Sleep Problems

Effective Sleep

Sleep is a behaviour and skill. Like any other behaviour we can develop good and bad habits. Good sleep habits leave us feeling rested and refreshed while ongoing bad sleeping habits can affect many areas of our lives. In addition to our sleeping behaviour, problems in our lives can also impact on our sleep. Worries, fears, negative expectations about sleep, tension, guilt, anger, anxiety, stress, medical problems, alcohol and drug use can all interfere with our sleep. 

Poor sleeping is associated with a wide range of problems. A reduction in sleep by a few hours may lead you to feel tired but is unlikely to affect your ability to perform physical and mental tasks. However, problems may emerge if sleep deprivation is prolonged. These include:     

• Irritability
• Short-temperedness
• Depression
• Worry
• Anxiety
• Frustration
• Anger
• Increased vulnerability to stress
• Poor attention and concentration
• Memory problems

Many problems are both causes and consequences of sleeping problems. Because of this we often talk about the vicious cycle of sleep problems.   

What is Normal Sleep?

Individual sleeping needs varies from person to person. Some people can sleep for 4 hours a night without any adverse effects. However, between 6 ½ and 8 hours sleep is typical. Similarly, while some people nap during the day to recharge, most people will find that napping disrupts their sleep at night and can contribute to overall dissatisfaction with sleep. On average it takes about 20 to 30 minutes to fall asleep. Some people fall asleep much more quickly than this and others can spend much longer falling asleep without any noticeable effects. 

Our sleep habits change throughout our life. Newborn babies tend to sleep between sixteen and eighteen hours a day, wich is spread out over six to eight periods. However, with training the child soon learns to sleep mainly at night. By the age of 70 most people are sleeping far less that they did at 40. They also often nap through the day, experience more interrupted sleep and tend to wake earlier. 

Habits of Highly Effective Sleepers

As sleep is a behaviour we can develop habits that help to improve both the amount of the sleep we get and the benefits it gives us. 

Noise. Reduce background noise and make the bedroom as quiet, dark and comfortable as possible  

Temperature. Maintain a moderate room temperature. Excessive heat or cold interferes with sleep. Between 15 and 18 degrees centigrade is considered optimal. Also try to ensure your room is well ventilated 

Stimulus Control. Only use the bedroom for sleep and sex. Avoid reading, eating watching TV or talking on the phone in bed

Falling asleep. Do not remain in bed for more than fifteen minutes unless you are asleep. If you cannot fall asleep in fifteen minutes get up, leave the bedroom, try to relax and then return to bed   

Exercise. Regular exercise will help you sleep longer and more deeply. However, if you exercise too vigorously then aches and pains may keep you awake. You should exercise in the afternoon or early evening if you want to improve your sleep. Too late and it will interfere with sleep; too early and you will not get the sleep benefits

Sex. Yes it’s true, sex does help you sleep! 

Caffeine. Eliminate caffeine at least six hours before bedtime. However, ideally you should not drink it after lunch

Nicotine. Don’t smoke before bedtime. Ideally you shouldn’t smoke at all. However, if you must smoke then try not to within three hours of bedtime 

Alcohol. Avoid alcohol for three hours before bedtime. Alcohol helps you get to sleep faster but once you are asleep it will disrupt the quality of your sleep 

Food before bed. Eat light snacks before bed. Hunger can interfere with sleep but so can a heavy meal. Try eating something light, like crackers, milk or cheese. Foods rich in tryptophan (a naturally occurring substance), such as meat, poultry, soybeans and dairy products are especially helpful for improving sleep. A glass of warm milk is great. Avoid chocolate, large amounts of sugar or excessive fluids. If you wake in the night, avoid eating or you may find yourself waking hungry

Sleeping patterns. Establish a regular sleeping pattern. Don’t nap through the day, it will only interfere with you sleep at night. Go to bed only when you are sleepy. If you try to go to bed when you are not tired you may in bed worrying about not being able to sleep. Get up the same time every morning. This is a very important aspect in establishing good sleep habits. It will also help you to make your bedtime more regular 

Don’t take troubles to bed. Put some time aside in the evening to sort through the events of the day. This will help you to stop laying in bed worrying 

Relax. Relax for at least an hour before bedtime. This may take to form of simply taking a warm bath, reading a pleasant book or watching TV. Alternatively you can use relaxation techniques such as Progressive Muscle Relaxation or meditation 

Sunlight. Expose yourself to at least 30 minutes of daylight every morning. 

