Women and Insomnia

I have a very sensitive nervous system – like 15 to 20 percent of humans.  Supposedly, this highly-atttuned nervous system evolved as a survival mechanism.

During the first trimester of my one and only pregnancy, I had tremendous difficulty sleeping.  Many nights, I did not sleep at all.  It was a version of hell, trying to practise law, fend off anxiety, exercise, eat right, and stay healthy for myself and my child.  It was psychologically distressing.  I remember a friend telling me at the time that I will sleep when I’m tired enough.  I couldn’t believe it!  I was beyond tired!  She obviously couldn’t comprehend what I was going through.  The day I entered into the second trimester of pregnancy, it seemed like a switch suddenly went off and I was able to sleep normally again.  What a relief!

Now, I am experiencing what I term, “extreme perimenopause”.  Sleep has become elusive again.  Some nights I do not sleep at all, some I sleep only a few hours. Seldom do I get seven or eight hours, let alone the average 6 hours and 41 minutes that women aged 30 – 60 get on average, according to the U.S. National Sleep Foundation which also reports that women are more likely than men to have difficulty falling, or staying, asleep. (1)  In my household, this is definitely true where I am outnumbered by peacefully slumbering males, 2 to 1.  And, both of these males have lifestyles which throw my circadian rhythm off balance, and which negatively impact my ability to, and quality of, sleep.  (Yes, I am in a version of hell again: sleep deprivation has been used as a method of psychological torture for centuries.)

A woman’s biology can certainly affect how well she sleeps. The menstrual cycle and pregnancy, perimenopause, and menopause all can affect the quality and quantity of a woman's sleep.  Because fluctuating hormones affect the nervous system, the more sensitive the nervous system, the more likely a woman is to experience moderate to extreme difficulty sleeping.  It is well-documented that changing levels of hormones like estrogen and progesterone have an impact on sleep.  Estrogen dominance is a key component which impacts a women's sleep negatively.

Research relating to sleep deprivation has uncovered that too little sleep results in daytime sleepiness, moodiness including irritability, and an increase in mood disorders such as anxiety and depression, an increase in the number of accidents, including those caused by poor coordination/poor balance/poor attention, problems concentrating/focusing, poor memory, poor job performance, compromised immunity causing illness, weight gain due to cravings and disordered eating, feelings of dissatisfaction and boredom, isolation due to difficulty having the energy to maintain friendships or attend social functions, blurred vision, an increase in muscle tension and headaches, and an increased risk of dying early from causes such as heart attack.

When insomnia persists over a long period of time, secondary anxiety can develop in which a person becomes anxious about not sleeping well, and about all the increased risk factors for his or her health due to not sleeping well. (Just 'google' sleep deprivation if you want to really worry about not sleeping well, and you'll get an idea of all the nasty things that may befall you due to insomnia.  Just to mention a few:  at increased risk of heart attack, alzheimer's, depression.)  It can become a 'vicious circle'.

Insomnia is the most common sleep problem in the United States (and I suspect elsewhere, too). Women are more likely than men to report insomnia. In fact, according to the 2002 NSF "Sleep in America" poll, more women than men experience symptoms of insomnia at least a few nights a week (63% vs. 54%). Fortunately, there are a number of approaches to improve sleep, including those you can do yourself such as exercising, establishing regular bed and wake times, making dietary changes (consuming less or no caffeine, avoiding stimulating foods and beverages, and avoiding alcohol), and improving your sleep environment and sleep hygiene (before-bed habits). One recent study found that overweight, post-menopausal women who exercise in the morning experience less difficulty falling asleep and better quality sleep than evening exercisers. (2)  Some individuals have found relief through yoga, meditation, or other relaxation techniques/exercises. Medications, supplements, and alternative remedies that induce sleep or relaxation, as well as those that treat underlying disorders may be helpful.  What works for one person, may not work for another.

D.

(1) and (2) National Sleep Foundation, “Women and Sleep", www.sleepfoundation.org

Optimism vs. Pessimism

One defining feature of a person's general outlook or attitude is whether they see setbacks as temporary and limited, or as all-encompassing.  According to Martin Seligman, a professor of psychotherapy at the University of Pennsylvania, "pessimists tend to believe they're to blame when bad things happen and that these bad things will persist and ruin other events in their lives." (1)  Optimists, on the other hand, see setbacks as temporary.

Now, whether an individual's general disposition is primarily inherited, or whether it is primarily influenced by the attitude/outlook of their primary caregiver(s) throughout their formative years is still open for debate.  It's most likely a blend of both and inherited disposition can change under influence by others and can also repel influence by others.  It can be quite difficult to separate characteristics we inherit from those which are the result of environmental factors although this is an area under continued study.  Traumas and other life events can go a long way towards whether any one individual tends towards optimistic thinking or pessimistic thinking.  But, how that individual learned to deal with traumas and life events, or how they learned to view them, would have an influence on how their general outlook develops, perhaps as much as, or more than, living through the event or trauma itself.  I think that the people closest to a developing child teach the child how to interpret life's events - what spin to put on them.  Was your parent open and trusting towards other people, or suspicious and antagonistic?  Was your parent generally agreeable, or basically disagreeable and bitter?  Did he or she see the silver lining in clouds or just the darkness?  Did they use pessimism as an attention-seeking mechanism?

