Archive for the ‘sleep’ category

Can’t wake up, sleep through multiple alarms — help!

October 21, 2019

Q:  I need several alarms to wake up.  Sometimes I sleep through them all or even turn them off, then go back to bed without knowing it.  Why can’t I wake up?

A:  Start with the idea that you “can’t wake up”.  Of course you can. 

Unless you’re Rip Van Winkle, at some point you do wake up.  Every day in fact, do you not?  So for you the keys are to both more accurately understand your experience and to better manage the sleep-wake process.

Presuming you have no underlying medical or psychiatric issues causing this (see a doctor if you aren’t sure), then you might look at a couple of likely factors.  One is sleep deprivation, and the second is motivation — or rather a lack of it.

Ideally — and if you plan a consistent wake time and schedule enough time for proper sleep —  you will awaken spontaneously and refreshed after the last of your sleep cycles completes, with no alarm clock at all.

For many people, keeping a very consistent sleep-wake schedule over time — especially important is a consistent wake time — results in awakening without the need for an alarm clock.  If you aren’t doing this now, it might be a good idea to start with as much regularity as you can.  Be sure to schedule enough time in bed for proper sleep, but be aware sleep duration is a moving target that changes as we age.

So you can expect to awaken when you’ve had enough sleep.  It’s as simple as that.  You won’t even need an alarm to get up because you won’t be sleep deprived.

And if you plan something you really want to do first thing in the morning, then you have good reason to get up and get going.

As for a good reason to get up and get out of bed, for most us work or school are sufficiently motivating.  But if you need more, try planning something you really want to do first thing so you have something to look forward to.

You are the best judge of this, but if you draw a blank on something to look forward to, then you might consider the possibility that your issue isn’t so much sleep as it is a healthy outlook on life.  In that case, counseling might help.

By better managing your sleep schedule, and by feeling more positively motivated about your day, there’s a very good chance you will permanently solve this problem.

Can’t sleep with a big event the next day

August 15, 2019

Q:  When I have something important the next day like a job interview, seems I toss and turn for hours.  But if I have nothing going on I sleep like a rock.  This has caused me to miss some good opportunities, so how do I deal with it?

A: It’s common and normal to feel some general anxiety and increased stress levels in advance of a job interview, or a test, or an important upcoming assignment.  Such stress increases, providing they’re not excessive, can help improve one’s ability to perform, and so can actually be desirable.

But in terms of sleep, you are right.  The increased stress and anxiety does commonly affect sleep.

Maybe it would help you to know that sleep is happening, you probably just don’t realize it.  Sleep state misperception is very common.  It may not feel like it, but if you allow yourself to just rest comfortably in bed with your eyes closed you will in all likelihood drift off and benefit.

Perhaps more importantly, a significant body of evidence shows even if we don’t feel like our best because of a restless night, our performance does not necessarily suffer.  This is true both cognitively and physically.  Pretty much every starting pitcher in game 7 of the World Series can tell you that!

If you ever feel overwhelmed by stress or anxiety, or if it becomes excessive and unremitting, then counseling can go a long way to help you get it back under control.

But if you are experiencing normal levels, then know it’s OK to let go the worry and be confident you will be just fine, even if it doesn’t feel that way.  The difference is largely in perception, not performance.

Negative thoughts prior to some big event are just one example of the many worrisome issues that can disrupt sleep.  For more help, consider using cognitive restructuring, one of the core methods in CBT sleep training.

What should I think about to fall asleep fastest?

June 24, 2019

Q:  What type of thoughts are recommended to fall asleep the fastest?

A: Great question. This actually has been studied. The conclusion:  Nothing.

That doesn’t mean not think, which isn’t possible. It does mean thinking about “nothing in particular”.

While it’s normal for all of us to replay our day to some extent before falling asleep, insomniacs tend to fret and worry about events that have already passed, and these thoughts tend to be negative and stressful.  This then typically results in a faster heartbeat, increased respiration, and a higher body temperature — the opposite direction you want to go to fall asleep.

Another variation is to excessively focus on one thing or another, which is a form of the occupying thought.  It may be listening to the slightest sounds in your bedroom, or replaying a tune over and over in your mind.  In either case, this kind of thinking is not conducive to falling asleep.

