This workbook aims to give you an understanding of the effect that sleep has on your overall health and wellbeing and provide you with techniques to overcome poor sleep. You will look at the causes of sleep problems and how to overcome them while learning what you can change simply and easily to help you get a good night’s sleep, every night.
Note: The material contained in this e-book is general and not intended as specific advice on any particular matter or situation that the reader might find themselves in. The author disclaims all and any liability to any persons whatsoever in respect of anything done by any such person in reliance, whether in whole or in part, on the contents of this e-book.
o There are two types of insomnia - primary and secondary insomnia.
o Primary insomnia has no obvious cause.
o Secondary insomnia is caused by an underlying problem, such as a medical condition or psychological problem such as grief and depression.
o Insomnia is considered to be short-term when it lasts for between one and four weeks.
o Long-term (chronic) insomnia lasts can last for more than four weeks.
o About one in four people in the UK suffer from insomnia at some time.
o Women suffer from insomnia more than men.
o Sleep problems often increase with age.
Sometimes insomnia begins because of a stressful event and continues even when the stress has been resolved. After this the sleeplessness will be because the sleeping environment has become associated with a state of being alert.
Some people have trouble getting to sleep while others get to sleep easily but wake in the night and take a long while to get back to sleep.
“It is a common experience that a problem difficult at night is resolved in the morning after the committee of sleep has worked on it.”
o Situational - for example, worrying about work, money or health, too busy.
o Environmental, such as noise
o Death or illness of a loved one
o Menopause
o Pain
o Obesity
Drug and substance misuse, including the misuse of:
o Alcohol
o Recreational drugs
o Caffeine
o Nicotine
NHS Direct also highlight psychiatric problems as being a cause of insomnia. Underlying mental health problems that can affect your sleeping pattern include:
o Mood disorders, such as depression or bipolar disorder
o Anxiety disorders, such as generalised anxiety, panic disorder or post-traumatic stress disorder
o Psychotic disorders, such as schizophrenia.
Insomnia can be caused by a range of underlying medical conditions. Consult your GP if you believe that this could be a cause of your sleeplessness.
And remember, although alcohol can make you sleepy, it will wake you up again before long because it is a diuretic and you’ll need to get up to visit the bathroom. It will also make you feel less alert next day. Always stick to the government recommended guidelines for alcohol consumption.
Some prescribed or over-the-counter medicines can sometimes cause insomnia, including:
o Anti depressants
o Epilepsy medicine
o Medication for high blood pressure, such as beta-blockers,
o Hormone treatment
o Non-steroidal anti-inflammatory drugs (nsaids),
o Stimulant drugs, such as methylphenidate to treat ADHD
o Modafinil to treat narcolepsy
o Some asthma medicines, such as salbutamol, salmeterol and theophylline.
The cost of Insomnia
o Lost days - Over two billion pounds a year is lost to industry due to time off, much of which is related to insomnia.
o Reduced performance - people with insomnia are three times more likely to struggle to get things done at work than their peers.
o The cost of drug treatments varies year by year but averages around ten million pounds annually.
Overcoming Insomnia
Complementary therapies
There is some evidence that the herb valerian is effective for insomnia. Passionflower, hops, lavender, lemon balm and Jamaica dogwood are also traditionally used to help you sleep, but their benefits have not been proven in medical trials. If you are taking any other medication, check with your GP or pharmacist before taking any herbal remedies.
Did you know....?
Dr Emery Neal Brown, a professor of anaesthesia At Harvard Medical School says:
“A lot of insomnia drugs work like low doses of anaesthetic - they create sedation, not sleep. The goal of treating insomnia is to promote natural sleep, but sleep is a cycle. How can one drug induce a cycle? That is why people who take a sedative may wake up and still feel groggy. They haven’t been through the natural stages necessary for the body to recover.”
If you are thinking of taking sleeping tablets, or are already taking them there are some things you might want to consider. Not all sleeping pills are the same. Each class of sleep aid works a bit differently from the other, and side effects vary.
It's important to ask key questions before choosing your sleep medicine.
o How long does it take for the sleeping pill to take effect?
o How long do the effects last?
o What's the risk of becoming dependent on the sleeping pill, physically or psychologically?
There are three categories of prescription drugs your doctor may recommend.
