Anxiety
DEALING WITH INSOMNIA
Dennis White, Ph.D.
According to the American Sleep Disorders Association, few medical problems today are as widespread and misunderstood as the variety of sleep disorders commonly referred to as insomnia. There is virtually no one who has not experienced some sort of irritating sleeplessness at one time or another. This may range from the occasional inability to fall asleep, stay asleep or sleep soundly enough to chronic, disabling sleepless patterns that can last for months or years.
When insomnia lasts more than a few days, it can take on a grinding, self‑defeating and self‑perpetuating course that can be exhausting to those who experience it. Over 100 million Americans suffer occasional sleep problems, and about a third of these have some form of chronic insomnia. About 10 million Americans suffer enough to seek professional help and many more spend millions of dollars on over the counter sleeping aids.
According to studies quoted by Drs. Peter Hauri and Shirley Linde, sleep disorders researchers, there are as many as 20 million Americans up watching television between midnight and 3:00 a.m. They also cite a study of 3,000 teenagers indicating as many as 30 per cant fall asleep in class at least once a week. They point out that sleep loss accumulates, creating a "sleep debt" in insomniacs that can't be made up with one or two nights' restful sleep. As this sleep debt accumulates, it reduces daytime alertness, efficiency and safety. We have all heard of transportation and industrial accidents involving people falling asleep or being drowsy. In fact, the real loss to our society in quality of life is immeasurable.
There are many forms of insomnia, and they are generally categorized by causes. These are insomnia due to psychological problems, medical problems, lifestyle and poor sleep habits. Assessing the exact causes of insomnia can take some time, but it is particularly important in order to determine the proper treatment. People seeking help for sleep disorders are usually asked to answer detailed questions related to their sleep habits, psychological and physical health as well as to keep a detailed sleep log to analyze their actual behavior over a period of time. Often this information will give clear indicators of the nature of the problem and point to obvious solutions.
The great majority of the most common sleep disorders can be identified and treated in this way. Those sleep disorders caused by psychological problems, lifestyle and poor sleep habits can be corrected by a fairly standard set of what might be called "good" sleep habits. One of the most important of these is to not become preoccupied with trying to get a good night's sleep, creating tension and the resulting self‑defeating and self‑perpetuating cycle of sleeplessness.
Dennis White is a License Psychologist in Sturgeon Bay, Wisconsin
He may be reached at (920) 746-1346
Email [email protected]
CONDITIONED INSOMNIA
Dennis White, Ph.D.
One of the most frustrating aspects of insomnia for many people is that, regardless of the original cause or causes, the insomnia can take on a life of its own. This phenomenon is often called conditioned insomnia and refers to a set of conscious or unconscious associations that come about the time someone gets ready to go to sleep. The associations are often related to the place of sleep or to certain rituals that are performed in preparation for sleep.
Consider this scenario. An individual has been under a lot of stress at work for the past few weeks with many deadlines to meet and a lot of anxiety when at home at night. As a result, he has been having a great deal of difficulty getting to and staying asleep. Gradually, in addition to the other stress he is experiencing, he is now also worrying about insomnia. Unconsciously he is associating many of his normal, healthy sleep habits with this new inability to sleep.
As a result, simple acts like going into the bedroom, turning out the light, or setting the alarm begin to activate his anxiety about sleep. Or, just thinking about going to sleep may activate conscious thoughts which are self defeating and usually self‑fulfilling prophesies. These may be thoughts such as, "I'll never get to sleep", or, "This always happens to me", or, "I'm not going to get any sleep tonight". After a few weeks or months, the original job stress may be long gone, but conditioned insomnia is now a part of his life.
While many people experience temporary insomnia when they are in strange places or under unusual conditions, conditioned insomniacs have trouble sleeping under normal conditions. In fact, the problem often comes to light when a conditioned insomniac finds, to his amazement, that he can sleep very well in a strange place, on a trip, but not at home in his own bed.
