Category Archives: Substances

Sleep, Substances, and Online Resources

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Last post I talked about healthy sleep: if we’re tired after a night of sleep, or it’s taking us longer than 30 minutes to fall asleep, we might actually try going to bed LATER. The key is condensing our sleep/time in bed, while maintaining a consistent wake-up time and exposure to light. This is a behavioral treatment for insomnia called “Stepped Care.”

So we talked about behavioral adjustments to bed time, but what about what occurs during the day? How does our alcohol, marijuana, caffeine or over-the-counter medication affect our sleep? In a word, badly.

A key part of sleep is our cognitions about it. We can psyche ourselves out about it. Easily. The more we use a tool like Ambien or Benadryl to get a good nights sleep, the more we are telling our brains, “I can’t do this on my own” (which is not true). It’s also likely we might have a night where the substance is not available and the thought, “I sure hope I can get to sleep without my ___” occurs, followed by feelings of doubt and our body taking those cues and having a terrible night of sleep.

In psychology, we call this a decrease in self-efficacy, and it’s not a good thing. There are ripple effects to it – most obvious may be a dependence on a certain item to get to sleep (for example, smoking pot, or a couple of glasses of wine).

Often the substances that seem to relax us and promote sleep, actually are not giving us good, quality of sleep. Some people realize this with alcohol – while we can drink enough to knock ourselves out, we don’t typically feel well-rested the next day. That’s because we never really entered into that blissfully deep REM sleep, and we ended up waking up a few times or waking up prior to obtaining enough rest. Even Melatonin can affect our circadian phases, and regular use can increase dependence.

All these things work but do not promote long-term, healthy sleep like these components do:
exercise, daily routines, creating a comfortable sleep environment, and controlling the amount of stimulating activity we have prior to bedtime. Humans are like computers, we can program ourselves. In psychotherapy, we utilize strategies like relaxation training to do this.

There are resources available online, such as:
1. Sleepio
a. 6 sessions
b. Weekly or longer
c. $11.30 / week
d. $80 / 12 weeks

2. SlumberPro
a. 4 – 8 weeks
b. free for first week, then $39

3. Cognitive Behavioral Therapy for Insomnia
a. 5-week, 5 session course = $34.95
b. on-line or CD

4. Shut-I
a. 16 week subscription = $129
5. The Insomnia Doctor: www.get2sleepnow.com
a. $29.99 / 1 month
b. $69 / 3 months

List (and inspiration for this blog post) courtesy a training by Rocky Garrison, PhD, CBSM, a psychologist specializing in the treatment of insomnia. www.rockygarrison.com

Sugar, a Substance?

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The average American eats 22 teaspoons of sugars every day. I’ve read many articles over the years saying this amount is way too high. Have you ever considered sugar a “substance?” It actually stimulates the brain in the same way cocaine does, which is why we are driven to crave more and more of it.

Obviously substances are all on a spectrum and we must all make decisions around how much enjoyment versus harm they are doing to our lives. But my point is that there are many different substances out there — everything we ingest and even the activities we do send messages to our brains. These messages can affect our future thoughts, cravings and behavior.

Every human has a relationship with substances (and a a variety of harmful and helpful relationships at that). I’ve often heard friends and family ask me about working with people who struggle with diagnosable chemical dependency, posing questions like, “why do they like [the drug],” “can’t they realize what it’s doing to their bodies and lives?”, and “isn’t it depressing when they just continue to go back to it and relapse?”

My response is always the same. I return their questions with a question: “Have you ever tried to change a behavior in your life? Maybe your diet, or how much you exercise?” Typically the answer is yes. I then have an opening to discuss with the person how difficult it was, how many days you experienced progress and how many days you “relapsed” or fell back into old patterns. The bottom line is change, like recovery, is a lifelong process. That process begins with personal insight. One of my favorite quotes from the Dalai Lama states, “critical thinking followed by action’ is the most important thing we can do now.” I love that idea, since it’s why talk therapy can be helpful to so many people. In most cases, we need to have an understanding of what’s going on, to think critically about it, before we can strategize about the action to take. I think all those articles about 22 teaspoons of sugar are trying to tell us all something (and prompt people to cut back!).