When better sleep becomes ‘crisis work’

Anne Brice (narration): As a new social worker, Emma Agnew didn’t get much sleep. It was 2016. She’d just graduated with a master’s degree in social welfare from UC Berkeley. And like a lot of people in her field, she felt pressure to put her clinical work first.

Emma Agnew: At that point is when most mental health practitioners are doing their most intense work, working with the most vulnerable populations in intense settings. I certainly was.

I was in community-based mental health, working with families who were with the foster care system. That can be intense, crisis-based work, and yet you’re expected to carry workloads that are past most people’s capacity, and to do it on little sleep.

There’s definitely, I think, even in the mental health field, a badge of honor around not sleeping enough, not resting enough and being able to do it all.

(Music: “TwoPound” by Blue Dot Sessions”)

Anne Brice (narration): It’s a cycle many of us recognize — the idea that we can simply power through exhaustion if the work is important enough.

Anne Brice: How were you feeling when you weren’t getting enough sleep?

Emma Agnew: Yeah, I mean, there’s the obvious things I think when we don’t sleep well, and for myself, you know, like your ability to think creatively, your ability to see the world accurately decreases.

But I do also think that I had really acclimated to less sleep. So I thought, “I can function well and move that to the side.”

Anne Brice (narration): In 2020, Emma returned to UC Berkeley as the director for clinical implementation and partnerships at the Golden Bear Sleep and Mood Research Clinic. The clinic focuses on the connection between sleep disturbances and mental health.

It was there that Emma began learning just how fundamental sleep is to everything — mood, anxiety, daily functioning and overall quality of life.

Emma Agnew: There is this eye-opening moment of like, “Why was I dismissing sleep? Why didn’t I see it as being so important?” We live in a society that really values maximizing productivity.

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You know, we have this saying, “You can sleep when you die,” or ideas of people who sleep in being lazy. There’s really interesting research even around how “night owls,” people who naturally have a later chronotype, tend to experience so much social stigma.

And so I think there’s been a disconnect between understanding how we have to have the right foundation and rest in order to do our best work. Fortunately, there is a transition happening now where I think there’s more of a conversation about how rest and sleep are important.

Anne Brice (narration): In her role at the clinic, Emma was tasked with implementing a new sleep treatment in community clinics across California.

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It was an effort that Berkeley psychology professor Allison Harvey, the founder and director of the clinic, had been working on for the past 15 years.

This is Berkeley Voices. I’m Anne Brice.

The Golden Bear Sleep and Mood Research Clinic was established in 2004. It has two broad goals, Allison explains.

Allison Harvey: First, we’re interested in leveraging basic science findings from various fields to improve treatments for mental health challenges. A key focus for us is on improving sleep problems, but we’re also interested in other topics like habit formation. In fact, we’re using the science of habits to help people who have media use habits that interfere with getting enough sleep.

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So that’s sort of one angle, leveraging basic science into new treatments.

And then when we have the new treatments, we put on our implementation-scientist hats and try to work out how to scale the treatment so it’s widely available.

Anne Brice: What does getting a good night’s sleep do for us?

Allison Harvey: Oh yeah, I mean it is just profound. You know, sleep helps us process emotions — that’s a key function of sleep — and helps us to think clearly, helps us at the level of problem-solving, creativity.

And, of course, maybe it’s less apparent on a day-by-day basis, the effects on our physical health. But over years, it does really play a role in our physical health, too.

I also want to be careful because I think that it can be the case that messages about the importance of sleep can make people anxious. And then when we make people anxious, they’re less likely to sleep.

So sleep is one of many things that contribute to our health and wellbeing. It’s an important thing, but there are times in life when we won’t sleep well, such as having a new baby in the house or caregiving responsibilities. And so, you know, the system is built to be robust and to be able to manage these periods of insufficient sleep.

(Music: “The Crisper” by Blue Dot Sessions)

Anne Brice (narration): In her research on the interplay between sleep and mental health, Allison has found that when you treat these issues together, the symptoms of each improve.

This was contrary to how the medical establishment had long viewed the relationship between sleep and mental health challenges like anxiety and depression.

Allison Harvey: Sleep science is a relatively young field. It actually wasn’t until the 1950s that sleep scientists were able to measure REM sleep and other stages of sleep. And sleep medicine, which refers to the focus on sleep problems, really didn’t take off until even later, like 1980-ish with the first classification of sleep and circadian disorders. So it’s a relatively new domain of science.

