Insomnia: It’s Okay to Hope

Last night Wichita State University fell to top-seeded Louisville in a valiantly fought Final Four semi-final NCAA men’s basketball tournament game in Atlanta.  As my blog followers know, I’m a Kansas Jayhawk first and foremost, but I grew up in Wichita and have strong ties to WSU.  My heart aches for the Wichita State Shockers, as it did last week when Kansas lost to Michigan.

Intermediate- to low-seeded teams are a rarity in the Final Four, and ninth-seeded WSU truly exceeded the expectations of many.  Few anticipated the Shockers to make it much past the second or third round of the tournament.  But as Wichita State continued to shock the nation with win after high-profile win, something beautiful started to germinate and grow in my native Wheat Country:  hope, hope that those wins will continue, all the way up to the end.  Could it be that this young mid-major squad, whose name sportscasters and game announcers can’t even pronounce properly (“Wishlata?”  “Stalkers?”  Seriously???), might possibly wrestle the national title from the vaunted blue bloods of college basketball?

 

The Merriam-Webster definition of hope:  “desire accompanied by expectation of or belief in fulfillment.”

Though the championship is now not to be this year for Wichita State, Shocker fans did not lose much by daring to hope.  Hope implies a transition from non-expectation to expectation.  Hope is also rooted in reality, arising from a personal interpretation of what is experienced, such as upsetting the top-seeded team in your tournament region.  Despite the inevitably profound disappointment when your team loses after having battled to within an arm’s length of the national title, there still lingers the warm feeling of what has been achieved, against all odds, and what therefore can be further achieved in the future.  The new expectation then morphs into a different belief system, and it is this new set of beliefs that generates optimism, a hopeful confidence that continues to build and grow as the years go by.

Nowhere in the realm of sleep medicine is one’s individual system of belief more important–and more responsible for great success or abject failure–than in the management of insomnia.  If you’ve had difficulties falling and staying asleep in your bed for years, you can gradually become conditioned to not sleep well there.  There is no longer the expectation that you will sleep well there due to years of experience to the contrary, so you begin to feeling you’re losing hope that you’ll sleep well again.

Therein lies the cognitive paradox pertaining to insomnia.  We all know that sleep is a necessary and required biological function, and that sleep must be achieved eventually and inevitably, because we must sleep no matter how bad our insomnia; as such, logically there is every reason to expect to sleep, every reason to hope.  However, previous experience sleeping badly enforces the idea that we won’t be able to sleep reliably well again, and this misconception is reinforced every time we try unsucessfully to achieve asleep–such as by counting sheep, listening to relaxation tapes, or what have you–and the resulting fear and frustration keep the hope from surfacing.

In a clinical scenario, a longstanding insomnia patient may respond to the physician’s suggestion, for example, with the knee-jerk exclamation, “But I’ve already tried that!”  I’ve heard that response once or twice in my career, sometimes loudly, even angrily.  But the thought process that generates that frustrated claim can be self-defeating.  First of all, by the time insomniacs feel compelled to visit me in my clinic, they’ve usually already been through a variety of physician-recommended or self-employed treatments or management programs.  Second, by the time they make it through my doors they usually have developed multiple specific reasons to have the insomnia.  Third, whatever was tried earlier probably wasn’t tried in the same context of what is being suggested now.  Finally, often what is “tried” in the first place is tried with the additional burden of performance anxiety:  that feeling of “this had better work,” which only compounds the frustration when what is tried doesn’t result in the achievement of sleep.  Despite all of this, however, hope exists:  were it not for hope, these folks would never have bothered to make an appointment.

My job in this situation is that of both doctor and coach.  Hope is based on reality and fueled by knowledge.  Therefore, for my chronic insomnia patients, the first thing I do after collecting a history and performing a physical examination is sit and discuss at length why I think the insomnia is happening.  I make a list and outline all the probable reasons why the problem has started and continued.  I’ve found this helps them understand the reasons why subsequent recommendations are made, and why I believe that real improvements can actually be achieved, no matter how stubborn or prolonged the insomnia has been.

