Sleep Disorders Answers

Can counselling help my sleep issue?

Dear CM,   Thank you for your message and sharing with me how you've been interacting with yourself, especially on how you've been handling unpleasant feelings and emotions, affecting your sleep.   As you said this has also affected your life significantly. Perhaps by addressing how to handle unpleasant emotions in a healthier manner, we can dive into addressing the issues in your life as well?   Often the experience we've had about anxiety (or any strong emotion such as stress / depression) was so terrible (even physically) that our body sort of become traumatized to it. We naturally become nervous about these unpleasant feelings because we don't like these sensations and experiences. As a result we would do everything we can to avoid / fight these anxious feelings, often using numbing techniques such as using substances or distracting ourselves. Yet only to find that the anxiety gets stronger over time because we have never been able to make peace with it.   Therefore rather than trying to "change" / "fight" / "get rid of" these unpleasant sensations, perhaps the best thing that we can do is to make room for these feelings and even sensations, while staying on track to do what brings us meaning and fulfillment. Floating without judging / blaming ourselves through the anxiety experience, while focusing on making room for anxiety can be helpful.   Here is a short video put up by the author of the book "The Happiness Trap" which does a good job explaining this concept:   Please take some time to watch this and share your thoughts later :) I also highly recommend picking that book as well to supplement this therapy process.   https://www.youtube.com/watch?v=rCp1l16GCXI    We as human beings do not like sufferings, therefore often times we would be doing our best to fight it. However just like the analogy of swimming vs floating that we have talked about before, the more we fight it, the faster we sink. While if we can learn to float with these waves, we will realize that we won't sink.   Radical acceptance / Expansion is about accepting of life on life's terms and not resisting what you cannot or choose not to change. Radical Acceptance is about saying yes to life and all that life brings (including all sorts of emotions such as joy, sadness, peace and pain), just as it is without forcing our ways into our lives.   Why do we want to accept life as it is? Because with anything that we do in life that brings us meaning and fulfillment, it always accompany a wide range of emotions, we can't possibly just choose the ones that we like and fight / avoid those that we don't like. Learning to experience all emotions as they are, is a sign that we are living our lives to the fullest.   To do so we must learn to accept (and make room for) any unpleasant sensations, feelings or thoughts that we experience.   We don't want to fight it because the more we fight, the stronger they will come back.   We don't want to avoid it either because the more we avoid, the more we'll be afraid of it.   So the key here is to make room for these sensations, feelings and thoughts, while continue to do what brings us meaning and fulfillment in life.    Learning to "co-exist" with these feelings will naturally reduce the intensity of them.   Floating, is a form of learning to accept these feelings and make room for it.   Let me give you some practical guidelines on what I mean by accepting these feelings and make room for it.   You can look up "expansion technique" under Acceptance and Commitment Therapy (ACT) for more information as well.   How to accept our emotions (and make room for them):   1. OBSERVE. Bring awareness to the feelings in your body.   2. BREATHE. Take a few deep breaths. Breathe into and around them.   3. EXPAND. Make room for these feelings. Create some space for them.   4. ALLOW. Allow them to be there. Make peace with them   Some people find it helpful to silently say to themselves, 'I don't like this feeling, but I have room for it,' or 'It's unpleasant, but I can accept it.'   • When you're feeling an unpleasant emotion, the first step is to take a few slow, deep breaths, and quickly scan your body from head to toe.   • You will probably notice several uncomfortable sensations. Look for the strongest sensation - the one that bothers you the most. For example, it may be a lump in your throat, or a knot in your stomach, or an ache in your chest.   • Focus your attention on that sensation. Observe it curiously, as if you are a friendly scientist, discovering some interesting new phenomenon.   • Observe the sensation carefully. Notice where it starts and where it ends. Learn as much about it as you can. If you had to draw a line around the sensation, what would the outline look like? Is it on the surface of the body, or inside you, or both? How far inside you does it go? Where is the sensation most intense? Where is it weakest? How is it different in the center than around the edges? Is there any pulsation, or vibration within it? Is it light or heavy? Moving or still? What is its temperature?   • Take a few more deep breaths, and let go of the struggle with that sensation. Breathe into it. Imagine your breath flowing in and around it.   • Make room for it. Loosen up around it. Allow it to be there. You don't have to like it or want it. Simply let it be.   • The idea is to observe the sensation - not to think about it. So when your mind starts commenting on what's happening, just say 'Thanks, mind!' and come back to observing.   • You may find this difficult. You may feel a strong urge to fight with it or push it away. If so, just acknowledge this urge, without giving in to it. (Acknowledging is rather like nodding your head in recognition, as if to say 'There you are. I see you.') Once you've acknowledged that urge, bring your attention back to the sensation itself.   • Don't try to get rid of the sensation or alter it. If it changes by itself, that's okay. If it doesn't change, that's okay too. Changing or getting rid of it is not the goal.   • You may need to focus on this sensation for anything from a few seconds to a few minutes, until you completely give up the struggle with it. Be patient. Take as long as you need. You're learning a valuable skill.   • Once you've done this, scan your body again, and see if there's another strong sensation that's bothering you. If so, repeat the procedure with that one.   • You can do this with as many different sensations as you want to. Keep going until you have a sense of no longer struggling with your feelings.   • As you do this exercise one of two things will happen: either your feelings will change - or they won't. It doesn't matter either way. This exercise is not about changing your feelings. It's about accepting them.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 10/18/2021

