You may be surprised to learn that the gold standard for treatment of insomnia doesn’t cost a thing. So what is CBT for insomnia? In this episode of The Brain Warrior’s Way Podcast, Dr. Daniel Amen and Tana Amen are again joined by Dr. Shane Creado for an extended look into this treatment modality, and what makes it so effective.
Dr. Daniel Amen: Welcome to the Brain Warrior's Way Podcast. I'm Dr. Daniel Amen.
Tana Amen: And I'm Tana Amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
Dr. Daniel Amen: The Brain Warrior's Way Podcast is brought to you by Amen Clinics, where we have been transforming lives for 30 years using tools like brain spect imaging to personalize treatment to your brain. For more information, visit AmenClinics.com.
Tana Amen: The Brain Warrior's Way Podcast is also brought to you by Brain MD, where we produce the highest quality nutraceuticals to support the health of your brain and body. To learn more, go to BrainMD.com.
Dr. Daniel Amen: Welcome back. We are in the middle of sleep week, and we've talked about a number of the causes of trouble with sleep. We talked about how critical it is to the success of your life-
Tana Amen: Yeah, so important.
Dr. Daniel Amen: But now, let's talk about how to get and stay asleep. So, what are some of the highlights? What are some of the most effective things you've seen to help your patients?
Dr Shane Creado: Well, the most effective strategy to help with insomnia is something we call cognitive behavioral therapy for insomnia. Not many people are even aware of this-
Tana Amen: I would have never thought of that.
Dr Shane Creado: Exactly. Not many people are aware of this, but this is the therapy that's the gold standard. It's approved by major international sleep organizations. Not Ambien, not Trazodone, not Gabapentin, not Klonopin, but cognitive behavioral therapy for insomnia. And that's the cornerstone of the course that we've just created for all our patients and friends and family.
Dr. Daniel Amen: So, how does it work? And I know, we would love for them to take the course, but what's the short story?
Dr Shane Creado: The short story is that it addresses everything starting with an understanding of why we sleep, the rhythms that are associated with sleep functioning, circadian and homeostatic drives. We talk about everything from understanding why those therapies and strategies are useful based on our knowledge of sleep, natural supplements and ways to deal with effective sleep, and then dive right into the meat of things. Everything from behaviors and thoughts surrounding sleep, or lack thereof, as well as ways in which we can regulate our rhythms. If you're in bed for nine hours only getting six hours of sleep, we need to reduce the time in bed, because you're lying in bed associating the bed with wakefulness, tossing, turning, worry. And then actually your brain thinks that's your worry time.
So first of all, if you can't fall asleep within 20 minutes, get out of bed. A comfortable chair, do a meditation, do something relaxing. No screen times, because you need to break that cycle between wakeful worry and the bed. Then get back into bed. If you're awake for nine hours only getting six hours of sleep, reduce your time in bed to six hours. People think I'm crazy for saying that, but they say I'm not going to be able to sleep. Well, are you sleeping anyway? If we do a sleep diary that are available with the materials in the course, you can actually track and see how much sleep you're getting.
So, if you're sleeping for six hours, but only in bed for nine hours, reduce that time. You're allowing your brain to get the same amount of sleep you get anyway. Keeping your wake up time fixed is really crucial, because we're trying to entrain the inner rhythms to align themselves in the brain. So, if you're waking up at 6:00 a.m. one day, and the weekend you wake up at 9:00 a.m., it's gonna throw your inner biological clock off every time. You're basically making your brain go through jet lag every week if you think about it.
So, always having a fixed wake up time, calculating how many hours you need and going to bed at the appropriate time. Wind down before bedtime. If you wake up in the middle of the night, get out of bed, get comfortable, get back to bed when you're sleepy. Most people don't know the difference between sleepiness and fatigue.
Tana Amen: This is so interesting. I've heard a lot of stuff on sleep, and most of it is repetitive. It's the stuff we think about. Darken your room, make it cool, all that stuff, which is important. But you're addressing things I've never heard of, like if you've been traumatized in the bedroom, or ... I mean, just some of the stuff you're talking about is really deep. So it's just so important that these things are addressed, and I just am loving what I'm hearing, especially some of the things, not just women, everybody, but it's just such a thing that I've never heard someone address these topics for sleep.
So, I just am fascinated by this. And one thing I want to throw in there, my sister actually went to the doctor for ... because she went through a highly traumatic experience. They gave her Gabapentin, she fell asleep on the toilet, fell off the toilet, and hit her head on the bathtub. So, just throwing that out there.
Dr Shane Creado: Right. And that's another point you raise. Medication may be okay, but is it the right medicine and the right dose at the right time-
Tana Amen: Is it optimal, right.
Dr Shane Creado: For the right patient. Gabapentin is great for restless legs, can help you sleep better, but if it's too much or you're too sensitive to certain medicines or a certain dose, that's what's going to happen.
Tana Amen: Yeah.
Dr Shane Creado: Would you rather have a head injury or break a hip, or would you rather sleep better through natural ways?
Tana Amen: Right. So, it just seems to me like it's at least where you should start is working on your thoughts and clearing up whatever's going on-
Dr. Daniel Amen: So we need to get the ants out of bed.
Dr Shane Creado: Get the ants out of bed.
Tana Amen: Oh, I like that.
Dr. Daniel Amen: So, a lot of people have an ant infestation in their bed, under their sheets, the automatic negative thoughts-
Tana Amen: That's really good.
