CONQUERING INSOMNIA—A Cognitive Behavioral Approach

Are you having problems sleeping? Insomnia is a health problem that will affect most Americans at some point in their lives. There are three major types of sleep disturbance. Onset and maintenance insomnia, and early morning awakening. Onset insomnia has to do with difficulty falling asleep; maintenance insomnia is related to staying asleep and EMA, means waking up earlier that one’s usual wake up time. Anxiety is usually related to onset insomnia. Have you ever found yourself lying awake at night, unable to sleep, because you cannot turn your mind off. You may be replaying the days’ events in your head or worrying about an important meeting tomorrow. EMA, on the other hand, is related to depression. If you find yourself awakening at three or four am, when your usual wake up time is six or seven you may have EMA. Many things can cause depression, but most often it is related to some type of loss—loss of a job, marriage, loved one, pet, or disability. These environmental events can lead to negative or distorted thinking patterns which in turn can lead to depression. Sleep disturbance is one of many symptoms of depression, be it hypersomnia (sleeping too much) or hyposomnia (sleeping too little). And then there are complications with sleep due to pain, disability, medication side effects, sleep apnea and environmental conditions such as temperature, and light.
Another group of people who may have sleep problems is shift work individuals. People who have been night owls all their lives, may have difficulty working during the day and sleeping at night. And conversely, people who are used to sleeping at night and working during the day, like most of us, may have trouble sleeping during the day and working at night. However, most people can adjust to a routine as long as it remains constant. Their body will likely eventually adjust to the new schedule. Unfortunately, those who are on rotating shifts, find It difficult to keep up with a constantly changing schedule. Their body never learns when It is supposed to sleep. It has been my experience that this group is the hardest to treat.
So you might ask, why is sleep so important. One of the most important reason is health. Studies have shown that when people are sleep deprived they tend to eat more, have higher blood pressure, and lowers immune functioning, which can lead to many illnesses. From a cognitive perspective, reaction time, attention and concentration, and memory are all affected by sleep deprivation. Slowed motor skills and mood changes are also side effects. Unlike, substance abuse, which can cause similar symptoms and the person is aware that the substance (ie, alcohol) may be causing their problem, most people are not aware of the impact of sleep deprivation on these different areas of their lives. Consequently, a person who is sleep deprived may have no problem getting behind the wheel of a car or operating potentially dangerous machinery. It takes only a moment of nodding off for a sleep deprived truck driver to cause a major accident. Most studies have shown that individuals need approximately eight hours of sleep per night, in order to feel rested and rejuvenated, irrespective of your age.
The good news is that there is effective treatment for insomnia that does not involve drugs. Cognitive Behavioral Therapy or CBT, involves changing thinking patterns and habits. The sleep hygiene rules listed below may help you get a handle on your sleep problems. A first course of action is to visit your primary care physician to rule out any medical reasons for having a sleep disturbance. Sometimes medications will be prescribed to help with sleep, especially in acute situations of severe stress or chronic illness. Over the counter medications can have mixed results. They often help initially, but if used for long periods of time, they may actually become ineffective and even interfere with your sleep.
Sleep hygiene rules
Regulate sleep wake cycle
Go to bed at the same time (within a 30 minute before and after bedtime window) and get up at same time every day. On weekends, do not sleep in more than one hour later than your normal wake up time.
Do not take naps. If you are severely sleep deprived, get up at your normal wake up time and if necessary take a short cat nap (15-30 min) and force yourself to stay awake until your bedtime.
Do not stay in bed for more than 15 minutes lying awake. Get up, go to another part of the house and do quiet things to make yourself sleep (TV, music, reading). Do not start cleaning the house, surfing the web, or doing work. And most of all to do not eat, because you may actually condition yourself to awaken during the night feeling hungry.
Avoid stimulants in evening
Do not smoke, drink caffeine, eat sweets, or exercise in the evening. However, if evening is the only time you have to exercise, it is better to exercise than not.
Relaxation techniques
Learning diaphragmatic breathing, imagery, or progressive muscle relaxation are ways of activating your parasympathetic nervous system (PNS) and facilitating asleep. Sleep is a passive activity, that requires you to let go. The sympathetic nervous system (SNS) is the alarm system, that kicks in when the body into fight or flight (increase blood pressure, respiration and heart rate). Think of the SNS as the accelerator and the PNS as the brake. When you are in an emergency situation you want to press the accelerator. But, if you are trying to go to sleep you want to put on the brake. Taking control and trying to force yourself to go to sleep rarely works. Tossing and turning and looking at the clock only makes the situation worse. Doing something that helps you slow down will help you to fall asleep.
Associate the bed with sleep not wakefulness
You should only sleep and have sex in bed. No TV, working, talking on the phone, or any other activity in bed. These behaviors require you to be awake and alert and contradict the calming down process for going to sleep. If you are doing activities that require you to be alert, you may begin to associate the bed with wakefulness not sleep.
Make your sleep environment conducive to sleep. Make sure you have a comfortable mattress, room temperature, and lighting.
Develop a pre-sleep routine
Signal to your body that it is time to go to bed by developing a routine just before bed. Activities such as showering, saying prayers/meditation, brushing teeth, or reading can all indicate to your body that sleep is imminent. Eventually, your body adapts to a schedule just like an infant whose parents maintain a rigorous feeding and sleeping schedule with them. After some training the infant will expect to eat and sleep at a certain time no matter where they are. The same can be true for adults. Good night and sweet dreams.

