Tuesday, 24 September 2024

Trouble sleeping? This therapy can help with insomnia

From theguardian.com

CBT-I involves actions like changing what you do when you can’t sleep and reframing anxious thoughts about slumber 

You might have heard of cognitive behavioural therapy, or CBT, a popular and well-researched type of psychotherapy. But did you know it can help people with sleep issues?

CBT-I, a form of CBT, is a successful treatment for insomnia. It involves actions like changing what you do when you can’t sleep and reframing anxious thoughts related to sleep. The distinctive difference between CBT and CBT-I is the inclusion of the principles and practice of sleep medicine, explains Michael Perlis, director of the Behavioural Sleep Medicine Program at the University of Pennsylvania.

For the past 15 years, Perlis and Donn Posner have taught care providers how to deliver cognitive behavioural therapy for insomnia, or CBT-I. Their course used to “get something like 25 to 40 people”, says Posner, an adjunct clinical associate professor at the Stanford University School of Medicine and president of Sleepwell Consultants. This year, 435 people have expressed interest in taking it.

Data supporting the effectiveness of CBT-I has been around for about 30 years, Posner explains, but only now is it finally “starting to come onto the radar”.

An increasing number of people are worried about their shut-eye but turn to habits that don’t help their sleep in the long run, such as melatonin and sleeping in. In reality, easy fixes are often not the best for getting back into the flow of good sleep – and the foundations of CBT-I can help explain why.

When does sleep become a problem?

Poor sleep is quite common. According to a 2024 Gallup poll, 57% of US adults said they would feel better if they slept more.

About one-third of adults experience acute insomnia, which can last a few days or weeks. And roughly one in 10 suffer from chronic insomnia, defined as happening more than three nights a week for at least three months.

Acute insomnia is almost always the result of some stressor, explains Posner, though not always a negative one. You might have a cold or jet lag; you might be excited for an upcoming event. If the stressor goes away, insomnia is likely to follow suit.

But if insomnia becomes chronic, it can persist even if the stressor has gone away, Posner says. This is because other factors, like going to bed early to make up for sleep loss or worrying about insufficient sleep, can perpetuate insomnia.

Insomnia is linked to a host of issues spanning mental and physical health. These include fatigue, decreased quality of life and an increased risk for disease.

The distinctive difference between CBT and CBT-I is the inclusion of principles and practice of sleep medicine. Photograph: Klaus Vedfelt/Getty Images

What is CBT-I?

CBT-I targets difficulties related to initiating and maintaining sleep. It combines cognitive therapy, behavioural interventions and educational interventions.

Its core components are Sleep Restriction Therapy (SRT) and Stimulus Control Therapy (SCT). A provider typically teaches these elements and the individual then practices at home.

SRT might sound intimidating, but it’s more about cutting down time in bed while awake than restricting sleep time. Eventually, this leads to improved sleep efficiency.

SCT is intended to strengthen the link between sleep cues – like the bed, bedroom and bedtime – and falling asleep easily and sleeping well. This can look like avoiding any behaviour in the bedroom that isn’t sleep or sex and only lying in the bed when you’re sleepy.

There are also two supplemental elements: sleep hygiene and cognitive therapy. Sleep hygiene promotes healthy habits that support sleep, like avoiding alcohol before bed. The cognitive element is about adjusting or reframing unhelpful behaviours and ways of thinking, for example, thoughts like “I can’t fall asleep without a sleeping pill” or “I am afraid of having another sleepless night.”

CBT-I is typically delivered over five to eight sessions, which can last 30 to 90 minutes. However, the length of treatment depends on how adherent a patient is, Posner explains. He compares it to physical therapy: if you do all the assigned exercises, you will likely graduate from treatment sooner.

Who can CBT-I help?

Data from multiple controlled clinical trials suggests that 70% to 80% of people with chronic insomnia who try CBT-I end up with improved sleep. Research also suggests these gains last.

In the early 2000s, research turned to how well CBT-I can help with secondary insomnia – insomnia that arises from a primary event, like a medical illness or mental disorder – says Perlis.

Originally, researchers assumed that treating the primary condition would stop the insomnia too. However, now it’s increasingly understood that even if other conditions improve, chronic insomnia generally doesn’t stop if left untreated.

