Sleep coaching (®Klösch & Holzinger) outlined
Part 4: Hypnosis, meditation and relaxation techniques
Summary of the previous parts and introduction
In the first parts of this article, we described what Gestalt is and why we chose it as the frame of our method, we explained why we sleep in our second part of this article dedicated to sleep education and we showed how cognitive behavioral therapy for insomnia (CBT-I) can quickly offer relief to unhealthy sleep.
We know now that we sleep to save energy, to strengthen our immune system, to grow, to regenerate, to consolidate our memory and to filter toxins from our body and our brain.
We described how we live in a 24 hours rhythm called the circadian rhythm, and how the 90 minutes long BRACs influence our sleep pattern and how stress (distress) can cause serious harm to our health and our sleep. We also now know that micro-awakenings are normal and part of the sleep cycle. Sunlight has a positive effect on our health if we expose ourselves to it during the day, but we should avoid exposing ourselves to it before bedtime, as much as to blue light, as it prevents the release of the sleep hormone melatonin.
Most important is to allow ourselves a positive attitude towards sleep, to grant it a place in our field, a place in ourselves.
Putting negative attitudes aside, integrating sleep, enjoying it, welcoming it, if possible with the help of a ritual, are key elements of the CBT-I. These measures once well integrated can keep stress at bay. As stress always can come back, the next time it overwhelms us, we can stop it with an internal stop sign or we carry it into another room and leave it alone in the worry chair while we return to our well-deserved sleep.
If stress returns frequently, then we may need additional, more powerful weapons in order to regain control, namely meditation techniques and hypnosis. This is what this part of our method is about. We will describe some techniques that can be used to find more paths to our inner selves, to balance energies, to prevent a lot of diseases and to make our body and mind happier and healthier. Many meditation techniques include a learning process, but while learning we already can find beneficial effects. Some of those techniques are very easy to learn and can be implemented right away in our lives.
Negative stress, called distress, is the biggest, the “number one”, enemy of sleep. Many of the aforementioned measures are directed against it. The worry chair, the evening walk, the calming scent of lavender, the bedroom as an oasis of peace, to name just a few topics from sleep education and CBT-I. However, these first two elements of sleep coaching only partially deal with the topic of stress, while our third element is solely dedicated to it. Let’s dive now into the worlds of meditation and hypnosis.
History and methods
In the course of the 18th and 19th centuries, medical hypnosis was already being experimented with and much was published about it. What back then was often viewed as charlatanism has now developed and finally found its rightful place in science.
In sleep coaching, we often use elements that could be called autosuggestion, or that are based on autosuggestion, including the CBT-I technique of cognitive restructuring, which I discussed earlier. By the way, autosuggestion only emerged at the beginning of the 20th century with Albert Coué. His findings led to the development of the nowadays highly praised meditation technique called autogenic training, developed in the 30s. We will take a closer look at it a moment, let us stay with hypnosis for now.
The state we reach under hypnosis, this deep relaxation, was first measured with the help of EEGs in 1990, when my Viennese colleagues Gutmann and Walter proved that the brain waves under hypnosis are similar to those of deep sleep. From then on, the researchers have dealt with the topic more in detail and hypnosis is now an indispensable part of the treatment of sleep disorders; it promotes deep sleep and has only one disadvantage: it takes a good therapist who has also been trained in hypnosis to conduct hypnosis sessions.
Self-hypnosis, autosuggestion and autogenic training: all three are very close to each other and easily accessible. There are many publications and also many CD’s, audio downloads or online videos, that lead you step by step into a state of deep relaxation. I myself have already released two CDs, one to help you to sleep better and one to learn lucid dreams, a topic that is particularly close to my heart and which I will deal with in the next chapter of this article.
Both CDs (available only in German) are based on autogenic training, which is particularly effective in relieving from stress. Anyone who decides to use autogenic training in order to cope with stress should be prepared for the fact that the positive effect often only occurs after 8 weeks and only if the exercises are done daily. It takes a little stamina, but the success that can be achieved is well worth every minute of the time. Pure relaxation!
The process of autogenic training can be briefly explained very easily: you lie down comfortably, close your eyes and slowly feel yourself inside your body, repeating mentally sentences like: “I am very calm and relaxed”. The further exercises focus on individual parts of the body that you feel in your mind, repeating sentences of warmth and relaxation in your mind.
Progressive muscle relaxation, or PME for the sake of simplicity, is similar, but before relaxation is achieved, specific muscle groups must first be specifically tensed. This method is aimed at people who are physically predisposed; athletes often prefer this method.
