Mindfulness: Bringing Presence to your Practice

When was the last time you felt awake, aware and fully engaged? Probably more recently than you might think. hands gathering wildflowersIt may be a surprise to learn that mindfulness is your natural state. Before multi-tasking and deadlines became the norm, humans would naturally become absorbed in one function at a time, only choosing to abandon the shores of tranquillity when a predator or threat invaded the scene.   The advent of the digital age ushered in access to more information than we’ve ever had before and with it more pressure to know more, do more and become more The results are often scattered attention, diluted problem-solving abilities, anxiety and fatigue, along with that unsettling undertone that convinces us we’re falling behind, will never catch up and are about to be found out. The stage is then set for the grand entrance of impostor syndrome with many clinicians subscribing to the view that you ‘rise to the level of your incompetence’.

As a healthcare professional or student, you probably experience more demands than most on your time and energy.

Having to make snap decisions with limited resources in squeezed timeframes can lead to less-than-ideal outcomes and dissatisfaction.  The bad news is, your schedule is unlikely to ease up anytime soon. The good news is, there are some techniques you can adopt that will help you master the illusion of time by dropping deeply into the moment and becoming fully present. The dividends of this practice include more pleasure in your work, greater productivity and better health for you and your patients. Mindfulness is one of those beneficial techniques that helps you do less and be more. In this blog series, we’ll be exploring the properties of mindfulness, kindfulness and heartfulness as instruments to enhance your wellbeing and add an extra dimension to your daily practice.

What exactly is mindfulness?

man practicing mindfulnessAlthough the study and practice of mindfulness originated in the Buddhist tradition and there are various explanations, the scientific definition of mindfulness is ‘the self-regulation of attention with an attitude of curiosity, openness and acceptance.’ According to Jon Kabat-Zinn Ph.D, who is widely regarded as a master of mindfulness and the founder of the mindfulness based stress reduction (MBSR) 8-week program, the practice makes you more attentive and less inclined to respond to thoughts and become distracted. He reminds us that when you pay attention to your breathing, you are moving out of the conceptual realm and into the awake, aware realm. He believes that if you practice it even for tiny moments each day you will ignite deep compassion within yourself.   Various clinical studies show the link between practicing mindfulness and increased wellbeing. Dr Kelly McGonigal health psychologist and lecturer at Stanford University, claims that when people train in mindfulness, they are better prepared and more willing to deal with suffering. She suggests that by imagining you have nostrils on your chest, attending to your breathing and connecting with your values, you can increase vagal tone and positive emotions.

How do you practice mindfulness in medicine?

By simply bringing attention to your breath, watching it flow effortlessly into and out of your body as you cultivate an attitude of patience and curiosity, you will be able to bring mindfulness to every moment of your day. With commitment to this daily practice you will start to notice the gaps between your thoughts without trying to control them. Time will become your friend as you experience more moments of awareness. Even if your schedule is jam-packed, there are usually brief opportunities to bring yourself back to ‘beginner’s mind’ and awareness of your breath while washing your hands or writing up your notes. Mindfulness and its application have exploded in popularity recently and there are many online resources available if you want to find out more. One of the most useful for healthcare professionals is the Mindful Practice® program developed by a team of physicians and led by Drs. Ron Epstein and Mick Krasner. These programs have been created to train clinicians and educators in cultivating attention, curiosity and presence so they can bring these qualities to the most difficult moments in clinical practice. Dr Epstein has also written Attending: Medicine, Mindfulness and Humanity, a book recommended for all health professionals. mindfulness note on corkboard It’s worth remembering that as a healthcare provider, you are always under scrutiny from your patients. Consciously and unconsciously they will be looking to you for cues on how to behave. By deliberately adopting an attitude of mindfulness at the beginning of every session with a patient, you will automatically be setting the tone and giving them permission to fully participate in their own healing journey. We’re always interested in stories about mindfulness in practice – please feel free to share your experiences below. Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of the Heart Based Medicine organization.  They are not intended to diagnose, treat, cure or prevent any disease. They are the expressed opinion of the author for the sole purpose of educating the public regarding their health and wellbeing. Individual results may vary. Seek the advice of a competent health care professional for your specific health concerns.   Photo credits: Photo 01: © anastasianess via Adobestock.com Photo 02: © fizkes via Adobestock.com Photo 03: © thinglass via Adobestock.com

6 Healthy Habits for Better Sleep

Previous blogs in this series have explored  Why We Sleep and Why We Dream.  Now it’s time to turn our attention to improving the sleep you do get so that you can reap the benefits of nature’s nightly medicine. Sleep as we now know restores body and brain, as well as recalibrating us emotionally. To get the most from this nocturnal cleanse it makes sense to prepare for slumber.  The body’s 24-hour internal clock keeps good time and uses daybreak and nightfall to ascertain whether you should be asleep or awake. Modern life sees us manipulating these regular planetary rhythms with the use of artificial light, electronic devices and controlled temperatures, while man-made stimulants such as tea, coffee, chocolate, alcohol and drugs give us the fuel we need to extend our activities beyond the boundaries we were born with.

