attention problems

Tips for better sleep

Having trouble sleeping is perfectly normal, especially as we age. It’s estimated that half of those older than 55 have trouble getting to sleep or staying asleep.

What to do if your sleep is poor

Let’s start with the easiest situation: you’re not getting enough sleep because you wilfully go to bed too late to achieve your needs.

This is unfortunately all too common. All I can do is point out how desperately important it is to get the sleep you need. By chronically depriving yourself of sleep, you not only are ensuring that your mental powers are under-par, but you have added significantly to the likelihood that you will develop cognitive problems in old age.

Life is a matter of priorities. To change this situation, you need to give sleep a higher priority than you’ve been doing.

Chances are, though, that your sleep deprivation is not wilful, but is caused by problems in getting to sleep, or staying asleep. If this is the case, you are probably aware of the standard advice, but let me bullet-point it first, before getting to less common solutions.

  • Have a routine
  • Have a regular schedule
  • Get some exercise during the day
  • Don’t do anything too stimulating before going too bed - this includes eating, drinking (caffeine or alcohol), smoking, working, playing games
  • Make sure your room is quiet and dark (wear earplugs and/or a sleep mask, if you can’t do anything about the environment).

Alcohol and sleep

This needs a special mention, because many people see a ‘nightcap’ as an aid to sleep. It’s true that alcohol can shorten the time it takes to fall asleep. It also increases deep sleep in the first half of the night. However, sleep is more disrupted in the second half. While increased deep sleep is generally good, there are two down-sides here: first, it’s paired with sleep disruption in the second half of the night; second, those predisposed to problems such as sleep apnea may be more vulnerable to them. Additionally, at high doses of alcohol, REM sleep is significantly reduced, and in any dose, the first REM period is significantly delayed, producing less restful sleep.

All in all, then, while alcohol may give the illusion of improving sleep, it is not in fact doing so.

Stress & anxiety

Stress and anxiety are of course major factors in chronic sleep problems, and the reason would seem to be the thoughts that plague you.

A good strategy for dealing with this is to write all your worries down, preferably with a planned action. Your planned action doesn’t have to be a solution! It simply needs to be a first step. Write it down, give it a priority rating or action date.

If your worry  is completely fruitless, with no viable action that you can (or want to) take, it’s still worth writing it down, along with its possible consequences. You probably don’t want to think about those consequences, but this is part of why the worry is plaguing you so much. Write down the possible consequences, and their likelihood, and you will get rid of much of their power over you.

Unfortunately, it seems that worriers are not simply more likely to have sleep problems, but they are more affected by them.

A study in which 18 young adults viewed images that were either disturbing or neutral, which were cued by a red minus sign (something horrible coming up!), a yellow circle (don’t worry, nothing disturbing), or a white question mark (you’ll have to wait and see), found that activity in the brain’s emotional centers, the amygdala and insula, rose dramatically when the participant was sleep deprived, with this effect being most extreme when the participant was an anxious type of person.

Sleep deprivation, it appears, has an effect on emotion that is similar to what is seen in anxiety disorders, and those who are naturally anxious are more vulnerable to these effects.

This means that sleep therapy is even more important for the naturally anxious.

How to relax

If you’re prone to stress or anxiety, you’re probably familiar with relaxation techniques. They’re a great idea, but if you haven’t found them as effective as you’d like, the problem may like in the ‘mental churn’ you can’t get rid of. Try the writing strategy first, then follow it up with a relaxation strategy.

If you’ve been unsuccessfully trying a standard relaxation exercise, you may also find a more mentally challenging relaxation strategy works better for you. T’ai chi, for example, is a form of physical meditation that demands your attention, and thus leaves less room for you to fret about your worries. It’s well worth learning for that alone (although it also has physical and mental benefits).

Another less common strategy for dealing with sleep problems is rocking. It does require some expense and effort, given that you need a bed that rocks gently, but it may be worth considering if you’re desperate.

