Category Archives: Relapse

I can’t sleep — How can I get more sleep?

Posted on December 18, 2014 by Melissa Killeen

Melissa Killeen

Sleep has a potent effect on the addicted brain

There are many tools available to a recovery coach. Information on the importance of sleep is one of them. Sleep is a necessity for everyone, including those in recovery from addiction. In fact, successful recovery and practicing healthy sleep habits are inseparable. Sleep has a potent effect on the addicted brain, proving to be one of the most influential factors in successful recovery.

Dr Ralph Carson, author of The Brain Fix, describes why proper sleep is crucial while recovering from addiction. He explains that for addicts in an inpatient treatment program, it’s paramount that individuals be prepared to accept new concepts, embrace a different lifestyle, and apply their creativity to this recovery challenge. The effectiveness of treatment is compromised if people aren’t getting quality sleep and thus don’t wake up feeling refreshed, responsive, positive, and committed to the hard work of recovery.

Of special interest to those in recovery, sleep impacts the pre-frontal cortex of the brain. Sleep removes neural toxins from the brain, which provides the brain the opportunity to re-organize the information that it has learned. Addiction negatively affects the pre-frontal cortex of the brain, leading to many problems, including compulsivity, impulsivity and most of all, impaired judgment. Strengthening this part of the brain is an essential part of the recovery process and strengthening the pre-frontal cortex involves getting enough sleep to clear out the neural toxins accumulated during the day.

Psychologist Jack Edinger, Ph.D., of the VA Medical Center in Durham, North Carolina, and Professor of Psychiatry and Behavioral Sciences at Duke University, cautions that treating depression usually doesn’t resolve sleep difficulties. From his clinical experience, he has found that most patients with depression should be checked for insomnia and should be examined for specific behaviors and thoughts that may perpetuate the sleep problems. When people develop insomnia, they try to self-regulate or compensate by engaging in activities to help them get more sleep. Maybe they sleep later in the mornings or spend excessive times in bed or nap. These efforts usually appear as depression and are not helpful in resolving insomnia.

According to sleep researchers, a night’s sleep is divided into five continually shifting stages, defined by the types of brain waves that reflect either lighter or deeper sleep. Toward morning, there is an increase in rapid eye movement, or REM sleep, when the muscles are relaxed and dreaming occurs, and recent memories may be consolidated in the brain. Experts say that hitting a snooze alarm over and over again to wake up is not the best way to feel rested. “The restorative value of rest is diminished, especially when the increments are short,” says psychologist Edward Stepanski, Ph.D. who has studied sleep fragmentation at the Rush University Medical Center in Chicago. This on-and-off-again effect of dozing and waking causes shifts in the brain-wave patterns. Sleep-deprived snooze-button addicts are likely to shorten their quota of REM sleep, impairing their mental functioning during the day.

Cognitive behavioral therapy and sleeping

From his clinical Cognitive Behavioral Therapy (CBT) work and research on sleep, psychologist Charles M. Morin, Ph.D., a Professor in the Psychology Department and Director of the Sleep Disorders Center at University Laval in Quebec, Canada, says that ten percent of adults suffer from chronic insomnia. In a National Sleep Foundation study released in the recent issue of the Sleep Medicine Alert, Morin outlines how CBT helps people overcome insomnia. Clinicians use sleep diaries to get an accurate picture of someone’s sleep patterns. Bedtime, waking time, time to fall asleep, number and durations of awakening, actual sleep time and quality of sleep are documented by the person suffering from insomnia.

A person can develop poor sleep habits like using their smart phone, tablet or laptop in bed, watching Jimmy Fallon in order to go to sleep or eating too much before bedtime. Many times they may compensate by sleeping late the day after a bout of insomnia, or taking a long nap during the day to compensate for the lost sleep. Some develop a fear of not sleeping and a pattern of worrying about the consequences of not sleeping, which perpetuates the insomnia and can result in a dependence on sleep aids. Cognitive behavioral therapies are essential for patients attempting to alter the conditions that perpetuate insomnia.

