As the dozens of emails in our inbox from every single company we’ve ever interacted with keep reminding us, these are unprecedented/uncertain/trying times. Seriously though, we are living through a global pandemic – an enduring worldwide crisis and natural disaster – and everything about what normal life used to look like has been upended. We’re simultaneously going through this together, yet isolated as we shelter in place, and each of us are experiencing unique challenges as we make the best of the cards we have been dealt. Perhaps you may benefit from taking a moment right now to give yourself patience and grace, to be okay with operating in survival mode, and to compassionately reorient yourself to self-care.
Naturally, I want to talk about self-care in the form of sleep.
Two main features of our shared experience during these times seem to be: 1) heightened stress/anxiety (about the virus, about loved ones getting sick, about economic impacts) and 2) a disruption to our normal routines (work, daily schedules, family life, recreation). Both increased stress/anxiety and disrupted routine can trigger acute, or short-term, problems with sleep, regardless of whether you have a history of sleep problems. Indeed, #cantsleep has been trending worldwide, and I’ve been hearing from my clients, coworkers, and friends that their sleep has taken a nose-dive recently.
Unfortunately, this comes at a time when getting good sleep is especially important for our health and well-being. Particularly relevant, sleep is linked to boosting the immune system, which reduces the risk of infection and helps to fight sickness more effectively. Also, sleep helps to better regulate mood and mental health – critical during this time when we are socially isolated, more stressed, and less able to engage in our normal coping activities. I want to encourage you to approach your sleep as an essential form of self-care to help you through these times.
Continue reading “Protecting Your Sleep During the Coronavirus Outbreak”
Sleep logs are usually an essential part of behavioral insomnia treatment for two main reasons: 1) baseline sleep data (pre-treatment) guides the initial sleep schedule modifications by providing important calculations such as sleep efficiency, average total sleep, sleep latency, and time in bed, and 2) ongoing sleep data shows trends during treatment and can tell us what is working or not working.
There is a third benefit that isn’t as immediately obvious, and that is that keeping daily track of your sleep/wake schedule brings awareness to your sleep patterns – shedding light onto patterns that may have been perpetuating over years or nuance into details you may have the tendency to filter through cognitive bias. This doesn’t always happen, but I have had clients whose insomnia started to get better simply by keeping sleep logs, before we even got to the behavioral intervention! For those folks, the awareness piece was all it took to identify and start un-sticking some of the maladaptive sleep patterns that they had been stuck in. They didn’t need the rest of the CBT-I therapy!
Am I promising that this will happen to you? Unfortunately not. The sleep logs are a tool, not some magic potion. It isn’t necessarily the one key that will unlock all of the sleep mysteries. However, it can be a powerful tool, and help you calculate baseline sleep data, illuminate trends as you progress, and offer awareness of sleep patterns. I want to share this tool with you as a resource and offer a few helpful pointers based on my experience.
Continue reading “Track Your Sleep Using These Nifty Sleep Logs (Part One)”
Not uncommonly I get asked about taking melatonin supplements, and I find that quite a few of my clients are taking melatonin currently or have in the past. And it’s not hard to see why it’s so widespread. You can get it without a prescription, it’s marketed as natural and safe, and it’s available in flavored teas, gummies and smoothies. There’s even liquid melatonin that comes with an eyedropper for convenient use with infants(!!). Walk down the “sleep” aisle at your local drugstore and you’ll see all of these and more.
Misunderstood and mis-taken
The only problem: melatonin is not really a sleep aid. It doesn’t make you sleepy. The majority of people taking melatonin are doing it all wrong. They tend to take it at the wrong time (right before bed), their dosing is too large (the smallest dose usually available, 1 mg, is still 4-5 times what the body produces), and they expect melatonin to induce sleepiness (it doesn’t). On the other hand, I have heard some physicians refer to it as a pretty effective placebo, and they’ll go along with patients who are convinced they need it to sleep. I guess I can’t argue with that.
Melatonin is not a sleeping pill, but rather, a “darkness signaling” hormone that operates as part of the body’s circadian rhythms. When the ambient light levels decrease in the evening – signaling that the sun is setting – special photoreceptors in the eye relay that information to the brain’s circadian control center (called the suprachiasmatic nucleus) which broadcasts that message to the whole brain by causing a tiny gland (the pineal gland) to release the hormone melatonin. As a result, various circadian processes know that it’s the right part of the 24 hour cycle to do things like: wind down, lower body temperature, reduce the alerting signals, etc. The actual feeling of sleepiness is caused by the homeostatic sleep drive that has built up during the day.
