Posted tagged ‘sleep tips’

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.

What is the process of falling asleep like?

June 18, 2018

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.

 

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.

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.