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Is Relaxation Training Hocus-Pocus?

I am frequently asked about the evidence for relaxation training. The concept of relaxation training has been around for many years and much research is available in the scientific and medical literature to support and recommend its use, not only for insomnia, anxiety, stress and depression but also for chronic painful conditions.

According to Wikipedia:

relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce levels of anxietystress or anger. Relaxation techniques are often employed as one element of a wider stress management program and can decrease muscle tension, lower the blood pressure and slow heart and breath rates, among other health benefits.[1]

Read the whole article here:

Read the article from Helpguide, a non-profit resource:

See what people at the Mayo Clinic have to say about relaxation techniques:

Watch the Mayo Clinic video: Mayo Clinic Video on Yoga for Relaxation

Peer reviewed medical and scientific literature is cited here for those who are skeptical and think of relaxation training as hocus-pocus:

J Psychiatr Pract. 2008 Nov;14(6):403-7.

Sleeping without a pill: nonpharmacologic treatments for insomnia.

Source

UCLA Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine/Resnick Neuropsychiatric Hospital, Los Angeles, CA 90024, USA. lkierlin@mednet.ucla.edu

Abstract

Insomnia is a complaint of patients seen in many medical settings, but it is particularly prevalent in patients who present to mental health practitioners. When choosing an intervention for insomnia, physicians often turn to pharmacological management options as their primary strategy, with other modalities only considered secondarily, if at all. Medications for insomnia, which include benzodiazepines, nonbenzodiazepines, and antihistamines, have been found to have both varying degrees of efficacy as well as side-effect profiles that may limit their use. In recent years, the American Academy of Sleep Medicine has studied nonpharmacologic interventions for insomnia and found evidence to support their use in achieving sustained improvements in sleep parameters over time. Methods such as cognitive-behavioral therapy, stimulus-control therapy, relaxation, paradoxical intention, and sleep restriction are efficacious treatments that mental health practitioners can consider in the treatment of insomnia. Researchers are only beginning to review evidence concerning complementary and alternative medicine therapies (CAM); however, given the preponderance of patients who may be employing these techniques for insomnia, it is important that clinicians be familiar with these approaches, which merit further study. This article reviews nonpharmacologic treatments for insomnia that are available to mental health practitioners as well as primary care providers, either via direct application of the techniques or by referral. The evidence for each of these modalities is presented in an effort to expand the treating physician's armamentarium beyond sole use of the medications traditionally used to treat insomnia.

J Psychiatr Res. 2012 Nov;46(11):1456-63. doi: 10.1016/j.jpsychires.2012.08.007. Epub 2012 Aug 30.

Comparison of relaxation training with a cognitive-behavioural intervention for indicated prevention of depression in university students: A randomized controlled trial.

Source

Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Campus Vida, 15782 Santiago de Compostela, Spain. Electronic address: fernandolino.vazquez@usc.es.

Abstract

Although cognitive-behavioural programmes for preventing depression have produced promising findings, their administration requires extensive training. Relaxation techniques are more straightforward psychological strategies, but they have not been investigated in the prevention of depression. This trial aimed to compare the results of relaxation training (RT) with that of a cognitive-behavioural programme (CBT) for prevention of depression in university students with elevated depressive symptoms. The 133 participants (mean age 23.3 years, 82% women) were randomly assigned to CBT or RT. Both programmes were administered to groups of 5 or 6 participants in eight weekly 90-min sessions. Participants were evaluated by independent raters before, immediately after, and 3 and 6 months after taking part in the programmes. By itself, intervention type had no significant effect on either depression or anxiety scores. The scores were lower at the follow-up time points with respect to pre-intervention scores. Effect size was greatest between pre- and immediately post-intervention scores for CBT, d = 1.32, 95% CI [1.00, 1.64], and between pre- and 6-month post-intervention scores for RT, d = 0.75, 95% CI [0.47, 1.03]. Anxiety symptoms were significantly improved by both interventions at 3-month follow-up, and by CBT at 6-month follow-up also. In the medium term (3-6 months), relaxation training produced similar reductions in depressive and anxiety symptoms as a more complex cognitive-behavioural programme.

