5 Things That May Surpise You About Sleepwalking

It's 2:30 a.m., and Adam thinks his baby is suffocating. He's frantically searching through the bedsheets, scanning the room, and plunging his hands into his pillow. The baby is only a few months old, unable to fend for itself. Adam is sure that he can save his infant son if he can find him in time. 

For Adam's wife, this scenario has become tedious and ordinary. The baby is fine; he's sleeping in his crib a few feet away. But Adam can't be dissuaded. He can't be soothed. He's still tearing sheets off the bed, eyes wide with terror. His wife tries to reason with him. He hears her, but her words don;t make any sense to him. He looks through her.

Adam is sleepwalking.

This doesn't fit the popular conception of sleepwalking. In pop culture, sleepwalking usually involves a person with his arms outstretched, more or less bumbling aimlessly. The reality looks a lot more like someone who has lost his mind completely, if only temporarily.

I had the opportunity to talk with both a sleepwalking victim and a celebrated sleep pathologist for the podcast I launched recently. From a health and well-being perspective, few things could be as distressing to a family as an emergent sleepwalking problem. This is partly due to the fact that sleepwalking is a complex and poorly understood phenomenon. Let's break it down.

Sleepwalking doesn't just involve walking.

Sleepwalkers are poised between sleep and wakefulness. During an episode, the brains of sleepwalkers evidence high-amplitude delta waves—a phenomenon otherwise only seen in the sleeping and the psychotic. Since sleepwalkers are partially awake, in a cognitive sense, there is little limit to the tasks they can perform and the delusions they can pursue.

Sleepwalkers can run around the house, drive a car, cook, and play musical instruments. Most of these tasks, however, manifest as surreal counterparts to their everyday equivalents. A person may cook, but the meal may consist of peanut butter, honey, pasta, and tomato sauce, unstirred and burned in a pot.  

Sleepwalkers are interactive, and not clearly sleeping.

A sleepwalker can be talked to, and even respond, but will usually do so illogically. They will usually have their eyes open and be mobile, and appear awake to the uninitiated. They will usually have no memory of the episode.

Sleepwalkers are highly agitated.

Sleepwalking is a particular type of parasomnia. Night terrors are also parasomnias, and the relationship between the two is evident in the agitation of the sleepwalker. Sleepwalkers are sometimes in full physiological fight or flight mode. Like Adam, they are often convinced something terrible is imminent and it is their duty to prevent it. Spikes in heart rate, adrenaline, and cortisol mean that the sleepwalker is in Hulk mode, and accordingly difficult to control and reason with.

They can be talked off the ledge, so to speak, but dismissing their concerns—however irrational—usually serves to exacerbate their agitation. Talking them through the episode, forcing them to participate in the logic (or illogic) of their concern is best.

 Sleepwalkers are not themselves.

Adam is not generally a paranoid and fearful person, but his sleepwalking episodes transform him. That's standard for sleepwalking. There have been cases of homicide during sleepwalking incidents. While this is obviously extremely rare, it is disquieting. It's important to remember that the sleepwalker is not themselves, and may share little with their waking personality. Supervision and vigilance are essential support mechanisms for those suffering from parasomnias.  

The cause of sleepwalking. 

I bet you can see this coming: no one knows the precise cause of sleepwalking. There seems to be an underlying genetic component, but the behavior needs to be teased out by environmental factors as well. Stress and lack of sleep are the main risk factors for awaking the sleepwalker in a predisposed individual. In Adam's case, stress and sleep deprivation were in full force after the birth of his first child. This is the perfect storm to bring forth the sleepwalker in him. 

What can you do?

Try and get enough sleep, of course. That and "drink plenty of water" will never steer you wrong. Of course, staying relaxed, especially before bed, is crucial to getting good rest and preventing sleepwalking. 

Shameless plug:

If you'd like to hear Adam and his wife's own description of their ordeal, as well as an interview with a sleep doctor, this is the podcast link:

http://tinyurl.com/againsttype

The Internet—the Worst Doctor in the World

Nate A___, a perpetually ruddy-faced guy with a "rat tail" and a propensity for amazing hole shots (rubber-burning peel-outs with his truck, performed primarily in the high school parking lot), once remarked that your dear author was "smart, but he don't have no common sense. I bet he don't even know how to change a carburetor."  Nate A___ was pretty astute, in his way.

