Getting a good night’s sleep may be more important than you realise

and there may be things you could do differently that would enable

you to sleep better.

There are 3 reasons why sleep is important;

Emotional Regulation – Our ability to regulate or respond effectively to our emotions. Lack of sleep increases the activity in the brain, signalling threat which then increases anxiety.  We may feel more irritable and unsettled.  The risk of becoming depressed can also increase when we are not getting sufficient sleep or sleeping too much.

Ability to think – Our mind is not as sharp and struggles to pay attention to the necessary information in our environment, things we see, hear and sense, meaning our perception is altered. There can be difficulty with attention, concentrating, reasoning, remembering things and learning.  Finding it hard to focus, formulate ideas and communicate effectively.

Health – Increased appetite and choosing less healthy options leading to weight gain.  Decreased motivation to engage in or complete exercise due to tiredness. Increased anxiety, irritability, stress and thoughts of not being able to cope have an impact on the body.  Studies have also indicated an increased chance of cancer and cardio-vascular problems with ongoing, long-term sleep disturbance.

Stages and Cycle of Sleep

There are different stages of sleep that support our body and brain to perform certain functions and each stage is important.  Stage 1 is fairly brief, lasting a few minutes and is the transition phase from wakefulness to sleep.  Stage 2- Prepares the brain for next day learning, consolidating the days learning. Stages 3 and 4 are deeper sleep and provide the body opportunity for growth and repair.  The brain prioritises the stage most needed when we fall asleep if we have been struggling to have a full night’s sleep.

Did you know we follow a circadian rhythm?  Which is basically a cycle over 24 hours that our body follows, impacting our behaviour, physical ability and mental capacity at different times through the day and night.  There are times we are more primed to learn, engage in physical activity, socialise with people, eat and sleep and this cycle is determined by light, more importantly sunlight!! So, when I work with depressed people one of the first things we might discuss is getting out of the house in the morning and absorbing some sunlight to start their circadian rhythm and really wake up. Conversely putting away screens and artificial light when getting ready for bed is also important as it signals to the brain that it’s time in our cycle for sleep. Darkness causes melatonin to be released which sedates the brain, interesting hey? Sleep problems are more of a modern day, western lifestyle manifestation, compounded by constant input from social media, advertising and daily demands.  So many of us attempt to manage everything which increases the brains activity, attempting to remember it all and meet the standards we perceive others to be reaching. Its stressful and relentless and not conducive to a good night’s sleep.

The average adult needs to be awake for 2/3^rd of the 24 hour cycle and asleep for 1/3^rd  . That’s 8 hours sleep a night.  Having less than 6 hours or more than 9 hours sleep can often cause difficulties, mentioned above, and it’s important to realise that sleeping too much has the same effects as not sleeping enough.

Sleep Problems and Strategies

Sleep problems can arise for different reasons whether its physical pain or discomfort, worry and distress, bad sleep habits or changes in your environment.  What often maintains poor sleep is thinking about how difficult it is to sleep and developing unhelpful behaviours to cope.  Interestingly enough only 2 alcoholic drinks is enough to disrupt your sleep.  Alcohol creates a sedated sleep which actually means you are not moving through each stage of sleep.  This can impact your ability to regulate your emotions the following day and you may notice you feel more anxious or irritable.  Completing or engaging in tasks may feel more difficult and you may choose less healthy food to eat and even avoid that exercise session you had planned.   That night you may feel like having a drink! Cutting out alcohol during the week may highlight a strategy that helps improve your quality of sleep and mood.

Creating a space that encourages, relaxation and sleep is helpful to signal to our mind it’s time to slow down and rest. Think about your bedroom, your bed, mattress, colour of your walls. How comfortable is it, how messy is it, how light it is, how quiet it is, how warm is it?  Did you know a cooler room is easier to sleep in than a hot one?  Imagining a space you feel calm and relaxed in can be helpful to develop your bedrooms design, how close is your bedroom to your calm space?  Another thing to be mindful of is what you do in your bedroom.  It should only be used for sleep and sex, strictly NO SCREENS.  That way the brain associates this space with rest and sleep.

