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Insomnia and Pain



The body, including the brain, requires a certain duration of sleep of a certain quality in order to function optimally. As this varies among individuals the best way to know whether you have a sleep problem is to ask yourself whether you are generally feeling awake, alert and refreshed during the day.

People sometimes come to me seeking treatment for insomnia because they wake up in the middle of the night or because they sleep fewer hours than they think they should. However, if they wake up refreshed and feel alert during the day on a regular basis, they don't have insomnia. They merely have a sleep pattern that works for them but is different from what works for most other people.


If (a) you are not feeling awake, alert and refreshed during the day,  and (b) you are not sleeping 7 to 9 hours per night most nights (especially on the nights preceding not feeling awake, alert and refreshed), this would suggest that the daytime fatigue may be due to sleep of inadequate duration or quality. However, it would still be advisable to consult with a physician to rule out medical causes or the fatigue (e.g., issues with the thyroid gland or with blood sugar levels).


Insomnia that is not due to a medical condition can take a variety of forms and can have a variety of psychological causes that are treatable.

Some common types of insomnia are difficulty falling asleep initially, difficulty staying alseep, and difficulty falling and staying asleep after awakenings.

Perhaps the most common type of insomnia these days is not insomnia at all, but rather voluntary sleep deprivation, in which you know you need to get to sleep at a certain time in order to feel good tomorrow, but you stay up playing with your phone, surfing the web, playing video games, watching TV or reading, usually because your daytime activities are so crushingly boring that you feel you deserve to enjoy yourself at night. Which you do. The only problem is that the result is that the next day you are both crushingly bored and  completely exhausted, possibly affecting your mood, concentration and performance. Time for a career change? . . .

Aside from voluntary sleep deprivation, enemies of sleep include:


(a) Overthinking when in bed (which increases the power of fast brainwaves, whereas sleep requires an increase in the power of slow brainwaves);


(b) Not adhering to "sleep hygiene" guidelines, including not ingesting caffeine less than about 6 hours before bedtime; not looking at a smartphone or computer screen less than an hour before bedtime (it tricks your brain into thinking the sun is up, and reduces the production of melatonin); and some others (click here for more info).

Whatever the initial cause of the insomnia, once the schedule, duration and quality of sleep has settled into a dysfunctional pattern, the pattern tends to continue and the brain begins to associate the bed with being awake rather than being asleep. At this point, you may benefit from a psychological treatment called "Cognitive Behavior Therapy for Insomnia," which I integrate with various meditation techniques.

CBT for Insomnia (CBT-I) involves changing some daytime, pre-sleep, nighttime, and early morning habits, as well as learning to challenge negative thinking during the hours that you want to be asleep.

As with other cognitive behavioral techniques used for depression, anxiety and other problems, CBT for Insomnia can be especially helpful when it incorporates meditative techniques to gain control over the cognitive process of overthinking (i.e., going beyond cognitive therapy, which helps you to change irrational negative thinking into rational thinking, by teaching you to use meditation to actually stop thinking). 


Pain is different from other targets of psychological treatment, both in terms of assessment and evaluating the progress of therapy. Whereas people don't always know whether their subjective experience constitutes "depression," "anxiety," "ADHD," "obsessive-compulsive disorder" or "panic disorder," everyone knows when they're in pain, and knows when the pain is not getting better.

Psychological and meditational therapy for pain by itself rarely completely eliminates the pain. Ideally, these are components of a multimodal intervention,  involving some combination of approaches such as physical therapy, chemical pain antagonists, acupuncture, tai chi, yoga, neurofeedback or possibly medical procedures. However cognitive behavioral therapies and meditation can significantly reduce how much the pain bothers you. Within the space of several minutes, it is not uncommon for the Dissolving Pain technique to reduce perceived pain from somewhere between 5 and 10 (out of 10) to somewhere between zero and 2 for the amount of time that it is practiced.


Psychological pain reduction techniques involve cognitive content (challenging the meaning of the pain), cognitive process (reducing the frequency and duration of time spent giving preferential awareness to the pain and it's perceived consequences) and the use of attention and awareness to strategically activate and deactivate regions of the brain's sensory cortex that are currently processing and not processsing pain signals. I consider this latter approach, called "Dissolving Pain," created by Les Fehmi of the Princeton Neurofeedback Centre, to be revolutionary, and have used it to help clients reduce pain in both acute care and outpatient settings.

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