Cognitive behavioral therapy (CBT) just got another star for treating insomnia, especially for people who suffer from chronic neck or back pain.

The study, published online by the journal Sleep Medicine, indicates that CBT can help patients who already are taking pain medications and might be reluctant or unable to take additional drugs to treat their sleep problems.

I've long believed in the power of CBT. Exactly what is it? The gist:

• As its name implies, CBT is one part cognitive and one part behavioral.


• The cognitive portion of CBT is about recognizing, challenging and changing the ways of thinking that keep you from falling asleep.


• If you can't get to sleep easily at night and find yourself tossing and turning while awash in irritating thoughts, chances are you're fueling your own fire with a distorted, stress-inducing behavior. The CBT Solution: Challenge these thoughts, with the help of a sleep psychologist, as they may be distorted or inaccurate.


• The behavior portion is about sleep hygiene - the ways in which you prepare yourself for sleep. My Solution: Follow a Power Down Hour and go to bed at the perfect time for your body so you're ready to fall asleep within 20 to 30 minutes.

Studies have shown that cognitive behavior therapy can, in fact, outperform sleeping pills. This proves just how powerful thoughts can be, and that getting restful sleep is often more about how you teach your mind to think than using any external tool such as a drug or other sleep aid.

The participants in this latest study, whose pain and moods were tracked for six months alongside sleep, received CBT and showed measurable, positive results. The researchers believe that CBT can be even more effective than other treatments for insomnia and chronic pain.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: insomnia, sleep hygiene, sleep problems

Labels: health and wellness, insomnia, sleep hygiene, sleep problems

I get asked pretty frequently about alternative therapies to treat sleep problems. While drugs do have their place in treating some types of sleep disorders, there's something to be said for the array of so-called alternative methods that don't entail pharmaceuticals but do, in fact, support restful sleep.

• Acupuncture, for example, has been used to treat insomnia for centuries in China, and clinical studies have shown that acupuncture may have a beneficial effect on insomnia compared with Western medication. And for those who need more solid proof, a recent study just confirmed this finding again.


• Acupressure, which is based on acupuncture but does not entail needles (instead, physical pressure is applied to the acupuncture points), also has shown promise in helping people beat insomnia. And another recent study confirmed this when it looked at the sleep-friendly effects that acupressure had on people who live in long-term care facilities. Acupressure on the HT7 point (a particular point on the body) may improve insomnia for up to 2 weeks after the intervention.

But alternative methods to pharmaceutical or even over the counter medication go far beyond just acupuncture and acupressure. When you consider all the other drug-free strategies for restful sleep, you'll find that the vast majority of techniques used to support sleep hygiene could be considered "alternative", such as:

• Aromatherapy: employing the power of scent to lull you to sleep.
• Sound machines: employing the power of white noise.
• Taking a warm bath or sitting in a hot tub or sauna before bedtime.

And my favorite one of all: quitting all forms of work and stimulating activities within an hour of bedtime and just relaxing. And there's nothing "alternative" about that.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: alternative therapy, aroma therapy, ealth and wellness, insomnia, sleep, sleep deprivation, sleep hygiene, sleep problems

A mind is a terrible thing to waste, as the old adage goes. But so is sleep.

Last week a new study emerged indicating that chronic insomnia may be doing more damage to your brain than you ever thought: it could be associated with a wasting away of its gray matter.

The area in question is known as a "stress sensitive" region, which involves memory formation. And the scientists who headed up this latest study out of the Netherlands have shown that insomnia patients have lower grey matter density in the brain regions that helps us to evaluate pleasant stimuli (i.e., that which helps us get to sleep!), as well as in regions related to the brain's "resting state" (i.e., sleep!).

The people most at risk for smaller brain volume? Not surprisingly, people:

• Under chronic and severely stressful situations.
• Depressed or those with post-traumatic stress disorder.
• With psychiatric disorders.

These circumstances are not all that unusual now that stress is very much a part of everyone's daily life. Psychiatric disorders may be rare, but unrelenting stress is not. These researchers noted smaller gray matter in people with chronic insomnia who were otherwise mentally healthy!

Since this is an early study, we also must ask the question, which came first - the smaller grey matter causing/influencing the insomnia, or the insomnia causing/influencing the grey matter? Only time will tell, as I am sure this is another study to be done.

The lesson: if you suffer from insomnia, get help in finding out its root cause. Chronic insomnia will wreak havoc on much more than your brain.

