Ways to beat stress-related insomnia

We all know we need sleep; when we don't get enough sleep we have unpleasant mental, physical and emotional symptoms to the point that we will seek medical help to cure both the insomnia and its results. Sleep keeps us healthy, mentally sharp and able to cope with stress more effectively, among other things. Unfortunately, the more stressed we are, the less sleep we often get, which can cause a vicious downward cycle.  

Some of the reasons that stress and sleep deprivation go together include:

Overthinking
Many people take their work home with them, either physically or metaphorically. With today’s demanding workloads it’s often difficult to come home from a day of problem-solving and issue-managing and simply stop thinking about them. Parents at home with children, people who work from home and students can all experience this as well, even if they are not physically changing environments when work ends. If you find yourself still trouble-shooting at the end of the day, and the thoughts won’t seem to leave your mind, this can make sleep become much more difficult. It can also wake you in the middle of the night, as you transition between sleep stages.

Over Activity
A hectic, busy life can not only keep your thoughts racing, but also rob you of time you can actually spend sleeping. If you find yourself pushing your bedtime back further and further to get things done, or getting up earlier and earlier in the name of productivity, you may feel tired a lot of the time but not realise the toll lack of sleep is taking. Less than six hours sleep on a reegular basis can damage your physical and mental health.

Cortisol
This stress hormone cortisol, released when you are in "Flight or Flight" mode, enables you to respond quickly to crisis situations, but needs to be "switched off" to enable relaxation and sleep. Chronic stress can lead to excessive levels of cortisol, and this can disrupt healthy sleep patterns through physical discomfort such as indigestion, stomach and muscle pain, as well as...

Anxiety
Like overthinking, anxiety can make sleep difficult and wake you up at night. Anxiety keeps your mind busy imagining threatening scenarios and worrying about how you could deal with them. You may become preoccupied with finding solutions, or simply repeating the same pattern of anxious thoughts over and over again. That racing of your mind can rob you of sleep by keeping your cortisol levels high, making sleep harder to achieve.
 
Caffeine and Alcohol
People under stress tend to consume significant amounts of caffeine to get a boost that gets them going in the morning, helps them make it through the day. Caffeine can actually exacerbate stress levels and significantly affect the amount and quality of sleep you get. Stressed people often try to relax with alcohol in the evening, not realising that it can inhibit sleep, increase anxiety and exacerbate the physical symptoms of excess cortisol.

Try these techniques if you are permanently stressed and/or find yourself regularly short on sleep:

Breathe
Use this exercise as a transition time between work and home - concentrating on the physical aspects will divert you from work-related thoughts and change your mental tempo. You can also do it lying in bed to help you go to sleep and if you wake in the night.

Breathe in a long, slow breath, right down into your diaphragm (you should be able to feel your belly, not your chest, going in and out) until your lungs are expanded fully (but stop before you feel you're going to burst). Breathe out slowly until your lungs are completely empty (but not so you're gasping). Breathe in and out five times like this, in your head counting up to five as you breathe in and back down from five to one as you breathe out. Keep the in and out breaths regular and flowing; don't hold the breath at any point. After five deep breaths, breathe more gently and normally and find your natural rhythm as you breathe in and out. If you can make the out breath longer, that's good.

"When the breath wanders the mind also is unsteady. But when the breath is calmed the mind too will be still…. Therefore, one should learn to control the breath."

Svatmarama, Hatha Yoga Pradipika (15th century)

By changing your breathing, you are changing your physical response to a situation. The message your body is giving your brain is: “I am breathing in a calm, relaxed manner therefore I am in control.” As your brain registers this message, it assumes any danger has passed and deactivates the Fight or Flight response, reducing the flow of cortisol and thus your feelings of anxiety.

Physical relaxation
We hold stress in our bodies, often on a long term basis, so conscious physical and mental relaxation is beneficial to reducing your stress levels and very conducive to sleep. Once you've learned the technique it can be done at almost any time, but making a habit of doing this before you go to sleep ensures a much more restful night.

