Sleep treatment without medication (iCBT)

Why can’t I sleep? Tips, tricks and when to seek help

We all need to sleep. Sleep is vital for our physical, mental and daily functioning. It helps us regain energy and repair our bodies. It is also crucial for recharging our brain, allowing it to learn and make memories. When we haven’t slept well, we’re usually not at our best.

When thinking about sleep, it’s common for us to focus on how many hours of sleep we get, however sleep quality is also important to consider. Sleep quality determines whether the time we spend sleeping is actually restorative, and is determined by progressing smoothly through the different stages of sleep.

The psychology of sleep

The practitioners at Foundation Psychology can provide support and treatment for people who are experiencing insomnia or sleep disturbances by:

• taking a thorough sleep history
• assessing whether the individual has experienced stress induces sleep disruption, or if there may be other situational or biological underpinnings
• discussing whether the individual is suffering from health problems that interact with sleep
• assessing the individual’s sleep environment
• considering if our iCBT group program would be of benefit
• helping the individual develop a personalised health plan including a balanced routine with the right amounts of rest, exercise, sunlight and a balanced diet
• teaching and practising relaxation and meditative techniques facilitating discussions that improve insight into one’s broader personality factors that may increase stress, anxiety and other symptoms that are contributors to insomnia

We cycle through different stages of sleep during the night, but what are they?

Deep sleep: This is believed to be the most important stage for restorative sleep, and usually happens within the first three to four hours of sleep. Brain activity during this stage is characterised by slow waves. Deep sleep allows for bodily recovery and growth and may also help bolster the immune system.

Rapid Eye Movement Sleep (REM): During REM sleep, brain activity increases and is similar to levels seen when we’re awake. This is the stage of sleep when dreams occur. REM Sleep is believed to be important for cognitive functions like memory, learning and creativity.  Most REM sleep occurs in the last 3-4 hours of sleep.

Why am I more sleepy in the morning than at night?

There are a lot of things that impact our sleep – some common factors are:

Sleep drive: This is our hunger for sleep. Sleep drive increases over the course of the day. A high sleep drive at bed time helps us to fall asleep quicker and stay asleep for longer. If we nap during the day – this can reduce our sleep drive at bed time (like snacking before we eat dinner) and makes it harder to fall asleep.

Body clock or Circadian Rhythm: We all have an internal body clock that indicates when it’s time to be awake and when it’s to be asleep. The body clock is majorly impacted by light, and most of our body clocks roughly follow the patterns of the sun.

Stress and sleep: Racing thoughts before sleep can override your sleep drive and make it hard to fall sleep. People are often busy throughout the day, working through their to do lists and their brain is collecting new information all day long. It’s not until they get in to bed that they have some time to process all the information that has come in and the worries that may have arisen. Waking up in the middle of the night with racing thoughts often indicates that there is something stressful going on in your life.

Have I got a problem with sleep?

Everyone’s relationship with sleep is different. Some people need more and others need less.

Sleep deprivation

Sleep deprivation occurs when we do not get enough sleep. It is normal to have some brief periods of sleep deprivation, but if we’re sleeping deprived over long periods of time this is when problems can occur. Examples of short-term sleep deprivation may be working a night shift, jet-lag, or a restless night after a stressful day.

Insomnia

Insomnia is different to short term sleep deprivation. Insomnia means that you struggle to sleep even when sleep conditions are perfect, it involves difficulty falling asleep and staying asleep. Everyone will go through sleep deprivation from time to time, but if you’re struggling to fall asleep or stay asleep at least 3 times a week over a 2 to 3 month period you are likely suffering from insomnia. Insomnia has been linked with depression, reduced ability to cope with pain illness or stress, inability to think clearly and make decisions, problems with anger, impairs memory and effects your ability to regulate your own emotions. If you think you may be suffering from chronic insomnia it is important to speak to a health care professional.

