What is the process of falling asleep like?

Posted June 18, 2018 by stephan
Categories: Insomnia, sleep

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Q:  Please describe what the process of falling asleep is like for a normal person.  I’m having trouble lately.  It’s almost like I’ve forgotten how to fall asleep.

A:  Great question.  There are some consistencies, but it’s also probably safe to say the process is very individual.  There is no absolute right or wrong way to do it, just what works for you.

The commonalities include progressive relaxation of the muscles of the body, and a decoupling of the mind from sensing and perceiving environmental stimuli.  The process is whole person, meaning mind and body working in concert together.  When it comes to sleep, the two are really inseparable.

Worth emphasizing falling asleep is a natural and autonomic process, like breathing, something we really don’t have to think about or try to force.

In fact trying to force sleep can and often does result in taking you in the opposite direction.  Instead of drowsiness, forcing can lead to arousal, including increased heart and respiration rates.

For those with chronic insomnia, the idea of relearning how to fall asleep has some merit.  A significant body of research has shown that intensive sleep retraining (ISR) works, and quickly.

With ISR, patients are hooked up to an electroencephalograph, which accurately determines when sleep onset occurs.  Individuals are immediately awakened after 3 consecutive minutes of any stage of sleep activity.  Over an extended period of time, sometimes 24 hours or more, this understandably builds up an acute level of sleep deprivation.  Even the most chronic insomniacs will generally experience dozens of sleep onsets in an extended session.  By repeatedly experiencing many sleep onsets in a compressed time frame, the recipient by association quickly relearns what the experience of falling asleep feels like.

The results show ISR rapidly improves the ability of insomniacs to fall asleep quickly and also helps increase total sleep time.

Most of us who won’t undergo a full ISR session and just want to sleep better can learn something valuable from this.  ISR suggests thinking back on what the experience was like last time you fell asleep quickly.  That is the good feeling to dwell on.  You don’t need to necessarily try to recreate that exact same routine or experience night after night; rather just let yourself go in the same way you did when you slept well.

Because that’s what falling asleep really is — a process of letting go.  When you find that place in your mind, and over time you will, stay with it and your sleep system will eventually grow stronger.

For more drug-free ways to help yourself sleep, check out the Sleep Training System.

 

Why can’t I sleep? Nothing helps

Posted May 15, 2018 by stephan
Categories: Insomnia, sleep, stress

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Q:  What is causing my insomnia?  This happened suddenly.  I am tired but as I start to doze off, I suddenly jerk awake.  I suspect it’s stress, but right now all’s well with me.  I’m physically active, try to eat right, have a good job, happy with my social life.  I toss and turn for hours and obsess all the time about sleep, but just don’t know what to do.

A:  First, see a doctor to either treat or rule out an underlying medical condition.  From the sound of your description, however, don’t be surprised if you have none.

Considering you have no history of insomnia and describe a healthy lifestyle, you may have psychophysiologic insomnia, one of the most common types. One of its root causes is excessive worry about the idea of sleep, which you are expressing.  Your worries about sleep may be potent enough to put you into a hyperaroused state that is the root cause, or one of the root causes, for your insomnia.

So a reality check is in order. No, your life isn’t “all well” at the moment.  You are describing a significant amount of stress about sleep that likely is fueling your insomnia to at least some degree. Moreover, some stress is in life is normal and healthy — the key is managing it effectively.

It’s likely that your hours and hours of frustration tossing and turning in bed — and those jolts awake just at the moment of falling asleep are the worst, aren’t they — has led to a conditioned negative response to your bed, bedroom, and the idea of sleep.  Again very common.

What you’re doing with respect to sleep hygiene is excellent, and you also sound like you’re leading or trying to lead an overall healthy lifestyle.  What is not in your description is any effective method at stress management or cognitive approach to your worries about sleep.

Ask your doctor about using CBT sleep training methods.  What CBT will give you are the sleep hygiene and good sleep behaviors plus powerful cognitive measures to combat the worry, stress, and anxiety.  By using all these proven, drug-free methods simultaneously, you stand a good chance of restoring better sleep.

Is it better to awaken quickly or slowly in the morning?

Posted March 27, 2018 by stephan
Categories: Health, Insomnia, sleep

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Q:  When waking up in the morning, I usually take my time as I still feel sleepy.  Is it generally better to awaken slowly and sort of ease into the day, or get out of bed as soon as possible?

A:  Part of the answer depends on whether or not you allowing enough time for proper sleep.

If you are allowing enough time in bed for your last sleep cycle to complete, sleep inertia — that feeling of sleepiness you described — is reduced.  In this case, most people are in a fully awakened state within about 15 minutes or so.

But if you did not allow enough time to complete that last cycle, and you awaken in the midst of a deeper NREM sleep stage, you can expect significantly more sleep inertia.  In that case it might take far longer than 15 minutes to feel fully alert.

