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.
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.
The Therapeutic Order
A key of naturopathic medicine is to use the least force medicine that will treat the problem. For example, take a person who is spending 9 hours in bed and sleeping 7 hours. If she will sleep better by simply reducing the number of hours spent awake in bed, that is done first. Prescribing a pharmaceutical sleep aid which may have side effects would be done after other lower force treatments were tried.
Here is the Therapeutic Order, NDs start at the top and work down as needed:
• Re-establish the basis for health.
• Stimulate the healing power of nature.
• Tonify weakened systems.
• Correct structural integrity.
• Prescribe specific natural substances for pathology.
• Prescribe specific pharmacological substances for pathology.
• Prescribe surgery, suppressive drugs, radiation, and chemotherapy.
Naturopathic Medicine is a unique philosophy of medicine which is based on the healing power of nature. Naturopathic Medicine has it’s roots in the traditional medicine practiced in Europe hundreds of years ago. It is philosophically distinct from the allopathic medicine practiced by MDs in this country.
The Principles of Naturopathic Medicine are: Vix Medicatrix Naturae – The Healing Power of Nature.
Nature acts powerfully through healing mechanisms in the body to maintain and restore health. The naturopathic physician works to restore and support these inherent systems. Primum Non Nocere – First Do No Harm.
The naturopathic physician seeks to provide the most effective health care with the least risk to the client. Tolle Causum – Find Cause.
The naturopathic physician shall strive to identify and remove the causes of illness, rather than merely eliminate or suppress symptoms. Docere – Doctor as Teacher.
The naturopathic physician educates the client, inspires rational hope, and encourages self-responsibility for health. Treat the Whole Person –
Health or disease comes from a complex interaction of physical, emotional, dietary, genetic, environmental, lifestyle or other factors. The naturopathic physician treats the whole person, taking these factors into account. Wellness –
Wellness is a state of being healthy, characterized by positive emotion, thought and action. Wellness is inherent in everyone. The naturopathic physician shall seek to restore, maintain, and optimize wellness. Preventive Medicine –
The naturopathic physician promotes health through the prevention of disease for the individual, each community, and the world.
In working with sleep patients, these Principles are so important that they are posted in the waiting room, and guide my work each day.