Mental Health and Sleep

I then proceeded to go through all of her videos and saw that she was ok. She explained that yes, this is awful but you will get through this and you will get back to a “normal” life. This gave me hope. Which was much needed during this dark time in my life. Cancer was by far the most traumatic experience I have ever gone through, but now that I’m on the other side of it I have to remind myself how amazing I truly am. I think about what my life was like in 2015. One month after treatment, I was getting my feeding tube removed and the only thing I could eat was Ensure. At first I could only drink it after numbing my mouth with Lidocane because it burned so bad due to the Mucositis. I drank 3 per day. This went on for a month before I started incorporating new things into my diet, and I still had to supplement with Ensure for several months.

Then I think about how awesome it is that I ate a hamburger patty (dipped in cheese sauce to help me swallow it) and macaroni and cheese for lunch today. There was a time when I couldn’t eat those things. And although many foods and drinks are still a struggle, I am so glad I didn’t give up. I’m so glad that I pushed through the pain and worked hard to regain my strength and retrained my tongue to eat and speak.

People can be insensitive. It usually isn’t intentional. People have said to me, “oh you’re so skinny, I’m so jealous.” Or, “I bet you don’t even want food.” Or, “Didn’t you want to lose weight anyway?” Or, “Can’t you just eat ice cream and baby food?”

I realize that no one knows what to say to someone who is suffering. Cancer scares people. I try to be patient with those who say the above-mentioned things. Here is what they don’t realize. Being skinny or losing weight does not always equate to being healthy. I lost 65 pounds in 4 months. I starved. It was painful. All I wanted was a sip of water and even that was too painful. All of this really takes a toll on you mentally. We find so much joy in food. In fact, when we are stressed or sad we often turn to food for comfort. I was not able to turn to food for comfort. Even thinking of food stressed me out because I associated it with pain. This made me very grumpy and very angry. I grieved my old life. I cycled through the grief cycle frequently and often skipped the acceptance part. I refused to accept that this would be my life forever. After treatment I was determined to do whatever was necessary to rehabilitate myself. I was successful in rehabilitating myself physically. I began to introduce new foods into my diet, I did my speech therapy exercises, physical therapy exercises, I took excellent care of my teeth, and I started to build up my stamina again. But something was missing. I struggled to sleep. I felt depressed, anxious, and obsessed about the negative aspects of my new life post cancer. Every day I worried that the cancer would come back and destroy all of the progress I had made.

I sought out my friend Meghan. She had survived Leukemia three times and was currently going through her fourth battle. She was always so positive so I sought her out as a cancer survival expert to find out what I should do. She told me to seek help before these feelings got so big that they took over my life. She recommended some specialists and I immediately sought them out. The first person I went to was a therapist that counseled me through how to deal with situations that made me feel anxious.

At that time, I had just gone back to work full time. I wasn’t exactly ready yet but I was afraid of losing my insurance so I went back anyway. I received so much attention. And although my coworker’s intentions were good, I found it very overwhelming. I struggled to set boundaries with them and with what to say when someone brought up my cancer. I just wanted to move on and try not to think about it while at work and everyday someone would bring it up. It was like rehashing the worst moments of your life every day. Everyone was just trying to be nice and let me know that they cared so I felt guilty about not wanting to share. I felt obligated to talk about things, even though I didn’t want to, because I didn’t want to hurt their feelings. It was very uncomfortable and made me very anxious.

Through therapy I learned how to redirect the conversation so that I was able to share as little or as much as I wanted. I learned that I can’t expect others to know what I’m thinking or feeling so I came up with things to say when I was put into situations that made me uncomfortable. For example, food is a very touchy subject. Everyone always wants to suggest things for you to eat and it’s difficult to explain why I can’t eat the things they have suggested. So, when it was brought up in conversation I told them that food was a touchy subject and I didn’t want to talk about it. When people commented on how skinny I was and how they wished they were that skinny, I tried to gently remind them that this was the worst diet ever. In addition to anxiety, I was very angry. I realize now that this was part of the grief cycle and partly due to being exhausted all the time from not getting a good night’s sleep. I was so angry about getting cancer and that there was no explanation as to why it happened. I felt like it was out of my control and could possibly come back at any time and destroy my life. I was also hungry and like I said I had begun to associate food with pain so not being able to eat made me very angry! I also learned it’s ok to be angry. Try to find a healthy way to channel it. I was not successful with this at first. I was depressed and angry so I started to isolate myself. I didn’t want to talk to my family or my friends. I was disappointed in people for avoiding me. I felt like a leper. Where was everyone? I felt like I had no one to talk to that understood me during treatment. After treatment it felt like everyone assumed my life was back to normal again which couldn’t be farther from the truth. Then, through therapy I realized that my mind was making up all of these scenarios and none of them were true. Cancer scares people. They don’t know what to say so they might not say anything at all because they are afraid for you, not of you. People are busy. Cancer may have turned your life upside down but some people unintentionally decide to avoid the situation because they are too busy and too scared to deal with their feelings about you right now. This is how they have chosen to cope. At first, I was angry, then I realized that it wasn’t fair to be angry at how other people felt or how they processed my cancer diagnosis. I had to let go of that anger. It wasn’t easy. My therapist recommended guided imagery to help me get through panic attacks and to help me get to sleep. I found this very helpful. It allowed me to focus on something else which helped to quiet my mind long enough to move on from an anxious moment or go to sleep. There are many guided imagery sources available. Some are free on Youtube. I prefer Belleruth Naperstek’s guided imagery which can be found on iTunes or you can purchase the CD’s online. I am particularly fond of the following selections: Fight Cancer, Healthful Sleep, Relaxation and Wellness, and Healing Trauma.

