Exploring the Ether

To sleep, perchance to dream - aye, there's the rub:
For in that sleep of death, what dreams may come,
When we have shuffled off this mortal coil...
~ William Shakespeare, Hamlet's Soliloquy

States of Consciousness

A state of consciousness refers to the mind's awareness of its subjective and objective experiences. By definition, our baseline state of consciousness is one in which we are fully awake and alert to our surroundings. Altered states of consciousness can produce hypervigilance or clouded awareness. States of consciousness in which awareness is reduced include trance, drowsiness, confusion, stupor, sleep and coma. A coma is a state of unconsciousness lasting more than six hours and from which a person cannot be awakened by painful stimuli. Consciousness appears to be entirely extinguished at the time of brain death, based upon the cessation of brain wave activity as measured by an electroencephalogram (EEG).

Sleep and Insomnia

Rest is the foundation for all activity, mental and physical. Without adequate rest, we cannot be healthy. Restful activities include relaxing, napping, sleeping, and meditating. Lack of sleep can more than double the risk of death from cardiovascular disease, and is a risk factor for weight gain, hypertension, and type 2 diabetes. In addition, sleep difficulties are closely associated with psychiatric disorders. It is the individual's circadian rhythm and the release of the hormone melatonin from the pineal gland that determines the ideal timing for a restorative sleep episode.

Trouble falling asleep, sleeping soundly, or long enough, is a very common problem for people living in developed countries. Insomnia is defined as repeated difficulty with sleep initiation, maintenance, consolidation, or quality, that occurs despite adequate time and opportunity for sleep, and that results in some form of daytime impairment.

While episodic sleep problems have been reported by 95 percent of Americans at some point during their lives, long-standing sleep complaints affect about a third of adults, women more often than men, and older people more often than younger ones. However, only about 10 percent of the population meet the strict diagnostic criteria for insomnia disorder. The recent identification of five distinct insomnia subtypes can help determine the cause and appropriate treatment strategies.

If you suffer from insomnia, which can manifest as difficulty initiating sleep, difficulty maintaining sleep, waking up too early, and/or non-restorative sleep, it is important to rule out physical causes such as sleep apnea, restless legs syndrome, lower urinary tract syndrome, chronic obstructive pulmonary disease, diabetes, heart disease, and psychological conditions such as anxiety disorders and depression, before attempting to address the problem with lifestyle changes.

Prescription medications including stimulants (methylphenidate), decongestants (phenylephrine, pseudoephedrine), anti-hypertensives (alpha and beta blockers), as well as drugs such as cocaine, methamphetamine, and nicotine, can interfere with sleep. Excessive alcohol and caffeinated beverage consumption has also been associated with sleep disturbances.

Ideally, adults should be getting 7 to 9 hours of restorative sleep per night. Too little sleep, and too much sleep, are both bad for your health. People with insomnia may have a 50 percent greater risk of stroke, and sleep disruption by shift work has been associated with an increased incidence of several types of cancer. Insomnia may contribute to cognitive decline in older adults, and difficulty falling asleep in midlife may be predictive of future cognitive impairment.

Sleep Hygiene

Blue light from the rising sun activates specialized cells in the retina that are sensitive to wavelengths around 460 nm. They signal the brain to halt melatonin production, helping us to wake us up. As the sun sets and blue light is replaced by redder hues, melatonin production increases, helping us to sleep. This natural cycle can be disrupted by both indoor and outdoor artificial lighting, and by viewing computer and smartphone screens, which emit blue light, during the late evening hours.

Exposure to outdoor, natural light, during part of the day, can improve sleep. The best strategy is to get some sunlight early in the day, within an hour of awakening, and don't wear sunglasses. Ideally, you will want your work environment to receive natural light during the day. Go for a walk outside in the late afternoon. Exercise will also help with sleep, as will avoiding caffeinated beverages and dark chocolate late in the day.

Dim all lights at least three hours before bedtime, and especially curtail your exposure to blue light. Make your bedroom as dark as possible, and go to bed early enough so you don't need an alarm to awaken. Remember Benjamin Franklin's maxim about "early to bed and early to rise" being what makes people "healthy, wealthy, and wise." People will also sleep better when their bedroom is cooler than would be comfortable during the day, so turn down the thermostat about an hour before bedtime. Global warming has resulted in people getting less sleep.

With the U.S. ceasing production of incandescent lights, amber LED bulbs are the next best thing. Look for lights with a "warm" color temperature of 2,700 degrees Kelvin or less. Fluorescent lights have a color temperature that is way too "cool." Table lamps with shades are preferable to overhead lighting. Turn on the "night shift" setting on your iPhone or the "blue light filter" on an Android phone in the evenings to reduce some of the impact of the screen's blue light.

