RingIn
Moderator
Posts: 696
(7/3/03 12:20 am)
------------------------------------------------------------------------
Below is an excellent article I found and would like to share with you all.
"Let me explain a little bit about tinnitus.
Tinnitus is the perception of noise in the absence of an acoustic stimulus. It can occur as a pure tone or multiple tones and can be high pitched, low pitched,
ringing, buzzing, roaring, clicking, hissing, rough, pulsatile, or steady. Because it is a symptom and not a disease, its treatment varies and is often
unsuccessful.
If a person has objective tinnitus, which is audible to the physician or another person or has a pulsating character, certain conditions are suspected. The
differential diagnosis includes vascular abnormalities, eustachian tube abnormalities, and tympanic muscle problems.
Subjective tinnitus is more common than objective tinnitus. Almost all persons experience tinnitus at some time. Patients perceive noise that is not generated
in their surroundings.
Subjective tinnitus is complicated by an inability to obtain an objective measure of its severity, and its cause is unknown. The symptom of tinnitus can be
likened to headache with multiple causes. It may be caused by abnormal conditions in the cochlea, the cochlear nerve, the ascending auditory pathway, or the
auditory cortex. It has been postulated that the cochlear hair cells injured by noise or head trauma may discharge repetitively, stimulating nerve fibers to
discharge synchronously in a way that the central auditory system cannot discriminate from actual sound. In the central nervous system or in the auditory
pathways, spontaneous activity within individual auditory nerve fibers may also be synchronized because of injury or metabolic abnormality, resulting in
tinnitus. It is also possible that hyperactivity in the nuclei of the ascending auditory pathways may stimulate the auditory cortex in a similar manner. An
alternate theory proposes that injury to cochlear integrity from any cause reduces the suppressive influence of the central nervous system, allowing increased
neuronal activity higher in the auditory system.
In obtaining complete histories of tinnitus patients, several etiologic factors are prominent. These are classified as otologic, cardiovascular, metabolic,
neurologic, pharmacologic, dental, and psychologic factors. For you ,we already know the meniere's disease is the main culprit, anyway, the largest number
of patients with tinnitus appear to have a history of noise exposure or are experiencing presbycusis. In both instances, there is a high-frequency neurosensory
hearing loss. Seventy-five percent of patients have a 30+ dB hearing loss from 3 to 8 kHz. This hearing loss is the single most consistent factor in patients
with tinnitus. Generally, the pitch of the tinnitus occupies the region of the greatest hearing deficit or the most abrupt loss.
A variety of other otologic disorders appear to accentuate or cause tinnitus, especially Meniere's disease, in which almost all patients complain of the
symptom. However, only 4% of these patients have severe and intractable symptoms that are unresolved by any form of management.
Three percent of patients had severe tinnitus secondary to prolonged otitis, and 2% had recurrent labyrinthitis. Although most patients with otosclerosis have
tinnitus, only 4% said it was significant. Dizziness is commonly associated with tinnitus. Thirty-five percent of patients were dizzy at least part of the
time, and a smaller percentage were dizzy all of the time. This rate of dizziness is higher than in the standard population for the respective age groups, and
the symptom should be considered in the workup.
Cardiovascular problems are frequently associated with tinnitus. Thirty percent of patients with severe symptoms had one or more cardiovascular complaints. The
high incidence of cardiovascular disease is consistent with the age group (>60 years), but it is still likely that hypertension is a major factor in the
onset or severity of the patient's disease.
Twenty-two percent of the patients who had tinnitus in our study had significant hypertension, and more than 1% related specific cardiovascular incidents to
the onset of their complaints.
Secondary vascular disorders must be excluded in evaluating these patients. These conditions include anemia (ie, tinnitus secondary to increased cardiovascular
output) and extensive arteriosclerosis, in which tinnitus tends to be objective and pulsatile.
Thyroid dysfunction can be associated with tinnitus. Hyperthyroidism, by increasing cardiac output, can cause a pulsatile or rushing noise.
Hypothyroidism has also caused this complaint. It is severe in about 4% of this population.
Hyperlipidemia (too high blood fat content) is increasingly reported as a factor in tinnitus, particularly in association with fluctuating neurosensory hearing
loss and associated dizziness. Vitamin A and/or B deficiency has been described as causing tinnitus.
