Sleep
How sleep affects overall wellbeing and how ketamine therapy can help
Sleep plays a crucial role in maintaining optimal mental health and well-being. It serves as a vital restorative process that allows our brains to recharge and process the events and emotions of the day. Sufficient sleep is essential for cognitive functions such as attention, concentration, memory, and problem-solving. When we sleep, our brains consolidate and organize information, helping us retain what we have learned and make sense of our experiences. Lack of sleep or poor sleep quality can have a profound impact on our mental health. It can lead to mood disturbances, increased anxiety levels, irritability, and reduced ability to cope with stress. Moreover, chronic sleep deprivation has been linked to an increased risk of developing mental health disorders, such as depression and anxiety disorders. Therefore, prioritizing and maintaining a healthy sleep routine is crucial for supporting and promoting mental well-being.
In addition to its cognitive effects, sleep also plays a vital role in regulating emotions and emotional processing. Sufficient sleep allows us to regulate and modulate our emotions effectively. When we are well-rested, we are better equipped to handle and respond to emotional challenges and regulate our reactions appropriately. On the other hand, sleep deprivation can lead to heightened emotional reactivity, making it more difficult to manage and regulate emotions. Lack of sleep can increase the vulnerability to negative emotions, impair judgment, and compromise decision-making processes. Furthermore, sleep disturbances are often seen as a symptom of various mental health disorders, such as bipolar disorder and post-traumatic stress disorder. By prioritizing good sleep hygiene and ensuring adequate rest, we can improve emotional resilience, enhance emotional well-being, and protect our mental health.
Insomnia
When we can’t sleep we call it “insomnia.” Insomnia was previously viewed as a sleep disturbance that was caused by either a medical condition, psychiatric illness, sleep disorder, or medication side effect, and would improve with treatment of the underlying disorder. However, the more we learn about insomnia the more we appreciate that it can also occur as an independent disorder, in and of itself. All medical, psychiatric, and medication side effects contributing to insomnia should be ruled out through testing and taking a history, and adequately treated. If it looks like there are no known contributing factors, then insomnia is regarded as its own, independent illness.
Sleep Hygiene
People with insomnia for any reason should also receive basic behavioral counseling about sleep hygiene. Sleep hygiene consists of a number of practices that help ensure a good night's sleep. Although many of them may seem like common sense, adhering to these practices improves sleep and provides an increase in energy level for most people. The most important sleep hygiene practice is to maintain a regular wake and sleep pattern, which means going to bed and waking up at approximately the same time every day, including on the weekends.
Good sleep hygiene practices include:
In addition to its cognitive effects, sleep also plays a vital role in regulating emotions and emotional processing. Sufficient sleep allows us to regulate and modulate our emotions effectively. When we are well-rested, we are better equipped to handle and respond to emotional challenges and regulate our reactions appropriately. On the other hand, sleep deprivation can lead to heightened emotional reactivity, making it more difficult to manage and regulate emotions. Lack of sleep can increase the vulnerability to negative emotions, impair judgment, and compromise decision-making processes. Furthermore, sleep disturbances are often seen as a symptom of various mental health disorders, such as bipolar disorder and post-traumatic stress disorder. By prioritizing good sleep hygiene and ensuring adequate rest, we can improve emotional resilience, enhance emotional well-being, and protect our mental health.
Insomnia
When we can’t sleep we call it “insomnia.” Insomnia was previously viewed as a sleep disturbance that was caused by either a medical condition, psychiatric illness, sleep disorder, or medication side effect, and would improve with treatment of the underlying disorder. However, the more we learn about insomnia the more we appreciate that it can also occur as an independent disorder, in and of itself. All medical, psychiatric, and medication side effects contributing to insomnia should be ruled out through testing and taking a history, and adequately treated. If it looks like there are no known contributing factors, then insomnia is regarded as its own, independent illness.
Sleep Hygiene
People with insomnia for any reason should also receive basic behavioral counseling about sleep hygiene. Sleep hygiene consists of a number of practices that help ensure a good night's sleep. Although many of them may seem like common sense, adhering to these practices improves sleep and provides an increase in energy level for most people. The most important sleep hygiene practice is to maintain a regular wake and sleep pattern, which means going to bed and waking up at approximately the same time every day, including on the weekends.
Good sleep hygiene practices include:
- Don't nap during the daytime as it can disrupt your normal pattern of sleep and wakefulness.
- Avoid stimulants like caffeine and nicotine for at least several hours before bedtime.
- Don't drink alcohol around bedtime. While alcohol may help you fall asleep, it can cause you to wake up in the middle of the night and to sleep less soundly.
- Establish a relaxing bedtime routine like reading a book or meditating.
