Mental Health Post #26: Expectations

I think the thing I wrestled the most with as I learned about mental health was my expectations.  When I was first diagnosed with post-partum depression (PPD) and started on an antidepressant, I thought I would feel better within a week.  Some of that came from how I responded to coming home after having expatriate depression (see previous post on this topic) a few years prior: for me, coming back to my home and to my familiar life brought me almost back to baseline within a week or so.  You can imagine my horror when the psychiatrist told me that it would take 4-6 weeks to see a full effect from the antidepressant, and 2 weeks to even see a mild effect.  Needless to say I was very disappointed.

Once I had PPD after my second child was born and realized that I needed to be full-time on antidepressants (not just after having children), I had other expectations in the back of the closet ready to be brought to life and stomped on.  I thought I would magically feel good all of the time and be healed from all mental illness, I believed I would naturally display more resilience and grit, and I imagined that I would automatically have more control over my feelings.  Let me lay these three fallacies out a little more...

The first one I mentioned is I think one of the most normal, but also the most harmful cognitive distortions that can beset people dealing with healing from any kind of mental illness/addiction.  As I expressed in my previous post, I have had to learn that normal life also includes some downs and griefs.  Life is not an opioid pillow where you float around all day long in bliss and contentment.  What taking medications, exercise, and having a wonderful support group have done for me is made it so when those disappointments come, I can grieve, and I can keep going.  I don't become non-functional, even when I am dealing with the monster PMS that comes from perimenopause (young women, be afraid, be very afraid...).  I grieve when people I love pass away and I get frustrated when my lawnmower locks up on me with only three strips of grass left to mow.  I sometimes don't get enough sleep and am irritable, and I even get mad at people (I know you're all SHOCKED to learn this about me).  I still have depression/anxiety and they still do pop up every now and then and I get to do a self-assessment of tweaks that need to be made for a fuller life.

On a related tangent, I want to interject that I have depression/anxiety and some other labels.  I, however, am not depression/anxiety.  I hope you have a chance to listen to the podcast I just posted about because there is a lot of talk about identity and labeling.  It is in long-form narrative, so set some time aside to take a walk, crochet or mow the lawn while you are listening.

I am just so fascinated by grit and resilience.  How is it some people are naturally just so full of it and others not so much?  At the risk of bringing up the same old example, my partner, Derek, is the most grit-ful person I have ever met.  Sure he's white and upper-middle class male, but he also navigated his parents divorce as a young teen, served a two-year mission in Siberia as an older teen, and has continued to live with and love me.  If that doesn't constitute resilience, I honestly don't know what does!  I credit some of this definitely to personality, but I also like to give his family of origin a lot of credit for being loving and supportive all of the time, even while going through some tough times.  If there's anything that our adoption training has taught us, it's that having parents who set firm boundaries but still express oodles of affection and love can truly change brain chemistry and levels of felt-safety.  I myself am not blessed with a personality that lends itself to bouncing back, but guys, the older I've gotten and the longer I've lived in a safe network of loving people, the most grit I feel like I've learned to deal out.  I feel more positive in negative situations and can be more of a peacemaker (as a parent must be) than before.  This is not to say I have magically become grit-ful.  I definitely haven't in by any stretch.  But I'm improving, and honestly, what more can a person ask than to improve?  That's what the billion dollar industry of self-improvement has taught me anyway...  ;)  

A library's worth of books could be written about control and mental health.  Heck, there already are judging by Amazon's offerings.  For some reason, I had this thought that antidepressants would automatically change my thought patterns and turn me into someone who was more charitable, less irritable, and more able to handle change.  It certainly took the edge off of things, but I would say anti-depressants gave me the opportunity to begin working on the genesis of thought processes that would trigger my amygdala and send me off the deep-end (so that I was catastrophizing and over-generalizing all over the place).  What helps me get out of the rut of these well-worn thought patterns has been intensive therapy and self-examination.  (It also helps to know that I have trauma in my history that needed to be painfully pulled out, dusted off, and worked through before healing can happen.  Unfortunately, this can be a seed that germinates into unhealthy behaviors.)  An important aspect of control of course is that people who have mental health illnesses can display controlling behavior in an attempt to feel better about the lack of control they may experience in their environment/own thoughts.  I know for myself that the more stressed I am, the more I start yelling at people to pick up their crap and do their chores!

