Latest news with #CBTI
Yahoo
2 days ago
- Health
- Yahoo
I'm a Psychiatrist. There Are Common Myths About Sleep That Are Preventing You From Being Well Rested.
Sign up for the Slatest to get the most insightful analysis, criticism, and advice out there, delivered to your inbox daily. If you've struggled to fall asleep, you may have tried a slew of tips and tricks: blackout shades, leaving your phone in another room, avoiding screens before bed, and keeping your room at a cool temperature at night. Perhaps you've indulged in new sheets or a special mattress or a wearable sleep tracker, too. Maybe these things have helped. Maybe they haven't. But there's another, more powerful approach to insomnia that's based on decades of research—and you might not even have heard of it. It works by changing our habits, questioning ideas that degrade our sleep, and bolstering our body's sleep drive. If its name is a bit of a mouthful, or its acronym a bit obscure, it makes up for it by sheer effectiveness, helping most people with insomnia slumber more contentedly. This treatment, cognitive behavioral therapy for insomnia, or CBT-I, is recommended by experts as the first and best treatment for insomnia, over and above sleeping pills, in part because its benefits last longer, compared to medications. It helps people fall asleep faster, spend more of the night sleeping, and feel happier with their sleep. And most people, in any case, say they'd rather try behavior change for insomnia versus a drug (which is perhaps why all those wellness sleep-hygiene tips persist). As a psychiatrist who has done extra training in sleep medicine, I've seen CBT-I work. About 10 percent of U.S. adults—or about 25 million people—suffer from insomnia, giving CBT-I vast potential. But there's a bottleneck: Traditionally, a clinical psychologist or therapist with extra training in CBT-I delivers the treatment over the course of multiple one-on-one there were just 659 behavioral sleep specialists throughout the entire U.S. as of 2016 (the most recent survey I know of). And fewer than 10 percent of clinical psychology training programs teach CBT-I. So there just aren't enough providers—not close to enough. The good news is that the core strategies of CBT-I still work when delivered by a digital app, or even, to an extent, by self-help booklets. So anyone who puts these principles into practice is likely to get some relief—maybe even someone reading this article. The 'cognitive' element—the C in CBT-I—seeks to dispel unrealistic ideas about sleep, pessimism about our power to improve our sleep, and the rush to blame sleep problems when we don't feel good. The theory is that certain beliefs—like the idea that we need eight hours, or that a bad night's sleep guarantees a lousy next day—worsen worries about sleep. These worries seem to activate our stress system and make it harder to fall asleep and stay asleep, triggering a vicious cycle of pessimism about sleep that makes sleep poorer. CBT-I tries to put a stop to this. It really is a myth, by the way, that everyone needs their eight hours. The experts recommend seven, not eight, as the minimum number of hours for an adult. And it's also a myth that something is wrong if you don't sleep straight through the night. In clinic, I've found that some patients get relief just from learning that waking up once or twice during the night is part of normal, healthy sleep. A 2014 study that looked at the sleep diaries of 592 adults without sleep disorders found an average of 1.4 awakenings per night. But it's not just how you think. It's also what you do. And while CBT-I does include sleep hygiene tips like avoiding caffeine and bright screens before bed, these maneuvers haven't been found to work well for insomnia, at least not on their own. CBT-I's main behavioral directives—the B in CBT-I—are probably less familiar: cutting back on time in bed, changing your habits for getting in and out of bed, and waking up at the same time each day (no matter when you fall asleep). It may seem kind of ironic to ask someone trying to get more sleep to cut down on their time in bed. But restricting time in bed is one of the most powerful levers we have to make it easier to fall asleep and stay asleep. In traditional CBT-I, the person with insomnia brings a two-week sleep diary to one of those all-too-hard-to-find behavioral sleep specialists, who tallies up how much time that person is sleeping every 24 hours, on average. Then, the dissatisfied sleeper adjusts their time in bed to that number. If they were, for instance, spending nine hours in bed each night, but only sleeping for six and tossing and turning for three, they'd start going to bed later, getting up earlier, or both, thus trimming their time in bed down to six hours. The idea is to work with your body and what it's currently capable of, rather than clinging to the wish for longer sleep when it just isn't happening. Cutting back on time in bed works partly through mild sleep deprivation, which makes you sleepier. And when you're sleepier, it stands to reason, you sleep more easily. (Just note that if you need to drive or operate heavy machinery, you should cut back on time in bed gradually, and track your daytime sleepiness. It's never safe to drive while sleepy.) As treatment progresses, if the once fitful sleeper finds they're sleeping longer and more easily, they extend their time in bed to match their newfound sleep ability. By doing this, you can actually train your body over time into getting more sleep, with small gains