On Happiness (part 1 of 2)

August is  “National ‘Admit You’re Happy’ Month” –Who knew?

And what better time, thought I, to focus on the topic of happiness than the sunny days of summer?

Still, as I thought about writing about it, I hesitated…for kind of a long time.

The thing is, I’ve long had a kind of prejudice against the idea of “happiness,” as I understood it. It seemed like a basically shallow experience to strive for (sort of like wishing for “joy, lite”), based as it is (was my thinking) on external factors that come and go, and on our basically ego-centered desires and aversions. As opposed to those deeper, less conditional experiences of joy, for instance, or of love, both of which can involve the experience of happiness, but both of which can be present without it (for more on this distinction, see my earlier post on joy ). 

But I’d also started to question my prejudice against happiness (which prejudice sounds as ridiculous as it is, when I see it in print!), since there’s no question that people with generally happy dispositions (or who are otherwise able to experience happiness) are more resilient in the face of adversity, have better relationships, and experience better physical health, among other benefits.

I was also aware that His Holiness the Dalai Lama himself talks a lot about happiness, and its importance to human life. He even wrote  the book on it: The Art of Happiness , which has become a classic on the subject (he has also written The Book of Joy ) “If the Dalai Lama is that enthusiastic about happiness,” I thought, “maybe I should…reconsider it.”images

So I started reading, and found his essential thesis to be simple, and unequivocal: that happiness is the purpose of life. And, in being what our lives most essentially lean toward and reach for, the longing for happiness, he says, is deeply connected to the experience of hope, without which (hope) we die.

In  Compassion as the Source of Happiness  (a teaching on the Dalai Lama’s website), he explains why:

“[O]ur survival is based on hope – hope for something good: happiness. Because of that, I always conclude that the purpose of life is happiness. With hope and a happy feeling, our body feels well. Therefore, hope and happiness are positive factors for our health. Health depends on a happy state of mind. […]

He then goes on to locate happiness within the larger scope of human experience:

This is the basic human level that I am speaking about; I am not speaking about the religious, secondary level. On the religious level, of course there are different explanations of the purpose of life. The secondary aspect is actually quite complicated; therefore, it is better to talk just on the basic human level. 

So what is that level, and what is its happiness made of?

The basic elements for [happiness] are compassion and human affection, and these come from biology. As an infant, our survival depends solely on affection. If affection is there, we feel safe. If it’s not there, we feel anxiety and insecure. If we become separated from our mother, we cry. If we are in our mother’s arms and held tight, warmly, then we feel happy and we’re quiet. As a baby, this is a biological factor.

This makes such total sense to me that it dissolved my problem with happiness on the spot. How could I have forgotten about  Maslow’s Hierarchy of Needs ? What I then understood was that happiness — the hope for happiness, and the ability to strive for and receive it– rather than being essentially shallow, is essential and necessary (not in itself sufficient, but definitely necessary) to our full access to other levels of experience (joy, say, and love). That it’s a biological need, and given that our bodies are where all the other dimensions of our being –spiritual, mental, and emotional– “live and move and have their being,” the hope for happiness –for the creature comforts (literally) of safety, security, connection, and pleasure–is necessary to our ability for those other dimensions to develop and to thrive.

Ironically, for all my (previous) difficulty with the concept of happiness, Jane Kenyon’s poem, “Happiness” has always been one of my favorites. images-1Kenyon herself struggled throughout her life with sometimes crippling depression, and died in 1995 at age forty-seven.  And I think it is in how the poem at once comprehends and acknowledges the ways that happiness can show up within and beside suffering (not in place of it),  its qualities of universality and surprise, and the dimension of grace involved that move me so in Kenyon’s poem.

