Insomnia

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Good Sleep

Naruto Sleeping

Image by lyk3_0n3_tym3 via Flickr

When our day feels out of control, perhaps our night doesn’t have to be.

During sleep, our body replenishes hormones and chemical messengers that it needs so badly to cope with the many physical and emotional stressors throughout our day.  If we don’t sleep well, we can’t cope as well.  It is during sleep that our memory consolidates and we can see where that might affect us.  Poor sleep means poor day time memory, concentration and focus.

Focus on the part of sleep that we can influence.  This is called sleep hygiene.  Possibly we can choose what time to go to bed, what time to wake up, what is in our bedroom and what we do before bed.

Any parent knows that there are times when these things are not in our control but they also know that without a good nights rest, parenting during the day is much harder.  Pick any one of those things to start with, such as getting to bed at the same time every night, at a time that allows us to sleep a good 7+ hours for the night.  Chart our sleep in a sleep journal for a week to get a better sense of our own sleep train and the areas we can take control over.

Taking care of others means taking care of ourself.  “You can’t give what you don’t have.”  And without sleep, we have a lot less to give to ourself and others.

Self Care Tip – get good sleep.  Be a friend to yourself.

Questions:  What does it offer you to know that the night doesn’t have to be another place of chaos in your life?  How has that improved your ability to be your own friend.

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Draw Sleep Hygiene Into Your Culture

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Thomas didn’t want to organize his life.  It wasn’t fun when things were predictable.  Lately however, that was the problem.  He wasn’t having fun anyways.  Thank God for work.  It was the one firm construct in his life.  Wake up, shower, drive and work until he drove home.  It was like Harold and his purple crayon had drawn this into place but forgot to draw up the rest.  When to go to bed?  When to eat?  When to play?

“Harold!  Get back here.”  

Before, Thomas had resented any imposed restrictions on him.  He liked to graze.  Now, with bewildering awareness of his unhappiness and unbounded self, he wanted help.  If help meant medication and the opinion of others, then so be it.  At least until he found out what happened him.

When Thomas came in to see me, he said he had lost himself.  His personality had changed and he was suffering.  We approached things from the biopsychosocial model.  We ran labs, got him in to see his primary doctor for a physical, considered life-stressors and his support structure.  We started medication and we introduced sleep hygiene.  I almost lost Thomas there.  Changing his sleep was changing his culture and he had enough recollection of his identity to know that he had liked to stay up at night.

Out came the sleep journal.  Thomas turned his body away and looked at me sideways.  We agreed to try improving Thomas’ field of knowledge on sleep and see if he would buy into this for himself.  We set a time-frame for his research and decision.  If he didn’t do the work to get informed, than he’d go with my recommendations until his brain illness improved enough to allow him to do more for himself.  We’d work together with our purple crayon and drawing in some lines.

Sleep hygiene is one of those purple lines in our life that help us know a better sense of who we are.  It does this for many many reasons you can read more about in previous posts listed below if you like – but it does do it.  Regardless of our temperament, if we like to graze or run to the barn, we all need solid refreshing sleep.

Self-Care Tip – Use sleep hygiene as a tool to get friendly with yourself.  Don’t be afraid.

Questions – Do you consider sleep hygiene as a useful tool in your life?  Does it come naturally or do you have to work at it?  How do you draw your lines in?  Please tell me your story.

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Sleep Is The Vital Sign Of Psychiatry

Yesterdays brief post, Just Go To Sleep, provoked and inspired many of us.  Perhaps it was its brevity, it’s mostly blank canvas in other words, that allowed for such freedom.  The comments ranged from major depressive disorder hypersomnia type, to insomnia related to anxiety.  We covered medication induced sleep, to parasomnias.  Some of us have to fight hard for our sleep time and others of us fight to get away from sleep.

I’ve covered a bit already on sleep in previous posts you can read if you want to review:

What I haven’t done is organize for you, as you did so well for me in your comments yesterday, the different reasons we sleep the way we do.  This isn’t a quick flick to show you but I will touch on Carl D’Agostino‘s question when talking about depression with increased sleep,

“Is our brain allowing us to escape the depression this way?”

