Overcoming Tinnitus

Have you ever had a ringing in your ears after a loud noise or a knock to the head, and did it go away after a few minutes? What if that noise stayed or became louder or sharper? For some people it doesn’t fade. Instead it comes and goes unexpectedly and can cause persistent and severe difficulties. This is called Tinnitus.

Some call it “ringing in the ears” or “head noise”, and sounds can include tones, whistles, hisses, static and pops, occurring individually or in combination, with patterns and changes in volume unique to each person. It is commonly known to affect experienced musicians who have listened to too much loud music, but I’ve recently discovered it affects all sorts of people and some quite severely, such as war veterans, construction workers, and even parents of crying infants. It has been suggested it will be a growing problem with increasing use of personal music players, with the volume set much too high!

The presenting issues can include headaches, reduced concentration, stress, insomnia, frustration, or anger. Depression, anxiety, panic or phobias can also develop if the condition is not properly addressed. For me, tinnitus has been the cause of restless nights with difficulty getting to sleep. I’ve had to work at not getting frustrated with the noise and agitated or worked up, at the risk of making the situation worse!

The suggested medical treatment is TRT or Tinnitus Retraining Therapy, but I was glad to discover that there are non-medical interventions for what I assumed was a purely medical condition. Cognitive behavioural therapy (CBT), exposure therapy and mindfulness have been found to be effective! These don’t remove the symptoms but help with better coping including being able to ‘ignore’ the symptoms, which is often the best outcome. For example, CBT challenges unhelpful thought patterns and replaces them with more beneficial self-talk. This more grounded and realistic way of thinking creates a greater sense of calm, and promotes habituation and adjustment to the sounds and sensations. Mindfulness similarly aims to reduce the impact of the symptoms by practicing acceptance of your whole experience, including the parts that might be unpleasant and beyond your control. For more info, speak to your psychologist.

For me I’ve learnt that psychological interventions can be more broadly beneficial than we might think!

For more about how one psychologist treated and overcame his own tinnitus see http://www.cbtfortinnitus.com/dr-hubbards-story/

Understanding the importance of sleep

Gabriel Wong
Clinical Psychologist

Understanding the importance of Sleep

According to the Maslow’s Hierarchy of needs, sleep is one of our biological and physiological needs apart from food, drink, shelter, warmth, sex, as well as WIFi. Sleep is also one of the three pillars of health in addition to fitness and food. Research says human beings can be deprived of food for as long as 36 days whilst we can only be deprived of sleep for 11 days.

About 50 to 70 percent of people do not get enough sleep, and about 40 percent of adults are chronically sleep deprived. Australian Research says students are getting about 7.5 hours a night’s sleep on school nights, and 25% of the students are getting 6.5 hours or less sleep on school nights.
The Australasian Sleep Association reports that each year 500 fatalities out of 10,000 accidents are related to falling asleep at the wheel and that three million Australians suffer from chronic sleep disorders. Lack of sleep has a big impact on the judgement, concentration and decision making. In the past both the France crash in 2009, the Chernobyl nuclear plant disaster, Exxon Vladez oil spill and the Space Shuttle Challenger explosion have be found to be a direct result of operator fatigue. Lack of sleep will affect our ability to learn and think. When we do not get enough sleep, it will affect our mood; it makes us feel grumpy, intolerance, lack of motivation, and short-fused. In addition, it deregulates our appetite hormone and makes us feel hungry.

How much sleep do you need? Children and adolescents require 8.5 to 9.2 hours whilst adults aged 22-55 need eight hours. Normally people usually take not more than twenty minutes to go to sleep. If you are really tired you may only take five minutes to go to sleep. Remember when we go to sleep we think of nothing.

Our circadian rhythms are our 24-hour biological cycles, and it controls our bodily functions like going to toilet, feeling hungry, controlling our body temperature and our high and low blood pressure. Our body has an alternating cycle of sleep and alert periods throughout the 24-hour sleep – the sleep drive and our cycle of alertness. A well-slept person is supposed to achieve a harmony between the sleep cycle and the cycle of alertness.