Five percent of patients report that tinnitus was the result of major trauma. Trauma generally included a skull fracture or closed head injury.
Whiplash injuries have initiated tinnitus, suggesting that abnormal proprioceptive input from nerve fibers in the neck and shoulder or possibly brain stem
injuries are factors. Tinnitus after whiplash injury usually occurs 7 to 10 days after the accident, and the appearance of tinnitus immediately after head
trauma without clearly defined ear abnormalities or vestibular disease is uncommon. Therefore, the physician must be careful in assigning a causal relationship
to this injury.
Past meningitis (brain infection)may be the cause of tinnitus. Multiple sclerosis can also have severe tinnitus in its constellation of symptoms.
Ten percent of patients relate the onset of significant tinnitus to initiation of or changes in pharmacologic therapy. All classes of medication are considered
possible causes of tinnitus. These include anti-inflammatories, antibiotics, and antidepressants.
Aspirin and aspirin-containing compounds were identified as the most common inciting medications. As little as 600 to 1000 mm/day of aspirin can create
symptoms. Aspirin-containing medications, such as Percodan, Darvon, Bufferin, or Ecotrin, are often overlooked as possible causes of tinnitus.
Nonsteroidal anti-inflammatories, including Naprosyn and ibuprofen, are frequently implicated but not often considered. The effect of these drugs is similar to
aspirin, although not as severe.
Antibiotics, chiefly the aminoglycosides, cause tinnitus. It occurs in most cases of antibiotics used concurrently with diuretics.
Quinine-containing compounds and the synthetic analogues can elevate the severity of tinnitus.
Mercury, arsenic, lead, and other heavy metals in high doses can cause symptoms. A thorough history and alteration of medications are essential components in
treating patients with this complaint.
Temporomandibular joint disorders and dental abnormalities must be considered in taking the general history, in the physical examination, and in devising a
treatment course for tinnitus. Forty-five percent of patients with severe tinnitus describe active temporomandibular joint problems at some time. Thirty-eight
percent of patients who have severe tinnitus describe it as concurrent with an increase in the severity of their temporomandibular joint complaints. The
tinnitus is generally low pitched, rough, and associated with a feeling of fullness in the ear.
Psychologic factors play a major role. Stress often increases the perception of tinnitus severity, and depression frequently accentuates the complaint. In some
cases, the tinnitus itself may be the cause of the psychologic disorder. Sixteen percent of the population with tinnitus admitted to depression. Many more
probably were unwilling to admit to it or did not recognize the symptoms. Some studies concluded that 20% to 50% of patients were clinically depressed, and
about half the depressed patients had a long history of depression before the onset of tinnitus.
There is undoubtedly a significant population in which depression plays a major role and for which treatment must be appropriately directed, but it is not
effective to apportion patients with tinnitus into groups who are psychologically disturbed and those who are not, because treatment may ultimately prove
beneficial to both.
If symptoms your are mild, several guidelines should be observed. You should realize that 25% of patients will improve significantly, 50% will improve to some
degree, and the remaining 25% will remain unchanged.
A small proportion have progressive symptoms.
If you have tinnitus, you should avoid chocolate, coffee, tea, cola, or other caffeine-containing beverages or medications. Fifty-four percent of patients with
severe tinnitus took excessive amounts of caffeinated beverages daily. You should also stop smoking.
Medications should be reevaluated, with specific avoidance of aspirin-containing compounds, nonsteroidal anti-inflammatory drugs, or other implicated
medications.
You should avoid disturbing noise, use noise protection, and employ home masking techniques, which include music at night or the radio tuned between the FM
stations at a level of white noise that masks out the tinnitus. A bedside masker can also be recommended.
If you had a history of depression or anxiety, psychologic testing and evaluation are advisable. This allows the physician to have your emotional status
reviewed before additional treatment and to tailor medications to the results.
Best wishes
Heru"
Sleeping With Tinnitus -- Addendum
When I wrote "Sleeping With Tinnitus," I considered writing a section on the importance of thoughts and attitude on sleep. As time went on, I
realized that this was quite a serious omission in that a person's attitude toward sleep can have a very important effect on whether that person will be
able to sleep or not. In fact, a person's attitude can be the MOST important factor in that person's ability to sleep. This addendum is intended to
address this omission.
