Insomnia

Should you develop a nighttime ritual?

Dateline, Portland, Oregon—Amelia J. Wilcox, Ph.D.: When our daughter was young we had a bedtime ritual—a series of events that slowed down the day and helped her know the time for sleep was approaching. Is there value in considering similar rituals for the rest of us?

Insomnia. It plagues us—depriving us of the restful sleep we need to feel restored and protect our health. Studies estimate that somewhere between 10 and 20% of adults suffer from insomnia, and the statistics are much higher for adults over the age of 65—42% of this population complains of difficulty falling or staying asleep.

Many things can get in the way of a good night’s sleep. People with a variety of medical and psychiatric conditions are more likely to suffer from sleep problems, and sleep problems can contribute to depression and anxiety, as well as a host of primary medical disorders including metabolic disorder, hypertension and weight gain. Addressing sleep problems is worth the effort in the short-term, and the long-run.

Cognitive Behavioral Treatment for Insomnia (CBT-I) is a short-term intervention that has been found to be highly effective in treating insomnia across all ages, and it may be necessary for many. But some may find that a careful evaluation of evening habits can give them clues for change, without professional intervention.

Stimulus control is part of insomnia management, and a bedtime ritual can be seen as a form of stimulus control. If you are having difficulty winding down at the end of the day and find yourself awake in bed after turning out the lights, you might consider developing a bedtime ritual of your own, the grown up version of the rituals we all used for our children when they were young.

Some things to consider:

·         Wind down smart phone/laptop/tablet use an hour or two before sleep, as these devices emit blue-range light that tricks our pineal gland into shutting down melatonin production

·         If you are a worrier, take some time an hour before bed to do a data dump on paper. This might include

o   A list of tomorrow’s tasks, so you can put them out of your mind overnight

o   A reminder that worrying about things tonight won’t change them, but sleep may help you tackle them with fresh energy in the morning

·         Create a sequence of events that tell your body it is time to wind down. This might include

o   A warm bath

o   A gentle stretch (save heavy exercise for another time of day)

o   Progressive relaxation of muscle groups

o   A good book (but not a page turner…you want to go to sleep!) on paper

o   A cool, dark and quiet room

·         Consider maintaining the same bedtime each night and waking time in the morning—even on the weekends. Doing so may keep you from Monday morning jetlag.

·         And remember, your bed is really only a place for sleep and intimacy. Don’t study, work, answer email,  pay bills, watch television or argue with your partner there, it will only associate your bed with not being relaxed

A good night’s sleep is worth some effort. Tinkering with the run-up to sleep may help you find your way back to sleeping well.

One effect of meditation on the brain

Dateline, Portland, Oregon--Amelia J. Wilcox, Ph.D.: Mindfulness-meditation is getting serious attention from scientists and consumers alike. Businesses are including it in their benefit packages, elementary schools are recognizing its power to improve classroom atmosphere, and psychologists are incorporating it into many treatments for conditions such as stress, anxiety and depression, pain management and insomnia. How, exactly, does it work on the brain?

Master meditators:
A number of years ago, psychologist and neuroscientist Richard Davidson began to look at meditation. In an effort to gain a clear picture of its effect on the brain, body and psyche, he went straight to the master-meditation source, Tibetan Buddhist monks. Monks in this tradition work for decades to become fully skilled in meditation practice, and they demonstrate the many positive effects of leading a life of contemplation. Monks are capable of a quality of focus, clarity, emotional control and mastery over bodily experience most of us would probably never expect to have in our own busy lives.

Can average people gain meditation’s benefit?
Davidson wondered whether some of the benefits of mindfulness-meditation practices could be taught to ordinary people with busy and stressful lives, and if so, whether the people who mastered basic skills would have a different experience of their world. To explore his idea that meditation might change people’s lives for the better, he brought a simple meditation training course to busy US executives. Eight weeks later he compared them to a matched sample of executives who had gone about life as usual.

Neural findings and experiential changes:
Davidson’s findings were powerful. EEG and fMRI data demonstrated that those who were taught simple meditation techniques shifted brain activity from parts of the brain associated with hypervigilance and stress toward brain regions associated with more positive mood states. Meditators in Davidson’s study also demonstrated improved immune response, when compared to those who were not taught simple meditation techniques.

