Author: Cathy Collyer

I am a licensed occupational therapist, licensed massage therapist, and certified CBT-i sleep coach in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment. It has been a joy to help people of all ages improve their ability to grow and thrive! Occupational therapists are focused on enhancing a client's functioning in everyday life. We are practical healthcare providers, interested in teaching, adapting actions and environments, and building a client's useful skills for living their best life, regardless of their challenges. I am the author of five books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training the Autistic Child". I lecture on many subjects, including sleep, trauma, and development. Contact me to learn more about how I can help you achieve YOUR goals!

What Depletes Your Melatonin Levels?

Actually, quite a lot of things.

Why should you care?

Because Melatonin is a neurohormone that supports sleep at night.  If you don’t have enough of it, you might have to resort to being sedated or exhausted in order to sleep.

In addition, Melatonin improves the quality and depth of our sleep.  Hours and hours of light sleep are seen in a “club” nobody wants to belong to:  patients with dementia!  The research on the benefits of high quality, sustained sleep with sufficient periods of deep sleep is piling up as we speak.  We aren’t certain that poor sleep causes dementia.  We know that no one with dementia displays healthy sleep, even if they seem to sleep all day long!

Nobody thinks that being sedated, exhausted, or demented sounds like a good deal. 

Here is an incomplete (but still impressive) list of the ways that Melatonin can be depleted:

  1. Age.  The pineal gland produces the Melatonin that supports sleep (your gut produces Melatonin too) and it calcifies in most of us as we age.  
  2. The prescription drugs we take:  Cardiac meds, NSAIDs for pain, SSRIs and SNRIs for depression and anxiety all decrease the production of or the accessibility of Melatonin for sleep.
  3. The recreational drugs we take:  Caffeine, alcohol, and tobacco suppress and therefore decrease Melatonin.  You don’t get a rebound once you sober up or put out your smoke.
  4. Sleeping with the lights on.  Even a dim light will reduce your Melatonin.  This is why every article mentions blackout curtains as a sleep strategy, and why eye masks work.

What can you do?

Well, you can reduce the risks above by discussing your prescriptions with your healthcare providers.  Relying on medications when there are non-pharmaceutical strategies to manage symptoms is a mistake.  Try to build out your toolkit so that you get relief from a number of sources.  Reconsider your recreational drugs.  And replace your lights with motion sensor lighting that eliminates blue light.  Turn the devices with lights away from your bed.  Or plug them into a strip that you can turn off in one motion.

Small amounts of Melatonin supplementation aren’t dangerous for most adults.  Not all.  And definitely children need special considerations from a licensed provider.

If you are also taking a sedative like Lunesta, have a medical condition that causes you to awaken very groggy or even dizzy, or are taking blood thinners or daily steroids, please discuss the use of Melatonin supplements with your healthcare providers.

Time-release formulations have the potential to be more effective for getting a deeper full night’s sleep for adults that can get at least 6-7 hours of sleep per night.  Less than 6 hours of sleep risks excessive grogginess on awakening.

Want more help with YOUR sleep?  Contact me for a complimentary consultation to determine if online sleep therapy, on your schedule, is right for you!  Go to the Contact Me section on the Menu, and send me a message today!! 

get good sleep

When Your Creativity Disrupts Your Sleep

dream signSome of my artistic/creative sleep coaching clients report that they wake in the middle of the night with ideas that they simply must get up and process.

Their sleep is never the same that night.

When this happens too frequently, they develop a diagnosable sleep disorder.  Usually a form of insomnia.

I haven’t ever heard a sleep physician address it in a training video or in a research article.  If one of my readers knows about a piece, I would love to read it.  This is a different problem from someone who stays awake creating and gets too little sleep because of it.  It also isn’t the same as someone who wakes early to take advantage of the peace and quiet in their home to write or create in some other way.

This is fracturing the sleep cycle in the middle of a REM sleep stage.

We know what is lost when you break up REM sleep.  The valuable dream sleep that would continue to fuel emotional processing is damaged.  The physical relaxation from the “paralysis” of REM sleep is lost too, contributing to chronic muscle and fascial tension.

An artist that gets up in the middle of the night, worried that if they didn’t act on the ideas that came to them in the night, could wake feeling physically worse and irritable.  This isn’t conducive to great art, or to a great life.

help signSo…what can creative people do when they wake with an idea?