The brain is not something you want to lose over lack of sleep. And it's not something you can get back easily once it's gone.

Like I said, a mind (quite literally, the brain) is a terrible thing to waste.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: brain, insomnia, sleep deprivation, sleep problems

Usually when I am asked questions about co-sleeping or "the family bed" it is in reference to having children sleeping in the bed with their parents. But recently I was asked to comment on pets in the bed, so I thought this might be a good thing for us all to think about. Some bulldogs can snore louder than our human bed partners, and whether your bed partner is a Great Dane or a Chihuahua, having a dog in your bed can make a difference in how you sleep.

Not to mention cats. Cats seem to be nocturnal, in that they always want to choose between kneading the dough of someone's belly in the middle of the night, or sleeping on your pillow with their tail falling flat on your face. And having more than one pet in the bed can make you the "meat" of an animal sandwich.

I am a sleep doctor, a pet owner (two dogs, one cat), my sister is a veterinarian, and I am married to one of the largest animal lovers of them all. We have had pets in our bed, kids in our bed, and I've certainly heard both sides of the story. In contemplating the issues, as well as the pros and cons, here are my simple rules on the subject:

1. Everyone has a different tolerance level for these types of situations, so both bed partners must agree on who sleeps where. If your pets don't disturb anyone's sleep, then there's usually no harm (but you may not realize that your pet is actually disturbing the quality of your sleep!).


2. Understand that once you allow pets to share your bed, it becomes difficult to curb or stop the habit. Pets rarely understand moving from your bed to their own bed. And let's face it, you dog or cat will jump on in, in the middle of the night, or whine by your bedside if you don't let them in.


3. When drinking alcohol, no one should allow a child or pet in the bed. Studies have shown that this is when problems occur, such as injuries, pushed off the bed, smothered, etc.


4. Also make sure that your intimacy needs do not suffer from sharing your bed with pets. Remember the bed is for both sleep and sex; do not trade one for the other.


5. Have your allergies checked. Over time it's quite easy to develop allergies to pets and not realize it. If you wake with a stuffy nose every day, put Fido or Tabby in their own space (probably at the end of the bed, on a blanket). A recent survey demonstrated that a reasonable percentage of pet owners who allow their pets in bed have sleep problems.

It is really a bit of a trade off. Pets are a wonderful addition to most families, and in some cases, their unconditional love, lying next to you, offers wonderful emotional benefits and can provide a relaxation response.

Not to mention fleas.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: cats, dogs, health and wellness, pets, sleep hygiene, sleep problems

If one your New Year's resolutions is to "get healthier" then read on. Surely among your newly minted list of things to do (or not do) is to watch your diet and the amount of caffeine you ingest. Right?

Watch out: caffeine is about as ubiquitous as water these days in food products and beverages. So much so that there's been a call for labeling standards to help us all know just how much we're getting and from where. Currently there are no guidelines, so yes you could be having sleeplessness nights thanks to that afternoon gum, candy bar snack, and sip of "water" (laced with caffeine).

In a recent article in the Los Angeles Times, a Duke University professor of medical psychiatry, Dr. James Lane, points to a number of side effects of excess caffeine:

• Exaggeration of attention deficit disorder
• Hyperactivity and insomnia
• Increased blood pressure, heart rate, and secretion of stress hormones
• Increased risk of hampering the body's ability to regulate blood sugar levels

All of these problems directly relate to serious medical conditions in our society that are largely preventable.

Caffeine does have its pluses and is not harmful in reasonable amounts, which are around 200 to 300 milligrams per day. But do you know how many cups of coffee or cans of soda that amounts to? Or how many jelly beans that equals (yes, caffeine can be found in some of these classic treats!)?

Probably not.

I doubt labeling will change what people eat or drink all that much. Who is going to start counting milligrams of caffeine throughout the day? The goal should be to become aware of what you're ingesting and whether or not it contains any caffeine. If you consume fewer than five things a day that contain caffeine, you probably won't enter the excessive category (though I don't mean five triple espressos from Starbucks). What to be mindful of:

• Headache medicines that contain caffeine
• Consuming caffeine late in the day
• Coffee-flavored treats like ice-cream and yogurt
• Dark chocolate, which naturally contains caffeine - a piece or two is fine!
• Energy drinks and sodas that pack a serious jolt

Cheers to sleeping well this 2010.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: caffeine, coffee, insomnia, sleep, sleep deprivation, sleep problems

Tired of the Christmas carols? Sick of holiday songs and jingling bells?

