Ep 4: CBT-I (Not “CBD, Aye”)

In episode 4 of the Sleep On It podcast, I talk about how getting better at perceiving your sleep can be improved, how that leads to better sleep and less insomnia. The best way to do this is by using a collection of strategies designed to change behaviors, habits and thinking patterns about sleep called Cognitive/Behavioral Therapy for Insomnia (CBT-I). The most supported of all the CBT-I strategies is called Stimulus Control: making the association between the bed and sleep stronger (think Pavlov’s dogs, but without the drooling). Enjoy!

‘Til Morning,

The Harpoleptic

Ep 3: At Least It Looks Cool!

Episode 3 of Sleep On It! podcast has me (“The Harpoleptic”) talking about sleep tracking with a wrist device, how that might actually not be good for people with insomnia (but they look cool!), and how there is no physical test for chronic insomnia (it’s subjective). Made some helpful adjustments to my microphone and software and podcast audio sounding better!

Ep 1: Sleep On It! Podcast

I have decided to do a regular podcast called Sleep On It!  I will be talking all things sleep: what we know about sleep, what we used to think sleep was, what happens during sleep, what happens to us with too little sleep, how to sleep better, and…me playing a little blues harmonica for bumper music!  It’s my new thing, and you can hear me get better (hopefully!) with each podcast.

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I just finished my initial recording – decided I just needed to get started and figure things out as I go! You can listen below. I will try to keep them short, around 5 min of me talking, and I will try my hardest to keep them interesting.  Who knows, you might get a chuckle, learn something, and even start sleeping better! Shoot me an email if you’d like me to talk about something specific!

Til Morning,

Michael, aka The Harpoleptic

Should I Stay or Should I Go?

Awake late at night.

The thought can be very troublesome to those who frequently experience it.  That nightly, predictable, wake-up in the wee hours can become so ingrained and expected that on the rare night it doesn’t happen, you would think a miracle of biblical proportions took place.

When sleep becomes elusive in the middle of the night, there are some clear must-dos and must-don’ts.

The first step is to establish your level of sleepiness/alterness.  Ask yourself:  Are you just experiencing a brief moment of wake, maybe just to use the bathroom or simply change sleeping positions?  If so, you can expect to return to sleep fairly easily.  Or do you feel like everything is ramping up:  mind racing, heart racing, fidgety, tossing and turning?  These are cues that sleep may not return for a while.  And the best thing to do is to leave the bedroom.

As Dr. Pavlov famously demonstrated over 100 years ago, all animals develop associations.  We develop responses to meaningful stimuli.  Just as the famous Russian’s dogs associated a bell ringing on the door (him entering the room) with a bit of meat powder (he was studying digestion so he needed the dogs to salivate), humans can begin to associate the bed, bedroom, and even bedtime with alertness.  This conditioning happens when you increasingly try to will/force yourself to sleep or back to sleep after waking (which by the way, all mammals normally wake at least a few times each night).

The next step is not to check the time.  This is one of those seemingly begnine little habits that most people have.  The problem is that doing so often leads to increased frustration and alertness, delaying your return to sleep.  Do whatever it takes:  move some clocks, avoid all backlit screens (they display time), don’t sleep with your watch on, etc.  Knowing the time is a “want”, not a “need”, and you may be amazed how avoiding it reduces sleep-related anxiety.

When you leave the bed, keep any light around you dim and ideally incandescent (old fashioned, heat-generating bulb) or candlelight.  Have a spot already set up on your couch or comfortable chair and do something you don’t mind doing:  read (paper material, not a tablet), listen to a story, listen to music, do some crosswords or a puzzle, play some solitaire with real cards, journal, color, knit, etc.  Get the idea?  Don’t try to bore yourself back to sleep.

Keep yourself warm.  In the winter months, leaving the bed when you’re alert can be daunting in a cold house.  (Side note: humans sleep better in a cool/cold environment with ample bedding and blankets).  Simple things like wearing a robe or sweatshirt, slippers, a heating blanket on the couch, a glass of warm milk or herbal tea, turning on the fireplace, etc., can make the whole experience less physically taxing.

Then, if/when the classic sleep cues begin (head nodding, eyes drooping, re-reading sentences, etc.), calmly go back to bed.  Repeat if needed.

This process, called “stimulus control” in sleep lingo, may take some effort.  The good news is that it is the most effective of all behavioral strategies for middle of the night awakenings, and it’s not something that you’ll need to do every night.  Just as Dr Pavlov was able to show that he could reverse the conditioned response of his dogs (salivating) by repeatedly entering the lab and NOT offering meat powder to his dogs, you can reverse your conditioned response of becoming fully awake during the night by doing this stimulus control that I’ve described.

