Disclaimer

Sleep, Play, Love: First responder | Mind-health survival guide 

Written by Michael Mantz, M.D.

I want to support our first responders: medical personnel, police, firefighters, etc… who are risking their lives to keep us safe during these incredibly challenging times.

Speaking to many of you during these past few weeks – your courage has inspired me to write a guide to teach you some of the core principles I teach my clients to help keep your mind strong during the COVID19 outbreak.

Preface: Biological Support: Supplements/Nutrition

Before I start with the main part of this article, many people have asked me what supplements they can take to help strengthen their immune system during this outbreak. I will address this question by giving you what I would take if I were in your (first responders’) shoes.

Please note: this is meant for educational purposes only and not intended to be medical advice. Everybody is unique and has unique needs. If you have medical comorbidities please check with your healthcare professional before considering taking supplements or any of the suggestions mentioned in this article. Lastly, just in case you were wondering – I do not have any profit incentives with any of the companies I mention.

What supplements I would take if I were a first responder:

• Life Extension’s Two A Day multivitamin 2 capsules with food per day
• Doctor’s Best Curcumin Meriva 2 capsules with food twice per day
• American Health Ester C 500mg capsules 2 capsules twice a day
• Now NAC 1000mg 1 tablet twice a day
• Vitamin D3 (Dose depends on my 25-OH Vitamin D level in my blood – which I aim for between 40-60 ng/ml. As a general rough rule 1000IU of supplemental D3 will increase your 25OH-Vitamin D by ~10 ng/ml after ~3 months of supplementation. Thus if your blood level is 28ng/ml you could take 2000IU of Vitamin D3 per day which should increase your blood level to ~48ng/ml after about 3 months of supplementation.
• Midori Emerald Class Matcha green tea 1.5 tsp in a blended shake.
• Happy Cows Grass Fed Whey Protein in my blended shake approximately 25 grams
• MuscleTech Platinum Creatine 100% pure powder 5-10gms
• Sweet Sunnah Black Cumin Oil 1 tsp twice a day – if my sleep became more fragmented I would use 2 tsp at night for a short time to get my sleep back on track
• Source Naturals Melatonin 3mg Time Release 1 tablet 1 hour before sleep
• Now Valerian Root Extract 500mg 2 capsules 1 hour before sleep
• As Needed: CBD-CBN Sleep tincture from CBDistillery.com 1 dropperful if I wake up in the middle of the night.

Nutrition:

• Frozen Wild blueberries (I get them at Trader Joes) – 1 cup blended in a smoothie 5-6x week
• Mushrooms – wide variety of different ones in soups, stews, scrambles, and gravies – should always be cooked – 6 days a week
• Cruciferous vegetables – broccoli sprouts are the best would eat 3 containers per week, broccoli, cauliflower, kale, collards, baby bok choy, cabbage, raw sauerkraut
• Onion family foods – garlic, onions (particularly red onions), scallions, leeks,….one positive thing about social distancing you don’t have to worry about garlicky breath – eat enough to scare away a vampire
• Foods high in Omega-3 Fatty Acids – wild Alaskan salmon, flax seeds, chia seeds, walnuts, hemp seeds

Avoid / reduce as much as possible

• Dairy – except grass-fed butter (Kerrygold) or ghee (Ancient Organics)
• Refined carbohydrates – especially added sugars
• Fried foods and foods cooked in oil
• Alcohol

SLEEP

Make SLEEP the priority

Recent neuroscientific research puts sleep as the premier booster of your immune system. No other behavior, whether it be exercise, nutrition, or supplements come close to the power of high-quality sleep to strengthen your mind and your immune system.

You can take Vitamin C & D, NAC, zinc, workout perfectly, eat perfectly in order to strengthen your immune system and brain function. However, if you continue to stay up late into the evening binge watching the news, or Netflix or have your eyes glued to your phone on social media – then you will screw up your circadian rhythms and your overall sleep quality – which has the potential to severely handicap your overall immune and brain function. It would be analogous to expecting to build muscle by drinking protein shakes and taking creatine and not exercising at all.

I wrote an article giving tips to getting high-quality sleep. Click: https://drmantz.com/powerful-ways-for-building-sustainable-brain-energy

You can also get my Enhanced Sleep Protocol that I give my patients on my sister website: https://www.mindbodyintegrationandhealing.com/resources  Simply click and download my Enhanced Sleep Protocol PDF for free. It is located on the right side of the page underneath the Session 2 documents heading (my brain health nutrition guide is there too if you are interested).

