Sleep (Step 6 of 6)

Finally, the last step to the Therapeutic Lifestyle Change (TLC) six step program to beat depression without drugs.  Sleep.
How is your sleep? Do you toss and turn and struggle to get to sleep at night?  Do you wake up throughout the night, disturbing you from getting the essential slow-wave sleep your body needs?  Do you wake up too early and can't seem to fall back asleep?  Do you have anxiety at night?  Are you tired all day long but then can't sleep at night?  If you said yes to any of the above, then keep reading!
Sleep disturbances is one of the major symptoms of depression, but it is also a trigger for the illness. When our bodies are deprived of sleep, even for a night, our memory and concentration wanes, we get more irritable, our judgement is poor (I find that I eat unhealthy food when I'm tired), reaction time slows down, coordination and energy say bye bye and we get sick easier. (194)  Sick as in colds and flu's but also as in depression. Anything we can do to improve our sleep will help fight off depression, and also prevent a future episode from occurring.
Fortunately, most of the steps in the TLC program can help with your sleep.  Exercise, as well as bright light in the morning (or at night depending on your sleep problems), help your internal body clock and sleep drive stay balanced.  Even our Omega 3s, anti-ruminative activity and social connection our beneficial - "by helping slam the brakes on the brain's stress response circuits - improving both the quality and quantity of sleep" (194).
So how much sleep do we need?  "Most adults need about eight hours of sleep each night for optimal physical and emotional well being" (195).  However, some people can manage perfectly on six or seven, while others might need nine.  Dr. Ilardi recommends starting with eight hours of sleep and after a few weeks, adjusting those hours to your needs.
Okay, so sleep is good, but it's not as easy as it sounds. I will go to bed and then toss and turn until 3 or 4 in the morning, Sleep sometimes feels impossible for me. What's my problem?  Dr. Ilardi discuss three variations of sleep disturbances.

The most common form in depression is known as terminal insomnia: waking up too early, usually an hour or two before intended, and being unable to fall back to sleep.  Middle insomnia, is marked by frequent awakenings throughout the night, is also fairly widespread.  The final variety-onset insomnia-is a hallmark of seasonal affective disorder and many forms of anxiety; it refers to an initial inability to fall asleep at night.

I have the last one, onset insomnia.  Remember how in my first blog I talked about some of my symptoms of depression.  "I still have anxiety off and on for no apparent reason at all.  For example, I will be laying in bed at night and my heart will start to flutter and race, but I have no idea what thought triggered me to start freaking out."  I never knew it actually had a name.  Onset insomnia.  I used to think it was because I had a lot on my mind and couldn't turn my brain off, but maybe it had something to do with my depression the entire time.  However, there is hope without Ambien, and all last week I took the following "Habits of Healthy Sleep" into consideration and was falling asleep within 30-40 minutes, which is a record for me.

