How to stop your worries keeping you awake at night

ONE-WEEK INSOMNIA CURE

ALL THIS week, in the Mail’s life-changing series, Professor Jason Ellis, Director of the Northumbria Sleep Research Laboratory, has drawn on his vast experience to help tackle your sleep problems — whether it’s a duvet-hogging partner or chronic insomnia. Today, he reveals the clever tricks you can use to banish late-night anxiety...

For many people — particularly women — endless nights are ruined by an infuriating inner alarm clock that sees them sitting bolt upright in bed, wide awake, mind buzzing with to- do lists and irrational or exaggerated worries.

For some of us it can be genuine stresses such as work deadlines, marital conflict, or family fall-outs, which keep us awake. But for others, the night-time brain just seems to take over, creating debilitating worries out of tiny things, which can swiftly spin out of control.

Even though your thoughts might start out with a quick review of the day’s events, they are all too likely to speed on to whatever might be lurking on your agenda for the following day. If you are the worrying type, this can swiftly escalate to the point where you are fretting completely unnecessarily about bigger, broader issues and sleep becomes an impossibility.

The irrefutable truth is no matter how small your problems are, they will seem worse in the middle of the night — and your ability to come up with effective solutions when you are sleep deprived and stressed is likely to be poor.

This is because different parts of the brain shut down during sleep. The parts of the brain that control rational thinking, reasoning and logic, for instance, will be typically given the night off. That’s why dreams can seem so irrational if we remember them in the morning.

Worrying keeps your brain active, and — worse — it can activate the stress response, waking the body up and making sleep more difficult. This is what keeps you awake no matter how tired you are.

Many women report that anxiety is an unwelcome symptom of menopause (see the back page of this pullout for more advice about dealing with menopausal insomnia), which is another reason women so often report difficulty sleeping at this time of their lives.

However, there are some very useful exercises you can try that are extremely effective at helping you manage your worries before you go to bed, which can have the knock-on benefit of calming your racing mind so anxious thoughts don’t keep you awake.

TRICKS TO CALM YOUR MIND

THERE’S a lot to be said for putting your day to bed before you go to sleep. For this exercise, I have created a special ‘tasks’ section in the evening part of your sleep diary.

It is something I’d really encourage you to take a little time to do each day.

First, it is a good idea to start by establishing a regular cut- off time from work or your daily activities and make a proper break between day and night to allow yourself plenty of time to wind down.

Try to make this exercise part of your new routine every evening and stick to it — however tempting it is to catch up on paperwork or clear your emails before bed. Here’s what you can do: 1 ABOUT two hours before bedtime, set aside 45 minutes to fill the box marked ‘ tomorrow’s important tasks’. Write a list of the most pressing (and potentially worrying) things you have to do tomorrow.

With your ‘to- do’ list written down, you don’t have to wake up in the night and worry about something you might have forgotten. If you do wake up with a new thought, add it to your list and then try to go straight back to sleep. 2 In THE box marked ‘what I have done to prepare for tomorrow’, list all the steps you have already taken to prepare for the next day’s tasks. For example: you might have written the report you need to present at work and proof-read it, or you might have selected a recipe for tomorrow night’s dinner and taken key ingredients out of the freezer.

Writing these things down should help reassure you that you are more prepared than you think. 3 on A separate piece of paper (or in the ‘ dreams’ box in your sleep diary if you are not a regular dreamer), jot down a list of all the things you have achieved today.

Be kind to yourself and generous with your praise. This will give you positive reinforcement and it sends a clear message to your conscious (and also your subconscious) brain about what you have managed to achieve despite your insomnia. 4 Add a few lines about how you feel your day went — this can help as part of the ‘downloading your day’ process and make it less likely that you will feel the need to run through your day in your head while you are lying in bed.

It gives your night-time brain a much harder time in its quest to find something to worry about.

MAKE WORRYING WORK FOR YOU

Another clever exercise if you find worries rushing through your head while you lie awake at night, is setting aside a little ‘constructive worry time’ in the evening to take the wind out of your worrying sails. Here’s what I suggest:

SET aside 20–30 minutes a few hours before bed.

