sleep hygiene

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“Off To Sleep!” with you!

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!…”)

2. Naps

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.

3. Exercise

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!” 

4. Lights

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.)

5. Routine

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.).

7. Caffeine

No caffeine in the second half of your day. Period. No matter how good that iced latte looks. Decaffeinated is the way to go!

8. Alcohol

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. 

9. Nicotine

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!

(Smile.)

Keep on!

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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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Fighting For Brain Health Is At The Core Of Being A Friend To Yourself

Nose-picking in progress.

Image via Wikipedia

Demanding what we cannot give is a cruel relationship with ourselves.  It is cruel that we must have insight to pursue health treatment for the brain whose variety of illness destroys our capacity to see into ourselves.

It’s one thing for us to choose not to do what we see is to be done.  We all choose not to take care of ourselves by degrees.  We all make choices against information and sight;

Smoking, exercise, sugar intake, sleep hygiene, working more hours, avoiding interpersonal connections, soda, driving fast, jay-walking, hand-washing, self-medication, self-injury, brushing hair from the top down, splashing our soup, flossing, nose-picking and eating with our mouth open.

Insight is there and we choose not to.

Even so, it is arrogant to presume insight into our own human condition and the more I know, the more I agree with the humility of any great teacher – there is so much out there that we don’t see into.  However this is critically different from the inability to see into and that is the cruel irony of requiring a decision that our brain is unable to be informed about.

There are a number of these.  I’m wondering if you can tell us about your own story of what healing has done for your ability to “see?”  It’s a service to many to know that fighting for brain health is at the core of being a friend to yourself.

Self-Care Tip – Fight for brain health – it is at the core of being a friend to yourself.

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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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Become a Better Friend To Yourself In and With Your Culture

"Energy Crisis!" ...

Image by Toban Black via Flickr

A barrier to getting friendly with ourselves might be our culture.  The inverse of course could also be true.  ‘Takes culture to design the flavor of our homes and habits, our communities and the energy between us and them.  Think, TV in the bedroom, alcohol tasters offered to children, books or the absence of books on the floor and shelves.  Think religion and diet, family meals or take-out.  The way we deal with shame.  Culture is a gate-keeper for many of us.

We could call our culture, the way we live together at home, the balance between each family member and the flavor of emotions there.  Culture might be layered, wrapping us from one balance of energy into another into another creating our own galaxy between each point of light.  In any room, if we look we can find culture.  In any space outside, there is a flavor telling us how to maintain the balance between me and thee.

I don’t know if sociologists look at culture this way yet, but I hope they will.  With all that observing, data gathered and surmising, I hope they study how the individual can be a better friend to herself in “this” culture.  And then I hope they tell us.

Becoming an active designer of your culture is not always easy.  But it is friendly.

Questions:  How has your culture introduced you to your friend, “Me?”  How have you been able to develop a more friendly culture for Me to live in and grow in?  What’s still keeping you?  Please tell me your story.

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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.

Related Articles:

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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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Are You Empowered to Start Everything and End Everything With Me?

Yesterdays blog-post brought a few neighborly questions for us to follow-up with.

One is regarding emotions from bluebee.  Is jealousy medical?  Followed by, What part of emotion is under our control?  Indeed.

Second, Sarah quietly slipped the question under our door of how to respond to emotions and behaviors that come from brain illness.  How?  Indeed.

Third, Carl banged a little louder when asking, what keeps him in a relationship with someone who is maltreating him verses leaving?  Indeed.

There is a nice flow to these.  They are leading into the next and circle back.  Emotions and behaviors come from the brain, much which is out of our control and some of which is.  The choice to engage in the life of the ill is like any other choice.  Our own.  If it matters to us if the way the brain is working in the “other” is in their control or not, we can spend more time trying to sus that out.  I’m not sure myself when I get it good from someone mean, but it has become easier to take care of my junk rather than there’s.  For that, I will say a million thanks.  If I’m getting yelled at, I do the checks on myself – anxiety? fear? anger? fatigue? shaking? dizzy? tone of my voice? do I know what this person is yelling about? (most often it has nothing to do with Me), empathy? empowerment? You’ve told me that you are growing in similar refreshing ways.

