Insomnia driving you crazy? Tips on getting better night’s sleep and the connection to mental health.

Type the words “sleep & mental health” into Google and you’ll get article after article from reputable sources relating how important sleep is to our mental well-being. From medical journals to blogs by psychologists, the interconnection between body and mind play out very closely when it comes to sleep and poor mental health.

While the studies of neurochemistry and neuroscience are still in infancy, researchers are discovering some very real connections between sleep and mental stability, or lack thereof. “There are some studies in both children and adults are suggesting that a lack of proper sleep may raise risk for, an even directly contribute to some psychiatric disorders And that treating the sleep disorder may actually help alleviate symptoms of the mental health problems caused by that sleep disturbance”. (Harvard Health 2009)

Depression, anxiety, ADHD, bipolar, Schizophrenia, PTSD, and psychosis, just to name a few, are disorders that have been studied in relation to sleep. Up to 80% of the people who have these disorders also have sleep problems and while it’s been long thought there was some kind of correlation, now scientists are starting to see an actual causal relationship. That means lack of sleep is actually contributing to the disorder itself. (Scott 2017) Just one statistic reports, people with insomnia are twice as likely to develop depression as those who sleep normally. (Khawja MD 2017) This is it to say sleep alone will cure all these diseases, but the more we can make a positive choice, the more we get a handle on each aspect of health, the more we can improve both our physical and mental health.

So what constitutes a good night's sleep? Is there a set number of hours you should sleep? What time is best? How do you get a good quality of sleep? The answers to all these questions are important so let’s dive into each one. 

A good night's sleep is one where you fall asleep within 30 minutes of going to bed, don't wake more than a couple times during the night, more than 20 minutes awake during those periods of time,  you spend 85% or more of time asleep while in bed, you don't need an alarm to wake you up, and you feel rested in the morning. 

Most sleep experts agree 7 to 8 hours is the optimal amount of time for a good night's sleep.  It is true some people seem fine, even appear to thrive on, under 7 hours on the pillow.  I've know a gentleman who slept less than 4 hours per night most of his life and he had so much energy he thought it was ok. Turn out he was bi-polar and sadly he ended up drying of suicide in his 60's.  Let this be a warning, you can't judge your sleep only by how much or little energy you have.  This can be a dangerous road. People think they are the exception to the rule until poor health sets in and it's too late.  Too much sleep can be indicative of a health issue was well.  Generally over 9 hours on a regular bases is cause for concern. Talk to your doctor if either of these apply to you.  

I know some of you night owls will disagree with this next one, but studies confirm it's best to get to bed between 8pm and midnight depending on time of the year, where you live, and other factors.  Most people have a spike in melatonin around 9pm, which is the hormone to help you sleep deep and to repair your body.

So how do you get the best quality of sleep? Develop a healthy bedtime route. Routines help our bodies maintain a systematic circadian rhythm enabling good sleep cycles.  Go to bed at the same time each night, get up the same time each morning, limit caffeine throughout the day, don't eat a large meal at least 4 hours before bed, have a relaxing routine 1 hour before bedtime, limit screen time 1 to 2 hours before bed (blue light affects sleep), keep the room dark as possible, leave electronics out of the bedroom, and don't do anything but sleep in bed (well, there is one other thing you can do but no reading in bed, texting, etc.).  The mind and body are habitual.  If you only sleep in bed it becomes a trigger to sleep just by laying there.

If you'd like to know how you are sleeping visit: www.higherpath.ca/sleep for a free assessment and hand out on sleep.

References:
“Understanding Sleep.” Mental Health Canada, www.mentalhealthcanada.com/article_detail.asp?lang=e&id=28.

Allen, Lauren. “How Sleep Affects Mental Health | Effects of Poor Sleep on Anxiety, Depression, & ADHD.” Neurocore, Neurocore, 12 July 2018, www.neurocorecenters.com/blog/how-sleep-affects-mental-health.
Breus, Michael. “Sleep and Mental Health Disorders.” Psych Central, Psych Central.com, 8 Oct. 2018, psychcentral.com/lib/sleep-and-mental-health-disorders/.
Scott, Alexandar J, et al. “Does Improving Sleep Lead to Better Mental Health? A Protocol for a Meta-Analytic Review of Randomised Controlled Trials.” NCBI, 18 Sept. 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5623526/.
Harvard Health Publishing. “Sleep and Mental Health.” Harvard Health Blog, Harvard Health Publishing, July 2009, www.health.harvard.edu/newsletter_article/sleep-and-mental-health.
Updated: June 19, 2018
Curtin, Cathryn. SHFAustralia. “Sleep and Mental Health.” The Sleep Health Foundation, www.sleephealthfoundation.org.au/news/sleep-blog/sleep-and-mental-health.html.
Khawaja, Imran, S, M.D. “Sleep Disorders and Mental Illness Go Hand in Hand.” UTSouthwestern Medical Center, utswmed.org/medblog/sleep-disorders-mental-illness/.
“Sleep Disorders, Depression, Schizophrenia -- How They're Related.” WebMD, WebMD, www.webmd.com/sleep-disorders/guide/psychiatric-disorders.
“Sleep Matters: The Impact Of Sleep On Health And Wellbeing.” Mental Health Foundation, 17 Jan. 2016, www.mentalhealth.org.uk/publications/sleep-report.
“Find Out Your Best Hours for Sleep Based on Your Biology and Your Life.” Sleep.Org, Sleep.Org, www.sleep.org/articles/best-hours-sleep/.

