A few days ago, I was running errands in my neighborhood. As I passed a grassy park, I saw a young woman sitting in the middle of a field sitting by herself, sobbing. I struggled with whether I should leave her alone or see if I could help. Sometimes it’s not clear what someone needs. I kept walking, and then I really felt like I should go see if she was ok. I backtracked, walked into the park, and approached her slowly and respectfully. I asked if she would like to talk, and she said she would.
I sat on the grass, and she started telling me her story. She has lived in Philadelphia for several years. She loves it here and feels that it is her home, where she has built her community. And she is moving across the country to attend art school in a couple weeks. She talked about how sad she feels at leaving and the pain of saying good-bye. And, as she talked, she kept judging her feelings and saying she shouldn’t be feeling this way.
Now, I have moved several times in my life, often for school or training, and I know how stressful and difficult it can be, even when the move is positive. And I know how fragile I feel when I move. I also know, as a psychologist, that moving and starting a new job or academic program are some of the most stressful things we can go through in life.
Stress can come from negative and positive life events. Distress is when stress comes from something painful or negative, such as losing a job or going through a divorce. But, what many people do not know is that stress comes from positive events too, such as getting married or having a baby, and it is called eustress.
It is incredibly normal for us to have a variety of feelings from an event, even a positive one. As I sat with her and we talked, I validated that of course she is sad and hurting at the thought of moving and leaving her home and community, even when she is moving for such a great reason and to a beautiful place. That is definitely how I have felt when I moved in the past. So, yes, she can be excited about what is coming, and also it makes so much sense that she also feels sad and in pain. As Walt Whitman has said, “I am large, I contain multitudes.” We all contain multitudes, and, regarding our emotions, it is very normal to have very different emotions floating around at the same time.
So please remember this the next time you have a variety of feelings in response to an event. Be kind to yourself, and talk to yourself as you would a friend, with support and compassion. Yes, you can be excited, and you can also hurt and be sad. You contain multitudes.
Recently, I was taking the bus to meet a friend for coffee. I found myself feeling cranky and annoyed about having to commute across the city just to go out for coffee and about the time it was taking to get there. My mind was having these negative thoughts that fed my irritation. Now, mind you, I had initiated this coffee date. And it was with a new friend who I wanted to get to know better.
So I took a mental step back and realized how my thoughts (and the cranky mood they were leading to) were not serving me well. I also had a moment to reflect on how this whole experience was something I had not been able to do recently due to the pandemic. I changed my attitude to one of gratitude. I recognized actually how fortunately I am that I CAN go meet with someone in person for coffee. I realized how wonderful it is to have the opportunity to work on making a new friend. And I also thought about how blessed I am that, as I started my business a few years ago, I now have the time and space in my life to meet someone for coffee on a weekday. I mean, seriously- how lucky am I?
I gave myself a good talking-to, and I tapped into gratitude. I worked on turning my mindset around. Gratitude is a very powerful and positive practice to have in life. Research shows that having gratitude can improve our mood, relationships, and well-being. And I know all of this, as a psychologist and well-being coach. I have a gratitude practice where I keep a Gratitude Journal nightly. (See my previous blog post of 1/27/20 if you want to read more about my practice.) And I talk to my clients regularly about the importance of gratitude; however, it can be easy to lose sight of this practice when you are living your busy life.
When you notice yourself being annoyed by irritations, try to step back and appreciate what you are able to do. Appreciate when you connect with someone. Appreciate when you see something lovely or taste something yummy. Appreciate when you have small moments of pleasure, such as sitting in the sun for a few minutes or reading a book. We are all human and it is easy to lose sight of the special and positive aspects of our lives, especially as we get caught up in the business of everything. But when you notice yourself cranky or annoyed, give yourself a good talking to and figure out how you can change your mindset to one of gratitude. It will help your life feel more special and bring you more moments of joy and connection. So what is one small thing you are grateful for from today?
Something interesting that I have noticed over many years of doing therapy and coaching is that, at times, a theme emerges in your work. Several clients will come to me with similar challenges in a short period of time, and this really has me pay attention to this issue. Sometimes a theme emerges in your life as well, with friends or with people with whom you speak. When I consider someone’s well-being, I think about their physical, social, emotional, and spiritual well-being, and a recent theme I have encountered is related to social well-being.
Two friends have recently come to me discussing how a friend or relative does not ask them questions. One woman, “Sue”, started running with a neighbor during the pandemic. She was excited to have someone to hold her accountable, and she also thought it would be a really nice way to develop a friendship as they would have blocks of time to chat. Sue talked to me about how, while she had been excited initially to run with her new friend, she was noticing that she felt frustrated when she got home. She realized that her friend almost never asked her a question. Sue would ask her friend about how she was, how her weekend was, how the kids were doing, etc. Her friend never seemed to reciprocate, and this left Sue feeling that her friend was not interested in getting to know her or curious about who she was. Sue tried joking about this at one time to get her friend to ask how she was doing, but Sue’s friend did not ask more questions.
Another friend, “Bob”, talked to me about how his sister seemed very self-focused and almost never asked him questions. When they talked, she would tell him all about her job, her relationship, her upcoming plans; however, she did not ask him about his life. He felt annoyed and frustrated, and he noticed himself pulling back and having less time for her.
