When Sleep Eludes

INSOMNIA comes in many forms and has many causes - from side effects of prescription medication, alcohol, coffee, vanilla [yes, it’s a stimulant], physical illness, depression or anxiety, negative emotions like guilt or anger, to excitement, diet, disturbance of usual sleep patterns, physical discomfort, allergies [e.g. to invisible pollens], or concrete disturbances like noise.  Add a long et cetera to the list!

Forms of Insomnia:  Difficulty falling asleep, Disturbed sleep, Nightmares or night terrors, Inability to access Deep Sleep, Too deep and too long sleep periods, Interruption of [+- 90 minutes] sleep cycles, Medical problems like Sleep Apnea;  Early Waking.

The pattern of someone’s particular sleep disturbance can often suggest the cause/s and thus the best solutions.  Unfortunately too many people become dependant on drugs [prescription, alcohol, other drugs or even starchy foods] in order to get enough rest while sleeping.  Except during times of trauma [physical, emotional, societal] it should not be necessary to use chemicals in order to get a great night’s sleep. 

Ironically, the same “rules” for having good sleep experiences generally have applied over many centuries and in different cultures, despite great changes in environmental or social circumstances or demands.  For instance, if you wouldn’t have felt restful if a troupe of actors came to perform Macbeth in your bedroom in 1620, you also will be unlikely to sleep well if you watch television in the bedroom in the 21^st century! 

Most cases of insomnia can be easily cured by simple changes in our lifestyle or thinking habits!

That would of course imply that we have to give up the immediate gratification type of comfort or stimulation for the longer-term benefits of great sleep.

If you believe you have sleeping problems or a sleeping disorder, it is a useful first step to note patterns of disturbance and possible correlation to patterns of behaviour or state of mental or physical well-being or discomfort.  Many times you will then be able to correct the problem appropriately [and without drugs!] but sometimes it may be necessary to consult a health professional like a Clinical Psychologist or a Doctor, or even to be assessed at a Sleep Laboratory, to find the best solution for the problem. 

Specialised techniques like Hypnosis or relaxation exercises are very useful adjuncts to any other methods to alleviate or manage sleep disturbance. 

More about types/forms of sleep disturbance and their causes:

First, unless you are quite sure that the cause is purely psychological or in your life style, it is always wise to rule out possible medical causes, then rule out possible substance causes [including prescribed medication], as sleep disturbances could be an early warning system that there is a physical problem that needs attention.

We can test for lifestyle causes by changing the things we are doing according to the list later in this article for at least 10 days, consistently:  If our sleep improves significantly, then we no longer have a problem!  If not, consult a physician who may also require some blood tests, if medical conditions [like thyroid malfunction or hormonal problems] are suspected.  Please note that while conditions like Sleep Apnea may have lifestyle causes [like being overweight and/or using too much alcohol] they can be life threatening conditions that need medical intervention until the lifestyle changes have positive results over time;  some conditions require medical management for life.

Medical conditions that may be misdiagnosed on initial inspection as Psychological, include Thyroid malfunction, Hormonal imbalance [in men also, not just the stereotyped women’s states of PMS, pregnancy or menopause! – for instance, low testosterone could contribute to high anxiety and sleeplessness in men].  It is important to treat the medical condition rather than its “psychological” symptoms only.

Conditions like diabetes, high or low blood pressure, kidney malfunction, sinusitis, digestive system problems, etc, etc, may also cause or contribute significantly to sleep disturbances.  The medication used to treat these and other disorders [like cancer, or allergies] can frequently be a cause of sleep disturbance, for instance, many medications used for high blood pressure can cause “restless legs” [also found in diabetes] that interferes with sleep.  Spinal injuries, especially if high in the spine, can cause interference with sleep due to conditions like spasticity of the limbs or “high tonus” [tension state] of skeletal muscles generally.  Acute and chronic pain can interfere with sleep.

Patterns of Sleep Disturbance and emotional arousal:  Generally difficulty falling asleep, or frequent waking [once medical causes are ruled out] appear to be related to stimulant/excitement chemical states of the brain [like anxiety or excitement], and early waking with inability to resume sleep appears to be associated with depressed chemical states of the brain [like depression or grief].

