Sleep disorder

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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.

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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

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Draw Sleep Hygiene Into Your Culture

hbofamily.com

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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Just Go To Sleep

Sleep

Image via Wikipedia

A multitude of sins would be forgiven, pills would be forgotten, pain would be diminished, hope would be restored, brain would be healthy if we would but go to sleep.

Questions:  What keeps you from self-indulging when it is time to go to bed but you’d rather not?  What helps you get your restorative brain rest?  Have you noticed that everything is better with sleep?  Would you describe it to us?

Self-Care Tip – Get solid restful sleep.  Be a friend to yourself.

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Sleep Does Not Lose As Gracefully As He Lets Us Think

Cougar sleep

Image via Wikipedia

Self-Care Tip #244 – Sleep when the day is over, and play another time.  Be a friend to yourself.

Sometimes it is hard to let the day end.  Michael told me that he was having trouble sleeping.  I asked him to tell me more and heard him describe fun-filled hours of movies, computer, phone-calls and late-night snacks that were disturbing his sleep-initiation.  Just listening to him, I felt a yearning catch spark in me to have the freedom to be spontaneous again.  You might know what I mean.

The opportunities to be spontaneous have shrunken up as our choices have brought us expanding fillers for time, attention, money, energy, emotion, personal resources and magic.  It is no wonder that letting the day end meets reluctance.  Those last few hours that sleep called shot-gun for are ours with less fist than big brother used to stage.  Sleep doesn’t put up much fight …at first.  At first, it concedes to us.  It lifts it’s chin casually until given turn.  However, much like the loan shark, sleep will never go unpaid.  It will take it’s due.  Maybe just not tonight.  Maybe you won’t hear about it until later.  And there are no promises that it won’t take by force, from one part or another of our body, our brain, our beauty, our emotions – debts are not forgotten here.

Michael says, as if he were the victim here,

It takes most people about thirty minutes to fall asleep.  But me!  It takes me hours to.  

We started talking about sleep hygiene and Michael just wasn’t interested.  I asked him to simply read about it and just see what he thought he might be able to start with.  One change maybe that he thought was tolerable.

These negotiations are sometimes best when the patient feels like they came up with the idea.  Michael is going to read about this and hopefully become his own advocate.  He will hopefully “sell” it to himself with the information both from facts but also from experience.  It’s no accident that Costco sets up samples at ever turn of their superstore.  Nor that we can never seem to leave without spending at least $100 in cash – not credit!  Cash!  (Argh.)  Maybe Michael will sample and decide to sleep rather than play at night.  He might have to “taste it” to believe and choose for himself.

Spontaneity will always lure us, dangle her jangly jewelry, give her side-ways glance and make us long for those midnight hours to open up in playful company.  However, sleep is not as gracious as it seems.  Don’t be fooled.

Question:  Do you consider sleep hygiene important to self-care and why?  How do you see it related to you being a friend to yourself?  Please tell me your story.

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When Self-Care Gives Pleasure, You Will Be Friendlier To Yourself

Self-Care Tip #128 – Connect pleasure with self-care.  Be a friend to yourself.

There’s a reason we have bad habits in our life.  It’s not only the loops, the neurological grooves in our brain, it’s also that they bring pleasure!  It’s not so unbelievable understanding obesity, drugs, addictions, poor sleep hygiene, inactivity, whatever it is when we think about the amazing effect that dopamine has on our pleasure center!  Ah.  Say, “Dopamine!”

Our real question with ourselves should be why we so often expect ourselves to do “good” things if they don’t give us pleasure?  How do we expect to stop over-eating if the substitute we offer our biological selves is suffering?  How do we expect to exercise, if we’d rather poke needles into our eye-balls than jog a mile?

We’re smart people, we have knowledge and we know what to do.  But, knowledge isn’t the answer always.  The “language of the heart” is dopamine, is feeling good.  How can we link what we want to do with ourselves objectively with feeling good.  It would be nice to pair up our dopamine with friendly habits and not those that are self-destructive.

How to do that might be worth some effort figuring out.  Figure it out individually if we want it to succeed.  The reason for the discussion here is not to give directions, but simply to draw attention to our need to find our own feel-good buttons and how we can wire them up to self-friendly behaviors.

I’m struggling through this also.  I hope to share this awareness with my kids before they move out, so I better get busy!  Can’t do that too well until I do it well for myself.

Today when I went on a mommy-date with my daughter, instead of taking her to Starbucks, we went and bought Bendaroos.  That was all I could come up with in the 10 minute date we had allotted for something feel-good.  Maybe she’ll develop shopping addiction instead of food addiction.  Time will tell, but I hope she got out of it the pleasure of creating shapes with Bendaroos instead.  Hopefully when she get’s creative, dopamine squirts out in her brain like a geyser.

Now, to get back to me…?  huh.

You can read a related post here.