Two of my main go to supplements for sleep:

1) Deep Sleep Herbs etc:  https://www.amazon.com/Deep-Sleep-Herbs-Etc-Liquid/dp/B006H9SW62/ref=sr_1_5?keywords=deep+sleep+herbs+etc&qid=1585374394&sr=8-5

Takes about 1-2 weeks for full benefits to kick in. Don’t count drops just pinch a dropperful which looks about 1/2 way up. 1 dropperful 1 hour before bed 1 dropperful right when you hit the pillow. If you wake up in the middle of the night you can use 1 more dropperful. Max 3 dropperfuls per night. Keep the bottle on top of your nightstand with a glass of water so that it’s right there if you wake up.

Tip: If the taste bothers you take a peppermint Altoids after.

This can be effective if your sleep becomes more fragmented as the alcohol tincture works much quicker than a capsule – often in 20min or less. It often delivers the extra nudge your mind needs to help coax it back to sleep.

Many clients report that this formula increases their dreams. If that happens to you, that is an excellent sign that your sleep quality is improving. As long as your dreams are not too intense/disturbing, you can continue to take it and the dream content will most likely iron itself out – usually over the next week.

If your dreams are too strong/disturbing, stop the supplement and  I recommend you seek out professional care and be evaluated for trauma. I suggest a competent psychotherapist who is trained in trauma-based therapies such as EMDR or a Cognitive Behavioral Therapist who has had specific training with trauma.

Therapist choosing tip: If you are looking for a therapist, I recommend you talk to them first on the phone before having your first session. One of the most important questions you can ask them is whether they themselves have undergone psychotherapy. If they have not, or refuse to answer, move on.

2) Melatonin 1-3mg Time Release:

I often recommend melatonin with the deep sleep tincture. The brand I currently recommend to my clients is:  https://www.amazon.com/Source-Naturals-Melatonin-Release-Tablets/dp/B07DQPSDXR/ref=sr_1_6?crid=11FQGT0WUZV6&keywords=source+natural+melatonin+3mg&qid=1585374627&sprefix=source+natural+melatoiin%2Caps%2C238&sr=8-6

I don’t usually recommend more than 6mg. Depending on the client, I may start with 3mg and adjust it accordingly. It’s usually not a great sleep aid by itself. It works much better as a supportive “augmenting” agent. If you are a shift worker, consider using melatonin 1 hour before bedtime. If you have a lot trouble winding down for the day you can split the dose and take ½ tab 3 hours before bed and the second ½ tab 1 hour before bed.

Block out Junk Light

Get blackout curtains, eye masks, ear plugs (I like Mac’s silicone ear plugs), noise cancelling headphones, whatever it takes to create a dark and quiet sleep environment that is like a cave. In addition, be conscious of not exposing yourself to bright light (often occurs in the bathroom – get a night light) where you tend to hangout T minus 2 hours before bedtime.

Consider Blue Light Blocking Glasses

I have personally experienced enhanced sleep using blue light blocking glasses and recommend them to my patients who have insomnia. I generally suggest using the red “twilight” glasses 1 hour before sleep. Positive sleep effects will generally kick in about 1 week of continuous use. The pair of glasses I currently recommend are: https://biohacked.com/product/truedarktwilight-var/  The red glasses are also great for when you have a 10-minute break. Put them on, lay back and imagine yourself on a hammock looking up at a blood-filled sky of red as the zombie apocalypse unfolds…..ahhhh so relaxing…… 😊

I prefer the more Kareem Abdul-Jabbar looking twilight glasses over the polarized ones. Yes, they don’t look as good (unless you’re wearing a Lakers’ Jersey) but they wrap around your head providing your eyes with better protection.

Quick summary – the science behind the importance of light and sleep

Light is the master signal your brain uses to detect what time it is in your environment. When the lighting around you becomes DIMMER, your brain detects that change and starts converting your serotonin into melatonin – the timing hormone that coordinates your brain’s sleeping programs. When the lighting around you gets BRIGHTER it reverses this process by breaking down your melatonin back into serotonin. This creates an alerting response. Not something you want when you are trying to go to bed.

Use bright light as a natural alerting agent and create a powerful circadian rhythm

When you are getting up for work, get natural sunlight 10-15min on as much of your skin as possible, without sunglasses or sunblock. Afterwards you can put on your sunblock and glasses if desired. You can go out on cloudy days as well, simply go out for 5-10 minutes longer.

Look away from the sun (yes I do have to put that disclaimer in) and look up at the blue sky. This is the time when blue light is beneficial and will increase your circadian alerting affect and may increase testosterone, boost your BDNF  (a brain growth boosting chemical that acts like brain fertilizer – tantalizing your neurons to grow and become stronger), and stimulates the break down of melatonin into serotonin which increases alertness and a sense of calmness. All of these effects combined can provide mood-boosting benefits – especially when you couple bright light with vigorous or rhythmic body movements done consistently most days for 30 days.