- Avoid "screen time" (including TV, tablets, smartphones, etc) in bed. The brightness and stimulating visual content of the screen makes it hard to fall asleep.
- Exercise regularly, but not before bedtime.
- Reserve your bed for sleep and sex. Don't do things like watching television or working on your computer in bed.
- Avoid heavy meals before bedtime. To prevent nighttime hunger from waking you up, consider eating a light snack before going to sleep.
- Keep your bedroom quiet and dark. Also, keep the room at a comfortable temperature.
- Take a hot bath or shower before bed – falling body temperature after hot water exposure can serve as a cue for sleep
If these standard interventions are insufficient, combinations of specific, targeted therapy and medications can be effective. A type of therapy called cognitive behavioral therapy - insomnia ("CBT-I") is an evidence-based, effective psychotherapy which incorporates principles of cognitive behavioral therapy and sleep hygiene into a patient centered remediation of insomnia.
Behavioral therapy for insomnia includes sleep hygiene education, sleep restriction therapy, progressive muscle relaxation, and CBT-I (please see above above). Progressive muscle relaxation combines gently contracting individual muscles for several seconds while breathing in, then relaxing them coupled with a slow exhale. The technique starts with the feet and moves upward as individual muscle groups are isolated (first feet, then calves, then upper legs, then gluts, etc.). Sleep restriction therapy involves restricting time spent in bed to exclusively those times when you are asleep. If you wake up, it is advised to get out of bed and so some light activity like reading until you are tired enough to try to fall asleep, again. Naps are not permitted. This type of therapy can cause significant daytime sleepiness for a brief period of time before it helps reset a sleep cycle.
Behavioral therapy for insomnia includes sleep hygiene education, sleep restriction therapy, progressive muscle relaxation, and CBT-I (please see above above). Progressive muscle relaxation combines gently contracting individual muscles for several seconds while breathing in, then relaxing them coupled with a slow exhale. The technique starts with the feet and moves upward as individual muscle groups are isolated (first feet, then calves, then upper legs, then gluts, etc.). Sleep restriction therapy involves restricting time spent in bed to exclusively those times when you are asleep. If you wake up, it is advised to get out of bed and so some light activity like reading until you are tired enough to try to fall asleep, again. Naps are not permitted. This type of therapy can cause significant daytime sleepiness for a brief period of time before it helps reset a sleep cycle.
Sleep Medications can also be helpful to promote sleep. Here are the different classes:
- Antihistamines (i.e., diphenhydramine, hydroxyzine, trazodone, mirtazapine) - these provide some anxiety relief and sedation. While not considered an "antihistamine" and instead belong to the "antidepressant" class of medications, both mirtazapine and trazodone have strong antihistamine properties and can also be effective.
- Benzodiazepines (i.e., alprazolam, lorazepam, diazepam, and clonazepam) - these medications enhance the transmission of a brain chemical called GABA and provide anxiety relief as sedation. They can cause dependence and it's best to think of them as short term solutions. Long term, the dependence they cause may make it difficult to get a good night sleep without them.
- Alpha-adrenergic modulators (i.e., clonidine prazosin, guanfacine, tizanidine) - these provide a sense of physical calm when the body begins to ramp up with anxiety or when a person begins to ruminate; they also cause some physical relaxation, but can cause sedation and low blood pressure. They are especially effective for treating the nightmares that sometimes prevent someone from getting a good night's sleep.Don't drink alcohol around bedtime. While alcohol may help you fall asleep, it can cause you to wake up in the middle of the night and to sleep less soundly.
- Antidepressant medications - great for generalized anxiety disorder, depression, and certain versions of insomnia that are caused by psychiatric illnesses.
- Antipsychotic medications - good for severe insomnia. They work by blocking histamine and something called a “D2” receptor which can contribute to intense emotional experiences.
- "Z-drugs" like Ambien, Lunesta, and Sonata - they carry a reduced risk of causing dependence (although they still can) when compared with benzodiazepines, but should also be thought of as short term solutions. They also increase the effectiveness of the brain chemical called "GABA" works.Exercise regularly, but not before bedtime.
- Gabapentin - this medication has a complicated mechanism of action but ultimately impacts GABA, as well. It is less habit forming than benzodiazepines and may be effective. It can treat insomnia and anxiety.
- Gabapentin - this medication has a complicated mechanism of action but ultimately impacts GABA, as well. It is less habit forming than benzodiazepines and may be effective. It can treat insomnia and anxiety.
- Melatonin: Doses of 3-5 mg taken in brief spurts (3-4 weeks) can help retrain circadian rhythm. Take this medication 1-2 hours before bed and limit light exposure, especially screens, which admit a blue wavelength light that can actually degrade the melatonin.
- Naturopathic agents - Valerian root, chamomile tea
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