Question:  How are you linking self-care with pleasure in your life?

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Escape Self-Loathing

happinessinthisworld.com

Self-Care Tip #91 – Put the fight down and take 2 steps back.  Be a friend to yourself.

He came in looking really good.  Chris had seen me for many years and he hasn’t always looked this way.  I said

You look great!

Chris shrugged and told me he had just had a long messy argument with his partner and somehow still felt alright.  In the past, after they fought and the self-loathing set in, he might have hurt himself – like using alcohol or cutting on himself to

…just feel something different.

I was ready to move past the story as he sounded like he was ok with it.  We talked past each other.  Me asking about his sleep, and Chris telling me clips and phrases from the argument.

But amazingly I’m fine!  If he wanted me out today, I’d be out of there, no problem.  He just needs to say the word!

Chris was sitting back in his chair, relaxed until then.  His hands came up and took control of his space, thrusting as he spoke.

Being a psychiatrist, my expertise kicked in and I realized I should turn back.  Chris wasn’t ready to talk about sleep.  You see what all those years of school can do.  Not everyone knows how to pick up on such subtleties.

Chris, maybe you aren’t so happy you argued.

We talked more about his energy, appetite and motivation.  Then we came back to his argument.

It’s none of his f—— business where I am during the day!  I’m not his child.  I’m his partner!  I told him…!

And so on.  Chris still looked better than when he was in the grip of post-traumatic stress disorder symptoms, or when he was catatonic.  But he didn’t sit comfortably with himself.  And I thought, Chris has fought so hard for himself, why can’t he handle what I want to say?  And I did.  And he did.  Beautifully.  He was a brave knight on a black steed holding his wounded sides.  Life had been a battle for him, but he was making choices to fight less and live more.

“Ok.  Yes.  You’re right.  I will next time.  That makes sense.”

When you’re about to engage in something that in the end will make you loath yourself, choose not to.  That’s friendly to you and your other.  Say something like,

When I was gone you felt jealous?

Give over stage and anger and open windows and breath.  Just choose not to hurt yourself.  Winning or losing the argument, in the end, you hurt by your own choice.

Biologically and probably spiritually Chris wouldn’t have known what to do with that years ago.  But he did now.  I saw him relax again and put his hands away.  I knew Chris had a love for Love and this clicked for him.

I can’t describe how happy I was/am.  Being a part of his journey is a great honor.

Question:  How have you escaped self-loathing and your mean self in the heat of the moment?  Please tell me your story.

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There is Room In Our Wanting Selves

Having another child born, our hearts somehow open up and make more love, more space where things once seemed crowed up like hobos in a boxcar.  Our time and energy does that too.  Feeling like you can’t do another thing by 6 PM?  Feeling like watching TV on the couch is an accomplishment at that point?  I’m telling you that this changes.  Do what you want.  You may not realize it yet but you want something special.  You want something that you were designed to do.   When you discover what that is, activity becomes joyful, congruent with your inner self.  Somehow there is more room in your day.  More energy that comes with no strings attached.

My husband just came home from a tech conference.  He was told by famous Silicon Valley junkies, while sitting in an audience of other wannabe’s, “Don’t do a startup.  You’ll fail.”  It was a secondary message that returned intermittently – unless you can’t sleep at night because you need to solve a problem – if you are trying to do a startup company for any other reason than for your own sanity, you won’t make it.  These people were doing what they were doing because they felt like it was their life’s nectar.  It was their pearl of great price.  Their efforts were fueled by their own genetic design.

In medical school, I used to look around me confused by the obvious natural positive responses of other students.  I looked at myself and thought I was a fake.

I looked at them and thought, “There’s the real thing.  I wonder what it feels to be the real thing.”  I know.  Sad huh?  Ah well.  Turns out I’m a flaming extrovert.  I get energy from being with people.  Being alone takes energy from me.  Wether it happens slowly or quickly, either way eventually I have to resurface and connect with someone to re-tank.  Every day when I sat down to study, I felt alone, energy sucked out of me, the ground was going to swallow me up.  And I did it still.  Ground through my long hours long enough to make it to where I belonged.  With you in psychiatry :).

Here’s the news.  We are all “The real thing!”  Yah!  We have our own greatness.

I’m not talking about opportunity to reach that greatness.  Some of that we are given and some of that we make.  I’m just ringing our bells with the idea.  If you want to read more about this, read the blog posts on temperaments.

Question:  Are you doing what you want?  Please tell me your story.

Self Care Tip #64 – There is room in your wanting self for more.  Be a friend to yourself.

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Celebrate Treatment and Live

Holding her breath, my niece swam the length of the pool underwater.  She popped up like an otter.  Slick, water rolling off of her like nothing in the world would bother her.  Click!  The timer showed her that she beat her record.  She was gasping but smiling like an olympian.