How can I get a better nights sleep?

Hi! I've worked successfully with many clients with sleep issues. When your mind won't let you sleep, it is having issues with too many brain waves stuck in beta frequency. The science of brainwave entrainment overcomes the beta wave pattern and gently downshifts your brainwaves towards calm (alpha waves) and eventually sleep waves (delta waves). Much of this technology available on music and video platforms is watered down and/or not high quality. I have my own specialty wave generator that I can customize to your needs at no extra cost as your therapist. It has been robustly successful for me and my clientele and has a mountain of research mostly supporting it's effectiveness. The presence of anxiety, worry, panic and life events tend to keep the brain in beta waves and in fight or flight or freeze and since this is mostly regulated by the autonomic nervous system which places you automatically into sympathetic response which makes any length of healthy and sustained sleep impossible. The goal is to activate the parasympathetic mechanism by reducing your stressors, having a consistent exercise program, maintaining a proper diet, receiving a regular massage, and/or adopting a lasting practice like yoga and/or meditation, all of which can help sleeping problems and disorders. Without adequate sleep, you descend into sleep deprivation, a state in which your ability to see your issues and deal with life events is severely impaired as is sound judgment and decision-making. Your cells perform a variety of functions while your mind sleeps that are essential to good health and overall body rejuvenation that if not functioning properly, usually begins a cascade and onset of more stressors in your outer world due to the compromised nature of your coping skills and reactivity, judgment, decision-making and many other abilities.  For many people, it is hard to overcome their stressors and the like through more conventional methods, which is why I advocate the use of high quality and effective brainwave entrainment utilizing Binaural beats and Isochronic beats set to nature sounds. My custom program can also use white or pink noise if you prefer.
(LPCS)
Answered on 10/18/2021

What can be done if anxiety doesn't let you sleep?

In your case the best way to overcome and deal with this bout of sleep deprivation or disorder you are struggling with is by treating the problem at the exact moments in which it is happening; those hours you lie in bed wondering. You can do this by using one or both parts of this activity I will outline for you to follow on the way to achieving better sleeping habits and longer sleep time. The first part of this activity or treatment approach is physical; please remember, do not attempt any physical activity or exercise unless you are cleared by your medical doctor or a licensed physician to do so and also to stretch and warm-up properly prior to starting any physical routine, and the second part is one or a series of mental exercise. The key to achieving success while using this method is by staying focused on the routine and not allowing your mind to wonder aimlessly about while attempting to fall asleep. You must be willing to invest the time and effort needed and not just try it one time then say it does not or won't work for you as your dedication and commitment to the process are also very intricate in making this work now and overtime. So let us begin your journey to falling asleep faster, sleeping longer and waking up more refresh and alert. When you are ready to go to bed begin by doing a physical activity you are comfortable with until becoming exhausted without overexerting yourself. Aim for at least three repetitions then lie down, inhale and exhale slowly in and out for about three seconds each breath until you begin to breathe naturally. Follow this by doing one or a series of the mental exercise; any of these can be counting from one to a hundred, reciting a poem or quote, narrating a story; fictional or otherwise, or reliving a specific pleasurable moment. Don't worry about time as you will eventually fall asleep just continue until you get the urge to begin again from step one. Please don't forget that I recommend you skip the physical activity part if you're not fit enough, recovering from injuries or medically cleared to do so. Practice this repeatedly until you begin to fall asleep without effort.
(DSW, LCSW, ACSW)
Answered on 10/18/2021

How do I deal with anxiety and insomnia ?