And I think there were just decades when sleep problems were considered to be secondary to mental health challenges, and it was assumed that if we improve mental health, the sleep problems would just go away. So the sleep problems were kind of ignored.

Anne Brice (narration): Take bipolar disorder, for example. The old assumption was that by treating the mania or the depression associated with the condition, the sleep problems that those with bipolar disorder often have would resolve on their own.

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Allison Harvey: But then we started to see findings coming out showing that sleep problems are actually an early warning signal to an onset of mania or depression. And that of course raises a possibility that if we can help people with their sleep, we might be able to reduce the time they spend in episodes of mania and hypomania and depression.

And certainly some of the data collected here at UC Berkeley showed just that: If we improve sleep while people are still taking mood-stabilizing medications, etc., both of those side by side, people did spend less time in episodes and were well more of the time.

So that kind of research, we were doing it on bipolar disorder, we also did it with teenagers who were depressed. More recently, we’ve been doing it with a broad range of folk who are experiencing severe mental illness.

And the finding just keeps replicating, and people all over the world are replicating this finding, too: If you treat sleep, you’ll improve the mental health symptoms.

Anne Brice (narration): The data clearly showed a connection. But Allison became frustrated that these findings weren’t reaching a lot of the people who really needed them.

Allison Harvey: So I started to contact community mental health centers all over California and ask for meetings to talk about whether there would be interest in a project to provide sleep treatment to people within who were receiving services.

(Music: “Ile Duchess” by Blue Dot Sessions)

Anne Brice (narration): Many were interested. Not only would it be helpful for their clients, they said, but also for the practitioners themselves. They all worked in highly stressful environments without sufficient resources. They could all use better sleep.

So Allison set out to create an accessible tool that allows practitioners to integrate sleep treatment directly into mental health care.

Anne Brice (narration): Treating sleep disorders is complex. Within traditional sleep and circadian disorder treatment research, the common approach for decades was to focus on one disorder, like insomnia or nightmares.

But Allison wanted to take a different approach.

Because different kinds of sleep disturbances often occur together, she wanted to create a tool that would address the multifaceted nature of these disorders.

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So she teamed up with Daniel Buysse, a professor of psychiatry and of clinical and translational science at the University of Pittsburgh. Together, they developed the Transdiagnostic Sleep and Circadian Intervention, or TSC. It’s a modular treatment that allows practitioners to mix and match different strategies — like adjusting a “night owl” schedule or managing bedtime worry — to fit each person’s unique needs.

Allison Harvey: It’s designed to be helpful for a broad range of mental health challenges. And it’s designed to be helpful for a broad range of sleep and circadian disorders that people experience.

Anne Brice: What does that look like when you’re working on improving someone’s sleep?

Allison Harvey: Most people coming in for treatment are looking for the one thing that they can change to get rid of this sleep problem. We find that we’re looking for eight-plus things that we can change that together will make a big difference for sleep.

Any one of those things, doing a tweak to it might not make an appreciable difference, but all eight-plus of them do.

So the kinds of things I’m talking about vary from person to person, so it’s individualized, but what pops up a lot is regularizing bedtimes on weekdays to weekends. That one right there is huge and definitely one that’s hard for teenagers and young adults, but is really important.

Then there are others that I might put in the domain of just general factors, like checking in with people about caffeine use, alcohol use, etc.

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Other examples would be making sure that people are in bed and ready for sleep. That involves having a regular wind-down and really working on what that looks like with people. It sounds like it’s not rocket science, but actually it’s very hard to do a good wind-down for many of us.

And we also do a kind of a rise-up routine. And we make sure that people aren’t spending, like, 11 hours in bed trying to get sleep when they’re only getting, say, seven hours of sleep.

Anne Brice: Is there something that you have taken and used in your sleep routine that has been really helpful to you?

Allison Harvey: Yeah. I think that exercise is one of the most powerful and underused tools for improving sleep. It helps in every way.

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You know, it increases sleep pressure, it reduces anxiety, it deepens slow-wave sleep at the beginning of the night, it helps us regulate our circadian rhythms. But it’s often the first thing to go when we’re not feeling like we’re getting enough sleep. So that continues to be my favorite tool.

Anne Brice (narration): For those of us who might worry about getting enough sleep, Allison says that it’s less about strictly enacting the techniques and more about setting the right conditions for sleep, then letting go.

Allison Harvey: We get phone calls, I get emails, you know, “I was reading whatever book, or listening to whatever podcast, or I just got a wearable, and I’m in a panic because my sleep is clearly not good enough and I’m going to die.”