  • Scribble it down and let it go.  The creative brain is always working.  Those wonderful ideas will float back from your scribble.  You do not have to flesh it out at 3 am.
  • Learn better methods of getting back to sleep.  Being able to detach from your thoughts, all thoughts, and go to sleep is a skill.   Just like painting or writing.  A skill.  One you can develop.
  • Make time during the day for creativity, and be efficient about it.  If you haven’t done so, your mind will be more likely to use your REM sleep stage to burst forth.  It will cost you in ways that erode your health and your pleasure in both creating and sleeping.  If you don’t know how to efficiently bring forth your creativity in daylight, then build this skill.  Scheduling creativity sounds like the antithesis of what it means to be an artist.  It is the opposite.  All great artists developed strategies to produce and work well.  You can too.

fingerpaint flowers

Is your Bed Partner Kicking You While Sleeping?

attentie-attentie-ig7vN6OkGNE-unsplash

One of my recent sleep coaching clients reported that their partner frequently keeps them awake with their extremely restless sleeping.  My suggestions were to consider using the guest room more often and asking their partner to speak with their physician.

There are medications and conditions that can cause this behavior, and severe sleep problems by themselves can cause or increase it.  When it is chronic and increasing in severity, it has to be addressed or you could get socked in the eye or worse.  Really. 

What I did NOT say is that there is a sleeping disorder characterized by very aggressive physical behaviors only while sleeping that has a high degree of accuracy in predicting a future diagnosis of a degenerative neurological disorder.  It is called REM Sleep Behavior Disorder.  It can begin with a preliminary diagnosis of Periodic Limb Movements of Sleep.  Both are much more common in people over 65, and both require medical treatment, not a bigger mattress or a pair of boxing gloves.

dream catcher

This degree of physical activity while asleep is NOT the same as someone who rolls back and forth while sleepless, or someone who gets up to use the bathroom 4x/night and collapses back into bed( both annoying!).  

This sleep disorder is characterized by an extreme degree of movement.  Bed partners use the words “violent”,  “aggressive”, and “dangerous”.   It has to be persistent over time, and it has be be unrelated to domestic violence, mental illness, and severe alcohol use.  It can be related to a current infection or taking a new medication, but REM Sleep Behavior Disorder doesn’t go away when the medication is stopped or the illness resolves.  

It isn’t Restless Leg syndrome, even though people with this disorder move about quite a lot.  Those patients have this behavior while awake in bed as well as while sleeping, unlike people with Periodic Limb Movements of Sleep, who display this only while sleeping.  But the level of activity, including the aggressive actions while asleep, make REM Sleep Behavior Disorder far more concerning.  

What should you do if you think your bed partner has Periodic Limb Movements of Sleep or REM Sleep Behavior Disorder?

  1. Consider sleeping in the guest room.  You need good sleep, and if your bed partner does receive a diagnosis of a neurodevelopmental disorder in the future, you will need to be well-rested to deal with it.  If you are concerned that physical intimacy or emotional closeness will suffer, get in front of that during the daytime hours.  Make plenty of time for sex and warmth then.
  2. Consider recommending that they get in front of a neurologist and a sleep doctor.  This isn’t something that is going to change with better sleep hygiene or even with CBT-i.  The medications used for these disorders are often those for nerve/seizure disorders and possibly those for Parkinson’s disease, and they can help.  They have to be carefully prescribed to avoid creating other problems.  And they have to be monitored.   There is a chance that your bed partner is having another medical issue or experiencing serious side effects from a combination of medications, so this means you need to speak with your provider(s).  Getting results means getting professional help.
  3. Getting your partner out into early morning light and becoming slightly more physically active might help, and neither of these actions should be harmful for them.  Age weakens the circadian rhythm in all of us, so making the signals stronger are easy ways to improve everyone’s sleep.
  4. Encourage your bed partner to avoid alcohol and explore any OTC medications that could be contributing to Serotonin syndrome.  This syndrome occurs most often when SSRI medication dosages are increased or start out too high, or when an OTC medication like cough syrup is taken at the same time as an SSRI.  Both alcohol and SSRI medications can act on REM sleep stages to contribute to more intense, frightening, and active dreaming.

bogdan-yukhymchuk-XmvuWRDimrg-unsplash

Want more information on sleep coaching for yourself, so you are able to optimize your own sleep while your bed partner gets checked out?  Get in touch with me!  Our initial conversation is free!  You will learn more about my approach and about how to improve your sleep.