For example: My morning routine part 1: 5-6x a week I will get up and put on my sneakers and gym shorts (which I lay out the night before to help ‘lubricate my environment’ making it easier for me to start my morning ritual) and go straight outside (I do not pass go) into the sun (shirtless). Next I grab my jump rope and do between 500-700 jump ropes. Then I go for a morning walk, come back and stretch. After that, I go take a cold shower that at the end I make very warm – > just for my back -> to help relax my muscles there and get them loosened for the day.  

What about us night shift workers?

If you are working the night shift you can use a special lamp that is intensely bright that is commonly used in Seasonal Affective Disorder or S.A.D. for short. Verilux is the brand I currently recommend for my clients. You can start with 30 minutes within the first 2 hours after getting up out of bed. Follow the instructions that come with the lamp and don’t look directly into the light. You can eat breakfast with the lamp off to the side hitting your eyes at an angle. Those of you with migraines, epilepsy, or eye conditions please check with your doctors first.

The bright light treatment can pull double duty by providing you with an alternative alertness booster to keep your caffeine use in check. Whenever you have a break and want a little alertness boost, studies have demonstrated that using these powerful lights for 15 minutes every couple of hours during your shift can be an effective way to boost wakefulness.  This is a healthier alternative to jolting your nerves with tons of coffee.

Side bar:  If you want powerful and restorative sleep – it’s recommended to not drink caffeine at least 10 hours before your bedtime.

Lay off the Booze

I highly recommend the bestselling book Why do we sleep? by Mathew Walker PhD. He spends several pages explaining the detrimental impact alcohol has on sleep. His final recommendation was no booze if you want your brain to be healthy and happy. Why?

Alcohol’s sedating properties may decrease the time it takes to fall asleep but alcohol gets metabolized by your liver into acetaldehyde, a known carcinogen, stimulant, and harsh stressor to your liver, your heart, and your entire nervous system.

Experiment: You can check out the difference in your pulse about 4-6 hours after you have had your last drink of alcohol and notice that it will likely be higher than normal. Your blood pressure will most likely be elevated as well. 

Alcohol fragments your sleep and you wind up waking up more than you normally would. Due to alcohol’s amnestic qualities – you may not remember these frequent awakenings. The only clues you may get is how tired and shitty you might feel the next morning along with the strong desire to quickly drink high quantities of caffeine.

The Power of REM SLEEP

In my last article What Dreams May Bring https://drmantz.com/what-dreams-may-bring/  I elaborated on the many benefits that rapid eye movement or REM sleep (when we are dreaming) has on our physical and psychological functioning. The 4 main mind-health benefits from REM sleep are:

1.  Increased creativity and problem-solving capacity
2.  Increased brain growth – synaptogenesis
3.  Improved integration of new information into our memory programs
4.  Improved emotional processing (both intra and interpersonally) and regulation

Alcohol is one of the most potent REM sleep blockers. The 4 benefits of REM sleep invert themselves when you drink:

1.  Lack of zest, difficulties thinking of solutions, dullness, tendency to feel overwhelmed
2.  Dimming of your brain function – feeling cobwebs and brain fog
3.  Forgetfulness, misplacing items, things on the tip of your tongue but you can’t get it out
4.  Exaggerated emotional reactions – most common anxiety, depression, and anger (often in the form of increased irritability and frustration).

Noteworthy: Studies show that lack of REM sleep makes neutral faces seem negative and potentially hostile. A bias that could have dire consequences for first responders deprived of REM sleep as this outbreak continues.

PLAY

One of the best antidotes vs. the tremendous stress you might encounter on any given day is to activate your PLAY circuitry. Jack Panksepp, a brilliant neuroaffecive scientist, defined 7 primal emotional circuits that all mammals share. They are the PANIC/GRIEF, LUST, CARE, RAGE, FEAR, SEEKING and PLAY circuitry.

Have you been watching any of those animal videos that people have been posting online? If so, you probably experienced some of the positive power that PLAY can have on your mind. PLAY is one of our primal social emotions that is so powerful that it can be activated simply be watching other animals PLAY on your TV screen – quickly bringing positive feelings and a smile to your face. You will often feel lighter and brighter when PLAY is turned on inside your brain.

