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By: Dr. Joanne Z Moore, PT, DHSC, OCS

Sleeping art

Dreams timeMy friend Beverly walked down the hall to the bedroom to dress for her husband’s funeral. She stopped short, unable to even re-enter that room to get her clothes. My friend Betty never again slept in the bed she had shared with her husband of 50 years, sleeping in the living room for 20 years. The bed is the one place we can’t distract ourselves from our loss. It is in bed that we feel the loss so acutely, and where we have the time to grieve most intensely. It is no wonder that sleep is elusive, and so many of us suffer from insomnia. Should we worry about it? Should we seek medical intervention? Or will it just go away after a while?

Widow/ers may find it easier to first enter the bedroom with someone else. My daughter-in-law helped me change the sheets after my husband died, and her presence was comforting to me. Lying on my husband’s side of the bed kept me from having to look at that empty place. I resisted putting a television in the bedroom at first, but did eventually, at the urging of my friends. I find it does help to have some “company” from the late night pundits at times. Retiring to the bedroom to watch tv before falling asleep also gets me out the kitchen area, and I find that I eat fewer evening snacks. Another bedroom addition was a small desk. I keep a journal there, and write about whatever is on my mind. Even with those modifications, I found that I fall asleep an hour or two later than usual, or that I wake up for an hour or two during the night. I had to change my work schedule, so that I now start at 9:00 instead of at 7:00. So if I am just getting into a deep sleep as morning approaches, I can enjoy it.

Our sleep patterns have certainly been thrown off by grief and anxiety. According to the Mayo Clinic, people who don’t get enough sleep function less well in several domains that we are just beginning to understand. They have slowed reaction time while driving. Lack of sleep exacerbates both depression and anxiety. And we know that depression and anxiety cause insomnia – what a downward spiral that sets up! And when we are tired, we tend to reach for a sugary snack for a boost of energy. And though the snack works in the short term, the weight gain that ensues makes life more difficult. Lack of sleep also predisposes us to high blood pressure, heart disease, and diabetes. Neurons that control sleep interact closely with the immune system. Infectious diseases tend to make us feel sleepy. This probably happens because cytokines, chemicals our immune systems produce while fighting an infection, are powerful sleep-inducing chemicals. Sleep may help the body conserve energy and other resources that the immune system needs to mount an attack. Lack of sleep can also be attributed to side effects of some medications, or to an underlying medical condition.

What happens in the brain during sleep?

We now know that our brains are very active during sleep. Short term memories are cemented, and creative strategies to deal with issues are developed.

Scientists at the University of Rochester found that brain cells in animals shrink during sleep. This creates a greater space between the cells, so that the waste products of metabolism and toxins can more easily circulate out of the brain. They extrapolate that the same mechanism occurs in the human brain.  

According to the National Institute of Health, chemicals called adenosine and melatonin build up in our blood while we are awake and their increasing levels cause drowsiness. The chemicals gradually break down while we sleep. If we don’t get enough sleep, the adenosine is still in our system when we rise, causing a tired feeling right from the beginning of the day.  Also during sleep, nerve cells are nourished so that they have enough energy for the next day.

What Interferes with Sleep?

Mange these on our own

Consult with physician/sleep specialist

Caffeine: coffee, chocolate

Cardiac or pulmonary conditions

Drugs, such as diet pills and antidepressants suppress REM sleep

Any painful conditions

Heavy smokers often sleep very lightly and have reduced amounts of REM sleep. They also tend to wake up after 3 or 4 hours of sleep due to nicotine withdrawal

Sleep apnea is a common problem that interrupts sleep frequently due to closing of the larynxSleep apnea is characterized by lapses in breathing, followed by a snore or snort.

While alcohol does help people fall into light sleep, it also robs them of REM.

Depression, anxiety

Behavioral therapy

Behavior therapies teach you new sleep behaviors and ways to improve your sleeping environment. They are generally recommended as the first line of treatment for people with insomnia. Typically they're equally or more effective than sleep medications.

Behavior therapies include:

  • Education about good sleeping habits: Have a regular sleep schedule, avoid stimulating activities or caffeine or alcohol before bed, and have a comfortable sleep environment.
  • Cognitive behavioral therapy: Learn to control or eliminate negative thoughts and worries that keep you awake.
  • Relaxation techniques: Progressive muscle relaxation, yoga, biofeedback and breathing exercises are ways to reduce anxiety at bedtime. These strategies help you control your breathing, heart rate, muscle tension and mood.
  • Stimulus control. Limit the time you spend awake in bed and associating your bed and bedroom only with sleep.
  • Sleep restriction. Spend less time in bed, causing partial sleep deprivation, which makes you more tired the next night.
  • Remaining passively awake. Also called paradoxical intention, this treatment for learned insomnia is aimed at reducing the worry and anxiety about being able to get to sleep by getting in bed and trying to stay awake rather than expecting to fall asleep.
  • Light therapy. If you fall asleep too early and then awaken too early, you can use light to push back your internal clock. You can go outside during times of the year when it's light outside in the evenings, or you can get light via a medical-grade light box.
  • Exercise and stay active. Get at least 20 to 30 minutes of vigorous exercise daily at least five to six hours before bedtime.
  • If you take medications, check with your pharmacist to see if they may be contributing to your insomnia. Include over the counter medications.
  • Don't put up with pain. Get a good diagnosis and treatment plan.

The Rewards of Sleep

When we’ve had a good night’s sleep, we awaken refreshed, with a sense of readiness for whatever lies ahead that day. Our brain works well. Our memory is good, and we can think clearly to solve problems. We feel calm and at peace with ourselves and with those around us. It’s easy to be patient and kind. We have enough energy to do all of our chores with enough left over for something that we’d like to do.

"Finish each day before you begin the next, and interpose a solid wall of sleep between the two." – Ralph Waldo Emerson

See this video on insomnia, Lisa Saunders interviews Dr. Joanne Moore & Rachel Baer about insomnia and yoga.

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