My next therapist was a sleep therapist. I was seeing a Tempomandibular Joint Disorder Dentist to help with my Tempomandibular Disorder (TMD) symptoms. Cancer treatment had caused my symptoms and jaw pain to intensify. I was getting physical therapy and wearing a mouth splint at night, but I still felt awful and my mouth opening was reduced. Physical therapy was a tremendous help with this but I needed to find out why I was clenching my teeth which was causing the TMD in the first place. So, my TMD Dentist recommended a sleep psychologist. My sleep psychologist was a firm believer in behavioral therapy. He informed me that in a study done where half of the patients were given sleep aids and the other half were given placebos, those given the sleep aid only got about 15 minutes more sleep than those who took the placebo. The mind is a powerful thing. So now that I knew he wasn’t going to dope me up on sleep meds, I was really interested in how he planned to “fix” me. To be honest, I was skeptical. My first task was to take standardized tests that determined

what the problem was. Results revealed that in addition to insomnia I also had anxiety, depression, and obsessive-compulsive disorder. This trifecta means that I was struggling with posttraumatic stress disorder (PTSD). Labels don’t always make a difference, but it was nice to know what was wrong so we could begin taking steps to make me better. Up until this point, I had no idea that cancer treatment could cause PTSD. I took some comfort in knowing that what I was going through had a name and that I was not alone. For me, it’s not just one moment that haunts me, it’s months of moments.

Step one was to tackle the insomnia. Apparently if you sleep for the recommended 8 hours, the first 4 hours our body is healing and the last 4 hours our mind is healing. I was only getting about 4 hours of sleep so my mind was not able to heal to allow me to work on recovering mentally from my trauma. My psychologist told me that during treatment I slept a lot, wherever and whenever. But now that I am back to work and moving on, I need to make my bed my sleep only zone again. This meant no more falling asleep in the living room watching TV. He told me to stay up until I was tired and then go to sleep. I had to be at work at 7:00 am so I thought he was crazy. How will I get enough sleep if I don’t go to bed until 3:00 am?! I had to retrain my sleep cycle. He told me not to lie in bed and stress about not sleeping. He told me to get up and go into another room and read until I get tired, then go to bed so I don’t associate my bed with thoughts of stress and not sleeping. He also told me to get up at the same time every morning even on my days off. Again, I thought he was crazy. I work in a school; we were about to go on summer break. But I did it. I kept a sleep log and did as I was told and in about 3-4 weeks I was sleeping through the night with no problems. My quality of sleep improved and I had more energy during the day. It’s amazing. I was cured of my insomnia! Now, that’s not to say it doesn’t rear its ugly head from time to time but overall, I am back to sleeping soundly.

Even though I was sleeping again, it was time to address the feelings of anxiety and depression. My psychologist provided me with techniques to work on that helped ease these feelings. The first thing he taught me was belly breathing. When we are stressed we go into fight or flight mode and breathe short breaths through our chest which activates those anxious feelings of “oh no, I’m about to get eaten by a lion!” or in my case, “oh no, here come feelings and memories of my cancer treatment.” This activates our sympathetic nervous system and as our breathing rate increases and so does our heart rate, pumping blood to our muscles and away from our skin. This is a defense mechanism that prevents us from losing blood if we are wounded. Rapid heart rate also pumps oxygen to our brain so that we are alert and ready for fight or flight. Anxiety is when you feel this way in situations that are not life and death. By making ourselves aware that this is happening and breathing so that our diaphragm makes our stomach rise and fall with each breath instead of our chest, we can slow down this fight or flight feeling and begin to activate our parasympathetic system. This system is known as our rest and digest feeling. Your heart rate and breathing slows down, you begin feeling more relaxed, and go back to normal functioning.

http://t2health.dcoe.mil/apps/breathe2relax

The app Breathe2Relax is free and walks you through diaphragmatic breathing exercises. I found it helpful when trying to learn this technique. It feels very unnatural at first and takes more effort than expected.