I'm smart. I think most people I know think I'm really smart. A few people think I'm "too smart for my own good," and most certainly think I'm a smart aleck. The people going the right way down the one way streets I've gone down the wrong way probably don't have a very multidimensional view of my intelligence. I'm not in a position to comment on any of this, but I'd like to offer an object lesson on how whatever agreed-upon intelligence I may have recently failed me. The failure is part of a cautionary tale.

I'd like to talk about WebMD and other "search-by-symptom" websites, and I'd like to begin by deploying a timeline.

1996: What we know as "WebMD" deploys as Healthscape. 
1997-Present:  People the world over, on the order of 86.4 million visitors per quarter, search the website for their symptoms, make slapdash diagnoses, become convinced they have terrible terminal illnesses, and freak out. 

The above dynamic has passed from "emerging" to "standard practice." The News warns you against this paranoia. My doctor friends tell me it's beyond common--we live in a world where every generation is Internet-savvy now, and the default move in any situation, from installing a garbage disposal to diagnosing that pain in your abdomen, is to consult the WWW.

But, see, I already know this. I should have been immune. Instead, I played directly into the hands of fear and quick-draw diagnosis, because the vortex of WebMD paranoia is so great that it can pull in even one of my titanic intelligence.

Long and harrowing saga short, I thought I had a life-ruining, ultra-debilitating condition. I can bail out Past Me a bit and say that 100% of the symptoms matched, that the people on the forums (oh, the forums) corroborated my diagnosis. But ultimately, I was wrong. The wrongness in this case was important, because the thing I thought I had (that I didn't have) was indeed so terrible that it made me anxious beyond description, and my life became a waking nightmare. When it comes to health and well-being, avoiding "waking nightmares" is a priority.

The problem with WebMD (and other sites like it) is twofold, as I see it:

First, the symptoms you're looking up are often false positives for other, worse maladies. Without a (brief, expensive, impersonal) visit to a doctor, you can't be sure that the tingling means anything at all. At the same time, relying on websites for diagnosis means you could be missing serious conditions which are asymptomatic.

Second, WebMD mainly subsists on advertising dollars, like most of the Internet. Who primarily advertises on WebMD? Pharmaceutical companies, of course. So there are ads on all sides, trawling for someone with "shortness of breath," "unexplained fatigue," and "frequent heartburn." Since the people visiting these sites are already looking for something to explain and/or fix their symptoms, these ads can be especially inviting. Not only that, but the ads often contain such ambiguous and common symptoms that most people could make a case for having them.

I already knew all this, but I was sucked into the vortex anyway. I found people describing symptoms similar to mine, and the fear took over. As soon as I talked to a real health professional, they made a different diagnosis, and my anxiety creeped back into the orange zone, where it usually resides.

This isn't very novel advice, but it's sound: if you have a physical problem, consult a doctor. The more Internet-literate you are, the worse the chance you'll descend through a portal of misinformation.

You don't have to take it from me.  Here's an article on "cyberchondria" published on...WebMD. 

Or, if you're avoiding that website altogether, here's a New York Times article on the phenomenon, instead. 

Who is Thinking Your Thoughts?

This is the second entry in an admittedly idiosyncratic miniseries about the intersection of health, anxiety, and the mind. Here's the first.

To paraphrase one of my favorite neuroscientists, our thoughts chase us out of bed. They are our constant companions through the day. It can feel like our thoughts are bludgeoning us to sleep. When you stop and think about it, which you are cognitively obligated to do as you read this sentence, you probably feel more like an audience than an actor inside your own mind, more or less forced to watch helplessly as your mind's eye throws an array of images on the inside of your skull. When you consider the thoughts you have in a typical five minutes, an overwhelming percentage are probably not things you feel like you're actively "thinking," so much as commercials for various plans and anxieties. (Here's an article from PsychCentral about this.)

