Mindfulness for Prolonged Grief

by Sameet M Kumar

  If you find that your dreams are getting extremely complicated and taking more and more time to write down, you may wish to take a break from keeping your dream journal for a little while. You may find that you have better recall of your dreams in general from this point on because you conditioned yourself to remember your dreams.

  If you find that you’re getting really obsessed about dreaming, take a step back. The techniques in this book aren’t about helping you avoid the realities of your waking life; they’re about living more fully while you’re awake. That’s the purpose of healthy sleep—to give you the emotional and physical energy to tolerate the ups and downs of waking life.

  Dreams of the Deceased

  Many people who are suffering from grief become obsessed with their dreams, specifically with wanting to dream about their deceased loved one. If you are sleeping too much in an attempt to dream more and it’s interfering with other goals in your life, you are probably going overboard with your pursuit of dreams. I don’t recommend a dream journal for people in this situation; it will only become part of the problem.

  Not everyone dreams of deceased loved ones. What I hear from most people who are suffering from prolonged grief is that when their deceased loved ones appear in dreams, they have a fairly passive role. Their loved ones may be present, but like Donna in Barney’s dream, they may not be very participatory. Your loved one may only watch from a corner as the rest of the dream unfolds. This is the most common experience I’ve heard regarding dreams that include the deceased.

  I also consider it normal to not have any dreams at all for three to six months after the death of a loved one. Similarly, intense emotional distress seems to get in the way of dreaming about a deceased loved one. Eventually, just about everyone sees their loved one in a dream.

  Every once in a while, people have reported having dreams in which they were reunited with their loved one, almost as if the person had never died, or in which their loved one was able to give specific information or express certain feelings he or she had been unable to share before dying. These are the most poignant dreams, because even though you may know you’re dreaming, part of you may indulge in the wish-fulfilling fantasy that unfolds around you.

  I don’t think there’s a certain type of dream people are supposed to have during grief. We dream for a number of different reasons, not all of which are understood. The main point about dreams is that you need to have healthy sleep habits that facilitate restful sleep, and being able to have pleasant dreams is a part of healthy sleep.

  When to See Your Doctor

  In addition to the stress of prolonged grief, a number of medical issues can impair sleep, and you should consult your physician if any are issues for you. In the remainder of this chapter, I’ll discuss the most common physical ailments I’ve seen that can contribute to poor sleep quality. This list is by no means complete; other issues may be present in your life in addition to those discussed below.

  Sleep Apnea

  Sleep apnea is especially common in people who are overweight or snore very loudly. In sleep apnea, your body stops breathing or breathes insufficiently for several moments at a time repeatedly. You may frequently wake up in a panic because of being deprived of oxygen and then fall back asleep. However, you may not fall back asleep very easily. Sleep apnea can be life threatening. Your doctor can recommend a sleep study to see if you have sleep apnea. If you do, a breathing device can be prescribed to help you.

  Hormone Changes

  For both men and women, aging and thyroid dysfunction can also disrupt sleep. The thyroid is a gland in your neck. It secretes a variety of hormones that regulate metabolism and energy levels. If you aren’t sleeping well, your thyroid function may have changed. Your doctor can test your thyroid function with a simple and commonly used blood test.

  If you are a woman in your forties or fifties, you may be experiencing menopause, which entails many changes in your body’s hormone levels and the physiological systems those hormones regulate. Women going through menopause often have hot flashes and profuse sweating at night, which can disrupt the sleep cycle.

  Gastroesophageal Reflux Disease

  If you are overweight or eat immediately before going to sleep, your sleep may be disrupted by gastroesophageal reflux disease (GERD). This is similar to what used to be called heartburn. GERD can cause a sore throat, stuffy nose, or cough, especially in the morning. If your stomach is leaking stomach acid or small food particles into your throat at night, you may wake frequently due to discomfort. Ask your doctor about what kinds of changes in diet or eating might be helpful, or any medications that may ease this condition.

  Anemia

  If you have anemia, this means your red blood cell count is low. These cells transport oxygen to every cell in your body, giving your body energy. As a result, if you have anemia, you may frequently be tired throughout the day. Despite the fatigue, people who have anemia typically don’t sleep very well. Paradoxically, the body simply doesn’t have the energy to sleep; it feels like it needs to stay awake to function properly. Since the body isn’t getting enough oxygen during the day, it feels anxious at night, despite oxygen requirements being lower during sleep. Your doctor can screen you for anemia with a commonly used blood test and recommend appropriate treatment if necessary.

  Medications

  Some medications can cause you to sleep too much, while others can cause you to sleep too little. If you’re taking medications and have problems with sleep, please check with your doctor or pharmacist to see if any of your medications may be interfering with your sleep. You may benefit equally from a different medication, from taking the same medication at a different time of day, or taking a different dose. However, please don’t stop taking any medication suddenly without first consulting your doctor.

