Archive for the ‘Fear’ category

Defeating the ‘monster of insomnia’

March 9, 2017

Q:  I have my doubts about cognitive behavioral therapy or any non-drug method to improve sleep.  They seem to me to be nothing more than tricks.  Unfortunately, the human brain can usually tell when it is being fooled so the monster of insomnia quietly awaits to return at the worst possible time.  Do you have any reason I should not believe this?

A:  The real “trick” is the mistaken belief that insomnia is in fact a real monster.

In the absence of an underlying medical or psychiatric condition, insomnia isn’t a monster. Insomnia is typically nothing more than a self-imposed problem we create!  Primary insomnia, which most of us have, is to a large extent a do-it-yourself issue.

CBT-based sleep improvement methods that counter insomnia are not “made-up tricks”!

These methods are in fact basic common sense, viable, proven, evidence-based solutions that help most people who try them.

To defeat the monster, you need to understand the monster is a fiction you to some extent are creating and empowering by false beliefs.  These negative sleep thoughts are often the raw fuel that prolongs and perpetuates insomnia in the first place.

Interestingly, you don’t have to deny all these terrible thoughts about insomnia for CBT methods to work.  All those negative thought are the understandable result of tossing and turning in bed for hours at a time, frustrated and angry at your inability to sleep.  Those negative thoughts probably are in fact a true and accurate reflection of what you think about your sleep experience.

What CBT suggests is re-thinking your ideas about sleep, to correct them to something more accurate, realistic, and positive.  Something that more truly represents the reality of sleep and human performance.  If your old ideas and beliefs haven’t been working out too well, why not try improving them to something better?

CBT methods work, and help most people who try them.  There is every reason to believe they will help you too.


Jealous of those who can sleep!

September 25, 2014

Q:  When I see somebody sleeping I get so jealous because I can’t do that.  Even worse, normal people sleep without having to take medication.  I am so frustrated and angry.  Why can’t I sleep?

A:  You can’t sleep?  Nonsense.  Of course you can.

Everyone sleeps.  Every animal.  Birds, fishes, every human being that ever lived.  So unless you have reason to believe you’re somehow different than every other mammal that ever existed, then rest assured you do in fact sleep — to at least some extent.

The truth is we as human beings can’t not sleep.  Maybe not as good as we like, but we do.

So perhaps what you really mean is you’re not sleeping as well as you’d like.  That makes more sense.  This idea is more realistic, and not only because it’s more accurate, but because this implies you have the capacity to make it better.  And you can.

Let’s also look more closely at the emotion of jealousy.  Everyone feels this at one time or another.  Jealousy is just part of the human experience.  But it’s very important to understand that intensely negative emotions like jealousy, hatred, envy, guilt, shame, frustration, and anger are doing you no good.  It wouldn’t be at all surprising if stewing on negative feelings like jealousy and anger are in fact perpetuating your sleeping problems.

There are a number of simple things you can do to make this better.  First, as always, if you haven’t had a recent checkup with your doctor it’s a good idea to get one.  This will enable you to either treat or rule out any underlying medical issues that could be causing or contributing to insomnia.

Second, learn to control and manage these intensely negative thoughts.  There are effective, drug-free ways to do this.  When negative thought patterns recur, they often underlie and cause anxiety.  And anxiety in turn is a potent fuel for insomnia.

You will also help yourself a lot by learning some basic fundamental facts about sleep, such as this:  our physiologic requirement for sleep is far stronger than insomnia.  Sleep for us all is at some point irresistible.  You can use that fact to your advantage with sleep timing methods.

Good sleep hygiene, such as a consistent sleep-wake schedule, daily exercise, avoidance of caffeine later in the day, and early morning exposure to bright light also help.

So rest assured there are good, effective methods to improve sleep that do not involve drugs.  Be determined to help yourself.  You can make this better.

Fear of Sleep: A self-help guide

July 23, 2014

To those who sleep well it may be difficult to understand how someone could come to actually fear sleep, considering how sleep — like food — is one of our most basic and primal needs.  Yet of all the questions we see, fear of sleep is one of the most common.

