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Are your sleep thoughts Sleep-Promoting, or Sleep-Disrupting?

April 1, 2021

So often, in the clinic, patients share the thoughts that they have about their sleep. They are thinking things like:

  • “If I don’t start sleeping, will I get early onset Alzheimer’s?
  • “When I get home and start making dinner, I start to worry about how I’m going to sleep tonight”
  • “I can never predict whether I’ll sleep well or not”

The first-line treatment for insomnia, recommended by the American Academy of Sleep Medicine, is Cognitive-Behavioral Therapy for Insomnia (abbreviated CBT-I). A key component of CBT-I is that cognitive piece, which is focused on shaping thoughts in ways that support sleep.

It’s useful to put each sleep thought in one of two camps, either a) sleep promoting thoughts, or b) sleep disrupting thoughts. When going through the day, the first step is to catch yourself having a sleep thought, and not let it be part of your automatic mental landscape. Instead, catch yourself, and evaluate “Is this a sleep-promoting, or sleep-disrupting thought?”

If it’s a sleep-disrupting thought, then challenge it by asking “Is this really true, or is there another way to think about it?” You may be able to see cases where that thought is not always true. As soon as that realization hits, the power of the sleep disruption thought diminishes.

The next step is to intentionally think sleep-promoting thoughts. Examples could be:

            “I have overcome health challenges in the past.”

            “Most of my life I’ve slept well”

            “I’m trying a new treatment plan, which has worked for thousands of people”

            “Regardless of my sleep, I’m getting done what needs to get done”           

Of course for these intentional sleep-promoting thoughts to work in re-shaping your view, they must have the power of truth, and be true for you individually.

There’s a saying in sleep medicine: “Only insomniacs try to sleep, everyone else just sleeps.” Sleep unfortunately is one of those rare areas in life that the harder you try, the worse you do. Reshaping your sleep thoughts so that you are more confident in your sleep and therefore can step away from trying so hard can be part of sleeping well again.

The Critical Importance of Sleep for Firefighters

September 11, 2019

September 11 is a day we will never forget. I am forever thankful for the firefighters and others who step forward to watch over us all as first responders.

In honor of the day, here is a summary of what we know about firefighters’ sleep, and the costs they pay to provide 24/7 service.

It is critically important that firefighters are able to perform well when they are on duty, however, a large number are impaired by inadequate sleep. Many common concerns of firefighters such as cancer and cardiovascular disease risk, barriers to physical fitness, food culture, psychological stress from trauma and injuries (1), are related to or can be improved by sleep health.

Health and Safety:

The effects of inadequate sleep on human mental and physical health have been well documented. For firefighters the leading causes of death are heart attack and auto accidents (2).

  • 51.2% of firefighters report disturbed sleep, which contributes to psychological distress (3).
  • 37.2% of firefighters surveyed screen positive for sleep disorders: 28.4% obstructive sleep apnea, 9.1% shift work disorder, 6% insomnia, and 3.4% restless legs syndrome (3). Of these, the majority (80%) have not been diagnosed or treated.
  • Those who have sleep disorders are twice as likely to have an auto accident, and 2.4 times as likely to experience falling asleep while driving. They also are at increased risk of cardiovascular disease, diabetes, anxiety and depression (4).
  • Another study found that 17% have sleep problems, and as sleep hours decreased, so did physical quality of life (5).
  • Sleep deprivation among firefighters appears to increase high-risk behaviors such as alcohol consumption and decrease mental health and physical well-being (6).
  • Compared to firefighters with 8 hours of sleep, sleep deprived firefighters show changes in both their inflammatory cells and evening cortisol levels which has been shown to have adverse health effects (7).
  • Night and extended shifts increase the prevalence of cardiovascular and mental health disorders (8).

Shift Work and Performance:

Night shift and the extended shifts typical among firefighters are inherently difficult, though improved individual sleep plans and administrative policies can improve daytime sleep and alertness at night.

  • Response time by firefighters is slowest at 5am, twice as long as at 4pm (9).
  • The risk of a work related injury peaks at 2am (10).

