Insomnia
Part One: The Systems of the Body
1.1 Sleep is nature’s way of enabling the body and mind to heal, restore, and replenish itself. Sleep restores the homeostasis of the body and the mind.
Homeostasis
Homeostasis can be defined as: any self-regulating process by which an organism tends to maintain its stability while adjusting to conditions that are best for its survival.
Homeostasis is derived from two Greek words:
i. Homeo: can be translated assimilar.
ii. ‘Stasis’: can be translated as stable.
For human beings, the stability attained through homeostasis is a dynamic equilibrium. Continuous changes in the brain and body restore physical and mentak equilibrium.
Homeostasis is achieved through four systems. These consist of:
i. The Stimulus.
ii. The Receptor,
ii. The Control Centre
iii. The Effector.
An example of the brain and body restoring homeostasis is the regulation of body temperature. This is very similar to the way a mechanical thermostat works.
.https://www.britannica.com/science/homeostasis
Homeostasis is involved in every organ system of the body. No one organ system of the body acts alone.
1.2 The Systems of the Body.
The body is composed of cells and extracellular materials that are organized into: tissues, organs, and organ systems. The body can be divided into 11 separate organ systems:
1. Muscular
2. Skeletal
3. Circulatory
4. Respiratory
5. Digestive
6. Urinary
7. * Nervous (central and peripheral)
8. * Endocrine (hormonal)
9. Integumentary
10. Reproductive
11. Immune.
The nervous system and endocrine system are particularly relevant to insomnia, as they help to maintain and restore hormonal and emotional balance in the organism. However other systems such as the respiratory, circulatory, digestive, and immune systems are also important and interconnected.
1.3. The Nervous System.
The Nervous System can be classified in six ways:
i. The Central Nervous System.
ii. The Peripheral Nervous System.
iii. Reflex.
iv. The Autonomic Nervous System.
v. The Sympathetic Nervous System.
vi. The Parasympathetic Nervous System.
1.4 The Central Nervous System:
The central nervous system consists of the brain and the spinal cord.
Bi-directional electrical messages are sent between the body and brain.
i. Physical information is carried from the body to the brain via the spinal cord. The spinal cord is the bodies central ‘telephone exchange system’ relaying the physical messages to the brain.
ii. Instructions are then sent back from the brain to the body, also via the spinal cord.
- The Peripheral Nervous System:
The peripheral nervous system consists of the nerves and clusters of nerve cell bodies (ganglia), which reside outside of the brain and spinal cord.
The peripheral nervous system connects the central nervous system to the limbs and organs of the body. It acts in a similar way to an outlying telephone system allowing messages to be relayed between the body, the spinal cord, and the brain.
1.6 Reflexes
Reflex movements are instinctual movements which are made without messages having to be routed to the brain. They occur directly through spinal cord pathways. An example of reflex movements is if one were to burn oneself by accidentally touching a hot cooker, the nerve endings in the fingers send a direct message to the spine. A message is also sent to the adrenal glands. These messages instruct the muscles to directly pull away from the flame as quickly as possible, without the brain first having to process the sensory information.
1.7 The Autonomic Nervous System
The autonomic nervous system is a system which regulates the body without conscious control. The autonomic nervous system regulates bodily functions such as heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. It acts in a way similar to a driver turning on cruise control in a car. Everything is on automatic. This system is the primary mechanism of control for the fight-or-flight response.
1.8 The Sympathetic and Parasympathetic Nervous Systems.
The Autonomic Nervous System is divided into two subdivisions:
1.9 The Sympathetic Nervous System (Fight and Flight).
i. Parasympathetic Nervous System. (Relaxion and Rest)
ii. The Sympathetic Nervous System.
The Sympathetic Nervous System is responsible for the fight and flight responses which we often experience and associate with the nervous system’s response to stress in everyday life.
1.10 The Sympathetic Response:
Electrical messages are sent through the central nervous system in response to the sensory information obtained by the peripheral nervous system. These messages are mostly processed in the brain which decides what should be done. The brain then sends instructions back down through the central and peripheral nervous system to, for example, run away! It may respond to the fight or flight situation by instructing the lungs to take short breaths which increases the speed of the blood circulation around the body. It may also instruct the glands in the body to secrete hormones into the blood stream such as Adrenalin and serotonin. These hormones will help the body to cope with or escape from the dangerous or stressful situation.
1.11 The Parasympathetic Nervous System:
During sleep the body goes into the parasympathetic mode of rest and relaxation. When the brain and body are in rest and relaxation, they are no longer preoccupied with fighting off the external challenges of the day and can instead turn to internal repair and restoration.
1.12 The Parasympathetic Response.
In the parasympathetic mode, the brain instructs the endocrine system to release hormones which can restore, re-generate and heal the body. For example the pituitary gland releases growth hormones, which helps the body to grow and repair itself. Other glands release cortisol and vasopressin and increases levels of endorphins, oxytocin, dopamine, and so on. These hormones travel into the blood stream and feed the organs. Rest and relaxation are essential for the restoration and replenishment of the body and mind.