Studies show that CBT-I is a promising treatment for insomnia that’s co-morbid with other conditions, like chronic pain and anxiety. Further, there are “halo effects”, explains Perlis. For example, when treating insomnia co-morbid with depression, the depression tends to improve.

It’s also possible that CBT-I may benefit people with daytime fatigue and sleepiness and people with poor sleep who don’t have chronic insomnia yet.

Principles of CBT-I can also help people who generally need help with sleep. For example, Perlis says getting out of bed is better than tossing and turning for hours. During this time, you should do something enjoyable, like reading a book and only return to bed when sleepy.

“Yes, you may lose a bit of sleep, but this will assist with getting over the transient insomnia and reduce your sense of dread when awake at night,” he says.

How does CBT-I compare to other insomnia treatments?

CBT-I is a highly regarded treatment. It’s recommended by the American College of Physicians (ACP) and the US Department of Veteran’s Affairs as the first-line therapy for chronic insomnia.

Experts often encourage people with insomnia to adopt habits like getting enough physical activity during the day, which some research suggests is comparable to CBT-I when it comes to long-term effectiveness. Doctors also might prescribe medications: according to the CDC, in 2020, roughly 10% of adults had taken sleep medication in the last 30 days.

Perlis co-authored a 2012 review of five studies comparing CBT-I with prescription and non-prescription medications, which concluded that CBT-I is as effective as medications for treating insomnia and its effects possibly more durable. It also doesn’t come with the side effects linked to some sleep medications, like impaired memory and nausea, linked to some sleep medications.

Perlis and the other authors identified two main disadvantages to CBT-I. First, people with chronic insomnia might not see improvements until a few weeks into treatment, and second, at the start of the therapy, the process might cause some to feel more tired. These hurdles can cause some to drop out of treatment prematurely. Accordingly, CBT-I is underutilized partly because some people stop too soon. There’s also a lack of qualified providers, which makes it easy to turn to medications or other drugs like melatonin first.

“There are not enough of us who know how to really do this therapy well to meet the need because the need is epidemic,” says Posner. “But it is getting better.”

How to get CBT-I therapy for insomnia?

You should speak with a medical professional if you’re concerned about your sleep. Posner says that often, people seek help after suffering from insomnia for too long.

According to Perlis, about 1,000 people worldwide are knowledgeable CBT-I providers. You can search for one via the University of Pennsylvania International CBT-I Provider Directory.

When evaluating whether or not to work with a therapist claiming to deliver CBT-I, Perlis says: “If they say the core approach for the treatment of insomnia is either relaxation or sleep hygiene, patients might want to look a little further.” Proper CBT-I requires SRT and SCT.

How you receive CBT-I also matters. While research suggests that learning about CBT-I through something like a self-help book can be beneficial, face-to-face interventions have the greatest evidence of good results. This could mean meeting in person or, some early research indicates, through video-based tele-health.

The American Academy of Sleep Medicine recommends that people who can’t access CBT-I delivered by a therapist try it through an app while they wait for an appointment. For example, the US Department of Veterans Affairs created a free app.

“The data is quite clear that those types of things [apps] are a nice start, but they’re not as good as face-to-face therapy,” says Posner.

https://www.theguardian.com/wellness/2024/sep/23/cbt-i-sleep-therapy

Monday, 23 September 2024

The 4 Unique Sleep Cycles You Have Never Heard Of

From cnet.com

Sleeping seven hours at a stretch isn't the only way to catch some Zzz's. Here are four alternatives -- and they are pretty obscure 

Science says you can take a guilt-free afternoon nap. No, really. Getting all of your sleep in a single stretch is the most common sleep cycle, but it may be beneficial to split your sleep for some. There could be cognitive benefits to a quick, 15- to 20-minute couch nap when you hit your 3 p.m. slump. 

There are different types of sleep cycles to consider if you have an unconventional schedule or don't need a lot of sleep. Some cycles result in as little as two to four hours of sleep throughout a 24-hour period. You may want to consider the possible downsides of cutting down on your sleep before you drastically change your schedule. 

What is the standard sleep cycle?