Costs:

Firefighter injuries in the U.S. are estimated to cost $3.7 to 11.7 billion per year (11). Sleep deprivation is known to contribute to obesity via changes in appetite hormones, calorie intake and the insulin system. Obese firefighters miss five times as many work days as those of normal weight, at an annual cost of $1683 per employee (12), and those with BMI >30 have a three times increase in worker compensation claims due to injury (13).

Public safety personnel need to be able to perform well at all times of the day and night, however firefighters are not getting adequate sleep to perform well, make good judgments, or maintain their physical and mental health. Implementing wellness and fitness programs has been shown to improve cardiorespiratory endurance, experienced health and job satisfaction, while decreasing weight, high blood pressure and anxiety(14). Providing expert-led sleep and fatigue management education to firefighters will assist in achieving a higher level of sleep health(15) and safety on the job. A simple sleep education and screening program for firefighters resulted in a 46% decrease in disability days, and 24% decrease in injury reports (16).

Seattle Sleep Community Urges School Board to Vote Yes

November 3, 2015

The Seattle sleep community encourages the School Board to vote “yes” on the revised Bell Times and Transportation proposal at their Nov 4th meeting.  Here is the text of the letter that will be delivered during the public testimony.

Seattle School District Attention: Board of Directors MS 11-010 PO Box 34165 Seattle, WA 98124-1165

November 2, 2015

Dear SPS Board of Directors,

As local sleep specialists, we support the revised Bell Times proposal, and urge you to vote “yes” on November 4th, for implementation in fall 2016.

The American Academy of Pediatrics and the Centers for Disease Control and Prevention have recommended that secondary schools start at 8:30am or later.  This recommendation is based upon conclusive research that with puberty the circadian rhythm shifts later, making it virtually impossible for teens to get the recommended 8.5-9.5 hours of sleep nightly before getting up for early school hours.  Later school bell times have been shown to increase the total weekly sleep in teens, and thereby improve learning, performance, health and safety.

The current proposal is a profound improvement over current Seattle school hours, with 100% of high schools and 90% of middle schools starting at a healthy bell time.  It also decreases significantly the number of schools in tier 3, a time that is inconveniently late for many families.  Although you may hear from a few families who struggle with the time their child attends school, this is an important public health advance that supports the health and learning of the vast majority of secondary school students.  We thank you for the diligent efforts on the part of yourselves and the district staff to engage the community in finding this solution.

Thank you for your work to align school schedules with optimal learning times thereby improving Seattle students’ academic success, health and safety.

Best,

Sleep Specialists in the Seattle area

Seattle’s Early School Start Times – personal experience

December 20, 2014

It’s 9am Saturday as I write this. My middle school student is still sleeping, despite the household noises. Yesterday, and every school day, she would be finishing math and be headed into science class in 10 minutes. Both essential subjects to master. Yet difficult to master at a time you’d naturally be sleeping.

Over the last 2-3 decades lots of research has demonstrated that puberty shifts natural sleep times later, that secondary students are largely sleep deprived because of early school start times, and that with later school start times students get more sleep, which improves academics, health and safety. You can learn more about this topic at http://www.startschoollater.net and http://www.schoolstarttime.org.

Since spring of 2012 thousands of Seattlites, Wa and Seattle PTA, teachers, school nurses, and sleep specialists have asked the Seattle School District to start secondary schools at 8:30am or later, evidence based times. After 2+ years, the district has established a “Bell Time Analysis Task Force” which will look at the issue and make a recommendation to the superintendent in June 2015, for possible implementation fall 2016. As they slowly move on this community-led initiative, the approximately 23,000 secondary students are struggling with sleep deprivation each and every day.
(She woke up now, 9:05am – time for science on a regular school day).