Sometimes when I was dating in the past, I would come home and realize, “My date didn’t ask me a single question the whole night!” That led me to feel that he had no interest in getting to know me- and it left me with no desire for a second date. One of the important ways I knew that my now-husband was someone I wanted to see a second time was that, on our first date, he asked me many questions and seemed interested in what I had to say. I loved this, and it was so refreshing for me, after so many solipsistic dates.
I think about tennis when I think about conversations. In a good conversation, there is a nice back-and-forth over the net. Both individuals share and ask questions, and they add to the conversation as it builds. On the other hand, when someone does not ask their conversational partner questions, it can feel like you are a just hitting balls against a tennis practice wall. You are putting all this effort in, and the wall just sits there. This one-sided conversation feels like it does not matter if you are there or not, and it feels like your partner really does not care about you or want to know you better.
I find trying to address this problem difficult, as this is something that that is very hard to change in someone. If your partner is someone that you trust and feel you can speak honestly with, you can carefully try to bring this up. You can let them know that it feels like they rarely ask you questions and explain how this feels to you. However, this is quite delicate and can only be done with someone who is open to feedback and willing to change. I find the other options tend to be to decide to accept the person as-is or to pull back some. In the most extreme cases, where you are engaging with someone who has proven time and again that they are not interested in asking questions and trying to know you, it might even make sense to think about ending the relationship if that is possible or desired.
Having been a therapist and coach for many years, I understand the power of the question. Questions show your conversation partner that you care, that you are listening, and that you want to know more about them. The right question can bring greater understanding or clarity for a person. And a good question can always provoke thought and richer conversation. In an intimate relationship, when both people ask questions and share in a mutually vulnerable way, this can really bring you both closer, and it is a foundation for a good friendship. And when interest and curiosity are not there, a relationship cannot really go deeper.
So I want to end with a couple questions for you: Have you experienced something like this in your life? And, if so, what did you decide to do?
I’m reading Brené Brown’s new book, Atlas of the Heart, in which she describes over 80 different emotions and clusters them in related categories. Why would such a book be useful? While on the surface, it is a simple concept; however, it actually is very educational for most of us, even those of us who are quite aware of our emotions. As Yogi Berra says, “If you don’t know where you are going, you might wind up someplace else.”
This book makes me realize how difficult it can be for us to really know what we are feeling emotionally. Often, people can only name a few emotions when asked to list all the feelings that they know. (Test yourself. List all the emotions you can name in a few minutes.) In our culture, we are taught about thinking and logic, but we are not taught about issues of the heart and emotions.
Having the knowledge and the vocabulary can only help. As the philosopher Ludwig Wittgenstein wrote, “All I know is what I have words for.” Once we have more precise and accurate words for what we are feeling and experiencing, we then have much richer tools for navigating life and relationships, as well as for making good decisions. I often talk to my clients about how helpful our intuition or “gut” is at providing us good information. While there is a condition (alexithymia) where someone has real difficulty knowing what they are feeling emotionally, most of us are just somewhat out of practice.
One way to improve your understanding and awareness of your feelings is to do a 3-Point Check 1-3x/day and to practice getting in touch with your emotions. To do a 3-Point Check, take a few deep breaths and close your eyes if you want. Then ask yourself these 3 questions:
1.What are my thoughts? (What’s going on in your mind? What are you thinking about or paying attention to?)
2.What am I physically feeling in my body? (Are you hot or cold anywhere? Are you in pain? Are you hungry, or are any of your muscles tight?)
3.What am I feeling emotionally? (What is your mood? Where do you feel this in your body? Some people feel their feelings in their stomach, others in their chest. Some feel their feelings in their head. Where do you feel your feelings?)
Taking this pause and checking in with yourself educates you about your heart and gives you a moment to be in the present and to be mindful. It will also help you better understand the differences between your thoughts and your feelings. Often when I have clients do a check in at the beginning of a discussion group, they think they are telling me how they are feeling, but they are actually telling me what they are thinking about. It can be challenging to separate our feelings and thoughts. One clue I often give my clients is that emotions are one word, whereas thoughts are usually a phrase or sentence.
When we practice any skill, we improve over time, so work to improve your self-awareness. Learn to clarify the subtleties between what you are emotionally and physically feeling. I encourage you to try this 3-Point Check 1-3 times/day for the next two weeks. It will anchor you in the moment, and it will help you better color your understanding of your emotions.
Life is busy, and it is hard to be aware and in the present. Our minds regularly think about work and life and what we have to do. We have cell phones to keep us entertained, to communicate, and to see what everyone else is up to on social media. And we have ear buds to always have music in our ears if we want.
With so much going on in our heads, around our heads, and in our lives, it can be challenging to use our senses and be in the moment. But, when we open ourselves up to what is happening right in front of us at this moment, magical things can happen. I got two reminders of this recently.
I tend to work out early in the day, and I love my early morning walks. This time of year, I get the added bonus of seeing the sunrise; in the fall and winter, sunrises are particularly beautiful. Recently, I was walking along the Delaware River watching a lovely sunrise. When I turned around, I realized the sky to the west was even more stunning. The clouds were pink, lit, and vibrant, and the city skyline reflected the rising sun. It was truly spectacular, and it was not where I had my attention or expected the beauty to be.
