For this month’s blog I thought I’d write about an area that causes a lot of people difficulty – sleeping difficulties – and just give a couple of very quick tips that I hope will help.
It is very common for people I see to be suffering from sleep difficulties. However, often that is not the reason they contacted me. Instead it is feelings of low mood or heightened anxiety that they’ve been suffering with. One of the questions I will always ask in an assessment though is around sleep. Simply put, although sleep may not be the primary concern, poor sleep can certainly be a contributing factor in maintaining depression and anxiety.
There are a couple of proven methods to combat sleep. The first is medication. There is no doubt that one can take prescribed sleeping tablets to help get to sleep. However, these tablets are commonly prescribed for only a short period – simply because they can be so addictive and can easily be relied upon as the ‘only’ way to sleep. Therefore, when they are not available, the sleep problem returns. Their effectiveness also wanes with time.
The second proven method is psychological therapy, namely Cognitive Behavioural Therapy (CBT). CBT for insomnia has been assessed in over 100 RCTs (randomised controlled trials – known as the ‘gold standard’ of research). The results show that on average 70% of people with even very long term poor sleep obtain lasting benefit from the treatment. CBT explores and works on two areas:
– the mental (or cognitive) factors associated with insomnia, such as the ‘racing mind’.
– the behavioural element that is hindering the development of a ‘pro-sleep’ routine and stopping one achieving a strong connection between bed and successful sleep.
The aim of CBT is therefore to use cognitive techniques to help with the former and behavioural techniques to work on the latter.
The cognitive techniques will often explore the anxious thoughts that may be hindering sleep. For example, typical thought processes that can hinder sleep are those focusing on:
– planning or problem-solving (this is what we do in the day and stimulates / switches on the brain)
– how we are not yet asleep and the effect this will have on your day ahead. This typically generates anxiety, and the brain typically thinks that if we’re feeling anxious then we must be in some sort of danger – and therefore sleep is not advisable)
– sounds in our environment that appear different – again this ‘switches on the brain
Techniques adopted may look at unhelpful thinking styles and we would work together on how you can tackle these. Mindfulness approaches can be helpful here to help us observe, rather than engage with our troublesome thoughts. We may also explore the content of thoughts and use diaries or thought records to help. Each area will typically involve a different technique, tailored to you.
In relation to behavioural techniques, the aim here is to focus on strengthening the relationship between your bed and sleep. There are a number of behaviours that can keep us awake and stop this connection growing. Given this, I thought it would be helpful if I laid out a few behavioural tips that may help improve your sleep. There’s loads of these about, but I thought I’d focus on some that many find helpful:
– Try to go to bed and get up at the same time – even at weekends! This helps your body get into a natural rhythm
– Avoid caffeine and nicotine for at least 4-6 hours before bed as they stimulate the brain.
– Avoid alcohol. Same as above, it’s best to avoid alcohol for at least 4-6 hours before sleep. It’s worth noting here that even though some people think alcohol helps them to get to sleep, alcohol negatively affects the quality of the sleep.
– Avoid ‘blue light’ in bed. Laptops, ipads, smartphones all emit ‘blue’ light. The brain can interpret this as meaning it’s the morning and so should ‘wake up’.
– Try not to clock watch. It often leads to ‘Oh no, I’ve only x hours till I wake up’. This creates anxiety and wakes up the brain. Try to cover any clocks and rely on an alarm to tell you when to wake up.
– Have a bedtime routine. Train the brain to know when it is bed time. You can create sleeping rituals such as 15 minutes of light-reading before sleep, or sitting down with a mug of tea before bed (caffeine-free of course!)
Finally, sleep difficulties can be very frustrating and challenging, so I would not want anyone to think that I’m implying that just by doing the above it’ll be fixed. Indeed, you may be reading this and thinking you’ve tried the above techniques to little effect. Whether you’d tried them or not, I’d be happy to speak to you further and discuss whether CBT could be of benefit.