The evidence for this is a little sketchy, unfortunately, but it seems a nice idea, and it certainly seems plausible. A small study involving 12 youngish healthy men found that when they took a 45-minute afternoon nap on a bed that rocked slowly, they went to sleep faster, moved into deep sleep faster, and showed more slow brainwaves and sleep spindles, compared to a similar nap on the same bed, held still. It is a very small sample, and a restricted one, which doesn’t include anyone with sleep problems. But it’s worth noting because apparently every one of the participants showed these effects.

Quiet time

One of the big problems for insomniacs is that typically the more you worry about not being able to get to sleep, the harder it is to fall asleep. Here’s a suggestion: redefine your goal. Why do we need sleep? Because without it we feel lousy the next day; we’re weaker, and we’re less able to think or remember. This is your real goal: giving your mind and body the opportunity to refresh itself.

You need to process the day’s material, to discard what you don’t need, to file what you do need, to wipe the sheet clean so you can start again. Try focusing on that instead.

Lie quietly in your bed. Make sure that it’s quiet and dark. If you find it helpful, you can have gentle music, but not anything that is loud or in any way exciting. Traffic noise, bright light, and temperature extremes, are all common causes of what is termed “environmental sleep disorder”. Moreover, one study found that morning performance on a psychomotor vigilance task was significantly worse if the person had been exposed to traffic noise during the night. Light interferes with circadian rhythms, which are also important for learning and memory.

So, lie there quietly in the dark, and guide your mind through the events of the day. When you come to events of particular interest, focus on them, picking out the details that are important to you. Give the event/information a descriptive label. Pay little attention to events that aren’t worth remembering (you could try mentally dumping them in a trashcan or dumpster). When you’ve run through everything, go back to your labeled sets. (My Memory Journal provides a place and structure for you to do all this.)

IMPORTANT! This is NOT about dwelling on things you need to do! Those should all be in your written list. They’re done.

This is about processing the day’s events and wiping the slate clean for tomorrow.

Let me say again: Bedtime is not, ever, for thoughts of the future.

Nor is it for dwelling on the past, in the sense of emotional wallowing or fretting. What you are doing is housekeeping. You are discarding, filing, and wiping the desk clean.

When you’ve done that, now is your time for your relaxation exercise. Fill your mind with your meditational image; progressively relax your muscles. Whether or not you fall asleep, your aim is to provide the quiet place your mind needs in order to get on with the processing at an unconscious level. You’ve done your bit, giving it the best possible start. Now let it do its job.

Providing a quiet place for your mind to process new information is also an excellent strategy during the day, and this is particularly true for those whose sleep is less than optimal. If you’re learning a new skill or wanting to remember new information, giving yourself 10-15 minutes of quiet reflection (optimally in a darkened environment) helps consolidate it.

If you’re prone to stress-related sleep disturbance, you may also find this strategy useful after any emotionally stressful event.

Sleep and health

It’s a truism that sleep gets worse with age, but a recent study suggests that age may not be the main culprit. The main problem is health - which of course also tends to get worse with age. Medications can cause daytime sleepiness; pain and discomfort can interfere with nighttime sleep.

Weight, too, can be a factor in sleep problems. A study of overweight and obese people found that weight loss improved their overall sleep score by about 20%. Interestingly, the loss of belly fat was particularly useful.

Sleep and diet

Sleep length has also been linked to diet. Data from the very large 2007-2008 National Health and Nutrition Examination Survey (NHANES) found that those who slept 5 to 6 hours a night had the largest calorie intake, followed by those who slept the ‘standard’ 7-8 hours, then those getting less than 5 hours, with those sleeping most (9 hours or more), eating least.

While there were many differences in the make-up of those diets, analysis revealed just a few nutrients that were critically linked to sleep differences. Very short sleep was associated with less intake of tap water, lycopene (found in red- and orange-colored foods, especially tomatoes), and total carbohydrates. Short sleep was associated with less vitamin C, tap water, selenium (found in nuts, meat and shellfish), and more lutein/zeaxanthin (found in green, leafy vegetables). Long sleep was linked to less intake of theobromine (found in chocolate and tea), dodecanoic acid (a saturated fat) choline (found in eggs and fatty meats), total carbohydrates, and more alcohol.

