It was the week before my best friend’s wedding, and my anxiety (nerves, plus excitement) had reached epic levels. I wasn’t sleeping, to say the least. Part of that had to do with the maid of honour speech I would be giving. I was terrified and could not shut my brain off to fall asleep at night.
After day three of lying awake until the wee hours of the night, I sheepishly admitted to her that I was too nervous to fall asleep, and she—the bride, who was sleeping like a baby the week before her own wedding—told me I needed to try the “4-7-8” breathing trick.
She happens to be a licensed wellness practitioner who studies meditation, stress, and breathing techniques, and told me it would change my life. You simply breathe in through your nose for four seconds, hold your breath for seven seconds, and exhale through your mouth for eight seconds. She explained that the studied combination of numbers has a chemical-like effect on our brains, and would slow my heart rate and soothe me right to sleep that night. “It works,” she told me. “It’s crazy.”
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I couldn’t wait to put the trick to the test, and to my complete disbelief, I woke up the next morning unable to even remember getting to the eighth second of the exhale because it knocked me out that fast. For the next four nights leading up to the big day, even as my stress increased, I was able to fall asleep the minute I tried the 4-7-8 trick. I also used it to relax in the moments leading up to the speech.
When you feel stressed or anxious, adrenaline courses through your veins, your heart beats at a rapid rate, and your breathing becomes quick and shallow. So before I get into the specifics behind how the 4-7-8 breathing trick works, I wanted to explain in my own words what it feels like when you try it. To me, the effect of the breathing technique feels almost like a sedative drug, because in order to hold your breath for seven seconds and then to exhale for eight—when your breath is so shallow and short—your body is forced to slow your heart rate. It has no choice. Holding your breath, and then slowly, deliberately exhaling for eight seconds, causes a chain reaction. It feels like going from a mad-dash sprint to a finish line to a slow, leisurely, calming stroll through the park.
When you first start, you’ll be desperate to just take in another breath, or you’ll want to speed up your counting, but if you stick to the numbers (or at least try to), and don’t take any breaks (in other words, consecutively repeat the 4-7-8 without resuming regular breathing), you can literally feel your heart rate slow down, your mind get quieter, and your whole body physically relax. It washes over you like a calming, relaxing drug. I can never remember getting past the first set of 4-7-8.
Do you know the feeling of being put under by anesthesia, where you are conscious, and the next thing you remember is waking up? That’s what this is like for me: As soon as I start the practice, the next thing I remember, I’m waking up in the morning and can’t even remember beginning the 4-7-8 count the night before. Crazy.
Now to the more technical details: People who are stressed or anxious are actually chronically under-breathing, because stressed people breathe shortly and shallowly, and often even unconsciously hold their breath. By extending your inhale to a count of four, you are forcing yourself to take in more oxygen, allowing the oxygen to affect your bloodstream by holding your breath for seven seconds, and then emitting carbon dioxide from your lungs by exhaling steadily for eight seconds. The technique will effectively slow your heart rate and increase oxygen in your bloodstream, and may even make you feel slightly lightheaded which contributes to the mild sedative-like effect. It will instantly relax your heart, mind, and overall central nervous system because you are controlling the breath versus continuing to breathe short, shallow gasps of air.
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Mindful breathing practices have been a part of yoga and Eastern wellness modalities for centuries, but aren’t as popular in Western culture. The most well-known champion of the 4-7-8 breathing technique in the U.S., who is somewhat responsible for the prevalence that the technique does have amongst integrative medicine practitioners, yogis, and those in search of stress reduction and overall relaxation, is Harvard-educated Dr. Andrew Weil.
Though I’m not promising or claiming (nor does Dr. Weil) that practicing this breathing technique can fight disease or provide clinical benefits, I can tell you one thing: If it affects you like it did me, it will help you fall asleep way faster. Not only is it free, it also works for a number of different instances. In addition to using it to fall asleep in a pinch, you can practice it if you wake up in the middle of the night and find yourself thinking about something you have to do the next day, in order to fall back asleep; if you are nervous before an event (like a wedding, or giving a speech); if you are angry about something and want to calm down. My friend (the bride-to-be who slept like a baby the week before her wedding), who gets nervous to fly, uses it before flights and during if the plane encounters turbulence.
It is now what I use to fall asleep every single night, and each morning, I’m amazed at how well it worked.
