Treating Insomnia with Cognitive-Behavioral Therapy and Relaxation Techniques
Heather Stone, Ph.D.
Clinical Psychologist, PSY 21112
Insomnia and other chronic sleep disorders affect more than 40 million people in this country, and studies have shown that anxiety and stress play a significant part in this problematic condition. Quality of life, general health, and performance at work or other areas of life are frequently impacted, and the effects of chronic sleep deprivation can be debilitating. Newer research indicates that there is a vicious cycle between anxiety and insomnia – while anxiety can certainly interfere with sleep, sleep deprivation can also lead to an anxiety disorder.
Anxiety and stress are often the principal causes of insomnia, due to the secretion and elevated levels of stress hormones. Cortisol and its precursor, adrenocorticotropic hormone (ACTH), are the typical culprits involved in sleep disturbance. While increases in cortisol can be adaptive in helping the individual to deal with short-term stress, the oversecretion of cortisol that accompanies chronic stress will keep the individual from achieving a restful sleep. What does all of this mean? It means that managing your stress levels during the day will help you to sleep much better at night.
The Anxiety Disorders Association of America (ADAA) along with numerous reputable organizations list cognitive-behavioral therapy as a first line of treatment for people with insomnia. What’s more, this treatment is safe and effective. Unlike hypnotics, benzodiazepines, and other sleep medications, cognitive-behavioral therapy is completely natural and helps you overcome the underlying causes of insomnia. By addressing the thoughts and behaviors that can interfere with sleep and by helping you to develop better sleep habits, the benefits of CBT can be long lasting – and there are no side effects. To find a CBT therapist in your area, you can go to the Anxiety Disorders Association of America (ADAA) website, and use their provider locator feature. www.adaa.org
1) Get some cardio exercise daily, and really wear yourself out (in a good way). Refrain from exercising 2-3 hours before bed. Don't drink alcohol or eat sugar at night, because your blood sugar will spike and then drop during the night and wake you up. If you have to indulge, try to eat some protein at night to keep your blood sugar from dropping too much. Don't drink too much liquid in the evening to avoid using the bathroom. Turn everything off, especially electronic screens and LED lights – they can interfere with melatonin levels and circadian rhythms.
2) Practice "sleep hygiene." Only use your bed for sleeping, sex or relaxation so that your mind knows what your bed is for and doesn't make any negative associations with going to bed. If you are lying in bed unable to sleep, get out of bed and don't go back until you reclaim your bed for relaxation only. Don't study in bed. Keep waking hours the same even if you're tired, so that your sleep cycle doesn't get off-track.
3) Keep a pad of paper next to your bed. If you have a particular worry, or if something simply pops into your head that you don’t want to forget, write it down before you go tosleep. Include the time tomorrow that you intend to either succumb to the worry or takecare of something concrete. While suppressing a thought never works (trying to silence your thoughts can backfire and make them even stronger), delaying a thought until later actually does work. Worrying on purpose during the day for a discrete period of time can also be an effective strategy, sometimes creating the paradoxical effect of making it difficult to worry. To clarify, planning to worry at a brief, designated time is totally different than “worrying all the time,” or letting your worry sneak up on you! But, you must actually make good on your promise, and attend to the worry or the task the very next day at the time you “promised” to do it.
4) Get yourself medically checked out for sleep apnea or other breathing obstructions. You might be waking yourself up to breathe, so it's worth ruling this out, just to make sure. Don't sleep on your back in case your own snoring wakes you up. If your partner is the one who snores, elicit their help in treating their snoring issue or sleeping arrangements.
5) This one’s important: be willing to be awake or asleep. If you refuse to be awake, you will be! Never give yourself imperatives or ultimatums – we always lose those types of power struggles with ourselves. With that said, it is okay to self-soothe, practice healthy behaviors, learn some new tools, comfort yourself, and improve your parasympathetic nervous system – but try to approach these things in a gentle, more flexible way.
6) Relaxation techniques are especially important in lowering stress levels throughout the day and improving your sleep at night.
First, slow and deep, diaphragmatic breathing (breathing through your nose, making your stomach, versus your chest, rise and fall), will produce a state of physical well being that tells your mind it is ok to relax.
Second, mindfulness can be practiced at any time, and any place, by simply directing your non-judgmental awareness to whatever is happening in the present moment. Or, you can become intently absorbed in following (or counting) your breath. Mindfulness meditation practices improve the relaxation response (parasympathetic nervous system) that lowers stress hormones and results in less reactivity to stress and pain. The best part is that the benefits carry over to your waking life, allowing you to witness your mind from a distance rather than becoming tangled up in your own thoughts.
Because the ADAA specifically lists meditation and music as two important relaxation techniques for reducing anxiety and stress, I have created some beautiful, relaxation music especially for you! I have also provided a very restful and calming spoken word “relaxation recording” that you can listen to at any time for relaxation and/or sleep. These free gifts can be downloaded and played at your convenience from my website in the section entitled, Relaxation Room. I recommend listening to music at night with the proper headphones on, so purchase headphones such as these that will feel as comfortable and smooth as your own pillow: www.sleepphones.com
Heather Stone, Ph.D.
©2014 Heather Stone, Ph.D.