During the month of December, Aspen Neurofeedback is offering a near 75% discount on QEEG Assessments to those who have previously been afflicted with the COVID-19 virus. "Long-COVID" symptoms like brain fog, lack of focus, and poor motivation have been linked with the neuro-inflammatory response to the virus. EEG is a great way to measure neuro-inflammation and cognitive function, which is why Aspen is offering such a steep discount to those who need this assessment most in our community.
To Schedule your EEG, simply use the promo code when you call (970) 281-7872, or email firstname.lastname@example.org
PROMO CODE: DEC21COV
The Internet exploded at the end of September when the Wall Street Journal published a series of articles based on documents leaked by former Facebook employee Frances Haugen. Covering topics such as political and medical disinformation, concerns about sex trafficking, and the detrimental effects of social media on young people’s mental health, the documents revealed a disheartening narrative - the people behind Facebook know about the problems with their platform, and rather than trying to improve them, appear to be taking steps to hide these internal workings. The publishing of the Facebook Files and Haugen’s subsequent Congressional testimony reignited a global conversation about the ways we use social media, and the ways social media uses us.
In our August newsletter, we discussed i-tech and digital addiction, a relevant topic considering how much of our lives are connected to our screens. But Facebook’s internal study on teenagers’ social media use and well-being had the team here at Aspen discussing another, deeply consequential question: what is social media doing to our kids?
To put it plainly, the landscape of adolescence has fundamentally changed with access to technology. Gone are the golden days of kids riding bikes around town, haunting parks and shopping malls and corner stores, only heading back home when the streetlights turned on or the dinner bell rang. Now, on average, teenagers are looking at a screen for six to nine hours a day (not including screen time for school or homework!), and according to a Pew Research Center study in 2018, 45% of teens ages 13-17 report being online “almost constantly.” The Millennial generation (born between 1981 and 1996) is considered to be the first generation of digital natives, a term for someone who has grown up with access to computers, cell phones, and the Internet. But today’s teenagers are the same age as the first iPhone, and they can’t remember a time before Snapchat existed. They are, more than anyone, entrenched in the digital experience.
Quantifying a change in the adolescent experience over generations is a challenging task. Longitudinal studies are difficult and costly to conduct, and changes to self-report measures over the years bring into question the validity and reliability of comparing certain data sets. There are, however, certain nationally representative surveys of teenagers going back decades that can help us understand how life is changing for our youth. Dr. Jean Twenge, a psychologist who specializes in research on generational differences, leverages these types of surveys in her studies on teens and digital media. After 2012, Twenge began to see a concerning trend in the data: a sudden decrease in teenagers’ reported self-esteem, life satisfaction, and happiness. This occurred simultaneously with a drastic increase in teenage depression and suicide, as well as a higher likelihood of adolescents reporting feelings of loneliness and being left out. Twenge and her colleagues attribute these changes to the rise of smartphone technology, noting that 2012 marks the first year that over half of Americans owned a smartphone.
Indeed, over the past two decades, numerous accounts of the harmful effects of social media on teenagers have come to light. A 2019 study found that 12 to 15 year olds who used social media for upwards of 3 hours a day had an increased risk of developing mental health problems like anxiety and depression. Any amount of time spent engaging with peers in online spaces puts young people at risk for cyberbullying, which is more challenging to recognize and regulate than bullying that happens in physical environments. And, as the leaked info from Facebook reminds us, social media reinforces a paradigm of comparison to which teenagers are particularly vulnerable. When everyone has the ability to put forth an idealized persona online, it is easy to feel like we are less rich, less beautiful, and less happy than others appear to be. Multiple studies have shown that a high amount of social media use is harmful to body image in both girls and boys, as highly edited and filtered images set an unrealistic standard for the ideal body.
On top of all that, social media is highly addictive - in fact, most social sites are carefully designed to keep you scrolling for as long as possible. Why? As Trevor Haynes puts it in Harvard University’s Science in the News blog, “Because most social media platforms are free, they rely on revenue from advertisers to make a profit. This system works for everyone involved at first glance, but it has created an arms race for your attention and time. Ultimately, the winners of this arms race will be those who best use their product to exploit the features of the brain’s reward systems.”
In 2020, the average digital media consumer spent nearly 2.5 hours per day on social media! We touched on it briefly in our digital addiction newsletter, but let’s dig further into some of the subtle ways the most addictive apps manipulate our attention and how it affects teenagers in particular.
In the 1950s, psychologist B.F. Skinner found that lab rats presented with a lever in their cage would press it almost compulsively when they couldn’t predict how often the mechanism would dispense a treat. This reinforcement method, referred to as a variable schedule of reward, is the same one that makes slot machines so addictive. As our anticipation of a reward grows, our brain releases dopamine, the “feel-good” neurotransmitter, leaving us continually seeking more, even after we receive the reward we thought we so desperately wanted.
