Empowering Yourself with Mindfulness: Attending Intentionally to What Matters in This Moment

By Annabelle Parr

We wake up each day to a new series of updates about coronavirus and its wide reaching effects: perpetually breaking news stories with new research, new statistics, new predictions, new guidelines, new stressors. Our attention is yanked like a yo-yo by the instant and constant stream of news in the palms of our hands. Additionally, attending to what used to be a basic task – grocery shopping – now feels like a massive feat involving lots of planning and caution. For those with kids at home, we are trying to attend to their needs, their schoolwork, and their emotions, even as we do our best to navigate working simultaneously.

Where we used to have separate spaces for separate parts of our lives, at least to some degree, we are now navigating the jumble of integrating every facet of our lives into one space: our home. With so many demands and pressing issues competing for our attention constantly, it’s easy to feel overwhelmed. It’s easy to feel like our minds have been hijacked in the same way that it feels our lives and routines have been.

This is hard, AND…

Yes, this is a scary and difficult time. Yes, there is a seemingly endless list of stressors to occupy our anxious minds. Yes, there is a lot of uncertainty and only so many variables within our control. AND. We are not helpless or powerless. As our hearts are flooded with emotions, our minds retain their ability to make choices about how to proceed when faced with the facts and the resulting feelings. We can choose to empower ourselves within situations in which our control over external variables is limited.

What does it mean to empower ourselves during COVID-19?

When I say that we can empower ourselves, I don’t mean that we can empower our way out of our pain. Our pain – our fear, our anxiety, our grief, our anger – is a natural human response when faced with loss and uncertainty, of which we are all getting an enormous dose. Our pain simply is. It is here for good reason, and it often points directly toward what matters most to us. It deserves to be felt and heard.

Empowering ourselves involves increasing our psychological flexibility in service of greater meaning.

When I say that we can empower ourselves, I am drawing on the wisdom of Acceptance and Commitment Therapy (ACT), which says that suffering is a result of psychological inflexibility. When we increase our ability to think and respond flexibly in the face of pain and stress, we empower ourselves to make choices based on our values. We reduce the struggle that comes from fighting with our pain – as if that were the battle to be won – and we free ourselves up to pursue that which brings meaning to our lives.

In his beautiful work Man’s Search for Meaning, Holocaust survivor, psychiatrist and creator of logotherapy (another form of therapy grounded in meaning), Viktor E. Frankl (1959) stated “that everything can be taken from a [person] but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way” (p. 66).

What if I feel guilty for focusing on meaning when basic needs demand my attention?

It may feel incredibly difficult or even indulgent to consider what brings us meaning when we are facing such a collective threat to our health and our financial stability. It may also feel trivializing to invoke the words of a Holocaust survivor here, as even though what we are facing is difficult, it is nowhere near the level of the atrocities which Frankl witnessed and endured.

Yet he suffered such unfathomable horror, pain, and loss, that the wisdom he emerged with certainly seems worth attending to during our own trying times. Additionally, suffering is not something that is meant to be compared. Frankl (1959) himself noted, “suffering completely fills the human soul and conscious mind, no matter whether the suffering is great or little. Therefore, the ‘size’ of human suffering is absolutely relative” (p. 44).

In other words, we do not have to experience the rock bottom of human atrocity in order to allow ourselves space and self-compassion for our emotional experience in the midst of suffering. This is hard. Your pain makes sense. 

An important piece of the psychological flexibility puzzle is mindfulness.

So, how exactly do we empower ourselves to become more psychologically flexible? A good place to start is with mindfulness, or present centered awareness. Jon Kabat-Zinn (1994), founder of mindfulness-based stress reduction, succinctly defines mindfulness as the ongoing practice of “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” (p. 4).

In her book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, & Stress Using Mindfulness & Acceptance, CSAM director Dr. Jill Stoddard (2019) invites us to imagine that when we are not engaging mindfully, we are like airplanes on autopilot. Not fully present to what is happening inside and outside of our skin, we are running on muscle memory. We are still making choices for which we are responsible, but we are not totally conscious of the fact that we are doing so.

It is easy to get lost in this space. When we are running on autopilot, we are more likely to react rather than respond: “if your autopilot has commandeered the cockpit, the space between intense emotion and response is utterly nonexistent, leading to an instant, impulsive reaction. It’s as if the intense emotion is a detonator and the reaction is a bomb” (Stoddard, 2019, p. 45). 

Sheltering in place during a pandemic is likely to create some intense emotions and difficult circumstances to which we may react. If we are on autopilot, we are much more likely to react in unhelpful ways, like lashing out at our loved ones and communicating ineffectively. Additionally, when we are on autopilot we may be unaware of what we are actually feeling and experiencing. We may be more likely to numb out in unhealthy ways, and less likely to attend to the things that help care for our minds and bodies. Also significant, we are likely to miss the little nuggets of joy that fly by us as we zone out into the distance.

So let’s flip it around. What does mindfulness empower us to do? When we show up to each moment mindfully, that is, we focus our attention on purpose, in the present moment, non-judgmentally, we are able to….