I believe that even the most hardcore insomniacs can use hope to their advantage.  I suggest that insomniacs choosing to visit a sleep specialist go in with an open mind, a willingness to absorb thoughtfully made recommendations and employ them with an expectation that they may well be helpful, though not necessarily immediately.  It’s hope that brings them to the clinic in the first place, so I recommend making the most of what they already have in them and allow themselves the willingness to believe that the sleep can get better.  If doctor and patient listen to each other openly, it just might.

Insomnia . . . For Wichita State and Gonzaga

I am and always will be a Kansas Jayhawk.  But my first awareness of college basketball was thanks to Wichita State University, the very school whose team just advanced to the Sweet Sixteen of this year’s NCAA men’s national college basketball tournament by trouncing top-seeded and top-ranked Gonzaga last night.

Wichita State was an integral part of my childhood.  My dad was a professor there for decades, teaching criminology, editing the journal he founded, The International Journal of Comparative and Applied Criminal Justice, and solidifying his legacy in the field of administration of justice.  I also took math, literature, and computer science classes there in the summer while I was in high school.  And, importantly, WSU’s infamous basketball coach, Gene Smithson, lived three doors down from us.  Growing up, we looked up to him and the young men he coached–particularly Antoine Carr and Xavier McDaniel, who subsequently became nationally recognized professional basketball players.  Smithson popularized (and perhaps even invented) the term “MTXE”–“mental toughness, extra effort.”  I live by this phrase every day.

 

So I have to say I was very pleased with WSU’s win over the Bulldogs last night.  As a Kansas native now living in Washington state, I empathize with both teams and their fans.  Nobody with ties to either school slept very well last night.

Here’s the Wichita State Shocker in bed.  You just watched your team pull down the heretofore #1 ranked college basketball team in the country.  Only now that you’re in bed are you processing what this huge upset means for you and your fellow Wu-Shocks.  It’s pure rapture.  You’re in the Sweet Sixteen in a year of absolute mayhem in men’s college basketball.  There’s no clear, inarguable favorite to take the title like there was last year.  It’s anybody’s tournament; any team can win it all.  This year it might, just might, be the Shockers!  Your head is buzzing from all this emotion and mental racket.  You imagine the improbable run to the championship game, a buzzer-beating final shot that clinches the title, the ticker-tape parade down Douglas Street.  How are you gonna sleep with all that adrenalin running through your brain?

Here’s the Gonzaga Bulldog in bed.  You’ve become tired of the pundits and analysts saying that Gonzaga became #1 by default.  You’ve just heard Dick Vitale on ESPN predicting loudly that “the Shockers are gonna shock the nation.”  Sure, your school is in the West Coast Conference, but you’ve had some wins against quality non-conference teams this season, and going into the Big Dance you know the Bulldogs now have the chance to prove the nay-sayers wrong.  And then . . . crushing, unmitigated defeat–in the third round.  It’s like someone ran over your dog and then sped off.  You feel helpless and in despair, left with the bitter reality of the loss.  You go to bed truly in mourning, knowing the mourning will only continue upon awakening the next day.  How can you hope to sleep tonight, knowing that any temporary rest will bring only minimal reprieve and solace?

Man, I’ve gone to bed both ways every late March and early April for years.  I know exactly how it feels.  And the fact is that all of us have, basketball fan or not, for one reason or another, throughout our lives.  Why?  Because we’re human.  We have emotions, hopes, dreams.  We put ourselves at risk emotionally by daring to hope in the face of adversity or unfavorable statistics.  When the risk pays off, the elation is something you will savor for the rest of your life.  But when you lose, well, that’s also something you remember forever.

It is part of the human condition for these emotional peaks and troughs to affect your sleep.  As such, everybody is susceptible to at least some occasional transient insomnia.  Usually the insomnia burns off as its trigger fades into the background of your life.  However, in some cases the sleeping problem can persist as dysregulation of bedtime schedules and mounting frustration over the insomnia set in and worsen.  It’s at this point that people start to schedule appointments to see guys like me.

Bottom line here:  anything you think about that is of emotional importance–whether good or bad–can cause at least transient insomnia.  Just ask Shocker and Bulldog fans.

I’m hoping that I won’t be going to bed tonight like the Zags did last night.  KU is playing Roy Williams and his Tarheels.  MTXE, baby, and Rock Chalk Jayhawk!