Posted tagged ‘anxiety’

Why can’t I sleep Sunday nights?

March 6, 2018

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?

January 25, 2018

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

December 5, 2017

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

October 19, 2017

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

September 26, 2017

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?

August 30, 2017

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.

Tired of not being able to sleep

May 24, 2017

 

Q:  I’m tired of not being able to sleep.  Seems I stay awake for days at a time, this is gets really old after awhile.  Any advice?

A:  You might be surprised to learn you’re already on the right track to making this better.  Tired is really what you want — because tired is what helps you sleep!

In other words, if you make a concerted effort every day to tire yourself out — both physically and mentally — that most definitely will help you sleep better at night.

For many of us though, tired sometimes isn’t enough.  One of the most frustrating aspects of insomnia is the “tired but wired” syndrome — the awful feeling of absolute exhaustion combined with the inability to sleep.

The tired-but-wired syndrome can result when distorted thoughts and beliefs get mixed into insomnia, thoughts such as “I stay awake for days at a time”.

Do you really?  Do you not even lie down for a little while in the middle of the night with your eyes closed?

If you examine that idea closely, it’s highly likely you’ll realize this is in fact an exaggeration, a false and inaccurate belief that may in fact be fueling your insomnia.   This actually is very common among insomniacs.

Most of us experience what’s known as sleep state misperception, meaning we actually are asleep for a significant amount of time but don’t know it.  This is because we are, well, asleep, and just don’t realize it.  Somehow all we remember from the previous night are all the negatives.  The frustration and aggravation of tossing and turning for what seems like hours at a time can be a potent fuel for insomnia.

Yet we often give no credit at all to whatever actual shuteye we do get.

If you were turn that belief around and view this more objectively and accurately, if you were to credit yourself for whatever actual sleep you did get, your more realistic and accurate attitude might work to help reduce some of the stress you likely associate with the idea of sleep.

Taking more of a realistic view is an excellent way to help reduce the self-imposed pressure we often inadvertently put on ourselves.  And doing so turns out to be one of the very best ways to achieve better sleep permanently.