Why We Aren't Sleeping

I apologize. I was obviously tired when I wrote this (so says FD). There's no mention of our limbic systems or reticular formations, or that many people actually sleep better on a full belly. But there's not time to edit it now. He tells me it will sing to some of you.

We're not feeling great in the morning, many of us, not sleeping so well at night. What's going on?

Aside from the obvious. 

The answer is multi-factorial. (There are many reasons). Let's dive right in because the obvious doesn't explain much. We need the commentary.

1. Work
If we're lucky enough to still have a job then working from home is essentially like working on another planet. Another planet that feels very familiar. Yet the shift of venue demands cutting new paths in the brain to adjust to an ever-changing environment. Outside in the workplace, despite perks like a yoga room or snack station, it can be ho-hum in that even the surprises are expected. It is as home used to be. These WFH (work from home) environmental changes are a new  paradigm, and new paradigms, revolutionary, stimulate. 

2. Furloughed/ lost job
On the other hand, if we have lost our job, there's the fear of never finding one. Also stimulating. Terrifying. The only difference there's so much company in this place that humiliation isn't associated with that anymore.

3. Annihilation anxiety
No matter if we have jobs or not, during discretionary hours there's always been the option of staying home or leaving home. No more. Leaving our comfort zone is laced with decisions and fear, or should be, and fear is stimulating. We don't sleep well under fear. It is called annihilation anxiety.

Oh! But you're not afraid. So you think, grasshopper. Enjoy. 

ANALYSIS of ABOVE/ ARMCHAIR PSYCHOLOGY:  That running program, let's call it the Must Protect program (MPP), demands attention, perhaps more than any video game (pick your addiction). The MPP Start button is activated as soon as we prepare to leave our homes. Where's my mask. Do I need a new mask. Can I even touch this mask. I just work it a few hours ago. Do I have my supplies: Purell in the pocket, disinfectant wipes for doors, grocery carts. Must I swipe the doorknob of my car? I must consider these things. 

Once activated, the MPP runs through the body as we move about the cabin, whatever cabin we visit, even the great outdoors. We're suspicious of a passing jogger who has no mask. What's wrong with him? I wish he were dead. 

Now. Do such thoughts and activities affect sleep 8-10 hours later? Maybe yes. No matter how sedating our shows, no matter how funny the memes, it takes energy to attend to them, to consume, and there's even more energy generated by some. Have we put all that to bed? Everything pounding our eyes, ears, even our noses distills to energy. 

And our mouths, dear G-d, our mouths. Let us continue.

4.  The food/exercise equation
Most of us complain that we are not exercising like before, and this is the problem. 

(You're thinking: Why did I never build a swimming pool in the back yard? Now I'll never have the money to do that, not that I ever did). 

Not exercising means changing eating habits-- but that's impossible, or let's say, really hard. If we could do that we'd weigh a zillion pounds less, probably a trillion. We're throwing around numbers differently these days due to the stimulus package. How will that affect our economy? Let's worry about that, too. 

But back to food and exercise. What we need to keep our current weight, calorie-wise, is an equal balance of calories in, calories out. What we take in, what we use. 

Consider: When we take in more than what we use the left-over calories have feelings. They want to be used and they are angry. Fine, that's a stretch. But it is not a stretch to say that they're just hanging around in our bodies. Before we swallow, potential energy. After, there's no limit to that potential  

So these buddies of ours, our calories, are chomping at the bit to be used. Yet we aren't cooperating. We refuse to use them. The exceptions? Worrying, sedentary work (brain), or watching. All imply brain activity. They work anyway. 

Food is digested and energy released, busy finding places to go. If the muscles aren't busy they find a marvelous home in our heads telling us: Stay awake. Pay attention to me

With so much food, so little exercise relative to that, how can a person get any sleep at all? 

5. The new reality
Let's not forget our new reality, the many casualties of war brought to us by whatever news source we prefer. This is a war against disease and deterioration, one that usually is fought in the laboratories of our friends, the scientists. 

The grieving for casualties is exhausting with endless possibilities, ramifications, thoughts about ourselves and those dear to us (scary stuff). Depression, sadness is exhausting. Throw this into the mix. The entire gestalt of 50,000 deaths just in the United States (at this writing) and a feeling person has to feel it. We mourn vicariously. Who hasn't lost someone, or heard of a loss in their community?  

The Zoom funerals, I've been to two, yes this is about me, so intense. A handful of mourners. No one can shovel dirt on the grave. A tractor does all of the work. A tulip in the coffin.

