Blog | Sleep Matters Sleep psychologists Perth Mon, 10 Aug 2020 01:23:38 +0000 en-AU hourly 1 Blog | Sleep Matters 32 32 TELEHEALTH CONSULTATIONS AS EFFECTIVE AS IN-PERSON FOR INSOMNIA Thu, 06 Aug 2020 11:18:46 +0000 Read More]]>

It can feel a little strange to think of having a session with your health professional via an online video session or phone. We’ve become a little more used to this during COVID-19 and there is now more evidence accumulating on the effectiveness of telehealth as a treatment format.

A recent American study suggests that online telehealth consultations are as effective as in-clinic consultations for the treatment of insomnia. This is welcome news for people experiencing insomnia, and especially those who find travelling to the clinic challenging due to work, family, distance, or COVID physical distancing needs.

The study, published in the online journal SLEEP, assessed treatment outcomes for 65 adults with insomnia. They were allocated to receive either in-clinic or telehealth consultations.  The treatment was six sessions of CBT-I which is the gold standard treatment for this sleep disorder.

The study looked at insomnia severity and daytime functioning up to three months after the end of treatment. Results suggested that both treatment delivery formats were effective for insomnia severity and daytime functioning. The positive treatment results held at the end of treatment and also three-month post-treatment. The therapy relationship was also equally positive across in-clinic and telehealth formats.

In addition to being convenient, telehealth allows clients to receive individualised care as they are working with their clinician ‘live’ as they would in a face-to-face consultation. It’s reassuring to see clinical trial results echoing what we are finding in practice, that telehealth can be a simple and effective method of treatment delivery.

The findings in this study are important as they may help to break down barriers to accessing non-drug treatment for insomnia. Many people use medication to assist with insomnia as they feel that therapy is too costly, time-consuming, and inconvenient. Much data is now accumulating to suggest that CBT is not only a more effective long term treatment than medication, but it is cost-effective and, as the current study suggests, can be delivered in a convenient Telehealth format.

Suitability for CBT-I.
In general, people experiencing two or more of the following symptoms for 3 months or longer may have insomnia and benefit from CBT-I :

  • Difficulty falling asleep 
  • Difficulty returning to sleep after nocturnal awakenings
  • Waking up not feeling refreshed
  • Daytime fatigue and reduced functioning
  • Worry about lack of sleep 
  • Low mood associated with sleep difficulties 

What does Cognitive Behaviour Therapy-Insomnia involve?

  • Providing science-based facts about sleep to help people understand what healthy sleep is, and how it is regulated.
  • Understanding the three barriers to sleep and how to manage them.
  • How to optimise sleep routines to fall asleep faster and reduce night-time wakings.
  • Strategies to calm a busy mind and/or tense body.
  • Strategies for improving daytime energy.
  • Reducing worry about sleep.
  • Reducing reliance on sleeping tablets (where appropriate).

We look forward to assisting you towards better sleep online or in the clinic.

COVID-19 Pandemic Dreams: the what, the why, and the how-to manage bad dreams Thu, 07 May 2020 09:52:32 +0000 Read More]]> Researchers around the globe are looking into the phenomenon of pandemic dreams and are finding that people are indeed experiencing COVID-19-related dream changes. According to an ongoing French study, the coronavirus pandemic has caused a 35 percent increase in dream recall among participants, and a 15 percent increase in negative dreams. All over social media, people are reporting bizarre and intense dreams during the pandemic.

Dr Melissa Ree spoke with Jessica Strutt on ABC radio today to discuss in the ins and outs of pandemic dreams. To catch the 6-7 minute audio, scroll to 3hr 7min and 40 seconds (close to the end).

Melissa also spoke with Andrea Gibbs on Sunday 17th May about dreams. Scroll to 33min40 seconds.

Do we all dream? And when during sleep do dreams occur?

A nights sleep can be described as a roller coaster ride where we cycle through different stages of sleep. We might typically have 4-5 cycles across the night with each cycle lasting for around 90minutes. We start the cycle with light or stage 1 sleep which feels rather like dozing.

We usually quickly progress to stage 2 sleep which is a little deeper and the stage that we spend the most time in. This is followed by deep sleep which is hard to be roused from and we know is important for cleaning out brain toxins.

Each sleep cycle ends with a period of REM, or rapid eye movement sleep. This occurs mostly in the second half of the night and is when we dream most vividly. Along with rapid eye movements, and increased brain activity, REM sleep is also recognized by low muscle tone  – in fact, we’re essentially paralysed during REM sleep which is a safety mechanism that ensures we don’t act out our dreams.

So why are people experiencing dream changes during this pandemic?

