Dr. Michael Breus, Ph.D., troubleshoots your sleep treatment.
We are halfway through the 90 Days to a Happier You challenge to change our habits and live better in 2016. Perhaps you've been following the advice from sleep expert Dr. Michael Breus's previous post, 6 Steps to Better Sleep. Here he addresses the most common issues that come up for patients going through his sleep treatment.
Q: How do I know this treatment will work?
A: These suggestions have been developed by clinical psychologists and tested in sleep clinics throughout the world. About 75 percent of chronic insomniacs have been shown to benefit from these procedures, with a 50 to 60 percent improvement in the time it takes someone to fall asleep and helping people stay asleep.
This is not a magic cure, but it will help you take control of your sleep and deal with future sleep problems you encounter. However, you must follow the suggestions consistently, every night, in order for them to be effective. In many studies, when patients followed the treatment only “selectively,” their sleep remained poor.
Q: Regarding the sleep deprivation part of the program, I’m reluctant to postpone my bedtime until I’m tired because I don’t want to miss the most refreshing portion of a night’s sleep. How can I avoid that?
A: Although deep sleep (the most nourishing sleep) usually occurs during the first part of the evening, it will always occur first, no matter what time you go to bed. What you miss is usually REM sleep, which is not as crucial.
Q: I can’t stay awake until my prescribed bedtime. What should I do?
A: Start by making a list of activities that will keep you engaged until the right bedtime and then refer to the list when you are feeling sleepy. For example, you can do something physical like exercise, cleaning or walking the dog. You can catch up on emails or balance the checkbook. Do not, however, do something passive such as read or watch a movie, as this will only put you to sleep.
Q. What should I do if I can’t fall asleep once I’m finally in bed or I wake up in the middle of the night and can’t fall back asleep?
A: If you’re unable to fall asleep within 20 to 30 minutes, get out of bed. This isn’t a punishment because you can’t sleep, it is a way to re-establish the association of sleep with the bedroom. Lying in bed trying to sleep only increases anxiety and frustration, which makes it harder to sleep. If it is too cold, have a robe sitting on the foot of the bed or an extra blanket.
If you do not know what to do when you get up, make a list of possible non-stimulating activities to do during the night (for example, reading, prayer, letter writing, watching a pre-taped relaxing movie, listening to soft music, meditating, etc.) Do not try to schedule your day, do anything physical or get on the computer—these are too stimulating.
Q. But what if, as soon as I do get out of bed, I think I’m going to fall back asleep any minute?
A: To avoid more restlessness and frustration in bed, you want to be sure your sleep drive is, in fact, strong enough to allow you to fall back asleep within a few minutes. A good rule of thumb, the amount of time you’re awake before you get out of bed is the time you must stay out of bed. For example, if it takes you 25 minutes to get up and out of the bed, then you shouldn’t go back to sleep for 25 or so minutes—or until your body clearly tells you that you are very sleepy (see below).
Q. Once I get out of bed, I’m afraid I’ll stay up all night and never get back to sleep. What should I do?
A: The longer you stay up the quicker you will fall asleep when you return to bed, providing that you stop worrying about your sleep. It’s important to be able to recognize when you are getting sleepy. For example, are your eyelids heavy? Your limbs heavy? Are you beginning to yawn a lot? If so then it’s time to return to bed.
Q. Can I sleep in on weekends?
A: It is incredibly important that you wake up at your prescribed time consistently. Insomniacs are notorious for messing up their biological clocks. This is how you can fix it.
First of all get an alarm clock if you don’t have one. Get a few and place them around the room. Have your partner wake you. Exercise with someone in the morning, lift the shades and get some light. Schedule activities that will make you get out of bed. Whatever works for you, but you must wake up at the prescribed time every day.
Q: What if I fall asleep in other places besides the bedroom?
A: This is common for insomniacs. As much as you can, try to get back to the bed to sleep; remember we are trying to associate the bed with sleeping.
Q: I like to read or watch TV before bed. Why should I stop?
A: For some people, reading or watching TV is sleep-inducing. Try this test: When you read or watch TV, how long does it take you to fall asleep? If it is more than 30 minutes, it is highly unlikely that this activity is helping you sleep.
Is it your partner or you who likes this ritual? If it’s your partner, try to get him or her to let you take the TV out of the bedroom, at least until you can get your sleep back under some control. Is the bedroom the only place you or your partner can do these things? Try to identify other places where the two of you can read together or watch TV. The bedroom should be reserved for sleep.
Dr. Michael Breus, Ph.D., DABSM
The Sleep Doctor ™
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 diplomate of the American Board of Sleep Medicine and a fellow of the American Academy of Sleep Medicine. 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.