Lifestyle causes of sleep disturbances:

Diet:  Eating a heavy meal  or meat late at night;  eating too much meat at supper, eating dairy products at/after supper if you are sensitive to them;  garlic, onions, vanilla, alcohol, caffeine [including in chocolate, tea, soft drinks, some food energy supplements], acidic fruits, MSGs [Monosodium Glutamate found as taste enhancer in many “fast” foods like potato crisps, pizza, sauces, Chinese food and most soya sauces, fish or chicken batter at fast food vendors, gravy or basting at many steak houses, some commercial salad dressings];  too low or too high blood sugar, etc.

Distraction/Stimulation: 
1] Every authority on sleep disturbances states that “The bedroom should be used for sleep, rest and sex only”.  Add to that meditative exercises or spiritual rituals like praying.
2] Do not read in bed.  Read on a chair, seated [not slumped/lying down], under good light somewhere else in or out of the bedroom.
3] Except if you are bed-ridden no one should have a TV or PC in the bedroom;  if you are renting a single room, then do not watch or work from your bed.  Lying down should be associated with rest, sleep, and sex/comfortable togetherness only.  We form “habit” brain pathways with repeated action and the brain gets confused when it has opposing pathways associated with the same situation [e.g. being in bed] – it does not know whether to sleep or not, which leads to sleep disturbance.
4] Some forms of meditation can actually stimulate the brain:  we need alpha states to rest:  do not play eg Beta state generator CDs/MP3s etc late at night.  Do not play arousing music or engage in arousing reading/Tv etc [eg thrillers] before going to bed/sleep.
5] As far as possible, keep regular times to fall asleep or wake up.  The Reptilian centre of our brain becomes anxious when patterns are interrupted frequently, and will assume a watchful-wakeful state.
6] Do not over-sleep or sleep late to “make up” for sleep lost through late night activities.  This affects your sleep-waking cycle.  Rather “catch up” with shorter rest or sleep sessions [“siesta” or “forty winks” are sufficient to replenish energy till the next “normal” sleep time.]
6] Do not exercise vigorously within 2-3 hours before bed time [certain yoga or gentle stretching exercises may be acceptable – always test to see if it makes a difference].
7] Create a “settling down” period of at least 30 minutes before attempting sleep.  This can include calm music, rubbing on body lotion, prayer/visualisation, affirmations of peaceful, positive thoughts, etc.
8] Use self-hypnosis/relaxation/autogenic training exercises if you feel alert/ anxious/ depressed/ irritable/ aroused at bed time, or if you are in physical discomfort like pain.

Hypnosis recordings can be extremely helpful in combating both sleep disorders and their causes, whether physical like pain or illness, or psychological like anxiety or depression.  A properly qualified Clinical Hypnotherapist [i.e. someone like a psychologist/psychiatrist who is qualified not only in hypnosis but also in the neurology and physiology affecting sleep] is recommended although there are also very good commercial sleep-hypnosis products available on the internet. PLEASE READ THE ARTICLES ON HYPNOSIS ON THIS SITE before you buy a product or see a hypnotist as here could be dangers if the hypnotist is not adequately trained or experienced.  Always ask for credentials before submitting to any form of treatment!

Disruptive Emotions or Thinking:

There is by now overwhelming evidence, especially since research by Cogitive-Behavioral and Brain scientists in the last half of the 20^th century and later, that any form of mental or physical distress can be exacerbated and often even caused by incorrect/dysfunctional habits of thinking or behaving.

Many people frequently sleep very little when they’re involved with something fun or stimulating, and feel fine [though I would recommend that this practice is limited to “occasional” sleep deprivation!].  Suddenly if we can’t sleep due to physical or mental discomfort, we tend to “catastrophise” [i.e. give it more power to disrupt us than necessary or real]…  People say “I had ONLY 5 hours’ sleep last night;  I MUST be tired and today therefore WILL be terrible!”  [So many thinking errors in one statement!] Rather say “I’m so happy and excited that I had a FULL five hours’ sleep and am looking forward to a wonderful day, full of positive energy, and a great night’s sleep thereafter!”

Use phrases like “I’m looking forward to a wonderful night’s rest, and a positive, glorious day tomorrow!” or “I’m welcoming this being awake and am grateful for the wonderful, restorative sleep I will soon enter…” etc, to plant seeds for good outcome in your mind.

Dr Wayne Dyer recommends that we use two verbal techniques to help us be at peace:
- Repeat words like Serenity, Calm, Peace, Joy, Tranquillity, Abundance [etc] until you feel good
- Say “I want to feel good!”, followed by “I intend to feel good!”