And the other day, I was working outside in a “streetery” at a coffee shop I love. I was reading a book for a workshop I am creating. I started hearing a noise out of the edge of my awareness, and it sounded like horse hoofs. Now, I am sitting in the street in a busy city, so that didn’t make any sense; however, when I looked up, I saw three beautiful horses being ridden by urban cowboys! It was an amazing moment. They stopped on their ride, and I got to talk to them for a few minutes. I found out it was only the second ride for one of the riders, and I got to pet his horse, Fiona. Not something that happens every day! This was such an exciting and unusual occurrence, and it had me smiling for the rest of the day.
There are so many ways in life now to be distracted. You may hear the word mindfulness and wonder what it means. It simply means to be aware, to be engaged in the present moment. It’s an easy and quick way to help yourself feel more content, calmer, and aware. So, work to find times and places where you are un-distracted. Use your senses- see what you see, hear what you hear, feel what you feel. Smile at someone on the street. Engage in a conversation with someone in a store. Be present and look for the beauty in unexpected places. What you find will surprise and delight you, and it will enrich your life in unexpected ways.
If you ever have the desire to see a perfectly executed eye-roll, or just have a glance at an eloquently blank stare, here’s what to do: Ask another attorney if he or she has been stressed out lately. Pushing the point can escalate the matter from grumbles to outright growls. There’s a good reason for it. Although everyone experiences stress from time to time, attorneys are more likely to suffer from stress more often, and at higher levels, than the general public. The numbers bear it out. Attorneys are 3.6 times more likely to be depressed than people in other occupations, 19 percent suffer from anxiety, and 21 percent have some form of substance misuse disorder.
Stress can negatively affect mental and physical health, cognitive processes such as attention, concentration, and memory. In this article, I want to explain how stress impacts your body, which will enable you to better understand the importance of actively and regularly managing it. I will also discuss several strategies and concepts to consider when planning how you can better address the stress you experience, professionally and personally.
How stress affects the body
One of the most important steps in getting stress under control is understanding how it affects the body. To begin to understand the connection, it helps to understand the difference between the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS).
The SNS is activated in response to a perceived threat, such as encountering a bear while hiking in Wyoming. This is commonly called the “fight, flight, or freeze response.” Stress is the neurological and physical shift that occurs when we detect a threat and is mediated, in part, by the release of certain types of stress hormones (e.g., cortisol). In response to seeing or hearing the bear, the heart rate goes up and blood gets pumped to the muscles. The muscles stiffen and you are ready to respond. Your thinking zeroes in on the here-and-now threat and higher-order thinking (e.g., long-range planning) diminishes. Your body devotes all its resources to the impending threat: digestion slows, the immune response diminishes to save energy, and even sexual responses are diminished.
Once the threat is over, and you have successfully fought off the bear, run away, or frozen (and the bear left), the PNS is more predominant. This is our “rest and digest” response, and this, ideally, should be our baseline condition. Although the SNS prioritizes problem solving, the PNS is more engaged in reflection, a key component of our humanness. The PNS is essential for our health and well-being. It is the state needed for deep thought, connection to others, creativity, sexuality, and digestion.
Our body and mind evolved to respond rapidly to predators, but mostly to be in a state of rest and recharge. However, our modern world, for many of us, has flipped this relationship. Instead, most everything that we experience appears to be a bear.
The relentless nature of modern life and technological stimuli encourage SNS activation regularly. The constant notifications of texts, emails, breaking news, etc. on our phones lead to a stress response and the release of stress hormones. Due to this, consider turning most notifications off on your phone and having phone-free time each day—especially at night. This will help reduce unnecessary stress responses in your body.
At work, deadlines, difficult clients, demanding partners, and billable hours can all trigger the same nervous system response as a predatory threat. When you are in this state, you start to perceive more threats, and this creates a vicious cycle. Further, in this constant state of stress, the part of the brain that manages executive function is less active, and this diminishes self-control and willpower: you might notice that you don’t eat very well or make poor decisions when you are stressed.
When we are in a constant state of stress response, it can lead to anxiety, insomnia, irritable bowel syndrome, muscle tightness, and other chronic physical and mental-health issues (e.g., low mood, lack of motivation, and lower sex drive and energy). Also, of relevance to attorneys, when not properly managed, chronic stress can also contribute to burnout and compassion fatigue.
Managing your stress-doing what works for you
Given all this, it is important to reflect on stress in your life. Which aspects of your stressful life can you eliminate? How can you minimize or lower your levels of stress? Stress reduction will help your body to engage the PNS, bringing you to a baseline of “rest and digest”—the place from which you will be more productive and creative at work.
Stress is something you can learn to actively manage: It doesn’t have to rule your life. Our response to stress, and what helps lower it for us, is personal and individual. When I discuss stress management with my clients, I strongly recommend incorporating strategies that are small, realistic, and doable. What I mean by this is using strategies that you can fit into your life and that are not time-consuming. These activities can be as brief as a two-minute breathing exercise or a 20-minute walk. By being pragmatic, you can figure out what works well for you personally and what you can incorporate in your life daily, weekly, and yearly.
