Recently, one of my clients shouted in French, “Pas si fort” after her neighbor repeatedly slammed his front door during our massage session. The sound was magnified by the thinness of her walls and affected her ability to fully relax. Translated to English it means “Not so strong.” The reality of living in a building with multiple apartments is the constant noise. While the sound levels vary, most people consider it a form of white noise. I am not one of those people. I don’t want to hear the next door neighbor screaming Farsi curses and the people upstairs throwing up in their bathroom at 1 a.m. every night like clockwork. It’s an odd thing to know the intimate details of people’s patterns and routines without ever having a conversation with them. I feel voyeuristic; almost stalker-like. But these observations are hardly forgettable. I can’t help but listen.
I am one of a percentage of the population who has a heightened sensitivity to sound, also known as hyperacusis. It is characterized by a collapsed tolerance to environmental sounds of a certain volume that can happen gradually over time or suddenly when in crisis. Mine began about 2 years ago after being terrorized by constant partying and threats in my own home from the son of my then landlord. I barely slept and my nervous system was on high alert at all times. Consequently, the sound of sirens, loud music, screaming and beeping became almost intolerable when previously I had never been bothered by such things. Gone are the days of restful sleep through anything. I hear EVERYTHING now.
Beyond a crisis, hyperacusis can be caused by hearing loss, where the tiny hairs in the inner ear have been damaged and become sensitive to certain frequencies played at louder levels. This is known as recruitment. Also, hypersensitivity to certain frequencies at louder levels can occur in conditions like Autism, which exist from birth. Phonophobia and misophonia can occur with hyperacusis. The former is a fear of the sound that one is intolerant to in the environment it is occurring in both real time and when anticipating its next occurrence. The latter has been associated with an adverse response to soft sounds like that of eating, chewing and lip movements. Interestingly, misophonia has been listed with specific diagnostic criteria in the diagnostic “bible” of psychological clinicians known as the DSM-5, but it’s not considered a discrete psychological disorder. Its origins are thought to be more neurological and need to be studied further. And speaking of the brain…
From an evolutionary standpoint, being able to pick up on sounds that others ignore lets me respond to potential danger much sooner and thus, will ensure my survival. DNA testing exists now that has isolated the gene that makes one more likely to have heightened sensitivity to sound. So it’s both environmental and biological – go epigenetics!! Nevertheless, those of us with sound sensitivity have to find a way to deal with the loud world that surrounds us. Aside from moving out of my apartment building and city limits, there are some therapeutic options. The main one is a combination of cognitive therapy and desensitization through retraining. Its goal is to get you to think about the sound with less of an emotional response and expose your ear to intolerable sounds in order to neutralize them. This weakens the neuronal activity associated with the fight-or-flight response these noises often produce. Other forms of treatment are cognitive behavioral therapy (CBT) alone, psycho-therapeutic hypnotherapy and occupational therapy. CBT allows the person to gain control of that automatic emotional response produced by the sound and desensitizes them to it. Hypnotherapy, through a reputable practitioner who is often a psychologist as well or recommended by one, uses the power of suggestion to overcome the emotions (usually the fear/rage response) to the sound. Lastly, occupational therapists deal with the sensitivity as a sensory processing disorder; therefore, they introduce each offensive sound at varying degrees of intensity along with other sounds in order to help the brain accommodate and then dismiss them. Guess I won’t have to move after all 🙂
There is nothing worse than going to a doctor with a host of symptoms and being told there is nothing wrong with you. Many people who appear on the program, Mystery Diagnosis, (my second Discovery Health obsession next to the The Food MD) have had this experience. I recall one particularly disturbing episode, where a young woman complaining of extreme gastrointestinal distress was prescribed an anti-depressant by one of the many doctors she sought answers from. Confused, she asked how these would help her to which the doctor responded that her condition was basically all in her head. When a physical illness or condition is caused by or aggravated by a mental factor it is termed psychosomatic. Essentially, that is how this young woman’s doctor viewed her illness. Many years later, she was properly diagnosed with severe endometriosis, a condition where the cells of the uterus grow in other places of the body causing cramping, severe bleeding and infertility to name a few. In her case, the cells had grown into and over parts of her GI tract. She had a full hysterectomy and a section of her large intestine removed in order to reclaim some quality of life. Take that, anti-depressants!
