Rest, Fuel, Recover: Treating Insomnia and Eating Disorders in Athletes with Kate Ringwood

In this video two experts cover the basics of sleep and food for athletes as well as recovering from insomnia and eating disorders. Together we…

• follow the story of Alex, a go getter athlete who finds herself exhausted and stuck through her journey to freedom from perfectionism.

• explore the perils of perfect sleep and rigidity with food

• discuss silent sport performance killers

• wrap up with resources about where to find more information and support

About the Speakers:

Kate Ringwood is a licensed therapist who helps athletes untangle perfectionism and eating disorders.  Whether it is a teen navigating recovery or parents tackling Family Based Therapist, she is in your corner, seeing folks in NJ, PA, MD, VT, FL, and AZ.  At Serendipity Counseling, Kate believes healing is about taking up space, being vulnerable and finding your true authentic self.

Kasryn (she/her) helps exhausted adults break the cycle of sleepless nights using research backed approaches. Based in Philadelphia, she serves clients across PA, NJ and Vermont. Kasryn is also available for speaking engagements to help your team or organization learn more about sleep.

Learn more at www.BodyMindAllianceCC.com

Full Transcript:

Hey everyone, welcome, thanks for joining. Um, today we are going to talk to you about rest, fuel, and recovery, treating insomnia.

And eating disorders in athletes. I am Kate Ringwood.

Um, and I am…. A therapist that specializes in helping athletes.

Heal the relationship with body, food. And their sport.

And hello everybody, my name is Kasryn. I help exhausted adults break the cycle of sleepless nights using research-backed approaches.

So, I'm trained, my bread and butter is cognitive behavioral therapy for insomnia.

A lot of people think of medications first for insomnia, but the first-line treatment is.

A behavioral approach. So, I'm excited to talk more about insomnia and sleep today in athletes.

And we're so glad you're here. Quick disclaimer. This is for education, it's not a substitute for treatment. We're both licensed.

Professionals, but we're not your therapist. So, we can't offer medical advice or personalized advice.

We hope this is helpful, and if it resonates, I'd encourage you to reach out to a qualified clinician.

Who can help you understand your…. Yourself, who can look at your medical background, and.

Really take all of it into account. So, this is for education.

It's not treatment.

So, today we're going to talk to you about someone named Alex. So.

Alex is a very hardworking person. Um, she's learned that going that extra mile.

Um, in every aspect of her life has been extremely helpful for her, whether it's in sports, staying on top of school.

Advancing pretty quickly in her career. I mean, she's a very high-achieving, kind of that Type A, structured person.

Um, Alex knows, of course, that sleep and nutrition are extremely helpful for their health.

Um, and is always really determined to do what she feels is right and best for her body.

But lately, she feels like the more she tries to stay in control around these things, the more she actually feels out of control.

So, she works so hard to try to fuel her body.

For her sport, um, with the…. Quote-unquote perfect foods, and now….

Fears going out to eat with friends, uh, because she doesn't….

Trust the restaurant and how they prepare the food. She spends a lot of hours searching online for.

What is going to be the healthiest for her sport, and for her overall, yet consistently feels exhausted during workouts.

Her body feels beat down all week after a race, and her nagging foot injury.

From last year keeps just popping up.

And now, on top of everything else, even though she's trying so hard to sleep well.

It feels like another thing that she's failing at. The harder she tries.

The more supplements she takes, the more things she adds to her bedtime routine.

None of it matters. Her brain will not shut off. She feels even more anxious about sleep.

And she knows that's not helpful, to worry so much about sleep, but she doesn't know how to shut her brain off.

She doesn't know how to make it stop. And it's taking over her life a little bit. Um, she feels like, I can't stay at my boyfriend's place anymore.

I hear him breathing. It changes my routine. And she wonders to herself, like, why can't I sleep like everyone else? Why can't I sleep like my boyfriend does?

And it's starting to really take over her life. It's affecting her.

