It's 7:01 AM ⏰

How to find calm and less pain upon waking.

A favorite mural in my neighborhood in Philly, and an acknowledgement that little sparrows loom larger than life in our city.

It’s 7:01 AM. You’ve been lying in bed for 60 seconds now, your consciousness reconstructing itself into personhood, your anxiety building in both vague and specific ways. It’s uneasy. There’s an icy discomfort as catecholamines constrict blood supply to your gut and extremities. Your blood pressure is rising. The stress hormone cortisol has begun to surge, and the dawn chorus of sparrows chirping outside your window sounds like a cruel sort of chaos. You give in to the electrochemical prodding and hop out of bed, only to feel a sharp pain tear through the bottom of your foot. Again. Your muscles ache, and you have to sit back down on the edge of the bed to wait for a sudden lightheadedness to pass. You couldn’t go back to sleep now, even if it were a lazy Saturday and you were snowed into a cozy cabin somewhere in the fjords of Norway, surrounded by all things hygge. Instead, you are in New Jersey, and it’s now almost 7:02 AM.

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Waking up in the morning is a bizarre series of events to which we have grown accustomed. We transition from an alive mass of cells and infrastructure to a conscious, aware, human being. Our bodies have been resting and repairing, preparing and restocking. Dreams have been deconstructing and rebuilding memories, plans, and thoughts. We relinquish our control to the night, and we must now wrest it back. Blood pressure, stress hormones, and sympathetic nervous impulses all increase. Muscles and the other means of locomotion have tightened and become relatively dehydrated, with fibers that stick instead of sliding past one another. This can all be quite uncomfortable, both physically and psychologically. Cardiovascular events like heart attack and stroke are more likely to occur during the morning hours.

Reassert calm.

As our conscious minds ride a wave of anxious machinations upon awakening, it is possible to temper the storm and reclaim some of the the calm from which we are emerging. There is really no better instrument than the parasympathetic nervous system, and its central highway the vagus nerve. To hack into this gentle conduit, just try one of the most fundamental ways: breathe.

Lying in bed, breathe in to a count of 5, pause comfortably at the top of a full inhalation, and then slowly breathe out to a count of 5 to 7. Whatever count feels right to the body and mind is the right one. A search reveals a million sources telling us how to breathe, but I’ll add my own, which may or may not be the best. Initiate the breath with your belly. It should rise as you start a breath. This ensures you are engaging your diaphragm, which ties into the parasympathetic system. Feel your chest rise secondarily. Luxuriate in that lungful of air. It should be a kind of pleasure. Exhale, letting your belly deflate first and then your chest. But don’t stress or concentrate too hard. Just belly to chest, wave in… belly then chest, wave out.

If your mind is filling with anxious thoughts and manic plans, don’t try to suppress that. Acknowledge the fretful chatter in your brain, but don’t engage with it if you’re not ready yet. Emerging consciousness can be too insistent. Don’t follow it. Return to your breathing, and the pleasure in that.

It may be tempting to distract yourself with your cell phone upon awakening. Dopamine hits from the glowing screen nurse a hungry mind with candy. Do the harder, more rewarding, and innately simple act of breathing instead.

Our blood pressure is coming down, premature heart beats are hopefully abating, and blood vessels are relaxing from their reflexive constrictions. But there are still natural surges and crescendos going on inside, with hormones like cortisol, renin, angiotensin, aldosterone, and adrenaline at high levels. Reasserting calm will reduce our risk of these factors adding up to cardiovascular events in the short and long term. In fact, a recent analysis in The American Journal of Hypertension showed that:

Cardiovascular disease, the most common cause of death in the United States and other developed countries, also has an intrinsic variation in events. These events are more common in winter, at the beginning of each month, on Mondays (in working people), and during the early morning hours of each day. Recent meta-analyses have quantified the excess risk of cardiovascular events in the hours around and just after awakening. Between 6 AM and noon, there is a 40% higher risk of heart attack, a 29% increased risk of cardiac death, and a 49% increased risk of stroke.

And so what about people with hypertension? Should they take medications at bedtime to reduce morning risks, or first thing upon awakening? The answer to this question is not obvious. Intuitively many of us would think that taking blood pressure medications in the morning is preferred. We are stressed and active during the day time, so why not load up our shields at the start of each day? This is when most people take their medications for convenience sake, too.

The two most recent and authoritative answers to this question have different conclusions. The first study caused quite a buzz in 2020, and had many doctors and media recommending people take their blood pressure pills at night. But the second study, presented at the European Society of Cardiology’s August, 2022 meeting concluded that it really doesn’t matter.

In short, the first study was called the Hygia Chronotherapy Study. It found a shocking 50% reduction in overall cardiovascular disease events when people took their blood pressure medication at night. Furthermore, that 50% held for specific outcomes like death, heart attack, coronary revascularization procedures, and stroke. Doctors hailed it as practice-changing, and many media outlets amplified this message.

The second and larger study, called the TIME trial, contradicted these findings. It found no differences in these cardiovascular outcomes, and was hailed as the more definitive answer to the question. The principle investigator concluded that people should just take their blood pressure medications at whatever time is most convenient for them to remember, and that minimizes any side effects.

But whether we have hypertension or not, we all face a morning surge. Breathing well is a free intervention, and I don’t know of any doctors who recommend against it. It is logical that the best time to consciously breathe is when our consciousness is most vulnerable and emergent in the morning. With all the automatic, fretful systems preparing us for our daily journeys into chaos, reasserting calm might never be more important than at 7:01 AM.

Chirping sparrows not withstanding.

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*To Be Continued *