Face Down w/Laundry and Gwen Stefani

Image by NCM3 via Flickr

I’ve seen this play out a little in my children.  My daughters and son are supposed to do the laundry every morning before they play.  I don’t know how many years now, but their arguments haven’t changed.

I’m doing this all by myself.  No one is helping me!

Mom!  He’s just laying on top of the clothes!  

Mom!  …

These questions above…;

  • where emotions and behaviors come from,
  • control over biological symptoms,
  • do I respond to others with brain illness
  • or do I walk away

These questions don’t mean much if we don’t find where our empowerment comes from.  Me.  Everything starts and ends with Me.

I’m ill for reasons I have nothing to do with, yet I will be accountable for myself and how I affect others.

I feel emotions I didn’t ask for, behaving ways that I am a spectator to rather than a whole person, yet I will do what I can to gain health.  In that, I have control.

I surrender what I don’t control to my Higher Power.  I take medication.  I exercise, guard my sleep hygiene and get regular sleep, eat responsibly, gather and engage community, attend therapy groups and/or individual, I try while at the same time I let go, I love my flaws as I love my perfections, I try to develop my natural genius, try as often as I can to pour any energies I have in that direction as I know I will heal faster, enjoy life more and be more successful at all my efforts when I do.

It reminds me of that saying, that if I have success, it is from standing on the shoulders of giant midgets.  We are all flawed.  We are all wonderful.  We are supported by others who also are full of flawed perfections.

Do I have control?  You bet.  …And no way.  Always, there are both.

Do I talk when someone is mistreating me? or mistreating themselves by neglecting their own self-care? by letting their illnesses shape their lives?  Do I walk away as that may be what my self-care demands.

Everything starts and ends with me.  There are a lot of stops along the way with other forces, but empowerment is mine.  Indeed.  That’s what I hope my kids will learn when doing the laundry.

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Self-Care Works You, Pushes You, Tires You Out Until You Are Happily Spent On Your Friend – You

two-girls-exercising-cayucos-beach2

Image by mikebaird via Flickr

What is being a friend to yourself?

Being a friend to yourself is more than getting our manicure, shopping, watching movies, being spontaneous and doing what we want.  In fact, often times, being a friend to yourself is not doing what we want.  Sounds great right?

Being a friend to yourself might be the hardest work you ever do.  For a time, it might feel like you are turning your back on your family, being selfish, sacrilegious and unfriendly.  You won’t get kudos from your support groups.  You won’t be noticed or hear thank-you very often.  I’m sure you can’t wait to hear the rest!  “Where can I sign up?”  Right?

Being a friend to yourself is taking accountability for our lives.  It says, everything starts and ends with Me.  It looks for accountability for our actions, our feelings, our health, our spirituality or connections in Me and not towards any external locus.

When we are a friend to ourselves, we don’t apologize and then say, “but….” We make amends for what we believe we are responsible for.  We do this without clarifying and justifying our behaviors.  We are not victims even though we may have been victimized, hurt, misused and forgotten.

Being a friend to yourself protects us against apperceiving that we are defined by anything we don’t choose.  Public opinion, stigma or even our pain does not define us. Our pain is not special. We are special.

We believe that we are free.  Free to choose self-care.  Free not because of the men who died for our freedoms, not because of our behaviors or spending power, but we are free because we are human.  Being our own friend is a privilege that we can choose freely to exercise or not.  No one can make it happen except Me.  Just like no one can make me love you or demand a gift because of the inherent freedom within them.  These things happen only because we believe in them, won over by Love.

We become our own advocate, admirer and treasure of high value.

When we are a friend to ourselves, we don’t deny our history but we claim the freedom to start over any time.  The history does not define us.  We are more than actions good or bad.  We have an essence that is timeless and unchanged by the ravages of illness or misuse.

Being a friend to yourself means caring for the specifics of your body, your simple needs that lead to complex outcomes.  Your exercise, your sleep, your diet, water and air are all worth fighting for.  These things you do for yourself become your currency.  You find that the better friend you are to yourself, the better you become for others.

At this new place of safety for you, where you give less, you give more to those you love.  You discover the mystery that no one can give what she doesn’t have.  Just like any bank, we deposit and withdraw and must protect our basic assets before we are taken over and lose the freedoms because we were poor managers of this one body that God gave us.