Copyright © 2012 Elsevier Ltd. All rights reserved.

PMID:

 22939979

[PubMed - in process]

 Am J Health Promot. 2012 Jul-Aug;26(6):e149-58. doi: 10.4278/ajhp.110516-QUAL-199.

Psychological and physiological response of students to different types of stress management programs.

Source

Cátedra de Química Analítica Instrumental, Facultad de Farmacia y Bioquímica, Universidad de Buenos Aires, Buenos Aires, Argentina. siglesia@ffyb.uba.ar

Abstract

PURPOSE:

To design, implement, and examine the psychoneuroendocrine responses of three different types of stress management programs.

DESIGN:

Randomly assigned. A pre/post experimental design comparing variables between three different programs and a control group. The first program included training in deep breathing, relaxation response, meditation, and guided imagery techniques (RRGI). The second program included training in cognitive behavioral techniques (CB). The third program included both RRGI and CB (RRGICB).

SETTING:

The study was conducted at Buenos Aires University.

SUBJECTS:

Participants (N  = 52) were undergraduate students.

MEASURES:

Anxiety, anger, hopelessness, neuroticism, respiration rate, and salivary cortisol levels were assessed.

ANALYSIS:

Wilcoxon signed rank test was used to investigate differences in pre and post variables.

RESULTS:

Subjects in the RRGI group showed significantly lower levels of anxiety (p < .011), anger (p < .012), neuroticism (p < .01), respiratory rate (p < .002), hopelessness (p < .01), and salivary cortisol (p < .002) after the treatment. Subjects in the CB group showed significantly lower levels of anxiety (p < .018), anger (p < .037), and neuroticism (p < .03) after the treatment. Subjects in the RRGICB group showed significantly lower levels of anxiety (p < .001), anger (p < .001), neuroticism (p < .008), hopelessness (p < .01), respiratory rate (p < .001), and salivary cortisol (p < .002) after the treatment. Subjects in the control group showed only one variable modification, a significant increase in cortisol levels (p < .004).

CONCLUSIONS:

The combination of deep breathing, relaxation response, meditation, and guided imagery techniques with CB seems to be effective at helping people to deal with stress.

PMID:

 22747323

[PubMed - indexed for MEDLINE]

Sehatu Sleep Granite Bay CADeep Relaxation Training at Sehatu Sleep, designed with sleep medicine and psychology principles, empowers people by giving them skills to turn the mind switch on and off on command and to relax when needed. Classes can be attended via Skype.

Sehatu Sleep and Yoga Studio, located in Granite Bay, CA,  also provides a variety of Yoga classes, including Yin, Gentle and Restorative Yoga, as well as Meditation classes, for individuals who are interested in practicing a healthy lifestyle at any age, starting at any time in their life at any skill level. 

SEHATU SLEEP VIDEO

What is Deep Relaxation Training? View the video and find out. The American Academy of Sleep Medicine recommends relaxation training and cognitive behavior therapy as effective and better treatments for insomnia than sleeping pills. Why then is it not offered by healthcare institutions?
It is now available at Sehatu Sleep and Yoga Studio, in person and via Skype to anyone anywhere at a very affordable cost, and in the USA, reimbursable from health insurance companies if recommended by your physician. It is a tax deductible health care expense, and FSA and HSA eligible with a physician's recommendation. Come to Sehatu Sleep!

What's the Big Deal About Deep Relaxation Training?

SEHATU SLEEP VIDEO http://youtu.be/nXyGySylMIg

View the video to find out more about relaxation training at Sehatu Sleep and Yoga Studio.

The American Academy of Sleep Medicine, the largest and authoritative body in sleep medicine recommends relaxation training and cognitive behavior therapy as effective treatments for chronic insomnia.

