Staff Perspective: Misconceptions About Sleep
You name it, we’ve heard about it. Our sleep consultants regularly come across purported new “solutions” for sleep problems, many of which of course involve only a low, low price. If I sound skeptical, it’s because I am; if a revolutionary cure for sleep problems existed, why do people continue to have problems sleeping? So many of my patients have been convinced something works, but still come in reporting they do not sleep well.
Let’s talk about all of the different strategies and products we may hear about, via news, advertisements, or even directly from our patients. Many things can interfere with the quality and quantity of our sleep, so some strategies and products are marketed broadly, while others are targeted for specific sleep concerns.
For example, for insomnia I have had patients report drinking a certain brand of tea, using a weighted blanket, consuming marijuana, and putting a special oil on their pillow. For general sleep improvement, I have heard anecdotal reports that avoiding sleeping near electrical lines that produce EMF radiation, buying a certain mattress or pillow, and eating certain foods definitively promote better rest. When tested on groups of people in controlled settings, the reality is that none of these strategies have substantiated evidence that they work. This is not to minimize the potential benefit experienced by an individual who believes they work – termed the placebo effect – but it may be that in some if not many cases these things work because of the belief rather than an actual effect. They won’t work for everyone, and they may not even really work for that person in the big picture.
For a humorous take on which strategies and products must surely be effective, I suggest this news article: Weighted Blanket Sure To Succeed Where CBD, Salt Lamp, Oil Diffuser, Acupressure Mat, Bath Bombs, And White Noise Machine Failed (theonion.com).
It’s hard to weed (pun intended) through all of the recommendations and options. Especially when some of them seem to make logical sense, and others just sound pretty cool. And if someone says it worked for them, maybe it will work for our patients too?
Or maybe not, here’s the catch. We know for each sleep disorder, there is a gold standard treatment that is considered first line for a reason, which is years and years of peer reviewed evidence across large groups of people. As a clinician, for me to implement something other than the gold standard treatment would take a pretty strong rationale. That is, if something is shown to work well for the majority of people, why not offer it to my patients? Perhaps it is almost unethical not to recommend or discuss that treatment option. So I know there is evidence for say, Cognitive Behavioral Therapy for Insomnia (CBTI) and continuous positive airway pressure (CPAP) for sleep apnea. On the flip side, just because something worked for one or a handful of patients doesn’t constitute sufficient evidence for these strategies and products.
Moreover, many of these options take agency away from patients. If only they bought this item or knew this tip, everything would be fixed. This reinforces the notion that there is an external solution rather than a change in behavior for which the patient can build self-efficacy. Worse, the focus on this external solution may prevent the patient from seeking care, bringing up sleep problems with a provider, or engaging in evidence-based treatment. They may actively harm a patient in that sense.
Not to mention sleep is wonderfully complex; there are many aspects of sleep regulation and many inputs to the system. This also means that addressing sleep issues isn’t as simple as recommending sleep hygiene tips. It is a disservice to patients for providers to recommend something simply because we read about it online or heard about it from another patient, especially if not trained in behavioral sleep medicine. Patients put stock in our recommendations given the inherent power differential, and it is incumbent on us to think critically and speak only to what we have scientific or professional knowledge of.
So there we have it. At this point, I am comfortable referring to what we hear about these strategies and products that lack evidence and may in fact be counterproductive or even harmful as “myths” or perhaps “misperceptions.” How do we as providers separate the misconceptions about sleep from the truly effective strategies?
That’s where we come in – we are excited to host a CDP Presents webinar titled “Debunking Common Misperceptions about Sleep Interventions” on October 12th in which our CDP sleep consultants will come together to talk through a few of the current hot sleep topics for potential misperceptions about insomnia, sleep apnea, and nightmares. Since we can’t cover all of the many things out there exhaustively, we’ll also offer an approach to help you evaluate strategies and products you will come across in the future. Please come join us in October, and I’d love to hear in the comments what you want to hear more about!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Diana Dolan, Ph.D., CBSM, DBSM, is a clinical psychologist serving as a Senior Military Behavioral Health Psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she develops and presents trainings on a variety of EBPs and deployment-related topics, and provides consultation services.