The poem begins:

There’s just no accounting for happiness,
or the way it turns up like a prodigal
who comes back to the dust at your feet
having squandered a fortune far away.
And how can you not forgive?
You make a feast in honor of what
was lost, and take from its place the finest
garment, which you saved for an occasion
you could not imagine, and you weep night and day
to know that you were not abandoned,
that happiness saved its most extreme form
for you alone.     
(click here to read the entire poem, which can also be found in the collection below)


Next post: “Cultivating the Habit of Happiness”

“Care of the Soul”

Twenty-five years ago, American psychotherapist and ex-monk Thomas Moore published  his book, Care of The Soul…and it immediately struck such a chord for so many readers that the book spent forty-six weeks on the New York Times best-seller list, and has been reprinted many times since.295132

Gathering some books from my shelves to accompany me on a soul-needed retreat recently, the title caught my eye, and I took it with me. Gratefully re-reading it over the course of my week of reflection, it was as though I was reading it for the first time, reminding me of how timely and timeless Moore’s words remain.

So what was the chord it struck then, and now? Maybe it is in the way the book speaks to the longings of so many among us to find a way to reintegrate spirituality (a sense of connection to mystery and meaning) into our lives—lives that have become weary and guilt-ridden as a result of all that problem-solving and striving for “self-improvement”  that our “can-do” culture tends to pursue (and to encourage), and that many (even most) standard therapy approaches reinforce.

“In the modern world we separate religion and psychology, spiritual practice and therapy,” writes Moore, in the introduction to the book. It is a separation, he says, that was unknown in earlier centuries of healing practices in the western world. But in our nation’s founding zeal to separate church and state in order to ensure for all the freedom to choose and to practice religion (or other spiritual practice) without persecution, we ended up pretty much throwing the “baby” (the conversation about the life of the soul) out with the “bathwater” (the power of any given religion to dictate the lives of its citizens), at least in secular life. As a result, modern psychology has become essentially secular and ego-centered. About the “self” (the ego) that is, but not about the “soul.”

With the soul having become off-limits to the field of psychology, psychology ended up aligning itself at the beginning of the 20th century with medicine: a safely “scientific” field which itself had become interested in understanding and treating mental and emotional disorders.

A result, however, was a severe impoverishment of the earlier scope of modern psychology, and a growing emphasis on “cure” (of symptoms) versus “care” (of soul).

And here’s the big irony: the word “psyche” itself in Greek means “the soul, mind, spirit, or invisible animating entity which occupies the physical body,” with “psychology” supposedly the field of knowledge of exactly that, and “psychotherapy” its tending practice.

In effect, then, we ended up with a “psychology” and “psychotherapy” without “psyche,” and treatment reduced to what could be called (I’m making this up:) “egotherapy.”

And it is that ancient understanding of the psyche/soul (the existence of which was assumed by both secular and religious peoples until very recent centuries) that Moore means when he talks about “soul” in the book: less a “thing” (in the object sense of a “thing”) than it is “the font of who we are […] holding together mind and body, ideas and life, spirituality and the world.” A dimension of our lives with a life of its own, distinct from the ego, connected with all other lives and with the source of life itself. “We can cultivate, tend, enjoy and participate in the things of the soul,” Moore says, “but we can’t outwit it or manage it or shape it to the designs of a willful ego.”

From the point of view of an ego-focused-but-soulless psychology, suffering and its symptoms are assumed to represent some kind of individual or relationship failure or imperfection. Add to that the medical point of view, and we have a way of looking at symptoms as indicative of a “disorder” or a “disease.” From both points of view, suffering and its symptoms represent “problems to solve,” which view encourages ever more striving for the perfection of some idealized self and trouble-free existence— a striving which, being futile, only leads to more suffering.

In contrast, Moore says, to attend to the soul is to understand that the soul’s life is, by nature, “complicated, multifaceted, and shaped by both pain and pleasure, success and failure.” It is a life “not without its moments of darkness and periods of foolishness.”  But instead of labeling these experiences as “bad” or “good,” or representing “problems to solve,” care of the soul focuses on the opportunities and possibilities that are inherent in all experiences for growing in “self-knowledge and self-acceptance, which are the very foundations of the soul.” It is an approach that also focuses on listening for, and giving the soul what it needs  to cultivate its well-being, many of which things might be quite ordinary: “more time in the garden,” say, or “a change of scenery,” or “taking the time to savor your food without checking Facebook at the same time.”