Dear Introvert,  I am so sorry to hear that you're struggling with the fear of dying. It is not uncommon to meet people who are afraid to go to sleep to never wake up. Were you ever diagnosed with sleep apnea? I have met several clients who have had a similar fear. They would have suffocation dreams. When they did a sleep study, they found that they had severe sleep apnea. I would recommend that you obtain a referral to have a sleep study done. It might provide you a lot of insight. I would refer you to a medical doctor to have a full check up and obtain a referral to a ear nose and  throat specialist to rule it out. I would also discuss having a sleep study done in a sleep clinic rather than at home because they tend to be more accurate. When you sleep, if your nasal pathways are obstructed and you experience loss of oxygenation, it will impact your health tremendously. Poor sleep is often associated to high level of cortisol and weight gain. If you experience apneas, your will become anxious as it will prevent you from experiencing sound sleep. You might end up feeling irritable and depressed too as a consequence.  Do you ever nod off during the day? Do you feel tired ?  Eating right, exercising will help. You mentioned that you had a severe illness a few years back. Are you still being followed for it? Was this illness a chronic illness?  It's not unusual for people who have had severe illnesses, to experience trauma associated with dying. Especially at a time where you felt that you might die, and had to reflect upon your mortality. You most likely felt powerless. Finally, I also recommend talk therapy to support you in processing your anxiety and help you learn coping and self-soothing skills to assist you in self-regulating. I would advise you to have a sleep routine to increase your sleep regularity and establish a sense of safety. Mindfulness is also very helpful in being in the moment and lessening anxious feelings.  I wish you a good and sound night of restful sleep.     
Answered on 10/18/2021

How can I better motivated myself and get a better sleeping pattern?

Dear Dec,   Thank you for your message and sharing with me how you've been interacting with yourself, especially on how you've been handling unpleasant feelings and emotions that affects your sleep. As you said this has also affected your life significantly. Perhaps by addressing how to handle unpleasant emotions in a healthier manner, we can dive into addressing the issues in your life as well?   Often the experience we've had about anxiety (or any strong emotion such as stress/depression) was so terrible (even physically) that our body sort of become traumatized to it. We naturally become nervous about these unpleasant feelings because we don't like these sensations and experiences. As a result, we would do everything we can to avoid/fight these anxious feelings, often using numbing techniques such as using substances or distracting ourselves. Yet only to find that the anxiety gets stronger over time because we have never been able to make peace with it.   Therefore rather than trying to "change" / "fight" / "get rid of" these unpleasant sensations, perhaps the best thing that we can do is to make room for these feelings and even sensations, while staying on track to do what brings us meaning and fulfillment. Floating without judging / blaming ourselves through the anxiety experience, while focusing on making room for anxiety can be helpful.   Here is a short video put up by the author of the book "The Happiness Trap" which does a good job explaining this concept:   Please take some time to watch this and share your thoughts later :) I also highly recommend picking that book as well to supplement this therapy process.   https://www.youtube.com/watch?v=rCp1l16GCXI    We as human beings do not like sufferings, therefore often times we would be doing our best to fight it. However just like the analogy of swimming vs floating that we have talked about before, the more we fight it, the faster we sink. While if we can learn to float with these waves, we will realize that we won't sink.   Radical acceptance / Expansion is about accepting of life on life's terms and not resisting what you cannot or choose not to change. Radical Acceptance is about saying yes to life and all that life brings (including all sorts of emotions such as joy, sadness, peace, and pain), just as it is without forcing our ways into our lives.   Why do we want to accept life as it is? Because with anything that we do in life that brings us meaning and fulfillment, it always accompany a wide range of emotions, we can't possibly just choose the ones that we like and fight/avoid those that we don't like. Learning to experience all emotions as they are, is a sign that we are living our lives to the fullest.   To do so we must learn to accept (and make room for) any unpleasant sensations, feelings, or thoughts that we experience.   We don't want to fight it because the more we fight, the stronger they will come back.   We don't want to avoid it either because the more we avoid, the more we'll be afraid of it.   So the key here is to make room for these sensations, feelings and thoughts, while continue to do what brings us meaning and fulfillment in life.    Learning to "co-exist" with these feelings will naturally reduce the intensity of them.   Floating, is a form of learning to accept these feelings and make room for it.   Let me give you some practical guidelines on what I mean by accepting these feelings and make room for it.   You can look up "expansion technique" under Acceptance and Commitment Therapy (ACT) for more information as well.   How to accept our emotions (and make room for them):   1. OBSERVE. Bring awareness to the feelings in your body.   2. BREATHE. Take a few deep breaths. Breathe into and around them.   3. EXPAND. Make room for these feelings. Create some space for them.   4. ALLOW. Allow them to be there. Make peace with them   Some people find it helpful to silently say to themselves, 'I don't like this feeling, but I have room for it,' or 'It's unpleasant, but I can accept it.'   • When you're feeling an unpleasant emotion, the first step is to take a few slow, deep breaths, and quickly scan your body from head to toe.   • You will probably notice several uncomfortable sensations. Look for the strongest sensation - the one that bothers you the most. For example, it may be a lump in your throat, or a knot in your stomach, or an ache in your chest.   • Focus your attention on that sensation. Observe it curiously, as if you are a friendly scientist, discovering some interesting new phenomenon.   • Observe the sensation carefully. Notice where it starts and where it ends. Learn as much about it as you can. If you had to draw a line around the sensation, what would the outline look like? Is it on the surface of the body, or inside you, or both? How far inside you does it go? Where is the sensation most intense? Where is it weakest? How is it different in the center than around the edges? Is there any pulsation, or vibration within it? Is it light or heavy? Moving or still? What is its temperature?   • Take a few more deep breaths, and let go of the struggle with that sensation. Breathe into it. Imagine your breath flowing in and around it.   • Make room for it. Loosen up around it. Allow it to be there. You don't have to like it or want it. Simply let it be.   • The idea is to observe the sensation - not to think about it. So when your mind starts commenting on what's happening, just say 'Thanks, mind!' and come back to observing.   • You may find this difficult. You may feel a strong urge to fight with it or push it away. If so, just acknowledge this urge, without giving in to it. (Acknowledging is rather like nodding your head in recognition, as if to say 'There you are. I see you.') Once you've acknowledged that urge, bring your attention back to the sensation itself.   • Don't try to get rid of the sensation or alter it. If it changes by itself, that's okay. If it doesn't change, that's okay too. Changing or getting rid of it is not the goal.   • You may need to focus on this sensation for anything from a few seconds to a few minutes, until you completely give up the struggle with it. Be patient. Take as long as you need. You're learning a valuable skill.   • Once you've done this, scan your body again, and see if there's another strong sensation that's bothering you. If so, repeat the procedure with that one.   • You can do this with as many different sensations as you want to. Keep going until you have a sense of no longer struggling with your feelings.   • As you do this exercise one of two things will happen: either your feelings will change - or they won't. It doesn't matter either way. This exercise is not about changing your feelings. It's about accepting them.   Looking forward to talking with you more, Jono
(MSW, LICSW, LMHC)
Answered on 10/18/2021

