Neil Saunders, a therapist specialising in anxiety at our Norwich centre offers some insight into the psychological elements of a healthy relationship with sleep...
Ever felt that our hyper-stimulated modern world has given us too many things to do and worry about - yet has also created anxiety about whether we are getting enough sleep?
We know that sleep is crucial for all aspects of self-regulation for physical, mental, and emotional health and there is plenty of information around on how to get that holy grail of eight perfect hours every night.
So why are we still having problems sleeping? Rather than offering you ‘ten tips for a good night’s sleep’, I wanted to examine the psychological elements of a healthy relationship with sleep. And perhaps some alternative ways to think about sleep.
Find what works for you
Let’s not get over-fixated with those eight perfect hours or that ‘sleep hygiene’ tick list (although many ideas on it are definitely worth a try). Experiment and see what works for you. The next time you have a week off work, try this: After allowing a few days of sleeping in to get rid of any sleep debt, go to bed at a reasonable time and make a note of what time you wake up in the morning. Do this for several days to work out the average hours you spend asleep. This should give you a baseline for knowing how much sleep you actually need.
Sleep is a process that naturally occurs when enough ‘sleep pressure’ builds. Essentially, the more time spent awake, the more this builds. Although daytime naps can work wonders for some people, just remember that these will release sleep pressure and may therefore affect your nighttime sleeping.
Having short periods of wakefulness during the night is normal. Most of the time, we don’t remember them but they are part of our natural sleep cycles. If you have a prolonged period of wakefulness and genuinely can’t go back to sleep, remember that you can’t force yourself to sleep. It may be wiser to see this as some free time to leave the bed and go and do something enjoyable such as reading, writing or watching TV (but don’t go on your phone, social media or emails.) When you feel sleepy, go back to bed. There is considerable evidence that this type of ‘biphasic’ sleeping was quite common in pre-industrialised societies.
Expect your sleep to change
Take comfort that most people, at some point in their lives, will experience some issues with sleep. Your sleep patterns will vary throughout life, related to the birth of children, stressful life events, medical conditions, hormonal changes, or the process of aging. So if you find yourself staring at the wall at 3 a.m. for the third night running, yes, it can feel distressing – but it is unlikely to persist. A few sleepless nights won’t harm you. Sometimes we perceive that we ‘have been awake all night’ when we’ve had more sleep than we realise. Research suggests that during nocturnal awakenings, our mood regulation and cognitive functioning are impaired which magnifies negative thinking. So be aware of this when you have catastrophic thinking in the early hours. Try de-fusing your thoughts by saying to yourself, ‘I am now having the thought that…..’
Take comfort that sleep is a self-regulating process and your body will ultimately compensate and deliver the type of sleep you most need, whether it be deep stage 4 restorative sleep or REM (dream) sleep for memory consolidation. The irony is that ‘insomnia’ is mostly a psychological phenomenon where anxiety about sleeplessness releases stress hormones that feed further sleeplessness - leading to a vicious cycle of behaviour.
Much of what we do is conditioned and habitual. Often, chronic insomnia develops when patterns developed from primary insomnia become embedded. For example, let’s say, you experience a very stressful life event such as divorce and this leads to an extended period of anxiety and sleeplessness, but then, after this initial situation becomes resolved, the sleeplessness remains. Now insomnia, which was secondary, becomes the main problem and we start to associate the bed with anxiety rather than sleep, so we need re-training from something like CBT-I therapy. Here are some things to consider about conditioning and sleep:
1. Human beings respond to 24-hour cycles of light and dark known as circadian rhythms so try to work with these by immersing yourself in natural light as soon as you wake up, ideally by going outside. Similarly, a darker sleep environment correlates with better sleep. A sleep mask can be useful for this.
2. Create a regular getting-up time and stick to it, even on weekends. If you find that you aren’t falling asleep within half an hour of going to bed, maybe consider staying up a bit later. Any later nights should soon trigger sleepiness on subsequent nights and prompt going to bed earlier, ultimately resulting in establishing a regular pattern.
3. Do everything you can to build an association with your bed being used only for sleep or sex, particularly avoiding an association with anxiety. So, if you are tossing and turning, get out of bed.
4. Be mindful of the other ‘cues’ you are giving your mind /body to sleep. Just lying down in the same darkened room at the same time every day is a cue. What else could you build into your routine to suggest the winding down of the day? See what works for you: reading, audiobooks, sleep podcasts, stretching exercises, warm baths/showers and relaxation practices can all be helpful. Avoid physical or mental activities that are stimulating and try to avoid going to bed on a full stomach.
Time to de-stress
Stress and anxiety are the enemies of sleep so, if you can tackle your stress, it can have a profound effect upon sleep. It can be a good idea to build stress-management strategies into your life generally whether these be communicating effectively with your partner or family, regular exercise, learning breathing/meditation/relaxation techniques or even considering having counseling/therapy. One useful technique is to have a ‘constructive worry’ journal where, before you go to bed, you write your concerns for tomorrow and how you plan to deal with them. Then, if anxious thoughts pop up in the night, you can tell yourself that you will deal with them tomorrow.
Avoiding caffeine in the second half of the day and not drinking too much alcohol before bed are both advisable. There are different opinions about the use of technology that monitors sleep but, personally, I think these can lead to increased ‘sleep anxiety’ and so I would avoid them. So, in summary, prioritize and enjoy sleep, accept that sleeplessness will occur from time to time, build conditioned behaviour, be aware of the vicious cycle of anxiety and work out what works for you.