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Tech for Sleep, Insomnia, and Nightmares (Next Generation Behavioral Health Podcast)

Tech for Sleep, Insomnia, and Nightmares (Next Generation Behavioral Health Podcast)

[Dr. Christina Armstrong] Hello, and welcome
to “Next Generation Behavioral Health”. [Dr. Julie Kinn] Ten-minute tips for modernizing
patient care. [Armstrong] [music] I’m Dr. Christina Armstrong. [Kinn] And I’m Dr. Julie Kinn. [Armstrong] In this show, we review the latest
technology to support mental health. [Kinn] What are we talking about this time,
Christy? [Armstrong] Today, we’re going to talk about
one of my favorite topics ever, which is sleep. [Kinn] That’s one of my favorite hobbies. [Armstrong] [laughter] That’s right. How’d you sleep last night? [Kinn] Great. Great. Because I’ve been working on the “A Better
Night’s Sleep” podcast, and so I’ve been learning lots of really good sleep tips. You all should check out that show too. But today, we’re talking more about technology
to support sleep, right? [Armstrong] Right. Sleep impacts so much of our lives. For the majority of my life, I’ve been a really
terrible sleeper, honestly. I’ve had insomnia, and honestly, up until
I had kids and then I realized, “Oh.” I was doing all the sleep hygiene things with
my own kids. And I realized, “Oh, I can do these things
with myself too.” So now, my sleep is wonderful. Julie, what are some of the bad things that
can happen when we don’t sleep well? [Kinn] The big thing for military populations
that we’re aware of is that it’s a big safety issue. First of all, just like when people are drinking
alcohol, when people are sleep-deprived, we don’t tend to have really good awareness of
it. We tend to overrate our wellness, for example,
when we’re drinking alcohol and we tend to think, “Oh, I could still drive.” And when we’re really tired, we tend to think,
“No. My brain’s working great.” But the studies show us that’s not true. And as a result, we see lots of car accidents
and on-the-job accidents due to sleep deprivation. And so for military service members, we’re
especially aware of this and want to help people understand how to get better sleep
to help with the mission. But of course, there’s lots of issues that
affect civilians as well. [Armstrong] When we don’t sleep well, like
you said, there’s a lot of effects all over in our lives. So on the job, driving, everything. But a lot of what people might notice is increased
feelings of depression, increased anxiety. Not sleeping well is associated with higher
rates of obesity. So when we’re stressed out, our cortisol levels
raise, and we are generally just feeling under more stress and, as a result, usually, go
for the more high-fatty, high-carb things, and we gain weight which puts us at-risk for
all sorts of other health complications as well. [Kinn] Yeah. Absolutely. If you look at just general health conditions,
sleep tends to correlate with a lot of different areas. Like you said, mood, cardiac issues, immune
system. We just tend to get sick more when we’re sleepy. If you are someone who lies in bed trying
to get to sleep and just being very frustrated, then you might want to consider some of these
technologies. And if you’re someone who the moment your
head hits the pillow, you fall asleep, there’s possibility there that you’re overly tired,
and then that’s why you’re falling asleep so quickly. Did you know, on average, it takes about 10
to 15 minutes to fall asleep? That’s a good sign. If you’re lying in bed, relaxing, it takes
about 10 minutes, then you’re doing OK. [Armstrong] And we know that sleep problems
affect a lot of people. So we know about a third of adults report
some sort of insomnia symptoms, and five to 10 percent meet criteria for insomnia disorder. But the great news is, there’s really effective
treatments for sleep problems. One of them is cognitive behavioral therapy
for insomnia. There’s just a ton of research to back it
up. So we want to talk a little bit about a really
great mobile health application that is developed by the Department of Defense and the Veterans
Health Administration called the CBT-i Coach. [Kinn] The CBT-i Coach is fantastic because
it takes the user through all sorts of tools related to traditional cognitive behavioral
therapy for insomnia. Plus, you’ve got the benefit of it being on
a smartphone or mobile device, so you can set your own sleep prescription based on when
you need to be on-duty, based on when your kids are going to sleep, those kinds of things. And it helps you slowly move towards better
sleeping habits. It helps you with sleep hygiene, helps you
with relaxation, and helps you identify the cognitions of thoughts that are keeping you
awake. It is meant to be used with a provider, but
as we learned in our recent episode with Dr. Jason Owen at the VA, they’re developing Insomnia
Coach, which is a self-help app, that by the time this episode comes out might be on the
market. That will help users with some of these tools
