Advanced Techniques to Enhance Sleep
John D. McKellar, PhD Clinical Psychologist Department of Veteran Affairs, Clinical Educator Stanford University
Arousal, Worry and Interference with Sleep
Difficulty in sleeping over time can lead to increased vigilance and arousal when trying to get to sleep
Arousal makes it difficult to identify the important signs of sleepiness (e.g., drooping eyelids) that cue us that we are ready for bed
Causes of arousal:
Unresolved issues of the day or the next day
Worry about things outside one’s control
Worry about consequences of poor sleep
Arousal, Worry and Interference with Sleep General Tips: 1.
Turn the clock around in your bedroom
2.
Create a time to unwind before bedtime or a “buffer zone” where one does not engage in stimulating or challenging activities
3.
Create “To Do” list for the coming day
Arousal, Worry and Interference with Sleep Create a “Worry Time” 1. “Schedule” a time to worry each day 2. Allow your worries to run, label as “good worry” or “bad worry” 3. Write down your thoughts and problem solve the “good” worries 4. When worries arise gently tell yourself “I will worry about that during Worry Time”
Arousal, Worry and Interference with Sleep Relaxation Training: 1.
Can reduce tension and anxiety to prepare for sleep
2.
Progressive Muscle Relaxation, Imagery, Deep Breathing or whatever works for you
3.
Much more effective when done regularly
4.
http://johndmckellar.com/zone_relaxation.html/
Common Thoughts that Interfere with Sleep 1.
If I don’t get a good nights sleep I will not be able to function tomorrow
2.
I need to get to sleep by ____ or I will be a wreck tomorrow.
3.
My insomnia is out of control.
4.
OMG, it’s (1am, 2am, 3am) and I am not asleep, what is wrong with me?
5.
I will never get to sleep.
Coping with Thoughts: Step 1 How much sleep is necessary? 1.
No single amount of sleep fits everyone
2.
Some people need 9-10 hours of sleep, some need only 4, most need 7-8
3.
Getting less sleep one night promotes sleep the next if we don’t get stuck on negative consequences
4.
If we think about our lifetimes there are many occasions where we only got a few hours sleep or no sleep and we were able to cope the next day
Coping with Thoughts: Step 2 De-catastrophizing worksheet for sleep:
Catastrophizing Thoughts (What if‌)
De-catastrophizing (Is this possible/likely? So what!!!)
If I don’t get a good nights sleep I will not be able to function tomorrow
What has happened in the past? Are you 100% sure or this true? How likely is this? Have you EVER had a bad nights sleep and then been able to function? So What?
Intro to Sleep Efficiency Training
1. Sleep efficiency training is perfect for people who have lost all confidence that they will “ever” sleep well again 2. Sleep efficiency training is also effective for people who need to “consolidate” their sleep- those who wake up in middle of night and are unable to return to sleep or who wake up too early 3. This treatment component was initially designed to help older adults with fragmented sleep but is now seen as the single most powerful intervention for improving insomnia!!!
Steps for Sleep Efficiency Training 1. Identify how many hours you sleep to set “Time in Bed” a.
Average sleep time over the last week (best from actual sleep logs but is ok to estimate amount)
b. Starting amount of time should not be less than 5 hours
2. Determining wake time and bedtime a.
Start with setting your wake time based upon your sleep patterns (are you a “night” or a “morning” person)
b. Once wake time is set, count backwards based on your “time in bed” and set your bedtime c.
Wake time must be same every day!!!!
3. Add 15 minutes to “time in bed” for each night of good sleep until you reach target amount of sleep
Example of Sleep Efficiency Training
1. Fred evaluates his sleep logs to determine that he sleeps about 6 hours each night (although he is in bed for about 8 or 9 hours) 2. He knows he is a “night owl” so decides to set his wake time at 8am (every day!) and a bedtime of 2am 3. After three nights of his “usual” sleep the effects of being tired start to “kick in” and he becomes more confident of falling asleep 4. After adding 20 minutes of sleep each time he get 3 good nights a month later he is up to sleeping 7.5 hours and his confidence in falling asleep is higher than he can remember
Common Obstacles to Sleep Restriction 1. Sticking with “time in bed” a.
If you are a “morning” person then find somewhat stimulating things to do before bed to help stay awake
b. If you are a “night” may want to schedule a fun activity early in morning to motivate to leave the bed
2. Spouse or partner issues a.
Difficulty in having different sleep scheduling and challenges to scheduling intimacy
3. Anxiety about Sleep Restriction a.
Having “sky high” anxiety can interfere
b. Alternative versions of Sleep Restriction (next slide)
Modifications to Sleep Efficiency Training 1. Add 30 minutes to average sleep time to set the “time in bed” more generously (also a good modification for high levels of daytime sleepiness)- if total sleep is estimated at 6 hours then initial “time in bed” is 6.5 hours 2. Sleep Compression Therapy: Moving from “time in bed” more slowly to total sleep time. a.
If a person spends 8 hours in bed typically and sleeps for 6 of those hours then the first step would be setting “time in bed” to 7.5 hours, then 7 hours, continuing down until one reaches the 6 hour target. Add time in bed with successful sleep as with normal sleep restriction
Helpful Self-Help Book
Quiet Your Mind and Get to Sleep: Solutions to Insomnia for Those with Depression, Anxiety, or Chronic Pain Colleen Carney & Rachel Manber