samia Estrada, PsyD (25:59)
the

Yeah.

Heather Martarella, PsyD (26:13)
If you're not going go that route and you're already going to be doing like a body scan, a passive muscle relaxation type thing, what about adding gratitude to that and saying just thanking your body parts, right? Like I'm currently doing with like an acute knee injury. And so as I'm going through a body scan last night, it was just like got in bed and kind of settling down. was thinking, yeah, okay, well, I'm thankful my knee still got me up and down the stairs today. It's still functioning, right? It's uncomfortable, but it did what it's supposed to do. So.

Samia Estrada, PsyD (26:23)
Yes.

and we'll

Yes.

Heather Martarella, PsyD (26:40)
having some gratitude practices where you kind of just on your body scan, scan through, thankful for my eyes that let me see this thing today, or, you know, my mouth that let me smile and laugh and whatever, eat something tasty, whatever, just going on down through your body. My feet got me walking through the day, right?

Samia Estrada, PsyD (26:50)
Good.

Heather Martarella, PsyD (26:55)
can do it that way too,

Samia Estrada, PsyD (26:58)
And I don't know if everybody knows about the body scan exercise. Would you mind just running through it real quick for those who haven't done it before?

Heather Martarella, PsyD (27:06)
Sure, if you're wanting to kind of calm yourself down to go to sleep, we want to start at the top of the head and just kind of focus on where's tension on the top of my head and imagine kind of a peaceful wave washing down through you or a cloud kind of settling down, a nice peaceful cloud, not like a heavy depression cloud, but something just kind of moving down through you or even imagining kind of like you're doing your own X-ray, starting at the top of your head and working on down. As you go down, I'm starting my forehead and going my eyes and my jaw.

noticing any unnecessary tension I'm holding and letting gravity give way and just letting go of unnecessary tension, ideally on an exhale. So I breathe in on an inhale and just say, okay, this is my current state. I'm recognizing some tension in my jaw and on my exhale, I'm it go. Letting just soften and then going down my body. And as I'm working down my body, I'm finding tension in my shoulders or my stomach or my hips or my feet.

And as I'm moving down, I'm just letting go of that tension with each bit. Adding the gratitude piece of it just says, this body part did this thing for me today, It's functioning as I needed to, or it's feeling neutral. It doesn't feel great. It doesn't feel horrible It's just neutral. So we look for neutral and feeling good, anything that feels safe in our body.

Samia Estrada, PsyD (28:20)
and by the end of that your body is so relaxed. It's so much easier to fall asleep and and even if you're not using it for sleep I know people who do it, you know during the day just to get their body to relax and And you mentioned something about going from the top to the bottom But I know sometimes people do it from the bottom to the top. Can you talk a little bit about the difference?

Heather Martarella, PsyD (28:25)
Thank you.

Yeah.

Yeah, certainly. If someone wants to be more alert, if someone's at work and they're taking a lunch break from work, maybe they have something that's stressful that just happened at work and they need to take a mini timeout for themselves. At that point, we may want to do just a grounding breathing practice or a passive muscle relaxation, body scan going down to kind of soothe. But if we need to be able to be more focused, I've got this meeting come up, I'm about to give a presentation or I have to go do this thing with my child and I have to be alert with them.

Then starting at the feet and working our way up can be more activating. So when we don't need to be more soothing and not activating an anxious way, we're doing it with intent, right? So we're doing it to calm the body, but we're also becoming more activated and now I can go forward with the actions I need to take. So I like doing the body scans going from the feet up when we want to be more alert and active afterwards. But if we're trying to soothe and we're going to sleep, so I was relating it to the sleep part.

Samia Estrada, PsyD (29:16)
Yes.

Heather Martarella, PsyD (29:33)
is that if we're starting and calming the way down, my brain's not busy with all of the worries of the day, right? It's just focusing on what body part am I moving to next. And here's where I am in this present moment. I'm focusing on the jaw, I'm focusing on the neck, I'm focusing on the shoulders. And so I get out of all of those worries about my day and just into what's neutral or pleasant in my body as I'm going down. As I'm relaxing, giving more weight to gravity.

And as you get used to this practice, it's kind of like learning a new musical instrument or a new language. With practice, that skill gets stronger. We get better at it and it becomes more and more effective. So it's rare that I wake up during the night and want to fall back to sleep, whatever reason I got up out of bed. And I start doing the body scan. It's rare now that I'm not asleep by the time I get somewhere around my hips, butt, thighs area. I don't usually make it to my feet anymore because I've done this so many times.

So when people say, I'm not finding any benefit from that, like, all right, can you keep it up? Can you continue getting experience and skill with it, right? It will become more more effective. It's that whole neural pathway. You're strengthening that new skill. And as it gets stronger, benefits get better. So I'd say keep it up. Practice, practice, practice. It'll get you there.

Samia Estrada, PsyD (30:37)
Yeah.

Exactly.

Just like when we learn a new language or a musical instrument, right? We're never good at it when we first start, but we practice and practice and then get better at it. Yeah. Yeah. So we have gratitude, we have the body scan. What other tools or what other techniques would you share with somebody who's having a hard time falling asleep?