Fear can be a potent disruptor of sleep, and often very difficult to overcome.  To an insomniac — who may lie in bed for hour after maddening hour, becoming increasingly frustrated and even angry at his or her inability to sleep — the emotion of fear can become very real when a part of the brain known as the amygdala becomes involved.  The amygdala is a deep inner structure of the brain that is involved with the processing of fear and conditioning of the fear response.

Fear of sleep may originate from two common sources.  One is the fear of losing consciousness, of losing awareness, of losing control, all of which are an inherent part of a normal sleep experience.  If you are in an unsafe sleeping environment, this fear is understandable.  But for those of us who more often than not are in a perfectly safe bedroom, this emotion is probably more similar to the irrational fear of going away and never returning, similar to a fear of death.

A second source of sleep fear is related to the consequences of sleep deprivation.  Most of us, and especially insomniacs, are well aware of the importance of good sleep, and of the negative impact on performance resulting from sleep deprivation from any cause.  One may even fear losing sanity or having a nervous breakdown after an extended period of no sleep, fragmented sleep, or unrefreshing sleep.

The fear response to sleep can sometimes be conditioned upon faulty and inaccurate beliefs about sleep.  Such as the idea that one must get an absolutely perfect 8 hours of sleep to function well the next day, a belief that soldiers, firemen, astronauts, medical residents and many others have consistently demonstrated to be false.

When the emotion of fear gets involved with insomnia, anxiety and worry about sleep are immensely compounded.  But because the amygdala is not involved with higher order thinking skills, this suggests a potential solution.

One potential solution is to use rational, higher order thinking skills to identify and disregard inaccurate, false, and overblown fears about sleep.  Doing so has the effect of countering the amygdala’s conditioned fear response, and helping the mind and body let go, a necessary precursor to sleep.

Rational thinking is a tool anyone can use, anytime.  It involves first identifying these negative, fearful thoughts about sleep, and understanding how they are excessive, inaccurate, and overblown.  Then, with deliberate intent, responding with more accurate and positive thoughts about sleep, beliefs which are scientifically based and grounded in reality.

This fact-based thinking process is known as cognitive restructuring.  It is entirely drug-free and can be a permanent solution to counter fear of sleep.  For those who are the self-help type, many good online resources are readily available that utilize cognitive restructuring as part of an overall sleep improvement plan.

So if you’ve been bothered by a lack of sleep, or even fearful of insomnia, rest assured there are effective ways to help yourself sleep better by countering this fear.  By using cognitive restructuring and other sleep training methods, you can improve sleep safely, permanently, and without the use of drugs.

How to manage anxiety that causes insomnia

June 11, 2014

Q:  When I get into bed I get tense and start to feel my heart pounding.  I get anxious about the idea of not sleeping, and when that happens I toss and turn for hours.  Any suggestions to counter this?

A:  What you are describing may be a conditioned negative response to your bed and the idea of sleep, likely from the frustration of dealing with insomnia. Fortunately, there are a number of effective solutions that can help you.

One is to plan a relaxing pre-bed routine every night.  The general idea is to minimize stress or anxiety during this time, to help transition from wakefulness to drowsiness.  This is one good way to help establish a positive conditioned response over time that you begin to automatically associate with a good night’s rest.

A second method is to consciously relax once in bed.  There are literally dozens of ways to do this, but some of the best involve deep diaphragmatic breathing and progressive muscle relaxation.

Another way to counter anxious thoughts is to distract yourself, and there are number of ways to accomplish that.  One of the simplest is the age-old method of counting sheep, but you may find creating more elaborate images of relaxing waterfalls or calm beach scenes to be more effective.

The most permanent method is to get to the bottom of this in the first place.  In other words, treat anxiety at its root.  This is exactly what cognitive restructuring will enable you to do.

The idea is to identify and reality check the underlying negative thought patterns that are fueling your anxiety.  When you examine these thought patterns closely, you will likely discover your worry about insomnia is overblown and excessive.  These thoughts could be irrational, distorted, or unrealistic.  More importantly, these negative thoughts about sleep are likely perpetuating your insomnia.

With cognitive restructuring, you learn to replace the negative distorted thoughts with better, more accurate thoughts about sleep.  Such as this — the true reality is we can’t not sleep.  We can’t not sleep any more than we can’t not breathe.  The key is to manage the process for the best results.  So worrying, or putting negative mental energy into the idea of not sleeping, is enormously counterproductive.  In fact, letting go the worry about not sleeping is one of the best things you can do to help yourself sleep better!

