CBT Part III: Sleep Deprivation

This article has been the hardest of all to write. Not because the subject matter is particularly daunting, deep or traumatic. But because it is the first time I have had to overcome fatigue and bodily wariness in a long, long time. Normally I am straight on a computer after a CBT session, full of energy and a desire to share with the world the wonders of cognitive behavioural stuff! Today, I had to overcome a big barrier of fatigue just to be here writing this, and I can’t promise anything special.

My recent episode of sleep deprivations seems to come from two places. Firstly, A gradual build up of anxieties, natural to living in a busy, expensive, polluted city. Secondly a loud idiot next door who shouts and wails at random intervals into the early hours. And I guess there is ultimately my own anxious personality and thinking patterns which can turn problems into serious problems. This I discovered from today’s CBT.

Lets start with the shouting. At random intervals in the night, a man will shout. It won’t be massively loud, but loud enough to jar you, or awaken you. For me it feels like his voice has entered by body, my being is filled with his sound. It is the exact same wail every time, a supposedly songful sound, but in truth, a horrible, mechanical, repetitive, intrusive load of shite. I came to associate any noise he made with the possibility of a wail or shout, and this puts me into a downward spiral of hyper-vigilance, which prevents me from having decent rest and recovering.

I didn’t realize how much this was effecting me. On the first day it was a nuisance. On the second day it hampered my ability to fall asleep. On the third I bashed on the wall at midnight and came close to telling him to shut the fuck up. On the fourth there was no shouting, but my system was in constant vigiliance, and wouldn’t let me fall asleep easily. This causes feelings of frustration, which develop into rage, something highly unconducive to falling asleep. I was, and still am, catastrophizing about the effects of sleeplessness.

Today in therapy we discussed this and revealed I do have unrealistic expectations and standards. I always feel the need to be active, alert and at around 80-90% capacity. I know we can never be at 100%, but I am very wary of being weak and vulnerable, especially having lived in countless environments where appearing unaware can be dangerous. It might seem obvious that this is a vicious cycle – the more you want to make yourself capable, the more you fear incapability, the more prone you are to anxiety and thus incapability. My therapist was very good in challenging this through questioning, making me run through the evidence and realize the vicious cycle. (But I don’t think it is entirely bad to have such high standards. Human beings are hunters by evolution, it makes sense that we will want to be capable of reacting to threat or opportunity at every possible occasion.)

But with me there is an additional problem, and the heart of the problem. The formation of patterns. I have used patterns to some good effect, building up positive days and exploits to get me out of panic disorder. The downside is, one or two shit days and I fear a bad pattern forming. This rigid thinking really is a double-edged sword, and never far from a downward spiral. The challenge is to be more flexible, to accept more sad days as inevitable. This is not easy to do.

My mind is prone to catastrophizing and thinking the worst. This is why the nuisance of an inconsiderate idiot’s shouting can become something frightening and world-shaking. If I stop fearing the predicted outcome of losing sleep, my body should become less hyper-vigilant toward such disturbances. I don’t feel our session quite went into enough detail. How could it? One hour cannot cover a lifetime of being this way. But it has been very helpful, in hindsight. I am less afraid of sleep deprivation, and less prone to it.

There was also the factor of a build up of anxieties. We tend not to realize sometimes how anxiety gets us. It is like a shadowy assassin, slowly poisoning you drop by drop. For the considerate, this causes internal strife and restlessness. For the inconsiderate, this inspires the harming of others to regain a sense of control. I am sadly in the former category of person, and so the day-to-day banalities of life occasionally build up and make it difficult to function, even at 50% or so.

But its not only the cost of living and banal problems like that. The backdrop of an idiot sitting on America’s nuclear arsenal, catastrophic climate change threatening to wipe out everything that breathes, the dissolution of communities and the watered-down experience of Facebook and the like to replace it, new technologies falling into the hands of powerful capitalists; among a host of world events and tragedies, make anxiety quite a normal and relatively sensible state to be in. How we react to that anxiety is another matter entirely – with fear and paranoia, or the will to change things and become more harmonious. Or like myself, a mixture of the two. Nevertheless, I entirely understand why it is there.

