Ladies and Gentlemen! It’s time to go to sleep! Wait. Not till you read this.
PsychU, a patient education website, has invited me to present on sleep. These are their questions and how I hope to respond. Do you have any recommendations, other interests, directives? Please help me! Smile.
1. Dr. Johnson-Quijada, in what ways is sleep important for our behavioral health?
Sleep rudders our biology ship, (if “rudders” may be used as a verb.) Our biology is the reason we have emotions and behaviors. Take out the brain and we don’t have any problems with emotions and behaviors. So the biological health of the brain and body is where our focus should begin with when thinking about emotional and behavioral well-being. This is not in exclusion of other import paradigms, such as the psychological or sociological influences on what make us who we are.
But let me ask you,
Where do emotions and behaviors come from?
Now think about it and answer your true beliefs.
I was speaking with a wonderful physician the other day to whom I asked this question, (let’s call her Doctora.)
I respect Doctora for her character, personality, standard of medical practice and interpersonal beauty. She is a bulldog in the operating room. When patients need studies done that insurances won’t pay for, she tears barriers to treatment apart with vicious tools of rightness. And she cares. She sits. She asks. And she cares. She sees the person in the paper gown, each one for the person she knows them to be and the person yet unknown.
I admire Doctora greatly not only for these qualities but also because it gets personal. I, who have my own special practice of medicine, cannot do her’s.
When just a green bumbler in medical school, there was a fateful day when I shadowed another great artist of medical care into a locker room. I suited up in that blue sack they call scrubs. I put little blue sacks over my tennis shoes too.
Do you know why there are blue sacks on the surgeon’s shoes? So what is on our shoes won’t contaminate the operating room. But also so that when wet things come out of the human body and fall onto their feet, their toes won’t feel squishy. Yep. That’s what was going through my mind as I scrubbed my hands, each finger and each finger nail the ten minutes it takesto reach what is considered clean.
Surgery in progress, the color red mixed with a smell and monstrous sensual force that clobbered me to the ground. I swooned, gagged and promptly ended my surgical career.
There is nothing more irritating to a surgeon than someone who doesn’t appreciate the “fun” of “cutting.” Yes. I irritated this mentor and others too I’m afraid.
This doesn’t keep me, unfortunately, from pleasuring in telling people, “I am licensed to do surgery.” I am you know. Any Jane with a medical license can pick a scalpel up and bring back the dark ages, or contemporary, depending on who holds the license. I’m irritating to my mentors, remember. It reminds me how anyone can go online and pay to become a marriage registrar, i.e. perform a marriage ceremony for couples. My brother did that twenty years ago and has yet to perform the marriage ceremony for a willing couple. For real judges and clergy, this might be irritating too and that makes me a little happy as well.
Anywho, Doctora and I were rolling with the injustices haranguing us in the practice of medicine, both from the angle of the physician and the patient. I was pumping her up for being the cutting-wonder who she was and she was dutifully marveling at my jabber-mouth work that she would, “never be able to do in a million years.” Somehow this brought us round to how our culture avoids embracing the biological paradigm of anything inside our skull but is so willing to celebrate it for any other part of our human bodies.
Where do emotions and behaviors come from?
Doctora answered me with a frozen breath. Then after I warmed and soiled the air with a lot of jabbering and she was finally able to speak, she said,
I would just be horrified if my brain got sick!
I wondered if it was scary enough to clobber her to the ground, but I do agree. Terrifying. Don’t you think?
So sleep is important from a basic rudder-rudimentary perspective of healing, restoring, and preserving our biological identity.
If we don’t sleep well, a disease process may develop.
During sleep, we heal from injuries, both physical and mental. Our brain actually shrinks for a small period, squeezing out, like a sponge, the toxins that accumulate during the day. It becomes smaller in mass without the fluid that filled it. The toxins drain into our cerebral spinal fluid (CSF) and after a period, the brain absorbs new clean CSF and expands in size again. Without deep sleep, the brain retains the toxins it accumulated during the day and those toxins go on to damage the brain cells, summarily over time, potentially harming the brain health and leading to disease.
These treatments relating to sleeping well are often better than pharmaceuticals when it comes to processing and treating stress. When we sleep, we allow our broken neuronal connections to regenerate. We re-stock our shed with ingredients like cortisol, hormones, and neurotransmitters that are fertilizer for well-nourished thinking, kind behaviors, and stable emotions. During sleep, our memories consolidate; they find their place in the folds between our cells and root down into our rich minds.
I have seen regular, restorative sleep bring someone from a place of mental decline to no longer needing psychotropic medication. Everything works better with sleep.