The standard sleep schedule is one long slumber, usually at night. This is also called the monophasic sleep cycle. Getting your rest all at once gives your body enough time to go through the various sleep cycles. This approach allows your body to complete the full range of sleep stages, including REM -- also called stage 4, or rapid eye movement. 

Closeup of hand stopping alarm clock from ringing.
Nitat Termmee/Moment/Getty Images

Monophasic 

In modern times, monophasic sleep is the standard cycle. Many experts recommend this sleep schedule because it best aligns with your body's circadian rhythm, which is largely guided by light and dark. This means your brain signals you to wake up when the sun comes up and begins to release melatonin and make you sleepy when it gets dark out. Sleeping in one long stretch also makes it easier for many people to achieve the recommended seven to nine hours of sleep per day as an adult. 

Your body goes through four stages of sleep each night. Annie Miller, licensed psychotherapist and sleep expert told CNET, "NREM sleep includes three stages, with Stage 3 (previously known as Stage 4) being the deep restorative phase. Stage 3 sleep is crucial for bodily repair, muscle growth and cognitive functions like memory consolidation. This stage typically begins about 90 minutes into the sleep cycle, though this timing can vary." She continued, "Monophasic sleep, which involves a single, uninterrupted sleep period, increases the likelihood of experiencing sufficient amounts of deep sleep, allowing your body to progress through all sleep stages."

What are alternative sleep cycles?

Getting all of your sleep at once is a relatively modern convention. If you always need a nap at 3 p.m. or you prefer to sleep in three-hour increments throughout the day, you may be tapping into a sleep cycle with a history. Limiting your sleep is not for everyone.  Miller added, "While these alternative sleep cycles may fit certain lifestyles, insufficient total sleep may lead to negative outcomes for some."

Biphasic

Biphasic sleep (sometimes called bimodal sleep) refers to a slumber schedule that is broken up into two parts. This could mean sleeping at night and taking a short nap or 60- to 90-minute siesta in the middle of the day, or breaking up your nightly sleep into two parts. Miller clarified, "This can mean having a longer sleep period at night followed by a shorter nap during the day, or splitting your sleep into two substantial segments within a 24-hour period."

The first sleep/second sleep schedule was common prior to modern lighting and machinery. People would often sleep once for a few hours beginning at about 9 p.m. and then wake up at midnight for a few hours before sleeping again for a larger block of time. 

The benefits of biphasic sleep include cognitive health. If you often experience fatigue and brain fog in the middle of the day, even a short nap can boost cognitive function for the rest of the day. Breaking up sleep into two phases may also better accommodate complicated schedules or morning people who wake before dawn. For people who work unconventional hours or observe specific prayer hours, biphasic sleep can make a lot of sense. Miller added, "However, the effectiveness of this sleep pattern can vary depending on personal needs and lifestyle."

Everyman

If you can get by on less sleep than the average person, the Everyman cycle may work for you. This method requires three solid hours of rest at night and three 20-minute naps throughout the day. You'll get a total of four hours of sleep per day. While this is efficient, Cleveland Clinic warns that consistently falling short of seven to eight hours of sleep could result in sleep deprivation. 

Some people can run on fewer hours of sleep. Miller told CNET that the Everman cycle may work for a group of people called "short sleepers." She stated, "Short sleepers naturally function well on less than six hours of sleep per night. Short sleepers are rare and usually have a genetic predisposition that allows them to maintain cognitive and physical health with reduced sleep."

The Everyman schedule could also be a good short-term option for people who are working long hours or have a new baby. Supplementing a short night-time sleep with multiple naps could keep you more alert and rested until you can resume a more regular schedule. Although, daytime sleep can negatively affect your ability to fall asleep at night for some. 

Dymaxion 

This sleep cycle gives you just two hours of sleep per day. Created by architect and inventor Richard Buckminster Fuller, this cycle mirrors Fuller's work methodology, which was to generate "maximal output from minimal energetic input." The Dymaxion sleep cycle involves getting 30 minutes of sleep every six hours. 

This type of sleep can accommodate long travel schedules or other extreme situations, it also falls far short of recommended sleep hours for adults. 

