Wednesday, 15 May 2019

ME Symptoms and Tips: Sleep Issues - Part Four

PART ONE ~ PART TWO ~ PART THREE ~ PART FOUR

Hello my lovely loves!

Welcome to the final section of this extremely long discussion on sleep health. If you've made it this far, congratulations, you are a trooper.

Our fourth and final section is looking at anxiety and how that relates to sleep.


Dealing with Anxiety/Sleep Anxiety

My experience of sleep issues was difficult. It took me a while to get a decent sleep environment, a routine that worked for me and find the level of activity that stopped overstimulation. But by far my most difficult issue was sleep anxiety, which I still struggle with on occasion.

Anxiety is a problem for me, more generally, and can be for insomniacs as well. Stress and anxiety are fairly common causes of sleep issues, but for me it ended up morphing into anxieties specifically about sleeping.

It’s hardly surprising that having an energy condition can make you very nervous about not getting enough sleep, but for a long time I didn’t actually realise that it was anxiety, not insomnia itself, that was causing me problems.

I never knew when it would happen, but sometimes I would have what I called at the time “insomnia attacks”. 
My temperature would skyrocket and I’d be dripping with sweat, my heart would beat incredibly fast, I’d feel dizzy and faint, would shake constantly, and would often end up throwing up. I had to wake up my mum to come and lie down with me just to get my heart to stop racing and to calm down enough to even think of going to sleep. 
Mum, saint that she is, would usually stay with me until I had gone to sleep to make sure I was alright. 
This happened at least twice a month to begin with and would take me days, or weeks to get over. I can recognise now, of course, that these were actually full blown panic attacks.

It’s taken a very long time to find something that works to deal with this, and, as I’ve said, it still happens now and again, although thankfully not to the degree it did before.

I tried a variety of different coping mechanisms for dealing with it, and then slowly took away the less effective, or those that gradually became unnecessary, until I was left with a core toolset.

These steps can also be helpful for dealing with stress and anxiety at night.


Routine

Establishing a routine is something most people tell you is useful to getting a good night’s rest, and can therefore be frustrating to hear, but it is actually a useful tool if you think about it in the right way.
A lot of people find routines a bit stifling, but what you’re actually trying to do is either find or create triggers to let your body know it’s time to go to sleep. That’s it. 

There maybe be things you already find do this (like closing the curtains, or brushing your teeth), but routine is useful because it trains your body and mind to see certain tasks and behaviours as signals to relax and sleep.

You’re essentially trying to train yourself like Pavlov’s dog. But with hopefully less drooling.



If it helps, think of yourself in this fabulous animal trainer’s outfit.


Clearly letting your chest hair be free is very important to animal training.
(Wild animal circuses are not a good idea btw. Be aware.)

For some people this will be simple, but given the fact you’re reading this, chances are that you need something a bit more comprehensive. Sorry, dude.

For my routine I’ve mentioned I have a wind down time. I have that and a light’s off time, rather than a single set bed time. My wind down time starts from when I go upstairs to my room (if I’m not there already). I also don’t keep those times rigidly structured, but give myself a window. If you have a specific time to do things it can add pressure and make you more anxious, so leaving a certain amount of flexibility should help keep that at bay.

Most professionals say you should try and keep your bed for sleeping, and try to go to sleep as soon as you’re in it, but that’s frankly not very practical, especially if you’re chronically ill. 

By giving myself a wind down period, I take that pressure off, and limit my activities to ones I find help me relax, not wind me up. I never read from a physical book in bed for example, because I find that harder to put down than reading on my phone.It’s that halfway house that tells my body and mind that it’s getting to the end of the day, so soon it’ll be time to sleep.

I can’t tell you exactly what your routine should be, because everyone is different, but I think the most important things to remember when building one is that a. you’re doing it for a good reason, and b. it can change over time.

Sometimes when realising we need to establish certain rules, it can feel like a punishment, but it’s actually not. It’s the familiar concept of short term pain for long term gain. Doing so will likely mean you have more energy and stabilise or improve your condition in order to have more options over time.

I’m not saying you can’t get upset or angry about it (I have definitely had a little cry on a summer’s evening when I’m in bed and I can hear the neighbour’s children still playing outside), but try to remember your goal. And that, secondly, it’s not forever.

When I first started my routine I really struggled with the concept because it felt like a life sentence. That I’d be going to bed at 5pm forever, and have lights out at 8pm, and have all these specific, set-in-stone things to do. But that’s not what happened. 
Routines change over time, and that’s normal.