What follows are a variety of strategies, concepts, and options that can help you manage your stress more effectively. Reflect on each one and see if it fits you and your lifestyle. You can do as many or as few of these as you like. Even just one of these tips can be a first step on the path to reducing the impact of stress in your life.
It’s a marathon, not a sprint
I am not crazy (or dedicated) enough to run marathons, but my husband is, and from him I have learned how one needs to approach a marathon. To complete a marathon, you need to determine the running pace that you can sustain steadily for 26.2 miles. This is not the fastest pace at which you can run—it is definitely slower. You also need to figure out when and how you will fuel your body with water and food and when you will rest if needed. The same ideas apply to your life and your career. Like a marathon, go at a sustainable pace, rest and take breaks as needed, and be well-fueled.
Five rules of life
These maxims apply to everyone. You can skimp on them for brief periods of time if necessary, but you cannot ignore these for long. To support your health, mood, and productivity:
1. Eat healthily and enough to fuel you well.
2. Sleep enough and well, for 7-9 hours/night.
3. Drink enough water.
4. Move your body regularly.
5. Relax and recharge.
Exercise is one of the most effective ways to release negative emotions and prevent the risk of burnout. In their book Burnout: The Secret to Unlocking the Stress Cycle, Emily and Amelia Nagoski analogize experiencing our emotions to going through a tunnel. We need to enter the tunnel, move through it, and then come out the other end into the light. It is important that we make our way through the tunnel and do not get stuck. If we get stuck in our emotions and do not complete the stress cycle, we are at greater risk for burnout. Exercise moves us through and out of the tunnel. Additionally, exercise really improves thinking, creativity, and problem-solving—all incredibly important qualities for your work.
You do not need to go crazy with exercising. As I like to say, the best exercise you can do is one in which you will regularly participate. Small periods of exercise are very helpful (e.g. taking a 20-minute walk during lunch, extending your walk to the train or bus after work, taking stairs instead of the elevator). It also is vital to engage in exercise that gets your heart pumping at least four times a week for at least 30-40 minutes.
Breathing is another extremely useful way to engage the PNS. If your exhale is longer than your inhale, it is particularly calming.
One breathing exercise I like to teach my clients is the “4-7-8” breath. It only takes a minute or two and is very effective. To do this exercise, you sit with your arms and legs uncrossed and both feet on the ground. You gently place the tip of your tongue on the tissue right behind your top front teeth. Close your eyes, if you are comfortable doing this. Then, inhale through your nose for a count of four, hold your breath for a count of seven, and exhale slowly through your mouth for a count of eight. You repeat this process either four or eight times, so this takes no more than two minutes.
Other breathing exercises or meditation are very helpful. Guided mediation can be useful if you are new to doing these kinds of exercises or if your mind is very busy. I especially like the app Insight Timer which has over 95,000 guided meditations that can help with calming or with sleep. Some people also like other apps, such as Calm or Headspace.
Mindfulness means paying attention in a particular way: purposefully, in the present moment, and non-judgmentally. “Be here now” is another way to describe being in the present. There are formal ways of being mindful, such as mindfulness meditation, but one can also be mindful in an informal way, paying attention to what you are experiencing right now as you live your life. As I tell my clients, “the present is the most powerful place to be.” If our attention is in the past, we tend towards depression, and when we are thinking about the future, we may experience anxiety.
Being mindful has many benefits, including lower stress, higher happiness, enhanced well-being, lower levels of anxiety and depression, and better physical health. There are many informal ways to be present in your daily life and to bring in the benefits of mindfulness. Options to consider:
· Choose one small activity to do mindfully each day. This could be eating a snack, washing the dinner dishes, brushing your teeth, or any other small thing you do daily. Use post-it notes to remind yourself to do this one activity mindfully.
· Be silent for one or two minutes each day and just be present. Take five or ten breaths and focus on these during this short mindful break. Just focus on your breath, feeling it come in and out. When your mind wanders, just bring it back to the breath. Doing this daily can have a powerful impact.
· Tune into one of your senses when you walk someplace or when you are sitting each day. This helps bring you into the moment and grounds you.
I often speak about the benefits of practicing gratitude. Gratitude decreases stress and increases happiness, improves physical health, and enhances thinking and creativity. Although gratitude is an important part of most religions, you do not need to be religious to benefit from practicing gratitude.
Practicing gratitude can be very short, simple, and pragmatic. I recommend trying to keep a gratitude journal or appreciation log daily for one week and then reflecting on whether this journal or log is beneficial. Keeping a gratitude journal serves a couple good purposes. First, it’s a great way to end the day, by reflecting on specific things we appreciate. Second, it encourages us to pay attention to these small positive things in our life throughout the day.
To start, put a small notebook and pen next to your bed. Each night, just before you turn out the lights, pause and review your day. Write down at least three things that you are grateful for, things that are small and specific to the day. For example, “I had a nice talk with ____,” That tree was beautiful,” “Dinner was great,” or “I was able to work-out today.” Even on the worst day, there are always things to appreciate, such as family and friends, contributing to the profession, having a safe place to live, and so on. The list is endless and it’s just a matter of thinking about it. Once you write, pause for 20 seconds to take in the feelings of gratitude. Research shows that has a positive effect on our brains and neurotransmitters.
