Amer Khan

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. 

I Know You Can't Sleep But Its Not Insomnia!

The word "insomnia" has become so ingrained in language and culture that even medical professionals have a difficult time telling the difference between what truly is insomnia and what is not. I have known many patients who came in to see me for insomnia that they have apparently had for many years, and treated often with multiple medications, but a short discussion later, they reveal the real problem.

The inability to fall asleep, stay asleep or wake up too early leading to the effects of insufficient sleep is defined as insomnia, and for it to be a medical diagnosis as a health disorder it is usually required to be of sufficient duration of at least a month. An individual with insomnia is unable to get sufficient sleep no matter what. Of course the word sufficient means the amount of sleep required by a person's body in order to feel fully rested. That number can also considerably vary by individual ranging from five to ten hours per day for an adult.

Herein lies the issue: First, how much sleep do you think you need, and are you really unable to sleep that much? Second, really, given the opportunity, can you really not get the amount of sleep you truly need? The differentiation is vital because it leads to the type of treatment that is most likely to help.

Many people have been stuck in a bad sleep routine for so long they have no idea how much sleep they need in a day. Young parents and middle age workers being a prime example of busy lives and responsibilities, find a short amount of time late in the evening to be by themselves to unwind from the day. They end up going to sleep late, wake up tired the next day and struggle through the day. They don't have insomnia. Send them on a vacation and they do just fine. In the busyness of life they often lose sight of how much sleep is necessary for them to feel charged up and function at their best, leading to excessive caffeine use.

Young adults and teens often report they can not fall asleep at a reasonable time, but given the chance they will sleep in, sometimes all day, to obtain the full amount of restful sleep they need. They stay up late and have to wake up early, struggling to make it to classes, then sleep till very late on weekends. They don't have insomnia. Given the opprtunity they sleep well and enough.

Retirees most often end up sleeping in fragments. My own mother for example, an eighty year old, has forever complained of not being able to sleep well at night. She falls asleep around ten, to wake up at two, then sleeps from four till about six. She will wake up, eat breakfast, then nap for an hour, spend a few hours sitting around then nap again for a couple of hours. The fragmentation of sleep, which is common biologically in the elderly anyway, gives the impression as if they have insomnia but in fact they are getting the amount of sleep they need, but only in fragments.

By any means, my implication is not that these are not real problems of real people. My point is that to solve these problems the answer is not in a prescription of Ambien or trazodone. And the argument here is not that these are bad medicines, but that it is the wrong answer simply because it does not address the real problem.

We shall continue this discussion.

 

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. 

 

The Human Condition: Is The Light Bulb Killing Us?

Just in the lifespans of our grandparents and great grandparents, life has changed completely. Its not just televisions, internet, cell phones and other electronics. The arrival of electric power had a dramatic effect on human life. We extended our waking day. For some of us it enables us to stay awake as late at night as we want. And many of us do want to stay up at night. It would not have been practical to stay awake at night without lights. Now, of  course lighted gadgets make it even easier. In those dark days without artificial light, insomniacs would still be counting stars, singing and telling each other stories, if it were not for the light bulb.

As we have made progress, and seemingly made great strides in improving the human condition, we have also come across a great hurdle. Our bodies are not designed the way we are trying to use them. Try using a truck as a sports car or vice versa. You get the idea.

The human body, by design, functions on a day/night cycle. The presence of light during the day and the absence of it at night is designed to set up a series of chemical reactions that depend on these signals. It is called the circadian rhythm. How is it supposed to cope with a never ending presence of light then?

The system by its design allows the body to maintain its functions during the night by synchronizing it with the onset of sleep. Sleep allows us to rest, recharge, manage the immune system, maintain metabolism including body weight, appetite, blood pressure and blood sugar levels, process our thoughts, consolidate and process memories and performs countless other functions.

When, by extending our daylight hours through the use of technology, we constantly tellour bodies that days are consistently long, we interfere with the ability of the body to allow us sufficient sleep. Short sleep equals disruption in all those functions listed above and more.

So now, with us trying to do more, more, more, with our bodies and minds, with less sleep, less consolidated memory, abnormal blood sugar and blood pressure controls, weaker immune systems that are poorly modulated, increased appetite, and feeling tired, is it fair to complain that we have a generation of overweight people; that diabetes, hypertension and heart disease occur earlier in life; that we have more allergies and immune system problems; that the businesses of energy drinks and coffee are booming; that we use billions of dollars worth of sleeping pills, antidepressants and anxiety medicines?

By not understanding how our bodies are designed to function, and not following the rhythms of nature, are we not killing ourselves?

