Tuesday, March 21, 2017

Sleep Basics

         

Sleep problems are very common among those who experience anxiety and/or depression. Problems with sleep serve to exacerbate negative psychological symptoms. While some sleep problems require a significant amount of intervention, others can be improved by practicing simple sleep hygiene. 

As a clinician, I assess a client's sleep during the initial assessment phase of therapy to determine if sleep is impacting on mental health. Sleep issues can be caused by difficulty switching off which is common in those who suffer anxiety. Other times, sleep specific fears cause anxiety about sleep. Regardless, poor sleep hygiene can be a factor that maintains the sleep problem. Below are a few simple things you can try at home to ensure you are doing everything possible to get the best night's sleep possible.

The first thing to keep in mind is that sleep is an automatic process and you can't just switch yourself off to sleep. In fact the harder one tries to strive for sleep, the more anxious one becomes and the more elusive sleep becomes. This is because striving for sleep increases anxiety and wakefulness which can overtake the drive for sleep. However, there are things you can do both during the day and at night to help make it more likely that you will get off to sleep.

Wake up and go
Anchor your wake time by getting up out of bed at the same times everyday including weekends. This will help to regulate your body clock and sleep/wake cycles.  Once you wake increase your noctornal 'sleep drive' by being active. If you are tired, napping during the day may feel like it helps but it actually burns off sleep drive decreasing the drive to sleep at night. 

As soon as you wake, get up and avoid catnapping in bed. Going out for a walk or exercising in the morning is a great way of waking yourself up. It is also important to expose yourself to as much light as possible for the first 90 minutes when you wake up to help regulate your body clock (i.e. alert earlier in the day and drowsy at night).

During the day

Ensure you have enough activity during the day so that you feel tired and are ready for rest at night. Exercising is an excellent intervention that improves your mood and also increases the quality of your sleep. Even if you can't exercise daily, going for a walk (like walking to work) or getting out in the sunshine (even if it's overcast) will keep you alert during the day and hopefully drowsy at night.

Evening

While many people exercise after work for convenience be sure to finish exercising at least 3 hours before bed as exercise can increase alertness. Limit alcohol as this reduces sleep quality increasing the chance of waking overnight. Avoid caffeine as it is a stimulant and may increase your level of altertness. Also ensure your bed is only used for sleep and sex (provided you do not feel too alert afterwards). 

Night time
Nocturnal technology use has become a mainstay of the average Australian home. However, research indicates that using technology devices at night can negatively impact how you sleep because it both increases alertness and the bright light from screens  suppresses melatonin secretion, a hormone that helps regulate sleep. 

So does that mean no Netflix after dinner? If screens are part of your wind down routine use light reducing technology such as: twilight (android), nightshift (iPhone), F.lux (for laptops and android phones) and turn the device's brightness down as low as possible. In addition to these you can also wear orange glasses which reduces the concentrated blue light emitted by devices from televisions, phones, iPads/tablets and computers. I buy the cheapest ones (about $23) I can find online because as far as I am aware there are no studies between brands, which vary greatly in price. 

Despite these strategies, interacting with a phone or playing online games can be stimulating and inhibit a person's ability to switch off. At minimum have a no technology in the bedroom at night rule.

Your sleep environment is also important. Ensure your sleep space is comfortable, quiet and dark. 

Managing daytime tiredness 
Feeling tired during the day is something that many people who suffer compromised sleep report as problematic. To try to cope many will nap during the day. However, this perpetuates the nighttime wakefulness because it lowers sleep drive (the physical pressure to sleep). Instead, wake yourself up by increasing your activity and access to natural light. If you feel you need to nap for your safety and increasing light and activity hasn't helped you wake up, then keep the nap to a maximum of 30 minutes and nap 7-9 hours after rising to reduce the possibility of it interfering with your sleep cycle. 

Stimulants and alcohol
While it can be tempting to have alcohol at night as it may make you sleepy doing so can disrupt your sleep later in the night. Also avoid smoking and caffeine late in the evening as they are stimulants.  

When to go to bed

It's a common practice among insomnia suffers to go to bed early in the hopes of falling asleep earlier. However, this is a practice that can aggravate insomnia because more time is spent in bed alert  worrying about sleep than sleeping. This turns the bed into a symbol of frustrated sleep and then the bed triggers the anxiety about sleep. Instead of this approach, go to bed when sleepy, not just tired

When sleep won't come
It may be useful to have a few relaxing activities up your sleeve for when you feel tired but not sleepy. These could include reading (from a book not a bright screen), mindful colouring, mindfulness meditation (try the headspace app), knitting, drawing etc. or any other activity that you find relaxing.

Avoid watching the clock or waiting for sleep to come because it will likely increase your alertness leading to feeling 'tired but wired.' If you find yourself becoming increasingly more agitated consider distraction like watch tv (while wearing your orange glasses).

When to seek additional intervention
If your sleep problem has persisted for more than 3-6 months and the usual strategies have not worked it may be time for a more targeted sleep intervention. As a Psychologist I conduct assessments to determine if a person would be a good candidate for behavioural sleep therapies or if referral to a sleep doctor is more appropriate. Where appropriate, I offer behavioural sleep therapy. 

Article written by Tena Davies, Psychologist. The aim of this article is to give you ideas on well being. Please note this article is not intended to replace therapy.

In addition to the links listed the information for this article has been obtained by the client manual CBT-i created by Professor S. Drummond, Dr C. Nappi and Dr M Jenkins developed for Project Rest. Additional information has been obtained from Dr Allie Peters, a sleep specialist and Psychologist.





Tena Davies is Psychologist based in inner city Melbourne. Tena has expertise in psychological counselling with adolescents and adults. She also works as a cyber expert providing cyber safety education to schools and professionals. As a Psychologist, Tena believes in helping clients to gain insight into their difficulties and teaching them new skills to grow and thrive. Please see www.tenadavies.com for more information.