What the research has found is letting your thoughts wander pleasantly without any force or direction is associated with faster sleep onset.  This might be simply described as just letting go.

We suggest that’s a good way to conceptualize sleep:  a process of letting go.

So for faster sleep onset, find a place in your mind where your thoughts can just meander pleasantly and then just go with it.  When you begin recognize this, you can return to it again and again to help yourself fall asleep.

To enhance this process there’s many additional supportive actions and behaviors you can use.  Of particular importance is consistency in your circadian rhythm.

For a comprehensive, substance-free, and permanent solution that includes all these methods, check out CBT sleep training programs.

Sleep and the EEG

April 16, 2019

When the EEG, or electroencephalogram, was invented, a whole new world opened for  exploration — the previously unknown world we all enter when we fall asleep.

Before the EEG, sleep was often thought of as a death-like experience, wherein one loses consciousness each night, hopefully to return in the morning.  Our remembered dreams gave us glimpses of this other world, often comprised of bizarre fantasies and sometimes disturbing nightmares, but no one knew for sure what was going on.

By measuring electrical activity in the brain, the EEG gave us a much better understanding of this unknown world.  The brain — powered by billions of neurons, or brain cells — produces measurable waves of electricity the EEG can record.  The first recording EEG machine was invented by German physiologist and psychiatrist Hans Berger in 1924.

Yet it would be almost 30 years later before scientists got the bright idea of attaching one of those devices to someone while asleep.  In 1953, two researchers at the University of Chicago, Eugene Aserinsky and Nathaniel Kleitman, first measured the alternating periods of REM (rapid eye movement) and NREM (sometimes called slow wave sleep) during all-night EEG recordings, launching the era of modern sleep research.

More than 60 years later the EEG remains the primary tool for laboratory sleep evaluation, and what researchers find looks something like this:

stages-of-sleep-eeg1

EEG recordings for various stages of sleep.  Notice the similarity between REM sleep (bottom) and an awakened state (top), and the striking difference between that and the slow deep rhythmic waves of Stages 3 and 4, the deepest forms of sleep.

When we fall asleep we transition through various stages, starting with a relaxed state, which leads to drowsiness, or Stage 1.  True sleep starts in Stage 2 with the appearance of the sleep spindles and K complexes, and the deepest form of sleep shows rhythmic waves of electrical activity slowly sweeping across the brain.

The transition of sleep stages usually ends with something that appears very close to an awakened state — the REM dream stage.  A complete cycle of NREM and REM usually takes about 90 minutes, and we typically experience 4 to 6 complete cycles of sleep each night.

Research has shown during these deepest slow wave sleep stages the brain clears itself of toxins and replenishes its energy supply for a new day.  It is thought these slow cycles of electricity literally draw cerebrospinal fluid into and through the brain to facilitate this renewal process.

If awakened during a deep NREM stage, we usually remember little about our dreams and are typically extremely groggy.  In complete contrast the REM dream stage is much closer to a fully awakened state.  In REM our dreams are vivid, and by completing one’s final REM stage of the night one likely feels better rested and more emotionally restored for a new day.

Use of the EEG opened a much broader understanding of sleep, with intense research still ongoing today.  There is still much more that we don’t know than we know about this hidden world we enter each night.

Easily fall asleep with TV on — but turn it off and bam! — wide awake

January 22, 2019

Q:  I can’t keep my eyes open in bed if I watch TV, but as soon as I turn it off I’m wide awake.  So frustrating, how can I fix this?

A:  You likely have what’s known as conditioned insomnia.  And this is not unusual, many insomniacs experience something similar.

Conditioned insomnia typically results from tossing and turning in bed for hours at a time, which of course is very negative and frustrating.  So a negative association is inadvertently created with your bed, bedroom, and the idea of sleeping.  This is why many insomniacs can’t sleep in bed, but easily fall asleep on the couch, in a tent, in a motel room, sometimes anywhere besides their own bed.

In your case, watching TV temporarily distracts you from the negative conditioning.  But once you turn off the TV and roll over to sleep — wham!  All those negative, stressful associations return and act like a shot of caffeine.

