Improving Sleep Quality and Reducing Night-time Anxiety: Evidence-based Strategies from a CBT Therapist.
Insomnia is a huge problem and anxiety at night is a big contributor to many people’s sleep struggles. According to the Mental Health foundation, up to one third of the UK population suffer from insomnia, which is either a lack of or poor quality sleep.
During sleep we process information, consolidate memories and undergo a number of maintenance processes which help us function effectively during the daytime.
“Sleep is an essential and involuntary process, without which we cannot function effectively. It is as important to our bodies as eating, drinking and breathing, and is vital for maintaining good mental and physical health. Sleeping helps to repair and restore our brains, not just our bodies.“
Mental Health Foundation
Anxiety at night is actually the same as anxiety in the day and, for many, it can often be in the quiet of night that worry thoughts come to their attention.
Our busy days with little time to pause act as a constant distraction away from our worries. Those worries left unaddressed or those not reframed to feel less threatening, are there during the day, but in the stillness and quiet of the night they come to the forefront of our thoughts.
Some of the common symptoms of anxiety:
heart beating extremely fast (palpitations)
sweating
breathing faster
restlessness
muscle tension
energy / adrenaline rushes
jaw clenching
““A sleepless night is as long as a year” ”
To frequently have trouble sleeping can be a frustrating and debilitating experience. People with sleep problems describe negative and frustrating cycles of sleeping badly at night which leave them feeling tired in the morning. Any energy they have can quickly disappear throughout the day and no matter how exhausted they feel at night, they still have trouble sleeping. And so the cycle begins again.
Anxious thoughts and feelings about sleep may in themselves play a large role in perpetuating sleep problems. For example, worst case scenario thoughts about not being able to sleep because of anxiety and the impact it might have on our life. Thoughts such as ‘what if this anxiety gets worse and I have a panic attack’, ‘what if I can’t sleep and it effects how I am able to perform at work’.
Many of those who are suffering are being advised to seek Cognitive Behavioural Therapy (CBT) which is an evidence based way off addressing these cycles. CBT aims to question the assumptions behind our thoughts and to break the links between our thoughts and how we feel about them.
Lisa Johnston, an Online CBT therapist and anxiety disorders expert shares a few strategies you can try to help improve the quality of your sleep and start to reduce night time anxiety.
Do remember that our focus should be on good quality sleep rather than the most amount of sleep.
Take some time to reframe you worry thoughts before you go to bed.
At night, thoughts and worries are harder to avoid. Things feel more dangerous or hopeless when the world is in darkness. Taking some time to get the thoughts out of your head and onto a piece of paper is a great place to start.
You can either leave the thoughts there on the page knowing they can be addressed in the morning, or (if you have allowed enough time) you could look at them a little more objectively and consider more realistic and helpful ways to see the worry. The aim is to reframe your most upsetting thoughts and consider things from a more helpful perspective.
To help you reframe your worry thoughts, you could ask yourself;
What evidence do I have for this thought?
Am I confusing a thoughts with a fact?
What advice would I give to a friend or loved one who had a similar worry?
Are my judgements based on how I feel rather than facts?
Am I overestimating how awful if would/could be?
Am I underestimating my ability to cope?
How likely is it that this will still be import in the morning? Next week? In three years time?
Once you have come up with a more realistic perspective on a problem, it then helps to think through more practical things you can do to help those more positive outcomes to be more likely to happen.
If you have trouble doing this, you may benefit from seeing a CBT therapist who is skilled at helping people to challenge unhelpful thinking patterns and replace them with more helpful alternative perspectives on things.
My Therapist Online can find you the right therapist for your needs. We have many CBT therapists who are experts in the treatment of anxiety and sleep problems.
Increase the amount of exercise you do in the day can help improve the quality of sleep at night - It is better to exercise earlier in the day because exercise, in the short term, increases the body’s adrenaline production which can make it difficult to sleep.
Set a regular wake time and stick to it, even at the weekends - This helps to regulate your body clock and could help you fall asleep and stay asleep for the night. Try not to oversleep because of a poor nights sleep. Sleeping late for just a couple of days can reset your body clock to a different cycle, you’ll be getting sleepy later and waking up later.