In essence, says Moore, The aim of soul work…is not adjustment to accepted norms or to an image of the statistically-healthy individual. Rather, the goal is a richly elaborated life, connected to society and nature, woven into the culture of family, nation, and globe. The idea is not to be superficially adjusted, but to be profoundly connected in the heart […] to all the many communities that claim our hearts.”


For more (including specific ways to put this into soul-tending practice, get a copy: Care of the Soul: A Guide for Cultivating Sacredness in Everyday Life, by Thomas Moore. New York: Random House, 1992.

“On Kindness”


Before you know what kindness really is
you must lose things,
feel the future dissolve in a moment
like salt in a weakened broth.
What you held in your hand,
what you counted and carefully saved,
all this must go so you know
how desolate the landscape can be
between the regions of kindness.
How you ride and ride
thinking the bus will never stop,
the passengers eating maize and chicken
will stare out the window forever.

Before you learn the tender gravity of kindness
you must travel where the Indian in a white poncho
lies dead by the side of the road.
You must see how this could be you,
how he too was someone
who journeyed through the night with plans
and the simple breath that kept him alive.

Before you know kindness as the deepest thing inside,
you must know sorrow as the other deepest thing.
You must wake up with sorrow.
You must speak to it till your voice
catches the thread of all sorrows
and you see the size of the cloth.
Then it is only kindness that makes sense anymore,
only kindness that ties your shoes
and sends you out into the day to gaze at bread,
only kindness that raises its head
from the crowd of the world to say
It is I you have been looking for,
and then goes with you everywhere
like a shadow or a friend.

(“Kindness,” by Naomi Shihab Nye)

As do many who know it (and many do), I cherish this poem– one of the poems which continues to deeply, directly, even intimately in-form me as I meet the challenges of live and love.

But what I want to write about here is not so much “kindness” itself (the poem does that, and beautifully), but about how writing (and reading) poems is such a powerful way to take what we suffer —what we think and feel and lose and grieve and love and celebrate— and take ourselves somewhere by giving these things shape and form with words.

Truly, poetry (along with movement and music) is one of the most powerful mental health tools I know.

I have been thinking about this again as we enter poetry month (every April!), and of the words and the poetry  specifically of poet and teacher, Naomi Shihab Nye. In an interview a couple of years ago with Krista Tippett (on the wonderful radio program, On Being) Naomi spoke beautifully about exactly that, with a story about how the poem above came to be in her own life. So I’m just going to let Naomi do the talking from here, from a transcript of that July 28, 2016 interview:images-1

One thing I’ve tried to say to groups over the years, groups of all ages, is that writing things down, whatever you’re writing down, even if you’re writing something sad or hard, usually you feel better after you do it. Somehow, you’re given a sense of, “OK, this mood, this sorrow I’m feeling, this trouble I’m in, I’ve given it shape. It’s got a shape on the page now. So I can stand back, I can look at it, I can think about it a little differently. What do I do now?” And very rarely do you hear anyone say they write things down and feel worse.

They always say, “I wrote things down. This isn’t quite finished. I need to work on it.” But they agree that it helped them sort of see their experience, see what they were living. And that’s definitely a gift of writing […] It’s an act that helps you, preserves you, energizes you in the very doing of it.

She then tells about the experience that resulted in the “Kindness” poem:

My husband and I were on our honeymoon. We had just gotten married one week before […] And we had this plan to travel in South America for three months. And at the end of our first week, we were robbed of everything. And someone else who was on the bus with us was killed, and he’s the Indian in the poem. And it was quite a shake-up of an experience. And what do you do now? We didn’t have passports. We didn’t have money. We didn’t have anything. What do we do first? Where do we go? Who do we talk to? And a man came up to us on the street and was simply kind and just looked at us, I guess could see our disarray in our faces.

And just asked us in Spanish, “What happened to you?” And we tried to tell him. And he listened to us, and he looked so sad. And he said, “I’m very sorry. I’m very, very sorry that happened,” in Spanish. And he went on. And then we went to this little plaza, and I sat down, and all I had was the notebook in my back pocket and pencil. And my husband was going to hitchhike off to Cali, a larger city, to see about getting traveler’s checks reinstated. Remember those archaic things?