• Notice and identify our emotions. Our emotions can span the full range of experience, from afraid to anxious to stressed to exhausted to angry to sad to grateful to joyful. Remember, the purpose of mindfulness is not to judge our experience, but simply to notice it.

• Choose how we internally respond to our own emotional experience. Responding gently, with the same kindness and compassion we might have for ourselves as children, for our child, for our friend, or for another loved one is generally a good place to start.

• Choose action in line with the kind of person, partner, parent, friend, employee, citizen, etc. that we want to be. It can be helpful to consider the qualities of being you aspire to embody, such as being compassionate, loving, loyal, diligent, reliable, kind, etc. Then you can purposefully choose to behave in a way that aligns with your personal values.

• Choose what we point our attention towards. This is especially important right now, given that our smartphones are perpetually present and can alert us to every single news update all day long. It’s important to stay informed enough to stay safe and responsible, but that doesn’t mean we are required to be glued to the news all day. When we are more present, we can make a choice about when we decide to update ourselves, how often, and for what purpose. It’s also easy to mindlessly let the day slip away watching Netflix or going down some other rabbit hole of distraction. It’s okay to watch Netflix or to let ourselves be unproductive, but it’s important that we connect with our intention and our reason for our behavior. When we watch our favorite show mindfully, we get to actually engage with it from a place of enjoyment so that we can return to our other tasks more rejuvenated.

• Be present to the things for which we are grateful. When we are more fully present to the moment, we give ourselves the opportunity to appreciate the sweetness in small moments we might otherwise miss. As much as this period of time is full of tragedy, there is goodness to be found if we know where to turn our attention. John Krasinski is working on helping us out here, with Some Good News. But we don’t need a celebrity news channel to tune in to gratitude and goodness. There is goodness to be found in the gift of time with our loved ones, watching our children play together, waving to neighbors from a solid 6 ft. + physical distance, or reconnecting virtually with friends we rarely find time to talk to under normal circumstances. Mindfulness allows us to be present to the joys when they show up and to actively cultivate engagement with the things that bring us meaning; we might just have to be a bit more creative in how we engage those things right now.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

References

Frankl, V. E. (1959). Man’s search for meaning. Boston, MA: Beacon Press.

Kabat-Zinn, J. (1994). Wherever you go there you are: Mindfulness meditation in everyday life. New York, NY: Hyperion.

Stoddard, J. A. (2019). Be mighty: A woman’s guide to liberation from anxiety, worry & stress using mindfulness & acceptance. Oakland, CA: New Harbinger.

How to Seek Therapy During Social Distancing and COVID-19: Telehealth Services for Anxiety and Stress Management

by Annabelle Parr

Within just the last week, most of us have gone from living our lives as usual to an entirely new pace of life and day to day routine: working from home, homeschooling cooped up kids, adhering to social distancing guidelines to keep ourselves and our communities safe and healthy, etc. As we navigate the COVID-19 pandemic together (yet apart), we are faced with a number of unique stressors in addition to the ones that we might already have been managing, and this may mean that we are experiencing increased anxiety.

Anxiety and fear are specifically designed to help us prepare for and respond to threats.

As Dr. Jill Stoddard put it in her new book, Be Mighty: A Woman’s Guide to Liberation from Anxiety, Worry, & Stress Using Mindfulness and Acceptance, “by simple definition, anxiety is a state of future-focused readiness to deal with potential unpleasant events; this is related to but different from fear, which is a more acute reaction to an in-the-moment perceived threat (Barlow, 2002).” It makes sense that many of us would be experiencing both anxiety – as we are grappling with an enormous amount of uncertainty regarding the future health and financial stability of our nation and our families – and fear, as we are facing an immediate threat to our individual and collective wellbeing.

Feeling anxious right now makes sense. Be gentle with yourself.

One important piece of self-care during this time is to recognize and honor our feelings. Anxiety has a purpose: it is specifically designed to motivate us to prepare to manage threats. It makes sense to feel anxious and afraid. A certain amount of anxiety and fear are adaptive in this situation; they are here to remind us that something is amiss. And stress can help us to adjust our behavior in response. As Kelly McGonigal (2013) pointed out, stress releases a combination of adrenaline and oxytocin, which are hormones designed to prepare us for action and to prompt us to connect, increase empathy, and seek and give care to others. All of these feelings are evolutionary responses designed to kick in in moments like this. So as always, responding to our emotions with self-compassion is crucial.

How do I know if my anxiety has gone too far?

If you are finding that the anxiety and stress you are experiencing during this time are impacting your ability to function – that is, if these feelings are negatively impacting your relationships, your sleep patterns (e.g. causing insomnia or impairing your ability to fall or stay asleep), your ability to attend to tasks needed to care for yourself or your family, or you are finding these feelings overwhelming and are unsure how to cope with them – support is available.  

Can I still seek therapy with social distancing requirements?

Despite the fact that we are required to maintain distance from each other and stay in our homes (except for essential work and errands or a walk/run/bike ride outside maintaining 6 feet between ourselves and others) it is important to know that you can still seek and receive therapy amidst COVID-19. Many therapists, including those here at The Center for Stress and Anxiety Management, have shifted to utilizing telehealth in order to both adhere to COVID-19 guidelines and still attend to patients’ mental health needs. Telehealth sessions expand access to care, as they allow therapists to work with anyone living in the state in which they are licensed (CSAM therapists are available to work with anyone in California). Also important to note is that studies have shown therapy via videoconference to be as effective as in person therapy. It is crucial that those who need support during this time are able to access quality care they need, and telehealth allows mental health providers to ensure it is available.

