Sleep Deprived in Seattle
Why local experts are prescribing fewer sleeping pills despite a growing insomnia epidemic.
By Sheila Cain
July 8, 2012
When Courtney Crocker found herself wide awake and cleaning her house at 4 a.m., she knew she needed a different way to manage her insomnia.
A recent nursing school graduate, Crocker, 30, of Eastlake, had been assigned the night shift at the University of Washington Medical Center’s intensive care unit. Within a couple of months, she was having a hard time sleeping on her nights off. Medication prescribed by her primary care doctor wasn’t working, and her lack of sleep was making her increasingly anxious.
“It would take me five hours to fall asleep,” says Crocker, “and then I’d only sleep a couple hours.”
When Crocker sought special treatment for her insomnia, she had more choices than she would have had only a few years ago. Researchers are learning more and more about the importance of sleep—and the pitfalls of getting too little—and that growing wealth of knowledge is leading to more diverse treatments.
It’s a good thing, too; Americans are more sleep deprived than ever. The National Sleep Foundation recommends that adults get between seven and nine hours of sleep each night, but data from the National Health Interview Survey show that nearly one-third of us are getting six hours—or fewer. The Centers for Disease Control and Prevention (CDC) calls insufficient sleep a “public health epidemic” linked to motor vehicle crashes, industrial disasters and medical errors. Driver fatigue is responsible for an estimated 56,000 motor vehicle accidents and 1,550 deaths each year, according to a 1996 National Highway Traffic Safety Administration report.
The effects of sleep deprivation are getting a lot more personal. Studies are increasingly linking inefficient sleep to health problems such as weight gain, depression, heart disease and diabetes.
The problem is getting worse, and the CDC knows why: The causes lie in broad-scale societal factors such as round-the-clock access to technology and work schedules, as well as an increase in sleep disorders such as insomnia and sleep apnea. There are now more than 70 known routes to exhaustion—at least 72 types of recognized sleep disorders, which fall into seven categories: insomnia, circadian rhythm disorders (mainly affecting shift workers), sleep movement (such as restless legs syndrome), parasomnia (sleep walking), hypersomnia (sleeping too much), and sleep breathing disorders, such as sleep apnea.
And the physical effects of sleep deprivation are getting a lot more personal: Increasingly, studies are linking inefficient sleep to health problems such as weight gain, depression, heart disease and diabetes.
HOW TO SLEEP BETTER
The goal of Catherine Darley, N.D., founder of The Institute of Naturopathic Sleep Medicine, is to help her patients shape actions to support sleep physiology. In other words, she helps change habits that keep people from falling—or staying—asleep. Her most common suggestion to people struggling with sleep is to take time—typically 30 to 40 minutes—to wind down before getting into bed. This doesn’t mean checking Facebook or emails. The light emitted by computer screens suppresses sleep-inducing melatonin; the computer itself stimulates thoughts and emotions. Rather, engage in an activity that’s not task oriented, such as knitting or taking a bath, and do it in low light so your melatonin soars. >> And for those who wake up—and stay awake—in the middle of the night? Whatever you do, don’t look at the clock. In fact, Darley suggests turning the clock toward the wall before you go to sleep to avoid the temptation. “A clock increases the performance pressure,” says Darley. “People will wake up, do the math and panic that they’re not going to have enough time for a good night’s sleep.”
Just 10 years ago, Crocker’s treatment would have likely ended with a sleep aid prescribed by her general practitioner, or a night at a sleep lab to rule out sleep apnea. Instead, she eventually found herself at a naturopathic sleep medicine clinic, where she learned behavioral techniques to help her get a restorative night’s sleep and ease the anxiety that often comes with insomnia—without the aid of prescription pills.
“There’s been this growing body of research showing that cognitive behavioral approaches for insomnia work better in the long run,” says Catherine Darley, N.D., founder of The Institute of Naturopathic Sleep Medicine in downtown Seattle and the doctor who eventually nailed Crocker’s sleep issue. Since 2007, Darley has been helping patients kick insomnia, adjust to shift-work schedules and basically get a restorative night’s sleep by examining their lifestyles, stressors and habits. A typical course of treatment includes three or four visits during which she helps her patients understand the emotional issues surrounding their sleep problems and offers a number of behavior-modifying exercises to help them snap out of their sleep-depriving habits. When behavioral approaches don’t work, she tries nutritional supplements and herbal medicine to improve sleep. She doesn’t prescribe drugs, and rarely has to refer patients elsewhere for medical management of their insomnia. “There’s a place for medicine, but not as a good frontline treatment,” she says.