There are so many false expectations and cognitive distortion that can come with mental illness, and I don't have time to list them all.   Let me offer a link to a nice article that can get you started in looking into some of the minutiae of these behavioral patterns:

https://psychcentral.com/lib/cognitive-distortions-negative-thinking#definition

Please know that change doesn't happen immediately, but contrary to what some talking heads may say, personal change can happen.  It takes time and dogged perseverance, and the willingness to step out of your comfort zone and to ask for help, and above all, being patient with yourself.

Photo note: he has been hereby renamed, "Mr. Amygdala"...

Mental Health Post #25: Support Systems

Almost every.single.thing I have ever read, listened to, or been told about mental health talks about having a support system.  At some point, you may sort of tune it out, especially if you've checked the box and moved on.  In my mind, a support system is the most important tool you will have in your fight to equilibrium.  A support system allows you to try new medications and thought processes, and practice them around people who will support you and not excoriate you for making mistakes.  I'm no sociologist, but I suspect that this is why things like AA continue to be so helpful for so many people.

What does a support system look like?  I like to think of it as number of overlapping Venn diagram circles, probably resembling your social circles.  For me, I would have one that is for Immediate Family, one for Close Friends/Neighbors, one for Extended Family/Family of Origin,  one for Members of My Congregation, and perhaps some for different people or groups of people that relate specifically to activities that I participate in.  Of course, you are absolutely not constricted by blood: we have some very dear friends and neighbors that we consider family, especially after living all across the nation.  Age is also not a limiting factor: one of my very most beloved people in this world is in her 80s, and I have almost always derived a measure of satisfaction and comfort from caring for babies and young children.

I get a lot of different things from these people or groups of people.  From my Family of Origin, we share a lived experience and because we are genetically related, we also share a great deal of personality and physical traits (which obviously can tie into mental health issues).  From some groups I am gifted with almost unconditional acceptance (including my beloved grandma who recently passed), and from other groups I get reinforcement for many of my dreams, ambitions, and goals.  Some of the people in my groups are people that I rarely have the pleasure of interacting with, but when I do, it's just like old times and I feel fulfilled from being with them.  Others I see frequently, particularly in my Immediate Family (spouse and children), and they know that I am very fallible.  While we have disagreements, and sometimes fights, we accept that we are on this journey together, despite mistakes we make.  From those who deal with similar mental health challenges, I feel comfortable talking deeply about the medical issues and dropping some dank gallows humor.  (Better to laugh than cry, am I right?!?)

One thing that can be especially hard is talking about mental health issues for the first time with someone you just met or maybe someone you've known for a long time.  Being this vulnerable is super scary and I think should be done with discretion.  Let's be honest: there are still many people who are stuck in the stigma of mental health and even a few that continue to shame people for behaviors, addictions and life choices, sometimes even family members.  The people that you know and trust though (which might only be a spouse or a therapist) are those who will make mistakes, but overall will work hard to support you as you (and maybe they) are educated about things like therapy, medications, lifestyle changes, etc.  I feel like we generally know who these people are and are often guided to those who aren't yet a part of our lives.  

What if you feel like you don't have anyone?  Start small, with someone you really trust.  I often like to write my thoughts down in my journal--it sort of helps me gather and collate my thoughts so they are hopefully a little more articulate.  This person might be a spouse, a close sibling, best friend, or even a therapist.  Please allow someone in your life because working through these things doesn't really work alone.  As a freakishly independent person, I can empathize with the desire to shoulder on and do it yourself.  I suppose for awhile, I was able to do that off and on, but being functional isn't the same as being satisfied with life.  (Please note that I didn't say endlessly happy, because life isn't an endless opioid cushion where nothing bad happens.)   Read any medical literature, and they will tell you that having a support system gives you better coping skills, resilience, and even longer life, not to mention diminished mental illness.  Oh, and let's not forget about pets: we know that petting an animal can literally lower blood pressure...  (Had to put my plug in for my Loaf, as my groomer calls him.)

***How could you say no to this look? ;)***

Required Podcast Episode

I just listened to a really great podcast that talks about being "stuck" (procrastination, or whatever word you want to use) that I highly recommend.  Anyone that has suffered from a mental health issue will be sooo familiar with the various types of "stuckness" that can come from anxiety/depression/etc.  I've attached a picture of the episode name and number (The Science of Stuck with Britt Frank, #230) on the You Are Not So Smart Podcast.  I use Overcast, but I know this is available on all of the major podcast providers (Spotify, Apple, etc).