Remember, your words [and thoughts] create your reality!

To learn more about this, read books on positive thinking, or watch the commercially available DVD of The Secret.

There are also many “releasing” techniques:  Find a therapist or life coach who is trained and experienced to help you to release whatever habits or experiences are interfering with good sleep.  Most of us really do not need medication in order to have fantastic sleep!  If insomnia is interfering with your ability to be happy and successful, it’s certainly worth the investment to see someone competent who can help you professionally.  When people prioritise health, all other aspects of their lives tend to improve dramatically also, at little or no further cost.

This technique was Presented by Reinette Steyn to the Psychology (PsySSA)Conference in Cape Town on 13 Aug 2009.

Whether big or small, Trauma has always implied disruption of our sense of being “OK”.

The German word Traum means Dream, suggesting an experience in Dream State, or Nightmare, if you will.  Traumatic experiences generally have dream state power: symbolism, irrationality, unpredictability, polarised effects, and 2-dimensional characters – good or bad, victim or perpetrator.

Psychoanalyst Melanie Klein held that the Imagoes or mental representations we create of people who have in some way damaged us, are far fiercer and more relentless than the real life people on whom they are based; they are indifferent to all others’ pain or even delight in it.

I believe the same holds true for damaging or threatening events or experiences in general. 

They seem one-sided and overpower us with their unmittigating attack – Nightmare stuff.

The counter-balance for a nightmare, with all its vivid imagery, movement, unpredictability, and frenetic action, can’t be just a calm dream.  We need a similar strong arousal level as that of the trauma or nightmare experience, one that would stimulate the release of large quantities of positive neurochemicals to neutralise or displace the negative ones.

We need colour, movement, rush of action, stimulation of all senses, and exuberant energy in our healing imagery.  Let’s call it a Brightmare!  A wonderful, bright, positive dream state experience, with imagoes as impossibly real and incongruous to everyday experience, as those of negative trauma states.

The changing of the brain state to a positive but aroused state is an important intervention since we know that our brain functioning is so-called “State-Dependent”:  It is very difficult for us to access positive memories or habits if we’re feeling depressed, or calm memories or experiences if we’re feeling anxious, or powerful feelings when we’re in a trauma-induced powerless state.  And since the brain appears to prioritise highly aroused states as mode of ensuring survival, we need to create a similar level of arousal priority for the brain to change to a more positive and powerful state of functioning.

Different de-briefing therapies appear to have 3 common elements in their various protocols:
1]  Re-visit the traumatic experience in minute details, accessing all 7 senses, and replay with different perspective and speeds.
2]  Re-frame aspects of the experience so that they are more empowering & validating.
3]  Generate a containment / safe space experience.

In EMDR the protocol typically ends with 3 containment steps:
a]  De-potentiate the threatening negative imagoes, for instance by putting them into a Perspex bubble, or a composting tank, or shark cage.
b]  Anchor a feeling of being protected through a suitable image – blue light, angels, huge dog, etc.
c]  Help client to create or access a Conflict-Free Image [CFI].  Examples from patients include floating in a dam, playing with their dog as a child, flying overseas on holiday, throwing clay at opponents across a stream, giving birth, a secret place in a garden, etc.

Making light of actual traumatic events [big or small] is likely to be harmful, invalidating the painful experience, causing repression of the negative impact, and hugely annoying the defensive or protective ego-states, which may have disruptive and damaging consequences…

But we can speed up the process of re-empowerment and stabilisation of the self by enlivening the safe space imagery to create an effective counter-balancing “Brightmare” to the trauma-bad dream experience.  We do this through adding incongruous, laughter-evoking imagery to the client’s CFT or safe space.

Example:  To a young rape victim’s Safe image of eating ice-cream on the beach, one ciould suggest that the “ice-cream baby” had a big protector ice-goose that would nozzle her neck with its flat orange beak, and tuck her under its belly to keep her safe, till she sneezed so hard that it somersaulted backwards and looked very funny trying to regain composure.  Experience shows that clients, old or young, keep remembering the incongruous image and e laughter thus evoked seems to speed up the creation of efficacy and normalcy neuronal pathways.

