By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I am a healthy, active 30-year-old woman. I have not slept through the night in over a year – I always wake up two or three times a night, restless and annoyed and unable to get back to sleep. Do you have tips/mental strategies for falling back to sleep easily? And what can I do to treat this? (I’d prefer not to take sleeping pills). The answer: Chronic sleep problems are very common and impact up to one-third of the population at any point in time. A much higher percentage of people will experience more short-term/transient sleep problems (often tied to particular events that are happening in their life, that resolve when those stressors resolve). The good news is there are very effective cognitive and behavioural strategies that can dramatically improve sleep length and quality. “Insomnia” is a broad term and can include trouble falling asleep, trouble staying asleep and/or early-morning awakening. There are a number of “usual suspects” that reliably and predictably impact our sleep:
You indicate you are healthy and active, which is great (as regular exercise will help improve the quality of sleep). But if you have not had a physical over the last year, I would encourage you to see your family doctor to ensure there is no other medical contribution (anaemia is a very common cause of sleep disruption for women in their menstruating years). If you are taking any prescription medications you may also inquire about whether they have any impact on sleep cycle/quality. Assuming there are no physical causes to your sleep problems, I would do an inventory of current stressors in your life. Worries and anxieties are a huge cause of sleep disruption. Identifying the stressors and taking an active, problem-solving approach to target those stressors would be important. It sounds counter-intuitive, but setting some dedicated “worry time” an hour or more before sleep can be helpful. Set aside 15-20 minutes to sit somewhere quiet (not your bedroom) and spend time thinking about and writing down all the worries that are on your mind that day. Ask yourself “what can I do about this right now”; if there is action to take, take it…usually though there is no immediate action that can be taken, and scheduling a time to deal with the problem can help get it out of your mind temporarily. Engaging in good sleep hygiene behaviours is important (sleep hygiene – like dental hygiene – refers to behaviours that promote good sleep and prevent later sleep problems). Finally, I am glad to hear you say that you are reluctant to take sleeping medications – although they can help with sleep for the short-term, sleep medications are habit-forming, they do not address the core issues that are contributing to sleep problems, and prescribing guidelines only recommend their usage for short, time-limited periods (usually 7-10 days only). The Canadian Sleep Society has some excellent, publicly available brochures on sleep. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth Why Practice Mindfulness – “I’m not good at it but I practice it anyway” Have you heard about mindfulness but are skeptical? Maybe you imagine mindfulness as meditation. You know the image we conjure, a person sitting cross-legged on the floor saying ‘ohm’, completely still and not thinking about anything. That’s not what mindfulness is! So, let’s talk about mindfulness, why I feel like I’m not very good at it but why I practice it anyway. What is mindfulness? Mindfulness is the practice of being present in the moment in order to prevent us from ruminating about the past or worrying about the future. It’s not an attempt to completely remove our thoughts but be aware of the things happening in the current moment. Think- being with ourselves and actually feeling our feelings. Why mindfulness is hard? One of the reasons I think mindfulness is hard is because we generally have an unrealistic expectation of what mindfulness is. Also, most people (myself included) don’t want to be bad at things and mindfulness is a skill you need to practice. I was first encouraged to engage in mindfulness practice when I started dialectic behavioural therapy (DBT). I’d heard of it before (at the time I was a psychology student in university) but I was skeptical about it being effective. The first exercise I was encouraged to do was a breathing exercise (which is very common with mindfulness practices, and I will talk a little bit more about later). The first handful of times I tried it, in many different variations, it was unsuccessful. Why? Because I was so fixated on being good at it that I missed the entire point of the practice. Rather than simply paying attention to my breath I was worried I was failing at it because I couldn’t breathe in or out for the total count they suggested. So, instead of being present I was focused on thoughts like ‘why am I so bad at this?’ and it actually made me feel more anxious. The first time I tried mindfulness was 2015, I believe, which is five years ago. I still practice mindfulness now and to be honest I don’t feel like I’m that much better at it. Why Practice Mindfulness Anxiety. I am an anxious person. I continually worry about things that’ve happened in the past, ruminating about small embarrassing moments and taking things people say out of context that convinces me they obviously hate me (they don’t!). On top of that, I spend an equal amount of time worrying about the things that could happen in the future. For me, something like simply test anxiety can turn into spirally thoughts. For example, that I’ll never graduate, or get a decent job, so I might as well quit now as my life is practically already over. Even though past evidence suggests this is untrue and will continue to be untrue. At the beginning of my time in therapy, I didn’t realize how much this prevented me from truly engaging with the present. Mindfulness works for anxiety. Despite all the research that says mindfulness works, I swore it didn’t for a very long time. Unfortunately, it just took a lot of practice and finding a way to engage with