sleeping pill

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. 

On Sleep Cycle Problems Wrongly Termed Insomnia: What Can You Do?

Continuing from our previous discussion on how problems with the sleep cycle are wrongly termed insomnia, let's talk about what you can do to help yourself:

1. Recognize the problem:

Of course, you have to realize the nature of the sleep problem. "Delayed Sleep Phase" is the commonest disorder of sleep cycle. It commonly runs in families, and is very prevalent among teens, young adults, creative people and those with "active minds". Anxiety is often associated with delayed sleep phase, as well as a tendency to want to stay up at night, to accomplish tasks that are difficult to complete during the day. A frequent statement is that "my mind seems to wake up when it is time to sleep."

2. Do you really want to make it better?

Sounds like a silly question. But the point is that it is very difficult to make this problem better unless the person suffering from it is motivated to make it better. The good news is it can be completely better, without prescription medicines if you are willing to learn about how the body's sleep mechanisms work, how they get disturbed and how to return them to their natural function. Some people decide however that their tendency to be awake at night and asleep during the day works for them; musicians, performers and writers being some of them.

3. "Just tell me what to do?"

I will expand on the following next time but here are some of the things to do:

- Bright light exposure of 5,000 lux or more starting 30 minutes before your "natural" wake up time. (Usual indoor lighting is 100-200 lux).

- Do not take a daytime nap of over 30 minutes, and none in the last six hours before bedtime.

- Turn down the lighting one hour before intended sleep time. Turn off all sources of lighted electronic screens.

- Take melatonin 1.5 mg or less from a large reputable manufacturer, one hour before intended sleep time, BUT no earlier than ten hours of "natural" wake up time. No added ingredients are necessary.

- Eat a filling starchy snack 30 minutes before bed time; not fatty, not sugary food.

- Avoid all sugary or caffeinated drinks in the last six hours before intended bedtime.

Relax. You will reach your goal and you can do it. No one has invented any magic pill stronger than human will power.

More next time. Adios.

 

Sehatu Sleep Granite Bay CA

 

Deep 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.

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.

 

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!