We can thus play the role of movie or dream state director, generating strong and vivid positive states, to create an exciting Brightmare through suggesting additions to patient imagery, using the following tools:

- Add colour, brightness, temperature, physical comfort – or even slight discomfort such a tickling, texture, smell, taste, sounds.
- Enlarge the protagonist/s [including the Self] to absurdly huge size in relation to other elements or characters.
- Add incongruous characters, actions, occurrences, and situations.  It should end up being “silly” and laughter-provoking, while remaining reassuring and protective.
- Add fast movement, unexpected behaviours or events, dramatic, positive action, and make sure the client is part of the action in a powerful way.

Benefits are numerous, for instance:

- Neuro-chemicals evoked by laughter and energetic imagery create a brain state in which it is easier to recall victory and positive experiences, in contrast to the disempowering state created by traumatic experiences;
- Re-association to three-dimensionality of one’s life and reintegration of positive life experiences into the life narrative can occur readily;
- Through the balancing of Nightmare Dream States with Brightmare Dream States, normalcy is validated and permission is given to the self to laugh and experience happy feelings “in spite of” negative experience, etc.

The possibility for selection of possible characters and events is endless:  Why can’t the Elvis impersonator surfing on a Harley Davidson bike near the person’s safe place not have a mouse with long green eye-lashes playing ego-strengthening songs on the red lacquered guitar across his back, while the foam that shoots up from the Hog comfortingly tickles the client’s cheecks?

As long as the characters and events maintain the client’s sense of safety and security, and integrity of self, and add humour and some form of reconnection to happier or more ppowrful experiences, anything is possible.

RELATIONSHIP HEALING:
MAKING RELATIONSHIPS WORK - SOME ASPECTS OF COUPLES / MARITAL THERAPY

The three essential life skills almost all of us weren’t taught at school:
- How to manage and make money
- How to be good enough parents
- How to be successful in relationships.

It’s estimated that couples / spouses who stay together for financial, religious, family, business, or other reasons when they really don’t get along without even a semblance of peace and joy in each other’s company, added to the divorce rate [over 54% in most western countries] would result in a finding that up to 80% or more of couples are in serious relationship trouble. Serious.

Unfortunately we tend to behave in ways that were modelled to us – by caregivers / parents / teachers / older siblings or extended family, and – alas! – horridly dysfunctional characters in most soap-operas and many books and movies. The problem with television-modelling is the immediacy and the repetitive nature of the characters’ interactions, and that it’s per se “allowed” in our homes. The unconscious mind is given the message that this is how people [may] behave in our home, work or other space. While a book may describe outrageous behaviour, we would interpret it idiosyncratically. (Think of how surprised you felt at times when a book was turned into a movie and the characters just look wrong compared to what you had in mind.)

In visual media, with colour, movement and sound added in screaming vividness, the modelling of behaviour, including facial expressions, micro-gestures, posture, tone of voice, etc., is exact. But we usually don’t get to feel the emotional and/or physical consequences of the behaviours thus modelled. No, we go for a sustenance break during the frequent adverts, and de-brief the impact.

But this does not happen in close real relationships. There we have to ride out the encounter not just for 11-16 minutes a day [all that’s left when advertising time, and subtitles or intro time is subtracted from the 30 minute program!], but we have to live “in the drama” 24/7, day after day, week after week, for months, for years.

It holds for all close relationships, not just romantic ones. Relationships with colleagues, managers or underlings may need to be managed – or survived – for 40 hours or more a week. Relationships with school-going kids draw us in for about 10 hours a day and may drive a parent to distraction during weekends and vacations! Yes, we drive the kids nuts too…

Fact is that our level of esteem for our Self, our trust in our self to care for our self, our regard and respect for our self as a worthwhile and respect-worthy entity, our enjoyment and discipline of self, etc, determines how we behave in relationships. Again, these factors are generally created by negative and positive experience of self-in-relation-to-significant-others when we are very young.

Donald W Winnicott [UK analyst, C20] talks about being a Good-Enough or Not-Good-Enough parent. A good-enough parent basically has relatively few failures in understanding, accepting, respecting and responding appropriately to the child’s needs (physical, social, mental and emotional). This parent’s few failures can be forgive [and usually forgotten] in the matrix of appropriately empathic interactions that provide a properly nurturing environment for the child.

