Ebb Insomnia Therapy: The Silver Bullet We’ve Been Waiting For?

The company name has changed. So has the wearable part of this sleep-promoting medical device.

But the product launch at selected sleep centers is still set for the final months of 2017, with full production capacity expected next year. Here’s an update on a device that will add to research-based treatment options for people with insomnia.

Ebb Insomnia Therapy helps people fall asleep more quicklyThe company name has changed. So has the wearable part of this sleep-promoting medical device.

But the product launch at selected sleep centers is still set for the final months of 2017, with full production capacity expected next year. Here’s an update on a device that will add to research-based treatment options for people with insomnia.

What It Is

The Ebb Insomnia Therapy device was developed by Ebb Therapeutics (formerly Cerêve, Inc.). Worn at night, it consists of a soft headband (rather than the plastic cap envisioned last year) attached by a tube to a temperature regulator that sits on a bedside table. Fluid is continuously pumped through the part of the headband that rests against the forehead, cooling it down. Research has shown that by cooling the forehead, the device reduces metabolic activity in the front part of the brain and hastens the onset of sleep.

Excessive Brain Activity at Night

The bane of many insomnia sufferers at night is a mind that keeps going and going and doesn’t want to stop. Such thinking and other executive activities (planning, decision-making) are functions of the frontal cortex, or the front part of the brain, involving the metabolizing of glucose.

Functional brain imaging studies—movies of processes occurring in the brain—have shown that the brains of normal sleepers are mainly quiet at night. No activity is detected in the frontal areas. In contrast, imaging studies conducted by Ebb Therapeutics founder Eric Nofzinger have revealed a great deal of metabolic activity occurring at night in the brains of insomniacs, including activity in the frontal cortex. Published images show that at night, the brains of people with insomnia are “lit up like Christmas trees.”

Cooling the Brain

Why might cooling the brain help? For starters, our core body temperature tends to rise in the daytime and fall at night. Previous research has shown that we tend to fall asleep more readily when our core body temperature is on the downward part of the cycle.

Two early studies conducted on people with insomnia showed that cooling the forehead at night

  • reduced participants’ core body temperature, and
  • reduced metabolic activity in the brain, particularly in the frontal cortex.

When Nofzinger and colleagues conducted a third, larger study (randomized and placebo controlled), they found that wearing the device significantly reduced the amount of time it took insomnia sufferers to fall asleep.

Compared With Current Insomnia Treatments

Many medications for insomnia have unwanted side effects. Ebb Insomnia Therapy is reported to have no appreciable side effects and classified as low risk by the FDA. As for its effectiveness, only time will tell how well it stacks up against insomnia drugs such as Ambien and Belsomra. New insomnia treatments like Ebb are only required to perform significantly better than sham treatment or placebo pill to gain FDA approval.

Cognitive behavioral therapy for insomnia (CBT-I), currently the gold standard in insomnia treatments, requires effort and commitment to a rigorous, weeks-long therapeutic process. Ebb Insomnia Therapy is relatively effortless. All it involves is wearing a headband at night. Some insomnia sufferers may begin to benefit right away, according to the company website. Others may take time to adjust to the device and need to use it anywhere from 2 to 4 weeks before seeing sleep improvements.

Limitations

The device will not be sold over the counter. It requires a prescription from a licensed physician or a licensed nurse practitioner. Nor has Ebb Therapeutics said how much it will cost. The company has taken out several patents, though, so the device will not be cheap. In addition, a new fluid cartridge will need to be purchased every three months. The device and cartridges are not expected to be reimbursable by health insurance companies anytime in the near future.

It’s doubtful the device will solve the sleep problems of every insomniac. The studies show that Ebb Insomnia Therapy reduces the time it takes to fall asleep and users report, after 30 days, that it improves sleep quality. Nowhere is the company claiming the device cuts down on night-time wake-ups or increases total sleep time, two items on the wish list of many insomnia sufferers.

Even so, it may be the silver bullet that at least some insomniacs have been waiting for. Particularly if you feel your sleep problem is driven by a yammering brain that just won’t stop, Ebb Insomnia Therapy is certainly worth checking out.