As you can glean from the above story, defining an illness as psychosomaticcarries with it an intense social stigma here in the west, even though almost all physical illnesses have mental factors that determine their onset, presentation, maintenance, susceptibility to treatment and resolution. When doctors dismiss symptoms like in the case of this young woman, the rest of the world follows suit. The person who is suffering internally and externally is labeled “dramatic” or even worse, a liar. For thousands of years, Chinese medicine viewed the psychosomatic as the greatest key to diagnosing deeper illness and imbalance in the body. The strength of the nervous system and physical state of the individual (including their environment) is assessed in order to understand the degree in which an organ or a system is affected. Every symptom is taken into account and treated seriously, with the objective being to restore balance. Moreover, the eastern approach considers how interconnected the body and mind are.
The biggest physical bully is emotional stress, which can infiltrate suddenly or slowly, over a long period of time. Even from a western perspective, stress can be incredibly destructive, wreaking havoc on connective tissues, digestion, vascular integrity and the body’s restorative sleep cycles if not managed properly i.e. not just a script for anti-depressants. In Chinese medicine, if the nervous system of the individual is weak, the symptoms of illness will be more psychological. On a physical level, the organ most affected by the emotional stress will be the weakest/dysfunctional one. Whatever the natural emotions associated with this organ are, they will become stronger and more destructive to the nervous system overall. As the organ breaks down, it takes the system it is associated with along for the ride, leading ultimately to disease. If the emotional stress comes on suddenly, it will affect the Heart and the Lungs. If it is gradual and long term, it will take a toll on the Liver, Spleen and Kidneys. Even more specific is the type of emotional stress broken down into these 5 categories: tense/chronic, shock/sudden, sadness, rumination and fearful emotion. This gives an even more precise view of the affected organs/systems in the body, further honing the treatment approach.
Our young woman with endometriosis would have been assessed as having a strong nervous system in the beginning, as her symptoms were predominantly physical. By the time she had gone to see the doctor who prescribed the anti-depressants, she was exhibiting a combination of physical and mental symptoms. This would signify that her nervous system was deteriorating. If she had also gone to see an eastern doctor from the get go, much of her later suffering might have been alleviated, as the weakest organ, her large intestine would have been addressed immediately with herbs and acupuncture/bodywork. Since organs are partnered in the Chinese system of yin/yang (solid/hollow), the untreated large intestinal dysfunction would have affected her lungs. This woman developed an eczema like rash all over her trunk and extremities that would get worse every time she had a violent bout of diarrhea. The skin is considered the 3rd lung of the body in Chinese medicine. This symptom developed 5 years after her initial bout of gastrointestinal distress. After ten years, she began to bleed copiously during her period, which lasted over two weeks. Initial blood tests had already indicated she was mildly anemic, but this massive blood loss rendered her immobile. Ironically, during this time, her large intestine dysfunction seemed to dissipate; however, as soon as the period would end, the violent diarrhea would return. At this point in her illness, the Spleen had become involved. Responsible for creating Blood/Qi and keeping things upright and in their proper place, it’s no wonder that when she finally got her diagnosis 15 years in the making, this was the most affected organ. (Note: One could even argue that the Spleen could have been the weakest organ overall, but I won’t complicate things for the reader) The cells of the uterus growing out of control outside of their proper place is demonstrative of Spleen weakness. The uncontrollable bleeding led to a massive loss of Qi that just couldn’t be replaced by her depleted system. The only solution, at that point, was to remove the uterus and large intestine to prevent the out of control cell growth from migrating elsewhere. While organ removal can have detrimental affects on the Spleen, it proved more harmful to keep the stagnation in there than to remove it. If I were this young woman, I would seek out an acupuncturist to help me keep my nervous system strong and balance the loss of the organs that were surgically removed. They would be able to recommend herbs and dietary changes to support her treatment. After watching this episode, it made me all the more fired up about Integrating Eastern and Western medicine. If East met West from the beginning, she and others like her would have been spared a lifetime of suffering. We would all have a better understanding of our body-mind relationship and keep the stigmatic tongue wagging at bay.
Many health and nutritional experts say that breakfast is the most important meal of the day, but I beg to differ. Let me draw your attention to the period of time that precedes that meal. A time that should be spent in a state of deep restfulness. Doing without this form of nutrition will set your body up for certain demise. Sleep is the meal that should never be skipped.