Now let’s look at those qualities again:
- being empathic*, i.e., understanding the world from the child’s point of view, and responding appropriately to his/her emotions and needs
[*by the way, there’s no such word as “empathetic”, which is a bastardisation/erroneous amalgam of empathy & pathetic, two words with completely different meanings!]
- respecting, i.e., granting the child the right and power to impress his/her interpretation of events on the world [e.g. the parent] and have his/her needs and feelings validated
- valuing the child as precious / estimating the child’s value to be high, so that his/her needs and communications are judged high priority
- being consistently trustworthy in care for the child
- giving the child the constant message that s/he is worth respect, trust, adoration, affection and healthy discipline; that s/he is adore-able
- I’d like to add too the list Carl Rogers’ [1940s] idea of unconditional positive regard.

There are many excellent books that teach us how to have really great, functional, and healthy relationships. Some of my favourites are:
- Dr Phillip McGraw: Family First – a blueprint for healthy close relationships in context of family
- Dr Phillip McGraw: Relationship Rescue – for those who’ve already inflicted much injury
- Tony Humphreys: Myself, My Partner – an excellent book, sadly out of print but very worth buying “used”. It works from the basis of relationship with Self to that with Other
- David Richo: How to be an Adult in Relationships – The Five Keys to Mindful Loving – This great book, published in 2002, suggests a holistic, mindful approach, which really helps to improve various kinds of relationships swiftly and with great success
- Thomas Harris: I’m OK, you’re OK – based on Transactional Analysis as proposed in Eric Berne’s The Games People Play, this book is an easy to read, understand and apply in any relationships.

David Richo’s book has an easy 5 concept recipe for success that I have found useful in all relationship counselling or therapy, between adults in various roles, including marriage or intimate relationships, or friendship, or work relationships, as well as between children, and between child & adult,and groups in interaction. [It even seems to work in relationships with dogs – manipulators, cats – controllers, and pot plants – demanders!]

Richo pre-supposes that healthy relationships is our right and obligation – or even “calling”, and gives us the tools that are guaranteed to help us have wonderfully healthy relationships with Ourselves and Others. Here are his “Five A’s”:
- Attention: I am paying close, respectful attention to Me /You
[not ignoring, being unavailable, interrupting, etc]
- Acceptance: I accept me as I am / you as you are, in this moment
[not trying to make someone over to our specifications]
- Allowing: I allow me to be myself / you to be yourself, to be free to grow to the best Self possible
[not being controlling, demanding or manipulative]
- Appreciation: I appreciate myself / you for what I / you have been, and are
[not criticising]
- Affection: I have real affection for myself / you, no matter what
[not acting selfishly or abusively]

No matter what the “diagnosis” of the relational problem/s, behaving from such a mutual mindful and respectful approach, will result in healing. Note that it needs to be mutual to last, but it can start from one side only, eliciting similarly better behaviours from the other side over time: “You teach people how top treat you” – as Dr Phil often says. Also remember that you need to start behaving towards yourself in this mindful manner: not only will others tend to respond to you similarly to the measure they observe you respect yourself, but in doing so you will become your own ally – the “inner child” will no longer have to behave so defensively when there is stress, empathic failure, or disagreement.

But a quick diagnostic tool is useful. Observe how successfully the relationship is working on three tiers represented in this pyramid: 

 The base of the relationship pyramid is Communication. If this is not mutually healthy, clear, respectful and appropriately responsive, the relationship cannot be great [even if the sex is and both parties are equally wealthy!]. You can’t fix Intimacy if Communication is dysfunctional. The next tier is power. Is the financial, social, decision-making, [etc] power shared equally or fairly, according to the needs of both? If not, some aggressiveness / passive-aggression or withdrawal / sabotage is highly likely to subvert both Communication and Intimacy. Finally, if both lower tiers are good, but Intimacy [emotional, physical, spiritual, sexual etc] is not satisfactory, this may cause reflexive problems in Communication and how Power is used. I suggest you try applying the ”Five A’s” and other quality behaviours at all three levels, from the bottom up.

Finally, although self-help questionnaires, books and workbooks can be wonderfully effective, most people will probably need a trustworthy coach-mentor-referee-witness to accompany them on the healing journey, in order to maintain openness and balance different points of view, as well as reintroduce realty when necessary.

I would go to a specialist, not just any doctor at random, if something in my body was seriously impaired. Similarly, I suggest that couples and other people with relational problems, consult a therapist or counsellor [or lay counsellor etc] who is properly trained and knowledgeable, but also thoroughly experienced in the field of relationship therapy. Ask about experience and competency: it is your right, and your responsibility to yourselves and your relational well-being.