in average length of sleep at the end of a course of traditional CBT-I, and with sleep time continuing to increase, for some, even weeks or months after the end of active treatment. If you find yourself balking at the idea of cutting back on your time in bed abruptly, there's a gentler way called sleep compression. This cuts back on time in bed more slowly, by 15 to 30 minutes each week, until sleep improves. With sleep compression, you can also stop, or reverse course and extend time in bed again, if you start to feel sleepier during the day. In one study, sleep compression and sleep restriction racked up similar gains in sleep satisfaction at 10 weeks. So, you cut back on time in bed. But the hypothetical patient who was getting six hours of sleep still wouldn't force themself to stay in bed for six hours no matter what. This brings us to the next behavioral prong of CBT-I: changing your habits for getting in and out of bed. Since 1972, when the pioneering sleep psychologist Richard Bootzin first proposed these instructions in a case report, they have been thoroughly investigated in different variations. Two key instructions are: Don't go to bed until you feel sleepy (even if it's already your new, sleep-restricted bedtime), and don't stay in bed if you can't sleep. If you can't sleep, try a relaxing low-light activity like reading, or listening to music or a podcast in the living room—and then return to bed when you're ready. The classic thinking is that this breaks the association with bed as a place of frustration, and restores it as a cue for slumber. It's also possible that it simply encourages the kind of sleep that's most likely to succeed—that is, going to sleep when you're sleepy, rather than trying to sleep whenever you just really wish you could fall asleep. (If you can't or just don't want to get out of bed, by the way, a couple of older studies do suggest that doing the same kind of relaxing low-light activities in bed when you can't sleep might still help with insomnia, at least to some degree.) No matter when you end up going to bed, or how often you wake up during the night, CBT-I also teaches patients to get up at (roughly) the same time each day. And there are two reasons why this matters. First, the later and the more often you sleep in, the more you tend to push back your body's internal biological clock—known as the circadian clock—which pushes your body's internal bedtime later too, making it harder to fall asleep when you want to. The second reason is that getting up later and keeping your bedtime the same shortens the length of your day, which means less time awake building up your drive to sleep, and less success at bedtime. If you woke up at noon, for instance, and then tried to go to bed at 6 p.m., you just wouldn't have built up enough sleep drive yet. And the same idea applies to more subtle shortening of the span of daytime wakefulness, like waking up late or napping. CBT-I works well. But no single treatment works for everyone, and no treatment is free of hazard. In particular, those at high risk of falls should skip getting out of bed when they can't sleep. And again, please don't drive if you're experiencing daytime sleepiness. Sometimes, too, insomnia is the harbinger of a different problem. So if your sleeplessness is unrelenting, you're waking up at night gasping for air (a symptom of sleep apnea), or if you have the strong urge to move your lower limbs at night (an ailment called restless legs syndrome), please look up a sleep specialist who can help get you a diagnosis and hopefully some relief. In the meantime, tell your friends about CBT-I. More people should know.
Yahoo
3 days ago
- Health
- Yahoo
Increase your sleep time by nearly two hours with this gentle exercise, finds new study
When you buy through links on our articles, Future and its syndication partners may earn a commission. Gentle exercise including yoga, Tai Chi and jogging should be considered a primary treatment method for insomnia, a new review published in the online journal BMJ Evidence Based Medicine suggests. Roughly one third of the population is expected to experience insomnia at some point but many treatment methods remain inaccessible — such as CBT-I — or come with potential side effects — such as medication. This review aims to better establish exercise as an accessible treatment for insomnia while encouraging further clinical research into which forms of exercise show the most benefits, to create better guidelines for patients. Key takeaways of the review Exercise is a low cost and accessible treatment for insomnia Yoga, Tai Chi and jogging effectively reduce insomnia severity Yoga can potentially increase sleep duration by up to two hours The systematic review undertaken by sleep scientists in China assessed 22 insomnia-focused randomized control trials featuring a total of 1,348 participants and exploring a total of 13 interventions (seven exercise-based.) What is CBT-I? CBT-I (Cognitive Behavioral Therapy for Insomnia) is a popular insomnia treatment that aims to reframe your approach and attitude to sleep, to improve your rest. While effective, the low number of practitioners means it's often hard to access. Based on sleep diary data collected from these studies, yoga, Tai Chi and gentle walking or jogging were determined to have the largest positive impact on insomnia. Yoga in particular proved effective at increasing sleep duration, adding an average of 110 minutes to the time spent snoozing — that's close to two hours. Tai Chi also demonstrated