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SECOND STAGE OF STRESS BREAKDOWN: NEURO-TRANSMITTER SUBSTANCES, IMPORTANCE OF SLEEP
Neuro-transmitter substances
When a brain cell or neuron is activated it fires off electrically; this firing-off releases a small amount of a chemical at the end of the nerve fibre. This chemical is called a neuro-transmitter substance.
The neuro-transmitter substance in turn stimulates the next neuron to fire off. Thus the conduction of impulses in the brain is via an electrical-chemical – electrical – chemical -electrical, etc., process.
The neurotransmitter substances of the reticular activating system are different from those secreted by the learning/ unlearning cells of the cerebral cortex. Noradrenalin and serotonin are neurotransmitters which probably play an important role in this system.
Because changes in the level of neuro-transmitter substances available to be secreted at nerve endings can affect brain function, it is probable that the inhibitory reserve reflects levels of available neuro-transmitter substances. Should levels of these neuro-transmitter substances in the brain become diminished as in malnutrition or where the brain’s metabolism is disturbed’ then it is possible that the inhibitory reserve will be adversely affected.
Importance of sleep
However, the single most important factor in the regeneration of the inhibitory reserve is sleep. Sleep is an essential part of the treatment of all patterns of disturbed mental function, and the relationship between lack of sleep and irritability is so self-evident that there is no need for scientific proof. Every mother with experience of looking after cranky children who have missed out on their daytime nap, has learned for herself the relationship between sleep and the regeneration of the inhibitory reserve.
*19/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: SELF-TALK
The best way to break unhelpful habits is to start exchanging them for helpful ones. The first thing is to recognize in what particular ways your habitual thinking or behaviour is keeping you in that sleepless groove. How do you talk to yourself and others about your sleep? If you label yourself ‘insomniac’ and tell yourself every time you head for bed that it’ll take you ages to get to sleep, you are simply reinforcing the programming that keeps you awake. You can change some of that thinking now, by lolling yourself that you are now on the way to improving your sleep, and by no longer telling other people that you suffer from insomnia.
Be honest with yourself about this. Lots of people ‘enjoy’ their ailments. In some cases this can be an excuse for avoiding things I hey don’t want to do, or even living a more fulfilled life. I would stress that this kind of pattern is very rarely deliberate: it’s often another conditioned response, perhaps going back to a time when being ill got a child more of its mother’s love and attention than when he or she was well. Never sleeping well may prevent people like this from facing up to other problems, or taking on new ventures which would mean change. That doesn’t mean 1 hey are purposefully choosing not to sleep, but it’s possible that lack of sleep has secondary advantages, like making their families feel sorry for them.
Could this apply to you? And if it does, do you really want to be someone others feel sorry for? Close your eyes and imagine for a moment telling your spouse or workmates, ‘I slept wonderfully last night!’ How does it feel? Probably uncomfortable at this moment, because it isn’t true. How comfortable would it feel if it were true?
Start noticing your habitual thoughts about insomnia. In particular, look out for sentences beginning ‘I always . . .’ or ‘I never . . .’ or ‘I know . . .’ For example:
‘I always take hours to get to sleep’ or ‘I always wake up for hours in the middle of the night!
These statements may not actually be true, although they feel true to you. As we’ve seen, most insomniacs over-estimate how long they take to get to sleep or lie awake during the night. You could make a start by recognizing that your perception of the amount of sleep you get may be inaccurate.
I’m never going to get to sleep tonight’ is another habitual statement which is an excellent way of programming your brain to stay awake.
7 know I’ll feel dreadful if I can’t get to sleep’. Of course, lack of sleep makes you tired, but you can also talk yourself into feeling worse. There are alternatives, such as telling yourself that even though you’d like more sleep, your body is still getting all the rest it needs.
Make a game of catching these kinds of thoughts. It may help you to write them down. Then try replacing your negative statements with positive ones; a good start might be: ‘I’m now learning how to sleep better.’ Make your positive statements ones you can believe. Telling yourself ‘I am going to sleep perfectly tonight’ may not work, because at this point you probably won’t believe it, and trying to convince yourself will set up further tension. But you could try: ‘I will take tonight as it comes.’ You may be surprised by the results.
Starting to change your self-talk can be a way of opening up other possibilities. Once you realize that you don’t have to be a victim of your own thinking and reactions, all kinds of barriers can begin to crumble.
*19/169/2*

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Other names: Neoral, Sandimmune