Everyone pull out your wallets and please empty them on the desk.  How much do you have?  How far will that take you?  Do you ever go a little crazy wondering where you will get more?

Now imagine that this is your body.  You have these assets; this currency.  Currency like your energy, positive emotions, interest, motivation.  You have bank when you can move around, walk, and muscles to lift your child, this vision to admire her new dress.  This is money, this beauty that you offer your significant other, your body, and your shape.

Now you are giving to your children.  Up in the night when they wake up and you can’t sleep afterwards.  You skip exercise the next day, in fact, why even talk about it.  You haven’t exercised in a year or more.  It’s been really hard when your body is either pregnant or recovering from pregnancy over the past seven years.

You never lost the weight and for some reason, now that you want to, your body is firmly telling you, “No.”  You don’t care enough about not having had sex with your husband in four months, but it does bother you that he uses porn so much.  You don’t talk about it.  You’re too tired.

Your child now develops eczema.  She’s nervous and complains of stomach-ache often.  She cries a lot and you can’t remember the last time you enjoyed being with her or any of your kids.  No doubt.  You do love them.  That’s what all this is about, right?  You are sacrificing everything for them and would do it again.  They are your life and when they move out in 15 years, you’re moving with them.  Husband or no husband.  What else do you have?  You aren’t even interested in anything to want to do anything else besides bleed yourself for them.

You can see that this story isn’t anyone’s fantasy.  But can you see that the mother-character – she’s not very nice.  She is not nice to herself and not that nice to anyone else either.  Even though many people are on her list of party invites, she is not connected much to any of them.  You can bet that her family enjoys her about as much as she enjoys herself.  She is angry with them for this but doesn’t realize that she feels ashamed by it more than angry.  Betrayed.

Now enters the victim-role this mother plays.  Oh boy.  I know.  You probably don’t want to hear about it.  It hurts just to start in like this, huh?  So let’s not.  Let’s draw another picture.

Look at your wallets again.  Now how do you get what you need to keep it full?  How do you get what you want to give and splurge on the ones you love?  Where does all that money come from?

Work.  You said it sisters.  And so this is you.  You are a mother of how many?  Three?  Two?  Who do you live with?  What are your jobs at home and elsewhere?  How much of that can you do if you don’t have energy?  Motivation?  Interest?

Oh but you do.  You take care of your basic needs.  You exercise even when your kids are pulling on your sweat pants all the way out the door to the gym.  You don’t get up for your kids at night as quick.  You let them cry it out or do what ever it takes for them to get themselves back to bed.  You take medication if you must to get back to sleep after you are awoken.  You practice sleep hygiene and although you miss, you desperately miss having spontaneous late night TV, you don’t.  You go to bed.  Recently you lost twenty pounds and you are working all your resources to keep it off.  You can’t believe how hard it is to keep off even though you can barely believe how fantastic it feels every day without that weight.

You take your medication because you understand that emotions and behaviors come from the brain.  When you used to not feel pleasure, it wasn’t because you didn’t want to, try to, pray to.  It was because the symptoms from the condition of your brain health were emotions and behaviors in the down direction.  And thank goodness!  Now when you see your kids, you not only love them, you like them.  Sometimes it takes your breath away.  You just can’t believe that you didn’t feel this before.  You like your kids.

I can go on.  But I think you get it.  No one can give what you don’t have.  Now show me your wallets.  Put whatever you took out back in.  Not much?  No worries.  You are your own friend and will take care of yourself.

I know I’m making it sound like being a friend to yourself isn’t that fun.  Having fun isn’t the agenda of friendship.  The agenda is doing what is positive for your friend.  It is some of the hardest work you’ve ever done.  It means connecting with others because you know it is good for you – even though you are shaking, nervous or just plain don’t want to.  It means going out to find love when love doesn’t find you.  It is hard!  It isn’t necessarily doing what is smooth and easy, although sometimes it may be.

Self-care is a discipline of action, presence or whatever is called for by you, your friend.  It takes your natural genius, the things that came to you without working, and it uses those to steer your energies.  It uses those to tell you where you will be working like a mad-dog at times to find the most pleasure and be the most productive, have the most service to offer, be connected in the most intimate way with those you love – God and man.

