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Thoughts that keep you up at night (3/8/11)

March 8, 2011

Thinking, Not Sleeping

“Honestly, I cannot sleep at night because I get so excited about doing good things for the world, changing the world,” says Miley Cyrus, the Hannah Montana star.

Sadly, most of my sleep patients don’t complain of excitement at the wonderful things they are about to do to save our volatile, environmentally failing world.  Many other thoughts keep them up at night.  Here are just a  common few:

1. “I can’t sleep.” There are innumerable variations, including  “Why can I never get a good night’s sleep?” and “Tonight I am not going to get enough sleep to function in the morning.”
Clinical problem – psychophysiologic insomnia, the scourge of many working people, parents, and long term insomniacs.

The real problem – turning sleep into a job. It doesn’t work.  It’s rather like turning breathing into a job.

Sleep is part of rest.  Rest regenerates the body.  Insufficient sleep, insufficient rest – which means your body does not remake itself right.  Fortunately, humans are very resilient.

Antidotes – sleep restriction (please see “Sleeping less to sleep well” article of 2/14/11 at” );  cognitive-behavioral techniques; physical activity, in light, often best in the morning to reset body clocks (morning walks can help a lot); getting a regular pattern of going to bed and getting up.

Just convincing people that a bad night will not destroy their careers, love life, and future is also important.  Unfortunately, people with psychophysiologic insomnia are often convinced that without an endless array of nights of perfect sleep they cannot function.  If that were truly the case, most of our already sleep deprived population would also not function (though I think they’d perform a whole lot better if they knew how to rest.)

2. “Money.” Varying all the way from “I don’t have enough money to buy for what I want,” to “I’m about to be evicted if I don’t find some cash – and I can’t sleep.”

Clinical problem – early and middle insomnia.

Real problem – crashed economy and local economic depression.

Sarasota-Bradenton, where I live, had the fastest increase in poverty of any American municipality according to the Economist.  That newspaper also noted one out of twelve people were recently homeless, and one out of eight were eating at soup kitchens.  Official  unemployment is now about  12%, with the real number perhaps twice as high – Depression era conditions.

Antidotes for individuals – careful reckoning of what money goes in and what goes out; financial analysis, with impartial help from others if possible, of what can and can’t be done to economically get by; government programs to keep people temporarily afloat (most are now headed for extinction); trying to retrain, difficult when retraining costs money and there are no funds though retraining will ultimately prove necessary.

Main antidote – social support. Many jobs are now obtained by personal word of mouth, just as they were in the Great Depression of eighty years ago.  Families are surviving with several generations living under one roof.  Many take one-off jobs that pay under the table.

Other antidotes – connecting with service organizations people would not normally turn to or feel ashamed to approach; calling up and writing old friends and acquaintances and seeing what connections they can bring; recognizing, as through cognitive-behavioral work, that making the past better will not fix the future; setting out a schedule for each day with defined goals and evaluating their success afterwards; starting regular physical activity at set times each day to improve mood and outlook.

3. “This sleeping pill isn’t working anymore.” Variations include “I’m putting this together with so many other pills something should work” to “This stuff should knock out a horse and it doesn’t even touch me.”

Clinical problem – sedative hypnotic dependence.

Real problem – the belief there’s a pill to solve most any physical or mental problem – constantly  propagated by multiple media that depict deliriously happy, very attractive people who appear transformed by their newly ingested solution to earthly ills. Five billion dollars a year of drug company advertising has many strange public health effects – beyond busting health care budgets.

Antidotes – recognition that many factors – like depression, anxiety, bills, family worries, horrible diets, inadequate physical activity, and a general lifestyle that turns many people into tired, nervous machines – can and does  perpetuate an inability to sleep.

Other antidotes – passive body heating; a nice, pleasant sleep ritual; morning and/or early evening walking, especially with a friend or family member; cognitive behavioral techniques; real rest before bed; providing adequate time for sleep.

Dying is Easy; Comedy is Hard

So said the great nineteenth century actor Edmund Kean.  Kean apparently also had trouble sleeping.

Insomnia afflicts perhaps one third of the population.  If insomnia  were very easy to treat it would not be such a terrible problem.

However, many of the treatments of insomnia are simple.  Most involve using the body the way it’s built.

The biggest issue – recognizing  that the body works through regeneration.  People need time to rest in order to rebuild their bodies.  To sleep they first need to learn how to rest – what rest is and what rest does.

That was simpler – in simpler times.  Yet active rest lets you redirect your body’s rebuild.

Aging is a script.  Would you rather be the director of the script, or somebody who passively waits to find out the end?
Rest, sleep, Sarasota Sleep Doctor, well-being, regeneration, longevity, body clocks, insomnia, sleep disorders, the rest doctor, matthew edlund, the power of rest, the body clock, psychology today, huffington post, redbook, longboat key news

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