CSAM IS HERE TO HELP

If you or someone you love needs support and might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, insomnia, or stress related to COVID-19, or if you would like more information about our telehealth services, please contact us at (858) 354-4077 or at info@csamsandiego.com

Treating Insomnia with Cognitive Behavioral Therapy

By Annabelle Parr and CSAM Insomnia Expert Dr. Melissa Jenkins

We all know what it feels like to get a bad night’s sleep. You know you have a big day tomorrow, but you watch as the minutes and hours tick by as sleep feels elusive. Or you fall asleep but you toss and turn, dreaming about that presentation you have to give at work. You finally fall into a deep sleep and it feels like that is the moment the alarm goes off. A bad night’s sleep on occasion is pretty typical – when we are super stressed it can be harder to sleep soundly.

When sleep – or lack thereof – becomes a problem…

But for some of us, bad sleep becomes a pattern. It can become a vicious cycle with loads of stress and a lack of sleep where it’s hard to tell what’s causing what. How can you tell if your poor sleep quality is typical or whether it might be time to get some help?

Is it a few bad nights or is it insomnia?

The DSM-V defines insomnia disorder as difficulty falling asleep, difficulty staying asleep, and/or waking up too early and being unable to return to sleep for at least 3 nights per week, lasting at least 3 months. The sleep difficulties must also cause significant impairment in important areas of functioning (such as work, relationships, school, etc.), and occur despite enough opportunity for sleep. It’s also important to rule out whether sleep difficulties are due to another disorder – sleep disorder or otherwise – and are not the result of substance use.

When to seek help…

Though full clinically diagnosable insomnia has fairly specific criteria, if you are unable to sleep well often enough that it is having a negative effect on your day to day life, it’s worth talking with a professional to see how you might get better sleep. It’s a common misconception that sleep difficulties require medication – such as sleep aids – to be alleviated. However, medication is often a short-term solution, like a band aid; in order to achieve long-term results, it’s important to address the underlying problem.

People don’t often think that therapy can help them with sleep – especially if it feels like sleep is the main problem rather than a byproduct of anxiety. However, there is a particular form of therapy entirely dedicated to the treatment of insomnia: Cognitive Behavioral Therapy for Insomnia (CBT-I).

What is CBT-I?

CBT-I involves a number of elements, and is based on helping the client learn strategies that will help facilitate better sleep. According to Dr. Melissa Jenkins, CSAM’s resident insomnia expert, CBT-I focuses on improving the quality and quantity of one’s sleep. Dr. Jenkins explains some of the core therapy components include… 

Sleep efficiency therapy: People frequently say there is no pattern to their insomnia, a very common yet frustrating experience. A skilled CBT-I therapist can help make sense of otherwise confusing sleep patterns. By first examining what your current sleep (or lack thereof) looks like, a CBT-I therapist then guides you to change your sleep schedule. This strategy can greatly improve your quality of sleep. It often involves making significant changes to when you go to bed and when you wake up. These changes are often counterintuitive! People with insomnia often find this one of the most difficult but most effective parts of CBT-I. With the help of a skilled therapist, you learn how to regain control over your sleep.

Stimulus control: After extended periods of not being able to sleep in one’s bed, bed often becomes a place of stress (not rest!). The body becomes primed to be alert in bed, the exact opposite of what we need to be able to fall asleep. So, we often say the brain needs to be re-trained!  A CBT-I therapist helps re-train your brain so that you can once again sleep when and where you want to. This involves looking at what you currently do when you cannot sleep as well as things you do in your bed and bedroom that are possibly maintaining insomnia (e.g., watching tv, reading).

Sleep hygiene and psychoeducation: Another important element of CBT-I is helping you to understand the host of habits that contribute to sleep quality. Sleep hygiene involves everything from the food we eat, to the substances (such as caffeine and alcohol) we consume, the environment in which we sleep, the times of day in which we engage in particular activities such as exercise, our exposure to light (natural and artificial), and our routine leading up to bedtime. It’s not all intuitive, but when we know what can help or hinder our shut eye time, we are empowered to improve our own sleep and our health overall. CBT-I can also help teach natural ways to “trick” the body to either increase sleepiness for bedtime or alertness for optimal daytime functioning.

Relapse prevention: The goal of therapy is to give you the tools you need to create change and empower you going forward. The relapse prevention stage of CBT-I involves consolidating gains made in treatment to maintain good sleep going forward. Helping you to recognize potential triggers for an onset of acute (short term) insomnia and providing you with the tools for preventing relapse back into chronic insomnia is critical. Also, if you need to come back to therapy for a tune up, good news! Clients who return to therapy for a tune up during a relapse tend to recover quickly.

Additional therapy components: Other important aspects of treatment can include stress management and cognitive therapy (how the way you think may be triggering or perpetuating sleep problems).