  Sleeping Pills

  If you have trouble falling asleep or staying asleep, or if you don’t feel refreshed in the morning, your doctor may have prescribed one of the many sleeping pills currently available. These have become very popular recently, as more people are having trouble sleeping well in our modern world. There are many kinds of medications that help people fall asleep. None of them should ever be combined with alcohol.

  If you’re considering sleep medications, please be aware that research consistently shows that mindfulness meditation practice has a beneficial effect on sleep quality, and that it also benefits well-being in many other ways (Howell et al. 2010). I’ve found that many people no longer need sleeping pills once they begin practicing mindfulness meditation and mindfulness-based techniques in their waking life and at bedtime.

  If you take sleeping pills every night, you won’t be able to stop taking them suddenly, nor should you try to. Many sleeping pills can be habit forming. I’ve noticed that any pill taken every night specifically for sleep can become habit forming very quickly, even “natural” supplements. Unfortunately, one of the withdrawal effects when you stop taking sleeping pills regularly is insomnia.

  If you’re taking sleeping pills and wish to stop, talk to your doctor first to find out how to do so safely and if there’s anything you should know before you begin the weaning process. You should never discontinue nightly sleeping pills suddenly. The gradual approach that your doctor will recommend, specific to you and the medication you’re taking, is much more advisable.

  Once you know how to reduce your intake of sleeping pills, use any of the mindfulness-based techniques in this chapter on nights when you don’t take sleeping pills. See how that goes over a period of a couple of weeks. Depending on your schedule for phasing out the sleep medication, you may practice these techniques just a few nights a week. However, I believe that once your body and mind relearn how to fall asleep naturally, you will thoroughly enjoy a much more restorative sleep.

  Summary

  The practice of mindfulness meditation is meant to give you a greater sense of awareness and well-being in your waking life. However, not getting enough sleep, which is so comm
on in prolonged grief, can wear down your emotional and physical reserves. Like stress, sleeping poorly can be physically uncomfortable. The techniques you’ve learned in this chapter should help you get more healthy, restorative sleep on a regular basis.

  Ensuring healthy sleep is a very important way to balance out the fatigue that can come from the chronic stress of prolonged grief. However, it isn’t the only thing you can do. In addition to meditation and relaxation techniques, another factor that often enhances the quality of sleep is getting physical activity during the day. Of course, exercise has many other physical, mental, and emotional benefits. Therefore, the next chapter focuses on how to increase your physical activity mindfully.

  Chapter 5

  Mindfulness in Motion

  Restful sleep is a vital component of emotional resilience. Another crucial part of resilience is regular physical activity. Exercise and sleep often go together: regular exercise helps you sleep better, and restful sleep gives you more energy to exercise and do other things you want to do. This chapter will guide you in establishing a mindful exercise routine to help you through your grief.

  Exercise and Emotional Pain

  Far too often, the most distressing periods of our lives tend to also be the most sedentary. Grief is no different. The silence of your home, the emptiness of rooms that may still be full of your loved one’s belongings, and the sheer magnitude of your pain can weigh you down like a ton of bricks. Grief often feels like wearing concrete boots that make each step seem like a monumental task. The pain of loss can feel so overwhelming that we are physically and emotionally paralyzed by its intensity.

  Recall cytokines, those substances discussed in chapter 3 that circulate throughout your body during times of prolonged stress and distress. If left to its own devices, your body will pump out industrial doses of these chemicals in response to the stress of grief. Since the body tends to process all the different types of stress you experience as physical danger, you are constantly being mobilized to fight or run away from the stress of grief. Because of this stress response, your body is actually preparing for physical activity, exercise, and movement, even though you probably feel sluggish. Most of us tend to not exercise or get much activity when we’re grieving. If this is the case for you, you may have an insufficient level of activity to process the fight-or-flight stress response that’s occurring in your body.

  A Comprehensive Approach to Well-Being

  Meditation is clearly helpful and can be the cornerstone of grief management, but often it isn’t enough. In order to successfully manage prolonged grief, you need to address the physical aspect of what you’re going through. Although mindfulness meditation techniques can help short-circuit the stress response, I think it’s also important to consider what happens to your body when you have so much built-up stress, sometimes on a daily basis. Prolonged stress can be bad for your health, impairing your immune function and causing damage to your blood vessels.

  This is where exercise comes in. Exercise should be part of your wellness plan. There is too much scientific evidence in its favor for it not to be. Too often, people who practice mindfulness regularly neglect exercise, despite its importance. Mindfulness, like grief, can easily become a sedentary experience and contribute to a sedentary lifestyle. That’s no solution!

  With prolonged grief, it can be challenging to start a new routine, including an exercise program. You may feel weighed down by a sense of inertia and seem to be unable to make changes that might ease your pain. The hardest part of changing behaviors is often the beginning, when you’re trying to start doing things differently. As the Chinese Taoist master Lao-tzu said, “The journey of a thousand miles begins with a single step.” You have to find an active way to mobilize change in your grief and in your life.

