Finally Solve Your Sleep Problems For Good

Therapy can help sleep problems.  There are many links between psychological well-being and sleep.  Sleep is the mind and body’s ability to rest and enter a state of peace and replenishment.  During a stressful time or following a trauma or period of grief, the mind is working overtime and the body is producing more stress hormones.  This is a time to make sure that you are giving them time to rest.

•First, make sure that you are doing everything you can to maintain proper sleep hygiene.  This is where you make sure that your bucket of sleep you are trying to fill doesn’t have a bunch of holes in the side.

•Next, learn about the biological side of sleep.  The best way to measure sleep recovery is not by the number of hours you sleep each night, but by the actual amount of time you sleep in relation to the number of hours you spend in bed?  Your goal is to increase your “sleep efficiency”; good sleepers are asleep 90% or more of the hours they are in bed.  Insomniacs are closer to 60%.

If you have chronic sleep problems, plan to track the number of hours you are sleeping and be in bed no more than 1 hour longer than your average.  So if you’ve been averaging 5 hours a night, set a consistent rising time and get in bed no more than 6 hours prior to that.  It is the tossing and turning and extra wakeful hours in bed that adds to the stress of not sleeping.  Once you have reached 85% “efficiency”, add 15 minutes per week on to your bedtime until you are sleeping your desired amount.

do you sleep better or worse when out of town? either way, it is partially about your association of your own bed with sleep

Learn about body temperature and wakefulness.  Did you know that Sunday night insomnia is not usually caused by the start of a busy workweek?  (Give your psyche a break!)  It’s usually because we sleep a little later on the weekends, and as a result the dip in body temperature that helps take the body to sleep also occurs later in the evening.  So we compound the problem by getting up late on the weekend and then trying to get a jumpstart on the week by getting into bed early.

•Last, use some cognitive therapy for your sleep problems.  Extensive research shows consistently that it is Cognitive Behavioral Therapy (CBT) that is more effective than any method in the short AND long term, including sleeping pills.  When an insomniac’s pattern grows worse, the approach of nighttime is stressful and filled with worry.  People have thoughts of “Oh no, I’m still awake” or “If I can just fall asleep now I’ll get 6 hours…5 hours…I just need 2 hours…”  They develop a “meta level” problem — a problem about the problem.  Insomnia is bad enough in practice that we don’t also need to compound it with these thoughts.  When you cannot fall asleep within 20 minutes, read until you feel drowsy and try again.  This particular practice is hard for insomniacs to accept: they want to believe that if they just lie there for 10 more minutes they will fall asleep. However, this contributes to the cognitive aspect of sleep problems and they learn to associate the bed with tossing and turning instead of rest. In fact, insomniacs are not typically drowsy during the day; their primary symptom is impaired mood.  (Short-term sleep loss clients experience drowsiness.)

Insomniacs can remind themselves that even if it doesn’t seem like it, they do sleep.  (Stages 1 and 2 of sleep are often overlooked by insomniacs, but Stage 2 especially is still good quality sleep.)  Try keeping a list of positive thoughts to refer to throughout the day.  Remind yourself that you can learn to sleep better, and if this is a new patch of sleep problems, remind yourself that you KNOW how to sleep and it will return.

Last, take comfort in several studies that show the ideal amount of sleep is NOT 8 hours; it is 7 hours and possibly less.  Higher risk of mortality is associated with those who sleep 8 hours or more compared with 7 hours or less.  Read more about this and the latest research in Say Goodnight to Insomnia by Dr. Gregg Jacobs of Harvard University.


Treatment Corner: Anger Management

Anger is one of the hardest emotions to express in therapy. When I say to a client, “It sounds like you are pretty angry with so-and-so”, they often deny it. Then the next session they come in and tell me about how they expressed anger to this person face-to-face. I would sometimes rather be angry than feel jealousy, grief, embarrassment, or regret. How about you?

In therapy, I treat individual anger by helping to “clean up” the emotions surrounding it. We first deal with the “meta emotion” – essentially the feeling about the feeling. How do you feel about being angry?

When feeling anger, people also often feel:

  • stressed out or confused
  • mad at themselves, guilty
  • embarrassed

As with most negative emotions, a little of it is not a problem, especially if you are using anger productively.

How can you do that?

  1. Anger is first felt physically. If you have issues controlling your anger, pay attention to your body and notice how it “buzzes” to attention and becomes angry before your mind does.
  2. Once you notice the physical symptoms, you learn to train your body to calm down so that rational thought can proceed. The research shows marked cognitive decline when you pulse rises above 100 due to agitation. So remind yourself that you can’t think properly until you calm yourself down.
  3. Train yourself to be calm by focusing on your breath, or using a mantra to talk yourself down. A reassuring sentence like “I will be understood” or “I am in control of myself” can help, but make it personal to you.
  4. Seek support from those close to you for help monitoring anger. Ask them to tell you when they perceive you to be angry, and help you communicate your feelings so that you can be understood without escalating tension.
  5. Work to understand some of your trigger feelings about anger, and learn how to manage those. Some people might always make you angry. Can you develop a different belief about them to avoid inflaming your anger? Can you avoid activities that escalate your anger (perhaps golf or traffic?) until you understand yourself better?

If someone has told you that they think you have a problem with anger, do yourself a favor and get help. Anger leads to physical health problems and is very treatable.

Treatment Corner: Bipolar Disorder

We think of someone as being “bipolar” in quite casually these days; usually we’re describing someone who is moody. Be careful with that label: true bipolar symptoms are like no moodiness you’ve ever seen. Bipolar Disorder is actually two separate disorders:

Bipolar I (classic): one or more manic or mixed episodes of mood; sometimes includes depressive episodes.
Bipolar 2 (rapid cycling): at least one hypo-manic episode and one major depressive episode. Depressive episodes are usually more frequent and intense.

Bipolar I, which is classic bipolar and a more serious diagnosis is more characterized by its manic episodes and does not even always include depressive episodes. A true manic episode has three of the following:

  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep (feels rested after only 3 hours of sleep)
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or experience that thoughts are racing
  5. Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
  6. Increase in goal-directed activity (at work, at school, or sexually)
  7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

While rapid-cycling bipolar (Bipolar 2)’s hypo-manic episodes can look simply like a high-functioning person, the depression in this disorder is what usually brings a client in for treatment.

How It’s Treated: Classic bipolar in treatment has some experimentation at first followed by hopefully a steep rise in improvement. Bipolar disorder is one of those diagnoses that therapists very grateful for the medication options available. Clients almost always require medication. There’s usually a mood stabilizer, as well as two other medications to help frame the high and low. When properly medicated, a person with Bipolar disorder feels relief and usually sees their medication as an important part of treatment.

Therapy is essential to help control behavior that results from bipolar disorder. A trusted therapist is crucial to maintaining a stable level of functioning. A client must also have his medication monitored regularly.