DEALING WITH THE CAUSE OF INSOMNIA: THE HABIT OF INSOMNIA
Whatever the cause or causes of your insomnia, sleeplessness is nearly always a symptom of some kind of disharmony in your daytime life. This disharmony may be mental, emotional, physical or environmental, often a combination. But whatever it Is, it needs to be faced and dealt with during the day. By the time you get to bed, it’s really too late.
Poor sleep cam be exacerbated by bad eating and drinking habits, lack of exercise, and other physical and environmental (actors which contribute further to tension and stress. We’ll be looking at all of these in due course. But since your physical habits usually reflect your view of yourself, let’s look first at the mental and emotional side.
The most important thing is to realize that you can do something. To decide what to do, you will need to look at your attitudes and lifestyle and possibly ask yourself a few questions. But once you start on a plan of action you will not only improve your sleep pattern but start creating for yourself a happier, more satisfying daytime life. As you read on, note what applies to you, and what you personally can change.
*17/169/2*

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HOPE FOR PEOPLE WITH BDD
In many ways, we’re only beginning to understand BDD, and much more research is greatly needed. At this time, there are still many questions. What causes BDD? Is it rooted in a person’s genes, life experience, or societal pressures? Is it a disorder of the brain, the mind, or society? Why do some people get it but others don’t? Is it related to eating disorders, like bulimia and anorexia nervosa?disorders that also involve distorted body image? Or is it related to obsessive compulsive disorder, a disorder characterized by obsessive thoughts? for example, about contamination or harm?and compulsive behaviors that, like those of BDD, often involve checking and reassurance seeking?
How is BDD related to , a disorder in which men fear that their penis is disappearing into their abdomen and will kill them? And where exactly should we draw the line between BDD and the normal concern with appearance that so many people have? Is BDD simply an exaggerated version of this normal, common concern?a more intense, problematic variant of it? Or is it something different?
While continued research is essential, we aren’t totally in the dark. There’s a lot that we do know?what people with BDD experience, what other problems and disorders they commonly have in addition to BDD, how BDD affects peoples’ lives. We know that this disorder often responds to certain psychiatric treatments. The suffering of many people with BDD?including Jennifer, Chris, and Keith?has been significantly alleviated by these treatments. Some are completely free of their tormenting concern.
Jennifer’s symptoms were alleviated by clomipramine (Anafranil), a certain type of antidepressant medication known as a serotonin-reuptake inhibitor. After several months on this medication, she began to notice that she thought about her skin much less often?only an hour a day instead of most of the day. It became much easier to resist extra peeks in the mirror. Her preoccupation no longer tormented her. She also felt better about how she looked. She still thought that she had “some pimples?, but she realized they weren?t particularly noticeable. They were no longer devastating. As she explained, “This is more of a normal dislike?it isn’t taking over my life anymore. I’ve put this problem in perspective. I don’t love my skin, but I can accept it. It no longer ruins me.” She stopped asking her mother about her appearance, and she’s been able to leave her house, go into stores to shop, and look for a job.
*17/204/8*

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SECOND STAGE OF STRESS BREAKDOWN: WHERE DOES WILL-POWER RESIDE IN THE BRAIN?
In my understanding, what we call ‘will-power’ is a function of the reticular activating system of the brain stem. This system is made up of a network of cells and connecting fibres situated in the lower part of the brain where the upper end of the spinal cord meets the brain’s hemispheres. It is the reticular activating system that puts us to sleep at night and wakes us up in the morning. It is this system that is responsible for selective attention, allowing us to concentrate on specific tasks, while excluding other outside stimuli from our conscious awareness.
The reticular activating system is under the executive control of the brain’s frontal lobes, which can direct the reticular activating system to enhance or diminish the level of excitation of different parts of the cerebral cortex, where the learning and unlearning neurons (nerve cells) are situated. (The cerebral cortex is the folded outer layer of the brain’s surface, containing the millions of cells which form the elements of the marvelous computer which is the human brain.)
*18/129/5*