And so this was also a little worrisome to us because, suddenly, we were going to split up. I was going to stay here, and he was going to go there. And as I sat there alone, in a bit of a panic, night coming on, trying to figure out what I was going to do next, this voice came across the plaza and spoke this poem to me, spoke it. And I wrote it down.

It helped her through the moment, as a stranded 20-something woman, writing things down…but it did so much more: it made her heart larger, and her compassion deeper, in the way that can only happen when we lose all the strategies (money, privilege, judgement, distraction) we use to insulate ourselves from the felt-knowledge that this could be you. But that transformation and deepening can perhaps only happen when we also pause and pay attention to that experience; when we listen to our suffering through language (which could as well be the language of paint or of music, or another), instead trying to get away from it, till [y]our voice/ catches the thread of all sorrows/ and you see the size of the cloth. It is a state of being that poet Kaveh Akbar  has called a kind of “permeability to wonder,” which is also the door to joy .

To listen to the complete podcast of Krista Tippett’s interview with Naomi Shihab Nye, click here )

Then go write something down.





The Gift of Heartbreak

(Okay, maybe that’s saying a little much. How about “The Gift in Heartbreak”?

In the month of daffodils and Valentines, I started wondering about the history of Valentine’s day, starting with the question, “who was St. Valentine, anyway,?” The answer seems to be lost in the murky history of the Middle Ages.

downloadIn one story, St. Valentine was beheaded for marrying young couples in Rome against Emperor Claudius’ decree that Roman soldiers remain single, so that they would remain more singe-focused as soldiers. In another story, he was killed for helping Christians escape from Roman prisons.

There are other stories also, but I was struck by how they all seem to involve as much or more heroism and heartbreak in the service of love than any of the emotionally delicious-but-safe sentimentality associated with the day named in the saint’s honor.

Which in turn made me think that maybe February would be the perfect month to write about the importance of heartbreak to how we grow in love (a downer of a beginning, I know…but read on! )

Several months ago, I read a wonderful magazine article by Glennon Doyle Melton, entitled “Important Lessons You Can Learn From Heartbreak.” In it, she begins by describing how her own, decades-long addictive involvement with food and then alcohol was a way, she realized in retrospect, to insulate herself from the unavoidable vulnerability of love. “If you couldn’t reach me, you couldn’t hurt me.” she writes, and  “I hid within my addictions for years.”

Ultimately, Melton goes on, she made her way to her first recovery meeting, which is where she began to learn to allow herself to be touched by pain and loss (especially the pain of things we can’t “fix”), and to even embrace these as her healers and teachers.

In our lives today, maybe it’s the homeless person we look away from, or suffering animals we can’t rescue, or refugees we see on the TV news. Maybe its a dying friend who is frightened and in pain whom we can’t bear to visit, our excuse being that it is too heartbreakingly painful to see him or her “that way.” Behaving (as Melton puts it:) “as if our hearts were meant to be returned to our maker in pristine condition!”

Quite the opposite. Explains Melton: “The heart is like any other muscle: it has to be worked, even ripped apart in order to grow stronger. We must get familiar with heartbreak, become curious about it, because there we will find essential clues for solving the mystery of who we are intended to be.”

As an example of the power of this kind of embrace, she then describes a group of women who’d each lost a baby in infancy or at birth.  “In 2003,” she writes, “they formed a sisterhood and then an advocacy group: ‘Healthy Birth Day.’ Together, through education and other kinds of support, they’ve contributed to lowering the stillbirth rate in their state so significantly that doctors are scratching their heads. My theory? Instead of withdrawing after their losses or finding ways to disconnect from the magnitude of their suffering, they ran straight toward it. Their pain became their fuel. Their courage saved others from the misery they’d experienced.”

Just like St. Valentine did.

So this Valentine’s Day, we might each ask ourselves what in the world breaks our hearts? Children who are being hurt or neglected? People going hungry? Violence against women? A personal loss we are not allowing ourselves to grieve?

Then maybe ask, “What are the ‘go to’ behaviors (judgement, avoidance, distraction) or substances (food, alcohol, or something else) I use to avoid my heartbreak, that so-necessary (because it’s the only thing that can create compassion in us) but so uncomfortable part of love?”

