Archive for the ‘naturopathic medicine’ category

“Sleep Deprived in Seattle” in Seattle magazine

July 14, 2012

It was a pleasure to talk with journalist Sheila Cain about my approach to treating sleep disorders. The article is now published in Seattle magazine’s Top Doc issue (July).

My favorite excerpt is: “My primary care doctor gave me a printout of things to try, then told me to go home and do them,” Crocker said. “With Dr. Darley, we worked on a very individualized plan that was specific to me.”

The thing I love most is the way in which each person’s sleepless story is unique, even if each one is coming in for what appears to be the same ‘insomnia’ complaint.  Taking the time in the first appointment to really understand how the sleep problem developed, how it impacts their quality of life, and the individual lifestyle makes all the difference in making an individual treatment plan that works.

Sometimes in an appointment a patient and I will have moments where we are communicating so clearly, heart to heart, and getting to the root of the sleeplessness. Those times I imagine if someone took a picture there’d be a big light bulb over both of us. Those break through moments make this work worth every effort.

You can read the full article here: http://www.seattlemag.com/article/sleep-deprived-seattle

Does a Hot Bath Help Sleep?

May 24, 2012

Many people ask me “Does a warm bath help sleep, or is that just a myth?” The research shows . . .

Yes, it seems to help somewhat. Medical research has investigated the impact of both baths and foot baths on sleep. One study in older people with sleep disturbance found that a 40 minute footbath at 41C decreased wakefulness in the second nonREM sleep period. Women undergoing chemotherapy for cancer have also found increased sleep quality with a warm footbath. Another study done in elderly insomniacs found that a full-body bath (immersed to the mid-chest) for 30 minutes at 40-41C did increase deep sleep, and caused people to experience a good night sleep. .

How does a warm bath improve sleep? Human body temperature is not constant, but varies with a consistent circadian rhythm.  There is a slight dip in body temperature at approximately 1pm, and then a more significant drop in the evening hours.  We get that sleepy feeling as our body temperature drops. The bath effectively raises our body temperature, and the subsequent drop helps sleep. The bath should be about 60-90 minutes before bedtime.

Of all the means you can use to improve your sleep, this one seems one of the most simple, with the least possible negative side effects. This is a good therapy to try first before using other, more invasive medicine.

Tobacco Impacts Your Sleep

May 7, 2012

In past posts we’ve talked about the impact alcohol can have on sleep, which is widely known. Nicotine also has an impact, which seems less well known by the public.

Studies show that nicotine changes sleep, so that it takes longer to fall asleep initially, people sleep a lower percentage of the time in bed, and REM sleep and total sleep time is decreased. None of these are effects we want!

According to the Centers for Disease Control “In 2010, 43.5 million adults (19.3%) in the United States were current smokers—21.5% of men and 17.3% of women.” So that’s about 1 in 5 people who are exposing themselves to nicotine, and suffering the consequences on their sleep.

If you are someone who struggles with sleep, and smokes, it may be worth the effort to stop smoking in order to improve your sleep, and reap all the other health benefits too. Many state health departments have ‘Stop Smoking’ helplines, and your primary care physician can assist you.

Cautions About Sleep Medications

February 13, 2012

In my office, people who are taking many sleep medications for long-term use often come in looking for alternatives. In naturopathic practice there is a place for medications in the ‘Therapeutic Order.’ In naturopathic medicine the ‘least force’ treatment is used which will be effective. For instance, behavioral medicine will be used for insomnia first. Of course, behavioral strategies may not work for each person, so then herbal or nutrient therapy may be used next, and then pharmaceuticals.

Recently a person came in who had been using a combination of four sleep medications over the last 10 years. He had been alternating the medications on his own schedule as they became ineffective, and to avoid the need to increase dosage. Here was his regimen:
Alprazolam (Xanax) at 4am at his early am wakening to get another 3 hours of sleep. Alprazolam is a benzodiazepine hypnotic. Side effects include an increase in depression. When stopping the medication rebound insomnia can occur. Most of the hypnotics should not be taken with alcohol.
Zolpidem (Ambien) or Eszopiclone (Lunesta) Both are non-benzodiazepine hypnotics. Ambien is long-lasting, and people should be sure to have a full 7-8 hours in bed after taking it. Lunesta is one of the few medications approved for use on long-term basis.
Clonazepam (Klonopin) which is a long-acting benzodiazepine.
Even with these medications he was having interrupted sleep and found his sleep to be unrestful.

Our approach was to first use behavioral strategies to make his sleep robust and restful. Once he was sleeping well, we designed a schedule in collaboration with his PCP to taper down off the medications slowly. In this way we were able to avoid rebound insomnia and other withdrawal symptoms.

