Insomnia
Occasionally having a poor night sleep is normal, especially during times of stress but it becomes a sleep problem once it is frequent, long lasting and causes problems functioning during the day. Poor sleep is associated with attention, concentration and memory deficits, as well as health problems. Psychological implications could be anxiety, depression, stress, frustration and irritability. Feeling tired and sleepy during the day reduces functioning levels thus chronic lack of sleep could lead to poor job performance, increase the risk of accidents, relationships problems and reduced quality of life.
Insomnia is defined as having trouble falling asleep (requiring more than thirty minutes) or staying asleep (waking up many times each night or waking up too early and not falling back a sleep). Insomnia is a common problem that can be brief (less than three nights per week for less than a month) or long/chronic insomnia (more than three nights per week for more than a month). Insomnia can appear in times of great stress and disappear on its own when life becomes less stressful. But, for some people it becomes a chronic problem regardless of stress levels in their lives.
Having a hard time falling asleep can be due to discomfort caused by medical conditions such as chronic pain or due to stress, being “on-edge”, anxiety, depression, high physical arousal, nightmares, alcohol/drugs abuse, having poor sleep habits etc. The focus of this post, however, will only be on the contribution of negative thoughts to insomnia. Worrying about things, reminiscing, reviewing bad things that happed through the day or even thinking about what you still have to do, can cause problem sleeping. Negative thoughts about sleep also make it very hard to fall asleep ( i.e if I will not sleep again tonight, I definitely will not be able to work tomorrow). The fear of not falling asleep causes anxiety, which increases bodily arousal, the heart starts racing and muscles become tense. The physical discomfort creates worrying, restlessness and even more negative thoughts. As a result it becomes very hard to relax and fall asleep. The quality of sleep becomes poor, which causes us to worry about sleeping and be frustrated. The increased anxiety results in even less sleep. Negative automatic thoughts create a vicious cycle of insomnia and maintain it. It becomes a sort of self-fulfilling prophesy. The negative thoughts focus on the fear of not falling asleep and its implications and as a result you indeed have a hard time sleeping.
Negative thoughts are often unrealistic, rarely helpful and often distort reality. Common themes of the negative thoughts are as following; some thoughts focus on assuming the worst i.e. I did not sleep well for months now, I will probably never sleep well ever again. Some people blame everything that goes wrong in their lives (ie. work problems) on their poor sleep, thereby putting overemphasis and importance on sleep, which increases the level of anxiety felt and reduces the sleep. People with insomnia also tend to underestimate the amount and quality of their sleep. There is also a tendency to think in extremes, such as a really good sleep and really bad sleep but forgetting degrees of sleep in between such as the ok/ good enough sleep that they had. This leads to the underestimation of actual hours of sleep. Selective attention tendency and dichotomous thinking style contributes to poorer sleep. Some people also tend to have strict rules for themselves i.e If it is not 8 hours of sleep a night then I did not sleep well and I will not be able function well tomorrow. Setting hash criterion can lead to more anxiety, apprehension, muscle tension and it also functions as setting yourself up to fail.
It is possible to improve sleep by challenging and changing the way we think into a more accurate, balanced, positive and healthier thoughts about sleep. By reformulating your thoughts, you will reduces stress and anxiety that disturb your sleep and as a result your will sleep better. In order to be able to change your thoughts you first must identify and acknowledge them. Use a sleep diary to write down the negative thoughts about sleep that come to your head when you are lying in bed, during the night if awakened and after getting out of bed in the morning. Additionally write the emotions that you are experiencing and their impact on you. You also need to learn about sleep, so read scientific articles and research findings so you will more have accurate knowledge and facts about insomnia and sleep. Accurate information will help you reformulate your thoughts, give you a sense of control and might even reassure you and reduce your anxiety. Write down next to each negative thought a more accurate thought to replace it. Use your newly acquired knowledge as well as ask yourself why do I believe this? What in reality supports my thought? A better formulated thought could be i.e. people vary in the amount of sleep hours they need. Sleep or no sleep, I will get through the day OR I have functioned well in the past on less hours of sleep, then if I will not sleep a lot tonight, it will not be such a big deal. The more often you practice replaying negative thoughts into more accurate ones, the easier it will become. Challenging negative thoughts in combination with other CBT techniques such as sleep hygiene, psycho-education, relaxation training, stimulus control and etc could improve and solve your insomnia.
