Tag: insomnia

When COVID 19 Steals Your Sleep

The world is still reeling from the Coronavirus pandemic. Here in Oregon, we are a few weeks into social distancing and shelter-in-place. Businesses big and small have shut down, families are struggling with unemployment and an uncertain future. Couples and families are strained with living in close quarters while at the same time people are feeling isolated and disconnected from friends, church and other activities.
Parents and teachers are scrambling to learn how to do online school from home. Medical providers are racing to prepare for a surge of patients with a shortage of available beds and personal protection devices.

I’ve been working in the field of sleep for the past 24 years, working for the sleep labs at OHSU and Kaiser Permanente. The past two weeks reminded me of the morning of 9/11 when I drove into work with my coworker at the sleep lab and we listen to the radio report of the planes hitting the towers. Later that morning we sat with a group of patients after their overnight sleep studies and we set them up with CPAP machines and watched the towers fall together.

This pandemic may not be as sudden as the terrorist attacks of 9/11 but it is wreaking havoc on our lives in many ways.

We’re under a tremendous amount of stress because of the disruption to our normal rhythms and routine. It’s not only taking a toll on relationships and our emotional health, it’s also stealing our sleep.

Here are a few resources to help you, those you work with or your family get your sleep back on track and to manage the stress you may be experiencing.

The first is the CBT- Coach App by the US Dept of Veteran Affairs

I recently had a client increased their total sleep time from just under 5 hrs sleep to 7.5 hrs sleep per night in the last three weeks.

There are other apps that can help with stress and sleep at the VA site:
Mindfulness Coach, Mood Coach as well as apps for Acceptance and Commitment Therapy and Anger & Irritability Management Skills.

The second resource is the book the Insomnia Answer.
In this book, Paul Glovinsky and Dr. Arthur Spielman teach the Spielman 3-P Model of Insomnia.
The three P factors that can disrupt sleep are Predisposing, Precipitating and Perpetuating Factors. The Predisposing Factors are our tendency to having Insomnia. If you have a low predisposition you probably have always slept well, if you have a high predisposition you are sensitive or vulnerable to disrupted sleep. You may be sensitive to noise and light, struggle with worry or anxiety or have struggled with sleep since childhood.

Whether you have a low predisposition or high predisposition for insomnia at some point Life can happen to your sleep. The Precipitating Factors are changes in life that disrupt your sleep. They can be negative stressful changes like conflict and stress at work, divorce, unemployment or a 20 page term paper that you’ve waited till the last weekend to start. They can also be positive changes like a job promotion, moving to a new house, a vacation,
The impact of Covid 19 is a huge Precipitating Factor on the sleep of many people, even folks who usually have no problems sleeping.

The Perpetuating Factors are ways of coping with being sleep deprived that may help short-term but end up perpetuating the problem. Things like caffeine, napping, watching Netflix or scrolling through Instagram till 1am. It can also include eating in the middle of the night or sleeping in for hours on the weekend to try to catch up on sleep. These are the the things that get us caught in a viscious downward spiral; for example, “I didn’t sleep so I drink coffee. But I can’t sleep because I drank coffee.” Or “I didn’t sleep so I end up falling asleep on the couch but then I can’t sleep because I took a 2 hr nap after dinner.”

The 3rd resource is especially helpful if you have trouble turning your brain off at bedtime and struggle to get to sleep or in the middle of the night and have trouble getting back to sleep is Say Goodnight To Insomnia by Gregg Jacobs.
Dr. Jacobs uses the phrase Negative Sleep Thoughts or NSTs to describe thoughts that trigger more stress and physiologic arousal, squirt your brain with the stress hormones adrenaline and cortisol. Some authors call these “hot thoughts”. He teaches you how to reframe your Negative Sleep Thoughts into quieter or cooler thoughts that are soothing, calming and less alerting.

Besides sleeping better right now after a few weeks of Insomnia. These resources will help prevent this acute or situational Insomnia from becoming the start of a chronic problem. Psychophysiogic or “conditioned” insomnia is the type of insomnia that becomes like a bad habit. It’s when you are exhausted and tired and maybe feel drowsy or sleep in the living room or on the computer but as soon as you brush your teeth, put your pjs on, get in bed and turn out the lights you feel more wide awake. When you start to struggle with getting sleep or staying asleep your bed, bedroom and bedtime can start to become associated with frustration and trigger a stress reaction. It can get to the point where folks have a mini-stress attack and start to avoid going to bed, staying later and later because they start to believe that sleep just doesn’t work for them.

One more note on improving sleep at this time, good sleep habits or sleep hygiene doesn’t just start with your evening or bedtime routine. Good sleep hygiene starts with your morning routine and can be practiced throughout the day because one keep to sleep is managing your mental, emotional and physical arousal during the day. Starting out the day well, eating healthy, getting some physical activity during the day, practicing mindfulness or other spiritual disciples all contribute to keeping your stress level down. For a lot of us right now, we are both bored or idle at times or extremely busy and scrambling around figuring out how to respond and adapt to new realities. Deciding on a structure and schedule for the day is helpful, especially for kids home from school.

My next blog post will be of some resources to help with homeschool and time together as a family, working from home, exercise and routine.
(I wanted to include it in this post but it’s getting late and I need to get ready for bed a good night’s sleep.)