“There is no need to go to India or anywhere else to find peace. You will find that deep place of silence right in your room, your garden or even your bathtub.”

Elisabeth Kubler-Ross, scientist, doctor, educator, mother (1926-2004)

Lying in bed, on the floor, or sitting comfortably, close your eyes and settle your breath as in Breathe. Now take your consciousness down to your feet and imagine them surrounded by a warm golden glow – like in the Redibrek ad, if you're old enough to remember it. Say to yourself internally, “My toes and feet are warm and relaxed; soft and heavy”. As you do so, try to release all tension from the muscles in your feet (sometimes it can help to tense, then release them).

Continue this process up your legs, abdomen, back, shoulders, arms and hands, neck, over your head and down your face until you have relaxed every muscle and visualised a golden glow enfolding your entire body. Feel each limb in turn loosen and soften like those of a rag doll. The more you practise, the better you will get at relaxing each muscle group, right down to detailed parts of your face. Check how much tension you release by relaxing your mouth and jaw, for instance.

This is a great technique to send you back to sleep when you wake up in the night, and if you do it just before nodding off, chances are you won't actually get to finish the exercise. Concentrating on the repetitive instructions to your body, and your conscious efforts to relax, divert your thoughts from anxieties and give your mind a chance to switch off.

“Sleep that knits up the ravell'd sleeve of care,

The death of each day's life, sore labour's bath,

Balm of hurt minds, great nature's second course,

Chief nourisher in life's feast…”

William Shakespeare, Macbeth

If you feel it would help to have an audio of this relaxation exercise, which we call "The Golden Glow", you can listen or download it FREE as an MP3 file from our website.

You will find more ways to de-stress, cope with anxiety and take control of your life in The Real Secret

 Posted by Lucy

Living with Anxiety and Panic Disorder

Panic Attacks are very sudden episodes of intense anxiety in the absence of real danger, and they often occur out of the blue with no obvious immediate trigger. Panic attacks have very strong physical sensations such as heart palpitations, nausea, shortness of breath, dizziness, hot sweats and a feeling of imminent danger.

Where do panic attacks come from? Deep in the the Limbic part of the brain lie two almond shaped pieces of tissue called the amygdala (the latin for almond seed). These are understood to be largely responsible for our experiences of fear and anxiety. The amygdala processes information received from our senses and decides whether we are in imminent danger; if it decides that we are in danger it alerts us to the potential threat. This effect is remarkably swift - it’s there to save our lives, after all - and takes effect well before the frontal cortex can analyse the situation in a more considered manner. It's very rare for our lives to be so threatened and in the normal course of events the amygdala is not often called on to save our lives in this way. However, in some cases the amygdala is overactive and appears to detect danger when none is present. Panic disorder is thus a malfunction of a system designed to keep us safe from threats.

Experiencing a panic attack is extremely frightening and many who experience a panic attack for the first time often believe that they are having a heart attack. When this happens more panic sets in because they mistake these very strong physical symptoms as potentially life threatening. This then sets off a vicious circle as these misinterpretations lead to more anxiety, leading to heightened physical sensations. Because panic attack symptoms can resemble life-threatening conditions, such as a heart attack, it’s important to seek an accurate diagnosis the first time you experience the symptoms listed above. The advice on how to cope with panic attacks given below is applicable only once your doctor has confirmed your diagnosis.

How are Panic Attacks treated?
For many years, anxiety related disorders such as panic attacks were treated with tranquillizers such as Valium. During the 1970’s Valium was the most widely prescribed drug in the US reaching a peak of 2.3 billion tablets dispensed in one year alone; then it was called ‘mother’s little helper’. Today a new class of anti-depressant (SSRIs, of which Prozac is one) is very often prescribed. This is despite robust evidence that a psychological therapy such as cognitive behaviour therapy (CBT) is  more effective for anxiety related disorders. But CBT is expensive and the waiting list for treatment can be many months. GP’s are often under pressure to prescribe anti-depressants when they would prefer to prescribe a non-drug treatment were it more readily available.