Unhealthy sleep habits that you need to watch out for…
When our sleep seems to be unsatisfactory, our natural tendency is to want to get some rest as soon as possible. This tendency may lead us to do things that help make up for the lost sleep in the immediate, short term but they are not helpful in the long-term. Here is a list of common ways people try to cope with their sleeping problems, but the consequences on the sleep is anything but helpful. It also includes other harmful habits that can disurb your sleep. Think about whether you have done any of these things too:
1.Staying in bed when you’re not tired and/ or being active in bed (incl. working, eating, watching television, talking on the phone etc) – our bodies learn cues or triggers that signal that it’s time to wake up or to go to sleep. Staying in bed for long periods while awake gets the body used to associate the bed as another place to stay awake in rather than a place to sleep in. When there is no strong association of the bed with sleep, the body does not get into a sleep induced relaxation mode. The likelihood of falling asleep easily is thus reduced.
2.Going to bed early the next night or Sleeping late in the morning – When you are getting sleep at times that do not fit your natural sleep cycle, it can confuse the body about the correct times to wake up and to be asleep. Sleeping in to make up for the lost sleep will mean being less tired on the next night so the sleep troubles will continue. Sleeping in late or getting to bed earlier than usual thus teaches the body a new sleep pattern, which messes up the natural sleep cycle even more.
3.Sometimes when we stay at home (e.g. in the weekend or a day off) we choose to nap during the day- Making up for the missed sleep during the day will mean that you will be less likely to fall asleep on schedule and/or less likely to stay asleep throughout the whole night. In any case, if you really must, know that naps longer than thirty minutes are discouraged by doctors and are also self- sabotaging to your sleep.
4.Doing emotional and/or cognitive demanding activities right before bedtime(e.g. discussing emotional issues, paying bills, working, studying, emailing etc). Your mind needs a wind-down period in order to be able fall asleep. Doing these activities keeps it alert and stimulated which is incongruous to the state it should be in.
5.Spending time thinking or worrying about not getting enough sleep and the possible catastrophic consequences thereof.
6.Focusing on things that are upsetting to you while lying in bed. If your thoughts are running uncontrollably and you find yourself awake for longer than 30 minutes then you might as well get out of bed and do something to calm down and relax, which will improve chances of falling asleep.
7.Using iphone iPads, tablets etc before bed time – These gadgets give off a bright blue light that suppresses melatonin production and messes up the circadian rhythms. As a result, you stay longer awake and alert, thus it is keeping you up later than you want to be and the sleep is more disturbed and restless. Additionally, studies show that respondents, who use iPad and even after they have slept 8 hours, were still sleepier and less alert the morning after.
8.Exercising right before bedtime (especially if it happens every night) goes against the natural sleep rhythm of the body and will make it more difficult to get back on a normal sleep cycle. Your body needs a wind-down and cool down period too.
9.Consuming caffeine beverages late in the evening– Caffeine is a stimulant that elevates heart rate and blood pressure and can make you feel more alert, which can interfere with your sleep. Don’t consume it before bed or after waking up in the middle of the night. Research actually encourages people, who have insomnia not drink caffeinated beverages after lunchtime.
10.Drinking alcohol before bedtime- While alcohol can help people fall asleep, this effect wears off after a few hours. Once the alcohol starts to wear off, it causes sleep disturbances and awakenings, leading to poor sleep quality. If you have insomnia and you like to drink with dinner, is it suggested not to have more than one serving of alcohol with the meal and certainly not afterwards.
11. Watching the clock– just like watching a pot does not make it boil faster, if you keep focusing on the clock and calculating how long it takes you to fall asleep every few minutes or how long sleep time you still have, it does not promote sleep but promotes anxiety, frustrations,muscle tension and restlessness. That disrupts your ability to fall asleep even more.