A Sleep-Friendly Bedtime Routine

A cardinal rule of sleep hygiene involves establishing a bedtime routine and here, I’m a believer. Even if I’m out till midnight, leapfrogging from a meeting or a party straight into bed is a setup for insomnia. I’ve got to have at least 45 minutes—better yet, an hour or more—to shift myself out of overdrive and into idling mode.

Here are some things to do in the run-up to bedtime to ease the transition between wakefulness and sleep.

Bedtime routine helps condition body and mind to expect sleepA cardinal rule of sleep hygiene involves establishing a bedtime routine and in this, I’m a believer. Even if I’m out till midnight, leapfrogging from a meeting or a party straight into bed is a setup for insomnia. I’ve got to have at least 45 minutes—better yet, an hour or more—to shift myself out of overdrive and into idling mode.

Here are some things to do in the run-up to bedtime to ease the transition between wakefulness and sleep.

Create a Healthy Sleep Environment

  1. Turn off devices with screens. The light they emit (and your proximity to it) may delay secretion of melatonin, a sleep-friendly hormone whose levels normally start to rise a couple hours before bedtime.
  2. Set the bedroom up for comfort in advance. Adjust thermostats, windows, or fans so that by the time you go to bed, the room temperature will be a little cooler than is comfortable during the daytime. Turn down the covers and set the alarm clock. Your sleep environment should be set up so that at bedtime, the only thing you have to do is slip between the sheets.
  3. Turn clocks to the wall. If you’re a sleep onset insomniac like me, clock watching at night will make you anxious—and anxiety is incompatible with sleep. Stay away from rooms with wall clocks.

Dial Down Stress

  1. Take an evening walk. High levels of circulating stress hormones prepare your body for action—not to slow down. Work the stress out with physical activity, even if it’s only walking around the house.
  2. Relieve tension with the help of a shiatsu massage pillow for 15 or 20 minutes.
  3. Do 20 minutes of diaphragmatic breathing, progressive muscle relaxation, or yoga. All these activities help to reduce stress.
  4. Take a bath or a shower. Warmth relieves muscle tension. Warming the skin also increases your core body temperature, triggering an internal cooling mechanism conducive to sleep. In the summer months, lower your body temperature more quickly by taking a cool shower instead.

Immerse Yourself in a Relaxing Pastime

  1. Read an engaging book (but steer clear of books that are scary or upsetting), and keep a stash of them by your favorite chair. Or listen to a book on CD. If reading’s not your thing, stream movies on the TV (but not on the computer screen).
  2. Listen to mellow music or make music yourself (if you can do it without disturbing others).
  3. Page through photo albums, coffee table books, old National Geographics and Life magazines, or catalogs. Arresting images capture the attention quickly: they’re a good way to refocus your attention outside yourself.
  4. Do crafts: beading, needlework, scrapbooking, knitting, woodworking, leatherworking, macramé, or any other sedentary activity involving use of the hands.
  5. Keep a sketchpad and pencil next to your favorite chair and draw.
  6. Do crossword puzzles or play Sudoku or any other word game.
  7. Play Solitaire (with cards, not online).
  8. Work on jigsaw puzzles.

Once you’ve got a comfortable bedtime routine, stick with it. Going through the same routine night after night will condition your mind and body to expect sleep when it’s finally time to turn the lights out.

What type of activity helps you fall asleep at night?

Tips for Overheated Sleepers

Feeling cold at night is the pits. Not only is it unpleasant, but it also gives me a whopping case of insomnia. So years ago I bought an electric blanket and a comforter for use in the winter.

But these items may not be good choices for people with insomnia or those who wake up with night sweats, according to recent paper by sleep scientists in The Netherlands. It has to do with the effects of skin temperature on core body temperature at night.

down-comforterFew things bother me as much at night as feeling too cold. It’s sure to keep me up and make insomnia worse. So several years ago I bought an electric blanket and a comforter for use in the winter.

But these items may not be good choices for people with insomnia or those who wake up with night sweats, according to recent paper by sleep scientists in The Netherlands. It has to do with the effects of skin temperature on core body temperature at night.