You name it, we’ve heard about it. Our sleep consultants regularly come across purported new “solutions” for sleep problems, many of which of course involve only a low, low price. If I sound skeptical, it’s because I am; if a revolutionary cure for sleep problems existed, why do people continue to have problems sleeping? So many of my patients have been convinced something works, but still come in reporting they do not sleep well.
Let’s talk about all of the different strategies and products we may hear about, via news, advertisements, or even directly from our patients. Many things can interfere with the quality and quantity of our sleep, so some strategies and products are marketed broadly, while others are targeted for specific sleep concerns.
For example, for insomnia I have had patients report drinking a certain brand of tea, using a weighted blanket, consuming marijuana, and putting a special oil on their pillow. For general sleep improvement, I have heard anecdotal reports that avoiding sleeping near electrical lines that produce EMF radiation, buying a certain mattress or pillow, and eating certain foods definitively promote better rest. When tested on groups of people in controlled settings, the reality is that none of these strategies have substantiated evidence that they work. This is not to minimize the potential benefit experienced by an individual who believes they work – termed the placebo effect – but it may be that in some if not many cases these things work because of the belief rather than an actual effect. They won’t work for everyone, and they may not even really work for that person in the big picture.
For a humorous take on which strategies and products must surely be effective, I suggest this news article: Weighted Blanket Sure To Succeed Where CBD, Salt Lamp, Oil Diffuser, Acupressure Mat, Bath Bombs, And White Noise Machine Failed (theonion.com).
It’s hard to weed (pun intended) through all of the recommendations and options. Especially when some of them seem to make logical sense, and others just sound pretty cool. And if someone says it worked for them, maybe it will work for our patients too?
Or maybe not, here’s the catch. We know for each sleep disorder, there is a gold standard treatment that is considered first line for a reason, which is years and years of peer reviewed evidence across large groups of people. As a clinician, for me to implement something other than the gold standard treatment would take a pretty strong rationale. That is, if something is shown to work well for the majority of people, why not offer it to my patients? Perhaps it is almost unethical not to recommend or discuss that treatment option. So I know there is evidence for say, Cognitive Behavioral Therapy for Insomnia (CBTI) and continuous positive airway pressure (CPAP) for sleep apnea. On the flip side, just because something worked for one or a handful of patients doesn’t constitute sufficient evidence for these strategies and products.
Moreover, many of these options take agency away from patients. If only they bought this item or knew this tip, everything would be fixed. This reinforces the notion that there is an external solution rather than a change in behavior for which the patient can build self-efficacy. Worse, the focus on this external solution may prevent the patient from seeking care, bringing up sleep problems with a provider, or engaging in evidence-based treatment. They may actively harm a patient in that sense.
Not to mention sleep is wonderfully complex; there are many aspects of sleep regulation and many inputs to the system. This also means that addressing sleep issues isn’t as simple as recommending sleep hygiene tips. It is a disservice to patients for providers to recommend something simply because we read about it online or heard about it from another patient, especially if not trained in behavioral sleep medicine. Patients put stock in our recommendations given the inherent power differential, and it is incumbent on us to think critically and speak only to what we have scientific or professional knowledge of.
So there we have it. At this point, I am comfortable referring to what we hear about these strategies and products that lack evidence and may in fact be counterproductive or even harmful as “myths” or perhaps “misperceptions.” How do we as providers separate the misconceptions about sleep from the truly effective strategies?
That’s where we come in – we are excited to host a CDP Presents webinar titled “Debunking Common Misperceptions about Sleep Interventions” on October 12th in which our CDP sleep consultants will come together to talk through a few of the current hot sleep topics for potential misperceptions about insomnia, sleep apnea, and nightmares. Since we can’t cover all of the many things out there exhaustively, we’ll also offer an approach to help you evaluate strategies and products you will come across in the future. Please come join us in October, and I’d love to hear in the comments what you want to hear more about!
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Diana Dolan, Ph.D., CBSM, DBSM, is a clinical psychologist serving as a Senior Military Behavioral Health Psychologist with the Center for Deployment Psychology at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. In this capacity, she develops and presents trainings on a variety of EBPs and deployment-related topics, and provides consultation services.