benefits across the PSQI (Pittsburgh Sleep Quality Index, a self-reported sleep assessment), as well as improving total sleep time and the time it takes to fall asleep. In addition, Tai Chi demonstrated long-term benefits for those who had experienced sleep difficulties, continuing to show improvement across sleep outcomes in the one to two year follow-up. Gentle walking or jogging was also shown to reduce insomnia severity. While the review recognizes CBT-I as the gold-standard for insomnia treatment, it encourages the above forms of exercise as "viable primary treatment options" for those experiencing insomnia. They recognize the treatments as "well-suited for integration into primary care and community health programmes." "Body awareness, controlled breathing and attentional training" The review theorizes that yoga and Tai Chi are particularly effective treatments for insomnia due to their focus on "body awareness, controlled breathing and attention training." Mindfulness for sleep encourages positive, relaxed thinking, qualities that are also prominent in many forms of yoga and Tai Chi. The study further theorizes that the "meditative movement" of Tai Chi can encourage emotional regulation while helping quiet busy thoughts. These two features might prove particularly useful for those finding anxiety or stress is keeping them awake. As for jogging and walking, the researchers behind the review suggest a combination of energy use, increased melatonin production and improved emotion regulation make these exercises particularly sleep-inducing. The dos and don'ts of exercising for better sleep Establishing a consistent exercise routine can benefit your sleep and help you avoid insomnia. Here are some dos and don'ts of exercising for better sleep to get you started. DON'T do strenuous exercise too close to bedtime We know a packed calendar can make scheduling your workouts a workout in itself, but it's important to consider both when you're exercising and the type of activity you're engaging in to find the best time to exercise for sleep. Vigorous exercise before bed is likely to keep you awake, as your body struggles to switch off after being put to work. However, research suggests intense workouts in the morning or afternoon can help you achieve deeper sleep. DO add gentle exercise into your pre-bed routine Light exercise — such as yoga, Tai Chi and walking — can be beneficial later in the day, particularly if you're using that mind-body connection to calm anxious thoughts that might otherwise plague your sleep. A few minutes of stretching roughly an hour before bed can help reduce muscle tension and release stress, so you're more relaxed when you climb beneath the covers. DO exercise for at least an hour a week Consistency is equally as important as timing when it comes to exercising for better rest — an occasional stretch every few weeks is unlikely to provide any long-term sleep benefits. Research published in the BMJ Open suggests consistent activity of at least an hour per week can lower your risk of experiencing insomnia symptoms. DON'T neglect the rest of your sleep routine Avoid following your half hour of Tai Chi by collapsing on your bed in your gym clothes and scrolling through social media for an hour while eating sugary snacks and enjoying a post-workout beer. You should also avoid workout supplements if exercising before bed. While it's probably no surprise these energy-inducing drinks contain caffeine, you might be unaware of just how much of the stimulant you'll be consuming — a single supplement can contain the equivalent caffeine of three cups of coffee. The science behind exercise and sleep is still developing — although this review emphasizes the importance of further research — so above all else, listen to your body. And if you're experiencing long-term sleep deprivation or insomnia, we recommend speaking to a healthcare professional to develop a treatment plan.
Yahoo
19-05-2025
- Health
- Yahoo
Doctors Are Calling Out The Sleep Mistakes You Should Stop Making Immediately, And It's Shocking
We recently asked medical professionals of the BuzzFeed Community to tell us the sleep mistakes people have no idea they're making, and they revealed what's actually ruining your sleep as well as tips to get better rest. Here's what they had to say: Note: Some responses were pulled from AMAs on Reddit by board-certified sleep physician and neurologist, Dr. Nate Watson (here), and board-certified sleep specialist and neurologist, Dr. Sanford Auerbach (here). 1."If you can't fall asleep after 20–30 minutes, you should get up and move to another room to do something calming until you feel tired again. Lying in bed awake trains your brain that the bed is not for sleep and makes it more difficult to fall asleep in the long run." —33, West Virginia "If you can't fall asleep after 30 minutes, DON'T stay in bed. Get up, move to another room, and do something calming." 