Check out Dr. Weil’s site if you are interested in further reading, and tell me what you think about this trick in the comments below.
At three and half years old he is capable of entering the security code on my iPad so that he can play one of his games. He knows his numbers from one to ten and is able to identify most of the letters of the alphabet. And just recently he has learned to play a pretty good game of catch.
So why is it that my son can’t wrap a blanket around his body by himself?
I can’t count how many times my son has asked either my wife or I to tuck him in. The first three hundred times he asked, I thought to myself, “when will he learn to tuck his own self in?” I mean usually we’re just talking about a foot sticking out here or a toe sticking out there.
Then it hit me last week that maybe it is not the physical act of tucking in that’s significant. Maybe it’s what tucking in represents that matters to kids.
It helps them to feel good.
It helps them to feel safe.
More than anything, it helps them to feel loved.
Tucking a child in only requires an extra moment or two. But that extra moment or two may be the difference between a fantastic dream or a frightening nightmare.
As I reflect more on how much it means to my son to be tucked in I can’t help but think that tucking in may be a metaphor that extends beyond blankets and children. Maybetucking in can apply to those moments in our lives when we can provide something for someone that they may not be ready to provide for themselves.
We’ve all had someone provide these moments of comfort and reassurance to us and we remember how good it felt to know that we were not alone. It’s possible that we would have been fine on our own, but it’s certain that we were better for someone stepping up and helping to tuck us in.
So starting tomorrow look for ways that you can tuck others in.
Sleep. Putting your head on a pillow. Looking up while thinking about the day that was. Rolling back in time, remembering other nights like this one. No matter what you have experienced or where you have been, sleep has been a part of you. Sometimes sleep takes time, but you can never not sleep, and no one can die from lack of sleep. Off course, reduced sleep-quality can have a profound impact on life, but one thing is for sure: Sooner or later, sleep will come.
Until sleep comes, remember to live. Let the moments awake be about something: Try doing new things, challenge yourself, let your brain live the dreams produced during the night. We need to bring something with us to bed. We need to feel that we have done something worth remembering. We need to see that we have done our best to survive, and that we can be proud of ourselves. Sleep is a part of a cycle. We need it to reboot, to start anew. Sleep takes us in its arms, rocking us back and forth. When it doesn`t take us in its arm, just wait. Let it take it`s time, because you can`t force a cycle. If you can`t sleep, get up and do something else. Because you will sleep, sooner or later. Until then, live and breathe.
After thinking and writing down some of my plans for the next couple of days, I will now draw the curtains and shut the window for the night. I’m quite excited, so I wonder if I can ‘shut out’ the thoughts and ideas that are jumping up and down. I just know I look forward to waking up, drawing back the curtains and opening the window for a new day with a different view.
Curing insomnia in people with depression could double their chance of a full recovery, scientists are reporting. The findings, based on an insomnia treatment that uses talk therapy rather than drugs, are the first to emerge from a series of closely watched studies of sleep and depression to be released in the coming year.
A student demonstrating equipment at Colleen Carney’s sleep lab at Ryerson University. Dr. Carney is the lead author of a new report about the effects of insomnia treatment on depression.
The new report affirms the results of a smaller pilot study, giving scientists confidence that the effects of the insomnia treatment are real. If the figures continue to hold up, the advance will be the most significant in the treatment of depression since the introduction of Prozac in 1987.
Depression is the most common mental disorder, affecting some 18 million Americans in any given year, according to government figures, and more than half of them also have insomnia.
Experts familiar with the new report said that the results were plausible and that if supported by other studies, they should lead to major changes in treatment.
“It would be an absolute boon to the field,” said Dr. Nada L. Stotland, professor of psychiatry at Rush Medical College in Chicago, who was not connected with the latest research.
“It makes good common sense clinically,” she continued. “If you have a depression, you’re often awake all night, it’s extremely lonely, it’s dark, you’re aware every moment that the world around you is sleeping, every concern you have is magnified.”
The study is the first of four on sleep and depression nearing completion, all financed by the National Institute of Mental Health. They are evaluating a type of talk therapy for insomnia that is cheap, relatively brief and usually effective, but not currently a part of standard treatment.
