Dr. David O'Hare

Specialist doctor in heart coherence

Positioning in relation to existing methods

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Current solutions

One of the main pieces of advice given to people having trouble falling asleep is to adopt better lifestyle/sleep hygiene, which includes tips such as: clearing your mind, exercising, going to bed at regular times. Unfortunately, these tips are often not well followed, not always easy to implement, and require changes and habit formation that rarely happen.

Sleeping pills, whose long-term danger has been proven (even from 18 ingestions per year), can only represent a temporary solution.

Falling asleep disorders are in the vast majority of cases linked to stress problems (see the studies cited below) or more precisely stress management (and even micro-stresses). People suffering from these disorders have too rarely been educated to manage their stress and to stimulate a "relaxation response" by themselves. Sophrology, meditation, and yoga, which directly address this problem, are effective solutions, recommended by sleep doctors, but which, like lifestyle changes, require a significant time and/or financial investment.

Dodow provides a turnkey solution

We believe that Dodow provides a turnkey solution, requiring no lifestyle change and demanding minimal time investment.

Our solution borrows from meditation (focus on breathing), yoga (slow breathing emphasizing abdominal breathing), and cognitive behavioral therapy (paradoxical intention), allowing to maximize the probability of success and enable the patient both to gain sleep time and to regain self-confidence. After a few months, they will probably be able to do without Dodow.

If Dodow allows to quickly, effectively, naturally, and simply counterbalance the effects of stress harmful to falling asleep, it is surprisingly also extremely effective for people suffering from circadian cycle disorders (jet lag for example).

Inspiration

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A dysregulation of the autonomic nervous system is at the heart of many falling asleep problems

Scientific data

Several studies have highlighted a correlation between activation of the sympathetic nervous system and difficulties falling asleep.

• Chronic insomnia is associated with nyctohemeral activation of the hypothalamic-pituitary-adrenal axis (2001) — This study conducted at the University of Pennsylvania highlights the role of an imbalance in the ANS (Autonomic Nervous System) which seems to play a more important role than circadian rhythm disorders in insomnia. "These findings are consistent with a disorder of central nervous system hyperarousal rather than one of sleep loss, which is usually associated with no change or decrease in cortisol secretion or a circadian disturbance."
• Sleep onset and cardiovascular activity in primary insomnia (2011) — This study conducted on 8 insomniacs and 8 normal sleepers showed that in the former, the return to autonomic nervous system balance (through deactivation of the sympathetic nervous system) occurred normally, whereas in insomniacs, the sympathetic nervous system remained activated. “These data suggest that, whereas normal sleepers follow the expected progressive autonomic drop, constant sympathetic hyperactivation is detected in insomniacs”
• Hyperarousal and insomnia (1997) — This other study shows that “good” sleepers subjected to sympathetic nervous system stimulation for a week exhibited the same disorders as insomniacs.
• Other studies support this thesis: The hyperarousal model of insomnia: a review of the concept and its evidence (2010), Human physiological models of insomnia (2007), Autonomic Activation in Insomnia: The Case for Acupuncture (2011).

Perspective

The autonomic nervous system is the part of the nervous system that manages the body's unconscious activities such as digestion. Activation of the sympathetic nervous system (the alert state) is a defense mechanism that has allowed humans to survive in a hostile external environment (secretion of noradrenaline, increased vigilance, muscle contraction, secretion of cortisol to cope with injuries). Through certain neurotransmitters, activation of the sympathetic nervous system stimulates wakefulness and alertness: external stimuli (and even internal ones like thoughts) are better perceived to help detect danger.

Moreover, the reaction to these stimuli is stronger than when the parasympathetic system (resting state) is activated. The activation of this state was certainly useful during prehistory in a constant danger situation, but it is much less so today when it comes to falling asleep. One could compare the dysregulation of the autonomic nervous system in insomniacs to a poorly adjusted car alarm that goes off at the slightest touch.