At the end of CBT-I, the goal is to become your own sleep doctor: To put you back in control of your sleep and to know what to do if problems return in the future. Over the course of CBT-I, you can also learn how to determine your optimal amount of sleep (which is often different than the common myth that everyone needs 8 hours!). CBT-I is short term and typically includes 7 or 8 sessions, but can vary depending on individual needs. Treatment, while structured, is tailored the specific person and their behaviors. CBT-I is offered in individual therapy or group therapy.

Announcing: CBT-I group therapy is available at CSAM!

Interested in learning more about or receiving CBT-I? Dr. Melissa Jenkins is CSAM’s resident insomnia expert! She offers individual and group CBT-I, and is currently accepting clients for a CBT-I group waitlist in our Carlsbad office. For more information, please contact us at 858-354-4077 or at info@csamsandiego.com

How Do I Know If I Need Therapy?

By Annabelle Parr

Each May we celebrate Mental Health Awareness Month to draw attention to and reduce stigma around mental health issues. According to the National Alliance on Mental Illness, or NAMI, 1 in 5 people will be affected by mental illness in their lifetime. And as we discussed last May during #CureStigma, “while 1 in 5 Americans are affected by a mental health condition, 5 in 5 Americans know what it is to feel pain. The frequency, intensity, and duration can vary, but pain itself is a function of being human. When culture stigmatizes the 1 in 5 and simultaneously dichotomizes illness and wellness, the resulting message is that it is shameful to struggle and to feel pain. In essence, stigma says that it is shameful to admit our own humanity.”

Do I need therapy?

Given that all of us will at some point encounter painful experiences and emotions, this year we are discussing how to know when it might be helpful to seek therapy. Though it may be clear that those affected by a previously diagnosed mental health condition could benefit from therapy, for those who are either undiagnosed or are struggling with anxiety, stress, grief, sadness, etc. but do not meet diagnostic criteria for a mental health disorder, it may be harder to discern whether therapy is warranted.

How am I functioning in the important areas of my life?

For nearly every condition in the Diagnostic and Statistical Manual (DSM-V; APA, 2013), clinically significant impairment in an important area of functioning is a required criterion to receive a diagnosis. In other words, the presenting symptoms must be making it very difficult to function at work or school, in relationships, or in another important life domain (e.g., a person is feeling so anxious that she is not able to make important presentations at work, or so stressed that he is finding it difficult to connect with his loved ones).  When life has begun to feel unmanageable in some capacity, or if something that was once easy or mildly distressing has become so distressing it feels impossible, it may be worth considering therapy.

Could things be better?

It’s also important to note that you do not have to feel as though things are falling apart before you seek professional counseling. Therapy can be helpful in a wide range of situations. It can help you not only navigate major challenges or emotionally painful periods, but also can enhance your overall wellbeing by helping you to identify your values and lean into them. Maybe things are going fine, but could be better. A therapist can help you identify what could be going better and can help you learn to fine tune the necessary skills.

I want to try therapy, but where do I start?

Whether things feel totally unmanageable or it just feels like they could be better, it’s important to find a therapist with expertise relevant to what you would like assistance with. Working with children requires different expertise to working with adults, just as working with couples and families requires additional expertise to working with individuals. Different conditions also correspond with particular evidence based practices. For stress and anxiety disorders – including social anxiety, generalized anxiety, panic disorder or panic attacks, and phobias – evidence based practices include Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT). The gold standard of treatment for obsessive compulsive disorder (OCD) is Exposure and Response Prevention (ERP), and evidence based treatments for PTSD include Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) (all of these—ERP, PE, and CPT --fall under the CBT umbrella). So no matter what you are seeking treatment for, ensuring that the therapist you choose has expertise that aligns with the types of concerns you are struggling with is critical. For some more tips on finding and choosing a therapist, click here and here. For more information on the different kinds of licenses a therapist may have, click here.  

Though there is no right or wrong answer as to whether or not you need therapy, if you are unable to behave in ways that make life manageable and/or fulfilling because of difficult thoughts or feelings, you may find therapy beneficial.

CSAM IS HERE TO HELP

If you or someone you love might benefit from cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT) for anxiety, panic, phobias, stress, PTSD, OCD, or insomnia, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at info@csamsandiego.com

HOW TO SLEEP BETTER WITHOUT SPENDING ANY $$$ ON SLEEP MEDICATION

a guest blog repost by Alisa Palioni

Do you often find yourself lying awake at night, staring at your alarm clock as it ticks away the time? Or, do you wake regularly during the night, leaving you feeling as if you haven’t slept at all?

According to the National Sleep Foundation, nearly half the population reports suffering from at least one symptom of insomnia (difficulty falling asleep, frequent nighttime awakenings, waking up too early, and waking up feeling unrested).

Many of your daily habits likely play a bigger role in your nightly struggles than you think. Both our ability to fall asleep, and the quality of sleep we have are highly dependent on a variety of external and internal stimuli.

Learning about how each activity impacts your sleep patterns can help you make changes and finally get a good night’s rest.

1. Exercise

Why An Exercise Routine Helps Regulate Sleep

Body heat: Part of the natural changes our circadian rhythm brings about over the day are changes in body temperature.