So, if you are struggling with insomnia, use the ‘least force’ treatment strategy that will solve your sleep problem. If you are recommended a sleep prescription, find out how long that medication can be safely used, any drug interactions to be aware of, and the typical withdrawal symptoms.

Sleep Health in the News

March 30, 2011

It’s been fun the last week to talk with several folks in the media, both here in Seattle and on the web.  Here’s the links:

Interview about sleep & social skills with Linda Thomas of KIRO news
radio will air Weds, 5-8am, 97.3 fm
http://www.mynorthwest.com/category/news_chick_blog/20110328/Lack-of-sleep-impairs-teen-social-life/#comments

Interview on sleep needs & performance with Michael Harthorne of KOMO
community news
http://ballard.komonews.com/news/health/specialist-ballard-students-suffering-sleep-they-arent-getting/630340

Interview about insomnia with Myrna Sandbrand, RN on BlogTalkRadio

http://www.blogtalkradio.com/ezsleep/2011/03/25/interview-with-dr-darley

I love to talk to people about sleep health, the may ways it impacts their well-being, and what to do to improve sleep.  If you’d like a speaker for your group let me know, drdarley@naturalsleepmedicine.net.

Cognitive Behavioral Therapy for Insomnia (CBT-I)

August 11, 2010

The Cognitive-Behavioral Therapy for Insomnia that we offer is based upon the program developed and researched originally at Stanford University Sleep Disorders Center. In this systematic program participants first learn some basics about sleep and to re-associate their bed with sleep. Next we reframe any sleep misconceptions or worries that actually interfere with sleep. An example is “If I don’t get to sleep right now I’ll never be able to get through my meeting tomorrow.” Realistically, the person who struggles with chronic insomnia has probably gotten through demanding days in the past after a disrupted night. While doing this cognitive work to reduce worries, we also teach relaxation techniques to relieve body tension that can contribute to insomnia. Another key component of our program is sleep restriction therapy. The client’s sleep diary is analyzed, and a agreeable bedtime and waketime set. As the client’s sleep improves, and they no longer have much (if any) time lying awake in bed, the bedtime is incrementally advanced each week. This process continues until the person reaches the goal – feeling well rested each day, and having consolidated sleep each night!

What makes our approach to Cognitive-Behavioral Treatment for Insomnia naturopathic is that we know the person’s health is an entire system, that their sleep can not be separated from the entirety. In addition to factors that conventional sleep specialists evaluate, we will also assess food allergies / intolerance, neurotransmitter levels, and overall wellness. Therefore we begin the program with an extensive intake interview. During this initial intake we review the clients’ health in all areas that have relevance on their sleep. This includes neurological, endocrine, psychological, and lifestyle, among others. We may also order lab tests to evaluate organ function. Our goal is to first identify the underlying cause of the sleep disorder, then to treat. Wherever the original cause lies, chronic insomnia has developed over time as an interplay of predisposing, precipitating and perpetuating factors, which will take time to tease apart and heal.

Sleep and Trauma

May 20, 2010

In my office, it is not unusual to learn that a person’s sleep difficulties started with a trauma or bad experience.  For many people, the trauma they experienced was years (or decades) ago, and still affects their sleep.   These sleep difficulties can take the form of insomnia, nightmares or excessive daytime sleepiness.   Although this can be a hard topic to discuss, it is something to be aware of.

It is thought that brain chemistry can be altered, creating a hyperalert state.  People can also become very vigilant, staying on-guard even during sleep time.

As a naturopathic physician, here are some of my thoughts when working with someone who has sleep changes after a trauma:

  • Biochemically, I think about the 24 hour cortisol rhythm.  Cortisol should be high in the morning, and decrease over the day. (For more complete discussion, see my blogpost on cortisol). 
  • I also think about changes in neurotransmitter levels that may have occurred. 
  • Current safety, creating a sleep space that feels (and is) secure.
  • Stress reduction throughout the day to reduce sympathetic activation.  This can be in the form of a 2-3 minute break every 2 hours to do some deep breathing.
  • Unravel negative sleep associations with the bed, bedroom and bedtime.
  • And the use of other Cognitive-Behavioral techniques for insomnia.
  • Referral to a mental health professional to address trauma.

This blogpost just scratches the surface of this important topic.  You can learn more about sleep and trauma on The National Sleep Foundation website http://www.sleepfoundation.org/article/sleep-topics/trauma-and-sleep.   They include tips for people who are suffering from temporary sleep disturbance.

Why House Calls are a Pleasure

January 11, 2010

As a naturopathic physician, it’s been a pleasure to do house calls for patients. It works out well for the patients and well for me, too.

For patients, they have the ease of fitting the visit into their schedule, with no added driving and parking hassles. They are comfortable and can be more relaxed in their home environment.

