1 ques­tion + 2 ex­perts = 360˚ solution

Best Health - - CONTENTS - by JILL BUCHNER



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.


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.

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