My Name is ANXIETY!!!

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Hi, Dr. Louella again. I want to chat with you about anxiety today. This comes off our talk on insomnia, where I realized that anxiety was the cause of my recent bout of insomnia.

Now, this is not a treatise on anxiety. It is just want to make you more aware of it and how to deal with it. I am in the advantageous position of both having studied and treated people with anxiety disorders and having suffered anxiety myself. Advantageous? Yes, I know both ends of the stick and it is a good feeling when what you’ve been through can benefit someone else.

Now, I’m not going to pretend that I am cured of anxiety because it is usually not that easy. But I am managing it so that it does not interfere with my life. That’s the key, how functional you are. And I do function!

Well, what is anxiety to begin with? The very essence of it is fear. It may be disguised as concern or worry. It is a negative respond to stress. We allow ourselves to ruminate or obsess over a situation because we are afraid of something going wrong in the future or are unable to let go of the hurts of the past.

Anxiety is basically a human emotion which we all feel. It can be useful in small doses. Say you are crossing a road. Next thing you see a truck come speeding out of nowhere. The anxiety you feel can catapult you to the other side of the road. That’s our “fight or fight” response due to adrenaline (‘epinephrine’, to the Americans), and we surely need it.

But there are other times when that response is misplaced. Your daughter goes out with a friend, and as the night draws later you start to worry more and more about her safety in these times of high crime. You think you have a right to worry about her as a parent. But do you? Examine it with me for a while.

You will be evoking in your body a similar but milder ‘fight or flight’ response with your worry. Hormones are going to be released. Your heart beats faster, blood pressure will elevate, digestive system is suppressed, muscles tense up, but unlike in the previous example, there is no action. You can’t run across the road and save her! You can do nothing.

You get your body in this hyped up state and the excess fuel is not used for any physical activity. Normal bodily functions are suppressed when we are ‘stressed’, including the ability to fight off diseases. You are like this, yet you can do nothing to help your daughter. I let my patients know they’re not helping her, and they’re certainly not helping themselves with their worry.

So now, imagine if you do this repeatedly. Everyday there is something new to worry about: the state of the economy, the package delivered late, the traffic conditions, murder, the failed dinner, the sick child, the list is exhaustive. What happens in our minds? What happens to our bodies?

You may be surprised by what a negative response to stress does to our bodies. Remember, everyone is faced with stressful situations on a daily basis. But we don’t all respond the same. Something one person throws over the shoulder, another person laughs at and yet another rants and raves about. So, it is not the actual stressor but our response to it that affects our bodies.

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When we respond with frequent expressions of fear such as concern, worry, fretting and anxiety, it affects us physically. We are constantly putting our bodies on alert to act but never do. Chronic anxiety affects us through: dizziness, fast heartbeat, fatigue, headaches, inability to concentrate, irritability, nausea, rapid breathing, trembling, digestive disorders, memory loss and premature heart attack.

Look again at those symptoms. Don’t you get some of those from time to time? I have sooo many otherwise healthy patients who come in with the symptoms above. I automatically think ‘stress’ when I see a young woman with mild dizziness. More often than not, there is a huge stressor in her life that she is not coping well with.

And isn’t everyone ‘tired’ or has lack of energy these days? What about stomach problems and memory loss? Hey! I’m not saying we simply dismiss these symptoms as stress-related but it is important to be aware, especially in general practice, that you may not be able to find an actual physical cause of a problem. The possibility that there are psychological factors triggering symptoms is real.

But, being a doctor and knowing my body, if I ever feel dizziness I say to myself, “Girl, you are stressing over something. You didn’t realize, huh?” And when I am forgetting a whole lot, I know I need a rest. When my acid reflux resurfaces, I don’t take meds. I just make a note to myself that I’m stressed.

I must re-direct you to the symptoms one final time. Do you see why you need a good night’s sleep before exams? For memory and concentration. And how could a healthy corporate executive just keel over with a heart attack? Extreme stress. Ever notice you’re just sitting there but you’re breathing hard?

So the long and short of it is that anxiety and excessive stress are not good for our bodies, especially as cortisol suppresses our immune system making us more susceptible to diseases. When I’m stressing myself out a lot I think, “You’re killing yourself girl; shortening your life. Stop it!”

But really, I would like to take you more inside the mind of an anxious person (you may well find that mind is your own) because it’s no big taboo. All of us get anxious, some more so than others. I want to teach you to be able to recognize the state and be able to get out of it quickly.

Ok, so I gotta go now. Will chat more later in the week. I have got an hour and 30 min to get to church, and for me, that ain’t enough. I’m not like my sis who needs an hour. Ciao!!!

 

Insomnia!!!