These worries are definitely harming natural, harmonious functioning. Not only in me, but in so many citizens of the ‘so-called’ first world. This includes that most natural and essential, but mysterious, phenomena that is sleep. Sadly, I can’t think of a way around this off the top of my head. Maybe to paraphrase Alain De Botton and to see the odd night of insomnia as a creative gift to be cherished. And to realize that normality isn’t quite so normal, and lots of people have trouble sleeping. This doesn’t give me much solace. If I could sleep eight hours a night without disturbance for the rest of my life, I would.

Learning what I have about my own need for patterns and rigid routines, challenging negative thoughts by seeking evidence, practicing breathing exercises and progressive muscle relaxation, I should have a decent night’s kip tonight, and be back up to a decent level of running, without fatigue tomorrow. I at least can write a half-way decent article three days into moderate sleep deprivation! I venture to say then that it isn’t quite as bad as anxiety has made it out to be, (even though it is far from ideal). As with all things in life, the breaking of the pattern has made me realize the pattern. Perhaps this is the key to changing it, and perhaps something better will actually emerge from it. I don’t know, lets see.





CBT Part II – Testing a theory

I have just come back from another great session, which ended in a real climax of excitement! Its all happening in the NHS mental health support team!

We covered some exposure exercises, to simulate the feelings associated with a panic attack. It is important to familiarize yourself with these sensations, so as not to fear them. Once in an anxious situation, anxiety tends to peak and then starts to drop. So-called coping strategies prevent the natural decline of anxiety, and prevent the subconscious from ever properly learning that a dreaded situation (such as getting on a bus!), is actually not all that dangerous after all, and there is nothing to be anxious about.

By trying to avoid bodily sensations associated with anxiety, we lend them a power they do not deserve. I call this ‘mythologizing anxious sensations’, something which feeds into the cycle of avoidance and furthers fear. Eventually anxiety becomes a general dread which you will dedicate the whole of your life to avoiding! The short-term cure, avoidance, is worse than the disease. And those who say that time heals all ills have obviously never recovered from a panic disorder before! Time will not heal this.
I must now expose myself to these situations and bodily sensations. This will let the natural course of things play itself out, and the subconscious can learn once and for all that there is nothing to fear. Likewise, I will stop fearing the sensations in my own body, which I have already done much to achieve.

This is all made much easier by going into what I am really anxious about, which my therapist helped me with by proposing a theory. Before we get to the theory, we need to examine my true fears.

Today I boiled down my fears of a panic attack to two things: i) fear of embarassment, not being helped and public humiliation. ii) Fear of bodily weakness after a panic attack, losing my independence, being dependent without a trustful support network.
So we proposed two theories. Lets start with Theory A. This states that if I have a panic attack people will laugh, think I’m weak, and might film it on their phones. The evidence from this comes from seeing lots of humiliating incidents at school and the general shittiness of certain human beings. If theory A is true, then a panic attack would be rather devastating, and the best thing to do is to avoid panic attacks at all costs and restrict my freedom. On recollection, I believe this theory to be about 20% true. In other words, its a load of anxiety-induced shite.

So lets move onto the (infinitely more plausible) Theory B! This states the problem is worry that other people will judge me, be humiliating and unhelpful. But the evidence is against it: I would definitely help others if they needed it. Some people will always want to be helpful, even heroic in such situations. And some people have similar problems with anxiety and depression, so can actually be understanding. If Theory B is true, I need to try to think more realistically and positively about things, and dispel the power of the panic attack. This is as far as I got in working things out. My therapist took the next step.
She gave me an analogy which really helped explain what we had to do to truly see the theory through. Imagine an apprentice on his first day at a building site. The workers on the site put up a wall and tell him to hold it up, or else it will fall down! He spends the whole day standing there, holding up this wall, getting tired and uncomfortable. As night falls, his bosses tell him he has to stay there all night. Well, this just won’t do. So what does the apprentice do, now that he is in doubt about the worth of holding up the wall? He can gradually release his hold on the wall, he can release his support and slowly step away. But will this do? What if there is a gust of wind or something? To truly see if the wall is sturdy, he will have to give it a darn good push!

Ultimately, a theory needs to be tested. ‘If panic attack then people will be helpful, and there will be no harm’ is the crux of the more plausible theory. So lets just say that we might end up doing some field research soon!
I am most excited about the opportunity.
p.s. Get CBT if you can, its great. Just be prepared to look deep inside yourself and realize what needs to change inside you.