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  • The early part of my career as a clinical psychologist

  • was spent in addiction research and treatment,

  • and now I treat sleep.

  • So when I reflect on my path, I feel as if I can legitimately say

  • that I went from helping people become conscious to helping people become unconscious.

  • (Laughter)

  • I love sleep treatment.

  • I think that sleep is so fascinating and it's exquisitely complex.

  • For people navigating that sleep treatment world, though,

  • trying to figure out what to do can be very daunting.

  • I was even surprised to find out

  • that some of the most effective treatments for insomnia were over 20 years old.

  • When I shared this with one of my clients, his response caught me off-guard.

  • He said, "Why is it then that you are my last stop, when you should have been my first stop?"

  • The night of sleeplessness here and there is actually normal.

  • Losing sleep over a broken heart - normal.

  • Losing sleep because your mind pops awake with one more idea

  • to add it to your big presentation tomorrow - normal.

  • But hopefully, we also know how great it feels to have a really good night of sleep.

  • And because I know how great it is to have a good night of sleep,

  • I am always struck with wonder

  • that sleep only recently has joined the conversation when you talk about health and overall longevity.

  • People even sometimes ask me,

  • "Isn't there some way I can hack into my sleep,

  • to somehow squeeze it down significantly,

  • so that I can just maybe go straight into, you know, the good stages, where the benefits are?"

  • Fair enough. Good question. The answer is no.

  • (Laughter)

  • It turns out a great deal of housekeeping is taking place while we sleep.

  • And sleep is much more complex than just a lack of consciousness.

  • When you get into bed, and you pull up the covers,

  • and you rest your head on the pillow,

  • with your exhale of all the concerns for the day.

  • As you close your eyes, sleep begins to unfold in a series of stages

  • that increase in depths as the night goes on.

  • All those stages work together

  • to orchestrate all the processes that are needed to derive all the benefits of sleep.

  • For example, we know that sleep is incredibly important for immune functioning.

  • Get a lot of consistent sleep, you're more likely to resist infection.

  • If you get sleep while you're sick, you're more likely to recover.

  • Recent evidence suggest that your brain even has its own dedicated waste removal system,

  • the glymphatic system.

  • And this is the system that works primarily while we're asleep

  • to remove the gunk out of our brains that seem to contribute to diseases such as dementia.

  • So really there is no consensus about why we sleep.

  • We don't really know why we spend the third of our life doing it,

  • but one thing that I can tell you

  • is just as the three trimesters of pregnancy can't be whittled down

  • to a convenient three months,

  • it seems like sleep and the benefits of it also have an optimum period of gestation,

  • which appears to be about 7-9 hours.

  • So, while some people are looking to get rid of sleep,

  • there are other people that would do anything to get more of it.

  • To them, sleep is not consistently rejuvenating, satisfying,

  • it doesn't leave them ready to go.

  • This is insomnia.

  • Now, that word doesn't always resonate with people.

  • If you ask them, they're saying, "No, no, I don't have insomnia."

  • "I just don't sleep."

  • "I don't look like this guy, so how bad off can I be?"

  • It turns out a diagnosis of insomnia doesn't depend on how bleary-eyed you are,

  • or even on the number of hours of sleep that you get.

  • If you consistently don't feel as if your sleep is rejuvenating,

  • or if more days that not you feel as if you're having a hard time falling asleep, staying asleep,

  • or you're unintentionally waking up too early,

  • maybe you should get it checked out.

  • And don't fall into the trap of thinking that whatever is happening with you,

  • that it makes sense that you have some chronic sleep loss.

  • Until recently,

  • sleep problems that occurred in the context of major life stress,

  • or medical or psychiatric conditions was largely ignored.

  • It was thought that if some sort of medical issue would be resolved,

  • that eventually sleep would fall into place.

  • That is clearly not what happens.

  • Sometimes, even when the primary issue is resolved, insomnia persists.

  • And the reason for that is that insomnia and a lot of other symptoms are mutually exacerbating.

  • What that means is that they're intertwined.

  • Take, for example,

  • that half of the 18 million Americans who have major depressive disorder,

  • also have insomnia.

  • If you intervene at the level of depression,

  • you might get symptom relief,

  • and yet, the insomnia can persist.

  • But the evidence linking the relationship between insomnia and depression suggest that

  • if you intervene on the level of sleep,

  • that people can get relief from those symptoms of depression,

  • and you can even prevent further episodes.

  • Insomnia is not just a symptom; insomnia is a disorder.

  • And when it occurs, it should be assessed and treated as the first-line problem.