According to Clinical Guidelines for the Treatment of Insomnia, published in the Journal of Clinical Sleep Medicine:

"Psychological and behavioral interventions are effective and recommended in the treatment of chronic primary and comorbid (secondary) insomnia.

• These treatments are effective for adults of all ages, including older adults, and chronic hypnotic users.

• These treatments should be utilized as an initial intervention when appropriate and when conditions permit.

Initial approaches to treatment should include at least one behavioral intervention such as stimulus control therapy or relaxation therapy, or the combination of cognitive therapy, stimulus control therapy, sleep restriction therapy with or without relaxation therapy—otherwise known as cognitive behavioral therapy for insomnia (CBT-I)."

Sehatu Sleep Granite Bay CADeep Relaxation Training at Sehatu Sleep, designed with sleep medicine and psychology principles, empowers people by giving them skills to turn the mind switch on and off on command and to relax when needed. Classes can be attended via Skype.

Sehatu Sleep and Yoga Studio, located in Granite Bay, CA,  also provides a variety of Yoga classes, including Yin, Gentle and Restorative Yoga, as well as Meditation classes, for individuals who are interested in practicing a healthy lifestyle at any age, starting at any time in their life at any skill level. 

Sehatu Sleep Yoga Warriors...do not be afraid!

“Rejoicing in the ordinary things is not simple or trite. It actually takes guts. Each time we drop our complaints and allow everyday good fortune to inspire us, we enter the warrior's world.” Pema Chodron

I never fully know why I choose one particular quote verses another to leave at the end of students' mats after one of my classes. Except, it is often something I feel for myself or want to remember for myself a certain day and figure... because we are all the same... it might strike a similar chord for someone else. If not today, then maybe, on just the right day this little quote, this little slip of paper, will appear.

I realize today's quote by Pema Chodron was especially meaningful because we had so many “first time ever practicing Yoga” students in the Sehatu Sleep studio. New Yoga Warriors giving themselves ninety minutes of union with self and some self-care on a beautiful summer morning.

I will never forget what guts it took for me to get up the courage to enter my first Yoga class. And, I guess, all my “complaints” were about myself and the way I thought I had to be, or the thoughts about the way I was not that prevented an earlier Yoga journey. I thought I had to know Yoga “stuff” like how to do all the moves, etc. So, I waited until I had done Yoga tapes on my VCR at home and read a Yoga flip book that showed a practice. I fully realize, even though I had several Yoga studios in the area where I grew up, I was afraid. Afraid, I guess, to do something “wrong”...who knows, it is hard to understand fears that are really just thoughts.

So,I started my own Yoga journey much later at a gym and then took, what I perceived as, another big step and entered a Yoga studio. As I am certain today's students found, and, as I know I found in my first class: I did not need to know any “stuff”, I am enough just as I am today, and there is nothing scary about a Yoga studio, nothing scary at all. They are actually quite welcoming and sweet. And, it is their job and their purpose to share with you how you might do Yoga stuff. Rejoice.

(I do still hold a little wish I had started practicing Yoga earlier and entered the Warrior's World of Yoga in community back in the day. Even though I know, as Yoga has taught me, whatever day you do choose, is the perfect day for you!)

Congratulations Sehatu Sleep Yoga students...you are Warriors.

