Understanding Sleep Difficulties

Sleep is such an important part of our lives, yet many of us don’t pay much attention to it until we start to have problems. Disturbed sleep is extremely common after any kind of stressor, and it is especially common after a bereavement.

Many of us will have patterns of sleep habits that we have formed over our lifetime.  They may have worked for us in the past, but sleep may never have been a problem before.

Losing sleep can make everything in life seem more effortful. If you are having difficulty falling asleep and/or experiencing problems staying asleep throughout the night this will have a profound effect upon your ability to function during the day. You may be experiencing nightmares or disturbing dreams.

Traumatic experiences like bereavement can cause our body and our brain to get out of sync, meaning that a deliberate effort to sleep better may be necessary.  It may involve changing your entire routine, a routine that previously worked for you.

It is not easy to change the habit of a lifetime and to come to terms with having to make significant changes in the first place.

If you have had problems sleeping for a long time you may have developed habits or strategies to help you sleep but they may actually be making things worse. This is very common.


The Basics

We are all organisms that learn by association.

If you have your lunch at the same time every day your body learns to associate that time with food, it will prepare itself, releasing digestive enzymes and sending signals to the nerve cells of the saliva glands.

Sleep works in a very similar way.  If the only thing we do in our bed is sleep then our brain will associate our bed with rest and release the necessary chemicals to induce restful relaxation.

We need to re-train your brain to associate your bed with only sleep.  This will mean working hard to eliminate any associations with being awake in bed.


Sleep Hygiene

There a few things that you should try eliminating until you have established a more stable routine.

mug
Bad sleep habits –
Caffeine

  • Caffeine is a drug that can interfere with our ability to get a good night’s sleep because it is a stimulant. Stimulants elevate our heart rate and blood pressure and can make us feel more alert. So if you are getting up in the night to make a tea or coffee, you might want to reconsider.
  • Caffeine is not only in coffee, it can be found in tea, soft drinks, chocolate, and even headache medication.
  • The most common withdrawal symptom from caffeine is a headache, which usually lasts 24-hours.
  • We recommend that you limit your intake of caffeine to 1-2 caffeinated drinks a day, and none after 5pm.

smoking
Bad sleep habits –
Nicotine

  • Nicotine increases heart rate, blood pressure, breathing rate, and makes you feel more alert.
  • Smokers sleep more poorly than non-smokers due to stimulant effects of nicotine, nicotine withdrawal during sleep, and irritated respiratory systems.
  • Many people think that smoking cigarettes is relaxing, but the nicotine in cigarettes is actually very stimulating and will work against you in your efforts to sleep. The relaxing part of smoking is the habit that is involved, and the key to quitting is to develop new habits.
  • Nicotine withdrawal symptoms include restlessness, irritability, anxiety, and headaches and usually lasts 10-days.
  • Quitting smoking will be helpful to your sleep and your health in the long run. However, in the short run there may be some impact on sleep from nicotine withdrawal.
  • If you are not ready to quit smoking completely, cut down on nicotine at night.
  • Avoid nicotine within 2-hours of bedtime.
  • Do not use nicotine if you get up during the night. It will stop you from being able to fall back to sleep easily.

drink
Bad sleep habits –
Alcohol

It is not uncommon for people with sleep problems to turn to alcohol to calm down, often in an attempt to relax or go to sleep.

  • While you may feel more relaxed initially and fall asleep, alcohol increases the number of times you wake up throughout the night. Part of why people with a hangover feel so bad is due to sleep disruption.
  • Alcohol increases dreaming and nightmares.
  • Even a small amount of alcohol as much as 6-hours before bedtime can increase wakefulness during the night. Limit alcohol use by not drinking after dinner until your sleep pattern improves.
  • Never use alcohol as a sleep aid. It only makes the problem worse.
  • Never mix alcohol with other medications, especially sleeping pills.

exercise
Bad sleep habits –
Lack of Exercise

  • Exercise is good for sleep because it increases your metabolism, making your body perform more efficiently and increasing the need to sleep.
  • Sufficient exercise during the day is essential for getting to sleep more quickly and staying asleep.
  • Engage in thirty minutes of a moderate exercise every day, early in the day. Doing so can help you sleep at night.
  • Exercise also helps reduce symptoms of depression and anxiety by giving you a sense of achievement.

tv
Bad sleep habits –

Noise

  • Lack of noise in the bedroom is important for getting a restful sleep. You may have previously fallen asleep with the TV on or other noises, but these things may trouble you more so when you are struggling to sleep.
  • Try to minimise noise in the bedroom as much as possible. You may find that earplugs are a helpful aid.
  • If you like background noise, try using the radio low and tuned in between stations, or try a fan or a “noise” machine. Don’t use the TV for this purpose.
  • Watching TV is a wakeful activity and should not be done in the bedroom. Your brain must associate your bed with sleep, not activities like watching tv or playing computer games. The same can be said for tablets and phones – until your sleep is better, they have no place in the bedroom!

alarm
Bad sleep habits –

General

  • Do NOT watch the clock. Cover any visible clocks you have in the room.
  • Avoid sleeping in any other room (i.e. Sofa)
  • Avoid daytime napping. Even a brief nap during the day can take away from your ability to sleep at night and weaken the connection between sleep and bed.
  • Lie down in bed only when sleepy: remain awake and out of bed until you feel drowsy. This will strengthen the connections between bed and sleep.

A better sleep routine.

This starts with a regular bed time.

Much like we mentioned before, when we eat at the same time each day our body associates that time with food. The same goes for sleep.

However, this will take time to develop. If you are used to sleeping at 1am but are now trying to adjust to 11pm then your body is unlikely to feel drowsy at 11pm.

It will take some work and some planning.

First, start by doing a relaxation technique about half an hour before bed, this can be a simple breathing exercise or a guided imagery exercise about 30-mins before your bed time.

Then try going to bed.

If you are not asleep within 15-minutes of lying down, get out of bed and go into another room.

Do something relaxing until you feel sleepy.

Repeat this cycle as often as is necessary:

Still awake after 15mins? Get up, leave the room. Do something relaxing until you feel sleepy.

Practice this 7 nights per week, no exceptions.

The 15-minute rule can be frustrating but ultimately you have to work to re-train your body.

How do I know when I am getting the sleep I need?

  • As long as you are not falling asleep at the wheel or during other important daytime activities, you are getting enough sleep.
  • Feeling bad during the day because of insomnia is usually caused by worry about sleep, feeling frustrated, anticipating another bad night, and feeling drained from all of the worry.
  • Your body will let you know when it is time to sleep.

The “the” technique.

This is very simple but can be very effective for the nights when your mind just won’t settle even after practicing all of the above.

It involves saying and mouthing the word “THE” over and over. You don’t have to say it aloud – you can just think it and mimic the movement with your mouth or tongue. The verbal chain uses up your working memory so that you are less likely to be taken off into thoughts of the future or the past that may keep you awake. And the actual act of mouthing the word slows your heart rate and breathing rate making it more likely that you will drift off. If you notice that your mind has drifted into thinking other things, don’t worry it will probably do this many times, just gently bring it back to the technique and continue.