I still go upstairs between 5 and 6pm, but it’s more some peaceful time I give myself rather than have taken away from me. The act of going upstairs is the trigger, so I don’t need to be strict with the timings, or what my wind-down activities are. 

I don’t settle down to sleep now until 9 or half past, because I’ve managed to find what works for me, and I don’t need to spend the extra time using sleep-inducing tools to get me to sleep.It’s still early, but it works for me and I ultimately feel better for it.

The following sections are everything I’ve done during my routine, after lights out, to help me sleep. They’re arranged in the order I would follow. Some I still use, some I really don’t need anymore and only break out occasionally. I’ll let you know which is which as we go.


Tapping/EFT

It’s the point in every tips post where I explain EFT/Tapping is a weird psychological tool that looks and sounds ridiculous but I’ve actually found really helpful. One of these days I’ll actually get round to doing a post on it exclusively so I can stop talking about it separately each time.

If you aren’t aware already, EFT (Emotional Freedom Therapy), or Tapping, is a way of working through your worries and emotions about issues in a more manageable way. 
Using it for sleep has been the most effective tool against my Sleep Anxiety because I’m able to get everything that’s worrying me off my chest before I settle down, and I do it every single night.

As I tap I talk through all the possible things that could go wrong; not being able to relax, not being able to drop off, having nightmares, waking up and not being able to get back to sleep again. The words I use have shortened over time, but I’ve said them so often now that I start to yawn constantly whilst doing it.It’s worked out as an extremely effective trigger for my brain to switch off.


Meditation

If you don’t want to do tapping you can always try meditating. There are loads of different guided ones available online to download. Try a few samples and pick someone who sounds relaxing to you. I like Andrew Johnson the best.Many end with suggesting that you sleep, which I’ll get into a bit more later.


Focus on comfort

This may be part of the meditation you do, but instead of getting caught in your head, try to focus on all the nice things about your environment. 
This can take practise, as it's very hard to snap out of your head once you're there, but focusing on the nice soft sheets you've debobbled, your comfy mattress topper and your squishy pillow helps you to stop going in circles.
If you can stop a spiral it makes relaxation a lot easier.


Stops

Sometimes, even with Tapping, my brain still likes to provide me with all sorts of information and worries that keep me awake. 
In those circumstances, I use the Stop method laid out for me by the Optimum Health Clinic. I’m not sure how much detail I can go into, because it’s not technically my method, but I’ve altered it a little in that whatever’s bothering me I mentally load into a giant catapult and punt into the distance. Whilst telling them to do one. It’s very effective.

(Seriously though, the actual method they use involves categorising your thought patterns so you can separate yourself from it and is very useful too, so if you’re able to do their course I would recommend it for that, and the other psychological tools they give you. It is rather expensive though.)


Notepad by the Bed

An oldie but a goodie. Keep a notepad by the bed to write down things your brain just won’t let go of. This will usually be tasks you need to complete. Or in my case, things to mention in my next blog post. 
Let the notepad take the strain.


Visualisation

Visualisations are a bit like self-guided daydreams. They’re designed to help you see how you want things to go in your mind. You can also use them like personalised meditations to signal to your brain it’s time to sleep.

I’m a very visual person, and sometimes meditations can be a bit boring. A beach. A forest. A lake. These are fine, but I like to add details to make them feel really real. And sometimes add a bit of whimsy.

Two visualisations I’ve used regularly involve “taking off the day”. In the first I walk around my dream house, locking the doors, saying good night to all the rooms, washing, and even clocking out on an old machine that goes from “awake” to “asleep”.

The second is even more elaborate and involves deciding on a beautiful dress that I think sums up that day. I’m talking full fairy princess. After all, it’s in my head and I can wear whatever I want, so I might as well make it fun.


This is my jam.

I’m slowly helped to change out of my fabulous gown into comfy nightwear, so I’m literally removing the weight of the days worries and stresses. I have imaginary helpers so I can give that weight to someone else. Sometimes particularly difficult things will be represented by very heavy jewellery, so you can imagine yourself feeling lighter as it comes off for the day.

I don’t use this one so often anymore, simply because I don’t need it, but it’s a nice one, and really great at putting your mind into a better state.


Sleep Tracks

If the visualisation didn’t work then I would break out a sleep track. These I do still use occasionally, even though a lot of the interim steps have become largely obsolete.Mine is from the Optimum Health Clinic, but there are a lot of these available online.