Anticipatory Grief: Experiencing Pain Before The Loss

(Taken from my Psychology of Grief research project)

Working through an impeding loss, or imminent death, gave rise to the term anticipatory grief by Lindemann in the 1950’s (Worden, 2009). Since then others have researched this topic with mixed results.  In fact, anticipatory grief is still controversial in both what it looks like and if it exists at all (Nielsen, Neergaard, Jensen, Bro, & Guldin, 2016) (“Grief, Bereavement, and Coping with Loss.” n.d.).  There are those who feel it is not possible to grieve until there is a loss (Reynolds, Botha, 2006). However since cognitive therapists believe emotions are often triggered by thoughts, how we think is ultimately our reality. In any case, there is stress associated with anticipating a death whatever the label it is given. With that preamble, the definition of anticipatory grief in this paper is: When an individual is anticipating an impeding loss, or death, and develops symptoms relating to that expected event.

Not everyone who knows someone who is going to die, will develop symptoms or go through anticipatory grief (“Grief, Bereavement, and Coping with Loss.” n.d.).  Anticipatory grief commonly affects those dealing with loved one who have terminal illnesses such as cancer and even long term illnesses such as Alzheimer's (Scott, 2009). Some believe it can also affect the person who is actually dying (Shore, Gelber, Wientzen, Koch, & Sower, n.d.). Symptoms range from physical one such as headaches, nausea, fatigue, sleep and appetite disturbances, to emotional ones like anxious, sad, helpless, disorganized, forgetful, angry or feeling discontented from others (Shore, Gelber, Wientzen, Koch, & Sower, n.d.). 

Due to the controversy surrounding anticipatory grief and the limited research on it, there are three schools of thought:

1.     It doesn’t exist, it’s a form of stress. (Nielsen, Neergaard, Jensen, Bro, & Guldin, 2016)

2.     It is pre-grieving or grieving started early (Worden, 2009)

3.     It is a separate event and has its own tasks or phases (“Grief, Bereavement, and Coping with Loss.” n.d.).

The University of Rochester (Anticipatory Grief, n.d.) lists the phases of anticipatory grief as:

1.     The person accepts that death is inevitable and there is no expectation of a cure. Feelings of sadness, anger, and depression can accompany this phase (Hogan, 2009).  This corresponds to Task 1 and starts into Task 2 of Worden’s model.

2.     Concern for the dying person.

3.     Death is “rehearsed” and preparations made.

4.     Person imagines what life will be like without the person.

While one might think knowing someone will die will enable them to process unfinished business, research shows mixed reactions.  Some grieve even harder after their loss, while others feel more closure (Worden, 2009) (Reynolds, Botha, 2006).  Variables are many, including some grow much closer to the person dying than in their previous relationship and thus the loss has an even greater impact, while others find they have dealt well with the unfinished business and are able to go through the uncomplicated grief tasks more effectively (Worden, 2009) (Reynolds, Botha, 2006).  

An additional note about complications.  Those whose loved ones have Alzheimer’s. One person shared she felt she was experiencing a new loss each time her husband forgot something else.  Unlike a terminal illness, a person with Alzheimer’s loses who they are bit by bit (Scott, 2009) (“Feeling Grief and Loss While You're a Caregiver” n.d.). 

Assessment for anticipatory grief is similar to grief in general except there is no death event that triggers it.  Instead symptoms may arise after a diagnosis or any time after.  An increase in anxiety is a common attribute of those suffering from anticipatory grief (Worden, 2009).  Questions, such as the following, can be used to assess a client (Use a scale to rate each one.) These have been modified from the grief assessment by Holly G. Prigerson, Ph.D., Paul K. Maciejewski, Ph.D.:

            Since the diagnosis of ________ how often have you felt yourself questioning the prognosis?