Whether you can change your sleep patterns by changing your diet is as yet unknown, but it is an intriguing speculation.

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Sleep and cognition in children

  • A U.S. survey provides evidence that both children and adolescents tend to be getting less sleep than needed.
  • Depression, lower self-esteem, and lower grades, have all been found to be correlated with sleep deprivation in middle-school children.
  • Sleep disturbance in infants and young children has also been found to be associated with lower cognitive performance.

We all know that lack of sleep makes us more prone to attentional failures, more likely to make mistakes, makes new information harder to learn, old information harder to retrieve ... We all know that, right? And yet, so many of us still go to bed too late to get the sleep we need to function well. Of course, some of us go to sleep early enough, we just can’t get to sleep fast enough, or are prone to waking in the night. (Personally, I can count the times I’ve slept through the night without waking in the last fifteen years on my fingers).

I talk about the effect of sleep on memory elsewhere; I want to talk here about a sleep problem that we don’t tend to think about so much — the sleep deficit children are running.

A survey commissioned by the National Sleep Foundation found that 3-to-6-year-olds in the U.S. get about 10.4 hours sleep nightly, while experts recommend 11 to 13 hours. 1st graders to 5th graders who should be getting 10 to 11 hours are averaging just 9.5 hours.

And a study of middle-school children (11 to 14 year olds) found a direct correlation between sleep deprivation and depression, lower self-esteem, and lower grades. "The fewer hours of sleep that children got, the more depressed they were, the higher number of depressive symptoms [they had], and the lower their self-esteem and the lower their grades."

The second largest growth spurt occurs during these years (usually 10-14 for girls; 11-16 for boys), so this is a time when a lot of sleep is needed. But it’s also a time when children become more capable and more independent; when they’re likely to start taking on a lot more activities, work harder and longer, and are monitored less by their parents and caregivers. So ... it’s not surprising, when we stop and think about it, that a lot of these children are starting to pick up the bad habits of their parents — not getting enough sleep.

Which also points, in part, to the solution: if you’re a parent, remember that your children are, as always, modeling themselves on you. And sleep habits usually reflect a household pattern. If you’re a teacher, remember you need to educate the family, not just the child.

The National Institutes of Health (NIH) have identified adolescents and young adults (ages 12 to 25 years) as a population at high risk for problem sleepiness based on "evidence that the prevalence of problem sleepiness is high and increasing with particularly serious consequences."

Sleep disturbance in infants and young children has also been found to be associated with lower cognitive performance. Previous studies have looked at the severe end of the spectrum of sleep disorders — obstructive sleep apnea. More alarmingly, a new study of 205 5-year-old children found even mild sleep-disordered breathing symptoms (frequent snoring, loud or noisy breathing during sleep) were associated with poorer executive function and memory skills and lower general intelligence.

Before you panic, please note that some 30% of the participants had SBD symptoms, so it’s hardly uncommon (although there may have been a bias towards children with these symptoms; it does seem surprisingly high). You might also like to note that I personally had a blocked nose my entire childhood (always breathed through my mouth, and yes, of course I snored) and it didn’t stop me being top of the class, so ...

Nor is the research yet developed enough to know precisely what the connection is between SBD and cognitive impairment. However, it does seem that, if something can be done about the problem, it is probably worth doing (in my case, taking me off dairy would probably have fixed the problem! but of course noone had any idea of such factors back then).

Here’s a few links that may be of interest to parents and teachers:

The NSF Sleep poll
https://sleepfoundation.org/sleep-polls-data/other-polls/2013-internatio...

a look at the school start times debate (I find this fairly amazing actually, because here in New Zealand, our children usually start school around 9am; the thought of kids starting school at 7.30 sends me into a spin!)
https://sleepfoundation.org/sleep-news/school-start-time-and-sleep

The National Sleep Foundation also has a site for children who want to learn about sleep and healthy sleep habits: www.SleepforKids.org For children from 7 up; with educational games and activities, as well as a downloadable copy of NSF’s new Sleep Diary designed especially for children.