Your PLAY circuitry is stimulated when you see silly creatures doing goofy things. PLAY feels good and has many benefits for your mind including:

• increases your ability to concentrate
• teaches you how to channel your aggressive impulses into socially acceptable ways
• allows you to confront fears and doubts and learn to overcome them
• increases creativity
• serves as a catalyst for releasing suppressed, repressed, and compartmentalized emotions that may be weighing you down.

As first responders you will usually face a bombardment of experiences laced with negative emotions throughout your shift. YOUR MIND KEEPS SCORE when it experiences negative emotions – whether you were feeling them or you were watching others feeling them that elicited a resonance response in you. Your mind then stores these charged experiences as “spiked” memories that can build up in your mind and become toxic if you are not giving your mind an outlet to process and discharge their emotional energy.

In other words, given the high probability that you will be exposed to a large amount of shitty feelings during this outbreak  – it’s important that you keep the 5 main outlets for emotional detoxing open and available.

Your body has 5 main outlets to let go of emotional toxins. They are:

1. Laughing
2. Crying
3. Shaking / rhythmic body movements
4. Shouting / Chanting
5. Dreaming

“How is it courageous to be afraid to feel your feelings?”  – Dr. Douglas Kahn

Being PLAYFUL sets the stage to keep your 5 outlets of emotional detoxification open and available.

It’s important that you give yourself some PLAY time to allow your mind to emotionally detox. While engaged in PLAY – laughing, shouting, and rhythmic body movements naturally occur, giving your mind a much-needed release from any emotional toxins it might have soaked up during work.

If you are all work and no PLAY, your mind can become emotionally constipated, getting clogged up with unprocessed anger, fear, sadness, anxiety and other negative emotions that you are likely to encounter in spades while performing your job. Emotional constipation can often lead your mind into some dark places including: drug addiction, anxiety and mood disorders.

I recommend you PLAY games that engage your attention. Sitting on your toilet, half asleep playing Angry Birds is unlikely to give you the major benefits of PLAY. You want to engage your body and your mind with games that are fun and interesting and if you live with others (you can play games with friends, coworkers, loved ones through videoconferencing if you don’t) get them involved to get the most out of PLAY. Dancing, singing, teasing, tickling and wrestling are all forms of PLAY.

MOVE THAT BODY

It’s difficult to get people to exercise. It’s especially difficult if they are stressed and lacking high-quality sleep.

I have found out, through my 10 years of clinical experience working with a wide-variety of patients, that moving your body to music is the most accessible PLAY activity that many of my “exercise-resistant” clients are able to do, most days of the week, as a long-term habit.

I recommend moving your body to at least 2 songs every day. Start with one song after you wake up and one song when you get home from work. Create a wake up playlist and a getting out of work playlist (while you are at it create a night time playlist as well).

Using music and rhythmic body movements is one of the healthiest ways to stimulate brain growth and induce healthy mood states. Rhythmic movements including drumming along with a great song is a potent way to release any pent-up negative emotional energy that you may have stored during your work shift.

Camaraderie booster: I recommend getting rhythmic songs that have a strong beat like We Will Rock You to be used with other co-workers either just before or after your shift. Drumming and creating beats in synchrony with each other is a powerful way to create social bonds and a sense of affiliation with one another. The technical term for this powerful category of social bonding is called behavioral social synchrony.

Creating synchronous or reciprocal hand gestures and/or body postures often seen during celebrations between athletes on the same team is another form of social synchrony. Be creative, silly, and goofy. In return, you will powerfully activate your PLAY circuitry, lighten your body load, brighten your mood and improve your sense of connection.

A sense of CONNECTION is vital to enhance your sense of security during these uncertain times.

LOVE

The current restrictions in place for most areas in the United States during the COVID19 outbreak has put many of us in close quarters (too close?) with our loved ones – family members, romantic partners, children, etc…Two areas that can help create a healthier living environment to engender a greater sense of love for both you and those people who are most important to you are: values and boundaries.

Get clarity on what you value

What do you want your life to stand for? What truly matters to you? What qualities do you want to embody when interacting with the ones you love and care about most?

Values are the principles or standards of behavior that you find meaningful and important. Getting clarity on what you value most is a powerful way to provide you with a “compass” that can guide you when you face difficult situations and choices ahead.

A partial list of common values:

Authenticity, Adventure, Compassion, Connection, Contribution, Cooperation, Courage, Creativity, Dedication, Truth & Justice, Fitness, Fun & Humor, Gratitude, Honesty, Love, Loyalty, Persistence & Commitment, Safety & Protection, Strength,….

I have my clients pick out their top values and practice what I call value sprouting – purposely creating daily activities that embody their chosen values.

