Archive for the ‘behavioral treatment’ category

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.

Tart Cherry Juice for Insomnia?

August 2, 2010

A couple weeks ago a pilot study was published looking into tart cherry juice for insomnia. Here’s a few details:

15 older adults who have chronic insomnia but are otherwise healthy drank the cherry juice blend twice a day for 2 weeks. They kept a sleep diary during this time and during another 2 week time.

The results showed that on the cherry juice they had less time awake in the middle of the night. Tart cherry juice contains naturally occuring melatonin, which is thought to be responsible of the effect. The authors state that this was a mild effect, and that cognitive-behavioral therapy and pharmaceuticals have a larger effect on insomnia.

So what’s our conclusion? At this point in time, you could try tart cherry juice, but if you have significant insomnia, other treatment methods will be more successful.

Zeitgeibers

July 20, 2010

What is a zeitgeiber???

The word ‘zeitgeiber’ comes from the German language, and means ‘time giver.’ Zeitgeibers are clues in the external world that help keep our internal body clock in sync with the 24 hour day/night rhythm. This word is used a lot in the field of chronobiology.

The most meaningful zeitgeiber is light, as it impacts melatonin, which in turn sets our circadian rhythm. Other zeitgeibers include meal times, exercise times, and social activities. When your zeitgeibers happen at close to the same time each day, you will be more firmly in sync with the 24 day/night rhythm. This can pay off in sleeping well, and being fully alert during the day!

Sleep vs. TV – Part II

June 9, 2010

How Can We Use this Information?
First off, think back to a time that you were really well rested. It may be on a vacation or holiday break, before the kids were born, while unemployed, or if you’re lucky, in the last week or two. Then answer these questions:
– How much sleep do you need to really feel your best?
– Are you getting that amount of sleep most nights?
– If not, how much more sleep time do you need?

Now, how are you spending the last couple hours before bed? Are you watching TV, or doing other hobbies that you could do at another time in order to get the sleep you need? If so, could you move this TV watching to another time, maybe using some recording device?

The biggest question though, the ‘Million Dollar’ question to ask yourself is: “Would I benefit more from getting more sleep and being healthier, or do I benefit more from watching TV in the evening?” Let me know your answer!

Sleep vs. TV

June 8, 2010

In June 2009, Drs. Basner and Dinges published an article titled “Dubious Bargain: Trading Sleep for Leno and Letterman.” Is this something you can relate to- staying up late to watch your favorite show even when you know you’re tired?

The relationship between exercise and sleep
The U.S. Census Bureau has a continuous telephone survey of 105 million households. It is called the American Time Use Survey (ATUS). This paper looked at how people spent the 2 hours before bed, and the 2 hours after getting up. They grouped people into 3 categories: Long workers (>8 hours daily), short workers (<8 hours) and non workers.

An estimated 20-40% of adults sleep less than the recommended 7+ hours each night. Remember that measured sleep is usually less than reported sleep, so these estimates may be low. Short sleep duration is associated with increased illness and obesity. The researchers’ goal was to determine if there are discretionary activities that can be eliminated to increase sleep time.

Among the three groups, bedtime was the same, and the long workers got up earlier than the others. People watch TV for 55 minutes of the 2 hours before bed. Travel and work took up 27% (about 30 minutes) of the 2 hours after waking for the day.

The authors conclude that watching TV may be an important social cue of approaching bedtime. They also conclude that “giving up some TV viewing in the evening should be possible to reduce chronic sleep debt and promote adequate sleep in those who need it.”

A Consistent Bedtime Routine Helps Baby Sleep

May 26, 2010

A consistent bedtime routine is a powerful tool to help infants consolidate their sleep into longer periods at night.  And when baby sleeps, parents can too!

Researchers had parents implement a 3-step bedtime routine.  The steps were a bath, a massage, and a quiet activity like cuddling or singing a lullaby, in that order.  Lights out was within 30 minutes of finishing the bath.  Nothing else was changed, the parents continued to put their child to bed they way they had been.

After just two weeks of this bedtime routine, the babies woke up fewer times in the night, and were awake for shorter periods.  Their mothers were less likely to perceive the babies sleep as a problem.  Not only that, but the mothers’ mood improved, so they were less tense, less depressed and less angry.

This gives hope to new parents, that they can help their child sleep better in just a few weeks, and that this improves the well-being of the family too!

Dr. Darley will be speaking on ‘Help your baby ‘Sleep Like a Baby'” on Tues, June 1st, in Mukilteo Wa.  This program is sponsored by Program for Early Parenting Support.

Sleep Promoting Thoughts

March 17, 2010

There’s a saying in the sleep community “the only people who try to sleep are insomniacs, everyone else just sleeps.”

Unfortunately, sleep can be one of those things that becomes more difficult the harder you try. Sometimes patients share that when it starts getting dark, they begin worrying whether they’ll be able to sleep well at bedtime. Other thoughts that can disrupt sleep include comparing your sleep to others, canceling fun activities due to your sleep, attributing your mood to your sleep.

So if you find yourself having negative sleep thoughts during the day: pause, and question “is this true, or is there another way of seeing this?” There may not be, but purposefully switching into sleep promoting thoughts when you can will help your sleep in the long run.

More about natural sleep medicine can be found at http://www.naturalsleepmedicine.net.

Positive Sleep Associations

February 16, 2010

Sleep is interesting in that it is a physiological process, which is strongly influenced by habit. When we work to have positive sleep associations with our bedroom, we can sleep better.

Remember Pavlov’s dogs? Whenever Pavlov fed the dogs, he would ring a bell. Eventually just ringing the bell would cause the dogs to start salivating, because they associated the bell with food.

People can also develop these type of associations. For instance, hard not to think about food when you’re standing in the kitchen. What associations have you developed about your bedroom?

Sometimes, when people spend a lot of time awake in their bed or bedroom, they start to associate it with being awake. This can feed into difficulty falling asleep or staying asleep.

To create a positive association of your bedroom as someplace to sleep, avoid being awake either in bed or in the bedroom.
– Choose to unwind before bed in another room.
– Don’t have a TV or computer in the bedroom, as those are waking activities.
– If you are awake more than 30 minutes at the beginning of the night, or 10 minutes in the middle of the night, get up and do something boring until you are sleepy enough to return to bed.

To learn more about Naturopathic Sleep Medicine go to http://www.naturalsleepmedicine.net.

How to Handle Shiftwork Well

January 6, 2010

You can learn to handle shiftwork as well as possible.  Here’s a few beginning steps:

  1. Educate your family or roommates about what you’ll need to sleep well.  This includes quiet without interruptions during your sleep time, a dark and cool room, and as regular a schedule as possible.  Sometimes family members are eager to see you and share their news.  When setting a sleep schedule, also schedule a predictable time that you’ll be available to them.
  2. Make your sleep schedule as consistent as possible over the entire week.
  3. If possible, take a short nap during the middle of your shift.  Be cautious to become fully alert before performing your job duties.
  4. Use caffeine strategically.  Caffeine is more effective as a stimulant if you don’t use it much.  During the night shift, take a serving of caffeine at the time when your alertness starts to dip.  The caffeine will take effect in about 20 minutes, and does improve measures of performance.  Be cautious not to take it so close to bedtime that it interferes with falling asleep.
  5. Limit light exposure on the commute home by taking public transit and wearing blue light blocking sunglasses.

With these strategies, shiftwork should be easier.  A special thanks goes out to all those folks who work nights, keeping the rest of us safe.

The Institute of Naturopathic Sleep Medicine focuses on natural care for sleep problems, including shiftwork.  More information is at www.naturalsleepmedicine.net.

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.