There are a few possibilities here:

  1. Stress and anxiety:  We’re dealing with lots of worry and uncertainty at the moment and this tends to be reflected in our dreams. Not surprisingly, research has found that the content of dreams becomes more disturbing under conditions of stress. Dreams may be a mechanism through which we process our worries, a form of ‘overnight therapy’. Indeed pandemic dreams are being coloured by stress, isolation, and uncertainty.
  2. Changes to our sleep routine:
    • If REM sleep has been suppressed for a period of time that it will bounce back stronger the next night when the REM-suppressors are lifted. Factors that might suppress REM sleep include sleeping for a shorter duration than usual, alcohol, caffeine, obstructive sleep apnea, or certain medications.
    • If we have conditions that suppress REM for a night or two, then we’ll catch-up with a REM rebound when the REM-suppressing conditions are removed – the REM rebound is experienced as more, longer, and very vivid dreams
    • The most intense bouts of REM sleep tend to happen later in your sleep period (i.e. the early hours of the morning).  During social isolation and working from home, many people are sleeping in a little bit later because they aren’t commuting to work or getting the kids ready for school. The later into the morning people sleep, the more dreaming sleep they are likely to experience.
    • Finally, spending longer in bed overnight can lead to more wakings and this may mean that dreams are recalled because the point at which we’re most likely to wake up is just after the dream at the end of a sleep cycle.

Why are dreams often so bizarre?

Interestingly, the prefrontal cortex which is part of the brain responsible for rational thought, is relatively quiet during REM sleep. This means that the emotional part of the brain is left unchecked during dreaming. This is why lots of usually unrelated ideas can be connected together, creating some very odd scenarios.

 Why is it that sometimes we can vividly remember our dreams and sometimes we can’t?

It’s a little known fact that, we all dream (almost) every night. We tend to only remember our dreams if we wake up during them. We need to be awake for a few minutes for the dream to be encoded into long term memory, otherwise, it’s lost forever.

Do we know much about the purpose of dreaming?

Dreams are likely vital, both psychologically and physiologically. All humans dream, (nearly) every night, but we don’t yet fully understand the function of dreaming and REM sleep.

Some studies show that rapid eye movement (REM) sleep, the sleep stage in which we have the most vivid dreams, is important for, aiding in memory, emotional regulation and learning. Dreaming may also promote neural development by providing the brain with stimulation – this may be why babies dream so much more than adults.

REM sleep is thought to enhance memory. The degree of emotion determines which memories the brain decides are important enough to keep. Emotionally laden memories tend to be the most critical for survival and daily function. You will likely forget mundane details such as what you wore two days ago, but if you see a car crash or you have a fight with your colleague, that’s emotional and it gets consolidated into memory more easily. This might also explain why our dreams tend to focus on emotional (and negative) material. In recent studies of dreams, about 65% are associated with sadness, apprehension, or anger; and 20% with happiness or excitement. 

Trusting that dreams (even the bizarre ones) are there for a good reason and are doing you good may help you to relax about the way they may have changed during COVID-19.

What people can do if they are having some weird dreams or nightmares that they are scared of?

We’d classify dreams as nightmares if they are vividly realistic, disturbing dreams that interrupt sleep. They can lead the person to feel scared of going to sleep, and worn out the next day,

Thankfully there are several interventions that can help:

  1. Remember that bad dreams are usually just a normal response to stress – they may serve an important function  – so while they can be disturbing they may actually be helpful – this mindset may help us to become more accepting of our bad dreams.
    • There is evidence that reminding yourself that this is ‘a dream rather than reality’ may help you to realise this when the dream appears.
  2. Being proactive in Stress management is important. 
    • Balance between commitments and leisure
    • Relationships and communication, asking for help
    • Responding to stressors rather than them accumulating
    • Practice relaxation (eg imagery, progressive muscle relaxation). There are lots of great apps to support this.
  3. Maintain a reasonably consistent sleep-wake routine- (within an hour or so each day).
    • Watch alcohol intake
    • Seek advice about if medications may be playing a role
    • Wind down before bed
  4. Imagery rehearsal training
    • Choose a nightmare you would like to work on
    • Write down the bad dream with as many details as possible, including how you felt during the dream.
    • Change an aspect of the nightmare – how it ends or any other aspect and rehearse the dream with the change
    • Rehearse the new dream before bed, reminding yourself that you can be in control of it.

Of course see your GP, sleep physician or us at Sleep Matters if you feel you need some support with managing nightmares.

Join us for our free online community Q&A series: “From the Couch” Tue, 05 May 2020 09:04:05 +0000 Read More]]>

Join us as leading clinical psychology practices collaborate to bring you answers to common psychological challenges that have arisen as we navigate COVID-19. 
Recent studies suggest that for many people, distress is increasing during COVID-19. The rates of Australians with poor mental health has doubled since pre-COVID-19. Stress, confusion and anxiety are on the rise, while optimism has reduced.
Despite these numbers, there has been a drop in people seeking professional help across public and private sectors. People may be unsure about when and how to seek help and what psychological interventions involve. 
We hope that our From the Couch series will encourage you to take care of your well-being and understand how to do that.
This Q&A series will to provide you with a better understanding of common psychological challenges, demystify what a clinical psychologist does, and give you some takeaway action points to help you or your loved ones in the right direction.
Session Schedule:
1. I can’t sleep! Understanding Sleep and insomnia: May 11th at 7 pm
2. Managing OCD during a pandemic: May 18th at 7 pm
3. Kids and parenting: sleep, school, behaviour: May 25th at 7 pm
4. What if….. one for the worriers: June 1st at 7 pm

Your Hosts:
Clair and Melissa are two like-minded, experienced clinical psychologists based in Perth, Western Australia. They are both involved in and love research and run clinical psychology clinics dedicated to providing gold standard evidence-based treatments. 
Intertwining research evidence with warm and compassionate care is our craft, and we’re super excited about this opportunity to provide a glimpse into the world of clinical psychology.