Silicon Valley tech companies refer to implementing variable reward mechanics into your platform as “The Hook Model” because of how effectively it hooks users. Every time you open Facebook, there’s no predicting what you’re going to see. It could be a cute cat picture, or a casual acquaintance from high school announcing their engagement. On the other hand, it could be a highly controversial news article, or an ad for a product you were just thinking about buying. The unpredictability keeps us coming back for more. Same thing goes for notifications. When our phone buzzes, it’s usually something insignificant. But the anticipation of a coveted digital interaction - someone retweeted my Tweet, someone commented on my latest Instagram post - makes us feel the urge to check. Again and again, like the rats in Skinner’s box.
Another way social sites keep our attention is through the simple mechanic of the “infinite scroll.” Think about it - when was the last time you reached the end of the page on your social media app of choice? The answer might be never. With infinite scroll, social sites will continue to generate posts as you scroll down the page, leaving you with a never-ending feed of content. This feature was designed to create a seamless user experience, but it has a more sinister side effect - it eliminates the opportunity for users to reach a reasonable stopping point. This is just another way to guarantee that once you’re on, you stay on, generating valuable ad revenue for whichever social media site has captured your attention that day.
These design tricks work on just about everybody - after all, they are built on evidence from decades of psychological research. But it turns out that they are extra efficient when it comes to the teenage brain. The prefrontal cortex is the last area of the human brain to develop, continuing to mature throughout adolescence and into a person’s mid-20s. This is the area of the brain that handles functions related to cognitive control: attention, planning, decision making, goal maintenance, and impulse control, among others. Consider, then, that most kids get their first social media account around 13 years old (the age at which federal protections on data privacy become more lenient), and that the part of their brain that allows them to regulate their impulses is still not fully formed. This means that teenagers are getting access to this addictive technology at precisely the time when they are least equipped to be able to control their behavior.
Teenage brains are susceptible in other ways, too. Studies on gambling have found that activity in the basal ganglia (part of the brain’s reward pathway) in response to monetary rewards peak in mid-adolescence. A high sensitivity to monetary reward keeps people at the slot machine even when they’ve lost a tremendous amount of money, because any pull of the lever could be the next jackpot. According to these studies, we’re most vulnerable to this level of sensitivity in our teenage years. Some researchers have posited that the adolescent sensitivity to monetary reward could also extend to social reward paradigms. Certainly, this would explain why teenagers are so driven by social media metrics like the “cool ratio.” Just like with gambling, a high sensitivity to social reward reinforces social media use, as the brain’s dopaminergic pathways are continually activated the more likes, comments, shares, and follows we accumulate.
Social media might even impact the volume of our brains. One study found that excessive social media use was associated with degradation of white matter in areas of the brain related to attention, emotional processing, and decision making. Those are all functions that are crucial for managing our behavior and time spent on social media, so a decrease in the connectivity of these areas could contribute to the feedback loop that keeps us scrolling. Another study found that high daily frequency of checking Facebook was linked to smaller grey matter volumes in the nucleus accumbens, the neural pathways that are activated in response to pleasurable experiences. This suggests that there may be a physiological explanation for the feelings of dissatisfaction and unhappiness that are commonly attributed to excessive social media use. Combined with teenagers’ underdeveloped behavioral control and elevated sensitivity to social reward, these factors make social media appear to be a near inescapable trap for young users.
The bottom line is that social media is designed to be addictive, and teenagers are more susceptible to that trap and all of its side effects due to their developing brains.
To schedule your appointment and get more information, call us today at (970) 281-7872 or visit aspenneurofeedback.com to get started.
Director of Neurotherapy, Aspen Neurofeedback
The Near Unescapable Trap Of Burnout In The Modern Age…
and what to do when you find yourself there.
Let’s start this month’s newsletter with an excerpt from Anne Peterson’s latest book, Can't Even: How Millennials Became The Burnt Out Generation.
. . .
“The only way to make it all work is to employ relentless focus – to never, ever stop moving. But at some point, something’s going to give. It’s the student debt, but it's more. It’s the economic downturn, but it's more. It’s the lack of good jobs, but it's more. It’s the overarching feeling that you’re trying to build a solid foundation on quicksand… It feels like it’s harder than ever to keep our lives – and our family’s lives – in order, financially solvent, and prepared for the future, especially as we’re asked to adhere to exacting, and often contradictory expectations. We should work hard but exude “work/life balance.” We should be incredibly attentive mothers, but not helicopter ones. We should maintain equal partnership with our wives, but still maintain our masculinity. We should build our brands on social media, but live our lives authentically. We should be current, conversant, and opinionated about the breakneck news cycle, but somehow not let the reality of it affect our ability to do any of the above tasks…”
. . .