It's somehow trite and profound to stop and realize that you are the only one inside your head, and the seemingly random broadcast of mental events you experience in a day is, well, you, and not the equivalent of pharmaceutical commercials you sit through until the real program returns.

Is this important? If you care about your health and well-being, it is important. That's because, much like ads on TV, your mental adverts have an agenda. They are trying to hook you with a clever tactic—usually some form of fear—and make you do their bidding. The intentions of your thoughts can be pure—anxiety about an unlocked door, for instance, can come from a natural impulse to protect your family and possessions. But there is a threshold where this sort of anxiety ceases to be productive, and indeed can begin to subtly warp your relationship with consciousness in an unhealthy way. This can have a direct impact on your health. 

Learned helplessness a psychological phenomenon that goes a little something like this:

In Scenario Number 1, I give you electric shocks until you pull a lever in your immediate vicinity. When you pull the lever, I stop. You walk away from this experience less-than-happy with me. Next time we play "this game," you pull the lever immediately, and I stop immediately, and all is well. (Sort of.) Your feathers are ruffled, but you're prepared for the next time we play, because you've figured out the system.

In Scenario Number 2, I shock you, and you pull the lever, and I keep shocking you. You are unhappy, and hate me, but that's beside the point. The next time we play the game, I've arranged for the lever to end the shocking, but you assume that the lever will perform identically to your previous experience —that it won't do anything. So you don't pull it, even though it would stop the shocking.

Sorry I had to walk you through that. I thought it would less disturbing than explaining the original 1960s experiment, which involved shocking a lot of dogs.

Consider this study, published in 2012 in Chest Journal, the official publication of the American College of Chest Physicians. (Don't act like you don't read every issue.) The study found that the friends and family of people admitted to intensive care units demonstrated significant learned helplessness, and this consequently affected their decision-making ability in regard to their loved ones' health. An overwhelming feeling of futility often breeds decisions that will birth more futility. This is common in the face of severe medical trauma. It's also common outside the medical sphere, as anyone who has hibernated in front of Netflix for 3 days with a cache of dark chocolate can tell you.

Conclusion: if you falsely determine that something is true about your health or well-being, your brain's predilection for pattern recognition will likely carry it too far. This is one way the brain magnifies feelings of doubt and failure until they metastasize into Depression and Anxiety and Frustration. (Luckily, the opposite is also probably true.)

To combat making unhealthy choices, in any context, it's important to realize something that sounds dimwitted at first blush:

YOU ARE THE ONE THINKING YOUR THOUGHTS.

This is a crucial realization if you are to become the master of your mental environment, and your health, and your well-being. This, though, is only one half of the equation, and the other half sounds almost like a contradiction, but it isn't:

Figure 4: a human brain (male).

IT IS NOT THE DEFAULT SETTING FOR HUMAN BEINGS TO HAVE MUCH CONTROL OVER THEIR THOUGHTS.

(I'm sorry. If you're an avid reader, you'll know I do not rely on capital letters for extra gusto. This questionable choice bespeaks my conviction in these ideas.) If you're interested in an extensive and fascinating object lesson on the distance between who we are and what we think, I highly recommend this episode of the NPR program Invisibilia, entitled The Secret History of Thoughts. 

The word "thoughts" implies a lot of personal agency, but I think thoughts are better conceptualized as "mental events." When you realize that you are thinking your thoughts, but they're not, by default, going to generally be thoughts that are in the interest of your self-esteem/health/well-being, you have the blueprint for a new personal directive: take control of your thoughts, before they take control of you.

Like hula hooping, it seems easy, and it's not. But simply being aware of your mental passenger status is the first step to becoming the pilot.

Researching this sort of thing will send you directly into the arms of sages of very disparate quality, obviously. But if you can stomach the cheesiness inherent in fostering a positive mindset, there are some great specific suggestions tucked into these articles:

http://www.lifehack.org/articles/lifestyle/how-to-master-your-mind-part-one-whos-running-your-thoughts.html

http://mountainmovingmindset.com/blog/?p=1173

Is Venting Good For You?

How bad was the traffic, Gilbert?