that don’t require a clinician too. So I would check out CBT-i Coach just to even
learn about CBT-i and to use some of the tools. And once it’s out, Insomnia Coach, I think,
is going to be tremendously helpful. [Armstrong] Yeah. The CBT-i Coach is one of my favorites. The things I like best about it is there’s
a whole learn section, so if you’re experiencing sleep problems, you can go in there, and even
if it’s not insomnia specific, if you’re just having sleeping problems, you can go in and
look through, “Hey, how is caffeine maybe impacting my sleep? How does alcohol affect my sleep?” How if you’re experiencing symptoms, of maybe
anxiety or post-traumatic stress, how does that play into this whole thing? And so it’s really interesting. And I do love the sleep prescription. And so you enter a sleep diary every day,
and then when you get a few entries in your sleep diary, it comes up with a sleep prescription
for you. It’s a recommendation of what you should be
doing based on how you’re sleeping. One of the really cool things that I like
to do, because I’ve dealt with insomnia in the past and I use this as a tool to help
myself as well as patients, I like to wear — I have a wearable that tracks my sleep
because it’s hard for me. So entering that information in the sleep
diary is great, but I find I cannot remember how many times I necessarily woke up in a
night, but then, with my wearable device, it lets me know, “Oh, you woke up four times.” And then I say, “Oh, that’s right.” And so I enter the data from my wearable device
into the sleep diary. Ideally, that would all kind of flow smoothly
together, and eventually, it will, but for now, that’s how I like to kind of step up
the tech game for tracking sleep. [Kinn] And you make a good point that one
size doesn’t fit all. For some people, the CBT-i Coach is going
to be the tool that just unlocks better sleep. For other people, it could be in-person treatment;
it could be podcasts; it could be other apps, and it could be paying attention to other
disorders that are interfering with sleep like PTSD and post-traumatic stress. [Armstrong] Oh, speaking of PTSD, Julie, a
common problem that comes along with PTSD is nightmares. And so let’s talk about a tool that was developed
to help with those individuals that are diagnosed with PTSD and are experiencing nightmares. [Kinn] Best treatment these days for nightmares
specifically, is imagery rehearsal therapy for nightmares. Prolonged exposure is one of the best treatments
for PTSD. But for patients who really just want to focus
on the nightmares specifically, either they’re due to a specific trauma or they’re just general
nightmares, imagery rehearsal therapy is phenomenal and it’s evidence-based. So we created the Dream EZ app to help with
it, and it’s ream and the letters E and Z. And you’ll recognize it in the store because
it’s got a cute little owl on it. But basically, what the app does is it teaches
you how to do imagery rehearsal therapy. We created it in conjunction with experts
in the field to be used with a provider. But just like the CBT-i Coach, it’s useful
just for learning about the treatment on your own, and there’s lots of self-help tools in
it. So I highly recommend this app, especially
since it can give you a sense of what it would be like to go see a provider about the nightmares. And again, although it’s useful for those
with PTSD, it’s also a good app for folks who just have nightmares not related to a
specific trauma. And the treatment’s good, and the app itself
is very easy to use. [Armstrong] Some things I really love about
this is that all those tools, the recording, all the information on how to do it, step-by-step,
is all in the app. Also, I really love that you can record those
nightmare experiences in the app, and then all your data is safe and secure within the
app and is not just going to be uploaded into the cloud when you connect your device to
your computer. So I love all that, that DoD and VA apps take
that extra special precaution to secure the information that’s inside of it. [Kinn] A thing I like about it is it doesn’t
have you jump right into nightmares. You start practicing the tools with really
innocuous, easy little exercises, and then learn the skill, and then you apply that to
your nightmares. I learned a lot just from testing out this
app. [silence]
[Kinn] Those are the main points we wanted to hit in our “Sleep Technology” episode. But also, our email address is in the show
notes. We want to hear from you and we want to hear
your feedback and your questions. Let us know what’s stopping you or your colleagues
from using technology to help your clients and patients. What questions can we answer for you? [Armstrong] Thank you for joining us today
on “Next Generation Behavioral Health” and learning about sleep technology tools
to support you and your patients. [Kinn] You can connect with us on Facebook
and Twitter @MilitaryHealth. [Armstrong] “Next Generation Behavioral
Health” is produced by the Defense Health Agency. [music]

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