Guidance

Meet the Team

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Nuno Cachada

I am a registered Clinical Scientist who specialises in Sleep Physiology.

I completed my degree in Cardiac and Respiratory Physiology in 2010, Portugal. Thereafter, I worked in the private sector and provided home care to patients with sleep disorders which included diagnosis and follow-up.

My career progressed in the UK while working within the NHS and privately in different sleep and respiratory departments. Up to date guidance is important hence my involvement in research projects and training. 

I am the Clinical Manager for S-Med and a Registered Polysomnographic Technologist (RPSGT).  

My further training in Cognitive Behavioural Therapy for Insomnia was with The University of Oxford.

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Kristina Štedul

My role in S-Med is a RCCP registered senior specialist clinical physiologist - Sleep Disorders and have also obtained certificates in both CBT-I from the Edinburgh Sleep Consultancy with Prof. Jason Ellis and Counselling Skills from COSCA.

 

I hold a SCOTVEC HND in Biological Sciences from Abertay University and Diploma in Psychological Studies from UHI. My professional memberships include the World Sleep Society, British Sleep Society, ARTP Sleep, British Psychological Society and honorary membership of SASA.

 

I was born in Australia and raised in Scotland where I now live with my own family. With over 30 years’ experience in sleep disorders within research and clinical medicine, both in the UK and Australia, in adults and paediatrics and in the public and private sectors, I very much look forward to working with you to improve not only your sleep, but as a consequence, also your health and wellbeing.

Assessment

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Sleep Diary

This essential tool should be filled in on a daily basis to track sleeping patterns as well as daily activities that could affect your sleep quality and routine. It is important to be commited to completing the diary as honestly as possible. This will be used in each of the sessions to review and progress into the next week.

Instructions:

- Add date in at the top of each column

- Each starts at midday and each box represents 1 hour

- Add the  relevant letter to a box if any of the following occur within the hour:

  • C if you take any stimulant drinks like coffee, tea, coke

  • A for each alcoholic drink

  • S when you smoke

  • E when you exercise

  • B when you go to bed

  • O when you get out of bed

  • T if you take sleeping tablets

  • D if you take recreational drugs

- Shade all the boxes when you think you were sleeping. Shade half boxes for any period between 15 to 45min.

Other Sleep Disorders

With the information collected during the assessment we can determine if this is the right therapy for you and  rule out other Sleep Disorders such as Obstructive Sleep Apnoea, Period Limb Movement Syndrome or Narcolepsy.

If CBTi is not recommended for you, we will guide you in the right direction so you can get the support you need.

Click in the button below to download the Sleep Disorders Symptoms checklist.

 

 

Therapy

Couples Therapy
Normal Sleep

There is no unified theory about the function of sleep. The current consensus is that  sleep is essential for good health, mental and emotional functioning. It is very important for repair and maintenance of physiological, biochemical and neurological functions. We know that sleep is needed, because when people do not get an adequate amount of sleep, they suffer negative consequences during the day (e.g., reduced alertness, compromised immune function) and also sleep longer than usual the following night (sleep rebound). People often ask, “how much sleep do I need?” from the current state of the science, the answer is not clear. Sleep duration varies with age and personal needs, depending on physical activity and other factors. Please see below a representation of recomnneded hours of sleep by the Sleep Foundation.

When good sleepers go to sleep at night, they usually experience a period of relaxed wakefulness. The length of this period of relaxed wakefulness varies from one person to the next, but it is typically less than 30 minutes. During a typical night of sleep, NREM and REM sleep states and stages occur in consistent and predictable cycles. Generally speaking there are specific physiological processes that the body and brain need to maintain good health and there is a certain time required in each of these sleep states to achieve that.

If you have been suffering with Insomnia, through CBTi, we will guide yo to achieve your goal to a more normal sleep. CBT-I is collaborative and requires patient engagement and commitment which will improve efficiency of therapy and equip the individual with lifelong skills to achieve good quality sleep.

CBTi Components

Therapy sessions can include the following aspects in an order to fit individual needs:

Sleep Hygiene

Quality of sleep has been impacted by the new normals of life - stressful jobs and the difficulty switching work off, 24/7 availability of information and advice, push messaging and targeted marketing, and enabling most of this is the smartphone. Fantastic devices that have opened up the world but they do come with a price.

​From the efect of the screen itself on sleep quality, to the interruption of sleep by constant notifications, it has to be recognised that smartphone use has impacted sleep quality for many people. Many of the basics of sleep hygiene have got lost in the data driven age.

Try to remember some of the basics of sleep hygiene​

Stick to a routine

Avoid the blue light of smart devices before bedtime

Avoid unnecessary stimulation before bedtime

Avoid caffeine after lunch

Maintain daytime exposure to natural light

Don't watch television in the bedroom

 

Consumer vs Medical Reports

​There is a huge market for apps and devices that claim to track your sleep quality and quantity. The smart wristwatch is a prime example of a consumer product that has been 'upgraded' to a type of medical device. It is worth remembering how little data these devices record in relation to how much information they provide in their sleep reports. The simple truth is that if these devices could do what they claim, as accurately and simply as the marketing suggests, they would just be handed out by the NHS and there would not be any waiting lists for sleep testing. Using these devices can even cause harm to some people who become fixated by the numbers produced, with an overall worsening of sleep the outcome, rather than any of the claimed benefits.

Sleep restriction therapy

Sleep restriction therapy (SRT) – a somewhat misleading term as this component does not restrict the amount of sleep you already achieve, just the time in bed you have to achieve it. In other words, time in bed is restricted. This is worked out on an individual basis over the course of therapy. With the information you provide, together we work out the best way to increase your total sleep time (TST) and improve sleep efficiency (SE). Sleep restriction therapy is done by first reducing the time in bed to be equal to the average amount of time that you report currently sleeping based on sleep diary data (but never below what will be safe) and avoiding daytime naps. 

Stimulus control

Stimulus control therapy (SCT) – sleep can be strongly associated with specific and learned behaviours. SCT deals with removing unhelpful habits and beliefs associated with sleep (perpetuating factors) and relearning useful behaviours. We determine the rules that work best for you and your current lifestyle or other considerations when implementing SCT. Stimulus control therapy reverses conditioned arousal by strengthening the bed as a cue for sleep. Patients are advised to use the bed and bedroom only for sleep and intimate relationships, and to wake up at the same time every morning, regardless of the amount or quality of sleep.

Cognitive therapies

CBTi includes strategies for helping patients reduce their worries and intrusive thoughts when in bed, since these are incompatible with sleep. Worries and other unpleasant thoughts that are experienced in bed also exacerbate insomnia, because they weaken the bed as a cue for sleep. Techniques include imagery or distraction, cognitive control techniques or restructuring approach. Some of these will work better for some people than for others and will be discussed with your therapist as you proceed through the course.

Relaxation techniques

There is no single relaxation method that is best for everyone. Progressive muscle relaxation, meditation, and diaphragmatic breathing can all help calm an active mind. Together, we can select a relaxation method that best fits you, and the therapist should recommned practice during the wind-down period. Playing white noise is also helpful for some people.

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Healthy Sleep: Foundation for Health