My daughter and family are negatively impacted by Seattle’s early school start times, here’s how:
– My daughter can’t fall asleep at the time she needs to to get enough sleep (9pm for a 6:30am wake-up). She often gets frustrated in the night, and asks for sleep medication. AT 11 years old, it’s a bad sign for her to think she can’t get to sleep on her own and needs medication! What she’s done a couple times this week is to get into bed with me after a couple hours of not being able to fall asleep on her own. She hasn’t gotten into the ‘big bed’ for years! This disturbs my own sleep, and causes sleep deprivation which impacts my day and the people I interact with.
– Getting woken up when she’s still sleepy often sets us up for negative interactions between us and feeling rushed in the morning.
– She’s been sick a lot, missing two full weeks of the 15 weeks this fall. Remember, sleep deprivation impairs immune function.
– It is now so dark at commute time that I drive her for safety, so she misses out on the exercise she needs to get by walking to school. (A child at her school was hit by a car yesterday on the walk to school. She was grazed by the side view mirror, and foot run over by the rear tire).
– At the beginning of the school year she often needed a nap after school, and now needs one on weekends, which cuts our ability to have activities with family and friends. She’s socializing less with her friends.
– When my parents retired they moved into Seattle to be near the grandchildren. It’s been a nice routine over the last years to have family dinner with the grandparents and my brother’s family on Fridays twice a month. Now we no longer can meet because my daughter is so exhausted by Friday afternoon that she is in tears and can’t politely interact with the family. Now the grandparents and cousins feel disconnected and our family ties are weakened.

From this personal experience, I see that the Seattle School Districts slow implementation of evidence-based school start times has a negative ripple effect throughout our community. In our family life alone the impact is felt by: the student, parents, grandparents, cousins, student’s friends, parent’s circle of interactions. That’s a lot of people negatively impacted by one student getting up too early (7 directly, plus more indirectly)!

How are the current early start times in Seattle’s secondary schools impacting your family and community?

Record of natural wake times on winter break:
Saturday 20th wake time 9:05a
Sunday 21st wake time 8:55a

Great video on Sleep Deprivation

April 3, 2014

Over the years I’ve written a lot about sleep deprivation and it’s effects.  Primarily because Behaviorally Induced Insufficient Sleep ie, chronic partial sleep deprivation, is the most common sleep problem, affecting 47% of adults in America.

Right now I’m working with a group of shift workers to help them create a lifestyle that promotes healthy sleep on work nights and days off, and optimal alertness when awake.  People can be very motivated to work nights because of the increased pay, and often shorter work week because of longer, 12 hour shifts.  But trying to sleep during the day is hard, and often shift workers are sleep deprived.  To help them stay motivated to get enough sleep, I’ve been teaching them about the negative impact of sleep deprivation.  This excellent youtube video about “25 scary and surprising effects of sleep deprivation” by List25 tells it well.  Enjoy!

http://www.youtube.com/watch?v=pbJxLITdt_E

 

Start School Later meets with the Dept. of Health

July 17, 2012

Tomorrow, July 18, the leaders of the national Start School Later initiative will be meeting with directors at the Substance Abuse and Mental Health Services Administration of the Department of Health. There is a connection between early school start times and depression and suicidal thoughts that needs to be addressed.

The full press release is below, and I’ll post the update from the meeting in the next few days. If you’d like to weigh in with your support of later school start times you can sign the petition at http://www.startschoollater.net
RELEASE: July 16, 2012: GRASSROOTS GROUP ASKS FEDERAL AGENCY TO ADDRESS LINK BETWEEN EARLY HIGH SCHOOL START TIMES, MENTAL HEALTH, AND TEEN SUICIDES:

Contact: Heather Macintosh, 410-279-4569 heathermac@verizon.net
Dr. Terra Ziporyn Snider, Co-Director, 410-262-6616

Start School Later, a national coalition advocating for sane, humane high school start times, is meeting with Dr. Anne Mathews-Younes, Director of the Division of Prevention, Traumatic Stress and Special Programs, and Dr. Richard McKeon, Director of the Suicide Prevention Resource Center, at the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the US Dept of Health and Human Services (HHS), Wednesday, July 18, in Rockville, MD.

Compelling scientific research shows that adolescents’ sleep needs are being dangerously compromised by the extremely early school schedules of many US high schools. Waking at 5:30 to catch a bus and begin school in the 7 o’clock hour is incompatible with adolescent sleep needs and causing teens to miss out on the crucial sleep they need for physical and mental health and development and optimum academic achievement. Sleep deprivation is strongly linked to anxiety, depression, and suicidal ideation, among other health effects.

SAMHSA is an agency of the U.S. Department of Health and Human Services (HHS), which, in turn, is increasingly recognizing the importance sleep plays in the health and wellness of young people.