Your Thoughts and Falling Asleep
Listed below are several thoughts (or non-thoughts) that may cross your mind as you near bedtime:
No thoughts about sleep
I'm positive I will be able to sleep
I think I will be able to sleep
I don't know if I will be able to sleep, but I will give it a try
I don't think I will be able to sleep
No way am I going to be able to sleep tonight!
These thoughts are listed in sequence from positive to negative in terms of their relationship to sleep. Note that "No thoughts about sleep" is
listed even higher than "I'm positive I will be able to sleep." A person who has no thoughts about sleep probably has no problem with falling
asleep and most likely doesn't even need to read this paper.
In general, if you think you will be able to sleep, you will. And if you don't think you will be able to sleep, you won't. So the question becomes
"How do I move from one of the bottom two thoughts to a higher thought?" Discussed below are some possible approaches.
- Try to discipline yourself to never think either of the bottom two thoughts. Many, many times because of anxiety or a spike in my T I have had concerns about
my ability to fall asleep. I have found that, for me, it is more calming to say to myself "I don't know if I will be able to sleep, but I will give it
a try." This "give it a try" attitude has resulted many, many times in sleep even when my "inner voice" was telling me that I probably
wouldn't sleep.
- Take advantage of past successes with sleep. Here is an example of what I mean by this. One night my wife and I got into a terrible argument, one of the
worst we had ever had. When I got into bed I didn't expect to get any sleep because I was so upset. In fact, I didn't sleep as well as normal. However,
I did get somewhere between four and five hours of sleep. In retrospect, I was amazed I slept at all considering how agitated I felt when I got into bed. So
now, any time that I am anxious about my ability to sleep, I look back on that night and think to myself "If I could sleep THAT night, I should be able to
sleep tonight." This reassurance has a very calming effect on me both mentally and physically.
- Learn a relaxation technique that works for you. There are many self-help books that describe relaxation exercises. Here is a mental exercise that I learned
in a self-hypnosis class that helps me to sleep. It is performed after getting into bed and while lying on your back:
Close your eyes and get very comfortable. Do not cross your legs or arms. Take several deep breaths and exhale slowly. The more anxiety you have, the more
breaths you will need.
Starting with your feet, mentally say to yourself "My feet and ankles, I want you to relax." Feel them relaxing. Then mentally say "My feet and
ankles are relaxed."
Repeat the process for your calves and knees, your thighs and hips, your lower back, your tummy and chest, your upper back, your shoulders, your neck, your
mouth and jaw, your eyes, your forehead, your upper arms and elbows, and your forearms and hands.
Affirm that your entire body is relaxed.
Now mentally say "My mind, I want you to relax." Blank out your mind. Then affirm "My mind is now relaxed." Enjoy the relaxation.
Finally, say to yourself "When I leave this state of mind, I will sleep well, I will have pleasant dreams, and I will wake up refreshed."
Note that this exercise sounds like it would take a long time. In fact, it normally only takes about 10 minutes. Don't rush it! Feel the relaxation. How do
I know that it works? Many, many times I have fallen asleep while doing the exercise. On other occasions I had been quite anxious when I got into bed and, yet,
after doing the exercise I was able to sleep quite well.
Note also that this exercise can be used to help you fall back to sleep if you awaken during the middle of the night and feel wide awake.
- If you are using sleep medications, keep a small supplemental dosage on your nightstand. I have been prescribed trazedone (an AD) and klonopin (an
anti-anxiety med). Each night I take my normal dosage and I make sure that I have a single supplemental dosage of each medication on my nightstand along with a
glass of water. Just knowing that I have access to these medications if I need them brings me extra calm and reassurance. Frankly, I rarely, rarely ever need
them, but it's very comforting to know they are there. (Note: be careful that the amount of the supplemental dosage is safe for you to take.)
Other Common Situations and Thoughts Related to Them
- Naps. I used to curse naps. When I would awaken from one, I'd grumble to myself "Now I won't be able to sleep tonight!" More recently, I
have altered my thought about naps. I now view them as a "headstart"on the night's sleep. I think to myself "Since I took a nap, I won't
need as much sleep tonight." I accept the fact that it may take me a little longer to fall asleep.