Sleep medications. Avoid sleep medications if at all possible. In the long run they will make sleep harder

Calming Your Mind

Sleep Encouraging Phrases

Sleep ‘encouraging phrases’ can be used in the same way as you use distraction techniques with your depression. Often unhelpful thoughts may jump into your mind when you are trying to sleep. When they do you can use statements or words to distract and relax yourself. Typical statements or words include: 

Muscle statements or words

“My body is getting heavier” or  “Heavy”

“My arm is becoming warm” or “Warm”

“My head and neck are becoming relaxed” or “Relax”

Mind statements or words

“I am calm” or “Calm”

“I am beginning to sleep” or “Sleep”

“I am rested” or “Rest”

These statements and words can become especially powerful when combined with Progressive Muscle Relaxation.  

Sleep Encouraging Images

Images can also be useful for some people. Think of a scene that is particularly relaxing for you. Take time to relax into the image. Experience every part of it. Engage all five senses and imagine the sights, sounds, smells, tastes and feel of things in your image. Try to make the image as three dimensional and real as possible. It may also be useful to create the scenes before you go to bed. That way you won’t spend time trying to work out what to think! Typically you would need three to five different scenes, from which you can select one you wish to use.  

Typical images include: 

• Lying on a beach in the warm sun
• Resting in front of an open fire
• Lounging in a warm bath
• Enjoying a picnic beside a gently flowing river
• Listening to a relaxing piece of music in a favourite place   

As with sleep enhancing phrases, images are particularly powerful when combined with progressive muscle relaxation.  

Cognitive Therapy

In addition to changing your behaviour you can also improve your sleep by changing your thoughts about sleep. Cognitive therapy, the approach used to treat many other problems such as depression or anxiety, is also helpful for targeting unhelpful thoughts that contribute to sleep difficulties. A number of thoughts are common to people with sleep problems. These include: 

“Now I’m awake, I’ll never get back to sleep”

“My sleep has always been bad and I can’t change it” 

“If I don’t get enough sleep tonight my day will be ruined” 

“I eiether sleep well or badly”

“I can’t cope with having poor sleep” 

These and other similar thoughts cause us to worry, ruminate, become anxious, and so on. As has already been mentioned worry, anxiety and other negative mood states contribute to sleep problems. When we have these thoughts you can employ the same cognitive therapy techniques used for other areas of your life, such as becoming aware of them and them actively challenging them. If you decide to use thought challening remember to get up and leave the bedroom before you attempt it. Then return to bed when you have challenged the unhelpful thoughts and feel more relaxed.  

Summary

Sleep is a behaviour and like any other behaviour it is influenced by good and bad habits

Although there are some indications of what normal sleep might be, in practice individual sleep behaviour varies greatly from person to person. What matters most is whether you are getting the quantity or quality sleep that you need  

There are a number of things you can do to change bad sleep habits, including changing your sleep behaviours, your sleep environment and employing relaxation techniques 

There are also some very useful calming techniques. These include sleep enhancing phrases and sleep enhancing images, which when combined with progressive muscle relaxation are particularly powerful

Cognitive therapy is a useful approach for challenging unhelpful sleep related thoughts 

If you would like to find out more about anything discussed in this handout a good book is:

Dr Timothy Sharpe, (2001). The Good Sleep Guide: Ten Steps to Better Sleep and How to Beat the Worry Cycle, 2001. Published by Penguin Books.   

Tony Merritt, Clinical Psychologist, 2000