heyy, do you subscribe any medications to your patients? What is your success rate?

Hi Mica, I am a licensed psychotherapist. We are not trained to be able to prescribe medications. Only doctors or nurse practitioners are licensed to do that. It might be helpful to look into the community mental health agency in your county. These agencies are in every county in the country and receive both state and federal funding to support everyone in the area, regardless of ability to pay. Often their case managers or billing offices will help you to pay on a sliding fee, or obtain low cost insurance, or Medicaid (insurance for low income folks).  At community mental health agencies the therapists, case managers, and prescribers provide a team approach, which I've found is very helpful in treating bipolar disorder. You didn't mention where you go to school. If you are in high school, please seek support from your guidance counselors around credit recovery for your grades, and counseling support. If you're in college, even online college, please look into student supports through your school's website. I'm hearing that some colleges are providing BetterHelp as part of their supports to students, especially in this pandemic year. If you're struggling with a mental health condition, 504 Plans are available to provide accommodations during challenging periods. Your mental health provider will need to write a letter to document need, so this is again a good reason to build a relationship with a local provider, whether in the community or on campus. There are some things you might be able to do yourself, and resources available online, although medication often plays a big role in managing bipolar disorder. First to consider would be a solid sleep routine. We humans require a daily routine to help our bodies wind down for a good night's sleep. Electronics at night is a big culprit. Put them all outside your bedroom at sleep time. Doing some stretching exercises before bed, or taking a hot shower, relaxes muscles and relieves tension for sleep. Be good to yourself at night, and settle in for a restful sleep. There are some apps, some free, that will help you to sleep at night. Look around for apps that can help you to monitor moods too. This can be helpful in providing the support you may need at times. Reach out to family and friends you trust who can support you as well. We all need each other to get through our daily challenges! I hope this has been helpful! I'm wishing you the best as you move forward in managing your wellness. Practicing various strategies will take time and commitment, but the positive results will definitely be worth your time.  
(LISW-CP, LICSW, LCSW)
Answered on 10/18/2021