People who live in areas where there are more streetlights and general "light pollution" such as cities have more trouble sleeping and poorer daytime functioning compared to those with less outdoor nighttime light exposure. If there's a lot of light coming from outside your home, try using a sleep mask or fit your bedroom with blackout curtains.

Melatonin production increases after lunch, causing sleepiness. More advanced cultures than our own accepted this natural physiological phenomenon and encouraged people to take siestas. Despite the pressures of the modern world, in countries such as Greece, Italy, Spain, Costa Rica, and the Philippines, to name a few, businesses are open from 8 am to noon or 2 pm, close for lunch and a siesta, then reopen from 4 pm to 6 or 8 pm. In pre-industrial societies, two intervals of sleep, a long one and a short one during a 24-hour period, was the norm.

Napping after lunch can be good for the brain. Recent research involving 378,932 subjects, with a mean age of 57, used the powerful technique of Mendelian randomization. It found a modest causal association between habitual daytime napping and a larger total brain volume. Presumably, at least for older people, a bigger brain is a better brain. So, when your boss catches you napping at your desk, just say that you're working on making your brain bigger.

Exposure to sunlight or artificial blue light in the early afternoon inhibits melatonin production, reducing post-lunch sleepiness. A cup of coffee can also get you through a mid-afternoon slump, but why fight Mother Nature? There is a certain wisdom possessed by one's body, and in the overall scheme of things, it is probably better to heed it than ignore it. There is a Zen saying: when thirsty, drink; when hungry, eat; when sleepy, nap.

What you don't want to do is take melatonin and mess around with your body's normal neuroendocrine cycles. Melatonin supplements are unregulated, often adulterated, and most of them do not meet acceptable standards for purity and potency. Rather than taking sleeping pills (sedative-hypnotics), which come with a plethora of undesirable effects (including cognitive impairment) and only target symptoms rather than causes, a referral for cognitive-behavioral therapy (CBT) can address the underlying stress-related causes of most refractory cases of insomnia.

Sleeping and Dreaming

The most common, naturally-occurring altered states of consciousness are observed during sleep. Dreaming and non-dream sleep are each associated with distinct patterns of EEG activity, metabolic changes, and eye movements, as well as subjective experiences. As one falls asleep, the predominant brain waves progress from beta to alpha, theta, and then delta, the deepest stage of sleep. What is fascinating is that during dreaming, also known as "REM sleep" because of the rapid eye movements, beta waves predominate even though we are not awake. The EEG pattern cycles through theta, delta and beta waves five or six times during an eight hours of sleep.

Dreaming during sleep serves a very important function. Experiments with dream deprivation in normal subjects, accomplished by waking the subject each time dreaming began, as indicated by rapid eye movements (REM sleep), resulted in the REM periods becoming progressively more frequent. The experiments were abandoned when it became impossible to stop REM sleep. Many researchers now believe that the brain is doing serious work while we dream, integrating what has recently been experienced into our long-term memory. People who are adapting to new challenges typically show increased REM activity.

Stress

Perhaps the greatest malady of our time is not a specific medical illness, but rather a psycho-physiological state that increases our susceptibility to illness. Stress can pave the way for cancer, heart disease, infectious diseases and a variety of mental disorders. Stress can be defined in terms of biological, psychological, or physiological processes. It impacts the neuro-endocrine and immune systems, precipitates fight-or-flight reactions, puts a strain on the body, impairs judgement, and produces unpleasant emotional states. Stress can be acute (eg. getting into an argument, sustaining an injury), chronic or recurrent (eg. unresolved grief, rancorous marriage), or residual from adverse childhood experiences.

Abuse, neglect, and early exposure to traumatic stressors are all too common adverse childhood experiences. Their long-term consequences include a significantly higher likelihood of illness and mental health problems. Repressed memories, habitually held grudges and a negative self-image make conventional stress-reduction techniques that focus on the present situation much less effective. Thus far, treatment has been piecemeal and dependent upon the presenting problem, such as alcoholism or drug abuse. Post-traumatic stress disorder (PTSD) may respond to guided sessions using psychedelic substances such as psilocybin, ketamine, and MDMA.

Because humans are a highly adaptable species, we can learn to live with long-term stress, but we will inevitably pay a price. Often, people won't realize that they are habitually stressed, because their stress-adapted physiological state feels "normal" to them. Chronic stress results in elevated levels of the adrenal hormone, cortisol. It has an effect on almost all of the body's organs and tissues, and can suppress the immune system, alter metabolism, and impact sleep-wake cycles. If sustained, it will shorten one's life expectancy.