Daytime performance, and…. No matter how hard she tries, it's getting worse, so it feels really stuck.

And if you're struggling with sleep. You're not alone. And NCAA study on undergraduate athletes.

24% reported traumatic or very difficult to handle sleep difficulties. And 61% reported daytime fatigue and sleepiness at least 3 days. So, that's a huge percent.

Of athletes struggling with sleep. And there's some unique challenges, too, although insomnia and sleep issues are really prevalent in general.

You're also dealing with potentially late games or early practices. There might be a lot of, um, perfectionism, wanting to optimize, wanting to do things perfectly.

Um, there's this idea of orthosomnia. Which is just trying to sleep so perfectly that it gets in the way of actually getting restorative.

Sleep. You may also be traveling across time zones. There's a number of things that make it uniquely challenging.

But, we know that sleep really matters for athletes. Poor sleep reduces.

Reaction time, endurance, impulsivity. While, on the other hand, good sleep can help with repairing your muscles, performance, and recovery.

And if you're watching this, you probably already know all that. You're probably a little bit too worried about that.

So I think it's important to say. But also know that there's not something wrong with you. Most likely. There's just….

An approach that's really counterintuitive and effective, that's not well known. We'll talk about that in a minute.

So, Alex is wondering, why can't I sleep like my boyfriend? Why can't I sleep like everyone else?

You know, you probably know sleep is important, but your body isn't letting you.

So there are effective solutions. I mentioned cognitive behavioral therapy for insomnia.

It's, in many ways, like an exposure therapy for a phobia, if you're familiar with that, you know that.

If you're afraid of, for example, spiders, instead of avoiding spiders and trying not to think about spiders.

You slowly move towards getting comfortable with it. And a lot of the sleep tips that help.

Are when you're someone who sleeps okay, but you want to sleep better.

So, um, one really common one I hear is counting to 100. If you're someone who sleeps okay, and you want to sleep a little bit better, maybe that would be helpful.

Or taking supplements and things like that. But when you don't sleep well, that effortful action.

Creates more stress in the body and makes sleep further away.

So, to go into a little bit more detail on that, a lot of people wonder, why can't I sleep even when I'm trying hard?

The trying hard itself is the opposite of sleep, which is disengagement.

Letting go, release…. And… and not….

Engaging in effortful action. There's a graphic here that's kind of….

An example where the person's saying, I'm determined to go to sleep. There's muscle tension in the jaw.

There's eyebrow tension, they're just really wanting to go to sleep.

And that makes sleep go further away. And that's something you would probably….

No, intuitively. But then, what do you do, right? If you can't try to sleep, what do you do instead?

Another thing that can come up alarming beliefs about sleep, so if I don't.

Sleep perfectly tonight. I'm gonna, you know, flop the next day, or….

Uh, you know, I'm not gonna be able to perform my best, and I have to be my best tomorrow.

Um, this long-term insomnia is gonna affect my health. There's a lot of alarming beliefs about sleep.

These thoughts increase the heart rate. Thinking scary, things like that about sleep. While they're not always totally incorrect, it increases that tension.

And there tends to be an over-focus on. The aligning beliefs at all sleep.

And this leads to a cycle. Where there's the stress in the body.

Leads to that tension, wound up feeling, which leads to sleep problems.

That leads to more worry and stress, and it kind of creates this vicious cycle.

Another thing that can happen is chasing sleep. So, I often hear people say, I have to go to sleep when my body feels like it, or I'll miss the opportunity, and I'll be up all night.

So that might mean going to sleep at, like, 8pm. Because I feel a little sleepy. But the body interprets that more as a nap, not ready for a full night of sleep.

So then you're waking up, and that creates a self-fulfilling prophecy, because the sleep jibe, or the sleep hunger, is reduced from the nap.

So then, there's not enough sleep. To sleep, drive, to stick through the night.

