Sleeping is an active process. It isn’t that your brain just shuts down and then restarts itself in the morning. When you go to sleep, your brain activity changes. Sleep doctors talk about sleep stages. Stages are defined by what’s going on in your brain at any given moment, usually based on looking at brain waves recorded from the skin on your head. As your sleep changes, the brain waves change. You go through several sleep stages in cycles during the night, from a shallow kind of sleep to a much deeper kind of sleep.

As you get older, the light sleep stage gets even lighter. You may wake up more easily, and may have more trouble going back to sleep. You may not feel as well rested when you wake up, too.

Doctors talk about different types of insomnia. Initial insomnia is when you have trouble getting to sleep in the first place. People with initial insomnia may lay in bed worrying about things that happened during the day. Middle insomnia occurs when you get to sleep OK, but then wake up during the night. Final insomnia happens when you wake up early in the morning and can’t get back to sleep. There are a number of causes for any of these insomnias, but anxiety and depression are common causes of insomnia. There are a number of physical causes, too, so anyone with insomnia needs to have a regular check up.

Although most people think about using some kind of sleeping pill for insomnia, there are some major drawbacks to taking sleep medication. Some people may have daytime sleepiness, memory loss, and problems with balance. Having said that, there’s no doubt that medications can be really helpful.

Another treatment option is cognitive behavioral treatment for sleep problems. The core idea here is to use psychological techniques to treat the insomnia. Research studies have shown that this approach to treating insomnia works, and people may avoid some of the problems that come along with using medications for insomnia.

More next time about cognitive behavioral treatments for insomnia.

If you worry a lot, other things may happen. You may be tense and you may not sleep too well. You may not be able to concentrate very well, and even may think that you have memory problems. You may have muscle tension and you may feel restless and be “jumpy.”

How does a doctor diagnose GAD? He or she would ask you about these symptoms. Many doctors use a list of symptoms from the DSM, or Diagnostic and Statistical Manual, of the American Psychiatric Association. (Click here if you’re interested in reading more about the DSM on Wikipedia.) If you have the right symptoms, and don’t have other reasons for having them (for example, an illness with your thyroid gland), then you may have GAD.

Do you want to take a short screening test about GAD? You can find one on the website of the Anxiety Disorders Association of America, ADAA. Click here to go to their GAD test.

Treatments for GAD include psychotherapy, medication, and lifestyle changes. More in our next post.

If this sounds like you, perhaps you are a worrier. That said, everyone worries. However, for someone who is a worrier, this behavior is very typical rather than in response to a particular event. For example, are you worried about your job? If you recently were informed that your company is downsizing, you may be rightly concerned that you could lose your job. On the other hand, if the organization you work for has had a banner year and you had a glowing performance review complete with a raise and a bonus, your concern is far more likely to be ill founded.

When worry is purposeful, it motivates you to consider the alternatives that are available and to develop a plan of action. In this case, a reasonable amount of stress works to your advantage. However, when your concerns are more in the realm of “What if’s…” then you may be spinning your wheels. Not surprisingly, worriers fall into this latter group.

We all know people who worry. These are people who always seem like there is a part of their body that is in constant motion. They cannot sit still! They always seem to be on the brink of some catastrophe — except when you think about their situation, it does not seem anywhere nearly as awful as they suggest, especially since they do not look for solutions — they just keep worrying. Other worriers have a myriad of physical complaints that are related to stress — they have headaches, backaches, are restless, complain of feeling jittery or on edge, have problems with their sleep, or are tired all the time. Some worriers are irritable or seem forgetful because they have trouble keeping themselves focused on the task at hand.

So what do worriers worry about? Simply put, everything! Their worries may involve ordinary, day-to-day tasks or chores or concerns about getting to places on time or just getting things done. They may be focused on work or school, about family life, finances, or relationships. Your own health or the health of the people that you care about may be a source of worry. Some people even spend an undue amount of time worrying about community or world affairs.

If everyone worries, why is this a problem? For some people, their worry spins out of control. Worriers can spend hours each day wrapped up in concerns over situations that are so far off in the future that it is unclear whether the feared catastrophic outcomes will ever occur. These worries also interfere with their ability to enjoy life. Instead of enjoying that their glass is almost full, worriers are miserable over the idea that there is some possiblity that there will be nothing available to refill their glass again.

If all of these worrisome thoughts are racing around in your head, it stands to reason that you might feel anxious and fearful. You might even be experiencing physical symptoms like headaches, muscle tension, an upset stomach or you might become irritable or short-tempered.

As a result of your thoughts and feelings, you might avoid talking to your boss or co-workers just in case they ask you how the project is going. You might be so caught up in getting the project done perfectly that you actually procrastinate. In addition, you might think that you need the extra incentive that being on a very tight schedule creates in order to motivate you to produce a great outcome.

Using CBT, you can begin to examine your thoughts and test whether the negative consequences you are envisioning actually happen. You would also go further than these initial thoughts to tease apart the underlying expectations and eventually, understand what the structure of your beliefs are regarding this situation. Going back to the example, getting fired might mean that this person thinks he will become homeless and people ignore him and treat him like he is not worthy of respect. A possible explanation for these worries that the person in our example holdsis a fundamental belief is that he is worthless. His negative emotions and avoidance type of behavior then make sense in light of his beliefs.

Of course, it may not be at all realistic that this person is worthless. With CBT you able put this belief to the test. For example, what experiences in the past have both shaped this belief and have countered it? Are there situations where this person felt worthwhile and respected? Has he ever rebounded from a disappointment and gone on to feel good about himself? Has he ever done something less than perfectly? What was the result?

He might also test out the consequences of not avoiding. If this gentleman took the risk to discuss his project with other people what might happen? We call this method of counteracting avoidance an “exposure.” If as a first stem, we asked him to talk about the project with someone outside of work, what happens? If he then approaches a secretary and mentions what he’s working on is he given the third degree. What about having a conversation over work with a co-worker — do they focus only on his project and then chastise him for not being further along. And finally, what happens if he actually brings up the project status with his boss? Are his worries and fears realized? If actually doing each of these steps is too hard, an alternative is to do an imaginal exposure. In other words, you can imagine each of these steps before doing them. In either case, you keep practicing these situations until your anxiety is less. In addition, you use the information you are gathering during the course of the exposures to help yourself re-evaluate the extent to which you believe the negative thoughts. You will also have much more realistic information that will help you develop a new set of beliefs that will, eventually, allow you to spend less time worrying.