Later Addition:

On September 10, 2012, the New York Times published a blog article about light exposure and sleep. A link to the article is copied here:

http://well.blogs.nytimes.com/2012/09/10/really-using-a-computer-before-bed-can-disrupt-sleep/?smid=pl-share

Really? Using a Computer Before Bed Can Disrupt Sleep
A recent study showed that exposure to light from tablets significantly lowered levels of the hormone melatonin, which plays a role in the sleep cycle.

Bring it on, Life, But Only If I am Rested and Relaxed!

I have had some interesting experiences this summer. It has been a busy, exciting, disturbing, hectic, troubling and inspiring summer. I went skydiving (for the third time) with my wife and son. Exciting. Our son was in a car accident, totaling the long time family vehicle. Scary. Our long time dearly loved family dog of ten years died abruptly. Disturbing. You probably get an idea of the wide variety of these experiences. You may identify with some of them too.

Rather than going into the minor details, my goal is to point out how experiences shape our lives. What life throws our way is not in our control. How hot the weather will be today or how bad the traffic will be on the way home from work are things beyond our individual control.

How we deal with what is thrown our way is critical. It also depends on what frame of mind we are in. Well rested, emotionally secure people will be able to deal with a lot of stressful events and deal with them differently than others. Suffering already from over work and stress, leading to lack of good quality sleep, many of us are left with little emotional capacity to take any more trouble and deal with it adequately.

There are people in this world who have to walk long distances for drinking water and wonder each morning if they will find the one meal for that day. There are people who have been through genocides, massacres, famines, floods, epidemics and all kinds of mass miseries inflicted on them by other people and by nature. Are they all emotionally exhausted, mentally paralyzed, unable to function, survive, move forward and build their lives? May be some, but not all.

On the other hand, there are people with every imaginable luxury of life, who would give anything to be able to take a nap, like Michael Jackson and Whitney Houston who gave their lives trying to obtain a few moments of forced, chemically induced rest for their minds.

What is the difference? The difference is in genetics, brain wiring, cultures, environment and upbringing. Given all else being equal, those of us who find themselves unable to feel emotionally secure, able to let go, calm their minds, rest and recharge to face the inflictions of everyday life, need to learn these skills. If it does not come naturally, it has to be learnt. Like a child learns to walk naturally, but has to be taught how to ride a bicycle.

It is the job of those who are in the position of helping others, to assist them in this journey. It is also the job of those who are looking for help, grasping for straws, to seek out this help. It is available. It is here. We do it every day at Sehatu Sleep and Yoga Studio.

Go, get it, wherever you can. It will make life better, easier and more fun for all.

 

 

On Life, Death, Health and Sleep

I have had a few enlightening encounters with my patients in the last few weeks. Recently, one of my patient's wife made an intense comment: "He gasps and chokes in sleep. I can't let him die like this! Two of my family members passed away in the last few years and I could not save them. I can't let it happen again!!" This led to a discussion. Another young patient in his 70's said to me today he probably has five to ten more years to live considering how sickly he is. This led to another discussion. A third patient said: "I know I have neglected myself and my family for the last several years. I have been spending all my time at work. I now want to switch my life around."

I just want to share a few of my thoughts from these encounters.

We all know we did not choose whether, when, and where to arrive in this world and won't choose the time of our death either. This fact however gets lost on us while we struggle in our lives to go to school, learn, have jobs and families, in the process developing a false sense of control over ours and our loved ones' lives.

Its not about how long we live. Its how we live. A healthy, useful, long life. A productive, loving life. The duration does count, but the quality does lots more.

While death is certain for every living organism, a realization of this absolute fact makes the job of making the best of every second, minute, hour and day of life even more significant.

Given good health care and a balanced lifestyle, people should be able to live happily way past 100 years. To have a fatalistic attitude towards life as one gets older prevents the person from enjoying every day of life that they still do have.

Its not about choosing between work and family. Its about finding a balance.

We can not hang on to those we love. We have to let go of them in order to love them.

The need to control.... a quality shared by many smart, intellectually gifted people is most often a major factor in them feeling unable to relax, let go, fall and stay asleep. This is a sign of loss of that delicate balance in life that is necessary for health, wellness and happiness.

This is exactly why we need to work hard towards restoring that balance, learning to control and let go, learning to live and die, by retraining our minds.

We need to learn to Relax, Sleep better and Perform at our best, for a healthy, longer, happier, more fulfilling life.

 

 

 

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

On The Subject of The Active Mind Syndrome - Do You Have It Too?

To be very frank there is no such condition identified in the Diagnostics and Statistics Manual that mental health providers use, at least not so far. Could it be that the prevalence of this problem is so high it is considered kind of normal to suffer with it?