And that creates something called sleep extension. So, just to orient you to this graph, this happens to be a schedule, a sleep schedule of 11pm to 7am.

But this is just random times. You could put in anything here.

The light blue is asleep, and the dark blue is awake.

So, we have…. Periods of sleep.

Sleep episodes, and then we wake up after them. You may have heard about sleep stages.

But essentially, we go through four to five cycles of sleep a night.

And wake up roughly around after each cycle. When those naps and going to bed early, trying to catch sleep.

That extends it and creates a habit. Of being awake in the night.

So, it's intuitive, right? We're trying to adopt. So, this is the initial insomnia episode. Maybe there was a really stressful event, a big.

Past, uh, a breakup, anything that led to less sleep, we're trying to adapt by extending the sleep window, but it just creates a habit.

Of sleeplessness in the body. Not something you're thinking about, it's just happening more physically.

So, something you might be wondering is, okay, is it bad enough?

Like, how do I know if it's bad enough to be considered insomnia? So for a real answer, a true answer, you're gonna have to consult with a healthcare provider. This is for.

Educational purposes only. But, um, typically, we're looking for at least one type of insomnia, so difficulty falling asleep.

Staying asleep or waking up too early. It's pretty rare to have all three, but it's not impossible.

Typically, we're looking for at least 3 nights a week or longer. It doesn't have to be.

Every single night. But at least 3 nights per week.

And for at least 3 months. And the difficulty can be tricky for people, like, how do I know if it's enough to be difficulty?

So, uh, you can talk to a healthcare provider, but a general rule is looking for more than 30 minutes of a wait time at night, or longer than 30 minutes to fall asleep.

But if it bothers you, it's worth checking out and looking into it.

So what do I do about it, right? If all of the sleep tips are just gonna make it worse.

And my sleep is really bothering me. What… what can I do about it?

So, um, there's the therapy I mentioned earlier, cognitive behavioral therapy is the first-line recommended treatment.

It helps you reset and heal your natural sleep mechanism. So, strategically tying the sleep.

When I talked about the, um…. Sleep extension that's happening.

We're gonna consolidate the sleep. We're gonna make it fit. So that your body gets used to sleeping well, we increase quality.

Than quantity. I'll also challenge your aliming beliefs about sleep. And change your relationship with sleep.

So that you're not gaslighting yourself, you're not saying, it's the best thing ever when I don't sleep at all. That's not the goal.

But rather to think about it in a different way, and know that stressing about sleep.

Kind of coming back to Alex's story, the more… the harder you try at something, it's helped her in the daytime.

But at night, it just gets in the way of achieving the goal.

That will change that relationship to sleep. And then we'll also leverage something called classical conditioning.

You may have heard of Pavlov's dogs, where they were conditioned to salivate in response to a bell.

You can look up that later, look that up later if you are interested, but basically, we'll train your body.

To sleep in the bud. So, there's an option we can do all of that. You can also look at self-guided resources to work at these different methods.

There's books and apps. At the end of the presentation, there'll be some resources, so you can find some of the specific books and apps that can help.

With this approach. And I'll hand it over to Kate.

Thank you. Um, yeah, so…. Along with sleep, of course, helping your body recover and become stronger as an athlete.

Having a healthy relationship with food as an athlete is also extremely important.

Um, a couple things that we're going to talk about today is relative energy deficiency in sport.

What that is, what it means, how it impacts your body.

Um, how shame intersects with. Uh, body image?

And shifting your thoughts and language.

Oh, sorry, I don't think I'm able to switch the slides, so you have to hit that for me. Thanks!

Awesome. All right. So, relative energy deficiency in sports. So, this is otherwise known as Red S, or Reds.

Um, and this is basically when…. Energy intake.

Chronically falls short of energy. Requirements, um, or the amount of energy that we expend as we're working out.

Um, so basically, it is… that's through training and exercise, but.

Basically, we're not taking in enough fuel through our diet to fuel the amount of exercise that we're doing.