More about your hosts:
Dr Clair Lawson. Hey everyone, I am a clinical psychologist based in Perth, Western Australia and have been helping people from all walks of life for the past 19 years. I spent the first five years of my career working with children and adolescents within the WA health department. I moved to the private sector in 2007 and established Lawson Clinical Psychology. Our mission is to improve lives through excellence in psychological healthcare. I have a keen interest in the treatment of obsessive-compulsive disorder in adults and children. I am involved in research and training of clinical psychologists. 
Dr Melissa Ree. Hello there. I’ve been a clinical psychologist for 20 years. Following a stint at Oxford University, I’ve been serving the Perth community in private hospitals and in private practice. I founded Jeffery & Ree Clinical Psychologists and Sleep Matters with Paul Jeffery and our clinic has grown to provide care for many West Australians. I’m also a part-time academic at UWA where you’ll find me teaching and conducting research in the field of sleep which is my clinical and research passion. The effective treatment of sleep difficulties such as insomnia brings so many good things to our health and well-being and I’m keen to spread the word far and wide.

Benefits of Telehealth Consultations Wed, 25 Mar 2020 06:54:26 +0000 Read More]]>
Telehealth is easy to use, effective, and convenient


It can feel a little strange to think of having a session with your doctor or psychologist via an online session or phone. COVID-19 is pushing us to be flexible and try new things, and we’re finding some unexpected benefits. We’d like to assure you that our telehealth options are:

  • Simple: just a click on the link we send you and you’re away
  • Secure: we only use top-end software
  • Effective: The research literature and our experience tells us that the benefits are usually just as strong as for in-person consultations.

We’re receiving great feedback about our telehealth sessions from clients.

Further, we’d like you to consider these benefits……

Convenience: Telehealth appointments are an efficient way to continue to work on your mental health goals. Having already met and worked with your therapist it is reassuring to have this contact to talk through the current Covid-19 situation and keep on track with your therapy goals. Whilst other areas of life may need to pause for a moment, you can feel you are maintaining and moving forward with the important work you have started. Most importantly, this only takes the time of the teleconference to do so, rather than having to factor in travel time and time off work.

Comfort: You can do telehealth appointments from the comfort of your own home and whatever the climate. Starting the call is easy, all you need to do is click on the link sent by your practitioner, you will arrive at the virtual waiting room and your psychologist will immediately start your call. You can use your device you are familiar with and don’t have additional charges for the conferencing system.

Confidentiality: was chosen by the practice due to its high level of encryption and security, safeguarding your privacy. When you book your telehealth consultation, we will ask you to sign a consent form and provide emergency contacts which are steps we take to provide additional safeguards in place for you.

COVID-19-Free:  By engaging in telehealth consultations from home you are not putting yourself or others at risk of the disease.

The Australian government are announcing fewer restrictions to the criteria for Medicare rebates by the end of this week – we look forward to updating you soon.

The COVID-19 situation does not need to get in the way of us supporting your wellbeing. Our team is excited to see you online soon.

Treating Insomnia, how can mindfuless help? Sun, 22 Sep 2019 14:05:07 +0000 Read More]]> Research is uncovering mindfulness to be a powerful aid in the quest to treat Insomnia.

In recent years, there has been a huge amount of scientific interest in the benefits of mindfulness to many aspects of health and wellbeing, including Insomnia. After describing what Mindfulness is, we present some interesting summaries of clinical research trials (including one by Dr Melissa Ree from Sleep Matters) that have demonstrated Mindfulness as effective in the treatment of Insomnia. 

What is mindfulness?

Being Mindful is being aware of the present moment in a purposeful and accepting way. Consciously choosing to be aware and accepting, in the moment, of what you are seeing, smelling, touching, tasting, hearing, feeling and thinking. In a mindful state, we don’t think ahead to the future, and we don’t re-live the past, we are aware of and accept the present for what it is. Encouraging the mind to be regularly in this state has a whole host of long term benefits. For those who would like further information I’d suggest Ruby Wax’s book “A mindfulness cure for the frazzled” as a very entertaining and useful overview. Ruby’s definition of mindfulness “isn’t about sitting erect on a hillock, legs in a knot, humming a mantra that’s probably the phone book sung backwards, it’s something that can help us all: learning to notice your thoughts and feelings so you can truly experience life“.

We (human beings) are not very aware of what’s going on a lot of the time, we are often absent minded and running on autopilot (ever forget someone’s name? intended to grab milk on the way home but forgot?). Improving memory is not the only benefit to paying attention mindfully: when mindful we become aware of aspects of life that otherwise may just slide by us, both the good and the bad.