“We’re looking forward to discussing ways federal agencies might be helpful in raising awareness and facilitating policies to ensure safe, healthy school hours for all children,” says Terra Ziporyn Snider, PhD, Start School Later’s Co-Director. “This has been impossible to achieve in many local school systems, where all too often politics and myth trump student health and well-being.”

Start School Later is an all-volunteer, national coalition working to ensure that all public schools can set hours compatible with health, safety, equity, and learning. Coalition members attending the SAMHSA meeting include Dr. Terra Ziporyn Snider and Kari Oakes, PA-C, both from Maryland, as well as Terry Cralle, RN, of Virginia, and Debbie Coleman, MBA, faculty member at the Miami University (Ohio).

Start School Later – Contact your Senators!

April 20, 2012

Thanks to Terra Snider, Kari Oakes, and Mary King for delivering the Start School Later petition to our Washington State Senators Murry and Cantwell in person on Weds, April 18. This team is committing many hours to speak with congress people from around the country on this important issue. Now is the time for each of us to reach out and voice our support of this initiative with our state congress people. Please do so today!

Senator Patty Murray
448 Russell Senate Office Building
Washington, DC 20510
Phone: 202-224-2621
Fax: 202-224-0238
Toll Free: 866-481-9186
Email: Web Form: http://www.murray.senate.gov/email/index.cfm

Senator Maria Cantwell
311 Hart Senate Office Building
Washington, DC 20510
Phone: 202-224-3441
Fax: 202-228-514
Toll Free: 888-648-7328
Email: HTTP://Cantwell.senate.gov

For those of you reading this in other states, you can learn more about this initiative at http://www.startschoollater.net. There is a tool to find the congress people for your zip code here: http://independenceave.org/. Please contact them now, as the Start School Later team is systematically contacting all the Congress and House of Representatives. Together we can make this important improvement for thousands of teens!

Start School Later goes to Washington DC

March 5, 2012

Over the last week the efforts for the national Start School Later initiative have been intense. This week, March 7th, this petition will be presented to Congress. You can see the press release copied below.

SUPPORT BY SIGNING PETITION NOW at http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

400 more signatures are needed as of this moment. I support this initiative in part because many of my adult insomnia patients say that their sleep problems began as a teen, and I’d like to prevent that in the next generation. Thank you, Catherine

Grassroots Petition to Start School Later Goes to Washington for Sleep Week
FOR IMMEDIATE RELEASE
March 1, 2012

CONTACTS
Annapolis, MD- Terra Ziporyn Snider, Ph.D., StartSchoolLater1@gmail.com 410-975-9759
Seattle, WA- Catherine Darley, ND, drdarley@naturalsleepmedicine.net, 206-293-2899

Annapolis, MD. To honor National Sleep Awareness Week, a grassroots coalition of parents, teachers, and health professionals will begin delivering a petition advocating a minimum school start time of 8 a.m. to Congress and White House officials on Wednesday, March 7, 2012. The petition, garnering national attention, has signatures from all 50 states and Washington, DC and has fueled activity in local communities from Short Hills, NJ to Woodinville, WA.
“Most U.S. high schools today start in the 7 a.m. hour, a practice that began several decades ago primarily to save money on bus runs,” explains Terra Ziporyn Snider, Ph.D., a medical writer and the petition creator from Maryland who is also the mother of three. After more than a decade of work advocating for later start times in her local school system, Snider recounts, “Although evidence is crystal clear that starting later is best for health and learning, political obstacles and myths have made change virtually impossible in most districts.”
The petition effort has galvanized a national coalition of health professionals, sleep researchers, educators, parents, and other concerned citizens called Start School Later. The coalition has representation from 16 states and includes an advisory board comprised of notable sleep researchers, adolescent health care providers, and education leaders.
Voluminous research indicates that later school start time can lead to:
• Reduced sleep deprivation, depression, mood swings, and suicidal ideation
• Decreased stimulant abuse, weight gain, and diabetes risk
• Reduced early morning traffic accidents and drowsy driving by new teen drivers
• Improved safety by eliminating waiting or walking in dark, low visibility settings
• Reduced risky after-school behaviors in unsupervised adolescents
• Reduced truancy and absenteeism, and improve school performance
• Improved lifetime earnings potential, according to a recent study published by the Brookings Institute
Locally, in Washington state about 375people have signed this national petition.
###
Signature totals and comments from Start School Later’s campaign: http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

For more information on Start School Later: http://www.startschoollater.net/
Start School Later is a coalition of health professionals, sleep scientists, educators, parents, students, and other concerned citizens dedicated to increasing public awareness about the relationship between sleep and school hours and to ensuring school start times compatible with health, safety, education, and equity.

