Sleep – TALK TO ANGEL

Difficulties with sleep imply a disruption in your body’s natural cycle of sleep and wakefulness.

Sleep disturbances don’t always have a specific cause, and can be a result of different factors. Before we look into why they occur, it is important to understand that there are different types of sleep difficulties, and the causes of each can differ.

Acute or short-term difficulties in falling asleep can be explained by physical disturbances such as pain or illness; environmental factors like uncomfortable light, noise and temperatures as well as alcohol use; and situational stress from life events, such as migration to a new city, loss of a job or death of a loved one.

For sleep difficulties that are more long-term, psychiatric conditions like depression and anxiety might play a role, as well as asthma, chronic pain and stress.

Stress and anxiety are the most common causes of sleep problems. Anxiety results in racing thoughts, hyperarousal and intense emotions like fear. Stress and anxiety both contribute to the activation of the sympathetic nervous system, leading to physical tension in the body and the release of hormones such as adrenaline, cortisol and norepinephrine. These hormones prepare your body for a fight or flight response by increasing your blood pressure, heart rate, energy and alertness. Anxiety can thus prevent you from falling and staying asleep at night. A relaxed body can aid your transition to sleep with the parasympathetic nervous system overriding the sympathetic nervous system and preventing this stress response.

A lack of sleep can further add to your stress and anxiety. Consistently practising forms of relaxation can help you manage stress throughout the day and de-stress at night, which can aid in improving your sleep. These techniques are safe since they have no side effects or risks, and can be used in combination with other techniques for better sleep, such as CBT for Insomnia and sleep hygiene. Meditation is also beneficial to manage anxiety, depression, blood pressure and pain. Deep breathing can increase the oxygen level in the body, helping your body work less hard; and slowly exhaling can mimic your breathing at the time of falling asleep. Such techniques are also in your control, and easy to include in your daily routine. Their ease of access and low cost also make them suitable for everyone.

There are multiple ways that you can relax and de-stress yourself before you sleep. Here are some techniques that you can try:

Mindful Breathing. Close your eyes and shift your attention to your breathing. Focus on your natural inhalation and exhalation, and notice the tension in your body. Visualise your breath reaching different parts of your body, and imagine the tension leaving your body when you exhale.

4-7-8 Breathing. Get in a comfortable position, with your eyes either open or closed. Inhale for four seconds, hold your breath for seven seconds, and slowly exhale for eight seconds. Repeat this process to relax your body.

Abdominal Breathing. Put one hand on your chest, and another on your stomach while lying down or while sitting in a comfortable position. Inhale through your nose, and feel the way your belly expands with air. Exhale slowly through your mouth and repeat.

Guided Imagery. Close your eyes and make yourself comfortable. Visualise a relaxing scene or image. You can also imagine a more organised scene that tells a story, or recall a calming memory or activity. Add on as many details to the scene as you can. This can help shift the focus from your worries to a more relaxing image or idea.

Whenever you find your attention wandering to a different thought, remind yourself to acknowledge it and let it go. Try to redirect your focus to what you’re doing.

In addition, try to ensure that the environment that you sleep in is conducive to relaxation. Keep your room dark and quiet when you go to bed. Find a soothing bedtime routine that can help you wind down and get ready to sleep, such as reading or taking a warm bath. Avoid staying in bed or looking at the time if you’re not sleepy since it can keep your mind awake and make you frustrated.

Try to be regular with your relaxation practices. However, if your sleep difficulties persist, or are causes of significant distress such as sleep apnea, restless legs syndrome or narcolepsy, reach out to a professional.

If you constantly find it difficult to fall asleep, don’t hesitate to reach out to us. An InnerHour therapist can help you

India is one of the few countries that has a National Health Policy (NHP, 2002) that categorically mentions mental health, as well as a National Mental Health Program (NMHP) and a dedicated Mental Health Act 1987 (MHA). The most recent one is THE MENTAL HEALTHCARE BILL (ACT) passed in 2016.