What you can do to help yourself without resorting to drugs
There are a number of tips for dealing with panic attacks, some of which I will list below, but perhaps the single most important thing to keep in mind when experiencing a panic attack is that the symptoms commonly last approximately forty minutes and it is very unusual for them to last longer than an hour. Knowing that the attack will end soon and that it is not life threatening will do most to reduce the panic and thus lessen the physical sensations. It’s also worth knowing that very many people suffer from panic attacks, so you are not alone.

Many experienced sufferers treat panic attacks with some of the following methods and techniques. The next time you have an attack try them and see what effect they have on you.

• Diaphragmatic breathing or abdominal breathing - breathe slowly through the nose using the diaphragm and abdomen. Focus on exhaling very slowly. This will correct or prevent an imbalance of oxygen to carbon dioxide in the blood stream.
• Stay Focused in the present - rather than allow yourself to imagine the worst case scenario (“I’m going to die!”), remind yourself that the attack will soon pass and is not life threatening. Do not think about the future at all but stay focused on your breathing.

• Acceptance and acknowledgement - many people say that accepting and acknowledging their susceptibility to panic attacks helps them not only deal with the symptoms when they happen but also allows them to see the attacks as a part of who they are. This is especially important for those of us who have tried but failed to eliminate the attacks altogether from our lives.

• Floating with the symptoms - allow time to pass and “float with the symptoms” rather than trying to fight them. This is another very successful technique for dealing with the unpleasant sensations as they happen.
• Smiling helps - I find, and I consider myself an ‘expert’ having lived with panic attacks for many years, that if I smile as I go through the attack this helps -  perhaps because it’s hard to smile and panic at the same time.
• Coping statements —  repeat “coping statements” as part of an internal monologue to help you keep focused on the present and to remind yourself that you’re going to be OK. Here are some suggestions;” No one has ever died from a panic attack.” “I will let my body do its thing. This will pass.” “I can be anxious and still deal with this situation.” “This does not feel good, but I can deal with it”.

For many people a panic attack may occur less than a couple of times in their life, whilst for others panic attacks happen quite frequently. If you experience attacks very frequently then you will have a condition known as a panic disorder. Cognitive behaviour therapy is extremely successful at helping with panic disorder and should always be tried before resorting to drugs.

Talking with other sufferers can be hugely helpful. I remember once in the staff tea room of a busy hospital I asked an assembly of colleagues, not all of whom I knew at all well, if anyone else - apart from me - ever suffered from panic attacks. The response was incredible. I was not alone and many of those who ‘admitted’ to having the odd attack came up to me later to thank me for being brave enough to talk about my attacks and making them feel less alone in their own affliction. Of course, it may not be appropriate where you work, but worth asking friends if only to make them as well as you feel a bit less anxious.

If you are a sufferer and have any advice to add to the list above then please leave a comment.

There are more exercises in The Real Secret which will help you take control of anxiety and panic, and are a useful start if you are waiting for therapy to start. You can get the book in either paperback or Kindle format from Amazon.com or Amazon.co.uk

Posted by Annabel

International Women's Day; Women's Mental Health

“Women are drawers of water, hewers of wood, labourers, preparers of food, bearers of children, educators, healthcare providers, producers, and decision-makers. Although they are central to caring for families and communities, to production and reproduction, they are accorded unequal status. Throughout the world they are overworked and undervalued. Their subordination makes it more difficult for them to cope with the demands made upon them whether of a physical, social or emotional nature. Woman are more vulnerable than men to sex exploitation and violence, to poverty and malnutrition, to environmental degradation, to chronic diseases which are often exacerbated by pregnancy and lactation, and to the debilitating effects of harmful traditional practices.”

This was the opening of the Preface to the World Health Organisation’s 1993 report into Psychosocial and Mental Health Aspects of Women’s Health. 18 years later, the same still holds, though there is a growing understanding of these issues and more work being done to attempt to right the inequalities.