Go back

Your message has been sent

Can Your Sleep Tracker Make Your Sleep Worse?

cropped-orange-ocean-sunset-1.jpg

If you are the type of person who becomes more anxious when you Google your headache symptoms, or fixates on whether your retirement fund went up a percent or down a percent…you probably aren’t a candidate for a sleep tracker.  It could make your sleep issues worse, and that can happen more quickly than you realize.

Why?

stethoscope with heart

Because the information from a wearable device or the app on your iPhone isn’t as actionable as the designers want you to believe it is.  After all, that doesn’t move products.  You will have a lot of data to digest, and some of it is useless, some of it is helpful, and some of it is only valuable when looked at in the context of your day, your week, and with your attitude attached to it. When the device assesses the data, it is making assumptions about you.  You, and your sleep issues, are probably more unique than they think.  The stress of not knowing what to make of the data, or getting it wrong and taking useless or counterproductive actions, could mess with your sleep.

What good sleep looks like isn’t distillable to only the data.  This is why getting a polysomnograph at a facility that does sleep studies doesn’t tell you how to fix your sleep.  It simply doesn’t.  More often, your data tells the clinicians about what you don’t have.  Nice for them to know.  You don’t have OSA, and you don’t have a neurodegenerative disorder.  You still sleep poorly, and you still want help for your sleep.

Understanding the psychology of sleep, as well as the biology of sleep, will help you more.  And if you are someone that has to do things “right”, worries that every cough is TB, or whose day is sunk when you calculate that you slept less than the recommended 7.5 hours…toss that tracker in the nightstand drawer.  It could make you stay awake tonight, wondering if your sleep issues are killing you, making you a bad parent/partner/friend/employee, or if those numbers are an indication that you already have some dread disorder.

Want to feel good about yourself and your sleep?  

Do sleep coaching with me!

 

Go back

Your message has been sent

What to do About Your Sleep When Your Bed Partner is a (Real) Dog

dog sleeping

I slept with a pet for decades.  It was both cozy AND crazy.  Paws in my face and hair.  Other parts ended up in my face too.  Parts that you wouldn’t typically want staring at you.  It didn’t destroy my sleep, but it didn’t optimize it either.  Then I became a sleep therapist and started wondering more about what effects sleeping with a pet had on my health.

Some people swear that they sleep better when they have their pet in bed with them.  They feel safer, calmer, etc.  And I do believe that they receive this psychological benefit.  Sometimes it is also a practical benefit.  Dogs, particularly, are both space heater and armed guard.  Cats?  Not so much.  They offer more psychological support, but it is support nonetheless.  But what we think is good for us and what is happening physiologically can also be opposites.  Pets can damage the quality and the quantity of our sleep without us being fully aware of it.  Blaming the garbage truck, another bed partner, or our full bladder for our insomnia might be off the mark.  It could be our pet that is both our emotional support AND our source of sleep problems.

kate-stone-matheson-uy5t-CJuIK4-unsplash

Some people are aware of exactly how their pet damages their sleep by waking them repeatedly, or by making it harder to be comfortable in bed.  And being physically uncomfortable will always damage your sleep.  Sleeping with creatures that don’t share our physiology means we automatically create challenges.  Dogs are biphasic sleepers, meaning that they sleep with longer breaks in between.   Breaks in which they want to eat, poop, pee, or play.  Cats are nocturnal animals.  They are sleeping with us by choice (no cat does anything because they are told to!), not by following their true nature.  They choose to synch with our schedules, but their biology compels them to want to be up and active when it is darkest out.  They sleep a great deal during the day to compensate for the deep restorative sleep they aren’t getting in our beds.

What can you do when you know that your pet is damaging your sleep?  You could find another way to feel cozy and connected, just like you do when you teach your kids to sleep in their own beds.  Boost the daytime warmth and develop increasing interest in their own pet beds, while you work on feeling good about being separated from them for the night.