Dr. Daniel Amen: That steal your happiness. So, learning how to not believe-
Tana Amen: Get the ants out of bed.
Dr. Daniel Amen: Every stupid thing you think is really critical. I mean, it's important. So, but also, because I know you, it's a routine. If your routine has been one that is sleep harming, let's put you in a routine, because your brain can then begin to associate sleep with the right routine.
Tana Amen: Is that what we call sleep hygiene?
Dr Shane Creado: Exactly. It's a component of sleep hygiene, and also another concept in CBT for insomnia called stimulus control.
Tana Amen: Let's make sure that they didn't hear what I heard the first time. I heard CBD, so let's make sure we're hearing this correctly.
Dr Shane Creado: CBT, cognitive behavioral therapy for insomnia.
Tana Amen: Right.
Dr. Daniel Amen: Well, but why you brought that up, so what's the deal with CBD and sleep? Everybody's taking it-
Tana Amen: It's a big thing now, so that's why I thought I heard it.
Dr. Daniel Amen: Everybody's, they're giving it to their granny. They're giving it to their dog who's got arthritis.
Tana Amen: I mean, I know a minister taking it.
Dr. Daniel Amen: What about CBD and marijuana for sleep?
Dr Shane Creado: Well, we all know the bad effects in terms of marijuana, right? In terms of your increased risk for schizophrenia to low blood flow in the brain. In the scans we've seen that every single time. CBD oil, there's more research that needs to come out, but from what I've seen thus far in terms of insomnia, CBD oil may be helpful for insomnia, but in very high doses. So it might be more expensive for people, and depending on your brain sensitivity, I don't know what kinds of side effects you'll have. So, until more evidence is out there in support of CBD oil, it's definitely not my first, second, third, or even 15th step in terms of a person with insomnia.
Dr. Daniel Amen: Isn't that interesting? I'm working on a new book called The End of Mental Illness, and I'm in a chapter called Mind Meds Versus Nutraceuticals, What does the science say? For example, if I look at depression, then Prozac is 13th on the list, where things that are much higher up are cognitive behavior therapy and Omega-3 fatty acids, maybe SAMe. So, rather than what most people do, go to the primary care doctor and get a drug, there's so many other things to do first, and that's what you talk about in the course and it's what we're talking about today. Let's go through the steps.
Before I get to Ambien, and quite frankly I don't think I've prescribed it in the last five years because it's not really even on my list because my mom took it forever and then she couldn't stop taking it. I wasn't the one giving it to her, trust me. Give us the top 10. What would you do? What would you start with if someone has got erratic sleep?
Dr Shane Creado: If someone has an issue with insomnia or disrupted sleep, the first thing is you look at is the bed environment. Is it comfortable? Is it conducive to better sleep? You look at what they're doing during the day. Is it something activating closer to bedtime? Caffeine, for example. Some people may feel that caffeine is okay for them to take in the afternoon, but if their brain is more sensitive, then avoid caffeine during the day, even if it's in the afternoon. If you're taking caffeine with an SSRI, an anti-depressant, or with hormone replacement therapy, with an oral contraceptive, caffeine is gonna last longer in your system.
Tana Amen: Oh, interesting.
Dr Shane Creado: It's gonna activate you. If you're taking alcohol too close to bedtime, it's gonna wake you up in the middle of the night. If you're exercising, which is a great thing to do in the morning, too close to bedtime, it's gonna make you more activated or energized.
Tana Amen: Yeah, I have that problem too.
Dr Shane Creado: Exactly.
Tana Amen: I can't settle down.
Dr Shane Creado: So, a few of those basic concepts. Your behavior is the first thing that needs to be taken care of. Screen time, reading, watching TV in bed, all gone. You need to have that barrier there. We talk about blue light and white noise, as well. Once those are taken care of, you can look into the medications you've already been prescribed. There's lots of information on the internet. See which ones may be sleep disrupting for you. Look at any thyroid issues you might have or any other health issues. Chronic pain is a big one too. By doing that, you can actually eliminate or deal with those initial things way before you resort to a medication like Ambien. There are medications that can knock you out, like antipsychotics, but they're dirty medicines. They cause a lot of side effects as well.
Tana Amen: Dirty medicines, I like that. Dirty medicines.
Dr Shane Creado: You can't fish in muddy water, right?
Tana Amen: I like that.
Dr. Daniel Amen: So, sleep hygiene. One of my favorite things has been hypnosis.
Tana Amen: Love it.
Dr. Daniel Amen: I actually have a hypnotic on Brain Fit Life. I have a hypnotic thing for sleep. I think my first three published papers was, I mean they were miraculous things using hypnosis for sleep. Parkinsonian tremor went away when I put a person in a trance for sleep, even before he went to sleep. A heart arrhythmia normalized under hypnosis for sleep.
Tana Amen: I love hypnosis and meditation.
Dr. Daniel Amen: So, that can be positive. In your course, you have the meditation that people can do. I know Tana has meditations on her site.
Tana Amen: I'm not a meditation expert. I just found that it really works for me.
Dr. Daniel Amen: It's retraining your brain to a calmer state. Then when we come back, we're gonna talk about supplements and okay, if you have to use medicine. What are some of the ones that won't get you into trouble? Stay with us.
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Dr. Daniel Amen: If you're interested in coming to Amen Clinics, give us a call at (855) 978-1363.