Ya casi tan urgente como la vacuna del coronavirus, una cura para el insomnio post pandemia parece ser el nuevo norte para una sociedad confinada y víctima de noches malas. Médicos reportan crecientes síntomas de coronasomnia como: agotamiento e incapacidad para dormir; ansiedad por el día siguiente, un intento de descanso que inexplicablemente se quiebra de madrugada y te deja despierto por horas, algunos días o cuadros de insomnio esporádico o que agravan una condición crónica. Al respecto, el diario británico The Telegraph difundió esta entrevista a una paciente histórica de insomnio severo que explica como venció este cuadro luego de 8 años acudiendo sin éxito al médico, acupunturistas, hipnólogos, maestros de reiki y sesiones de coaching.
¿Cómo lo hizo?. La historia completa la cuenta en su libro “The insomnia diaries”, pero el resumen es la Terapia Cognitivo Conductual para el insomnio (CBT-i por sus siglas en inglés) que reemplaza la medicación a largo plazo con sesiones con un psicoterapeuta con quien se reprograma la asociación que el cerebro hace entre la cama y el sueño a través de nuevos hábitos. Esto, a través de un mix de educación sobre higiene del sueño y el “recableado” de los propios mecanismos de somnolencia del cerebro. Trucos tan sencillos como la regla de los cuartos de hora (salir de la cama si llevas 15 minutos dándote vueltas), reforzar el vínculo entre la cama y el sueño usándola solo para dormir y sacar la ansiedad por no poder dormir fuera de las sábanas, entre otras.
Si bien el tratamiento no es para todos por su costo y exigencias, se reporta que puede lograr los primeros resultados entre las 4 y 6 semanas en cerca de un 60% u 80% de quienes recurren a la CBT-i. En el prólogo del “The insomnia diaries” la Dra. Sophie Bostock, explica que mientras más tiempo se ha tenido un problema de sueño, menos probable es que los trucos típicos y consejos para conciliar el sueño funcionen. Esta lucha permanente para poder dormir, combinada con el agotamiento diario, la dificultad para lograr concentración y los decrecientes niveles de energía exigen una intervención concreta, señala. “La ciencia del sueño no es ciencia espacial, pero el sistema del sueño tiene bastantes partes móviles y mientras más tiempo hayan estado estropeadas, más difícil puede ser volver a torcer las piezas para darles forma”, cree.
La experta aclara también que las benzodiazepinas ( y “medicamentos Z”) que consumen para dormir 1 de cada 10 adultos no son una cura eficaz a largo plazo pues no se ha registrado diferencia en la calidad o duración del sueño entre quienes los tomaron en comparación con las personas que no lo hicieron a lo largo de 2 años.
La caja de herramientas de la Terapia Cognitivo Conductual para tratar el insomnio (CBT-i)
Una parte del tratamiento para dejar de sufrir por las noches de insomnio tiene que ver con el comportamiento y los hábitos (conductual) y la otra es psicológica y opera a través de hábitos simples de higiene del sueño que deben reemplazar los ya existentes. Entre ellos:
El sueño estricto
La recomendación es ir a la cama solo cuando se esté cansado y salir de la cama solo cuando ya no lo estés. Parece fácil, pero para algunos, ir a la cama más tarde es garantía de dormirse inmediatamente, cuando en el corto plazo esto sólo significa una noche de mal dormir.
Control de estímulos
Reforzar el vínculo entre la cama y el sueño es un trabajo que debe hacerse en la mente y la práctica, así que usar el dormitorio solo para dormir y tener sexo es un primer paso. El segundo puede ser sacar el televisor, el computador o el teléfono fuera de la pieza para dormir.
La regla del “cuarto de hora”
Si llevas más de 15 minutos bien despierto, lo mejor es salir de la cama en lugar de frustrarse y sumar ansiedad. Los expertos recomiendan entrar en un estado beta con actividades relativamente aburridas como doblar calcetines, ordenar la despensa por fechas de caducidad o leer el manual de la lavadora, regresando a la cama solo cuando los ojos estén cansados.
Evitar la luz azul
La radiación lumínica de celulares, computadores, tablets y televisores interfieren con la producción de melatonina, la hormona del cerebro que promueve el sueño. Como en una extensión del ciclo diurno, esta fábrica de sueño queda en espera de la penumbra para empezar a trabajar. Esta alteración se potencia con el denominado doomscrolling (el consumo interminable de malas noticias en el feed de redes sociales y medios de noticias que abundan desde el inicio de la pandemia)
Técnicas de relajación y atención consciente
Para algunos un recurso new age, pero para otros una actividad biológica más, el mindfulness cuenta con su propia práctica de relajamiento muscular como atajo para detener la aceleración de la mente de noche y acercarse al sueño. Este relajamiento progresivo implica tensar y liberar los principales grupos musculares del cuerpo.
El diario de sueño
Nadie mejor que tú puede descubrir las causas de tu insomnio. Una bitácora puede entregarte claves importantes sobre tu conducta nocturna si anotas: la hora a la que te fuiste a la cama, una aproximación de la hora a la que te dormiste, cuántas veces te despertaste o cuánto tardaste en volver a conciliar el sueño. También la hora a la que despertaste, cuánto dormiste de siesta en el día, qué dieta estás llevando o, incluso, qué soñaste.
Mantén la rutina
Si pones una alarma a determinada hora, ser constante es un buen inicio no solo para crear un hábito, sino para tu día. Mientras más temprano, la luz de la mañana le da play al ritmo circadiano (los cambios físicos, mentales y de conducta que se repiten en ciclos de 24 horas) y programa la liberación de melatonina al final del ciclo.
Perseverar en el estilo de vida saludable
Comer sano, hidratarse, realizar algún ejercicio, mantener activo el cerebro y tender al relajamiento, parecen indicaciones obvias. Pero, pregúntate: “¿Es algo que estoy haciendo?”. Es más fácil proponérselo que concretárselo.
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