Grinding. It's not just a dance.

Before the Dude and I go to sleep, there is something we can never forget to do before we turn out the lights.

Pop in our nightguards.

We’re major teeth-grinders in our house, otherwise known as Bruxism. For me, this problem is not just at night. I find myself clenching and grinding my teeth when I’m stressed or anxious which, ever since I became a mama, is more often than not.

Unfortunately, Bruxism is not my only issue. I also deal with TMJ Disorder. It’s fairly common to suffer from both.

I remember waking up one morning around the age of 16 with a splitting headache and my jaw in a painful locked position. I couldn’t move it at all and I was terrified. I happened to be visiting with my dad at the time who managed to calm me down and massage my jaw enough for me to move it again. From that day forward, my jaw started to click or pop every time I opened my mouth. It was also occasionally very tender and painful. My dentist at the time shrugged at my complaint and said it was quite common. He also mentioned that there wasn’t much that could be done. When I asked him why this happened, he blamed the problem on the two years of braces (with rubber-bands) I wore from the ages of 13-15. I remember thinking, geesh, had I known the consequences I would’ve lived with snaggle-teeth! Whether or not the braces are to blame can’t be proven. There are many theories as to why 5-15% of the population is affected with a TMJ disorder.

At this point, nearly 18 years later, I still cannot fully open my mouth without having to actually move my jaw in a way that makes an annoying popping sound. The pain and tenderness is something that comes and goes, but I’ve lived with it long enough to know what to do about it. From my own personal experience and based on all the information I’ve gathered over the years, there’s not a whole lot that can be done. There are a number of remedies out there, from pain meds and Botox (hell no!) to yoga and CBT therapy. Being that I am trained and educated in CBT methods, I can easily incorporate what I know into my life. Admittedly, the relaxation methods I use can work very well for me during the day…but when I’m grinding my teeth at night, not so much. I also use massage exercises, acupuncture, and chiropractic methods.  Now, if you’ve been reading my blog, you know I’m a huge fan of acupuncture and chiropractors.  Acupuncture and chiropractic treatments can work very well for my TMJ /Bruxism issues but, I have to admit, just like almost everything else I’ve tried they can only offer temporary respite.

The bottom line is that there is no cure. If you have Bruxism and/or TMJ issues, you will have to learn how to manage the symptoms. Very few people have a serious enough case that requires surgery. And, even then, surgery is no guarantee for a cure. Other than make some lifestyle changes, like reducing or eliminating gum and foods that require more chewing (buh-bye, steak!), and incorporating daily relaxation and massage exercises, the nightguard is really the best course of action I have found. Don’t just get any nightguard, though. Spend the few extra bucks and have your dentist create a custom-fit nightguard. They run about $300-$400 and some insurance companies cover at least half of the cost.

It’s not that fun to wear a nightguard every night and it certainly isn’t sexy, either. But when your spouse or partner wears one, too, it makes it a bit more enjoyable. The Dude and I always have a laugh when we kiss each other good-night as our nightguards click. It can also be useful for setting the mood. If one of us comes to bed without wearing our nightguard, well, let’s just say that the nightguard code works well.

Sweet dreams, indeed.

A different era of therapy that was simply...'Mad'

Finding a good therapist is very similar to dating. You’re not going to connect with everyone and, chances are, you might have to try out a few different types to find *The One.*

When you’re dating someone and you just don’t feel a connection, you probably won’t continue to see that person…right? Well, the same should go for a therapist. When you see a therapist, whether it’s for 10 weeks, 10 months, or for 10 years (you know, for the Woody Allen types), there needs to be a good connection, a good rapport, and a huge level of trust. Without those essential components, which we all know are necessary for any healthy relationship, it’s just not gonna work. Of course, trust and rapport don’t usually happen overnight. It will probably take a few sessions or more to figure out whether or not the therapist is a good fit or not.  It’s OK if the therapist is not the right for you. The best thing to do is tell them. Most therapists don’t take it personally and will even help refer you to someone else. Don’t you wish bad dates would do the same?

The Process of Therapy

There is something important to keep in mind: the therapist is not your friend.