On average it takes 15-25 minutes to get to sleep, I like the way Alison Harvey describes getting to sleep like a dimmer rather than an off switch, allow yourself to drift off.  If you are not asleep in 20 minutes get out of bed and come back once you’re sleepy. Do not sleep anywhere but your bed, no sofas or kid’s room! No napping during the day either, building up your appetite for sleep is important which requires staying awake until bed time.

Associate ‘head on pillow’ with soothing, reflect on 3 things you are grateful for that day.  I often hear the time someone worries, is when they go to bed.  Write your worries down and pick them up tomorrow, allow your brain to engage in the sleep process.  Practice some relaxation techniques or listen to some guided meditation before bed or whilst in bed. Help to sedate the brain with relaxed breathing, longer exhales.  (see my Learning How To Breathe blog for more help with this http://www.westlondonpsychotherapy.co.uk/uncategorized/learning-how-to-breathe/). Associating your bed with sleep is important and if you’re struggling to sleep these techniques can really work!

It may sound strange to have a blog about learning how to breathe.  It’s something we do without even thinking most of the time.  However, because we rarely pay attention to our breathing we don’t notice the bad habits we may have inherited from our parents/care givers and are even less aware of the impact our breathing has on our body, mind and mood.   The problem arises when we engage in breathing habits that alter oxygen and energy levels such as shallow breathing, over breathing and holding your breath.  The consequences of which include anxiety, stress, fatigue, insomnia, tension and poor exercise tolerance.

Bad Breathing Habits

• Shallow Breathing–  We breathe minimal air into the top of our lungs, usually at a faster rate, not drawing oxygen into the base of the lung.
• Over Breathing– We take in more air than we need, which draws in too much oxygen and depletes the CO2 levels. Signs of this may be sighing, yawning and snoring.
• Holding Your Breath–  Usually occurring when we are under stress which can cause the breathing muscles to tense up. The eyes must have oxygen, holding your breath can cause eyesight issues.

This increased and shallow breathing immediately communicates to the brain that we are unsafe and triggers a stress response. You may notice its harder to focus and concentrate, form ideas and communicate.  Physically you may feel hot, tense, agitated, faster heart rate and notice sensations in your stomach.  You may find it harder to relax and get to or stay asleep.  This in turn increases our anxiety and fuels further poor breathing patterns, developing a cycle. All of this from irregular breathing?!

A full breath relaxes the body and brain, slowing racing thoughts and indicating to the brain that we are relaxed, coping and in control.  So learning to breathe in the correct way, the way you were designed to breathe, can have a positive impact on your body, mind and mood.  It is something you can practice right away and can help you to feel more able to cope with difficulties.

There are two ways of breathing. One way is to breathe from the chest; the other is to breathe from the diaphragm. With chest breathing, the chest and ribs expand with each inhalation, while the abdomen remains relatively motionless. All three bad breathing habits fall in to the category of chest breathing.  With diaphragmatic breathing, the stomach expands as the diaphragm moves downward to allow air to fill the lungs. Try to keep your mouth closed and breathe through your nose.  Research has shown that people who are experiencing anxiety tend to breathe more with their chest than their diaphragm.

For the most part concentrate on breathing out the stale air. You look after the emptying and the lungs will look after the re-filling.  Now you know this, try to breathe only with your diaphragm. Allow yourself to have a complete breath and make use of all of your lung.  Prolonging and deepening the out-breath calms and sedates. A technique I often use with clients is Breathe in for 4, Hold for 2, Breathe out for 6.  This can help to give some idea of the pattern and tempo we’re working toward.

An interesting fact is that the advice often given to anxious or agitated people is to `breathe deeply’.  However, this can be misleading since most people interpret this by taking deep in-breaths, which is likely to create an even more aroused state. When feeling anxious you need to prolong and slow your exhale.  Maybe imagine slowing things down and grounding yourself in the moment as you exhale.  Taking charge of your life again with each slow breath.