  • Being aware of the ‘good’ means that life is as rich and pleasant as possible (eg. drinking a cup of coffee and really tasting, smelling and enjoying it).
  • Being aware of the ‘bad’ means that we’re in a much better position to take skilful conscious action when difficulty arises. This means that we are less likely to get sucked into old, habitual patterns of reacting when things go wrong or challenging emotions arise. Depression/anxiety/stress/tension can more easily creep up on us when our minds are elsewhere. Left unchecked, these emotions can lead us down unhelpful, well worn paths (eg. snapping irritably at our partner when we are tired).

Mindfulness applied to sleep

One of the biggest barriers to sleep is increased tension. Some people with long term insomnia tell us that they are very tense when they are in bed. Others describe to us that they are no longer tense and rather, are resigned to their poor sleep. The bad news is that when we look more thoroughly, we often find that there is tension there, the good news is that these people do not have to be resigned to a life of terrible sleep. 

When we can’t sleep, the thing we want more than anything is the very thing we can’t seem to get. As we try harder and harder to sleep, we become more tense, and so begins a struggle. The night goes on, our desperation for sleep increases and so does our sleeplessness.  This gap between our present state and where we want to be can bring up a range of unpleasant emotions (anger, tension, anxiety, frustration, helplessness, tears). Mindfulness suggests that we drop the focus on the goal of getting to sleep. Mindfulness offers an alternative ‘goal’. Rather than trying to get to where we want to be, we re-focus attention on where we actually are. We stop trying to fight the situation, and instead accept it without judgement. This is quite a shift in strategy for dealing with sleep problems. It recognises that that frustration/anxiety/resignation about not sleeping are at the core of keeping the problem going. Finding a way to let go of these emotions resolves a large piece of the puzzle of sleeplessness. Mindfulness clears the way for the natural process of sleep and wake to unfold, less hampered by tension. 

The research into the use of mindfulness techniques in the treatment of Insomnia is still developing, but it is gaining traction within the field of behavioural sleep medicine. Next we have a look at what recent research suggests about the benefits of mindfulness to healthy sleep.

What the science says……

There are now many controlled clinical trials that investigate mindfulness in the treatment of Insomnia. Some research is suggesting that it may be as effective as sleeping pills but without the side-effects. 

  • Mindfulness can enhance Cognitive Behaviour Therapy for Insomnia (CBT-I). CBT-I is widely accepted as the gold standard in Insomnia treatment (see here for a blog post on treatment guidelines), and researchers are continually working to understand how best to make this treatment maximally effective. Dr Melissa Ree from Sleep Matters along with colleagues from Murdoch University recently published a study that suggests that mindfulness may be a useful addition to CBT for Insomnia. In the treatment trial, people with Insomnia underwent a standard 4-session CBT-I treatment. Half the participants went on the receive 4 sessions of further therapy, one of these being Mindfulness Based Therapy. The results suggested that receiving 4 sessions of Mindfulness Based Therapy significantly improved outcomes – people slept better and felt better during the day after the additional treatment.  What’s more, it seems that it helped that the additional treatment was not just more CBT. The addition of a different treatment was beneficial for the latter 4 sessions. 
  • Mindfulness alone can be effective as a treatment for Insomnia from adolescence to elderly. Recent studies have investigated the the effects of mindfulness on Insomnia in adults, older adults, and adolescents. ​
    • Mindfulness as an Insomnia treatment in adolescence. An interesting school-based study investigated the effects of mindfulness-based sleep interventions during school time, among a group of year 9 students who were suffering with poor sleep. Following Mindfulness training, the students experienced improvements to sleep (reduced time to fall asleep, better sleep efficiency, and greater total sleep time). 
    • Another recent trial of 54 adults with Insomnia found that mindfulness-based treatments led to significant sleep improvements such as reduced insomnia severity, awake time at night, and arousal levels before bed. Further, the improvement were durable across the 6 month follow-up period. 
    • ​A recent treatment trial of older adults with Insomnia symptoms found that mindfulness led to significant improvements in sleep. Improvements were found in insomnia symptoms, daytime fatigue, and depression.
  • Be mindful during the day to improve sleep at night. A study published in 2014 found that Mindfulness practices during the day are associated with better sleep quality at night. It appears that mindfulness during the day increased people’s ability to detach their mind from daytime business during the evening hours—and this was a factor in sleep improvements.

Interested? Where to next?
1. There are lots of options for getting a mindfulness practice established. Smiling Mind and Headspace are two very good apps to get you going.
2. Mindfulness WA are experts in applying mindfulness to a range of psychological difficulties.
3. The team at Sleep Matters can assist with specific Insomnia treatment that utilises mindfulness practice.

Sleep Tips: Get your sleep routines in order Mon, 11 Mar 2019 15:30:41 +0000 Read More]]> It’s World Sleep Day this Friday March 15th, and to support this we’d like to encourage people to take a step towards building a healthy sleep routine by getting their sleep conditions in order. Give any changes you make a couple of weeks to work. Below are some of the behaviours we help our clients at Sleep Matters to implement.

