

Monday, May 11, 2015

Happy Mother's Day, fellow Trauma Mamas.

Thursday, May 7, 2015

How to get some sleep

Some common causes for issues with sleeping:

  • Mental illness - Bipolar disorderADHD...
  • Sexual Abuse - if a child was abused/ molested in bed, the bed and bedtime can become a trigger.
  • Sleep Disorders -
    Restless Leg Syndrome (RLS) - a disorder of the part of the nervous system that causes an urge to move the legs. People with restless legs syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body) and an irresistible urge to move their legs to relieve the sensations. The condition causes an uncomfortable, "itchy," "pins and needles," or "creepy crawly" feeling in the legs. The sensations are usually worse at rest, especially when lying or sitting.

Some techniques for getting sleep:
  • BEDTIME ROUTINE. Have a set bedtime routine and stick to it. (Bath, brush teeth, "room time," quiet activity in a dimly lit room, parent reading a book or telling a story*, singing a song or rubbing the child's back...).
  • Room Time. This was for both the kids and the parents. Room time was 1/2 hour before bed or 9pm whichever was earlier. Even my older kids had room time. Especially as teens most of my kids didn't really go to sleep at 8 or 9pm anymore, but if they were up running around, the kids who needed more sleep would want to be up too. Plus, Hubby and I wanted some adult time (Get your mind out of the gutter! We just wanted to watch non-Disney TV shows and talk about our day!). 
  • Avoid stimulating activities between dinner and bedtime. This is not the time for a rousing game of tag or scary movies/ stories.
  • Establish a regular exercise routine.
  • Eating and drinking. Avoid eating a heavy evening meal and caffeinated beverages.
  • Avoid overstimulation - bedrooms should not be playrooms. Our therapist suggests bedrooms should have a bed, a dresser (even this can be too much for some kids!), a stuffed animal or two, a book or two and a quiet activity if the child doesn't read independently. No TV or other electronics with screens belong in a bedroom.
  • Give your child tools to overcome his worries. These can include a flashlight, a spray bottle filled with "monster spray," or a large stuffed animal to "protect" him.
  • Screen time ending 2 hours before bedtime - Screens – found on computers, cellphones and TVs – emit blue light that is found in the light spectrum present during daytime hours. Acting as artificial sunlight, blue light decreases your production of melatonin.
  • No electronics in the bedroom - nothing with a blue light - no tv, no computer, no mobile devices (had to be charging in parent's room overnight)... My older teens were allowed to have their laptop in their room if they could be trusted, didn't have sleep issues, and needed them for homework and such. 
  • Melatonin - a mild herbal supplement available over the counter that helps regulate your sleep and wake cycle. A small does is usually given near dark to signal the body that nighttime is coming (does not really work during the day). 
  • Essential oils - I don't claim to know anything about these, but a lot of parents swear by them. 
  • Sleep meds - children taking sleep meds should do so only under a doctor's care. If an adult requires sleep meds more than a few days in a row, it's probably a good idea to discuss it with a doctor.
  • Set bedtime and wake time. No matter what time I went to sleep the night before, I get up every day (even weekends) at the same time. This helps force my body to keep my circadian rhythms more regular. For children past the age of napping. Avoid naps during the day.
  • Sleep time. People generally need 8 hours of sleep a day. Kids and teens usually need closer to 10. Especially when my kids are dysregulated, I move their bedtime earlier.
  • Daylight Savings time and school holidays. Changing your body's sleep schedule takes time. I usually start getting the kids back on schedule 2 weeks prior to school starting again after winter and summer vacations, and avoid letting the kids stay up too late or sleep in too much on weekends and holidays.
  • Sleep Study - Having a professional sleep study done can rule out things like Restless Leg Syndrome
  • Biofeedback - Practice biofeedback and other calming techniques at other times of the day. Then you can use them at bedtime.
  • Counting to 100. I use this one a lot. I get comfy, close my eyes, breathe slowly and deeply, and count to 100 in my head - each breath in and out is a count of 1 (deep breath in, deep breath out - "1", deep breath in, deep breath out - "2"... If I move for any reason then I have to start over with 1. If I reach 100 and I'm still awake, then I roll over and try a new position - and restart the count.
  • Progressive Muscle Relaxation - The link gives a good tutorial, but basically PMR teaches you how to relax your muscles through a two-step process. First, you systematically tense particular muscle groups in your body, such as your neck and shoulders. Next, you release the tension and notice how your muscles feel when you relax them. This exercise will help you to lower your overall tension and stress levels, and help you relax when you are feeling anxious. 
  • Sleep Phase Chronotherapy (SPC), which progressively advances sleep time by 1–2 hours per week until you've gone all the way around the clock to your preferred bedtime. The idea is that it's almost impossible to make yourself get sleepy and go to sleep early, but it is possible to stay up a little later every night until you move your bedtime all the way around the clock to the right time. Yes, this is as difficult to do as it sounds.
  • Weighted Blankets - You can even make these yourself. How to Make a Weighted Blanket
  • Nightmares - One thing my mother taught me is that we can take control of our dreams and nightmares. When I have a recurring nightmare (such as being chased). I try to think of what's going on in my life that might be making me feel this way. Then I rewrite the dream in my head (might be right when I wake up, might be later in the day). I imagine every detail of what I want to have happen instead. (Turn and confront the person chasing me. Have the ability to fly. Whatever.) Think of defeating a bogart in a Harry Potter movie.
  • How to have good dreams. My "secret trick."
    Kitty wanted to have a good dream, and I told her I knew a secret trick.