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HOPE FOR PEOPLE WITH BDD: MY PATIENTS?S STORIES
Keith responded to a combination of a serotonin-reuptake inhibitor known as fluoxetine (Prozac) and a type of therapy known as cognitive-behavioral therapy. He stopped worrying about his appearance almost entirely. Like Jennifer, it’s now much easier to go out in public because he no longer thinks that everyone is staring at him. The serotonin-reuptake inhibitors, which are antidepressant medications with antiobsessional properties, appear particularly effective for BDD. Those currently marketed in the United States are citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), fluvoxamine (Luvox), clomipramine (Anafranil), paroxetine (Paxil), and sertraline (Zoloft). Cognitive-behavioral treatment also appears effective for BDD. This treatment helps patients stop their compulsive behaviors, face the situations they fear, and develop more accurate and helpful appearance-related beliefs.
The field of psychiatry is rapidly advancing; some of the things we now know about the workings of the brain were barely imaginable even a decade ago. Many advances?such as those in brain imaging and genetics?will be applied to BDD and are likely to exponentially increase our knowledge. A statement made by Eric Kandel, a famous neuroscientist and Nobel Prize winner, about his area of research struck me as particularly applicable to BDD: “We are at the foothills of an enormous mountain range.”
*18/204/8*

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DEALING WITH THE CAUSE OF INSOMNIA: HERBAL SEDATIVES
Practitioners of natural therapies would much rather help you to solve your sleeping problems altogether than be dependent on medication, but herbal tranquillizers can be useful and safe as a temporary prop while you recover your normal sleep.
Over 90 sedative herbal pills can currently be bought over the counter at health food shops and some chemists. Most of them contain slightly differing proportions of the same ingredients including valerian, scullcap, passiflora, wild lettuce and other sleep-inducing herbs. They can be taken during the day to counteract anxiety as well as to help you sleep at night.
Most herbal remedies are very mild, without the mind-deadening effect that chemical tranquillizers can induce, and they are not technically addictive; however it is possible to become psychologically dependent on them. While preferable to chemical drugs, there is still a risk of using them as a substitute for really dealing with your insomnia, and taken regularly for a few weeks on the trot their effectiveness can be reduced.
Herbal pills in general have no side-effects, and are safe to take; their sale is supervised by the Committee of Safety on Medicines. In 1989 newspapers reported that a woman had suffered liver damage after regularly taking a herbal tranquillizer; however, after investigation, the pills were not withdrawn from the market. Sometimes a herbal remedy is blamed when the person taking it has also been taking medication which could cause liver damage. Very occasionally, a person has an individual allergic reaction to a herbal product, which does not mean that it is dangerous to the rest of the population.
It says much for the safety of herbal pills that one case of a bad reaction can make the headlines, in comparison with the thousands of people suffering from tranquillizer addiction, and the hundreds who die every year from an accidental overdose of paracetamol-based drugs.
*16/169/2*

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Other names: Endep

“NO ONE TAKES ME SERIOUSLY”: LETTERS FROM BDD SUFFERERS AND THEIR FAMILIES ? SON?S PROBLEM
I received an extremely sad one sent to me by a woman whose son had been preoccupied with the shape of his head. She had just read about BDD in her local paper and realized that this was the disorder with which he had suffered for so long. She started her letter with the following:
“I read the enclosed article nearly a month after my dear son hanged himself in sheer desperation. Until we read the reporter’s words, none of us had any perception of my son’s suffering and feeling that no one could help him … My son had been telling us for many years how he felt and that he wanted to die.
The last letter shocked and haunted me for a long time. I spoke with the woman, who told me about her family’s and her son’s suffering and of her long and unsuccessful quest for a diagnosis and effective treatment. No one could tell her what his problem was. And she felt that no one had truly understood the depth of his suffering. She blamed herself for this. She felt she should have understood. In retrospect, her son’s suffering and hopelessness couldn’t have been clearer, but at the time it had been hard to understand?he was a handsome young man whose head looked completely normal. Her self-blame made his death all the more painful.
The tragedy of this young man’s death and other stories I heard spurred my resolve to learn more about this serious and underrecognized disorder?to start doing research so we could understand who gets it, how to identify it, and how to treat it.
*16/204/8*

