Evidence based solutions to sleep problems and night time anxiety
Combatting Insomnia and Night-time Anxiety. Effective Strategies from My Therapist Online
Do you struggle to get enough sleep?
Is the qualify of our sleep worrying you?
Insomnia, a prevalent issue impacting sleep quality, is a significant concern for many, with anxiety at night being a primary factor. The Mental Health Foundation reports that up to one-third of the UK population suffers from insomnia, characterised by either insufficient sleep or poor sleep quality. This condition not only affects nightly rest but also impacts overall well-being and mental health.
At My Therapist Online, we understand the critical role of sleep in mental and physical health. During sleep, our bodies are not just at rest; we process information, consolidate memories, and undergo essential maintenance processes vital for effective daytime functioning. Poor sleep can lead to a range of issues, from decreased cognitive function to heightened anxiety levels.
Our team of experienced therapists, specialising in Cognitive Behavioural Therapy (CBT), offers tailored strategies to combat insomnia and reduce night-time anxiety. CBT is a proven approach in addressing the underlying causes of sleep disturbances and equipping individuals with practical tools to improve sleep hygiene and manage anxiety.
By engaging with My Therapist Online, you gain access to personalised therapy sessions focused on enhancing your sleep quality and overall mental health. Our therapists are dedicated to helping you understand and modify the thought patterns and behaviours contributing to your sleep issues, paving the way for more restful nights and productive days.
If you're struggling with insomnia or night-time anxiety, read on or reach out. Together, we can work towards achieving better sleep and improved mental well-being. We can arrange for you to have quic and easy access aCBT sleep therapist.
Understanding Night-time Anxiety. When Silence Amplifies Worries
Anxiety at night mirrors the anxiety experienced during the day, but it often feels more intense in the stillness of the night. For many, the quiet hours become a stage where worry thoughts take a lot more of the spotlight.
During our busy days, which are often filled with continuous tasks and minimal pauses, our worries often get pushed to the background. These unaddressed concerns, or those not yet reframed to seem less daunting, linger beneath the surface. However, in the tranquility and silence of night, these worries emerge more prominently in our thoughts.
The symptoms of anxiety, whether experienced during the day or at night, can include:
Heart palpitations or an extremely fast heartbeat
Increased sweating
Accelerated breathing
A sense of restlessness
Muscle tension
Sudden energy or adrenaline rushes
Jaw clenching
Recognising these symptoms is the first step in addressing night-time anxiety. By understanding that these worries are the same ones we face during the day, albeit magnified by the night's quiet, we can begin to develop strategies to manage them effectively. My Therapist Online offers insights and tools to help you reframe these thoughts and find peace, even in the stillness of the night.
Breaking the Cycle. How CBT Can Help with Sleep Problems and Anxiety
Struggling with sleep problems can be a deeply frustrating and exhausting experience. Individuals facing such issues often describe a relentless cycle, where poor sleep at night leads to fatigue in the morning, their energy dwindles throughout the day, and despite feeling utterly exhausted, they find themselves unable to sleep again at night. This cycle not only affects physical energy but also takes a toll on mental well-being.
A significant factor in this cycle is the anxious thoughts and feelings specifically about sleep. These worries can exacerbate the problem, creating a self-fulfilling prophecy of sleeplessness. Common concerns include fear of anxiety escalating into a panic attack or apprehensions about the impact of sleeplessness on job performance. Thoughts like 'What if I can’t sleep again?', ‘What if my anxiety worsens?' or 'What if I can't function at work due to lack of sleep?' are typical examples that can heighten nighttime anxiety.
To address these patterns, many are turning to Cognitive Behavioural Therapy (CBT). CBT is an evidence-based approach that helps individuals examine and challenge the assumptions behind their anxious thoughts. It aims to break the link between negative thought patterns and the emotional responses they trigger, particularly those related to sleep.
CBT techniques involve questioning the validity of these worrisome thoughts and learning to view them in a more realistic light. This approach not only helps in alleviating anxiety but also in establishing healthier sleep patterns. By changing the way one perceives and reacts to their thoughts about sleep, CBT can effectively interrupt and transform the frustrating cycle of sleep problems.
In addition to addressing thought patterns, Cognitive Behavioural Therapy (CBT) also places a strong emphasis on sleep hygiene and the adoption of helpful behaviours and tools to improve sleep. Sleep hygiene involves creating an environment and establishing routines that are conducive to sleep. This includes aspects like regulating the sleep-wake schedule, creating a comfortable and sleep-friendly bedroom environment, and engaging in relaxing activities before bedtime.
