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This week I am delighted to have a guest post from Brandon Ulmer of Elevation Process. I’ve worked with Brandon several times before and it is such a joy and an education at the same time. And this time, Brandon talks about the difficulties of sleep and chronic pain, which I’m sure is something a lot of us can relate to. Read on to find out his new programme can help you. And check out the discount below for readers of my blog.
Most people have experienced times in their lives when sleep was elusive and difficult to attain. For most people however, these difficulties are usually related to life stressors (for example job loss or relationship difficulties) and are generally acute in nature. That is to say, the problems are usually short-term and resolve within weeks of their initial appearance.
For a growing percentage of the population however, this sleep loss can become chronic in nature and develop into full blown clinical insomnia – defined as the inability to attain both sufficient quality and quantity of sleep despite making enough time for it (7-9 hours per night).
Being sleep deprived is not insomnia. Going months without proper sleep quality/quantity, to the point that it severely impacts your ability to function the next day, is insomnia.
Read Brandon’s previous posts:
Insomnia is a common condition with chronic pain. Having worked with thousands of people with chronic pain over the years, the overwhelming majority (over 95%) also experience significant difficulty with sleep and would meet clinical diagnosis for insomnia.
The devastating impact of this sleep loss can be felt in virtually every aspect of life. Physically, chronic sleep loss activates our fight/flight mechanism which causes our blood pressure to skyrocket and inflammation to occur; increased blood pressure and inflammation have been linked with increased risk of developing cardiovascular diseases (heart attack and stroke), cancer, obesity and diabetes. Even our reproductive and immune systems become compromised when we are not obtaining as mush sleep as we should.
Cognitively, sleep loss disrupts our ability to concentrate and form new memories (as anyone with chronic pain can attest). It also deals a devastating blow to our mental health and is strongly associated with major depression, anxiety, and other psychiatric difficulties.
Those are the stats and reality of long-term, chronic sleep loss. What this “feels” like though is perhaps more important. Sleep loss drains us of the energy and motivation that we desperately require to engage in the self-help activities that are crucial for the ongoing management of chronic pain.
It also wrecks havoc on our lives and relationships by increasing emotional swings and outbursts. It feels like we lose control of our emotions and we become subject to the negative self-evaluation and feelings of guilt, hopelessness and helplessness commonly associated with depression.
In our quest to “feel better” we access health services at an increased rate and endure all manner of tests, receiving many more diagnosis (and pills) in the process. These pills are an attempt to deal with the symptom rather than problem.
I believe that many of the co-existing diagnosis that folks with pain receive are the fallout from years of chronic sleep loss; science would certainly seem to support this claim.
Sleep loss, for people who experience chronic pain, often comes in two forms. Sleep onset insomnia is defined as the inability to attain sleep when you first try to get to bed, for a period of longer than 30 minutes. Sleep maintenance insomnia is waking up multiple times during the night and taking longer than 30 minutes to fall back asleep.
Most people with chronic pain experience a combination of both onset and maintenance insomnia. Of the two, maintenance insomnia is the most difficult and leads to a fractured pattern of sleep that leads us to wake feeling exhausted and unsatisfied with the quality of our sleep overall.
The unfortunate reality of chronic pain is that ANY position that you stay in for too long will increase the experience of pain; yet this is exactly what happens when we finally do fall asleep.
This pattern of waking multiple times throughout the night, due to pain, ultimately leads us to seek the help of doctors who recommend more medications (often long-lasting pain killers or worse – sleeping pills).
This becomes a downward spiral due to the eventual tolerance and dependence on medications that develops over time; the more that I take, the less effective and more reliant on them I become.
The situation seems quite bleak overall, but there is hope. It is important that we start to become an active participant in our own care, and the first part of that plan is to educate ourselves on both the issue and potential solutions.
At Elevation Process I drum on about the value of education all the time and for good reason. When I understand what is going on with me and my body, it empowers me to make informed decisions about the care that impacts me. I understand what the medical plan is and why it is being implemented; this leads to a greater sense of control overall which is particularly important to our ability to manage chronic pain and the ongoing challenges this presents. Many people with sleep issues are surprised to find that they have developed (over years) many behaviors that are counter-productive to sleep.