Peterson’s words ring true not just for Millennials, but for all of us trying to make a living in the modern age. For Boomers, X’ers, and Millennials alike, accessibility has become foundational for success, with intrusions accepted, and expected, at the most vulnerable of times. It’s not enough to simply be available though, we also have to out-perform our peers – which, by the way, have gone from intergenerational to intragenerational – and lest we forget, on top of both prior requirements for successes, we also must maintain “promotable” personalities in this new age of 24-hour access. On top of working as hard as we can, we’re grappling with how our personal and professional personalities (and entire industries, for that matter) are being represented on Facebook, Twitter, and LinkedIn, all while acknowledging that this digital space in no way represents our actual lived experience. When was the last time in history we had to erroneously but successfully manage two, or even three, identities at the same time? At the end of the day, anyone participating in this modern conundrum (including and especially our kids) is hopelessly and unequivocally exhausted. Burnt through, used up, and burnt out. We seem to be willfully ignoring the fact that our energy, attention, and time, is limited - and the more we pretend that it isn’t, the sicker we get.
If you’ve been following along with our newsletters you’ll remember that in August we wrote about our addiction to i-tech, and how we can’t seem to shake the near magnetic pull and false relational promise of our beloved devices. Last month we talked about sleep and our nervous systems, and how the two often get completely misaligned and inflamed by our rest-less modern lifestyle, leading to disastrous consequences in our physical, cognitive, and emotional lives… This month, October, we’re talking about exhaustion - the culmination of our dysregulated priorities, routines, and circumstances. This topic involves i-tech, sleep restriction, and is intricately intertwined with our autonomic nervous system response to stress. In many ways, the topic of exhaustion is continuing and building on the themes we’ve been discussing since we re-launched this newsletter. Themes that try to illuminate the slippery and often overlooked aspects that keep us in need of more coping, more medications, and more mental health interventions.
The term ‘burnout,’ also known as Exhaustion Disorder, was coined by psychologist Herbert Freudenberger in 1974. Freudenberger defined the condition as a “state of mental and physical exhaustion caused by one's professional life.” The phenomenon of burnout, however, is nothing new. As early as the fourth century AD, the term ‘acedia’ has been used to describe a state of listlessness and torpor - a lack of care or concern with one’s place in the world. In 1976, social psychologist Christina Maslach formally defined burnout as a syndrome with three domains: 1) exhaustion, 2) depersonalization, and 3) a reduced sense of professional accomplishment. Burnout has become a hot topic in the workplace, as it has been identified as a major factor in job dissatisfaction, decreases in job performance, absenteeism, and employee turnover. In many cases, burnout can lead people to abandon their careers, and even leave their field or profession entirely. Outside of the workplace, burnout makes us less connected, less content, and is associated with a cavalcade of negative health outcomes.
As burnout has become more prevalent in our personal and professional worlds, researchers have attempted to identify the physiological mechanisms that underlie the syndrome, a task that has proved challenging given the wide variety of symptoms associated with burnout. What we do know is that burnout is a result of prolonged stress, and there are two main systems in the body that respond to stressors: the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis. When we encounter a stressor, the ANS responds immediately, triggering a sympathetic response that causes our heart rate and blood pressure to elevate. This ‘fight-or-flight’ state is an adaptive survival mechanism meant to be engaged only as long as a threat is present. But, as we discussed in last month’s newsletter, repeated activation of the sympathetic nervous system or prolonged exposure to stressors can actually keep us from returning to homeostasis.
Acute stressors also activate the amygdala and hippocampus, which triggers the HPA axis to release cortisol into the bloodstream from the adrenal cortex. You’ve likely heard about cortisol, a hormone that plays a role in regulating metabolism and blood pressure and boosts our energy to help us respond to stress. Typically, cortisol levels peak when we wake up and decrease throughout the day, but prolonged exposure to stress can change this cortisol awakening response (CAR). In groups with clinical burnout, researchers have observed both heightened and suppressed cortisol responses. While science has yet to identify the exact causal relationships between these biological processes and burnout, we nonetheless have established that they are intimately intertwined.
Burnout can even impact the physical structures of our brains. In animal trials, researchers have found that neurogenesis - the process by which our brains create new neurons - is impaired in response to stressful events, particularly in the hippocampus and some frontal areas of the brain. These structures help regulate the HPA axis; if damaged, the body’s cortisol response may be elevated. This stress response may lead to further neuronal cell death, creating a feedback loop that continues to impede the ability of the brain to repair itself. Imaging studies have shown reduced grey matter volume in key frontal and limbic structures of the brain in individuals with chronic occupational stress. Other studies of burned-out individuals show a reduced functional connection between the amygdala and areas of the prefrontal cortex, a part of the brain associated with emotional regulation.
This disconnect means that people experiencing burnout have a much harder time regulating their response to emotional stress and returning to a neutral state once the stressor is gone. As a result of these structural and functional changes in the brain, burned-out individuals often show changes in cognitive ability. Studies on clinical burnout groups have demonstrated deficits in attention, episodic and working memory, and aspects of executive function, likely due in part to reduced neuroplasticity in the hippocampus and frontal lobe.
While the main symptoms of burnout and its impact in the workplace are well known, less frequently discussed are the long-term impacts of burnout on the body. For example, people working in more stressful jobs have shown signs of accelerated skin aging as well as shortening of our DNA’s telomere length, essentially increasing the biological age of our body’s cells. Burnout is a risk factor for many types of infectious disease, as it is associated with a suppressed immune response and higher levels of inflammation in the body.