CBT helps individuals to identify and modify behaviours that can have a negative impact on sleep. For instance, reducing screen time before bed, avoiding caffeine and heavy meals in the evening, and establishing a calming pre-sleep routine are all part of good sleep hygiene. CBT therapists may also introduce relaxation techniques and mindfulness exercises, which can be particularly effective in reducing physical tension and mental stress, thereby facilitating easier onset of sleep.
For those grappling with sleep-related anxiety, CBT offers a promising path to better sleep and improved overall well-being. Embracing this therapy can be a significant step towards reclaiming restful nights and more energetic days.
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.
Enhancing Sleep Quality. Reframing Worry Thoughts for Better Rest
At My Therapist Online, we emphasise the importance of quality sleep over quantity. It's crucial to address and reframe worry thoughts before bedtime, as the night often amplifies these concerns. In the darkness, worries can seem more daunting and insurmountable. A simple and practical and effective strategy is to jot down these tricky thoughts on paper. This simple act can help in externalising and distancing yourself from these anxieties.
You have the option to leave these thoughts on the page, with the reassurance that they can be revisited in the morning, or, if time permits, to examine them more objectively.
The goal is to transform your most distressing thoughts into perspectives that are more realistic and helpful.
To help in reframing your worries, consider asking yourself the following questions:
What concrete evidence supports this thought?
Am I mistaking a thought for a fact?
What advice would I offer to a friend with a similar concern?
Are my judgments influenced more by emotions than by facts?
Am I overestimating the potential negativity of the situation?
Am I underestimating my ability to handle it?
How significant will this issue be in the morning, next week, or in three years?
Developing a more realistic viewpoint on a problem enables you to think about practical steps that can make positive outcomes more likely. If you find this process challenging, consulting with a CBT therapist can be immensely beneficial. CBT therapists are skilled in helping individuals challenge unhelpful thinking patterns and replace them with more constructive perspectives.
At My Therapist Online, we can connect you with the right therapist to suit your needs. Our network includes many CBT therapists who specialise in treating anxiety and sleep disorders. They are equipped to guide you through the process of transforming your thought patterns, ultimately leading to improved sleep quality and overall well-being.
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.
Boosting Sleep Quality with Daytime Exercise
Increasing your daily exercise can significantly enhance the quality of your sleep at night. Engaging in regular physical activity is known to promote deeper and more restful sleep. However, the timing of exercise plays a crucial role in how it affects your sleep patterns.
Exercising earlier in the day is generally more beneficial for sleep quality. This is because physical activity, especially vigorous exercise, temporarily boosts the body's production of adrenaline. Adrenaline is a hormone associated with increased energy and alertness, which, while beneficial during the day, can make it challenging to wind down and fall asleep if experienced close to bedtime.
Morning or early afternoon workouts can be particularly effective. They not only increase your exposure to natural daylight, which helps regulate your body's internal clock, but also ensure that by the time evening arrives, the stimulating effects of adrenaline have worn off. This natural decrease in energy levels in the evening sets the stage for a restful night.
Additionally, exercise has been shown to reduce symptoms of anxiety and depression, both of which can interfere with sleep. Regular physical activity helps in releasing endorphins, the body's natural mood lifters, which can create a more positive mindset and reduce stress levels, further contributing to better sleep.
Incorporating a consistent exercise routine into your daily schedule doesn't necessarily mean engaging in intense workouts. Even moderate activities like walking, cycling, or yoga can be highly beneficial. The key is to find an exercise you enjoy and can perform regularly, and to schedule it at a time that aligns with your body's natural rhythm, ensuring that it supports rather than hinders your sleep.
A CBT Approach to Sleep Regulation - Establish a Consistent Wake Time
Setting and sticking to a regular wake-up time, even on weekends, is a cornerstone of Cognitive Behavioural Therapy (CBT) for insomnia and sleep regulation.
This practice is grounded in evidence-based strategies that focus on regulating your body's internal clock, or circadian rhythm, which is crucial for healthy sleep patterns.
Consistency in your wake-up time helps to anchor your body's circadian rhythm. When you wake up at the same time every day, you reinforce your body's natural sleep-wake cycle, which can make it easier to fall asleep and stay asleep throughout the night. This regularity sends a clear signal to your body about when to feel alert and when to wind down, reducing the likelihood of sleep disturbances.
CBT for insomnia often emphasises the importance of avoiding oversleeping, especially after a night of poor sleep. While it might be tempting to compensate for a restless night by sleeping in, this can actually be counterproductive. Oversleeping, even for just a few days, can shift your body clock to a later schedule, leading to a pattern where you find yourself feeling sleepy later at night and struggling to wake up in the morning.
To implement this strategy effectively, it's recommended to choose a wake-up time that suits your lifestyle and stick to it as closely as possible. It's important to be realistic; the goal is to find a time that you can maintain consistently, not just for a few days, but as a regular habit.