Conditioning Your Body to Sleep

• Habit #1:  Use the Bed Only for Sleeping (200-201)
• Anytime you've been lying awake for fifteen minutes, get up, leave the bedroom, and do something relaxing until you feel drowsy enough to return to bed.
• Avoid getting into bed anytime you aren't already drowsy. If you go to bed just after watching a scary movie, surfing the Internet (bright light), or exercising, your throwing yourself into bed just to hop right back out.  Instead do activities that are relaxing, not arousing.
• Anything you do to increase your drowsiness should be done somewhere other than the bedroom.  For example, I used to play games on my phone at night to increase my drowsiness, or read.  Now I do this all on my couch, not in my bed.  Your bed should be associated only with sleep, not the state of being awake.
• You can make an exception in the case of sex.  Of course you were wondering, right?  Sex apparently helps you sleep and is associated with positive happy feelings, which in turn will help you associate sleep with good feelings, not anxiousness.
• Avoid sleeping anywhere other than your own bed.
• Habit #2: Get Up at the Same Time Every Day (201-202)
• All of us have a sleep meter in our brain that helps set our sleep drive.  You can boost your sleep drive by getting up at the same time every day, which is hard, especially on the weekends, but it's essential to help sleep disturbances.
• Habit #3:  Avoid Napping (202-203)
• "Simply put, anytime you nap, it strongly reduces the brain's sleep drive, which then sets you up for potential insomnia later that night.  There is also evidence that napping can cause a reduction in restorative slow-wave sleep" (203)  Though if you have healthy sleep already, napping doesn't seem to harm your sleep pattern.
• Habit #4: Avoid Bright Light at Night (203-205)
• If you are around bright light at night, your sleep drive can't kick in unless its around night time light (low light settings).  Do not use your computer an hour before bed time.  Do not watch TV in bed, and keep your bed room pitch black while you sleep.  If you use a light box, make sure you use it in the morning (unless otherwise directed).
• Habit #5: Avoid Caffeine and Other Stimulants (205)
• Stimulants like caffeine and nicotine really screw with your sleep drive.  "Caffeine has a typical half-life in the body of about four hours. (This means that every four hours, your blood level drops by 50%.)  So, let's say you have a strong cup of coffee-with 200 milligrams of caffeine-at noon.  By 4:00 in the afternoon, you still have 100 mg of caffeine in your body, and at 8:00 pm, there's still 50 mg in your system.  Even at midnight, you're left with 25 mg of caffeine coursing through your veins; that's about the equivalent of a cup of green tea, and it's enough to disrupt your sleep" (205).
• Habit #6: Avoid Alcohol at Night (205)
• A lot of people use alcohol as a way to get drowsy at night, but it will interfere with your sleep, causing you to wake during the night and feeling exhausted all day.
• Habit #7: If Possible, Keep the Same Bedtime Every Night (205)
• By going to sleep at the same time every night, your sleep drive will kick in about 30-40 minutes before bed time habitually.
• Habit #8: Turn Down the Thermostat at Night (205-206)
• "There's evidence that a mild drop in temperature at night helps increase sleep drive" (206).  Dr. Ilardi suggests dropping your thermostat 5 degrees an hour before bed time.
• Habit #9: Avoid Taking Your Problems to Bed with You (207-209)
• For most people, and especially depressed people, bed time is when you dwell on negative thoughts or worries you have.  When you ruminate, it stirs your brain's stress response circuits, and in turn, makes it super hard to sleep.  Dr. Ilardi suggests mental activities, (no not counting sheep, but kind of), to help get to sleep at night.  I actually tried a few of these and they work!
• Replay scenes from a favorite movie in your head.  I keep replaying scenes from Love Actually.  It's a happy movie, nothing scary or stressful about it.
• Visualize a relaxing scene.  I did this one too.  I took myself back to Costa Rica on the beach.  Oh how I love it there!
• Play a round of golf in your mind's eye.  Um, no thanks.
• Use progressive muscle relaxation.  This is a technique that I actually learned in high school for volleyball.  Simply tightening and then relaxing each major muscle group in the body, somehow relaxes you and distracts your mind from rumination.
• Use another proven relaxation technique.  Diaphragmatic breathing involves learning how to inhale and exhale slowly and deeply from the diaphragm.  Autogenic training  makes use of guided imagery to create a pleasant feeling of warmth in each party of the body.
• There are also things you can before you actually get into bed.
• Talk things through with a trusted confidant.
• Write down your ruminative thoughts.
• Fill your mind, right before you go to bed, with explicitly positive thoughts and images.
• Habit #10: Don't Try to Fall Asleep
• This has actually been the number one thing that has helped me.  Before I would stress about sleep.  I would anxiously watch the clock as my sleep hours would tick away and the more stressed I got, the harder it was to sleep.  "Sleep can never be stalked and caught - like some sort of wild animal -  when you hunt it with intense, focused effort.  Instead, it will appear unbidden, sneaking up on you gently after you've fully let go of the struggle" (209).  These two sentences are something I remind myself of every night.  If I just let go of my worry for sleep, my less worried self, falls asleep much faster.

I highly encourage you to get the book if what you read here has peeked your interest.  It seems like a lot to take in, a lot of changes you must do, but the nice part about the book is the week by week implementation process.  Dr. Ilardi doesn't think anyone should just do all of these six steps at once, but instead invite each step in every week.  I'll be blogging at least once more about The Depression Cure and I will go over this guided process, as well as, road blocks that might occur.