Therapy is and should be hard work and a good therapist will challenge you. Often. Some clients take issue with the challenging stuff because it can be a painful process. The thing to remember is that a therapist is not out to hurt you but rather to help pave a way for you to get to a better place in your life. Good therapists are a support system. They not only help provide you with tools to help you but they also point out the your strengths, some of which may be buried beneath internal conflicts and everyday struggles. A therapist doesn’t give you advice about how to live your life. They won’t tell you that you should leave your spouse, quit your job, or give tough-love to an unruly teenager.  They don’t know the answers for you because they will never know you better than you know yourself. They don’t live with the consequences of your life choices. But what they can do is help shine a light on those internal resources and strengths within yourself to help get you to the place you want to be.

Different Labels – What the Degrees Mean

Therapists come with different labels:

• Licensed Social Workers (MSW), Family Counselor, Professional Counselor (LPC), and Marriage and Family Therapists (MFT) have Masters Degrees (MS or MA). Many refer to themselves simply as psychotherapists, counselors, or therapists. They are primarily trained in diagnosing mental health problems and counseling.
• Psychologists have a PhD or PsyD. They are licensed to conduct psychotherapy and use psychological testing to help diagnose mental health problems. They are not medical doctors and they are not licensed to prescribe medications.
• Psychiatrists are medical doctors that diagnose and medically treat mental illness. Psychotherapists refer clients to psychiatrists when they need to be evaluated for medical treatment.

Therapists tend to work closely with other therapists and doctors. During the process of therapy, clients may be referred to a psychiatrist for an evaluation for medical treatment. In some cases, therapists may also refer clients to a General Practitioner (MD) for a medical evaluation. Some mental health issues are related to physical health problems: only a medical doctor can determine that link.

Types of Therapy

There are many different types of therapeutic styles and modalities. Most people are aware of the founder of talk therapy, Sigmund Freud, which is why so many people still assume that therapy is all about lying down on a couch discussing their fetal memories. Psychoanalysis or psychodynamic therapy is still prevalent, but it has been updated quite a bit since the days of Freud. This type of talk therapy usually requires many sessions and there is an emphasis on digging down into the past (but not THAT far back). In contrast, there is another widely used therapeutic modality called Cognitive Behavioral Therapy (CBT). CBT is more goal-oriented and focuses on the present and the future. CBT helps a client identify and change negative thought processes in a short amount of time. Although this type of therapy usually doesn’t require many sessions (no more than 10), CBT is also proven to be very effective for changing behavior.

Many therapists consider themselves to be “eclectic” therapists, which means they draw from a number of therapeutic modalities as they see fit. You probably won’t know what style your therapist is using unless you’re trained in psychotherapy…or you just simply ask. The most important thing is whether or not the therapy is working for you. Many people respond well to psychodynamic therapy, while others respond well to CBT. It doesn’t matter what works for you as long as there is progress. Just keep in mind that if you’re uncomfortable with the process, speak up and talk about it with the therapist. A good therapist will always discuss their course of treatment with you, if you ask. If they do not or will not disclose their treatment plan, I would suggest finding another therapist.

Another thing to consider is whether or not individual counseling is right for you. If you’re having problems in your marriage or relationship, it’s usually best to get counseling together. Not always though. If there is domestic violence or other volatile issues, joint counseling may not be a good idea.  If there are family issues involving children, the entire family might want to look into family therapy sessions.  For other issues, like bereavement or substance abuse and/or dependence problems, group therapy can also be a good idea. Sometimes people require a much larger support system and group therapy can be an ideal way to go.

Things to Ask Before You Start Talking

Referrals are usually a great resource when trying to find a therapist, but I also recommend calling around. When you speak to a therapist on the phone, ask them about their therapeutic style and if they have experience in the issues you are bringing into their office. Therapists usually know many other therapists and will refer you on if they know someone else who might be a good fit or are not taking any more clients.

Trust Yourself

Let me reiterate how important it is to have a good relationship with your therapist.  Trust your instincts and gut when it comes to your therapist. If there is no connection or if you feel there is something amiss, find another therapist.  I have personally spent many wasted hours and money with therapists that were not the right fit for me, simply because I didn’t trust my initial instincts. Don’t make the same mistake. If you dedicate the time and energy into finding the right type of therapist for you, the pay-off will be worth the effort.

One more thing. If your therapist ever asks you to go back into the womb…run.

Sleep. We all need it but, not surprisingly, very few of us get enough of it. A 2002 National Sleep Foundation study revealed that about 74% of all American adults experience symptoms of insomnia a few nights a week, or more. Insomnia could mean a variety of things – not able to go to sleep within 15 minutes of laying down, getting up too early, waking up periodically through the night, and not feeling rested the next morning even after an adequate amount of sleep. The research indicated that 39% get less than 7 hours of sleep each weeknight and 37% are so sleepy during the day that it interferes with daily activities. 20% of Americans use sleep medications and 15% use sleep medications every night. Women make up the majority (63%) of the people who suffer most from insomnia.  In addition, 66% of people dealing with insomnia have children in the household.

