Archive for the ‘Depression’ category

Can’t wake up, sleep through multiple alarms — help!

October 21, 2019

Q:  I need several alarms to wake up.  Sometimes I sleep through them all or even turn them off, then go back to bed without knowing it.  Why can’t I wake up?

A:  Start with the idea that you “can’t wake up”.  Of course you can. 

Unless you’re Rip Van Winkle, at some point you do wake up.  Every day in fact, do you not?  So for you the keys are to both more accurately understand your experience and to better manage the sleep-wake process.

Presuming you have no underlying medical or psychiatric issues causing this (see a doctor if you aren’t sure), then you might look at a couple of likely factors.  One is sleep deprivation, and the second is motivation — or rather a lack of it.

Ideally — and if you plan a consistent wake time and schedule enough time for proper sleep —  you will awaken spontaneously and refreshed after the last of your sleep cycles completes, with no alarm clock at all.

For many people, keeping a very consistent sleep-wake schedule over time — especially important is a consistent wake time — results in awakening without the need for an alarm clock.  If you aren’t doing this now, it might be a good idea to start with as much regularity as you can.  Be sure to schedule enough time in bed for proper sleep, but be aware sleep duration is a moving target that changes as we age.

So you can expect to awaken when you’ve had enough sleep.  It’s as simple as that.  You won’t even need an alarm to get up because you won’t be sleep deprived.

And if you plan something you really want to do first thing in the morning, then you have good reason to get up and get going.

As for a good reason to get up and get out of bed, for most us work or school are sufficiently motivating.  But if you need more, try planning something you really want to do first thing so you have something to look forward to.

You are the best judge of this, but if you draw a blank on something to look forward to, then you might consider the possibility that your issue isn’t so much sleep as it is a healthy outlook on life.  In that case, counseling might help.

By better managing your sleep schedule, and by feeling more positively motivated about your day, there’s a very good chance you will permanently solve this problem.

Is there a connection between depression and insomnia?

July 13, 2015

Q:  I have been diagnosed with depression.  What I don’t understand is if insomnia is only a symptom of depression and not a disease by itself, how did I get insomnia in the first place?

A:  You are right that insomnia is invariably only a symptom of something else going on deeper that is causing the sleep problems.  You are also right that insomnia is often correlated with depression, although the direction of causality is often not clear.

Are we depressed because we can’t sleep?  Or is it we can’t sleep because we’re depressed?  Maybe a little of both?

Medical surveys show up to 80% of patients with depression have insomnia, and those with chronic insomnia are up to three times more likely to develop depression.  The conditions seem to be two distinct but overlapping phenomena.

In treating insomnia some doctors prescribe pills to unnaturally force sleep, but many healthcare professionals take the position that in some cases sleeping pills may do more harm than good.  That’s because sleeping pills by themselves are only treating the symptom (sleep), not the true underlying cause for the insomnia, and tend to reinforce the idea that the solution to insomnia is external and resides out of one’s self-control.

On the other hand, depression is a legitimate psychiatric condition that is treatable with drugs as well as cognitive therapy, and by successfully treating depression sleep may well improve.  Interestingly, studies have also shown nondrug cognitive therapy can actually work better and faster than drugs to both lift depression and improve sleep, and the results can be sustained long term.

One compelling reason why cognitive therapy is so effective on both insomnia and depression is because both conditions are often characterized by underlying patterns of recurring negative thought distortions.

Distortions of rational thought are often at the root of many psychiatric disorders like depression and generalized anxiety disorder, both of which are correlated with insomnia.  Similarly, negative and often inaccurate thoughts specifically about sleep also tend to fuel and perpetuate insomnia.

One of the best self-help resources on cognitive therapy for depression is the book “Feeling good:  New mood therapy” by psychiatrist David Burns.  In his book Dr. Burns cites his own research as well as the findings of other medical researchers showing sometimes nearly immediate and lasting improvement of depression symptoms as the patient comes to understand how his or her underlying concepts and attitudes are unrealistic, distorted, and overly pessimistic.

The same holds true with sleep.  The nondrug methods in a good cognitive behavioral therapy-based sleep training program combine cognitive therapy with powerful behavioral tools like stimulus control and sleep hygiene.  Together, the two are an exceptionally effective way to improve sleep.

So your question somewhat defies a direct answer.  But you should be reassured that both your depression and insomnia are treatable as you come to grips with their true root causes.