If you have trouble implementing these, or fid that you are still sleeping poorly, consult with your GP or sleep specialist.

We’d love your feedback and tell how these measures improved your slumber.

See also our printable tip sheet on setting up a healthy sleep routine. 

Have your sleeping conditions in order

Many sleep problems can be corrected by following some simple lifestyle guidelines. Setting up the right conditions for restful sleep can make a real difference. We don’t need to be obsessive or overly complicated with this, but being mindful and sensible about your sleep conditions is a good first step to improved sleep.

Don’t feel you need to follow every step on this list at once, but rather, use this list to help you think about a couple of changes you’d like to make to improve your sleep conditions.

1. Bedroom environment

  • Dark – Pitch black should not be necessary but decent black out curtains or blinds will give your brain the signal that it is sleep time. Do open these on waking in the morning though, as daylight will help you feel more alert and ready to start the day.
  • Quiet – silence is not necessary but working to manage disturbing noises can make a positive difference. For example, double glazing if there is excessive outside noise, or using the drone of a fan or white noise machine to ‘cover up’ other disturbing noises such as partner snoring or breathing. See our blog post on managing noisy partners
  • Cool – research suggests humans sleep best at a reasonably cool temperatures. There is evidence that sleeping in temps above 24 degrees or under 12 degrees can have a negative impact.  Not always achievable in an Aussie summer, but a simple fan can make a significant difference.
  • Restful – can you make your bedroom a peaceful sanctuary? Safe, cosy and with no work pressures or chores visible (eg. files/papers, open computers, laundry piles). Gentle lighting, comfortable, clean, bed linen, a pleasant and relaxing smell (eg, linen spray, aromatherapy). These touches will not cure a sleep disorder, but they may help to establish an association between the bedroom and relaxation.
  • Don’t sleep with the enemy – we suggest keeping the clock or phone out of sight overnight. Checking the time tends to lead to calculations about how much sleep will be obtained (or lost) and this can lead to mental busyness and worry. Read more in our blog post.

2. Watch for Substances that may work against sleep

  • Caffeine – coffee, tea, chocolate, energy drinks. People vary in their sensitivity to caffeine. You can be pretty sure you’ll be free of the effects of caffeine at bedtime if you cease intake around 12noon. 
  • Alcohol –  It’s well known that alcohol may assist with falling asleep faster at the start of the night but it impacts negatively on sleep later in the night. Reliance on alcohol or medication to sleep can also keep people stuck in a cycle of not being able to sleep on their own. Tolerance and dependence can also become problems. An occasional beer or glass of wine with dinner should not present a problem for sleep. Read more here.
  • Medications – if you feel that any of your medications may be interfering with your sleep, check with your prescribing doctor.
  • Food – some people find that a heavy meal too close to bedtime can hinder sleep. Others find that they are sensitive to certain foods. 

3. Only use the bed for sleeping and relaxation sleep

  • When we use the bed/bedroom for activities other than sleep, an association develops between the bed/bedroom and being awake. What we really want for good sleep is an association between the bed/bedroom and feeling sleepy and relaxed. When we are frequently awake in bed, we literally ‘learn to be awake in bed’. The bed becomes a cue for being awake instead of being asleep. We end up tossing, turning, worrying, feeling frustrated, anxious, and alone. All of this tossing, turning and mental busyness is not compatible with sleep: it makes us more alert and awake. The harder we try to fall asleep, the further into the vicious cycle of insomnia we get. (When this goes on, it can develop into what is called Conditioned Insomnia and you can read more about this in an earlier blog post). We suggest to get out of bed if this cycle is occurring. Go into another dimly lit room to settle down, returning to bed once sleepy again.
  • As well as lying in bed trying to sleep, people often find that wakeful activities creep into the bedroom. These include watching TV, phone, computer, tablet use, paperwork, reading for work or study, and eating, to name a few. These wakeful activities have the same problem as tossing and turning in bed – they create an association between wakefulness and the bedroom. Are you able to get these activities into another room and save the bedroom for sleep, sex, and perhaps reading for leisure before bedtime?

4. Wind down Before bed

An important and relatively simple improvement that can be made to your sleep routine is to introduce a wind down period before you turn out your light to go to sleep. This creates a buffer zone between helps the mind and body transitions from the day to sleep. A wind down period may be between 30-60 minutes, and may need to be longer if your day has been physically, mentally, or emotionally demanding. It is unrealistic to expect that you can go from the busyness of the day to bed and fall asleep easily.  It is helpful to still have a wind down period even if you are retiring to bed later than usual – for example if you have been working late or have been out during the evening. Staying up and extra 30 minutes to wind down may mean that it takes you far less time to fall asleep.

Can you brainstorm wind down activities and think about how you will fit them into your routine? What might get in the way of a wind down?