While an acute stress response to sudden danger takes place within a short time frame and is mediated by epinephrine (adrenaline), chronic stress occurs in ongoing situations that produce frustration, anger, worry, or other negative psychological reactions that might be taking place without our conscious awareness. Cortisol, in this context might be called the "quiet desperation" hormone. One of the consequences of excess cortisol is an increased deposition of abdominal fat. If you are putting on weight and your waistline is expanding faster than the rest of body, that could be an important clue that you have been living in a stressed state, even if you don't feel stressed.

The best prescription I can offer for effectively dealing with stress involves being well-rested and well-nourished, minimizing stressful external stimuli, and dropping beliefs that cause inner turmoil, especially those that encourage you to fight with reality. Stress is a product of the interaction between external situations and the beliefs that we hold about them. Whenever you resist what is presently true, you create stress, conflicts and suffering. The process of dropping stress-causing beliefs involves first becoming aware of those that have an associated negative emotional charge (ie. those that lead us to feel fearful, sad or angry), and then examining the validity of their existence and their consequences. This process requires both curiosity and courage. However, as Socrates declared during his trial, "The life that is unexamined is not worth living."

Cognitive-behavioral therapy (CBT), based on the principle that beliefs and perceptions shape people's emotional responses and behaviors, can help to identify and correct negative or irrational thoughts that have become ingrained through mental repetition. Cognitive errors, caused by faulty logic or reasoning, can be addressed through a step-wise process of inquiry that examines the validity of beliefs when put up against what is actually true at the present time. Maladaptive beliefs are evaluated in terms of their emotional, physiological and interpersonal costs. People often pay an exorbitant price for holding on to their maladaptive beliefs and behaviors, typically sacrificing their happiness and peace of mind in the bargain.

Subjective Experiences

Unverifiable personal experiences are beyond the reach of what can be measured and independently validated. Accounts of an extra-corporeal consciousness do not lend themselves to objective, scientific investigation. Many such anecdotal reports involve so-called out-of-body experiences, the collective unconscious, and states of non-local consciousness. Intense subjective experiences can occur with lucid dreaming, during deep meditation, and in trances. Hypnotic suggestions regarding past lives, and non-ordinary experiences attributed to the presence of disincarnate entities (ghosts) and spooky action at a distance (spells) have created a fertile field for the imagination. Many people are convinced about the reincarnation of souls, and almost all religions are based upon stories about supernatural beings and extraordinary events that contradict the basic facts of biology and laws of physics.

Mythologies about the existence of an immortal soul are accepted by billions of believers. As an article of faith, this belief is typically inculcated during early childhood, before the development of critical thinking can challenge it. About the only thing agnostics can say about any widely held beliefs that are unsupported by scientific evidence is, "Who knows?" In contrast, most scientists and rational philosophers will invoke the principle of parsimony and remain skeptical of untestable hypotheses. Reports of phenomena that cannot be independently verified by qualified observers are typically dismissed, since extraordinary claims require extraordinary evidence.

Induced Altered States

Altered states of consciousness can be produced by certain types of chemicals, infections, strokes, and traumatic brain injuries. A number of psychoactive substances can cause significant deviations from ordinary waking consciousness that range from a decrease in awareness produced by sedative and hypnotic drugs, alcohol and general anesthetics, to an increased sensory sensitivity produced by some stimulants and cannabis, and the dissociation, delirium and hallucinations produced by psychoactive plants and synthetic psychedelic drugs. The perceptual changes produced by psychoactive chemicals are usually accompanied by cognitive and emotional changes as well. While providing a recreational diversion that has become illegal in this country, the legitimate medical uses of mind-altering substances is a subject that holds much interest for researchers.

Medical researchers continue to study the safety and effectiveness of hallucinogenic drugs such as psilocybin and ketamine as an adjunct to psychotherapy for patients with terminal illnesses, crippling anxiety, and refractory depression. The risks and benefits of inducing altered states of consciousness are well known to indigenous healers and shamans. They have ritually used consciousness-expanding botanicals such as psychoactive mushrooms, peyote cactus, and ayahuasca for millenia.