Throughout life, how traumas are dealt with, and how life's day to day events are interpreted, have a great influence on whether more positive interpretive neural pathways are laid down, or more negative ones.  Does life wear you down, or do you rise to most challenges?  Individuals continue to be affected by experiences during their adult years and new neural pathways, whether positive or negative, continued to be forged.  It is not uncommon for individuals to become more optimistic as they age, nor is it uncommon for them to become more pessimistic.  The experiences we have, no matter what our age, affect both the mechanism and chemistry of the brain.*  All sorts of subtle workings continue to be at play in the brain, two of which are neurotransmitters and neuromodulators, and these are influenced by a whole host of other factors such as sleep, stress, diet and illness.  (It's complicated.)

No matter the mechanism, study after study seems to prove better health outcomes as people age for those with optimistic outlooks.  (Whether they are more optimistic because they are healthier, or whether they are healthier because they are more optimistic requires further study.)  Slowly, but surely, however, it seems that scientific studies are showing that thinking optimistically can make you mentally and physically healthier.  (Perhaps being an optimist is, in itself, a sign of good mental health.  Perhaps optimists look after themselves better and avoid more self-destructive behaviours.)

In Holland, researchers discovered after studying approximately 1,000 seniors, that the most optimistic among them had a 55 percent lower chance of dying from all causes and a 23 percent lower risk of cardiovascular death.  A study of law students at the University of Kentucky found that students who were more optimistic than their counterparts had stronger immune systems.  And, a study at the University of Pennsylvania which involved incoming freshman who participated in a series of workshops aimed at helping them cultivate a positive attitude, lowered their risk of developing depression.  Other research indicates that high levels of optimism are linked to better recovery from heart transplants and heart bypass surgery, protection from stroke risk, and even delayed onset of frailty among the elderly. (2)  And, another study has shown that seniors who still think of themselves as healthy despite the fact that they may have some issues with their health, have better health outcomes and stay stronger and more vital longer.

Researchers don't know exactly how optimism is a protective factor.  Further study is required.  What they do seem to now know is that the evidence they do have strongly suggests that pessimism is detrimental when it comes to disease development and outcomes of disease whereas optimism points towards added protection.

A 2009 study by The Social Issues Research Centre in Oxford, UK came up with what they have termed, an "optimism spectrum", which I thought might be of  interest here.  Some of you may find that the categories overlap.  For what it's worth, here are the categories - which category describes you?:
Unabashed optimist:  I am always very optimistic, whatever the circumstances
Contagious optimist:  I am always optimistic, and my optimism spreads to those around me
Concrete optimist:  I am optimistic, but I am realistic about the possible outcomes of events
Cautious optimist:  I am optimistic, but I am careful not to be complacent about my good fortune
Situational optimist:  My levels of optimism/pessimism change from situation to situation
Realist:  I am neither optimistic nor pessimistic, but simply realistic about the good and bad things in my life
Fatalist:  I accept that essentially I can't change what's going to happen to me, whether it's good or bad
Individualist:  I believe that essentially I have control over what's going to happen to me, whether it's good or bad
Pessimist:  I am generally pessimistic, whatever the circumstances. (3)

D.
*the changing nature of the brain throughout life is called  'neuroplasticity'.  Up until a couple of decades ago, it was thought that the brain was incapable of changing during the adult years, apart from changes induced by injury or disease.  (Like the old adage that you can't teach an old dog new tricks.)  It has been well-documented over the last several years, however, that you CAN teach that old dog some new tricks, and that ongoing experiences and learning does, indeed, change the brain.  Much is being written on this 'plastic' nature of the brain - on the ability for it to continue changing as we age, to continue laying down neural pathways and making new synaptic connections, based on what we learn and experience.

(1)  and (2)  Health:  Total Wellness For A Better Life, October 19, 2011, Chris Wadsworth, www.newsmaxhealth.com.
(3)  Optimism:  A Report from the Social Issues Research Centre, February, 2009, p. 22.

Disorders of Personality

Familiar Personality Disorders (PDs) include narcissistic, antisocial, dependent, histrionic, borderline, and avoidant ones, although about 10 conditions are recognized by psychiatrists and psychologists as PDs.  Everyone knows that individuals with this type of disorder have a problem - except for them. They often seek professional treatment only after persuaded to do so by another person.

PDs are among the most difficult cases to successfully treat. They don't exist apart from an individual's core personality, like something like an anxiety disorder does; rather, they wind through a person's entire personality and, generally speaking, IS the personality, not just an adjunct to it.  It is estimated that about 40 percent of individuals suffering from a PD can find some improvement with a combination of medication and some form of 'talk' therapy. 

