How Are You Sleeping These Days?
I don’t like Daylight Saving Time. This is not just a personal opinion, but also my professional one, because I know how disruptive even minor changes to the sleep-wake cycle can be – to mood and emotion regulation, memory and cognitive function, as well as overall health. Sleep is foundational to good mental and physical health, and most of us aren’t getting enough of it, which contributes to increased rates of vehicle accidents, as well as diabetes, obesity, addiction, anxiety, and depression.
“Spring ahead” is worse than “fall back.”
Most people find it harder to get up one hour earlier, as we did last week, than one hour later, as we do in the fall. It’s also more challenging to make yourself feel sleepy one hour earlier in the evening, versus staying awake longer. The alarm clock may force you awake in the morning (if you don’t just sleep through it) but there’s no corresponding device to force you to fall asleep. As a result it can take a couple of weeks to fully adjust to the time change and catch up on sleep. You can read more about the origins of Daylight Savings Time here, but now I’d like to focus on sleep – why we need it, what keeps us from getting it, and how we can improve our sleep habits.
Why do we need sleep, anyway? To understand why it’s so important, let’s look at what happens while we sleep. Over the course of a typical night’s sleep, we will cycle through 4 different stages, from light sleep to deep, including a phase called REM, for rapid eye movement, which is when we dream. Here’s a graph of a normal adult’s night of sleep, showing the cycles:
Notice that most deep sleep (stages 3 and 4) occurs in the first half of the night, while REM and light sleep alternate in the second half. It’s easier to awaken from a light sleep stage than a deep one. As we age, we spend more time in light sleep and less in deep (children spend most of their time in deep sleep).
While our conscious awareness is turned off during sleep, and some systems slow down – like those that regulate movement – other body systems become more active. These include the immune system, so lack of sleep lowers your resistance to cold or flu viruses, and leads to being sick longer. Other restorative benefits of sleep include hormonal balancing, removing toxins, and regulating your metabolism. And although scientists still don’t know exactly why this is true, if people or animals are totally deprived of sleep, especially REM sleep, they die within weeks.
Even short periods of sleep deprivation have negative consequences for health and mental health. In one study, healthy young men who were allowed only 4 hours’ sleep a night for 2 nights reported a 23% increase in hunger; similar studies have revealed that restricted sleep ramps up production of hormones that stimulate appetite, and increases the risk of developing type 2 diabetes. Other studies have demonstrated that even brief sleep restriction leads to an increase in negative thinking patterns as well as low mood.
As Professor Robert Stickgold from Harvard Medical School explains in this video, sleep helps us to remember and consolidate what we learned during the day, organizing and making meaning from our experiences, as well as improving our ability to problem-solve: Why We Sleep video
If sleep is so essential, why is it so elusive? According to the National Sleep Foundation, adults ages 18 to 65 need an average of 7 to 9 hours of sleep per night. However, in surveys conducted by the National Institutes of Health every few years, about 35% of adults report getting less than 7 hours a night. Alarmingly, 38% report nodding off during the day at least once in the previous month, and 5% report they’ve nodded off while driving!
Reported rates of insomnia and other sleep problems have steadily increased over the last hundred years or so, which scientists attribute to a combination of factors (people have migrated from rural to more densly populated urban areas, lead busier, more complicated lives, and work longer hours in brightly lit buildings) but clearly, exposure to artificial light is a key factor.
What can you do to improve sleep without drugs?
The rate of prescription sleep medication use has nearly doubled in the last decade, with higher use among women, older adults, and those who seek mental health treatment. (There is an insightful analysis about these trends in this Huffington Post blog, Who Is Taking Sleeping Pills?) These medications are intended for short-term use, can have unpleasant side effects, and disrupt normal sleep phases, especially REM sleep. What works best is to establish healthy habits that promote sleep.
The one habit that will give you the most benefit: Establish, and stick to, a regular sleep-wake cycle. The practice of skimping on sleep during the school or work week, and then hoping to catch up on the weekend, is an unhealthy one. When you keep changing the time you go to bed or get up, it interferes with your body’s natural ability to self-regulate, to wake itself, and to fall asleep easily. Ideally, you should awaken and go to bed at roughly the same time every day, or at least most days. This helps to set the body’s internal clocks that regulate things like metabolism and mood.