Our appetite for sleep is programmed into a part of the brain known as the hypothalamus, which is the regulating center for the various biological drives that keep our bodies functioning. When we are infants, the part responsible for sleep and wakefulness is out of control. Think of how many babies sleep all day and are up all night or those that have short bouts of sleep spread out over an entire day. The reason for this insane sleep schedule is the immaturity of the internal clock that sets daily functions to the rhythm of 24 hours. Human beings have it, as do plants, animals, fungi and certain bacteria. Dubbed our Circadian Rhythm, sleep and wakefulness is dependent on exposure to light and dark. The first few months of life are pivotal in establishing this internal rhythm, but some babies take as long as a year to sleep a solid 8 hour night. Once the rhythm is established, your body will function on a 24 hour cycle. When in the presence of darkness, our brain’s pineal gland, which is light sensitive, produces a hormone melatonin that helps to make us sleepy. Desire for sleep is strongest during the darkest hours between midnight and 6 a.m. and to a lesser extent in the mid-afternoon. In American culture, this is the 2-4 p.m. slump when most people grab themselves a coffee and/or some kind of energy boosting snack. In Europe and Latin America, this would be your afternoon nap-time otherwise called the “siesta.”
Sleep itself is a highly involved process consisting of 4 stages that each have a physiological affect on the body and brain. The first three stages are part of what is called Non-REM or quiet sleep, a state where thinking and most physiological activities slow down, but movement can still occur, and a person often shifts position while sinking into deeper stages of sleep. Unless something disturbs the process, people will pass through these 3 stages of sleep smoothly. The fourth stage of sleep is called REM or dreaming sleep, a state where the brain is very active, but the body is paralyzed. Normal sleep cycles alternate between quiet and dreaming, with most deep sleep occurring in the first half of the night. During the second half of the night, dreaming sleep gets much longer and alternates with the second stage of quiet sleep. More on these stages now…
During the first stage of sleep, dubbed drowsiness, your brain no longer receives visual stimuli from your shut eyes, body temperature begins to drop, muscles relax, and eyes often move slowly from side to side. Although you may start to lose awareness of your surroundings, you can very easily be awakened. In the second stage of sleep, known as light sleep eyes remain still and breathing and heart rate are much slower. The brain starts to show irregular electrical patterns of slow waves and short bursts of activity. The brain can also respond to outside stimuli, like someone whispering your name, which scientists believe could be a built in vigilance system to ready you for awakening if necessary. Half of a good night’s sleep is spent in this stage. Once you enter the third stage of sleep, known as deep sleep, your body undergoes some important cellular changes. Blood flow to the brain decreases and it stops responding to outside stimuli, making it difficult to wake up the sleeper. Breathing becomes regular, blood pressure falls and the heart slows to 30% of its waking rate. The pituitary gland releases growth hormone at the beginning of this stage which stimulates tissue growth and muscle repair. Proteins in the blood that activate your immune system also increase, helping build the body’s defenses against illness and infection. Interesting side note here: People in young adulthood have many stretches of deep sleep, while those over 65 have none.
Enter now the fourth stage of sleep or dreaming sleepwhere the eyes dart back and forth rapidly behind your closed lids ( this is where the acronym REM comes from standing for “rapid eye movement”) and the brain races with thoughts and “dreams. Your body temperature and blood pressure rise, and your heart rate and breathing speed up to daytime levels. What is interesting is that the sympathetic nervous system, our fight-or-flight response, is twice as active as when we are awake. Despite all this activity, the body hardly moves, except for intermittent twitches. The rest of the muscles not needed for breathing or eye movement are essentially paralyzed. A normal night’s slumber consists of 3 to 5 approximately 90 minute periods of REM, but as we age they get shorter. Many scientists feel this is the time when the mind restores itself, which is important for cognition and memory. Early research into the role of REM sleep in-utero indicated that the rapid firing of nerve cells during this period was important for the growth and development of nerves. Subsequent studies on adult humans found that REM sleep deprivation led to poor performance on a variety of recall tests or logical tasks. In addition, memory loss occurred when sleep was deprived on the same night or two nights after the material had been learned and especially when subjects had been selectively deprived of one of the first two or last two REM episodes of the night. In other studies, REM cycles were found to increase after complex material had been studied, indicating that the brain uses this time to sort and process information into its memory banks. Other scientists suggest that REM sleep functions to dispose of unwanted memories through a mechanism called reverse learning. Reverse learning operates during this period of sleep to prevent the brain from being overloaded with massive amounts of information stored during wakefulness. A fine explanation for the insane dreams one may have, but testing this is pretty difficult, so it’s just a theory.