The cost to society resulting from PDs is great.  Individuals suffering from a PD are often perpetrators of spousal and child abuse and other forms of violence, creating unhealthy living conditions for others. Even if they are able to be persuaded to undergo therapy, they may continue to deny that they have a problem, preferring to list everything that is wrong with everyone else - blaming everyone else, or the situation, for their problems.  They seek therapy under duress, often using the sessions in order to bolster their claim that they don't have a problem;  that it is others - their spouse, their colleagues - who are to blame for the way they act and that their actions are completely justified.  They are usually self-absorbed, believing that they have every right to be because they're 'so hard done by' at home, or at work.  When the therapist doesn't provide them with the expected validation for their behaviour, they simply fire the therapist.

PDs are extremely complex and as noted above, difficult to treat.  They are often heritable conditions, but can also come about as a result of conditioning during a person's early years because of things like childhood abuse or some other trauma.  A PD doesn't usually manifest itself until the late teenage years;  however, earlier signs may simply have been missed by parents.  Alternatively, because a parent may have the disorder, they can't see that anything is wrong with the child.  Even when environmental factors such as child abuse take place, it is hard to determine whether the reason the child ended up with, for example, a narcissistic personality disorder, was simply because of the abuse which led to self-loathing and low self-esteem - to then be covered up by self-aggrandizement - or that the abuse ended up manifesting as it did because it triggered the heritable condition.  In other words, that is how the abuse manifested itself in that particular child due to genetic factors, whereas in another child it may have manifested itself in another type of PD, or in anxiety or depression.

According to Jeffrey Kluger's article "Pain, Rage and Blame" in a special edition of Time magazine, "personality disorders are ego syntonic:  individuals believe that the drama, self-absorption, and other traits that characterize their condition are reasonable responses to the way the world is treating them." (1)  As a result, because the patient doesn't accept that there is something wrong with them - as they do when they have something like panic disorder or a phobia - how can they accept the treatment required to give them any chance at all towards healing?

While antidepressant and anxiety medications do little to change something as fundamental as personality, they may help to smooth out the rough edges, to calm the stress that comes from living so disordered a life.  Once some patients feel less stressed, they may be motivated enough to take on the harder work of a therapy like cognitive behavioural therapy in which new ways of thinking and reacting about life situations are taught, and then utilized, in order to enable patients to repair what is not working in their lives.

D.

(1) "Pain, Rage and Blame", Jeffrey Kluger, Time magazine special edition: "Your Brain:  A User's Guide", p. 52.

On Stress and the Brain

Stress inhibits neurogenesis (the formation of new neurons) in the brain.  Help!!!

Aerobic exercise (which increases the availability of oxygen and nutrient-filled blood in the brain, nourishing the brain) increases neurogenesis.  Yeah!!!


D.

In the Words of Eckhart Tolle: Meaning and Purpose

I am not a follower of Eckhart Tolle, but found this passage to be of some importance.  It reads as follows:  "As soon as you rise above mere survival, the question of meaning and purpose become of paramount importance in your life.  Many people feel caught up in the routines of daily living that seem to deprive their life of significance. Some believe that life is passing them by or has passed them by already.  Others feel severely restricted by the demands of their job and supporting a family or by their financial or living situation.  Some are consumed by acute stress, others by acute boredom.  Some are lost in frantic doing;  others are lost in stagnation.  Many people long for the freedom and the expansion that prosperity promises.  Others already enjoy the relative freedom that comes with prosperity and discover that even that is not enough to endow their lives with meaning.  There is no substitute for finding true purpose." (1)

D.

(1)  Eckhart Tolle, A New Earth:  Awakening to Your Life's Purpose.  New York, Pengin Group, 2005, p. 257.

Iphones, Blackberries and Other 'Smart' Devices

According to a recent article in the journal, Cortex, we are not addicted to our mobile devices, we are in love with them.  (Gleaned from brain imaging studies.)

D.

Should She or Shouldn't She

I recently came across a letter I wrote a while back in response to an article in the January 2005 issue of Canadian Living Magazine. I thought that the contents of the letter would make a good post for this particular blog.  So, here it goes.  (You'll be able to figure out, from the contents of the letter, what the article I was responding to was all about.)

Dr. David Posen "missed the mark" with his usage of the word "should" in "Happy New You" (paragraph 3, page 54, January 2005).  Even though he was trying to convey to us some examples of positive reprogramming of that little inner voice, the word "should" carries with it too many connotations of guilt and obligation to form any part of a healthy relationship with ones self.  It is never the right word to use for positive self-talk or reinforcement.  Better phraseology would be "my needs are important" or "I think I will do that for myself because it is something I enjoy doing".  In fact, one could even argue that he contradicts the initial content of his previous paragraph where he mentions standing up to the "shoulds" and "musts".  Even when trying to use "should" in a positive manner, as Dr. Posen attempts to do when he writes, "I should be able to do something for myself...I should start taking better care of myself" the feelings of guilt and obligation still lurk beneath these suggested phrases.  Such feelings perpetuate the process of "beating ourselves up" because we should be taking better care of ourselves, but we are not.  This can only detract from the goal of achieving a "happy new you".  The less we fill our heads with "should messages", the more at peace we will be.

D.