Introducing Cognitive Behavioural Therapy (Introducing...) (3 page)

For the majority of people with sleep disturbance the following techniques and changes will solve the problem. However, making improvements in your sleep can involve changing bad habits which you may have had for a long time and allowing your body and mind to relearn how to sleep effectively. In other words, changing your sleep pattern and routine can be difficult and can take time and commitment. The important thing is to apply our advice consistently and over a period of time. Frequently this advice seems too simple and people complain that they have already tried all the suggestions. However, the techniques have often been applied inconsistently and for only one or two nights at a time. It can be hard to stick to new routines but if you are able to persevere you will see positive changes in the quality of your sleep. These suggestions won’t necessarily work for everyone, so you may well need to experiment in order to see what works best for you.

Simple changes in your routine can make a big difference but only when consistently applied and practised.

Step 1: monitor your sleep

Keep a sleep diary.
As we have said it can be hard to estimate how much sleep we are really getting. Using a diary can help you to identify patterns and problems in your sleep. This can help you pinpoint both the changes you need to make and where to start. Keep your diary for a week before considering what you have learned from it. Then look at the techniques and strategies suggested in the following steps. Which of these seem to fit with issues highlighted by your diary?

Step 2: adjust your environment

Look at your sleeping environment
. Is the temperature right for you to sleep comfortably? Is it too light or perhaps too dark? Is there anything you can do to reduce noise that might disturb you? Is your bed comfortable? Everyone is different and so finding the right sleeping environment for you can be a process of trial and error. It’s important that you are comfortable in bed. It may be worth investing in a new bed or simply a mattress that is more supportive.

Consider your partner.
If you do not sleep alone, you may encounter additional problems. Many couples find that they have different needs for a good night’s rest. Perhaps one partner snores or is very restless when asleep. Perhaps each prefers a different kind of mattress. Factors such as these can need some discussion and negotiation. Some couples find that choosing to sleep apart can work for them, provided both are clear why this is necessary. This solution certainly doesn’t have to mean you stop sharing a bed altogether – just that when you want to
sleep
, one or the other retires to a different bed.

Example sleep diary

Step 3: change your sleeping behaviour and habits

Look at the diagram at the start of this chapter. Can you see how some behaviours might help us to sleep better and how others might maintain a sleep problem? Think about your own behaviour in relation to sleep. Is it helping or hindering? The following guidelines can help you change your behaviour to improve your sleep. In CBT we call this
sleep hygiene
.

Develop a bed-time routine.
About an hour and a half before bed start to give your body cues that it’s time to wind down for sleep. You could try having a warm bath or shower, having a hot drink, listening to soothing music or watching or reading something relaxing. It’s important that your brain is not over-stimulated at this time. Don’t work, exercise vigorously or watch or read anything too exciting within two hours of going to bed.

Watch what you eat and drink.
The caffeine from beverages such as tea, coffee or coke is a stimulant and can stay in your system for a surprisingly long time. Avoid these completely for several hours before bedtime. Additionally, drinking too much of anything in the evening may mean you need to go to the toilet during the night. Try to consume most of the liquid you need earlier in the day. Don’t eat a large meal within a couple of hours of bedtime but, equally, don’t go to bed hungry. Eating a generally healthy diet will also help you sleep better.

Cut down on alcohol and tobacco.
Alcohol may help you fall asleep, but you are very likely to wake after a few hours and then find it difficult to get back to sleep. Avoid drinking any alcohol for a few hours before going to bed. Tobacco is a stimulant and may interfere with your body’s ability to fall asleep. Again, avoid smoking shortly before bedtime.

Be strict about bedtime.
While you are trying to improve your sleep you should make sure that you go to bed and get up at the same time every day. Choose a bedtime which is when you’d normally begin feeling tired. It could be 10 p.m. for some people, or around 1 a.m. for others. Work out a schedule that will give you around 8 hours in bed. The crucial thing is to make sure you get up at the time you’ve set yourself, even if you’ve slept badly and feel shattered. A very loud, repeating alarm clock sitting out of reach can help. Do not nap during the day. Wait until your set bedtime to sleep. Once you have established a good routine and are sleeping better, the odd late night or morning lie-in will not do any harm, but try as far as possible to keep to a good routine.

If you can stick to a rigid routine you will probably find that your body settles into a natural rhythm and you will sleep much more easily. This can be very difficult for the first few days and it can be hard to resist napping during the day. Enlisting the support of people around you to encourage you to keep it up can be helpful.

Don’t lie in bed not sleeping.
If you don’t fall asleep within 15 minutes of going to bed, get up and go and do something quiet and relaxing, preferably in a different room. This will help you to break the cycle of making matters worse through worrying about not sleeping. Go back to bed once you are tired. Repeat this if you cannot sleep again after 15 minutes.

You must still get up at your set time whether or not you have slept.

Associate your bedroom with sleep.
If you usually read, work or worry in bed, this can mean that you are not relaxed when you then try to sleep. Move these activities out of the bedroom. Your bed should only be used for sleep and sex. Only read in bed if you know it relaxes you and helps you to sleep. Think about what you read. Is it likely to relax or stimulate your mind? Breaking these habits will mean that you are cueing your mind into sleeping when you go to bed.

Use relaxation techniques.
Try some of the strategies suggested in
Chapter 4
on managing anxiety. They also include the techniques of
self-hypnosis
and
deep relaxation
. You’ll probably find some of them are easier and more fun than you would have imagined. Remember it is usually better to learn to use these strategies during the day first, before you start to use them to help you sleep. Once you have found a strategy that works well you can use it to relax you and help prepare your body and mind for sleep.

Increase physical exercise during the day.
We all sleep better when we are active and using energy during the day. Try to increase the amount of exercise you get. This does not have to involve going to the gym or taking up a sport if this is not for you. Think about your journey to work or to the shops. Can you park a bit further away from where you are going, rather than circling to find the nearest spot? Could you get off public transport a stop earlier or later than your usual one and get a bit of a walk then? A brisk 20-minute walk can be excellent exercise and may make all the difference to your sleeping pattern. Make sure though, that you get this exercise earlier in the day and not within two hours of bedtime.

Increase pleasurable and relaxing activities during the day – and night!
These days many of us work too hard and do not make time for doing things we enjoy or which relax us. This can affect our mood, make us anxious and mean it’s very hard for us to sleep well. Try to build in something that you enjoy, however small, every day. Think creatively. It does not have to be something big. Spending some time with a friend, partner or child, reading for pleasure, playing a game or just walking around the garden can all help us to feel better. If our mood is better we are much more likely to sleep well. Try some of the strategies in
Chapter 5
to improve your mood.

How you spend your time during the day will have a big impact on your sleep at night.