When asked why I went into sleep medicine 36 years ago, I reply, “Sleep is what I like to do best.” It was during my first two months as a rotating intern in 1974 in Obstetrics and Gynecology, when I learned that the shift rotation of 36 hours on duty, and 12 hours off duty, was not a good fit for me. While I loved delivering babies, the long nights up “on call,” left me tired and exhausted. I even fell asleep, face first, into my fondue dinner one night. Another night writing an Intake note about a new person, I wrote, “This 36 year old picnic coca cola…” Clearly I had had a “micro-sleep,” while writing my report.
Rather than becoming an OB-GYN, I became a psychiatrist and Sleep Medicine specialist. When I returned to Dartmouth-Hitchcock Medical Center, I had the good fortune to do my sleep medicine research fellowship with Peter Hauri, PhD, who had just authored a book in 1977, in which he coined the term, “Sleep Hygiene.” While he never particularly liked this term, it stuck. Sleep hygiene has come to be well known as the behavioral ways we can help our healthy natural abilities to sleep, and feel well rested the next day. On April 5, 1978, I passed the first Clinical Polysomnographer certification exam with an auspicious certificate number of “007,” next to the likes of Dr. William Dement and Dr. Elliot Weitzman, both pioneering sleep researchers. (Polysomnography uses brain wave measurements to measure changes in neural activity – normal or abnormal – as a patient stays overnight in a sleep lab.) As the field of Sleep Medicine developed, this term was updated to Board Certification in Sleep Medicine by the American Board of Sleep Medicine in 1991.
By 1979, I was in Alaska, the “Land of the Midnight Sun,” to serve three years in the US Air Force as a psychiatrist to pay off my Dartmouth school debt, and adventure in the Far North. My love for Alaska kept me there for 10 years, 5 years in Anchorage and 5 years in Fairbanks. In 1984, I began doing clinical research with light therapy for Seasonal Affective Disorder, in collaboration with Norman Rosenthal, MD who was at the National Institute of Mental Health. It was in becoming a Charter Member of the Society for Light Treatment and Biological Rhythms, that I came to know Michael Terman, PhD, and other key players in this field.
My particular interest area emphasizes an integration of traditional psychotropic medications with other therapeutic modalities, such as light therapy, melatonin, changing sleep related behaviors, mindfulness and meditation. I integrate principles of Cognitive Behavioral Therapy for Insomnia (CBT-I) with Mindfulness and strategic use of medications. After a thorough evaluation to assess for co-morbid conditions, such as sleep apnea, Restless Leg syndrome, depression, anxiety, or primary medical disorders, the treatment plan may include four to eight sessions of CBT-I, nicknamed in my clinic, “Sleep School.” By learning about how the body clock, alertness, and sleep are interrelated, people with insomnia and shiftwork problems may change choices they make about their self care that can minimize or eliminate need for prescription or OTC (over the counter) sleep promoting medications.
Check back here for my upcoming posts, which will focus on patients’ experiences with their sleep and mood problems, and the therapeutic strategies we developed.