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SLEEPING DISORDERS: TAKING PILLS
Most experts advise avoiding sleeping pills except for those emergencies when you cannot get to sleep and you must be rested for some important reason the next day. Taking pills long-term leads your system to tolerate them – they stop having an effect.
Besides being a bad habit, insomnia has many causes, including serious illness. If Dr. Bootzin’s do’s and don’ts are no help, go to a sleep center.
At the other end of the scale, 300,000 Americans have narcolepsy – they fall asleep without warning at any time, in any place. Says Joe Piscopo, a computer executive, “I slept through just about all of college and barely graduated in 1965 from the University of Illinois with a degree in computer science. From ages 16 to 25,1 was in 15 car accidents – I fell asleep at the wheel. It was sheer luck that no one was hurt.”
In 1969, doctors at the Mayo Clinic in Rochester, Minnesota, diagnosed his narcolepsy. They gave Mr. Piscopo a strong stimulant, which he still takes. It enabled him to found a successful software company and retire at age 42. He is chairman of the American Narcolepsy Association, which helps narcoleptics learn about their disease and find help.
Scientists have made rapid progress in helping the nation’s 3 million or so night-shift workers, who must get their sleep during the day. Many arrive on the job at midnight and spend the next 8 hours trying to work while fighting sleep.
They can’t synchronize the wall clock with their biological clock. This is dangerous and inefficient.
Dr. Charles A. Czeisler and others at Brigham and Women’s Hospital in Boston have scored a major triumph: In just 4 days, using sun-bright light therapy, they actually shifted workers’ biological clocks, allowing them peaceful sleep during the day and productive work at night. Light therapy possibly could solve night-shift problems forever, reducing accidents and poor work.
In 1993, Dr. Al Lewy and colleagues at the Oregon Health Sciences University in Portland achieved similar effects on volunteers by giving them capsules with an artificial form of melatonin, a chemical produced naturally in the brain’s pineal gland.
It long has been known that the gland produces melatonin only in the dark at night, but when the artificial chemical was given to humans at night, it seemed to create no reaction. When Dr. Lewy’s team gave it to the volunteers during the day, however, the chemical shifted their internal clocks.
Dr. Lewy says melatonin can help jet lag. It also may aid those who need to sleep in the day and stay up at night, or go to bed very early and rise at or before dawn. Once tested, melatonin also might help those with delayed- or advanced-sleep problems or those who get “winter depression” from waking up in darkness. Dr. Lewy says when melatonin is taken in the afternoon, the body behaves as if it had wakened to a bright dawn.
Because melatonin can be classified as a dietary supplement, it has hit the so-called health food stores in a big way. It’s OK for Dr. Lewy to do experiments, it’s another thing to offer it to the public before extensive testing has been done.
If you think melatonin may help you, you may want to ask a sleep expert before you start popping pills.
*16/266/5*

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“NO ONE TAKES ME SERIOUSLY”: LETTERS FROM BDD SUFFERERS AND THEIR FAMILIES ? STRUGGLE WITH SEVERE BDD
Another woman wrote me about her brother’s long struggle with severe BDD:
My 49-year-old brother has suffered from body dysmorphic disorder his entire adult life. He has been hospitalized, had shock treatment, taken drugs, and received psychotherapy on and off for years as he imagines people are making fun of his looks. Nothing has helped him. Now, thank God, this disorder is finally being recognized and hopefully can be successfully treated.
The following letter conveys that this disorder can indeed be treated successfully. The young woman who wrote it had responded to psychiatric treatment after several years of suffering:
My history of BDD is relatively short, but very painful! I had what would probably be a mild case of it years ago in regards to my eyelids. I chose to have cosmetic surgery done and instead of remedying the situation, I became obsessed?I was sure that my eyelids looked even worse and terribly abnormal. It consumed me. I consulted six more cosmetic surgeons, mirrors began to be a terrible problem, I became reclusive, and I thought about it from the minute I woke up until I fell asleep. It was a nightmare. I’m sure you’re familiar with the story. Anyhow, this went on for two years before I got help. … I’d have to say I’m about 85% recovered from the BDD and that is a big relief!
*15/204/8*

