It's the typical scenario that sleep psychologist Paul Saskin, PhD, faces: A Las Vegas entertainer comes to his office, reporting that he's tired all the time. His job's late hours keep him out until the wee hours of the morning. Before joining his wife in bed, he tries to wind down for an hour or two, but at 7 or 8 a.m., he gets up to see his son off to school, then naps for a few hours before heading back to work as singer, dancer and actor in a musical revue.
The solution is often simple: In this case, Saskin suggested that his patient stay up through the night, then go to bed after his son left for school and the house was quiet--a schedule similar to those who get home from work at 6 at night and go to bed at 11.
"Within a couple of weeks he was already doing remarkably better, sleeping seven hours a day," says Saskin, clinical director of the Regional Center for Sleep Disorders at Sunrise Hospital and Medical Center in Las Vegas.
It's those types of practical behavioral changes that most often alleviate insomnia and other sleep disorders, says Saskin. "I apply standard behavioral interventions without going too deeply into underlying psychopathology, because typically that's not the reason why they have trouble sleeping," he explains. "Most of the time it's learned and behavioral patterns."
The only psychologist at his sleep center, Saskin works with nine pulmonary physicians and internists to help patients with trouble adjusting to shift work, insomnia, sleep apnea and a host of other sleeping disorders.
"His expertise as a psychologist is really helpful because, if you have a sleep disorder, it affects your entire life," says Steve Kaner, MD, a pulmonologist who works with Saskin. "When you're tired and sleepy, it obviously affects your relationships. Having a psychologist who has been able to heal the relationship problems is a really important part of treating the whole patient."
The center, which Kaner helped to found in 1993, is one of more than 530 accredited by the American Academy of Sleep Medicine. Most rely on consulting mental health professionals, since there are relatively few experienced sleep psychologists.
A typical day
Saskin starts his day by reviewing the polysomnograms--electronically gathered, detailed data on a person's sleeping patterns--of the patients who spent the night in his clinic's sleep lab, scouring for clues as to what may be causing their disorder.
The data can pinpoint why a person is having trouble with their sleep, such as changes in breathing, unusual body movements or even a neurological condition. Saskin then reviews the results with the physicians and suggests a course of treatment.
In the afternoon, Saskin meets with patients. He may evaluate a patient on his or her first visit to the center, review a patient's sleep diaries to decide a first course of action, advise a shift worker having problems sleeping during the day, explain a sleep study to a patient or use behavioral techniques to treat insomnia.
While most patients at the sleep center have breathing disorders like sleep apnea, Saskin sees many patients with sleeping problems related to shift work, he says.
"I may help patients learn how to sleep during the daytime or provide techniques for helping members of the family deal with these [shift work] problems," explains Saskin. "We have to take into account that they may not be able to follow standardized routines and modify their treatment accordingly."
For nighttime sleepers with insomnia, Saskin uses standard behavioral techniques, such as biofeedback, hypnosis and cognitive-behavior therapy. But for shift workers, Saskin tries to help them balance their need for sleep with the practicalities of a day-focused world. For example, simple things like eliminating light from the room, turning off the telephone ringer or cutting back on caffeine can make a big difference for day-sleepers.
In addition to providing treatment for his own patients, Saskin often consults with other physicians in his practice on specific cases. For instance, he shows patients with mild sleep apnea how to avoid sleeping on their backs (called positional retraining) and helps those with more severe cases adapt to using mechanical devices that assist their breathing while sleeping. The combination of behavioral and medical treatment makes for better outcomes, he says.
"Sleep is one of those areas where the mind and body meet very closely," he explains. "Sleep medicine allows me to bring my area of expertise to physicians--and I'm able to learn from them as well. It is absolutely a multidisciplinary field."
It's also a field he happened on by accident. Early in his career, before sleep was its own field, Saskin was using his training in health psychology to do research at a sleep center in New York. One thing led to another, and Saskin found himself evaluating patients for sleep disorders.
"It was easy to get into sleep because there was nobody really doing it," he explains. Now an American Board of Sleep Medicine-certified sleep medicine specialist, he urges others to consider the field. "About 25 million people have trouble falling asleep or staying asleep," Saskin says. "I'd like to get psychologists more interested in it."