How negative thoughts feed insomnia

March 18, 2015

One of the great accomplishments in cognitive psychology over the past several decades is arguably the defining of recognizable categories of thought distortions by psychiatrists Aaron Beck and David Burns.  Distortions of rational thought are often at the root of many psychiatric disorders like depression and generalized anxiety disorder.  Similarly, negative and often inaccurate thoughts specifically about sleep also tend to fuel and perpetuate insomnia.

In his book “Feeling good:  New mood therapy” (one of the top self-help books ever published), Dr. Burns lists 10 of these very common categories of thought distortions.  And it’s probably safe to say nearly all of us have succumbed to one or more of them at one time or another.

As one example, consider “disqualifying the positive”.  This occurs when you only see the negative aspects of a certain situation you are in, and completely overlook any positives as if they don’t count.  It’s not a valid or accurate representation of what’s truly there, and such distortion tends to feed worry and anxiety — sometimes to the point of being debilitating.

Moreover, seeing the situation more accurately can work to almost immediately lift one’s spirits and reduce depression.  Dr. Burns cites clinical evidence showing more rational understanding actually works better than drug therapy.

Specifically for sleep, insomniacs are prone to many common but inaccurate distortions of thought that tend to feed insomnia.  Such as, “I must fall asleep RIGHT NOW because I’ve got this very important (presentation, job, assignment, exam, project due, etc.) tomorrow, and if I don’t get a solid 8 hours I’ll be a complete wreck tomorrow!”

Which of course makes it nearly impossible to sleep at that point.

Interestingly, empirical studies have found that particular negative belief about insomnia is simply not true.  In reality, we adapt and usually perform well even when sleep deprived; and this is true both in terms of physical performance and cognitive performance —  Insomniacs tend to perform just as well as good sleepers.

But for insomniacs, it typically doesn’t feel that way. Studies also confirm that insomniacs tend to feel like they don’t perform well, even when they do.

So the real difference is in mood and perception, not performance.

You typically don’t hear much about this side of insomnia, because the media tends to be so one-sided.  What we do hear about more or less constantly is how awful sleep deprivation is and how much damage it causes.  Worry and fear can sell a lot of sleeping pills and herbal sleep supplements.

But knowing the negative consequences of a bad night are typically limited mostly to mood and perception, and not necessarily to performance, helps to reduce anxiety about sleep.  And the corresponding reduction in worry often results in better sleep.

By reducing the pressure we put on ourselves about sleep, we can relax more easily, let go, and fall asleep easier.  And learning how to do this consistently and when you want is a permanent tool you can use for the rest of your life.

Better yet, this method of cognitive restructuring is completely drug free.

So if you are subject to sometimes sleepless nights and don’t have an underlying medical issue causing insomnia, consider using these clinically proven non-pharmacological methods for sleep improvement.  Doing so will help you understand how some of your thoughts — especially about sleep — are distorted and inaccurate.  By learning to safely let these negative thoughts go, you can help yourself sleep better.

How distorted thinking fuels insomnia

January 21, 2015

Q:  I have battled insomnia for the past 12 years.  In college I would often go weeks with no sleep.  Today, I can’t sleep through the night without taking anti-anxiety medication.  The idea of being addicted only adds to my depression and anxiety about sleep.  In bed I think “if I don’t fall asleep right now, I won’t be able to perform tomorrow.  I’ll get fired from my job, and then won’t be able to pay my bills, or fulfill my dreams … so what’s the point of going on?”  I hate suffering like this.  What can I do?

A:  To permanently treat insomnia, you’ve got to get to the true root of the problem.  And it’s not sleep, or the lack thereof.  Insomnia is invariably only a symptom of something else going on deeper that’s causing the problem.  In your case, it could be excessive and unrelenting anxiety, along with stress about the idea of sleep.

Not to be disrespectful or minimize what you’re experiencing, but your question expresses at least two very common misconceptions about sleep.  So part of your solution is to understand why these thoughts are distorted, unrealistic, and excessively negative.

For instance, consider your statement that “I would often go weeks with no sleep.”  Well congratulations, you are now the new record holder.  The longest documented time for no sleep is 11 days, by Randy Gardner.  (He recovered completely by the way).

Your reality is no doubt far different than your mistaken belief.  In fact, it’s quite common for insomniacs to significantly underestimate when and how long they actually sleep, a phenomenon known as sleep state misperception.