Even low levels of burnout among supposedly healthy workers is associated with an increased risk of heart disease, and that risk increases as levels of burnout rise. Burned-out individuals are 4.3 times more likely to develop type II diabetes than their healthy counterparts. In general, burnout has been shown to be related to all-cause mortality in people under 45 years of age. The Japanese even have a word for this - 過労死, or karoshi, literally meaning “overwork death,” to describe occupational sudden mortality often due to heart attack, stroke, or suicide. Burnout and depression are also highly correlated, as the two share overlapping symptoms and similar biological markers in the brain.
Clearly, burnout is a complex beast to tackle, both from an emotional and biological perspective.
Here are a few action steps, interventions, and resources to help you kick burnout to the curb.
(look to the bottom of this newsletter for more information on how to begin this process)
Action steps like taking a walk or prioritizing self care can be amazing tools to begin the process of getting better sleep, but sometimes we need more neurological, cognitive, and therapeutic support to have real success. Our faculty of seasoned neuro and talk therapists specialize in helping people with stress reduction, insomnia, sympathetic activation, depression, trauma & grief, and much more. Our human experience is so complex and stressful, and especially during times like these, it is helpful to have a treatment team that can come alongside you.
Director of Neurotherapy, Aspen Neurofeedback
“The best bridge between despair and hope is a good night’s sleep.”
- E. Joseph Cossman (American inventor, businessman, & entrepreneur)
“I sleep like a baby - I’m up every two hours.”
- Billy Crystal (comedian, actor)
As compelling, truthful, and even heartwarming as the first quote might be, sentiments like this don’t often get very far with an over-caffeinated, overworked, and underslept crowd - which I will admit, includes myself (and possibly, the majority of you all reading this newsletter). We’ve heard it a thousand times. First from our mothers, then from our teachers, and now from every mental health professional who circulates the internet. I can hear the cries of readers coming through my inbox now: “We know, we know! Just get off of it already!”
More than likely, it's the second quote which echoes how most of us feel about sleep. According to experts, more than 40 million Americans are currently suffering from a diagnosable form of insomnia, and if we slightly loosen the strict criteria for diagnosis, we’re looking at roughly every two out of three Americans having trouble regularly getting to sleep or staying asleep... but, c’est la vie, that’s life - right? You snooze, you lose. At least that seems to be the attitude that our western sensibilities demand. However, when you start to look at how different facets of cognitive, emotional, and physical health interact with sleep (and particularly the lack thereof), a bigger picture begins to emerge, one that looks a lot like we’ve neglected a cornerstone to happy, healthy, and lengthy living.
Mental health researchers have known for decades how disastrous poor sleep can be for disorders like anxiety or depression (disrupted sleep is a facet of almost every diagnosable mental health disorder, as defined by the DSM 5), but have largely failed to inform people of the mechanisms behind this interaction, as well as the true extent to which they put their health at risk for sacrificing sleep. As I have come to find out - thanks in part to the prolific research of Mathew Walker, PhD, sleep scientist and self-titled Sleep Diplomate - the consequences of this error in thinking reach far beyond what I would have ever imagined. For example, when sleeping roughly 5 hours a night, which many of us might classify as “enough,” the brain and body enter a state in which we are much more likely to develop or maintain high blood pressure, relapse on drugs or alcohol, have a heart attack, develop Alzheimer’s disease, or commit suicide (Why We Sleep, 2017).
It’s shocking to hear that such damage can come from what seems like a relatively benign sleep deficit, but over time things add up - anything under regularly getting 7 hours a night and we begin to enter a state of ‘chronic sleep restriction,’ the effects of which can take years to come back from. ‘Sleep deprivation,’ however (which modern society also regularly practices) is less of a slow burn, and more of an out of the frying pan & into the fire type scenario. After only 16 hours of being awake, many of us will begin to perform similarly on a cognitive assessment to someone who is legally drunk (bringing up major implications for public health and motor vehicle accidents), and for night-shift workers who stay awake while the rest of us are tossing and turning in bed, the likelihood of developing cancer increases significantly, so much so that the CDC is now classifying this particular work shift as a probable carcinogen.
As if all this wasn't bad enough, we have also been proven to be quite terrible at assessing how sleep deprived we actually are (as well as assessing our own cognitive abilities) while in a sleep deprived or chronically sleep restricted state. “With chronic sleep restriction over months or years, an individual will actually acclimate to their impaired performance, lower alertness, and reduced energy levels,” (Why We Sleep, 2017). This acclimatization process from chronic sleep restriction brings to mind the myth about the frog being dropped into a pot of boiling water only to jump right out, versus being dropped in tepid water which is slowly brought up to a boil. In the latter scenario, the frog fails to notice the change due to a slow and steady acclimation - and also because it has easy access to the finer things in life, like caffeine, sugar, and interactive technology. As unlikely as it is that this whole frog scenario would prove out in real life, it seems an uncanny metaphor for the frighteningly real issues we are facing in regards to sleep.
