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Gulf Coast Pain
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Understanding
and Treating Insomnia
You
are not alone in having trouble sleeping.
It is estimated that insomnia periodically
affects
The
only good news is that most people with sleep problems can learn to
improve their
sleep. SLEEP PROBLEMS
Before
discussing what to do to correct sleep problems, it is important to
understand
the
Types
of Sleep Problems
There
are different ways that sleep can be disturbed.
Pinpointing the problem helps
in figuring
Causes
of Sleep Problems
There
are two basic categories of insomnia, Primary Insomnia and Insomnia Due
to Other
Primary
Insomnia, insomnia without any obvious medical or psychological cause,
is quite
Insomnia
Due to Other Causes requires taking care of BOTH the cause as well as
the
NORMAL SLEEP
In
order to know how to correct sleep problems, it helps to understand the
normal
sleep that
MHz 0 4 8 12 16<--------------------------------------------------------------->
Delta
Theta
Alpha
Low Beta High
Beta <---------------------------------------------------------------> low
high
eeg frequency
cognitive effort
attentional focus
reflective
consciousness __________________________________________________________________________
Table
1. EEG states of
consciousness
BETA: Effortful
problem solving (either productive or wasteful worry) is associated
with fast
ALPHA:
Calm, clear attention (meditation, listening to a concert or
a lecture, or
watching
THETA:
Letting-go of effortful focused attention to one's
environment and allowing
oneself
Typically,
persons flow through Beta, Alpha and Theta throughout the
day, as all these
states
DELTA:
Deep sleep is associated with low frequency Delta eeg
brain waves. This state
In
fact, all these states are always occurring to more or less of an
extent. Problems with
Stages
of Sleep
We
go through four distinct stages of sleep.
These are simply called Stage I, II, III and IV,
__________________________________________________________________________ Awake BetaAlpha
pm
am
Theta
.
. Stages
Light I
.
pr.
. pr.
. pr.
. pr.
.
. Of
Sleep Sleep
II
. .
. .
. .
. .
.
.
Delta III
.
.
. .
. .
. .
. . Deep
IV
. .
. .
. .
. .
. . Sleep__________________________________________________________________________
Table
2. Stages of Sleep.
Normal sleep includes cycling through four stages of sleep
every
Stage
I is a light sleep stage, one we enter into upon initially
falling asleep, and again
when
Stage
II is a deeper level of sleep, one which most
people fall into just after stage I
sleep,
Stage
III and IV sleep are the deepest levels of sleep, and
important for feeling rested Disruption of Normal Sleep:
Problems with sleep occur when these normal sleep cycles are disrupted.
Disruption
can
-
Trouble falling asleep:
one might have difficulty initially falling asleep.
This usually
-
Trouble staying asleep: Many
persons wake repeatedly throughout the night.
If this
Trouble sleeping deeply:
Perhaps the most troubling type of insomnia is when one
sleeps
All
of the above can be improved through healthy sleep habits, what we call Sleep
Hygiene
-
Trouble due to medical problems:
Restless leg syndrome, sleep apnea, hormonal
changes ARE YOU REALLY READY TO BEGIN
Before even beginning with techniques
for improving sleep patterns, it is important to
first
-
Motivation to do whatever it takes:
It WILL
take a lot of effort, in terms of life
-
Willingness to let-go.
. Many people with insomnia have a need to remain vigilant.
But
-
Attentional Retraining:
Persons who have a
baseline anxiety come to believe that
“if
Rule
#1: Whatever you pay
attention to, you enhance. If
you pay attention to worry,
Rule
#2: You become what you
pay attention to. If you
pay attention to worries,
your
-
Don’t wait!
If you wait until you feel like exercising, until you’re
“ready” to set a
regular SLEEP HYGIEN
Now that you understand the nature of
sleep, and are motivated to do whatever it
takes to
What
to do:
-
Stop working and relax an hour before going to bed.
-
Go to bed and wake up at the same time every night, as
consistently as possible
-
Do a relaxation exercise (see Table 3, below) just before
getting into bed.
-
Continue to focus on your breathing when you get into bed.
Rather than focus on your thoughts, focus on your breath.
-
Use the bed for sleep (and sex) and that’s all.
-
Have a comfortable environment, no TV blaring, computers
humming, etc.
-
If you have an important thought, that you can act on in
the morning, write it down on a pad of paper you keep next to your bed
for such “emergencies!”
-
If you wake up at night,
o
first do the relaxation exercise (Table 3), in bed.
o
if still awake after 20 minutes, get up and out of bed and
do something active
o
When you feel
tired, do your relaxation exercise again, in a chair and continue
o
Repeat this cycle as often as you need to, never staying
in bed, awake, for more
-
Don’t take naps during the day.
It may be rough for the first few days, but it will
-
Don’t drink caffeine, especially after 2pm.
-
Don’t drink alcohol, certainly not within three
hours of going to bed (alcohol
-
Don’t read, watch TV, do work, argue or do
anything else in bed, except sleep
-
Don’t exercise within three hours of going to
bed.
-
Don’t eat spicy food at night.