The reality of death is grievous and terrifying and although we defend very nicely on an ordinary day with our humor and our song covers, defending against anxiety--  hey even I wrote one at the very beginning of all of this-- it is still a fact that millions of people are sick and thousands are dying, and as we are reminded by the World Health Organization: It is not over. 

6. Reopening 

People worry, whether they admit it or not, that reopening the economy is going to lead to a corona revival. That is worrisome, too. Our MPP (Must Protect Program, remember?) is activated. Our automatic defenses, the ones that never stop working, even when we think they have, even when we're getting ready to lie down to sleep, operate at full strength. 

Hearing about reopening and resurgence alone-- just hearing about it--  activates the Start button. 

Once again we look our mortality in the face. This is anticipatory anxiety, mother of them all, at its very best. 

7. Body rhythms

There's one more thing, something else that is relevant to the conversation, although we hinted at it earlier when we spoke of working from home, being at home, that ever-changing ecology.  

And that is that for most of us, our lifestyles truly have changed. We aren’t required to clock in at work at a certain time. Our appointments aren't in the flesh. We don't have to wear heels. We don't have a commute. In many ways this is far more healthy and far more normal . Think about it.

In many countries, especially those with intense mid-day sun much of the year, the weather commands a mid-day shut-down. The 2-5 pm siesta is the norm, or it used to be. There's a nap. People take one and don't feel guilty. Linner (lunch-dinner) is before or after.  Then the shops reopen, the malls fill up. Back to work.

Western nations eschew this as unproductive and a waste of time. The go-getter mentality that we associate with America isn’t, or didn't used to be thing in such countries, and it is why, according to the American work-ethos, the American economy thrived, prevailed over all others. 

That may be a be a thing of the past, that siesta,that shut-down, I’m not sure. But even if it is, consider that this is a less stressful lifestyle. The mental set associated with that changes bio-rhythms. People rest. The brain shuts down out of habit. 

PollyAnn-ish, probably, maybe untrue, women surely still second shifted. 

To bring it home, sum it all up, we all have bio-rhythms. 

Those of us who never had sleep problems in the past, who once shut down at around the same time, say 11 PM or even 4 PM for the sundowners are responding to their biorhythms. Our biology lets us sleep a solid 5-7 hours or more. 

Under stress, even before Covid-19 and the uptick in cortisol,  sleep is  interrupted, a problem under stress. We judge it as a problem. We can't function the next day, or so we think. 

In therapy we would discuss it, all of the stress, all of the things that buzz through the brain, and aside from venting, work at relaxation strategies. Breathing is the winner. You still breathe when you lie down to go to sleep. So focusing there is advised (see a recent previous post). It is very hard, but helps. 

Therapy addresses early awakening, too. Up at 3 or 4 AM? The recommendation: Don't give in and get up so fast, give it a half hour and DON'T check the clock. Watch the breath. If this isn't working, don't dwell on thoughts, do something, anything. Get up, drink a beverage without calories or caffeine. Be productive. If jet lag doesn't set in after a few hours begin your day and push through it. Whenever that feeling of inevitable sleep hits, give in. Disappear.

If at all possible. Make excuses. Take an hour and sleep. Set an alarm. 

In the process, especially when sleep is elusive, try not to judge it as a bad thing. Not judging is very Zen and it is crucial now. 

It also means no judging the nap. The nap is the bomb. The nap is life-saving, crazy-smashing. You've heard the expression that quarantine is crazy-making? The nap serves as the opposite when we are sleep-deprived.

And then there's the signature therapydoc recommendation, 
which would be that when you do nap, when you take that nap, if at all possible, do it with someone you love.

therapydoc

The Honeymoon is Over

While the last few weeks have been challenging, the visible among us rise to the challenge of isolation. We're using social media (I restarted my FaceBook account!). We want to check in on friends and family, really want to, as opposed to feeling that we must. Some of us are soothing our lonely souls with stabs at painting, reading, praying, and playing-- either solitaire, video or board games. What puzzle are you doing? Let me show you mine! All done. 

And yet, the honeymoon is definitely over. The most patient among us is feeling either claustrophobic or crowded, out of sorts, at least once or twice a day. even more than we do working outside the home. 

Your therapist will tell you that your mood ebbs and flows as the day wears on without isolation. Nobody isn't cranky sometimes. 

That over-crowded feeling is leading to arguments. I'm hearing about really explosions. The kids are scared. Tensions are boiling over. Consider yourself lucky if your quarantine relationships are in better shape. But people lose it. If they're healthy they apologize, work it out. 

