Dear Dr. Yael,
I struggle with sleep issues. Some nights I sleep very well. Other nights I keep waking up. It seems like I sleep every other night. I never nap and I do not drink any caffeine because I am caffeine-sensitive. I know if I nap, it disturbs my nighttime sleep. My biggest problem is that if anything more serious bothers me, I cannot fall asleep that night. For example, if someone whom I am close to is seriously ill or if someone close to me is struggling with a serious issue of any nature, it affects my sleep. I know this is ridiculous as my lack of sleep does not help these people, but I cannot seem to sleep anyway. Please advise me.
An Avid Reader
Dear Avid Reader,
Many people, unfortunately, struggle with sleep disorders. It is also very “normal” to worry if a close friend or family member is ill and most people cannot sleep well when in this situation; however, it seems from your letter tha your sleep issues are more chronic. Cognitive behavioral therapy, sometimes called CBT, can successfully treat long-term sleep problems. CBT can help you figure out which thoughts and behaviors cause sleep difficulties or exacerbate them. CBT can help you learn how to replace these thoughts and behaviors with habits that support better sleep. Unlike sleeping pills, CBT can focus on helping you deal with the causes of your sleep problems. The cognitive part of CBT teaches you to find and change beliefs that impact your ability to sleep. For example, you mentioned that your sleep is often impacted by worries. CBT can teach you how to control negative thoughts and worries that keep you awake by replacing them with positive and calming thoughts. The behavioral aspect of CBT assists you in developing good sleep habits and in avoiding behaviors that keep you from sound sleep. Some of the following ideas may be helpful:
Establish a consistent sleep routine. Set up a bed time and wake time that makes sense for your schedule and stick to that routine to help get your body used to it.
Only use your bed for sleep, so your body knows what to expect when you’re in bed. If you can’t fall asleep for about 20 minutes, get up and don’t go back to bed until you’re tired. Even if you go to bed later, keep the same wake-up time, so your body doesn’t get confused. You will be tired the next day, but you are training your body to learn to sleep when it is bedtime. Once your sleep gets better, you will feel less tired.
Change your lifestyle habits. Make sure you aren’t drinking caffeine, at least later in the day (though you said you’re not), and establish a daily routine for physical activity as physical activity also improves sleep. Winding down 1-2 hours before bedtime can also help you sleep better.
Create a cozy sleep area. Make sure your bedroom is quiet, cool, and dark. Do not watch TV in your bed and don’t have a clock that you can watch while trying to sleep as that increases sleep anxiety.
Use relaxation techniques. Relaxation techniques can help you calm your mind and body. Different people like some techniques better than others. Meditation, imagery, and muscle relaxation are usually the most helpful. The basic steps of meditation are to lie down, close your eyes and breathe slowly, inhale and exhale deeply, and focus on your breathing. If a thought pops into your head, let it go and refocus on your breathing. There are a lot of apps and videos online that can help you learn how to meditate. Imagery is when you visualize somewhere tranquil and calming that will help relax any tensions or stressors that are disturbing your sleep. The basic steps of imagery are to lie down, close your eyes and imagine a peaceful scene like a tropical beach or whatever you find calming, and think of the details in your scene (almost like making a movie in your head). Relax in your scene for as long as it takes to fall asleep. Anxious thoughts may pop into your mind, if this happens, rewind and start again. You can do this several times until you’re able to “watch” your movie without any interruptions. Sometimes it helps to imagine a calming scene you actually experienced, other times it’s helpful to imagine a scene you want to experience. Either way, it’s your experience and you should find what helps you feel the most relaxed and use it before bedtime to force all of the stressful thoughts from your mind. For muscle relaxation, you also lie down in bed. You then breath in and tense the first group of muscles for about 5-10 seconds, breath out and quickly relax the muscles in that group, and then stay relaxed for 10-20 seconds before moving to the next muscle group.
Do not worry about not being able to sleep. Once you are in bed, do not think about falling asleep. Some people worry about sleep and then this stops them from being able to fall asleep. Letting go of this worry can help you relax and make it easier to fall asleep.
I hope these ideas are helpful to you. If none of these work, please reach out to a professional to help you manage your worries and sleep better. Hatzlacha!