Core Body Temperature vs. Skin Temperature

Core body temperature is measured internally. It typically hovers around 98.6 degrees in the daytime, but it drops by a degree or more at night. You typically feel sleepiest when your core body temperature is going down. A lower temperature helps you fall asleep quickly and sleep through the night.

Skin temperature, on the other hand, is easily influenced by temperature changes in the environment (and changes in posture, lighting, anxiety, and pain). It typically runs somewhat cooler than core body temperature. But moderately warming the skin tends to promote sleep. It dilates blood vessels close to the skin, facilitating the release of heat from your body and thus lowering your core body temperature.

Here’s the catch, though: warming the skin too much has the opposite effect: it increases your core body temperature, and eventually you may be too hot to sleep. Then you wake up.

Reducing Heat-Related Wake-Ups

If you wake up with night sweats or are prone to insomnia like me, you may need a more subtle approach to warming yourself on winter nights. Here are three suggestions:

  1. Get rid of the electric blanket. Constantly adding heat to the body will eventually increase your core body temperature and likely wake you up.
  2. Comforters are bad news for the same reason. Yes, they make you warm and toasty when you crawl in bed. But they, too, may lead to overheating and nighttime wake-ups. Replace these items with blankets that allow for lesser temperature changes if you get too hot and have to throw one off.
  3. Finally, consider taking a hot bath or shower right before bed. Studies show that warming the skin keeps blood flow high for a few hours after bathing. This will accelerate the release of heat from the body, lower core body temperature, hasten sleep onset, and improve sleep in the early hours of the night.

If you wake up too hot at night, what have you found that helps?

Footbaths to Fight Insomnia?

Dr. Oz’s tip for curing insomnia—wearing heated rice footsies to bed (see my blog last March)—may have led to second- and third-degree burns for TV viewer Frank Dietl, but Oz is not responsible for the injuries, the New York Supreme Court ruled on Oct. 3. Moral of story? Take the advice of tele-evangelist health gurus with a grain of salt.

But let’s get back to the notion that heating the extremities might help to promote sleep. For some of us, this may be a useful strategy.

Foot-bathDr. Oz’s tip for curing insomnia—wearing heated rice footsies to bed (see my blog last March)—may have led to second- and third-degree burns for TV viewer Frank Dietl, but Oz is not responsible for the injuries, the New York Supreme Court ruled on Oct. 3. Judge Saliann Scarpulla dismissed the lawsuit against Oz, saying that there was no “duty of care between a television talk-show host and his vast home-viewing audience.”

Moral of story? Take the advice of tele-evangelist health gurus with a grain of salt. Frankly, some of Dr. Oz’s tips on insomnia sound pretty lame. Eat lots of gelatin to combat sleeplessness? Puh-lease!

But let’s get back to the notion that heating the extremities might help to promote sleep. Particularly in people who normally can’t sleep until late at night, this may be a useful strategy.

Body Temperature and Sleep

The rhythm of your core body temperature has a strong effect on when you feel sleepy; you start feeling sleepy when your temperature is going down. People who have trouble falling asleep until very late may have internal clocks that run on a 25-hour day, a recent study in the Journal of Sleep Research shows, delaying the downturn in temperature and the onset of sleep.

Light exposure in the morning and melatonin supplements in the evening may be the best remedies for people with longer-than-normal circadian temperature periods. But a warm footbath before bed may also help.

Why It May Work

Most heat loss occurs through the hands and feet, and heating the extremities hastens heat loss by dilating blood vessels. This allows for the swift release of body heat and a lowering of core body temperature, in turn helping promote sleep. So hot footbaths and warm socks may be a good idea for people who struggle to fall asleep at a reasonable hour.

But a new study from Taiwan confirms the results of an older study showing that footbaths prior to sleep do not alter sleep patterns in older adults. Heating the extremities may only help with sleep if you’re young or middle aged.

Do you bathe at night and/or wear socks to bed? Have you noticed it has any effect on your sleep?