Already tired of talking about sleep?
Let’s switch gears for a moment and discuss another common thread which has been shown to connect different aspects of mental illness and disease - the sympathetic nervous system. You’ve likely heard of the fight or flight state, in which our nervous system mobilizes different resources and stress hormones in order to help us be on high alert for any threats in our environment. This heightened state of alertness is known as being in a “sympathetic” state, or being “sympathetically activated.”
The inverse of the sympathetic state, in which the nervous system shuts down our stress response to give our brains and bodies the opportunity to digest, sleep, and recover, is known as being in a “parasympathetic” state. Think of it in terms of a light switch. Above the switch is a piece of scotch tape with the word “sympathetic” scribbled on it; below the switch, a piece of tape which reads the word “parasympathetic.” Ideally the switch is in the ‘on’ position for short periods of time when we need to assess real threats or find our way out of dangerous situations. Once we are out of said danger, the switch flips to the ‘off’ position for much longer periods of time so that we can relax and recharge, preparing for the next short burst of exertion we might need. The problem is, we seem to have a particularly tough time finding the “off” position to this stress switch. (For a more detailed discussion of this dynamic, check out this article from Harvard Health.)
As we’re finding out, many different things can push us into a sympathetic nervous state: a significant or traumatic event, being overworked, too much stress or conflict at home, excessive screen time, or - coming full circle now - being sleep deprived. One can imagine how easily this dynamic can become a vicious cycle. While sympathetically elevated, we have a terrible time getting to, and staying, asleep. Consequently, insufficient quantity or poor quality of sleep makes it more likely that we will continue to stay sympathetically activated. “With few exceptions over the past half century, every experiment that has investigated the impact of deficient sleep on the human body has observed an overactive sympathetic nervous system,” says Walker. This cycle has been implicated in the high number of Americans dealing with insomnia, as we have found that one of the side effects of a sympathetic nervous state is the anxious and intrusive thinking which blocks the onset of sleep.
Although constant sympathetic activation might not necessarily sound appealing, having high levels of norepinephrine and cortisol in your system can make you feel alert and focused - especially if you are sleep deprived or chronically sleep restricted. In the case of poor sleep, being sympathetically activated actually might feel like an improvement over the alternative of lethargy, and while being in a sympathetic state doesn't lead to real focus (it leads to vigilance, which we often get confused with focus), it sure beats being lethargic and foggy when you have to complete your to-do list, pick your kids up from soccer practice, or meet your homework deadlines for school
The physical effect of this prolonged state of alertness can be seen in a higher resting heart rate and higher blood pressure, resulting in strained blood vessels. Regularly sleeping less than six hours a night can leave you 200-300% more likely to have calcification of the coronary artery over the next five years, increasing your chances of heart attack. As noted in the introduction, cancer in night-shift workers is also being linked to this interaction between sleep and the sympathetic nervous system, due to the body's heightened immune response while in this state. An immune system stuck in a heightened alert state will produce unnecessary amounts of inflammation, which not only plays a role in cancer, but many other facets of physical and mental health.
Less frightening, but equally devastating, are the impacts of insufficient sleep on cognitive and emotional functioning. Many of us know “how we can be” when we haven’t gotten enough sleep - more irritable and on edge, and less empathetic and patient. Generally speaking, we become frustrated spouses, reactive parents, and inattentive friends. As it turns out, this transformation in personality isn’t merely a dramatic display of our preference for sleep being violated. Rather, a very significant shift takes place in the functioning of the under-slept brain, making us much more likely to behave and react in an unpredictable manner. “Analysis of the brain scans revealed the largest effects I have measured in my research to date,” reports Walker. “A structure located in the left and right hemisphere, called the amygdala… showed well over a 60% amplification in emotional reactivity in the participants who were sleep deprived.”
If that weren't enough, the scans also revealed that the prefrontal cortex (the part of the brain responsible for many aspects of executive functioning, including impulse control) decouples from the amygdala and other brain structures in the underslept brain. It’s as if the lock which securely holds the caged lion back has been broken by setting one's alarm too early, or getting to bed too late. Being sympathetically activated, the lion will either fight, run, or freeze. These three choices tend to play out in ways you would expect, ranging from the careless and unfortunate, to the tragic and irreversible.
So what are we supposed to do about our overactive nervous systems and sleep restricted nights?
Here are a few Action Steps, Interventions, and Resources you can use to help break the cycle.
Using targeted, non-invasive neuromodulation protocols, Aspen has had very high success in being able to take people out of a sympathetic nervous state, and into a parasympathetic nervous state. If you believe your nervous system might be stuck in the “on” position, and the action steps below seem ineffective or too difficult to carry out, our process might be right for you.
(look to the bottom of this newsletter for more information on how to begin this process)
Sometimes getting to sleep or feeling calm enough to rest can feel unattainable or out of reach.