This article originally appeared in the November 2004 newsletter.

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Why good readers might have reading comprehension difficulties and how to deal with them

The limitations of working memory have implications for all of us. The challenges that come from having a low working memory capacity are not only relevant for particular individuals, but also for almost all of us at some points of our lives. Because working memory capacity has a natural cycle — in childhood it grows with age; in old age it begins to shrink. So the problems that come with a low working memory capacity, and strategies for dealing with it, are ones that all of us need to be aware of.

References: 

Press release on the first study: http://www.physorg.com/news/2012-01-high-school-whiz-kids-comprehension.html; see also http://rrl.educ.ualberta.ca/research.html

Second study: Banas, S., & Sanchez, C. a. (2012). Working Memory Capacity and Learning Underlying Conceptual Relationships Across Multiple Documents. Applied Cognitive Psychology, n/a-n/a. doi:10.1002/acp.2834

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Seeing without words

I was listening on my walk today to an interview with Edward Tufte, the celebrated guru of data visualization. He said something I took particular note of, concerning the benefits of concentrating on what you’re seeing, without any other distractions, external or internal. He spoke of his experience of being out walking one day with a friend, in a natural environment, and what it was like to just sit down for some minutes, not talking, in a very quiet place, just looking at the scene.

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Forgetting to do things

  • Forgetting future tasks and events is the most common type of memory failure
  • Older adults are in general no worse at this type of remembering than younger adults
  • Older adults may have more difficulty at remembering to do actions at particular times
  • Older adults also need to make more effort in situations when an action cannot be performed immediately, but must be held in memory for a brief period.

The other day I was sitting in the sunshine in my living room going through some journal articles I'd photocopied. I realized I needed to staple the pages together and went down to my study to get the stapler. Approaching my desk, I decided to check my email while I was there. And then, I decided to check my library account online to see whether a book I had requested had turned up. When I'd done that, I went back upstairs to my papers. Where I realized, of course, that I'd forgotten the stapler.

This type of memory failure — going to do something, getting sidetracked, doing something else and forgetting the original task — is familiar to all of us. As are everyday memory failures like forgetting to put the garbage out; forgetting to take medication at the right time; forgetting a dentist appointment (although there's more than one reason for that!).

This type of memory failure — forgetting the future, as it were — is a failure of a type of memory called prospective memory, and it is probably the most common type of memory failure older adults suffer from. And probably the biggest concern.

It's a concern because it's a failure of memory that has consequences, and those consequences are often not only obvious to ourselves, but also to others. Which makes us feel worse, of course.

But it's not just a matter of being embarrassed. Older adults are particularly vulnerable to thoughts that they are "losing" their memory — and the fear of Alzheimer's lurks in all of us.

So, should you be worried if you forget what you're doing?

Like other types of forgetting or absent-mindedness, it depends on the degree of your forgetfulness. But prospective memory failure is common among older adults for a very good reason. Not because it's a precursor of cognitive impairment, but because it's the most common type of memory failure for everyone.

In fact, older adults in general are no worse than anyone else in this particular memory domain, although they may worry about it more (because they worry about any memory failure more).

In some aspects of prospective memory, older adults are actually better than younger adults! One reason for this is that they are more likely to use memory aids — like writing down reminders, or putting reminder objects in strategic places — to help them remember.

However, it does seem that older adults may do less well at remembering things that have to be done at particular times, and one reason for this seems to be that they tend to be poorer at monitoring time. In these cases, it's therefore a good idea to use timers as reminders.

Older adults also seem to have more trouble in the situation when a remembered intention cannot be performed immediately, but must be held in memory for a brief period. Even 5-10 seconds is too long! Tasks that you are "just about" to perform, but in fact are not doing that very second (because you have some other intervening task to do first) are probably particularly dangerous because you don't feel a need to make an effort to remember them (because you are "just about" to do it). But without rehearsal, information falls out of working memory (the stuff we're holding in the conscious "forefront" of our mind) in seconds. So you do need to make an effort. And often, that's all it needs.