Avoiding Jet Lag: A Tip for Eastbound Travelers

The first few days in Paris can be miserable as your body clock tries to sync up with local time.

To lessen the effects of jet lag, it’s important to get daylight working in your favor, which is not as simple as many in-flight magazines make it sound.

paris-e1367232068702The approach of summer calls up thoughts of travel to distant lands, but the first few days in Paris can be miserable as your body clock tries to sync up with local time. To lessen the effects of jet lag, it’s important to get daylight working in your favor, which is not as simple as many in-flight magazines make it sound.

Eastbound travelers often get this advice: go out in the sunlight immediately upon arrival. In some cases, this will work to your advantage, but in others, it will make your jet lag worse. It all depends on when the exposure to light in the new time zone occurs in relation to your body temperature. Here’s how it works.

Your body temperature is lowest from one to three hours before you normally get up. So if you get up at 7 a.m., your body temperature bottoms out around 5. This temperature minimum is a critical meridian when it comes to determining the effect light will have on your sleep. The simple rule to remember is this: exposure to bright light soon after your temperature minimum will help you fall asleep sooner at night. Exposure to bright light in the hours leading up to the temperature minimum is going to delay your sleep cycle, making it harder to get to sleep.

Taking an Overnight Flight to Europe

Let’s say you live in the eastern part of the U.S. and you decide to take an overnight flight to Paris, arriving at 8 a.m. To get in sync with local time, your body clock will need to shift forward six hours so you’re ready to go to sleep six hours sooner.

Yet if you heed the advice offered by in-flight magazines and spend the first few hours of your trip outdoors in the sun, your body clock will shift in the wrong direction. At the time of your 8 a.m. arrival, your body thinks it’s 2 a.m.—well before your temperature minimum. Rather than helping you fall asleep sooner that first night in Paris, exposure to morning sunlight is going to delay your sleep cycle further, making it harder yet to adjust to life in the Latin Quarter.

So what to do if, after an eastbound flight, you arrive at your destination before your body temperature reaches its low point? If spending the first few hours of your trip indoors in low lighting is unappealing (and why wouldn’t it be? We’re talking Montmartre and the Luxembourg Gardens, for Pete’s sake!), then definitely wear dark glasses for your maiden stroll down the Champs-Elysées.

On the other hand, if your arrival time falls after your body temperature reaches its nadir, immediate exposure to sunlight is the best way to lessen jet leg and start your trip on the right foot.

Too Hot to Sleep

Pet peeve: I turn down the bed covers in my hotel room only to discover that the bedding consists of sheets and a comforter, without a blanket in sight.

Maybe the hotel management assumes that adjustments in room temperature will allow this arrangement to work. But no matter whether I turn the heat up or down, my next several hours will be a challenge: Sheets + comforter = a comfortless night.

using comforter can make you too hot at nightPet peeve: I turn down the bed covers in my hotel room only to discover that the bedding consists of sheets and a comforter, without a blanket in sight.

Maybe the hotel management assumes that adjustments in room temperature will allow this arrangement to work. But no matter whether I turn the heat up or down, my next several hours will be a challenge: Sheets + comforter = a comfortless night. I’m either roasting with the comforter on or freezing without it.

Bedding Sold Around Town

Room and body temperature have a huge impact on my sleep, yet the evidence suggests this temperature sensitivity is probably not the norm.

“We sell more comforters than blankets,” said Rob, the sales manager at Sleep Number, an upscale mattress and bedding store not far from my house.

I believe it. At Bed Bath & Beyond, the big box store just across the parking lot, an entire quadrant of the store contains comforters packaged in suitcase-size plastic cases. A “Complete Bed Set” features a comforter, sheets, a bed skirt and two shams. Just think: I could set myself up for nights of roasting and freezing in my very own home!

The blanket section of the store, by contrast, is about the size of a 12-by-12-foot room. It’s labeled “Quilts and Coverlets.” Are blankets becoming passé?

