[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.
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