There are pet beds that are really wonderful for your pet.  Cats love warmth, so a heated bed strongly appeals to them.  These can be plug-in or use a microwaved insert that stays warm all night.  Both big and little dogs can sleep next to your bed in a clever bedside table/dog bed combo that even comes with a step for older dogs!

61PzCGRHDWL._AC_SL1001_

Retrain your brain, instead of using willpower and self-criticism:

Make waking and rejoining the “pack” less of a treat so that both of you don’t inadvertently train your brain to sleep lightly in anticipation of the emotional boost.  Your pet might embrace the habit of a late snack right before  going into their own bed, instead of climbing into yours.  Make the morning run with your dog or the evening cuddle with your pet a thing you really look forward to.

Need more help with your sleep and your bed partners?  Contact me!

Send me a text or an email by going to the menu and clicking “Contact ” today.

There is no charge to discuss whether sleep therapy is right for you.  Working on your sleep will change how you feel and how you think about your life.  It is never too late to improve your sleep, and it is an investment in yourself.

We will come up with a plan that makes ALL of you feel good about sleep!

Will A Nap Wreck My Sleep?

hammock

There seem to be two cognitive-emotional camps on this subject:

The Never-Nappers:  Naps are a sign of illness and infirmity.  Take a nap and risk destroying your sleep forever.

The Always-Nappers:  Naps fuel creativity and health.  They are the source of greater productivity and accomplishment.

Will a nap wreck YOUR sleep?  It depends…

  • Are you ill?  Wanting/needing to sleep when you have an acute illness like COVID or the flu is nature trying to heal your body.  Take a nap and let your amazing immune system do its job.
  • Are you jet-lagged?  You would do better to try to jump into the time zone you landed in, and go to bed as close to your regular bedtime.  The exception is if you are so sleepy that you would crash that rental car or injure yourself on the slopes.  Take a short nap to prevent disaster.
  • Are you sleep-deprived?  This can happen if you sleep a lot of hours but get poor quality sleep.  And it can occur at any age.  You could benefit from a short nap.  And I mean short.  And scheduled.  Your attention and productivity could improve with an early afternoon nap of about 20 minutes. Try to do this every day at the same time each day.  Your brain expects it and doesn’t see it as a damaging one-off to your circadian rhythm.
  • Are you an insomniac?  You would do better without a nap.  Every nap removes the buildup of adenosine in the brain.  That is the neurochemical that makes you sleepy at night.  Nap and you drain out a lot of beneficial adenosine.  If you are sleepy, get up and get active in sunlight instead.  Play  music.  Do almost anything active.  You want to be sleepy tonight. 
  • Are you a super early bird or super night owl?  You already struggle to be awake when most other people are happily awake, and struggle to sleep when they are fast asleep.  Taking a nap probably won’t make things better and get you more in synch with everyone else.  It could make you an insomniac bird/owl.

breathing trauma

Life can be hard.  Sleep should be easier.

Need more help with your sleep?  Click on the Contact page above, and send me a text or an email to schedule your complimentary consultation.  Let’s talk about your sleep issues and my consulting program.  Let’s get things going better for you right away.  

Are There Alternatives to CPAP?

ghordianknot

Short answer: Maybe. Under certain circumstances.

Longer answer: How you manage your breathing, your diet, your schedule, and even what position you sleep in can make a difference!

If you have severe obstructive sleep apnea, you probably don’t have an equally effective alternative to CPAP. And you need to get in front of this thing. It can really damage your heart. Sorry. You will have to make peace with this appliance. It can be done. I promise to write a post on that soon!

If your obstructive sleep apnea is mild, and you are certain that you don’t have a form of central sleep apnea, (your brain is stopping you from breathing while asleep), there are some alternatives less disruptive than CPAP, stomach stapling, and getting a divorce from your bedmate.

baby surprised in upright

 

  • Try sleeping on your side.  Your tongue and your uvula (that thing that hangs down in the back of your throat) are less obstructive in this position.
  • Avoid drinking alcohol at night.  The sedative effects of alcohol can make the tissues in your throat floppier, creating more of an obstruction.
  • Eat a lighter dinner and a bigger lunch.  Filling your belly late at night and then thinking that it won’t make it harder to breathe isn’t logical.
  • Make sure you aren’t congested.  Use a saline nose spray and perhaps use a humidifier if your central air system can’t moisturize the air well enough.
  • Get enough sleep.  This is a desperate cycle, in which short sleepers eat more and want to use alcohol to quell their anticipatory anxiety around insomnia.  Work on all the other aspects of your sleep to boost both the quality and the quantity.  