mindfulness in a way that made sense for me. (Not every way of practicing mindfulness is going to work for everyone). When we’re anxious, regardless of what we are anxious about, we get into our fight-flight-or-freeze response (our stress response). Mindfulness helps to break us out of that. One of the things we likely notice first when we start to feel anxious is our increased heart rate, engaging in a mindful practice helps to control our breathing which reduces our heart rate. What Mindfulness Practices Work for Me THE BASIC My go-to mindfulness practice is very basic. I use it when I notice myself getting fixated on particular thoughts or my thoughts are in an escalating feedback loop. I make sure to put away all distractions like my phone and my laptop. Sit in a comfortable position and close my eyes (I get too distracted by things in my environment but closing your eyes is not essential). Then pay attention to my breathing. I do not try to change my breathing, I just pay attention to it. While doing, it’s important to notice when thoughts enter your mind but let them go without judgement. For me, it’s helpful to say (or think) something like ‘this is just a thought I’m having’. When my fight or flight is engaged, and I am feeling less in control of my anxiety, I generally require a more focused mindfulness practice such as focused breathing or body scan. This gives my brain a little bit more to focus on which can sometimes help. FOCUSED BREATHING A focused breathing exercise requires a person to pay more attention to their breath as well as controlling it. One of the ways to do this is four stage breathing. The goal is to make each full breath last at least 10 seconds – 5 seconds on the inhale, and 5 seconds on the exhale. You do so by breaking each inhale and exhale into two parts: On the first inhale, fill up most of your lungs; on the second inhale, think about ‘topping up’ your lungs with air. On the first exhale, push out most of the air, and on the second exhale, think about fully emptying your lungs. This works better for me than some breathing techniques because there is less focus on counting which always throws me off and makes me feel like I’m failing. BODY SCAN I start in the same position as my basic mindfulness practice but ideally sitting on a comfortable chair with my feet on the floor. Then, while taking slow controlling breaths, I start at my feet and pay attention to all the sensations in each part of my body and then consciously think. For example, I think about how my feet feel inside my socks, how they feel pressed up against the floor and I may even wiggle them. Then move up my legs to my calves then my thighs, etc. Final Thoughts These are by no means the only ways to practice mindfulness, but they’re a decent place to start. Just remember that mindfulness works, but it takes practice. Don’t get discouraged; find something that works for you and try practicing it every day, not just when you’re feeling anxious. By Dr. Joti Samra, CEO & Founder of the Psychological Health & Safety (PH&S) Clinic and MyWorkplaceHealth The question:
I’m in my first real same sex relationship. After hiding my sexuality for years, I am finally ready to admit I am a lesbian. The woman I’m with doesn’t want to define me as her ‘girlfriend’ as she’s not admitting that she’s a lesbian. But we hang out every day, and I’m in love with her. My friends are worried about the lack of labels and defined commitment – I’m not, but should I be? The answer: The road to acknowledging and openly coming out about your sexuality can be a challenging and emotional one – so congratulations on taking what were likely some very difficult steps. It can be a wonderful and liberating feeling to no longer have to hide a core part of who you are from others. It may feel both exciting and scary to start to now embark on dating and relationships. Many individuals will say that starting to date after they first come out feels like adolescence all over again – which can be fun but also nerve-wracking at the same time! It is natural to be experiencing a range of emotions, including some nervousness, anxiety or insecurity. You may be having a number of questions about what you want out of a relationship and a partner. Defining and putting labels on the relationship is only important as it isto you – this is true for anyone, whether in a same or opposite sex relationship. You need to first ask yourself what it is that you want in a relationship at this stage of your life. As you well know from personal experience, the journey one takes to get to the point of coming out is a very personal one and can be made complicated by a number of factors. It sounds like you are at a stage where you are ready to openly and fully be in a relationship. You need to ask yourself whether you will truly be happy with someone who is at a different stage of acceptance about their sexuality. Selfishly, will you get what you need and want from this woman? You say this is your first “real” same-sex relationship. What is that you mean by “real”? You say that you hang out every day and that you are in love with her. Is there physical intimacy in your relationship? How does she feel about you? How does she define your relationship and how would she describe you and your relationship to others? You also say friends of yours are worried. Assuming that these are friends that love and care for you, and that have your best interests at heart, I wonder about where their concerns are coming from. I would ask them. Perhaps they have a perspective on your wants and desires that is hard for you to see right now. Although I don’t by any means want to convey that you should just blindly listen to your friends, often those we care about can see things that we are unwilling or unable to see when decisions get clouded by what our love for another. Ensure that you are getting what you need and what would make you truly happy in a relationship. Excerpted from Dr. Joti Samra’s “Ask the Psychologist” weekly column in The Globe and Mail. |
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