If Darley’s patients show signs of sleep apnea or sleep movement disorders, she’ll refer them to a sleep lab or clinic for overnight sleep testing. But Darley has found that more and more patients are coming in with complaints of sleepless nights caused by overwork, worry and stress—lifestyle issues that can be addressed through behavior modification, often called cognitive behavioral therapy (CBT).
Crocker came to Darley and CBT after other attempts to solve her insomnia failed. Her general-practice doctor suggested four different types of sleep medications, all of which worked for Crocker for a while—and then didn’t. She was referred to a psychotherapist for anxiety, which she says only made the situation worse. She visited a sleep clinic, and the specialists there gave her Darley’s name.
“My primary care doctor gave me a printout of things to try, then told me to go home and do them,” Crocker said. “With Dr. Darley, we worked on a very individualized plan that was specific to me.”
Darley put Crocker on a regimented sleep schedule to help even out the inconsistencies of her erratic work schedule. She also encouraged Crocker to keep a journal of her habits and emotions to help her better understand the mind-body connection. Crocker said she started sleeping better after her first session.
A shift in approach
While Crocker’s path to a better night’s sleep was circuitous, the fact that she eventually found a fix is proof that providers are recognizing the prevalence and seriousness of sleep problems—and that the best solution might not always be found in a prescription pill bottle.
“Sleep medicine as a field is changing,” says Lina Fine, M.D., a neurologist and psychiatrist who works as a sleep specialist in Swedish Medical Center’s Sleep Medicine Program. “There’s been a big transformation among medical doctors. They are more mindful of what practitioners of cognitive behavioral therapy have been doing for years.”
Case in point: Swedish has begun offering a formal CBT program for insomnia, in which patients meet in six to eight weekly sessions without the introduction of any sleep medications. This is appropriate for patients who are motivated to get off their sleeping pills and pursue a behavior program, says Fine. Swedish’s program is expected to expand over the next several years.
Priya Oolut, M.D., medical director of the Diagnostic Center for Sleep Health at Pacific Medical Center, says specialists there choose to address behavioral or environmental factors over prescribing drugs in the vast majority of cases. More and more of her patients are coming to her already aware of the various treatment options available to them, she says, and are often referred by their primary care doctors.
“The change is at the primary care level,” says Oolut. “We’re definitely seeing that our primary care doctors are not automatically reaching for a sleep aid, but instead, referring their patients to a specialist.”
But for some, medication may be the answer. Those suffering from the effects of a traumatic event or the death of a loved one, for example, may be good candidates for the immediate relief sleeping pills often provide. “Therapy may not always help overcome the grief or suffering,” says Oolut. “Our goal is that patients are getting a good, restorative sleep. If that means we have to help them with medication, that’s what we do.”
SLEEP SPECIALISTS IN SEATTLE
Here’s a list of this year’s Top Docs who specialize in helping people get their z’s.
Cynthia Anonsen, M.D. Bellevue Ear, Nose and Throat Clinic
Preteem Bandla, M.D. Swedish Sleep Medicine Associates
Edward Carter, M.D. Pediatric Pulmonary and Sleep Medicine
David C. Chang, M.D. The Polyclinic Sleep Medicine Center
Morris Chang, M.D. Auburn Region Medical Center Sleep Clinic
Maida L. Chen, M.D. Seattle Children’s Hospital Pediatric Pulmonology and Sleep Medicine
William De Paso, M.D. Virginia Mason, Seattle Main Campus
Ronald Gibson, M.D., Ph.D. Seattle Children’s Hospital Pediatric Pulmonology and Sleep Medicine
Ronald J. Green, M.D. The Everett Clinic
Steven H. Kirtland, M.D. Virginia Mason, Seattle Main Campus
Gandis G. Mazeika, M.D. Sound Sleep Health
George Makari, M.D., Mary Bridge Children’s Hospital & Health Center
Kimberly A. Mebust, M.D. MultiCare Neuroscience Center of Washington
Frederick E. Pascual, M.D. The Everett Clinic
Christine Puig, M.D. Ear, Nose, Throat and Plastic Surgery Associates of the South Sound P.S.
Bonnie W. Ramsey, M.D. Seattle Children’s Hospital Pediatric Pulmonology and Sleep Medicine
Gregory J. Redding, M.D. Seattle Children’s Hospital Pediatric Pulmonology and Sleep Medicine
David Russian, M.D. Western Washington Medical Group
Daniel Seely, M.D. Bellevue Ear, Nose and Throat Clinic
Sarah E. Stolz, M.D. Swedish Sleep Medicine Associates
Mark E. Whipple,M.D. Harborview Medical Center, Otolaryngology Clinic
Originally published in Seattle magazine.