Description of the mechanism

Summary

Deactivation of the sympathetic nervous system seems essential to be able to fall asleep quickly. The cited studies all recommend relaxation to treat insomnia problems. Which methods are the most effective and easiest to implement? We studied two practices: meditation (with breathing as the object) and yoga (pranayama), whose effects are well known and have been the subject of numerous scientific studies.

Slow breathing as a tool for regulating the ANS

Breathing is at the heart of practices such as meditation (with an object), Yoga (Pranayama), and Sophrology. These different practices experienced a resurgence of interest starting in the 1970s, and numerous studies have shown that these practices promote a decrease in sympathetic activity. While meditation does not impose a specific breathing rhythm, focusing on this breathing almost always leads to a rapid slowing of the breath. Conversely, Yoga and Sophrology aim to slow the breathing rate when the goal is to calm down and, on the contrary, to accelerate it to feel more energetic.

The explanations for the influence of slow breathing on autonomic nervous system activity are varied: stimulation of the baroreflex? Hyperpolarization phenomenon? — Physiology of long pranayamic breathing (2006) — More simply, the fact that breathing is one of the only components of the autonomic nervous system that humans can control may not be accidental. — Meditation & Neuroscience: from basic research to clinical practice (2010).

A particular rhythm: 6 breaths per minute

The rhythm of 6 RPM found in one of the previously cited studies also appears in what is called cardiac coherence, popularized in France by Doctor David Sevran Schreiber, whose goal is also to rebalance the autonomic nervous system. According to several studies, this rhythm optimizes the stimulation of the baroreflex. While each organism is different, it seems that the rhythm of 6 RPM is relatively universal.

The baroreflex is the response triggered by the stimulation of baroreceptors. Baroreceptors are mainly located on large vessels, the aorta and carotids. When they are stimulated by a distension of the arterial walls, they send a signal that activates the vagus nerve and thus stimulates parasympathetic activity.

On the graph, a real jump in HRV (heart rate variability) can be observed from 6 breaths per minute (the higher the HRV, the more the heart rhythms vary smoothly (as opposed to stepwise variation), a sign of dominant parasympathetic autonomic activity). For ease of use, we decided not to go below 6 breaths per minute.

A particular rhythm: 40% inhalation, 60% exhalation

After consulting Yoga teachers, we decided to use a longer exhalation than inhalation. A long exhalation indeed promotes a sensation of fatigue.

This phenomenon was explained to us by a sleep doctor: "When breathing slowly and exhaling longer than inhaling, more CO2 is expelled. And when the CO2 concentration in the blood decreases, a reduction in the diameter of cerebral vessels is observed. This phenomenon called vasoconstriction causes a sensation of fatigue that promotes falling asleep."

This effect is particularly useful for a person suffering from a mild circadian rhythm disorder (having watched television, going to bed at variable times) and not being tired. Melatonin is indeed supposed to produce a fatigue effect. The absence of sufficient melatonin production due to one of these disorders prevents the person from feeling tired. The effect produced by a long exhalation can thus serve as an effective substitute.

Concentration is an additional factor

Focusing attention on an object (breathing in the case of meditation or the sound of falling rain) can have a relaxing effect and facilitate falling asleep.

Herbert Benson, cardiologist, professor at Harvard, is one of the pioneers in the study of mind-body relationships. He was interested in ways to rebalance the ANS by studying transcendental meditation (repetition of phrases (mantra) in the head). He deduced certain criteria to stimulate the "relaxation response." The two main ones are:

• A mental object
• A passive attitude (not forcing)

This mental object is what the mind comes to "fixate" on. According to Benson, it can be a sound, a word, a phrase, or a visual object. "There should be a constant stimulus e.g., a sound, word, or phrase repeated silently or audibly; fixed gazing at an object is also suitable. The apparent purpose of these procedures is to minimize one's attention to other stimuli" — Psychosomatic Medicine (1974)

The goal is to occupy part of the brain to minimize rumination of thoughts that can trigger a stress reaction and thus prevent the deactivation of the sympathetic system or simply stimulate the wakefulness center. It's like when watching a good movie: the wakefulness center is stimulated and it is difficult to fall asleep. The brain shows "interest" in the images passing before it. The same happens at the moment of falling asleep when the brain shows "interest" in certain thoughts, thus blocking sleep onset.

