Blog About Health & Medicine

DIFFICULTY FALLING OR STAYING ASLEEP: THE DISORDERS OF INITIATING AND MAINTAINING SLEEP (DIMS)Generally, DIMS includes those conditions responsible for creating disturbed or insufficient sleep. These disorders are distinct from those that cause excessive daytime sleepiness or disrupt the normal circadian cycle of sleeping and waking. As we will see, however, their symptoms and their effects on health and performance may be much the same.The DIMS category accounts for approximately 30 percent of all cases of sleep disturbance. DIMS consists of four major groups:* Disorders caused by a conditioned response or negative expectations about sleep* Disorders caused by medical, environmental, psychiatric, or alcohol or drug problems* Disorders caused by breathing or muscular irregularities* Disorders arising from true organic insomnia (a very rare condition)DIMS takes many forms: difficulty falling asleep initially, frequent wakenings, trouble returning to sleep once aroused, waking too early in the morning. The pattern of the disturbance is crucial in diagnosis, because it can help to differentiate DIMS from other categories of disorder. For example, disturbances caused by patients’ emotional or environmental situations tend to prevent them from crossing the threshold of sleep. In contrast, victims of endogenous depression are subject to awakenings that occur in the early hours of the morning.*106\226\8*

TREATMENT OF STRESS BREAKDOWN: BRAIN RESPONSE TO SEDATION CAUSING WITHDRAWAL AGITATION
Sedative drugs include alcohol, chloral hydrate, barbiturates, and the benzodiazepine drugs such as diazepam (Valium), oxazepam (Serepax), nitrazepam (Mogadon), and the increasing number of drugs on the market whose generic names end in ‘azepam’. The effect of any of these drugs is mainly on the cerebral cortex, interfering with the inhibitory cell groups and the mechanisms which trigger the alarm or anxiety response. Some of us like to feel slightly sedated, relieved of our fears by the Dutch courage of alcohol and other sedative drugs.However, while sedative drugs may make us momentarily feel good, the brain does not happily accept the sedative drug’s slowing-down effect on the brain cells in the cerebral cortex. In response, the reticular activating system reacts to the sedation by sending increased stimulatory impulses to the cerebral cortex.As the sedation from the last dose of drug wears off, the person begins to experience a hangover, a feeling of touchy hypersensitive agitation, due to the over-stimulation by the reticular activating system. This vague over-stimulation of the brain, as a reaction to the last sedative dose, usually lasts four times as long as the sedation did. After that time, the brain is able to reduce the stimulation and the cells get back to normal function.Thus, a person feels more anxious after a sedative drug wears off than he would have if he hadn’t taken the drug.After the sedation wears off the mild agitation from the brain’s response to the drug feels very uncomfortable and the person seeks another dose to relieve the agitation resulting from the previous drug dose. The problem is that this agitation is additive; after taking multiple doses of the drug, the person will experience such a high degree of agitation on ceasing the drug, he or she may become fearful of not being able to relieve the agitation with another dose and drug dependence may result. The risk of sedative dependence is so high where a person is being treated for stress-breakdown symptoms that sedative drugs should only ever be given when the anxiety symptoms themselves have become the major cause for concern. For example, a person who reacted to stress-breakdown symptoms with a phobic avoidance reaction (such as agoraphobia) and became unable to leave the house for fear of experiencing anxiety, might be more disabled from being unable to leave the house from fear of anxiety than by drug dependence.Sedative drugs, in order to bring the situation under control, might be justified in those circumstances. However, I believe that in the vast majority of cases of anxiety symptoms caused by stress overload, the use of sedative drugs cannot be justified.
*48/129/5*

In any operating manual or handbook, there is always a section on trouble-shooting—how to handle problems and what to do if things go wrong.

Now what can go wrong with the control of our in-built sleep mechanism? The main failure with the psychological switch is our lack of perseverence in maintaining the THS. We lose confidence and let our thoughts go wild without coming back repeatedly to the THS. We must control that spotlight so that it will only focus on our relaxing thoughts. Self-hypnosis is an active exercise, and we must activate that spotlight to focus on the relaxing parts of our bodies. Do not reject any intruding thoughts, as rejection means focusing on them.

Not being able to follow good sleep hygiene is another failure. Too much caffiene, not putting the alarm clock away, or waking up at different times every morning are all detrimental to good sleep.

If you suffer chronic insomnia because of chronic stress, you must learn how to manage your stress properly. Normal ordinary stress should not cause insomnia, as we experience this everyday. Look at the 80 per cent of what you have achieved and ignore the 20 per cent of bad luck, as one can never be always lucky. Revise chapter 16 on Sleep and Stress if you still have a problem coping.

Sleeping pills are useful in only a limited number of circumstances, and they should not be used for more than two weeks. When you stop them, they must be stopped very gradually to minimize rebound insomnia. You must distinguish between true insomnia and rebound insomnia.

You cannot fall asleep if you already have had too much sleep. Also you cannot fall asleep easily at the wrong time of day, according to the biological clock.

Finally, if all else fails, call in the professionals.