You should always discuss any type of treatment for sleep apnea with a trusted medical provider.  Not every idea is a good one.  Not every strategy is as safe as it seems.  

Many of my clients are surprised when they discover that strategies that seem innocuous could harm them.  Weighted blankets, for example.  If you have osteoporosis, placing something heavy on your bones when you are unconscious isn’t smart.  Or magnesium supplements;  it is possible to buy the wrong type.  There is a formulation of magnesium supplementation that easily gives you diarrhea.  Talk about not being able to sleep;  you could end up seriously dehydrated and admitted to the hospital overnight for IV fluids!  

Pay attention to the responses you receive from your healthcare providers when you mention alternative strategies to address mild OSA.   Their responses will vary from dismissive to open and curious to rapidly enthusiastic.

 Beware the dismissive provider as well as the immediate embracer.  Neither of them are giving your ideas enough attention.  The best responses are either in the category of “I will investigate and get back to you.” and “Here is what I know about your diagnosis and symptoms that makes me concerned about/interested in  the X approach.”   

guy-on-phone

 

Want to do sleep coaching with me online?  I  make it easy !  Go to my “Contact ” page and send me an email today.    

We work on your specific sleep goals together, using the latest techniques drawn from sleep science and behavioral health.  

Don’t compromise…optimize!

get good sleep

If I Easily Fall Asleep After Drinking Coffee, What’s the Problem?

Your sleep quality.

breathing trauma

Being asleep is one thing.

Getting optimal benefit from being asleep is another.

Sadly, your sleep after consuming caffeine can be scientifically assessed and found to be lacking in quality instead of quantity.  That matters.  It is the equivalent of eating snack food for dinner.  You will only know this about your sleep subjectively by  feeling unrefreshed when you wake up, feeling tired at a point in the day much earlier than you would expect, or seeing other signs of fatigue like forgetfulness or clumsiness for no other reason.  Assuming that you are getting older or that your job is overwhelming you could be incorrect assumptions.  

Your evening cappuccino or soda could be the cause, or a least the biggest contributor, to a rough day after a full night of sleep.  

You were tired enough to fall sleep easily, and you may not recall awakening briefly during the night.  Your brain remembers.  Somnography (where brain waves are measured, along with muscle tension, heart rate, etc.) tells the story of your liver’s efforts to process caffeine during sleep. Caffeine is particularly damaging to the deep sleep phase.  This is the phase in which you get the most help solidifying information learned the day before, reap the greatest cardiovascular and neurohormonal benefits of sleep, and clear out the detritus of brain processing through the CSF’s housekeeping functions.  That last one is the effect suspected to be neuroprotective against Alzheimer’s disease.

OOPS.

The half-life of a caffeine is 6-7 hours.  The quarter-life is 12 hours.  Even in people who are genetically-fast metabolizers of the drug, it matters.  This means that some caffeine from your lunchtime coffee is still in your system at midnight, working its way through your bloodstream and into your brain.  If you want to get the full benefit from your night of sleep, reconsider your PM coffee or tea.

dream catcher 

Should You Use a Light Box to Improve Your Sleep?

sunflower purple bkground

Here in the northeast, it gets pretty dark pretty early these days (late November).  The days can be rather gray as well.  For people in higher latitudes, the days are even shorter.  SAD (seasonal affective disorder) has already begun for those who are vulnerable to this issue.  They often sit in front of a light box to life their mood.

But what if you don’t have SAD.  You feel mentally fine.  Your sleep isn’t terrific, and you have heard about getting enough full-spectrum light exposure in the morning to support a strong circadian cycle.  In the northeast, you could wait all day for the sun and go to bed having never seen it peek out.

Should you get a light box?

Not necessarily.

Light boxes aren’t prescription-only.  You can grab one on Amazon and it will be at your doorstep in a few days.  You should know, however, that they do create risks for certain people, and aren’t helpful for even more folks.  Most of us get far more sun exposure by going outside than using a light box for a short period in the morning will provide.  Access to sunlight at the right time of the day should be sufficient for most people.