5. Get up at the same time each day

No one likes it when I suggest this, but I keep suggesting it because I’ve seen it help people time and time again.
If you are sleeping poorly and have irregular rising times, establishing a regular rising time can be a great step in the right direction. When we are working to get on top of a sleep problem I tend to suggest no more than 30 minutes variation in rising times.

A regular rising time can act as an anchor for your whole 24 hour sleep system. It often leads to feeling sleeping at a more regular time at night as your body learns what is sleep time and what is wakeful time. Consistent rising time can help prevent the ‘social jet lag’ that people experience when their routines are irregular.

If this sounds like a challenge for you, see this short video and tipsheet below to help you on your way.

Sleep Matters is a team of health professionals in Subiaco and O’Connor, with specific training and experience in helping people with Insomnia. 

2016 Clinical Guidelines recommend that all adult Insomnia patients receive CBT-Insomnia Thu, 31 Jan 2019 13:29:50 +0000 Read More]]> Insomnia is a very common health problem, affecting 10% of the adult population, but it is often viewed as a symptom of another disorder rather than a condition warranting independent clinical intervention.  

Further, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recognised that the previous dichotomy of primary versus secondary insomnia does adequately describe the disorder. Indeed, DSM-5 suggests that ‘Insomnia Disorder’ should be coded “whenever diagnostic criteria are met whether or not there is a co-existing physical, mental or sleep disorder”.

​Insomnia is far from being a benign condition, with high medical, psychological, social, occupational and economic burdens. For example untreated insomnia in the case of depression can increase risk of relapse. Treated insomnia in the context of depression can improve response to antidepressant medication, 1. Further, research has suggested that about half the incidence of depression at 1-year follow-up could have been prevented if the existing Insomnia had been addressed at baseline.

There is much evidence to suggest that Insomnia does not always resolve upon successful treatment of a comorbid condition, 2. Indeed, we know that unhelpful thoughts and behaviours exist in both stand-alone and comorbid Insomnia, and that these should be specifically addressed in order to optimise treatment outcomes. It is important to emphasise that, whereas Insomnia onset may be linked to an event or illness, chronic Insomnia is maintained by specific (psychological and behavioural) factors that are not addressed by treating the other condition.

Insomnia treatment
Peak professional bodies recommend Cognitive Behaviour Therapy CBT-I as the first line treatment for Insomnia. CBT-I has been repeatedly shown in clinical trials to be the most effective long-term treatment (compared to medication and other behavioural interventions).

The American College of Physicians published guidelines late in 2016 that recommend ALL adult patients with insomnia receive Cognitive Behaviour Therapy-Insomnia (CBT-I). 

Our evidence supports this, and we note that:

  • CBT-I is surprisingly cost effective  – For straightforward cases 3-5, 60 minute consultations is common – Gap for patients on a mental health care plan = $65×4 = $260 out of pocket for the treatment.
  • Insomnia and sleep problems are valid referrals under the Medicare Better Access scheme (mental health plans). Conditions covered by Mental Health Treatment Plans is informed by diagnoses in the ICD10 Diagnostic and Management for Mental and Disorders in Primary Care. Insomnia that occurs as part of another condition is eligible as well as Insomnia that occurs in isolation. ICD10 code F51.0 Sleeping Problems.
  • CBT-I works well when combined with sleep medication, 23. A short course of a sleeping medication can provide immediate relief and CBT-I brings about lasting benefit and the medication can be gradually withdrawn. At Sleep Matters, we often implement CBT-I in this context. 

Suitability for CBT-I.
In general, patients experiencing one or more of the following for 3 or more months may be suitable:

  • Difficulty falling asleep 
  • Difficulty returning to sleep after nocturnal awakenings
  • Waking up not feeling refreshed
  • Daytime fatigue and reduced functioning
  • Worry about lack of sleep 
  • Low mood associated with sleep difficulties 

​The Insomnia Severity Index is a normed and validated,  useful screening tool that is quick to administer.

We are happy to receive queries from GPs and other health professionals who are interested to hear if their patient might benefit from CBT-I.

Sleep Matters is a team of health professionals with specific training and experience in helping people with Insomnia.

​For other posts on sleep, Insomnia and it’s treatment, have a look at the Sleep Matters Blog. 
Please also see information about Sleep Matters and the treatment services we offer.

Treating Insomnia to treat depression Wed, 26 Dec 2018 16:17:54 +0000 Read More]]> New research shows great promise in treating people with insomnia and depression, and may ignite new excitement for an inexpensive therapy for these and other conditions.

Previously, researchers and doctors believed that depression caused insomnia. Indeed, poor sleep is a diagnostic symptom of depression with about 90% of people with depression experiencing disturbed sleep. Insomnia was considered ‘secondary’ to the low mood and it was assumed that if the depression was treated that the insomnia would improve too. This does happen in some cases. Not all cases though. More recent research research has found that poor sleep often predates the depression and can be seen as a warning sign for low mood. Might it be that the poor sleep is a factor in causing the low mood?  Many of our clients would nod their heads to this. They describe that chronic sleeplessness has a huge impact on mood, anxiety and overall wellbeing. 