Whether or not you view these contributing factors as positive or negative impacts on our development as a species, there is no question that insomnia is a modern epidemic.

A poll conducted by the National Sleep Foundation in 2005 revealed that roughly 30 % of the population of Western countries suffers from sleep disorders. Signs of sleep deprivation include poor memory and concentration, low mood, deterioration in performance, eating more without feeling satisfied and an increase in accidents and injuries. Practicing good ‘sleep hygiene’ (which, disappointingly, has nothing to do with how clean your bedding is!) optimizes the hours you spend asleep by harmonizing you with your natural rhythms. 

Adopting these six healthy practices will have you sleeping soundly in no time:

1. Be a creature of habit.

This is probably the most crucial tip of all for getting into a healthy sleep routine. Hitting the pillow and waking up at the same time every day – sorry, weekends are not exempt – trains your body to get tired at the same time every night. Exercising for at least 30 minutes each day is also important, but make it no later than 2 – 3 hours before bedtime to avoid an upswing in cortisol. Hot baths can also help you feel sleepy as your body rushes to get rid of excess heat and drops your core temperature.

2.  Sleep like your ancestors.

Our bodies were designed to sleep with the moon and rise with the sun. If this isn’t naturally possible, investing in blackout blinds, sleep masks and earplugs will create similar sleep conditions. A comfortable sleeping environment will also help you drift off. Keep bedroom temperatures to around 18 degrees Celsius and choose a supportive mattress and pillow with natural bedding that keeps temperatures even. Remove all electronic devices and turn your alarm clock away from you so you don’t spend the night clock-watching.

3.  Power down and drop off.

Your hardworking brain needs to slow down before it can stop. Switching off your screens an hour before bed and choosing a relaxing pastime like reading or listening to restful music will reset your racing mind for the transition into deep sleep. You should also avoid caffeinated drinks, chocolate, alcohol, nicotine and heavy meals late in the day. Caffeine can take up to 8 hours to wear off while alcohol, drugs and heavy meals can all stimulate your liver, which will interfere with your ability to sleep properly.

4. Blue screens, restless dreams.

Blue light from your phone, laptop or TV is known to interrupt the circadian rhythm that directs our sleep/wake cycle and suppresses melatonin, the chemical that induces sleep. Adjusting screens to night mode and switching to mellow yellow low-level light sources like candles and lamps in the evenings will help prepare you for the Land of Nod.

5. A ray of sunshine.

By avoiding light by night and getting some sunshine or bright light in the morning, you’ll help your circadian rhythm keep the natural beat of your body. Vitamin D can help in darker seasons.

6. Supplementary support.

Supplements can help to sustain and improve your health. Popular sleep-enhancing supplements include:
    • Melatonin – The granddaddy of sleep supplements, melatonin is a chemical your body makes naturally to induce sleep. Take it 30 minutes before bed.
    • Valerian Root – This plant extract is most commonly used to treat insomnia but evidence also suggests it can be used to treat the symptoms of anxiety as well. Its effectiveness is backed my multiple clinical studies.
    • Magnesium – Magnesium is critical to many functions in the human body, and its deficiency can cause many problems – including sleep issues.
    • L-Theanine is an amino acid found in tea leaves and some mushrooms that promotes relaxation and sleep.
    • Phenyl-GABA (Gamma-Aminobutyric Acid), a naturally occurring amino acid found in food and a potent neurotransmitter in the brain. It calms the brain and relieves stress. It is available in combination with L-Theanine for synergistic effects. 
If you’ve tried everything on this list and still find yourself staring at the ceiling in the dark after 20 minutes, get up and do something that makes you sleepy, like reading or meditating. The anxiety of not being able to sleep can make it harder to fall asleep. Cognitive Behavioral Therapy (CBT) is another technique renowned for relieving insomnia and failing all else take a 30 minute nap before 3pm. If you have your own tried and tested tips for better sleep, we’d love to hear about them in the comments. Sweet dreams!   Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of the Heart Based Medicine organization.  They are not intended to diagnose, treat, cure or prevent any disease. They are the expressed opinion of the author for the sole purpose of educating the public regarding their health and wellbeing. Individual results may vary. Seek the advice of a competent health care professional for your specific health concerns. Photo Credits: Photo 1 © Tran-Photography, via AdobeStock.com Photo 2 (and teaser) © contrastwerkstatt, via AdobeStock.com  Photo 3 © grapestock, via AdobeStock.com Photo 4 © valya82, via AdobeStock.com

