Stay Awake! to sleep well

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(Whomever it is that originated this stinking hilarious picture and quote, thank you!)

The glass half empty view on sleep and age:

When you are a child, you don’t want to sleep. When you are a parent, you could if you would, and you want to, but there are the kids. When you are fortunate enough to grow old, you want to, don’t have kids, but can’t.

 

The National Sleep Foundation Recommends:

Preschoolers (3-5): Sleep range widened by one hour to 10-13 hours (previously it was 11-13) School age children (6-13): Sleep range widened by one hour to 9-11 hours (previously it was 10-11) Teenagers (14-17): Sleep range widened by one hour to 8-10 hours (previously it was 8.5-9.5)

Younger adults (18-25): Sleep range is 7-9 hours (new age category) Adults (26-64): Sleep range did not change and remains 7-9 hours. Older adults (65+): Sleep range is 7-8 hours (new age category)

Should-a, could-a, would-a, right?

“The amount of sleep required by the average person is five minutes more.”

~Wilson Mizner

One thing that gets left out of most sleep books (um, did I include it in my book??) and sleep talks, is how to be awake. Because, the opposite of sleep is not just slogging around in a haze. It is alertness, attention, and memory.

Sort of abandon sleep hygiene for a while. Give yourself a break from the disappointment. And then be firm on the effort of daytime alertness.

Practically, all of this means reading, writing, talking, and moving. No nap unless before noon. The body requires all these to be alert. And vice-versa for alertness.

This is where I additionally bring in the concept of a stimulating medication such as Modafinil. Don’t confuse this with taking caffeine. Caffeine is metabolized way to fast to be helpful in this regard. There are others one may discuss with their treatment provider.

Self-care tip: Get awake, really awake, during the day to sleep well at night.

Questions:

What is your daytime energy like? Alertness, attention, and memory? Do you sleep well in relation to this?

Please tell your story. Keep on.

Bilbo and Me, trying to get to the Smoky Mountain

jake

Imagine, a young father playing basketball with his buddies on a Sunday in the gym, joking around, slapping each others butts, (because, help us, that’s what they do!) Sweat is rolling down his face. Call him Jake. He’s heavier after three kids, but he’s trying to lose the baby weight. His wife has to wear earplugs to sleep, he sounds so loud in their bed. Jake has been playing hard for about thirty minutes. He’s feeling good. He never lost his touch. He’s with his same buddies from high school. They stay in contact. They’ve got each other’s backs. They’re running down the court. He’s guarding Tom and everyone’s diverted, running, heaving and breathing hard. Tom makes the shot and they’re all slapping each other’s butts. They are throwing the ball back into play and someone laughs at Jake. “Hey Jake! Get up!”

Obstructive Sleep Apnea (OSA) is a leading cause of early heart attack.

I wrote this out in what may seem almost tasteless detail only because this is how it happens. I wish it didn’t and I want it to stop. It is as horrible as you imagine. Jake dies. His wife and gorgeous kids are left to live life without his laughter and counsel and noisy snoring that his wife would do anything to have again. Jake’s community is man-down. Obstructive sleep apnea is a deadly sleep disorder.

CPAP is 99% effective when used to treat OSA. It works. It is just not always the easiest treatment to tolerate for many reasons. But it is worth fighting for. The fight for CPAP might look something like multiple visits to your primary care practitioner to get that referral to go through to your sleep lab. A referral is made, and silence, then made again, silence, then finally by the third or fifth try, it goes through. Or multiple visits to your sleep specialist, exchanging one sleep mask after another and then another until you finally find one that keeps a good seal on your face through the night. There are truly a mountain of barriers to compliance that you will trek across, more barriers than Bilbo encountered heading toward Smaug, and you’ll need as much courage.

Keep on!

Questions: To start with, how is your breathing, or your loved one’s? Did you know that you might have to walk such a circuitous trail toward being your own friend? Who else will do this for you?