The second most beneficial habit: Turn off all screens (television, computer, tablet, phone) at least an hour, preferably two, before bedtime. The blue light that emanates from our devices interferes signficantly with our natural Circadian rhythm. Scientists have recently discovered that our internal “master clock” is much more sensitive to light on the blue end of the spectrum. So if you must use your devices at night, at least block the blue light with a special filter or amber-lens glasses. To read more about this, see my article Clock genes, manic mice, blue light, amber lenses.
Create a restful sleep environment. We sleep best in a room that is dark, quiet, and comfortably cool (60 to 65 degrees F). Because the body’s temperature naturally drops in the evening just before bedtime, you may be tempted to bump up the thermostat, but it’s better to just dive under the covers and relax into the coolness of the sheets. Electric blankets can be used to warm the bed, but shouldn’t be kept on all night. Down comforters work best to hold in body heat at night. It’s important to have a mattress that supports the spine in its natural curve, and pillows that can be adjusted as you shift positions during the night. Everyone has different preferences, but personally, I don’t think memory foam or the number system beds are worth the extra money.
Avoid these things in the hours before bedtime: Stimulants, including coffee, black or green tea, colas, chocolate, energy bars, spicy food, and some cold/allergy medications. Alcohol in all forms. The traditional “nightcap” may make you drowsy quicker, but once the alcohol is metabolized, in 3-4 hours, you’ll pop back awake again and find it harder to get back to sleep. You should also avoid intense, aerobic exercise, TV news, and arguments with family members within 3 hours of bedtime.
Try adding these sleep promoters: Herbal tea, especially containing valerian or chamomile. I use a valerian-peppermint blend, with a little honey. If you must snack before bed, eat lightly, of foods that contain tryptophan – milk, bananas, turkey. Some people like a mug of warm milk, with a dash of cinnamon. Other things that help to promote sleep: a warm – but not hot – bath, dim lights, soft music, gentle touch or massage. And some form of prayer or meditation. Some people find that taking melatonin, which is naturally produced by the body, helps, but it should be taken in the smallest possible dose (I use a 1 milligram sublingual tablet).
References:
Daylight Saving Time article in Wikipedia
The National Sleep Foundation website
Sleep On It! Robert Stickgold in Scientific American, October 2015.
The Clocks Within Us. Keith C. Summa and Fred W. Turek in Scientific American, February 2015.
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How Can Mindfulness Help Me Stay Sober?
Looking for ideas to help you deal with a drinking problem, or other problematic substance use? Have you stopped and are finding it’s a struggle to stay stopped? Are you seeking an alternative to AA? Or just searching for some additional tools? Let me tell you how mindfulness can help.
The definition of mindfulness I use is: “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” It comes from Jon Kabat-Zinn, founder of the Mindfulness-based Stress Reduction programs that have been taught world-wide over the last 30-plus years.
Let’s examine this definition: “on purpose” means having the intention to step out of our usual autopilot mode, where we’re more likely to behave reactively. Then we bring our attention into “the present moment,” with an awareness of our breath and bodies – which always exist in the present – and working with our mind’s tendency to dwell in the past and worry about the future. Finally, we make this effort “non-judgmentally,” acknowledging the mind’s natural tendency to judge, as we try not to take ourselves, or our critical self-judgments, so seriously.
Can you begin to see how this approach might help? “Paying attention” leads to greater awareness – of both the things that can trigger addictive behaviors, as well as the impulses themselves – which interrupts automatic patterns of thinking and reacting. Being “in the present moment” means learning to accept what’s happening, whatever the experience may be, without using substances or behaviors to change it or escape from it. And doing so “non-judgmentally” helps to detach from the automatic thinking that often leads to a relapse after you’ve quit.
Mindfulness-based Relapse Prevention (MBRP) is an innovative approach that integrates evidence-based cognitive behavioral relapse prevention skills with mindfulness meditation practices. It is intended for adults in recovery from alcohol, drug, or other substance addiction – or who are simply concerned about problematic substance use. It offers an alternative to traditional aftercare and 12-Step programs, or an additional source of group support and tools to maintain sobriety. I’ve been using MBRP informally with my clients for a few years, and I’m now facilitating MBRP groups.
MBRP is similar to 12-Step groups and other relapse prevention programs in that it begins with an awareness that one’s substance use or other addictive behaviors are causing significant problems, and places responsibility for addressing these problems on the individual, while emphasizing the need for group support. It encourages developing “the wisdom to know the difference” between what we can and cannot control, as the Serenity Prayer says.
