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

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.

Can’t sleep with a big event the next day

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?

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

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?

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

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.

Desperate for sleep and need help

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.