CBT attempts to change a person’s dysfunctional beliefs and attitudes about sleep such as letting go of thoughts like, “I’ve got to sleep eight hours tonight” or “I’ve got to take medication to sleep” or “I just can’t function if I don’t sleep.” These thoughts focus too much on sleep, which can be similar to performance anxiety. Sleep has a way of creeping up on you when you are not actively seeking it. Banishing negative thoughts will allow sleep to arrive at your bedroom door.

According to a study published in the October 2004 issue of The Archives of Internal Medicine, cognitive behavior therapy is more effective and lasts longer than the sleeping pill, Ambien. The study involved 63 healthy people with insomnia who were randomly assigned to receive Ambien, cognitive behavior therapy, both or using a placebo. The patients in the therapy group received five 30-minute sessions over six weeks. They were given daily exercises to “recognize, challenge and change stress-inducing thoughts” and were taught techniques like delaying bedtime or getting up to read if they were unable to fall asleep after 20 minutes. The patients taking Ambien were on a full dose for a month and then were weaned off the drug. At three weeks, 44 percent of the patients receiving the therapy and those receiving the combination therapy and pills fell asleep faster compared to 29 percent of the patients taking only the sleeping pills. Two weeks after all the treatment was over, the patients receiving the therapy fell asleep in half the time it took prior to the study, and only 17 percent of the patients taking the sleeping pills fell asleep in half the time.

What works in many cases, is to give a person more control over their sleep. A person can keep a sleep diary for a couple of weeks so a clinician can monitor the amount of time spent in bed to the actual amount of time sleeping. Then the clinician can instruct the patient to either go to bed later or get up earlier or vice versa. A person can also establish more stimulus control over his or her bedroom environment, such as going to bed only when sleepy, getting out of bed when unable to sleep, removal of electronic devices from the bedroom and not smoking or drinking before bedtimes. The same wake-up times every morning (including weekends) and avoiding daytime naps are also good regimes to adopt in thwarting insomnia.

Finally, a person can incorporate relaxation techniques as part of his or her treatment. For example, a person can give herself or himself an extra hour before bed to relax and unwind and time to write down gratitude lists, meditate or use tapping (Emotional Freedom Techniques).

In CBT, said Morin, breaking the thought process and anxiety over sleep is the goal. “After identifying the dysfunctional thought patterns, a clinician can offer alternative interpretations of what is getting the person anxious so a person can think about his or her insomnia in a different way.” Morin offers some techniques to restructure a person’s cognitions. “Keep realistic expectations, don’t blame insomnia for all daytime impairments, do not feel that losing a night’s sleep will bring horrible consequences, do not give too much importance to sleep and finally develop some tolerance to the effects of lost sleep.”

How can I get more sleep?

According to leading sleep researchers, here are some techniques to get more sleep:

• Start a sleep diary to chart your progress
• Keep a regular sleep/wake schedule and develop a regular bedtime (go to bed at the same time on weekends as on weeknights)
• Try and wake up without an alarm clock—get rid of the snooze alarm
• Attempt to go to bed earlier every night for a certain period of time; this will ensure that you’re getting enough sleep
• Give yourself a 60-minute relaxation period before you sleep, meditate, chant, write a gratitude list, complete an eleventh step
• Don’t drink or eat caffeine four to six hours before bed and minimize daytime use
• Don’t smoke, especially near bedtime or if you awake in the night
• Avoid alcohol and heavy meals before sleep, curb night eating
• Get regular exercise
• Minimize noise, light and excessive hot and cold temperatures where you sleep
• Avoid daytime naps, especially after 3pm
• Reading is okay, however make it a non-stimulating choice, romance, murder mysteries and sci-fi thrillers are very stimulating and can inhibit the relaxation portion of your pre-sleep ritual
• Consider taking a hot shower at bedtime, instead of in the morning. Use aromatic soaps that promote sleep such as chamomile and lavender

Dr Ralph Carson writes about the additional impacts of having a pre-frontal cortex that is “shut down” due to poor sleep. He explains: “This can cause you to overreact to negative experiences. Instead of facing your problems like a well-reasoned adult, you’ll be more apt to act moody, inpatient, or irritable.” For those in recovery, these negative mood states can be extremely triggering, increasing the likelihood of relapse.