But hey, that's my clinical population. The truly dysfunctional relationships aren't rising to the occasion. And we're hearing that domestic violence is skyrocketing, and marital sexual assaults are on the rise. No place to go to escape.

We'll look at one type of social dysfunction in this post: The Over-adequate Under-adequate Relationship

In this model someone is sick, either has a physical, mental, or behavioral disorder that sucks the air out of the room for the other(s). To be fair, attention is inevitably on a person who is sick-- it has to be. Nobody wants to ignore the needs of a helpless individual. When there's love and understanding, patience, and especially experience in care-giving or health care, the stress is less of a problem.* It is only dysfunctional when there are systemic issues going on. I.e., the one in the sick role

 (1) the 'helpless' partner, is liking it and isn't doing much to be less so.  Or

(2)  the helpers won't let the sick person do more, when he could. That could be for a variety of reasons, such as the fear that the condition will worsen. But also,

(3) it feels good to be a helper. It raises self esteem knowing we're helping someone who needs the help. Yet you can see how that need for an ego boost isn't helpful for a person who wants to flex a few of her under-employed muscles. 

Then there's another creepy reason, which is that

(4) having a sick person stay sick legitimizes avoiding avoidance. We can't . . . you know. 

No, not a thorough discussion but add your own thoughts by all means, in the comments. They are undoubtedly correct. 

And guess what? We're all in the inadequate role now! We're all being told to stay home, get help with the groceries if you can. If at all possible, for crying out loud Stay home! Don't go here, don't go there, don't do this, don't do that. 

Some of us rise can't take it and are going out anyway. Our self, the independent individual that we have become, needs air. And we wonder, how crazy are we, taking the chance of infecting someone else or being infected. Who me? 

Having our arms tied, legs shackled, we're rising to a new level of empathy, the feeling of what it's like to truly be sick, too weak to go out, that feeling we have when we're stuck in a hospital, for whatever reason, for having a baby on a sunny day.  

Back to the OA-UA

In this classic dysfunctional relationship someone is well and someone else is not. The well person can do more and usually does. The sick person does less-- she is under-adequate. Her partner (or child) does more, compensates, relates as over-adequate relationship. 

The therapy is always to get the over-adequate to do less, the under-adequate to do more. It's more complicated, but that helps.

Now we're all theoretically under-adequate, ordering fruits and vegetables to be delivered, doing as little as possible outside our four walls. This upsets the entire homeostasis we've been talking about.

TWO EXAMPLES

(A) Say it is the young adult in the family who always makes the beer run to the fridge for the adult alcoholic. The child is already over-adequate, a parental child we say. But she has enabled since the dawning realization that this behavior, getting daddy a beer from the fridge while he watches TV is rewarding. There's secondary gain, his love and admiration. 

How does that work when she can't get him a beer, when there is no more beer? He may not be as nice. She may be confused and have to re-examine the relationship. That could be good for her, or alternatively, the relationship might become even more dysfunctional. She may spend an inordinate amount of time trying to make her father happy, land in an even more co-dependent role.  

Or 

(B) What happens when the one in the sick role wants to raise the level of corona awareness with the one who is usually healthy, but incurably carefree? The sick partner pounds the healthy partner with instructions on mask-making, how many feet he must stay away from others, and wiping down his shopping cart with alcohol swabs. Will the "healthy" one not lose his cool? Will it become a horrible argument? Of course it will. This won't go over well, the sick telling the healthy what to do. It just feels wrong.

Suffice it to say that in a clinical population upsets like these aren't unusual. Now, more than ever before, they are what no one needs or wants. There is nowhere to go to cool down. Domestic violence is rising in these troubled times, as is marital sexual violence.  

 So much depends upon the relationship, right? In the above dysfunctional OA-UA relationship model  the therapy is about inching toward the center. The OA, the over-adequate partner, gives over some of the work to the UA, the under-adequate partner, who is to do more. They listen to the complaints of one-another and delve into the origins of learned dependency. Support, trust, and validation rule. This is not the time for criticism. 

Success depends upon tone, the process of expressing wants and needs, validation. 

We could say, as we did at the start of this post, that truly dysfunction families will still be dysfunctional in a crisis; the more things change, the more they stay the same. Or we use this as an opportunity to change them.

Yes, let's do that. 

therapydoc

*Watch Zoey's Extraordinary Playlist to see how that's done. You'll need insulin, but it's okay.