A 'cozy nest,' a 'shrine to sleep' and other ways to battle insomnia
Duluth News-Tribune - 11/13/2018
Nov. 13--Here's something to sleep on:
One out of 10 of us suffers from chronic insomnia.
And here's a wakeup call:
Sleeping pills aren't recommended as your first line of defense.
That's what the American College of Physicians concluded in their 2016 practice guidelines, relates Kerry Sopoci, a psychologist at St. Luke's outpatient mental health services in Duluth.
Instead, the group, which is a national organization of internists, recommends starting with something you can't get from your pharmacist. It's called CBT-I, shorthand for cognitive behavioral therapy for insomnia.
The method of adjusting behaviors to improve sleep was the topic of an hour-long presentation Sopoci gave to health professionals on Nov. 5 as part of the annual St. Luke's Mental Health Conference.
The audience was seated around tables in the Greysolon Ballroom, and if any of them were sleep-deprived, Sopoci had drawn a tough assignment. He was given the mid-afternoon shift, his listeners had been in learning mode since 8 a.m., and it was the second day after the change to standard time.
But his topic was a matter of serious concern. Besides the 1 in 10 of us who have chronic insomnia -- defined as three or more bad nights of sleep a week for at least three months -- another 30-35 percent experience briefer occasions. And insomnia can be a contributing factor to a lot of bad things, Sopoci said. They include suicide, the development of post traumatic stress disorder after a trauma occurs, depression, substance abuse and anxiety disorders. It also may result in poorer treatment outcomes for mental health conditions.
So what's the CBT-I prescription for insomnia?
Here's a partial summary of the guidelines, all based on current scientific evidence, that Sopoci presented:
--Stay active during the day. You're building up something called "sleep drive," Sopoci said. "The more you're awake during the day, the more active you are, the more sleep drive you're going to have."
--Go to bed about the same time every night. Don't vary that by more than a half-hour, or an hour at the most, Sopoci said. Pointing to a "sleep diary" of someone who went to bed at 2:15 a.m. on a Saturday and 10:15 the next night, he commented, "They virtually crossed four time zones in the space of a day."
--The caveat: You should go to bed only when you're sleepy, "not forcing yourself by lying in bed and staring at the ceiling and wondering how much time it's been."
--If you can't get to sleep, get out of bed. Make a "cozy nest" for yourself somewhere else, preferably in another room. Don't return to bed until you're sleepy.
--"Cozy nest" activities should be "mildly pleasant and relaxing." Reading a magazine, watching the History Channel, working on crossword puzzles could be good. Reading a James Patterson page-turner probably wouldn't. "It's probably best not to watch the news," Sopoci added.
--Pick a time to get up in the morning and stick to it. Don't sleep later on Saturday and Sunday. Get up when the alarm goes off. Stay away from the snooze button.
--Keep the bed as a "shrine to sleep." No reading in bed, no other activities. The only exception is sex.
--No daytime naps.
The guidelines are for people struggling with insomnia, Sopoci noted. An afternoon nap is OK if you still sleep well at night. Likewise, reading in bed is OK for someone who doesn't have sleep issues.
In an interview after his talk, Sopoci said sleep medications have their place. "The difficulty is ... they don't get to the underlying problem of sleep," he said.
He was drawn to the study of sleep because insomnia is a contributor to so many mental health issues, Sopoci said. "So ignoring the sleep difficulty is missing an important piece of treating their other conditions."
He wasn't drawn to it because of sleep struggles of his own. Although he admitted to tossing and turning the night before another presentation, that happens to him "rarely," Sopoci said. "I'm one of those lucky people that sleeps well almost all the time, really."
(c)2018 the Duluth News Tribune (Duluth, Minn.)
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