Well, as you pack up those holiday decorations, I suggest you check this out: a group of musicians got together and created a montage of snorers from around the United Kingdom to the tune of, well, let's just say a very odd sounding "Silent Night."

Now that's not what I call a "silent" night!

My hope for all those snorers (and their bed partners) out there is that you find relief in 2010. Here are my top five tips for curbing snoring and getting that proverbial silent night:

1. Lose the excess weight. The heavier you are, the higher your risk for sleeping disorders and, you guessed it, snoring. People who have thick necks are more likely to experience OSA due to the extra fat they have at the back of their throats, which can be an underlying cause to the blocked airway.


2. Speak with your doctor to discuss testing to rule out an underlying condition such as obstructive sleep apnea (OSA).


3. Avoid alcohol within a few hours of bedtime. Alcohol can not only interrupt sound sleep, but also stimulate (and exacerbate) snoring.


4. Get moving. Studies also have shown that OSA, which causes a lot of unwanted snoring, decreases among people who begin exercise programs, regardless of the amount of weight loss.


5. Don't become sleep deprived. If you fall asleep before your head hits the pillow and begin sawing away, you're most likely sleep deprived. Getting into a routine that honors your body's need for quality sleep every single night can work wonders on achieving a silent night. To that end, practice good sleep hygiene.

Approximately 90 million American adults snore, and of those, 37 million snore on a regular basis. It's a problem among all ages and both genders, but it seems to affect men more than women, and it can worsen with age. If you sleep with a snoring bed partner, you can lose up to an hour of quality sleep a night. Let's see if we can all get to a true "Silent Night" by the time we're singing that song again next year.

Remember, true silent nights make for good nights.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: sleep, sleep deprivation, sleep problems, snoring

Most of us know whether we're a lark who likes to beat the sunrise, or an owl who prefers to work by moonlight. Larks function best in the morning and tire through the day, whereas owls feel sharper as the day goes on and reach their optimum level at around 9 o'clock at night. Owls tend to envy larks, though, especially when they hear about their counterparts who can rise before the sun and get half a day's work done before much of the world eats breakfast. So should an owl try to turn into a lark?

Not likely a good idea. A recent article outlines why this isn't such a good idea, stressing the fact that owls who may try to wake earlier than usual will just set themselves back and suffer the consequences of sleep deprivation. Some of the article's chief points:

• Whether you're a lark or an owl, you still likely need seven to eight hours of sleep.
• If you don't get enough sleep, what time you go to bed or rise won't matter-you'll still experience the side-effects, from depression to a lack of concentration to problems with coordination.
• If you break your natural sleep cycle by forcing yourself to get up early, you'll be tired, less attentive, and not nearly as productive throughout the day.

Something else to keep in mind: Not all "high-powered" people are early risers. Though we do hear stories about tycoons who don't need more than four hours of sleep at night, these are the exception - not the rule.

Last year, scientists discovered that our skin cells may hold the clues to whether or not we are larks or owls. That's right: your internal clock may be pre-programmed to be an early riser or late-nighter. So don't mess with Mother Nature. Go to bed when you are tired, and get up when you are well-rested. Period.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: body clock, early riser, night owl, sleep problems

Let's be thankful that the sleep disorder suffered by a British man who unwittingly killed his wife in his sleep is extremely rare.

When the Associated Press reported on an unusual murder case out of England, it soon got lots of attention and raised more than a few intrigued eyebrows. Brian Thomas, who pleaded not guilty by reason of insanity, was accused of killing his wife of nearly 40 years. He'd strangled her during a nightmare about fighting off an intruder. Prosecutors withdrew the case after experts explained that he wasn't insane at all. Rather, he suffered from a rare, long-term sleep disorder that put him in a state of "automatism," in which his mind had no control over his body. So he strangled her without knowing it.

Mr. Thomas will not have to be sent to a psychiatric hospital, though I can't imagine how he explained himself to his two daughters, who lost their mother in the incident. This is not the first time I have heard of a case like this. I think this has occurred in the US, in my own town of Scottsdale no less. I have seen people do some pretty complicated behaviors in their sleep, and the culprit here apparently is a sleep disorder.

Could this happen to you? Not so fast. What should be pointed out is that not only is this kind of sleep disorder very rare, but it doesn't usually stand on its own. In other words, people who suffer from brief periods of unconscious behaviors during which they are unaware of their actions typically have an underlying condition. Automatic behavior (the type of behavior apparently exhibited by Mr. Thomas) often occurs in certain types of epilepsy, seizure disorders, Narcolepsy, or REM Behavior Disorder or as a side effect of certain medications.

