Sleep Doctors Show

00:00:00 - Introduction00:03:19 - Catch-Up & Guest Intro00:08:07 - Defining a Nightmare00:10:51 - Screening for Nightmares00:14:19 - Nightmare Disorder Criteria00:20:50 - Imagery Rehearsal Therapy00:26:17 - ERRT for Trauma Nightmares00:31:22 - Why Imagery Rehearsal Works00:34:47 - CBT-I as Nightmare Treatment00:39:59 - Pharmacotherapy for Nightmares00:48:35 - Meds That Cause Nightmares00:52:51 - Nightmares in Sleep Apnea00:56:58 - Lucid Dreaming Therapy01:02:34 - Nightmare-Awakening Devices01:05:00 - Nightmares Are TreatableMedical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911.Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show.All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.More about Dr Courtney Worley:Websites:www.DrCourtneyWorley.comhttps://upwardbehavioralhealth.com/staff/courtney-worleyInstagram: @DrWorleyConsultBooks:The Nightmare and Sleep Disorder Toolkit: A Workbook to Help You Get Some Rest UsingImagery Rehearsal Therapy and Other Evidence-Based Approaches: https://www.newharbinger.com/9781648485817/the-nightmare-and-sleep-disorder-toolkit/Nightmares and Nightmare Disorder- Advances in Psychotherapy – Evidence-Based Practice -Volume 59: https://www.hogrefe.com/us/shop/nightmares-and-nightmare-disorder-103368.htmlSubscribe to the newsletter: https://newsletter.sleep-show.com/Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/If you have any suggestions or questions, do reach out to us: [email protected] Summary:When does a nightmare become nightmare disorder, and what actually treats it? The Sleep Doctors Show welcomes guest Dr. Courtney Worley, double board-certified in clinical psychology and behavioral sleep medicine and co-author, with Dr. Michael Nadorff, of The Nightmare and Sleep Disorder Toolkit.Dr. Worley separates dreams, bad dreams and nightmares, explains why patients call nightmares night terrors (a parasomnia under DSM-5 and ICD-11), and defines nightmare disorder by dysphoric emotion, awakenings and daytime impairment. The panel covers distress over frequency (Ross Levin), the missing DSM frequency criterion, sleep avoidance, and why only about a third of patients report nightmares to a provider (Nadorff, 2015).Treatment covers imagery rehearsal therapy (IRT), the AASM first-line intervention, and the cognitive behavioral therapy for nightmares (CBT-N) umbrella: exposure, relaxation and rescripting therapy (ERRT), lucid dreaming therapy, and CBT-I as a nightmare treatment. Dr. Worley compares IRT and ERRT, written nightmare exposure, cognitive processing therapy themes, rehearsal and visualization, and the neurobiology (amygdala, hippocampus, visual cortex in REM sleep), with references to Lisa Cromer and Kristi Pruiksma's CBT-N web training.Dr. Saema Tahir and Dr. Shelby Harris cover pharmacotherapy: prazosin as a mixed-evidence second-line option, propranolol, benzodiazepines, trazodone, Z-drugs, SSRIs and REM suppression, and medications that cause nightmares, including melatonin, diphenhydramine, inhalers and cardiac drugs. They also discuss undiagnosed obstructive sleep apnea, REM rebound on PAP therapy and COMISA-mares.Finally, Dr. Jesse Cook asks about lucid dreaming therapy, Benjamin Baird and Giulio Tononi's lab, nightmare-awakening devices, and finding a specialist through the Society of Behavioral Sleep Medicine provider directory.