As previously stated, sleep deprivation inhibits the pre-frontal cortex’s ability to work efficiently, making it more difficult to focus on “what your big goals are.” Addicts who increase the duration of their sleep experience an improved ability to “resist relapse.” Increased sleep makes their brains cleaner and better fueled, helping them remember their goals to remain sober.

If you choose to try a few of these suggestions, please first speak to a medical professional about your lack of sleep or insomnia.

Resources using in compiling this blog:

National Sleep Foundation
http://www.sleepfoundation.org/

American Academy of Sleep Medicine
http://www.aasmnet.org/

American Insomnia Association
http://www.americaninsomniaassociation.org/

Sleep Research Society
http://www.sleepresearchsociety.org/

NIH National Center for Sleep Disorders Research
http://www.nhlbi.nih.gov/sleep

The MayoClinic.com Sleep Center
MayoClinic.com

Ralph Carson (2012) The Brain Fix, Health Communications, Deerfield Beach, Florida, p 214
http://ralphcarson.com/

National Institute of Health (2013) How Sleep Clears the Brain,
http://www.nih.gov/researchmatters/october2013/10282013clear.htm

National Institute of Health (2013), New Brain Cleaning System Discovered:
http://www.nih.gov/researchmatters/september2012/09172012brain.htm

Martica Heaner (2004), Snooze Alarm Takes Its Toll on a Nation, Health Section, New York Times.com, http://www.nytimes.com/2004/10/12/health/12snoo.html

American Psychological Association (2014 ) Why Sleep is so important and what happens when you don’t get enough, http://www.apa.org/topics/sleep/why.aspx

John O’Neil (October 5, 2004) Treatment: Think before You Sleep, New York Times.com, Vital Signs Section, http://www.nytimes.com/2004/10/05/health/05trea.html

Posted in Health, Recovery Coaching, Relapse, Sleep Deprivation, Sleep Loss | Tagged cognitive behavioral therapy, insomnia, recovery coach, sleep | Comments Off

10 Things I Can Do When I Need to Fight Fair

Posted on July 8, 2014 by Melissa Killeen

Melissa Killeen

The following is a new post about my continuing journey with a particular client, its focus is on how he might have better conversations with his girlfriend, even when they start out as hot-headed disagreements and potentially explosive discussions.

In the last post, my client and I discussed some ground rules for fighting fair. I suggested he speak to his girlfriend after making up from a previous argument, and discuss with her how to resolve difficult topics in a healthier manner. I also proposed they establish some common ground rules.

He asked if he should show his girlfriend this blog post, and I felt that would be a great opening to their discussion of setting new guidelines for healthy conversations. When both of them accept these ground rules for managing heated dialogues, then positive resolutions will become more likely.

Fight Fair Guidelines
I advised the client to take pen and paper to write down his answers to the following 10 guidelines, and then review them before he anticipates a heated discussion:

1. Before you begin, ask yourself, “What exactly is bothering me? What do I want the other person to do or not do? Are my feelings in proportion to the issue? Or is there something under these feelings that I am not seeing that makes this a colossal issue?”

2. Know what your goals are before you begin. Understanding that all discussions are an exercise in give and take, what are the possible outcomes that could be acceptable to you? Write them down.

3. Remember that the idea is not to win but to come to a mutually satisfying solution to the problem. What would be a mutually satisfying solution for you?