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teddy-is-sleeping-vector-583552Hi, it’s Dr. Louella again. Would you imagine that after that talk about the basics of health I haven’t yet gotten enough sleep? While people looked forward to this, another long weekend in Trinidad, I didn’t. I knew that preparing for the Indian dance on Friday would take all day. Today I’m opening my office and then am part of a community-based clinic. I must attend a wake tonight then church tomorrow and event planning after. Breathe doc!

But there was a time, not so very long ago, that I wanted this very sleep but could not get it. I experienced insomnia for the first time in my life the end of 2013 into 2014. Now I know this is common among patients, but when you yourself suffer with something you sit up.

And my doc tried everything. He was a psychiatrist so I trusted his judgment and tried very much not to practice self-medicating. But I knew the medical options were limited.

First he thought the air-conditioning in my bedroom was too cold. If you research it you will see that environmental factors have a lot to do with sleep. You need a dark room. They advise you turn off your TV, computer, cell phone, anything with a lighted screen, about an hour before going to bed.

They repeatedly say the bed is only for sleep and sex. But we are all guilty of lazing around, reading, talking, using the computer, watching TV etc. on our beds.

Then what about the noise factor? Our bedrooms should be quiet except for some soothing or isochronic music (did not work for me though; isochronic tones got me tense).

Now these things never mattered to me before. I used my computer, watched TV and chat on my bed. Then next moment I was asleep. It is when you begin to have problems that you need to start examining your environment.

Is your partner’s snoring affecting you. Let him visit an ENT doctor or research solutions on the net. Maybe it’s frequent awakenings from a crying child. Can no one babysit for a couple of nights for you to get back your rhythm? At the other extreme we have the elderly who may need mild sedation at night to prevent them from disturbing the household.

I turned off my air condition and used the fan and still couldn’t sleep on my own. Then I admitted to my doctor my frequent trips to the bathroom. That obviously disturbed my sleep. He wanted me to do less water guzzling (or as they say abstain from fluids for an hour or two before bedtime). When I said it was small amounts of urine he said I needed to learn to hold it, to retrain my bladder.

Good advice. But it didn’t work. I still awoke frequently and couldn’t get back to sleep. This is when I started doing my own research as to what else was out there. I had been using melatonin, which is supposed to be a natural sleep aid, but it just wasn’t kicking in.

I focused on trying to get myself to relax prior to bed. Against my will I had a warm cup of milk, I did not exercise too close to bedtime, I tried mild meditation, and progressive relaxation. As I said, the isochronic tones were not for me but my radio chimed love music throughout the night.

I tried to have a routine time to go to bed and to wake up. I saw where it was said that you ought to limit daytime naps to 30 min and then not after 3 pm. Now, mind you, I have no qualms in telling this to my patients. Because that’s what ‘they say’. But to me it was a bunch of hogwash since I have been taking afternoon naps for years and sleeping perfectly.

In this present scenario, when I missed a nap I slept no better at night. At least if I could get an hour or two under my belt during the day I would feel better.

Of course I know someone who sleeps a lot during the day may having difficulty sleeping at night. I didn’t sleep all day. And the elderly with little physical activity or who sleep all day, may be also unable to sleep at night.

Another rule that I broke is where they say if you haven’t fallen asleep after half hour, get out the bed. Go do something. When you’re sleepy again come back. Sounds good. But when I’m battling with my bed to sleep I’m down for the long-haul. (Maybe that’s why I usually lost the battle).

I feel for my patients a lot more in this area of insomnia after having been through this myself. It was terrible!!! You “awake” on mornings totally unrested, eyes heavy and burning, head groggy. And of course you have to go to work that day.

I only got a good night’s rest when I used the benzodiazepines (e.g. Valium, Ativan) my doctor prescribed. He kept trying to reset my clock with them and started and stopped them. He was particularly concerned about not aggravating another condition I have, that is triggered by lack of sleep.

But we all know benzodiazepines are addictive. You simply cannot take them for long. By now I thought I had figured out what caused my insomnia…anxiety. I never realized anxiety could cause such horrible insomnia. I was getting insights for my patients all the time. But I couldn’t shake the anxiety.

I had always thought that patients often had trouble sleeping because of their thoughts at night. But I had no self-defeating thoughts at night (except “I can’t sleep; I’m gonna die”). I learnt that it was also the daytime thoughts, fears, worries, ruminations that play on our subconscious and prevent us from sleeping at night.

My doctor next prescribed antipsychotics. I went along with it because things were not improving. Within three days I had horrible side effects so I stopped. I realized I had reached the end of the line. This anxiety thing had to stop. I willed my mind to be calm and trust in the Lord I believe in.

In two days, I was sleeping naturally again. It had to happen. I came from a history of beautiful sleep and I was not now going to be condemned to a life of insomnia.

I’ve been sleeping well since, making it two and a half months. I’m still working on the anxiety and have insights to share on this.

I know that a lot, a lot of people have problems to sleep. Please try some of these methods I mentioned above, I can always clarify, and above all, be anxious for nothing (KJV).

Dr. Louella. Over and out!