Self-Care Tip: When you are deflected, when you get stuck in the moment of loss, pull back into the big picture. You are your own friend and it starts with Me.

Honking my horn

….check it out ( yay! smiling!)

Sleep Well

Sleep Well: A “Friend to Yourself” Resource

by Sana Johnson-Quijada MD (Author)

In a culture that demands our time, our attention, and our energy 24-7, sleep has gotten a bad reputation. A full night of rest can feel like a weakness, an indulgence, something selfish. But sleep, says Dr. Sana Johnson-Quijada, is critical to our mental and physical health. And when we are not getting enough quality sleep, our lives suffer. Dr. Q explores the reasons why we sabotage healthy sleep patterns, identifies our unique sleep temperaments, and offers practical, positive, and achievable goals for sleeping better. From a daily sleep log to the 12 Rules of Sleep Hygiene, readers will walk away with the motivation and tools to get the rest they need.

Consider Sleep as a Symptom of Brain Health

English: Lou Ruvo Brain Institute

English: Lou Ruvo Brain Institute (Photo credit: Wikipedia)

When the brain gets sick, what does it look like?  Do we grow warts, or turn purple or loose our thumbs?  How does our brain say,

Help!

Through emotions and behaviors.  That’s how.

If we were an internist, a primary care physician, we would look at the vital signs.  We’d put our fingers on the wrist, count beats of the heart and breathing, and measure the pressure in the blood filled arteries.  This would tell us some of the story, the introduction to the body.

A church secretary came in complaining of indigestion times two weeks….

Or,

In a far off land, there once was a young maiden who by chance came to a magic filled glade…

Smile.

How does one do this in psychiatry though?  We start with the vital sign of SLEEP.

A farmer in the vast expanse of corn fields went each night to his bed with determination, gritted teeth and racing thoughts.  He worried over things that others thought were insignificant.  He ruminated and chewed over information.  Making decisions followed him around as if each were a crisis life balanced on.  The farmer was awake in the night for hours before his mind turned off.  And when he awakened, he was not refreshed….

Question:  Are you comfortable with considering sleep as a symptom of brain health?  When do you decide to look for medical reasons for poor sleep verses adjustment issues?  Please tell us your story.

Self-care tip:  Get to know your story to know better about your health.

Sleep Related Blog Posts – A Reference Guide

Sleeping German Shepherd

Sleeping German Shepherd (Photo credit: rightsandwrongs)

Organizing the “shelves” 🙂

  1. Sleep.  Be a Friend to Yourself.

  2. Sleep Hygiene – My Version

  3. Self-Care Does NOT Always Mean Doing What You Want

  4. Draw Sleep Hygiene Into Your Culture

  5. Sleep Is The Vital Sign Of Psychiatry

  6. Just Go To Sleep

  7. Good Sleep

  8. You Can’t Barter With It.  Sleep.

  9. Keep It Simple

  10. Regardless The Reasons Not To, Go Get Your Sleep

  11. Sleep Does Not Lose As Gracefully As He Lets Us Think

Sleep. Be a friend to yourself.

English: Мy friend is Wikipedian. Русский: Мой...

English: Мy friend is Wikipedian. Русский: Мой друг – википедист. (Photo credit: Wikipedia)

Being a friend to yourself, comes just when we need it.  When conflicts of interest seduce us into confusion, into late nights of activity; a talk perhaps or a project, a subject of interest, yahoo news perhaps – it is then that being a friend to yourself lovingly redirects our thoughts to the priority of sleep.

During sleep, our friend reminds us that we will heal.  We will receive treatment for the stressful day, better than medicine.  We will allow our broken neuronal connections to regenerate.  Our pantry will restock for clear thinking, kind behaviors to ourselves and emotions with ingredients like cortisol, hormones and neurotransmitters.  During sleep, our memories will find there place in the folds between our cells and plant.