Action steps like intentionally winding down at night limiting your light intake can be amazing tools to begin the process of getting better sleep, but sometimes we need more neurological, cognitive, and therapeutic support to have real success. Our faculty of seasoned neuro and talk therapists specialize in helping people with insomnia, sympathetic activation, addiction, depression, anxiety, trauma & grief, and much more. Our human experience is so complex and stressful, and especially during times like these, it is helpful to have a treatment team that can come alongside you.
John VanDeGrift, Director of Neurotherapy
As I wander through the aisles of my local pharmacy, my puffy and bloodshot eyes do a poor job of scanning the products. It should be illegal to stay awake this long. 15 hours ago I woke up in Frankfurt, Germany at 6am, after getting only a few hours of restless sleep in a stuffy hotel room. A few cups of coffee and one plane ride later, and it’s 5pm Denver time. There seems to be a thin line between sleeplessness and drunkenness to which I’m coming dangerously close. I still have around four or five hours to go before I can go to sleep, but the siren song of my bed is becoming increasingly more tempting as the night… ahem - I mean, day, drags on. I just have to find one thing before I go to sleep. One thing that will hopefully make the process of changing my brain back to Colorado time a little less painful.
The human circadian rhythm will adjust about an hour each day to re-align with whatever day/night cycle your eyeballs currently occupy. I say eyeballs specifically because this brain rhythm is dictated by the light, or lack of light, which makes its way into the brain through the eyes. Frankfurt is eight hours ahead of Denver, so if my circadian clock adjusts about one hour a day, I’m looking at eight days before I become re-regulated to my current time zone. But I’m hoping I can find something in this pharmacy to bring my eight days down to, let’s say, four.
Like a light that cuts through the fog, illuminated before me is a sideways hanging sign: “Sleep Aids.” Yes, my brain tells me, look here. My focus narrows now to scan a single column of jumbled words and logos as I attempt to sift through the chemical rubble that makes up the sleep aid section. “Mel… Mela…” I whisper to myself, not finding what I’m looking for. Use your finger, my brain pipes in. “M… M… M – here it is, Melatonin.” But wait - I see “melatonin” one, two, three, four times… there are at least ten different brands of melatonin, all at different doses. Melatonin gummies at 2.5mg each. Extra strength melatonin quick dissolving tablets at 5mg each. Maximum strength melatonin at a whopping 10mg each. How could they do this to me? My brain adds to the chaos, “Remember that study? Actual melatonin levels in these pills can range from 15% to 400% of what’s listed on the bottle.” A quick Google search reveals that everyone else is as confused as I am. Nearly every brand here is listed as “the best,” certified in this or that regulation process. Looks like I’m going to roll the dice with one of these brands and hope I don’t get the 15% or the 400% mystery pill.
I wonder if this overall confusion about which brand and how much characterizes most people’s experience with melatonin. In neurotherapy, and mental health in general, we talk A LOT about sleep, and when you ask people what their sleep-routine looks like you begin to hear the M word over and over again. In a world that is completely and utterly confused about sleep, melatonin for many, seems like a holistic alternative to a habit-forming sleep aid. I often wonder if people get more of a placebo effect from melatonin than anything, as the hormone is merely an initiator of a brain state where sleep is more likely, rather than a chemical which carries the brain through a deep and restful sleep. That’s not a knock to the placebo, by the way, which has the most powerful and consistent treatment effect in all of medicine… but more on that in my next blog.
One thing to keep in mind about melatonin is that it is a hormone which is naturally produced and dispersed by the pineal gland in your brain. I think that’s a fact that often gets lost in the conversation about sleep and sleep aids. Hormones are serious business when it comes to the brain and body – if you don’t believe me, ask anyone with a hormone imbalance. This is not to say that melatonin use is inherently dangerous or will surely cause adverse side effects, but I have heard my fair share of reports from people who have overused the supplement and begin to experience depressive symptoms that can be associated with drowsiness. I am not for or against melatonin use in general, but I do want people to understand that when they take it, they are influencing a naturally occurring hormone pathway. If you want to regulate this pathway to work as intended without supplementation, try exposing your eyes to sunlight in the morning and sunlight in the evening. For most, this will give you all the melatonin you need.
Enough about what melatonin is, let’s talk about what it does. Simply put, melatonin kicks off the possibility for sleep. As Matthew Walker, Ph.D. describes it, if sleep is a race, melatonin is the official who fires the starting shot – not one of the runners. Sometime in the evening, our pineal gland releases a burst of melatonin. The timing of this starting shot is dictated by our circadian rhythm (our internal sleep and wake clock), which is primarily influenced by the time at which the sun rises and sets. So, sometime after sunset – pow. Your suprachiasmatic nucleus (the gear that runs the circadian clock ) tells your pineal gland to release a dose of melatonin and we're off to the races. Melatonin concentration typically peaks around 4:00am, and then decreases again come sunrise.
Now we can see that for most people, we wouldn’t need to artificially start that race – the sun is already doing that for us. There are exceptions for people with circadian disorders, or people who work night shifts, or… you guessed it - people experiencing jet lag.