MBRP takes a slightly different approach to abstinence, treating it as a desired goal rather than a requirement for group participation, and de-pathologizes cravings, seeing them as based in normal human needs. MBRP group participants focus on their moment-by-moment experience, rather than processing their feelings or telling their stories. And they practice being mindful, using a series of guided meditation practices, each day of the week between group meetings.
One of the most valuable tools in MBRP is the SOBER Breathing Space. It’s a mini-meditation that can be done anywhere, any time you need to be able to pause, take a step back, and hit the reset button. You can try it for yourself, here:
Another really useful meditation practice we use is Urge Surfing. It’s based on the principle that any urge, craving, or strong emotion behaves like a wave in the ocean: it rises, crests, and then will eventually fade away. If we can learn to surf that wave, using our breath like a surfboard, we can ride the wave rather than succumbing to the urge and being wiped out by it.
A note of caution about this practice: some people find it to be an intense experience, so it isn’t advisable to try it when you’re already feeling triggered, or traumatized, or really stressed. But if you’re in a stable state, and have a way of managing any intensity that may arise – like going for a run, doing some meditative breathing, or calling a friend – then give it a try. One more word of caution: please don’t pick the most triggering situation for you when you first try this exercise, it’s best if you choose something that’s only a 2 or 3 on a scale of 1 -10.
The MBRP curriculum is designed to be presented in weekly 2-hour sessions over eight weeks. The initial sessions focus on learning and integrating basic mindfulness practices, then we move into how to apply these practices in daily life to deal with cravings, triggers, and stressful situations. The final sessions address self-care, support networks, and life balance.
Research studies have shown that MBRP leads to greater overall reduction in substance use, greater decreases in cravings, and greater self-acceptance than traditional treatment/aftercare approaches. My students have reported increased self-awareness – including better ability to identify automatic thoughts and recognize habitual thinking patterns that get them into trouble – as well as improved ability to deal with their feelings and strong emotional reactions, fewer cravings, improved overall mood, and better decision-making.
If you’d like to learn more about MBRP, please check out the main website, here. And if you’re interested in taking an MBRP group, or getting individual guidance in it, please contact me.
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Living with Chronic Illness and Pain
It is possible to live a full and satisfying life even when your life has been turned upside down by chronic pain and/or illness. Recently I’ve been learning more about how, from the experts: three people who are doing it themselves, and are pointing the way to others.
I have a personal interest in this topic – although I’m a fairly fit and healthy person, I inherited a susceptibility to certain conditions affecting my nervous system and spine. These conditions began to affect me in my early 20’s, led me to alternative and holistic health practitioners, and inclined me toward developing healthy lifestyle habits around nutrition, exercise, sleep, yoga, and meditation. My healthy habits have served me well, but have not always prevented injury and trauma that at times have led to long periods of life-limiting illness and pain. So I can relate to the struggles of my patients who are dealing with chronic illness, chronic pain, or both.
For many of us, these are invisible illnesses. Unless you are in a wheelchair, like Vidyamala Burch, author of You Are Not Your Pain, you may appear to be an ordinary healthy person – or at least you can pull yourself together long enough to appear so, despite your pain. One of my patients recently told me that he’d spent two hours at the mall with his teenage daughter, cheerfully interacting with everyone they met, even though his pain level the whole time was “excruciating.” No one offered him a chair or even asked how he was doing, because he’s a big guy who looks strong and healthy. Other patients have told me about being yelled at for parking in a handicapped spot, questioned when they decline social engagements, and even having their pain doubted by their own doctors.
Living with chronic pain or illness can be exhausting. Pain itself is ennervating, it saps your energy, and the medications that help to relieve it can make you lethargic. You probably don’t sleep well. You may be on a restricted diet, require bed rest, or spend an awful lot of time going to doctors. And although chronic pain and illness can strike at any age, it’s particularly challenging when you’re still young. At a workshop I attended recently on “Meditation for Pain Management,” a young woman in the audience asked what she should say to her friends, who think she’s joking when she says she’s in pain, and don’t understand when she declines their invitations to go out.
