Dr. Ashley Mason on Sauna Use for Depression, Conquering Insomnia, and Mindfully Breaking Bad Habits

Dr. Ashley Mason and Whole Body Hyperthermia

• Dr. Ashley Mason: Director of the Sleep, Eating and Affect Laboratory at the Osher Center for Integrative Medicine at UCSF
• Specializes in nonpharmacological treatments for changing behavior, such as sleep, eating behavior disorders, and mood disorders

Whole Body Hyperthermia vs. Sauna

• Whole body hyperthermia: more intense than sauna, involves consistent heating for a longer period, head is outside the heating element
• Sauna: less intense, shorter sessions, whole body (including head) inside the heating element

Preliminary Findings on Whole Body Hyperthermia

• 2016 study by Janssen et al. tested whole body hyperthermia as a treatment for clinical depression 
  • Participants were either given whole body hyperthermia or a sham treatment
  • Results showed significant drops in depression scores within a week, maintained six weeks later
• 2013 study by Hanusch et al. also showed positive effects of whole body hyperthermia on depression, but lacked a control group

Quick Effects and Lasting Results

• Whole body hyperthermia showed effects within a week, faster than SSRIs (antidepressants)
• One session of whole body hyperthermia had lasting effects for six weeks

Possible Mechanisms

• SSRIs and whole body hyperthermia both involve sweating (hyperhidrosis)
• Literature shows temperature dysregulation in people with depression 
  • Higher nighttime body temperatures, less efficient thermoregulatory cooling
  • Successful treatments (e.g., ECT) often result in decreased core body temperature alongside decreased depression symptoms
  • Hanusch study found a correlation between decreased body temperature and decreased depression after whole body hyperthermia treatment

• Sauna use may affect thermal regulation and body temperature, potentially impacting depression symptoms
  Depression and Body Temperature Regulation

• Clinical depression vs. situational depression 
  • Major depressive disorder: mental health disorder
  • Correlation between body temperature dysregulation and depression in some studies
• Stress and thermoregulatory system 
  • Unclear data on whether stress can cause dysregulation of body temperature
  • Plausible that prolonged distress could lead to depression symptoms

Inflammation and Depression

• Inflammatory response can induce depressive symptoms in healthy individuals 
  • Example: Injection of lipopolysaccharide (LPS) causes inflammation and depressive symptoms
  • Prevention: High dose of EPA (marine omega‑3 fatty acid) can negate inflammation and depressive symptoms
• Sauna and inflammation 
  • Sauna use can affect inflammation and potentially improve depression

Sauna and Exercise

• Sauna use mimics moderate cardiovascular exercise 
  • Similar physiological responses: increased blood flow, sweating, elevated heart rate, blood pressure changes
  • Studies show exercise can improve depressive symptoms in people with clinical depression
  • Sauna use may help depression in a similar way to cardiovascular exercise

Whole Body Hyperthermia Studies

• Developing accessible and affordable whole body hyperthermia treatments for depression 
  • Goal: Create a treatment that can be used outside of hospitals and in various settings
  • Experiment: Testing various saunas to find one that can raise core body temperature to 101.3°F (the temperature used in previous studies)
  • Challenges: Most saunas cannot reach the desired temperature without causing discomfort or health risks
    Sauna Studies for Depression and Cardiovascular Disease
• New study focusing on the effects of sauna on depression and cardiovascular disease 
  • Two parts:
    • First study: 16 people, all receiving the same treatment
    • Second study: 30 people, split into two groups receiving different treatments
  • Delayed due to COVID-19
• Investigating the molecular effects of sauna on depression 
  • Biomarkers and heat shock proteins play a role in adaptation to heat stress
  • Potential benefits for both mental and physical health conditions
• Importance of developing protocols that people will actually follow 
  • Sauna is more accessible and easier to comply with than exercise for some individuals
  • Applicable to those with disabilities or who are not physically active
  • Could provide benefits for both depression and cardiovascular disease
    Biomarkers in Depression Studies
• Measuring biomarkers in studies: 
  • BDNF (Brain-​​derived neurotrophic factor)
  • Heat shock proteins
  • Inflammatory cytokines
  • CRP (C‑reactive protein)
• BDNF role in depression: 
  • Involved in neuroplasticity
  • Exercise increases BDNF, potentially helping with neuroplasticity
• Depression may be inflammatory for some people 
  • Exercise is temporarily inflammatory but leads to adaptive, anti-​​inflammatory changes

Whole Body Hyperthermia and Cognitive Behavioral Therapy for Depression

• First study: 16 adults with major depressive disorder 
  • Participants receive whole body hyperthermia treatment and cognitive behavioral therapy (CBT) for depression
• Cognitive Behavioral Therapy (CBT):
  • Psychotherapy used for depression
  • Gold standard, first-​​line treatment for depression without medications
  • Focuses on the connection between thoughts, feelings, and behaviors
• Combining whole body hyperthermia with CBT: 
  • Idea comes from traditional communal sauna experiences
  • Hyperthermia may make people more willing to engage in therapy
• Second study: 30 people, half receive CBT only, half receive CBT and whole body hyperthermia 
  • Aim to see if adding hyperthermia leads to larger decreases in depression

Future Research and Potential Applications

• Developing a booster method for maintaining wellness and reducing depression symptoms 
  • Home sauna tents as a supplement to more intense whole body heating
• Opening the door for more research on different types of sauna and heat therapy 
  • Finnish sauna, hot baths, jacuzzis
• Small clinical studies showing hot baths can improve depressive symptoms in people with depressive disorder 
  • 2017 study: hot baths improved symptoms at two weeks, but reduction faded by four weeks
• Many research questions still need to be answered in the field of heat therapy and depression 