1. Benzodiazepine hypnotics can be highly effective. Yet, for some people they can be too heavily sedating making them feel groggy and exhausted the next day. They also have a propensity to cause physical dependency. Drug names include Ativan, Xanax, and Halcion.
2. Non-Benzodiazepines like Ambien, Lunesta and Sonata are a newer class of sleep medicine, which are less likely to cause addiction. People also report feeling more refreshed when the awaken after taking this type of medication.
3. Antidepressants such as Aventyl, Desyrel, and Paxil are sometimes prescribed to help people sleep because these medications have a sedating effect.
Non-prescription medicines
There are many over the counter remedies available at a pharmacy. The common ingredient in all these pills is an antihistamine, which causes drowsiness. So whatever you choose you are essentially getting the same type of medicine.
Always check with your doctor before taking over-the-counter medication. Even commonly available sleeping pills can cause side effects and interact with other medication you are taking. So exercise caution and take only as directed by your doctor.
Some people believe that they are sleep deprived because they are not getting eight hours sleep a night or as much sleep as they used to. However, not everyone needs eight hours sleep – Margaret Thatcher famously was said to need only four hours. Most people find that as they age they need less sleep.
If you function pretty well during the day, do consider that perhaps you are getting enough sleep.
If this is the case, you can stop lying in bed worrying about not getting enough sleep. Change your sleep patterns. Go to bed later or get up earlier, whichever suits you. Most people find that getting up earlier works better for energy levels. Try it for a few days to see if it works for you.
The Five Stages of Sleep
1. Pre-sleep - when your muscles are relaxed and your heart rate and breathing
slow down.
2. Light sleep - when you're lightly asleep, can still be woken up easily and won't
feel confused.
3. Slow wave sleep - the time when you might sleepwalk or talk in your sleep.
4. Deep slow wave sleep - when you're hard to wake up and, if someone does
wake you, you may feel disorientated and confused.
5. Rapid eye movement (REM) sleep - when your eyes move from side to side
and your brain is very active but your muscles are totally relaxed. You dream
Sleep comprises cycles of slow wave and rapid eye movement (REM) sleep. During slow wave sleep, the body experiences a surge in growth hormones. This is the healing phase of sleep when rejuvenation takes place.
In the normal sleep cycle, REM sleep occurs in short bursts and is the time when we dream. The purpose of REM is to wipe the slate clean from the events of the previous day.
In the low mood sleep cycle the REM periods are longer and that reduces the healing sleep leading to low-immune system and waking up exhausted.
This suggests that the more negative thoughts/experiences we have during the day, the more time our sleeping brain must spend wiping clean the slate and the less time it can spend in renewing and rejuvenating our energy. Thus, if we can lead calmer lives, we may find this is a vital key to sleeping well.
Keep a Sleep Log (see P22) for a week so that you can start to identify any patterns or trends.
Review the Log at the end of the week. The first thing to look at is whether you have a regular sleep pattern. Maintaining your body’s natural sleep - wake cycle is one of the most important strategies for sleeping well. Consistency is important, so go to bed and get up at the same time every day, you will feel much more refreshed and energised than if you go to bed and get up at different times each day. If that means a change to your bedtime you can help your body to adjust by making small changes of 15 minutes per day.
If you find yourself nodding off in front of the TV before bed do something mildly stimulating to avoid falling asleep, e.g. getting your clothes ready for the next day.
Make notes of what you have identified:
What happened on the nights that you had better sleep?
What happened on the nights that you had better sleep? What worked well?
What changes could you make to do more of what worked well?
SLEEP BETTER STRATEGY - MAKE YOUR BEDROOM SLEEP FRIENDLY
The quality of your bedroom environment makes a huge difference in how well you sleep. Make sure the room is dark and cool and quiet. Most people sleep best in a slightly cool room with adequate ventilation. Make sure you have a comfortable bed.
Do not keep TV or office equipment in your bedroom, remember, this is a place for sleep (or sex). If you have a TV or computer in your bedroom you may be tempted to use them and this will make your mind too stimulated for you to get to sleep easily. This will be especially true if you watch any TV with disturbing content, including the news.
Do you need to make any changes? Tick any that you need to do to help you sleep better and state when you will make the changes by.
This is, of course, a huge topic and here we can only give suggestions for things you may like to try. If you believe that you have underlying or ongoing emotional problems you may like to see a counselor, therapist or hypnotherapist.