The rise and fall of our body temperature associated with exercise mimics the natural fluctuations which lead up to sleep.

This can be enough to gently nudge your circadian rhythms back into ideal synchronization if exercise is performed at the right time of day. 1

Beneficial stressor: Exercise is a “beneficial stressor” in that it activates sympathetic nervous system (our flight-or-fight response). Your body compensates by increasing the time spent in deep sleep - leaving you feeling more rested. 

Decrease stress, anxiety and depression: Many of us experience difficulty falling asleep due to ruminating thoughts related to real or perceived stress.

Exercise has been scientifically proven to reduce reactivity to stressors, so that we are better able to manage stressful situations when they come our way.

It has likewise proven itself to be effective in reducing the symptoms of anxiety and depression. 2

What Kind Of Exercise Should I Do?

When it comes to improving your quality of sleep, aerobic exercise wins. Numerous studies have documented the efficacy of regular aerobic exercise programs for treating chronic insomnia. 

Aerobic exercises (“with oxygen”) include any that involve sustained activity which requires the body to consume large amounts of oxygen, such as walking, swimming and biking.

Whereas, weight training and sprinting are anaerobic exercises. While an important component of a healthy lifestyle, these activities are not effective for promoting sleep. 3

What Time Of Day Should I Exercise?

While fitting in exercise whenever feasible for your lifestyle can go a long way towards improving your sleep, studies have shown that exercising in the late afternoon or early evening has the greatest impact.

The reason for this relates back to how exercise promotes better sleep: In order to take advantage of the drop in body temperature you’ll want to complete your workout approximately 3-5 hours before bedtime.

How Long Should I Exercise?

While exercising for 15-45 minutes daily is the optimal duration; however studies have shown that 150 mins/week is sufficient to see improvements in quality of sleep up to 60%.

2. Diet

Your diet impacts your sleep through more means than just providing calories: What we eat and when we eat it can enhance or inhibit our sleep.

Foods That Inhibit Sleep

While some foods are well known for their ability to interfere with sleep, other dietary staples are equally responsible for keeping you up at night.

1. Coffee: Caffeine has a half-life of 5 hours: which means that 10 hours after drinking your coffee, 25% left in your system; and 20 hours later 12.5% of the caffeine still remains.10

So, while an early afternoon coffee as a post-lunch pick-me-up may seem like a good idea, it might be what is keeping you up at night.

2. Alcohol: Alcohol is a little more tricky in how it affects sleep; because it causes drowsiness many mistakenly believe that a drink can serve as a sleep-aid.

However, research has shown that while alcohol increases slow-wave sleep during the first half of the night, it actually leads to an increase in sleep disruptions during the second half. 4

3. Chocolate: Chocolate, particularly dark chocolate, can contain high levels of caffeine and thus needs to be treated similarly to coffee and other caffeinated beverages. 

In general try to avoid any kind of sweets in the evening though since it will not only improve your sleep but your overall health as well.

4. Spicy Foods: Capsaicin - the molecule which gives your spicy foods that kick - can causes changes in body temperature that can cause a disturbance in your circadian rhythms if consumed late at night.

5. High-Fat Foods: We all know that certain unhealthy fats negatively impact our health; but there’s also evidence that they may be keeping you up at night.

Animal studies have shown that high-fat diets are associated with more fragmented sleep, along with excessive daytime sleepiness.

Researchers speculate that this may be linked to the neuro-chemical orexin -- which plays an integral role in our sleep-wake cycles. Rats who were fed high-fat diets showed a decrease in orexin-sensitivity. 5

Foods That Promote Sleep

There are many foods that are lauded for their ability to promote a better, more restful sleep. These are the key components you want to be on the lookout for when planning your bedtime snack:

1. Magnesium and potassium: One of the symptoms of magnesium deficiency is insomnia, so you’ll want to load up on healthy sources of this mineral such as leafy greens, beans and lentils, and bananas. 6

Magnesium and potassium promote muscle relaxation, and thus not only help you feel more comfortable but can help deal with nighttime leg cramps.

2. Tryptophan: Tryptophan is an amino-acid found in both animal and plant proteins. Our bodies use tryptophan to create serotonin -- a neurotransmitter involved in both mood regulation and sleep cycles.15

Many foods are great natural sources of tryptophan, such as milk, bananas, peanut butter and walnuts.

3. B Vitamins: B vitamins are essential for both the synthesis and release of certain neurotransmitters and hormones that are part of the sleep-wake cycle: such as serotonin and melatonin.

Supplements are often prescribed to treat restless-leg-syndrome - a nighttime movement disorder which significantly disrupts sleep.

However, there’s no need to take a supplement. You can get your fill from legumes (chick peas), dark green vegetables, whole grains and fish. 7

4. Theanine: Theanine is yet another useful amino acid when it comes to treating sleep disorders. Research has shown that administering a theanine supplement improves sleep quality and increases sleep efficiency, while decreasing nighttime awakenings.

There is one superfood packed with theanine: Green tea. However, while green tea has significantly less caffeine than a cup of joe, it is recommended to opt for the decaffeinated kind if your goal is a good night’s sleep. 8

5. Melatonin: Melatonin is naturally produced by your pineal gland under direction of your circadian rhythms and is what makes us feel sleepy as we near bedtime.

