The Atlanta Journal-Constitution
Family honors lost loved one’s dream
The Brain Station opens in memory of daughter and sister, Emily Clark.
If she were still here, Emily Clark would be 29 years old. Her parents imagine she’d be living a beautiful life in Savannah. They picture her married to her longtime boyfriend, working as a nurse, and running a boutique out of a pharmacy, just like she’d talked about. But when Emily tragically died in 2015, the future she dreamed of went with her. Now, nearly nine years later, her parents are doing what they can to ensure one of their daughter’s dreams still comes true.
Emily was a happy young lady who loved life. In 2015, she was a junior at Georgia Southern University, a member
the Alpha Delta Pi sorority, in a serious relationship with her boyfriend, and thriving in nursing school.
On the morning of April 22, Emily and six of her fellow nursing students were carpooling to St. Joseph’s/candler Hospital in Savannah for their final clinical rotation. Emily had two passengers in her car, and the other four girls were in a separate car. The girls were stopped in traffic on Interstate 16 when a semi-trailer careened toward them at 70 miles per hour. The driver didn’t stop or slow down. The truck plowed over Emily’s car and into the car of friends ahead of them. Five of the girls, including Emily, were killed.
“The accident happened at 5:50 a.m. and we didn’t get confirmation about Emily until 3:30 that afternoon,” said Kathy Clark, Emily’s mother. “We knew there had been an accident with nursing students,
we were frantic, trying to reach her, trying to get an answer from someone. I was sitting at work when my husband called to tell me she was gone.”
After losing Emily, Kathy chose to retire earlier than planned. She wanted to be more available to her youngest daughter, Haily, a freshman
CBT-I instruction is easy to access online. Yet it is rarely the first thing people try, said Aric Prather, a sleep researcher at the University of California, San Francisco, who treats patients with insomnia.
Instead, they often turn to medication. According to a 2020 survey from the Centers for Disease Control and Prevention, more than 8% of adults reported taking sleep medication every day or most days to help them fall or stay asleep.
Studies have found that CBT-I is as effective as using sleep medications in the short term and more effective in the long term. Clinical trial data suggests that as many as 80% of the people who try CBT-I see improvements in their sleep and most patients find relief in four to eight sessions, even if they have had insomnia for decades, said Philip Gehrman, the director of the Sleep, Neurobiology and Psychopathology lab at the University of Pennsylvania.
Sleep aids can carry risks, especially for older people, who may experience problems such as falls, memory issues or confusion as a result of using the medication. CBT-I, on the other hand, is considered safe for adults of any age. It can even be adapted for use in children.
What is CBT-I?
Many people mistakenly assume that CBT-I is entirely focused on sleep hygiene — the routines and environment that are conducive to good sleep, said Shelby Harris, a psychologist with a private practice in the New York City area who specializes in CBT-I.
CBT-I does use a series of treatments to target behaviors that are inhibiting sleep, such as daytime naps or using digital devices before bed, and replaces them with more effective ones, like sticking to a consistent wake time. But it also aims to address anxieties and negative beliefs about sleep.
Much of the time, insomnia can lead to the feeling that sleep has become “unpredictable and broken,” Prather said. “Every day people with chronic insomnia are thinking about ‘How am I going to sleep tonight?’ “
CBT-I teaches people different ways to relax, such as deep breathing and mindfulness meditation, and helps patients develop realistic expectations about their sleep habits.
It is especially important that people with insomnia learn to view their bed as a place for restful sleep rather than associating it with tossing and turning. Patients undergoing CBT-I are asked to get out of bed if they are not asleep after around 20 or 30 minutes and do a quiet activity in dim lighting that doesn’t involve electronics. In addition, they are told to stay in bed only while drowsy or sleeping.
“CBT-I leads to more consolidated sleep and shorter time to fall asleep, which is a major gain for many,” Harris said.
How do you find a provider?
If you’re having problems sleeping, first visit your health care provider to rule out any physical problems (such as a thyroid imbalance, chronic pain or sleep apnea) or a psychological issue such as depression that might require separate treatment, the experts said.
You can search for a provider who is a member of the Society of Behavioral Sleep Medicine or use the Penn International CBT-I Provider Directory. Your primary care doctor may also provide a referral. If you’re using a general online therapist directory like Psychology Today, be wary of those who claim to offer insomnia treatment but do not have specific training in
CBT-I, Harris warned.
Finding someone who specializes in CBT-I may prove difficult — especially one who takes insurance — because there are fewer than 700 clinicians trained in behavioral sleep medicine in the United States. And one 2016 study found they are unevenly distributed: 58% of these providers practice in 12 states. The clinic where Prather works, for example, has hundreds of people on its waiting list.
Can you try CBT-I without a provider?
A review of clinical trials found that self-directed online CBT-I programs were just as effective as face-to-face CBT-I counseling. If you are self-motivated, there are several low-cost or free resources that can teach you the main principles.
One option is the fiveweek program Conquering Insomnia, which ranges in price from about $50 for a PDF guide to $70 for a version that includes audio relaxation techniques and feedback about your sleep diary from Dr. Gregg D. Jacobs, the sleep and insomnia expert who developed the program.
You can also check out Insomnia Coach, a free app created by the U.S. Department of Veterans Affairs that can be used by anyone. It offers a guided, weekly training plan to help you track and improve sleep; tips for sleeping; an interactive sleep diary; and personal feedback.
Sleepio is another reputable app, Harris said. There are also free online resources from the AASM and educational handouts from the National Institutes of Health, which include a sample sleep diary and a guide to healthy sleep.
And for those who prefer to avoid technology entirely, more than one expert recommended the workbook “Quiet Your Mind and Get to Sleep” by Colleen E. Carney and Rachel Manber.