Shocking? Not really.

It doesn’t take much to figure out why parents, and specifically women, have trouble sleeping. Parenting and anxiety tend to go hand-in-hand. There is so much to worry about – money, mortgage, marriage, soccer practice, homework, paying for college, will he get into college?, crazy people, pedophiles, car accidents, H1N1…whew! It’s enough to make any parent stay up with worry every night. But who has the time to worry about all that stuff during the day? We’re too busy being pulled in a million directions and thinking about the next thing we need to do…or just don’t have time to do. Often enough, our anxieties surface much more at night than during the day. As soon as we lay our tired bodies down to sleep, those anxious worries and thoughts may begin to ruminate. It’s hard to go to sleep and stay asleep when there are a billion worrisome thoughts racing around in our minds.

If anxiety is the key factor for restless and altogether sleepless nights, there are many options for people. We all know that medication is one of them. Have you ever taken sleep medication? Chances are you have. The number of people who have tried and/or regularly use sleep medication steadily increases each year. For one thing, there are a lot more options for the sleepless, from herbal and natural remedies such as Melatonin and Tryptophan to over-the-counter sleep aids such as Tylenol PM and Nytol to prescription drugs like Ambien and Trazodone. If you choose to take a sleep medication, whether it’s herbal or prescription, it’s important to do your homework beforehand. Just like any other medication, there can be side effects and possible interactions with other medications. And for prescription medication, especially, there is also a risk for dependence, lowered tolerance, and rebound insomnia.

I have an opinion on prescription sleep medication and it’s mostly based on personal experience. Like so many other people, I have experienced anxiety issues. Several years ago, over the course of about 6 months, I had trouble sleeping and staying asleep. I called my doctor and without even stepping foot in her office, I was prescribed a variety of drugs, including Xanax and Ambien. I didn’t take the Xanax, except to fly (a story for another blog) but within a few weeks, I became dependent on Ambien. What does that mean exactly? I was not able to go to sleep at all without popping an Ambien pill. This lasted for months. I attempted to quit Ambien several times, each time more difficult than the previous time. I suffered intense panic attacks at night and even a few during the day. I also went though bouts of rebound insomnia that seemed 100 times worse than the actual insomnia I originally experienced. It was one of the most physically and mentally excruciating times in my life.  I was finally able to quit Ambien with the help of cognitive behavioral therapy, a therapeutic model that is found to be the most useful for changing negative thought-processes. It was not an easy process, but it was a process that worked in the long run. I have not taken one sleeping pill, or any other type of prescription medication for anxiety, in over 3 years and my anxiety is largely under control.

My personal experience is not to say that I think prescription sleep medications are a bad thing. Each person is different and what worked (and failed) for me may or may not work for you. I just believe that sleep medication should be considered as a last-resort for insomnia when all else fails. I would be wary of a doctor that immediately prescribes sleep medication without first suggesting other non-medicinal or non-prescription remedies and alternatives. Any prescription drug should be taken seriously and with thoughtful consideration before heading to the pharmacy. I am also of the opinion that if insomnia is related to anxiety and/or another mental health issue, any prescription sleep medication taken should coincide with therapy as well.

Tips for a good night of sleep (adapted from the National Sleep Foundation):

• Avoid caffeine several hours before bedtime. For some people, avoid caffeine at least 8 hours before sleep.
• Avoid alcohol before bedtime as it can lead to disrupted sleep.
• Exercise regularly but complete your workout at least 3 hours before bedtime.
• Establish a regular relaxing bedtime routine, such as taking a shower or bath.
• Create a sleep-conducive environment that is dark, quiet, and preferably cool and comfortable. Use a sound machine or fan for white noise. Use a sleep mask to help block out light.
• Do not nap during the day as this will interfere with your body clock. If you must nap, make sure it is less than 30 minutes. 5-10 minutes is ideal.
• Don’t eat a large, heavy meal before bedtime as indigestion can interfere with sleep.
• Don’t drink too much liquid before bedtime.
• Don’t read or watch anything too excitable, stressful, or scary prior to bedtime. In other words, don’t read or watch the news.
• Use a sleep diary, which can help a therapist or doctor determine poor sleep habits.

Sweet Dreams!