  Having to make a deliberate and mindful attempt to incorporate physical activity into our routines is very new for our species. For millennia, human beings had no choice but to live extremely active lives. Until very recently, daily survival required long walks, hunting, running, plowing fields, herding animals, or manual labor for almost everyone. Even today, in much of the world survival still requires putting in hours of physical work daily. You won’t find gyms in areas where people have to work outside in the hot sun for hours every day to put food on the table; they simply aren’t needed.

  But like many people in the developed world, you may live a fairly sedentary life. For most of us, especially as we age, including physical activity in our routines requires planning and discipline. Especially when experiencing intense grief, you may need to make a conscious effort to just change out of your pajamas, bathe, or brush your teeth every day. Pumped full of unused cytokines due to the stress of grief, your body probably feels sluggish, lethargic, and unmotivated.

  Yet this is all the more reason to explore every technique at your disposal to feel better. Science has proven that physical activity plays a crucial role in emotional well-being. This isn’t to say that those who have to toil in fields or mines feel better because of working under difficult conditions. However, what we do know is that without some sort of physical activity, our minds don’t do as well. Whereas in some societies a grueling level of activity is required, our society is generally at the other extreme, resulting in an unprecedented level of inactivity.

  Like most people in our society, you may assume that any talk of exercise is also about weight loss. Most ads for gyms or exercise equipment make claims about how many pounds you can lose using their system. This chapter isn’t about weight loss, although you may find that exercise helps you maintain a more stable and healthful weight. What I want you to focus on as you read about exercise is the effects that physical activity can have on your mood. I’d like you to think of starting an exercise routine as part of a path to emotional health—something that numbers on a weight scale can’t accurately measure.

  Research on Exercise and Depression

  A lot of approaches to grief neglect the importance of exercise. This is unfortunate because we’re constantly learning about how important exercise is for all of us. Researchers are consistently finding that exercise can be neuroprotective, meaning exercise can help protect the brain from the effects of aging and distressing mood states (see Kramer et al. 2005 for a review).

  In addition, studies indicate that exercising regularly in sufficient doses can be as powerful as an antidepressant medication such as sertraline, also known as Zoloft (Blumenthal et al. 1999, 2007). For example, in a 2007 study (Blumenthal et al. 2007), 202 people diagnosed with major depression were divided into four groups. One group was put on the antidepressant sertraline without any exercise, one group was given a placebo drug without exercise, one group did exercise under supervision without the drug, and the final group did unsupervised exercise at home, also without the drug.

  At the end of sixteen weeks, the researchers found that all the groups except the one receiving a placebo drug had similar reductions in depression. The group that took antidepressant medication had a faster decline in depression scores, but their final scores didn’t differ significantly from the improvement reported by the two groups that exercised after about four months. This means that exercise may take a little longer to reduce depression, but in the long run it can be as effective as some medications.

  It’s also worthwhile to keep in mind that the groups that exercised didn’t have to deal with the side effects of the medication. Although the researchers didn’t measure all possible side effects, it would be interesting to look at whether the groups that exercised tended to sleep better and what kinds of changes in weight and libido they might have experienced in comparison to the group taking medication.

  If you’re taking sertraline or another antidepressant, please don’t interpret the results of this study to mean you can stop taking your medication if you exercise. Please check with your prescribing doctor first. These kinds of medications can’t be stopped suddenly; they must be tapered off under a doctor’s supervision. Furth
ermore, you should never make any changes in psychiatric medications unless you’re making healthy changes in your lifestyle.

  Choosing the Right Exercise for You

  There are many different forms of exercise to choose from. Some of the most popular are cardiovascular training (like running or bicycling), weight bearing, and dance (like Zumba or line dancing). Any of these can help you manage your mood. If you have cardiovascular issues or an injury, you may benefit more from gentler, low-impact exercise, such as yoga or tai chi. If you play sports, you can certainly include that as a form of exercise if you get an aerobic workout during practices and games.

  If you haven’t been exercising for a long time or haven’t ever had a regular exercise program, be sure to consult your physician to make sure you’re healthy enough to begin. You may need a cardiac stress test just to make sure you can handle whatever form of exercise you choose to do, even if it isn’t in the cardiovascular category. Any type of exercise will increase your heart rate. If you plan on running or doing another form of exercise that places high demands on your cardiovascular system, it’s especially important to make sure your heart is healthy enough first.

  If you’re overweight or obese or haven’t exercised in a long time, choose a gentle method of exercise, such as walking or water aerobics (exercising in a shallow pool), to begin with. People who are overweight or out of shape and suddenly decide to start running or lifting weights can easily do unintended damage to their joints or tissues or throw their back out. This won’t help your emotional state.