            Since the diagnosis how distressing has the though been you will lose _______ ?

            Has this thought been disruptive to your daily routine? How often?

In the past month, to what extent have you felt on edge, jumpy, or easily startled?

In the past month, to what extent do you feel that life will be empty or meaningless without _____?

            Do you find yourself wondering what life will be like after _______ is gone?

Answers to these questions can help provide insight as to further testing for depression and anxiety, and of course use the standard rating scales (At each session, in addition to suicide ideation exploration. These questions also help determine how the client is processing the tasks of grief, such as Task 1, do they accept this event.  As such anticipatory grief lends itself to really working on Task 1 and 2 of grief (Worden, 2009).  Some of the treatment suggestions recommended include:

·       Normalize the clients emotions. What they are feeling is common, ok, and real (Scott, 2009) (Hogan, 2009).

·       Help client find resources as needed. Hospice care, support network, etc. (Scott, 2009).

·       Teach the client to deal with the extra stress and strain. CBT, relaxation techniques, stress management, etc. (Scott, 2009).

·       Work through any depression or anxiety symptoms. (Hogan, 2009)

·       Start working through the tasks of grief (Worden, 2009)

While experts disagree on whether or not anticipatory grief exists and if it exists what it really is, individuals do experience real emotions and stress when faced with an impeding loss of a loved one.  These specific symptoms can be dealt with using various psychotherapy tools and techniques regardless of the label attached. 

Bibliography:

Anticipatory Grief. (n.d.). Retrieved from https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P03043

Grief, Bereavement, and Coping With Loss. (n.d.). Retrieved from https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/bereavement-hp-pdq#link/_167_toc

Feeling Grief and Loss While You’re a Caregiver. (n.d.). Retrieved from https://www.webmd.com/palliative-care/caregiver-grief-and-bereavement#1

Hogan, Marty, L. M. (2009). Anticipatory Grief. Ashland: Sacred Vigil Press.

Nielsen, M. K., Neergaard, M. A., Jensen, A. B., Bro, F., & Guldin, M. B. (2016, March). Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/26796738

Reynolds, L., Botha, D. (2006), Anticipatory grief: Its nature, impact, and reasons for contradictory findings, Counselling, Psychotherapy, and Health, 2(2), 15-26, July 2006.

Scott, P. S. (2009, August 07). Anticipatory Grief: How to Cope With the “Living Death” of Alzheimer’s. Retrieved from https://www.caring.com/articles/anticipatory-grief-alzheimers

Shore, Julia Carl, FNP-BC, ACHPN, Gelber, Marianne Wientzen, GNP-BC, ACHPN, Koch, Lauren M., ANP-BC, ACHPN, Sower, Emily, ANP-C, ACHPN. (n.d.). Anticipatory Grief: An Evidence-Based Approach : Journal of Hospice & Palliative Nursing. Retrieved from https://journals.lww.com/jhpn/Abstract/2016/02000/Anticipatory_Grief__An_Evidence_Based_Approach.5.aspx

Worden, J. W. (2009). Grief counseling and grief therapy: A handbook for the mental health practitioner. Springer Publishing.

Coping With Information Overload

I had a client recently who came to me to learn more about plant based nutrition, as many do.  They had concerns about whether or not they were eating right because of various symptoms they had.  In the course of our sessions, she discovered one of her biggest issues was actually information overload.  While, she did need help with menu planning, the heart of the matter wasn't food but rather trying to wade through all the things in her life that demanded her attention.  Believe it or not, information can put some of most intense demands on you.

We are constantly bombarded with a myriad of useless facts, family updates, intense controversies, pseudoscience, and more on social media like Facebook, Twitter, Instagram, and Google.  Add to that shopping, like cereal choices at the grocery store, choices on which store to shop at, keeping track of sales, etc. and that's only TWO aspects of your life that flood you with information.  What about work, recreation, family, and other more important parts of life?

This all adds up to stress or stressors that are all around us every day, day after day.  How do we cope with this flood of facts, stories, questions, decisions?  It will vary from person to person.  You may choose to limit the time you spend online, for example I only go on Facebook a couple times a week. Or limit the sources you know to be accurate so you're not spending more time trying to figure out if what you are reading is true or false. These help me tremendously.  Others find meditation or relaxation techniques helpful.

Learn more about stress and stress management with our online course "Cooling Down Stress" which comes with an e-book and videos, regular priced $100, SALE 90% off, for only $10 OR get all our courses for $1 for one month.  Use coupon: blog90 when you check out. Click here to learn more.

Angela Poch, CN