 

Now that I could sleep and I was beginning to cope with my anxiety I needed to address the overwhelming feelings of stress and depression in my life. This is when my psychologist introduced me to Mindfulness. We spend most of our waking hours on “auto pilot” meaning that we are constantly dwelling on the past or anticipating the future, or both. We barely notice what is happening right now in the present. Mindfulness encourages you to keep your attention on the present moment no matter how happy, sad, good, or bad it may be. Mindfulness teaches us to relax and accept whatever is happening moment to moment. It’s an attitude toward living. This sounds easy. I quickly learned it is not. It takes a lot of mental training and practice to think about nothing. A mindfulness exercise might consist of washing the dishes without thinking of the bad day you had at work or making a mental grocery list for tomorrow. Instead, you would try to be present in that moment. Feel the warm water, smell the scented soap, focus on the act of cleaning the dishes only. This might sound silly but it gives your mind a much-needed break. I personally stress about everything that has already happened or will happen and I forget to live my life. I am a worrier. This causes me to be exhausted and anxious all the time. Learning to be mindful is a way to live your life right now and learn to enjoy it. I still found this practice difficult and I felt like I was doing it wrong. My psychologist recommended Mindfulness Based Stress Reduction. There is a free 8-week online program available at www.palousemindfulness.com

If you think this sounds hokey, try reading and watching the videos for week 1. This will explain the science behind mindfulness and further explain what it is and how to do it. After one week I found myself craving the formal practice sessions that allowed me to decompress by tuning into my body and what it’s feeling and attempting to turn off yesterday and tomorrow’s thoughts and tune my brain into the present. I felt my tension melt away and began using the strategies in my everyday life. I started to notice and appreciate the little things. I felt happier and less stressed. I really think everyone could benefit from this program.

 

Other things I have tried to relax include Floating. Float pods are sensory deprivation tanks. The ultimate goal is to feel weightless and experience moments of nothing. I am constantly seeking out ways to make the most of my time. I am always go, go, go and I often forget to slow down and just be present. Inside the pod there is no light, no sound, no smell, and you feel weightless as you float in water that is the same temperature as your body. In this pod you are able to relax and let go of tension and stress. There are floating pods with lids and private floating pools for those who get a little claustrophobic. The water is filled with Epsom salt which also relaxes your muscles. I opted for the pod. In my room there was a shower and a pod. I had to shower before and after floating. While inside the pod, I floated to the top of the water and just relaxed. It was difficult for me to turn off my brain so I would recommend listening to music your first time or two to give you something to focus on so you can enjoy yourself. Overall it was an enjoyable experience and I left feeling relaxed. Float therapy has a lot of benefits including: reduced stress, depression, and anxiety, improved sleep and memory, speeds up muscle recovery, reduces migraines and tension, pain management, increases your absorption of magnesium, lowers your blood pressure, and you might see softer, healthier skin. Here is some more information if you are interested: https://draxe.com/sensory-deprivation-tank/  

 

Something else I enjoy doing to relieve stress, tension, and neck and shoulder pain is yoga. Attending a yoga class is a lot of fun and forces you to make time for yourself. It’s very easy for me to make excuses not to go or not to do yoga at home. I have to remind myself that I deserve a little me time. I always feel great after doing yoga. For me it’s really all about stretching and doing what feels good. Listen to your body. It’s not a competition to become the stretchiest human being alive. I am no yoga master. I would definitely place my skills at the beginner’s level. I have found a few simple poses that I like and I try to focus on going slow and using correct form and breath.
YouTube has a lot of free videos of yoga exercises. Here is a beginner’s video that shows some simple stretches for neck and shoulder pain.

During treatment I sat around a lot and got very stiff. I have found that my neck and shoulders are even more sore and stiff from the side effects of radiation treatment in addition to my regular stress and tension. Yoga can be done seated, standing, or lying down, whatever you are comfortable with.

Now that I am able to do more physically, I find that I like to do simple, restorative yoga exercises.
Here is a video that shows some of my favorite poses. This is not me. I found this video on YouTube.

Find a creative outlet. This really helps to combat depression. It is so hard to force yourself to do anything when you are feeling depressed, so I realize this is easier said than done. I’ve found that mindlessly scrolling through the internet made me isolate myself and made me more depressed. So, I put my phone down, turned off the TV, and tried to force myself off of the couch to pick up activities that I used to enjoy. This was not easy, but over time I was able to push through and begin enjoying activities again. I suggest joining a club, picking up a hobby, go hiking, or just trying something new. For me, I like to crochet, craft, paint, and create things in my art journal. It gives my mind something productive to do so that I’m not focusing on how stressed out I am. Here are some of my creations.