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Wednesday, July 14, 2010


A mildly-unpleasant physical manifestation of something has been happening as of late: insomnia. I am not sure if this a pregnancy thing, or if this is yet another bipolar (yuck)... as I have so aptly referred to some of the quirky symptoms the go along with the existence of a mental ailment. But alas... it is frustrating.

Insomnia was not an issue ten, even five years ago, when I would simply use the time to imbibe copious amounts of self-medication, and explore the saltier side of whatever town I graced. Needless to say, those are the old, dead days beyond recall and I have been forced to move on. Much to my chagrin, I do use the wee hours of the morning to my advantage... reading and writing and feeding the polywog in my womb, but as my partner-in-crime rises to begin his work day, I suddenly become sleepy. Something is not right; my clock is off.

According to The Mayo, "Insomnia is a widespread condition that's characterized by a difficulty in falling asleep, staying asleep or getting restful sleep. Like many people who experience insomnia, you may have turned to sleeping pills for relief." Never mind sleeping meds and pregnancy, as we all know mixing sleep aids with antidepressants, seratonin reuptake inhibitors, anticonvulsants, antipsychotics, etc., can be toxic.

The Mayo Clinic continues "There are times — such as during periods of pain or grief — when sleeping pills may help those who experience sleep deprivation. In addition, several hypnotics are now approved by the Food and Drug Administration for indefinite use.

However, many sleeping pills shouldn't be taken for more than a few days to a few weeks. Because they can be habit-forming, some people take these drugs far longer. Others may increase their dosage as the pills become less effective over time. Sleeping pills can also:

Mask the real causes of poor sleep, such as depression, heart trouble, asthma and Parkinson's disease, and delay treatment of these disorders
Interact with other medications or alcohol, often with serious, even deadly, results.

Cause next-day grogginess or rebound insomnia — an inability to sleep that's worse than the original problem
Lead to high blood pressure, dizziness, weakness, nausea, confusion, short-term amnesia

Cause bizarre behavior that goes beyond traditional sleepwalking to include "sleep binge eating," "sleep shoplifting" and "sleep driving" — none of which the person remembers."

The Mayo Clinic suggests CBT (a.k.a Cognitive Behavioral Therapy)as a successful alternative treatment for insomnia, sans medication. CBT is a relatively simple, short-term treatment that has long been used to treat a range of conditions, including depression, panic attacks, anxiety, eating disorders and substance abuse.

Studies have shown that psychological and behavioral factors play an important role in insomnia and that CBT can be effective in treating insomnia. A 2006 review of insomnia treatment studies conducted by the American Academy of Sleep Medicine found that CBT can help improve sleep and that benefits can be sustained over a long period of time.

The Mayo Clinic states, "CBT can benefit nearly everyone, including older adults who have been taking sleep medications for years, people with physical problems such as restless legs syndrome, and those with primary insomnia, a lifelong inability to get enough rest. What's more, the effects seem to last — a year after CBT, most people still show benefits from the therapy and sleep more soundly than before. And there is no evidence that CBT has adverse effects."

How does CBT work? The Mayo Clinic states "Cognitive behavioral therapy helps you change the thoughts and actions that interfere with your ability to get restful sleep. The approach is based on the idea that how you think (cognition) and act (behavior) affects the way you feel.

The cognitive portion of CBT teaches you to recognize and change false beliefs that affect your ability to sleep. For example, you may believe that you must get eight hours of sleep every night to function. In fact, seven hours of sleep may be adequate for you. Cognitive therapy also deals with misperceptions about the amount of time you actually spend sleeping. People with insomnia often sleep more than they realize.

The behavioral portion of CBT helps reprogram the part of your brain that governs the sleep-wake cycle. It targets specific behaviors — what sleep experts call "sleep hygiene" — that negatively affect your sleep. Such behaviors include failing to exercise or drinking beverages that contain caffeine just before bedtime.

When used as an insomnia treatment, cognitive behavioral therapy usually requires four to eight 30-minute sessions with a trained sleep therapist. The approach works on multiple levels and contains one or more of the following elements:

Cognitive control and psychotherapy. This type of therapy helps you control or eliminate negative thoughts and worries that keep you awake. It may also involve eliminating false or worrisome beliefs about sleep, such as the idea that a single restless night will make you sick.

Sleep restriction. This approach tries to match the time spent in bed with your actual sleep requirement. Reducing the amount of time you spend in bed without sleeping will actually increase your desire to sleep.
Remain passively awake. Called paradoxical intention, this involves avoiding any effort to fall asleep, with the goal of eliminating any anxiety you may feel about falling asleep easily.

Stimulus control. This method helps disassociate any negative cues you attach to the bedroom environment and condition a positive response with getting into bed. For example, you might be coached to use the bed only for sleep and sex.

Sleep hygiene. This method of therapy involves correcting basic lifestyle habits that influence sleep, such as smoking or drinking too much coffee or alcohol late in the day and failing to exercise regularly. It also includes tips that help you sleep better, such as winding down an hour or two before bedtime with a warm bath.

Relaxation training. This method helps you relax to reduce or eliminate the arousal that disturbs sleep. Approaches include meditation, hypnosis and muscle relaxation.

Biofeedback. This method measures certain physiological signs, such as muscle tension and brain wave frequency, with the intent of helping you control them.

The most effective treatment approach may combine a number of these methods. Realize that unlike sleep medications, CBT requires steady practice and that some approaches may cause you to lose sleep at first. Stick with it, and you should see results."

If the insomnia episode continues, I will certainly try the CBT route; it sounds promising! In the interim, I'm going to try MMM: mindfulness, music and warm milk. I will let you know how it unfolds.

I close with a download recommendation (pure genius in my humble opinion). Since the first time I listened to Radiohead "KID A" probably ten years ago, it has never ceased to seduce my senses with what I feel is its dream sequence-like perfection. Listen to it in it's entirety; I know you will concur on one level or another. It repeatedly becomes my subconscious. Perhaps it will inspire yours, too.
Sweet Dreams, Amanda xo

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