Tag: sleep

Start School Later

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Start School Later

I know it’s been awhile since I last posted, and it’s because I’ve been working on two pretty big projects. I thought I’d announce the first one here, as it’s ready to at least begin…

Soon, I’ll be starting a public education project to share the research about the benefits of starting high school at 8:30 or later. (I even got back on Facebook for this purpose. I hadn’t been on Facebook since my 10 year old was born – HA!) 

The body of research is huge and well established – teens go through (like all mammals do!) the adolescent sleep phase shift – a natural, developmental, biological delay in sleep drive and change in circadian rhythm that means they get sleepy later and become alert later. (See… you really WEREN’T just being lazy or undisciplined!) Teens also need more sleep than adults, or even older children – an average of about 9.25 hours/night! 

So, asking teens to be alert for driving or school at 7:30 is really like asking adults to be alert for driving or work at 3:30am! 

Research shows that delaying high school start times until 8:30 or later:

  • improves academics (less tardiness, fewer absences, higher GPAs, higher standardized test scores, better graduation rates, etc…)
  • improves teen physical health (healthier BMI, less obesity, less screen time, more physical activity, better dietary choices, reduced substance use, reduced risk taking, fewer accidents, fewer injuries, etc…)
  • improves teen mental health (less depression, less suicidal thinking and planning, less anxiety, improved mood, better emotional regulation, better coping strategies, improved teen-family interactions)
  • improves teen behavior (better decision making, less risk taking, less juvenile delinquency, fewer suspensions, better classroom behavior, less risky driving and sexual behavior, etc…)

Here, you can read a research summary that I put together specifically for my district (FBISD), but that is full of research relevant to any school district. 

And here, you can watch some videos (2-12min) that I put together, fleshing out some of the research a bit more, as well as addressing myths/misconceptions and common concerns/possible solutions. 

I’m still working on finishing up one other big project, and then I’ll get back to regular posts – I have tons in my mental queue, but just don’t have time to get them written out just yet. 

Comment below: Do you know any additional research I’ve missed? What time did you start high school? What time do your kids start? What other concerns do you think parents/teachers/etc have? Is there anything else that deserves a video that I don’t have posted yet? 

 

 

 

 

 

 

Online Resources Vol. 4

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Online Resources Volume 4

If you haven’t seen them, here are Volumes 1, 2, and 3!

  • The Reveri app  – It’s free (of course!) and the BEST actual hypnosis app I’ve ever come across. (And I’m ASCH certified in clinical hypnosis). I’ve previously recommended Comfort Talk, and stand by it, but Reveri is also excellent and covers a lot of great, specific topics – e.g., sleep, anxiety, chronic pain, smoking cessation – the kind of stuff it’s probably ok to work on by yourself without a therapist. 
  • Greater Good Magazine – Honestly, this isn’t a great resource for therapists, as far as I can tell. But I think it’s one of the better lay-accessible internet resources.  It’s mostly research-based and comes out of Berkeley, and has lots of different kinds of content, all focused on well being. Worth a look. 
  • Andrew Huberman Podcast – For nerdy therapists (and maybe clients), Huberman is a neurobiologist and does a lot on mental health related topics – sleep, depression, addiction, stress, etc. – as well as some stuff that’s more like “optimizing wellness.” Easy to listen to, extremely knowledgeable, great sources, smart occasional guests. Honestly, his mental health series was not my favorite, but when it’s outside my direct area, I learn a lot. 
  • Kardia Deep Breathing App – FINALLY!!!! I finally found an app that lets you control the timing of the breathing! Remember the cardinal rule – breathe out longer than you breathe in. The end. But finally, there’s an app that will let clients personalize that, rather than putting them on a strict 5-minute, 5 seconds in, 5 seconds out, rigid program! THANK YOU! It’s $0.99 for the full functionality, but the free version works perfectly well for my personal use and for how I use it with clients.  
  • Spanish & Mandarin relaxation tracks – offered by the University of Texas Counseling Center, There’s a 3-minute breathing and a body scan available in both Spanish & Mandarin – I have a hard time finding resources for clients who, even though they may do their therapy with me in English for various reasons, might prefer or better utilize resources in their native language. These are free and you don’t need to be a student to access them. 
  • Various Downloadable Workbooks – The Govt of Western Australia has a resource that includes free, downloadable self-help workbooks on lots of issues – body image, depression, procrastination, distress tolerance, panic, health anxiety, etc. I haven’t gone through the whole workbook on all the topics, but the ones I have looked at are pretty legit. Maybe a good option for clients who want to work outside of session, or for your own use as smaller handouts or in-session activities if you break them up.