Self-care is not for the people who need it.  It is for those who want it.  If you don’t want it, stop listening and be on your way.

Questions:  What is called for by you, your friend, to do?  What has pushed you, worked you, tired you out until you were happily spent on caring for your friend, you?  Please tell me your story.

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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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Self-Care Does NOT Always Mean Doing What You Want

The Red Kangaroo is the largest macropod and i...

Image via Wikipedia

Self-Care Tip #132 – Remember, you are your own friend.

So today up up up like a ghoul that wouldn’t die, came this confusion over self-care v. selfish-care.  Somehow, intuitive, or what, we see that word “self” and throw up our hands.  There always seems to be that guy, or it could be that girl, let’s call her Terri, who acts like a two-year old, who can’t think about anyone but herself and does what she wants.  She is toxic to her family and throws her perceived needs in their face faster than they can turn their heads.  That’s not good for them or for her.  That’s not friendly.

Self-care may or may not be doing what we want, Terri.  If we are fortunate enough to have it be what we want, great.  If not, the end goal is still the same, and still great.  It is friendly to us.  Self-care does just that, cares for us responsibly.  We don’t need a mother or a police officer or the government to strong-arm us to do it, because we WANT to take care of ourselves.

Self-care may or may not be doing what is consistent with our temperament.  Achilles taught us that.  The grazer may never want to get in the barn, but in the end, find herself at the jaws of a wolf.  The barn animal may never want to graze and, well, you get it… fill up the barn with poop and such.  It’s just not good.

Barn

Image via Wikipedia

Let’s use sleep as an example.  Just as a generalization, grazers tend to enjoy the late hours.

I don’t get any time to play if I don’t stay up and that’s not good for me.  If I plan my play, it loses spontaneity and then it’s not play any more.

You don’t have to be a grazer to think this sounds delightful.  But here’s the thing about this.  If we don’t get our deep sleep, our sleep hours, do sleep hygiene, in short – if we don’t sleep well enough and long enough we don’t heal.  We don’t replenish our hormones and neurotransmitters which predisposes us to mental and physical illnesses and decreases our ability to respond to psychotropic medication.

Geochelone gigantea eating

Image via Wikipedia

I’ve seen regular, restorative sleep bring someone from a place of mental decline to no longer needing psychotropic medication.  Everything works better with sleep.

Ah today I drift some.  Point being, doing what we want is not the same as being friendly to ourselves.  It can be a VERY different thing, or not.

Questions:  How have you found that self-care has been what you wanted to do, or what you didn’t want to do?  How did you overcome those barriers to getting friendly with yourself?  Please tell me your story.

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Do You Feel Pleasure? Lacking The Ability to Feel Pleasure Leads to Suffering.

Grazing in Spain

Self-Care Tip – Enjoy what you do or else find out why you don’t.

Pleasure.

I often ask patients when I am taking their mood history,

Are you able to feel pleasure?

I need to figure out how to ask this without you or anyone thinking that I want to know more about lube and feathers.  No, thank you very little.  But what I am trying to ask about is the ability to enjoy what you are doing.  It is not necessarily “joy” but at least it includes having a positive sense about you while you are progressing through something.  Being able to feel pleasure does not mean being happy at a fiesta or while doing kangaroo jumps with your child.  It does not mean changing your personality so that someone who prefers to work turns into someone who is playful, or a grazer* turns into a barn animal*.

Feeling pleasure does not mean that we achieve our fantasies.  It does not mean we are on vacation.

To understand what pleasure is, it helps to understand ones temperament.  It is enjoying what you do when you do your thing.  For example, if you are someone who in any given day or mood and regardless of weather or wealth would want to complete the work for the day – when you do that, are you feeling it?  Are you feeling pleasure?  Or, to contrast, if you are someone who would more often choose an unstructured and unmarked day – how is it going down for you?  Are you feeling pleasure?

Pleasure when you are doing your thing is quality of life.  If you do not feel it, life is crackers without soup.  It comes and goes dry and without anticipation.  If you do not feel pleasure, you lose your perceived connections around you and including with yourself.  Suffering is when you feel alone, even from your self.  Losing the ability to feel pleasure results in suffering.