Vacations are necessary and non-negotiable. Taking time off is one of the best ways to recharge, refresh, and reinvigorate yourself. It also is a highly effective way to improve your productivity. Many studies show that the more time we take off, the more productive we are at work6. And many Americans, who get less time off than most other developed countries, still do not even manage to use all of their vacation time.
There are so many benefits to taking vacation time. First, the anticipation, planning, and excitement about the upcoming vacation time can be very positive for your mental health. They really lift your mood and give you energy. The idea of an upcoming break can also help us get through our current tasks.
Second, although our culture has created the perception that it is acceptable to work even a little while on vacation, it should be a time when you are truly “off-duty”—meaning not working, not checking work emails, not reading law journals (even this one). We need time not to be working and just to be living. This gives us opportunities to reconnect with ourselves, listen to what we may want to do or enjoy, feel what it’s like to sleep late (or to get up early to spend the day doing what you want to do, not what you have to do), or eat and drink a bit more than usual. It allows us to come back to ourselves, mentally and physically.
Finally, it allows us to reconnect with those important people who we love and with whom we share our lives: partners, friends, children, and relatives. Vacation time is a perfect opportunity to reflect on and remember what we love about these special people. Vacation time makes valued memories, ones that we will look back on in the future with fondness and, hopefully, smiles and laughter. These people and these experiences are what truly matter in life.
Set one goal for yourself
I have just presented you with a wide variety of strategies and concepts which may help you manage your stress more effectively. I did this to provide you a menu of options, not to overwhelm you. As the saying goes, a journey begins with a single step. So, I challenge you: What is one goal you can set for yourself to do this week? Make sure it is small (something you can do in an hour or less), realistic, and doable—and schedule it in your calendar!
 Krill, P. R., Johnson, R. & Albert, L. The Prevalence of Substance Use and Other Mental Health Concerns among American Attorneys, available at J. Addict. Med. Jan-Feb 2016; 10(1): 46-52.
 Skovholt, T. M. & Trotter-Mathison, M. The Resilient Practitioner: Burnout and Compassion Fatigue Prevention and Self-care Strategies for the Helping Professions (3rd ed. 2016).
 Nagoski, E. & Nagoski, A. Burnout: The Secret to Unlocking the Stress Cycle. (2019).
 Southwick, S. M. & Charney, D. S. Resilience:The Science of Mastering Life’s Greatest Challenges. (2012).
 Graham, L. Rewiring your Brain for Maximum Resilience and Well-being. (2013).
HEATHER HERSH, PSYD, is a licensed clinical psychologist, Ivy League professor, and well-being consultant with over 20 years of experience. In her workshops and groups, Heather is an engaging and innovative presenter who brings warmth, compassion, and wisdom to help people move forward in their lives. She specializes in supporting people to improve their stress management, work-life balance, burnout, and mindfulness. After her workshops, participants leave with skills and tools to help them thrive. Heather also supports organizations by doing “deep dives” into an organization’s emotional health and well-being. More information about Heather can be found at thrivewell-being.com.
I recently spoke with Dr. Amanda Swain, a family medicine physician and sleep specialist. She had some very important and useful information about how important sleep is and how to improve your sleep. This interview has been edited for length, clarity, and style.
HH: I talk to my clients a lot about the importance of getting 7 to 9 hours of sleep. Talk to me a little bit about why that’s important and what may happen if someone doesn’t.
AS: I think he first thing people need to figure out, and people can do this with a sleep diary or sleep app (such as CBT-I coach), is how much sleep they actually need. Because not everybody needs 9 or even 8 hours. People can start to track their sleep a bit and get a sense of how they feel throughout the day on various amounts of sleep. They may note that on 9 hours, it may actually be hard to wake up and their energy isn’t as good throughout the day, but wow, if you hit that 7 hour and 15 minutes, that’s a sweet spot that’s just the right amount. So, first, experiment with how much you personally need.
Adequate sleep helps to support all these important processes in the body. Like the ability to concentrate, retain information, and new memory creation. All of these things that are really important to academics and work and executive functioning. And you have the impact on mood, managing stress, and anxiety and depression management. We also know that risk-taking behaviors are higher in people who don’t get enough sleep.
If you’re not getting enough sleep, you may be using substances as a crutch. Like caffeine to get you up in the morning and alcohol in the evening, when you want to relax and try and sleep. Or tobacco or marijuana. We do worry about people using substances to manage what could be best-managed with getting adequate sleep.
And then there are a whole host of physiologic effects. There have been many studies on people who get chronic sleep deprivation, and you can see that their cardiovascular system is not as healthy, so they’re at risk for coronary artery disease, strokes, diabetes, obesity, and a whole host of other medical conditions. It’s not that sleep is the only thing that people need, but it’s hard to overlook how important sleep is in supporting all these other systems. And sometimes people will look and try to figure out what to do about all these other things when you can just take a step back and say, “if we just help you sleep, you’d feel so much better”. Sleep does a lot!
HH: Can you say a bit more about how it impacts mood and thinking if someone is not getting enough sleep?