TAKE out a note pad and create a table with three columns.

LABEL the first column ‘ My worries’ and jot down your biggest concerns. The only rule is that these worries should not be related to your sleep or insomnia.

LABEL the second column ‘What can I do about that situation right now?’ and put one of three options here: 1) nothing at all/nothing comes to mind (red); 2) nothing right now but later (yellow); 3) Something immediate (green). LABEL the third column

‘Actions’ and write down as many possible solutions or ways forward as you can think of alongside all of the yellow and green responses. If you have a red response, where there is no action that you can think of right now, leave it blank.

FInALLY, sit back and review your solutions, then transfer any that you feel you could implement tomorrow to the ‘tomorrow’s task’ section of your sleep diary.

DuRInG the night, if you find yourself starting to worry, remind yourself it’s all covered in your notebook. If, on the other hand, something that you had previously forgotten wakes you up, jot it down in your sleep diary — even if it is in the middle of the night. Then tell yourself it is done with for tonight.

AnY worries which continue from one day to the next can be transferred to your sleep diary the following day.

DON’T PANIC ABOUT NOT GETTING ENOUGH SLEEP

IROnICALLY, many people find that worrying about falling asleep, or about not getting enough rest, can interfere with their sleep — and they are right, this can happen. But it is exactly these sorts of thoughts that are the most likely to keep you awake, for instance: ‘If I don’t get enough sleep, I will be unable to function tomorrow.’

But research has demonstrated that people with insomnia don’t actually show a noticeable drop in reaction times, problem-solving ability or accuracy, although it does take more out of them than most to be able to maintain a high level of performance.

It is helpful to know that many of the people I see, who very often exist on pitifully poor amounts of sleep, are usually able to function surprisingly well during the day, nonetheless. Most of the time people only have difficulty performing the most boring or monotonous tasks.

Besides, if you’re reading this, you are already doing the best you possibly can to improve your sleep. Stick with the course, and very soon sleep will be the very last thing on your list of concerns.

THE SLEEP DISORDERS YOU MAY NOT KNOW YOU HAVE

SOMETIMES sleep problems might not be due to insomnia, but to other very common night-time conditions that you might not realise you’ve got. If you suspect any of these apply to you, see your GP.

SIGN ONE: An irresistible urge to move your legs, commonly accompanied by an uncomfortable, itchy, crawly sensation in the legs in the evenings or if you are sitting still.

COULD BE: Restless leg syndrome (RLS). In the evenings this can be alleviated by walking around, but if it strikes when you are in bed, it can make falling off to sleep difficult. RLS can crop up in pregnancy and it can be triggered in women with very heavy periods and/or a poor diet. Doctors now believe that it could be linked to low iron levels in some cases.

If you suspect you might have RLS, see your GP and ask for a ferritin blood test. If your RLS is due to low iron then, once it is managed, the problem should, in most cases, go away as should any difficulties getting off to sleep.

SIGN TWO: Cramping or an uncomfortable sensation in the legs or brief jerking movements which can occur when asleep.

COULD BE: Periodic limb movement disorder (PLMD). This condition is very similar to RLS (in fact, 80 per cent of people with restless leg syndrome have PLMD), but is more likely to occur when you are actually asleep. It may wake you up, or you may not notice it and be left wondering why you have such a restless sleep and wake unrefreshed in the morning. Again, it’s a good idea to talk to your GP.

SIGN THREE: Excessive daytime sleepiness.

COULD BE: Obstructive sleep apnoea (where slack muscles in the throat mean your airway becomes obstructed at night, disrupting sleep — loud snoring can be a sign), narcolepsy (unintentially falling asleep) or hypersomnia (where you actually do need more than ten hours sleep a night).

You shouldn’t try the techniques in my plan until you have your apnoea under control. The main symptoms of narcolepsy are excessive daytime sleepiness, temporary loss of voluntary muscle control (known as cataplexy), hallucinations and sleep paralysis (you might wake up in the night but be temporarily unable to move).

In these cases, see your GP, as my plan might not be suitable.