You can read more about planning memory strategies in my ebook on planning memory.

 

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Multitasking

  • Doing more than one task at a time requires us to switch our attention rapidly between the tasks.
  • This is easier if the tasks don't need much attention.
  • Although we think we're saving time, time is lost when switching between tasks; these time costs increase for complex or unfamiliar tasks.
  • Both alcohol and aging affect our ability to switch attention rapidly.

A very common situation today, which is probably responsible for a great deal of modern anxiety about failing memory, is that where we're required to “multitask”, that trendy modern word for trying to do more than one thing at a time. It is a situation for which both the normal consequences of aging and low working memory capacity has serious implications.

There’s an old insult along the lines of “he can’t walk and chew gum”. The insult is a tacit acknowledgment that doing two things at the same time can put a strain on mental resources, and also recognizes (this is the insult part!) that well-practiced activities do not place as much demand on our cognitive resources. We can, indeed, do more than one task at a time, as long as only one of the tasks requires our attention. It is attention that can’t be split.

You may feel that you can, in fact, do two tasks requiring attention simultaneously. For example, talking on a cellphone and driving!

Not true.

What you are in fact doing, is switching your attention rapidly between the two tasks, and you are doing it at some cost.

How big a cost depends on a number of factors. If you are driving a familiar route, with no unexpected events (such as the car in front of you braking hard, or a dog running out on the road), you may not notice the deterioration in your performance. It also helps if the conversation you are having is routine, with little emotional engagement. But if the conversation is stressful, or provokes strong emotion, or requires you to think … well, any of these factors will impact on your ability to drive.

The ability to switch attention between tasks is regulated by a function called prefrontal cortex. This region of the brain appears to be particularly affected by aging, and also by alcohol. Thus, talking on a cellphone while driving drunk is a recipe for disaster! Nor do you have to actually be under the influence to be affected in this way by alcohol; impaired executive control is characteristic of alcoholics.

More commonly, we get older, and as we get older we become less able to switch attention fast.

The ability to switch attention is also related to working memory capacity.

But multitasking is not only a problem for older adults, or those with a low working memory capacity. A study [1] using young adults found that for all types of tasks, time was lost when switching between tasks, and time costs increased with the complexity of the tasks, so it took significantly longer to switch between more complex tasks. Time costs also were greater when subjects switched to tasks that were relatively unfamiliar.

Part of the problem in switching attention is that we have to change “rules”. Rule activation takes significant amounts of time, several tenths of a second — which may not sound much, but can mean the difference between life and death in some situations (such as driving a car), and which even in less dramatic circumstances, adds appreciably to the time it takes to do tasks, if you are switching back and forth repeatedly.

To take an example close to home, people required to write a report while repeatedly checking their email took half again as long to finish the report compared to those who didn't switch between tasks!

In other words, while multitasking may seem more efficient, it may not actually BE more efficient. It may in fact take more time in the end, and the tasks may of course be performed more poorly. And then there is the stress; switching between tasks places demands on your mental resources, and that is stressful. (And not only are we poorer at such task-switching as we age, we also tend to be less able to handle stress).

There is another aspect to multitasking that deserves mention. It has been speculated that rapid switching between tasks may impede long-term memory encoding. I don’t know of any research on this, but it is certainly plausible.

So, what can we do about it?

Well, the main thing is to be aware of the problems. Accept that multitasking is not a particularly desirably situation; that it costs you time and quality of performance; that your ability to multitask will be impeded by fatigue, alcohol, stress, emotion, distraction (e.g., don’t add to your problems by having music on as well); that your ability will also be impaired by age. Understand that multitasking involves switching attention between tasks, not simultaneous performance; and that it will therefore be successful to the extent that the tasks are familiar and well-practised.

This article originally appeared in the February 2005 newsletter.