Let me vent for a second. By "a second," I mean as long as I like. But then, you knew that, because I'm Venting. If you've been Vented at, you know that time is not a prime consideration of the Venter.

The title, "Is Venting Good For You?" promises another piece of pop quasi-science. Since frustration (and the need to communicate it) is universal, the title attempts to wrangle the human condition for its own ends. The title is also posed as a question, which implies that 1) the author has not reached a conclusion, or 2) the author has reached a conclusion and is holding out on you in an attempt at suspense, and/or 3) the author hopes to convey his even-handed approach to a legitimate investigation.

In my view, this sort of title is ubiquitous because, 4) it has proven to generate traffic, despite the fact that it is artless, and deftly avoids doing what titles have done historically: indicate the thesis or thrust of the article, because the author is compiling a sloppy hodgepodge of extant information on a well-worn topic and dressing it up as an earnest inquiry.

Phew. Do I feel better? Not really. I have vented, and the conventional wisdom says I should be relaxing about now. But upon rereading what I've just typed, my rhetoric inspires in me the same feelings of discontent that prompted the words in the first place. My cortisol levels remain dangerous, I can tell. Where there should be dopamine, there is only a dusty twister. 

This interaction is missing something crucial: you, or someone like you. (Obviously, you're irreplaceable. I'd rather have you, but I'd make do with anyone.) A good venting session is incomplete without some sort of validation. This seems to spread a finite amount of angst across a psychic space twice the size; any engineer will explain that the pressure on the venter will accordingly decrease. (Meanwhile, it increases on the ventee, as any ventee will tell you.) If you were listening, and said something like, "Yeah, I hate vacuous click-bait articles with silly titles too," then I might feel better. Right? I'd feel less alone, because what felt like an irritation borne of the friction between me and the world would become something shared, and the resulting solidarity would diminish said friction to an acceptable level.

But what if venting was not a release at all, but rather a reinforcement of our own rage? What if the seemingly-healthy act of simply complaining about other drivers and our boyfriends and Congress and people who smoke too close to the building is fortifying a rampart of gloom deep inside us somewhere? I have tried certain gripes on for size, found I liked the fit, and purchased them. They become mine, and eventually graduate to the status of Pet Peeve, even though I avoid the phrase "pet peeve" because it's gleefully precious and self-indulgent. In fact, I'm forcing myself to use it, because the phrase itself is a Pet Peeve of mine, and Pet Peeves themselves are exercises in self-indulgence.

Sometimes a simple scalp massage will do the trick.

What's wrong with self-indulgence, ergo, what is wrong with venting? It's not my job to tell you that, or even arguably to be talking about this at all. But after years of selling extracts and tonics to calm people down, help them sleep, manage stress, and all the rest, I thought it would be novel to try examining the roots rather than pruning the branches.

So, like I was saying, what's wrong with self-indulgence? Well, if you're going to indulge, it should be fun, at least. Venting is less like candy, and more like anesthetic. When the numbness disappears, the pain will still be there.

So please, do try kava kava. Do enjoy the benefits of Omega 3s, and restful sleep, and the proper quotient of Vitamin B12. But consider, for instance, what this article from Psychology Today tells us: venting feels good while it's happening, but has very little lasting benefit, and generally negative psychological consequences. If you like, here's another interesting article with a similar take. I'm feeling generous, so here's another, from livescience.com. Perhaps you'd like to peruse this lifehacker.com article, which espouses the same idea. 

This temple is like, way too loud, and I'm going to snap.

Obviously, not all venting is the same. Stoicism has its place, but people need to share their feelings.* But there's a Pettiness Threshold™ that an event should cross before we decide to begin chattering to ourselves and our fellow humans about it. Not because venting is "wrong," but because we'll actually feel better in the long run by showing some restraint and pursuing reflection, and feeling better is what this blog is all about.

Frustration and anxiety are natural symptoms of living, but they can have a big impact on both health and well-being. I'll be examining the issue of frustration and its effect on health further in the coming entries. If you like what you read, tell a friend. If you don't, keep it to yourself—for the sake of your health.

Before we see each other again, I challenge you to listen to this the next time you find yourself in a tizzy. I promise I'll do the same.



*I guess.