If you find yourself lying awake in bed for more than twenty minutes in the middle of the night, the most helpful thing may actually be to get out of bed instead of being frustrated about being awake. When you do so, you might simply use the bathroom, walk around your home to get a change of scenery, or drink a small amount of water (not so much that you might wake up again because you need to use the bathroom).
If you’re going to stay up longer, it’s best to engage in a quiet, relaxing activity that will help prepare your body for sleep. Refrain from turning on any bright lights, including the TV or computer screen. This may wake you up too much. Use a flashlight or night light if you need one.
Sleep Conditioning
If you’ve had trouble sleeping for a while, your body may need to be trained, or retrained, to sleep well again. A lot of people who have issues with sleep use their bed or sleeping area for other activities. Over time, your body learns that the place you’re supposed to sleep in isn’t really for sleeping. You may then have a very difficult time falling asleep, staying asleep, or falling back asleep once you wake up.
Seemingly minor things like following a regular bedtime routine and changing out of your pajamas after you wake up for the day may sound too simplistic to be effective. However, these are very important behaviors for training your mind and body to achieve healthy sleep. This type of behavioral training is called conditioning, and when applied to sleep, it’s called sleep conditioning.
You may have heard about the famous Russian neurologist Ivan Pavlov. About a century ago, he was able to train dogs to salivate to the sound of a bell ringing. All he did was ring a bell whenever the dogs were given meat powder. After some time, the dogs salivated at the sound of the bell, even if they didn’t receive any meat powder. Even years afterward, the same tone of the bell would elicit the same response: the dogs would start to salivate at the sound, even in the absence of food.
Conditioning in itself is neutral. You may notice conditioning in various parts of your life, for better or for worse. Certain cues may make you feel a certain way, like suddenly getting hungrier when you sit down in a restaurant. Your mind can become trained to do a variety of things based solely on where you are or what you’re seeing, hearing, or even smelling. Here are some examples of how conditioning can be involved in grief, with certain triggers bringing up memories and powerful emotions:
Hearing a song that was special to your loved one.
Seeing the hospital or location where your loved one died.
Smelling perfume similar to the one your loved one wore.
But again, conditioning is neutral, it doesn’t have to be painful, or accidental. You can also use conditioning intentionally, just as Pavlov did, harnessing it to help you sleep well once again.
practice: Improving Sleep Hygiene
This exercise will help you use the principles of conditioning to train your mind to sleep better. Just as the mind can be trained, or conditioned, to experience distressing emotions and problematic sleep, it can also be trained, or retrained, for healthier behaviors and rejuvenating sleep.
Healthy sleep habits are called sleep hygiene. Over the years, some consistent guidelines about good sleep hygiene have emerged. Read through the following list of good sleep habits and check off the ones that you already do on the left. Check off those you currently aren’t doing on the right.
As these guidelines indicate, some very simple behaviors can greatly improve the quality of your sleep. Think of your mind as a small child or puppy. Just as small children and puppies need to be trained, your body also needs to be trained to know when and where it is supposed to sleep. This may sound strange to you. After all, sleep is one of the requirements of the body. It isn’t something you should have to practice; it’s supposed to be automatic. However, from time to time, especially with significant stressors, the body and mind may be so far removed from a healthy balance with sleep that it’s necessary to retrain them to sleep well. All of the suggestions in the list above will train your body to sleep well by clearly letting it know when it’s time to wake up and when it’s time to sleep. This explains the recommendation that sleeping clothes, such as pajamas, should be used only for sleeping and not worn when you’re hanging out at home during the day. Similarly, if you have another space available, don’t use your bedroom to work in or to do anything other than sleeping.
Definitely try not to hang out in your bed during the day, and avoid watching TV at bedtime or in the middle of the night if you have sleep problems. I can safely say that most of the people I’ve seen in my clinical practice who have sleep problems watch TV in bed, sometimes out of habit, but often out of desperation to pass the time until morning. Unfortunately, watching TV in bed usually doesn’t lead to a good night’s sleep and can even train the body to associate the bed with wakefulness.
If you violate all of these rules but still sleep well and wake up refreshed, don’t worry about following the guidelines. They are more important for people who are having trouble sleeping than those who are sleeping well.
practice: Mindful Sleep Induction
If you’ve been having trouble sleeping, the sleep hygiene tips in the previous exercise can be tremendously helpful. However, for a lot of people these techniques may not be enough to help them develop steady, restorative sleep. If you follow all of the guidelines above but still can’t sleep, try the following mindful sleep induction technique. It’s sort of like counting sheep, but with a mindfulness component built in. It’s been very helpful for many of the people I’ve worked with. Read through this section in its entirety before putting this approach into practice at bedtime:
Complete your bedtime routine. Brush your teeth, use the bathroom, and change into your pajamas. Do all the sleep hygiene techniques you need to do to let your body know it’s time to sleep.