Time to Help Teens Sleep

February 16, 2012

Teen Sleep

Do you remember dragging yourself out of bed for high school, then struggling to stay awake during class?  You were not alone in this.  Physiologically, teens are set to go to sleep later, and get up later.  Unfortunately school start times require that students be alert and functioning before their bodies are awake.  The good news is that a national movement to start schools later is gathering momentum, and you can join in!

Teen Body Clocks

As part of puberty, the circadian rhythm or ‘body clock’ shifts later.  Research in the last couple years has shown that this shift to later hours happens early in puberty, before other changes may appear.  Decades ago it was thought teens’ late hours were because they enjoyed late-night socializing or sadly some teens were called ‘lazy’ because they slept late.  We now know these sleep hours are based on their physiology. 

This shift can contribute to teens being sleep deprived in that they aren’t able to go to sleep earlier in the night because they aren’t sleepy, but yet they have to get up at a time they are sleeping well to go to school.  Research shows 80% of high school students are significantly sleep deprived, that’s a higher percentage than adults!

Help your Teen get Adequate Sleep

First, figure out how much sleep your teenager needs each night. It might help to remember a vacation when s/he was sleeping on their own schedule and was rested & energetic during the day. Next, plan to get up at the latest time for school, and count backwards to determine the bedtime that allows enough sleep. If it is not possible to go to bed at that time during the week, allow extra time for sleep on weekends.

Sometimes teens aren’t able to fall asleep even when they are in bed at a reasonable time. This is because their body clock is shifted later. They may need medical help to shift their body clock earlier.

Help Change Teens Sleep Nationally

In the last several months an effort to Start School Later has grown. There is a national petition to legislate that schools not start before 8am. This will be presented to Congress during National Sleep Awareness Week, March 5-11. Please join this effort to improve the teen sleep and the entire teen experience by signing this today (it will take 2 minutes). My hope is that we can change generations of teen experience of highschool and that time of life.

Sign the petition today!http://signon.org/sign/promote-legislation-to.fb1?source=s.fb&r_by=1521139

Grandma Died . . . I Can’t Sleep

January 30, 2012

Sadly, my special grandma died Friday night. I will miss her, and remember all the great times we had, and the things she taught me over the years.

Having learned on Saturday morning about her passing, it was on my mind as I settled in to sleep Saturday night. My thoughts were on Grandma, flitting from one memory to another, I was upset. So it took a long time to fall asleep, then I was in and out of sleep through the night, disturbed by the high winds, thinking about the next days’ activities, and even wondering what time it was, if it was time to get up.

This was acute insomnia, which is really typical when people have some type of life-event. Fortunately, I have a long history of robust sleep, so this one night won’t throw me off. On the other hand, for people who have recovered from chronic insomnia, even an understandable acute insomnia in response to an identified stressor can bring up worries about their sleep. That worry about sleep makes sleep more elusive, and can trigger another episode of chronic insomnia.

So what to do? First of all, if an identifiable life-event has happened, keep in mind that it is normal for sleep to be disturbed as we are processing our emotions. As best you can, take time each day to sit and reflect on your experience, allow your emotions to come up, and express them either to a friend, by journaling, or other way. Do this during the day, at least 2 hours before bed, and then in the night tell yourself “I’ll have time to think about this more tomorrow, now is time to rest.” Second of all, don’t begin to worry about your sleep, knowing that as you recover from the event, your sleep will improve. During this emotional time, keep in place all those healthy sleep habits mentioned in other posts – regular bedtime and wake routine, getting out of bed if awake long in the night, saving the bed just for sleep, regular exercise, etc.

Use these strategies. If a time comes that you are no longer feeling emotionally charged about the event, but your sleep is still disturbed, then it is time to get sleep help.