Asian methods of meditation
There are a number of meditation methods, especially from the Asian region, that can be used to reduce stress. Unfortunately, people from a different cultural background like my western European one, did not grow up with those techniques, thus it takes us a long time to understand the mental implication and to learn the precise movements and breathing techniques attached to them. Qigong, Yoga, even Tai-Chi (which can be considered a martial art based on Qigong), for the particularly sporty people: all of them have the advantage of strengthening our cardiovascular system. Many fitness studios now offer courses to learn those methods, also online courses can be helpful but should preferably be done in front of a mirror, as getting the right position is very important for those methods to be effective and also to avoid hurting yourselves by getting into wrong positions.
Qigong is perfect to be practiced in the morning or early afternoon, as it is much about stretching, opening the body to breathe better. Many of us naturally stretch themselves and also yawn while waking up: stretching arms and legs have the effect to allow oxygen to flow in the joints and muscles, thus, our body wakes up “from the inside”. Yawning is basically the same process, with the big difference that it allows more oxygen to flow towards the brain. This explains also why we yawn when we are tired but try to stay awake: our brain claims more oxygen to function better! Now getting back to Qigong, the movements are in a flow, they optimize our blood flow and our breathing, which brings more oxygen to our entire body. Practiced in the morning before work for only 10 to 15 minutes, it will help to focus better when needed and to be physically warmed up, if our work includes more physical activity. As it also has a meditative aspect focusing on awareness of the self, Qigong might also help to prevent stressful events that might occur during the day to affect us and to turn into negative stress.
As you can see, meditation is not only useful once stress becomes a burden, it also can be used as a prevention method.
The second Asian meditation technique I would like to address is the one which has spread also a lot in our western European countries, namely Yoga. Those who never experienced it, might have difficulties with it at first. I just need to remember a friend of mine, whose medical doctor counselled her to learn yoga techniques after she had a first, very light stroke. Cardiovascular diseases are the number 1 death cause in our countries (over 30%) and need to be addressed not only through medication but also through a shift in our lifestyle, especially the ones addressing our stress levels. My friend needed to get her stress level down, as a stroke (even a small one) is a very serious warning from the body, that it cannot cope with a harmful lifestyle anymore. On the day she had her first yoga class, she again was rushing through the day from one appointment to the next, but she managed to squeeze this yoga class in between two business appointments. She told me later how she left after only a few minutes, as “just sitting there” was something she considered as a loss of her precious time, and just thinking about all the things she could have achieved instead of yoga, made her feel even more stressed than before.
This is a thinking that I hear quite often in many different variations and this hesitation might come from the fact, that those meditation techniques do not match our cultural background and the beliefs we grew up with. Meditation in Asia has a spiritual aspect to it that differs from the spirituality in our culture. Maybe for people like this friend of mine, who are used to move fast and to rush, a more physical meditation technique like Qigong would be more appropriate, the same way than the Western European technique of progressive muscle relaxation addresses more physical people than autogenic training. The problem though, is that if a cardio-vascular disease already is there, sport needs to be practiced with care, therefore yoga is safer for starting with than Qigong or even the more martial art branch of Qigong, Tai-Chi. I would advise to simply get into the right mood before joining a yoga class. Do not squeeze it into a busy day, rather try to find a class at the end of the day, so that you can leave all stress behind you and give in to it, take the time it takes to finding the inner peace that yoga can lead to. Some yoga techniques can also be more physical, this depends on the classes and teachers, so make sure to join a course that reflects best your own personality. Trying to learn yoga alone at home is something that I believe will only rarely work: use the opportunity to meet a different circle of people with which you can share non-work-related topics. It might be helpful to use a kind of autosuggestion technique before entering the yoga or qigong class. Repeating to yourself some simple sentences like “I will now reward myself and grant me some time finding inner peace”. Remember that taking care of lowering your stress level and thus strengthening your heart also leads to more healthy sleep: you will be sustaining your health on many different levels.
If you are not a spiritual person, you still can focus on the basic theories of Gestalt and the field. As we already described in detail before, let me just put it here in a nutshell:
You interact with it, you are inherently bound to it and your inner self is more than only you, it involves the whole field around you.
The sympathetic and the parasympathetic
To better explain the link between your stress level, your heartbeat and your sleep quality, let me go into the quite old but still valid thesis about the sympathetic and the parasympathetic.
All possible stress sources (namely stressors), that we might encounter during the day, can be listed into several groups: work issues (including long working hours or the stress of not finding a job/losing a job), family issues (often linked to no clear boundaries set between work and private life), being constantly available through modern tools (like smartphones, modern communication/free time tools like computer games or Tv increasing our adrenaline levels while we quietly sit and cannot act on them). All those daily stressors affect our nervous system, more precisely it affects the electrical impulses of the nervous system linking the heart and the brain, the sympathetic nerve fibers. The counter part of the sympathetic nervous system is the parasympathetic one, linking the brain to the basis of the heart. The parasympathetic nervous system is the one that induces relaxation and the lowering of the heart beat rate.
