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.


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