Learn to manage your time efficiently – go on a time management course or read a book on the topic. Make changes to work smarter, not harder. Keep a time log daily for a week to help you to spot where changes may be necessary.
Learn the art of self-soothing – if you find yourself agitated about many things throughout the day, practice self-soothing. This means noticing that you are becoming agitated and saying to yourself ‘Stop, relax’. As you do this, relax your body and face, and take several deep breaths from low in your chest. Breathe in for the count of four and out for the count of seven. Picture something that you find pleasant – the face of someone you love, or a favourite place in nature for example. You’ll be delighted at how quickly you can calm yourself.
Avoid mental stimulation near bedtimes (apart from enjoyable sex). Don’t watch the news, go near a computer, watch horror films, etc.
Often worrying about poor sleep can be the cause of poor sleep. When this is the case it can be the belief about the lack of sleep that is the problem. CBT teaches an ABC approach to looking at worrying issues such as lack of sleep.
A Activating Event Lying awake
B Beliefs about the problem I’ll never sleep well again. I’ll be ruined in the morning and won’t perform well at work’
C Consequences Worry even more and stay awake longer
If this sounds like you, the odds are that you already know that the belief isn’t true because you have coped pretty well after a sleepless night in the past.
Here is an alternative ABC much more likely to give you better sleep.
A Activating Event Lying awake
B Alternative Belief about the problem
I can’t sleep. I’ll get up and drink some warm milk, and I’ll read a bit of that Jane Austin novel again. Then when I come back to bed I’ll do the relaxation activity to get back to sleep easily. Even if I don’t, I know I’ll manage, I’ve done it before.’
C Consequences More sleep.
Questions to help you explore the ABC of the issue under discussion:
What must you believe to think that?
Is that belief helpful to you?
What other belief would it be possible for people to have in this situation?
Can you imagine yourself accepting this belief? Close your eyes and try it on for size.
What would be the consequences of behaving as if you had this new belief?
What difference would that make to how you feel?
What difference would that make to how you behave?
What difference would that make to how others respond to you?
In CBT, we talk about people having ‘faulty thinking’. Most of have one or more of these thoughts at some time, but if you have them a lot and they get in the way of you enjoying life or sleeping well, you may want to use the advice at the bottom of this list to help you banish them.
Catastrophising:
Here you have a tendency to think the worst will happen in every occasion. Events which others may shrug off you dwell on and ‘turn a molehill into a mountain’.
To overcome this: o Remember that you don’t have to believe your thoughts. Ask yourself ‘Is this
thought helpful?’ o Ask yourself what an optimistic person would make of this event o Consider less frightening explanations o Weigh up the evidence
All or Nothing Thinking:
This is the black or white approach with no shades of grey. So if something goes wrong it must be someone’s fault (yours or someone else’s)
To overcome this: o Remember you don’t have to believe your thoughts. Ask yourself ‘Is this thought
helpful?’ o Be realistic - we all make mistakes, forgive yourself or others o Develop ‘both-and’ reasoning - see that two options can exist together. For
example, you can fail an exam and still be an intelligent person
Fortune Telling:
This is when you predict the future - gloomily
To overcome this: o Remember you don’t have to believe your thoughts. Ask yourself ‘Is this thought
helpful?’ o Test out your predictions o Be prepared to take risks o Understand that past experiences don’t mean the same thing will happen in future
Mind Reading:
This is when you think you know what others are thinking ‘They think I’m an idiot’.
To overcome this: o Remember you don’t have to believe your thoughts. Ask yourself ‘Is this thought
helpful?’ o Find some alternative reasons for what you see o Consider your guess may be wrong o Get more information if appropriate
This is when you think that something must be true for all time, everyone etc. You find yourself thinking ‘Everyone must...’ ‘No one...’ ‘Always...’, ‘Never...’
To overcome this: o Remember you don’t have to believe your thoughts. Ask yourself ‘Is this thought
helpful?’ o Find a different perspective that takes into account a less generalised view o Suspend judgement
Making Demands:
This is when you think others must do something for you, or the world must operate in a certain way.
