Clinical psychologist Dr. Kristen Casey has more than 136K followers on TikTok, but she strongly advises against watching her reels — or anyone else's for that matter — right before bed. In fact, she tells her patients to avoid looking at their phones up to an hour before going to sleep.
"Who likes that? Nobody!" Dr. Casey says. "Do it anyway. You're not gonna like it, but do it because it's really going to help your mental health."
Trust her, she knows. A self-described "former anxious insomniac," Dr. Casey specializes in Cognitive Behavioral Therapy for Insomnia, also known as CBT-I. She is House of Wise's resident sleep expert, joining our sex expert (Dr. Kate Balestrieri) and our strength expert, Ariel Belgrave.
Dr. Casey earned her Doctor of Psychology in Clinical Psychology from Midwestern University and fell in love with the study of sleep during her internship at the Veterans' Administration in Phoenix. She now owns a private practice, Evolve Psychological Services, where treats patients for insomnia as well anxiety, depression, and other concerns. Her practice is intentionally 100% telehealth.
"One of the biggest things people talk about with mental health is accessibility," Dr. Casey says. "Not everyone has access to quality mental health treatment. So I think it's really important to be on telehealth so that people in rural areas don't have to drive an hour and a half to see a therapist."
Similarly, Dr. Casey choses to have a presence on Instagram and TikTok in order to connect with more people. "I have all this knowledge in my mind, and what a disservice to keep it to myself or just the clients that I see," she says.
"I don't really know what my life purpose is, but I feel like it's connecting with people, and [social media] is one way to do that."
A Sleep Doctor's Origin Story
Dr. Casey's origin story begins with her own insomnia, which she suffered from a very young age. She grew up in New York City, in various neighborhoods in Staten Island and Brooklyn, where the nights were filled with sirens and crime.
"My insomnia was really bad when I was younger," she says. "I would stay up all night because I was scared, then I would sleep during the day when there was more supervision and people were around."
Dr. Casey's sleep issues got even more severe when she started working as an Emergency Medical Technician at the age of 18; shift work confused her circadian rhythms. But working as an EMT had benefits as well: Dr. Casey took the job in part because she recognized that she was hanging out with a bad crowd and potentially going down a dangerous path.
"I barely graduated high school, and I came from a very traumatic upbringing. I just needed something to get me off the wrong path," she says. "[The job] created a family that I didn't know I needed at the time."
"I desperately needed some direction, and that job put me on a trajectory to help other people and get my life in order."
Through her work as an EMT, Dr. Casey received a hands-on education about mental health, healthcare-related burnout, and the mind-body connection. She also realized how rewarding it was to help people, which led her to a career in mental health — specifically the field of health psychology, which focuses on people's overall functioning and how that relates to mental and physical health.
Falling in Love With Sleep
In search of warmer climates, Dr. Casey relocated to Arizona and enrolled in Midwestern University in Glendale, where her dissertation was focused on helping graduate students in healthcare professions manage burnout using self-compassion and healthy lifestyle habits. She landed a coveted internship at the VA, which offered a very well-rounded training in pretty much all aspects of mental health.
When she was required to facilitate a CBT-I group during her internship, she admits that she dreaded it at first; it sounded dull. But as it turns out, the study of sleep became her passion. "That's just where I fell in love. It made everything make sense. I learned so much for myself and for my clients."
Perhaps unsurprisingly, sleep is often a major issue for people who struggle with other mental health issues, such as trauma, anxiety, and depression. "If we are depressed or dealing with a mental health issue, it's likely our sleep will suffer as a result," says Dr. Casey. In particular, women with anxiety have a higher likelihood of experiencing insomnia issues, but not everyone who has insomnia suffers from anxiety.
"Sleep is part of our life pie," Dr. Casey says. "When our sleep suffers, it's likely we may suffer in other areas of life, too. For example, we know that sleep deprivation may lead to increased irritability, depression, or anxiety."
Misconceptions About Sleep — And What Actually Works
When working with patients, one of the first things Dr. Casey asks is, "What is your relationship with sleep? What do you think sleep does for you?"
"A lot of times, people confuse sleep with relaxation," she says. "Really, sleep is for restoration. It's to restore your cognitive processes."
Another misconception is that people often think insomnia means they aren't getting a certain number of hours of sleep, such as the oft-quoted eight hours. But while everyone needs a certain amount of sleep, not everyone necessarily needs eight hours a night. What's far more important is that you're getting quality sleep. One focus of CBT-I is improving a patient's sleep efficiency score. Practitioners strive to help clients achieve a score of at least 85, meaning that you are sleeping at least 85 percent of the time you are in bed.
While CBT-I is the ideal treatment for someone suffering from insomnia, Dr. Casey suggests other measures that we can all take to make sure we are getting quality sleep. The first is making sure your bedroom is dark (if possible, try blackout curtains) and cool. "To get into deep stages of sleep, your temperature has to drop," she says.
Another important practice is coming up with a bedtime routine, or what Dr. Casey calls a "buffer time." That's the part that involves avoiding your phone for at least an hour before bed, which is advice no one wants to hear. Another unpopular but highly effective tip is to maintain a consistent wake time, even on weekends.
"People hate it when I say that," she says. "[They say] 'I don't want to wake up at 6 a.m. on the weekends!' Me neither. Nobody does. But it's going to help."
CBT-I also involves what the professionals call "anti-arousal measures" — that is, relaxation and self-soothing techniques that involve progressive muscle relaxation, diaphragmatic breathing, and guided imagery and visualization. When you are anxious in bed, your sympathetic nervous system is engaged, and that's the part of the nervous system that governs the "fight or flight" response. Your stress could be caused by an actual physical threat or something emotional, like your job or your finances, but the effect is the same.
"If you are stressed, it's a threat to your being and your psyche, and you're not going to go to sleep," Dr. Casey says. "You can't possibly be relaxed and anxious at the same time."