The workshop leader, Oren Jay Sofer, noted that he himself had been diagnosed with a painful and chronic illness in his 20’s, which influenced him to become a Somatic Experiencing practitioner (SE is an approach to healing trauma than involves working with the body). He talked about how socially isolating it is to live with chronic pain and illness, how difficult it is to explain what it’s like to people who haven’t experienced it, and how tiring it can be to listen to the suggestions of well-meaning friends or relatives about what you should do to “get over it” or “get well.”
As Toni Bernhard, author of How to Live Well with Chronic Pain and Illness, says, “Even though 130 million people suffer from chronic illness in the United States alone, we live in a culture that repeatedly suggests that, with proper diet and lifestyle changes, no one need be sick and no one need be in pain. When we’re not living up to what we perceive to be that cultural standard, we feel embarrassed.” Toni knows this because she had to give up her career as a law professor due to her illness, but she has since become a popular blogger and author, despite often being bedridden.
All three of these experts – Burch, Sofer, and Bernhard – found tools to help them cope with their chronic pain and illness in mindfulness meditation practice, and from the Buddhist philosophy of learning to accept and work with your suffering rather than try to escape from it. That’s not to say they didn’t also seek treatment from Western medicine, including pain-relieving medication. In fact, mediCAtion and mediTAtion are not opposite approaches at all – both help in different ways.
Most of my patients with chronic pain or illness must take medication, and lots of it, just to be able to function at all. But what most pain patients soon learn is that the drugs just take the edge off the pain, so one must learn to live with pain, in addition to all of the other ways in which chronic illness can limit one’s activities. This is where mindfulness and meditation can help.
What is pain? It is simply a neurological phenomenon, a signal from the body, calling our attention. The normal reaction to pain is to try to make it go away, and if we can’t, then to mentally push it away. But our efforts to resist feeling pain can actually make the pain worse, either because we tense up, and muscle tension can cause more pain, or because in trying to ignore our pain we may be doing more harm. While it’s a normal and adaptive coping response to “suck it up and tough it out,” if you are a person with a chronic illness, ignoring your body’s signals of pain or fatigue can have severe consequences. With chronic illness, you just don’t bounce back.
Mindfulness practice offers an alternative to resisting or ignoring painful or unpleasant sensations: we learn to acknowledge them, investigate them, and then just let them be. While it’s not easy to learn how to do this, once you’ve learned, it becomes so much easier to live with chronic pain or illness. We develop the capacity to choose where we place our attention, so we can notice pleasant and joyful experiences even in the midst of pain. We learn to not take our illness or its symptoms personally, so we neither blame ourselves for being sick nor feel like a victim. Instead, we can feel kindness for ourselves. And we are able to take a more pragmatic, realistic attitude toward what we can reasonably accomplish, so we don’t make our condition worse by overdoing it.
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Shame, bullying, and the pain of social rejection
Let’s talk about shame. Let’s not run from it, trying to avoid its pain, or hide from it, pretending we don’t have any, or allow ourselves to be bullied by others who believe they have the right to make us feel shame. Let’s drag it out into the open, take a deep breath, and examine it.
What is shame? Shame is a basic human emotion – we’re born with it. And it’s universal – everyone feels it. I think the best definition comes from Brene’ Brown, the shame researcher: Shame is the intensely painful feeling or experience of believing that we are flawed and therefore unworthy of love and belonging. (You can find Brown’s TED talk on shame here)
Why are we born with shame? Its definition points to a possible explanation: as social animals, we depend on others for our survival, so we need a mechanism to insure that others can be depended on. If we all have the basic need to belong – to feel we’re part of a tribe, a family, or a group – and if we all feel intense pain associated with not belonging, then we will be strongly motivated to cooperate and work together. Perhaps it forms the basis for an internal moral compass.
Let’s call this healthy shame – because it’s normal, and it functions to keep us connected to our tribe, which can help us survive. We can learn from it. If we could stop being so afraid of shame, and instead see it as a normal emotion, based in our need for social connection, then we could begin to talk about our experience of shame with others, which would lessen its control over us.
Of course, we don’t experience shame as useful, in fact we’re ashamed to even admit that we have it, and we’d do anything to avoid experiencing it. Shame avoidance is at the heart of addiction, because it drives us to numb those intensely painful feelings in the quickest way possible. And it underlies depression, lurking in our negative self-talk: I’m such a loser. No one wants to be my friend. I might as well be dead. Shame can truly make us suicidal, because it hurts so much to feel unworthy of belonging – and because without our tribe/family/friends/group, we’re alone, and that’s scary.