It usually begins to release around 9 p.m. and remains at a high level for the next 12 hours, throughout the night into the next morning.

While there are certain foods that contain melatonin, you can also purchase this essential sleep-inducing hormone in capsules at your local pharmacy or health food store.

Taken at the right time of day, and in the right dosage, melatonin supplements can help reset your biological clock to optimal levels and is often used as a natural treatment for sleep disorders.19

However, you don’t need to take supplements: simply add tart fruits, like cherries and pineapples, to your diet. Oats, walnuts and bananas are likewise great natural sources of melatonin.

Here are some more foods that will help you to sleep better.

via Well+Good

Timing Your Meals

It’s not just what you eat, when you eat also counts.

Research at Yale’s School of Medicine has revealed just how vital the timing of our meals is to maintaining optimal circadian rhythms.

For instance, when we wake in the morning and our central clock is being stimulated by the light of day, but we decide to skip breakfast we have just given our body conflicting information that can in turn disrupt our circadian rhythms. 9

The main takeaway from this study and similar research is that you should not be eating close to your intended bedtime; but the recommendations for how long before bed you should refrain from eating vary: some saying not to eat after 7 pm, while others suggest 5 hours before lights-out and still others indicate a minimum of 12 hours before you eat breakfast. 

It’s also recommended to reserve large meals for the first half of your day, and consuming lighter snacks in the evening.

3. Environment

Mattress & Pillows

When it comes to choosing a mattress and pillows, there’s no universal rule for everyone to follow. Whether you should opt for firm or soft, memory foam or pocket coil all depends on your personal preferences, particularly the position you sleep in.

Back SleepersSleeping on your back is often the sleep position recommended by doctors, since it allows the body to lay relatively straight.

However, that does not mean there is no pressure being put on your spine as you sleep.

You should have a mattress which is both able to support the spine -- and not allow the exaggeration of any curves -- but is also plush enough to not cause painful compression.

• Opt for a medium to firm mattress
• Memory foam is more ideal since conforms to natural curves while maintaining support
• May substitute for a pocket coil with pillow top.

Side Sleepers: Sleeping on your side has its own benefits: It can help reduce acid reflux, reduces the pressure on the lungs, and promotes better blood circulation.

The main complaints of side-sleepers are achiness in the shoulder and hip area. The way to circumvent this is to ensure your mattress adequately cradles these parts.

• Medium to soft mattress
• Memory foam is ideal for reducing number of pressure points

Front Sleepers: Sleeping on your front is by far the worst for your health: Not only does it put pressure on your stomach, but the spine is the least supported in this position.

While it is recommended you switch sleeping positions, there are certain considerations when choosing a mattress that can help alleviate some of the negative side-effects.

Opt for a firmer mattressPocket-coil mattresses are a big no-no, as the entire front side of your body is exposed to the pressure points and they will not support your spine.

Bed Sharing

There’s no doubt that sharing beds can add to your difficulty getting a good night’s sleep.

It’s unlikely that both people with have identical wants and needs when it comes to their sleep position and mattress preferences; and when one partner is uncomfortable their tossing and turning can quickly cause problems for the other.

Upsize to a Queen: A Full-sized bed will leave you and your partner with only 27 inches of space -- which amounts to the size of a baby’s crib.

Opt for memory foam, or ditch your box spring: While memory foam is the optimal choice for reducing the transfer for movements, replacing your box spring with slats can serve as a quick fix.

Invest in a mattress designed for couples: The Sleep Number mattress let’s you and your partner select your ideal level of firmness, comfort and support so you don’t have to compromise.23

Colors

Research has shown that people who sleep in blue rooms tend to sleep longer than when compared to other colors. Blue toned walls can serve as yet another signal telling your brain it’s time to sleep.24

It’s important that your bedroom makes you feel comfortable and relaxed. It’s less important to follow a strict guide than to follow your own intuition.

Light

Light is one of the most powerful cues for your body’s internal clock, it’s thus important to ensure that you are exposing yourself to light and dark during the optimal times.

Try to keep your bedroom as dark as possible while you sleep by using black-out curtains.

However, lighting is not just important when you are sleeping. It’s recommended to dim the lights one hour before heading to bed to cue your brain it’s time for sleep.

For this reason it’s also best not to stare at bright screens (TVs, computers, and smartphones) during this time period, although many phones do offer a “night-mode” setting that can help.

In fact, the blue light -- in the 460-nanometer range -- emitted by electronics and energy-efficient lightbulbs has been shown to delay the release of melatonin.25

Temperature

Generally speaking, the optimal temperature for sleep is between 60-70 degrees Fahrenheit (15.5-19 degrees Celsius).

This, yet again, links back to the natural changes that occur as part of your circadian rhythms: your body temperature drops during the night, and thus maintaining a cooler room will help maintain this.

Setting your thermostat far below or above this ideal point can make it more difficult to fall asleep, lead restlessness and even affect the time you spend in REM sleep.26

The material of your mattress, pillows, bed linens and pajamas can significantly impact your temperature while sleeping. Look for fabrics that are breathable and won’t trap heat such as cotton; likewise choose pillows made of natural materials over synthetic.