The new report, from a team at Ryerson University in Toronto, found that 87 percent of patients who resolved their insomnia in four biweekly talk therapy sessions also saw their depression symptoms dissolve after eight weeks of treatment, either with an antidepressant drug or a placebo pill — almost twice the rate of those who could not shake their insomnia. Those numbers are in line with a previous pilot study of insomnia treatment at Stanford.
In an interview, the report’s lead author, Colleen E. Carney, said, “The way this story is unfolding, I think we need to start augmenting standard depression treatment with therapy focused on insomnia.”
Dr. Carney acknowledged that the study was small — just 66 patients — and said a clearer picture should emerge as the other teams of scientists released their results. Those studies are being done at Stanford, Duke and the University of Pittsburgh and include about 70 subjects each. Dr. Carney will present her data on Saturday at a convention of the Association for Behavioral and Cognitive Therapies, in Nashville.
Doctors have known for years that sleep problems are intertwined with mood disorders. But only recently have they begun to investigate the effects of treating both at the same time. Antidepressant drugs like Prozac help many people, as does talk therapy, but in rigorous studies the treatments, administered individually, only slightly outperform placebo pills. Used together the treatments produce a cure rate — full recovery — for about 40 percent of patients.
Adding insomnia therapy, however, to an antidepressant would sharply lift the cure rate, Dr. Carney’s data suggests, as do the findings from the Stanford pilot study, which included 30 people.
Doctors have long considered poor sleep to be a symptom of depression that would clear up with treatments, said Rachel Manber, a professor in the psychiatry and behavioral sciences department at Stanford, whose 2008 pilot trial of insomnia therapy provided the rationale for larger studies. “But we now know that’s not the case,” she said. “The relationship is bidirectional — that insomnia can precede the depression.”
Full-blown insomnia is more serious than the sleep problems most people occasionally have. To qualify for a diagnosis, people must have endured at least a month of chronic sleep loss that has caused problems at work, at home or in important relationships. Several studies now suggest that developing insomnia doubles a person’s risk of later becoming depressed — the sleep problem preceding the mood disorder, rather than the other way around.
The therapy that Dr. Manber, Dr. Carney and the other researchers are using is called cognitive behavior therapy for insomnia, or CBT-I for short. The therapist teaches people to establish a regular wake-up time and stick to it; get out of bed during waking periods; avoid eating, reading, watching TV or similar activities in bed; and eliminate daytime napping.
The aim is to reserve time in bed for only sleeping and — at least as important — to “curb this idea that sleeping requires effort, that it’s something you have to fix,” Dr. Carney said. “That’s when people get in trouble, when they begin to think they have to do something to get to sleep.”
This kind of therapy is distinct from what is commonly known as sleep hygiene: exercising regularly, but not too close to bedtime, and avoiding coffee and too much alcohol in the evening. These healthful habits do not amount to an effective treatment for insomnia.
In her 2008 pilot study testing CBT-I in people with depression, Dr. Manber of Stanford used sleep hygiene as part of her control treatment. She found that 60 percent of patients who received seven sessions of the talk therapy and an antidepressant fully recovered from their depression, compared with 33 percent who got the same drug and the sleep hygiene therapy.
In the four larger trials expected to be published in 2014, researchers had participants keep sleep journals to track the effect of the CBT-I therapy, writing down what time they went to bed every night, what time they tried to fall asleep, how long it took, how many awakenings they had and what time they woke up.
When the diaries show consistent, seldom-interrupted, good-quality slumber, the therapist conducts an interview to determine if there are any lingering issues. If there are none, the person has recovered. The therapy results in sharp reductions in nighttime wakefulness for most people who follow through.
In interviews, several researchers noted that the National Institute of Mental Health had sharply curtailed funding for work in sleep treatment. Aleksandra Vicentic, the acting chief of the agency’s behavioral and integrative neuroscience research branch, said that in 2009 the funding strategy changed for sleep projects.
In an effort to illuminate the biology of sleep’s impact on behavior, the agency is now focusing on how sleep affects the functioning of neural circuits. But Dr. Vicentic added that the agency continued to fund clinical work like the depression trials.
Dr. Andrew Krystal, who is running the CBT-I study at Duke, called sleep “this huge, still unexplored frontier of psychiatry.”
“The body has complex circadian cycles, and mostly in psychiatry we’ve ignored them,” he said. “Our treatments are driven by convenience. We treat during the day and make little effort to find out what’s happening at night.”