For those who do complete that final sleep cycle, some hop right out of bed and get going immediately.  But most are probably like you and take some time to get going.

If your preference is to lie in bed awhile and frame your day, that can be constructive.  Doing so enables you to visualize your goals for the day, prepare mentally for your challenges, and generally feel more ready with a positive attitude.

Taking some time in bed may also be useful to challenge some of your negative thinking and reality check your self-doubts.  These kinds of pessimistic thoughts are something we all experience from time to time, and they often occur first thing in the morning as well as just before nodding off at night.  When they do, making the effort to put them in proper perspective — safely letting them go — can be time very well spent.

So there’s nothing wrong with taking your time to start your day.  Just be sure to schedule for it so you don’t get stressed about running late.

Why can’t I sleep Sunday nights?

Posted March 6, 2018 by stephan
Categories: Health, Insomnia, sleep, stress

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Q:  I suspect part of this has to do with thinking about the upcoming work week, but I have no problem sleeping on any other nights.  Any suggestions?

A:  What you are experiencing is fairly common.   It likely is a conditioned negative response in anticipation of the upcoming work week, as you’ve already identified.  In other words, stress and worry are keeping you awake.

If that’s the case, welcome to the club.  Every one of us also deals with this in one form or another.  Most of us just accept it and get on the best we can.

But even without sleeping all that great, you may have noticed your performance isn’t adversely affected.  This is in fact what human performance studies consistently show.  We adapt to sleep deprivation and perform reasonably well even after a restless night.

Some people actually perform better with increased stress about an upcoming event, especially if there’s an anticipated positive outcome or expectation.

This is something you probably can and should try to control.  On Sunday nights you might try an extended wind-down period of relaxation to prepare for sleep, an hour or more might be reasonable.  A relaxing bath or soak, getting your clothes ready for the morning, some herbal tea, whatever helps you relax.  No stimulants, and avoid stress during this time, which can take you the other way.

You might also try writing down some of your concerns or worries about the upcoming week, and listing some solutions or constructive ways to approach those concerns.  In other words, you can restructure your expectation about the upcoming work week.  That might help you feel more positive and more prepared; and could assist in releasing some of that negative stress.

If and when awakened during the night, try some deep breathing and progressive muscle relaxation to drift back to a drowsy state more conducive to falling asleep.

Then just let go the worry.  Worry only feeds this.  It’s OK to let it go and know you’ll be just fine the next day.

Big exam tomorrow, can’t sleep. What can I do?

Posted January 25, 2018 by stephan
Categories: Insomnia, sleep, stress

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Q:  Before big tests I have a history of not sleeping well.  Seems I get in just a few restless hours.  On test day it feels like I’m in a fog trying to work my way through.  Do others experience this?  What can I do to help myself?

A:  What you are experiencing is very common with insomniacs.  Your description — and expectation for trouble sleeping — are a great examples of what’s known as negative sleep thoughts.

These negative thoughts come in many forms and are a potent raw fuel for insomnia.  If it’s not an exam, it could be an important project deadline.  It could be an upcoming athletic competition, or starting a new job, a new semester at school, or a million other things to stress or worry about.

But take heart.  The evidence shows these worries about lack of sleep are way overblown.  After a restless night, the evidence shows we adjust and perform comparably to normal sleepers.  And this is true both cognitively and physically.  It just doesn’t feel that way.  The difference is in perception, not performance.

Sometimes knowing facts about the reality of human performance and sleep is helpful in letting go the negativity and worry, because that is what feeds insomnia.

So what can you do?  Lead a good healthy sleep supportive lifestyle for starters, including daily exercise and a sensible sleep-wake schedule.  Consider trying some stress management methods as well.  If you find yourself awakened in the night and worried, try some in-bed relaxation methods such as deep diaphragmatic breathing and progressive muscle relaxation to help yourself fall back asleep.

If your insomnia lasts longer than a month, see your doctor to either treat or rule out an underlying medical condition.  And consider using CBT sleep training methods as a permanent, drug-free solution.

Then just let go the worry.  Sleep is a process of letting go more than anything else.  And be confident the odds are you’ll perform just fine on the test.

Use simple scheduling methods to strengthen your sleep system without drugs

Posted December 5, 2017 by stephan
Categories: Insomnia, sleep

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Q:  I’m having a hard time setting a reasonable bedtime.  I need about 9 hours of sleep, but my actual bed time swings wildly and sometimes I don’t go to bed until about 4 a.m.  This understandably puts a big crimp in my day.  On the flip side, when I do manage a reasonable bedtime and get in my 9 hours I function so much better during the day.  Any suggestions to fix this?

A:  Try some simple sleep scheduling ideas.