What happens in the brain when we meditate:
Decades ago, neuropsychologist Donald Hebb coined the phrase neurons that fire together wire together. Some years later neuroscientists Per Andersen and Terje Lomo did basic brain research that led to the discovery of long-term potentiation, the scientific observation of Hebb’s neuropsychological theory. What does this have to do with meditation? Neurons that learn to fire together are developing habitual patters of action that have behavioral, emotional and learning correlates. As this applies to meditation and the frontal lobes, specifically, the meditating brain increases left prefrontal activation. With repeated practice, this activation becomes easier to produce, because healthy and functional neural pathways are created in the brain, and are strengthened and reinforced through meditation exposure. This is but one example of what is likely to be happening when you sit down to meditate.

Anecdotal reports:
Theory or practice, most people I know who make meditation part of their lives have a great deal to say about its positive impact on their mood and stress levels. And the research seems to back them up—indicating regular meditation may have powerful effects on a host of symptoms that are accepted as part of being alive in a stressful age.

People flock to yoga studios and meditation retreats in order to capture some of the effects in their own lives. But research indicates that even a few minutes a day spent in meditation, even if they happen while sitting at your desk, waiting in the carpool line or just before taking a big test in school, can lead to improvements in attention, concentration and clarity, and an improved sense of well-being.

Pond with lotus blossom.jpg

Getting started:
How do you get started? There are countless meditation apps available for your smart phone. Find one that works for you and see how it goes—keep a journal to track your progress. See what happens when your neurons fire together and wire together.

The sleeping brain remembers: Memory consolidation during sleep

Dateline Portland, Oregon—Amelia J. Wilcox, Ph.D.: We all know sleep is important, and here’s another reason why: When you sleep, your brain takes fragile new memory traces from the day and consolidates them into memory.

Why we sleep:
Some say we evolved to sleep in the dark of night so that we wouldn’t accidentally injure ourselves or become a night predator’s meal. While that may be part of the story, our brains have learned to take advantage of the quiet time. Housekeeping takes place—glial cells clearing the neurotransmitter detritus of the day. We dream—a fascinating topic for another blog post. And we work to consolidate memory from the day.

Sleep and memory consolidation—the secret weapon of studying:

Once our understanding of memory formation was mostly theoretical. We couldn’t see it happen, but we knew that it did, and so we explained it in ways we could understand. Our human memory was described as something of a filing system. One place for the recollection of a birthday party, another for the names of US presidents, and so on.

But the arrival of increasingly sophisticated brain imaging techniques has helped us make exciting discoveries about memory consolidation, the brain and sleep. Our theoretical understanding has evolved as a result. 

Now when I teach my students about the consolidation of new memories, I can tell them with certainty that the hippoCampus is where new memories go to camp for the day. (Corny, I know.) These memory traces are fragile. There is no certainty they will be consolidated. These fragile memory traces strengthen and reach their final destinations in the brain while we are sleeping. 

Here’s how it works: Say you work hard to learn new information during the day and then spent the night in an fMRI, a sophisticated imaging machine that charts brain activity in real time. This is what would be seen. Your hippocampus would fire, a distant region of your brain would fire in reply, hippocampus fires again, then that region again, or perhaps another one or two or more would fire. This neural conversation continues throughout the night, allowing new memories become strong and move to their home bases in your brain. And bases is not a typo—aspects of each memory live in disparate places in the brain—it is not the tidy filing system we once conceptualized it to be.

How to optimize memory consolidation:
There are many ways to optimize memory consolidation, and most of those include conscious and effortful engagement with the material you are working to learn. Dig in to the information. Don't try to learn it all at once. Study it every day. Ask yourself questions, grapple with the answers. Write, ponder, teach someone else what you know. And at the end of each day, sleep. Because we now know new and fragile memory traces stored in the hippocampus strengthen and reach their final destinations in the brain while we are sleeping. 