Non-​​pharmacologic Treatments for Chronic Insomnia

• Another area of expertise for the speaker 
  • Focus on helping treat people with chronic insomnia using non-​​pharmacologic treatments
    Insomnia vs. Chronotypes
• Chronotypes: genetic predisposition to being a night owl or morning person 
  • Roughly a third of people are morning people, a third are evening people, and a third are somewhere in the middle
  • Society is built to favor morning people, causing difficulties for night owls
  • Chronotypes are not necessarily sleep problems, but can pose health risks for night owls
• Insomnia: difficulty falling asleep, staying asleep, or waking up too early 
  • Must occur at least three nights a week for at least three months and be distressing
  • Different from chronotypes, as it is a sleep problem

Causes of Insomnia

• Major changes in life can cause insomnia 
  • Retirement, changes in relationship status, losing a job, having a child, etc.
• Behaviors that maintain insomnia are often different from what caused it 
  • Bad sleep hygiene behaviors, such as using electronics in bed or napping during the day, can perpetuate insomnia

Treatment for Insomnia

• Cognitive Behavioral Therapy for Insomnia (CBT‑I) focuses on: 
  • Sleep hygiene
  • Stimulus control: only using the bed for sleep or sex
  • Sleep restriction: focusing on the amount of time spent in bed
  • Cognitive techniques
  • Relaxation techniques

• Recommended book: “Quiet Your Mind and Get to Sleep” by Dr. Rachel Manber
  Dr. Panda on Sleep Consistency

• Importance of not waking up at different times 
  • Artificial jet lag
• Patients go to bed when tired, wake up at the same time for 7 days 
  • Calculate average sleep time per night

Sleep Restriction and Cognitive Techniques

• Restrict time in bed to actual sleep time 
  • Improve sleep quality
  • Extend sleep time by 15 minutes per week, maintaining 85% efficiency
• Cognitive techniques
  • Work with worries and thoughts
  • Identify dysfunctional thoughts 
    • Black and white thinking
    • Personalization
    • “Should” thoughts
  • Thought record exercise 
    • Look at evidence for and against a thought
    • Develop a new, more realistic thought

Sleep Treatment Components

• Sleep hygiene
• Stimulus control
• Sleep restriction
• Cognitive techniques
• Relaxation techniques
  • Progressive muscle relaxation

Important Components for Good Outcomes

• Sleep restriction
• Stimulus control

Pharmacological Treatment for Insomnia

• Ambien: common drug for insomnia 
  • Can lead to dependence
  • Side effects: sleep eating, memory issues, potential association with dementia
    Cognitive Behavioral Therapy for Insomnia (CBTi)

• CBTi is a non-​​pharmacological treatment for insomnia

• Helps people taper off sleep medications
• Involves working with providers and creating a taper plan
• Can take up to six months or longer to get off drugs
• Standardizes medication use and addresses underlying issues causing insomnia
• Can be done through books, apps, or finding providers through websites like the Academy of Behavioral Sleep Medicine
• Treatment can last for a long time, with some people maintaining it for the rest of their lives

Overeating and Reward-​​Based Behavior

• Overeating can be due to stress, cravings, or other reward-​​based behaviors
• It can be difficult for people to stop overeating or consuming unhealthy foods and beverages
• The first step to change is determining if someone wants to change their behavior

• Understanding the underlying reasons for overeating can help in developing strategies to address the issue
  Changing Unhealthy Behaviors with Mindfulness

• People struggle to change unhealthy behaviors even when they know the consequences

• Example: eating donuts when feeling down 
  • Provides temporary relief from negative feelings
  • Over time, this behavior can lead to weight gain and other health issues
• Mindfulness can help change these behaviors 
  • Slowing down and paying attention to the experience
  • Realizing the reward may not be as satisfying as initially thought

Mindfulness in Action

• Example: smoking cessation 
  • Patient asked to focus solely on smoking, without any distractions
  • Patient realized they didn’t need to smoke as much as they thought
• Mindfulness can help people become disenchanted with unhealthy behaviors 
  • Slowing down and really tasting the food or experiencing the behavior
  • Realizing the reward is not as great as initially thought

Changing the Reward Perception

• Focusing on the actual reward can help change the perception of it 
  • Realizing there may be a better approach to dealing with negative feelings
• Mindful eating intervention study 
  • Overweight women learned to be curious and open to observing their experiences
  • Resulted in eating in response to cravings less often

Impact on the Brain

• Mindfulness can change brain activation patterns 
  • Serious meditators show different brain activation during meditation
  • Changing perceived reward value can alter brain patterns
• Banning sugary beverages and providing motivational intervention 
  • Resulted in reduced soda consumption over time
    Mindfulness and Harm Reduction
• Mindfulness can help reduce harmful behavior 
  • Slowing down and paying attention to the experience
  • Consuming less of harmful substances or activities
• Can be applied to various addictive behaviors 
  • Eating junk food, smoking, gambling, internet addiction
• Techniques to help reduce harmful behaviors 
  • Being mindful during the behavior
  • Changing the reward by being mindful of it
  • Checking in with your body and emotions
• Challenges with mindfulness 
  • Pausing and slowing down isn’t naturally rewarding
  • Mindfulness may not be the whole answer
• Other ways to work with harmful behaviors 
  • Environmental interventions (e.g., not having junk food at home)
  • Planning ahead (e.g., looking at menus before going to a restaurant)
  • Episodic future thinking (imagining future health goals or events)
• Reward-​​based learning and positive/​​negative reinforcement 
  • Powerful in shaping behaviors
  • Mindfulness can help break the cycle by focusing on the experience

Dr. Ashley Mason’s Contact Information

• Twitter: @DrAshleyMason
• Lab website: sealab​.ucsf​.edu (Sleep, Eating, and Affect Lab)