Posted tagged ‘sleep help’

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.

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.

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.

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.

Busting the myth of “I can’t sleep”

July 19, 2016

Q:  I want to sleep more than anything else, but just can’t.  Seems I lie in bed for hours and hours, and no matter what I do can’t fall asleep.  Any ideas?  I just want to sleep!

A:  First, let’s clarify. Yes you can sleep. The fact is you can’t not sleep, even if you tried.  Maybe you mean you can’t sleep when you want for as long you want, but in reality sleep at some point becomes irresistible for us all.

The experience of those with severe untreated obstructive sleep apnea demonstrates this fact well.  Those with untreated OSA can’t sleep for more than a few minutes at a time before waking themselves up, often gasping for air.  They may compensate by getting dozens if not hundreds of microsleeps throughout the night and often throughout the day — a potentially very dangerous situation for anyone with this condition who drives or operates machinery.  Microsleeps are of course a poor substitute for normal sleep, but it demonstrates how one way or another your mind and body will simply not be denied sleep, no matter what you do or don’t do.

The key is, of course, managing the inevitable sleep process for the best results.

The frustration you are expressing is understandable.  There is nothing quite like the agony of being dead tired in bed, wanting to sleep, but aggravated at our inability to do so when we want.

What we can’t do is try and force sleep. That tactic usually backfires as one becomes more alert, more frustrated, more angry at one’s inability to sleep. A frontal assault just doesn’t work.

There are better ways.

We suggest you’ve got to outflank this insomnia to beat it. Take at indirect approach. Outsmart it.

This is usually done by attacking insomnia at its true roots.  First, see a doctor to ensure you are either treating or have ruled out any underlying medical issues.  But don’t be surprised if you have none.  Most insomnia is not caused by a legitimate medical condition.  In that case, you may need to incorporate nonmedical strategies.

These typically include CBT sleep training methods. Such cognitive behavioral methods usually consist of some combination of stimulus control, sleep hygiene, consistent sleep timing, stress management, relaxation training, and control of anxiety.  Any of these issues, if not properly managed, can and will disrupt sleep.

Sleep is more than anything else a process of letting go.  Of not doing more than doing.  The process is the direct opposite of forcing.  But rest assured there is help, including effective methods that are entirely drug free.

Acknowledging the fact that yes in fact you can sleep may be an important first step in a permanent solution for you.  By controlling your thoughts, behaviors, and your environment you can in effect “stack the deck” in your favor for better sleep when and for how long  you want.

 

Why can’t I sleep at night but can during the day?

April 21, 2016

Q:  I have been struggling with insomnia for a couple of years now, and find it very difficult to sleep at night.  But for some reason I have no problem napping during the day.  Why is this?  What can I do to sleep better at night?

A:  Your circadian rhythm is likely involved.  There can be many reasons why you can sleep during the day but have difficulty at night.  As always, it’s best to talk to your doctor to either treat or rule out an underlying medical basis — but here’s some general information that might help.

First, our mind-body systems have evolved over the eons specifically to sleep at night and be alert during the day.  The two most important internal systems controlling this process are known as the circadian rhythm and homeostatic sleep drive.

Circadian rhythms refer to the 24-hour cycle of day and night we all experience.  Your circadian rhythm sends out an alerting signal in the morning, and the cue it uses to determine this is light.  The circadian alerting signal diminishes in strength when night comes.

Our homeostatic sleep drive is a separate regulatory function in addition to the circadian rhythm.  Sleep drive is the biological pressure to sleep.  It builds up over the course of a day.

After about 16 hours of nonstop wakefulness, your sleep drive sends a signal reinforcing the lull in the circadian alerting system.  When the two systems are synchronized and working well together, sleep when you want it can become practically irresistible.

One way to strengthen these two processes and assist them in working well together is to have a consistent sleep-wake schedule.  Particularly important is a consistent wake time in the morning, followed by the immediate exposure to bright light.  This consistency helps to both regulate your circadian rhythm and synchronize it to your sleep drive.

Since you have been struggling with chronic insomnia for some time now, you may also be affected by a conditioned response to being awake at night, frustrated and tense, while trying to sleep.  In other words, you may have learned inadvertently over time to be awake and alert during the night as a result of your negative experience with insomnia.  This is actually common with insomniacs.

But just as it has been learned, it can be unlearned.  There are a number of methods known collectively as stimulus control you can use to counter this negative conditioning, and support better sleep.

The best overall strategy is to combine all these methods at once into one unified program for better sleep.  Taking a comprehensive approach enables you to address all the nonmedical issues that may be preventing you from getting a good night’s sleep.

Don’t get stressed by sleep restriction

January 27, 2016

Q:  Falling asleep isn’t my problem, but I awaken typically at 2 or 3 a.m. then often cannot fall back asleep or it takes me what seems like hours to do so.  I’ve tried sleep restriction and cannot do it anymore because I get overly stressed by the idea of limiting my sleep.  Any other ideas to help me sleep better through the night?

A:  Sleep restriction therapy (SR) is one of the most effective ways to help consolidate sleep into one unbroken period, but if it causes you stress then it might be helpful to take a new and better approach.

In the Sleep Training System (STS), our approach is to modify the practice of sleep restriction therapy with the intent of reducing stress, while also gaining its significant benefits to counter insomnia and improve sleep.

SR is a key component in cognitive behavioral therapy specifically designed for insomnia (CBTI), and its benefit has been proven repeatedly by empirical science.  The method can be modified in a number of ways, however, so what might work for you is to re-think the idea of SR to work to your advantage.

SR is critically important because it sets and maintains a consistent pattern of sleep and wakefulness.  Your inherent sleep system thrives on this sort of regularity.  By establishing a consistent sleep-wake pattern, you accomplish many things.

Most important is the profound benefit of regulating your circadian rhythm, and synchronizing that to your homeostatic sleep drive.  Circadian rhythm and sleep drive are the two most important internal components controlling sleep.  Control these two to your advantage, and you are well on your way to better sleep permanently.

In the STS, we call this practice sleep timing.  Instead of thinking of this idea in a stressful way, we suggest re-conceiving it in a strategic way — one that supports a comprehensive effort to improve sleep.

Part of this strategy for better sleep is simply to get up at the same time every day.  Another part is limit any daytime napping to no more than 10 to 15 minutes.  A third and key part is to limit your time allowed in bed to more closely match how much you are actually sleeping each night.

This is where the restriction comes in, but if that idea causes you stress, throw out the idea of restriction.  Think of it instead as your strategy, your beneficial plan that enables you sleep better permanently.  Focus on the rich rewards that idea holds!

Indeed, a separate and supporting method we call “constructive imagination” in the STS enables you to re-think your old ideas about sleep and let go of the counter-productive negativity that is causing you stress.  The re-casting of your old, stressful ideas about sleep into new, better, more positive, and more accurate ideas is actually a key part of the solution.

In this sense, you literally think your way to better sleep, while sleep timing methods enable you to regulate and synchronize your physical sleep system.  The two methods synergistically combine in a potent and very powerful way.

Don’t give up on SR, sleep timing, or however you conceive of this practice, because it works.  By making this positive effort, by controlling what you can reasonably control, by letting go of the stress-producing negative thoughts about sleep, you may find your sleep naturally consolidates much more easily into one unbroken period.  This is exactly what the science tells us, as well as the experience of many satisfied STS users … and there is every reason to believe it will work for you too.