Goodnight Mind (13 page)

Treatable mood problems.
Certainly if you have depression, but even if you don’t, there is a close relationship between low mood and low energy. When you feel down, you are more likely to feel fatigued. There is also a vicious circle wherein the lower your mood, the more tired you feel, and the less you feel like doing anything; the less you do, the more likely you are to feel tired. Combat temporary low mood by distracting yourself and doing things that make you feel more positive. If your mood is more pervasive, you may be experiencing depression and should seek help. Depression is treatable.

Inadequately treated or managed pain.
Dealing with pain uses physical and emotional energy, which can cause you to feel fatigued. In addition, some conditions that cause pain may also cause fatigue.

Seek treatment for pain. Pain is manageable through a variety of approaches. This may include pain medications; there are a variety of non-narcotic medications available if you do not wish to take potentially addictive medications. Additionally there are proven psychotherapeutic approaches, including cognitive behavioral therapy for pain, that teach physical, mental, and behavioral techniques for addressing pain.

Talk to your health care provider about safe ways for you to continue to be active despite pain; it will help you manage fatigue as well as secondary pain (the pain that comes from consequences of inadequate activity, such as muscle shortening or deconditioning).

Anxiety and stress.
There can be a cycle in which you have sleep problems that make you anxious or create stress and the resultant anxiety or stress worsens and maintains your sleep problems. The same can be said of anxiety about fatigue. The more anxious you are about what your fatigue means for your future functioning, the greater your levels of fatigue will be.

Even if you are not explicitly anxious or stressed about your sleep problems, you may be someone who generally experiences high levels of stress and anxiety. People who are overly anxious or stressed keep their bodies in overdrive. The body often uses adrenaline to deal with anxiety and stresses, which, over time, causes fatigue to set in. The fatigue can also relate to chronic muscle tension. Attributing fatigue to sleep problems rather than anxiety may keep you from properly addressing an anxiety or stress-related problem. Follow the guidelines in chapter 6 to establish a relaxation practice and you will no doubt notice a reduction in your fatigue levels.

Immune system or allergic response.
Fatigue can be brought on by bacterial or viral infections such as colds and flus, autoimmune reactions, and food allergies. Your body uses a lot of energy to fight infection and deal with what it identifies as unwanted foreign substances, thus leaving you feeling fatigued. It is important not to assume that fatigue is related to poor sleep when it could relate to a treatable infection or an allergy.

Hormone-related problems.
In most cases, fatigue is a benign symptom, but it is also a fairly nonspecific symptom of many more troublesome disorders. Whenever you are faced with chronic fatigue, tell your doctor. Ask your doctor to check for some common hormonal imbalance disorders such as hypothyroidism, which is characterized by an underactive thyroid. Hypothyroidism can cause fatigue and is relatively easily treated with medication.

Summary

This chapter discussed how taking a second look at your beliefs that worrying is helpful and that having had a sleepless night handicaps you during the day can help you get better sleep in the future. It also provided a wake-up call that maybe your problems are about more than just sleep (or lack thereof). When you take steps to address other possible causes of fatigue and try to stay active and have a normal day in spite of insomnia, you will benefit. Don’t forget:

• Question your worries.
  
• Look for all the other common reasons for fatigue, rather than exclusively blaming sleep for how you feel during the day.
  
• It is normal to sometimes feel sleepy for up to an hour after waking up.
  
• Drink plenty of water; eat regular, well-balanced meals; and get regular physicals to check for fatigue-related problems such as vitamin deficiencies or hypothyroidism.
  
• Avoid rest or inactivity as a response to fatigue resulting from insomnia.
  
• Ward off fatigue that is the product of boredom and eye strain by taking breaks from monotonous activities.
  

Chapter 10

Accept and Be Willing: What You Resist Persists

S
o far we have given you tools to help you work with, rather than against, your body’s natural sleep system. We have given you tools to manage unwanted thoughts and worrying, anxiety, and other thoughts that worsen your sleep problems and/or fatigue. Some of these tools require practice and consistency before their full effect is felt. If you find it difficult to use one or more of these effective tools consistently, it may be because thoughts and feelings about your sleep problems get in the way. If this is the case, you may find this chapter particularly helpful. This final chapter discusses the important role of acceptance and willingness in helping you quiet your mind.

The Finger-Trap

You are probably no stranger to lying awake frustrated at not being able to sleep. When this happens, does your mind go around and around thinking about how you can get rid of your sleep problems or wondering why they persist? Do you notice things that interfere with your sleep, such as nervousness in your stomach, thoughts that won’t stop, bothersome noises, and pain in your body? Perhaps you do not think of sleep at all. You may be thinking about your day, tomorrow’s activities, or that you do not like lying awake.

Sleep problems can be frustrating and even upsetting. However, the greater your frustration and distress, the more difficult it is to sleep. So, should you try to
pretend
that you are not upset by your sleep problems? Not exactly.

Have you ever had your fingers caught in a Chinese finger-trap? The way a Chinese finger-trap works is this: You place your index fingers in each end of a soft woven tube and then your task is to get your fingers out. As you try to pull your fingers out, you notice that your fingers are gripped more tightly—you are trapped. The harder you pull your fingers, the tighter the tube becomes, making it impossible to escape. Brute force only makes the situation worse.