Society has been hard at work to train our children and adults alike, to work hard, be responsible, worry about the consequences of our actions and be held accountable. Nothing wrong with any of that but there are ramifications to this training that we never see coming.

In going through the process of developing these necessary traits in our personalities, we de-train ourselves from how were were as young children, happy go lucky, taking a day at a time, relaxed and unhurried. Some of us can cope with the change simply because they have been blessed with a calm demeanor implanted genetically into their minds. The rest of us suffer. We worry about getting to places on time, paying bills, caring for loved ones, making money, spending money, socializing, networking, entertaining, being entertained, even sleeping. We take our busy minds to bed with us and rise with these busy multi tasking, active minds. Our minds keep busy problem solving, thinking, recalling what happened and planning ahead for what might happen, even when we are supposed to be resting.

Rest doesn't come easy, sleep doesn't come, and if it comes it is not restful. We keep tossing and turning in bed trying to fall asleep. We wake up within 2-3 hours of falling asleep often staring in the dark, counting sheep, checking text messages and emails, turning the TV on and off and finally giving in to the temptation to take some sort of sleeping pill. Some will keep going to the bathroom or get up and eat. Then comes the dreaded morning and back to the race to finish tasks, be on time, finish the work, on and on and on.

I see these people every day in my sleep medicine practice. Nice, responsible, good people. Suffering people. Distressed people. "Doctor, the more I try to sleep the harder it is to fall asleep. My mind just races and doesn't stop, even when there is nothing stressful happening. What should I do? Can you help me?" And I find myself thinking, here is another patient with the undiagnosed and so far unnamed Active Mind Syndrome.

There are many ways to treat it should you be one of those people who have experienced the ill effects of this condition. Its important to know two facts first though. Firstly, there is no use asking the doctor since most doctors don't know what it is (and likely they have it too) and they wouldn't know how to treat it. Secondly, the answer is not in a pill.

What is your motivation? How strong is it? How bad is your suffering?

We at Sehatu Sleep think we have the answer. We call it Deep Relaxation Training (www.sehatusleep.com). We feel it requires re-training the mind to make the best of both worlds. People can learn to be productive, efficient, high achieving, and at the same time able to let go, relax, and loosen up on demand; able to sleep like a baby. It does require hard work, commitment and consistency but is very do-able. It is very powerful and gives you the capability to deal with life as it happens.

It is certainly not the only answer. Many paths can lead you to the same goal. We think ours is the most comprehensive. If not us, there are many wise people around you wherever you are. It just takes recognizing the problem and then seeking help. Its around the corner. Waiting for you. Wherever you are.

Happy dreams!

The Magic of Melatonin! (Requires a Magic Wand)

People looking for over the counter sleep aids often find melatonin along side other supplements. Since it is easily available, considered a supplement and not a medicine, there is plenty of incentive to at least try it. There are dozens of melatonin products on the market, freely available at supermarkets, pharmacies, health food stores and online. People take it in increasing doses (I have known people to take as much as 15 mg in one night), combine it with Benadryl products or alcohol, with various vitamins and in combination with various herbal preparations. It may make you briefly drowsy. It may seem to help you fall asleep for a few days. Unfortunately, that's about it. So what about the magic?

The magic wand you need to unleash the powerful magic of melatonin is to know the science behind what the substance is and how it works, and most importantly what it works for. Melatonin works fantastically well for people with "delayed sleep phase syndrome", a medical term describing the inability to fall asleep at a socially acceptable time and wake up at a socially acceptable time in order to be productive. It is a very common sleep problem often misdiagnosed as insomnia. It is more common in adolescents, and in creative people, musicians and artists; and often runs in families.

These people are fully capable of getting sufficient sleep but end up not getting enough because they don't get sleepy until later in the night and have to wake up early to go to school or work. If they could sleep in every day and work started later in the day they would be fine.

If melatonin is taken in the smallest amount available, it works best. Take more and you will likely be groggy when you wake up. It should be taken no earlier than 8 hours after naturally waking up, and about an hour before intended bed time. The product has to come from a reliable manufacturer since no one is effectively regulating the quality of the product.

Most of all, if you expose yourself to bright sources of light after taking melatonin you will cancel out its effects. These bright sources include all kinds of handheld and electronic device screens that emit light. Its effect will also be reduced if you activate your mind, get busy thinking, worrying or performing mental tasks.

Lots of caveats, true. But the potion's magic has the potential to change countless lives, provided it is used properly, with wisdom and knowledge. It is typically inexpensive and works much better than sleeping pills, for the person with "delayed sleep phase". For everyone else, unless your sleep physician specifically recommended it, you are probably wasting your money.

 

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.