“Sleep Deprived in Seattle” in Seattle magazine

Categories: behavioral treatment, insomnia, naturopathic medicine, Seattle, sleep, sleep deprivation

“Sleep Deprived in Seattle” in Seattle magazine

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

Curing Insomnia is Like Climbing a Mountain

Categories: behavioral treatment, insomnia, sleep

Curing Insomnia is Like Climbing a Mountain

Being unable to sleep can be very distressing, especially when it’s an acute episode. One analogy that works when I think about treating insomnia is that Curing Insomnia is Like Climbing a Mountain.

Think about going for a hike up a mountain to the scenic view from the peak. You look at the paths that lead to the top, and choose the one that’s best for you. Your choice is based on where you came from, your preferences (a long gradual climb, or a short steep one), and your other abilities or conditions. Once you choose your path you stick with it, knowing that if you switch to another path, that horizontal movement is not getting you any closer to the goal.

It’s helpful to think of curing insomnia in a similar way, that you look at the treatment options available to you, and choose the one that’s the best fit. Once you’ve selected the treatment you want, stick with it long enough for it to be effective. Sometimes when people are in an acute episode of insomnia it is tempting to try different treatments, each for a short time. What’s more effective is to give a reasonable trial of a treatment approach (several weeks or a month at least), before switching paths. Knowing that insomnia is cured one night at a time, bit by bit, just like climbing a mountain can help keep you calm and focused on the end goal.

Here’s to the view from the top, and the peaceful sleep at the end of the path!

I’m Dizzy with Sleep Debt

Categories: driving safety, insomnia, overweight, sleep, sleep deprivation

I’m Dizzy with Sleep Debt

So although I’m a sleep expert, unfortunately that doesn’t make me immune to the havoc that life events can wreak on sleep health. My usual healthy 8.3 hour average sleep which leaves me energetic and sharp all day has plummeted to a mere 6.5 hours over the last week. I’m not alarmed, as identifiable events are interfering with my sleep, and I know that once those settle down my sleep will easily bounce back. Today I’m feeling the effects of acute sleep deprivation, a perfect chance for a blog post.

During acute sleep deprivation, people can feel a variety of somatic symptoms, like stomach or head aches. Others may feel dizzy or have difficulty concentrating. And of course there are performance decrements which we’ve discussed previously, and health problems too.

For me, today, the sleep loss is making me feel slightly dizzy, ravenously hungry for sugar (which is more difficult to resist than usual), my eyes feel irritated, and I’ve been making errors like hitting the wrong elevator button, and feel I need to work extra hard to pay attention while driving. My temperature control also seems to be off.

Now 6.5 hours of sleep nightly for 5 nights is not bad for many people. About 30% of American workers report getting less than 6 hours on work nights. What I wonder is whether people who are habitually sleep deprived get accustomed to the feelings of sleep debt, so that it becomes their normal? Granted I’m not a good person to say, both because I spend more time thinking about sleep than average, and because I’m usually well-rested, so can really notice the effects of sleep debt.

Today and the rest of the week I’ll keep my healthy sleep habits in place, and not worry about it, knowing my sleep will get back on track in a day or two. Until then, sugar anyone?

Does a Hot Bath Help Sleep?

Categories: behavioral treatment, circadian rhythm, insomnia, naturopathic medicine, sleep, Women's sleep

Does a Hot Bath Help Sleep?

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

Categories: fall asleep, insomnia, naturopathic medicine, sleep

Tobacco Impacts Your Sleep

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.

Sleep Interruptions – Not so Trivial!

Categories: bedroom, behavioral treatment, insomnia, parenting, sleep

Sleep Interruptions – Not so Trivial!

Many people talk to me about their difficulties sleeping, either difficulty falling asleep initially, or returning to sleep in the middle of the night, or in some cases waking up before they want to start the day.

One question that can be very helpful in this situation is “what woke you?” or “what prevented you from falling asleep?”  Surprisingly often, there is a clear environmental disturbance that is interrupting sleep.

Here are some of the external sleep interruptions I’ve heard of over the years:
– a snoring, or moving, bedpartner who may have a sleep disorder of their own
– bedpartner who gets into bed later, or who gets up earlier, thus waking up the person experiencing insomnia
– dog’s collar jingling
– cat asking for attention by scratching on the bedroom door
– outdoor lights that turn off and on with movement (hate those!)
– children in the bed, snuggled right up against the patient who then is uncomfortable
– an appliance or toy that beeps
– the cell phone, often a problem when it is used as an alarm clock
. . . and the list could easily go on.

When you are working to improve your sleep, you first want to eliminate as many of these interruptions as possible. I recently was working with a woman struggling to sleep well, waking 2-4 times each night. When asked “what wakes you in the night” she identified that sometimes her husband’s snoring woke her. We dialed down into that a little more, and she estimated that his loud snoring is responsible for half of her wakings, and realized looking back on it that when he’s away she does sleep better. Another person, a mother, said that she’s often squished between her children during sleep, and has no sleep problem if she has the bed to herself.

When you are working to improve your sleep, a helpful first step is to see if any external factor is interrupting or preventing you from sleep. Systematically resolve those interruptions, and then re-assess. You may find that those interruptions you were tolerating are not so trivial!

Start School Later – Contact your Senators!

Categories: Uncategorized

Start School Later – Contact your Senators!

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: 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 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!

Sleepy Transportation Workers – Scary!

Categories: circadian rhythm, fatigue, performance, shiftwork, sleep, sleep deprivation

Sleepy Transportation Workers – Scary!

Last week was National Sleep Awareness Week, and the time each year that the annual Sleep in America Poll is unveiled. This year it is all about sleep health in the transportation industry. This data raises concerns about public safety, and the health of the transportation workers. Here’s what pilots, train operators, and professional drivers of all types reported about their sleep.

Sleepiness and Safety
When asked about sleepiness, 1 in 4 pilots and train operators said that sleepiness has impacted their job performance once a week. Even more concerning is the number of professionals who say that sleepiness caused safety issues: 20% of pilots, 18% of train operators, and 14% of truck drivers.

These safety issues persist during transportation employees personal time: 6% were in an auto accident due to sleepiness compared to 1% of those who work in other industries.

The Sleep Schedule
Almost half of transportation workers are dis-satisfied with their sleep. Many say their work schedule does not allow enough time for sleep (44% train operators, 37% pilots). This compares to 27% of non-transportation workers.

Transportation professionals tend to work longer shifts, with less time off between shifts. They also tend to have longer commute times, and irregular shiftwork type schedules.

Adequate Sleep for Transportation Professionals
It’s been a pleasure in my office to help transportation professionals get healthy, natural sleep. This is primarily about strategically using our body’s sleep systems to promote alertness during work hours and sleep during sleep times.

First, create a window of time for sleep that can be as consistent as possible. Also put into place a routine of meal times, exercise, activity – all those things that signal time to the body. Second, reduce the commute as much as possible. Third, use precisely timed melatonin and light therapy to promote sleep at sleep times and increase alertness during the work day. This is a very individualized approach which takes into account the irregular work schedule, commute time, sleep environment, and lifestyle.

Summary

“The margin of error in these professions is extremely small. Transportation professionals need to manage sleep to perform at their best,” said David Cloud, leader of the National Sleep Foundation.  His comment really sums this up, that sleep health is so important for transportation professionals and the safety of the public they serve.

 You can read the report here: http://www.sleepfoundation.org//article/press-release/sleepy-pilots-train-operators-and-drivers

Start School Later goes to Washington DC

Categories: Uncategorized

Start School Later goes to Washington DC

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

Categories: Uncategorized

Time to Help Teens Sleep

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