Yet another reason to get a good night’s sleep:
What is the take home message here? This is another reason sleep matters. If you are getting less sleep than you need, you are shortchanging yourself in the memory department. Research demonstrates this fact.

We know students pulling all-nighters to cram for tests often do less well than their peers who study over time. They almost invariably have poorer memory of the material once the test is over—a real problem when you are working to deepen your knowledge in an academic discipline, and have foundational material that is necessary to know well in order to understand what comes next. We now understand the consolidation process that comes with sleep is an essential part of the memory formation process.

Could there be more efficient study time? I often encourage my students in the days before an exam to consider spending the last bit of time before sleep every night reviewing notes (on paper--not on a screen—read my blog post about blue light and sleep disruption to understand why). Their brains will work to solidify those notes as they sleep—a twofer!

This is another reason that “catching up” on sleep over the weekend appears not to be a real thing—we don’t make up sleep debt. And the opportunity to consolidate new material appears to be an opportunity lost if that night’s sleep is too short or disrupted.

Sleep perchance to dream? Sleep certainly to remember!

Screen use at night for work, studying or entertainment can disrupt your sleep

Dateline, Portland, Oregon, Amelia J. Wilcox, Ph.D.: Are you having problems with insomnia, your sleep disrupted by difficulty falling or staying asleep? The screens you use in the hours before sleep or take to bed with you at night could be part of the problem.

night-blooming-cereus-14557_960_720.jpg

Sleep disruption’s impact on well-being:
A good night’s sleep has become the unicorn of our age—we’ve heard the myths but have yet to catch sight of the magical creature. And sleep is a kind of magic, well worth hunting down. Just a few examples of what we are doing while we sleep will illustrate what I mean. During sleep, glial cells clean our brains of the day’s neurochemical residue, young bodies grow and all bodies repair muscle and tissue damage brought about by the day’s activities. Sleep regulates ghrelin and leptin, two hormones that are important to appetite regulation and the feeling of being full. Restful sleep allows us to wake refreshed, ready to meet the challenges of a new day. It is essential to mood regulation. Sleep is vital to health and well-being.

Disrupted sleep and screen use:
There are many things that can disrupt a good night’s sleep. A major culprit—one that is both the easiest and perhaps the most difficult to control—is screen time. Most of us have grown accustomed to constant contact—texts and Instagram photos come in with no heed to the hour of the day. Squeezing in just a few more email replies has become a nightly ritual for many, justified by a more controlled inbox, reinforced by a boss who replies in real time, or (for our kids) the anxiety that comes with 'needing' to respond to messages as soon as they come in. And available entertainment—the all-hours access to binge watching episodes of favorite shows has become a nightly ritual. These things have changed the terrain of sleep preparation for countless people.

The implications of these new rituals on sleep go well beyond squeezing in the last email reply or no longer having to endure the clever cliff-hangers that script writers once used to keep us in suspense from week to week. The ritual of actually leaving friends or work behind at the end of the day, and the discipline once supplied by network scheduling is now up to us as individuals. For many, staying up at night in front of our screens is the new normal.

night blooming flower 5.jpg

Your pineal gland:
Buried deep in your brain is the pineal gland. Small and mighty, this brain structure’s singular mission in life it to create melatonin, a hormone that makes us sleepy.  The pineal gland is deactivated by light. The turning on and off of melatonin is essential to the sleep-wake cycle of your circadian rhythms. The light spectrum provided by your favorite screens—phones, tablets or laptops—bathes your eyes in the bright light of a sleep disrupted night. It does so because the light travels through your eyes to your brain, which is not evolved to recognize that light as a Netflix episode or a book on an e-reader. Reading the light as daylight, your pineal gland shuts down melatonin production, and your brain gears up to get ready for a new day.

Clinical life in the age of technology:
As a clinical psychologist, I see the results of insomnia in my practice all the time. As a college professor and a parent, I am particularly concerned about a new source of sleep disruption. Text books and other online materials are becoming ubiquitous in 21st Century education. It is certainly less expensive to download an electronic copy of a book, and more of my college students are making that understandable economic choice all the time. My daughter’s high school made the decision to go entirely online for textbooks last year.  It is great on the back to have a tablet replace a dozen heavy textbooks. But as parents, we need to understand that teens and young adults are developmentally more likely to have sleep disruption. And in an unfortunate trick of nature, it appears this age group is even more sensitive to the impact of lighting on the pineal gland than are the rest of us.

