There is no doubt that sleep is an essential component of our health and wellbeing routine. The evidence is very clear that getting good sleep contributes to better performance at work or when studying and better health overall. For this reason, when we’re not sleeping well, we can put a lot of pressure on ourselves to ‘fix’ the problem for fear of the ramifications. In our blog on sleep in July 2018 “How to Get a Good Night’s Sleep” Dr Jodie Thomas stepped us through several highly effective health behaviours to support good sleep and if you haven’t read it, it would be a great post to return to as it is rich in information. In this blog post we’re extending the conversation on sleep by exploring sleep and insomnia through the lens of Acceptance and Commitment Therapy and the work of Dr Guy Meadows, sleep physiologist, author of “The Sleep Book” and co-founder of “The Sleep School”.
Acceptance and Commitment Therapy (ACT) is a method of psychological therapy that helps people to live full and meaningful lives that are aligned with their personal values, and to learn ways of managing uncomfortable thoughts and feelings to support this process. In ACT, people are taught not to fight or attempt to control their discomfort and distress. Instead, ACT teaches people to accept the presence of discomfort and to attend to their thoughts and feelings with openness, curiosity and receptiveness. In this way, uncomfortable thoughts and feelings have less power and negative influence.
According to Dr Meadows, sleeplessness and insomnia can be worrying experiences because we become afraid of the consequences of being tired. This then fills us with dread, anxiety and fear which can potentially have a lot of power over us both in anticipation of sleep and during the night. Sleep is perceived as ‘dangerous’ which triggers a lot of stress and at worst, our fight or flight response. None of this of course is conducive to a restful night. Using an ACT approach to sleep, Dr Meadows instead encourages acceptance of being awake periods of less sleep and a non-judgemental attitude towards the uncomfortable thoughts and feelings that come when one is awake in the night. Rather than “I can’t sleep and tomorrow will be a disaster”, try “I’m having the thought that I won’t be able to sleep and tomorrow will be a disaster” and “I’m experiencing feelings of stress and worry”. When you struggle less, your arousal levels lower and paradoxically, you are more likely to sleep. This is not typically the way most of us instinctively approach our sleeplessness but given there is good empirical evidence supporting this method, it might be a new method to try.
In addition to this, Dr Meadows and the ACT approach to sleep say that it is not just your nightime behaviours that influence your sleep, but your daytime health behaviours too. People who are good sleepers seem to have a lot in common, and a lot of it reportedly has to do with how you take care of yourself during the day, all of which prepares you for your night of sleep. Below are some additional health behaviours that you might want to consider trying to support your sleep.
Sleep Timing
· Keep sleep regular – choose a time to go to bed that you can stick to, including on the weekends
· Keep your sleep timing flexible – allow some variation in the time you go to bed (e.g., plus or minus 30 minutes). Having a buffer zone is what normal sleepers do.
· Make your sleep timing workable – allow it to fit with your life demands.
· Get up on time – if you get up at the same time it can help prevent the body clock from getting confused. If mornings are difficult, have a plan – set alarms, get up from bed straight into a shower, have your work clothes and your breakfast already prepared.
Your Daily Actions
Wind-up
What you do after waking in the morning. What you do here can be just as helpful as what you do in the wind-down phase in the evening. When not sleeping well, it can be easy to fall out of routine, can lead to getting out of bed at the last minute and starting the day in a chaotic fashion.
· Try to get out of bed at roughly the same time every day
· Open your curtains, turn on your lights, have a shower, turn on the radio or TV
· Eat breakfast, have coffee or tea if you enjoy them or do some exercise
· Get your kids ready for school, go to work etc.
Daytime
Being awake during the day builds a natural drive to fall asleep. Daytime tiredness can be a challenge but can be managed without impacting on night-time sleep.
· Short naps (10 to 20 mins) can help to recharge you without disrupting your sleep-wake cycle.
· Exercise or activity during the day can help with tiredness. A 20-minute walk at lunch time can help to get through the day.
· Short mindfulness exercises can help with training attention, being aware of your thoughts and feelings and reducing the feeling of being in battle with them.
Evening - Roughly 5 pm to when you start to wind down.
· Start a gradual decline of stimulation and it can be helpful to use time as a guide for the things you’re doing and the way you’re winding down.
· An example might be: at 6 pm come home from work, or do some exercise; at 7 pm, you might eat dinner, then do some chores, put kids to bed or finish up work or personal commitments; at 9 pm, schedule in some recreation time such as time with partner, TV, cruising internet, read etc.
Wind-down - What you do 30 to 45 minutes before bed. The aim is to not promote sleep but to signal to the brain that sleep is on the way. By not taking a sleep-focused wind-down, you take the pressure off yourself to sleep and are more likely to increase the chances of sleeping
· Stop stimulating activities.
· Engage in gentle end of day activities e.g., warm drink, getting ready for the next day, locking doors, brushing teeth, changing into nightwear – this is not a strict schedule but a supportive and flexible routine; you can omit some or all the things if, for example, you’d like to watch a movie with the family on occasion.
Night-time
The time between turning out the light and getting up in the morning.
· Closing your eyes, get comfortable and lie quietly until falling asleep.
· Know that the pre-sleep phase involves waxing and waning of consciousness levels as the brain moves between wakefulness and light sleep.
· Know that your mind may reflect on the day’s events or memories may flash up and there may be no obvious agenda to where the mind goes during this time.
· Remember, falling asleep is a gradual process of disengagement over time, not a switch.
· Resist trying to force sleep, encourage yourself to be happy to ride along with the process, accept that even if you don’t fall asleep, you’re getting rest and rest if wonderful.
· Be willing to watch and welcome any thoughts or memories, both wanted and unwanted. Trying to stop the ‘struggle’ with sleep. If this is something that is challenging, you might benefit from integrating some mindfulness into your day or evening.
· Have a plan about how long you are willing to stay in bed before getting up for a break. You don’t have to be rigid about this. Welcome rest and time being awake in bed. Welcome and accept discomfort. Over time, you can try and reduce the amount of time spent out of bed and the frequency of trips per night.
Managing sleeplessness and insomnia isn’t easy and implementing new strategies can be hard on your own. At Melbourne Group we have several practitioners who utilise Acceptance and Commitment Therapy and can support you with your sleep and other health and wellbeing concerns. For more information or to link in with one of our practitioners contact our administration team (03) 9882 8874 or explore our website at melbournewellbeinggroup.com.au.
This blog was written and prepared by Dr Victoria Miller - Principal Psychologist and Associate Director at Melbourne Wellbeing Group.
Reference:
Meadows, G (2014) The Sleep Book: How to Sleep Well Every Night. Orion Publishing Co. London, UK.