Confident Sleeping
Sleep is a frequent topic of discussion in therapy. It is often something that is getting in the way of other mental health goals. Who can feel motivated to tackle difficult behaviors, thoughts, and feelings when you’re worn out. When you sleep, your brain’s cleanup crew arrives and picks up all the debris from a day full of thinking. If you are anxious, coping with difficult things, or feeling big feelings, you have more debris than you typically do, and your cleanup crew needs to put in some overtime hours. The goal is not to have perfect sleep, but instead to feel confidence that you will get enough sleep to do life.
What is disrupted sleep?
Disrupted sleep can be defined differently, but for the purposes of this post, I would define it as taking more than 30 minutes to fall asleep or taking more than 30 minutes to fall back asleep if awoken. If you can easily fall asleep but wake up 5+ times a night, then that would be disrupted too. If you are awaking with severe nightmares/panic attacks or awake unrested due to vivid dreams, those are other forms of disrupted sleep.
While sleep can be disrupted in different ways, the issues are similar in some core respects. The interventions I will suggest are based on behavioral associations with your bed. For example, when you open your snack cabinet/drawer or open the fridge, even if you aren’t particularly hungry, you can often talk yourself into eating something. This is the same behavioral principle at work. We want bed to mean “sleep,” just like your snack cabinet means “food.” Thus, if you are not sleeping, get out of bed.
The intensity of this intervention depends on the current degree of disruption to your sleep. If you are sleeping poorly more than half the nights or feel wired and not sleepy when you awake in the middle of the night, then I would suggest fully getting out of bed. If you have occasional sleep disruption and tend to be drowsy already, you could try doing these sleep-inducing activities in bed.
Difficulty Falling Asleep
Despite the important role they play in relaxation, your TV/computer/phone/ tablet are not helping you get better sleep. Even in night-time mode or with blue light glasses on, you are shooting light directly into your retinas. The technology in your eyes and brain was created to interpret light as meaning daytime, time to be awake and do things, things like thinking! You can use these amazing devices to help wind down, but I would suggest a transition activity to allow you to feel more tired. Such an activity would ideally keep your brain busy and your body quiet- reading a book, doing a crossword puzzle, doing a sudoku puzzle. Reading would be the best of these, given its ability to occupy different areas of your brain all at once. An even more specific suggestion would be reading fiction (e.g., science fiction, historical drama, fantasy). Non-fiction, the news, and even intense fiction that makes you think about your own life can be risky; these areas are interesting for your brain to ruminate about, to try and stay tuned in and remember what you read. When you read at night it should be relaxing and enjoyable, not for class, not for self-help. You want to read something that allows your brain to play, but not ruminate or spark additional deep thoughts. Additional bonus points for fiction are related to how the act of reading will allow your eyes to get tired and the plot of a book provides a great thing to think about when you finally turn out the light and close your eyes.
Engaging in this transition activity allows you to become tired and you can transition to sleeping once you feel yourself starting to struggle to stay awake and alert or when you are feeling quite sleepy. You want to think about neutral thoughts, like the plot of the book, rather than thinking about today, tomorrow, or yesterday. If you are plagued with good ideas or random reminders as you relax into sleep, try putting a note pad and pen next to your bed and jot them down, so you don’t have to try to remember these, which will likely activate your brain. If your brain is particularly busy, you might try an activity that is interesting and slightly challenging, but not important. For example, trying to list the states in alphabetical order, trying to remember all the wall art in your grandparents’ home, the contents of the aisles in order at your grocery store, etc.
If you are struggling to enter sleep, you do not want to keep trying for more than 30 minutes, now you are just thinking, not sleeping. In this case I would suggest the use of a white noise app, where you can set a timer for about 30 minutes. If you are already asleep, then you won’t awaken when it turns off, if you are awake when it abruptly stops, then you know it’s time to get up. Then you go back to your transition activity, or a variety of similar options. You don’t want to activate your body or brain too much, so no cleaning, studying, or social media.
Difficulty Awaking in the Middle of the Night
You want to use the same principles from above when attempting to fall back asleep, such as thinking about neutral topics, making lists, etc. If you notice that you are awake for 30 + minutes, then we will want to engage in a sleep-inducing activity, as identified above. If you co-sleep, you will want to problem solve ahead of time and ask if it is OK to experiment with turning the light on to read (a low light, like a side lamp or a reading light). These sleep-inducing activities should be enjoyable but not riveting. This is one of the key components to sleep difficulties, is if you get really frustrated about not sleeping, you will have a harder time getting to sleep. If instead you don’t like being awake but at least get to engage in a generally relaxing activity, that reduces the emotional intensity and will not actively interfere with sleep onset.
What About Sleep Medications?
There is a reason your doctor won’t give those out anymore. They typically interfere with your natural ability to fall asleep and can cause odd behaviors in a sleep-like state. If you are really struggling with sleep, you can certainly use medications to help, but I would set up an expectation for yourself, such as once every three days. In other words, if you have one night of bad sleep it sucks but you make it through, two in a row it is super rough, and you don’t want to have a third night in a row. This way you are allowing yourself time to experiment with new coping skills and tools while also working to reduce impairment from poor sleep.
Other Areas of Disruption
When distressing dreams or panic is happening at night, it is typically due to a high level of stress, recent trauma, or other dysregulation of your stress system. Another way to think about this is the idea that evolutionarily your body has decided you are in a stressful and scary time, thus it needs to be vigilant to more scary things, even when you are sleeping. There may not be specific noises to startle you awake, but it could even be your hand falling asleep and your body reacting with a fight or flight response.
While there is little you can do in the moment, other than the same things described above, you can work on your baseline level of stress. Sometimes our life situations are not fully changeable, but your muscle tension could improve through yoga, stretching, use of a heating pad, use of a massager, etc.
Above, we discussed the idea of stress creating more debris for your brain to clean up. I like to think about emotional stress as energy that operate on the same rules of physics as the matter all around us. You cannot expect your emotional stress to simply disappear. It needs to be expelled. Different people expel stress in different ways, so I cannot tell you how to do it, but often people find improvement through verbal communication about the feelings, physical exercise (especially for anxiety and anger), artistic expression of emotions, and meaningful rituals. If you find ways of expressing/expelling this energy, you may see nightmares and physical symptoms of stress reduce, thus improving sleep quality.