About fifteen years ago, Dr. Richard Bootzin devised the following behavioral techniques to treat conditioned insomnia:
1. Go to bed only when you are sleepy, regardless of how late it is.
2. Use the bed only for sleeping. No TV, reading or eating.
3. If you are unable to sleep, get up and go to another room. Do something else (but don't eat or smoke) until you feel sleepy, however long it takes. When you are sleepy, go back to bed. If sleep does not come easily, get up again, and repeat this as many times as necessary.
4. Set the alarm and get up at the same time every day, regardless of how much sleep you get or how tired you are.
5. Do not nap during the day.
These five techniques have proved quite effective at breaking the most common negative associations related to conditioned insomnia. Going to bed only when sleepy avoids the common mistake of pressuring one's self to sleep. Doing nothing but sleeping in bed, and leaving tke bed unless one is sleeping helps associate the bed with sleeping only. Keeping a regular wakeup schedule and no napping helps the body establish a regular sleep/wake cycle. And doing something else when sleep doesn't come (instead of worrying about it) helps keep one7s mind on something else instead of recycling negative, self‑defeating thoughts.
Dennis White is a License Psychologist in Sturgeon Bay, Wisconsin
He may be reached at (920) 746-1346
Email: [email protected]
SOME HINTS FOR INSOMNIACS
Dennis White, Ph.D.
Insomnia can be caused by a variety of factors. Regardless of the specific causes, however, there are some basic things every insomniac can do to improve the length and quality of sleep. Some are rather simple while others will. require a great deal of effort. Some people who have difficulty with sleep find that even one or two of these changes can greatly improve their sleep, while others have to do all of them to get any improvement.
1. Reduce or eliminate caffeine, cigarettes and alcohol. Caffeine and cigarettes are stimulants which can cause all sorts of physical reactions which interfere with sleep. Some people are so sensitive to caffeine that even one cup of coffee or cola drink in the afternoon can disrupt sleep. Many people consume much more caffeine than they realize, and the simple elimination of this from their diet can make a world of difference. Cigarette smokers. especially those who smoke before going to bed or when they can't sleep, are increasing their heart rate, raising their blood pressure and adding to their stress rather than reducing it. Using alcohol moderately at night was once thought to be a sleeping aid, especially since it is a sedative drug. But in addition to the risk of developing a dependence, alcohol doesn't help everyone fall to sleep, and it causes most people who do fall asleep to have fitful sleep and to wake up frequently in the night.
2. Improve your sleep environment. Sometimes simple things like the quality of the mattress, lack of quiet, room temperature, outside noise, etc. can be critical. The best way to check these things is to adjust them one at a time to see if they make a difference. One very important thing for an insomniac to consider is to remove the clock from the field of vision. If someone is asleep, they don't need to know what time it is. If they are awake, what good does it do to know what time it is? Seeing the clock for an insomniac just adds to the tension and worry about why sleep is so difficult.
3. Learn to think straight about sleep. Most people with chronic insomnia develop very irrational and self‑defeating ways of thinking about their problem. Among these irrational beliefs are: "The longer I stay in bed, the better chance I will have of getting sleep", "If I can't fall asleep, I have to try harder", and "Insomnia will ruin tomorrow and wreck my life". All of these are common beliefs, and all are false. In fact, people with sleep problems do better if they go to sleep later, and get up earlier, even if they have to force themselves. Instead of trying hard to get to sleep, people who can learn to relax find that sleep comes naturally (if they are tired). Finally, most people find that their actual performance the next day isn't much different than if they had a good night's sleep, But they don't feel that way, and they may go to sleep early the next night in a attempt to improve the situation.
4. Learn to relax. Especially before bedtime, doing simple relaxation exercises, such as progressive muscle relaxation and deep breathing can be the biggest single remedy to sleep disturbance. Actually what happens is that relaxation allows sleep to occur naturally, if the person is tired. When people can relax well and don't fall asleep, they probably don't need sleep at that time.
5. Learn to manage stress. This, of course, is more difficult than it may sound. But studies show that it is the slow accumulation of stress, without relief, that causes many people to be so tense at the end of the day that they just toss and turn, thinking of all their problems, including the lack of sleep. If stress is a reason for poor sleep, it will take some time and possible professional help to overcome it.