The belief that insomnia is a mere symptom of depression means that the insomnia doesn’t get treated in its own right. We know, however, that insomnia often lingers even after depression has been treated, and that the lingering poor sleep can act as a risk factor for depression down the track.

We now understand that the relationship between mood and insomnia is not one-way but bi-directional, chicken and egg. So for a person suffering with both depression and insomnia, would it not make sense to treat both conditions rather than just focussing on the depression?

Luckily some great research has come out that looks at this issue.

Some really interesting research in the USA has explored the relationships between depression, insomnia, and their treatment.

In one study, a group of 107 participants who suffered with both insomnia and depression received one of three treatments: CBT-Insomnia; antidepressant medication, or  CBT-Insomnia plus antidepressant medication. CBT, or Cognitive Behaviour Therapy is a behavioural/psychological treatment  and is the recommended first line treatment for insomnia. 

The CBT treatment lead to improvements in sleep, both assessed by self report sleep logs and objective sleep recordings. The antidepressant treatment showed mixed results on sleep. Interestingly, the CBT-Insomnia group produced the same positive effect on mood as the antidepressant treatment. This suggests that CBT-I, a treatment focussed on improving sleep, has antidepressant properties.

Another study investigated treatments for people suffering insomnia and depression, and published a  with 3 year follow-up. This study also found that the depression responded as well to CBT-Insomnia as it did to antidepressant medication at 3 years after the treatment. CBT-Insomnia, however, produced more benefit overall when sleep and mood symptoms were considered.

A third study found that CBT-Insomnia enhanced response to antidepressants in a group of participants with insomnia and depression. Adding 4 sessions of CBT-Insomnia to antidepressant treatment brought about greater improvements in both mood and sleep. 

The research thus far has been very consistent in suggesting that a small number of CBT-Insomnia sessions can bring about really positive results for people with both depression and poor sleep.

Sleep Matters is a team of health professionals in Subiaco and now O’Connor, with specific training and experience in helping people with Insomnia.

All I want for Christmas is a good night’s sleep! Mon, 17 Dec 2018 16:31:24 +0000 Read More]]> We know that sleep is essential for health and wellbeing. Sleep supports the immune system, assists physical growth and repair, strengthens memory, and improves mood and wellbeing. Lack of sleep can contribute to feeling irritable, stressed and overwhelmed which are common experiences in our busy modern Christmases. 

It’s common for sleep to deteriorate during the festive period due to increased busyness and stress associated preparing food, buying presents, end of year work functions, completing work tasks before going on leave, kids being on holidays (while you’re still working), travel, entertaining guests, & increased financial pressure. Phew, it’s an exhausting list. 

Add in a large measure of alcohol and an increase in indulgent treats – and you have a time of year that isn’t the kindest on our bodies.

One recent survey suggested that stress related to Christmas is one of the biggest causes of lack of sleep at this time of year – and this is especially the case for women, with a third of women losing sleep because of festive stress.

So how can we respond to festive sleep-stressors in a helpful way? Read on……

Christmas Stress

When stressed, we produce cortisol and adrenaline, hormones that provide energy and help us function through stress. These hormones keep us alert so if they are around in great quantities, are not conducive to a good night’s sleep.

Especially when busy during the day, we’re prone to take our busyness to bed with us. We can feel fatigued before bed, but when the head hits the pillow, worrying thoughts, deadlines, and to-do lists pop up, and then cortisol and adrenaline floods in.

Daytime (not nighttime) is the time for thinking, planning, & worrying.
It’s possible to train the mind to do it’s thinking/planning, & worrying during the day and get it out of the bedroom. Try using a notebook or your phone during the day so that you can write down reminders and worries as they come up. Create 15 minutes a day to quietly sit, reflect, plan and problem solve. Or talk about what is on your mind with a friend or family member.  Revisit your notebook/phone list at this time.

At Sleep Matters, we find this ‘thinking time’ a helpful strategy for our clients. ‘Bottling up’ stress tends to lead to poor sleep.  If you are able to process worries during waking hours they are less likely to pop up whilst in bed at night. What’s more, if they do pop up at night, it can be easier to let go of them if you know you will come back to them during your thinking time the following day.

Stimulus control
If overthinking and stress does get the better of you overnight and you feel there’s no way you’ll be able to get back to sleep, we advise to get out of bed. This is an insomnia treatment technique called Stimulus Control. Get up out of bed and ask ‘what will help me wind down?’  It might be listening to a relaxation app, practicing some slow breathing, adding items to your list to organise the next day, reading a book, or doing a crossword. Once you notice that sleepiness has returned or that you are feeling calmer, return to bed.

Many of us enjoy a tipple or two at Christmas time, but alcohol can negatively impact our sleep. It changes the structure of sleep, so even if you get enough sleep hours, you won’t feel as refreshed when you wake up the next day. Further, getting up to the loo, or feeling dehydrated can be causes of sleep disruption. See our earlier blog post on the impact of alcohol on sleep.