- Tossing and turning. If you haven't been able to fall asleep in the first hour or two, it's very easy to get frustrated. Instead of focusing on the
thought "I've been tossing and turning for two hours!" it's more beneficial to think "I still have several hours left to get some
sleep."
- Waking up in the middle of the night. It's not a comforting feeling when you expect to sleep for seven or eight hours and you wake up after only two or
three. One option is to let this upset or frustrate you. Another option is to be thankful for the sleep you have gotten. If you let yourself get upset or
frustrated, this will affect your ability to fall back to sleep. If you learn to appreciate the sleep you have already had, it will calm you, making it easier
to fall back to sleep.
- Dealing with a poor night's sleep. How many times have I thought "I only got a couple of hours of sleep last night"? Of course, this may have
actually been the case. However, I have learned over time that we often have slept more than we thought we did. When I was on a fishing trip with my brother, I
remember saying to him "It took me a couple of hours to fall asleep last night." He responded "That's funny. You were snoring ten minutes
after you got into bed!" I had fallen asleep (which I didn't recognize or remember) and later woke up (which I did remember). On another occasion, my
wife couldn't sleep, so she got up to watch TV in our family room. Later, I woke up when I felt her getting into bed. In the morning I asked her "What
time did you come to bed? It was around 1:30, wasn't it?" She replied "It was almost 3:00." Thus, I thought I had only slept an hour and a
half (I go to bed at midnight) while, in fact, I had slept for three hours.
Final Comments
I realize that many of my suggestions might be thought of as simplistic rationalizations. I can understand this reaction. However, I believe that a good
attitude can truly be a matter of seeing the glass as half full or half empty. The "half full" attitude leads to thoughts that bring about calm; the
"half empty" attitude can lead to thoughts that bring about anger and frustration. Remember this important fact regarding sleep: You can't
MAKE yourself sleep. You can only LET yourself sleep. Thus, any attitude that leads to calm will enhance a person's ability to fall asleep.
Edited by: Dirkh at: 7/6/04 5:07 pm
Moderator
Posts: 696
(7/3/03 12:20 am)
------------------------------------------------------------------------
Below is an excellent article I found and would like to share with you all.
"Let me explain a little bit about tinnitus.
Tinnitus is the perception of noise in the absence of an acoustic stimulus. It can occur as a pure tone or multiple tones and can be high pitched, low pitched,
ringing, buzzing, roaring, clicking, hissing, rough, pulsatile, or steady. Because it is a symptom and not a disease, its treatment varies and is often
unsuccessful.
If a person has objective tinnitus, which is audible to the physician or another person or has a pulsating character, certain conditions are suspected. The
differential diagnosis includes vascular abnormalities, eustachian tube abnormalities, and tympanic muscle problems.
Subjective tinnitus is more common than objective tinnitus. Almost all persons experience tinnitus at some time. Patients perceive noise that is not generated
in their surroundings.
Subjective tinnitus is complicated by an inability to obtain an objective measure of its severity, and its cause is unknown. The symptom of tinnitus can be
likened to headache with multiple causes. It may be caused by abnormal conditions in the cochlea, the cochlear nerve, the ascending auditory pathway, or the
auditory cortex. It has been postulated that the cochlear hair cells injured by noise or head trauma may discharge repetitively, stimulating nerve fibers to
discharge synchronously in a way that the central auditory system cannot discriminate from actual sound. In the central nervous system or in the auditory
pathways, spontaneous activity within individual auditory nerve fibers may also be synchronized because of injury or metabolic abnormality, resulting in
tinnitus. It is also possible that hyperactivity in the nuclei of the ascending auditory pathways may stimulate the auditory cortex in a similar manner. An
alternate theory proposes that injury to cochlear integrity from any cause reduces the suppressive influence of the central nervous system, allowing increased
neuronal activity higher in the auditory system.