To overcome this: o Remember you don’t have to believe your thoughts. Ask yourself ‘Is this thought
helpful?’ o Notice your language - check yourself when you find yourself using words such as
must, should, ought to, and change them to prefer, wish, and want o Limit your approval seeking - find ways to approve of yourself rather than needing
to seek it from others o Understand the world doesn’t play by your rules
Bearing the ‘Unbearable’:
If you find yourself thinking that things are unbearable, this is very unlikely to be true or you’d probably already be dead.
To overcome this: o Remember you don’t have to believe your thoughts. Ask yourself ‘Is this thought
helpful?’ o Push yourself outside your comfort zone to do things that are a challenge o Give yourself positive messages that you can cope
With any of these it is helpful to ask yourself: ‘IS THIS THOUGHT HELPFUL?’ If it is, accept it. If not, gently acknowledge it and let it drift away. If it comes back, gently acknowledge it again and let it drift away. Eventually your brain will get the message.
Then ask yourself: ‘WHAT WOULD BE MORE HELPFUL TO THINK?’
What belief do you have that keeps you awake? Like the example, it might be a belief about the ability to get to sleep. But it could also be a belief about something that you worry about that keeps you awake. The belief may include one of the ‘Faulty thinking’ types we just explored. When you have explored this, identify a more empowering belief.
Use the format below to help you.
Activating Event
Beliefs about the problem
Consequences
When you have done this, write a new empowering belief that will help you get to sleep more easily.
My new belief is ...................................................................................................................
This activity is something you can do any time you can’t sleep. Expect to take about ten minutes to complete it, although you’ll probably be asleep before you have completed it.
Make yourself comfortable on your chair or on the floor. Close your eyes. Take a deep breath and another deep breath. Make any little adjustments to be comfortable. You may be aware of thoughts, feelings and sensations as you relax. That’s completely normal, just let them drift away.
Become aware of your toes. Tense them then let them relax.
Become aware of your feet. Flex them and then let them relax. Breathing easily.
Become aware of your calves. Tense them and then let them relax.
Become aware of your knees. Tense them and then let them relax. Becoming more relaxed.
Become aware of your thighs. Tense them and then let them relax.
Become aware of your stomach. Pull it in and then relax it.
Become aware of your bottom. Tense it and let it relax. More and more relaxed.
Become aware of your back. Tense it and let it relaxed.
Become aware of your chest. Let it relax, relaxing now.
Become aware of your upper arms. Tense them and let them relax.
Become aware of your hands, flex them and let them relax. Drifting away.
Become aware of your shoulders. Tense them and let them relax.
Become aware of your jaw. Clench your teeth and then allow them to open a little.
Become aware of your cheeks. Imagine that they are being massaged to relax completely.
Become aware of your eyes. How heavy they are. Let the muscles around them relax.
Become aware of your forehead. Frown slightly and let your forehead relax.
Become aware of your scalp. Imagine someone massaging it restfully, massaging down the back of your neck, that lovely relaxed feeling
GETTING BACK TO SLEEP IF YOU WAKE DURING THE NIGHT
Stay out of your head. Maintain the comfort of sleep, so remain in your bed in a relaxed position. Use one of the ways we’ve discussed to talk yourself back to sleep.
If that doesn’t work, get up and do something boring. Read a boring book, do the ironing or whatever you really don’t want to do. You’ll soon find yourself heading back to the bedroom.
Use your notepad and pen. Make notes of actions for the next day, quickly imagine yourself doing whatever it is and then imagine yourself going back to sleep.
Other treatments for sleeplessness
There are other therapies that can help you to learn a number of ways of improving your sleep. Some of the main ones are listed below.
o Exercise regularly, but not before bedtime.
o Hypnotherapy
o Stimulus-control therapy. This helps you to connect your bed with going to sleep and to create a regular sleep routine.
o Relaxation. This helps you to relax your muscles and to clear your mind of distracting thoughts.
o Cognitive Behavioural Therapy. This can help you to deal with anxieties that may be stopping sleep and helps develop positive ideas about sleep.
o Sleep restriction. This limits the amount of time you spend in bed to the time when you are actually asleep. So, you set the alarm for six hours after you go to bed and get up even if you haven’t slept the whole time. No daytime sleeping. Within a few days you will be tired enough to sleep well and break your previous pattern.
Finally, poor sleep is sometimes connected to low self esteem. If this is the case for you, you may like to see a hypnotherapist, counselor or other suitable helper.
