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Gregg D Jacobs, Ph.D.  
Male

Interests: Sleep medicine, Behavioral Medicine
UMass Memorial Medical Center
Sleep Disorders Center
Worcester, MA
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10 additional key tips for improving your sleep

Feb 08, 2009 - 8 comments
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sleep

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Insomnia

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better sleep

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improve sleep

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restless sleeper

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sleep disorder



To view my original 10 tips to Better Sleep entry, visit: http://www.medhelp.org/user_journals/show/47782?personal_page_id=1376

Here are 10 additional key tips for improving your sleep.

1. Research consistently demonstrates that poor sleepers are getting more sleep than they realize. This means that, by recognizing you are likely getting more sleep than you think, you will reduce anxiety about sleep loss and sleep better.

2. It is not just how much sleep you lose that affects your daytime functioning but also your negative thoughts about your sleep loss. Therefore, if you can reduce negative thoughts about sleep loss, you will minimize the effect of insomnia on your daytime mood and functioning.

3. If you wake up and begin your day with a negative sleep thought such as “The day is going to be miserable because I did not sleep well.”, it is the combination of sleep loss and negative mood from this thought that affects your daytime functioning

4. Although research shows that sleep deprivation can adversely affect daytime performance, the effects of sleep loss on performance also depend upon how much sleep is lost and how consistently this occurs

5. No matter which type of insomnia you have, research on insomnia suggests that poor sleepers have a wake system that is too strong and a sleep system that is too weak. Cognitive behavioral therapy teaches you to strengthen your sleep system and weaken your wake system so that you fall asleep and stay asleep at night more easily.

6. Short-term insomnia develops into chronic insomnia as a result of worrying about sleep loss; associating the bed with wakefulness; spending excessive time in bed; trying to “force” sleep; engaging in other disruptive or negative sleep behaviors, such as arising at irregular times; and, experiencing stress.

7. It is important to realize that the effects of sleeping pills are partly due to a “placebo” effect. This means that the effect of a sleeping pill is due in part to you and your belief that the pill will work.

8. Prior wakefulness refers to the number of hours that has gone by from the time you get out of bed in the morning until you turn off the lights at bedtime to go to sleep. The greater the amount of prior wakefulness, the stronger the sleep system and the better you will sleep. Thus, the earlier you get out of bed and the later you go to bed, the better you will sleep.

9. A regular arising time is crucial to establishing a consistent sleep rhythm and amount of prior wakefulness. If you sleep late on weekends or after a poor night’s sleep, you delay the rise and fall in your body temperature, which will make it hard to fall asleep at bedtime. Furthermore, you will reduce your prior wakefulness because you stayed in bed later. This will weaken your sleep system and make it harder to sleep.

10. The more that you reduce the time you allot for sleep so that it closely matches your average sleep duration, the stronger your bed will be a cue for sleep. In addition, the more you reduce the time you allot for sleep, the more you will strengthen your sleep system by increasing prior wakefulness.

Dr. Gregg D. Jacobs
www.cbtforinsomnia.com/mh

To view my original 10 tips to Better Sleep entry, visit: http://www.medhelp.org/user_journals/show/47782?personal_page_id=1376


The development and treatment of insomnia

Dec 31, 2008 - 7 comments

Insomnia is defined as insufficient, inadequate, or poor-quality sleep due to one or more of the following reasons:
• difficulty falling asleep
• difficulty staying asleep during the night
• waking up too early in the morning
• feeling overtired and unrefreshed in the morning

How did you get insomnia? It starts as short-term insomnia. Not being able to sleep for a few days or weeks is normal, especially in response to stressful life events and usually resolves within a few days or weeks. Insomnia that persists for a month or longer is termed chronic insomnia, which can affect you a few nights per week or most nights, and can occur weekly or in a cyclical fashion.

Short-term insomnia develops into chronic insomnia as a result of worrying about sleep loss, associating the bed with wakefulness, spending excessive time in bed, trying to “force” sleep, engaging in other disruptive or negative sleep behaviors such as arising at irregular times, and experiencing stress. As a result, the insomnia becomes a "learned" habit due to these behaviors.