References: 

Rubinstein, J.S., Meyer, D.E. & Evans, J.E. 2001. Executive Control of Cognitive Processes in Task Switching. Journal of Experimental Psychology - Human Perception and Performance, 27 (4), 763-797.

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Short-Term Memory Problems

  • Short-term memory problems are, by and large, attention problems.
  • Attention involves both the ability to keep focused on the information you want to keep active, and the ability to not be distracted by competing and irrelevant stimuli.
  • You need to actively attend to keep information active, particularly as you get older.
  • Many of us over-estimate how much information we can keep active at one time.

Many people, particularly as they get older, have concerns about short-term memory problems: going to another room to do something and then forgetting why you’re there; deciding to do something, becoming distracted by another task, and then forgetting the original intention; uncertainty about whether you have just performed a routine task; forgetting things you’ve said or done seconds after having said or done them; thinking of something you want to say during a conversation, then forgetting what it was by the time it’s your turn to speak, and so on.

This is clearly an issue for many of us. Part of the reason, I believe, is simply that we expect too much from ourselves. For example, research has shown that even a very, very short delay between recalling an intention and being able to carry it out is sufficient to dramatically reduce the likelihood that you will remember to do the intended action — we are talking about a delay of only 10 seconds!

The problem is exacerbated by age (I’m not talking about advanced age — I’m afraid certain aspects of cognitive processing begin to decline as early as the 30s).

Part of the problem is also that we tend to believe that we don’t need to do anything to maintain a thought, particularly when it has “popped” into our minds easily. But current estimates are that unrehearsed information lingers in working memory for less than two seconds!

Some of these problems are dealt with in my article on action slips (these problems are not, strictly speaking, a failure of memory, but a failure in attention), and in my e-book on Remembering intentions.

But in this article I want to talk about another aspect: the relationship between working memory, and attention (and, as it happens, intelligence!).

In my article on working memory and intelligence I talk about the difference between crystallized and fluid intelligence — that fluid intelligence is probably a better measure of what we think of as “intelligence”, and that working memory capacity is often used synonymously with fluid intelligence. A new theory is that the relationship between working memory and fluid intelligence is due to the ability to control attention.

This theory emphasizes the role of attention in keeping information active (i.e. in working memory), and argues that working memory capacity is not, as usually thought, about the number of items or amount of information that can be held at one time. Instead, it reflects the extent to which a person can control attention, particularly in situations where there is competing information / demands.

I have to say that this makes an awful lot of sense to me. I can’t, in the space I have here, go into all the evidence for and against the theory, but here’s one situation which is interesting. The “cocktail party phenomenon” is a well-known method in psychology, whereby people are given two streams of audio, one for each ear, and instructed to listen only to one. At some point, the person’s name is spoken into the unattended stream, and about a third of people pick that up. In a recent take of that classic study, researchers compared the performance of people as a function of their working memory capacity. Only 20% of those with a high capacity heard their name in the unattended channel compared to 65% of low-capacity people. The point being that a critical aspect of good attentional control is the ability to block our irrelevant information.

This ability is one that we already know is worsened by increasing age.

The message from all this, I guess, is that:

  • short-term memory problems are, by and large, attention problems.
  • attention involves both the ability to keep focused on the information you want to keep active, and the ability to not be distracted by competing and irrelevant stimuli.
  • you need to actively attend to keep information active, particularly as you get older.
  • many of us over-estimate how much information we can keep active at one time.

And if you want strategies to help you keep more information active, I suggest you look at improving your ability to chunk, condense and label information. If you can reduce a chunk of information to a single label quickly, all you need to do is remember the label. (I explain all this at length in my book The Memory Key, but I’m afraid it needs far too much explanation to go into here).

Anyway, I hope this helps those of you (most of us!) with short-term memory problems.

This article originally appeared in the April 2005 newsletter.

References: 

Heitz, R.P., Unsworth, N. & Engle, R.W. 2004. Working memory capacity, attention control, and fluid intelligence. In O. Wilhelm & R,W. Engle (eds.) Handbook of Understanding and Measuring Intelligence. London: Sage Publications.

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