English: Monitor of vital signs in intensive c...

(Photo credit: Wikipedia)

I love this question because it discloses simply by inquiry the full body involvement in the disease process of major depressive disorder.  Sleep is known as the vital signs of psychiatry.  It reflects what’s happening in the whole system, the whole person even down to a sore on your foot to the ravages of post traumatic stress disorder in your hypothalamus.  When sleep changes, we know to look into things.  There’s an investigation to be done.

 

 

We can, each of us, be part of the investigation:

  1. Maintain sleep hygiene.  Don’t indulge when we don’t want to go to bed.
  2. Observe our nights – is our sleep solid?
  3. If yes, is it restful?  Do we feel refreshed in the morning?  How is our day time energy?
  4. If not refreshing, why?  For example, do we snore?
  5. When do we have the most trouble – falling asleep, staying asleep, or falling back to sleep if we awaken?

When our sleep deteriorates, if nothing else has yet, we can bet it will soon if we don’t get our sleep restored.  Not everyone knows that during sleep, we heel, our hormones replenish and our memories consolidate.  Marie from blog-site, livingvictoriously, told us yesterday about her day time inattention after poor sleep,

“I have had nights with very little sleep that have left me feeling like I am unable to concentrate well the following day.” 

We all become a little drunk, disinhibited, inattentive and impulsive when we get little sleep.  Or opposite, as Carl described, with too much sleep we feel,

“vapid and uneventful.”  (Good word Carl, vapid.)

One of the sad times for me in clinic is when I meet a new patient who has suffered with insomnia for a long time along with another one or more combined brain illnesses and I fall into the, “what if’s?”  Knowing how much healing they would have gotten so long ago simply by getting sleep gets to me and I have to push it down and be grateful for the now, when I know they will find some relief.

Don’t minimize the role of sleep in our life.  Don’t minimize any changes in our sleep.  Take sleep seriously.  More serious than the rest of the stuff we usually ruminate over, like offenses taken, our appearance and the weight of our road bike.  If sleep changes, get a professional consultation.  If it doesn’t resolve, get another consultation and push and fight for your sleep.  It may be that health and lifestyle changes must happen.  Whatever it is, do it.  It is a friendly thing to do.

Questions:  What have you noticed about your whole body’s relationship to brain illness?  Has sleep been a part of it?  Did sleep harold any other important changes in your medical/emotional health?  Please tell us about it.

Self-Care Tip – Forget about sleep.  Just kidding.  Sleep well my friends.

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So Many Choices, So Little Time …For Self-Care

"Sophia Western", engraving after Bu...

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Self-Care Tip #198 – Being a friend to yourself might be saying,

No.

Our culture is brimming.  Brimming with…, well take your pick; walking the dogs, turning in a take-home test, watching The King’s Speech, writing a journal entry, making pancakes or reading Savvy – we have options.

However, today and often, options are stalkers we think difficult to restrain.  …More difficult, say than filing a restraining order against your husband.

Walter filed for divorce with his unhappy wife.  Vengefully, his wife turned around and filed a restraining order on him and just like that, he was unable to see his kid for over two months.  That was easy.  All she had to do was file it.

And when we have these many options, all we need to do is say, “Yes,” to one and to the rest,

No.

I love it when my four year-old son is rocking carelessly on my outstretched legs, flopping about, a happy-drunk bird-on-a-wire, and predictably although unintentionally falls.  Crumpled on the floor, he flicks his bangs back and says rather coolly,

I was okay, Mommy.  I was okaaaay.

I had tried to rest on the couch and type, doing my self-care thing after doing Mommy-stuff with the kids for a large chunk of the day.  But telling him to stop doing that really cute thing he does was not so easy.

According to The Economic and Social Research Council,

Having older siblings is not related to children’s happiness with their family, but having younger siblings in the household is associated with lower levels of satisfaction and this effect is greater the more younger siblings present in the household.