Light boxes need to be used at the right time of day to get the right results.  Most people with SAD, depression, and advanced sleep phase disorder use them within 60 minutes of awakening.  Use later in the day can push bedtime far later into the night.  Using them inconsistently, for short periods of time, walking too far away from them during use, even turning away from them will make them ineffective.

Clinicians struggle to do research on light boxes because getting people to use them consistently and correctly is harder than simply handing out a pill.

dream catcher

Who should not use a light box without checking with a physician?

  • Anyone with diagnosed retinal disorders.  This isn’t nearsightedness.  This would be macular degeneration and a few more things.  Most people over 65 should speak directly with their eye doctor as well as their PCP.
  • Anyone with bipolar illness.  Strong full spectrum light can trigger a manic episode in some people.  It isn’t the most common reaction, but because the cost of a manic episode can be high, a physician should be involved in choosing a protocol and monitoring use.
  • Anyone that has a history of light sensitivity, including people with brain trauma, seizure disorders, etc.  You have a lot to lose if things go south.  A physician can help you decide what your risks are.  Most clinical-grade light boxes filter out about 99% of UV rays.  But that doesn’t mean ALL light boxes you can buy on Amazon do that.  The clinical-grade light boxes run 3-4x the price of the cheapest boxes, and you get what you pay for.
  • Anyone with conditions that can create retinal damage, such as diabetes.  You don’t have damage yet.  You don’t want to risk developing some.
  • Anyone taking medications that render them more sensitive to light.  This includes some antibiotics and seizure medications, but the list is far longer and includes some very common antidepressant meds and NSAIDs.

Who could benefit from using a light box?

People with circadian rhythm disorders and SAD, primarily.  Some people with insomnia, shift workers, and people who aren’t able to get sun exposure for various reasons will also benefit.  This is one of those treatments that should be used with input from a medical provider as well as a sleep therapist.  Using a light box isn’t plug-and-play.  Identifying the timing and the set up to get the best results mean that most people need more guidance than they can find online.

guy on phone

What are some alternatives?

There are light glasses and full-spectrum lightbulbs that allow people to have either more mobile exposure or less intense exposure.  These should not be used in the evening if you want a good night’s sleep!  And neither have been studied as treatment for SAD or circadian rhythm disorders due to their difficulty in measuring consistent light exposure to the retina.  Blending sleep strategies that include strong wake up routines and wind down routines can be as effective as a light box for people who do not have circadian rhythm disorders or SAD.

Read more about sleep treatments here: Are You “Wired and Tired”?  and How to Dim Your Screens to Reduce Blue Light at Night  .

How to Dim Your Screens to Reduce Blue Light at Night

guy on phone

 

Change your nighttime screen settings now to improve your sleep tonight.  It is simple.  It only has to be done once.  Ever.

My favorite sleep strategies are the ones I call “crockpot solutions”.  Set it and forget it.  Things that you don’t have to remember and prioritize.  You take an action and it’s done.  Willpower is overrated.  It is hard work.  Easy habits and crockpot solutions will triumph over willpower all the time.

Altering your screen settings is easy and effective.  Reducing the amount of full spectrum light hitting your eyes in the evening will help your brain secrete Melatonin, the neurohormone that induces sleepiness.  Leaving the lights on will delay Melatonin secretion and make it harder to fall asleep.

Is it as effective as turning the screens off or being many feet away from them?  No.  But lots of people will need some time and creativity to alter their screen use habits.  This can start them off on the path with a few clicks.

Yes, viewing a screen that isn’t using full spectrum light looks slightly strange.  Particularly for skin tones.  If your goal is to sleep better, the less-than-desirable coloring should make viewing less enjoyable and help you turn it off and go to sleep.  These settings automatically revert to full spectrum light after dawn if you use the auto settings.

For Macs/iPhones/iPads:

  • Go into System Settings.
  • Click on Displays.
  • Select Night Shift.
  • Make your choices for timing and appearance.  These include custom settings.  The warmer your screen, the less full spectrum light you receive when looking at your screen.  

 

For PCs/Android devices:

  • Select Settings.
  • Now select System.
  • Click on Display.
  • Select Night Light.
  • Turn on Schedule Night Light.
  • Select Sunset to Sunrise or Set Hours for custom times.

 

sunset