Mr. Thomas would do well to check into a sleep lab, if he hasn't already.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: nightmares, sleep problems

Think you've got it bad putting up with a snoring bed partner? Well, think again. This month a British woman has been recorded as one of her country's loudest snorers. Her snore is so loud that from a decibel standpoint, it's louder than a jet plane!

Impossible? Not at all. Though snoring rarely exceeds 85 decibels, sixty-year-old Jenny Chapman comes in at 111.6 decibels, which could drown out a spinning washing machine, diesel truck, and speeding express train.

People confuse decibels all the time, because they aren't "units" per se. A decibel is literally one-tenth of a bel - the number of bels (named after Alexander Graham Bell) being the common logarithm of the ratio of two powers. In other words, they measure a ratio of powers. Decibels do measure loudness, but it's best to think of them in terms of percentages because they aren't quantities of anything. Here's a list of common sounds and their associated decibels:

Decibel Level	Sounds
0	The softest sound a person can hear with normal hearing
10	Normal breathing
30	soft whisper
50	rainfall, refrigerator, large office
60	normal conversation
70	Some research suggests that any sound above this range can stimulate the nervous system
70 - 95	garbage disposal
75 - 85	flush toilet
80	doorbell, ringing telephone
80 - 90	blender
85	heavy traffic, noisy restaurant
110	car horn, baby crying, shouting in ear, power saw, leaf blower
120	thunder
170	shotgun
180	rocket launching from pad

So what can Jenny do to tone down the volume (and invite her poor husband back into bed who sleeps in another room)? She's been working on living a healthier life - cutting back on alcohol and food intake at night, and exercising more. Though snoring is a multi-factorial problem, studies have long proven that excess weight, alcohol use, and being too sedentary can trigger or exacerbate the problem. When Jenny manages to gain better control of her snoring, she won't just make her husband happy. But she'll also make herself happier. Less ferocious snoring means more restful sleep.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: sleep problems, snoring

Yes, Andy, we do sleep about a third of our lives away.

And I agree, it would be nice to have a gauge on us to let us know when we need to get some shut eye or when we've had enough, much like a battery light that comes on to tell us it's time to charge a certain device for optimal use. Green means go. Red mean stop.

Earlier this month when Andy Rooney gave his classic spiel during the last segment of 60 Minutes, he talked about sleep. He doesn't quite understand why so many people have problems with sleep, especially since he "can sleep night or day, sitting, standing, or lying down" and he admits to falling asleep right at his desk or on a bus going across town. He can get along on 7 hours, and thinks that anyone who gets 9 hours or more is sleeping his or her life away.

Andy's quips were no doubt enjoyed by many. But a few big topics Andy failed to cover, though, are sleep's impact on:

• overall health;


• memory; and


• the ability to get things done (ahem, like work into your nineties and have the energy to go on television on a weekly basis).

But what about that "device" to tell us when we've had the perfect amount of sleep? Might I suggest:

• Signs of your battery is getting low: fatigue, sleepiness, low energy, need for caffeine, moodiness, inability to focus, difficult concentrating


• Signs of your battery has been charged properly: feeling refreshed when you wake up, having the energy to get through your day, not needing caffeine to stay awake, alert, and productive

Put simply: the body tells us when we need sleep. It's the "y" effect. When we're hungry, we eat, when we're thirsty, we drink, and when we're sleepy, we sleep - or at least we should. And I sense that Mr. Rooney knows that, alongside the other secrets to sound sleep. How else can he be so vibrant, focused, and productive at ninety years old?

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: sleep deprivation, sleep hygiene, sleep problems

If you learned upon landing that your plane's pilots had overshot the airport by 150 miles because they fell asleep at the controls, what would you feel?

Terrified?
Shocked?
Lucky?

I'd feel a mix of the above. In this week's latest hit to the airline industry, a Northwest flight to Minneapolis overshot its destination and pilot fatigue could be to blame. Of course, the pilots are saying they were in an argument at the time and that's the reason for the blunder (not that I'd like to see my pilots so distracted over a "debate" that they still overshoot the runway!).

Fatigue among pilots has been a recurring theme this year, punctuated earlier this year by the deadly crash near Buffalo that was partly blamed on fatigue (that crash was blamed on pilot error).