AS: Most people can probably think of a time when they were truly sleep-deprived, and they can probably remember that there was just so much more emotional lability. They could turn on a dime, felt more tearful. They were really affected by things that normally wouldn’t affect you. The world just seemed so overwhelming. That’s after only one or two nights or a week of sleep deprivation. But for people who are chronically sleep-deprived, it can really take a toll on their health exacerbating any underlying predisposition to anxiety, depression, or suicidality.
HH: This is good. I often talk to people about how not getting enough sleep can affect your mood and your ability to think and remember. Studies show you can be as impaired as if you were drunk if you don’t get enough sleep.
AS: It’s true. There are studies that show that driving while sleep-deprived is similar to driving with impairment from alcohol.
HH: How do you think COVID-19 has changed sleep for people? Have you seen changes with this pandemic affecting people’s sleep?
AS: More people have had concerns about their sleep, in general. This might be because they are spending more time in the home and have more time to focus on sleep and worry about it. It could be that the rise in anxiety in the general population has disrupted sleep. It could be that many people have lost their normal circadian cues that would usually help keep them on schedule. Or it could be due to how so many people are working in the same space where we sleep. This is very confusing for the body in terms of signaling, as the bed becomes part of so many activities. When this occurs, the bed no longer just has a strong association with sleep. If you’re doing many things on the bed, it’s not good. I think there are a whole host of reasons why people have potentially had trouble with sleep during the pandemic. This isn’t just my experience. I went to a sleep conference last month, and this is a recognized phenomenon. In North America, there has been an increase of sleep disturbance and insomnia in the past year.
HH: What are the things you think are most important for good sleep?
AS: That’s a good question. I think I’ll answer it in a slightly different way. I would say there are a few behaviors that people do to help sleep once it comes apart. If I could do anything, it would probably be to educate people on these few things to avoid doing if their sleep gets off track.
One very common misconception is that spending more time in bed is actually good for sleep. The rationale that people come up with, on its surface, is logical- “if I don’t get enough sleep, but I spend more time in bed, I will get more sleep”. But what often happens is that people then spend more time in bed awake, wishing they were sleeping. And so, the first thing I like to tell people is if you’re having trouble sleeping, you actually want to spend the same amount of time in bed you normally do, or better yet, spend less time in bed. What you want to do is really be sleepy enough to take advantage of your time in bed. Resisting the urge to spend more time in bed is key.
And the other thing that I think people lose sight of is that the bed should actually just be associated with sleep. This goes back to classical conditioning and the idea of stimulus control. If you think about little kids, you can put a child in a crib or a bed and if they’re not sleepy, they will do anything to get out of that bed because for them the bed is only associated with sleeping. As adults, we lose that association, and it becomes a substitute for a couch and for a desk and for a table to eat upon. We really want to preserve the bed as a place for bedtime. And aside from sex and sleep, we shouldn’t be using the bed for anything else. When sleep isn’t going well, you really want to limit the amount of time you spend in bed to remind your body of that association. And that will take a few weeks most likely.
And the third thing is that it is helpful for people to get an idea of how much sleep they need. Again, I think they could do this with a sleep diary and something that tracks how they feel through the day. If people think that 9 hours is the gold standard and that they need to get 9 hours, they may be doing themselves a disservice. It’s far better to appreciate how much sleep is just the right amount. Most people have a sweet spot, kind of like our weight. Most of us have somewhere within half an hour of where our bodies do the best in terms of amount of sleep. It’s helpful to get a sense of that and not attach any good or bad association with it. If you need 9 hours of sleep, that’s what you need. Figure it out. Make it happen. But if you’re someone that needs 7 hours, that’s fine. You don’t need to feel like you’re doing anything detrimental to your health if you don’t get 8. Those would be 3 things that come to mind.
HH: What is sleep hygiene?
AS: Sleep hygiene is just the basics of supporting your body in sleep. Sleeping in a dark cool quiet environment. Having some sort of routine associated with bedtime. Not overheating in bed because it’s going to disturb your sleep. Try not to have a screen in your face before bedtime because the bright light is going to interfere with your melatonin. Don’t eat a big meal before bed. It won’t feel good and it can set you up for acid indigestion.
HH: I find that I’m often talking to my clients about it. And one of the things that I find the most important is having downtime before bed. Allowing yourself to prepare for sleep.
AS: I agree. It’s all going back to that stimulus-control thing. You wouldn’t think of doing something high energy and super stimulating before doing something very restful. Like you wouldn’t go jogging around the block before you try to meditate. It feels a little out of sync, and it’s the same with sleep. You want to do some activities that allow you to start to disconnect and slow down and quiet your mind and your body before sleep. Now, some people find a fairly structured routine helps, but for others, they find that to be anxiety-inducing. It’s just important that people find something that works for them. And it doesn’t need to have a lot of bells and whistles. It may be something as simple as showering before bed. Or turning the screen off 30 minutes in advance, washing up, straightening up the bedroom, and getting into bed. I just never recommend that someone powers down their laptop and gets right in bed because those two activities are very different.
HH: I’ll often talk to people about how you have to prepare your body for sleep. And slow things down. What are your thoughts on sleep meditations to help you fall asleep?