When someone wants to talk to us, a conflict grows importantly, or when we mistake good parenting for enabling bad sleeping habits in our children, our friend, Me, says sleep.  Clarity and inner congruence swath us then and we know that we can’t give what we don’t have.  Tomorrow we can do those things.  Now, it’s time to sleep.

To ally yourself with your friend, Me, keep a sleep journal for a week and see how it looks.

Self-Care Tip:  Sleep.  Be a friend to yourself.

Printable Sleep Diary

Sleep Hygiene – my version

1.  The bedroom is only for sleep and for sex.

  • If you aren’t having sex than all you get to do is sleep.  No food, no phone, no TV.  Only sleep.
  • The bedroom is a sanctuary for sleep. Your subconscious is way to powerful to toy with.  When you go to bed you want it to be telling you to sleep, not read that last chapter or check the latest on @Twitter.
  • This can be a change in family culture and affects everyone in the home.

2.  No naps longer than 20 minutes during the day time – Known as a “Power Nap.”

  • If you are tired and have the luxury of lying down, do it!  But set your alarm to wake you up in 20 minutes.  You can do this 20 times a day if you want to.  But no longer than 20 minutes.  Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture) at night.

3.  No caffeine second half of the day.

4.  Exercise but not before bed.

  • Exercise will help regulate your sleep cycle at night if you just give your sleep initiation some space.
  • Try to get forty to sixty minutes 5-7 days a week of aerobic exercise to get best results.
  • Look at exercise like a pill.  A prescription.  Something for your medical and emotional health (inspiring to me), not necessarily for your waistline (inspiration notoriously short-lived.)
  • Every day think, “I’m exercising so I feel good, so I sleep good, so I can do what I want in life” – what ever that may be for you.  Some people will say, “…so I’m not a crazy Mom!”

5.  Keep the lights dim before bed.

  • Light turns off melatonin release from the pineal gland in our brains.  Darkness releases it.  Having your face 6 inches from the computer screen or TV before you lay down doesn’t give your body much time to turn itself off.  Melatonin is a cornerstone in sleep architecture.
  • Some people who feel they must be on the computer or TV before bed have found that wearing sunglasses for at least the last 30 minutes helps.

6.  Go to bed and get out of bed at the same time every day.

7.  If you can’t fall asleep in 30 minutes, get out of bed and do something else until you feel sleepy.  Then go to bed and try again.

  • Refer back to #5 when choosing what and how to do your activities during that time.

8.  If you can’t fall asleep in 30 minutes, consider taking a sleep aid.

9.  Do not take any sleep aids over-the-counter except melatonin, valerian root, or chamomile.

  • All others including anything containing diphenhydramine, block your deep sleep. You may end up sleeping a longer amount of time, but you won’t be getting restorative sleep.  It is during the deep sleep that your body heals, replenishes it’s hormones and neurotransmitters, and consolidates memories.

10.  If you choose to take a prescription sleep aid, do not take benzodiazepines such as diazepam, temazepam, clonazepam, alprazolam, or lorazepam to name a few.  These also block deep sleep.

  • Sleep aids safe for deep sleep and sleep architecture, include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata).  The main differences between these are how long it takes for them to be metabolized/washed out of the body.  Some are quick and some last the full 8 hours.
  • Trazodone (Desyrel) is also safe for sleep structure and maintenance.
  • Sometimes people will find that combining something like zolpidem with trazodone is most effective for them rather than using only one agent.

11.  Do not use alcohol to sleep.  Alcohol is a depressant (will make you depressed) and also blocks deep sleep.

12.  Do not smoke before bed or if you awaken from sleep.  Nicotine is stimulating.

13.  Don’t sleep with your pets or children.  They are disruptive.

  • It’s not personal.  It’s sleep hygiene.

Self Care Tip #34 – Use these tips to decode how to sleep well.  Be a friend to yourself.

Questions:  Why do you skip the bits of sleep hygiene that you do?  What helps you in your tough work of being your own friend in regards to sleep?  Please tell us your story.