From a Western European medical point of view, the effect of Asian meditation techniques is to activate the parasympathetic nervous system by strengthening the heart, calming down the stress levels in the brain thus preventing the release of stress hormones, lowering the heartbeat rate, promoting a healthy blood flow, which leads to increased levels of oxygen in the whole body including the brain. Mindfulness could be considered as the spiritual wording to express what leads to this effect. The neuronal interaction between heart and brain is still matter of research and not yet fully understood, though many new studies are being conducted. Some findings can already lead to first conclusions, they show a very positive effect in psychotherapy of exercises strengthening the heart, especially in cases linked to stress. If the heart beats calmly, at a more regular pace, it activates the parasympathetic nervous system and through it, affects positively the brain with a non-verbal message stating: you can relax.
Sleeping is breathing
To continue on this heartbeat path to find relaxation, I would like to approach it by means of breathing, because we can easily achieve a lot here. What happens when we breathe?
When we inhale (breathe in), our pulse speeds up a little. When we exhale (breathe out), our pulse slows down a little. We can use this knowledge very easily, as I found out in an interview with Christian Redl, the world-famous apnea diver. Anyone who achieves top athletic performance under water, i.e. without breathing, simply has to have in-depth knowledge of oxygen, breathing and pulse!
We do not dive under water but instead, in the deep waves of sleep.
Let’s go to bed as relaxed as we can, thanks to our bedtime ritual. Our room is ventilated, the light is off and our eyes are closed. Lying comfortably under the blankets, we can begin our simple breathing exercise. We breathe out deeply and slowly. Exhaling deeply also means that our stomach relaxes. Then we breathe in again, but faster than we breathed out. Our belly also becomes a little thicker, this is the only way we can breathe with our entire lungs and allow a lot of oxygen to flow into our body. Breathe out slowly and deeply again, that’s what we concentrate on. You will always automatically breathe in after deeply breathing out, just make sure it happens fast. Breathe out slowly, breathe in faster … and keep going.
Exhaling slows the pulse, as we learned thanks to Christian Redl. If we breathe in as long as we breathe out, our pulse will stay at the same speed. With the breathing technique as I just described it, the exhalation is longer than the inhalation, so our pulse gradually slows down. The result is obvious: the heartbeat slows down, the parasympathetic is activated and sends its message to the brain, the stress level drops, we slide into sleep. The other advantage is that by focusing our thoughts on breathing, we will not start to brood on an annoying topic and, because we breathe properly, we have plenty of oxygen, which promotes heathy sleep in which our body has the means to properly do its nightly tasks.
So simple and yet so effective. Meditation techniques do not need to be complicated.
How to handle stress during the day
Distancing yourself from the stressor is a good start. This distance can be a mental one, preferably though would be to distance yourself physically. For example, if you work in one room (office) and feel stressed, leave the room for a moment. If this is not possible, turn around, away from the computer or working space. You might be able to look out of the window at the landscape or just close the eyes. Opening the window or going outside also can help, as you benefit from fresh oxygen. This is the starting point for the second phase, the one called regeneration. Sort the issues at hand, name them and set priorities. A short breathing exercise can additionally calm you down and allow a boosting of energy. Now you can focus on the tasks at hand, one by one, setting a new direction to it.
Alternating relaxation phases and active phases is part of the teaching of Helmut Allmer. According to him, it is important to grant the same value to both phases. Allmer’s studies with sport teams noted also a difference in relaxation and recovery after a success in comparison to what happens after a failure. Passive/inactive relaxation techniques such as massages had less positive effect after a failure than after a success. A more physical approach to recovery measures, like walking, proved more successful after a failure, as it allows the athletes to distance themselves from what just happened and thus, the recovery process starts.
Wellness and massages
The most passive way of finding relaxation is probably a massage session. Those massages can also be combined with aromatherapy, which increases the relaxing effect and can already to be considered wellness. One of the reasons why massages are so relaxing, is because they usually take place at another location, away from the stressor: by going to a wellness center or a massage studio, you physically distance yourself from all stress sources, be they of private nature or work related. You enter a different place and state of mind. The second relaxing effect comes from the touch of the massage therapist: physical contact makes your body release endorphins, the famous happy making hormones. The third positive effect comes from the fact, that massaging the muscles stimulates the blood flow and helps the body to clean off accumulated toxins while providing more oxygen to the body.
Altogether a wonderful and relaxing experience, that if the opportunity is given, should always be considered. In Japan, some companies specialized themselves in providing short massages of shoulder and neck during lunch breaks. They address mainly office employees, as working all day in front of computer screens has a stiffening effect on precisely the upper back, neck and shoulders. Those massages are provided while seated and leaning forward. Many of their clients use the opportunity to take a nap of only a few minutes, their head leaning in front of them, right after the massage. This combination sounds like the perfect lunch break, as it has the relaxing effect of the massage and offers at the same time recovery of the brain activity. We can only hope that this kind of service will also spread in our countries.
