Sleepless in Cape Town.Psychotherapy July 5, 2011 - 3:07 am No Comment
Outside the wind is howling and the rain lashes down, my eyes spring open and my mind begins to roam. At first it goes to the poor living in the informal settlement about a kilometer from my warm home, it peeks inside their leaking shacks and watches as the occupants huddle beneath their black plastic refuse bags trying to escape the freezing rain. My mind then unpacks the previous day like an airport customs agent looking for contraband, it rifles through my mental pockets looking for sharp objects, relational conflict, things left undone, these are all grist to the mind’s mill. In an effort to repair any inconsistency it finds, my mind then begins to construct a to do list for the following day, taking mental notes, commenting inanely like an aging monarch waving at the passing crowd. Somewhere buried deep in my consciousness, is an awareness that my mind shouldn’t be doing this at 2:37 a.m. the recognition flickers and is then subsumed by the next pale thought.
Why do i continually do this to myself? I went looking for answers (at 2:53 a.m.)
Current research about insomnia falls into different categories, for example:
Psychophysiologic Insomnia :
In many cases, it is unclear if chronic insomnia is a symptom of some physical or psychological condition or if it is a primary disorder of its own. In most instances, a mix of psychological and physical conditions appears to cause insomnia.
Psychophysiologic insomnia occurs when:
Transient insomnia disrupts the person’s circadian rhythm. The poor sod then begins to associate bed not with rest and relaxation but with a struggle to sleep. A pattern of sleep failure emerges. Over time, this repeats, and bedtime becomes a source of anxiety. Once in bed, the now harrowed individual broods over the inability to sleep…”but i was tired when i went to bed!” , the consequences of sleep loss “…and i have 10 clients tomorrow!” , and the lack of mental control …”OHM….AUUUMMM….BUGGER!!…OOOHHHMMM”. All attempts at sleep fail…”F*&%$%….OHM…BUGGER!”
Eventually excessive worry about sleep loss becomes persistent and provides an automatic nightly trigger for anxiety and arousal. Unsuccessful attempts to control thoughts, images, and emotions only worsen the situation. After such a cycle is established, insomnia becomes a self-fulfilling prophecy that can persist indefinitely.
Medical Conditions and Their Treatments
Among the many medical problems that can cause chronic insomnia are allergies, benign prostatic hyperplasia (BPH), arthritis, cancer, heart disease, gastroesophageal reflux disease (GERD), hypertension, asthma, emphysema, rheumatologic conditions, Alzheimer’s disease, Parkinson’s disease, hyperthyroidism, epilepsy, and fibromyalgia. . Other types of sleep disorders, such as restless legs syndrome and sleep apnea, can cause insomnia. Many patients with chronic pain also sleep poorly.
Medications. Among the many medications that can cause insomnia are antidepressants (fluoxetine, bupropion), theophylline, lamotrigine, felbamate, beta-blockers, and beta-agonists.
About 10 – 15% of chronic insomnia cases result from substance abuse, especially alcohol, cocaine, and sedatives. One or two drinks at dinner, for most people, pose little danger of alcoholism and may help reduce stress and initiate sleep. Excess alcohol or alcohol used to promote sleep (normally >3 glasses) tends to fragment sleep and cause wakefulness a few hours later. It also increases the risk for other sleep disorders, including sleep apnea and restless legs. Alcoholics often suffer insomnia during withdrawal and, in some cases, for several years during recovery.
Ok, so I am currently not an alcoholic in recovery, do not have Alzheimer’s (to my knowledge), have not got a nostril full of cocaine, nor restless leg syndrome…hmmm, could it be that i am just a little anxious about an academic paper I have to write and have been avoiding at all costs (including my sleep)? Probably, so i think i’ll avoid it for a moment longer and go and make myself a warm cuppa.