If your sleep is going to be interrupted, you do not want it to be during your stage 3 and stage 4 cycles. Overtime, deprivation of these levels of restorative sleep will take a toll on your outward appearance and your internal health, mentally and physically. Dermatologists have noted that collagen production increases during sleep, strengthening the bond between your exterior and deeper skin layers and allowing for the water retention necessary for suppleness. Also, growth hormone gets released in deep sleep, as mentioned earlier, which builds and repairs tissue. Without it, water evaporates from the skin leading to a dry, sallow complexion and the appearance of fine lines. Keep it up and skin could react with rashes and eczema. Lack of deep sleep increases the amount of inflammatory proteins in the blood and decreases immune system response. The more deprived you are, the more likely it will be that your body will react to pathogens and itself. The increased inflammatory proteins can lead to such conditions as heart disease and overall, research has indicated that people who get less than 6 hours of rest a night tend to have a higher mortality rate than those getting the recommended 7-8 hours. If you are a person who weight trains or exercises a lot, the lack of deep sleep does not allow for muscles to repair themselves and grow properly. This negates the affects of the workout and leaves them prone to injury. Outside memory loss, deprivation of REM sleep can lead to a diminished awareness of one’s surroundings, a severely reduced response time and an inability to perform tasks that are highly involved, such as driving or operating machinery. Far beyond drinking and drug use, lack of sleep is responsible for most of the accidents that occur on America’s roadways.
If you are having trouble getting to sleep at night, some of the obvious culprits could be stress, use of electronic equipment before bed, drinking too much caffeine and eating a big meal or going to bed hungry. Those have easy solutions, relatively speaking. You can get a massage, meditate or do some yoga to relax your body and bring your mind down from its stressful state. Have your coffee earlier in the day and cut down on the amount. No eating of large meals or snacks within 2 hours of going to bed, so you have ample time to digest. Shut the computer and the television and get them away from the area dedicated for sleepy time. Plunge yourself into darkness (remember that melatonin) and relative warmth, and sleep should come to you. However, there are some not so obvious culprits for disturbance of sleep. Check these out:
Taking a B vitamin supplement before bed – The B’s are super important for stimulating the nervous system, so popping supplements before bed can lead to fidgeting and constant awakening because the brain is way too “ON” to enter deep sleep.
Having a few drinks in your system – While it might get you to sleep faster, alcohol impedes the natural cycling of sleep stages, plunging you into what feels like deep sleep right away, but wearing off in the second half of the night when your REM cycles start kicking in. Since you never get to REM, you wake up more often than not feeling groggy, achy and depending on how much you drank, possibly still drunk.
Taking Prescription medications – Consider that sleep disturbance is a common side affect of some high blood pressure pills, birth control pills, steroids (including asthma inhalers), diet pills, antidepressants and cough and cold medications.
Smoking – Nicotine is a stimulant like caffeine so depending on how much you smoke and for how long, sleep can be dramatically reduced.
Working out at night – Some work schedules do not allow for morning or midday exercise, so many people will go to the gym after work. Exercise raises epinephrine levels in the blood, which makes us more alert and overall body temperature. These 2 factors can prevent sleep.
Hormonal changes – Long before menopause has kicked in, many women find they wake up in the night numerous times. This is due to fluctuating levels of estrogen and progesterone. Some younger women suffer from erratic sleep patterns before or during their menstrual cycles due to imbalances of these hormones.
Sleeping in on the weekends – It’s good for the circadian rhythm to awaken and go to sleep around the same times each day, but many of us tend to stay up later and sleep in more on days off. This throws off your internal clock, making it harder to fall asleep and awaken when faced with your normal schedule. Doctors suggest to sleep no longer than an hour more than you normally would in order to maintain the cycle.
Lastly, if you are chronically deprived of sleep despite your best efforts you should really think about visiting a doctor and/or finding a sleep clinic in your area to better assess and diagnose your problem. Now, go get a heaping helping of rest please!