By Marty Seitz
Good sleep is one of the fundamental things that matter for overall wellness. Just as we cannot exist long without air, water and food, we cannot exist long without sleep.
Sleep is a basic physiological need, and inadequate and/or poor-quality sleep is a causal factor in many mental, physical, behavioral and interpersonal problems. In my experience, most people suffering from anxiety and/or depression, as well as from stress in general, usually have some significant sleep disturbance and improving sleep often decreases the anxiety, depression and/or stress.
In my previous column (We’re a sleep-deprived nation because we don’t make sleep a priority), I offered a few cognitive methods for overcoming insomnia and for obtaining better sleep. This time, I suggest a few behavioral interventions to aid sleep.
Keep a sleep diary
Keeping a record/diary of sleep-related information is extremely useful because it allows you and/or a sleep specialist to spot problems or progress more easily. The following kinds of things should be recorded daily:
• Time, duration, and type of exercise
• Time of last meal or snack
• Type and time of last drink
• Temperature of bedroom
• Pre-sleep preparation activities in order
• Time into bed
• Time (approximate) to get to sleep;
• Number of times consciously awakened at night
• Time awakened
• Time and frequency getting out of bed
• Subjective feeling
Several of the books I mentioned in my previous article have sleep diary charts, and you can also find examples online. WebMD has a good general format called “Sleep Disorders Health Center: Keeping a Sleep Diary”.
At some point, at least two hours before bedtime, exercise is very helpful. Exercise has all kinds of benefits, but one of the most beneficial for overall health is that it helps people get to sleep more easily and stay asleep more restfully. Exercise could be problematic for sleep, however, if it’s too close to bedtime for the body to cool down adequately or if it causes aches and pains that interfere with sleep.
Develop good sleep habits/routines
We need regular times for going to bed and getting up in the morning. Biochemical processes regulate our sleep. We are made sleepy or awakened by chemicals released in our bodies at specific times. We function best when the releases happen routinely, at the same time each day/night, biorhythmically.
When we vary our sleep/awake times from day to day, we confuse our bodies. The body doesn’t know when to start releasing the going to sleep chemicals and when to release the waking up chemicals, so it may release them at inopportune times or not release them when they need to be released.
Consequently, the best way to have good sleep is to go to bed at the same time each night and set your alarm to wake up the same time each morning — seven days a week. Listen, some people can eat and drink whatever they want and never gain weight, but most of us have to watch what we eat and drink to stay healthy. Similarly, some people can vary their sleep schedules dramatically day to day with seeming impunity, but most people need a regular sleep schedule to stay healthy.
We need to maintain a bedtime preparation ritual. In addition to maintaining a regular time to go to sleep and to awaken, we should institute and keep a ritual when preparing for bed. Do the same things in the same order when getting ready for bed. Why? Our bodies learn by associating behaviors that usually follow other behaviors.
When we follow a regular pre-bedtime set of behaviors, our bodies get the message to begin releasing the sleep-promoting chemicals. If we don’t follow a set sleep-time pattern, our bodies won’t know to start preparing us for sleep until the last minute. We’ll get to sleep faster if our bodies have lead time. Starting into a sleep preparation routine forewarns our bodies that we want them to get us ready for sleep.
Sleep stimulus control therapy helps us learn what stimuli are associated with good sleep versus poor sleep and encourages us to increase the stimuli associated with good sleep and decrease the stimuli associated with poor sleep. In general, we want to decrease our exposure to stimuli associated with wakefulness, mental/physical engagement, or interests when we’re in bed because we don’t want our minds and bodies to associate waking activities with bed.
Beds are ideally to be associated only with sex and/or sleep. Sleep specialists encourage people not to read, watch TV, work/play on computers or other electronic devices while in bed. Instead, do such things outside the bedroom, if possible, or at least not in/on the bed itself. Furthermore, people are encouraged not be awake in bed awake for more than 20 minutes so as NOT to develop an association between being in bed and being awake and frustrated by not being asleep.
If you are not asleep after 20 minutes, the usual recommendation is to get up and do nonstimulating, uninteresting, nonrewarding, and unnecessary chores (such as polishing shoes that don’t need to be polished or cleaning the grout between the tiles in the shower) until getting drowsy. When drowsy, return to bed but with the understanding that you’ll get back up if you’re not asleep within 20 minutes. Amazingly, some people magically fall asleep to avoid doing such chores. Repeat these steps until you’re asleep.
Sleep restriction therapy
The goal of sleep restriction therapy is to limit the time spent in bed only to the amount of actual sleeping time plus 20 to 30 minutes to get to sleep. After determining how many hours of sleep averaged per night (using a sleep diary for two weeks), we can set our standard bedtime and waking time to accommodate sleep plus 20 to 30 minutes.
We can then get up the same time every morning and go to bed the same time every evening. If, after two weeks on this schedule, we find ourselves sleeping well the majority of nights and aren’t sleepy the next day, then we can keep that schedule. If, on the other hand, we sleep through the night for the allotted time but are sleepy the next day, we need to increase our sleep period by moving bedtime 15 minutes earlier for a week. We keep adding an additional 15 minutes per night per week until we find we aren’t sleepy the next day.
Learning to use relaxation techniques to get to sleep and to have more restful sleep is the last behavioral sleep aide I’ll mention. Relaxation exercises fall into four common categories:
• Progressive muscle relaxation
• Breathing-relaxation exercises
• Visualization/imagery-based relaxation
• Autogenic training
These exercises can be learned by most people and can be effective for promoting sleep if practiced. The Relaxation and Stress Reduction Workbook details instructions for each of these types of relaxation techniques. The instructions are also online here.
My next article in this series will talk about physical and physiologically based interventions for aiding sleep. Until then, sleep right!
Marty Seitz is an associate professor of psychology in the Department of Behavioral Sciences at Asbury University, where he has taught since 1989. He got his bachelor’s in psychology from Asbury University, studied at Asbury Theological Seminary, got a master’s degree in community counseling and a doctoral degree in counseling psychology from Georgia State University. In addition to his teaching, he has practiced as a licensed psychologist in Lexington since 1989, doing individual and couples’ counseling and has been working with the Access Wellness Group since its inception.
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