-
Above all, don’t worry.
It only makes things worse.
Sleep
hygiene will set the stage for healthy
sleeping. However, leading a
healthy
lifestyle
Regular
Exercise: Daily moderate
exercise, best done earlier in the day, every day,
at the
Regular
Eating: Eating healthy (non-fatty, non-sweet, non-excessive) meals,
including
Regular
Recuperation: Spending
as much time in Alpha and Theta as you do in Beta
o
When you wake up
o
Sitting in your car before going into work
o
Before lunch
o
Before you go into your house after work, or before dinner
o
Before bed.
These five minute “mini-breaks” can help your nervous system
regulate itself throughout
the
Sit in a comfortable chair, with your hands on your belly:
-
Feel your body sinking into the chair
-
Feel your legs sinking into gravity, and all the muscles
letting go of tension
-
Feel your body sinking into the chair, and all your back
muscles melting
-
Feel your arms sinking into gravity, and all the muscles
letting go of tension - Feel your head, resting on your shoulders, and your facial muscles melting
-
Feel the soft cool air flowing in, and the warm
comfortable air flowing out
-
If your attention is distracted by thoughts or sounds, let
them go and return your
-
Notice your entire rib cage filling and emptying all
around, like a balloon
-
Don’t try and breathe, simply let the breath breathe
you.
-
And every time you exhale, let go of the breath a little
bit more, and a little bit longer, Focus on the warmth of your
hands, for six breaths
-
Blending with the warmth of your belly
-
Rocking forward and back with the breath moving your belly
Table 3. Rapid Deep Relaxation Exercise.
Severe
Insomnia - when nothing else works.
Most people improve their sleeping in
a matter of days or weeks by:
a)
being motivated to do whatever it takes, and are willing
to let go of worry
b)
following sleep hygiene guidelines
c)
improving and having a regular healthy lifestyle (exercise
and nutrition)
d)
resting and recuperating throughout the day, and
especially before bed.
Yet
there are some people (and probably some times for all people) who,
despite their
Sleep
restriction
-
You have attempted all the sleep guidelines, discussed
above, for at least one month,
-
Don’t let yourself go to sleep until you are really
exhausted. That is, if you
try to go
-
Calculate the number of hours you typically sleep, and
then
-
Don’t let yourself go to bed until you are ready to get
that amount of sleep
-
Keep this up for several nights, and then begin going to
bed 15 minutes earlier every YOGA POSES
If
you are still having difficulty falling to sleep, there is an old Yoga
trick that is sure to help. Inverted Pose: There are two easy ways to get into this Yoga pose.
Method
1: Place two large pillows on the floor
next to your bed. Lie on
your back on the
floor,
Method
1: is easier to do for most people than method 2 (below), but the problem
is
you
Method
2: Put two large pillows on your bed, next to the wall.
Lie in bed with two
pillows
Temporary
Medical Support
-
You have attempted all the sleep guidelines, discussed
above, for at least one month, and you continue to implement these sleep
guidelines.
-
Sleep Restriction has been attempted
-
Medication can be used 2 times/week (maximum) to
“catch-up”
The problem with sleep medications is that even the better
ones (the one’s that allow for
__________________________________________________________________________
Medications
Most Restrictive of Deep Stage Sleep and Paralytic REM: Alcohol (often results in a “rebound” of wakefulness several hours later) Narcotics (MS Contin, Vicodin, Percoset, etc) Benzodiazapines (Vallium, Xanax, Klonopine, Ativan, etc.) Antihistamines (Benadryll, Atarax, etc.)
Sonata (2 hours duration; useful for initial sleep difficulties; waking
up once and can’t Ambien (3-4 hours duration of action; same uses as Sonata, but lasts longer) Trazadone (8 hours duration, good for sleep with multiple wakings; strong) Elavil (similar to Trazadone for purpose and duration, also good for pain) Paxil (shorter duration, and gentler; useful for concurrent anxiety) Serzone (longer duration, stronger than Paxil; useful for concurrent depression) Remeron (longer duration, stronger than Paxil, useful for concurrent depression)
Note:
Treatment of Anxiety or Depressive Disorders with a less sedating
antidepressant __________________________________________________________________________
Table
4. Sleep medications and
other medications useful for sleep.
CONCLUSION
References:
Bootzin RR, Perlis ML:
Nonpharmacologic treatments of insomnia. J Clin Psychiatry
Dingemanse
J: Pharmacotherapy of insomnia: practice and prospects. Pharm World Sci
Edinger
JD, Wohlgemuth WK, Radtke RA, et al. Cognitive behavioral therapy for
The
Gallup Organization: Sleep in America: A National Survey of U.S. Adults. Kupfer DJ, Reynolds CF III: Management of insomnia. N Engl J Med 1997; 336:341-346
Parrino
L, Terzano MG: Polysomnographic effects of hypnotic drugs: a review.
Tsoi
WF: Insomnia: drug treatment. Ann Acad Med 1991; 20:269-272 |
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Painlessly
enjoy what you love doing most.
Gulf Coast
Pain Management
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