 *Please note for my friends who do not like swearing, she does use some moderate language.  So maybe not for littles, but the information is truly life-changing for those old enough.

 

Mental Health Post #24: How the Mental Affects the Physical (and vice versa)     

(Trigger warning: for those that can't stand talk about scatological issues and medical TMI, this is your one and only chance to bail.  Just know you are missing a really good post....)

I'm a veteran pooper-in-public (not sure about the correct terminology here ;).  For many, many years, I've dealt with IBS (irritable bowel syndrome), often at the most inopportune times.  It's kind of Murphy's Law at this point that if on any walk, run, or hike and my stomach is going to go for broke, it will always, always, always be when I am the furthest away from any available restroom.  This has led to me pooping all over Ann Arbor on Derek and I's runs, Sunstone Knoll in Utah, and the top of Mt. Timpanogos (to name just a few of my favorites).  I've been doing this one so long that I have absolutely no shame at all.  We keep camping TP in the car, and I design my running routes so that if I think I may have any possibility of needing to powder my nose, there is a restroom adjacent.  I'm familiar with the ins and outs of the toilets in my places of routine shopping (thank you Joann's Fabric for FINALLY making the "Men's" toilet a Unisex one.  Pretty sure it's used about .0001% of the time by biological males).  For most of my life that I've dealt with this (since my early 20s), I assumed there was some sort of physical cause for fecal incontinence.  I was right, sort of: my uterus has prolapsed onto my rectum after 5+ pregnancies (especially the hippopotamus that came last), the endometriosis and subsequent surgeries have all caused scarring and adhesions that have "frozen" many of my organs into distorted placements, and I do have a number of allergies that can affect my digestion.  But there is one big puzzle piece I was missing beyond these frank physical symptoms.

Actually, I wasn't so much missing it as I was in denial about it.  I mean, who wants to own up to the fact that the anxiety they felt all night about something was to blame for me barely making it to the toilet after a morning run?  And again, it's a little tricky because I indicated that this isn't a physical issue, when it really is.  All mental health issues are, by definition, physical health issues when you think about it.  We are physical beings and our meatsacks are assuredly affected by the physical stresses played upon them when we have big or prolonged releases of cortisol, adrenaline, and all the other hormones.  While I don't understand the science at a deep chemistry level, I can tell you that any time you have a release of any kind of hormone or neurotransmitter, this leads to cascades of other chemical processes.  And as many of you probably already know, our gut is sometimes euphemistically called our 'second brain' because it hosts a multitude of special receptors just like those that are in the rest of our nervous system.  The way I see it, anything that stresses our brains, also stresses our guts.  The output, so to speak <<wink, wink>> may be different, but only because our brains aren't in the middle of digesting foods.

I've learned a few things that have helped me to manage my obstreperous gut.  One of the most important for me is that I can't let the plumbing get clogged up or I can guarantee at some point that I'll get to have 5 days of gold stars compacted into a few hours.  I take magnesium pills because I need to for other health reasons, and it has the added benefit of giving me a gold star every day.  Another helpful thing is to not consume a lot of caffeine.  Oh my caffeine is so bad for you, and yet such a useful tool.  As sad as it is, I've kept from making it a daily part of my life, tho I do partake on long road trips.  Finally, I do the very most obvious thing of all: try to keep my mental state in good health so that I don't have to deal with public poops on top of everything else that could stress a person out.

For me personally, pooping issues aren't the end of the world.  Actually, they are fodder for some amazing jokes (it's possible my mind got stuck in the humor of a 7th grade male).  But there are often other issues that aren't as humorous to me.  Like the extreme gastritis and nausea I've dealt with since I was tiny that now requires constant antacids.  Or the perennial sweating that comes from chronic release of stress hormones. I hate when I am so anxious that I am constantly being startled by the simplest things--like hiccups, you really can't control a severe startle reflex.  There are tight muscles that lead to tension headaches, and crushing fatigue.  My least favorite of all is the insomnia that I used to drown in, month after month, and year after year.  These things are things that as I've learned to better manage mental illness, have decreased in a way that is less of a problem and more of an occasional annoyance.  Things never go all the way away, and I find it important to have realistic expectations of life: everyone has some sleepless nights, and some bad stomach days, and stressful times.  But those have become the exception rather than the rule.

