As part of Live Happy’s special series 90 Days to a Happier You we’ve gathered experts from around the country with unbeatable advice about how we can change habits and live better in 2016. Below, in the first part of an ongoing blog series, sleep expert Michael Breus, Ph.D., walks us through the steps of a successful sleep intervention.
Wasted. Wiped out. Zonked. Knackered. If you have insomnia, then you know what it feels like to be very, very tired during the day. That’s because you simply are not getting enough good quality sleep at night.
Research shows that sleep deprivation affects every organ system and can bring on severe psychological distress. In fact, in many countries it is used as a form of torture!
Many factors can cause acute or chronic insomnia, including anxiety, stress, depression and physical ailments such as asthma, cancer and heart failure. In addition, noise, light or extreme temperatures can interfere with one’s sleep, as can a change in sleep schedule and many other factors.
What are the symptoms of insomnia?
If you have insomnia, you might have difficulty falling asleep, you may wake too early, or, like Live Happy editor at large Shelley Levitt, you may wake up many times during the night.
During the day, you might feel tired, irritable and have a lack of motivation or problems with concentration and memory. You might find yourself making mistakes at work or school and having unexplained headaches or stomach pains. Not surprisingly, one symptom is worry about sleep!
How is insomnia treated?
The main treatment for insomnia is Cognitive Behavioral Therapy, a highly effective form of talk therapy in which you counter irrational thinking with more logical thought patterns. Before we start CBT, I ask my patients to make a few lifestyle changes and sleep schedules.
1. Make lifestyle changes to improve sleep
Give yourself a chance to relax before bedtime by bathing or listening to relaxing music. Try not to eat a heavy meal late in the day.
Make your bedroom comfortable for sleep: Keep it dark, quiet, and not too warm or cold. Use a sleep mask to block light or earplugs or a fan to block noise.
I know it’s a struggle, but try not to worry about sleep when you go to bed. You can distract yourself with reading, prayer or meditation. Turn your clock around so you won’t be tempted to constantly check the time; you may even want to move your clock across the room to resist temptation.
2. Be aware of triggers that set off your insomnia
Many people have a predisposition to stress and anxiety, which may then make them more likely to fall into insomnia. Something occurs called a “precipitating event,” which can be the loss of a loved one, a divorce or a new job—anything that causes a large amount of stress. This event in turn can bring on negative habits such as not getting to bed regularly or using alcohol to help with sleep and deal with the stress. Things start to snowball and can develop into a case of insomnia.
If you know you are about to encounter a stressful situation or time, try to seek ways to alleviate the stress, such as exercise and meditation, so that you do not end up falling into a negative sleep or caffeine/alcohol pattern.
3. Keep a sleep diary
I ask patients to keep a sleep journal in which they write down the information below, which we then review, looking for patterns:
- Time you went to bed.
- Approximate time you fell asleep.
- Time you woke up.
- Number of times you woke up during the night.
- Amount of time you stayed awake during the night.
- If you used any medication.
- Any grogginess upon waking in the morning or during the day.
- Naps and durations.
4. Sleep restriction
This technique is highly effective if done correctly under the supervision of a sleep specialist or health care professional. It is completely counterintuitive, but it really works.
I ask my patients to go to bed later, not earlier. So for example, if you’ve been going to sleep at 10 p.m. but not falling asleep until 12 a.m., and then getting up at 6:30 a.m., I would ask you to go to bed instead at 12:30 a.m. This allows for only 6 hours in bed. After seven to 10 days, I usually see that the number of awakenings at night reduced and the amount of sleep consolidated. The brain is starting to know when to go to sleep and stay asleep. It is difficult, though, and the schedule must be maintained on the weekends as well.
5. Cognitive restructuring
It turns out that the way you think about sleep affects the way you sleep. For example if you think, “If I don’t get eight hours of sleep, it will cause me major health consequences,” you create a level of anxiety every time you don’t get that eight hours. I use a specialized questionnaire to identify cognitive misperceptions like this one. Next we spend time investigating these perceptions to see if they are true (in most cases they are exaggerated) and what the patient can do to reframe his or her thoughts about sleep. Then doctor and patient work through these misperceptions together. (This step is an example of Cognitive Behavioral Therapy.)
6. Meditation and relaxation training
If the sleep restriction is working, but you are still having difficulty falling asleep when your bedtime is moved earlier, I go to specialized relaxation techniques designed to help specifically with falling asleep or waking up in the middle of the night.
Read Michael's second blog here.
To see Michael's recommendations in action, read sleep intervention "subject" Shelley Levitt's blog here.
Listen to Michael himself explain how to overcome chronic insomnia on our podcast!
Michael Breus, Ph.D., is a board-certified sleep specialist in Los Angles, California. His books include Good Night: The Sleep Doctor's 4-week Program to Better Sleep and Better Health and The Sleep Doctor’s Diet Plan: Lose Weight Through Better Sleep. Michael has made appearances on national media, including Dr. Oz, Oprah and CNN.