The Federal Aviation Administration is rewriting its rules that govern flight time for pilots and their required rest periods in order to reduce the chances of fatigue. It will be the first update to the rules in decades and will utilize research that wasn't available before.

Does that make me feel better the next time I fly?

A little, maybe. Trouble is, it can be hard to legislate such rules. And sometimes fatigue over a series of poorly slept nights can catch up to you days later. In other words, you could have a sleep-deprived weekend, feel okay on Monday but be a zombie on Tuesday when you're expected to perform - and the lives of countless others are in your hands.

I've written about shift workers a lot in the past. But those who have jobs that put the lives of many others at stake should be scrutinized to a much higher degree. If it's that easy to fall asleep at the controls of an airplane - without the airplane knowing (or its numerous flight attendants!), then I say, let's invent something that can keep check on that. With all the gadgets we have at our disposal today, can't we find one that can alert the crew on a flight when its captain has nodded off?

Just a thought. Now that would make me feel safer in the skies.

Sweet Dreams,

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: fatigue, health and wellness, sleep deprivation, sleep problems

This topic is always popular: sleeping in separate beds for the sake of getting restful sleep and enjoying your partner even more as a result.

• Have you ever been awakened by your bed partner? (snoring, thrashing, moving around)
• Have you ever been the unintentional recipient of a battle by your bed partner in the middle of the night? (hit or punched as your bed partner physically plays out his dream without even knowing it)
• Have you ever gotten better sleep in your partner's absence?
• Have you ever slept on a couch because you couldn't get the sleep you needed in the same bed as your partner?
• Have you ever thought about sleeping in separate beds on a routine basis?

If you answered yes to any of the above, you're not alone (well, maybe you are alone now sleeping soundly in your own bed).

In 2005, the National Sleep Foundation began reporting on this trend in separate sleeping beds. A survey then showed that 23 percent of married Americans sleep alone, an increase from 12 percent in 2001. Glamour magazine also reported on a survey of builders and architects who predict that double master bedrooms will soon be the norm.

Then there's the report by British sleep specialist Dr. Neil Stanley at a recent conference that has lots of people talking on the Internet: married people suffer 50 percent more harmful sleep disturbances if they share a bed. And this does not bode well for the sufferer of poor sleep, as it can cause depression, heart disease, stroke, lung disorders and accidents.

No doubt about that. He could have just summed it all up by saying bed partners are hazardous to your health!

But I think this is a bit one-sided. I am not questioning the validity of his results, but there are some serious advantages to sleeping with a bed partner.

• In many cases this is the time for intimacy, from cuddling to sex, and it usually occurs in bed. Sure you can have "dates" for this, but how do you say "Honey I love you, thanks and Bye!"
• Sometimes this is one of the best times for communication. If you have been running around all day, and not had time to "catch up" with your partner, this is usually the best time to do it. Of course large emotional discussions are best out of the bedroom, but just everyday catching up is fine.
• While I can't put my finger on it, the mere fact that you are physically close to someone, feels like (no pun intended) it has a positive effect on any relationship. Think about what you are saying to someone when you refuse to sleep next to them.
• There is also one research study from Australia that shows men sleep better when they are sleeping next to someone.

Okay, so the separate bed thing may not be for everyone. But if you have a bad bed partner, and the last time you got a good night's sleep was when you were alone in your bed, then it may be time to look at this situation. Here is what I suggest:

If you are concerned that your bed partner may have a sleep disorder, a visit to a primary care physician and/or sleep specialist is the place to start to rule out potentially serious disorders like sleep apnea, periodic limb movement, or restless leg syndrome, or any other health issue that could be interfering with their (or your) sleep.

• If it is snoring that bothers your sleep, consider ear plugs, a sound machine, or some type of anti-snoring device.
• If it is their movement that bothers your sleep, consider a new mattress that reduces motion transfer.
• If they get up in the middle of the night and disturb you, consider two beds in the same room, or a mattress that reduces motion transfer.
• If they have a different schedule, consider scheduling changes, eye masks, book lights, etc.

Or, in the very least, opt for a bigger bed. You may be surprised by how well today's mattresses can accommodate two very different sleepers.

Here is what I know to be true above all else:

I have saved more marriages as a sleep specialist than I probably would have as a marital therapist, just by getting people back in bed, sleeping together!

Sweet Dreams.

Michael J. Breus, PhD
The Sleep Doctor™
www.thesleepdoctor.com

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Labels: health and wellness, marriage, sleep, sleep problems, snoring