Like more help with your sleep?  Contact me for an Sleep Coaching session via cell or Skype!  And for you Android insomniacs, your long-awaited Android version of my Sleep On Cue app is well underway…stay tuned!

Til morning,

Michael

Making Sleep Effortless

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Sleep is a struggle for roughly 15% of all adults.  Trouble falling asleep or falling back to sleep lead many insomnia sufferers to resort to medication(s) of some sort, be it prescription or over the counter (OTC), or alcohol.

I’ve always thought that physical fitness is a good analogy to sleep health.  People do fitness training to stay in shape, that is, to make themselves stronger.  Although perhaps not completely “effortless”, physical tasks become easier with fitness training.  Stairs become easier to climb, getting in and out of cars easier, walking, running, etc.  Everyone is different.  Training is something done to make doing other things require less effort, and sleep training is no different.

Most “better sleep” programs involve time-tested behavioral changes.  For example, consume less caffeine, avoid alcohol, learn relaxation techniques, and reduce light exposure at night.  Also learning to associate the bed/bedroom only with sleep (not bill-paying, watching TV, etc.).  Some of the more cognitive (mental) suggestions are also important, such as learning to deal with worry and anxiety.  But one of the more successful approaches to insomnia is a type of sleep training called “sleep restriction” (SR).

The reasoning behind SR is that a person with trouble falling to sleep or back to sleep (or depends on medication for either) usually spends too much time in bed awake.  The associated tossing and turning result in more frustration/anxiety/worry about sleep, thus keeping the insomnia going.  With SR, the person with insomnia is asked to temporarily reduce (or restrict) how much time she spends in bed.  The typical scenario has the person, for a week, only spending about as much time in bed as she has been actually sleeping.  For example, if she has been going to bed around 9pm and getting up at 7am (10 hours in bed), but only actually sleeping about 6 of those hours, doing SR would have her only spending about 6 hours in bed each night (1am – 7am) for a week.  Should falling asleep (or back to sleep) become a bit easier (more effortless), she would give herself a bit more time (15-20 min) in bed the next week, and so on.  Should sleep not improve, she would continue with the restricted time in bed.  Daytime napping is usually discouraged during SR.

In the short run, SR can be challenging.  Asking someone struggling with insomnia to purposefully deprive him or herself of sleep is a tough sell.  Clinically, most reports of SR show 2-4 weeks before sleep becomes easier.  This can feel like eternity to a person not getting enough sleep.  Not surprisingly, SR is difficult to do on one’s own, and should be discussed with the doctor before embarking.  Some people doing SR may benefit from being in a support group.

Thankfully, the Sleep On Cue app can help greatly with SR.  Implicit in SR is a later “prescribed” bedtime.  In the example above, the person started by delaying her bedtime from 9pm to 1am the first week.  A logical question from someone is doing SR is, “What should I do while waiting for my later bedtime?”.  TV use is discouraged, and some people struggle to keep awake reading or doing puzzles late into the night, and may ultimately succumb to falling asleep on the couch.  Doing some sleep training with the Sleep On Cue app leading up to the prescribed bedtime can enhance SR, ultimately reducing the time it takes to work.  Many app users have ended their chronic insomnia in just 2-3 nights of sleep training, much faster than the usual 2-4 weeks of simple SR.  The Sleep On Cue app improves ability to fall asleep by increasing awareness of sleepiness, something sorely lacking in someone with insomnia.  The Sleep On Cue app uses a modified version of Intensive Sleep Retraining, shown in sleep lab studies to reverse insomnia as well as traditional behavioral sleep therapy.

So if you are going to do SR for your insomnia, consider adding some sleep training with the Sleep On Cue app.  Effortless sleep might not require so much, well, effort!

~ Michael

v 2.0!

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One week ago a new version of the Sleep On Cue app for iPhone was released!  You may have noticed the name change from “SleepQ”, and the new color scheme.  The name is more intuitive, and the color change reduces glare.  Other great upgrades were also incorporated, all for a much better experience for the user.  We’re really proud of the new version, so be sure to upgrade soon! 

This winter, we will embark on a campaign to inform/educate sleep clinicians about the app and it’s usefulness in helping people get off and stay off sleeping medication. This is done by occasional 1-2 hour sleep training sessions around bedtime, following poor nights of sleep.  Sleep training increases ability and awareness of falling asleep, which in turn lowers a person’s dependency on medication for sleep. Non-drug therapy for chronic insomnia has been shown conclusively to be the best method for better sleep.