It is quite clear, though, that "gender determines the differential power and control men and women have over the socioeconomic determinants of their mental health and lives, their social position, status and treatment in society and their susceptibility and exposure to specific mental health risks. Gender differences occur particularly in the rates of common mental disorders - depression, anxiety and somatic complaints. These disorders, in which women predominate, affect approximately 1 in 3 people in the community and constitute a serious public health problem." (World Health Organisation)

MIND’s factsheet on Women and Mental Health gives us the following statistics about women’s mental health in the UK, taken from a variety of sources: 

• ·     Recorded rates of anxiety and depression are one and a half to two times higher in women than in men.
• ·     One study showed that 57% of those attending emergency departments for self-harm were women.
• ·     13 to 15% of new mothers experience postnatal depression.
• ·     Women in custody have a high level of psychological disturbance – 78%, compared with 15% in women in the general adult female population.
• ·     Nearly two-thirds of women on remand have a diagnosis of depression. More than 40% have attempted suicide before entering prison. More than twice as many have an eating disorder compared with women in the general population.
• ·     One in four women will experience intimate partner (domestic) violence (IPV) in their lifetime. Depression affects nearly half of women exposed to IPV, and post-traumatic stress disorder (PTSD) affects almost two-thirds.
• ·     90% of the 1.6 million people in the UK who have an eating disorder are female.

 Another WHO report demonstrates the international and cross-cultural phenomenon of women’s vulnerability to depression, anxiety, psychological distress, sexual violence, domestic violence and escalating rates of substance use, which affect women to a greater extent than men across different countries and different settings. “Pressures created by their multiple roles, gender discrimination and associated factors of poverty, hunger, malnutrition, overwork, domestic violence and sexual abuse, combine to account for women's poor mental health. There is a positive relationship between the frequency and severity of such social factors and the frequency and severity of mental health problems in women. Severe life events that cause a sense of loss, inferiority, humiliation or entrapment can predict depression.”

Williams and Miller report that “Gender inequality in society leads to differences in the life experiences of men and women, which affect mental health in different ways. Gender inequality is described as a system that tends to give more advantages to men in terms of employment, status and ownership. Women are much more often expected to look after others in the home or in society, often doing work that is undervalued and unpaid or poorly paid.”

The Geneva report of the WHO agrees that “Some risk factors for mental health problems affect women more often than men. These include gender-based violence, social and economic disadvantage, low income and income inequality, low or subordinate social status and rank, and major responsibility for the care of others.”

For some women, family life may contribute to mental distress. Many women have primary or sole care of children, and women are more likely than men to take on caring responsibilities (e.g. for older family members). Women also tend to work in part-time jobs, and are over-represented in low paid occupations and sectors such as teaching and care work. Williams finds that the low social status traditionally associated with domestic and caring work can damage feelings of self-worth, while the stresses of overwork, extensive responsibilities and feeling undervalued can damage women’s mental health. While the extent of gender-based disadvantages varies according to social class and ethnicity, it has been argued that women bear the brunt of reconciling paid work with family life.

Research also shows that there are three main factors which are highly protective against the development of mental problems, and especially depression. These are:

• having sufficient autonomy to exercise some control in response to severe events.
• access to some material resources that allow the possibility of making choices in the face of severe events.
• psychological support from family, friends, or health providers

Women around the world are less likely than men to have the first two, but hopefully number among their armory against mental health problems the support of family and friends.

And Pilgrim has found that women in the UK receive more services than men for mental health problems at the level of primary care, though this difference is less at the level of secondary care (specialist and hospital treatment). It is difficult to know whether more mental health problems are diagnosed in women at primary care level because they seek help more often than men, or because they actually experience more distress.

Either way, women's place in society the world over - their central role as carers of young and old,  their lower economic status and perceived value compared to men, their difficulties in balancing working and domestic life and their greater vulnerability to violence - negatively affects their mental health outcomes. This is mitigated by supportive relationships with friends and family and a willingness to seek help for problems - but it is not enough. Greater equality for women will bring improved mental health: a number leading charities brought together by Annie Lennox are working towards it under the banner of We Are Equals.