With cognitive restructuring, you learn to take this negative mental energy and turn it into positive mental energy that supports good sleep.  The method works.  It is powerful and very effective.

You can learn cognitive restructuring methods by working with a counselor or psychologist, or there are many books and online resources that use this method.

So be confident that by proactively managing  your anxiety, you can help restore better sleep.

Tried everything and still can’t sleep

April 14, 2014

Q:  I’ve had insomnia for over 15 years.  I average maybe 3 hours of sleep on a good night.  Been to sleep doctors, spiritual healers, herbalists and more.  My naturopath believes my hormones are out of whack and wants me to take supplements.  But nothing I’ve tried has helped and I feel my insomnia is worsening.  I’m in pain and scared and don’t know what to do.

A:  Even if you’ve had insomnia for decades, rest assured there are effective solutions that will help you sleep at least to the best of your ability.

Let’s start with this:  reduced to its simplest, you can improve sleep by a combination of two overall methods: medical, and nonmedical.

Sounds like you are already addressing, or attempting to address, the medical potential root causes that could be interfering or disrupting sleep.  However, it’s worth noting the AASM (American Academy of Sleep Medicine) has found no scientific evidence that supplements of any kind (including melatonin) are safe or effective for treating chronic insomnia.

To treat any underlying medical issues, we suggest starting with a primary care medical doctor for a full work up, and if needed from there possibly see an MD that specializes in sleep.  Be confident that by working with a trusted healthcare professional you will be able to manage and address your medical issues.

Now, regarding nonmedical potential root causes:  This is where medical doctors, herbalists, naturopaths or other healthcare professionals who typically prescribe drugs and/or supplements cannot directly help.

That’s because the true underlying nonmedical root causes that typically cause insomnia are usually some combination of bad sleep habits and excessive worry about the idea of sleep.  Drugs and supplements by themselves cannot directly address bad sleep habits or excessive worry.

But rest assured there are effective ways to manage them both.

First, your sleep habits are very important.  There are a number of simple guidelines you can and should be following to help in essence “stack the deck” in your favor for improved sleep.  Particularly important is a consistent sleep-wake schedule, especially a consistent wake time, which enables you to manage your circadian rhythm and homeostatic sleep drive, two key internal processes that control sleep.  Watching your diet, getting daily exercise, and deliberate exposure to light are also part of a sleep-supportive lifestyle.

Practicing most of these sorts of healthy lifestyle habits are likely well within your control.  If you are not doing them now, we suggest you begin as soon as possible.

Excessive worry is without question a potent fuel that feeds and perpetuates insomnia.  We suspect the majority of insomnia is actually caused by worry about sleep.  The best method we’ve found to manage it is through a psychological technique known as cognitive restructuring.  Basically, you learn to safely let go of the the negative underlying thought patterns that cause anxiety, and replace those mental images with more positive, accurate, and realistic thoughts about sleep.

You can learn this method through books or by working with a counselor who uses CBT — cognitive behavioral therapy.   CBT specifically applied to insomnia is a safe, effective, drug-free, and permanent method to help improve sleep and effectively manage worry.

Using a combination of behavioral and cognitive methods combined simultaneously has been repeatedly found to be one of the very best approaches to improve sleep.  If you are the self-help type, all of these nonmedical approaches to sleep improvement are contained in a good CBT-based sleep training program.

Be confident that by effectively managing the true underlying root causes for your insomnia, you will be able to at least improve your sleep, if not restore a normal sleep pattern.

Capture negative sleep thoughts to control them

January 23, 2014

Q:  I am going through a severe bout of insomnia.  I have no underlying medical problems and believe this is entirely an anxiety issue.  Despite knowing that, I seem powerless to stop it.  I just cannot stop the obsessive, fearful worrying about sleep.  For me it seems like even the smallest worry thoughts are enough to keep me awake.  Any advice?

A:  The racing mind and negative sleep thoughts you are describing are a major problem for many insomniacs.  But rest assured there are effective ways to deal with this.

To specifically deal with the anxious worry about sleep, it’s very helpful to write down these negative thoughts.