First, set and keep a consistent wake time 7 days a week.  Set this at your most desired wake time and stick with it.  Do not allow yourself to sleep in.  Do not nap — or at least limit your nap to no more than about 15-20 minutes, and in the early afternoon.

Second, set your bed time about 8 or 8.5 hours earlier than your wake time.  This is slightly less than what you’re used to, so it will have the effect of revving up your homeostatic sleep drive.

If you don’t feel drowsy at bed time, stay up.  But do relaxing things to help yourself feel drowsy.  Be alert to the signs of drowsiness — like yawning, head-nodding, droopy eyelids.  Avoid caffeine in any form after about mid-day.

You may not feel drowsy the first or second night at your desired bed time, but inevitably your physiologic requirement for sleep will soon catch up with you.  Stay consistent, and do not allow yourself to fall asleep on the couch or anywhere else before your scheduled bed time.

Stick with your consistent wake time no matter how sleep deprived you may feel the next morning.  Get up and going.  Expose yourself to bright light right away.  All this is setting you up for the following night, when you will sleep that much better.

Going forward, your sleep system will strengthen and improve with this consistency.  You can then gradually add in more time in bed as you like.

These sleep improvement methods combine parts of what’s known as sleep consolidation, stimulus control, and sleep hygiene, three of the core methods in cognitive behavioral therapy (CBT) specifically applied to insomnia.  Check out CBT sleep training for dozens more drug-free ways to help yourself sleep better and when you want.

Combine CBT methods for best results

Posted October 19, 2017 by stephan
Categories: Health, Insomnia, sleep

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Q:  After dealing with insomnia for months, I am looking for solutions without drugs.  Some experts say if you don’t fall asleep within about 20 minutes, get up and out of bed.  Others say stay in bed and try to relax.  Which is better?

A:  You are wise to seek non-drug solutions to insomnia.   Primary insomnia is not some sort of a disease you can treat with drugs like sleeping pills.  Insomnia is a complaint.  Sleep, or rather the lack thereof, is only the symptom.

Your first step should be to see a doctor to either treat or rule out an underlying medical basis.  But don’t be surprised if you have none.  Most insomniacs don’t.  In that case, look at the much more common nonmedical reasons for your sleep issues.

Most primary insomnia is typically caused by some combination of bad sleep habits and excessive worry about the idea of sleep.  Identifying and treating the true underlying basis can lead to a permanent solution.

You’ve described getting up and out of bed when you can’t sleep, which is part of what’s known as stimulus control.  This is one core method of CBT sleep training. The idea is to begin to undo the negative conditioning you have likely acquired between your bed and the idea of sleep.

The second method you’ve described is in-bed relaxation, also one of the core CBT sleep training tools.

Which should you use?  Both are important components of a permanent insomnia solution.  The answer will be unique to you, and a judgement call only you can make.

If you are lying in bed, tense and worried, not in the least bit drowsy, then that’s the time to get up and out of bed and do something sedentary and relaxing until you feel drowsy.  Then try sleep again.

But if you are lying in bed with eyes closed, drowsy but persistently awake, you can help yourself fall back asleep more quickly by practicing some in-bed relaxation methods.

Importantly, these are only two of many effective CBT methods you can and should use to help restore normal sleep.  Another essential one is cognitive restructuring, which allows you to get a handle on the negative sleep thoughts that are likely fueling your insomnia to some degree.  Another is sleep timing, a behavioral method which enables you to set and keep a sleep-supportive schedule specific for your needs.  Yet another is sleep hygiene.

All these methods reinforce one another and combine very effectively.  They work best when used simultaneously.

To do this, consider using a full and comprehensive CBT sleep training program.  This will give you the structure and support to deploy all these methods at once.  By doing so, be confident you will improve your sleep permanently, and without drugs.

 

Insomnia ruling my life

Posted September 26, 2017 by stephan
Categories: Insomnia, sleep

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Q:  My insomnia started a couple of years ago, and my whole life has been ruined ever since.  The original source was stress, and I have found nothing that helps.  I do have some good nights, maybe about half the time.  I had a bad night last night, so I know today will be awful.  How can I break this vicious cycle?

A:  You should be encouraged by the fact that half the time you do have a good night.  That is what to dwell on, the fact that you can sleep well.

You are expressing intensely negative thoughts — even catastrophizing — about the idea of sleep, which is understandable considering your negative experience.  But when it comes to your thoughts, remember you create them — and you have a choice.

When the choice is let insomnia control you or you control insomnia, that’s an easy decision to make.

In your case you should consider the possibility that your intensely negative thoughts about sleep are to at least some degree the raw fuel that is perpetuating and prolonging your insomnia.

You don’t mention your lifestyle or sleep habits, but most primary insomnia is actually caused by some combination of bad sleep habits and excessive worry about sleep.  Both are something you can control.