As for mattresses, memory foam is the best option when it comes to temperature control.

Noise

Your brain continues to register noises while you sleep, which although unknown to you may be causing you to toss-and-turn or wake briefly.

It’s more likely for a noise to wake you up while in stages 1 and 2 of sleep, than while in 3 and 4. Additionally noise tends to cause more sleep disruptions in the second half of the night.

There’s also evidence that you’re more likely to respond to a sound while sleeping if it is emotionally significant to you: Such as when a mother hears her baby crying.27

If noises outside of your control are keeping you up at night, white noise can be used to “drown” them out. White noise works by reducing the difference between the ambient noise and a sudden, “peak” sound -- like a toilet being flushed -- lowering the chances your sleep will be disturbed.

There are many white noise generators you can purchase, and now there are even phone apps that can do the trick. However, a simple fan or air purifier may be sufficient to help you sleep through the night.

4. Meditation

Fifty percent of people who experience difficulty sleeping blame stress and worry for their troubles.

Meditation, in relieving feelings of stress and anxiety, and - over time - improving our overall response to stressful situations, has been proven to improve both the duration and quality of sleep, with the effect increasing with prolonged practice.

Researchers at the Stanford Medical Center conducted a pilot study to investigate the effectiveness of meditation in treating insomnia. 10

Following a six-week mindfulness meditation training program, 60% of the participants no longer fit the qualifications for the diagnosis - falling asleep twice as quickly as they had previously.

A 12-month follow-up revealed that the majority of the benefits were long lasting.28 Similarly, experienced meditators show enhancement in both REM and non-REM sleep; as well as experiencing fewer awakenings when transitioning between cycles. 11

Meditating at any time of day helps to reduce stress and improve sleep; however, incorporating meditation into your bedtime routine can be especially effective in preparing your body and mind for sleep.

5. Structuring Your Bedtime Routine

Sleep is a behavior: You can teach yourself to sleep well, but you can equally teach yourself to sleep poorly. Our habits surrounding our bedroom routines have a much more significant impact on the quality of our sleep than many of us believe.

Children often have bedtime routines to encourage the onset of sleep, but this is just as important for adults.

Our body needs time to adjust and cool down after a busy day: Just as sleep inertia affects our ability to feel alert after being abruptly roused from a nap we need to allow our body and mind time to transition into a state of relaxation and finally sleep.

When structuring your bedtime routine the main goal is to reinforce your natural circadian rhythms. By developing a scheduled routine of activities at bedtime we can form habits that promote sleep, while avoiding those that impede it.

General Guidelines:

• Follow a scheduled pre-sleep routine
• Avoid stimulating activities and all screens for 30-60 minutes before bedtime
• Reserve your bed for sleep and intimacy
• Get rid of your alarm cloc

Rituals

Maintain a regular sleep/wake schedule (even on weekends): While it may seem like a treat to sleep in way past your usual waking time on the weekends, altering your sleep-wake schedule for just one night is sufficient to cause disruptions in your circadian rhythms that will affect you for days following.

Choose a favorite relaxing activity to wind down: Close off your day with a period of relaxation by incorporating one of your favorite calming activities into your bedtime routine.

Choose what works for you -- while one person may find reading relaxing, if you aren’t a bookworm yourself this will be counterproductive.

Some suggestions include:

• Reading
• Listening to music
• Stretching (yoga)
• Meditating

Prepare your room for sleep:

• Dim the lights
• Lower the temperature

Make your bed: A recent poll conducted by the National Sleep Foundation revealed that making your bed may be more than just a morning nuisance.

Those who reported they made their bed every morning had a 19% higher chance of getting a good night’s sleep than those who skipped this chore.

While the reason behind this is still unknown, researchers speculate that it’s related to feeling good about where you sleep.

Decluttering and maintaining a tidy bedroom can go a long way towards promoting better, more restful sleep.31

6. Tools And Resources

Nowadays there are many helpful tools to help you sleep better available at the click of a mouse -- or the swipe of a finger.

Sleep Cycle

Sleep Cycle Alarm Clock will revolutionize the way you wake up. This innovative app actually tracks your sleep patterns, and uses this information to gently rouse you when you’re in a light stage of sleep -- preventing sleep inertia.

The app achieves this by monitoring your movements throughout the night, as these vary depending on what stage of sleep you’re in.

There are two modes: Either using your phone’s microphone which “hears” your movements, or the accelerometer, which is placed on your mattress to detect your movements throughout the night.

At only $0.99 on iTunes it’s a small price to pay for waking up feeling refreshed.

F.lux

F.lux began as a software which adapts the colors of your computer’s display for different times of the day: Not only optimizing your viewing experience, but reducing your exposure to blue light - which inhibits the release of melatonin, a hormone essential for sleep.

While the app is still under construction, there are plenty of similar ones to choose from on iTunes and Google Play Store, so you can enjoy your devices in the evening without disrupting your sleep.

For iOS you can also use the built-in Nightshift mode to adjust white balance of your screen based on time of day.

White Noise

White Noise by TM Soft allows you to choose from a library of sound loops including beach waves, air conditioner and running water.

