Posted tagged ‘anxiety’

How to deal with middle-of-the-night wake ups

December 17, 2019

Q:  Seems most every night I awaken after about 4 hours of sleep.  Sometimes I can’t fall back asleep for a couple of hours, and it’s really starting to bother me.  What can I do to sleep more solidly through the night?

A:  What you’re experiencing is surprisingly common, and especially this time of year with the long nights and short days.  It’s sometimes called the “first sleep, second sleep” phenomenon, and was reportedly the norm prior to advent of electric lighting — when people might spend 11 or 12 hours a night in bed.

Fortunately, there’s a number of things you can do to help consolidate your sleep into one more or less unbroken block of time, although some wake ups are expected and normal for even the best sleepers.

One key is to keep a very consistent sleep-wake schedule.  Especially important is a consistent wake time every day.  This does two things — one is to regulate your circadian rhythm, and the second is synchronize it with your homeostatic sleep drive.  Circadian rhythm and sleep drive are the two most important internal components controlling sleep.

Avoid sleeping in or napping later in the day.  This helps preserve your prior wakefulness.

Schedule your bed time to allow enough time in bed for proper sleep, but no more.  This also helps consolidate your sleep.

Upon arising, immediately expose yourself to bright light.  This helps regulate your circadian rhythm, and your sleep drive begins tracking wakefulness.

When awakened in the night, again which is common and normal, do what good sleepers do — pay no mind.  By doing so you increase the chances of falling back asleep quickly.  What you don’t want to do is start fretting about it, which takes you more into a state of worried wakefulness.  Use in-bed relaxation methods to help fall back asleep, such as deep abdominal breathing combined with progressive muscle relaxation.

Note that none of these methods requires drugs or substances of any kind to work.  Just be conscientious about a healthy sleep supportive lifestyle and good sleep habits, and you will likely improve your sleep and your satisfaction with your sleep.

For more ideas like this, check out using a full CBT sleep training program.

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.

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.

Desperate for sleep and need help

September 11, 2018

Q:  I’ve now gone almost 5 days without sleep.  I’ve tried everything and nothing works:  benadryl, weed, alcohol.  Melatonin and exercise have no effect.  I’m desperate for sleep and just want to know what’s wrong.

A:  What’s wrong is probably at least in part your attitude that you in fact “can’t sleep” — and need drugs to do it.

What’s wrong is likely your belief that you’ve really gone almost 5 straight days without any sleep whatsoever.  Are you saying you never even once laid down with your eyes closed during that time?  How do you know you didn’t sleep — did you use a sleep tracking device or some sort of written log?

Far more likely: you slept, but don’t realize it.  Or dismiss what sleep you did get as meaningless.

If you’re like millions of others with primary insomnia, your solution at least in part includes changing your beliefs and attitudes about the idea of sleep.  This is something you can control.

Suggest you first see a doctor to either treat or rule out an underlying medical or psychiatric condition causing this.  If you have none, then look to nonmedical solutions.

The best are contained in CBT sleep training programs.  These have a component called cognitive restructuring to reality test your beliefs and correct them to something better and more accurate.  Using this method, you can stop these negative thoughts from fueling and perpetuating your insomnia.  As part of a complete CBT solution, you can literally think your way to better sleep.

CBT sleep training also includes sleep hygiene.  Using this method you’ll learn how to lead a healthy sleep-supportive lifestyle, including how the use of drugs and alcohol are no answer for insomnia, only treat the symptom, and may actually worsen the problem.

 It’s highly likely your permanent solution will not come from drugs or any other substance to artificially force sleep.  Ask your doctor about using CBT sleep training methods.  You’ll find real help there to address the true underlying root of the problem.

Can I die from lack of sleep?

July 6, 2018

Q:  I haven’t slept now for 8 straight days.  I don’t know why and no meds work.  What will help me?

A:  Start with the idea that you’ve actually gone 8 straight days without sleep.

Did you not even lay down one time with your eyes closed during those 8 days?  How do you know you didn’t sleep?  Did you keep a log, or use a sleep tracking device?

Sleep state misperception is rampant among insomniacs.  Studies in sleep labs consistently show insomniacs underestimate how much actual sleep they get by at least an hour or more per night.  This happens when we are in fact asleep but don’t realize it because we are, well, sleeping.  All we remember is the aggravation of tossing and turning in bed, frustrated at our inability to sleep.

If you honestly examine your belief that you’ve gone 8 straight days without sleep you’ll likely find that it is false and inaccurate. An overblown exaggeration.

What you probably mean is you haven’t slept as well as you’d like over the past 8 days.  And if so, welcome to the club.  You’re no different than literally millions of others who struggle with sleep.

This is key for you to understand:  your false belief about the reality of sleep, the excessive negativity you are buying into, is probably fueling your insomnia to at least some degree.  And you are hardly alone in this.  Many if not most insomniacs do the exact same thing, and it becomes a vicious self-perpetuating cycle that can be difficult to break.

Fortunately, there is a way out.  There is a proven way to derail inaccurate and negative sleep thoughts, and replace them with something better, more accurate, and more supportive of good sleep.  It’s called cognitive restructuring.  Using this method you can literally think your way to better sleep.

Cognitive restructuring is one of the core tools in CBT sleep training.  What a good CBT sleep training program will do is give you a positive, supportive structure for implementing cognitive restructuring, as well as provide many other proven methods to help yourself sleep — and all without drugs.

As always, you should check with your doctor to either treat or rule out any underlying medical issues disrupting your sleep.  But be confident you can fix this, permanently.

Why can’t I sleep? Nothing helps

May 15, 2018

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?

March 27, 2018

 

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.