I was recently at a seminar called Cognitive Behavioral Therapy for Insomnia (CBT-I) given by presenter Colleen Carney, Ph.D. The training was very informative and scientific and I was able to get a glimpse of what sleep specialists do. There are many assessments and assignments for someone with chronic insomnia, such as working on a sleep schedule and written recordings. This is what I learned from the course, more specifically about getting better sleep which I also use as a tool in my private practice.
According to The American Sleep Association, 50 to 70 million adults in the United States have a sleep disorder, with insomnia being the most common. Insomnia is having trouble falling asleep and staying asleep. Women seem to have more difficulty than men falling asleep possible due to some biological factors. The main factors that disrupt sleep including medical, medication, disruptions of circadian rhythm (ie. shift work) and environmental factors (ie. room temperature and noise). So, how do you work on getting that good night sleep when dealing with these factors?
The major concept that was presented in the seminar was the analogy of blowing up and releasing a balloon. Blowing up the balloon represented energy that was being used during day. The more energy one uses, the more inflated the balloon gets. The trick is to fill your balloon up as much as possible during the day. When the balloon is full there is more time for the balloon to deflate. The deflating here represents quality sleep time. When you take naps during the day your balloon will be less full and therefore you will have less quality sleep at night. This is often contrary to popular believe that you need to catch up on sleep by going to bed super early or getting up late.
Another misconception is that if you’re having trouble sleeping you should stay in bed until you eventually fall asleep and if you got up you would be heightening your alertness. According to experts, it is encouraged that you get out of bed, leave the bedroom and engage in something neutral (not very stimulating and not too boring) until you’re tired again. After doing so, you then return to the bedroom to take another crack at it. You should not be lying in bed struggling mentally about why you can’t get to sleep. Forcing yourself to sleep only stimulates arousal. You can definitely get caught up with frustrating thoughts which often leads to increased anxiety. One of the suggested activities to promote decreased frustration and anxiety was doing gratitude journaling. A gratitude journal promotes positive thoughts and allows the body to relax.
The bedroom should only be associated with sleep (and sometimes sex). Television or other electronics in the room are discouraged. People with trauma who may have an adverse reaction to silence could use white noise as an option. The same hold true for those who have loud neighbors or construction going on.
In the seminar they mentioned that fitbits or other sleep trackers may do more harm than good. Electronic sleep trackers are often not reliable and can make you more obsessive about your sleep and more anxious. Sleep aides like melatonin are also not very effective because they can affect the type of sleep needed. Some people like to drink alcohol before going to bed because it helps them relax and feel tired. The fact is that drinking alcohol before bed affects the kind of sleep needed to be fully rested. It is important to avoid drinking alcohol as well as coffee for at least 3 hours before bed. Strenuous exercise and dramatic movies should be avoided before bed as well.
Routines are key when dealing with insomnia. Routines can include going to bed and waking up at around the same time each day and exercising during the day (blowing up the balloon). Routine helps train your body and sets your internal clock. It is important to do winding down behaviors when going to bed which may include brushing teeth, getting into sleep clothes and reading a particular book. This helps the body and mind get into sleep mode
It is very frustrating and sometimes dangerous to not get enough sleep. Lack of sleep can lead to having accidents and can cause medical issues. There are other sleep disorders that may require medical attention or a sleep study like sleep apnea. So to work on getting a good night's sleep you need to be patient with yourself, avoid certain stimulating behaviors and you get into a routine.
Ian Sherman, LCSW-R