Um, and this can actually take place in both males and female athletes.

Um, and…. It… there's a lot of different consequences, so… but you can go to the next slide.

Um, okay, so…. Consequences of RIDS is basically that it impacts every.

Organ system in the body, including the heart, brain, endocrine, immune system, reproductive system.

One that a lot of folks may know is, um, the loss of a period.

And through…. What used to be called the Female Athlete Triad.

This was before REDS was a thing. It was basically…. Showed the impact that under-fueling can have.

On female bodies. Uh, and that that tends to lead to poor bone health and.

Loss of period. However, they have recently. Now understand more that this actually impacts males as well, as.

And also, basically every single system in your body. Okay, you can go ahead on to the next slide.

So, there's specific performance consequences for athletes specifically. Um, and this is loss of energy and increased risk of injury.

Um, so the hormone imbalances, uh…. Affect both male and females differently. For females specifically.

There is, um…. Their hormone imbalances tends to lead to lower bone density, which.

Creates a higher risk of. Stress fractures and things along those lines.

Intense dieting can negatively impact. Vo2 max and running speed.

Decreased concentration and ability to manage your emotions within your sport. So, if you tend to get a lot of anxiety around.

Um, like, the day of a big competition or a race.

It can be actually harder to manage those emotions. Um, and then excessive exercise and restricting often leads to dehydration, which, of course.

Can compromise performance as well, especially in this brutal heat that we're having.

So, another impact…. Um, that can impact recovery is shame and body image.

Um, about half of girls ages just 6 to 12 are concerned about their weight.

Almost 80% of those on diets actually were sport. Report coping with.

Sigma against their weight by eating more food. Weight-based victimization among youth have been linked to actually less physical activity.

Lower self-esteem. Higher body dissatisfaction and a higher risk of eating disorders.

So, what that basically tells us is that…. When….

We are being told that we need to lose weight. Because our body size is just not okay, whether that's by doctors, by coaches, by parents, by peers.

It's actually less likely to do the things that. They say, we want to do in order to be healthier, so it leads to this lower satisfaction with ourself.

Tends to actually eat more food. Physical activity goes down, I mean.

The high risk of eating disorders just skyrockets when. There's weight-based victimization.

So… okay, we know this information, we have this information, so then….

Than what, right? These… shifting our thoughts and our language is not just for someone that is struggling with.

Um, reds, or an eating disorder, this can be just creating a positive atmosphere.

Among…. Teams, because we do know that teams have a….

The relationship between a coach and their team and the athletes on the team.

Have a very, um, can actually increase the risk of an eating disorder happening.

Um, and athletes themselves are 2 to 3 times more likely.

Than the average individual to develop an eating disorder. Um, and I want to also.

Just bring up that this, again, is not just females. Males contribute to about 25% of those struggling with anorexia and bulimia, and about.

40% of those. Our males who are struggling with binge eating disorder.

Binge eating disorders, actually, probably the one that creates the most shame and is the least talked about.

Um, and is the actual eating disorder out there? So, we know that it's there.

So, what do we do? Um…. So, avoid using terms that label foods, so it creates judgment towards foods.

Saying that they're good or bad. I mean, it's so common these days to hear something like.

Oh, I… I can't eat that cookie. Right? Um….

Or, I'm gonna be so bad if I eat that cookie.

Well, if we label the food as bad. Then we have this automatic thought of then we are bad if we eat that food.

So avoiding that judgment around it is extremely important. Remember, foods don't need to be earned.

The one thing that I like to remind folks of is that.

Even if you have committed the worst crime and you are in prison for life.

You still get fed. We all deserve to fuel our bodies.

Um, focus on what your body can do for you, rather than the size or the shape.

So, if you're an athlete. Thinking about how your body actually helps you do your sport.

Um, the strength that it takes to compete. All of those things.

Avoid using numbers, measurements, or calories. Um, that… basically, avoiding….

