1 question + 2 experts = 360˚ solution
AT NIGHT, MY BRAIN WON’T SHUT OFF AND I’M UP FOR HOURS WORRYING. HOW CAN I FALL ASLEEP?
THE PSYCHOLOGIST SAYS…
A AS A FIRST STEP, I WOULD INTERVIEW YOU to get a sense of your sleep routines and anything else that might be going on with you. Then I’d ask you to log your sleep for about two weeks, so we can design a treatment plan together based on the objective information you provide. Insomnia isn’t defined by a certain number of hours of sleep; instead, it’s defined by dissatisfaction with sleep quantity or quality that is significantly distressing or impairing daytime function. For a diagnosis of insomnia, this has to happen over a minimum of three nights a week for three months, despite an adequate opportunity for sleep.
However, cognitive behavioural therapy (CBT) can help people who struggle with sleep difficulties that don’t reach the threshold for a diagnosis of insomnia. Sleep problems can become characterized by certain worries about sleep or strategies on how to manage sleep difficulty. CBT is based on the relationship between your thoughts, feelings and behaviours, and it’s what I use to help treat insomnia.
So, after looking at how much sleep you’re getting, we’d start to look at your routines. Certain behaviours, like waking up at the same time every day, not drinking alcohol before bedtime, reserving your bed for only sleep, and giving yourself a wind-down period at night can all help you get a better sleep. We’d also talk about things like only going to bed when you’re sleepy and getting out of bed when you can’t nod off in order to condition yourself to associate the bed with sleep, rather than a place to stay up and worry. And we’d look at behaviours you’ve adopted to cope with your sleep loss, like taking naps during the day or cutting back on daytime activities, which could be counterproductive to you sleeping well.
Finally, we’d talk about your thoughts around sleep. People tend to have anxiety about what will happen if they don’t get enough shut-eye, which can lead to hours of watching the clock or increased difficulty getting shut-eye. And, when we are anxious, we tend to focus on worst-case scenario outcomes that may or may not be likely. You can practice asking yourself, “Are there other ways of looking at that thought? What’s the evidence for that?”
It can take as little as four to six sessions to treat insomnia, and the goal is to help you learn the tools to challenge your thoughts and become your own therapist. Dr. Leorra Newman is a clinical psychologist at CBT Associates Toronto.
THE YOGA TEACHER SAYS…
A I WORK WITH SLEEP SCIENCE AND YOGA and relaxation techniques to help people get back to sleep. I typically begin by getting a history of when your sleep issues started and if any changes in your life or health precipitated the onset. I’d also ask you to track your sleep for about a week.
I would work with you on reprogramming your sleep response by doing everything from keeping the temperature in your room cool to reducing your sugar intake to keep your blood sugar stable. I’d encourage minimizing stressors, including addressing unhelpful thinking with CBT, and addressing stress as it arises with exercise, yoga and guided meditation..
At night, lighting is key, because blue light emitted by devices can interfere with your body’s ability to produce the sleep hormone melatonin. I usually recommend that, for half an hour before bed, you keep lighting low — think warm candlelight levels — turn off the TV, turn off social media and engage in relaxing activities for half an hour.
I teach relaxation techniques that help turn off your stress response (a.k.a. the sympathetic nervous system, which is triggered by worried thoughts and interferes with sleep), and turn on your parasympathetic system, which promotes relaxation and is essential for the body to feel safe enough to sleep. One particularly effective technique is belly breathing. I like to use modified box breathing, in which you inhale for a count of four, pause, then exhale for a count of six, pause, and take a regular breath. You repeat alternating those counted breaths with regular breaths when you’re in bed to cue your body to relax and to refocus your mind on completing the pattern rather than on your worries.
Another technique I teach is a simple pose that involves lying down and extending your legs up against your wall or headboard. It encourages relaxation. When you’re relaxed, there is less blood in your muscles and more blood in your core organs, while when you’re stressed, your body redirects blood to your muscles to prepare your body for fight or flight. Propping up your legs lets gravity pull the blood from your limbs to your core, signalling your body to adapt a more restful state. I also recommend doing deeply relaxing forward folds (like child’s pose or seated forward folds) before bed to encourage relaxation.
Some people will just come for a couple of sessions and find a few simple fixes were all they needed to help them sleep, but if you’ve had insomnia for a while, it may take longer and we would try more advanced mindfulness techniques. Sarah Domes is a sleep coach and yoga teacher.