6. Watch what you eat and when you eat it. In general, a healthy diet for life is also a healthy diet for insomniacs. Sticking to a healthy diet may be very difficult for some insomniacs because they develop the habit of eating a heavy meal just before bedtime, or even worse, eating in the middle of the night when they can't sleep. At this point, eating becomes a self‑defeating compulsion. It may feel good and sooth anxiety, but it causes indigestion, further insomnia and frustration.
7. Get regular exercise. Just like a healthy diet, regular aerobic exercise is good for everyone, not just insomniacs. But it is especially important for people who have trouble sleeping. Regular exercise can help tire out an insomniac. It also becomes a wonderful stress management and relaxation technique. Good exercise doesn't have to hurt, and brisk walking is the single best exercise we know.
Dennis White is a License Psychologist in Sturgeon Bay, Wisconsin
He may be reached at (920) 746-1346
Email:[email protected]
CHALLENGING IRRATIONAL THINKING
by Dennis White, Ph.D.
Licensed Clinical Psychologist
“I can't stand it when that happens!” “He drives me up the wall.” “I can't do anything right!” Do these statements sound familiar? They should. They are ones that most of us have used many times, whether talking to ourselves or out loud. They may seem so common that they appear to be relatively harmless. But they all happen to be false. They are also statements that do not stand up to rational scrutiny. Learning to recognize and challenge these sorts of statements is basic to learning stress management techniques. This is part of an approach known as cognitive therapy.
A basic assumption of cognitive therapy is the belief that most troubling human emotions are caused not by events themselves, but by the way people think about those events. This assumption runs contrary to the popular notion that our feelings are directly caused by the things that happen to us. Cognitive therapy suggests that when events happen to us, we very rapidly, often unconsciously, evaluate those events, and then have emotions that are based on those evaluative thoughts. Because those thoughts are so fast and so frequently unconscious, We do not even recognize they are there. They may be so habitual as to be automatic, so that all we are aware of is an event happening and a feeling that follows.
Cognitive therapy also assumes that people have a continual mixture of rational and irrational thoughts, most of which generally do not cause us too much distress. It is only when irrational thinking gets us in trouble by causing extremely disturbing feelings, such as frequent depression, guilt, anger or anxiety, that we would do well to challenge that thinking. When people learn to recognize, challenge and replace irrational thinking, their troubling feelings often moderate or disappear by themselves.
Consider the following example: Someone has an irritating habit of interrupting you when you are speaking.
A typical automatic irrational thinking scenario might be: “He is being extremely rude, on purpose. He should know better. I can't stand it when he does that. I can't stand it so much that I have to do something about it.” With this line of thinking you can imagine how angry you might get, as well as what words might come out of your mouth. But you may only be aware of thinking that “he did it again” and that you made an angry remark.
However, a careful review of these seemingly “automatic” thoughts reveals all of them to be false, or at least not definitely true. Challenging them might produce the following: “I may see his actions as rude, though he may not. I certainly don't know that he is doing it on purpose. I my think he should know better, but apparently he doesn't. I can stand it, I just don't like it very much. Since I can stand it, I don't have to do anything, though I may choose to.” With these kinds of thoughts instead, we may only be mildly irritated, or even see it somewhat humorously. We might choose to say something about it, or not, but whatever we say, it is not likely to be an angry outburst we later regret.
The goal of cognitive therapy is not to be emotionless robots. Many of our emotions are valid reflections of strongly held beliefs. The goal is to be able to manage emotions that get out of control and cause us trouble by learning to recognize and challenge the irrational beliefs that cause those emotions. If emotions such as guilt, depression, anger, anxiety and hurt are not causing you trouble, you are probably not engaging in particularly harmful irrational thinking. If, on the other hand, any of these emotions are bothering you or are causing you to behave in ways that you do not like, learning to recognize and challenge irrational beliefs might help a lot.