    I asked her what she wanted to dream about -"getting married and having kids with Jesse McCartney" (Bleech!). But I decided to ignore the gross factor, so we both could get some sleep seeing as she'd had a tough day.

    So to have a good dream you tell yourself a story or write a play in your head while you're laying comfy in your bed. Your story is about what you want to dream about, but you have to imagine EVERY detail. Where are you? What does your house look like, is it a 2 story or a one story, are you in the living room? Where is Jesse? Is he at work? Do you go with him? Do you work? What do you do? Picture it in your head. What are you wearing when you go to work with Jesse? Are you wearing an evening gown? What color is it? Do your heels hurt your feet? Are you in a crowded club or a private limo? What color are the seats in the limo? Is it moving or are you stopped? Does Jesse take your hand as you get out? What does his cologne smell like? Can you feel his hand in yours?

    All of this was done in a quiet, calm, monotonous voice, and I didn't usually wait for answers for most of the questions. I just wanted her to visualize the picture. I did biofeedback when I was her age so I tried to mimic the method of painting imagery.

    In the morning she said it worked!
**Storytime - At our house, to keep kids interested in listening to stories long after they'd passed the stage of Goodnight Moon, I made up stories unique to them. Because I had kids of varying attention spans, emotional age, and intelligence in the same room, reading a chapter in a book, just wouldn't work.

So I created a Choose Your Own Adventure type story. Each child got to pick 3-5 things (depending on how many kids were listening) to put in the story. This could be themselves, a place, an activity, an animal (lots of flying unicorns in the girls' stories), a favorite toy, a friend...

Then came the "fun" part. I had to tell a story that incorporated all of the things they'd chosen. Often the story had a secret moral to the story (when someone had been stealing, it was amazing how often the characters in the story dealt with that particular issue!). Sometimes, I drew on fairy tales (Hansel and Gretel) or Narnia type stories (went through a secret door in a tree). The story was always different, although sometimes we might travel to the same place (they really liked the secret door in the tree!).

I always told the story in a quiet, calm, monotonous voice, usually while laying on the kid's bed with them (gently patting their back or stroking their hair), or sitting on the floor next to the child's bed if that kid couldn't handle having someone on the bed with them (sexual abuse issues). If I was telling the story to more than one child, I usually sat on the floor or in a chair nearby to avoid jealousy issues.

The best part was, the story could be as long or as short as I wanted, so if I was tired...

Sleep Phase Chronotherapy


Anonymous Commenter: Circadian Rhythm disorders are a research interest of mine. Almost everyone's internal, natural circadian rhythms are slightly over 24 hours. These rhythms are kept in check by bright light every morning coming in through a person's eyes. This turns off a person's melatonin production (the sleep signal). She is likely not receiving this signal {commenter was under the mistaken impression that Kitty was blind}. A more effective treatment would be for her to take .3 mg of Melatonin every day at 6PM. This very small dose would signal her body that nighttime was coming. This would keep her regular and in phase with the world.