Much less dramatic than psychedelic experiences, there are other altered states of consciousness that can be induced during periods of deep relaxation, meditation, and hypnosis. A major area for scientific research on the neural correlates of consciousness involves the relationships between experiences reported by study subjects and the activities simultaneously observed taking place in their brains. EEG and functional MRI (fMRI) are used to measure the specific areas of brain activity. The research suggests that brain wave patterns observed during meditation are different from those of relaxation and hypnosis. Beta waves predominate while subjects are awake and alert. Alpha waves appear during relaxation, and theta waves during meditation, light sleep and hypnosis. The rare phenomenon of synchronized gamma waves from the somatosensory cerebral cortex has only been observed during deep meditation by long-term practitioners such as Buddhist monks, leading to the proposal that this represents an entirely distinct state of consciousness.

Sensation and Perception

Our sensory system deals with visual, auditory, olfactory, gustatory and somatosensory stimuli. The somatosensory component consists of the receptors, neural pathways and areas in the brain's sensory cortex that process stimuli of light touch, pressure, temperature and pain, as well as proprioceptive stimuli that provide information about muscle movements, joint positions and our posture. Receptors are triggered by stimuli exceeding a threshold intensity, sending nerve impulses to the appropriate area in the sensory cortex. The raw sensations are then selected, organized and interpreted by other parts of the brain, such as the thalamus, limbic system and frontal cortex, to create our perceptions. One of the big challenges for neuroscience is figuring out how the brain converts simple sensory inputs into complex perceptual experiences. Perceiving a light touch seems to depend as much upon attention, memories and expectations, as upon the stimulus itself.

It is a well-known fact that perceptions are shaped by beliefs, assumptions, values and conditioning. Rather than directly experiencing raw sensations, our mind filters, organizes and interprets our sensory input according to our memories and beliefs. The mind, when in a waking state of consciousness and not totally focused upon something specific, engages in a constant stream of mental chatter. This chatter can distract some of our attention and thus make us more prone to oversights and accidents. Our thoughts, however, do the most damage when we come to believe the stories that we repeatedly tell ourselves and invest them with emotional energy. Distorted perceptions, rather than an objective reality, determine our responses to situations. We can greatly reduce our stress level by recognizing our distorted perceptions and challenging their underlying assumptions.

Unexamined thoughts can rob us of our freedom, generate stress, create conflicts in our relationships, and cause much unhappiness. Every time we think that we should or shouldn't do something, or should or shouldn't be a certain way, we feel shame. Every time we project our stories onto others, believing that they should or shouldn't do something, or be the way they are, we create judgments and blame. Refusing to accept what is, while insisting that reality conforms to our wishes, guarantees internal stresses and external conflicts. In the same way that dreams are products of nocturnally restless minds, our waking thoughts are nothing more than emotionally charged stories demanding attention. Troubles arise when we uncritically believe the stories we tell ourselves. We become emotionally attached to our repetitious thoughts, identify who we are with our collection of stories, and want to believe our stories, even when they are untrue. However, when we are able to investigate their validity and effects, our stories are much less likely to create problems.

The Case for Paying Attention

"When we are not living examined lives, when we aren't paying attention, when we are not practicing self-reliance, other forces slip in to dominate our lives, our behavior, and ultimately our fate and our future."
~ Laurence Gonzales, in Everyday Survival: Why Smart People Do Stupid Things (2008)

There seems to be a pervasive problem affecting all of humanity, something that makes it very difficult for people to experience the same kind of playfulness, curiosity, creativity, affection and spontaneous joy that can be observed in young children from a nurturing environment. By the time most of us reach adulthood, our capacity for expressing these innate qualities has become stunted, and we tend to go through the rest of our life like sleepwalkers, with our mind somewhere else. We are no longer fully present in our actions, and we mistake our thoughts for what actually exists, here and now.

This affliction, which lies at the root of so much suffering for ourselves and others, is a syndrome that includes a deficiency of here/now awareness, mistaking beliefs for reality, and misidentifying who we are with the ego (self-concept) in its various guises. From a medical perspective, this psychological dysfunction, which has not yet been assigned to a single diagnostic classification, can eventually lead to anxiety, depression, anger-management issues, feelings of alienation, interpersonal conflicts, dependence on mood-altering drugs, compulsions and addictions, self-destructive behaviors, and a host of stress-related illnesses. From a social perspective, a collective dysfunction of consciousness leads to aggression, international conflicts, and the destruction of our environment.

While painful episodes in life are inescapable, suffering is optional. Suffering is something that we unconsciously add to our pain by taking the painful situation personally. That is why many people continue to suffer long after the emotionally or physically injurious event. For example, a dog with a broken leg after being struck by a car will lick its wounds and get on with life as best it can. When humans break a leg in an automobile accident, they are typically upset by the unfairness of their situation, and feel sorry for themselves. Their undischarged feelings of anger and sadness can persist long after their leg has healed, resulting in continued physical disability and mental anguish.