1.13. The Vagus Nerve:
The Vagus nerve, is the main connecting nerve for the parasympathetic nervous system. It connects the brain with the heart, lungs, and digestive tract. The Vagus Nerve helps to explain the soothing and beneficial/restorative effect of massage on the body.
1.14 The Endocrine System.
The endocrine system is made up of different glands which make chemicals. These chemicals are called hormones. Hormones act as “messengers” to control many bodily functions. The circularity system transports these chemical messengers around the body, much like a motorway acts as a transport system for cars. In this way the hormones are delivered to the different organs of the body to facilitate restoration and repair.
The endocrine system makes hormones that help control:
- Growth
- Reproduction
- Sexual development
- Energy
- Sleep
- Response to physical stress or trauma
- Levels of water, salt and sugar in the body
1.15 Endocrine Glands.
The endocrine glands produce and release hormones into the body.
There are eight endocrine glands:
1. Hypothalamus
The hypothalamus is located in the centre of the brain. It makes hormones that increase or decrease the release of the hormones made in the pituitary gland. It also makes hormones that help to control water balance, sleep, temperature, appetite and blood pressure.
2. Pituitary Gland
The pituitary gland is located at the base of the brain and is about the size of a pea. It is the master gland in the endocrine system. It regulates the amounts of hormone made by the thyroid gland, adrenal gland, and testes or ovaries. It also makes the hormones prolactin, vasopressin and growth hormones.
3 & 4. Thyroid Glands & Parathyroid Glands.
The thyroid and parathyroid glands are located in the front of the neck, below the larynx (voice box). The thyroid plays an important role in the body’s growth and development, as well as weight and energy. The thyroid and parathyroid glands play a role in controlling the level of calcium in the body.
5. Adrenal Gland
The adrenal glands are located on top of each kidney. The adrenal glands make hormones that help the body deal with stress and illness. The hormones made by the adrenal gland also maintain blood pressure and blood glucose, and play a role in sexual development.
6. Pancreatic Glands
The pancreas is located behind the stomach. It plays a role in digesting food, but it also makes hormones. The pancreas makes insulin, which is important for blood glucose control.
7. Ovaries
A female’s ovaries are located on both sides of the uterus, below the opening of the fallopian tubes (which extend from the uterus to the ovaries). The ovaries contain the egg cells necessary for reproduction and also produce the hormones oestrogen and progesterone. These hormones regulate the menstrual cycle.
8. Testes
A male’s testes are located in the scrotum. The testes produce testosterone and sperm. The testes produce the hormone testosterone, which is responsible for the development of male characteristics, and protects muscle and bone health. https://www.cincinnatichildrens.org/health/e/endocrine
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2.0 Part Two: Polyvagal Theory (Stephen Porgess)
2.1 The Amber State.
Everyday life is full of challenges and stresses. Therefore, during the day the autonomic nervous system needs to be in a state of readiness and alertness. Stephen Porgess describes this state of readiness and alertness, the amber state. The amber state can be likened to a self-driving car sensing its environment and sending messages to the control centre about any dangers in the environment.
The amber state can also be likened to a badminton player jumping, actively trying to reach, defend and respond to their opponent’s shuttlecock. The body and mind are actively responding to external stimuli, sensing, and responding to danger, defending and protecting the body and mind from external threats and stresses, whilst simultaneously regulating the body and mind to any changes in environment such as changes in temperature.
2.2 The Red State:
When a real or perceived danger occurs the body moves from a state of readiness and alertness to fight or flight mode. Stephen Porgess refers to this as the Red State.
In the Red state the brain instructs the body to release fight/flight hormones. The endocrine glands release hormones such as serotonin and adrenalin to help the body to fight or escape from danger.
2.3 Stress
Normal life is full of challenges. Usually, we are able to successfully cope with and meet such challenges much like the badminton player above, However, sometimes our normal experience of stress increases and our coping mechanisms may feel overwhelmed. This is particularly true when we experience sudden and dramatic change and loss, or multiple stressors at the same time.
2.4 Stresses due to Loss
Often stress is associated with loss. Some of the most stressful life events, associated with loss include:
- The of a loved one due to bereavement.
- Loss due to the break down in relationship.
- A loss of a job.
- Loss of Financial security.
- Loss of health due to illness.
- Loss of control due to alcohol and drug-based addiction
2.5. Multiple Stressors.
Sometimes more than one life stressor can occur at the same time. For example, we may experience the loss of a loved one, and the loss of financial security simultaneously. Alternatively, we may experience the loss of our health and the break-up of a relationship at the same time. Multiple stresses can lead to a feeling of being overwhelmed. Our coping mechanisms may feel overly challenged, our support systems inadequate or non-existent, and we may feel as if we are completely losing our balance.
2.6. Prolonged Stress:
Stress may also be prolonged, lasting for months or even years and may seem never ending.