Yoga and The Mind Body Connection

Sehatu Sleep Granite Bay CAI attended the first Gentle Yoga class at Sehatu Sleep this morning. I was a student. Iram, the teacher and co-owner, had not taught many classes indoors before. She said after the class she was a bit nervous. I never would have known it. From the first word she spoke, I was at ease. Iram's voice is very soothing and it carries an involvement in what she is saying. We laughed afterwords about how she had to remind herself during the class that she was the teacher. She was so connected. I loved it and realized that is such an important quality, to me, in a yoga class; the teacher be in union/connected to what they are teaching. Left or right, foot here or there…foot anywhere…does not help me to drop into the present moment, my practice. What helps me to feel safe and comfortable in my practice, in the present moment, is when I feel the teacher is in a similar union/yoking. I felt there was meaning and purpose behind every word Iram shared. The definition of Yoga is that connection to body, mind and spirit. I want my teacher in a Yoga class to be connected, too. I enjoyed the gentle sequence and felt refreshed and renewed after the class. I even brought a friend by later in the day to see the studio and consider taking class ! es from Iram, and at Sehatu Sleep.
(Okay, so now I am a blogger and Yoga Pusher, too.) Thank you, Iram…I'll be back!!!
This entry is by our new contributor Joan Marks, a senior yoga teacher and integrative restoration practitioner. She can be reached at joan@sehatusleep.com.

Teen Texting Trouble

Being able to text a short message to someone is a blessing of the times. It works when you can't pick the phone up and call, when you are in an environment where speaking is not appropriate and in a lot of situations. Like any other useful technological feature, young people find uses for it to suit their life style. In my medical practice I started seeing teens who were texting 5 to 6000 times per month when texting plans had not even been invented by the phone companies. Now, those appear to have been ancient times. With unlimited texting plans, and parents losing control of their children's phone usage, texting continues to reach new highs. The Pew Research Center published a study earlier this year about increasing texting use in teens. Click here to read: Pew Research Center Study on Teens and Texting

One of my teen patients recently told me there were some very important people texting her at 2 in the morning and she HAD to respond. Come to find out it was her suspicious controlling boyfriend checking on her. One sleep problem solved.

Anecdotes aside, my concern as a sleep doctor is that the frequency of use and obsessive use, particularly during sleeping hours, interferes with a teen's ability to sleep restfully, keeping them on the edge, waiting for the phone to buzz, then alerting themselves to read and respond. Adrenaline levels, blood pressure, anxiety levels, moodiness, complaints of being tired all the time and many physical symptoms worsen with these habits, and are frequently overlooked. Often the adults in the household are not even aware of this behavior.

As I have written before, there is solid science supporting the observation that lack of sufficient good quality sleep leads to weight gain, behavior issues and accelerated aging; It triggers headaches, dizziness and even fainting besides making all kinds of existing physical problems worse.

I spoke to the local Sacramento radio channel KFBK today on this subject. Click here to listen: Teens and Texting on KFBK Radio 06-13-2012

Which one works best for insomnia: Ambien, Lunesta, Sonata ..... or a golf club?

 

 

"There is no difference between taking a sleeping pill or asking someone to club you on the head"

The inability to fall or stay asleep, or waking up too early and then feeling the effects of sleep deprivation is commonly termed insomnia. The cost of insomnia to the US economy is estimated at over $35 billion each year. There are many types and many causes of insomnia. The commonest problem by far, is a state of mind called "hyper arousal" in which the person feels their mind continues to work and be active, even if they are not worried about anything. The problem tends to run in families, affects millions of people and affects smart people more, should that be consolation to some.

Since doctors have few tools to work with besides medicine, they tend to offer their patients the least addictive of the sleeping pills they know of, but end up in a wild goose chase of changing doses, managing side effects and development of tolerance to the sleep inducing effects. The pharmaceutical industry has also found insomnia therapy to be a major money maker. Ambien, also known by its generic name Zolpidem is one of the most commonly prescribed sleeping pills. The ever present Lunesta commercial on TV has inspired many comedy show spoofs. Trazodone has been used for many years. Ativan, Valium, Seroquel, Risperdal, Restoril; there are so many . Never mind the dozens of so called "natural" remedies, supplements (a chemical is a chemical, call it natural or pharmaceutical), gadgets, even iphone apps. None of these however address the issue of hyper arousal of the mind or do so ineffectively over the long term.

Research has shown over and over that sleeping pills i.e. "clubbing your head", works for short periods of time only. Cognitive behavior therapy, relaxation training, stress management techniques including yoga and meditation work better, and work long term. The problem so far has been that trained therapists are hard to find and even harder to make health insurance companies pay for it.