So a quick fix is actually, “Well, stop reading the book, stop the podcast, and let’s talk about a more balanced view of sleep.” It’s hard to both get the messages out that we should value sleep, but also not overvalue sleep, because that’s a problem as well.

Anne Brice (narration): It’s a gentle reminder that sleep isn’t a performance that we have to perfect. It’s OK if some nights are difficult. The goal of the Berkeley clinic isn’t to add another “to-do” to an already stressed life, but to give us permission to stop fighting against our own bodies.

(Music: “Arequipe” by Blue Dot Sessions)

Allison and her team had the data and the flexible tool that they could use. But in clinical science, there’s often an “implementation cliff” between a successful lab study and real-world use.

The real test was whether TSC could hold up in the high-pressure world of public healthcare. To find out, the Berkeley team would take these sleep strategies out of the lab and into the field.

Anne Brice (narration): With funding from the National Institutes of Mental Health, the Berkeley team partnered in 2014 with a community clinic in Alameda County to prove the tool worked in the real world. It did.

Allison Harvey: We saw that the transdiagnostic sleep treatment improved sleep, but also improved symptoms of the comorbid psychiatric disorder.

Anne Brice (narration): In 2017, Allison co-published a book describing the tool and how it could be applied.

Two years later, the project expanded to include over a dozen counties across California. Emma was tasked with winning over busy practitioners, showing them exactly how this treatment could work in their own hectic clinics.

Emma Agnew: Those relationships were key to helping people change attitudes toward sleep, helping people really understand why sleep was important, because there’s so much messaging around, even in the mental health fields, around sleep not being important.

We were trying to take the approach of like, “We’ve got some research, some of these tools around sleep treatment. You’ve got the expertise and the knowledge around your clients, your treatment setting, what you’re doing already. How can we partner with and empower you and give you the tools to adapt this?”

And that worked really well. I mean, it’s a long process. It takes time to build relationships.

Anne Brice (narration): Devin Ma is a clinical supervisor on the performance improvement team at Solano County Behavioral Health. He’s been with the county since 2013, primarily as a youth clinician, and he was part of the team that collaborated with UC Berkeley during the study.

Devin Ma: The challenges that clients come in facing are from areas with trauma, anxiety, depression. Something that’s been really coming up a lot are eating disorders. There’s housing, that’s an issue.

Anne Brice (narration): When Devin trains other clinicians on the Berkeley sleep protocol, he emphasizes that the tool is designed to be flexible.

Devin Ma: And so when I’m training and teaching sleep coaching, every single piece is important, while at the same time, you don’t have to use all the modules. You can pick one of them and use that as a targeted work with your client.

Anne Brice (narration): For Devin, the most critical module is the “wind-down” — a period of transition designed to shift the body from daytime arousal to a state of rest. While this includes techniques like deep breathing or progressive muscle relaxation, Devin found that the most transformative change is detaching from the digital world. It’s a practice he’s seen transform his own children’s behavior.

Devin Ma: Once I learned about sleep back in 2020, I was like, “Oh, so this is how much separation a person needs from electronics to settle down.” Because kids are staying up, playing games on YouTube, TikTok, whatever social media they pick. And so detaching from that. Even with my kids, it’s done so much for them emotionally and physically. They’re more focused. They’re more present.

Anne Brice (narration): Devin says that talking about sleep can sometimes be a bridge to deeper conversations.

Devin Ma: We are taking very vulnerable people at their most vulnerable moments and asking them to share everything with us.

You know, culturally there’s, as you mentioned, there might be challenges in having people be open and transparent and honest about what’s really going on in a household. It’s really building that trust, building that relationship.

So if I’m sleeping too little, it could just be a conversation of, like, “How come you’re not sleeping so much?” And it can go, “Oh, I’m just bothered. I’m just thinking about stuff.” “Oh, what are you thinking about? Tell me more about that.” “Oh yeah, my kid, he’s been drinking so much that I just don’t know what to do.” “Oh, that is a problem. So I’m just wondering, what are you worried about that they’re drinking so much?” “Well, I’m worried they could get into an accident, they might hurt someone or they might hurt themselves.”

So sleep, it opens up the doors for other related issues that are happening.

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Anne Brice (narration): Sophie Tagliamonte was another practitioner who saw the impact of the sleep treatment firsthand.

During the study, she was a psychologist at First Hope, an early psychosis program in Contra Costa County. Sleep often played a pivotal role in her clients’ symptoms.