Heather Martarella, PsyD (30:52)
There you go. Exactly.

Related to gratitude, you can write a gratitude letter if you want to do that. There's other things you can do. There are other gratitude practices at bedtime. I think we've covered the big ones that I really like and that most people resonate with and find value from. But there are others for people who are like, I don't want to do those. There are options. But otherwise, the body scan is a good one. Getting out of our head with other things. Even changing our core body temperature.

Samia Estrada, PsyD (31:15)
Yeah.

Yeah.

Heather Martarella, PsyD (31:27)
a little bit, right? So even just topically, I can say, take a wet washcloth. This works particularly well for women and those in the perimenopause and menopause phase. If you're feeling any kind of heat, you can take a cold washcloth and just kind of hold it to your neck or upper chest area. And then if you have a fan or you just kind of fan it with your hand and you start feeling a little bit more of that coolness, it will help us feel like, okay, I can kind of settle in and focus on those physical sensations and not what's going on in the head. There's autogenic scripting.

And I know like a body scan, a lot of people aren't familiar with that. I say many, many people have never even heard of that and that's perfectly fine. But autogenic scripting is where we're in bed or wherever you are gonna be sleeping, couch, recliner, wherever you consistently sleep. And we are imagining that sense of calm in our body. We're having that more peaceful, comfortable breathing. We don't have to be counting it, but we're just doing this kind of settled breathing. And then we're focusing on a sense of warmth in our hands and feet.

Samia Estrada, PsyD (31:58)
Yes. ⁓

Heather Martarella, PsyD (32:19)
And this one works for all genders, but we do find that women's bodies don't circulate blood the same way as men's do. Our circulation is just different. It's just different, right? ⁓ And so women in particular can find good benefit from the autogenic scripting in that it really is focusing on just using your brain to focus on a sense of warmth in your hands and feet and doing that again and again. My hands feel

Samia Estrada, PsyD (32:28)
Yeah. ⁓

Heather Martarella, PsyD (32:42)
calm and heavy, There's a sense of heaviness. So you're giving weight to gravity and allowing them just kind of sink into the mattress or the chair, wherever you're lying on, the hands and your feet and keeping those warm or that sense of warmth even will be helpful.

Samia Estrada, PsyD (32:46)
Yeah.

that's

a really good one. Thank you for sharing that. What would be, just to kind of wrap things up, one piece of advice that you wish more people knew about, whether it's about sleep or gratitude.

Heather Martarella, PsyD (33:00)
Sure.

I guess they kind of come together, but in this thought. the biggest thing would probably be to let go of the worries as much as you can about the sleep. I'm not going to get enough sleep tonight. Tomorrow is going to be a mess. Not necessarily, We can function quite well on a night of of poor sleep. Now, if it's something that's happening on a regular basis, then we start having more of the consequences of poor sleep. But if it's something that you just feel like, I'm not going to be able to function tomorrow,

Maybe think back to other times when you've had poor nights of sleep and you're still able to function the next day because clearly you've gotten to this point. You've survived all of those past times of poor sleep. You've been able to recover at some point and get back to sleeping well again.

Samia Estrada, PsyD (33:44)
Yeah.

yeah, leaning on your past successes. Yeah, good. Well, we started the show with something that you were grateful for personally. How about if we end the show with something that you're grateful for about the work that you do.

Heather Martarella, PsyD (33:51)
Yeah.

Oh, well, yeah, I just find it really fulfilling So it's just something that I'm passionate about and feel really, yeah, it's part of my core values, right? So one of my core values is service to others and it feels like that's life giving and my purpose. So I'm grateful for it on a daily basis, even when there's challenges, even when people are going through something and it's like a big protective event in their nervous system, right?

Samia Estrada, PsyD (34:13)
Yeah.

Heather Martarella, PsyD (34:27)
just really in a highly distressed place. I've got some folks having surgeries this week. So I'm kind of thinking about them and just wishing them well with that. And other things that people have going on, other challenges in life and such too. But just so much gratitude that we have those connections and that I can be there to support them on their journey, And that just feels great. Get to live one of my values, more than one.

Samia Estrada, PsyD (34:30)
Good.

Yeah. yeah. It's wonderful that

you're doing exactly what you love to do. So thank you for doing the work that you do.

thank you very much, Dr. Martarella for being here. You have taught us so much and it's been really interesting to hear about all these different aspects of sleep and gratitude and everything else that you brought to the table. So I really appreciate you being here. Thank you so much for joining us today.

Heather Martarella, PsyD (35:13)
Thank you so much for having me. It's always fun to get to talk with you.

Samia Estrada, PsyD (35:16)
Always a pleasure!

Samia (35:23)
Thank you so much for tuning in to Thursday Tea with Sami, your sip of wellness and mental health. I hope that today's episode gave you a little inspiration in your journey. Remember, your journey to wellness starts here. I would love to hear from you. Drop me a comment letting me know how you liked this episode or what topics you want to hear more about. Until next time, stay well and keep being your best.