Uniquely, Sehatu Sleep, a small start up company in Northern California, has taken up this challenge. They offer on site and online, "Deep Relaxation Training" to empower insomniacs, to calm their minds and get restful sleep. No chemicals, no gadgets, no gimmicks. This, is what we need, not clubs on our heads!

Sleep, Weight Gain and Obesity

sehatu photos

Apple sold millions of iPads as soon as the new product came out. We buy the newest gadgets. We tend to see and hear what excites us, and gravitate towards it. What is often not as sexy and difficult to market but critical for human well being gets lost in the news.

We buy supplements to lose weight. We buy treadmills to exercise. I know many people who spent much to undergo major surgery to reduce weight or improve their bulky appearance. How many of us though have heard the terms Leptin and Ghrelin? Ask your doctor. The physician has probably not heard the terms either. The research is now over ten years old: Leptin and Ghrelin are two chemicals that control our weight, our appetite and the amount of fat produced by our body. The delicate balance between them is held in check by one critical function of our body: Sleep.

Lack of sleep, either in duration or quality upsets this balance, increasing stress on the body, increasing fat production and deposition, reducing satisfaction from what we eat and leading to weight gain and obesity.

Inability to fall asleep, stay asleep, wake up too early, snoring and trouble breathing in sleep, all lead to this disaster.

One of many articles from the scientific literature is here for you to read.

Click here: The Link between Sleep and Obesity

Enjoy every moment, sleep well, live longer and healthier.

The Price of Being Smart & Sleep...

  A state of the mind called hyper-arousal is very common, particularly among smarter people. Smartness comes at a tradeoff. There is increased sensitivity to noise, smells, textures, emotions, and often an inability to loosen up, relax and let go. The last one is what often makes people miserable keeping them from getting adequate restful sleep. Sleep, which is required to do the body's housekeeping work. Imagine a house that has not been adequately cleaned, dishes not washed and laundry not done, week after week, month after month, and year after year. The treatment is in training your mind to do what does not come naturally to it.

 

Dr. Amer Khan-"Good Day Sacramento" Ch. 31: Caffeine, "Aero Shots" and Sleep...

Melissa Cabral at the local Sacramento CBS affiliate Channel 31 asked me this morning on the live morning show “Good Day Sacramento” about the new powdered form of caffeine called “Aero Shots”. As a society we are increasingly busy using our bodies and minds to their maximum efficiency and productivity, in the race to do better.

Recently we have learned to pay more attention to physical exercise and nutrition. However, we have not made the connection with the real key to emotional and physical health: Sleep. This has led to the energy drink culture. All kinds of shots, sprays, supplements and powders have flooded the market to provide us with much needed energy to keep working.

Why is it that we don’t have enough energy to be maximally productive? Are these products filled with some sort of nuclear or solar energy? Of course not. Caffeine, sugar and a variety of vitamins and some exotic chemicals are added together to relieve the effects of what is in reality a lack of adequate rest. Adequate rest is required, not optional, for the working of the human body. Rejuvenation, cleaning up, organizing and reorganizing, which is essentially housekeeping work for the body and mind, is performed during sleep. The science has been there for years.

Sehatu Sleep can help you sleep better.  Ask us how!

Sehatu Sleep Opens its doors to the public on June 1, 2012

Sehatu Sleep Granite Bay CA We will open our doors to the public on June 1, 2012.

Registration is now open for introductory sessions for Deep Relaxation Training. Timings and days are listed on our calendar and classes pages. Pre payment of $25 for the 2 hour session is required, valued at $50. Please contact us at info@sehatusleep.com, call us at 916-742-7718 or schedule online by going to our classes page.

Registration is now open for Yoga classes. Timings, types of yoga and instructors are listed in our calendar and classes pages. Please contact us at info@sehatusleep.com, call us at 916-742-7718 or schedule online by going to our classes page.