Uberman

The Uberman cycle was inspired by the Dymaxion model and results in the same amount of sleep, just on a slightly different schedule. This sleep schedule involves six 20-minute naps per day or one nap every four hours. The creator, Marie Straver, said she suffered from insomnia in college, and this sleep schedule helped her get enough rest to be productive throughout the day. 

The Uberman schedule may be good for people who have insomnia or need a short-term solution, but it may not give you enough REM or deep sleep. "The success of this is anecdotal and if you are struggling with insomnia, this would not be an effective way to treat insomnia. Sleeping during the day can lead to further insomnia by reducing your ability to fall asleep at night," Miller stated. 

Drawbacks of biphasic and polyphasic sleep cycles

gettyimages-2167617399
Fresh Splash/Getty Images

2022 literature review published in the Journal of Sleep Health found no provable benefits to polyphasic sleep cycles. The researchers concluded that current evidence suggests there may be serious risks. The sleep deprivation caused by polyphasic schedules could lead to a variety of negative outcomes related to mental health, physical health and cognitive performance. 

"While chronic sleep deprivation can have adverse effects, there are some nuanced considerations. For instance, higher sleep drive due to partial sleep deprivation can reduce insomnia and increase restorative deep sleep," warned Miller. "Additionally, controlled sleep deprivation has been explored as a treatment for depression in certain clinical settings. That said, for most people, consistent, ongoing sleep deprivation is likely to be detrimental, impacting overall health and daily functioning."

Notably, these outcomes are related to lack of sleep. If you choose a biphasic or polyphasic sleep schedule that keeps you close to the recommended minimum sleep for adults, you may not experience any negative outcomes. 

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives

https://www.cnet.com/health/sleep/4-unique-sleep-cycles/

Tuesday, 17 September 2024

Which Countries Top the Charts for Worst Sleep Habits?

From athletechnews.com

recent study conducted by Onebed has identified the countries where people struggle with sleep the most. The study analysed factors like average hours of sleep, air quality, noise pollution, stress levels, and the volume of Google searches related to sleep deprivation and insomnia.

Australia emerged as the nation with the worst sleep habits, despite its relatively high average hours of sleep per night. Australians average 6.24 hours of sleep per night, but despite spending more time in bed than in many other countries, sleep quality remains concerning. There is a high volume of Google searches for terms like “sleep deprivation” (66,450 monthly searches) and “insomnia remedies” (47,770 monthly searches). Additionally, noise pollution, a known disruptor of restful sleep, is a major issue in Australia.

Dylan Tollemache, Co-Founder & CEO of Onebed, commented, “Sleep is something we all need, but it’s becoming increasingly clear just how challenging it is for people across the globe to get a decent night’s rest. It’s no surprise to see Australia leading the charge, with so many of us turning to the internet for help with sleep issues. What struck me most was the sheer volume of searches for sleep-related problems here in Australia, even though we’re getting the most hours in bed. It’s clear that sleep quality is becoming a bigger concern.”

Americans are also struggling with sleep. The average amount of sleep per night in the country is just 5.7 hours, the lowest among the top ten countries analysed. With stress levels at 7.29 and noise pollution at 46.56, the U.S. has dire sleep issues. There are also 1.1 million monthly Google searches for terms like “sleep deprivation” and “insomnia remedies,” far surpassing any other country.

The Philippines ranks third with a composite score of 0.879, suffering from the highest noise pollution levels at 55.60 and significant stress, both of which contribute to poor sleep quality. Residents average 6.13 hours of sleep per night.

The United Kingdom is fourth, with relatively better sleep habits compared to the top three. However, the U.K. still faces sleep challenges, averaging 6.8 hours of sleep per night. Although stress levels are more moderate at 5.0, the country still sees over 220,000 monthly searches related to sleep problems.

Mexico ranks fifth, with the worst air quality among the top ten countries (scoring 103 on the air quality index), along with high noise pollution levels. These environmental issues contribute to the country’s sleep struggles, despite residents averaging 6.62 hours of sleep per night.

The study’s results highlight the importance of raising awareness about sleep quality. Stress reduction, noise pollution, and air quality all contribute to the concerning sleep issues across these different countries. With the United States receiving the second-worst scores, promoting meditation and sleep aid tools can have a lasting impact on Americans’ health and wellness.

https://athletechnews.com/countries-with-worst-sleep-habits/