And what would it mean to move toward it instead, with courage and trust that it will take us deeper into love?

“Pain knocks on everyone’s door,” Melton writes, and “If we are wise, we will greet it and say, Come in, sit down, and don’t leave until you’ve taught me what I need to know.

Water on walkway, Riverfront Park. Salem, OR 2017


“Every Angel is Terrifying”


2017 was a rough year in this country.

Some practices by way of which I have tended (and continue to tend) my own mental health include participation (in both resistance and support in the public sphere), yoga (and regular meditation practice) in the personal sphere, and —again and again— poetry. 

 I have been especially drawn back lately to the poems of Rainer Maria Rilke, especially his  Duino Elegies.  Rilke was born in 1875 in Prague, but after its occupation lived most of his life in France, writing in German.

I’ve also been reading the poems of the more contemporary Eastern European poets whose lives and work were forged in the fires of fascist and totalitarian political regimes. Among many poets from these countries and eras (Adam Zagajewski, Wisława Szymborska, and others), I have been re-reading Czesław Miłosz in particular. Having lived in California for decades after his political exile from Lithuania in 1940, he was eventually able, in his final years, to return there in 1981, after the restoration of Lithuania’s independence.

At a time in which “political catastrophe has defined the nature of our age,”  as Terrence Des Pres has put it, Miłosz’s poems grapple with the central issues of our time, those being (Terrence Des Pres again:) “the impact of history upon moral being [and] the search for ways to survive spiritual ruin in a ruined world.” As does Rilke, in his way, grapple over and over with the mystery of being, and with the potential of sorrow and of longing to deepen and transform our existence, to the degree we participate and surrender to Mystery  as our very mission

Both poets also explore the ways in which there are many voices and forces within each of us, not particularly in harmony, and about the way poetry offer witness and shelter for one and all. When so much of the suffering that we as a species inflict on each other is a direct result of the way we project all our own inner “demons” (all those parts of ourselves with which we are most uncomfortable) onto “the other,” demonizing the other instead (“the wounds by way of which we wound others” as I have heard “sin” defined), the importance of poetry as a home and a mirror for all that we contain cannot be overstated. As Milosz writes in the poem “Ars Poetica,”


“The purpose of poetry is to remind us

how difficult it is to remain just one person

for our house is open, there are no keys in the doors,

and invisible guests will come in and out at will.”


So here are a couple more excerpts from some others of Miłosz’s poems (all of which can be found in his  Selected Poems, 1931-2004.), and two excerpts from Rilke’s  Duino Elegies. And while, for me, the excerpts themselves stand alone powerfully as aphorisms, I hope they will lure you into the deeper dive of the poems from which they come.


“This hasn’t been the age for the righteous and the decent. 

I know what it means to beget monsters

And to recognize them in myself. ”  

                                       (From “Winter,” Miłosz)



“In our lives we should not succumb to despair because of our

errors and our sins, for the past is never closed down, and receives the

meaning we give it by our subsequent acts”

                                   (From “What I Learned from Jeanne Hersch” Miłosz)



How we squander our hours of pain

How we peer past these into the bitter distance

to see if they have an end. Though they are really

our own seasons, our winter evergreen foliage,

ponds, meadows, our interior landscape,

where birds and reed-dwelling creatures are at home.

                                (from Rainer Maria Rilke, “The Tenth Elegy” [translation mine])




Who, if I cried out, would hear me among the angels’ hierarchies?

and even if one of them pressed me suddenly against his heart:
I would be consumed in that overwhelming existence.
For beauty is nothing but the beginning of terror, which we are still just able to endure,
and we are so awed because it serenely disdains to annihilate us.
Every angel is terrifying.
And so I hold myself back and swallow the call-note of my dark sobbing.
Ah, whom can we ever turn to in our need?
Not angels, not humans, and already the knowing animals are aware
that we are not really at home in our interpreted world.


Yes–the springtimes needed you. Often a star was waiting for you to notice it.
A wave rolled toward you out of the distant past, 

or as you walked under an open window, a violin yielded itself to your hearing.
All this was mission. But could you accomplish it?