Not understanding the unconscious causes of our suffering, many of us try to escape from it, seeking distractions or symptomatic relief outside of ourselves. The results of such efforts are typically short-lived. A new lover, a shopping spree, medications from our physician, binge drinking, overeating, and so on, fail to relieve the underlying causes of our suffering. The dysfunction persists, and when the suffering resumes, the cycle of seeking external temporary relief is compulsively repeated. Fortunately, there is a safe and effective treatment for this kind of suffering, and it doesn't come in the form of a pill. Although it is not a quick-fix, it is a lasting one. All that's required is that we pay close attention to what is within us.

Mindfulness Training

Relief can be found in techniques that have been tested and refined for at least 3,000 years. Over the centuries, the many techniques for meditation have been adorned with different bells and whistles in order to make them seem like something new. They have also been imbued with a variety of religious ideologies, none of which are essential for their successful employment. All of these disguises are for the purpose of marketing something that should be part of everyone's elementary school education.

The basic technology involves paying attention to our inner experience. This is much more difficult than it sounds, because we have been so conditioned to turn our attention toward external stimuli, and even then, the quality of our attention is usually very superficial, as we try to multi-task and get distracted by our mental to-do lists. Consequently, we look, but don't really see; we hear, but don't really listen. We touch things without feeling them, barely taste the food we're shoveling into our mouth, and rarely pause what we're doing long enough to notice the subtle scents wafting into our nostrils. So, it's not going to be easy to acquire a new set of skills that involves totally paying attention to things that at first may seem quite boring. Think of it as a mental discipline. And, if mindfulness training seems like too much trouble, you can always stick with the suffering.

The many psychological and physical benefits of training the body to relax while the mind remains alert and attentive to one's experience have been experienced by its practitioners for millennia. It is disappointing that western medical science has only recently recognized that the best techniques for this kind of mental training are able to counteract the damaging effects of stress, reduce patients' blood pressure, stimulate their immune systems and promote beneficial changes in the structure and function of the brain itself.

In my many years of practice as a physician, I have not found a more valuable means of dealing with stress-related illnesses than mindfulness training, and that covers most of what I've encountered in primary care medicine. The value of this approach is even more apparent when one considers the ratio between its benefits and risks. The importance of this technology has been recognized by the National Institutes of Health. Aside from the deeply relaxed state of body-mind it produces, opening up the subconscious for conscious exploration allows maladaptive belief systems to relax their hold.

Mindfulness training has also been shown to increase the brain's density (more neurons) and alter its circuitry, as demonstrated by PET scans and fMRI. The Laboratory for Affective Neuroscience at the University of Wisconsin in Madison conducts research on mind-body interactions, including the influence of mindfulness meditation upon the functioning of the immune system and as a treatment for attention deficits. According to one of their lead researchers, "Attention can be trained in a way that is not fundamentally different from how physical exercise changes the body."

There is one particular meditative practice needs to be cultivated right at the very beginning of one's involvement in mindfulness training; it involves being aware of one's breathing. That is something anyone can do, at any time, and in any place. We will soon discover that noticing our breathing centers our attention in the present moment. This can even be carried out while performing other tasks. As a result, we learn how to witness ourselves, including our thoughts, emotions, sensations, perceptions and behaviors, as we go about our daily actions and interactions.

There is an important reason for making the breath the object of one's attention during meditation. The process of breathing is under both voluntary and involuntary control. Paying close attention to that process positions awareness right at the interface between the conscious and subconscious mind. That interface can be thought of as a membrane that becomes increasingly porous during meditation. As a result, a two-way connection between our waking consciousness and the subconscious mind becomes established. Profound insights and flashes of intuition can make their way into our awareness, while positive thoughts and feeling can be intentionally directed to the subconscious.

If you don't already know how to meditate, I hope you will feel encouraged to learn its most basic technique. Simply sit still, close your eyes, and notice your breathing. When your mind wanders, gently bring your attention back to breathing. It will feel really boring, but you will be surprised at how quickly 10 minutes goes by. Set a timer, notice your restlessness, and repeatedly refocus your attention on the effortless movement of the breath. After 30 days of doing this exercise twice a day, you will begin to notice how it is paying off in many areas of your life.

There are a number of meditation apps for smartphones that can guide you through the practice. One that I have found particularly useful is called "Waking Up," developed and refined by a neuroscientist and long-time meditator, Dr. Sam Harris. The app not only offers guided meditations led by Sam and a number of his guests, it also provides lots of background information explaining the neurobiology of mindfulness and its practical, everyday applications, without the sectarian indoctrination typical of guru-taught meditation practices.