4. Set a time for a discussion with your partner or colleague. It should be as soon as possible but agreeable to both persons. Springing a conversation on someone when they are unprepared may leave them feeling like they have to fend off an attack. If you encounter resistance to setting a time, try to help the other person see that the problem is important to you. Set an appropriate location for the talk. If it’s a work colleague you want to talk with and you work in a cubicle farm, reserve a conference room. If you are at home, select a time after the kids go to bed, or early on a weekend morning, before they wake up.

5. Write the problem down on a piece of paper. State the problem clearly. At first, try to stick to the facts; then, once you’ve stated the facts, state your feelings (also write these down on paper). Use “I” messages to describe feelings of anger, hurt, or disappointment. Avoid “you” messages such as, “you make me angry. . .” instead, try something like, “I feel angry when you . . .” Understand the power of body language, sit next to this person, do not point your index finger at them, attempt not to cross your arms over your chest, or place your hands on your hips and keep approximately four feet between you at all times.

6. Invite the other person to share his or her point of view. Be careful not to interrupt, and genuinely try to hear his or her concerns and feelings. Repeat or restate (paraphrase) what you heard in a way that lets your partner know you fully understood, and ask your partner to do the same for you.

7. Walk a mile in their moccasins. Try to take the other person’s perspective; that is, try to see the problem through his or her eyes. The opposing viewpoint can make sense to you, even if you don’t agree with it.

8. Propose specific solutions, (write these down ahead of time) and invite the other person to propose solutions, too.

9. Discuss the advantages and disadvantages of each proposal.

10. Be willing to compromise. Allowing the other person only one option will make it difficult to resolve the concern. When you reach an agreement on a way forward, celebrate! Decide together on a time to check-in, discuss how things are working, and make changes to your agreement if necessary. Some people have the type of personality that thinks about important issues, twice as long as you do. These folks are still brilliant people, but they just are not comfortable coming to a quick resolution. So, if no solution has been reached regarding the original problem, schedule a time to revisit the issue and continue the discussion later.

When Nothing Seems to Work
Sometimes, despite our best fair-fighting efforts, a disagreement or conflict seems insurmountable. When this occurs, talking with a trained professional can help. A trained mediator, marriage and family therapist or conflict-resolution coach can help you communicate more effectively and eventually work your way through to a solution. Here are some books that may help as well:

The Dance of Anger: A Woman’s Guide to Changing the Patterns of Intimate Relationships by Harriet Lerner. HarperCollins, 1997.

Hostage at the Table: How Leaders Can Overcome Conflict, Influence Others, and Raise Performance by George Kohlrieser. Jossey-Bass Publishing, 2006.

Communication Miracles for Couples: Easy and Effective Tools to Create More Love and Less Conflict by Jonathan Robinson, Conari Press, 2012

Messages: The Communication Book by Matthew McKay, Martha Davis, and Patrick Fanning. New Harbinger Publications, 1995.

Love is Never Enough: How Couples Can Overcome Misunderstandings, Resolve Conflicts, and Solve Relational Problems Through Cognitive Therapy by Aaron T. Beck. Harper Perennial, 1989.

Fighting the Good Fight: Learning to Deal with Conflict Constructively in Permanent Partners: Building Gay and Lesbian Relationships that Last (pgs. 169-200) by Betty Berzon. Plume, 2004.

Posted in Recovery Coaching, Relapse | Comments Off

A Checklist: How Emotionally Mature Are You in a Heated Conversation?

Posted on May 29, 2014 by Melissa Killeen

Melissa Killeen

[This is the final in a series of posts about my interactions with a recovery coaching client. In these blogs, I wanted to share what happens during a recovery coaching engagement, the discussions that take place, what usually comes up for the client and how, as a recovery coach, I respond. The series will pick up again in the near future]

I asked my client a very specific question after a blowup between he and his live-in girlfriend. If you have been following my blog, recently, you know that I have dedicated a number of posts to the topic of this particular client’s recovery and relapse, and his attempts to repair his relationship with the woman with whom he lives. So it’s become fairly obvious to me that this is going to be a recurring subject in our coaching and recovery relationship.