Biofeedback and Neurofeedback
A more technical and scientific approach to relaxation would be biofeedback or neurofeedback. Those techniques have been developed to specifically address health issues linked to stress, pains, headaches, migraines and many others. Some clinics offer biofeedback techniques to specifically address sleep disorders. The treatment starts with sensors being placed on the body and the head. Those sensors are linked to a computer and measure heart rate, blood pressure and muscle tension to assess the stress level. Depending on the device, it shows on a graph how tense the patient/client is and it emits a sound when the stress level rises. This teaches the client to better realize what his body feels like when under tension, as very often people have difficulties assessing their stress levels. With those feedbacks, they become more aware of their bodies and minds and learn how to control their stress levels, how to relax themselves. Several sessions are necessary to reach the self-awareness level that makes the machine obsolete and the treatment successful.
There are different kinds of Biofeedback. Some measure the breathing pattern, some the heartbeat, some the electrical activity of the brain or the skin temperature. The principles are similar and the choice depends on the issue at hand. With biofeedback training some researchers seem to have treated successfully even clients suffering from sleep apnea, bruxism, ADHS and Restless Leg Syndrome. It might even help clients suffering from COPD by increasing their lung function as biofeedback increase the patient’s adherence to pulmonary rehabilitation exercises. As COPD can lead to sleep apnea, or at least worsens the symptoms of sleep apnea, this treatment might be of great help also to improve sleep quality.
In many cases, biofeedback training can support awareness and through it, help the client/patient to assess better the relaxation state of their body and learn more precisely how to find relaxation within their inner selves. Of course, the disadvantage to it, is that you need to find a clinic or a practitioner specialized in biofeedback and sleep related issues, but the advantage is that it addresses more than only stress related issues, it can help even in cases where of a physical issue led to unhealthy sleep.
Relaxing too much?
For some people, mediation and relaxation have a positive connotation, unfortunately, it is not the case for everyone. Some people consider being relaxed the same than being lazy and slow thinking. Though it is quite the contrary, this negative image of relaxation is widely spread. This is how it happens that in a work environment, when the boss comes by, people who are calmly fulfilling their tasks start moving more hectically in order to appear busier and more dynamic. The same often happens within families. There is a lot for us to learn here. Being calm and relaxed helps to focus better, the blood flow is strong and brings a lot of oxygen to the brain, thus we are actually more productive. If everyone would know that, there would be no need for pretending!
Nonetheless, the question if we really can relax too much, is a legit one. Like in most things, we need to find the right balance between relaxation and activity. If before work we dedicate 15 minutes to Qigong, we will be more resilient to stressors and will have a perfect state of mind to focus while at work. If we make some breathing exercises at bedtime, we will have a healthier sleep and benefit from all the advantages that come with it. This does not necessarily mean that more is better. The right balance between relaxation and activity varies individually. It is a matter of personality and also a matter of the field we are living in. Meditating includes an active component as we have to work on it, the issue at hand is rather to find relaxation within our definition of it.
Relaxation often has the connotation of “doing nothing” and giving in to laziness and lethargy. Contrary to common beliefs, “doing nothing” can actually be stressful, as in the back of our minds we might find a little, but nonetheless loud voice claiming attention and reminding us all that should have been done, is still to achieve or is missed out. Relaxation should therefore not be confused with “doing nothing”.
If you feel like doing nothing, you might want to take a little walk, this is way more relaxing than sitting on the sofa (and pondering about all the things that should still be done) and this would benefit your health. One technique of meditation actually is called mindful walking. In this technique, walking does not mean going from A to B, rather the goal is to focus on the walking itself, on the breath, every single step, observing the structure of the ground you walk on, on the slowly changing landscape and so on. The mindful walking is derived from ZEN Buddhism and has been proven effective to combat stress also within medical studies. One of the most famous promoters of mindful walking was the Buddhist monk Thich Nhat Hanh, who called it “Walking Mediation”.
Staying calm and relaxed means staying healthy and productive while experiencing improved life quality and more joyful moments. There are so many different relaxation methods, that I could only present here some of the possibilities. The preferences depend on the personality and on the cultural background and no matter which technique you choose, the important thing is to give into it, enjoy it and find peace of mind.
Once you can go to bed fully relaxed, the moment is ideal to turn to the world of dreams. This is the last element of our method and at the same time the element that makes the sleep coaching method sustainable. In the next chapter we will describe the role of dreams, how to understand their messages, what to do with them and, of course, the very important topic about how to cope with nightmares will be addressed.