It turns out that children feel more happiness in their homes when there are fewer younger children.  They perceive that there is less energy available for them from their parents with each born child.  And I’m here to say, there is.  With my son on the floor, flicking his hair and going,

I was okaaay…,

my middle daughter kissing my shoulder and burrowing into my arm like an ear-wig, my eldest daughter came back to ask for the sixth time if I would play jump rope with her – I remembered this study.  So true.  I don’t need more options, i.e. more children who ask and I say,

No.

With these many wonderful options, choosing Me, is not always easy.  (See post, “‘You’ Are the Best Gift.”)

Now throw in a little inappropriate guilt, some ruminating thoughts, self-loathing, bad sleep, some low motivation and energy and choosing Me becomes the hardest thing anyone has come up against.

Questions: How do you choose you when you could pick so many other great options?  How has this helped quality of life for you and others in your life?  Please tell me your story.

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Put The Struggle Down and Take 3 Steps Back

I almost gave up on tonight’s post.  But after taking a Glee break watching Kurt get bullied, get defended, then get out of his school, I felt more refreshed.  Go figure.  What I have to tell you about self-care tonight is to go back to the basics.

When you become inundated with all the good things out there to do, go back to the basics and let it rest.  Get your sleep.  Take your omega 3’s and vitamin D.  Take your medications regularly and step back from the struggle not to.  In fact, if possible, put all struggles down and take 3 steps back.  There is time enough to pick them back up when ever.  Go to sleep and sleep well.  If you don’t think you will, take something to help.  Something safe that will protect your deep sleep.  Then, get up, worship God, exercise and see what’s next.

Any time you want, any time you need, any time, you can go back to the basics any time.  These are mine.

Good night folks.

Self-Care Tip #120 – Get basic with yourself.

Question:  What are your basics?  Please tell me your story.

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The Great Lie.

One of the great lies of mental illness is that, “If things weren’t so stressful, I wouldn’t feel so bad.”  Look inside ourselves now and see them.  All the numbered and ranked stressors we tick off to explain how we feel and/or behave.  How about someone we love.  Do we tell them, “Of course you feel that way!  Look at all you’re going through!”

Because major depressive disorder (MDD) is mainstream enough, I’ll use it as an example.  Who, when they are down, doesn’t look for reasons why?  Say there is an additive effect of stressors such as home conflicts, financial duress, and poor sleep.  Since these events, you haven’t felt pleasure, you’ve felt sad and depressed.  You aren’t motivated or interested in your usual.  And where you normally would seek people out when you felt down, to get more energy, now you just want to be alone.  And so on.  You are able to say that you started feeling this way progressively since triggered with those stressors about 3 months-ago.  Before that you were “fine.”

Many people in your life, have told you that you are just going through a bad spell.  You have believed them but say, “Even if this is a bad spell, if it goes on much longer I think I’d rather die.”  Your best friend responds, “Anyone would be depressed if their boss was that evil!”

My answer, “No.”  Feeling down is appropriate to stress when it doesn’t disrupt your life for more than two weeks at this level.  And it is never normal to want to die.  Everyone has stress but not everyone responds to stress in the same way.  Not everyone if put under your same triggers would develop MDD.

Would you have developed this disease if you weren’t put under these stressors?  I can’t say.  We develop illnesses for many reasons.  One of the many reasons is external stress.  A hypothesis supporting this is that stressors trigger our genes for MDD much like we know cancer genes can be turned on by stress.  However, we do not have a direct correlation to the stressors as being entirely causal events.

Even if it were, none-the-less, we are left with the disease process in progress.  It is not an adjustment reaction to stress.  It is medical illness.

Feeling this way is not normal for what you are going through.  Telling yourself that it is, that is the great lie.

Self-Care Tip #118 – Don’t believe the lie if what you’re going through is affecting your function in life.  Be a friend to yourself.

Question:  What whispering lies are you struggling against?  Please tell me your story.

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Claim Your Brain

My mind, like rusted gears, was not moving well.  It hadn’t been really since my 1st pregnancy 8 years ago.  There are few things that dumb us down as much as pregnancy and children!   Hormone changes, lack of sleep, fluctuating from 145-200-145 pounds three times, and then the subsequent growing beloveds around me to contribute to mental dissociation.  Simple sensory overload from talking, yelling, crying, petitioning, inquiring kids factors in.  You may read more about sensory issues here.