Another exciting development is the collaboration between us here at MicroSleep, LLC and the behavioral sleep research group at Flinders University in Adelaide Australia.  This group did the original research upon which the Sleep On Cue app is based.  The group plans to use the app in an upcoming study of Intensive Sleep Retraining next spring.  In addition to exploring new protocols for ISR, the study will serve as the first clinical trial of the app, so this is very exciting!  Look for more information about this next year.

Finally, the website is a bit “under construction” as we implement new screenshots, logo, etc., for the new app.  We would like to highlight the different menu options on the site:  FAQ (very important to for first-time app users to read), Sleep Coaching (1-on-1 via cell or Skype), and Workshops (on-site).  MicroSleep, LLC has many options for learning to sleep on cue!  

Til Morning,

Michael

Options

Rarely do I hear someone say, “I just did this one thing and my sleep now is great!”  At least, it is rare that I hear that after a little while.  Almost anything can help sleep for a few nights, or even a month or two.  The effectiveness of sleeping medications, various herbs, foods, etc., comes and goes.  Sleeping pills are notorious for this, for both physical and psychological reasons.  CPAP is one possible exception to all of this, although success with CPAP is usually tied to other general improvements in health (weight loss, sleep hygiene, etc.).  For long-term sleep health – truly overcoming insomnia – a “big picture” approach must be adopted.  All factors that perpetuate sleep troubles must be addressed.  And perhaps more importantly, a series of mini “experiments” must be conducted.  Simply put, there is no way to know precisely which behavioral or cognitive changes might result in the most significant improvement in sleep.  If someone tells you that they know the one thing that fixes sleep forever, run 🙂

This opinion might sound a bit odd from someone who recently created a powerful, revolutionary, sleep-training smartphone app.  The SleepQ app for iPhone provides a convenient and affordable method of behavioral sleep training shown to be highly effective in Australian sleep laboratories.  Specifically, the SleepQ app offers a highly efficient way to apply the most effective part of cognitive behavioral therapy for insomnia (CBTi).  But even the best cognitive/behavioral strategies have been shown to only improve sleep about 50% – 60% on average.  There is so much about sleep that is still not known, and may never be, that such a modest improvement with CBTi is understandable.

The chance of getting more improvement in your sleep can be greatly enhanced through guidance, or coaching.  Think of an exercise analogy: you can read about various techniques, and then embark on your own.  Unfortunately, as many of us know, attaining and keeping fitness gains are difficult.  Let’s face it: we are not experts in fitness.  And the support and encouragement of others can be a major perpetuating factor for exercise.  In other words, fitness classes and gym memberships tend to be more effective and used more than treadmills in the den.

Sleep can be challenging, elusive.  When the decision to “work” on sleep has been made, knowing where to start can be confusing.  Sleep can be very personal.  We can feel awkward discussing it with others, even with our doctor.  We don’t want to take sleeping pills, but we can become desperate for help.  Once you have spoken with your doctor to address medical conditions that may contribute to insomnia, I may have help for you!

At www.sleeponQ.com, I offer three options for help:

1) SleepQ app for iPhone – This is a great starting point.  Doing a little sleep training around bedtime, especially following a rough night of sleep, gives you an active way to work on your sleep.  SleepQ can effectively and rapidly increase your ability to get to sleep, reducing worry about sleep.

2) Online Sleep Coaching – Programs like Skype have created an amazing way to meet.  As I mentioned before, sleep difficulties can be personally challenging.  Many of my clients comment that they really like the the online coaching format.  With the assurance that I will not be prescribing a sleeping pill (I’m not a doctor), I find my clients to be highly receptive to the proven behavioral sleep strategies I present.  Also, it’s a great way to explain how to integrate the SleepQ app into an overall sleep health program.

3) Sleep Health Retreats – New this year!  I’m really excited to be offering this most effective level of sleep wellness.  The format is 2-nights, with a small group atmosphere.  The highly supportive environment is designed to enable people to experience all of the cognitive and behavioral sleep strategies shown to improve sleep.  And the crowning feature is your ability to do sleep training in the evening with me available to guide you in real time.  No iPhone?  No problem!  I even have developed a “no-tech” method so everyone can realize the proven effects of active sleep training.  Sign up today for the first sleep retreat, in central Oregon!

Til Morning,

Michael

Sleep Training with a Twist

As the SleepQ app for iPhone gains popularity, I had a chance to communicate with one user who took a different approach to his sleep.  And he discovered a way to use the app to help get back to sleep in the middle of the night easier.  Difficulty getting back to sleep is a very common issue, mostly as we age.

Clint, a life-long insomnia sufferer, first started by doing a couple evening sleep training sessions with the SleepQ app.  He quickly learned that in fact he could “let go” and fall asleep, in a reasonable amount of time.  And with the awareness feedback component to the app, he seemed to really learn what falling asleep felt like.  He seemed to quickly become less worried and more confident in his sleep.  Success!