AS: That’s what I kind of reference in terms of people getting focused on a bedtime routine. I kind of like to separate activities that require some concentration, like mindfulness, from bedtime. Just because If people don’t feel like they’re getting where they need to be, they’re anxious about going to bed. I tend to say, “if you want to do a mindfulness activity or a mediation, think about placing it earlier in the evening”. Just because I don’t want people to be like, “I have to relax! I have to relax!” right before bedtime. That said, if people find that’s really helpful, great, I’m all for it. As long as they have the insight about whether or not it’s revving them up or feeling like something they have to accomplish. It just depends on how they feel about it.
HH: That makes sense. I really like your approach, how you want to meet the person where they are. What are your thoughts on melatonin?
AS: Melatonin is fine for people who use it to support a circadian rhythm switch. It’s not really designed to be used as a sedative, although it can have that affect in people. Often because it’s used in elephant-sized dosages, like 5mg and 10mg doses at CVS. The clinical dosing that’s been studied is .1-.3mg, so we’re talking about much much smaller doses. So people are going to feel sleepy on larger doses, but then that often leads to headaches, some grogginess in the morning
HH: Are there any things that you feel are effective and safe to help someone sleep?
HH: Yes. There are absolutely times when medication can be helpful, like when someone is really struggling with insomnia. Or someone who, the night before an exam, does everything in their power to sleep well but the anxiety keeps them up. That might be a time that they want to use a medication. There are times to use medication. I just worry about, with melatonin or anything else, that you don’t want someone in a situation where they feel that the only reason that they can sleep is this pill or this oil or whatever it is. Because you’re not doing yourself any favors if you convince yourself that you’re unable to sleep without something that’s external. Sleep is a really really basic bodily process.
For most people, they don’t think about their sleep until it goes off the rails, and all of a sudden, it’s a real issue. I would just encourage people to take their sleep seriously, and if they have concerns about it, they should bring it to the attention of their physician, their psychologist, or their coach. It should be low-hanging fruit in terms of a reason to seek support.
Amanda Finegold Swain, MD is a board-certified family medicine physician who has pursued additional training in behavioral sleep medicine. She practices community-based family medicine at Penn Family Care in West Philadelphia and is a Clinical Assistant Professor in the Department of Family Medicine and Community Health. She also provides Cognitive Behavioral Therapy for Insomnia (CBT-I) through her behavioral sleep medicine practice (www.phillysleepworks.com).
This past year was incredibly stressful, as well as full of loss and grief for most of us. However, it also gave many of us the opportunity to do some things that better supported our well-being. For example, I have heard from clients that they have been sleeping more, cooking more and more healthily, exercising more, and spending more time with their families. The limitations of the pandemic also forced most of us to simplify our lives and slow down, enjoying more downtime at home.
I know for myself, there are a couple things I have really appreciated over this past 15 months. I have been pleasure reading much more. And my husband and I have been walking most afternoons to keep me from going crazy and to get us out of the house. These walks have also been a nice time for us to chat and connect, and I have valued them.
As things are reopening, I am as excited as most to start re-engaging with activities that helped my life feel larger and more enjoyable pre-pandemic. I also find myself wondering how I am going to maintain some of these special things I have gained in my life during the pandemic and how I am going to re-enter life going forward.
While there is much we lost and missed from last year, many of us discovered ways of living that we appreciate and which benefit us. I am hoping that we do not just jump back into living our past life because it is familiar and known. Just because something is comfortable and familiar does not mean it is necessarily positive for us.
My hope is that we will re-enter our lives thoughtfully and mindfully. Through the pandemic, we have been given an extremely rare and valuable opportunity. We have paused living our lives and now have the possibility to take a step back, having gained some distance from how we used to live. This will allow us to carefully determine how we want to live now. What activities do we want to keep? What people do we continue to value? How do we feel that spending our time works best for us?
These three steps can help you move forward and re-configure your life in a thoughtful, optimal way:
1) Take some time, even 10 minutes, and reflect on what you appreciated about this pandemic time. What were your grateful for in how you were living? What have you learned that supports your well-being? Have you been exercising more? Eating better? Sleeping more? Socializing less and enjoying having more downtime? Doing more pleasure reading? Playing games or taking walks with your family? Write down the things that you have been grateful for over the past 15 months.
2) Prioritize these activities and determine the 2 or 3 that you most value and want to keep in your life. Schedule them in your life, on your calendar. Hold space in your life for these activities. Perhaps they will not occur as often as they did during the pandemic, but how can you schedule and keep them? For example, perhaps you were walking daily. Can you now schedule 3 walks in your week? Maybe you enjoyed game-night with your kids several times a week. Can you now make a ritual or routine where one night, perhaps Fridays, will be game night? Hold time in your weekly schedule for these 2 or 3 things that you value and want to maintain as life opens up. Put these priorities in your schedule first.
3) As options and additions come up and you have more activities you can attend- eg. social events, sports for your children- consider in a mindful way what you want to add back in. Will this activity or person feed your spirit or support your health, mentally or physically? Also, learn to say no and value yourself and your time. You do not need an excuse. You can say, “Thanks so much, but that doesn’t work.” Or you can give yourself some space to consider the invitation and say, “Let me check my schedule and get back to you.” And do just that- check your schedule and your gut and determine if you have time and desire to add this activity back in to your life.