  • Knit one, pearl one’ when it comes to Christmas alcohol consumption. This means, have a glass of water in between every drink. And drink plenty of water before retiring to bed.
  • Avoid drinking on an empty stomach, Even an energy bar, nuts & fruit to help fill your stomach is better than no food at all.
  • Set a time for your last alcoholic drink. Ideally with a space between this drink and when you retire to bed. Tis will allow for a little more processing of alcohol before sleep.

The festive season is a time for travel for many.

Jet lag can be an issue for those traveling across time-zones. While there is no way to completely avoid jet lag, there are ways to overcome it faster, for example by moving your sleep schedule towards the new time zone before you travel.  I love to tell people about Jetlag Rooster – a great resource complete with calculators which can help people plan for traveling across time zones.  Taking short acting melatonin for a few days can also be very effective. 

Sleep is of course essential for people travelling long distances by car. If you feel sleepy whilst driving,  it’s crucial to stop and have a rest or short nap, or swap the driving with another passenger.

If you’ve travelled, are stressed, or have had a few late nights you may benefit from a short daytime nap to keep you going.

However, the guidelines around napping may surprise you. Keep naps short and early. We recommend naps to be less than 30 minutes and 7+ hours before the night-time sleep period. Most people find surprisingly good benefit from even a short nap like this. Check our our earlier blog post for more on naps. 

Nightly wind down (even after a night out)
Creating a buffer zone between the busyness of the day and sleep is really helpful and important for promoting sound sleep.

Before your wind down, write out a to do list for the next day. Then give yourself permission to switch off from planning and problem solving.

For some people the wind down period might be 30 minutes before bed, for others, especially after a busy day, and hour might be needed. This 30-60 minute period is for quiet activity – a shower or bath, TV, reading, a relaxation or meditation exercise or some gentle music. Quiet hobbies such as craft or jigsaw puzzles may also work well. If you engage in the same activity each evening in the period of time before bed it can become an activity that ‘cues’ sleep.

I often suggest to my clients to engage in the nightly wind down even if they have been out and are later to bed then usual. It can take a little encouragement and time for the mind to calm down after the stimulation of socialising. It is often better to carry out your wind down routine than to jump straight into bed which may result in tossing and turning and a long time to achieve sleep. 

Finally, do your best to avoid over worrying about sleep
Remember that disturbed sleep for a night or two, or even a week won’t cause long-term harm – your body is resilient in the face of short term sleep loss.

Make sensible decisions about sleep but don’t ‘over-worry’ about it. Worry about sleep tends to make sleep much worse.

Results are in! Effectiveness of Sleep Matters’ group treatment for Insomnia Fri, 14 Dec 2018 16:38:09 +0000 Read More]]> 100s of clinical trials have lead to the recommendation that Cognitive Behaviour Therapy for Insomnia (CBT-I) be the recommended first-line treatment for Insomnia.

Through 2018, researchers from Curtin University, Dr Clare Rees and Ms Jamie Hardman, have analysed data from the group CBT-Insomnia program developed by Sleep Matters and run through The Marian Centre in Perth, WA. This is important research as it evaluates whether treatments found to be effective in highly controlled research settings are also effective in real-world settings.  Much of the existing research is conducted under very well-controlled conditions in university settings, which is quite different from real-world clinical settings where the complications of being human (such as co-existing conditions and medications) can’t be excluded.

The study included 74 adults who have attended the group treatment program. Approximately 70% of the participants had a a diagnosis in addition to Insomnia. The most common conditions alongside the insomnia were depression and anxiety disorders. The majority of patients were taking medication to help them sleep.

The treatment consisted of four, weekly Cognitive Behaviour Therapy sessions. Groups tended to have 3-6 participants.  

The 4 week program covered:

  1. Science-based facts about sleep to help you understand the range of ‘normal’.
  2. The three barriers to sleep and how to manage them.
  3. How to adjust your sleep routine to fall asleep faster and reduce night-time wakings.
  4. Strategies to calm a busy mind and/or tense body.
  5. Strategies for improving daytime energy.
  6. How to reduce worry about sleep.
  7. The use (and misuse) of light in assisting sleep
  8. How to reduce reliance on sleeping tablets (where appropriate).
  9. Where to find additional support if required (self-help resources, referral for treatment of other sleep disorders such as sleep apnea, individual follow-up for insomnia or related issues such as stress, anxiety, low mood).

The program assisted people with their sleep, but it also helped people feel better in general, which is important, as of course, we want to sleep well in order to feel well during the day. ​The data showed that participants strongly benefited from the program, with large and clinically significant improvements in insomnia symptoms. Insomnia Severity Index scores reduced by an average of 8 points, bringing many patients into the normal sleeper range at the end of the 4 weeks. Further, quality of life improved and so did mood, anxiety and stress symptoms. The results were similar, if not a little better than those seen in randomised controlled trials. The results suggest that CBT-Insomnia is an effective treatment in a real-world setting, in participants with both simple insomnia presentations and more complex presentations with diagnoses in addition to their insomnia.