As you lie in the bed, become mindful of your breath. Are you belly breathing? If not, take a few deep breaths centered in your belly.
Notice the breath rising and falling in your body.
Check in with your body. Notice any tension in your body, especially around your jaw and forehead.
As you become aware of any potential areas of tension, bring your mind back to your belly breathing. Try to relax tension as you become aware of it.
Bring your awareness to your eyes and your eyelids. Notice them relaxing.
Begin counting exhalations, one at a time, as you do in sitting mindfulness meditation. Try to keep the focus on the numbers, letting all other thoughts come and go. If you lose count, remember that it’s no big deal. Start over again at one each time you lose count.
If your body becomes tense, keep breathing through your belly slowly and steadily as you ease muscles in tight areas of your body.
I’ve observed that most people drift off to sleep before they are able to count one hundred breaths. If you do get to one hundred breaths, simply start counting down, going backward from one hundred to zero.
If you get back down to zero and are still awake, go back up to one hundred again.
Repeat as often as needed.
Most people are able to fall asleep using this simple mindfulness-based technique. Even for people who have counted a lot of breaths before falling asleep, the night is much more pleasant when they try to maintain awareness of the breath, rather than ruminating and getting lost in thoughts and worry.
You can count your breath as many times as you need. If you wake up frequently and can’t fall back asleep easily, you can use this technique every time. You can never overdo it with mindfulness of breathing!
If this mindful sleep induction technique doesn’t seem to work for you, try one of the body scan practices in the previous chapter once you’ve gone through your bedtime routine and are lying in bed.
Dreaming
Another component of healthy sleep is the ability to dream. Most people dream several times each night, but some remember their dreams better than others. Like most people, you may assume that if yo
u don’t remember your dreams, you don’t have any dreams to remember. However, this isn’t true. Rather, the parts of your brain that would consolidate your dreams into memory aren’t very active. You may just remember fragments of dreams or not remember them at all. Sometimes you may remember a dream later in the day, when you have an experience that reminds you of the dream.
What Happens When You Dream
There are two primary types of sleep. One is called REM sleep, which stands for rapid eye movement. Some people also call this “paradoxical sleep” because the brain is quite active even as the body is sleeping. This is when dreams seem to happen. Your body is immobilized, but your eyes may be moving around rapidly. The other type of sleep is called non-REM sleep. This is when you are completely asleep and not dreaming.
As the course of the night wears on, you go from longer periods of non-REM sleep to more frequent periods of REM sleep. You may wake up right before or right after each interval of REM sleep, since this is the period of sleep when your brain is most active. As your brain is getting ready to dream, the increase in its activity may wake you up. What you experience as “deep sleep,” the most restful kind of sleep, is non-REM sleep in the predawn hours. This is also the time when you have the most vivid dreams.
Dreams in Grief
After you lose a loved one, your sleep may also be complicated by the quality of your dreams. You may be bothered by the presence or absence of your loved one from your dreams. In my clinical work, I’ve noticed that the more intensely people experience grief, the less likely it seems that they will dream about their deceased loved one, especially in the first weeks and months after death. However, everyone is different, and other people may dream about their loved one more easily and more often than you do.
For example, I once worked with Barney, a recent widower whose wife, Donna, died shortly after being diagnosed with advanced lung cancer. For months afterward, he was overwhelmed with distress because he didn’t dream about her but their children did. After several months, he finally caught a glimpse of her in a dream. She didn’t say anything to him in the dream, but just seeing her again was enough for him.
Be patient with yourself and the dream process. Dreams play a different role in each individual’s journey though grief.
If your symptoms are consistent with PTSD or if you witnessed your loved one undergo intense suffering, you may have nightmares related to your experiences. If your loved one died traumatically, you may also be troubled by disturbing dreams that seem to grow out of your loved one’s pain. I’ve occasionally heard stories of haunting dreams where a deceased loved one is in trouble, aggressive, or upset.
We don’t know what happens to us after we die. Your beliefs about this may lead you to give certain powers to dreams, seeing them as prophetic or intuitively accurate about an afterlife. This belief may feel very strong when it comes to certain distressing dreams. However, just as we don’t know what happens to us after we die, we also don’t know exactly what the purposes or meanings of dreams are. We certainly don’t know if how we feel about certain distressing dreams has any bearing on reality or if it even should.
In contrast, as Swiss psychologist Carl Jung (1969) pointed out, certain dreams may seem to reach out to you with tremendous power and guidance and feel rejuvenating. These are dreams that often carry life-changing potential, guiding or steering you closer to your life’s purpose.
You may have had dreams that later came true or provided you with valuable information you didn’t even know you would need. Other dreams may just be your mind decompressing from the day with random events connected to your most intense feelings. When you’re in a bad mood, your dreams often extend your mood. When you dream, you may be building events in the dream around a particular feeling or thought.