In obtaining complete histories of tinnitus patients, several etiologic factors are prominent. These are classified as otologic, cardiovascular, metabolic,
neurologic, pharmacologic, dental, and psychologic factors. For you ,we already know the meniere's disease is the main culprit, anyway, the largest number
of patients with tinnitus appear to have a history of noise exposure or are experiencing presbycusis. In both instances, there is a high-frequency neurosensory
hearing loss. Seventy-five percent of patients have a 30+ dB hearing loss from 3 to 8 kHz. This hearing loss is the single most consistent factor in patients
with tinnitus. Generally, the pitch of the tinnitus occupies the region of the greatest hearing deficit or the most abrupt loss.
A variety of other otologic disorders appear to accentuate or cause tinnitus, especially Meniere's disease, in which almost all patients complain of the
symptom. However, only 4% of these patients have severe and intractable symptoms that are unresolved by any form of management.
Three percent of patients had severe tinnitus secondary to prolonged otitis, and 2% had recurrent labyrinthitis. Although most patients with otosclerosis have
tinnitus, only 4% said it was significant. Dizziness is commonly associated with tinnitus. Thirty-five percent of patients were dizzy at least part of the
time, and a smaller percentage were dizzy all of the time. This rate of dizziness is higher than in the standard population for the respective age groups, and
the symptom should be considered in the workup.
Cardiovascular problems are frequently associated with tinnitus. Thirty percent of patients with severe symptoms had one or more cardiovascular complaints. The
high incidence of cardiovascular disease is consistent with the age group (>60 years), but it is still likely that hypertension is a major factor in the
onset or severity of the patient's disease.
Twenty-two percent of the patients who had tinnitus in our study had significant hypertension, and more than 1% related specific cardiovascular incidents to
the onset of their complaints.
Secondary vascular disorders must be excluded in evaluating these patients. These conditions include anemia (ie, tinnitus secondary to increased cardiovascular
output) and extensive arteriosclerosis, in which tinnitus tends to be objective and pulsatile.
Thyroid dysfunction can be associated with tinnitus. Hyperthyroidism, by increasing cardiac output, can cause a pulsatile or rushing noise.
Hypothyroidism has also caused this complaint. It is severe in about 4% of this population.
Hyperlipidemia (too high blood fat content) is increasingly reported as a factor in tinnitus, particularly in association with fluctuating neurosensory hearing
loss and associated dizziness. Vitamin A and/or B deficiency has been described as causing tinnitus.
Five percent of patients report that tinnitus was the result of major trauma. Trauma generally included a skull fracture or closed head injury.
Whiplash injuries have initiated tinnitus, suggesting that abnormal proprioceptive input from nerve fibers in the neck and shoulder or possibly brain stem
injuries are factors. Tinnitus after whiplash injury usually occurs 7 to 10 days after the accident, and the appearance of tinnitus immediately after head
trauma without clearly defined ear abnormalities or vestibular disease is uncommon. Therefore, the physician must be careful in assigning a causal relationship
to this injury.
Past meningitis (brain infection)may be the cause of tinnitus. Multiple sclerosis can also have severe tinnitus in its constellation of symptoms.
Ten percent of patients relate the onset of significant tinnitus to initiation of or changes in pharmacologic therapy. All classes of medication are considered
possible causes of tinnitus. These include anti-inflammatories, antibiotics, and antidepressants.
Aspirin and aspirin-containing compounds were identified as the most common inciting medications. As little as 600 to 1000 mm/day of aspirin can create
symptoms. Aspirin-containing medications, such as Percodan, Darvon, Bufferin, or Ecotrin, are often overlooked as possible causes of tinnitus.
Nonsteroidal anti-inflammatories, including Naprosyn and ibuprofen, are frequently implicated but not often considered. The effect of these drugs is similar to
aspirin, although not as severe.
Antibiotics, chiefly the aminoglycosides, cause tinnitus. It occurs in most cases of antibiotics used concurrently with diuretics.
Quinine-containing compounds and the synthetic analogues can elevate the severity of tinnitus.
Mercury, arsenic, lead, and other heavy metals in high doses can cause symptoms. A thorough history and alteration of medications are essential components in
treating patients with this complaint.
Temporomandibular joint disorders and dental abnormalities must be considered in taking the general history, in the physical examination, and in devising a
treatment course for tinnitus. Forty-five percent of patients with severe tinnitus describe active temporomandibular joint problems at some time. Thirty-eight
percent of patients who have severe tinnitus describe it as concurrent with an increase in the severity of their temporomandibular joint complaints. The
tinnitus is generally low pitched, rough, and associated with a feeling of fullness in the ear.
