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Wednesday, March 28, 2012
When trying to understand insomnia, you should consider sleep is from a neurological point of view. In general, a sleep state represents a significant neurological reorganization. This means that many areas of the brain are substantially inactivated and others activated. For instance, the Reticular Activating System, which is located in the brain stem and has a lot to do with conscious awareness. (Also, the brain stem controls breathing, which is why meditators, who consciously modify their breathing, can substantially change their mental states.)
When modulating (i.e. inactivating the RAS) the levels of the neurotransmitter GABA (gamma-Aminobutyric acid) are changed. GABA subtype A receptors are thus the target when general anesthesia is desired. This is why many physicians prescribe hypnotics (i.e. medications which are used for patients who report poor sleep). Drugs such as Ambien and Lunesta, which are two such hypnotics affect the RAS. However, they have also been reported increase hazards of death threefold even when prescribed less than 18 pills per year (See http://www.ncbi.nlm.nih.gov/pubmed/22371848).
Sleep medications are designed to tinker with the RAS to force a patient into an artificial sleep state. However, they don’t address the core issue, which is the need to reorganize how the brain distributes energy and thus activates other areas of the brain. One such area is the anterior cingulate cortex (ACC), which is a bicameral (i.e. on both sides of the neocortex) area of the brain right in front of the limbic system, which handles hunger, nurturing, fear, anger, compassion, and sex drive. The ACC facilitates problem solving and therefore acts as a switch board for our thoughts. Together with the basil ganglia (in our limbic system) and the right orbitofrontal cortex, which handles inhibition, simulation, and anticipation, when hyper-active, the ACC plays a role in obsessions, phobias, and compulsions. Even at a lesser level, ruminations, multi-tasking, and excessive worrying also involve the ACC. Hyperactivity of the ACC is probably the leading issue when it comes to sleep deprivation. It is difficult to achieve a healthy sleep state if your mind is racing. So, the goal should be to calm the mind, which is synonymous with calming the ACC.
The problem with insomnia is very often an inability to quiet the ACC – rather than create an artificial sleep state by using GABA-related drugs (i.e. Ambien and Lunesta) to mitigate the RAS. This is why taking a hot bath, not checking the news right before going to bed, not exercising vigorously before turning in, and similar calming processes are helpful. They are simply activities that facilitate calming the ACC. One technique that I regularly use is self-hypnosis. I merely think about a yardstick. With every number, I exhale a breath and sub-vocalize a suggestion that will relax, and that I will soon drift off into a deep slumber. I sometimes visualize or think of a hamster running on a wheel. The further down the numbers go the slower the hamster gets. Starting at 36, many times I am only aware that I go through a few numbers before I later wake up after a refreshing sleep. In fact, the resulting sleep is normally coupled with very vivid dreams, meaning that I attained a REM sleep level.
The other issue is anchoring. Many of my psychology colleagues will recommend that their clients limit their bed to sexual intimacy with their partner and sleep. The recommend that they read, watch TV, and play computer games. Another form of anchoring is to hold or cuddle a special pillow which may have a calming affect. (Of course, a teddy bear could also be used provided that the client was open to that. However, I’ve never recommended that for my patients.)
I do 90 minute sessions with many clients who come to me expressing sleep problems. This includes intake, various forms of talk therapy, and a 15-minute guided meditation/hypnosis session. The intent is to train (i.e. condition) them to quickly calm their mind and to get them the post-hypnotic suggestions that anchor the act of going to sleep and their sleeping environment (e.g. bed and bedroom) with easily going to sleep. While I suggest that they listen to relaxing music before and while going to sleep, I suggest that they regularly do self-hypnosis (with the exception of the technique mentioned above) at other times during the day. This approach to insomnia is fully supported by numerous medical laboratory and university studies which have been highlighted in peer-reviewed articles published by the US National Library of Medicine of the National Institutes of Health.
The methods that I use are based upon numerous examples of highly controlled scientific research. I suspect that the reason that these methods are not as widely known is that they cannot be patented and controlled by profit-making pharmaceutical corporations. Also, when a patient goes repeatedly to a physician for evaluation and to get their prescription renewed this becomes very lucrative to the physician. Sleep clinics make a lot of money as well. And, the manufacturers of sleep apnea equipment also have a financial stake in this. There is a time and a place for medications and equipment. However, many honest physicians will admit that they are over used and may present substantial risks to patients.
On last thing that I wish to mention is the existence of nasal and/or bronchial deformities that may affect sleeping patterns. Therefore, when warranted, corrective surgery can make a lot of difference for the right patient.
For the record, the word “hypnosis” is used somewhat differently by an anesthesiologist (or physician) than it would be used by hypnotists or a hypnotherapist. To the former it means a total lack of awareness. To the latter it actually represents a process in which the subject becomes hyperaware. The reason for this discrepancy is that the Greek word “hypnosis” actually means sleep. Thus the medical folks are correct and the hypnotists incorrect. The latter’s use of the work hypnosis comes from a Scottish medical doctor by the name of James Braid. In the late nineteenth century he coined the word hypnosis to explain the trance-like state that his patients achieved when staring at an eye chart. He later tried to change his term. However, he was unsuccessful. Previously, the word used to explain the transformative power of suggestion and imagination was often “mesmerism,” which is also incorrect.
Keywords: Hypnotherapy, insomnia, lunesta, ambien, sleep deprivation
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