Most of the people I know with bipolar disorder have chronic issues with insomnia. It is probably also an issue with PTSD and the hyper-vigilance that goes with that. Bear often had bouts of horrible flashbacks or night terrors that caused his whole body to react as though he were reliving the trauma (which he probably was). Understandably he fought sleep and while most sleep meds didn't work, the one that helped (also an anti-psychotic) he usually refused to take.

Kitty and I both have the sub-type -
Delayed sleep phase disorder (DSPD), aka delayed sleep phase syndrome (DSPS), characterized by a much later than normal timing of sleep onset and offset and a period of peak alertness in the middle of the night. Like babies who get night and day mixed up!

When Kitty did a sleep study in April, we realized that sleep medicines just don't work for her (including Melatonin, Ambien, Lunesta, Seroquel...), and were told that the only treatment left was Sleep Phase Chronotherapy (SPC), which progressively advances sleep time by 1–2 hours per week until you've gone all the way around the clock to your preferred bedtime. The idea is that it's almost impossible to make yourself get sleepy and go to sleep early, but it is possible to stay up a little later every night until you move your bedtime all the way around the clock to the right time.

The doctor told us that few people attempt this treatment, because it's so disruptive to real life (how many people can miss 3 to 8 weeks of work?) and of the few of his patients that do attempt it, a substantial portion fail.  Even worse, if something happens to disrupt the process then Kitty's sleep schedule could end up even more horribly distorted.  At the time, we decided that all of Kitty's compliance issues would make this treatment impossible.

When nothing else worked, we did attempt Sleep Chronotherapy. I'm not sure how we ended up deciding that it could be done in 1 week, maybe we were so tired that we misunderstood the doctor. There was also a major issue caused by Kitty's refusal to miss any scheduled work hours (it was summer, but she had a part-time evening job at a local entertainment center).

Kitty and I did it together - for many reasons (including the fact that I probably needed it too), but primarily because Kitty doesn't have the ability to do it on her own. If you're going to try this, I highly recommend having a partner to help both of you stay awake.

I wrote out a schedule of sleep and awake times for the entire week (again, this should have taken a couple of months!). This is important! When your sleep schedule is off, you'd be amazed at how complicated and confusing it all gets trying to remember what time to set the alarm for and when not to make appointments.

If I had to do it again, which I WON'T!, here's some things I would do differently.

  1. Figure out a meal schedule.  I think I lost 2lbs because I never remembered to eat, and I'm guessing Kitty gained quite a bit, because she ate continuously (she tends to turn to food when she's upset and/or bored).
  2. Have planned activities, especially with other people involved (since Kitty and I are both extroverts). For times when others are asleep or busy, try doing something active, like taking a walk.
  3. Extend the time to make the transition (6 to 8 weeks?). It takes a full month for your body to accept a new circadian rhythm. 
  4. On the first night, be sure your new bedtime is at least an hour (preferably 2) after the latest time you tend to fall asleep.  We've both stayed up until 4am many times before.  I didn't schedule it this way, because we had something to do at 1pm, and I wanted to give us a full 8 hours plus some time to wake up and get ready for an appointment. Kitty wasn't able to fall asleep until 5am.
  5. Avoid driving (or operating heavy machinery) and making life altering decisions. 
  6. You might want to avoid deep conversations with people you care about - you will regret a lot of things you say when you're sleep deprived and cranky.
  7. Remember sleep deprivation is a common means of torture and brain washing.

Honestly chronotherapy did not help either of us. We were both back to having chronic insomnia within weeks. If you attempt it, please do so under the supervision of a doctor and take significantly longer than a week to make the transition.

Now, many, many years later, we are ready to try this again, and by "we" I mean Kitty, who is now 22. Hopefully by doing it right this time (advancing at 2 hour intervals a week over a period of 2 months), Kitty will be successful, but I'm not holding my breath. I'll keep you posted here. Remind me if I forget!