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SUFFERING FROM SLEEPING DISORDERS
The 1992 report of the National Commission on Sleep Disorders Research, which Dr. Dement chairs, estimates that 40 million Americans suffer from some kind of chronic sleep sickness. About half of them are plagued by a condition called sleep apnea (from the Greek, meaning “not breathing”). Such individuals actually stop breathing while asleep. As carbon dioxide builds up in the lungs, the brain senses something gone wrong and sounds its alarm, waking the person enough to activate the chest and diaphragm muscles. With a terrible snore, the lungs suck in fresh air. Sleep ends for the moment. This can happen 500 times a night, fracturing any peaceful, restorative slumber. During the day, the afflicted person, lacking a restful night, constantly dozes off.
I. M. “Rusty” Gralnik, an engineer in Santa Clara, California, tells this story: “I would go to a ball game and, instead of going in the stadium, stayed in the parking lot to sleep in the car. I didn’t know something was wrong – I just thought I was tired. I would fall asleep working at my computer or while trying to read. A year ago, my wife was complaining that I was a terrible host: I’d fall asleep in front of our guests.”
People with sleep apnea inhale with high suction. It was so high in Mr. Gralnik’s case that it caused his throat to close, waking him repeatedly. This happens most often to people who are greatly overweight, although Mr. Gralnik is thin. Scientists have developed a breathing machine for apnea patients that pushes air into the nose under positive pressure, expanding the windpipe and making breathing easier.
“I feel a little more alert now,” Mr. Gralnik says, “but I’ve been down so long, it will take a while for my body to rejuvenate.” For those not helped by the machine or unable to sleep while using it, surgery opens the throat.
Rusty Gralnik’s apnea was diagnosed at Stanford’s sleep laboratory, which boasts rooms with air and light controls, and infrared TV cameras that “see” in the dark. A microphone and wires lead from a subject’s scalp to a recording machine, so doctors can see and hear the breathing, the snores, the apnea. Now 140 medical centers have such labs.
Great progress has been made in helping insomniacs – people who can’t fall asleep easily. Many perceive, sometimes falsely, that they have not had enough sleep or have endured bad, non-restorative slumber. The National Commission on Sleep Disorders Research estimates that 60 million Americans have experienced some insomnia, 15 million of them severely and chronically.
Gina Braun, a Tucson, Arizona, homemaker and mother of three young children, bore the burden of chronic insomnia. Her worst wakefulness struck during her last pregnancy. In her 8th month, pills helped Mrs. Braun rest for a while, but their effectiveness faded.
She found Richard Bootzin, director of the Insomnia Clinic of the University of Arizona Sleep Disorders Center in Tucson. Says Dr. Bootzin, “People need to develop skills for falling asleep.”
“Dr. Bootzin got me on a schedule,” Mrs. Braun says. “Before, I’d go to bed at 9 P.M., wake up at midnight, and stay awake ’til 9 A.M., when my husband [a fireman] would come home from his 24-hour shift. I had no sleep cycle.”
Dr. Bootzin used these do’s and don’ts that sleep scientists have developed to break insomniacs’ bad habits:
? Do keep a diary of your bedding-downs and waking-ups for a week, to observe your slumber pattern.
? Do maintain a regular schedule. Go to sleep and get up at the same time daily.
? Don’t drink caffeine after noon or alcohol at any time.
? Don’t nap during the day – be active.
? Don’t go to bed until you’re drowsy. If you’re wide awake, staying in bed makes matters worse.
? Do keep your bed for sleeping and sex only. Read, sew, or watch TV elsewhere.
“Dr. Bootzin told me to get out of bed as soon as I felt anxious,” says Mrs. Braun. “At first, I was out of bed 10 to 15 times a night. Now, if I can’t sleep, I get out of bed and go read. I’m thankful things are so much better.”
*15/266/5*

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SECOND STAGE OF STRESS BREAKDOWN: WILL-POWER, EMOTIONAL CONTROL AND THE SELF-STARTER FUNCTION
The ability to keep our emotions under control is a necessary pre-condition for any organized, civilized society. Mutual cooperation and teamwork are only possible when people can delay demands for gratification of their needs and desires, and are able to inhibit the outward display of feelings of resentment or anger. It is important for human beings to be able to control their emotions in situations of emergency and unexpected threat, because the ability to survive such crises usually involves teamwork and co-operation.
In emergency situations we are usually able to call on reserves of will-power to control our emotions enough to cope with the immediate problems which present themselves. Many people have experienced calm in the midst of a crisis, which has enabled them to take clear and decisive action. When the immediate danger has passed, they begin then to experience the fear that was appropriate to the situation.
The inhibitory reserves which allow us to delay the experience of fear and anxiety in crisis situations are only meant to operate in an emergency. However, we know that people under stress and beginning to experience anxiety symptoms from overload can, for a time, use their emergency inhibitory reserves to ignore the nervous system’s alarm signal, that is, the symptoms of anxiety. When these reserves are exhausted, the ability to dampen down unwanted or inconvenient emotions is lost. As a result the person becomes emotionally labile, that is, his or her emotional display can change very rapidly from tears to laughter and back.
Our will-power mechanism also gives us the ability to force ourselves to do things which are not in themselves enjoyable. However, our ability to continue forcing ourselves into unenjoyable tasks has a definite limit. In stage two stress breakdown, the symptom of loss of the ability to motivate oneself to adapt to changing circumstances is caused by the self-starter mechanism running out of energy, like a car battery running out of electric charge. People who experience second stage stress breakdown symptoms will report that they are utterly incapable of forcing themselves to do anything. They seem to have run out of the energy they need to psych themselves into doing things.
Some people, who are beginning to experience stage two, find that whereas they cannot force themselves into tidying up the house, they can do it if they don’t try to do it. Listening to the radio and wandering about tidying up things which happen to be in the vicinity while concentrating on the radio programme, is a method used by some people. Others find they have the ability to help someone else, but don’t have the psychic energy to plan to do the tasks themselves.
*16/129/5*