Insomnia is an inability to fall asleep or enjoy uninterrupted sleep. Individuals with insomnia may have persistent difficulty initiating or maintaining sleep, and as a result, they experience poor quality sleep that affects their day-to-day functioning when awake. Most adults have experienced insomnia or sleeplessness at one time or another in their lives. An estimated 30%-50% of the general population are affected by insomnia, and 10% have chronic insomnia. Insomnia affects more women than men, and can occur at any age. It is particularly common in the elderly and is more common with people in lower socioeconomic groups, chronic alcoholics, and those suffering other mental health issues.

Insomnia is generally classified based on the duration of the difficulties experienced. Symptoms lasting less than one week are classified as transient insomnia; symptoms between one to three weeks are classified as short-term insomnia, and those longer than three weeks are classified as chronic insomnia.

There are links between depression, anxiety, and insomnia. In order to properly treat and manage your insomnia, our practitioners will assist you to monitor and analyse your sleep patterns. Because emotional issues including stress, anxiety and depression can cause insomnia, our practitioners will also work with you to help you understand how your daily routine and thought patterns affect your mood state, behaviours and sleep patterns.

 

How can a psychologist help with your sleep issues

For a lot of people, sleep difficulties get worse because of things we do that we think are helping us get more sleep but are actually interfering with good sleep habits. Cognitive behaviour therapy (CBT) is recommended as the first line of therapy for sleep difficulties such as insomnia. Sleep medications can play a role in the short-term management of acute sleep difficulties, however CBT for insomnia has longer lasting benefit and impact and less side effects.

 

10 tips for getting a better sleep

1. Keep the bed a place for sleep (and sex)

When we aren’t sleeping well, many of us spend a lot of time in bed awake instead of asleep. The brain then associates the bed with being awake instead of asleep. Where possible, we recommend doing activities like reading, playing on your smart phone, watching TV and gaming outside of the bed. This helps to retrain your brain to associate the bed with sleep again. Don’t stay in bed if you’re wide awake and unable to sleep – if possible, move to the couch or another area to do something quiet and relaxing and only return to the bed again when sleepy.  It’s also important to avoid looking at the clock throughout the night as this create more stress, making it harder to fall asleep.

2. Spend less time in bed.

People who are not sleeping well often try to catch up on sleep by going to bed earlier or sleeping in in the morning. While this might seem like it should help, it often leads to worse sleep over time. Instead, it is recommended that you only get in to bed when sleepy (but not too early even if you’ve slept badly the night before), and get up at the same time each day no matter how much sleep you’ve got the night before (no less than 5.5 hours in bed is recommended). This helps to keep your body clock regular.

3. Wind down the key to a healthy night’s sleep.

Wind down time before bed allows our brains to slow down and come off duty. Ideally wind down time should start 1-2 hours before you plan on sleeping. Dim or turn off the lights as much as possible during this time. It is recommended you put your phone on “do not disturb” or “night mode” during wind down time. Above all – wind down time is your time to slow down and let go of any stress and or anxiety that may have built up during the day. Wind down activities may include listening to a podcast or audiobook, doing some light reading, listening to a playlist, watching TV, or doing some drawing/other artwork. You can experiment with these activities and see which ones work best for you. AVOID – work, study or scrolling on your phone during wind down time as these things are not very conducive with feelings of relaxation and can create more stress and anxiety – which is the enemy of having a good night’s sleep. Prioritising wind down time will allow you to get the most out of your time in bed and ultimately improve your daily energy levels so you’re ready to tackle life the next day.

4. Put down the technology

While smart phones were originally designed to make our lives easier and more productive, they have also led us to feel like we can never truly switch off. Checking your phone stimulates your brain – even that quick check before bed can engage your mind long after you put the phone down. Listening out for notifications can also disturb your quiet mind – this is why we recommend ‘do not disturb’ or ‘night mode’ – so those notifications aren’t coming through as we’re winding down or trying to sleep. Try and stop phone use about 1-2 hours before bed (there’s no hard and fast rule around how long before bed you need to stop – but aim for the same time as you start winding down).