The app comes in three versions: Free, Full and Pro; with even the freebie coming with 40 sound loops as well as additional alarm sounds.

Whether you are looking for a way to drown out nighttime noise disturbances, or need a substitute for your favorite fan while traveling, White Noise’s variety will suit any preference.

Headspace

For those interested in experiencing how meditation can transform your sleep, Headspace is a great place to start.

With short guided meditations readily available on both desktop and mobile devices Headspace makes it easy to incorporate meditation into your bedtime routine.

You can try their Take 10 program for free, or choose from a variety of subscription options to get started today.

GoodnighT

While lying awake at night staring at your alarm clock waiting for sleep to come may make you feel powerless, there are a lot of concrete actions you can take to conquer your sleeping problems once and for all.

It’s not necessary to undergo a total life overhaul in order to enhance the quality of your sleep. Start by experimenting with the tips that are most appealing to you and see how they impact your sleep.

Keeping a journal can help you track what works and what doesn’t. Once you’ve felt the effects of a good night’s sleep you’ll wonder how you ever got by without it.

Originally posted on NestMaven.com.

THE POWER OF BREATHING

by Annabelle Parr

Whether or not you struggle with an anxiety disorder, we have all found ourselves overwhelmed by stress or anxiety at some point.  We each have slightly different stressors that trigger our body’s natural stress response, but we all know what the response feels like: sweaty palms, racing heart, tense muscles.  This bodily reaction can feel overwhelming, as if it controls us.  It is easy to feel powerless to our biological response to stress, but we have more control than we think.

THE STRESS RESPONSE

Source URL: http://www.gestaltreality.com/2012/07/11/metabolic-diet-supplements-an-exploration/

Before we deem our biological reaction to stress bad, let’s talk about what happens and what purpose it serves.  When we get stressed out or anxious, our body begins preparing us to face threat.  Stress activates our sympathetic nervous system, triggering the fight-flight-or-freeze response.  This causes the sweaty palms, racing heart, panicky breathing and muscle tension (McGonigal, 2013).  We often look at the stress response as inherently bad, because it is not healthy to be in the fight-flight-or-freeze mode chronically (McGonigal, 2013).  However, it’s important to remember that when your heart starts racing or your palms get sweaty, your body is just trying to help prepare you.  Nevertheless, these sensations can feel overwhelming, and perpetuate our experience of anxiety.  So how can we calm ourselves down once this cycle is in motion?

DEEP BELLY BREATHING

Using our breath, we actually have the power to activate our parasympathetic nervous system.  The parasympathetic nervous system allows our body to “rest and digest” as opposed to the sympathetic nervous system’s fight or flight response (Hunt, 2016).  While “take a deep breath” is common advice, how we actually take that breath is important.  This is how to use the breath to calm down:

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

1. Find a comfortable, relaxed seated position with your feet planted on the ground; alternatively, you can try breathing laying down.  Now begin to bring your focus to your breath.
2. With each breath, your belly should rise as you inhale and fall as you exhale. 
3. Your shoulders and chest should remain still.  If you notice your shoulders rise, or your chest move, drop the breath down to the belly.  Breathing into your chest is reminiscent of hyperventilating, which will only further activate your sympathetic nervous system (Hunt, 2016).
4. Now focus on breathing into your belly for four counts.  Hold your breath for a second or two.  Now exhale for five counts and relax (Hunt, 2016).  Repeat this process, focusing on your inhalations and exhalations, and making your belly rise and fall.
5. You may notice that your heart rate speeds up at first.  Don’t panic or give up.  Your body is not used to calming itself down, and is simply adjusting.  After a few cycles of inhaling and exhaling, you should notice your heart rate begin to relax. 
6. If you begin to get distracted or thoughts pop into your mind, simply notice they are there and then come back to focus on the breath. 

Source URL: http://goodrelaxation.com/2015/05/deep-breathing-for-headaches/

See if you can practice doing four or five deep belly breaths a day.  Then see if you can work your way up to thirty seconds at a time.  Then maybe a minute.  Eventually, you will be able to sit in this space with your breath for a long period of time.

Being able to tap into your breath to find a calm, centered space, no matter where you are, is an invaluable resource.  This diaphragmatic breathing essentially turns off your sympathetic nervous system and turns on your parasympathetic nervous system (Hunt, 2016). 

This is not to say that you will never feel stressed again, or that you will never experience the fight-flight-or-freeze response.  But using deep belly breathing can help you to calm your body down and lessen the biological reaction to a stressful situation.

CSAM IS HERE TO HELP

If you or someone you love might benefit from acceptance and commitment therapy (ACT), cognitive behavioral therapy (CBT), or biofeedback for anxiety, depression, stress, or PTSD, or if you would like more information about our therapy services, please contact us at (858) 354-4077 or at csamsandiego@gmail.com.

REFERENCES:

Hunt, M. G. (2016). Reclaim your life from IBS: A scientifically proven plan for relief without restrictive diets. Toronto, ON: Sterling Publishing Co., Inc.

McGonigal, K. (2013, June). Kelly McGonigal: How to make stress your friend [Video File].  Retrieved from: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=e