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THE SECOND STAGE OF STRESS BREAKDOWN
The person experiencing excessive stress who fails to heed t warning of anxiety symptoms, may cross over the first threshold and experience the symptoms of stage two.
In stage two there are two extra symptoms added on to the anxiety symptoms of stage one.
These are the symptoms of failure of emotional control, and failure of self motivation.
Whenever I lecture on the topic of stress breakdown, aft discussing the symptoms of stage one, I often ask the members of the audience if they can identify the symptoms of stage two. usually put this question: Suppose you were working with friend who you knew had been under a great deal of stress and train, and had been having trouble sleeping, and had been complaining to you about feeling tense and jumpy. One day something happens which leads you to say to your friend, ‘Look, I think you’d better take the rest of the day off – go home and have a rest. I’ll finish up here. Don’t you worry about talking to the boss – I’ll fix that up – you go home and take it easy!’ ? What was it that happened?
The response from the audience usually includes answers such as:
- Suddenly burst into tears for no apparent reason.
- Suddenly lost his or her temper over only a little thing.
- Became inefficient, couldn’t do the work.
- Was laughing one minute and crying the next.
- Was just sitting there looking at the work, not doing anything.
- Couldn’t get moving.
I have found that members of an adult audience usually have difficulty identifying with the question, and they tend to give remarkably consistent answers. Not only can people generally recognize the symptoms of second-stage stress break-down, but they usually recognize these symptoms as serious.
Furthermore, it seems that caring people instinctively know that the person in stage two stress breakdown has already lost the ability to go to the boss, arrange time off, close down the shop, and so on. It is as though we recognize loss of emotional control as a signal of serious disturbance, and that the person needs to be rescued. That is, we seem to know that the person who has lost emotional control will have simultaneously lost the ability to initiate adaptive changes in behaviour. Although caring people may well recognize these changes as temporary, we generally regard them as serious enough for us to insist on taking some of the load off the stressed person, often in spite of his insistence that he is perfectly capable of carrying out his duties.
*15/129/5*

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DEALING WITH THE CAUSE OF INSOMNIA: SLEEPING PILLS (A LAST RESORT)
Publicity about the side-effects of sleeping pills and tranquillizers belonging to the benzodiazepine group of drugs has made the general public wary of taking them, and doctors wary of prescribing them. When they were first produced in the 1960s they seemed to answer all sorts of problems: now we know that these drugs don’t solve any problems, and can be extremely addictive.
In addition, when taken as sleeping pills, benzodiazepines reduce the quality of your sleep. They cause suppression of REM sleep in the first part of the night, often with a rebound effect with more dreaming later in the night, which can cause early wakening. They can also leave people feeling fuzzy-minded next morning, which is particularly dangerous in the old, since it can make them confused and increases the risk of falls.
Recently some new sleeping pills have come on the market, the cyclopirolones, which don’t disturb normal sleep patterns. They haven’t been around long enough for their long-term effects to be known for certain, and it’s likely that doctors would discourage patients from taking them consistently for any length of time.
There may be a case for taking medication for a day or two under certain conditions ? after the shock of a bereavement, for instance. But no one should take sleeping pills for year after year, as has been the case in the past.
What if you are already taking them? There have been many stories about the horrors of withdrawal symptoms. That may make you scared of giving them up, even if publicity about their effects on your sleep is also causing you anxiety.
Not everyone goes through horrendous withdrawal symptoms; a less well publicized fact is that numbers of people have given up sleeping pills relatively easily. Since we all have individual body and brain chemistry, the effects of both taking and giving up benzodiazepines can vary a great deal.
Giving them up is really worth it. Once they are out of your system you will return to a normal, natural sleep pattern, and your mind will be clearer.
It’s vital to come off them slowly, by gradually tapering off the dosage over at least two or three months; the worst withdrawals happen when people give them up suddenly. Some people try reducing their intake by cutting their pills in halves or quarters, but this method is not very accurate. It’s best to consult your doctor so that he or she can prescribe gradually smaller doses. Your GP may be able to refer you to other sources of help, too, such as a relaxation class or self-help group. Some GPs are in touch with natural therapists and may be able to suggest someone reliable who can help you, through massage, aromatherapy, or hypnotherapy, for example.
Practitioners of natural therapies can be very supportive in helping you to come off sleeping pills, or dealing with the aftereffects of coming off. They are not allowed to recommend you to go against your doctor’s advice; you can of course make your own decision, but it’s best if you work in co-operation with your doctor. Some natural practitioners prefer people to give up sleeping pills before starting treatment, either because the drugs may interfere with their treatment, or because they like to know that the patient is committed to stopping.
A hypnotherapist was asked to treat a woman with agoraphobia, who had already been helped by a herbalist to wean herself off the tranquillizers and anti-depressants she had taken for eight years. On her first visit, the woman’s husband came with her because she couldn’t go out alone; on her second, she came by herself. The hypnotherapist commented: ‘She was very, very committed to her own recovery. She was going to do it! That commitment is something the therapist can’t supply’
What natural practitioners can supply is the time and the listening ear that busy GPs are rarely able to give, together with natural treatments to strengthen and detoxify the body. A naturopath and osteopath tells me that about 5 per cent of her patients are hooked on sleeping pills when they come to her. They usually come for treatment for some other problem, and after a while ask for her help in giving up the pills. She has found it possible to help them by using herbal pills as a bridge, and combining counselling with her physical treatments.
On giving up benzodiazepines, some people experience increased fatigue for a time, and some increased agitation. There can also be a period of increased dreaming. And it can happen that the suppressed anxieties for which they originally took the pills start surfacing. This is easier to cope with if you accept it as part of the healing process rather than a sign of sickness: it shows that these feelings are now on their way out. Counselling from a professional counsellor or alternative practitioner can help you through this stage.
*15/169/2*