Continue reading “Boosting Your Melatonin (With This One Weird and Completely Legal Trick)”
Sleep problems don’t usually get triggered for no reason – they’re usually caused by an identifiable event or source, for example: work stress, going away to college, an injury, or a new baby. Similarly, sleep problems don’t usually stick around for no reason, either – that also has a cause. In other words, there are identifiable factors that perpetuate the sleep problems, and targeting these is an important part of getting your sleep back on track.
If you know a little bit about CBT-I, or if you’ve read my insomnia guide, you’ll know that this approach is part of a “behavioral” understanding of insomnia. Research shows that a behavioral treatment approach is extremely effective – in fact, more effective than medications in the long term – which is why CBT-I is widely recommended as the first line treatment for insomnia.
From my experience treating insomnia, here are the most common coping behaviors that clients have adopted in order to manage their sleep problems which actually further perpetuate the insomnia.
1. Getting into bed earlier.
The thinking goes like this, “If it’s taking me 1 to 2 hours to fall asleep, I should be getting into bed at least 1 to 2 hours earlier so I can get the same amount of sleep.” Seems to make sense. If you’re in bed, even if you’re not sleeping, at least you’re resting, right?
Continue reading “5 Common Coping Behaviors That Actually Perpetuate Insomnia”
If you’re like me, having the morning cup of joe is a daily (and mandatory) ritual. We’re in good company, as more than 60% of Americans reportedly drink coffee every day, drinking an average of 3 cups daily. Caffeine is an effective stimulant, and the world’s most widely used drug. Most of the caffeine we consume comes from coffee, but it is also found in sodas, teas, energy drinks, pre-workout supplements, among others.
When I give classes about insomnia or meet with clients individually, I definitely do talk about caffeine and how it can exacerbate sleeping problems, and I usually do a quick assessment of how much caffeine the person is consuming on a regular basis. Caffeine has a relatively long half-life, (usually about 5-6 hours) which means that it takes your body a long time to metabolize the substance, and it stays active in your body. The general guidance regarding caffeine is to stop consuming caffeinated beverages around early afternoon, say 2-3pm, so that it is less likely to affect you around your bedtime. Of course, individuals have differing levels of sensitivity to caffeine, so you may need to experiment with adjusting that time earlier or later.
I rarely ever advise a client to cut out coffee altogether, and I am quick to point out that I am a huge fan of coffee (and sometimes I’ll admit to having entered what could be construed from the outside as ‘coffee snob’ territory over the years of brewing and consuming this beverage) and am in no way interested in taking away their right to enjoy a cup of medium-roast arabica. However, caffeine is obviously a stimulant and has a significant potential for being disruptive to sleep onset, depending on the quantity consumed and time – so it is important to be aware of the effects and consider making changes as necessary.
Continue reading “Coffee, Insomnia and a Better Way”
By now, you probably have already read somewhere or been told by someone that it’s not good to be using your phone in your bed. Perhaps you’ve even tried cutting back on your in-bed screen time, but haven’t noticed much difference or found it too hard. After all, your phone is your bedside alarm clock… as well as your ebook reader, and your anti-boredom device, and your social network portal, and your emergency communications system… It’s no wonder that people have such a difficult time unplugging from it, even in bed. So exactly how bad is it? And, do you really need to give it up?
“Blue” light is disruptive to sleep
There’s now wide scientific consensus that the type of light emitted from our digital devices (smartphones, tablets, computers, etc.) is particularly disruptive to our body’s regulation of sleep, and it has to do with light wavelengths and your circadian rhythm. Up until the advent of electricity, humans have relied on the sun’s schedule to sleep and rise, and we now know that our bodies are biologically attuned to sunlight to keep our circadian rhythms aligned with the earth’s day and night cycle. With the invention of electricity and artificial lighting, we have effectively been able to extend the daylight hours, causing disruption to the circadian rhythm.
In fact, research in recent years has found the exact mechanism that gets disrupted – the secretion of melatonin, a sleep-related hormone, gets suppressed with light exposure and causes the onset of sleepiness to become delayed. This effect is most pronounced for light with shorter wavelengths, which means light on the blue end of the spectrum. And that, it turns out, is exactly the type of light emitted by our digital devices: smartphones, tablets, laptops, TVs, and other LCD screens. Thus the brighter the screen and the closer to bedtime your use is, the more likely it is to disrupt your sleep that night as well as your circadian rhythm in the longer term.