Doing that has many benefits.  First, it seems much easier to recognize how distorted and overly pessimistic these thoughts are when they’re reduced to cold black and white on a page.  Writing them down helps us be more objective in understanding them rationally.

Along the same lines, it’s especially important to evaluate these thoughts for realistic accuracy.  You might use the “worst case/most probable scenario” analysis to judge whether or not these thoughts are overblown or something important to address.  This analysis is just one of many helpful tools you can use to evaluate recurring negative thoughts; there are many good ways to to do this.

If and when you find a negative sleep thought has actual merit or basis, then you can devise an action plan to address it.  And with that plan in mind then more easily let the negative thought go and allow yourself to fall asleep.

Maybe more importantly, when these negative sleep thoughts recur it will be much easier to release them with the countering rational thought that “oh yes, I’ve already covered that and eliminated it as a realistic concern.”

To insomniacs, distorted and negative thoughts about sleep are a lot like cockroaches — they hate to be exposed to the light of day.  Seems they would much rather try to scurry off and hide in poorly lit corners where they’re more difficult to control.  Writing them down enables you to shine a bright light and really examine them.  By capturing and controlling these seemingly amorphous negative thoughts, you effectively counter them.

The method we’re describing here to control negative thoughts is known as cognitive restructuring, one of the core methods in CBT-I — cognitive behavioral therapy specifically designed for insomnia.  CBT is actually a combination of proven methods that are usually very effective for most people in helping to restore better sleep permanently, without drugs, and with no side effects.

So be assured good methods are available that you can use to control and counter these negative thoughts.  And of course if you ever feel overwhelmed, there’s no shame in reaching out for professional help.

Desperate for sleep, wants sedation

January 7, 2014

Q:  After 4 straight days of little to no sleep, I got desperate and went to the emergency room.  I was so tired but did not feel sleepy.  I was shaky and desperate and felt like fainting, but sleep would not come.  I wanted to be sedated, but the doctor prescribed a high potency anti-anxiety drug, which finally made me pass out.  Now I am worried this is my life.  I  cannot function like this and don’t know what to do.

A:  Your story may reflect what happens when a part of the brain called the amygdala gets caught up with our ability to rationally manage sleep.  The amygdala is the part of the brain that largely generates the fear response. When fear kicks in, the common worry and concern many insomniacs feel about the idea of sleep gets intensified greatly. The body’s stress system goes into overtime, pumping adrenalin, cortisol, and other stress hormones into the body, putting us into a hyperaroused state, and thus making it very difficult to feel drowsy, let alone sleep.

On the other hand, our inherent requirement for sleep, our physiologic requirement for sleep, is much like breathing.  At some level we know we can’t not sleep any more than we can’t not breathe.  And indeed, we inevitably reach the point where our sleep response becomes autonomic, overpowering even our worst fears and anxieties.  When that happens, we crash.  And sleep.  Every time.  Without fail.  Sounds like this is what happened to you.

The key of course is managing this inevitable sleep process intelligently, rationally, and for the best results.

A good first step would be to see your primary care physician for a full work up.  Describe this issue in detail.  Your goal should be to either treat or eliminate the possibility of any underlying medical problem.

Your true underlying problem however, may not be medical.  It may be some combination of bad sleep habits (alcohol near bed time, inconsistent sleep schedule, and so on) and excessive worry, even fear, about the idea of sleep.  The worry and negative thoughts are a very potent fuel for insomnia.

If that’s the case, look first at non-drug solutions that are behavioral.  You can in fact change your behaviors and your thinking to support better sleep.  The best way to do this is through cognitive behavioral therapy, specifically designed for better sleep.  CBT is the standard of care as recommended by the American Association of Sleep Medicine, the society of doctors specializing in sleep medicine.  CBT-based sleep training is very effective for most people, is drug-free, permanent, and has no side effects.

Also be aware that sedation is not the same as sleep.  Anesthesia produces more of a “switched off” physiologic state, whereas natural sleep is a much more dynamic metabolic process.

Your description suggests the possibility you may have a legitimate psychiatric condition that is beyond normal levels of worry and anxiety.  If that’s the case you may need to work with a psychotherapist, but be assured all this is treatable.  You can make this better.