One more tiny mention: not only is distressing to have your mental health spill over into frank physical symptoms, but having poor physical health leads to poorer outcomes of mental health.  It's a bit of a chicken and egg thing, but it's obvious, right?  Anyone with chronic illness can attest to how disruptive and difficult things like being home-bound, or having chronic pain can be.  In the end, I ask, as I keep asking, that we give grace to those who struggle with these issues, including ourselves, and remember that we are only asked to do the best we can each day, and believe me, for most of us that is far less than we think.  Instead of asking ourselves what tasks we accomplished today, perhaps we can focus on the uncounted but essential things like, the fact that you did not, in fact, kill any family members or pets for leaving muddy footprints around, or not cleaning their rooms, or unloading the dishwasher like you only asked 13,000 times.  

 Photo note: I may or may not have fallen asleep at the end of General Conference.  In my defense, I was warm and snuggled up on the couch with my people.

 

Mental Health Post #23: Advocacy    

More than a decade ago, a friend of mine received a tough diagnosis for their baby.  It wasn't immediately life-threatening but it was certainly severe and looked to impact their daily lives in a very visceral way.  Not too long after the diagnosis, this person discovered a new treatment for this diagnosis that was at the time experimental.  The treatment was completely non-invasive, took only a few treatments over a couple of days,  and likely would completely cure this diagnosis for several years, if not forever.  This person talked to more than five medical professionals, showing them the data and the relevant studies.  All but one brushed it off and said they would not be willing to write a reference for the insurance appeal (as most of you probably know, insurance as a general rule will not cover treatments that are still experimental).  After two appeals to the insurance company, this person was completely blasted emotionally, but persevered because that's what you do for your helpless baby.  They were willing to figure out a way to pay for it out of pocket, despite being very young and new to the workforce.  Thankfully the third appeal went through and they were able to fly to the facility and have the treatment completed.  That baby is thriving and has no further problems thanks to this treatment. 

This story is not actually to bash on the complicated bureaucracy of insurance companies.  What I actually want to get out of it is how dedicated this person was in seeking the best possible care for their baby.  How they found the optimal treatment, and kept getting up to fight for it even when their mental health was getting low, and people kept saying no.  In this story, you are the baby.  And you are the parent.  (Sorry, did that get too Predestination?...  ;)  You deserve to receive the best possible care.  You are necessary and important and anyone that says otherwise is wrong.  Including if your own mind says this.  Remember how we talked about the big LIE of mental illness?  That things have always been this bad and will always be this bad?  Let me add another dimension to this LIE: that they are and always will be this bad because you are worthless.  This is the BIG LIE.  Not only are you important and full of worth, but you are always your own best advocate.  Anyone with a chronic illness can tell you this: you know your body and your life best, and when you are able, you are the best possible person to fight for the best care for them.  Enlist the help of your support group and where possible, advocate for others with similar challenges.  But please don't feel shame if you aren't capable of discussing your mental health challenges at length.  We all do what we can when we can. 

You will face a lot of roadblocks.  If you aren't already aware, there is a stigma about living with mental health issues.  (See my previous post.)  I've had a lot of people ask over the years how they can help, both personally to me and in general concerning mental health.  The most important thing I think is to normalize talking about it.  This can be done with tact and without disclosing other people's private information, but it won't be without discomfort.  It is pretty hard to do things outside of the social norms, and talking about mental health in an open way is still not done with regularity.  Along with this, I want to super encourage those who do not struggle with mental health issues to help shoulder the load.  It can be incredibly difficult for someone with a mental health disorder to talk frequently and at length about their own personal vulnerabilities--if you want to help, please do so by committing to be a safe and open person that others can come to to talk about those things.  Educate yourself about resources and keep an open mind when dealing with others who don't act like you expect.  Be forgiving and tolerant as people learn how to manage their own care.  We all have to start somewhere and learning to manage disease doesn't happen overnight!

Photo note: he feels like laying on my head is the best possible way to show his deep and abiding love for me...  ;)

Mental Health Post #22: Stigma

I apologize for the long delay in posts.  I decided I needed a break during the holiday season, but your favorite dark humorist is back with more dog pictures and oversharing...