Why We Dream

Don’t you find it strange that every night you have the equivalent of a psychotic episode while you’re sleeping? In his book ‘Why We Sleep’ Matthew Walker goes so far as to say we are routinely psychotic when we dream, swinging between hallucinations, delusions and emotions and waking with almost instant amnesia. Since we now have more insight into why we dream than ever before, you may be relieved to know that it’s a perfectly natural and essential biological and psychological process!

We actually dream in all stages of sleep but the most vivid are those we experience during the REM phase, when brain activity is enhanced.

According to Walker, the areas of the brain responsible for emotional processing are up to 30% more active during REM sleep than when we are awake, while the logical decision-making zones of the brain are deliberately repressed.

But what is the purpose of dreams and where do they come from? The Egyptians and Greeks generally believed that dreams were sent as messages from the Gods, with the exception of Aristotle who suggested they were more likely to be related to recent events. Sigmund Freud asserted that dreams emerged from unconscious, unfulfilled wishes, a theory that has since been abandoned by science. That’s not to say that the content of your dreams is unimportant. In the words of Socrates ‘the unexamined life is not worth living’ and dream analysis is still recognised as having proven mental health benefits. It was once thought that dreams were merely the by-product of sleep and not inherently useful in themselves, but that theory has recently been debunked. There is also a popular myth that dreams are just a rerun of our activities during the previous day, however a Harvard University experiment by Robert Stickgold concludes that only 1–2 % of the content of our dreams can be described as ‘daily residue’. Interestingly, the same study revealed that between 35 and 55 % of the feelings and concerns we have experienced during our waking hours frequently resurface in dreams. So it is the emotional context that is the backdrop to our nightly movies rather than just a mental replay.

How do dreams help us recalibrate?

Being able to accurately read the facial expressions of people in our environment and identify them as friend or foe is key to our survival. One benefit of REM sleep is it recalibrates this function in the brain, giving us sharp focus precision each day. A dream-starved brain is unable to decode with such accuracy and is prone to fear-based decisions.

Now consider this fact in the context of roles and occupations where sleep deprivation is considered normal – medical professionals, emergency services and law enforcement as well as becoming a new parent to name just a few.

It’s quite alarming to realise that such responsible roles are being entrusted to people with a marked deficiency in their ability to spot critical signs such as whether a patient is experiencing discomfort or is in a life-threatening situation!

Perhaps one of the most fascinating discoveries about our dreams is that they act as nocturnal therapy, nurturing our emotional and mental health.

Production of a stress-causing hormone known as noradrenaline – the brain equivalent of the body’s adrenaline hormone – stops completely during REM sleep, giving the dreamer a chance to relive emotional experiences in a safe environment. Kind of like a therapeutic life review where the thorny barbs are removed, yet the salient knowledge is preserved and stored as part of our autobiography.

Dreaming enhances creativity and problem-solving.

This is a fact used by great minds, eminent scientists, artists, writers and musicians to find creative solutions and inspire their art. Keith Richards and Paul McCartney have both composed songs in their sleep and the periodic table of elements is known to have been revealed to Dmitri Mendeleev in a dream in 1869, long before we understood the atomic structure of the Earth’s elements. If this article hasn’t inspired you to ‘sleep perchance to dream’ try keeping a dream journal for the next week and delving into your own creativity. Feel free to share what you discover in the comments. You can follow Matthew Walker on Twitter @sleepdiplomat. Disclaimer: The views and opinions expressed in this article are those of the author and do not necessarily reflect the views of the Heart Based Medicine organization.  They are not intended to diagnose, treat, cure or prevent any disease. They are the expressed opinion of the author for the sole purpose of educating the public regarding their health and wellbeing. Individual results may vary. Seek the advice of a competent health care professional for your specific health concerns.

Why We Sleep (and What Happens When We Don’t)

Sleepless Nights
If you don’t mind me asking, when did you last get a good night’s sleep? When I say ‘good’ I mean more than 7 hours, uninterrupted. Insomnia is a modern plague and most of us get far less than the recommended amount of 8 hours every night. Sleepless Nights

The World Health Organisation has even recently declared a sleep loss epidemic throughout industrialised nations.