(Some researchers have suggested that the pain of social rejection, or of anticipated rejection, is as severe as any intense physical pain, and may in fact be processed in the same area of the brain.)
But there is something even worse than feeling shame: being shamed publicly, by someone else. Some people seem to think it’s their right to make someone else feel shame – maybe their child, or another family member, even a friend, or co-worker. Two of my clients recently experienced public shaming by co-workers, and it was absolutely devastating to them.
The research shows that the value of shame as a moral compass is only when it arises as the result of self-reflection. Shame cannot be commanded or demanded by another person – because then it’s humiliation instead: an abuse of power by one person to reduce another’s social status in the group. Humiliation is trying to control someone else’s behavior by manipulating their emotions – in this case, their need for belonging, and fear of being ostrasized from the group.
Let’s make this clear: publicly shaming someone is not constructive or useful. It’s humiliating, it’s toxic, and it’s really no different than bullying, harassment, or other forms of interpersonal violence.
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Opposite Koans
A koan is “a story, dialogue, question, or statement, which is used in Zen practice to provoke the ‘great doubt’ and test a student’s progress” (Wikipedia). While I’m not a Zen practitioner, I enjoy pondering koans that others pose as well as posing my own. Here are a few for your consideration:
The opposite of addiction is not abstinence, it’s connection. (Sarah Bowen)
Sarah Bowen is one of the psychologists who developed Mindfulness-Based Relapse Prevention. I heard her say this in the MBRP teacher training, and it was like a light switch going on – I’d never thought of it quite that way, but it made total sense. Since then, I’ve repeated her words to many of my clients, and it has the same effect on them. It’s powerful.
Addiction begins with a desire to disconnect from whatever reality seems too uncomfortable to bear, but it takes you to a place where you lose the ability to re-connect. You become disconnected from the people you love the most and who are the most important to you – starting with yourself. When you’re in your addictive behavior, you’re not present, and you’ve lost yourself.
The opposite of love is not hate, it’s indifference.
One of my clients said this recently, and I thought immediately of my father, who throughout my life has said he loves me – always from a distance, in his letters and postcards – but I’ve never felt loved by him. What I’ve actually felt is his indifference.
Love is an action verb. It takes effort, it requires showing up. Sometimes it’s really hard to love, and sometimes it hurts. Hate takes effort, too, in fact it’s exhausting to hate someone. What’s easy, and takes no effort at all – that’s not love, it’s only the idea of love, which is really indifference.
The opposite of faith is not doubt, but certainty. (Anne Lamott)
Anne Lamott has written several well-regarded books about her struggles with faith, her recovery from addiction, and raising her son as a single mother. I read this quote in The Gifts of Imperfection by Brene Brown, who goes on to say, “Faith and reason are not natural enemies. It’s our human need for certainty and our need to ‘be right’ that have pitted faith and reason against each other. . . We need both faith and reason to make meaning in an uncertain world.”
The opposite of play is not work, it’s depression. (Stuart Brown, founder of the National Institute for Play, also quoted in The Gifts of Imperfection)
The hallmark trait of depression is anhedonia, which means “a loss of interest in things that normally are pleasurable.” When true depression sets in, there is no play, there is no pleasure, there is no interest in seeking pleasure. (And you can’t just “snap out of it,” thank you very much.)
When we forget to play, or don’t make time for it because we’re too caught up in work, after awhile life loses its meaning. Have you ever said to yourself, “Why am I doing this? It’s not fun anymore.” To play and have fun is a human need – not as basic as water, food, and shelter, but it helps us keep going through the tough times. And it’s part of taking care of ourselves.
The opposite of scarcity is not abundance, but sufficiency: enough. (Brene Brown)
I found this in Brene Brown’s new book, Rising Strong. And I’ll close with a paragraph from that book, which poses more opposite koans for us to meditate on:
“The opposite of recognizing that we’re feeling something is denying our emotions. The opposite of being curious is disengaging. When we deny our stories and disengage from tough emotions, they don’t go away; instead, they own us, they define us. Our job is not to deny the story, but to defy the ending – to rise strong, recognize our story, and rumble with the truth until we get to a place where we think, Yes, this is what happened. This is my truth. And I will choose how this story ends.”
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