                                                     (excerpt from Rainer Maria Rilke, “The First Elegy” [trans.                                                           Stephen Mitchell])



“Taking Care,” Part 2

(Note: the following post will mostly be of interest to members of the South Wasco County , Oregon “community of care”:)

In October, a few members of the South Wasco County community who are primary caregivers to older, cognitively-impaired, or otherwise disabled family members, gathered at Canyon Wren Wellness Center for the first of two community wellness classes on the topic of “Taking Care.” It was a rich evening of support, ideas, and information-sharing. As one participant said, leaving, “My shoulders feel much lighter!”

A few more people attended the November class, and the response was similar: participants spoke about how helpful it was to receive information about specific medical conditions, community resources, specific strategies for care and self-care, and to share support and hope with others who understand the challenges and satisfactions of family caregiving. And everyone agreed about how good it was to be able to meet in our local community, when the demands of caregiving itself make it difficult to leave home for the time it takes to attend a group, much less the two hour round-trip involved in going to and from a group in, say, The Dalles.

When Steven Woolpert (behavioral health specialist at Deschutes Rim Clinic) and I initially planned the two-session “Taking Care” class, we had intended it to be just the two classes, but with the idea that if the interest was strong in continuing it, we would consider that, too.

Well, the interest was definitely strong! Everyone in the group was eager for it to continue, and several people said they planned to encourage other family caregivers they knew to go, based on their own positive experience. So, Steven and I have agreed to continue “Taking Care” as an ongoing, monthly information and support-sharing group for family caregivers.

Just as with our community wellness classes in the past, the group is open to anyone to join at anytime, and there is no charge to participate: the group will continue to be co-sponsored by Canyon Wren Wellness Center and Deschutes Rim Health Clinic as a community service, with Steven and I co-leading.

The next “Taking Care” group gathering will be on Tuesday, December 19 from 5:00-6:15 pm at Canyon Wren Wellness Center. So if you live in the South Wasco County community, and would like to be on the email list for information and reminders about the class (whether or not you plan to come), please let me know by leaving a message at 503-838-6144, or email  canyonwrenwellness@gmail.com, and I will be glad to add you to the list.

Deschutes River, Maupin. Photo by Kathi Ringo

And speaking of “taking care,” I can’t stop talking about how excited I am about the Deschutes Rim Clinic’s new facility fundraising campaign, and by the ways the community and the state legislature, both, are supporting its success! As you may already know, the fundraising dinner at the Wamic Community Center in November was an overwhelming success, with contributions from the community that evening exceeding even the most optimistic guestimate.

What that tells me in turn is that we as a community know how very, very special and crucial, both, the presence of high-quality, local health care is to the “well-being infrastructure” of our community.

When I was fresh out of training in the early 1980s, my first professional job was as a school social worker in Linn County, providing family and individual counseling and parent support services to kids and families in and beyond Lebanon and Sweet Home. Since there was only me, much of my work involved helping people connect with the community social services they needed. But while the need was huge, at that time local services simply did not exist, and (as in so many rural areas) access to services in the nearest cities was often a deal-breaker: parents, if they worked, could not get or could not afford to take the time necessary to drive the hour or so involved in getting to Albany, where county health and mental health services were located…and those who were unemployed could not afford the gas to get there. 

I did that work for seven years, and my experience resulted in a career-long dedication, in the 25 years since, to locating my own practice in the rural and small towns in which I have lived, instead of in whatever the closest city might be.

A little earlier, I spoke of how lucky we are to have “high quality local care” at Deschutes Rim, and I want to say that again: the primary care available at our local clinic is not only convenient, but it is really, really good. I know that for many of you reading this, I am telling you something you already know, but I am too impressed and too personally grateful not to say so for the sake of anyone who may not yet be aware of it! 

When we first moved to Maupin, my husband and I both established with primary care providers in The Dalles, in part because we didn’t know the community well yet, and because we moved here in the midst of some health issues requiring ongoing specialty care. So it seemed best at the time to just get all our healthcare in The Dalles. But we have both since transferred our primary care to Deschutes Rim, and we couldn’t be happier. Not only because we receive such excellent care nearby, but because it is a way also of “being there” for the services that we depend on, which in turn helps those services to continue to be there for all of us in this community.