I haven't addressed this directly yet, but for sure you can see some hints about how the stigma surrounding mental health issues has affected me and those I love.  It's a tricky topic because basically all of us have stigma deep (and some of us not so deep) inside of us, though we may try and root it out.  If I asked if you think less of me because of my posting these essays, you would say, "of course not!"  But if I offered to care for your kids a couple of hours every day, or hold a leadership position in anything, would you be able to honestly say that you did not factor in my diagnosis when responding?  I don't want to push this too far, because many of you who read this don't even know me that well anyway, so you don't know other important things about me, like whether I am dependable, honest or responsible.  I just know that while I am passionately anti-racist and anti-homophobic (among other things), I still find in myself programmed responses that indicate that I still hold some racist and homophobic mental patterns.  I am confident that this is also true when it comes to mental health issues.  

I wish I could speak about stigma in the work force, but it has been too many years since I have been a part of that.  I have volunteered intensely in my children's schools and in my congregations though, and I have had opportunity to witness peoples' biases against mental illness and those who have mental illness.  As I alluded to in my post about '10 Things You Shouldn't Say to Say to Someone with Poor Mental Health,' I was once shamed for suggesting that someone who was having a hard time should consider looking into depression and anxiety as a possible issue.  I was told that there is no way that that person could possibly have either of those things and that they probably just needed to read their scriptures and pray more.  The intimation of that statement is that I probably wasn't doing enough of either of those things either.  Also suggested is that mental illness can be "cured" by reading scriptures and praying more.  Look, I'm a deeply religious person, and I don't want to discount the role of God in my life.  He's helped me out a million times, and some of those times have been leading me to therapists and psychiatrists that have educated me and provided medications I need to be functional and whole.  But I argue that God doesn't always part the Red Sea and that often, He guides us to measures present here that can help us, including peer-reviewed medical science that has made a huge difference in my life for the good.

Another issue I've noticed is there is a generational gap in knowledge about mental health.  The older someone gets, the more likely they are to not know how to talk about, or handle mental health issues.  I have no numbers to back this up--it's purely anecdotal.  But I think we can all agree that in the 46 years that I have been alive, great strides have been made in how we talk and think about mental illness, and what options are available to those who struggle with it.  I hope this doesn't come across as "Ok, Boomer" when we (and I include myself) are all learning to navigate these waters.  I have loved ones who deal with mental health issues and I still find myself weekly struggling with knowing how to act, and what direction to turn for guidance.  It's HARD, and it's hard for everyone.  I appreciate everyone in my life who has taken the time to learn more about these diseases, especially for those for whom the learning curve was very steep.  Hopefully we will all be open-minded in how we hear each other and give each other grace as we grow in maturity and awareness.

The last big thing I want to mention relating to stigma is how you treat yourself.  Are you too afraid to seek help for your own psychiatric needs?  You should know that you can go 80 years without issues and then find you're dealing with chronic mental illness.  You can be born with those issues and you can literally develop them at any time.  They can come and go, or be a constant feature of your life.  You can have issues that have a huge impact on your life or ones that you are able to push down and still be functional with.  I know people who have channeled extreme anxiety into workplace ambition and for the most part been successful.  But there are always costs, if not now, then at some point.  I would argue that in a world that encourages us to be our best selves, we should for sure (for ourselves and those we love) seek treatment and help if we feel that we are struggling in some way related to mental illness.  It's never too late to start and it's never wrong to show yourself compassion. 

Photo note: sometimes we just feel this way...

Mental Health Post #21: Sleep

Few things screw me up more than not getting good sleep.  Ironically, not getting good sleep is part of the game with almost all mental health disorders.  Whether it's insomnia, or sleeping too much, or bedtime procrastination, there's always something in the grab bag for those who struggle with poor mental health.  I've struggled with all of these (and more!) in my fight to have good mental health.

One of the most severe times I experienced insomnia was when I was going through post-partum depression (PPD) after my first child was born.  I struggled to sleep every night.  It felt like I never slept at all, but after weeks of "not sleeping", I'm pretty sure I was experience micro-sleep or I would've been dead, literally.  Still, the feeling of laying there awake in bed, alone, for hours at a time haunted me.  I got up each day more tired than the previous one and I became fixated on my need for sleep.  I was just.so.tired.  Because I was bottle-feeding this baby, my husband and mother- and father-in-law stepped in to help withe night feedings so I could, ostensibly, "sleep."  We moved in temporarily for a few weeks with my MIL and she gave up her giant, super comfy bed for Derek and I.  It was exactly what I needed for healing and finding a new daily schedule as I was starting antidepressants and seeing a therapist.  But I still struggled to sleep.  Over a period of months, especially once I had started the antidepressant, I finally started getting a healthy amount of sleep and over the next few years, things eased.  I now know that what prevented me from sleeping was extreme anxiety (as well as the depression).  Not knowing when my baby would awaken and need me and all the fears of being a new mom, along with the lifestyle changes and the physiological changes of giving birth, realllllly made it hard for me to relax.  I still struggle with this because anxiety is omnipresent and never goes all the way away for me.  (It's just well managed.)  At night, I practice deep, even breathing (remember how I talked about breath-holding being a symptom of anxiety?), and I focus on relaxing the muscles of my jaw and neck.  I do this every single night.  The only times I don't have to do this are after extreme exertion (like hiking) or if I have to take something like a Benadryl that night.