5. Routines

Routines are important to set our body clock and increase our sleep drive (appetite for sleep) when we go to bed.

• Get up at the same time each day
• Don’t go to bed before your normal sleep time.
• Stay consistent with your wind down time
• Try and exercise most days as it can help improve sleep –  however, avoid exercise 2 to 4 hours before bed as it can affect your body clock.
• A healthy and balanced diet and eating meals at same time each day (roughly) will help with sleep, energy levels and keeping your body clock stable.

6. Make the bedroom a place you want to be

Keep the bedroom a place you feel relaxed and want to spend time. Adding or changing candles, plants and pictures to your bedroom can help to change negative associations you may have with the bedroom. The general rule is to have your bedroom cool (around 18 degrees is ideal), dark, and quiet when sleeping.

7. Develop some healthy thoughts about sleep

Negative or unhelpful thoughts about sleep can make us worry which then makes it harder to sleep. Here’s some healthier ways to think about sleep.

• Instead of thinking “If I don’t sleep well,I should go to bed earlier or get up later”, remind yourself – “our body is designed to catch up on sleep, and will sleep deeper rather than needing to sleep longer”.
• Instead of thinking “I need 8 hours of sleep to function” – remind yourself that everyone’s sleep is different, some people need more – some people need less. Remind yourself that a sleepless night every now and then is normal.
• Instead of thinking “I cannot function after a poor night’s sleep, today is going to be awful” – remind yourself that it’s ok not to be functioning at 100% all the time – we can function usually function just fine on say 70% – AVOID a self-fulfilling prophecy.

8. Avoid food, caffeine, alcohol and cigarettes before bed

• As a general rule of thumb you should allow 2 to 3 hours between your last main meal and going to sleep – a small smack is ok.
• Avoid caffeine for at least 4 hours before sleep.
• Avoid alcohol for 4 hours before sleep (where possible) – alcohol disrupts sleep and often means that you wake up frequently during the second half of the night.
• Nicotine in cigarettes is also a stimulant that may make it harder to fall asleep or stay asleep – so try to avoid before sleep.

9. Look after your mind and body to achieve a quiet mind before bed

Focused breathing is one of the easiest tools to calm your active mind. Take a breath in for 4 seconds (through your nose if possible), hold on to this breath for 2 seconds, and then release the breath over 6 seconds.. and repeat. Make sure you’re using a stomach breathing style (instead of shallow chest breaths), you can check this by placing one hand on your stomach which should rise with each in breath. Guided meditations (found through Apps or YouTube) can also help with achieving a quiet mind before bed.

10. Create a worry time

Worries can often seem bigger and scarier at nighttime, when we are not so distracted with daily grind. A strategy to deal with worries is to postpone your worry to a particular worry period so they don’t keep building. Here’s some tips on how to create a worry time.

• Set a time each day for worry time (preferably at least 3 hours before bedtime)
• During the day as you become aware of a worry – postpone It to the worry period – note your worry briefly on a piece of paper, notebook or notes in your phone. Remind yourself that you will have to think about it later and there’s no need to worry now.
• When worry time comes around (set about 10 -15 mins) – take some time to reflect on your worries from the day and write them down.
  • Separate worries that are solvable e.g. I need to pay that bill or return that email. And write down things you could do to tackle that worry.
  • Then for unsolvable worries – that are usually “why” and “what if” worries about the future- which are often far out of our control and far from what is happening in the present moment. Using mindfulness strategies for these thoughts can be helpful such as imagining your thoughts as thought bubbles – observing these thoughts as bubbles, watching them come and go and trying not to respond or interact with them.

Here at Foundation Psychology we are running CBT for insomnia groups, these groups will include lots of the information included above and more. We tailor these sessions to your specific sleep needs so you we can get you sleeping better quickly. Please enquire below if you are interested in taking part.