For me as the physician, I get to know my patients better, and to really understand their lifestyle. Since I specialize in sleep, it’s also helpful to see the bedroom sleep environment. Although we routinely discuss light in the initial office visit, I’ve discovered two patients had a skylight over their bed that they had forgotten to mention.

Historically, house calls were the way medicine was practiced until late into the 19th century. In 1971 only 1% of doctors visits were house calls. In recent years house calls have become more popular, especially for the elderly.  My hope is that this type of visit can become more common for people of all ages, and helps deepen the physician-patient healing relationship.

Sleep Health Education in Seattle

December 14, 2009

Talking with people about sleep health, giving them the facts, and the knowledge of how to promote healthy sleep for themselves and their families, is one of the things I love to do.  Just last week we put excerpts from a recent PTA talk on YouTube.  You can view it here http://www.youtube.com/watch?v=syxCF12fWdM.  Watch it and let me know what you think!

The calendar for 2010 is growing, please let me know if you’d like me to come talk to your PTA, civic group, or corporation.  Here’s a sample of what’s going on so far.

“Optimizing Work Performance – The Sleep Connection”

Vulcan Inc.
January 26, 2010, 12:30-1:30pm
Open to employees

Join Dr. Darley to learn about how good sleep health can improve your job performance.   Objectives for this one hour “Lunch and Learn” are:

  • Understand the ways poor sleep interferes with mental, physical and emotional performance
  • Understand the most prevalent sleep disorders, including insufficient sleep
  • Learn ways to improve sleep

“Sleeping Like a Baby”

PEPS (Program for Early Parent Support)
Good Shepherd Center, Seattle
January 26, 2010, 6:30-8:00pm
Open to PEPS participants

Many new parents struggle to help their infant get into a regular sleep routine, and get enough sleep themselves.   Dr. Darley will discuss questions parents frequently ask about how to get their baby to sleep, the safety of co-sleeping, nap routines and sleep schedules.   There will be 30 minutes for questions and discussion after her presentation.

“Sleep and Mental Health: A Dynamic Interplay”

Continuing Education event for the Seattle Counselors Association (SCA)
February 19, 2010
Open to SCA members and visitors

Dr. Darley will discuss the dynamic interplay between sleep and mental health.   We’ll look in depth at a few conditions, including ADHD, anxiety, and depression.   The second half of the presentation will include screening questions for counselors to use in assessing whether sleep may be a contributing factor.   We’ll also discuss the effects of pharmaceuticals, over the counter medications, and supplements.   There will be ample time for questions and discussion.

“Sleep Well, and Succeed in School”

Loyal Height Elementary, Seattle Washington
April 29, 2010, 7:00p to 8:30p
Open to school parents

Many children have sleep problems, and their mood and performance suffers.   Come learn about common pediatric sleep problems, how they influence your child, and what you can do to ensure your child gets healthy sleep.

Join Dr. Catherine Darley, ND from The Institute of Naturopathic Sleep Medicine as she discusses:

  • normal sleep in children
  • the effects of insufficient sleep, the most common sleep problem
  • sleep disordered breathing in children
  • Learn steps to take at home to improve your child’s sleep

The Healing Power of Nature

December 2, 2009

Over the last several months we’ve talked a lot about sleep medicine.  This month I’d like to share with you some interesting information about the healing power of nature.  The Healing Power of Nature is one of the principles of naturopathic medicine, which sets it apart from other medical philosophies.  As the year comes to a close, you may be thinking about how you want 2010 to be different.  Using this information will get the new year off to a great start.

Medical research has shown many ways that being in a natural environment with views of trees, birds, and plants of all kinds improves health as opposed to being in a ‘built’ environment.  ‘Built environment’ means the man-made cars, concrete, high-rises and pollution most of us are surrounded by in our urban neighborhoods.  Here’s a sample of the research findings:

-         Hospital patients recover more quickly, require fewer painkillers, and have fewer post-op complications when they have a view of trees and animals out their window.

-         Office workers report less job stress, fewer illnesses and overall higher job satisfaction when they have a view of nature outside their desk.

-         When roads are surrounded by a greenbelt drivers’ blood pressure and heart rate decrease, as does their sympathetic (fight or flight) nervous system.

-         When urban people go into a natural setting for a few days (like on a camping trip) their concentration and problem-solving improve while mental fatigue decreases.

In our modern lifestyle we spend less time outdoors than people did historically.  Recently the book Last Child in the Woods brought attention to this disconnection from nature that children experience.  In my practice many sleep patients report problems with stress and anxiety.  One of my recommendations is to cultivate a habit of being outside regularly, as lower stress, lower sympathetic nervous charge, and greater feelings of pleasure will improve sleep.


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