There are many things that we can do to improve both the quality and quantity of our sleep. Our program for sleep is about educating people as to the important steps that they can take, right now, to improve their sleep.
Our Sleep Program
Our program for reducing insomnia and helping to improve sleep consists of eight educational videos that address the following topics:
This session introduces the product, as well as what to expect in the weeks ahead. It specifically covers two particularly important concepts for sleep: circadian rhythm (our day/night cycles) and homeostatic drive (how sleepy you feel). Behavioral strategies for improving sleep are introduced and encouraged for homework.
Sleep and Life
This session discusses the stages of sleep and the 90-minute sleep cycle that constitutes a complete sleep cycle. The normal progression of sleep across our life cycle is also addressed and challenges that come with attaining sleep as we age discussed. Behavioral strategies are given and recommended for homework.
Sleep and Health
This session specifically addresses the scientific evidence linking sleep and health, both physically and mentally. Sleep loss has been linked to many of the top maladies effecting humanity including cardiovascular disease, cancer, diabetes, obesity, memory and concentration loss, dementia/Alzheimer’s, depression, anxiety, and other psychiatric conditions. The aim of this session is to start to take sleep loss seriously and to prioritize sleep in the same way as diet and exercise. Behavioral strategies are recommended as homework.
This session addresses the topic of dreams and why we have them. What are their proposed function and purpose? The sections of the brain that are active during dreaming is also discussed.
This session introduces CBT-I or Cognitive Behavior Therapy for Insomnia. Insomnia, its two primary kinds, as well as factors driving its maintenance are discussed. Sleeping pills and their usage is addressed and the sleep diary introduced as homework.
Cognitive Re-structuring and Sleep Scheduling
This session introduces two of the main therapeutic techniques in CBT-I: learning to re-structure the content of our thoughts and working to build sleep pressure by sticking to a structured plan for sleep.
Stimulus Control and Relaxation
This session addresses what to do when you wake up and cannot fall back asleep. The rebuilding of the bed as a strong cue for sleep is priority here and 3 main steps to facilitate this discussed. Relaxation is key in reducing tension and stress which, can make sleep easier to attain; we discuss this greater detail.
The sleep diary is a vital tool for psychologists in addressing sleep issues. I take you through and discuss exactly what I am looking for in a “real-world” example. This will help you to understand how to read your own sleep diaries and make important changes to your sleeping pattern.
Our program is based off something called Cognitive Behavior Therapy for Insomnia or CBT-I. CBT-I has been thoroughly researched and tested in real-world scenarios all over the globe. It is also the recommended “first line” treatment for chronic insomnia. This is the information that I go through with my patients. It helps them to start to take an active approach, but it also boosts the effect of medications that they may already be taking by reducing problematic bed-time behaviors. It is important to recognize that, though especially important, education (cognitive and behavioral intervention) remains one piece of the puzzle that is sleep.
Talk with your doctor about a referral to a specialized sleep clinic; these folks are generally more knowledgeable about sleep than the average general practitioner and can help identify issues with sleep apnea (among other things).
Also remember that medications are just another piece of that puzzle and come with many significant side-effects themselves. Sleep is important for our overall health and well-being; it can also take a long-time to change. Be patient. Your effort will be rewarded with better health. Thanks for reading.
In closing, I would just like to express my gratitude to Alice for allowing me to contribute to her blog. I know that she works extremely hard to write and educate others who are also having difficulty with chronic pain and managing life. I feel truly fortunate to have the opportunity to work with her, as well as to contribute in a meaningful way to the lives of her readers.
If you are interested in the sleep program, or have any questions please feel free to email me at: email@example.com. Readers of Notebooks and Glasses can get 25% off the price of the sleep programme by using the code notebooksandglasses2.
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Does Brandon post resonate with you?
Do you have trouble sleeping because of your pain or illness?