2."Reading something exciting before bed can get the brain and body activated, making it harder to fall asleep or stay asleep." —35, Washington 3."Working until exhaustion can be harmful if you don't give your brain and body time to wind down. This can lead to nightmares or even panic attacks while sleeping." —35, Washington 4."I'm a clinical psychologist, and I've learned that for some individuals, hot showers right before bed can actually increase blood pressure and/or heart rate, making it difficult to fall asleep." —35, Washington Related: People Are Sharing The Wildest Medical Self-Diagnoses That Actually Turned Out To Be Correct 5."It's common for people to have awakenings through the night. Hopefully, they are brief, and you fall back asleep quickly. But for many, waking at about 3 a.m. may be a problem because you have already slept for a period of time, and your body is starting to gear up for the day. You need a greater degree of relaxation at that time. So, avoid any stimulation at that time, and avoid looking at the clock, if possible. On the other hand, if you start to worry about not sleeping, you will be in trouble." "Try to get out of bed and do something you find relaxing. If you still have issues, then investigating CBTI (Cognitive Behavioral Therapy for Insomnia) may be helpful. Then, you may address this with your primary care provider." —SanfordAuerbach 6."Sleep apnea. I've seen patients come in with pretty bad heart failure after never using their CPAP machine at night. People have no idea how much strain being unable to breathe at night affects their hearts. Use your CPAP machine!" "It may be ugly, but it will keep your heart strong so you can live out the many years you have left." —Anonymous, 34, Ohio "Sleep apnea worsens every other health condition because you aren't sleeping, and your body can't heal and recover overnight. It's not normal to snore; get it checked out and start using CPAP. Ditto: if you're tired all the time and fall asleep every time you sit down." —Anonymous, 40, Canada 7."[If your mind is busy at night, and you have issues falling asleep], I suggest that you start a worry journal in the evening — set aside 15 minutes before you go to bed. Write down your negative thoughts and then close the book, allowing you to go to bed with those thoughts on the page, not in your head." —SleepDocWatson 8."A hot bath before bed has been shown to increase deep non-REM sleep. Some medications, like antidepressants, can reduce REM sleep." —SleepDocWatson Related: 22 Cute, Happy, And Wholesome Posts I Saw On The Internet This Week That You Absolutely Need To See 9."ECU RN for seven years here. When you sleep on your side, you keep the weight of your core off your lungs and organ systems. If you are suffering organ damage from an accident, this is the best way to sleep." —RAGECOMIC_VICAR 10."If you experience restless leg syndrome, ask your doctor to check your iron levels. There are a number of very good medications for RLS that your doctor can prescribe for you to tackle this. Massaging your legs before bed can help, and doing activities that are mentally engrossing can also reduce RLS symptoms, but this is typically not what we recommend right before bedtime!" —SleepDocWatson 11."[Not getting enough sleep is serious.] Very few people can succeed and be healthy on less than seven hours of sleep per night. Insufficient sleep, due to inadequate or mistimed sleep, contributes to the risk for several of today's health epidemics, including cardiovascular disease, diabetes, and obesity. Simply missing one night of sleep can lead to decreased cognitive function, trouble concentrating, headaches, and general moodiness." "Sleep deficiency can lead to trouble making decisions, solving problems, controlling emotions and behavior, and coping with change, as well as distractions and mistakes. Sleep loss increases the risk of accidents caused by human error. Sleep deprivation impairment is comparable to being legally drunk. Those in relationships who consistently experience poor sleep are more likely to engage in conflict with their partners; sleep loss decreases levels of empathy." —SleepDocWatson 12."When you take a nap, set your alarm for just 10–15 minutes from the time you lie down; that way, you don't wake from a deeper stage of sleep and end up groggy." —SleepDocWatson 13."If you find it easier to fall asleep during the daytime than at night, there can be various reasons. For some, it may be a disorder of the natural rhythm or the circadian rhythm of sleep; if your natural rhythm doesn't mesh with your lifestyle, it may be helpful to consider shifting the rhythm. Often, a combination of properly timed bright lights and melatonin may be beneficial." "This might require consultation with a sleep specialist." —SanfordAuerbach 14."If you have sleep apnea, making sure you are of a healthy weight and avoiding sleeping on your back to keep your nasal passages clear can be helpful. Other options are oral appliances custom-fabricated by a dentist." "There are also surgical options from ear, nose, and throat specialists. We always recommend seeing a board-certified sleep specialist to sort this out for you." —SleepDocWatson And finally... 15."There is an ideal number of hours to sleep at night, which varies for each person. To find out how much you need, try to go to bed when you are tired and wake up spontaneously when refreshed for a while — that will help determine your needs. This bedtime calculator could also serve as a guide." —SleepDocWatson Fellow medical professionals, what are some other sleep mistakes people should avoid? Tell us in the comments, or use this anonymous form below. Note: Some responses have been edited for length and/or clarity. Also in Goodful: I Prayed For Years That No One Would Discover The Issue With My Private Parts. Now I'm Done Hiding. Also in Goodful: 21 "Fatal" Safety Mistakes People Make Every Day (And How To Avoid Them), According To First Responders Also in Goodful: "It's Soul-Crushing": People Are Revealing The TellTale Signs Someone Has Been Through A Lot Of Shit In Their Life, And Some Of These Might Surprise You