The objective of the Act is “to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto.”

Simply put, this means that any individual with a diagnosed mental illness has the right to access healthcare and any other related services. These services will be delivered with dignity and respect to the individual.

The act clearly defines all parties and subjects mentioned in the bill. It addresses what mental healthcare is (analysis, diagnosis, treatment and rehabilitation of an individual with a diagnosed or suspected mental illness). It outlines the parties involved including family members and caregivers, psychiatric social workers and mental health professionals. It very importantly defines and underlines all the aspects of informed consent, a very significant matter in a country where a quarter of the population are illiterate and lakhs are medically uneducated. It also clearly and comprehensively defines mental illness as different from mental retardation.

The bill is very important to the average Indian citizen because it finally opens up the mental health space to anyone who wants help, regardless of the diagnosis. In the coming years, it could go a long way to destigmatise mental health treatment. Here are some of the most important points of the act that we all need to be aware of as its beneficiaries:

Decriminalisation of attempted suicide

In a much needed move, survivors of attempted suicide will not be sent to jail but instead to a rehabilitation program where they can receive treatment for their issues. The individual shall be presumed to be suffering from ‘severe stress’, a term which has replaced the earlier bill’s assumption of ‘mental illness’. They are therefore exempt from trial and punishment.

Empowerment of the mentally ill

While earlier acts sought to ‘protect’ the general population from those suffering from mental illness, the new bill recognises the agency and abilities of such people and grants them facilities for rehabilitation and support. This means recognising the inherent dignity of such persons and according them the right to make decisions regarding their treatment, if they can understand relevant information. It also gives every person the right to make an Advance Directive regarding the treatment they wish to receive in the case of any future mental illness, and this Directive must be followed unless overturned by the respective Board.

Restricted use of Electro-Convulsive Therapy (ECT)

Electro-Convulsive Therapy will only be used in the rarest of cases and with informed consent. It is completely prohibited as emergency treatment, without muscle relaxants and anaesthesia and minors, although the last one is subject to permission from the guardian and the relevant Board. The Bill also prohibits the sterilisation of the mentally ill unless it is part of their rehabilitation.

Empowerment of the police

Police officers will be required to take under their protection any mentally-ill person on the streets within the limits of their police station. They are also to take notice of any case of ill-treatment of a mentally-ill person and report it to the Magistrate, who can then have the individual examined by a mental health professional and rehabilitated if necessary.

The importance of informed consent

In the definition of informed consent, there’s a very crucial factor marked out: using language that the individual can understand. Too often professionals trained in urban areas consider it too cumbersome to actually break down complex terms and biological processes to patients who, regardless of economic or educational background, may have difficulty grasping these concepts. It’s very important as mental health professionals to remember that their purpose is to help, not to dictate. It is the ethical responsibility of treating professionals to work with people rather than simply assume that educational qualifications alone give the power to dictate an individual’s treatment. The bill also grants the patient complete access to their medical records unless such a disclosure would result in harm to themselves or others.

Placing responsibility on the government

The very first line of the act allocates responsibility to the government to either run or fund mental health care centres that will make a range of quality treatment accessible to all citizens, regardless of economic or social background. The act goes on to make special provisions for those living below the poverty line, destitute or homeless, entitling them to free care.

Placing the quality of healthcare for mental illness on par with that for physical illness

This is another strong step towards the destigmatisation of mental health. By assuring care equal in quality, the bill aims to bring mental health care into the mainstream, and no longer treat it as rare and specialty treatment only available for the wealthy and urban citizens.

The right to complain

By outlining the steps a citizen can take if discriminated against, and detailing the persons to be approached, the area of mental health care is finally transparent. If a patient suffers a breach of confidence or poor quality care, they can approach the medical officer or mental health professional in charge of the establishment, the concerned Board and finally the State Authority to seek justice.

To take control of your health, it is important to know your rights. Being informed is the first step towards being a better citizen.

Tag: Sleep

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