In this season of giving, I hope each of us will think about how we might give an extra gift of our resources —money, time, or something else— to the community (the clinic or something else) that supports us each and all.

It’s all about taking care.

A Good Night’s Sleep

If that headline caught your attention, you may be one of the 70% (by one estimate) of Americans who have trouble falling asleep, staying asleep, or waking up feeling rested from sleep. If you don’t sleep well, you are probably quite aware already of the ways sleep deprivation lowers energy and impairs judgment, mood, concentration, coordination, comprehension and memory.

These days, medical science is even more concerned with the growing evidence that insomnia is one of the most powerful contributors to such major health problems as obesity, diabetes, heart disease, hypertension, immune system disorders, severe mental illnesses, general disease risk and overall life expectancy.

While the specific science of this is beyond the scope of this column (though it’s pretty interesting stuff!), it comes down to the fact that chronic sleep deprivation increases inflammation levels in the body…and inflammation is now known to play a key role in the development and maintenance of many chronic diseases.

So if you or yours have persistent difficulty with getting a good night’s restful sleep, it is something to take seriously, and to take steps to address: your overall health depends on it!

In planning my topic for this month’s column, I had intended to write about a topic associated with military veterans in some way (since it’s Veterans’ Day Month),unnamed which was exactly what got me to the topic of sleep, since sleep is one of the most prominent and frequent symptoms of Post Traumatic Stress among veterans of deployments, and one that makes other symptoms worse.

According to the Dept of Veterans’ Affairs, insomnia has been found to occur in 90-100% of Vietnam-era Veterans diagnosed with Post-Traumatic Stress. It was also the most commonly reported symptom in a survey of Veterans from Afghanistan and Iraq.

Given the demands of the job for active duty servicemen and women, problems with sleep are hardly surprising: soldiers are trained to be highly and persistently vigilant, able to instantly react in case of need. And once the most reactive part of our nervous system (that fast-acting part of our brains connected with our fight-or-flight response) has been trained to remain always activated or ready to activate, re-training to relax is…well, complicated.

Which is why, in their trainings for behavioral health therapists on a range of conditions (but especially for trauma-related conditions), the U.S. Center for Deployment Psychology (CDP) places tremendous emphasis on accurately and thoroughly evaluating and treating problems with sleep. And because the factors that may be contributing to insomnia for one veteran  (or civilian, for that matter) may be very different from that of another, (even if both have experienced acute or prolonged trauma), The CDP advises that behavioral health therapists begin with a detailed, exhaustive (these take a couple of sessions just to complete) structured interview in order to comprehensively review and  identify potential contributing factors. Clients are asked, meanwhile, to complete a detailed sleep diary for a couple of weeks. Click here for these resources)

What I have learned from using both these tools with people in my practice is how very individual and complex a given person’s sleep problems can be –civilian or military– and how very important it is, therefore, to take whatever time it takes to gather all the data that might even possibly be related to a given person’s sleep issues. Often, in the process of doing so, surprising discoveries are made that can naturally suggest a remedy.

All that said, everyone with sleep difficulties would do well to start with the basics of what is antiseptically referred to as good “sleep hygiene,” since the strategies involved can go a long ways toward ensuring a good night’s sleep. But don’t take my word for it— give them a try!

1) Avoid caffeine, alcohol, nicotine, and other substances that interfere with sleep


News flash: caffeine and nicotine interfere with restful sleep, and are generally best avoided for four to six hours before bedtime. And while alcohol may help you fall sleep, it also causes wakefulness, “rebound anxiety,”  and generally poorer quality of sleep later in the night. So if you do drink, experts advise (for this and general health reasons) no more than one to two drinks, and none within three hours of bedtime

2) Turn your bedroom into a “sleep room.”