Daily writing, like a staunch governess, found my brain under cobwebs, bug carcasses, and musty stench.  (Hello old friend!  There you are!)  This helps to explain the joy gripping my hand, like girlfriends on the playground, when I sit down to write!  The world is active to me, including rather than excluding me. My in-between moments used to hang like an old woman’s breasts.   Now much more time full of nourishing thoughts bless me.  I am in awe.

My patient came in sighing deeply.  He wasn’t better.  No, he said.  He lacked motivation and interest and connection from the world.  He felt selected out to suffer.  A dumping ground for misfortune and misunderstood.  Efforts through medication, after medication changes were like looking for love in all the wrong places.

We talked about cognitive distortions, tapping into things that used to make him happy, road-blocks in poorly designed neurological grooves – volunteering at the library or animal shelter, journaling, sharing his life story with others, exploring his spirituality.  No.  No good.  Nor could he consider psychotherapy as he’d been through too much of it already to consider it again.  And he just couldn’t get interested in groups such as through NAMI.

His brain, assaulted by stressors, disease, and disuse was growing silent.

Being a friend means yelling, fighting to reclaim your journey, finding something to connect you to your process of life.  My patient was letting squatters take his property simply by being absent.

Self Care Tip #60 – Claim your right to health.  Be a friend to yourself.

Question:  What has helped you connect with your own journey in life?  What do you think?  Please tell me your story.

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Look Around At The Other Reasons – Depression

Flagellants mortifying the flesh, at the time ...

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“I’ve done some bad things.”  Patient tells me she can’t sleep well, is nauseated, depressed mood, worried with perseverating thoughts about acts that shame her and ramifications, doesn’t feel as much pleasure in life, isolating, tearful and more.  I was alarmed!  What could she have done that deserved this kind of self-flagellation?  When she told me, I didn’t realize it.

I was still waiting for the rest of the story.  I got caught up in her own self-judgment and found myself sitting beside her “in court.”  Once I realized what I was doing, I was chagrined.  Here I was collaborating with her in her inappropriate guilt.  It took me too long to register that her reaction was not proportionate to the offense.  I told her I was sorry she was going through all this emotion.  She said, “It’s my own fault.”  Is it though?  We needed to start looking at additional reasons that might be influencing the way she felt.

Start looking at other paradigms when the emotional response is out of proportion to the event(s).

An analytical approach would look at unconscious reasons, such as other personal choices that conflict with a core beliefs.  Or perhaps, something like unresolved anger coming out in physical and emotional symptoms. Ask about our “closets,” peel away pretense and let your flawed self into the air.  Keep it real.

Another paradigm is medical.  Inappropriate guilt is a symptom of Major Depressive Disorder, a debilitating disease process of the brain that affects the whole person/body systems.  When distorting things out of proportion, personalizing too much, we must ask if there is a depression going on.  Ask yourself.  Ask others.  But don’t let it continue if at all possible.  Major Depressive Disorder is a progressive disease that does more damage to the brain the longer it goes untreated.  In other words, the brain is affected more over time, it is harder to treat and it is more dangerous to the person.  The average length of an episode is 2 years and the more times it returns, the more chance to have the disease process continue for life.  Treating sooner and for longer, decreases the chance of relapse.

Excellent for us are the many treatment options for this potentially devastating disease.  Even in the “lifer,” when staying on medications, the relapses are much easier to get through and shorter in duration.  The medication has a protective effect on the brain.  Prophylactic against further insult.

In the woman I told you about, there was another emotional spectrum disorder, anxiety.  Anxiety and depression are like brother and sister.  They often go together.  But for today, we’ll leave it on the symptom of inappropriate guilt and let it rest on the reminder that the brain is human, mortal, attached to our neck and not an aura.  When the brain gets sick, it shows how it is doing the only ways it can, often through emotions.

Self Care Tip #46 – Look at all the reasons influencing the way we feel.  Be a friend to yourself.

Question:  What do you think?  Agree or disagree?  What is your story?