Monthly Archives: August 2010

Cognitive Behavioral Therapy for Insomnia (CBT-I)

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.

Children’s Sleep and School Success

Children’s Sleep and School Success – How they are related
School start is on the horizon. For those with children this can be a busy time, doing those last minute summer activities, getting school supplies, and preparing children for a successful year. Let’s take the time to get children on a good sleep schedule that will help them in school.

Children’s Sleep
Why is it important to think about children’s sleep? To start, many children simply don’t get enough hours of sleep. Here’s how much sleep kids need:
• children 3 to 5 years old need more than 11 hours
• children 6 to 12 years old need 10 to 11 hours
• teenagers need 9 to 9.5 hours
Looking at the school start times here in Seattle, and allowing just one hour from wake-up to being at school, grade school children should be sleeping by 9pm, middle schoolers by 9:30p, and high school students by 9:30-10pm. (If your child needs more than 1 hour from wake-up to school start time then move bedtime earlier accordingly). Are your children getting to sleep at that time? If not, your child is probably feeling the effects of insufficient sleep.
Impacts of Insufficient Sleep
Going to school can be demanding, children are asked to concentrate, learn physical skills, and develop socially with their peers. Here are some highlights:
• Only 20% of children grades 6-12 get the necessary amount of sleep (>9 hrs)! Can you believe it?! In younger children, only 47% get the sleep they need.
• Increased playground injuries in children who sleep <10 hours.
• Children with insufficient sleep are more likely to be angry, depressed, or overly emotional. Kids who sleep less take more risks, and this is especially true in teens.
• Cognitive effects include impaired memory, creative problem solving, and decreased verbal fluency, all skills that your child needs in school

What you can do to improve your child’s sleep:
• Establish bedtimes for your children, so everyone in the household knows the standard. You may want to have a time when everyone finishes their activities and starts to “wind down.”
• Start a trend in your social group of starting activities early enough that they usually end an hour before bedtime. This gives you time to travel home safely, and wind down a little before going to sleep.
• Remove electronic media from your child’s bedroom so they are not tempted to continue with homework, TV, or texting after bedtime
• Kids (and parents) can get excited about activities. Emphasize quality wake hours rather than quantity. Is it really fun to stay up late if you are so tired that you can’t think or are teary the next day?
• Allow your children to catch up on sleep on the weekends or vacations if necessary. The golden standard is to wake up on their own, feeling refreshed and energetic throughout the day. If your child sleeps a lot more on weekends, consider moving their school night bedtime earlier in 15 minute increments until it evens out.

Sleep and Moral Judgement

Ever noticed that when you haven’t been getting enough sleep, you have more difficulty thinking? We already knew this was true for many types of cognitive function, from mental math to logical reasoning. Also mood regulation and even humor are impaired when we don’t get enough sleep.

New research looked at moral reasoning in a military setting, where sometimes very difficult choices must be made. (Think ‘whether to attack insurgents in a setting succounded by civilians,’ the example given by these authors). This study had cadets respond to 5 moral dilemmas by rating 12 different decision making items. The cadets did this twice, when getting normal sleep, and with only 2.5 hours for the last 5 nights.

The people who made their judgements based more on principles when rested, shifted into more rule-based and self-oriented reasoning when sleep deprived.

This study has important implications for those situations when sleep deprived people are having to perform in a situation that involves moral dilemmas. For instance, military, police, other emergency workers. Can it also have relevance for more common situations, when we are faced with doing the right thing (or not)? Maybe so, something to think about.

Olsen. SLEEP 2010;33(8):1086-1090.

Tart Cherry Juice for Insomnia?

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.