I recommend choosing 2 values, write them down and display them in a place where you will see them during your day. I also recommend practicing value sprouting which has 3 main effects: 1) Teaches you whether your chosen values are truly what you value. 2) Strengthens your connection to what you value – enhancing a sense of meaning and connection in your life. 3) Increases your comfort and skill in making tough decisions (once you know what you truly value – your values become “compasses” to guide your actions especially when thrusted into difficult situations.

Boundaries

It’s important that we respect each other’s boundaries if we want to optimize our relationships during these challenging times.

There will be many times during this outbreak when we all will lose our shit – whether we are feeling intense panic, frustration, fear, grief or frustration. We all need appropriate boundaries to be negotiated beforehand to help create an environment to optimize the appropriate responses to intense emotional experiences and limit suffering.

The first step is to negotiate boundaries with your partner. The goal is to create a flexible and evolving set of guidelines that help the two of you reduce conflict and reduce patterns of suffering.

The best time to negotiate is when you both are feeling relatively well. We often don’t take advantage of these “good” times because we may not want to “rock the boat” when things are more relaxed. This is understandable, unfortunately it’s a form of avoidance that misses out on the best times to create positive shifts in your relationships.

Famous psychotherapist and author, Irving Yalom, said it’s best to “STRIKE WHEN THE IRON IS COLD.” The reason for this is because if you strike when it’s hot it’s most likely going to escalate and quickly become a shit show that neither of you want to be a part of and both of you will suffer from.

Get good at knowing your SUDS level

SUDS stands for Subjective Units of Distress and is a measure of negative emotional intensity scaled 0-10.

Emotional Learning Zone (ELZ) : SUDS 2 through 7

You learn best how to handle your negative emotions when you are within the 2-7 SUDS level range. If you are consistently above a 7 most of your brain’s blood will shift out of your rational thinking, analyzing, and planning mind programs and into your more ancient brain centers where the energy runs high and the logic runs low.

If you detect a SUDS score consistently higher than a 7 within you or your partner (most likely both of you) then that is an indicator to break away from engaging one another and to TAKE A TIMEOUT and let things cool off. Give yourselves 30 min to an 1 hour to report back in and if both of you are below a 7 you can reengage your conversation. If not TAKE ANOTHER TIME OUT………This is a difficult process, for both of you, and it takes a lot of practice and trust.

Don’t expect yourself or your partner to get it right on the first time. That would be a ridiculously unrealistic expectation and will lead you to feel more anger, hurt, resentment,…aka – unnecessary suffering. Reward approximations to what you want from your partner (called shaping).

Side Bar: Emotions within relationships strike deep primitive chords in all of us. If we were raised in subpar environments (hypercritical, unresponsive, neglectful, punishing, abusive) by our caretakers and we haven’t worked with someone to help us process through some of our old shit, we will unknowingly replay many of our unprocessed painful experiences again within our romantic relationships. Be open to getting a good couples therapist to work with. One that doesn’t take sides. Consider reading Parenting from the Inside Out by Dan Seigel – its an excellent read even if you’re not a parent. 

When emotions run high, our minds become more like a dog’s mind. If you want to teach your inner dog or your partner’s inner dog new tricks, then just like how you would train a real dog a new trick, you reward small shifts towards the desired behavior.

Partner Training Tip 🙂 Whenever you see a shift towards a more desirable behavior – simple acknowledgement (noticing it and mentioning it) will reinforce the new shift AND will increase the likelihood for bigger shifts in the future.

Partner Training Tip II  🙂  DO NOT pair a positive acknowledgement with a BUT…., IF ONLY…., NOW I WANT YOU TO…..follow up statement or you will destroy the power of the positive reinforcement. If you want to bring your partner’s attention to something else do it at another time. Let the positive reinforcement do its magic without running interference into it with more demands.

Boundaries Summary:

• The first step in creating healthier relationships is to negotiate boundaries and guidelines with each other.
• “Strike when the iron is cold” and don’t fall into the “I don’t want to rock the boat” avoidance trap. Unless you like to suffer – then by all means continue to avoid.
• Both you and your partner – learn how to report your SUDS level to each other and practice giving each other space when either or both of you are consistently above a level 7.
• You may have to break away and report back a few times before both of you are below a SUDS of 7 . This may require sleeping on it without a resolution until the next day. This is not easy, but the alternative is much worse. It does get easier with time and practice.
• You learn best when you are in the Emotional Learning Zone (ELZ) = SUDS range (2-7)
• Recognize and reinforce shifts in behavior from your partner that approximate the desired behaviors you ultimately want from them (SHAPING). Changing behaviors, especially when stressed, takes time and the willingness to accept a lot of mistakes and the willingness to press the reset button over and over again.