Counting sheep and still can’t sleep? Practical tips for getting a good night's rest.
By Dr. Lauren Vanhusen
Photo by Fergus So on Unsplash
It is no mystery that Covid-19 has greatly affected many facets of our lives and for many of us, sleep is one of them. Researchers have begun to examine the impact of Covid-19 restrictions on sleep patterns as many of our routines have been disrupted. As compared to pre-pandemic sleep patterns, individuals have reported significant changes to sleep including later bedtime and wake time, reduced overall night-time sleep, increased napping, and overall poorer sleep quality (1, footnote). Other symptoms of poor sleep include difficulty falling asleep and/or staying asleep, waking up earlier than expected, and experiencing anxiety or worry about not sleeping. If any of these symptoms sound familiar to you, know that you are not alone and there is hope!
Additionally, we know that sleep concerns can be both a consequence of and exacerbate other mental health concerns such as anxiety and depression (2, footnote). For some, a consequence of increased anxiety and/or depression is poor sleep, and poor sleep can further exacerbate feelings associated with stress. This cyclical pattern between mental health and sleep can feel never ending and torturous! Thankfully, if we address disruptive sleep patterns and behaviors, we can have a positive impact on our overall well-being.
There are many options for treating disrupted sleep, including medication as well as cognitive and behavioral interventions. As always, it’s a good idea to discuss any recent changes to your sleep with your medical doctor to determine the best course of treatment. In the following post, I will be discussing many of the cognitive and behavioral tips and strategies I use with individuals in therapy who are experiencing sleep challenges.
Improve the sleep drive
There are two processes that help our bodies regulate sleep. One process is called the sleep drive, which is akin to our hunger or need for sleep. You can think of this like a gas tank: you start the day off with a full tank and it empties as the day goes on based on your activity level and energy expenditure. In other words, the more you do and the more energy you spend throughout your day, the more you will drain the tank. Furthermore, the longer it’s been since you last slept, the more gas you will use throughout your day. This makes it more likely that by the time you are ready for bed your tank is empty, thus increasing your likelihood to fall asleep.
Thankfully, there are several actions you can take to make sure you start off with a full tank at the beginning of the day and end the day with as close to empty as possible.
Eliminate napping if possible. If you must nap, limit daytime sleeping to short (less than 1 hour) naps earlier in the day and not too close to bedtime.
Limit daytime dozing. If you find yourself sleepy and it isn't bed time, consider doing something physically or mentally activating.
Engage in moderate physical activity each day as able. Movement helps “drain the tank” and also contributes to improved overall energy levels during the day.
Regulate your circadian rhythm
The second process that regulates sleep is called the circadian rhythm. Simply put, this biological process is known as our “alerting system” and serves to keep us awake during the day and prepare us for sleep at night. The stronger our circadian rhythm, the better quality sleep we will get.
This process is very sensitive to our routines and habits, including when we go to bed and wake up each day and even our mealtimes. A great example of a disrupted circadian rhythm is jet lag. If you have ever traveled to a different time zone, your body may take time to adjust to new sleep and wake times and you might notice difficulty getting to sleep and waking up when you need to.
If your current sleep schedule is inconsistent, this is like being on perpetual jetlag and may weaken your circadian rhythm. This biological system is also sensitive to signals from the environment including light (e.g., sun) and darkness. Below are several behavioral changes you might consider in order to strengthen your circadian rhythm and possibly improve your sleep.
Maintain a consistent sleep schedule. It may be difficult to get to sleep exactly when you want to so aim for a consistent wake time each day. Consider when your daytime activities start and set a realistic time to wake up each day - even on the weekend and even if you don't get to sleep until late the night before.
Do not try to “make up” sleep if you get to bed late. This often backfires leading to decreased sleep drive aka “hunger for sleep” the following night, thus perpetuating the sleep problem.
Decrease exposure to light sources close to bedtime. Your brain does not know the difference between a TV screen and the sun. If it senses light, it will think, “Oh, it is time for me to be alert and awake!” Consider limiting screen time 30-45 minutes before bedtime and dim the lights in your living space.
Manage anxiety
Many who come to me struggling with sleep concerns report that the number one contributor to their sleep problems is anxiety (e.g., racing thoughts, muscle tension, persistent worry about various life stressors, including body image). Sleep science shows that our bodies and minds need to be in a relaxed state in order to be ready for sleep and anxiety is the opposite of relaxation. Anxiety can override even the strongest circadian rhythms and sleep drives.
In other words, your body can be ready for sleep, but your mind can keep you awake. Oftentimes, when we notice we haven't fallen asleep and are tossing and turning with our anxiety, we may have thoughts such as, “Oh no! It’s been an hour and I’m still awake. Tomorrow is going to be terrible!” As you can imagine, these types of thoughts can lead to even MORE anxiety thus making sleep even MORE elusive. We may then check the clock several times throughout the night cueing even more anxious thoughts, “Oh my gosh, it’s 3am, I only have 4 more hours to sleep”, and the cycle of anxiety and sleeplessness continues. Believe me, I’ve been there - it's a special kind of torture!
Below are a few tips for optimizing relaxation and managing anxiety so that your body will be in an optimal state for sleep.
Consider setting up a relaxing bedtime routine. For example, find a comfortable space in your living area and curl up with a good book, plan your outfit for the next day, or engage in meditation/relaxation practices. Doing the same routine each night will start to condition your brain to associate these behaviors with bedtime.
Schedule a worry time. If you find yourself worrying about different stressors at night, consider setting up a time each day to let yourself worry. Write out your worries, talk with someone else about them, problem solve what is in your control, and work on letting go of aspects that you cannot control. This may sound strange, but if you allow yourself to work through your worries during the day they are less likely to pop up at night!
Keep a pen and paper by your bed. If you find yourself lying awake thinking about your “to-do list” for the next day, consider keeping a pen and paper handy to get that to-do list out of your mind and onto paper. This will allow you to put those worries to bed - pun intended - so you can come back to them tomorrow.
Limit clock watching at night. Counting down the hours does nothing except rev up your anxiety. There is nothing useful about knowing what time it is and how long we’ve been awake, so we are better off focusing on relaxing activities rather than calculating how many hours we have left to sleep.
Limit activities in the bed to sleep and sex. The more time we spend in bed tossing and turning and engaging in worry, the more our bed becomes associated with being anxious and not sleeping. If you find yourself dozing on the couch and then are wide awake as soon as you get in bed, your bed has likely become associated with anxiety or sleeplessness. In order to break this association, consider getting out of bed and engaging in a relaxing activity if you have not fallen asleep after 15 minutes. You may need to repeat this several times to break the link between your bed and sleeplessness.
Let’s talk about your sleep!
If you are having difficulty sleeping, know that you are not alone and there are effective treatments. Whether your sleep problems are chronic or new, anxiety therapy specifically targeting sleep can help!! Contact us for more information about therapy for sleep and to schedule an intake appointment with our Chicago therapists to determine if this therapy is right for you.