What to do:
If you are having trouble with sleep at night, try putting down your devices in favor of a book or conversation. Don’t even allow electronic devices in your room for a while, to see if it helps your sleep. 

If you are a parent, making sure your kids keep screens out of their bedrooms probably feels like a losing battle. Serve as an example—they will learn by watching you. And talk with your kids about their pineal gland and sleep. It is unfair for a group that appears already to be perpetually sleep deprived to be unintentionally making things harder on themselves.

night blooming flower a.jpg

My parents had a television in their room in the 1980’s. Why wasn’t this understood then?
Many of us remember going to sleep at night to the distant sounds of Johnny Carson or Jay Leno, and though it wasn’t nearly as common as it is today, many families did have televisions in their bedrooms. The difference between a television and a personal electronic device has to do with both the light spectrum, and the distance from your face. A television does not have the blue light spectrum, and across the room the light it does have had little or no impact on our pineal glands. A screen propped up on a pillow in your lap, more. The worst culprit is a smart phone—held close to your eyes, blue light spectrum, access to the universe—could there be a better recipe for disrupted sleep? Plus, when you finally do get to sleep, there is a high likelihood someone will ping you and it’ll start all over again.

Is there anything we can do to counteract the light source?
The best thing anyone can do is turn these devices off a couple of hours before sleep. This is increasingly difficult to do, especially for students who have come to rely on them for educational access. Plan your studies accordingly. If you have trouble with sleep, evening studying should be in printed form. Print from your tablet, study from notes, use a physical text. If you find you absolutely have to use your screen at night, turn the brightness down as far as possible—doing so will decrease its activating effects on the brain. And do everything you can to keep your phone, tablet and laptop out of your bedroom at night. 

Insomnia and sleep hygiene

Dateline, Portland, Oregon—Amelia J. Wilcox, Ph.D.: If you struggle with insomnia, chances are good people have talked with you about sleep hygiene. While sleep hygiene principles are important, many people find it necessary to pursue sleep therapy, a treatment focused on clarifying thoughts and feelings related to troubled sleep patterns and insomnia, with accompanying exercises designed to put insomnia to rest.

If you have difficulty sleeping, you’ve probably been given the following advice by many people:

·         Go to bed and wake up at the same time every day

·         Don’t nap during the day

·         No caffeine-containing beverages or chocolate after 3:00 p.m.

·         No liquids at all after 7:00 p.m.

·         Remember that alcohol is a CNS depressant, and can cause middle of the night wakefulness when it wears off if you tend to drink more than you should

·         Have a bedtime ritual that signals your body it’s time to go to bed

·         If you can’t sleep, get out of bed and do something quiet in a dimly lit room

·         Bed is for sleep and sex only—no screens or books or work or studying

·         Make sure your bedroom is cool, dark and soothing—and that your mattress is comfortable

·         Exercise regularly—but not after work

These excellent suggestions come under the general heading of sleep hygiene. They are common sense and practical interventions anyone can use to manage periods of bad sleep. It makes sense, for example, to keep yourself from being awakened by your bladder if getting to sleep is difficult for you.

The suggestions are great, but they have a somewhat limited utility for people who have got themselves into a poor sleep pattern that has gone on for a while. Often times that sleep pattern comes along with thoughts, feelings and behaviors that worsen bedtime anxiety and decrease the likelihood of sleep, no matter how closely sleep hygiene principles are followed.

If this is the case for you, it can be helpful to work with a psychologist who is skilled in cognitive behavioral interventions for sleep. That person will work with you to sort out nature of your relationship to sleep—what you are thinking about it, the triggers for those thoughts and how you respond both behaviorally and emotionally as a result. You will be given exercises to use, including exercises designed to tease out the above chains of thought and feeling, and exercises designed to help you short circuit those patterns and relax into sleep again.