You can effectively counter this by not watching TV in bed, or doing anything else in bed besides sleep.  You can also help this process by not allowing yourself to sleep anywhere else besides your own bed.  Over time, and with consistent discipline, the negative association weakens and is replaced by increasing confidence in your ability to sleep when and where you want.

To help break the old, negative associations, you might consider something as simple as a new blanket or bedspread or pillow.  Taking control of your sleep behaviors and bedroom environment is part of the stimulus control method of improving sleep.

In addition, there’s probably more going on that initially led to your inability to sleep in the first place.  Fortunately, there are a number of ways you can improve, restore, and strengthen better sleep.

For overall sleep improvement, CBT sleep training methods are the gold standard.  These methods are comprehensive, simple, and common sense.  They include stimulus control and much more, are completely substance free, and have no adverse side effects.

Be confident that by taking some healthy sleep supportive actions you can fix this and sleep when and where you want.

How long does CBT sleep training take to work?

December 19, 2018

Q:  I’m now on week 2 of CBT sleep training, using sleep restriction therapy, and find myself lying on the couch at night unable to sleep.  I’m stressed about using the methods because they don’t seem to be working and feel worse off than I was before.  How long before I can expect some improvement?

A:  First be sure you are using the full CBT sleep training program From your description, you may not be doing it right.

As part of the stimulus control method, you sleep only in your bed, never on the couch.

The idea is to reduce frustration by getting up and out of bed when you are too awake to sleep.  Watching TV or reading while sitting on the couch is OK, but you risk falling asleep if you let yourself lie down.  That then results in an unhealthy association of your couch as the only place you can fall asleep.

It’s very important you head back to bed when you begin to feel drowsy.  You may need to remind yourself of what drowsiness feels like — yawning, droopy eyelids, wandering thoughts, head nodding are all sure signs.  When you feel that, head back to bed and try sleep again.  Stimulus control supports and improves what you’re doing with sleep restriction.

Also be assured as you continue learning all the CBT methods, you’ll soon have the tools needed to effectively counter these negative, stressful thoughts.  These negative sleep thoughts are like the raw fuel that prolongs and perpetuates insomnia, so countering them is actually one of the most important keys to a permanent solution.

To answer your question, results are very individual.  Some people respond very quickly, within a week or two of first starting the methods.  For others it is slow but steady progress that can take months.  The good news is CBT sleep training methods help most people and the benefits tend to be lasting.

Bottom line is it’s very important to use all the CBT methods simultaneously within a structure. That’s the support a full CBT sleep training program gives you.

What to do if there’s not enough hours in a day to feel tired at bedtime

October 26, 2018

Q:  I normally sleep for about 8 hours, but don’t feel drowsy or ready for bed again for at least another 18 hours or so.  This is causing me problems as my natural wake time steadily gets later each day.  My only alternative seems to be less than 8 hours in bed and then I feel bad from lack of sleep.  Any solutions to break out of this pattern?

A:  Your description suggests your circadian rhythm is longer than 24 hours.

In your case, it would appear you are experiencing more like a 26-hour day.

A slower than normal circadian rhythm is actually common from about age 14 through 30, and one reason some high schools are moving to a later start time.

There are no easy answers in your situation.  Your best solution is probably to use substance-free CBT sleep training methods.

First, keep a very consistent wake time 7 days a week.  That does two things — regulates your circadian rhythm and synchronizes it to your homeostatic sleep drive.  Those are the two most important internal components controlling sleep.

If you keep a consistent wake time and don’t feel drowsy at bedtime, stay up — but do something relaxing to help you feel drowsy, then head to bed.  And keep that wake time no matter what.  Use an alarm if necessary as consistency is important.

To help yourself feel drowsy at your preferred bedtime, avoid caffeine later in the day, and try to get some good exercise most days.

You can also try a relaxing wind down period starting about an hour or so before your scheduled bedtime.  The idea is to begin conditioning yourself for the expectation of sleep after a certain interval.

Also, to help better reset your circadian rhythm for a new cycle, it’s important to expose yourself to bright light immediately upon awakening.  Natural sunlight is best but regular indoor lighting is fine for most people, providing it’s sufficiently bright.

Fortunately, by about age 30 most people’s circadian rhythm returns to a more normal 24 hours.