This global pandemic was a once-in-a-lifetime event, that changed the world at a global level, and changed each of our lives in a very individual way. While there has been much loss and suffering, it is OK to acknowledge that some of the changes in your life might have been valuable and even necessary to your overall well-being. By being mindful and reflecting honestly on the changes you’ve experienced in the last year, you might discover new habits or hobbies that you wish to keep as a part of your life, even as the world begins to reopen. Take some time to follow the steps described above thoughtfully. Allow yourself to add experiences into your life that you truly want to welcome back, while prioritizing and valuing the pandemic-inspired habits that you want to keep. This unique time of re-engagement allows us to rebuild our lives in a deliberate way that can be even better and more fulfilling than the unexamined lives we once had.
I would love to hear your experiences. Reach out to me in the comments below or on Facebook or LinkedIn and tell me what one pandemic-inspired habit or hobby you would like to keep in your life.
I love plants, and my house is full of them. Plants make a place feel more like a “home”. They bring life, peace, and color to a space. I also enjoy the process of caring for them, watering them, removing dead leaves, and determining how to help them thrive.
For several years, I have had a plant that was doing fine. It was in a small 4” pot. Recently, I realized that I had a larger 9” pot and thought that moving the plant into it might be beneficial. As soon as I moved it, the plant exploded! It grew rapidly, and it was quickly twice as high as it had been. It expanded outward, and it sprouted many new leaves. Definitely, a happier plant!
I’ve been reflecting on this plant and how this growth can really mirror our growth as well. Once restrictions are removed, we can also blossom, grow, and thrive!
For more than a year, our lives have been severely restricted, as if we’ve been put in a too-small pot. We are just beginning to step outside of these artificial, narrow, and diminishing limitations as things in the world begin to expand and vaccinations are on the rise.
While we, and our lives, are starting to open up in this way, I am reflecting on limitations that may come from our world, our families, or ourselves. Our constraints may be self-inflicted, with doubts or fears getting in our way. Or they may be external, with a job or a life situation restricting us. Once we are able to remove the things that bind us, we can learn, grow, and express more of ourselves.
I found this to be true when I started my own business. I had the fortunate ability to leave my last job when I realized that I wanted to work in a different and expanded way, offering options to support people to move forward in their lives. As I started my business, I began to use parts of myself that were long-neglected or that I had never used before. I began in inhabit a new identity as an entrepreneur. I learned new ways to connect with clients and to market myself. I used technologies I had never used before, and I had so much fun working on my logo and building my website. Most importantly, I was able to work in new and different ways with my clients, providing education and support that excited and engaged me. As I speak about resilience, I talk about how we are most able to grow and learn when we take risks and try new things. I clearly saw this in action with myself.
Consider the life lesson from my houseplant. What is your too-small pot? What things constrict you in your life? Are they internal or external? How can you remove them or give yourself more space to grow and learn?
Last spring, I wrote about how the pandemic had constricted and diminished our lives and well-being so that my life’s orchestra now felt like a trio. Things are now starting to expand and open up, and that is both exciting and anxiety-provoking for me. We are living in a complicated time in which we can see the light at the end of the tunnel; however, we really don’t know when we will get there or what it will look like. We are at various vaccine statuses, with some people able to be with friends and family again and others still not protected. Different states are opening up in a variety of ways. Things feel complicated and uncertain in new ways.
A year ago, when I envisioned returning to “normal life”, whatever that means anymore, I was only filled with excitement. I imagined jumping right back into my “old life” enthusiastically. However, after living in masks, socially distant, and in fear for so long, I am changed and possibly a different person. I actually feel uneasy and uncertain also about what it will be like to re-engage with the missing parts of my life.
Some things fill me with unabashed excitement and enthusiasm. My husband and I have tickets to a drive-in concert next month. I am so happy to have something positive to look forward to! Having things to anticipate with joy has been really missing in my life, and I love seeing live music so much! It feeds my spirit and soul, and I’ve felt parched without it. I think I may be so happy that I will cry when Greensky Bluegrass starts to play!
But then, consider hugs. I have barely touched or been touched by a person outside of my husband and hairdresser in a year. I sorely miss hugging my friends and family; however, hugs now seem almost as intimate as sex! Although I’m somewhat joking, I feel like there will need to be a conversation and full consent before I start hugging my friends. And this seems crazy to me, that hugging would feel anxiety-provoking, but it is. The idea of touching friends casually or being near people without masks makes me nervous. I don’t like the person I’ve become, but this year has changed me. I think it will take time and exposure to adjust to the next stage of “new normal”.
So, if you are feeling mixed emotions while imagining things to come, realize that this is normal. Be kind to yourself and determine step-by-step what you need. It is perfectly acceptable for you to do things differently than others or to take your steps at a slower pace than your peers. Be gentle with yourself. Check-in on how you are feeling and what you need. Honor your boundaries and communicate in a clear healthy way what you need- and if you are not ready for certain actions yet.
This past year has really demonstrated that we are all in this together. We need to act together to take care of each other and to be able to move forward. We have all been changed and impacted by this past year in ways we probably cannot even see yet. It is very important that we honor each other and support everyone as we move forward in our own, individual ways.