Apart from the incessant demands of working, parenting, caring for a loved one, even socialising, many of us are helplessly attached to our digital devices, clocking up an average of 11 hours of daily screen time. With too much to think about and too many demands on our energy, shut-eye gets pushed to the bottom of our list of priorities when it should be firmly at the top. Our modern 24/7 lifestyles, illuminated by artificial light, are pushing our natural rhythms to their limit. Since the beginning of the industrial age, humans have had to adjust their natural sleep times to fit around the working day. Whereas in pre-industrial agrarian cultures we would have slept from 9pm til dawn and enjoyed an afternoon nap of around thirty to sixty minutes, now we tend to just sleep at night, and that time window is getting shorter and shorter as we try to cram more into our day. Unless you live in a culture which still observes the siesta tradition, your afternoon nap is likely to have fallen by the wayside. Yet your body is still pre-conditioned to snooze mid-afternoon, a fact you’ll be well aware of if you’ve ever tried to sit through a boring presentation at 2pm!

The medical culture expects doctors, nurses and surgeons to work some of the longest hours in any profession, knowing they are making life or death decisions with insufficient sleep which severely impairs judgment.

Seeing medics, world leaders and CEOs boast about their ability to survive on 4 hours’ sleep a night perhaps leads us to believe that it’s a disposable commodity, something we can take or leave. Nothing could be further from the truth. No Rest = Bad Days

Penguin has recently published ‘Why We Sleep’, an insightful and sometimes shocking book by Matthew Walker which explores the science behind the mystery of our nightly power-downs and why they’re so important for our health and wellbeing.

The book reveals that as well as demolishing our immune systems over time, routinely getting less than 6 or 7 hours’ sleep more than doubles our risk of cancer, reduces fertility and increases the risk of blocked arteries which can lead to cardiovascular disease, stroke and congestive heart failure. A person getting insufficient sleep for just one week will have their blood sugar levels disrupted so acutely, a blood test would diagnose them as being pre-diabetic. Add to this the hormone imbalance which a lack of sleep causes, making you crave more sugars and carbohydrates, and you can see why it’s almost impossible to lose weight when you’re sleep-deprived. Concentration and reaction times are one of the first casualties of not sleeping enough, leading to microsleeps and fatal injuries when driving or operating machinery.

Very little research has been conducted in the past about why we sleep, so you’d be forgiven for not knowing why it’s so important to every living being. Sleep laboratories are now fortunately giving researchers far more insight into what actually happens when we close our eyes at night. Here’s a brief summary: First you will drop into a calm NREM sleep, a deep-wave state of repose that allows your brain to reflect on the day’s events and process them. If it helps, visualise memory packets being moved from a short-term storage facility to a more secure long-term storage site within the brain. You will eventually move into REM sleep, a much more mentally active hallucinatory state accompanied by the release of a chemical which paralyses the body, presumably to stop our dreams being acted out. During this dreaming phase, emotions, memories and experiences will be integrated, helping you to solve problems creatively and fine-tune a more accurate model of the world. Your brain will cycle alternately through both these cycles during a full night’s sleep, improving cognitive functioning such as balance, memory, learning and co-ordination when you wake up.

Your brain is not the only organ to benefit from this deep cleanse.

Shakespeare sums it up in Macbeth when he says that sleep is ‘the chief nourisher in life’s feast’. A 2011 study that tracked half a million men and women of different age, race and ethnicity across 8 countries, resulted in the conclusion that shorter sleep (which raises blood pressure and calcification of the coronary arteries) was associated with a 45% increased risk of developing and/or dying from coronary heart disease within seven to twenty-five years of the start of the study. Midlife predictions are even more startling. Adults aged 45+ who sleep fewer than 6 hours a night are 200% more likely to have a heart attack or stroke in their lifetime, compared to those sleeping seven to eight hours a night. Rest Well

During a good night’s sleep, rich in NREM phases, the brain sends a calming message to the body’s nervous system, reducing stress hormones, calming the heart and managing blood pressure. Ample sleep also replenishes the bacterial community known as the microbiome in your gut, rebalances the hormones necessary for reproduction, reduces inflammation and restocks the immune system so it can fight off infection and diseases.

With all this evidence to support the benefits of a good night’s sleep, you’re probably interested to know how you get one!

One of the fastest ways to improve your sleep is to go to bed and get up at the same time every day – sorry, that includes weekends. Invest in a sleep tracking device such as a Fitbit if you can to establish your baseline and understand how long you’re spending in each sleep phase. You can also sign up for our free 5-day mini-course to receive daily tips which will help you function at your best each day and sleep better for longer.

We hope you’ve enjoyed this post. Look out for more to come in the monthly sleep series. We’d love to hear about your own sleep patterns and insights – feel free to comment.