Numbers and measurements like that creates less of an atmosphere for comparison, and comparison.

Is something that can be really high when it comes to eating disorders.

Pay attention to the mind-body connection, such as hunger, fullness, and satiety.

This is something that, you know, we're born with this instinct.

To, uh, you know, babies cry when they're hungry, they push away the bottle when they're full.

Um, and then over time, all the messages that we get.

Through commercials, through what people are saying, judgments around foods and bodies.

We learn to just ignore those cues. And push them away.

And when we do that, we actually lose trust with our body.

And that creates a lot of difficulty when we're trying to actually fuel our body enough.

In order to perform. Uh, talking about social media and the messages around diet culture.

So, if you're unaware, diet culture is kind of the messages that we get through commercials, advertising.

All the judgments around food that are out there in the world.

It's everywhere, and…. We need to talk about it more, and talk about how things are not accurate.

All the shame that that…. Like, diet culture creates so much shame.

And the more that we talk and are vulnerable around that shame.

The less power that that gives. Um, to us.

So, the last thing that I have here is thinking about who you are and your top values.

If you… I often have clients list out, like, their top 5 values that they want for themselves.

And sometimes it can be helpful to look at someone maybe that you admire.

Um, and what you admire about them, and what qualities maybe you have, or that you want to have, and work towards.

And identify your top 5, because. You can….

Make…. Calls around your life, like, make decisions around what those values are.

So if you are sitting… this is one that comes up often for me, you know.

If you're a mom sitting with their 5-year-old and their 5-year-old really, really wants ice cream and wants to go.

Share an ice cream cone. You know, maybe your value is family, and you want to be able to put them first.

And so you have to…. Make that decision, then, to.

Lean towards your value of family. Versus maybe those disordered thoughts that you may have.

And that's kind of an extreme example of how it would be used in this.

Dynamic, but…. This really helps you identify who you are as a person inside and outside of your sport, and how to lean in towards that.

So, this brings us back to Alex's story. So. Alex is nervous, and the messy middle can be really scary as she steps into maybe seeking help.

But she realizes that she doesn't want to have to…. Do this alone. She reaches out for help.

And while it can be really uncomfortable, she knows it will result in better sleep and a better relationship with food.

One thing that I noticed the similarities of between. Sleep and improving your relationship with food.

Is that kind of aspect of exposure, and sitting in that uncomfortable, messy middle area.

Where you have this increased anxiety. And that can be something really, really scary to step into.

And yet, it's needed to be uncomfortable in order to improve the relationship with both of those things.

So, we can challenge. We can be challenging, scary foods in order to gain flexibility with the foods.

Um, and this results, ultimately, in less stress and anxiety over the choices that Alex is making on a daily basis.

She will learn that her stomach can adapt to eating closer to workouts, and leaving her feeling more energized with a faster ability to recover from tough races and workouts.

Over time, her bone strength will increase, and that nagging foot injury will disappear and never come back.

She'll be able to truly test what foods feel good for her own unique body without feeling certain judgment around what is right and wrong.

Yeah, absolutely. There's so much overlap in the exposure, and with sleep.

She learns that trying to force herself to sleep is like, just calm down.

And telling herself to do that, it only backfires. Not trying, especially effortful trying, makes sleep less likely.

And instead, she learned that loosening her grip on sleeping perfectly, which is scary.

It allows her to sleep more and feel more well-rested, too.

And it allows sleep to come on its own. So, instead of spending hours trying to sleep, she enjoys her evening.

And she gets good advice that she can count on. She's trained her body to sleep in the bed, not with her thinking mind, not with.

Trying to convince ourselves to sleep, but it's just something her body's doing on its own.

And she starts to notice that once again, the bed is a safe and restful place.

Instead of a source of tension. And one really fun outcome, too, is that she feels more free.

Just stay at her boyfriend's place. She's not bothered so much by his breathing. In fact, it's….