00:00:00 - Introduction00:02:39 - Catch-Up00:08:03 - Sleep Inertia00:13:31 - Chronotype and Permanent DST00:18:51 - Indications for Sleep Tracking00:20:47 - Polysomnography (PSG)00:22:49 - Epoch-Based Sleep Staging00:26:13 - ORP and N3 Amplitude Criteria00:29:06 - Wearable Validation vs PSG00:31:45 - Actigraphy00:34:11 - Oura and FDA Wellness Criteria00:38:01 - Consumer Health Trackers00:42:02 - Psychological FlexibilityMedical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911.Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show.All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.Subscribe to the newsletter: https://newsletter.sleep-show.com/Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/If you have any suggestions or questions, do reach out to us: [email protected] Summary:Is polysomnography really the gold standard, and what does that mean for the accuracy claims on consumer sleep trackers? The Sleep Doctors Show takes a critical look at sleep measurement, from the sleep lab to the ring on your finger.Dr. Jesse Cook (sleep psychologist, behavioral sleep medicine), Dr. Cathy Goldstein (sleep neurologist, professor of neurology, University of Michigan) and Dr. Shelby Harris (clinical associate professor, Albert Einstein College of Medicine, private practice in New York City) start with sleep inertia: how you should feel in the first minutes after waking, and why a slow ramp-up is normal. Dr. Saema Tahir sits this one out.A listener comment on the Sunshine Protection Act opens a debate on permanent standard time versus daylight saving time, evening chronotypes, dark winter mornings, the 1974 year-round DST experiment, Save Standard Time, and the Sleep Research Society position statement by Beth Malow.Dr. Goldstein explains why Susan Redline calls polysomnography (PSG) a bronze standard: inter-rater reliability in the mid-80s, sleep staging as discretizing a continuum, the 30-second epoch inherited from paper recordings, surface EEG with as few as three leads, local versus global sleep, and the odds ratio product (ORP) and hypnodensity. Dr. Cook adds the age and sex bias in N3 (slow wave sleep) amplitude criteria from Shaun Davidson and colleagues, and how human-scored PSG caps the AI staging algorithms trained on it.Then consumer sleep technology: why benchmarking wearables that measure acceleration and cardiac autonomic activity against EEG-defined sleep may be unfair (Massimiliano de Zambotti's validation framework), sleep state misperception, actigraphy for circadian phenotyping, the Oura class action over its 95 percent accuracy claim, FDA wellness device criteria, influencer marketing, the World Sleep Society consumer health tracker recommendations led by Michael Chee, Dr. Cook's wearable study with University of Wisconsin women's volleyball, and acceptance and commitment therapy (ACT) and psychological flexibility over obsessive tracking.

00:00:00 - Introduction00:02:33 - Catch-Up00:12:38 - Vetting CBT-I Providers00:14:23 - DBSM and SBSM Credentials00:18:54 - When Patients Say CBT-I Failed00:21:38 - Sleep Hygiene Is Not CBT-I00:24:32 - Practicing Within Competency00:27:51 - The CBT-I Referral Note00:33:38 - Motivation and Adherence00:37:15 - A Standard Pre-CBT-I Workup00:38:39 - How to Pitch CBT-I to Patients00:42:55 - Relapse Prevention00:44:44 - ACT vs Cognitive Therapy00:48:15 - Cognitive Defusion and Values00:50:06 - Acceptance in the Sleep Clinic00:54:29 - Control vs Letting Go00:56:23 - OutroMedical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911.Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show.All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.Subscribe to the newsletter: https://newsletter.sleep-show.com/Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/If you have any suggestions or questions, do reach out to us: [email protected] Summary:How do you find the right CBT-I provider, and what makes a useful referral? The Sleep Doctors Show continues its discussion of cognitive behavioral therapy for insomnia (CBT-I), focusing on connecting patients with care.Dr. Shelby Harris (Albert Einstein College of Medicine, private practice in New York City) explains how to assess a provider's qualifications. She covers DBSM and CBSM credentials, the Society of Behavioral Sleep Medicine (SBSM) provider directory, training programs from Michael Perlis and Colleen Carney, and questions about supervised hours and caseload.The hosts explain why a sleep hygiene handout is not CBT-I, share Rachel Manber's dental hygiene analogy, and discuss what to ask when a patient says CBT-I has already failed.Dr. Cathy Goldstein (sleep neurologist, University of Michigan) and Dr. Saema Tahir (pulmonologist and sleep physician, New York City) outline what belongs in a referral note: sleep disorders ruled out, obstructive sleep apnea and circadian rhythm findings, medications, sleep habits, and motivation for change.The panel also discusses patients' ability to follow stimulus control and sleep restriction, equitable access to treatment, a standardized assessment before referral, presenting CBT-I as first-line treatment ahead of medication, and relapse prevention.Finally, Dr. Jesse Cook (sleep psychologist, behavioral sleep medicine) introduces acceptance and commitment therapy (ACT) for insomnia, exploring cognitive defusion, psychological flexibility, allowance versus acceptance, and letting go of control over sleep.