*102\174\4*

We have seen that if we really understand the basic cause of our pain, we do something to reduce our anxiety and so lessen the pain. Further, if the cause of our anxiety lies in some conflict that we are aware of, then we can reduce our anxiety and pain by facing up to the problem realistically. However, as we now know there is another way to reduce our anxiety, and that is by learning how to be more relaxed. We do this by means of our relaxing mental exercises. While we are practising them we are more relaxed. Some of this relaxation stays with us afterward. Then with continued practice we find it pervading our everyday life. There is less anxiety in us to motivate functional pain, and we find that it gradually disappears.

Increasing Our Threshold of Pain-If we gently pinch our skin, we feel it but it does not hurt us. If we pinch it harder we come to the stage when it does hurt. This is our threshold of pain in these particular circumstances. We can see that our threshold of pain is quite a variable affair. If we get someone else to pinch us, and at the same time if we ourselves consciously relax, he is able to pinch much harder before we feel pain. In a similar way if he distracts our attention as he pinches us, we do not feel the pain of it so readily. But if our friend makes rather a show of what he is going to do, pain comes more readily because he has mobilized our anxiety, and this lowers our pain threshold.

Our relaxing mental exercises are used to increase our pain threshold in two ways. In the first place the reduction of our general level of anxiety makes us less sensitive to pain, and in the second place we can use our relaxing mental exercises in a positive way to condition ourselves against being disturbed by painful stimuli. It is important to remember that this approach is effective with pain which is due to either functional or organic causes.

*124\57\2*

“Asthma, Had it for years. Comes and goes. The threat of it is always there. Have been tested and tested. Allergic to dozens of things. Some may bring on an attack, some don’t seem to make any difference. A touch of ‘flu or even a cold may bring it on. Or something upsets me. Mother was affected the same way. I don’t know what to do about it.

Tm tied to this spray. Don’t move without it. Forgot it the other day. Everything going well. Then discovered I had not got it, and the fright was enough to bring on an attack.”

Asthma is one of the conditions which demonstrates clearly the multicausal nature of disease. There is the genetic factor, the allergy, the respiratory infection and the stress factor. In different patients the different factors are of varying importance. The ultimate physiological cause, of course, is the contraction of the small air passages in the lungs. This may be complicated by the exudation of mucus which further obstructs the air passages.

The genetic factor means that some individuals are inherently more susceptible. The allergy produces disordered function of the cells. The infection further irritates them. The muscles in the air tubes are supplied by nerves from the autonomic nervous system, and so are vulnerable to stress. If the influence of one factor can be reduced, it may mean that the total influence of all the other factors is insufficient to produce the contraction of the air passages, and so bring on an attack.

Approximately one third of asthma patients, whom I have seen, and who have learned to reduce their stress through intensive meditation, have ceased to suffer attacks. About one third have been improved, and about one third have not been helped. An interesting point is that many of those who have been helped had very well-marked allergies.

*54/98/5*

Old age

“Winter is coming. The sun is setting. The cold wind blows. The last of autumn’s leaves flee across the grass. All natural enough. But why the thoughts? This leaf is me. And the next, and the next. They go to enrich the earth, and the new season’s growth. But me? Thoughts, thoughts, thoughts. It never ends. But of course it will.”

There is such a difference between simple repetitious thoughts and philosophical thinking. The one clogs our brain to no purpose, priming it for inevitable stress. But philosophical thinking allows some new understanding. Our coping mechanisms are enhanced, and the stream of disruptive thought subsides to a trickle.

Widowed

“Widowed, it is three or four years now. And I am coping no better. When part of you has gone you are maimed; life is not the same. Changes are made, and a new way of life starts. That’s not the coping I mean. That’s the chair where she used to sit. It’s empty now. How she would have liked this? What would she have said about that? Strange, because I know that she would have liked this. And I know what she would have said about that. But the thoughts of it are still there. The emptiness of home-coming. Why should I feel like this? I can cope, I can cope. But I can’t. The restless pillow. Restless, because it is made for two. My brain is in turmoil. Peace has gone from me. Team up with another? What would she think of that? If one does not know, how can it matter? But it is not as simple as that.”

We can test ourselves. Toes in the water before stepping in. Explore. Life is a sequence of explorations. One reality after the next. Why call a halt when one phase ends, and we must move to the next?

Dying

“I am older. This trouble I have could break out again at any moment. Keep thinking of death. We all must die. I know that. But knowing it is not much help. Say goodbye to a friend. Is this the last time? Will I ever see him again? It’s my own weakness. Tried going to church, but it did not seem to help.”

With some, the approach of death, and their thinking about it, sends enough messages to the brain to be a real cause of stress. I have seen others with whom the approach of death has brought no stress at all. Not just those who are seeking relief from the burden of life. But people who have developed some inner tranquility in which they seem to understand that life and death are really just different aspects of some greater process.

Many patients dying of cancer, whom I have shown how to meditate, have developed this tranquility of mind, without my saying anything about it.

The experience of letting the mind run quietly has enabled the brain to sort things out. The disturbing messages are integrated, and the individual is free from stress.

*18/98/5*