When your circadian rhythm is operating in opposition to, rather than in accordance with, the sun, we have a problem. In the jet lag scenario, instead of your greatest potential for sleep coming around 8 or 9pm, it's now showing up at noon. Even worse, your lowest potential for sleep, which normally arrives around 7am, is now arriving when you should be gearing down for sleep. This causes people to become disoriented, groggy, and can lead to poor cognitive and emotional functioning as your internal circadian clock is resetting. For me, I can pretty much count on a headache, lack of motivation, and an overwhelming desire to crawl into bed and watch tv.
The effectiveness of melatonin for jet lag has been well documented, but if we go back to our original predicament with melatonin of how much we should be taking – what does the research have to say about that? Here is a brief snippet from a literature review (an analysis of many different research articles) on not only the effectiveness of melatonin for jet lag, but also under which circumstances the hormone supplement was most helpful…
Main results: Nine of the ten trials found that melatonin, taken close to the target bedtime at the destination (10pm to midnight), decreased jet-lag from flights crossing five or more time zones. Daily doses of melatonin between 0.5 and 5mg are similarly effective, except that people fall asleep faster and sleep better after 5mg than 0.5mg. Doses above 5mg appear to be no more effective. The relative ineffectiveness of 2mg slow-release melatonin suggests that a short-lived higher peak concentration of melatonin works better. Based on the review, the number needed to treat (NNT) is 2. The benefit is likely to be greater the more time zones are crossed, and less for westward flights. The timing of the melatonin dose is important: if it is taken at the wrong time, early in the day, it is liable to cause sleepiness and delay adaptation to local time. The incidence of other side effects is low. Case reports suggest that people with epilepsy and patients taking warfarin may come to harm from melatonin.
Reviewer's conclusions: Melatonin is remarkably effective in preventing or reducing jet-lag, and occasional short-term use appears to be safe. It could be recommended to adult travellers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet-lag on previous journeys. Travellers crossing 2-4 time zones can also use it if need be. The pharmacology and toxicology of melatonin needs systematic study, and routine pharmaceutical quality control of melatonin products must be established. The effects of melatonin in people with epilepsy, and a possible interaction with warfarin, need investigation.”Pubmed
So there you have it – melatonin might not be the best option for your sleep AID, but it seems to be effective at helping people lessen the effect of jet lag. From the review, it sounds like I won’t get much relief as I recently traveled west (Frankfurt to Denver), but next time I go overseas, rest assured I will be taking melatonin at the appropriate times days before, as well as days after, my flight.
For now – bon voyage, auf wiedersehen, and goodnight.
I'll see you on the other side of my sleep, hopefully well-rested, readjusted, and ready to talk more about our wonderful and amazing brains.
Director of Neurotherapy
What has a ring, but no finger?
What demands that you answer it, yet never asks a question?
What can never be allowed to die, even though it was never born?
Ok, Ok. A little much, I know. But you get the point: our devices have an invisible grasp on us.
There’s some unseen force which pulls your hand towards your phone time and time again, insisting you must have it with you on the toilet, and sending small waves of panic as you pat down your pockets only to realize you left it in the other room. Let’s face it, if this interaction were taking place between two people, it would leave onlookers deeply concerned - i.e. the codependent couple whose relationship secretly scares all their friends.
Although silly, the riddles above are actually quite poignant because they imply that there’s some kind of emotional relationship taking place here. Take a child away from a screen and tell me the response isn’t eerily similar to taking an infant away from its mother's warm embrace.
The reality is that for many of us, we are attached to our devices because they give us a form of emotional safety. A secure base that we can take with us everywhere, all of the time. And why wouldn’t we? We control, command, and rule over our digital pacifiers to exert our will on the world and improve our lives in the process... But the next time you catch your hand in mid-reach for your phone and you can’t figure out why, consider the likelihood that the shoe is on the other foot - and it's probably been there for some time.
So what makes the “pull” towards our devices so great? Dr. Mari K Swingle, a leading researcher and practitioner in the field of Digital Addiction, describes it as the “perfect storm of process and content.” The term ‘process’ refers to the interactive nature of the apps and devices we engage with. Swipe down on any social media app, or your email, and get a fun sound linked with an animation indicating to you that the application is about to refresh your feed. Woo-hoo! The action of swiping, linked with the sound and the animation, create feelings of wellness and stimulation. Think of it as a reward for engagement – every time I do this action, I get this response. That is a process.
Process is king in the gaming world, but over the last few years it has slowly been making its way to other platforms like social media or even work-related apps. Have you noticed the fun sounds that Slack has started to make? Those sounds give you a feeling of wellness, which not only conditions you to interact with the app, but to anticipate more fun sounds… and this is where things start to get diabolical.
Research has proven that the most powerful reward schedule for the brain is a reward schedule that is intermittent. This means that the reward doesn’t come on a consistent schedule, or even at predictable times, but rather at irregular intervals.
So, every time I do this action, I might get this response...