Posted by Lucy

More at:

http://www.who.int/mental_health/prevention/genderwomen/en/

http://www.mind.org.uk/help/people_groups_and_communities/women_and_mental_health#_ednref13

Williams, J. and Miller J., 2008, ‘Gender inequality and the mental health of women and men’, in T. Stickley and T. Bassett (eds) Learning about mental health practice. Chichester, Wiley: 381–400.

Astbury, J., 2001, Gender disparities in mental health. Mental health. Ministerial Round Tables 2001, 54th World Health Assembly. Geneva, World Health Organisation

Pilgrim, D., 2010, ‘Mind the gender gap: mental health in a post-feminist context’ in: Kohen, D (ed) Oxford textbook of women and mental health. Oxford University Press, Oxford

Perrons, D., 2009, Women and gender equity in employment, Institute for Employment Studies.  

Williams, J., 2005, ‘Women’s mental health’, in: Tew, J (ed), Social perspectives in mental health: developing social models to understand and work with mental distress, Jessica Kingsley Publishers, London

 Department of Health, 2002, Women’s mental health: into the mainstream, DH, London

How to be happy - tips from recent research

It appears that people suffering with mild to moderate depression focus too much on the bad and the sad*, and that socially anxious people tend to remember negative rather than positive experiences*. When trained to shift their attention, both groups experienced a major improvement.

In the case of the research on depression, sad faces seemed particularly attractive to people with mild to moderate depression, whereas non-depressed people found neutral or happy faces more attractive. The question is whether the increased attention paid by depressed people to unhappy or sad themes is simply a byproduct of depression or might it be a cause?

Researchers looked at the question of whether biased attention towards sadness plays a maintaining role in depression and, more specifically, they looked at the question of  whether modifying the attention for sadness, by training participants to shift their attention toward neutral stimuli, could reduce depressive symptoms.

The study provided evidence for the first time that training attention away from unhappy or sad stimuli to neutral stimuli reduces depressive symptoms. In addition, these effects lasted beyond the duration of training. Perhaps most notably, these results provide additional evidence that, rather than being by-products or symptoms of depression, attentional biases towards sad themes play a causal role in the maintenance of depressive symptoms.

These findings worked with people with mild to moderate cases of depression, and those are also the people for whom anti-depressants often don’t work. Since we are all prone to episodes of mild depression, it may well be worth remembering to keep a tab on the amount of attention you pay to sad or unhappy events - and try to stop yourself.

In the study that looked at people who suffer from social anxiety, results showed that socially anxious individuals more easily forget socially positive words and experiences than do non-anxious individuals. It’s not that socially anxious individuals have fewer positive experiences than non-anxious individuals, it’s just that they appear not to recall them as readily.

Martin Seligman’s research is worth noting here. He found that the habit of writing down Three Good Things that went well each day increased happiness and decreased depressive symptoms for six months after the single week of testing.

So if you can get into the habit of writing Three Good Things that went well, and reasons - preferably to do with you - why they went well, even if you only manage it twice a week, you’ll have clocked up over Three Hundred Good Things that have happened to you in a year.

The first and last Steps of The Real Secret "Choose to be Happy" and "Smell the Roses" give you Habits that promote focusing on the positive and have been shown to raise happiness levels. Get your copy from Amazon.com or Amazon.co.uk in paperback or Kindle



* Tony T. Wells and Christopher G. Beevers (2010) Biased Attention and Dysphoria : Manipulating selective attention reduces subsequent depressive symptoms Cognition and Emotion, Vol. 24 (4)
* Chi-wen Liang et al., (2011) Absence of a positive bias in social anxiety: The application of a directed forgetting paradigm" Journal of Behavior Therapy and Experimental Psychiatry, Vol. 42 (2)

Post by Annabel