With a repetitive signal materialized by a blue light, a focal point is guaranteed to anchor one's attention, replacing "interesting" thoughts with something ultimately rather boring.

Psychology

This effect is rather involuntary, but it is very interesting and is an additional factor facilitating falling asleep.

Some people (often rather stressed and therefore prone to suffering from falling asleep disorders) create their own insomnia because they are afraid of not sleeping, they fear the effects of insomnia on their next day's activities (such as an exam or an interview) and thus create what is called performance anxiety. This anxiety is a barrier to falling asleep.

Paradoxical intention in the context of insomnia boils down to staying passively awake without trying to fall asleep. This is exactly what happens when the user lies on their back with eyes open and synchronizes their breathing with the light signal. Thus, with Dodow, performance anxiety disappears and falling asleep is facilitated.

This study thus cites the effectiveness of "paradoxical intention": "Stimulus control therapy, relaxation training, and cognitive behavior therapy are individually effective therapies in the treatment of chronic insomnia (Standard) and sleep restriction therapy, multicomponent therapy (without cognitive therapy), biofeedback and paradoxical intention are individually effective therapies in the treatment of chronic insomnia" — Practice parameters for the psychological and behavioral treatment of insomnia (2006)

Blue light

An interview with a sleep specialist doctor raised a question about blue light, which normally contributes to the disruption of the circadian cycle and the inhibition of melatonin secretion.

Dodow does not disturb the circadian rhythm.

Being projected onto the ceiling, the light signal, at its maximum intensity and for someone lying in bed, has a very low intensity (less than 1 lux) compared to the relatively strong intensity of a computer or television screen (about 60 lux at a distance of 50cm). Moreover, the exposure time (between 8 and 20 minutes) is short.

The impact of Dodow on the circadian rhythm is therefore almost nil or at least far too weak to delay falling asleep and counterbalance the positive effects described above. The light halo is thus more akin to color than to light.

The color blue was chosen after many trials, based on the generally accepted perception that blue is calming. Studies seem to confirm this perception: Blue lighting accelerates post-stress relaxation (2017). This comparative study between different colors shows a decrease in skin conductance following exposure to the color blue.

Why is the exercise difficult to do alone?

Finding the right rhythm can be difficult, even stressful, and go against the passive attitude described by Benson as a necessary condition for the relaxation response.

• A person having difficulty falling asleep may not have the courage to stimulate a relaxation response by themselves. Due to its simplicity of turning on, use, and proximity to the bed, Dodow makes the process much easier.
• People who have difficulty falling asleep often also have trouble concentrating (made difficult by the activation of the sympathetic nervous system) and tend to get lost in their thoughts during the exercise. With Dodow, for 8 minutes, we indicate to this person that there is indeed an exercise to perform.
• The optimal rhythm of 6 breaths per minute is very difficult to achieve on one's own; Dodow gradually reaches it starting from a rhythm of 11 breaths per minute.

By projecting a light onto the ceiling, Dodow materializes a mental object and allows the user to escape their thoughts.

Conclusion

Dodow is a solution that tackles one of the main obstacles to falling asleep. It is simple to use, harmless, non-addictive, inexpensive, and can be used at any time during the night. Our goal is to democratize its use and make it a reference solution for doctors.

Dodow Hackademy:

• Types of insomnia: How Dodow concretely helps you

• Understanding Dodow: The scientific demonstration demonstration (for doctors)

• Our tips #1: Getting started with Dodow 

• Our tip #2: I adopt good habits

• Our tip #3: I sleep more deeply