How to raise your game

Peak Performance Training (PPT) is a program designed to help you improve your level of performance by facilitating mind/body synchrony. If you are trying to take your game to another level, PPT may be for you. Studies have shown that stress can interfere with the body’s ability to relax, the mind’s ability to make good decisions, and one’s ability to manage his/her emotions. Whether you are making a shot, performing on stage, having difficulty focusing on a task, taking a test, making an executive decision or trying to lower your blood pressure, getting into “the zone” is beneficial.

GETTING INTO THE “ ZONE”

The zone is playing without thinking. When one is in the zone there is complete mind/body synchrony. The zone is the state of consciousness where your higher motor faculties and intuition merge in liquid coordination.

PPT APPLICATIONS

*Sports/Entertainment

*Business

*Health

*Education

PPT TOOLS

*Mental Skills Training

*Behavioral Conditioning

*Heart rate variability (HRV) feedback measured by em Wave® by HeartMath®

*Relaxation techniques

*athletes, teams, coaches

*business (decision making, stress)

*patients (pain/blood pressure)

*students (ADD/ADHD, test anxiety)

*anyone who wants to improve performance or quality of life

*changes in anatomy & physiology

*improved cognitive clarity

*improved eye hand coordination

*established routines versus rituals

*mind/body synchrony

*emotional/intensity regulation

*better decision making under pressure

*coping with winning, losing, & injury

HeartMath and em Wave® PC provide a system of tools and techniques that are based on 15 years of scientific research on the psychophysiology of stress and emotions and the interaction between the heart and the brain. In general emotional stress creates erratic heart rhythm patterns, that in turn affects the body’s ability to function properly. Heart rate variability (HRV) coherence training systems have been used effectively to improve performance anxiety in the areas such as, but not limited to Sports/Entertainment Business , Health, and Education. Moving from chaos to coherence by learning to control HRV in real time, with the use of cutting edge technology is the goal of HeartMath strategies..

Tiger Woods comment: In an interview with Jimmy Roberts of NBC Sports, Tiger Woods was quoted in part as saying:, “the guys who are really controlling their emotions are going to win.”

other services

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PAIN

IS IT ALL IN MY HEAD?

Stephanie L. Livingston, PhD

 

 

 

Pain is the most common presenting complaint by patients to their physicians and pain medications are the second most prescribed drug.  The direct and indirect costs for the treatment of pain is staggering.  These costs include surgeries, loss of job, absenteeism, pain treatment (medical and psychological), legal implications, and the impact on families.  Despite the costs and the fact that the concept of pain is better understood than a decade ago, the assessment and treatment of chronic pain is complex. One of the reasons for this complexity is the fact that pain is a subjective experience.  One can only make inferences about another’s experience of pain, by looking at “pain behaviors”.  Talking about the pain, walking with a limp, taking pain medication, being irritable, or grimacing are all examples of how one might demonstrate their experience of pain.  Consequently, a multidisciplinary approach to the treatment of chronic pain is needed and  includes the expertise of physicians, psychologists, physical therapists, and occupational therapists. Each healthcare professional offers a unique perspective in understanding chronic pain.

 

Many people do not realize that acute pain and chronic pain (six months or greater) are very different experiences.  Acute pain is typically thought of as a signal that something is wrong in the body and once the injury goes through a healing process, the pain disappears.  This is not the case with chronic pain.  Some people have had pain for many years, long after the original injury has resolved physically.  At this point, there are many factors which influence one’s experience of pain. From a Biopsychosocial perspective these factors include biological, psychological, and social/environmental  aspects.  Pain tolerance, genetic predisposition, and medication effects are examples of biological factors.  Depression, anxiety, stress, and anger are psychological factors.  Weather, exposure to toxins, work or family situations address social and environmental factors that influence chronic pain. 

 

Melzack and Wall, early pioneers in the area of the pain, introduced the idea of acute (ie, sensation) versus chronic (ie, perception) pain in their Gate Control Theory of Pain in 1965.  This theory attempts to explain the interaction of multiple factors in the production of the sensory and emotional experience of pain.  Some stimuli “open the gate” or increase one’s perception of pain and some stimuli “close the gate” or decrease one’s perception of pain.    The latter suggests subjectivity, meaning that how the person experiences the pain will depend upon whether or not the “gate” is open or closed. Examples of things that open the gate are sedentary lifestyle, negative mood states, low pain tolerance, and stress.  Examples of things that close the gate are medication, exercise, positive emotional states, relaxation, hypnosis, distraction and biofeedback, to name a few.  Therefore, many pain programs incorporate ways of closing the gate into their pain management strategies.  These treatment approaches might include, but are not limited to surgery, injections, medication, psychotherapy/psychoeducaction, physical therapy and occupational therapy.  In the case of surgeries for the management of pain, psychological assessment is a critical element in evaluating the prognosis for outcome after surgery (eg, compliance with treatment recommendations, making lifestyle changes).  Although psychological approaches are helpful in understanding pain, none can actually identify whether the pain is organic or psychogenic.

 

So, is the pain all in your head?  In many respects the answer is yes.  Not because the pain is not real, but because psychological factors, that originate in the mind can  play a role in one’s pain perception.  By learning to control psychological aspects of pain, the pain may be managed better.  If you have chronic pain and are having difficulty managing it, consider seeing a psychologist who specializes in pain management, in conjunction with your treating physician.

                                                  

Stephanie Livingston, PhD is a licensed psychologist practicing at the Woodland Pain Clinic. Call 312 907-3644 for an appointment.

 

Biopsychtech of Chicago, Ltd

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Chicago, IL 60601

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Michigan City, IN  46360

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E-mail: drstephanie@nappypsych.com