Worry thoughts about sleep - You could try a brief reframe of worry thoughts about sleep itself that come up in the night, but don’t get into a mental debate or argument with the worries. For example, you could replace thoughts such as ‘I’m never going to get to sleep, what if this is what if this lack of sleep never ends?” with “I’m not sleeping yet, but I do usually get some sleep during the night. I will fall asleep when my body is ready”.
Appraising the situation more accurately and positively, you will reduce the pressure on yourself to get to sleep, which makes sleep more likely.
Break the paradox of trying too hard to sleep - Most good sleepers don’t spend much time thinking about sleep or how they are going to get to sleep. Doing so paradoxically keeps us on high alert about the need to sleep which makes it harder to sleep. It is the absence of effort that helps good sleepers to sleep easily. By adopting a more passive approach to sleep and reduce the effort and pressure to get to sleep, sleep will come more easily.
Never problem solve in bed - nighttime is not a good place to work through your worries or find solutions for problems. If you have done a paper exercise as above, it may have come up there. Or you can tell yourself, this is just a worry thought, if it is important enough, you will remember it and address it in the morning. Alternatively, keep a pen and paper by your bed and put your ‘to do's’ onto there to be addressed the following day.
Create some wind-down time - Your body needs time to shift into sleep mode. Give yourself some wind-down time an hour before bed - turn off your TV and engage in some relaxation activities such as progressive muscle relaxation, listening to music, reading a book or having a warm bath.
Don’t dine after nine - try to eat your evening meal early so you are not going to bed on a full stomach. Some foods may have sleep inducing properties; for example, rice and oats may contain small amounts of melatonin, which increases the desire to sleep. Also some foods, such as dairy products, contain the amino acid tryptophan which is useful in manufacturing melatonin.
Only use your bedroom for sleep. Bedrooms need to be associated with sleep, so try to limit activities such as TV, eating and working to other rooms.
Ensure you have a good pillow and supportive mattress
Turn tech off or onto blue light blocking mode - The blue light from our phone is stimulating to the brain and can suppress melatonin release (melatonin helps you sleep). Ideally, it is best to try to not look at your phone or other screens an hour or two before you go to bed. However, if that feels like a habit you are not keen to change, then you can use a blue light blocking mode such as “Night Shift” on iPhones or wear blue light blocking glasses, and turn the brightness on your screen right down.
The 20 minute rule - don’t toss and turn for more than 20minutes. Get out of bed, try not to put too many lights on as this will wake you up even more. Go to the loo, have some water and focus on a low stimulus activity for 5-10 minutes or so before re-setting and returning to bed.
Make sure your room is quiet and dark - you can block out unwanted noise by wearing earplugs, putting on a fan or play a white noise (designed to screen out the sleep-disruptive sounds).
Keep your bedroom cool - generally speaking temperatures much above 24 degrees Celsius cause unwanted wake-ups from sleep.
Limit caffeine, alcohol and nicotine, all of which can impair sleep quality.
Limiting caffeine before sleep is important because caffeine is a stimulant that can disrupt the body's natural sleep-wake cycle and make it difficult to fall asleep or stay asleep.
Caffeine can also reduce the amount of deep sleep you get, which is important for feeling rested and refreshed in the morning.
To improve sleep quality, it's recommended to avoid caffeine for several hours (if you go to bed at 11pm, ideally don’t drink caffeine after 1pm) before bedtime or to limit overall caffeine intake.
If you struggle with anxiety at night, you're not alone. Quiet nights can bring worries to the forefront of our minds, perpetuating sleep issues. But, as discussed in this article, there are solutions. Reframing worried thoughts before bed can improve sleep quality, and taking a more passive approach can reduce pressure.
Cognitive Behavioural Therapy (CBT) is highly recommended for addressing these cycles. With CBT, you can challenge unhelpful thinking patterns and replace them with more helpful alternatives, leading to better sleep and improved mental wellbeing.
Remember, nighttime is not a good place to solve problems, so avoid problem-solving in bed and start getting the restful sleep you deserve.
Director of My Therapist Online
If you or someone you know is struggling with anxiety during the night which is affecting their sleep, My Therapist Online can match you with an online Cognitive Behavioural Therapist equipped with the skills to help you tackle the anxiety.
Please visit www.MyTherapistOnline.co.uk for further information or get in touch with me at hello@mytherapistonline.co.uk
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