My client would like to believe that he is a mature, rational, 40-year-old adult. But if he is honest with himself, just as if we all are honest with ourselves, he’s surely held on to some inner emotional immaturity. The truth of the matter is that we can act like adults in our relationships or we can act like we’re 6 years old. When one partner displays emotional immaturity during a discussion, the other often follows suit, seemingly without much hesitation. Then the entire conversation fails. Perhaps the trigger is a feeling of being less-than, or of rejection or abandonment. In a flash, we become the 6-year-old that was lost in the department store, the 9-year-old that was reprimanded by a teacher or the 12-year-old listening in as their aunts and uncles fight at a Thanksgiving dinner.

As a coach, I like to differentiate between the emotional maturities of the 6-, 9- or 12-year-old, and those of the forty-year-old. When we begin to mature, our childlike behavior no longer reaps the same reward and we are forced to act more maturely. A 6-year-old is extremely limited in their choice of options when it comes to handling most types of situations. They learn as they grow, finding out what works and what doesn’t work. As adults, we have far more choices and options than a 6-year-old. Before reacting to questionable comments from another, it’s important to ask ourselves the very same question I asked my client: Do you want to be 6, 9 or 12 – or do you want to be 40? A true adult gets to choose!

Let me illustrate the difference . . .

Immature		Mature
I snap at my partner because I feel irritation.		I recognize that I am irritable and why, so I calmly let my partner know how I feel and what I need to help me feel better.
I hold something that bothers me inside until I blow up at my partner. I hold something in until it comes out sideways.		I tell my partner as soon as I am aware that something is bothering me so we can calmly discuss it.
I call my partner names and belittle them when we are arguing. I point fingers, invade my partner’s space and raise my voice.		I realize that name-calling and belittling does not help the situation and I can voice what is really bothering me, instead. I recognize my body language, keep my hands at my sides, lower my voice and keep my distance.
I stuff my feelings, or lie to my partner because I am afraid it will start a fight, or that they will reprimand me.		I am honest with my partner because I am emotionally prepared for their reaction.
I act on my sense of urgency to fight with my partner, knowing that I am reactive and emotionally activated.		I recognize that I am reactive and I force myself to wait until I feel more stable to discuss it with my partner. I never respond immediately to something when I am angry, even if my partner insists.
I am defensive, hurt and argumentative when my partner complains about something I am doing.		I recognize that my I am not perfect. I say I am human, I can make mistakes. I expect that sometimes my partner will have comments about my actions or behavior.
When my partner complains about me, I remind them that they have done the same thing or they did something that bothered me in the past (pointing the finger, deflection or cross-complaining).		I hear that my partner is bothered by something and I validate their feelings. Any complaints I may have about them can be brought up at another time.

I spent some time with my client to discuss his reaction to this most recent blowup with his girlfriend. He identified with several of the immature characteristics in the above columns, characteristics evident in this and past exchanges. How many did he use? Did this number of immature responses overwhelm the number of mature responses? We discussed what the mature responses would have been.

Immediately, he said this was a good chart and that he was going to show it to his girlfriend to let her know that she had also displayed immaturity in their past discussions. I suggested he not do this, pointing out that as a mature adult, he need not shame his partner, even under the guise of using, to her benefit, a learning tool. It would be more effective, I explained, for him to practice mature, adult responses to future, potentially explosive situations. That that would help ensure the temperature of the next conversation not rise to a dangerous level, and expect his girlfriend to recognize his positive responses and emulate his mature behavior in these dialogues.

Using correct tools of engagement in heated discussions is seldom taught in families, or school. We learn how to argue and fight from our parents, family members or friends. At forty, it is time for my client to approach a heated conversation as a forty-year-old, not a 12-year-old.

Posted in Family Dynamics, Recovery Coaching, Relapse | Comments Off