2. What are some of the tools that you like to use to help people develop better sleep hygiene?
Sleep Hygiene, according to Dr. Q!
1. Bed is for
The bedroom is only for sleep and for sex. This means no food, no phone, no TV. If you are not having sex, then all you get to do here is sleep. This might be an adjustment for the entire family, if your spouse is used to clicking on the late news or your kids want you to read them stories in your bed. But your subconscious has to recognize this place as a sanctuary, and not the place to read one last chapter or check Twitter.
(I have yet to have someone tell me that this improved their sex-life, but one would think!…”)
No naps longer than 20 minutes during the daytime. If you are tired and have the luxury of lying down during the daytime, do it! But set your alarm to wake you up in 20 minutes, and then make sure you wake up fully. You can take these “power naps” 20 times a day if you want to, as long as they are no more than 20 minutes at a time. Anything longer will break into your deeper stages of sleep and throw off your sleep cycle (also known as sleep architecture or circadian rhythm) at night.
Exercise, but not before bed. Exercise during the day can help to regulate your sleep cycle by making your body tired at night, but make sure you do not crowd it against sleep initiation. Try to get 40-60 minutes of aerobic exercise, 5-7 days a week. Look at it like a pill, prescribed by a doctor. This is something you need to do not for your waistline, but for your medical and emotional health. Every day, tell yourself, “I’m exercising so that I will feel good, so that I will sleep good, and so that I can do what I want in life.” Some say, “I’m exercising for my brain!”
Keep the lights dim before bed, and turn off the screens early. Darkness releases melatonin from the pineal gland in our brains, which helps to regulate our sleep cycle. Light suppresses it. Melatonin is a cornerstone in sleep architecture. Having your face six inches from the computer or TV before you lie down doesn’t give your body much time to turn itself off. (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.)
Go to bed and get out of bed at the same time every day. Enough said there.
6. 30 Minute Get Up
If you go to bed but cannot fall asleep in 30 minutes, get up and do something else until you feel sleepy. Then go to bed and try again. Refer back to the other rules when choosing your activities (no screens, no reading in bed, etc.).
No caffeine in the second half of your day. Period. No matter how good that iced latte looks. Decaffeinated is the way to go!
Do not use alcohol to sleep. Alcohol is a depressant (will make you depressed) and also blocks deep sleep. Alcohol hits the same receptors in the brain as the benzodiazepines mentioned above.
Do not smoke before bed or if you awaken from sleep. Nicotine is stimulating. (It also decreases blood flow to the penis, so that’s one less of only two allowable bed activities we are allowed… Bummer.)
10. Sleeping Aids
If you cannot fall asleep in 30 minutes, consider taking a sleep aid. Do not take any over-the-counter sleep aids except natural melatonin, valerian root, or chamomile. Others almost all contain diphenhydramine, which blocks your deep sleep. You may end up sleeping a longer amount of time, but you will not be getting restorative sleep.
If you talk to a doctor about a prescription sleep aid, do not take benzodiazepines, such as diazepam (Valium,) temazepam (Restoril,) clonazepam (Klonopin,) alprazolam (Xanax,) or lorazepam (Ativan.) These also block deep sleep. Sleep aids that don’t block deep sleep and sleep architecture include atypical benzodiazepine receptor ligands – such as zolpidem (Ambien), eszopiclone (Lunesta), or zaleplon (Sonata). Trazodone (Desyrel) is also safe for sleep structure and maintenance. The newest FTY (Friend to Yourself) sleep aids are Belsomra and Silenor. Sometimes people will find that combining sleep aids, such as zolpidem with trazodone, is more effective rather than using only one agent. Some of these wash quickly out of the body, and some take a full eight hours.
11. Sleep With Me
Do not sleep with your pets or children. Pets and children are disruptive, and no one gets the rest they need. Get the sweet buddy-dog out of bed.
It is not personal. It is sleep hygiene.
I’ll insert here, that one thing that gets left out of most 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 provigil. Don’t confuse this with taking caffeine. Caffeine is metabolized way too fast to be helpful in this regard. There are others one may discuss with their treatment provider.
3. What parting words do you have for other practicing psychiatric healthcare professionals regarding this topic? How about for the consumers?
For providers and consumers alike, remember our identity is as humble as the cells from which is is generated from. Our identity is as vulnerable as those cells are. The basic needs of the body, such as sleep, lead to the most beautiful and marvelous developments that this life can bring. Without our biological health, without healthy sleep, everything in our body and what our Me connects to, is affected.
Questions for you, readers: Again, do you have any recommendations, other interests, directives?
Please help me!