2.7. Homeostatic Imbalance
A prolonged period of stress or multiple stresses may lead to an extended period in the red state. The state of prolonged stress and tension requires a lot of energy, and the mind and body become easily fatigued and exhausted by the sensory overload. The muscles of the body remain in a constant state of tension and anxiety, preparing to either fight or run away from the perceived danger. The breathing and heart rate remain at an elevated level which may result in hyperventilation and panic attacks. The endocrine system releases more and more of the stress hormones (adrenalin and serotonin) into the blood stream. Over a prolonged period at a time the constant and continued release of such hormones can be harmful to the body and attack its organs. At a time when we most need rest and recouperation for essential healing our body and mind is on overdrive and we are experience insomnia.
2.8 Over-drive:
Meanwhile the brain keeps trying to process thoughts, trying to find strategies to escape the danger. We go into overdrive, much like a driver with his or her foot pressed down on the accelerator, revving the car engine whilst the car is stuck in mud.
2.9 Catastrophizing: A Sense of Impending Doom.
In the red state one may feel as if one’s world is about to fall apart. A person may feel as if everything one holds dear is about to be destroyed or struck by lightning or that they are being punished by the wrath of God, and all is doomed. The unknown stretches out into the future and the only outcome seems to be catastrophe, even when there may be no actual objective evidence that such a catastrophic future is the inevitable result
2.10 Fear and Dread:
In such a stress state a person may lie awake, dreading and fearing the future, trying to work everything out in one’s mind. The subjective feeling may be like having swords hanging over one’s head, awaiting an inevitable disastrous fate. All our energy is directed to the perceived threat, as opposed to the rest and restoration which the body so desperately needs.
If the distress continues over a long period of time, exhausted, with no end in sight, and with the range of opportunities to end the suffering appearing so limited, that one may start to entertain suicidal thoughts to end the suffering.
“To be, or not to be, that is the question:
Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them….
to die, to sleep, to sleep perchance to dream..”
Hamlet’s soliloquy by William Shakespeare
Such thoughts may lead to a vicious circle of anxiety and panic attacks. The initial triggering stress is now exponentially compounded. Now, one’s own mind is becoming a threat to one’s very existence. Routine day-to-day activities and challenges may pale into insignificance in the light of the existential threat. Everyday routine social, personal and professional obligations may seem insurmountable, and feelings of inadequacy may start to further compound the feelings of despair, helplessness and self-hatred. Such feeling may even lead to self-harm. Meanwhile other people seem oblivious to one’s struggle for survival and are competently getting on with their lives, increasing our sense of loneliness and isolation.
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Part Three: Can Homeostasis Be Restored?
3.1 The Green State:
During rest and relaxation, the body and mind attend to restoring homeostatic balance. Stephen Porgess refers to the rest and relaxation mode as the Green State. In the Green State the nervous system is no longer on high alert. The body and mind feel safe enough to let their guard down.
3.2 Homeostatic balance in the body:
In the Green State, the parasympathetic nervous system takes over. Stephen Porgess emphasises that in order to enter the Green State, the body and mind must feel safe. Therefore in order to restore homestasis it is important to try to create conditions of safety.
In the Green State, the messages from the nervous system to the brain no longer signal danger. Instead, the brain registers it is safe to focus on restoration and repair. The brain instructs the endocrine system to release restorative hormones from the glands into the blood stream. These hormones are directed to the organs, supplying them with essential nutriments to facilitate healing and repair.
One example of the experience of being in the Green State is when a person is massaged. The body and mind’s response to the soothing repetitive movements of massage is very similar to a cat’s contented response of purring when being stroked. The Vagus Nerve connects the brain and the internal organs and helps to explain the soothing, beneficial, and restorative effect of massage on the body.
3.3 Homestasis of the Mind:
In the Green State homeostatic balance is also restored in the mind. According to Freudian psychology, the mind is a dynamic, self-regulating three tier system consisting of the conscious, sub-conscious and unconscious mind. In normal waking time, events of the day are experienced and processed by the conscious mind, thinking, analysing, processing, instructing etc. According to Freud and Jung, in sleep, the day’s events are processed through the unconscious mind and in particular dreams. Dreams are one of the ways the mind regulates the feelings and experiences of the day, restoring homeostasis to the mind.
3.4 The Benefits of Psychotherapy: Regaining Control:
Talking psychotherapy can help to facilitate the conscious mind by creating a safe environment where the client feels held, heard and supported. The therapist helps the client to work through the maze of what may seem like insurmountable concerns. The skilled practitioner will act as a guide facilitating you to untangle the complex web of issues in a non-judgmental and safe space. The therapist will facilitate you in finding your own answers. They will also empower you with a range of tools and techniques to regain control over your body and mind. These tools may include breathing and relaxation exercises, hypnosis, stress management, mindfulness-based CBT etc. Such stress management techniques help to normalize the level of stress hormones like cortisol and vasopressin, and increases levels of endorphins, oxytocin, dopamine, and so on.
The therapist will also help you to delve deeper into the underlying sub-conscious and unconscious issues and habitual patterns which may be the underlying causes of the distress experienced at the conscious level.
The therapist will also empower you with new life and interpersonal skills to help re-balance your internal and external worlds. These skills may include assertiveness training and boundary setting, and may be fostered through role play and visualization techniques. Finally, the therapist may guide you towards other self-help mind/body systems such as yoga, tai chi and meditation.
Contributed by Andrew Singer