A quiet, dark, comfortable and cool environment can do a lot to support sleep. Turn down the heat, turn off all artificial light, and use earplugs or white noise machines to mask sound. Make sure your mattress and pillows are right for you. And if a pet regularly wakes you during the night, you may want to consider keeping it out of your bedroom (I know, I know: I don’t want to do that either!). And keeping electronic devices out of the room will help to strengthen the mental association between your bedroom and relaxation, while also reducing your exposure to the electromagnetic fields (EMFs) they emit, which are thought to interfere with normal sleep. Better yet, unplug your WiFi system at night altogether: the EMFs they emit have been implicated in melatonin suppression in humans, and there is evidence that their higher rate of oscillation (vibration cycles) affect the natural electromagnetic field of your body at rest…and not in a rest-supporting way! In short: make your bedroom a place that becomes associated with sleep and sex and rest only, by furnishing and using it for only those activities.

3) Establish a sleep-supportive pre-sleep routine

Train your subconscious to prepare for sleep by developing a pre-sleep “transition” routine. This might include taking a bath or shower, putting on night clothes, reading a book, meditation, or relaxation exercises. Avoid stressful, stimulating activities (like doing work or discussing emotional issues). And if you tend to take your worries to bed, create a ritual to deliberately set them aside for the night: write them down, for instance, and then put them in a box or jar until morning…and close the lid.

4) Go to bed when you are tired

Struggling to fall sleep just leads to more tension…which makes sleep even less likely! So go to bed at the hour that is right for you, even if this means going to bed earlier or later than your partner. Then, if you’re not asleep after 20 minutes, get up and go do something relaxing (preferably not involving electronics) until you feel tired enough to sleep. But keep the light dim; bright light stimulates the brain.

5) Don’t watch the clock!

images-1Checking the clock when you are trying to fall asleep (or after waking at night) increases stress, making it harder to fall asleep. In addition, a digital clock emits a steady stream of artificial light that stimulates the brain even when your eyes are closed. Turn your clock’s face away from you.

6) Expose yourself to natural light

Exposure to natural light in the morning and regularly during the day is essential to keeping our internal clocks on a healthy sleep-wake cycle. So let in the light first thing in the morning and take sun breaks during the day if you work indoors.

7) Keep your internal clock set with a regular sleep schedule

Going to bed and waking up at the same time each day programs the body’s “internal clock” to expect sleep at a certain time each night. Some sleep experts say that waking up at the same time each day no matter when you went to sleep the night before is the most important of the two in setting and maintaining your body’s clock.

8) Experiment with napping

For some, afternoon napping may make sleep more difficult at night. For others, it may help nighttime sleep by easing the “fight to stay awake” exhaustion that can actually make falling asleep more difficult later. So experiment! If you do nap, it’s better to keep it short (45 minutes or less) and before 5 p.m.

9) Make your evening meal early, and light.


Finish dinner at least two hours before bedtime and avoid foods that cause indigestion and reflux.  Eating early and lightly in the evening also allows the body to “cool down” (from the metabolic heat of the digestion process) by bedtime…and cooler body temperatures “cue” the body for sleep.

10) Ditto with your evening fluids!

Drink water throughout the day, then not close to bedtime. This will help you stay hydrated enough not to wake thirsty, while also avoiding the need for nighttime trips to the bathroom.

11) Exercise wisely

Exercise in general can help you fall asleep faster and sleep more soundly. But vigorous exercise late in the day can be more stimulating than relaxing, so save that long run or Zumba class for the morning (or at least several hours before bedtime) and relax with a “restorative yoga” DVD instead.

12)  Follow through!

Some of these behaviors will be easier to include in your daily and nightly routine than others, and none of them may have immediate results. But if you persist with them, your chances of achieving restful sleep will definitely improve.

If sleep problems persist even so, try keeping a sleep diary on your own, and/or use a structured interview questionnaire to ask yourself the relevant questions, and see what they point to– you may be surprised at the associations you are able to make on your own. In addition, consulting with your primary care and/or a behavioral health provider (counselor) trained in sleep problems is always a good idea (clinical hypnosis, for instance, can be very effective). Your PCP can take steps to diagnose and treat what may an underlying medical issue contributing to sleeplessness (there are many that do). And a behavioral health care provider can help you to further identify mental, emotional or behavioral factors, and to plan behavioral strategies that can lead to better sleep.

Sweet dreams…