Comment below: As always, if you know of great, free, online resources, let us know, too! These things are out in the world to be shared and used!  

 

 

 

 

Sleep Lesson from my 8 Year Old

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Sleep Lesson from my 8 Year Old

I have to share this amazing sleep tip from my kid!

 

(Side note: Let me say we do prioritize sleep in the household, but we don’t follow every perfect sleep hygiene prescription because, well, we’re human people. But we do have a nighttime routine and a regular waketime even on weekends! I have a sleep hygiene handout for clients that I really like and you’re welcome to use it if you like – find it here.)

 

Back to my kids: here is what she told me, completely unprompted:

“Can I tell you how I put myself to sleep? (Yes, of course!) First, I lay down  comfortably. Then I yawn. If I don’t feel like yawning, I do it anyway and then it becomes a real yawn. Then I close my eyes. Then I find the place in my body that feels the warmest and I think about it until the warmth goes to the rest of my body and then it’s relaxed and then I’m asleep.”

What an awesome technique!! I told her I would share it with the therapy world and also with clients who might be helped by it. So, there you go. 

 

 

Comment below: Any favorite sleep strategies that you use or teach to clients?

 

Supplements are a thing

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Supplements Are A Thing

And it’s worth knowing about, because your clients might bring it up.

ETHICS NOTE: Don’t recommend them! That’s outside our boundaries of competence!! If you want to help clients in other areas, become a teacher of how to recognize credible sources and read the scholarly literature!

Here I’ll give you some research about mental-health related supplements that have happened to come up from my clients recently (links attached, of course!!). Probably this will end up being a series, but who knows? 

 

Comment below: Any supplements your clients are talking about, that you’ve looked into? Share your info! Anything you’d like me to look into for a future post?  

 

 

 

Post Concussion Syndrome

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Post Concussion Syndrome

Diagnostics is always more complicated then it seems – more like a DND roll than a simple symptom checklist or binary “has it” or “doesn’t have it” question. Here’s a great example:

 

Post concussion syndrome (PCS, or postconcussional syndrome) is a relatively vague set of symptoms that can continue to occur well after someone has had a head injury. The symptoms are wide and many of them are mental health symptoms, which is why it’s especially important for us to know about it. A headache is usually accompanied by symptoms like:

  • sleep problems
  • depressed mood
  • irritability
  • anxiety
  • trouble concentrating
  • difficulty with memory

Sound familiar?! YIKES! 

In fact, it’s so closely associated with other mental health conditions that 10-20% of student athletes meet criteria for it… even if they haven’t had a head injury – just because they’re stressed and somewhat sleep deprived! So, it’s important to consider all facets of this diagnostic mess!

 

 

PCS codes in ICD-10 as F07.81. Now, we probably wouldn’t want to diagnose Postconcussional Syndrome…. but we very well might want to put it in as a Rule Out or make a referral for additional testing/diagnosis with a physician or neuro specialist. 

 

We definitely want to have a question on our intakes that helps us keep this possibility in mind. For example, on my regular intake I have this question:

Have you experienced:
– chronic headache, migraine, vision changes, loss of consciousness, or dizziness?
– changes in your vision, hearing, other senses, or movement? (e.g., blurry vision, ringing in your ears, difficulty swallowing, trouble speaking, weakness or paralysis)
– difficulties with your memory, planning ability, or thinking clearly?

If so, when did you experience these symptoms and for how long?

That allows me to consider PCS, along with some other potential issues such as mild neurocognitive disorder and functional neurological symptom disorder (formerly conversion disorder). These answers can also “flesh out” other conditions, such as chronic headache associated with generalized anxiety disorder or difficulty concentrating as part of a depressive disorder. Loss of consciousness sometimes maps onto a substance use disorder. It’s a big question, but it gives lots of data and paths to follow-up on during the actual intake. 

