» insomnia

Another reason to get enough sleep: diabetes

Dr. Jonathan — Thu, 04 Mar 2010 12:05:07 +0000

Getting short-changed on sleep causes multiple harms. Here’s a paper just published in the journal Diabetes Care that assessed

“the relationship between habitual sleep disturbances and the incidence of type 2 diabetes.”

The authors analyzed 10 studies that included 107,756 male and female participants. Their clear-cut conclusion:

“Quantity and quality of sleep consistently and significantly predict the risk of the development of type 2 diabetes. The mechanisms underlying this relation may differ between short and long sleepers.”

The mechanisms include hormone dysregulation, low-grade chronic inflammation, and gastroesophageal reflux disease (GERD; see earlier post on how medication can worsen this association). For help with sleep disorders there are sound functional medicine resources that address the biological component, cognitive behavioral methods (see recent post about internet-based CBT for insomnia), and neurotherapies including neurofeedback and brain wave entrainment tools.

Internet-based therapy for insomnia: studies show success

Dr. Jonathan — Tue, 02 Mar 2010 12:15:43 +0000

This post presents mounting evidence that internet-based therapy for insomnia can be very successful at improving sleep onset, duration and quality, followed by two resources that you can use now if you would like to try it. I’ll start with a study published not long ago in the journal Archives of General Psychiatry that begins with the observation that “Insomnia is a major health problem with significant psychological, health, and economic consequences. However, availability of one of the most effective insomnia treatments, cognitive behavioral therapy, is significantly limited.” The authors then set out to “evaluate the efficacy of a structured behavioral Internet intervention for adults with insomnia.” Their welcome conclusion: “Participants who received the Internet intervention for insomnia significantly improved their sleep, whereas the control group did not have a significant change. The Internet appears to have considerable potential in delivering a structured behavioral program for insomnia.” (For the record, they just published a correction of “2 minor computation errors” that “do not substantively change any of the results and do not alter any conclusions reached about the impact of the Internet intervention on sleep.”)

Another study appeared last summer in the journal Sleep that “evaluated the impact of a 5-week, online treatment for insomnia.” The participants were 118 adults suffering from chronic insomnia who received online treatment from their homes. The authors reported “results showed that online treatment produced statistically significant improvements in the primary end points of sleep quality, insomnia severity, and daytime fatigue,” but also observed that motivation of the participants was a factor (naturally).

These studies added to an earlier paper published in the Journal of Consulting and Clinical Psychology that randomly assigned 108 subjects “to either a cognitive-behavioral self-help treatment [internet-based] or a waiting list control condition.” The authors stated that “Results showed statistically significant improvements in the treatment group on many outcome measures, including total sleep time, total wake time in bed, and sleep efficiency,” but also noted that “improvements were also found in the control group. Overall, between-groups effect sizes were low, with the exception of the Beliefs and Attitudes About Sleep Scale.”

One more paper for your consideration was published in the Journal of Occupational Health a while back. It evaluated the effectiveness of an intervention program that lasted for only 2 weeks. The authors stated these findings and conclusion: “The sleep quality score increased in the intervention group at post-intervention… Sleep-related behaviors also greatly increased in the intervention group at post-intervention… Sleep-onset latency reduced in the intervention group at follow-up, with a marginally significant effect. The Internet-based self-help program improves subjective sleep quality and sleep-onset latency among adult workers.”

There is a caveat here. As you can see from these studies, internet-based CBT (cognitive-behavioral therapy) can be very helpful for insomnia. However, the biological component can be very significant and, in many cases, decisive. And as you know, the common medications have serious side-effects. It makes sense that the ideal program combines a functional medicine approach to any underlying neurological, endocrine and metabolic factors with the behavioral modifications of CBT. For those who would like to try an internet-based CBT program for insomnia, two resources presently available are CBTforInsomnia.com and HealthMedia Overcoming Insomnia (I have no affiliation with either.)

Medicating insomnia when there is reflux can make both much worse

Dr. Jonathan — Mon, 01 Feb 2010 01:00:06 +0000

I wonder how many people took note of the extremely important paper published recently in Clinical Gastroenterology and Hepatology. The author marshals twenty additional studies to bolster the finding that, when there is gastroesophageal reflux (GER) disease, medications for insomnia can make both conditions worse: “Sleep-related GER causes insomnia. Patients might not realize that GER is contributing to their insomnia. When patients complain to their physician about their insomnia, they might not appreciate that GER is a contributing factor, so that instead of intensifying GER therapy during sleep time, they prescribe a non-benzodiazepine hypnotic such as zolpidem. This hypnotic prolongs esophageal acid clearance and delays the arousal response, which can further worsen reflux and thus their insomnia. To avoid this cycle, we should consider sleep-related GER as a possible cause of insomnia and treat GER during the sleep period instead of prescribing a hypnotic medication. This investigation has significant clinical relevance.” The author concludes by admonishing doctors: “…common medications used to manage insomnia depress the arousal response that is vital to esophageal refluxate clearance. The data are impressive. Ask your GER patients what happens during sleep!”

Insomnia, melatonin and serotonin

Dr. Jonathan — Sat, 21 Nov 2009 21:23:00 +0000

If you’re wondering whether you should take the hormone melatonin for a sleep disorder, bear in mind that melatonin is synthesized from the neurotransmitter serotonin (as described in this paper published in the journal Cell & Tissue Research). The functional approach avoids taking melatonin (except temporarily for extensive time zone travel) because of the possibility of suppressing native hormone pathways. This is only one of a number of factors that can cause or contribute to insomnia, but the possible need for physiological support with precursors and co-factors to normalize serotonin production and conversion to melatonin shouldn’t be overlooked since they can be depleted by stress.