A safe, comfortable place again in the bed, and she doesn't even notice his breathing anymore. She's not so aware of the….

Surroundings. She also notices improvements in her daytime performance. How she's thinking, her response times, and….

Overall, feeling much better. So we've come to the end of the presentation, but I wanted to share some of the resources and some information.

About how to work with us, or, you know, where you can get connected if any of this really resonated.

So, you can schedule a free consultation through my website or my email that are listed below.

Um, and we can talk and see if we're a good fit. Um, I can… and if….

I know that I'm not a good fit for anyone… everyone, so if I'm not, I am always happy to talk to you.

And see maybe which direction we feel like would be best to go, um, and how I can assist.

Very cool. I'm also happy to serve as a resource, too.

Um, sleep medicine, behavioral sleep medicine in particular, is…. Um, a best-kept secret….

And so, feel free to reach out, and I can get you pointed in the right direction, even if that's not working with me.

I have a wide range of colleagues who do this insomnia and sleep disorder work, and.

I'm happy to get people connected. You can schedule a free consultation by emailing me or checking out my website. You can learn more there, too, about.

The sleep therapy, step-by-step, it's on the website. And I really encourage you to reach out.

For sleep resources, I mentioned I'd share apps and books and where to find more information. You can find, um, apps for sleep.

Here, there's a couple links, there's a couple book options here.

And then, um, I serve clients. One-on-one in Pennsylvania, New Jersey, and Vermont.

If you're not in one of those states, do feel free to reach out as well, but you can also find a directory of sleep providers.

Um, in these two places. And one final thing I forgot to mention is.

If your team or your organization needs someone to come and talk about sleep, and you want support in that way.

I also offer, um. Speaking engagements and talks. I think Kate might do the same, too.

So I'll let you share your resources and any additional things.

Awesome. Yeah, so…. Um, yeah, I also do talks if anyone wants to learn more, or, um.

Educate… I do talks for different teams. Things like that. Um….

I am also only licensed in specific states. Those are New Jersey, Pennsylvania.

Maryland, Florida, Vermont, and Arizona. Um, and this resource below, um, a directory of providers that work specifically with eating disorders or disordered eating.

Um, among athletes is, uh, lane9.com. Um, that is a…. Um, organization that is set up specifically for athletes, um.

Working with female athletes, even more specifically around these topics, um, and it's everything from therapists, dietitians.

Physical therapists, doctors. You name it in the athletic world.

Uh, and you can basically find it. Trainers, um….

And then a couple podcasts, uh, Lean 9 Project Podcast, same organization.

Amazing podcast, focuses a lot on runners. Specifically, the appetite is run by, uh, Opal Food and Body, which is an eating disorder treatment facility in Seattle.

Also amazing, and then fit for a Queen is…. It's a good one as well.

Um, a couple books, uh, running in silence and Brave Enough, um, ones by a runner, one's by a skier.

Uh, just some different perspectives on their own battles with sport and eating disorders.

Okay, cool. Any final things that you…. Wanted to share or mention before we wrap up?

Yeah, I'm sure this was a lot of information for a lot of folks, and it can be a bit overwhelming.

Um, and…. This is something that you have to go at your own pace.

And so I welcome folks of… no matter where you are in your journey.

Um, with disordered eating, or an eating disorder, you don't have to be diagnosed with one in order to come and talk to me.

Um, just, I'm assuming the same for you, where they don't need to be diagnosed with some sleep disorder in order to.

Seek help, or just talk to someone, and so I encourage you just to….

Make that first really difficult step, because that is the most vulnerable, hardest part.

And know that there's… there's people out there to help. Support you, and you don't have to be alone.

Yeah, yeah, absolutely. Yeah, that next step, where it can be overwhelming thinking about, how do I do this, and what's the next, and….

Um, and really, it's just the next step. Um, and taking that, so….

Thank you to everyone for watching. Made it all the way to the end. It was a pleasure speaking with you, Kate. I really enjoyed.