Through our communication, Clint told me he was also using the app to get back to sleep in the middle of the night.  He said the periodic monotones disrupted the “racing mind”  he normally experienced while trying to get back to sleep.  So upon returning to bed after a simple bathroom break, he would put his earbud headphones in and start the app – but in the Nap Mode, not the Training Mode.  This is interesting.  The Nap Mode was designed to allow users to set their own daytime nap parameters, with one of the settings being total length of the nap.  I had a max setting of three hours programmed when designed the app, thinking this would allow someone who was simply sleep deprived (due to unusual circumstances, not due to ongoing insomnia) to take a long daytime recovery nap, up to three hours.

In the Nap Mode, the SleepQ app emits the periodic monotone until the user stops responding with a slight shake of the phone (indicating sleep has started).  Clint discovered that if he simply turned off the vibrate setting on his iPhone, and set the nap time to three hours, he could fall back to sleep easier with the monotones.  Again, he indicated that the monotones were very effective at disrupting a very common problem for people: intruding negative thoughts and ruminations (i.e., “racing mind”).  In the nap mode, the user also is informed how long it took to fall asleep/back to sleep, so Clint was able to learn that in fact his ability to get back to sleep was improving.  More success!

Clint also let me know that over the years, he had spent literally thousands of dollars on his sleep – prescriptions, doctor visits, herbs, teas, pillows, etc. etc.  This is not an unfamiliar story – I have heard this from other users of the SleepQ app.  Insomnia and sleep loss are very impactful.  I try not to dwell on the deleterious effects and daytime sequela of someone’s chronic insomnia.  Questions become rhetorical.  I prefer to focus on the remedy.

It is a must to talk with your doctor about your sleep, as there are some sleeping conditions (e.g., sleep apnea) that are very serious and must be treated medically.  But if you have exhausted your options or are becoming dependent on sleeping medication (or alcohol) for sleep, the SleepQ app for iPhone is definitely worth a look.  And as was shown, there may be some application twists yet to be discovered!

Til morning,

Michael

How Do You Cope?

Chronic insomnia is not just a nighttime thing.  The sleep loss from worry and anxiety about sleep usually leads to problems functioning during the day.  We are more sedentary, we avoid social situations, we may consume high amounts of caffeine, etc.  Studies have shown that we consume higher calorie foods without even realizing it.  Essentially, we cope.

Coping is a natural human response.  We have to work, take care of dependents, and get through our day.  But with sleep loss, our normal daily tasks can feel daunting, so we cope.  Unfortunately, the common coping strategies for sleep loss tend to perpetuate the very sleep loss we are trying to avoid.  Less active days, both physically and socially, can lead to more stress and tension at night.  It can increase chances of depression and obesity, two conditions that are highly associated with poor sleep.  Depressed people often experience early morning awakenings, while obesity dramatically increases chances of snoring and sleep apnea, a serious health problem.  Extra morning caffeine and sugar can spike cortisol and insulin levels, leading to an afternoon energy crash.  Caffeine in the late afternoon can make getting to sleep more difficult because caffeine is a long acting stimulant.

Following a day of coping strategies for sleep loss, the approaching evening can bring on two of the most popular coping strategies: alcohol and sleeping pills.  While alcohol is a strong CNS depressant and can make us relaxed and even sleepy, it has well-documented adverse effects on our sleep and our health in general.  In regards to sleep, alcohol is metabolized while we sleep, essentially turning into a sugar.  Sugar is a stimulant, the last thing your sleeping brain needs in the middle of the night.  It is also a diuretic, and it’s sedating effects worsen snoring and sleep apnea.

Sleeping pills come in many forms, with different half lives.  Some are designed for putting you to sleep, some for keeping you asleep.  All FDA-approved sleeping medications are safe when used as directed.  Sleeping pills, however, are often not used as directed.  They are designed to be used for short periods of time, such as during a time of acute stress.  They should not be used with alcohol, or with sedating medications.  And most are not designed to be taken in the middle of the night as this can lead to morning grogginess.  In the elderly, sleeping medications can lead to increased risk of falling during the night and in the morning because our metabolism rate slows as we age.

So is there a way to effectively cope with sleep loss, whether from insomnia or just plain old “didn’t get enough sleep “?

Yes.  Sleep training with the SleepQ app in the late afternoon or early evening for an hour or two following any rough night of sleep can restore confidence in your ability to get to sleep and/or back to sleep, which in turn reduces worry about sleep.  SleepQ eliminates the need for all those coping strategies that feed our insomnia.  It is non-drug, convenient and affordable…just a quick visit to the App Store and you can put that insomnia to rest!

Til Morning,

Michael