The daily rhythm of alertness shows that we have two periods of alertness, 8-10a.m. and again at around 8-10p.m. and two periods of minimal alertness at around 2-4p.m. and 1-5 a.m. The minimal 2-4p.m. alertness is also called the post afternoon dip.

Sleep consists of two basic states: the rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep. The period of NREM sleep comprises Stage 1-4 and lasts from 90 to 120 mins, with each stage lasting anywhere from five to fifteen minutes. Surprisingly, however, Stages 2 & 3 repeat backwards before REM sleep is attained. So, a normal sleep cycle has this pattern: waking, stage 1,2,3,4,3,2,REM. Usually REM sleep occurs about 90 mins after sleep onset.

Scientists believe that we dream to fix experiences in long-term memory – that is, we dream about things worth remembering. The first period of REM typically lasts for ten minutes, with each recurring REM stage lengthening, and the final one lasting an hour.
What are the secrets of a good night’s sleep?
• Implement a routine: our body loves consistency, i.e. going to bed at about the same time each night and waking at the same time in the morning.
• Avoid having a nap in the afternoon: only have not more than twenty minutes of nap if you really feel tired. As twenty minutes will take you to go to the Stage 1 and 2 of the NREM sleep.
• Relax before bed: listen to some relaxing music such as the Pachabel’s Canon in D Major or some Mozart music.
• Don’t sleep in too warm a bed: we need to cool off our body temperature in order for the brain to go to sleep.
• Turn the clock away especially digital clock: the tiny luminous rays will disrupt the sleep cycle. Make sure you do not look at your iphone, ipad or computer in the middle of the ight as the blue light from our computer will disrupt the secretion of melatonin from our body making us feel awake.
• Don’t not use alcohol to help you go to sleep. Alcohol may help you go to sleep short-term, but after a few hours you will be waken up after the alcohol effect is gone.
• Write the list of “problems” down instead of thinking of these problems in your mind before your sleep. Look at the lists of problems the next day and see if you can resolve it. Two main rules are: solve it if you can or survive it you cannot.

If you have tried all these tips and still cannot sleep for a period of time, you probably may suffer from chronic insomnia. You feel tired, exhausted, irritable, and cannot concentrate. Primary insomnia refers to your sleep problem is related to the sleep process itself. It may already have started in childhood years or your early days. Secondary insomnia means the sleeplessness is caused by another problem like you are worrying about the work, exam or a relationship, etc. You may visit your GP to look at the root of your problem. Sometimes the melatonin hormone may help you go to sleep if this is only related to the sleep process. Many long-haul flight pilots require to use melatonin to help them sleep the next day when they arrive in another country. If your sleep is caused by a psychological problem, it would be better to go to see a psychologist so that the psychologist can help you work out the root problem and resolve it. Once the root problem is being resolved, the person can gradually go back to the sleeping pattern using the sleeping tips mentioned above. Sleeping pills or tranquilisers are the last resort but it cannot be used long-term.
Have a good night sleep everyday!

References:
Harrington, C. (2014). The complete guide to a good night’s sleep. Australia:Macmillan.
APS Institute. (2016) APS practice certificate in sleep psychology. Retrieved from http://elearning.psychology.org.au/pluginfile.php/9422/mod_resource/content/7/Sleep01_LearnerGuide.pdf. (Accessed: 4 March)
Australians Sleep Association. Retrieved 2016 http://www.sleep.org.au/information/consumer-information/tips-and-facts-about-sleep.
Carr-gregg, M. (2004). Surviving year 12. Second Edition. Austrlia: Finch Publishing
Carskadon), M. (2016) Available at : http://www.brown.edu/Divisions/Medical_School/biomed/Faculty/C/Carskadon.html (Accessed: 4 March).
Rickard, N & Rickard-Knight, W.E.J. (2001). Relaxing music prevents stress-induced increases in subjectivity anxiety, systolic blood pressure and heart rate in healthy males and females. Journal of Music therapy, 38(4).