I would recommend having them on something different than your phone, because hopefully by this point your phone is off and not tempting you with social media and cat videos.

I use an iPod shuffle for my sleep and meditation tracks, but any simple MP3 player would do. It’s entirely possible you have one lying in a drawer somewhere.I like the shuffle because it doesn’t have a screen, so there’s no display to accidentally wake me up when I’m starting to get sleepy.

I’d also recommend making sure you have something on after your favourite sleeping tracks that is a soft sound. You don’t want to have finally started to drift and then get blasted by death metal.


Lol to this gif.

To begin with I would use sleeping tracks every night and still be awake at the end of a track. Then I would find myself missing parts and waking up enough during the next track (rain sounds) to turn it off and put it away. Eventually I fell asleep enough during the track that it became unnecessary.


Relaxation

Before I started to fall asleep during the sleep tracks I would do a relaxation meditation afterwards. Rather than a guided mediation, at this stage I preferred a self guided one, as there’s nothing to turn off afterwards.I would start at my left toes, and go through each section of each limb, imagining them relaxing. I would often use the phrasing my various meditations tracks had used as a guide.


Sleeping tablets

If I've gone through all these various stages and it’s still not happening, I use sleeping tablets.They’re not something I like to rely on all the time, but having them available to me has made an INCREDIBLE amount of difference.

As I’ve said before, you might find it a little difficult to get prescribed straight-up sedatives. Some GPs are unwilling to give them to use all the time, as they can be addictive. If you have other issues, like pain, then your GP will probably explore other avenues before breaking out the big guns.

By the time I actually got round to asking for them, my main problem was the sleep anxiety. Most other avenues have other options, but it’s a little more difficult to control anxiety issues.
I explained to the doctor what was happening, and our discussion wound down to this; if you know you can sleep, you worry less that you can’t.

Having access to sleeping tablets has made me need them less, because I know that if things get really bad I can take a tablet. I have a safety net, and that has calmed me down massively. I only take half at a time and that’s usually enough to help me drift off.

For a time I felt guilty and nervous about using sleeping tablets, but I average out at around one box of Zopiclone (28 tablets) a year. Some people have to use them every night (and that’s ok too). 

For daily peace of mind it’s 100% worth it. Over time I hope to slowly need them less and less until I ended up with a box that has gone out of date and I don’t feel the need to replace it anymore.

I do occasionally worry that my GP will take my single yearly box as a sign that I don’t actually need sleeping tablets (especially as I’ve recently moved GPs), but I’m pretty confident in my argument to keep them, and I have various other healthcare professionals who’ll back me up.

If you think this is something that could really help you, then it’s worth talking to your GP about. 

One warning though: if you do take them, put water in your mouth first, chuck it to the back of you mouth and swallow as quickly as possible. Then drink more water. Potentially have a biscuit.They taste VILE. I got one caught in my throat once and I nearly vommed - it’s that bad.I’m reasonably sure they’re deliberately manufactured to be as disgusting as possible to prevent you from using them too often.

Other options that might be suggested are Melatonin, Promethazine, and of course Amytriptaline. You can also try lavender teas and extracts, but make sure your doctor knows you're taking them if you're discussing medication options.


Have everything on hand

It’ll help you keep calm if you have everything you might need close at hand before you settle down for the night.
By my bed I keep:

Water
Oat Biscuits (slow burn off)
Painkillers
A hot water bottle
A sleeping tablet (I have a small pill box with a pre cut tablet so I don’t accidentally take too much, or drop them when I’m struggling. The rest are elsewhere.) 
Earplugs - two different types
Eye masks - two different types
iPod with sleep tracks
Fan/heater remote
Clock
(A damp flannel in the summer)

Knowing every eventuality is covered allows you to relax and switch off much more easily.And finally…



A universal truth

I want you to remember something: sleep fluctuates.It doesn’t matter if you’re healthy or not, sleep cycles fluctuate and you will naturally have good days and bad days. Or nights, as the case may be. 

Don’t panic when this happens, because there are so many things you can try, and there’s always another night to try again.

I believe in you. You can do the thing. 


May your sleep be as deep and soft as this cat’s leg floof.

No source I'm afraid. 
I just have this on my phone for when I feel sad.


H




PART ONE ~ PART TWO ~ PART THREE ~ PART FOUR

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