The solution to the finger-trap is a paradox. When you resist the urge to fight the trap and instead relax into it by pushing your fingers farther into the tube, you create more space and can release your fingers. When you choose to no longer struggle, trusting that it will be okay, the trap opens and you are free.

Think about difficulty falling asleep. The harder you try to sleep, the more elusive sleep becomes. As is the case for a Chinese finger-trap, the solution is to change tactics; rather than trying harder, relax into it. We are not talking about giving up. We are saying that a willingness to experience wakefulness and fatigue, rather than resisting them, may be necessary in order to get out of the sleeplessness trap.

Learn How to Accept

Jason Ong, PhD, is director of the Behavioral Sleep Medicine Program at Rush University Medical Center in Chicago. In his innovative mindfulness-based treatment for insomnia, he uses the poem “The Guest House” by Rumi to teach acceptance. “The Guest House,” which describes people as houses, suggests that emotion—whether joy, tension, frustration, or anxiety—is a visitor to be welcomed into your house. Welcoming unpleasant emotions and experiences such as wakefulness in the middle of the night, an overactive mind, frustration, fatigue, or tension may at first seem an unusual suggestion. However, the fact is that these unwanted guests are already at your doorstep. You may want them to leave, but you have little control over whether they will actually leave. Attempting to control that which you have little control over allows unwanted thoughts and feelings to dominate your house. Perhaps you can consider an alternative approach, much like the solution to the Chinese finger-trap. Invite bothersome thoughts or feelings, such as worry, frustration, anxiety, anger, sadness, or fatigue, into your house. This will put you in a calmer state of mind, opening the door to the guest you really want: sleep.

Be Open to Being Awake

“The Guest House” reminds us that being invested in making something
not
happen makes it more likely to happen. Trying to make something not happen takes up an enormous amount of energy and focus. What if you were open to being awake during the night? If you were open to the experience, you wouldn’t be as upset when it happened. In fact it is likely that you would still be calm enough to soon fall asleep.

Understand that being open to a situation is not the same as being happy about it—the suggestion is to be at peace with the way things are. Understand and accept that there is little you can do, and choose not to devote any more energy to resistance.

There is nothing inherently disastrous about being awake at night. Think of a time when being awake during the night was enjoyable. Think of one of your first sleepovers or when you spent the night with someone you love. In these instances it was enjoyable to stay up at night. When you cannot sleep, challenge the part of your experience that says, “This is horrible.” Instead, choose to engage in something enjoyable and peaceful outside the bed (see chapter 4 for suggestions) and you will have a different experience.

Be Open to Feeling Tired during the Day

After a night of poor sleep, you may feel tired. You may feel unmotivated and have trouble concentrating. You may think,
I am never going to be able to make it through today
, leading you to call in sick to work, cancel or avoid certain activities, attempt to sleep in, or take a long daytime nap.

In the same way that you can choose to accept being awake during the night, rather than staying stuck in a struggle against the experience, you can choose to accept feelings of tiredness during the day, rather than giving in to these feelings and reducing your activity levels.

If you choose to accept feelings of tiredness during the day, you can turn your attention to ways to cope with fatigue. What if, in the spirit of “The Guest House,” you were to say to yourself:
Okay, so tiredness is here; that’s fine. Tiredness is an unwelcome guest, but it is not going to stop me from doing what I normally do. I’ll control what I can. I will take frequent breaks from my work to manage eye fatigue/strain and boredom; I will get fresh air to provide mini-bursts of energy; I will drink lots of water to avoid caffeine and the crash that inevitably follows; I will accept that today may or may not be a difficult day because of the way I am feeling. It’s okay.
Try to adopt an accepting stance toward fatigue this week and notice the transformation in your experience.

Live in the Moment: The Time Is Now

When you worry, you focus on the future: you fear that something bad will happen and you will be ill-equipped to deal with it. If you are concerned that you will not sleep tonight, that tomorrow will be a bad night because of how poorly you slept, or that you will never recover from your sleep problems, you are focusing on a future that may or may not happen. A considerable amount of misery is attached to thinking about the future rather than your present reality. There is a simple solution to this unhelpful habit.

The solution is found in the present moment. You cannot know what will happen in the future, but the present moment is certain. There are no disasters in the room at the moment—only imagined ones in the future. Take a moment right now, at this moment, and notice what is around you. What do you notice about your surroundings? What do you hear? What do you smell? How does the temperature feel on your skin? If you are sitting, tune in to the places where your body comes in contact with the chair. If you are standing, focus on your feet touching the ground. What do you notice? Listen to your breathing. Feel the air move into your nose or mouth and down into your chest. Awaken your awareness to the present moment. The current moment is peaceful, and the current moment is more helpful for sleep than either the past or the future. Being mindful of the moment will help you accept what the current moment brings.

Practice Mindfulness by Creating Mindful Moments

Becoming more presently aware in the moment takes practice. One of the pitfalls to watch out for as you develop this skill is impatience. As you try to increase your awareness and be in the moment, your attention may stray. A common reaction to realizing that your attention has strayed is to become frustrated and become tempted to give up. Yet, the moment you realize that your attention has strayed is a moment of increased awareness of the present; this is part of the process and an opportunity for you to calmly redirect your attention to the present moment. Be patient; mindfulness takes time to develop. Remember Jon Kabat-Zinn’s parachute analogy from chapter 6, and think of taking the time to cultivate this skill as weaving your parachute.