I hope not. Blankets of different weights and thicknesses have been my salvation when it comes to navigating the temperature changes my body goes through at night. But before I go further, let me explain:

Temperature Fluctuations at Night

The best room temperature for sleep is a little lower than is comfortable during the day, sleep experts say, and I’m a believer. The hundred-degree heat I tried to sleep through in southern India was impossible. If it’s true overall that insomniacs have trouble down-regulating body temperature, then I am Specimen Number One.

But body temperature also fluctuates during the course of the night. From a temperature high in the evening, the core body temperature in humans drops to its nadir a few hours before normal wake-up time, then rapidly starts to climb again.

I can’t count the times I’ve woken up early in the morning to a body that’s sweaty and boiling. (If this is night sweats, then I’ve had them all my life.) Being able to peel off the covers in layers—going from hot to cooler rather than from hot to cold—gives me a better way of adjusting to my body temperature and a better chance of falling back to sleep.

So down with comforters, I say, and up with blankets! Temperature fluctuations may be more of a factor in insomnia than we think.

Does anyone else experience body temperature issues at night? How do you manage them?

Dr. Oz’s Sleep Tip Sparks Lawsuit

Dr. Oz is at it again, spreading careless advice about sleep. And this time somebody besides me is complaining.

Last week, Frank Dietl, 76, filed suit against Dr. Oz for a sleep tip that left him with third-degree burns on his feet and several weeks’ confinement in bed.

Dr. Oz is at it again, spreading careless advice about sleep. And this time somebody besides me is complaining.

sleeping-footsies

Last week, Frank Dietl, 76, filed suit against Dr. Oz for a sleep tip that left him with third-degree burns on his feet and several weeks’ confinement in bed.

Oz gave his tip in a show last April, telling viewers that they could sleep better by heating their feet with a “heated rice footsie.” He said to fill the toes of a pair of socks with uncooked rice, heat the socks in a microwave and then wear them about 20 minutes while lying in bed.

Dietl, who is diabetic and suffers numbness in his feet, followed Oz’s instructions. But then, instead of removing the footsies after 20 minutes, he fell asleep wearing them. He woke up in the middle of the night to discover burns on his feet that left him barely able to walk.

I am truly sorry for Mr. Dietl, but I’m happy to see tele-evangelist health gurus like Dr. Oz get challenged on some of the half-baked advice they toss our way.

This time, Dr. Oz’s facts weren’t inaccurate. His explanation for why heating the feet might help with sleep—“When your feet get hot . . . your body gets cold. Your body will automatically adjust its core temperature and, as it gets cooler, you’re going to be able to sleep better”—is basically true as far as it goes. Yet as usual, Dr. Oz was short on details. And in this case, the details just might have saved poor Frank Dietl’s feet.

Body Temperature and Trouble Sleeping

It’s easier to sleep when your core body temperature is falling, and people who have problems falling or staying asleep may be saddled with bodies that have trouble cooling down. Sleep experts say that insomnia is sometimes characterized by a failure to down-regulate core body temperature at night.

So how can you cool yourself down? Lots of heat loss occurs through the hands and feet. So one way to promote heat loss—and this may sound paradoxical—is to heat your extremities before going to bed (as you might with a foot bath). Heating the extremities dilates the blood vessels, in turn allowing for maximum release of body heat and a lowering of core body temperature. In some experiments (but not all), this heating of extremities has helped subjects fall asleep sooner and stay asleep. Hence, Dr. Oz’s brilliant idea for the heated rice footsies.

What Dr. Oz Failed to Mention

But here’s the catch. In the case of older people with insomnia, this doesn’t work. Heating the extremities has not helped elderly poor sleepers fall asleep sooner or sleep better, according to research (see below). If Dr. Oz had bothered to qualify his advice, Frank Dietl, 76, might have passed on the idea of the footsies and avoided the disabling burns.

But Dr. Oz and his ilk are not big on nuance. Which is why I don’t trust them, particularly on matters relating to sleep. People with insomnia differ one from another. The last thing we need is advice from doctors that treat us all alike.

What do you think about Dr. Oz? Speaking in sound bites is the norm on TV these days. Am I expecting too much?

Warm Footbath Before Bedtime

Skin Temperature and Falling Asleep