My sleeping habits have made me frustrated

Hello:  Thank you for feeling comfortable with reaching out for support regarding your sleep.  A good night's sleep happens when a few variables come into play as it is important for both your physical and mental health.  Proper sleep can have many benefits it.  It can help to improve mood, productivity and actually overall quality of life, though it requires developing healthy habits and sticking to them.  Small changes, to begin with, can lead to lasting changes in the long run.  The first thing to explore is adopting a regular sleep schedule.  This is considered one of the most important steps in working on sleep hygiene.  We normally do our best with getting between six and nine hours per night of sleep.  Going to bed and waking up at the same time every day trains your body to sleep and will help to regulate your internal clock.  There may be times that you want to sleep later in the morning, but resisting this will help you to gradually work toward your goal of consistency.  The second area to explore is to look at limiting nap time.  If you do find yourself needing a nap for some reason try to keep it short.  A quick nap of 20-30 minutes can improve your mood and make you more alert, but any longer may interfere with your nighttime sleep.  The third area to explore is trying to get regular exercise.  Even 10 minutes can have a positive effect on your overall well-being.  Exercising regularly can also lead to high-quality, and continuous sleep.  It is best to try and aim towards exercising in the morning or early afternoon as exercise does release endorphins, which are good for you, but endorphins may keep you awake if you do too much strenuous exercise during the evening.  The fourth area to explore is to try and avoid nicotine, and or alcohol before bedtime.  Both of these substances are stimulants, which means that they are most likely to interrupt your sleep.  The effects of caffeine, which is found in not only coffee but also tea and some chocolate can interfere with sleep.   Another area that may be interfering with your sleep is worry thoughts.  It is important to try and not work on areas of concern as you are approaching bedtime as it keeps the mind active and becomes difficult to shut thoughts off.  Many times I suggest that someone pick a time to work on "worry thoughts" during the day, allowing them permission to work on areas of concern, but also giving them permission to shut thoughts down as bedtime approaches.   The following tips can be accessed through the American Sleep Association and summarize some of the above suggestions: *Maintain a regular sleep routine. *Avoid daytime naps. *Don't stay in bed awake more than 5-10 minutes. *Don't watch TV, use the computer, or read in bed. *Drink caffeinated drinks with caution. *Avoid inappropriate substances that interfere with sleep. *Try to have clean fresh air in the room. *Try to have a quiet, comfortable bedroom. *Try not to be a clock watcher when sleeping. *Try taking a warm bath or shower prior to bed. *Try to quiet the mind with gentle meditation. In regards to concerns with your weight, getting a good night's sleep by developing better habits will allow more energy and motivation during the daytime which can also allow more focus on eating habits and exercise.  Everything starts with a refreshed mind which comes from a balance in all areas of your life.
Answered on 10/18/2021

Any tips for coping with ptsd flashbacks?

The key to the healing for this client is trauma treatment. EMDR would be a very effective intervention and could diminish or eradicate the flashbacks in a brief period of time. In person therapy would be preferred as we are not on a platform yet that can use EMDR. Flashbacks are symptoms of post traumatic stress disorder and the unprocessed emotions of the trauma. EMDR helps with the completion of processing the emotion connected to the trauma and lessens the intensity of the flashback and can sometimes give the patient more control over the situation. Journaling is also a helpful tool for flashbacks, documenting as many details as possible to be followed up with a therapy session. Trauma treatment needs to be done by someone who specializes in this type of intervention and a therapist who is also able to manage dissociation and abreactions to a situation. It can be detrimental and cause more damage if the therapist is not well trained to manage the potential fall out from the interventions that can be quite common. I generally recommend that a client view videos of patients in an EMDR session to demystify the process and also give them the basic theory behind why EMDR works. Like anything else the therapist and the client need to have a trusting relationship as EMDR involves the client being able to follow direction without question or discussion during the process. I have seen EMDR work amazingly well for many different types of clients both children and adults and in most cases immediate relief can be experienced. Again a lot has to do with the skill of the therapist. In addition to EMDR, Trauma ART Therapy is also a helpful intervention again processing the situations through pictures and words, the therapist must alleviate any concerns that the client has related to being some type of an artist so to not impinge the flow of thought. Stick figures and shapes are fine what is more important are the words that the client can put to the illustrations. Again this is a process and should only be used by a therapist trained in the intervention.
(LCSW)
Answered on 10/18/2021