In reality, you do sleep, and probably at least some every night.  That’s because we all sleep.  You in fact cannot not sleep, unless you have reason to believe you are somehow different than any other human being to ever live anywhere anytime.

Second, your thought process of “what’s the point of all this” — although understandable when feeling dead tired in the middle of the night and unable to sleep — is classic catastrophizing.  It is a distortion of rational thought.  Your reality is probably not that much different from most everyone else’s —  you have some successes and some failures.  You’re human, not perfect.  In reality, you are probably like most people who adjust and perform reasonably well even when sleep deprived.  Allowing yourself to dwell on the worst is likely a major part of what’s fueling your insomnia.

The good news is there are effective drug-free ways to make this better.  Many have done it, and you can too.

The standard of care for treating insomnia is cognitive behavioral therapy (CBT), specifically designed for sleep improvement.  CBT methods are permanent and help most people who try them.  These methods include potent non-pharmacological techniques to help manage the negative thoughts that feed insomnia, in addition to improving habits and lifestyles that support better sleep.

Since you have been prescribed anti-anxiety medication, it’s important to work with your doctor on treating your anxiety, but we suggest it’s also important to consider healthy non-drug ways you can sleep better based on CBT methods.

These methods may be part of your permanent solution to eventually taper and even eliminate the need for drugs to sleep.

Insomniac’s Resolution: Permanently Debunk “I can’t sleep”

January 5, 2015

 

The start of a new year is a perfect time for insomniacs (and anyone experiencing sleep difficulties) to make a clean start.  And one of the best ways to do this is to make a clean break from your old ideas about sleep that haven’t been working out too well, and replace them with better, more accurate ideas that enable better, more refreshing sleep.

If you are having trouble sleeping, there’s a very good chance one of your biggest myths to debunk is this:

“I can’t sleep.”

It would not be at all surprising if that is one of your chief complaints.  We hear this constantly, and it’s quite understandable.  After all, what torture it is to lie sleeplessly in bed, dead tired, night after night, tossing and turning for hour after frustrating hour.  “I can’t sleep” seems to sum it up perfectly.

Except it’s wrong.  Completely, spectacularly wrong.  “I can’t sleep” is actually only an illusion with no basis in reality.

The reality is you can sleep — unless you have reason to believe you are unlike every other mammal that has ever lived, or that you for some reason are unlike every human being to ever walk the face of the earth for all time.  You sleep.

You do in fact sleep.  You must.  Your mind and body require it.  Sleep is one of life’s most basic necessities, like air and water.  You need it to survive, and rest assured one way or another you will get it.

The experience of those with severe untreated obstructive sleep apnea demonstrates this well.  Those with untreated OSA can’t sleep for more than a few minutes at a time before waking themselves up, often gasping for air.  They may compensate by getting dozens if not hundreds of microsleeps throughout the night and often throughout the day — a potentially very dangerous situation for anyone with this condition who drives or operates machinery.  Microsleeps are of course a poor substitute for normal sleep, but it demonstrates how one way or another you will not be denied sleep, no matter what you do or don’t do.

So yes, even for the most extreme insomniacs sleep is unavoidable, even irresistible, at some point.  The key to making it better is to manage the inevitable sleep process for the best results.  And one key component of this sleep management process is to rid yourself of dysfunctional, inaccurate, and unrealistic thoughts — like “I can’t sleep” — that only work to feed and worsen the problem.

There are many variations of “I can’t sleep”, including “I absolutely must have 8 solid hours of shuteye in order to function well the next day”, or “I must have a sleeping pill (alcohol, melatonin or other substance) in order to sleep.  Nonsense.

For an insomniac, the lack of sleep is only the symptom, not the underlying cause of insomnia.  To think lack of sleep causes insomnia is like thinking a runny nose causes a cold.

Getting to the real root of the problem goes a long way to making it better, but it requires understanding insomnia’s true basis, which often is some combination of bad sleep habits and negative thoughts about sleep.

For many insomniacs, part of the lasting solution is learning to disregard distorted and inaccurate thoughts like “I can’t sleep”.

Better sleep through the holiday season

December 2, 2014

Q:  I dread the holiday season because of my insomnia.  I worry about everything, including meals and family visits.  Eventually I get through it but I always feel tired.  Any suggestions?

A:  The holidays can be stressful for many reasons.  One way to cope is to have a written plan.

Break it down into small manageable steps so know what you’ve got to do when.  Doing so helps reduce stress and anxiety, which tend to undermine good sleep.