  • Now, when people do seek treatment, they usually receive a medication,

  • and medications are great.

  • If you have a stressful meeting with your boss tomorrow, pop a pill;

  • you're going to sleep tonight.

  • But oftentimes, people don't want to have to rely on anything,

  • especially over the long term, in order to get a good night of sleep.

  • I have good news,

  • and that is that healthy sleep is largely shaped by the things that we do,

  • by our choices, by our behaviors.

  • So in this way, the best sleep medicine is our behavior, behavioral medicine.

  • Cognitive behavioral therapy for insomnia,

  • which is a really long name for a treatment, let's just call it CBTI,

  • has a substantial evidence-base for the treatment of insomnia.

  • And we know that not only does it work for most people,

  • there are several different patient populations that can derive benefit:

  • cancer survivors, people with PTSD,

  • chronic pain, fibromyalgia, major depression.

  • Here, there is consensus.

  • CBTI should be the first line of treatment when it comes to insomnia.

  • And why is that?

  • Why would something like therapy cure something that feels like a very physiological need?

  • Well, in order to understand why CBTI works,

  • you need to know a little bit about why acute insomnia becomes chronic,

  • and has a lot to do with our behaviors.

  • The seemingly benign decisions we make in order to try to fix insomnia,

  • actually perpetuate it.

  • I blame our instincts. Let me give you an example.

  • If you sustain an injury,

  • you automatically apply pressure to any sort of bleeding wound.

  • In this case, your instincts are helpful.

  • But let's say you're going on a hike,

  • and it's a beautiful Colorado day,

  • and you run into a bear.

  • Every cell in your body mobilizes to react to your instinct to turn around and run.

  • Your instincts are wrong.

  • The bear will chase you, the bear will outrun you,

  • the bear will catch you, and then

  • Well, it turns out the way your instincts should have told you to do

  • is to make yourself look bigger,

  • to stand tall, to puff out your chest, and talk to it on a loud voice,

  • and in the very unlikely scenario where the bear actually attacks you,

  • what you're supposed to do is pick up a stick and fight back.

  • So… (Laughter)

  • So this is the same thing that happens with sleep loss:

  • we compensate for sleep loss because it tends to make sense to us.

  • So what do we do?

  • We doze off on the couch, we go to bed early, we sleep in late,

  • we have an irregular sleep schedule,

  • we become really preoccupied with whether or not we'll be able to sleep,

  • whether we've lost the ability to sleep,

  • and this leads to a lot of hyper arousal, which is where CBTI comes in.

  • So there are several different components of CBTI

  • that are tailored to each individual person.

  • But in brief, what happens with sleep restriction is it takes someone's existing sleep debt

  • and grows it a little bit in order to consolidate sleep,

  • so that people fall asleep faster, and they're less likely to wake up.

  • Stimulus control likes to strengthen the relationship between bed being a place for sleep,

  • rather than other engaging activities,

  • such as checking your email, plotting revenge, worrying, stress,

  • or whatever else it might be.

  • (Laughter)

  • Cognitive therapy helps people identify strategies

  • that might be able to help them distance themselves from a mind that doesn't seem to be able to turn off.

  • How do they stuck up?

  • How do medications and cognitive behavioral therapy compare with one another?

  • Well, the evidence is in, and the results are clear.

  • In the short run, CBTI and medications are equivalent,

  • but in the long run, CBTI is the clear winner.

  • The problem with behavioral therapies is not a lack of evidence that they work;

  • it is a lack of awareness that they exist.

  • You could probably rattle off the names of several different sleep medications,

  • but how many commercials have you seen for CBTI?

  • If you have insomnia, take heart.

  • The odds are squarely in your favor.

  • Your sleep can get better.

  • You can wake up rejuvenated, with mental clarity,

  • who knows, maybe even enough energy to stand up to a bear.

  • (Laughter)

  • But here, I think that what I'll do is I will heed the advice of a great mind,

  • who says that it's more important to know what sort of person has a disease

  • than to know what sort of a disease a person has.

  • So, I know sleep science, but I don't know you.

  • We just met.

  • I don't know you or the relevant medical history

  • that would have helped me design a treatment to help you cure your insomnia,

  • But I can leave you with this:

  • eat healthy, exercise, take care of your body,

  • and do all that you can do to cap it all off with a night of great sleep.

  • Thank you.

  • (Applause)

The early part of my career as a clinical psychologist

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B1 US sleep insomnia treatment bear people behavioral

【TEDx】Understanding "How do I Sleep Better" | Dr. Vyga Kaufmann | TEDxBoulder

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    程名豪 posted on 2017/08/02
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