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When
you are not sleeping well, your body becomes more reactive and your ability
to think clearly is reduced. Chronic sleep problems can cause your symptoms
to escalate and interfere with your ability to learn the skills described
in this book. In fact, clients with poor sleep habits often find that
simply improving the quality of their sleep significantly reduces their
symptoms.
Since
chronic sleep problems can be caused by many different medications and
physical problems, it is always best to discuss sleep problems with your
physician. If they are a major issue, you may even want to consult a physician
who specializes in sleep disturbances.
Fortunately,
many sleep problems are simply due to poor sleep habits or to thinking
patterns that interfere with sleep. Here are several suggestions for developing
what is commonly called good sleep hygiene:
-
Establish
a regular time to go to bed and get up. Avoid making up for lost sleep
on weekends or holidays. If you have been going to bed and getting
up at widely varying times, you may need to reset your biological
clock by following a regular schedule for sleep. It is alright to
take naps if they are taken on a fixed schedule and you make appropriate
adjustments to your nighttime schedule.
-
Reserve
your bed for sleeping and sex. Watching television, reading, or doing
other activities in bed is one of the most common reasons for difficulty
in falling asleep. If you are finding it very difficult to sleep well,
make the bedroom off-limits to everything except sleep and sex.
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Create
a proper environment for sleep. People often forget about obvious
things such as making sure the bedroom is dark, quiet, and well ventilated.
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Develop
a routine that prepares you for sleep. This routine becomes a conditioned
response trigger that tells your body, “It’s time to fall
asleep.” A typical routine might include brushing your hair and
teeth, pulling down the sheets, and setting out clothes for the next
day.
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For
two hours prior to sleeping, restrict your activities to those that
are relaxing. These activities might include taking a hot bath or
shower, reading, watching television, praying, and meditating. Avoid
anxiety-provoking activities like paying bills or arguing.
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Use
relaxation response techniques. Many find that breath counting is
especially useful. See appendix 4 for an explanation of this and other
techniques.
-
If
you’ve been lying awake for twenty minutes, get up. If you have
spent twenty minutes using one of the relaxation response exercises
in appendix 4 and are still awake, get up and go to a different part
of the house. Do a relaxing activity such as reading a book or watching
television until you feel tired. You may at first find yourself spending
much of the night out of bed, and get only four or five hours of sleep
altogether, but these short periods of continuous, sound sleep will
gradually expand to fill the night.
-
Avoid
caffeine, nicotine, heavy meals, and strenuous exercise for three
to five hours before bedtime.
-
Exercise
during the day. Exercising in the late afternoon increases the amount
of deep sleep you get in the first half of the night. Even a brisk
walk around the block may help. However, exercise just before sleeping
interferes with sleep because it raises the core body temperature.
-
Create
“noise screens.” If noise in your surroundings makes it
difficult for you to go to sleep or wakes you up, block out the noise
with a noise screen. One way to do this is to place a radio next to
your bed and tune it between stations to produce white noise, which
will masks other sounds. Some find that earplugs or a combination
of earplugs and white noise helps.
-
Stay
away from alcohol. Even moderate amounts of alcohol can disturb sleep
or create a backlash of sleeplessness later in the night that makes
sleep problems worse.
-
Avoid
using sleeping medications regularly. Over-the-counter remedies (usually
antihistamines) are often not very effective. One exception seems
to be melatonin, a relatively new product that can be purchased in
tablet form in health food stores. While early reports indicate that
Melatonin can be helpful, be sure to consult your physician before
using it. Prescription drugs can alter normal sleep patterns and suppress
deep sleep or REM (rapid eye movement) sleep—the time during
sleep when you are dreaming. They can also leave you groggy the next
day. Because the body becomes tolerant of some drugs, higher and higher
doses are needed, leading to dependency. In fact, sleeping pills are
often one of the main causes of long-term sleeplessness.
-
If
you get drowsy during the day, change the pace of your activity. The
most “natural” way to keep awake is to move: Get up from
your chair, pace the floor, and stretch. Try light rests and creative
breaks instead of alcohol, cigarettes, or coffee.
If
worrying about problems makes it difficult for you to fall asleep or keeps
you awake in the middle of the night, try the following:
-
Get
out of bed and go to another part of the house. Develop a concrete
plan for dealing with the problem and write it down on a piece of
paper. After you’ve developed your plan, write a one- or two-sentence
summary of what you are going to do.
-
If
you are drowsy when you complete your plan, go on to the next step.
If you are not drowsy, do a relaxing activity to wind down.
-
Go
to bed and use one of the relaxation response techniques described
in Anxiety, Phobias &
Panic or Overcoming
Anxiety. Again, many people find breath counting especially
effective.
-
If
you find yourself thinking about the problem, recite the one- or two-sentence
summary you wrote and use a relaxation-response exercise to distract
yourself.
-
If
worry over problems prior to going to sleep is a recurring pattern,
establish a regular time at least two hours before to your bedtime
during which you think about your problems and develop concrete plans
for dealing with them.
Some
people are awakened by panic attacks in the middle of the night. Current
research suggests that these nocturnal panic attacks are due to some neurological
mechanism that is not understood at present. If you experience nocturnal
panic attacks but are able to return to sleep fairly easily, continue
to do whatever you do to return to sleep. However, if nocturnal panic
attacks are triggering negative self-talk and high levels of anxiety that
make it difficult for you to return to sleep, do the following:
-
Prepare
an index card with coping statements such as “My nocturnal panic
attacks are due to a neurological quirk. They are not dangerous. The
uncomfortable feelings they generate are uncomfortable but they last
only a little while. Find something relaxing to do until you feel
drowsy. Then, go back to bed and use your relaxation-response exercise.
After you’ve made your index card, place it beside your bed or
in your bathroom.
-
When
you experience a nocturnal panic attack, get up and wash your face
so you become fully awake. Once you’re fully awake, read the
card you’ve prepared.
-
Next,
spend about five to twenty minutes with a distracting and relaxing
activity that allows your body to settle down, such as reading a book
or having a cup of warm milk (avoid cocoa since it has caffeine in
it).
-
Finally,
when you begin to feel drowsy, go back to bed. If you are still a
little restless, use one of the relaxation-response techniques sin
appendix 4 to help you get back to sleep.
(Excerpted
from the books Anxiety,
Phobias & Panic and
Overcoming
Anxiety)
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