Your most distressing dreams may just be part of your waking distress, carried over into sleep. You begin to prepare for sleep and dreams the moment you wake up in the morning. Your activities throughout the day become the raw materials for your dreams at night. If you are distressed during the day, chances are your dreams at night will communicate that back to you.
If you are troubled by your dreams, it’s only logical that you won’t sleep well. All of the concerns about dreams discussed here are normal during grief, and they can definitely affect your sleep quality. They can make dreaming something you wish to avoid and, as a result, literally lose sleep over.
practice: Lucid Dreaming
The Mindful Sleep Induction technique presented earlier in this chapter can help improve the quality of your sleep and may help make dreaming pleasant again. Another technique that many people have found helpful in restoring restfulness to their sleep is using a soothing, repetitive phrase. I’ve found that if people say simple phrases, timed with steady, rhythmic belly breaths, it can help them fall asleep and wake up feeling more refreshed and restored. It can also improve the quality of their dreams.
Again, the first step is to ensure you’re following a good sleep hygiene routine. Once you’re in bed, become aware of your breath. Make sure your belly is doing the work of guiding air into and out of your body. Then simply repeat your chosen phrase, saying it silently and gently in your mind once with each breath.
Here are some simple phrases to use. I recommend that you use only one phrase at a time; otherwise you may increase the amount of noise in your head at night:
I am sleeping.
I am relaxed.
I am resting.
Time to sleep.
I am dreaming.
When using such phrases, sometimes you may maintain a very subtle level of awareness even after you fall asleep. You may find yourself conscious in the middle of a dream. This is a common experience for people who practice mindfulness in their waking life and use mindfulness-based techniques to fall asleep.
There’s nothing wrong with this, but it might feel strange at first. This phenomenon of being alert while dreaming is called lucid dreaming. If this happens to you, try to relax into the experience. If it keeps happening, I recommend that while you have conscious awareness in your dreams, you simply stay put and begin meditating within the dream itself. Practice your mindfulness meditation while you are dreaming. This is easier to do if you fall asleep mindfully. I’ve done this a number of times and find it to be a very relaxing and rejuvenating experience.
Tibetan Buddhists have been practicing lucid dreaming, which they describe as “dream yoga” for centuries. It was taught to them by the skilled Indian yogi Naropa, through his main Tibetan student, Marpa Lotsawa, in India about a thousand years ago. Our understanding of lucid dreaming in the West is relatively new. We owe much of it to Stephen LaBerge and his excellent book Lucid Dreaming (2009). If you are interested in lucid dreaming, I highly recommend it.
practice: Keeping a Dream Journal
Years ago when I was in college, I had the privilege of working very closely with G. William Domhoff, whose excellent book summarizes much of what we know about dreams (2003). This remarkable man was trained as both a sociologist and a psychologist and has a keen interest in dreams. He taught many of his students the technique of keeping a dream journal to improve sleep and enhance the quality of dreams.
When you dream, your brain usually isn’t encoding your dreams into memory. Unless you either write your dreams down or say them out loud immediately, you’ll probably forget them within minutes of waking up.
I’ve found that mindful techniques for getting to sleep, such as counting your breath or repeating a soothing phrase, help people not only sleep better but also remember their dreams better. If you’re frustrated by how little of your dreams you remember in the morning, you may wish to start keeping a dream journal. You’ll need to keep a notebook and pen at your bedside. A computer won’t be as effective. Those seconds and minutes spent turning on a machine or waiting for it to boot up can be crucial for retrieving dream content. When you wake up in the morning, reach over to the notebook and write down any dreams you reme
mber immediately. I don’t recommend doing this in the middle of the night, as it will probably make it difficult for you to fall back asleep. What you might find amazing about recalling your dreams in the morning is that you will begin to remember all of your dreams, no matter what time of night you had them.
Keeping a dream journal will help consolidate your dreams into waking memory. Write down your dream or dreams as soon as you wake up, even before you use the bathroom. You can jot down key pieces of information if you don’t have time to record your dreams in full. As long as you write something down, you’ll be more likely to remember what you dreamed. If you wait too long, you may forget crucial details or even entire dreams. Here are some of the details you might record in your dream journal:
What was happening in your dream?
Who was in your dream?
Do you remember any colors in the dream?
What did you do in your dream?
Where did your dream take place?
What were you wearing in your dream?
Was there any music in your dream?
How did you feel in the dream?
How did you feel when you woke up from the dream?
Did your dream seem to have an overall message?
Were you mindful in your dream?
Structure each entry in your dream journal to address these questions. Keeping track of this information will get easier with practice. As it does, your recollection of your dreams will become more detailed and enriching.
When I’ve done this in my own life, I’ve found that over time I begin to notice patterns in what I dreamed about and who was in my dreams. In addition, my recall of dreams became extremely detailed. Whereas the first dreams I jotted down required only a few sentences or a short paragraph, later dreams took up pages.
Mindfulness for Prolonged Grief Page 7