Psychologic factors play a major role. Stress often increases the perception of tinnitus severity, and depression frequently accentuates the complaint. In some
cases, the tinnitus itself may be the cause of the psychologic disorder. Sixteen percent of the population with tinnitus admitted to depression. Many more
probably were unwilling to admit to it or did not recognize the symptoms. Some studies concluded that 20% to 50% of patients were clinically depressed, and
about half the depressed patients had a long history of depression before the onset of tinnitus.
There is undoubtedly a significant population in which depression plays a major role and for which treatment must be appropriately directed, but it is not
effective to apportion patients with tinnitus into groups who are psychologically disturbed and those who are not, because treatment may ultimately prove
beneficial to both.
If symptoms your are mild, several guidelines should be observed. You should realize that 25% of patients will improve significantly, 50% will improve to some
degree, and the remaining 25% will remain unchanged.
A small proportion have progressive symptoms.
If you have tinnitus, you should avoid chocolate, coffee, tea, cola, or other caffeine-containing beverages or medications. Fifty-four percent of patients with
severe tinnitus took excessive amounts of caffeinated beverages daily. You should also stop smoking.
Medications should be reevaluated, with specific avoidance of aspirin-containing compounds, nonsteroidal anti-inflammatory drugs, or other implicated
medications.
You should avoid disturbing noise, use noise protection, and employ home masking techniques, which include music at night or the radio tuned between the FM
stations at a level of white noise that masks out the tinnitus. A bedside masker can also be recommended.
If you had a history of depression or anxiety, psychologic testing and evaluation are advisable. This allows the physician to have your emotional status
reviewed before additional treatment and to tailor medications to the results.
Best wishes
Heru"
Sleeping With Tinnitus -- Addendum
When I wrote "Sleeping With Tinnitus," I considered writing a section on the importance of thoughts and attitude on sleep. As time went on, I
realized that this was quite a serious omission in that a person's attitude toward sleep can have a very important effect on whether that person will be
able to sleep or not. In fact, a person's attitude can be the MOST important factor in that person's ability to sleep. This addendum is intended to
address this omission.
Your Thoughts and Falling Asleep
Listed below are several thoughts (or non-thoughts) that may cross your mind as you near bedtime:
No thoughts about sleep
I'm positive I will be able to sleep
I think I will be able to sleep
I don't know if I will be able to sleep, but I will give it a try
I don't think I will be able to sleep
No way am I going to be able to sleep tonight!
These thoughts are listed in sequence from positive to negative in terms of their relationship to sleep. Note that "No thoughts about sleep" is
listed even higher than "I'm positive I will be able to sleep." A person who has no thoughts about sleep probably has no problem with falling
asleep and most likely doesn't even need to read this paper.
In general, if you think you will be able to sleep, you will. And if you don't think you will be able to sleep, you won't. So the question becomes
"How do I move from one of the bottom two thoughts to a higher thought?" Discussed below are some possible approaches.
- Try to discipline yourself to never think either of the bottom two thoughts. Many, many times because of anxiety or a spike in my T I have had concerns about
my ability to fall asleep. I have found that, for me, it is more calming to say to myself "I don't know if I will be able to sleep, but I will give it
a try." This "give it a try" attitude has resulted many, many times in sleep even when my "inner voice" was telling me that I probably
wouldn't sleep.
- Take advantage of past successes with sleep. Here is an example of what I mean by this. One night my wife and I got into a terrible argument, one of the
worst we had ever had. When I got into bed I didn't expect to get any sleep because I was so upset. In fact, I didn't sleep as well as normal. However,
I did get somewhere between four and five hours of sleep. In retrospect, I was amazed I slept at all considering how agitated I felt when I got into bed. So
now, any time that I am anxious about my ability to sleep, I look back on that night and think to myself "If I could sleep THAT night, I should be able to
sleep tonight." This reassurance has a very calming effect on me both mentally and physically.