Doesn’t sound inciting? Our brains would beg to differ. Dopamine production is actually stronger in anticipation of a rewarding event than it is during or after the event. Thus, if I make a reward schedule irregular it keeps you on the hook longer because you’re making more dopamine than if I were to simply give you the reward every time or right away. Video games have been capitalizing on this insight for some time, creating systems like the “loot box,” which keeps players on the game for long hours only to get a chance (yes, like a slot machine) at getting the reward they seek. They keep coming back to play the same content over and over because they want a certain piece of “loot” out of the box – or at least that’s what they think. What they really want, however, is the feeling of the chase. This feeling of the chase (the heightened state of arousal in anticipation of a reward) is what also characterizes the struggle of the gambling addict. Win, lose, or draw, it is the heightened state of arousal in anticipation which keeps people coming back for more.
And what about content? As I’m sure we all know, content has a powerful pull of its own. The chemical release of the brain in response to content is what has kept the pornography industry thriving since its inception. Not only is dopamine heavily involved in the viewing of porn, but if orgasm is also involved, pornography will release a powerful dose of the bonding chemical oxytocin – the same neuromodulator which bonds mothers to babies, and sexual partners to one another. Similarly, heightened states of fear and stress influence the release of adrenaline and cortisol in the body. Ever seen the local news? It only airs four times a day.
Now that we have a better picture of what Dr. Swingle was referring to when she called today's “i-tech… the perfect storm of process and content.” Not only do we still have the original heavy hitters like gaming and pornography, but now we also have to deal with the new wave of social media apps which combine the best of both worlds. These apps have content similar to the nightly news, mixed with content bordering on pornography, mixed with how to make a great lasagna, delivered to us (along with likes and comments) on an intermittent reward schedule, tied up nicely in an interactive package that allows for a pleasurable user experience full of vibrant colors, sounds, and animations. Oh yeah, and I forgot to mention, the “I” in Swingles “I-tech” refers not only to the word interactive, but also internet-based. When an app is internet-based it implies a certain amount of access we have to it. Which, currently, is unlimited.
Now, this newsletter is not intended to be a strike against technology. Quite the opposite. Advances in technology are exactly what allows us to help people using neuroimaging and neuromodulation techniques. To reference one of the basic principles of toxicology – the dose makes the poison.
We cannot continue to indiscriminately consume mass amounts of I-tech without suffering the consequences (and many of us already are). Much like alcohol consumption and overeating, i-tech has become socially sanctioned, and it is now considered “normal” to be locked into our devices nearly at all times. However the symptoms emerging from Digital Addiction are all but normal. Depression, Anxiety, Obsessive Compulsive Disorder, Sexual Dysfunction, to list just a few.
Dr. Swingle's research is uncovering more consequences of digital addiction every day, the most frightening of which emerge when children under the age of three are introduced to i-tech and can create an emotional attachment with the device rather than their caregiver. This of course has huge implications for developmental milestones in a child’s brain, most of which can only be reached through interactions with other humans.
Here are some resources and interventions for you to begin the process of breaking the invisible chain.
Hacks like turning your phone on greyscale mode can be amazing tools to begin the process of breaking free, but sometimes we need more neurological, cognitive, and therapeutic support to have real success. Our faculty of seasoned neuro and talk therapists specialize in helping people with addiction, depression, anxiety, trauma & grief, and much more. Our human experience is so complex and stressful, and especially during times like these, it is helpful to have a treatment team that can come alongside you.
To schedule your appointment and get more information, call us today at (970) 281-7872 or visit aspenneurofeedback.com to get started.
Director of Neurotherapy
Welcome to the Aspen Neurofeedback Blog!
Aspen Neurofeedback hasn’t had a blog for a number of years, and as it’s current Director I am incredibly excited for us to begin this journey again. This blog is going to be a place where we explore all things neuroscience, why those things matter, how they impact on our lives, and what we can all do to incorporate daily practices to improve our functionality and joy. This will be a place of exploration, free thinking, and personal experimentation on my part… which I will then share with you in great detail.
Note: I’ve grown to love experimenting on myself, and am more than happy to do it on your behalf.
So, here’s the format: once a week I will post a blog here about something related to neuroscience, mental health, peak performance, etc.. The topics will range from sleep, to meditation, to brain stimulation, and everything beyond and in between. The goal for this blog is to bring things into discussion that might help improve our lives, increase our joy and functionality, and empower us to be better parents, spouses, siblings, and friends.
Like other professionals in this arena there are a few states of consciousness that I am obsessed with: sleep, calm focus, rest, and exertion. A lot of my time is spent researching, learning, and meditating on how to better help individuals to achieve these states, as they seem to be the spring board for peak performance across many arenas. I say this only to prepare you that these are topics we will constantly be circling around and coming back to for deeper understanding and practice.
I couldn’t be happier for us to be creating, exploring, and learning together in this new space. I’m signing off for now, but ill be back next week with our first topic. In the mean time, stay hydrated, go to bed early, and make sure to carve out a few moments for gratitude.
Director of Neurotherapy