During this season, it’s important to stay with your usual sleep schedule every day as much as possible.  Consistency helps support better sleep.  Especially important for most people is a consistent wake time, which has the profound effect of both regulating your circadian rhythm and synchronizing it to your homeostatic sleep drive.

However, we suggest you don’t deny yourself family get-togethers or events, even if they take you somewhat out of your normal routine.  Cultivating a good social support network is associated with good mental health and better sleep.  Moreover, the mental stimulation of positive social interaction helps work your brain and effectively tire you out, which also helps support better sleep.

If any of your social engagements involve alcohol, we suggest moderation and switching to plain water an hour or more before the event ends.  This helps to both rehydrate you and reduce the potential for sleep-disruptive rebound later, which are common consequences of over-imbibing.

It may be challenging, but try to stay with your sleep improvement methods during the holidays, whatever they might be.  These may include stress management and control of anxiety.  Consistency with your methods helps, and especially when under increased stress.

Part of your stress and anxiety management should be to examine your expectation of “always feeling tired”.  Are you sure this is absolutely unavoidable?  Or are you unreasonably setting yourself up for a harmful self-fulfilling prophecy?  Understanding how negative expectations and beliefs fuel and perpetuate insomnia is one of the keys to making it better.

Another factor affecting sleep this time of year (presuming you live in the northern hemisphere) are the short days and long nights, which can wreak havoc on some people’s sleep.

To counter this, the smart use of light is important.  Make an effort to expose yourself to bright light first thing upon awakening.  For many of us, that means using artificial indoor lighting that’s sufficiently bright to make up for the lack of natural sunlight.  During the day, try to get outside for at least some time in the sun.

If you don’t have an effective sleep improvement method, or are looking to find something better, continue looking, but you might want to hold off on any big changes until the new year if it might be too disruptive.

In the meantime, keep your chin up.  Good luck and happy holidays.

 

Is insomnia all in my head?

August 21, 2014

Q:  Insomnia has really taken a toll on me over the past few months.  Seems all I do is obsess about sleep all the time.  I am no longer the happy and positive person I once was.  Is insomnia really just all in my head?  Am I making this worse by worrying about sleep all the time?

A:  See a doctor first to answer your question about whether or not it’s all in your head.

Your doctor will be able to help you determine if there are any identifiable medical or psychiatric issues underlying your insomnia.  If that’s the case, you have what’s known as secondary insomnia.  Because insomnia is not a disease but rather a symptom of something else going on, by identifying and treating the true root causes you can expect to start sleeping better.

But don’t be surprised if there are no identifiable medical problems.   Most insomnia is actually caused by a variety of nonmedical issues that disrupt sleep.

If you have no underlying medical issues affecting sleep, you likely have some form of primary insomnia, which is by far the most common type.  But even then it’s probably not “all” in your head.

At least some insomnia is typically caused by bad sleep habits that are often easily controllable.  As an example, an inconsistent sleep-wake schedule will undermine your ability to sleep well.  By setting and keeping a consistent sleep schedule, you can fix that problem.  Consuming caffeine in any form (colas and chocolate are loaded with it) too late in the day is another bad sleep habit that can and will cause insomnia.  So making some simple lifestyle adjustments can often go a long way to improve sleep.

One of the most common forms of primary insomnia is known as psychophysiologic insomnia, which is typically caused by some nonmedical combination of bad sleep habits and excessive worry about the idea of sleep.  Literally millions of people have this, and yes, worrying about sleep all the time feeds it.

The good news is primary insomnia is very treatable.  The gold standard of care is known as CBTI — cognitive behavioral therapy specifically designed for insomnia.  CBTI is a combination of a common sense methods that enable you to effectively address both bad sleep habits and the worry about sleep that typically underlie primary insomnia.

Strong clinical evidence proves CBTI works.  Using these methods, you learn specific skills to help counter the negative thoughts that largely perpetuate insomnia, and you also learn good positive lifestyle habits that support better sleeping.

Combined, these methods help most people who try them.  The methods, once learned, become permanent life skills that support better sleep, and best of all, are completely drug free.

The methods need to be used of course to be effective.  But eventually with practice they will help you deal with the ongoing issues of stress management and control of anxiety that we all face every day, which can be a potent fuel for insomnia.

So by addressing the true underlying causes for your insomnia, be confident you can sleep better permanently — and recover the happy positive person you once were.