In clinic this week at my New Mexico sleep center, one of my sleep techs and I were discussing follow-up with a patient doing well with ABPAP therapy. He had lowered his pressures in the past year as he struggled with Aerophagia, but since starting Gabapentin for his leg jerks, he experienced far fewer episodes of air swallowing. He was very pleased with the results, and one of the main reasons for the visit was to raise his pressure settings back to higher levels. His data download confirmed some residual breathing events, mostly flow limitations and some hypopneas, and he was eager to raise pressures as well as to continue his gradual increases in the dosage of Gabapentin.
In the last portion of the appointment, insomnia symptoms were discussed. He described the classic finding of racing thoughts or “I can’t turn off my mind.” When I hear these complaints, I often query the patient on the content driving the mental wheels to keep turning. As you would imagine something deeply personal and conflictual generates the most intense emotional distress and therefore results in the greatest difficulties in setting the mind at ease. In these situations, we often see quite clearly a patient in need of psychotherapy, counseling, or perhaps a 12-step program to work directly on a daily basis on the interpersonal nature of the problems.
Occasionally, someone will mention that political news keeps him or her up at night, and the fellow we spoke to last week was one such case. No doubt, politics is a very passionate area of human behavior and conversation, which generates strong emotional reactions. Never have these points been so true than in the current political climate fueled by instantaneous media interactions, be it through internet browsing or social media entanglements. It is not necessarily that everyone has such strong views on politics in the USA, especially since data reveals as many as half of eligible voters never vote. However, it appears the expressiveness of many of those who do vote is becoming the modern rage.
In this case, unfortunately, I’m not using the word “rage” in its antiquated meaning of fad or custom. I’m referring to its baser meaning where so many people are willing to vent their hostilities when things are not going well for their preferred political agenda. Nowadays, you can tap into this rage whether you lean toward the left or right, or even if you fall along other political spectrum's such as greens or anarchists. And, because so much can be written pro or con about any and all these political belief systems, once you go down a path to follow politics closely, your emotions are almost certain to be aroused and bound up in the drama.
When discussing this problem with our insomnia patient, one of the funniest aspects was his immediate recognition of the cause after which he commented, “My mother told me to stop watching the news before bedtime, but I wouldn’t listen.” Turns out his mother had developed the same insomnia problem and promptly solved it by no longer watching any newscasts or reading any news before bedtime.
Now, this individual was not identifying himself as an activist, which of course is a very different animal. Someone who perceives himself or herself as deeply involved in politics has good reason to live and breathe all the political information he or she can consume. The intention to use the information for action coupled with whatever emotions and reasons driving the individual toward activism would further fuel a desire to consume as much knowledge as possible. The knowledge might be about one point of view (gun control) or the opposing point of view (2nd amendment rights) with the expectation of applying this information in activist duties. We’ll return to activism in a moment.
Our patient was not an activist. He was simply caught up in the modern entanglements of browsing the web or watching too much news. He didn’t even want to discuss his political views with us, but he did recognize the behavior was gnawing at him and grinding his mental wheels to such an extent before bedtime, he could no longer fall asleep at his usual time of 11 PM. It often required two more hours to wind down again, which led to a falling asleep at 1 AM. And, he was actually losing sleep, because he still needed to wake up for work no later than 7 AM.
Our intervention was simple, because the patient not only already knew the correct solution, but also his own mother had informed him of the “treatment” several months earlier after she had made herself sick watching the news every night. She had simply stopped her focus on news after dinnertime, and therefore she stopped watching the news while lying in bed preparing for sleep. Our patient declared he was going to stop watching the news at bedtime and fully expected a relative cure of the problem. We concurred with the plan and anticipate it would succeed, albeit we reminded him that a more powerful approach is to also monitor distressing emotional experiences throughout the day so that immediate attention and coping skills can be implemented. In this way, insomniacs lessen the generation of racing thoughts at night, which are dead giveaways of “unfinished business” from earlier in the day. In contrast to the intensity and effort required to actively work through emotions throughout the day, it is nevertheless rather intriguing so many people can and have cured insomnia simply by ceasing to watch the nightly news.
Returning to activism, we are dealing with an entirely different animal where you may find many people with very decent, noble and sincere intentions, but you will also find many individuals with very serious mental health symptoms that they have learned to channel into political activism. In fact, I would venture to say, you will find an equivalent amount of mental health symptoms in the upper echelons of political candidates, leaders, strategists, consultants, and ultimately government officials.
Although I am not aware of any research that proves there is more mental health difficulties in those deeply involved in politics, it certainly seems like there is greater visibility of such symptoms. For example, regardless of which side of the political spectrum you reside on, in terms of perception most people on one side of the aisle tend to see the “other side” as filled with individuals ready, willing and able to constantly make promises that are never kept or worse, perceive the opposition is simply lying. We used to notice these traits mostly during election cycles, but now they seem almost omnipresent day in day out.
The reason this activism is such an important factor influencing insomnia is that these rounds of promises and lies make up a large proportion of what is covered in the news, and here again we have news organizations with their own slants, left and right, that seem to magnify the various lies and promises to such extremes, is it any wonder that audience passions are deeply aroused?
Thus politically-induced insomnia is probably at an all-time high and likely to stay high for years to come given how much news can be consumed on an almost minute by minute basis. When I was growing up, the news was a morning paper, evening national newscast and the local night time newscast unless you chose to read a weekly news magazine. Just think about how dramatically different news consumption was then compared with today’s news smorgasbord. It is easy to imagine politically aroused insomnia is affecting millions of individuals, unless or until they commit to ending their attachments to the screen.
Barry Krakow MD
Dr Krakow’s 27 years of sleep research have focused on the complex relationship between
physiological and psychological sleep disorders. Dr Krakow currently operates private sleep medical
center, Maimonides Sleep Arts & Sciences, Ltd., and serves as Classic SleepCare’s paid Medical Director.
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