I have to admit I have rarely had trouble with sleeping too much, though I know this is a common problem for those with depression.  But I have really struggled with having an uncooperative body clock.  I'm a night owl.  Like a SUPER night owl.  I find going to bed between 1-3am to be comfortable for me.  I've been able to sleep in late for the past few years because of arrangements Derek & I have made, but before that, I was a consummate napper.  Frustratingly, this body clock issue seems to have gotten worse as my hormones have been changing during perimenopause.  Just a few years ago, I found midnight a good time to go to bed.  I'm really hoping things will adjust better once I hit full-on menopause and the hormones get sorted.  In the mean time, I make due by napping when needed, and sleeping in when I can.  I often wonder how others are able to cope when they have wonky circadian rhythms like me, though I assume they are able to help control their sleep through the use of caffeine and alcohol.  (I tried caffeine and it's a good short-term solution for me when driving or vacationing, but I super-ultra-mega rapidly metabolize it so it just doesn't last for me.  Not to mention the fact that it messes with my mental health, and physical health, as well as my sleeeeeeep.)

But let's talk about bedtime procrastination.  I think this is something many, many of us struggle with, even those who may not have a mental health issue.  I think you can figure out what bedtime procrastination is from it's title, tho teasing out the why is a little harder.  It differs from day to day or situation to situation for me.  I know that when I had young infants, especially when I was breastfeeding and no one could take night feedings for me, I sometimes had to cut into my sleep time because I was dying from the lack of Me Time.  Derek would sometimes gently chastise me and ask me why I wasn't going instantly to bed, and I would explain to him that sometimes recharging the emotional reserves is more important than sleep.  This is still true sometimes today though I have a lot more time and flexibility in my schedule than I did with young children.  Today my biggest problem is the computer in my pocket.  Sometimes I find myself on social media or YouTube or reading the news and look up and it's been an hour.  This seems to me a common issue for all of us in the digital age, and especially bad for those who are working on better self-regulation.  I've used alarms, or screen time limits, or even going off of social media each time I feel like I am doing a poor job of moderating my usage.  Even then, I find that I sometimes struggle to go to bed, sort of like a toddler who needs a drink and a snack, and to pee again, etc, etc as soon as bedtime rolls around.  I attribute this to some residual sleep anxiety--after enough years of struggling to sleep, one can dread laying down and hoping that they will fall asleep without laying awake for too long listening to the clock tick.

What do I look like when I am consistently not getting enough sleep?  I become super fragile, emotionally, and don't deal well with distress of any kind.  I become less able to function socially, and I have less control over how I speak and react to those around me.  Basically I turn into a big ole toddler who's naptime is overdue.  My family has learned that it's best for everyone if I make sure I get enough sleep.

I recognize that not every is like me and puts sleep down as one of their hobbies.  (I literally was flabbergasted when I realized that not everyone else put sleep down as a hobby when Derek and I moved into our first young married congregation and we were filling out get-to-know-you papers.  What is wrong with you monsters? ;))  Not everyone needs as much sleep as I do to be fully functional.  But it's also crystal clear that for those that struggle with emotional health, finding a way to tame  sleep by having a consistent schedule, and clean bedtime hygiene, is as important as any other tool used to improve mood and behavior.  It's also super tricky and can take a lot of time and effort to find solutions, and just when you find a good solution, bam, you are pregnant or you hit perimenopause and you find you need to reevaluate your approach and possibly your methods for getting enough sleep.  Being patient and flexible, as hard as it is, can again be one of the most important things to bring to the table when working to have better sleep.

Photo note: if only we could all sleep as easily as dogs do...