00:00:00 - Introduction00:02:27 - Catch-Up00:09:52 - What Is CBT-I00:12:25 - CBT-I in Physician Training00:16:34 - Group vs Individual CBT-I00:18:16 - CBT-I Beyond Insomnia00:22:11 - Dropping the I From CBT-I00:25:24 - The Problem With CBT-I Name00:27:14 - Digital CBT-I and Cadence00:30:42 - Best and Worst Ingredients00:33:06 - Choosing Medication Options00:41:45 - Tapering and Rebound Insomnia00:44:23 - Trazodone and Seroquel00:46:41 - PRN vs Nightly Dosing00:48:34 - Combination Treatment00:50:57 - Sleep Confidence00:52:14 - Sleep Tracking and Orthosomnia01:03:56 - ReflectionsMedical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911.Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show.All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.Subscribe to the newsletter: https://sleep-show.com/Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/If you have any suggestions or questions, do reach out to us: [email protected] last week's episode: https://youtu.be/CmW8bvx5FPUCBT-I is the gold standard for insomnia. It is also, by the panel's own admission, a slightly magical black box to the physicians who refer for it, a hard sell to the patients who hear "therapy," and a treatment that rarely unfolds the way the manual says it will. Part two of the insomnia series takes the acronym apart: which ingredients actually move the needle, which ones the psychologists would happily drop, and why Dr. Jesse Cook wants everyone to forget the "I" for a minute.Dr. Shelby Harris walks through the CBT-I toolkit (sleep hygiene, sleep restriction, stimulus control, cognitive restructuring) and names her favorite and least favorite. Dr. Saema Tahir explains why she recommends it for nearly every sleep patient, including idiopathic hypersomnia. Dr. Cathy Goldstein lays out how she chooses an insomnia medication by onset, maintenance and comorbidity, and delivers a memorably firm verdict on Seroquel and trazodone. The panel covers digital CBT-I apps, session cadence, the pandemic-era medication cocktails now being tapered, rebound insomnia from tapers done too fast, whether to take a hypnotic every night or only "if needed," and the case for combination treatment. They close by lifting the lid on orthosomnia, the Oura class action, and the potential harm of sleep tracking technology in the context of insomnia, a conversation that continues next episode.

Chapters:00:00:00 - Introduction00:02:19 - Catch-Up00:04:39 - Rams vs 49ers Circadian Debate00:16:32 - Clinic Models and Burnout00:29:38 - Defining Insomnia00:34:51 - Referrals and Access to Sleep Care00:42:34 - How Insomnia Develops00:47:04 - Building a Treatment Plan00:56:34 - What Is CBT-I01:02:01 - Next Episode PreviewMedical disclaimer: This episode is for general informational and educational purposes only. It is not medical advice, diagnosis or treatment, and does not create a clinician-patient relationship. For advice about your own health, consult a qualified healthcare professional. In an emergency, call 911.Sponsor disclosure: This episode includes paid promotion from WAKIX: https://wakixhcp.com/The Sleep Doctors Show is supported by Harmony Biosciences. The partner has no editorial control over the content of the show.All views expressed on this show are the hosts' and guests' own and do not reflect those of their employers or affiliated institutions.Subscribe to the newsletter: https://newsletter.sleep-show.com/Follow us on LinkedIn: https://www.linkedin.com/showcase/sleep-doctors-show/Follow us on Instagram: https://www.instagram.com/sleepdoctorsshow/If you have any suggestions or questions, do reach out to us: [email protected] has had a bad night. The reason insomnia is the single most common thing a sleep clinician sees is that the line between a rough week and an actual disorder is blurrier than anyone admits. This is part one of the panel's two-part sit-down on insomnia, and before they reach the bedroom they make a stop on a football field: two California teams, the Rams and the 49ers, flying to Australia for a week one kickoff that starts at 10:30 a.m. local time, which is roughly 5:30 p.m. back home. One team is acclimating, the other is refusing to, and four sleep doctors have very strong opinions about who has it right.From there, Dr. Jesse Cook, Dr. Cathy Goldstein, Dr. Saema Tahir and Dr. Shelby Harris compare what a real clinical day looks like (Cathy sees a patient every 30 minutes, Saema caps hers at four) before building the case on insomnia: the three-nights-a-week, three-months definition and why distress matters more than the stopwatch, when a bad stretch is simply normal, the referral and access gap that can leave patients waiting six months, how insomnia takes hold through Art Spielman's three-P model, and whether you treat the sleep apnea, the mood and the insomnia all at once or one thing at a time. Shelby lands it with a plain-language tour of CBT-I. The deep dive into CBT-I's ingredients, the medication debate with Cathy and Saema, and how to taper are saved for part two.