For more info here’s a video I did on sleep and stress on Facebook.

Feel free to let me know if you have any questions about sleep.

Smart People Anxiety

  One of the great things about working and living in Portlandia is the people.

I’ve found Portland is kind of a mecca for some of my favorite types of people: creatives and artists.

I enjoy meeting with folks who are insightful, thoughtful, compassionate, those who sometimes are slow to speak outside the counseling office because they want their words to be well-considered. Often they are introverted but not all. Many are grad school students at the seminary, involved in leadership or ministry. They care deeply about people, often very empathetic and authentic. They inspire me because they see things beyond the surface. Their everyday walking around, thoughts are art. I’d love to read their memoirs or journals. They fascinate me.

The downside though is often creatives and artists because of the way they see the world and the depths to which they think and process things can really struggle with anxiety and depression.

They have high highs and low lows. They quickly can go from “Everything is awesome to everything has gone to hell”. (They’d describe this much better)

They get paralyzed by their introspection

Overwhelmed by the intensity or the changes of their emotions

They can feel isolated and misunderstood.

And frustrated at feeling out of control.

If you add, for many of my clients and grad students, being devote in their faith; they can be vulnerable to another layer of anxiety around believing they are not doing enough for God or for others.

For example, they may feel overwhelmed at the enormity of a social justice issue, at how big the problem is or how much work and changes needs to be done in that area. And they can have a hard time turn off or turning down how concerned or troubled they are about the issue.

When I see this, one thing I tell them is they are suffering from what I call “Smart people anxiety”.

It’s not the simple, garden-variety anxiety or depression – it’s complicated!

Strong thinkers are strong feelers.

There’s levels and layers to their anxiety!

Their anxiety doesn’t just get triggered and then follow one railroad track to a catastrophic ending.

Their anxiety branches off in multiple and elaborate permutations that quickly can overwhelm them.

It becomes a huge suffocating mess to untangle.

Because of how creative and thoughtful and imaginative they are.

Another phrase I use as way of talking and exploring this other than “smart people anxiety” is “Inception level anxiety” or “Inceptionesque anxiety”.

Inception being the movie directed by Christopher Nolan and starring Leonardo DiCarprio.

Inception is about a team of people that get hired to create dreams and implant new realities and memories into their targets. A young member of their team played by Ellen Paige has a talent for creating very realistic elaborate dreams. The more realistic the dream world and images she creates, the greater the chances at their deception, their inception, will work.

In the movie, with a challenging target, they attempt to plant a dream, within a dream, within a dream. The problem is the deeper they go the harder it is to distinguish the dreams from reality.

For artists and creative, I think this is a part of what makes their anxiety or depression harder to untangle and treat. They can quickly build elaborate constructs, metaphors, inner worlds and word pictures for what they are going through. We all do this when we go through struggles and experiences, we try to make meaning, to make sense of things. Creatives can overdo this. They can attach so much meaning and attach so many different things to their stressors and triggers; they don’t just catastrophize, they globalize. What might be, what it might mean, quickly becomes reality.

Thing is, it often isn’t completely true, or true at all. Because it might mean something doesn’t mean that is the best or truest interpretation to hold. Just because it feels, or seems real, doesn’t mean it is.

Here’s a few things that the team from Inception did that might help you if you struggle with this type of anxiety:

  • They set limits. When one of their team went down into the psyche, into the dream state, of their target they set alarms to pull them out of the dream. This prevents them from getting trapped in the dream and disconnected from reality forever. If you struggle with rumination and worry you can set limits too. You can literally set an alarm, a time limit, just like the Inception team to remind you to get out of your head and go do something else. You set limits by having a designated space to worry. You can journal. The thoughts can seem a while lot smaller on a page, and you can literally close the book on them when you write them down. Journalling also slows you’re racing thoughts down because we usually can’t write as fast our thoughts. You can also set limits by having boundaries on the types of conten, and how negative it is, that you allow as input or what you create and dwell on. For example, what types of music, media, news, people – and how much and how long – you expose yourself to.
  • They had a totem. Each member of the team had a something to hold, something with someone weight, that they could “carry” with them down into the dream to root them to reality and help them distinguish what was real and what was a dream. DiCaprio’s character had a top that he kept in his pocket and held onto. For folks struggling with the anxiety of quitting tobacco, they often use a totem of their own, a “worry stone” to help them focus on the present and work through a period of craving. For folks with this type of anxiety, focusing on what’s present, being mindful, focusing on things external to them instead of their thoughts (diaphragmatic breathing and exercise help), focusing on their core beliefs, what’s most important, what they know to be true, instead of thinking too far ahead or focusing on their ruminations and visualizations can be very helpful. These are a few ways of grounding themselves and reconnecting with reality.
  • They didn’t do the work alone. DiCaprio’s character, because of his past, lost objectivity. He started to struggle with what was real. It made him vulnerable to making selfish, poor choices that comprised the team’s mission. His past was haunting him. He needed the others on his team, especially Paige, to keep him on track.

If you’re a creative or introvert, struggling with how powerful your anxiety or depression can be, I hope this post will encourage you to use your powers of insight and imagination “for good”.
Watch here on the blog for more posts on anxiety and depression.

In the meantime, what do you think? If you’ve seen the movie, anything you’d add?

And, most importantly, anything you’ll do with this?