Continue reading “Here’s Why Your Smartphone Should Stay Out of Your Bed”
If you have children, going through a period of “baby sleep training” probably sounds familiar. There is a wide range of popular methods for sleep training your infant, from the cry-it-out method on one end of the spectrum to attachment parenting on the other end, and many methods that fall in between. While there are significant differences between them, there are also commonalities that I think are important. Having three young children, with whom we have gone through sleep training, and at the same time teaching adults about sleep training as an insomnia specialist, I have come to appreciate the ways sleep training in adults and in babies are parallel. And many of my clients who are parents themselves also have made connections to their experiences sleep training their babies.
1. A consistent sleep schedule
This is a pretty obvious similarity. With baby sleep training, an important goal is to help your infant develop a sleep pattern that is consistent and synchronized with the day/night cycle. It is common for a newborn to have its days and nights reversed, and over the first 4 months, the internal clock shifts multiple times. Not all baby training methods are in complete agreement, but most advise keeping a consistent sleep schedule to help the infant develop a predictable sleep pattern.
With adult sleep training, keeping a consistent sleep schedule is important to help reinforce and strengthen the circadian rhythm. Not only that, in order to increase the sleep drive and consolidate your sleep, behavioral sleep interventions recommend initially setting a later bedtime (if it usually takes you a long time to fall asleep). While it is understandable to want to stay out late on the weekends and sleep in, this behavior reinforces an irregular sleep pattern, which further perpetuates poor or disrupted sleep. During the period of sleep training, it is important to keep a consistent sleep schedule.
Continue reading “4 Ways Adult Sleep Training is Like Baby Sleep Training”
Why are naps bad?
Sometimes, I’m asked by a client why they have to give up napping. Or if power-naps are okay. If you glance through any number of “sleep hygiene” guides, most will specifically recommend to avoid napping. So, why are naps bad for you?
Truthfully, there is nothing inherently wrong with napping. In fact, people have been doing it probably as long as human history. Many cultures throughout history have actually had naps built in to their schedule. “Siestas” are still common in Spain, Italy, Mexico, and a handful of other countries. Some tech-oriented companies actually encourage on-the-job napping to boost productivity. On a slightly less related note, before the invention of electricity and artificial lighting, people commonly slept in two separate periods of sleep throughout the night (biphasic sleep), with a period of wakefulness in between for socialization and other activities. My point is, there is no one “right way” when it comes to patterns of sleeping.
Naps and insomnia
The problem with napping for insomnia sufferers is mainly that it disrupts night-time sleep and perpetuates disrupted sleep.
Continue reading “To Nap or Not to Nap, That is the Question (For Insomnia Sufferers)”
CBT-I (Cognitive Behavioral Therapy for Insomnia) is a behavioral treatment approach specifically developed for treating insomnia. It consists of several treatment components – based on cognitive behavioral therapy (CBT) principles – that are commonly used together to treat insomnia. Because it is a multi-component approach, there isn’t one authoritative or manualized version of CBT-I; instead you’ll find different variations with slightly different emphases based on the researcher or the author of the protocol.
CBT-I is considered to be the most effective non-medication-based treatment for insomnia (and in fact has been shown by research studies to be more effective than medications in the long term) and is overwhelmingly recommended as the first line treatment for insomnia. CBT-I is the modality that I have been trained in and utilize at my clinic (day job) to treat clients with insomnia, with great efficacy. I created this primer for anyone who wanted to learn more about the specifics of CBT-I.
A brief history of CBT-I
As I mentioned earlier, CBT-I isn’t a single structured intervention created at one point in time, but one that is made up of multiple components and has had many contributors as it evolved over the years. Prior to the 1970’s, teaching relaxation techniques (including progressive muscle relaxation) was the primary behavioral/psychological tool for treating insomnia. In the early 1970s, psychologist Richard Bootzin developed a method called stimulus control therapy, which focused on preserving the bed and bedroom as a cue for sleep, and which turned out to be a critical component of CBT-I. In the late 1970s, the concept of “sleep hygiene” as we now understand it in sleep medicine was introduced by psychologist Peter Hauri.
Continue reading “What is CBT-I?”