For some people when they first begin using breathing exercises they can experience dizziness. This usually indicates that your body is not used to the richer supply of oxygen and further evidence this is a good route for you. It is nothing to worry about and with practice the oxygen-carbon dioxide ratio will even out and you will begin to notice the benefits.

Because breathing is something we do without thinking, it is very easy to slip back into the old patterns – even now we know the consequences.  Human’s don’t like change!  In order to `wire-in’ the new habits try to resolve to be mindful of your breathing each day with particular attention when you notice yourself feeling more anxious or stressed.  With practice this will become your more automatic way of breathing, returning to the way in which you are designed to breathe, and you’ll be sure to notice the difference in your mood, mind and body.

When working with individuals presenting with anxiety I explore breathing techniques within the first session.  It can provide the client with some understanding of their symptoms and delivers a practical and easy technique they can apply the same day.  Feeling better able to respond to anxiety and feel more in control is invariably the goal anyone struggling with anxiety sets. Acknowledging your current breathing habit and its’ effects can be helpful and may enable you to better understand some of your difficulties.  Developing a calmer and fuller breathing habit can be the start of feeling more relaxed and in control, so give it a go!

I attended another piece of training this week about the Resonance Factor, a refreshingly new approach to the treatment of substance misuse.  It is an intervention that has been developed and implemented by the team at Janus Solutions who provide an abstinent based day programme for people struggling with their drug/alcohol use.  As they open their second treatment centre I have been invited to provide counselling for their service users, which I feel honored to do. So todays training was about understanding their method. I really enjoyed the training and met some passionate workers who were there to learn about the Resonance Factor to then deliever within their respective services.

So what is the Resonance Factor?

Well it comes from cognitive resonance which is a psychological model that works to bring new awareness to a person to shift their perceptions. It is an empowering approach as it hands responsiblity back to the client to reconsider their ideas about things and encourages them to look for evidence to support their position on aspects of their lives. Paying attention to problematic areas of a persons life in this way can provide an opportunity to gain insight in to the problem in a new way.  It bolsters their ability to to renegotiate things and with the new understanding make different choices. In the treamtment of addiciton it highlights the clients drug using behaviour and works extensively on their relationship with substances, bringing the justifications and reasons they use to their attention.  Do you know the difference between a justification and a reason?? Well I learnt that yesterday 🙂 Work is also done around cravings and the transition into recovery. A large part of treatment is spent on choices and responsibility.

Overall a great days training. Moving forward I feel confident I understand the approach and look forward to working at http://www.janussolutions.co.uk with the clients.

I attended a great piece of training today which I wanted to share.  As an ever increasing issue and one that has only just been recognised by NICE as seperate to OCD; Hoarding Disorder is different to Hoarding. With the disorder comes great anxiety at the thought of having to let any of the hoard go. It was enlightening to learn about the vast array of things a person can hoard; from animals, clothes and dolls to electrical goods, books and rubbish, to name a few.

I learnt about the three main thrusts of hoarding;

ACQUISITION; Buying or collecting too many things

COMPULSIVE SAVING; Not being able to throw things away due to belief they have an importance or hold a memory

DISORGANISATION; Mixture of important and unimportant things with no discernable structure

As we moved through the day we explored why a person may hoard and as vast as the things a person chose to hoard were the reasons they may do it.  It appears as another behaviour a person may use to cope with something difficult.

Many of the approaches taken to address a person’s hoarding actually prove more damaging than supportive.  The compulsive clear out, often enforced by the local authority or environmental health, may cause great distress to the person hoarding as their posessions are rifled through and disguarded.  What is often observed is that the property is soon refilled with things. This is because the underlying issue that is fuelling the hoarding has not been acknowledged or treated.

We discussed the approaches that do have effective outcomes and one of those treatments was CBT.  We further explored the approach CBT takes with this disorder and I felt confident this was something I could deliver.

So if you or anyone you know is struggling with Hoarding Disorder and lives in London, get in touch. ‘Lets take a journey to a new understanding’

With thanks to Mosaic Training and Consultancy for the training.

www.mosaic-training.co.uk