From time to time, practically everyone experiences insomnia. However, persistent sleep problems can be both a cause and symptom of negative emotional states.
Insomnia is a classic symptom of depression, with as many as 90% affected. Sleep loss is common among people with anxiety—perhaps as high as 70 percent. (About 60% of those with depression had anxiety first.) Poorer sleep quality interferes with your ability to regulate negative thoughts and emotions, to attend and concentrate, and to follow through.
If you have trouble sleeping, can you sleep better? Cognitive behavioral therapy (CBT) sleep methods are an evidence-based first line of defense against insomnia (Koffel et al 2014; Taylor & Pruiksma 2014; Jacobs et al. 2004). These methods can be especially beneficial for a sub-group of people who ruminate too much, have trouble falling asleep, or who wake up ruminating and have trouble falling back to sleep.
I'll start with a pink elephant dilemma. Then I’ll describe 15 more cognitive and behavioral methods you can try to calm your body and ease your mind prior to sleeping; some can be useful if you have interrupted sleep and want to cruise back to slumber land.
The Pink Elephant Dilemma
You feel stressed about work. It’s midnight. You’d like to settle down and sleep. However, you lament yesterday’s mistakes. You worry about tomorrow’s problems. You are mindful of the sleep that you expect to lose, and worry about that. You tell yourself, I have to stop worrying. I have to fall asleep. The harder you try, the more distress you feel. Now you feel more awake than before.
Welcome to the pink elephant dilemma, and here is how it works. When someone tells you not to think of a pink elephant, are you more or less likely to think of a pink elephant? In this instance, you think of the pink elephant.
To rid yourself of the pink elephant, you try to distract yourself. You think of a purple fox. Nevertheless, the pink elephant remains on your mind. The harder you try to snuff out the image, the brighter the pink elephant shines. You are now emotionally charged.
If you are like practically everyone, when you try hard to get something off your mind, you are more likely to attend to the thoughts that you want to forget. How do you resolve the pink elephant dilemma and fall asleep?
Start with a passive volition exercise. Passive volition is an attitude of allowance. It boils down to this: "If I think of a pink elephant, so I think of a pink elephant." By giving up the struggle of trying to pressure yourself to snuff out your image of the elephant, you are managing yourself with ease and compassion, and more likely to feel rested.
Cognitive Behavioral Sleep Methods
Here is a sample of fifteen cognitive and behavioral techniques to improve your sleeping patterns:
1. Follow a regular sleep schedule. Go to bed when you are likely to feel sleepy.
2. Try white noise to muffle outside sounds. An example of white noise is a low-volume sound from a non-operating television channel. (Put on the TV timer so that the set shuts off, say, in 60 minutes.)
3. Avoid associating your bed with wakefulness. When you are unable to sleep, get out of bed. Return in a few minutes. You may feel more ready to sleep.
4. Do moderate aerobic exercise during the afternoon every day. Most sleep experts suggest avoiding exercise two to four hours before you go to bed. Note: There is some research indicating that mild evening exercise at night aids sleep. Use your experience as a guide.
5. Avoid ingesting coffee, cola, tea, or chocolate (or other caffeine-containing substances) seven hours before your regular bedtime.
6. If you smoke, refrain from doing so several hours before going to bed. (Because of demonstrated health risks, it is a good idea to stop smoking permanently.)
7. Avoid alcohol for three hours before going to bed. A glass of wine in the evening may cause you to feel relaxed, which may make it easier for you to fall asleep; however, as the body breaks down alcohol, you compromise the quality of your sleep.
8. Sleep in a well-ventilated room with a room temperature of sixty-five to sixty-eight degrees Fahrenheit. Sleep is associated with a drop in body temperature.
9. Relax your body during periods of interrupted sleep. This has some restorative value. For example, squeeze and relax your main muscle groups. Imagine a fluffy cloud moving slowly across the sky.
10. Plan to rise between 6:00 a.m. and 7:00 a.m. There is some evidence that sleeping late increases the risk of depression.
11. Give yourself something to compete with negative cognitions. Count backward from one thousand by threes. Think of a positive event for each negative thought.
12. Sleep problems may co-occur with anxiety. Anxiety is a state of aroused apprehension. Isolate those negative thoughts. Question them. By asking and answering rational questions, you’ve asserted control over the course of those thoughts, and this control can help diminish them. If you have trouble sleeping because you anxiously reflect on the trials and tribulations of the preceding day, adopt a coping perspective. Whenever feasible and reasonable, resolve daily conflicts as they arise.
13. Sleep problems may co-occur with depression. Insomnia commonly precedes depression, serves as a symptom of depression, and may continue to occur after depression lifts. Cognitive behavioral methods that target insomnia can help improve sleep patterns and prevent depression or relapse.
14. If you know, or suspect, you have a medical condition affecting your sleep, and haven’t addressed the condition, you are health procrastinating: putting off actions to correct or prevent a real or potential health problem. Overcome this procrastination by making a medical appointment now.
15. If I have trouble sleeping, I'll sometimes take a small LED flashlight and quickly flash it into my eyes three times. I start yawning. I typically fall asleep shortly thereafter. (There is no science behind this idea, but it does illustrate how inventing personal solutions can prove useful.)
For some, less sleep is best. Albert Ellis got by on 3 hours of sleep a night. Ellis was a prolific writer and inventor of rational emotive behavior therapy. He lived until he was 93.Some people just require less sleep. This is not insomnia.
You are likely to sleep excessively if you have an atypical depression. As a bridge technique, set three alarms at 2-minute intervals so they go off in sequence. See if that helps.
If you have a calm mind and body and still have trouble sleeping, get a medical checkup.
See The Cognitive Behavioral Workbook for Anxiety for coping with anxiety and The Cognitive Behavioral Workbook for Depression (Second Edition) for corrective actions for dealing with depression and related sleep problems. To end procrastination thinking that interferes with taking constructive actions, click on Part 4: Procrastination Thinking from a free eight-part multimedia Combatting Procrastination series.
Thumbnail photo by Dale Jarvis AreaOne Art and design Fayetteville NC
© Dr. Bill Knaus
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Koffel E. A., Koffel J. B. and Gehrman . P. R. (2014) A meta-analysis of group cognitive behavioral therapy for insomnia. Sleep Medicine Reviews. Abstract: [Epub ahead of print].
Taylor D. J. and Pruiksma, K. E. (2014). Cognitive and behavioural therapy for insomnia (CBT-I) in psychiatric populations: A systematic review. International Review of Psychiatry 26(2):205-13.
Jacobs G. D., Pace-Schott E. F., Stickgold R. and Otto M. W. (2004). Cognitive behavior therapy and pharmacotherapy for insomnia: a randomized controlled trial and direct comparison. Achieves of Internal Medicine164(17):1888-96.