- Learn a relaxation technique that works for you. There are many self-help books that describe relaxation exercises. Here is a mental exercise that I learned
in a self-hypnosis class that helps me to sleep. It is performed after getting into bed and while lying on your back:
Close your eyes and get very comfortable. Do not cross your legs or arms. Take several deep breaths and exhale slowly. The more anxiety you have, the more
breaths you will need.
Starting with your feet, mentally say to yourself "My feet and ankles, I want you to relax." Feel them relaxing. Then mentally say "My feet and
ankles are relaxed."
Repeat the process for your calves and knees, your thighs and hips, your lower back, your tummy and chest, your upper back, your shoulders, your neck, your
mouth and jaw, your eyes, your forehead, your upper arms and elbows, and your forearms and hands.
Affirm that your entire body is relaxed.
Now mentally say "My mind, I want you to relax." Blank out your mind. Then affirm "My mind is now relaxed." Enjoy the relaxation.
Finally, say to yourself "When I leave this state of mind, I will sleep well, I will have pleasant dreams, and I will wake up refreshed."
Note that this exercise sounds like it would take a long time. In fact, it normally only takes about 10 minutes. Don't rush it! Feel the relaxation. How do
I know that it works? Many, many times I have fallen asleep while doing the exercise. On other occasions I had been quite anxious when I got into bed and, yet,
after doing the exercise I was able to sleep quite well.
Note also that this exercise can be used to help you fall back to sleep if you awaken during the middle of the night and feel wide awake.
- If you are using sleep medications, keep a small supplemental dosage on your nightstand. I have been prescribed trazedone (an AD) and klonopin (an
anti-anxiety med). Each night I take my normal dosage and I make sure that I have a single supplemental dosage of each medication on my nightstand along with a
glass of water. Just knowing that I have access to these medications if I need them brings me extra calm and reassurance. Frankly, I rarely, rarely ever need
them, but it's very comforting to know they are there. (Note: be careful that the amount of the supplemental dosage is safe for you to take.)
Other Common Situations and Thoughts Related to Them
- Naps. I used to curse naps. When I would awaken from one, I'd grumble to myself "Now I won't be able to sleep tonight!" More recently, I
have altered my thought about naps. I now view them as a "headstart"on the night's sleep. I think to myself "Since I took a nap, I won't
need as much sleep tonight." I accept the fact that it may take me a little longer to fall asleep.
- Tossing and turning. If you haven't been able to fall asleep in the first hour or two, it's very easy to get frustrated. Instead of focusing on the
thought "I've been tossing and turning for two hours!" it's more beneficial to think "I still have several hours left to get some
sleep."
- Waking up in the middle of the night. It's not a comforting feeling when you expect to sleep for seven or eight hours and you wake up after only two or
three. One option is to let this upset or frustrate you. Another option is to be thankful for the sleep you have gotten. If you let yourself get upset or
frustrated, this will affect your ability to fall back to sleep. If you learn to appreciate the sleep you have already had, it will calm you, making it easier
to fall back to sleep.
- Dealing with a poor night's sleep. How many times have I thought "I only got a couple of hours of sleep last night"? Of course, this may have
actually been the case. However, I have learned over time that we often have slept more than we thought we did. When I was on a fishing trip with my brother, I
remember saying to him "It took me a couple of hours to fall asleep last night." He responded "That's funny. You were snoring ten minutes
after you got into bed!" I had fallen asleep (which I didn't recognize or remember) and later woke up (which I did remember). On another occasion, my
wife couldn't sleep, so she got up to watch TV in our family room. Later, I woke up when I felt her getting into bed. In the morning I asked her "What
time did you come to bed? It was around 1:30, wasn't it?" She replied "It was almost 3:00." Thus, I thought I had only slept an hour and a
half (I go to bed at midnight) while, in fact, I had slept for three hours.
Final Comments
I realize that many of my suggestions might be thought of as simplistic rationalizations. I can understand this reaction. However, I believe that a good
attitude can truly be a matter of seeing the glass as half full or half empty. The "half full" attitude leads to thoughts that bring about calm; the
"half empty" attitude can lead to thoughts that bring about anger and frustration. Remember this important fact regarding sleep: You can't
MAKE yourself sleep. You can only LET yourself sleep. Thus, any attitude that leads to calm will enhance a person's ability to fall asleep.
Edited by: Dirkh at: 7/6/04 5:07 pm