Sophie Tagliamonte: Lack of sleep can precipitate or exacerbate symptoms of psychosis. One client in particular, I remember him saying, “Wow, I’m not seeing things as much or, you know, the hallucinations had decreased” when he noticed he was getting better sleep, more sleep.

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Anne Brice (narration): Sophie found that the protocol’s practical nature made it “easy to digest” for families of loved ones with early psychosis, including conditions like schizophrenia.

Sophie Tagliamonte: It is very isolating, it’s very stigmatized. We try to treat not only the clients, but the families as well, to get back to a sense of normalcy, get back to school, get back to work, function in their daily lives and achieve their goals.

Anne Brice (narration): For clinicians like Devin and Sophie, sleep became more than a measure of rest. It was a way to build trust, stability and connection. In helping clients open up and families heal, they began to see just how much was at stake — insights that are now starting to shape care at the state level.

(Music: “Momentary Ease” by Blue Dot Sessions)

Anne Brice (narration): The Berkeley study ended in 2025. In all, nearly 600 clients at clinics across California formally received sleep treatment, although Emma estimates about 2 or 3 thousand more received it informally.

The Berkeley team has begun to publish their findings. Emma says the results are a stark validation of Allison’s decades of research.

Anne Brice: What have been some of the outcomes that you’ve seen come from the clinics?

Emma Agnew: In some of our early analyses, we found that four out of five clients that received sleep treatment alongside their normal care experienced fewer symptoms of psychosis. Sixty-three percent reported drinking less alcohol. Suicidal ideation severity was reduced for almost half of the clients, which was huge. Sleep treatment is literally something that is life-saving I think for people.

I think that that’s a really hopeful thing, again, about treating sleep. It really increases people’s capacity for dealing with the challenges in their life. And I think of it as also almost like a despair intervention. It really changes that.

​​Anne Brice (narration): The change wasn’t just in the clients, either. Emma saw an evolution in how practitioners thought about sleep.

Emma Agnew: A lot of times initially there would be a lot of skepticism. One line we heard a lot was, “Our clients are dealing with really severe issues or presentations that have to take priority. And yes, maybe we can get to sleep when there are no crises in their life or when everything else is going better.”

And I think there was a shift over time to realizing that improving sleep was crisis work and wasn’t a secondary issue. That it was something that would help, that it was actually one of the quickest and easiest tools to implement to help stabilize crises, to help improve the other things that were going on and that it shouldn’t be something that should wait.

Several of our county partners ended up changing their intake workflows to make sleep be one of the first things that clinicians talk to clients about and prioritize making referrals for if there were problems. So that is one example of how the approach to sleep really changed.

Anne Brice (narration): And Allison’s decadeslong research, she says, has been influential in this greater shift.

Emma Agnew: She is someone who I think has hugely impacted and shaped the mental health field and the sleep treatment field. And I think some of her biggest impacts have been firstly seeing sleep treatment as critical and fundamental for anyone, no matter what mental health issues they’re dealing with.

(Music: “Lahaina” by Blue Dot Sessions)

Anne Brice (narration): Emma recently started a new position as manager of clinical care at a national therapy company called Two Chairs. She plans to take the sleep and implementation science that she learned at the Golden Bear Sleep and Mood Research Clinic to all of her future roles as a clinical social worker.

Emma Agnew: Sleep is definitely something that I will continue to specialize in for the rest of my career. It’s something I love working with, something that I want to keep at the center of my private practice and my work at Two Chairs, because I just think it is such a foundation.

I think in the mental health field, there has sometimes been this approach or philosophy of almost, like, good mental health treatment is just this sort of, like, dusting or sprinkling of magic that happens. Maybe it’ll happen, maybe it won’t, it’s all about the therapeutic alliance.

But really, we can boil this down to real techniques, real strategies, really learnable tools that hugely improve clients’ mental health and capacity.

So yeah, I’m just a big believer in all of that now.

Anne Brice (narration): I’m Anne Brice, and this is Berkeley Voices, a UC Berkeley News podcast from Strategic Communications. Music by Blue Dot Sessions. You can find Berkeley Voices wherever you listen to podcasts, including YouTube @BerkeleyNews.

This is the sixth and final episode of this season of Berkeley Voices. Over the season, we heard from UC Berkeley scholars working on life-changing research and the people whose lives are changed by it.

We also have another show, Berkeley Talks, that features lectures and conversation at Berkeley. You can find all of our podcast episodes, with transcripts and photos, on UC Berkeley News at news.berkeley.edu/podcasts.

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