A good night’s sleep is essential for our minds and bodies, and recent research is saying sleep reduces our risk of cardiovascular disease, heart attack and stoke, obesity, diabetes and depression.
Getting enough good sleep can be difficult for many of us from young children to the elderly, so having the tools to address insomnia from the start is important in preventing further health issues, as the research says! sleep is essential for our health and wellbeing.
There are many theories on why we need to sleep from saving calories, house cleaning (glymphatics), tissue repair, brain connectivity, performance restoration to cognitive function, either way all species from the fruit fly to the whale, humans included, we all need sleep and when we go without sleep we certainly feel the effects.
Our sleep is regulated by the circadian clock and sleep homeostasis. Across the 24 hour clock and under the effect of natural day light and dark cycles, a typical 8 hour sleep comprises of several sleep cycles that will alternate between non rapid eye movement (NREM) and rapid eye movement (REM) sleep, each stage of sleep has a beneficial effect on brain connectivity and performance restoration.
A good night’s sleep is when you fall asleep quite easily, do not wake up during the night, do not wake up to early and feel refreshed in the morning.
Primary insomnia can either be acute or chronic insomnia. Acute insomnia lasts for less than 4 weeks and generally it is triggered by stress, ill health, pain or changes in medication, once the event passes, sleep should settle back into a normal routine.
Repeat acute insomnia can evolve in chronic insomnia because often when we experience ongoing sleep difficulties we think and behave differently about sleep. Chronic insomnia is unlikely to spontaneously remit and overtime will cause cycles of relapses and remissions or become a persistent symptom. Cognitive behaviour therapy aimed at treating insomnia (CBT-i) are techniques that look at areas of the sleep routine that may need to change to support a healthy sleeping environment and mind, and are usually delivered in four to ten sessions with a psychologist, (there are many categories of sleep disorders that are associated with other physical and mental disorders and CBT-i maybe contraindicated.)
CBT-i include
- Stimulus control
- Sleep restriction therapy
- Relaxation technique
- Cognitive therapy
- Sleep hygiene education
- Mindfulness
Stimulus control
Is aim at promoting a positive association between the bedroom environment and sleepiness, by removing all stimuli that is potentially sleep incompatible, this includes reading, watching television, talking on the phone, paying bills, use electronic social media, using computers, worry or planing activities in bed. The only exception is sexual activity. Go to bed only when sleepy/comfortable and intending to fall asleep, if you are unable to fall asleep within what feels like 15 -20 minutes (without watching the clock) leave the bed and bedroom and go to another room and do a non – stimulating activity.
Sleep Restriction therapy
Is setting a strict bedtime and rising schedule. By using a sleep diary you can determine the average hours of sleep you get in a night. You should never set less than 5 hours sleep time, allow a period of time equal to this plus 30 minutes and set a regular rising time. As sleep becomes more regulated, the length of time can be increase in small 15 – 20 minutes increments. This intervention induces natural sleepiness and that the bed is a safe place to sleep.
(http://yoursleep.aasmnet.org/pdf/sleepdiary.pdf)
Relaxation Techniques
There are various breathing techniques, visual imagery and meditation that can be used to reduce stress and induce a calm and relaxed body and mind. You should practice progressive muscle relaxation daily and practice shorter relaxation periods (2 minutes) a number of times throughout the day.
Click to access progressive-muscle-relaxation-script.pdf
Cognitive therapy
Uses mindfulness to alter your approach to sleep by identifying beliefs that may be interfering with stimulus control and sleep restriction. Unhelpful beliefs can include overestimating the hours of sleep required each night to maintain health, overestimating the power of sleeping pills, overestimating the actual sleep obtained and fear of sleep restriction or stimulus control for fear of missing the time when sleep will come.
Cognitive therapy helps you to recognize how unhelpful and negative thinking about sleep increases physiological and psychological arousal levels, by setting aside 15 – 20 minutes in the early part of the evening to write down any worries, make plans for the following day and address any concerns that may arise during the night, allow the day to be put to rest. It may be helpful to challenge thoughts that arise at night by expressing “ I have already addressed this and now I can let it go!” often some soothing activity before bed can be helpful in reducing arousal levels.
Sleep hygiene
Suggestions include avoiding long day time naps, short naps less than ½ hour are fine, exercise regularly, maintain a regular sleep – wake schedule 7 days per week, avoid stimulants (caffeine and nicotine), limit alcohol intake especially before bed, avoid visual access to the clock when in bed, keep the bedroom dark, quite, clean and comfortable.
There is limited evidence to suggest that sleep hygiene on its own is efficient to induce sleep but it is a essential component of CBT-i and involves cleaning up your sleep environment, behaviours and habits that are disrupting sleep,
Mindfulness
Is likely to promote sleep by reducing cognitive and physiological arousal, mindfulness emphasises being non-judgemental in the present which potentially can reduce mind activity, the chattering mind is usually focused on the past or future events.
“O sleep, O gentle sleep, natures soft nurse, how have I frightened thee, That thou no more will weigh my eyelids down, And steep my senses in forgetfulness”
Henry IV William Shakespeare
My next sleep blog part to 2 will discuss food and sleep
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5168528/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924526/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2924526/