My niece would have liked to have added another lap before coming up for air but her body wouldn’t let her.  She needed to breath!  Have you seen the same thing happen in your spouse when they are sleeping?  They look like they are holding their breath doing laps and need to come up for air?  Gasp!  Ah!  Oxygen!  Sweet Oxygen!  Nothing like it.  This event when someone stops breathing for more than 10 seconds during sleep is called apnea.  When it happens more than 30 times in a night it is called Obstructive Sleep Apnea.  The gold standard for treatment is a machine that pushes air into the airway to keep it open – either bipap or cpap.

My patient is young, not obese, exercises regularly and looks healthy.  However, he has tested positive for Obstructive Sleep Apnea during a sleep study and has been prescribed cpap.  My patient used to wear it but frankly doesn’t feel sexy in it.  He feels like he’s wearing a jock-strap on his face.  My patient prefers to snore loudly, go silent, then gasp, over and over through his sleep rather than wear cpap.  No one had told my patient why he must wear cpap, nor did he look it up. We talked a little about his marriage and how he was happy at home.  We talked about school and how well he was performing.  Then we talked again about sleep apnea.  My patient didn’t know.  He didn’t know that he was gifting his wife with a future impotent man.  He didn’t know he was enjoying fewer an fewer functioning brain cells every day.  He didn’t know that he was gifting his children with his early death from heart attack.  He didn’t know that his anxiety might not be responding to his medications because his brain is screaming for oxygen.

Just thinking about his story made me take a deep breath and pray a prayer of gratitude for the air, oxygen, and life.  He did too.   We’ll see if he decides to use cpap or not over time.

In medicine, we can’t diagnose a primary emotional illness if someone has an ongoing medical disease that may be causing similar symptoms.  We need to be as sure as we can about where symptoms are coming from.  I liken it to a steam engine train chugging along, steam blowing out of the chimney.  The steam is what we see, but the onward movement of the train is the disease process.  Obstructive Sleep Apnea affects every cell, organ, system in our body because as it turns out, every bit of us needs oxygen to survive.  I’ve seen people after heart surgery, with no idea that they could have avoided all of that by simply using cpap.  I have been treating one woman now for 7 years for severe treatment resistant depression who is still not using cpap.

So many of the people I work with have sleep apnea.  They feel embarrassed and ashamed by it.  I’m not sure how to help them better but I’ll keep trying because their lives depend upon it.  To feel the sense of accomplishment my niece felt when she came up for air, “Ahhh!!”  Accepting treatment is that wonderful.  We could celebrate.  It’s all perspective.

Question:  Do you have any recommendations for those of us suffering and ashamed?

Self Care Tip #47 – Celebrate treatment and live.  Be a friend to yourself.

Mother’s and Sleep
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Mother’s and Sleep

I was speaking with a friend, mother of 3, including a new baby of 3 months.  Any on-looker could say she had it all.  However, she wasn’t feeling happy.  Looker’s on could also guess just as well some of the reasons why.  Especially those of us who’ve raised infants.  It’s called sleep.  Sleep, the elixir of good living.  Without it, color fades.  Sounds and voices take on an edge like the underside of a long fingernail.  Our thoughts swim about in a mire.  Finding words is confusing and speaking them reduces us to… to what?  Well you’ve been there where my friend found herself struggling to say why she wanted to cry and beat her children.  Just to hear her is enough to make your milk let down.

Hearing someone say get sleep is uncomfortable.  It brings up all the cultural reasons why we don’t get sleep, the emotional reasons, the relationship reasons, and the reasons around discipline.  Well, whatever it makes you feel or think, it comes down to biology.  You won’t feel good and be healthy emotionally and be able to do things you want to do for others if your body and brain isn’t getting restored at night.  So losing sleep may feel like a sacrifice you’re doing for your new baby or husband who wants to stay up and watch movies together, and it may.  However it is also other things.  Losing sleep is taking yourself away from them tomorrow.  It takes from your own journey, disconnects you from your own self.  Losing sleep is a biological cascade that leads to deteriorating goals, including your ability to give well.

There is sacrifice also in letting your child cry for 5 more minutes before going to him at night.  There is sacrifice in going to sleep instead of staying up to play with someone you love.  Don’t be fooled in to thinking that you’re getting your child from her crib when she cries for 30 seconds for her sake.  Don’t be fooled into a mother’s martyrdom.  Babies are also healthier when allowed to self soothe.  Babies are healthier when they learn to put themselves to sleep if they awaken at night.  To get good sleep, look past the guilt, look past the immediate pleasure, look past the distraction, look past and see yourself as you will be tomorrow.  Let that be the sacrifice in your life.  A healthy mom, a healthy wife, and healthy individual for those you love.  Sleep for your own valuable self.  You have a chance to live well.

Self Care Tip #3:  Get sleep for any reason that makes sense to you, but sleep.  Be a friend to yourself.

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