Goodenough, PhD

Not everyone connects that emotional illness is a state of suffering – whatever one or combination of illness(es) come to us in.  Looking in at ourselves, at our Me, from the outside, we observe expressions and behaviors that we interpret from our own bank of information and intuition.  When I tell someone, what you are observing in your child, or wife or whomever is my patient at the time with mental illness – when I say,

They are really suffering,

it tugs our unconscious awareness into consciousness   We often do not actively know about this internal world where there is no pleasure.  We do not know that lacking pleasure leads to suffering.

Are you able to feel pleasure?  Do you find it harder to feel pleasure than you used to?  What things do you still enjoy? How long has it been since you last felt pleasure?

The ability to feel pleasure is a wonderful gift.

Questions:  What has helped you most in healing your suffering?  What has helped you connect again with others when illness pulls you away?  Please tell me your story.

*Reference:
Temperament definitions according to Dr. Q:
grazer = someone who comfortably wanders from idea to idea
barn animal = someone who is goal oriented and does not like things unfinished

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Just to Feel Pleasure

week-end-pleasure

Image via Wikipedia

Self-Care Tip #189 – Heal for yourself, and you’ll see that also, everyone heals.

The best thing I ever did was go on antidepressants.

Bianca sat, but her whole body was talking.  She was telling me about her changing life.  She had read some of her journal from a year ago when she pounded on herself for her behaviors.  She thoroughly grieved the time with her children when they heard her scream about small things that kids do.  She told me about her sons face when she was irritable.  He showed all the waiting tension that an open child will when waiting for Mom to lose it.  She was trying to push it aside and think rather about how she now could finally enjoy them.  Bianca said,

I just had no idea before how much better life could be.

Bianca’s face became tight and she didn’t make eye-contact,

There’s no way to describe what it’s like to not enjoy your kids – My own kids! – for most of their born lives and then wake up and experience something different.  I just can’t explain what it means to now actually like being with them.  I’ve always loved them but I didn’t feel the pleasure and I hate that.  I want that time back but I can’t have it and I can’t give it to them either.

I’m so scared it will end, the pills will stop working and I’ll lose this new life.

Before her medication, Bianca worked hard at taking care of herself.  She was a check-list of responsible self-care.  Bianca thought it was important that I knew this.

  • Aerobic exercise – check!
  • Healthy diet – check!
  • Sleep hygiene – check!
  • Bianca talked about God but things got confusing for her there.  She didn’t like to think about Him being on “a list.”  He was in her life and didn’t feel He failed her even though she couldn’t feel pleasure or joy.

Still, she continued to coil up and release hard punchy words at her kids and then hate herself for it.  She had prayed so much about this and wouldn’t even mind if God had to puppet her, if that’s what it took, in order for her to treat her kids better.  She could not stop herself from being what she called,

Crazy Mommy.

But now, after she was treated, Crazy Mommy was gone.

Aside from dropping the shame, the best thing for Bianca was knowing that her kids could trust her, felt safe with her and that she felt safe with herself.  Everyone was healing subsequent to Bianca healing.

How many of you have told us a similar story.  A similar rescue.  Yet, never-the-less others of us are afraid to go there.

Question:  How are you present with others who don’t understand your rescue story?  How do you stand beside someone who needs medical help for emotional illness but won’t accept it secondary to stigma?  Please tell us 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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Keep It Simple

Being a friend to yourself is obviously a changing effort, depending on your needs. It includes many intersecting paradigms including physical health and biology, genetic predisposition, coping skills, what you do to your body, what is done to your body (such as trauma), emotional triggers, spirituality. I’m sure there are more that we will continue to learn about through the ages.

Deciding where your energies will go can be more objective when we tease apart these paradigms. For example, if I’m tired during the day, have irregular sleep hours, feeling emotional and irritable, I’d start with sleep hygiene. This basically says that if you aren’t having sex in your bed, all you get to do is sleep. No food, no phone, no tv, no reading; just sleep.

Where you are going to spend your energies should be as basic as possible. As preventative as possible. As elemental as possible to start out with. Although the efforts you make shift with your needs, being friendly with yourself means picking your battles wisely. You only have so much energy. Keep it simple.

Self Care Tip #13 – Keep it simple. Be a friend to yourself.