That could be your way out.  It is for many others.

Your first step should be to get a checkup to either treat or rule out the possibility of an underlying medical or psychiatric condition.  But don’t be surprised if you have none.

In that case look at the nonmedical underlying issues, like bad sleep habits and excessive worry.  Sleeping pills won’t help you fix those.  By artificially forcing sleep, pills only treat the symptom and unfortunately leave the true basis unaddressed.

Consider trying CBT sleep training methods.  These are a combination of proven, drug-free methods that will help you comprehensively address both negative thoughts and enable you to cultivate a lifestyle supportive of good sleep.  CBT is the standard of care recommended by the AASM, and it helps most people who try it.

If you are the self-help type, you will find much good information online about CBT sleep training.  Or seek referral to an MD who specializes in sleep, or a counselor that can provide you with a guided form of CBT sleep training.

So yes you can break this vicious cycle.  Help is there.  Rest assured by getting to the true roots of your insomnia, you can like many others restore better sleep.

I’m 15 and think I have insomnia. Should I take sleeping pills?

Posted August 30, 2017 by stephan
Categories: Insomnia, sleep, stress

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Q:  I’m 15 and I think I may have insomnia.  Sleep is a struggle for me, and it has been for many months now.  Even though I usually go to bed about 10 p.m., I often don’t fall asleep until about 3 a.m. no matter how hard I try.  Should I take sleeping pills?

A:  Most people go through times of sleeplessness for a variety of reasons, often having to do with stress.  Usually the stressful problem resolves or we adapt to it in some  way, and normal sleep returns.  But if this has been worrying you for many months now, then a checkup with your doctor is probably a good idea.  This will allow you to either treat or rule out the possibility of an underlying medical basis for your insomnia.

But don’t be surprised if you have none.  Most people with insomnia don’t.

Most insomnia is caused instead by some nonmedical combination of bad sleep habits and excessive worry about the idea of sleep.  If that’s the case with you, then sleeping pills won’t help.  Pills unnaturally force you to sleep — and they all have at least some side effects, possibly severe —  and leave the true root of the problem unaddressed.

You might try some basic CBT sleep training methods.  These include keeping a consistent sleep schedule 7 days a week.  Especially important is a consistent wake time.  Avoid napping or sleeping in, as these will in effect steal sleep from you at night.

Also avoid caffeine in any form (including colas and chocolate) after about mid-day.  Be sure to get some good exercise most days.  Basically, make an effort to tire yourself out both mentally and physically every day, and you will tend to naturally sleep better at night.

And rest assured it’s OK to let go the worry about sleep, which only tends to fuel insomnia.  “Trying” to sleep may be part of the problem — sleep really is more of a process of letting go, not a frontal assault.

If worry about sleep continues to be a problem, look into cognitive restructuring, another of the CBT core methods.  Like all CBT tools, it is completely drug-free and has no side effects.

Good luck and be confident you can sleep better without drugs.

Use positive emotions to supercharge cognitive restructuring

Posted July 24, 2017 by stephan
Categories: Health, Insomnia, sleep, stress

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Those practicing cognitive restructuring to improve sleep know how effectively it can counter and control negative sleep thoughts.  These persistent negative thoughts are often the raw fuel that prolongs and perpetuates insomnia.  But did you know you can in effect supercharge cognitive restructuring by adding a positive emotional trigger?

Cognitive restructuring — one of the core components of CBT sleep training — uses reason, rationality, and understanding to correct inaccurate and distorted thoughts about insomnia to something better, more realistic, and more supportive of better sleep.

But reason and rationality by themselves — while essential and important — don’t necessarily counteract the underlying feeling or emotion behind those inaccurate thoughts.

By intentionally adding a positive emotional component to the practice of cognitive restructuring, you may find your old negative and entrenched attitudes and beliefs about sleep begin lose their grip more quickly — to be replaced by positive and supportive beliefs that you create and control.   In the practice of CBT sleep training, this is one of many ways to take better control over your sleep performance.

The method we suggest in the Sleep Training System takes the normal CBT route of restructuring distorted sleep thoughts into better, more rational thoughts, but importantly adds a meaningful emotional trigger to that thought — specifically a feeling, but not just any feeling.

By associating a concept that triggers for you a good and positive emotion along with the restructured positive sleep thought, the benefit is enlarged and magnified.  The new and more complete positive thought can now more effectively counteract all the incessant negativity and stress insomniacs tend to associate with the idea of sleep.

As part of a comprehensive sleep improvement program, thinking your way to better sleep works naturally — and without drugs or side effects.  This process enables you to constructively address the true underlying root issue of insomnia that afflicts so many people — that seemingly nonstop barrage of worry and persistently negative thoughts about sleep.