Comment below: What are some of the diagnostically oriented questions you have on your intake? 

Childrens Melatonin

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1 milligram!

I found this at my nearby Walgreens, and I was unbelievably thrilled! Children’s melatonin!

“Now, wait,” you’re saying. “That doesn’t sound like the Ellis I’ve been reading.” (And if you’ve ever heard even a small piece of my “Bad Pharma” rant, you’re especially confused.)

The reason I’m excited is NOT because I think we should be giving kids melatonin. I pretty frankly don’t think we should, at least unless all the other behavioral/psychological/family issues have been worked out and the problem is still there. Unsurprisingly, I’ve never had a family committed enough to go through that process.

Also, it doesn’t do very much, in children or adults. Here’s a meta-analysis for you – increases sleep time by 8 minutes. (It might work better in older adults?) 

I AM excited, though, because there’s an easy-to-access 1mg dosage that adults can choose. I consistently have clients asking me about using melatonin. Of course, the first thing they get is a talk about sleep hygiene and a sleep hygiene info sheet! But, if they insist that they’re going to use it, they get a secondary talk about how the typical 3mg and 5mg dosing wildly, outrageously increases the amount of melatonin in your system (I mean 50x and more!). And when we flood our bodies with something that our bodies already make, our bodies quit making it. (This is how hormonal birth control typically works, btw. And it’s why testicles shrink when men are given supplemental testosterone.) Do clients with sleep problems want to shut down their bodies’ own melatonin production?? I doubt it.

Get this – I put “melatonin supplement” in Amazon and the first option was TEN MILLIGRAMS! I’m so pleased to at least have a less insane option to point clients toward.

You may want to read the National Sleep Foundation’s article about sleep and melatonin, as well.

Comment below with sleep tips, or general pharma rants. There will be more posts to come in this area, of course!

 

 

 

 

Sleep Deprivation

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Sleep Deprivation

Here’s a fun little (billable!) diagnosis I ran across recently. I’m always looking for just the right diagnoses to use that “get the job done” in terms of professional communication and clinical research that ALSO honor the individual’s experience by describing them faithfully. (See the previous post on Diagnosing Well). See if this one might add to your diagnostic repertoire!

 

Z72.820 Sleep Deprivation

Approximate Synonyms

  • Lack of adequate sleep

Clinical Information

  • Lack of the normal sleep/wake cycle
  • Prolonged periods of time without sleep (sustained natural, periodic suspension of relative consciousness)
  • State of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder.
  • The state of being deprived of sleep under experimental conditions, due to life events, or from a wide variety of pathophysiologic causes such as medication effect, chronic illness, psychiatric illness, or sleep disorder.

Comment: When is this truly useful and appropriate and when might you choose not to use it?

 

 

 

 

Just close your eyes and rest…

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“Just close your eyes and rest.”

This is what we need to tell our kids, and ourselves. Trying to demand that you fall asleep, or that awful thing where you think “if I could just go to sleep NOW, I’d get 5 hours. … if I could just go to sleep NOW, I’d get 4 ½ hours…” NOT HELPFUL. Changing this language is just the beginning of the wide array of strategies we can use to help clients get restful sleep – something that’s associated with pretty much every physical and mental health measure there is! 

 

Sleep hygiene is maybe the thing that’s most applicable to virtually every client – more so even than journaling, I’d say! It’s a shame, I think, that many accessible resources for sleep hygiene are quite poor (even though they’re usually pretty accurate). I’d like to share with you the sleep hygiene handout I made for my clients – feel free to share (but, you know, obviously don’t SELL!).

 

It’s geared toward adults, but could pretty easily be modified. It doesn’t mention sleep meds (which are often antipsychotics or antianxiety meds – BEWARE; also the sleep specific meds like Ambien have some really alarming side effects!) or pharma sleep “helpers” (like antihistamines or melatonin). It also doesn’t mention some of the sleep re-set techniques for when sleep has gotten really out of control, e.g., the 24 hour re-set or the 5.5 CBT-I strategy .

 

 

Comment if you teach sleep hygiene to clients, or if you’ve learned a new sleep hygiene technique you can share!