Differential diagnosis of insomnia
Sound Sleep Guru Blog
by Pia
1w ago
In the medical setting, we separate insomnia into two categories, acute and chronic. Acute insomnia is something that is very recent and might be related to a stressful event like an illness or a divorce. In this scenario, the person might try over-the-counter medications or go see their primary care doctor but eventually, the insomnia resolves. In other cases, the insomnia persists and evolves and here is where having a comprehensive assessment by a board-certified sleep doctor make a difference. At this point, the person has been living with insomnia for several months or years and we call t ..read more
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Sleep Tip Sunday
Sound Sleep Guru Blog
by Pia
2w ago
‍We’ve all been hearing about putting electronics away at night and wearing blue light glasses. However, the underlying problem runs deeper, it starts with a dearth of light exposure during the day, in particular at our wake time and misaligned with our modern “daytime.” In the Pacific Northwest we also have the feature of seasonality where the number of hours of daylight is dramatically shorter as compared to he summer. Many of us wake up leave for work in the dark and drive home in the dark and if we never go outside, never see daylight. Many of us may also falsely assume we work in a very b ..read more
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Mind Racing
Sound Sleep Guru Blog
by Pia
2w ago
Hi guys! Today I want to talk to you about mind racing. Racing thoughts are a real bugger when it comes to sleep so let’s take a closer look at what they are and what we can do about them. Racing thoughts tend to occur when we are sitting alone with our thoughts, in neuroscience we conceptualize this network of regions in the brain as the “Default Mode Network.” The default mode network was first discovered by researchers using functional imaging (PET) to map task specific functions in the brain. They noticed when the subjects were in a passive state this collective group of brain regions woul ..read more
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‍Exogenous Melatonin Use
Sound Sleep Guru Blog
by Pia
3w ago
Hey guys today I wanted to discuss immediate release (IR) and prolonged release melatonin (PRM) and some of the factors I consider when choosing these formulations. The most important factor I consider when determining if melatonin has a role in each case is figuring out what the root cause of the sleep disturbance is. For example, if my clinical assessment is that patient has undiagnosed sleep disordered breathing, melatonin isn’t going to be my first choice for treatment. Unfortunately, thousands of people will continue to self medicate with hypnotics rather than having a sleep study to inve ..read more
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Advancing Sleep Phase w/Melatonin 
Sound Sleep Guru Blog
by Pia
1M ago
One of the useful clinical applications of exogenous (supplemental) melatonin is administering it before typical dim light melatonin onset (DLMO) to shift the bedtime earlier. Advancing = shifting earlier. This concept comes in handy in several clinical scenarios: Delayed sleep-wake phase disorder in teens or adults Eastward travel Daylight saving time Social Jet Lag Chronic insomnia when circadian misalignment is a factor ‍The crux here is determining when DLMO occurs. This can be measured in the blood or saliva with a test or estimated with clinical history, actigraphy, diagnostic sleep te ..read more
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‍4 Strategies For Training Your Child to Stay in Bed and Fall Asleep
Sound Sleep Guru Blog
by Pia
1M ago
‍If keeping your little one in bed is a challenge, check out these posts (linked in my stories) I wrote describing three strategies for training to stay in bed and fall asleep. The Sleep Fairy Reward Chart Bedtime Fading ‍I have one additional strategy that is a favorite called the  “bedtime pass.” The bedtime pass is a token you give to your child which they can use to get out of bed. But if they don’t need to use it, at the end of the week they earn a reward. Remember, a reward, not a bribe. ‍Remember, when you’re child gets up, the most important thing is to remain neutral about it ..read more
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All About Naps 
Sound Sleep Guru Blog
by Pia
1M ago
Last week I attended a fascinating conference on napping. After that, I had to dig in more and decided to dedicate a few posts this week to napping. Naps are an under-utilized tactic to enhance performance and facilitate learning, optimal performance, and mood. First, let’s set the record straight that insomnia and sleep deprivation are different. If you have insomnia, you aren’t necessarily sleep deprived in the manner I’ll be talking about in this post as it pertains to naps. Naps are built into our physiology. It wasn’t until the industrial revolution when workers started getting paid by th ..read more
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Light and Darkness for Sleep 
Sound Sleep Guru Blog
by Pia
2M ago
We humans love predictions. Think about the weather for example, knowing whether it’s going to be sunny, rainy, or snowy is super helpful to planning and navigating the days activities, even in this day and age with our tools. Circadian rhythms likely evolved, at least in part because they help us make predictions. It’s a good survival tactic to be alert and active when it’s light out and to sleep and rest when it’s dark, for example. Circadian rhythms are endogenous rhythms, they exist independently of external cues. These cells in our brains, in the suprachiasmatic nucleus (SCN) are unique t ..read more
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Sleep Tip Thursday
Sound Sleep Guru Blog
by Pia
2M ago
‍It might not seem obvious, but knowing your values and priorities is extremely important for getting a good night of sleep. With so many variables vying for our attention, we have to examine how we spend each moment and prioritize so that we have ample time for sleep. Every day I make a checklist of all of the things I want to get done. I try my best to stay on task and not to deviate (but I always do). I also number my checklist in the interest of prioritizing the items since most days I don’t complete all of the tasks. This helps me to direct my energy to the things that are most important ..read more
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What To Do When You Dread Your Bed
Sound Sleep Guru Blog
by Pia
2M ago
This book has a great title because it aptly describes the conditioned arousal so characteristic of chronic insomnia. And it turns out, cognitive behavioral therapy for insomnia (CBT-I) is applicable for kids too! This book is geared towards older children, listing ages 6-12 as the target audience but I think it’s going to be most effective on the older end of that age rangr. Even for an older child, the best approach with this book would be for a parent to read the book first, making sure they understand all the concepts first (and practicing them would be even better)! I love how fun this bo ..read more
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