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DEALING WITH THE CAUSE OF INSOMNIA: FORMULATING A STRATEGY
In a sleep clinic, once a detailed assessment has been made, a strategy would be worked out with you for improving your sleep. If you were found to be severely depressed, drug therapy might be recommended for a time. And of course if you were found to be suffering from a medical, neurological or psychiatric illness, you would be referred for appropriate treatment.
For most people, the options could include relaxation training, or a behavioural programme to restructure your sleeping habits. Or you might be referred to a psychiatrist or a clinical psychologist to help you deal with emotional stress. Psychological help might take the practical form of helping you to deal with anxiety by sorting out your priorities. You might be considered a suitable candidate for cognitive therapy, a way of learning how to change negative and anxious thoughts and beliefs about yourself. You might be helped by hypnotherapy, which a few psychiatrists and psychologists practise; or it might be considered that you would benefit from psychotherapy. We’ll be looking at these options in the next few chapters.
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“NO ONE TAKES ME SERIOUSLY”: LETTERS FROM BDD SUFFERERS AND THEIR FAMILIES
BDD isn’t rare. While we have only limited data on its prevalence, these data suggest that it’s far more common than is generally recognized. Preliminary data from a growing number of researchers suggest that BDD may affect about 1% of adults in the general population, from more than 2% to 13% of students, and 13% of people hospitalized in a psychiatric hospital. It’s been found that 9% to 12% of people seeking treatment from a dermatologist, and 6% to 20% of people who receive cosmetic surgery, have BDD.
These numbers translate into many millions of people in the United States alone. While these findings need to be confirmed in larger-scale studies, I and other researchers have been surprised by the relatively high rates of BDD we’ve found in the groups we’ve studied. When stories about BDD have run in newspapers and magazines, I’ve been deluged with calls and letters. I hear from people who wonder if they have BDD and want treatment, from family members who think a loved one may be suffering from the disorder, from professionals asking for information and sometimes for help for their own family members. One woman, who read about BDD in her local newspaper, wrote the following:
I am 45 years old?and I don’t ever remember not feeling this way. It is very
difficult to discuss with anyone, as no one seems to take me seriously or can relate
to the amount of pain I feel. Therapy has helped me work on many of my other
issues, but I seemed to skirt around this more serious problem, which didn’t get
addressed… The hardest part for me in this is that no one takes me seriously
and so I never feel heard. It is very distressing and has affected many areas of my
life.
The sense of isolation and aloneness implied in this letter is more directly conveyed in the following letter, which a woman wrote to me after seeing a story about BDD on Dateline NBC in 1993:
I am 29 and never knew that there was anyone else out there who thought the same way I do about themselves.
*14/204/8*