The treatment for chronic insomnia can include the careful use of a sleep medication such as Ambien, Lunesta, or Sonata to break the insomnia cycle. These sleeping pills may temporarily improve sleep for a brief or occasional episode of insomnia. However, the use of sleep medicines is not recommended for the treatment of chronic insomnia for the following reasons:
• They are only moderately effective and lose their effectiveness with long-term use
• They have multiple side effects that can outweigh their benefits
• People can become dependent on the medication
• They do not treat the causes of insomnia
• The insomnia returns when the medications are discontinued

The recommended first line treatment for chronic insomnia is Cognitive behavioral Therapy, or CBT. CBT is based on the idea that chronic insomnia is due to the learned thoughts and behaviors described above that can be unlearned. CBT teaches poor sleepers how to:
• Modify stressful, inaccurate thoughts about sleep
• Modify disruptive or negative sleep behaviors
• Improve relaxation skills
• Improve lifestyle practices that affect sleep

A significant amount of research now suggests that CBT is more effective than sleeping pills for insomnia. Because of these findings, CBT is now recommended as the preferred first line treatment for chronic insomnia by the National Institutes of Health; in reviews in major scientific journals such as the New England Journal of Medicine and the Lancet; and, by Consumer Reports.

If you have a sleep center in your area, they may offer CBT. However, many sleep clinics don't offer CBT because they are directed by physicians who specialize in sleep apnea (see Dr. Park’s forum on sleep-related breathing disorders for a description of sleep apnea). For that reason, CBT is becoming increasingly available online in interactive format. You can visit my website for more information on online, interactive CBT if you cannot find a sleep clinic in your area that offers CBT.

Dr. Gregg D. Jacobs
www.cbtforinsomnia.com/mh

Is Sleep Deprivation a "One Size Fits All" Phenomenon?

Dec 25, 2008 - 5 comments

Although sleep deprivation can have a significant adverse effect on our daytime functioning, it is not a “one size fits all” phenomenon. Recent research has shown that younger and longer sleepers (eight or more hours per night) are more sensitive to the effects of sleep loss. A recent study involving older people (on average, age 58) found that their performance after sleep deprivation was not significantly altered and another  study found that older people (on average, 68 years) appear to need less sleep than younger people (on average, 22 years).  

Besides age, there are significant “trait-like” differences in individual response to sleep loss. One study discovered that while some subjects showed significant impairment in daytime functioning after 36 hours of sleep deprivation, other subjects exhibited minimal impairment.  In addition, because the study involved a group of young, healthy adults, the researchers believe that individual differences in response to sleep deprivation in the real world population of young, middle age, and older adults would be even greater.

These recent findings demonstrate that the effects of sleep deprivation are not a "one size fits all" phenomenon: just as people have different sleep needs, their responses to sleep loss vary significantly.  

It turns out that the effects of sleep deprivation are dependent upon whether a person has experienced partial or total sleep loss; over how many days the loss occurs; whether recovery sleep is possible; and the circumstances under which the loss takes place. Sleep loss in laboratory studies on sleep deprivation, typically  involving only four hours of sleep a night with no recovery sleep allowed for a week or even longer, is far more severe than the more modest sleep losses most people struggle with in daily life.  And sleep loss does not have the same negative effects if the person is motivated to cope with it; for example,  if he or she dealing with a crisis, on call as a doctor, being paid to work long shifts with little sleep, or caring for a newborn. It also helps if the loss occurs under positive circumstances such as a vacation or social event. Of course, because of the stress of lab experiments, it is not clear if stress or sleep loss produces the impairment, but real-life sleep loss can occur as a result of stress. In fact, stress is a typical cause of sleep problems so we don't  know yet if the performance decrements after sleep loss are due to sleep loss itself or the stress that causes the sleep loss.

The bottom line: sleep loss does not always have significant detrimental effects on daytime functioning.

Dr. Gregg D. Jacobs, www.cbtforinsomnia.com/mh


The Eight Hour Sleep Myth

Dec 20, 2008 - 14 comments

Dr. Park’s recent blog in his Sleep-Breathing Disorders Forum, titled “Do you sleep like a rock?, touched on a very important concept that I call the eight hour sleep myth. We have been told for years that more sleep is better and we need at least eight hours of sleep sleep to stay healthy. However, as Dr. Park noted, studies have shown that if your sleep duration is too short or too long, you'll have a higher likelihood of having heart disease or depression later in life.

In fact, numerous studies involving millions of people have now proven that 7 hours of sleep is associated with the greatest health and longevity. Although sleeping less than 7 hours is associated with increased health problems, sleeping longer than 7 hours is associated with more health problems than short sleep. This relationship holds true for not only heart disease and depression but also mortality rates, cancer, obesity, diabetes, and cholesterol.

The bottom line: We don’t have to worry about getting eight hours of sleep for our health. This is why many sleep specialists now recommend that most adults need between six to eight hours of sleep- but some may need less or more.

Dr. Gregg D. Jacobs
www.cbtforinsomnia.com/mh