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TROUBLE SLEEPING: RULES FOR BETTER SLEEP
Sleep experts have developed some simple rules for good sleep.
Rule 1. Go to bed and get up about the same time every day, weekends included. A regular routine keeps you in step with your biological rhythms.
Rule 2. Exercise regularly. Some people, however, may find exercise too physically arousing if it’s done too close to bedtime.
Rule 3. Recognize that sleeping pills, alcohol, caffeine, and cigarettes may induce sleeplessness. People who drink or smoke often remain awake in bed for a long time. Sleeping pills are often successful in breaking the distorted cycle of sleep-awake. Warning: They should be used to change the cycle and usually not longer than a month.
Rule 4. We all have the capacity to fall asleep. It is built into us. If we don’t sleep for a night or two, no harm will come unless we try too hard. So don’t try to force sleep. If you cannot sleep, get out of bed. Do something boring. Don’t watch TV?it may stimulate you to remain awake.
Rule 5. Find a quiet place. Noisy environments disturb sleep, even for deep sleepers.
Rule 6. Don’t use the bedroom for reading, watching television, playing games. You will associate bed with activities that make the mind race. Bedrooms are only for sleep and sex.
Rule 7. Learn some kind of relaxation technique. Meditation is one, biofeedback another. You can relax by alternately tensing and relaxing your muscles.
*14/266/5*

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Other names: Clomicalm

FIRST STAGE OF STRESS BREAKDOWN: ANXIETY WHEN PERFORMING NEW TASKS
Whenever we call on the nervous system to carry out some ne task, something it has no experience of, there will usually be an anxiety response. The first time we stand up and address the class, give a lecture, take out an appendix or get behind the wheel of the car, we experience significant anxiety. This doe not mean anything other than the fact that the nervous system has not done this thing before and therefore alerts us to its difficulty in processing the information by triggering an anxiety reaction.
In our society, therefore, we tend to recognize that anxiety is normal and expected part of learning new skills and performing new tasks. However, there should not be any anxiety in learning new information. A student would not expect to experience significant anxiety just simply from sitting in lectures listening to his teachers. This distinction, I believe, is important. Our schoolchildren these days display increasing levels of anxiety; it is important for educators to consider carefully how much of the children’s anxiety is primarily due to stress breakdown and how much is due to performing new skills.
When a normal person is suffering the adverse effects of excessive stress, the first symptoms to be experienced are the symptoms of anxiety. Anxiety is the alarm mechanism of the nervous system which alerts us to the fact that the nervous system is beginning to fail to process the information adequately. It is possible to diagnose our anxiety symptom immediately they occur with five questions – two related to the tasks required of the brain, and three related to factors which will reduce the brain’s processing ability.
A person suffering from anxiety symptoms due to excessive stress can stop whatever he or she is doing immediately and take steps to restore the normal balance between the brain’s processing ability and the tasks required of it. These steps will prevent progression of stress breakdown beyond this first stage, the stage of anxiety symptoms.
*14/129/5*

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TROUBLE SLEEPING: BRUTALITY OF SHIFT WORK AND DANGERS OF PILLS
The Brutality of Shift Work
Factory, postal and hospital employees, bakers, truck drivers, police, and fire fighters often rotate their work hours in three shifts: day shift (8 A.M. to 4 p.m.), evening (4 p.m. to midnight), and night, or “graveyard” (midnight to 8 a.m.). The problem for these workers is that shifts often change weekly. This is not enough time to reset the internal body clocks.
Seventy percent of shift workers have trouble falling asleep and staying asleep; they complain of stomachaches and irritability. (One man joked that he was going to bed hungry and waking up ready for love, instead of the reverse.)
Such work schedules probably disturb the sleep and digestion of 20 million to 30 million people, says Dr. Charles Czeisler of Harvard Medical School. He devised a shift schedule for a Utah chemical company that closely followed nature’s body clocks. He reports that complaints about sleep and stomach troubles dropped dramatically and work production increased by 20 to 30 percent.
Shift workers who have trouble sleeping should go to sleep at the same time every day and should eat a similar meal at the same time each day for the duration of the work shift.
The Dangers of Pills
Most experts agree that sleeping pills should be used only for occasional sleeplessness. A conference of experts assembled by the National Institutes of Health warned against using sleeping pills of any kind for chronic insomnia, except perhaps for a month to make other treatments easier.
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