In addition to setting a regular wake-up time, CBT for insomnia also involves other behavioral techniques such as sleep restriction therapy and stimulus control instructions. These methods work together to improve sleep efficiency and quality. By combining a fixed wake-up time with these other strategies, you can significantly enhance your ability to get a good night's sleep and maintain a healthy sleep schedule.
Remember, changes to sleep patterns may take time to show results, and consistency is key. Patience and adherence to these practices can lead to long-term improvements in sleep quality and overall well-being.
Address worry thoughts about sleep
Addressing worry thoughts about sleep is an important step in cultivating a healthier sleep pattern. It's common to encounter such thoughts during the night, especially when struggling to fall asleep. However, engaging in a mental debate with these worries can exacerbate the issue, leading to increased anxiety and making sleep even more elusive.
Instead of wrestling with these negative thoughts, a more effective approach is to briefly acknowledge them and then gently reframe them into something more positive and realistic. For example, when you catch yourself thinking, 'I'm never going to get to sleep, what if this lack of sleep never ends?', pause, slow your breath and gently shift this thought to something like, 'I'm not asleep yet, but it's normal to take some time to fall asleep. I usually do manage to get some rest, and my body will eventually drift off when it's ready.'
This reframing technique is a form of cognitive restructuring, a key component of Cognitive Behavioural Therapy (CBT). It involves changing the narrative in your mind from one that is anxiety-inducing to one that is calming, rational and uses a growth mindset. A growth mindset is the belief that abilities and intelligence can be developed through dedication, hard work, and perseverance, viewing challenges as opportunities to learn and grow. By doing so, you reduce the self-imposed pressure to fall asleep immediately, which paradoxically, can make it easier to relax and eventually fall asleep.
Moreover, this approach helps in developing a more compassionate and understanding attitude towards yourself and your sleep struggles.
It's important to remember that sleep is a natural process, and sometimes, it requires patience. By appraising your sleep situation more accurately and positively, you create a mental environment that is more conducive to rest, thereby increasing the likelihood of a good night's sleep.
Break the paradox of trying too hard to sleep.
The paradox of trying too hard to sleep is a common trap for those struggling with sleep issues. Most good sleepers often share a common trait: they don't obsess over sleep or worry excessively about how they will manage to fall asleep. This lack of preoccupation is key to their ability to sleep well. In contrast, when we focus too intently on our need to sleep, it can keep us in a state of heightened alertness, which ironically makes sleep more elusive.
The effort to sleep can become counterproductive. It's akin to telling yourself to relax – the more you consciously try, the more elusive relaxation becomes. Good sleepers often benefit from what can be described as an 'effortless effort'. They don't actively strive to sleep; instead, they allow sleep to come to them naturally. This absence of effort is a significant factor in their ability to drift off easily.
Adopting a more passive approach to sleep involves reducing the mental and emotional effort you put into the act of falling asleep. It means shifting from a mindset of 'trying hard to sleep' to one of 'letting sleep happen'. This can involve relaxation techniques, such as deep breathing or mindfulness, which help shift the focus away from sleep itself and more towards a state of general relaxation.
Attempting to force sleep is like trying to smooth out ripples in water with your hands. The more you agitate the water in an effort to calm it, the more turbulent it becomes. Sleep, when pursued too directly, behaves similarly; the effort to control and induce it often leads to increased mental and emotional turbulence, making restful sleep even more elusive. Just as calm waters are achieved by simply letting them be, a peaceful night's sleep is often best attained by releasing the urge to control it and allowing the mind and body to relax naturally.
By reducing the pressure and effort to fall asleep, you create a more conducive environment for sleep to occur naturally. It's about creating a space where sleep can enter effortlessly, rather than trying to chase or force it. This shift in approach can be a significant step towards overcoming sleep difficulties and achieving a more restful, natural sleep pattern.
Reserve Bed for Rest. Avoiding Problem-Solving at Night.
It's essential to establish a clear boundary - bed is for rest, not for problem-solving. Nighttime is not the ideal time to tackle worries or seek solutions for your day-to-day problems. Engaging in such activities while in bed can create a mental association that turns your place of rest into a space of stress, disrupting your ability to relax and fall asleep.
If you've engaged in a reflective paper exercise earlier, as mentioned, you might have already encountered some of these worries. It's helpful to remind yourself that nighttime ruminations are often just worry thoughts. If an issue is truly significant, trust that it will still be there in the morning, when you're better equipped to address it with a fresh mind and clearer perspective.
To further facilitate this separation of day-time concerns from night-time rest, consider keeping a pen and paper beside your bed. If a worry or a 'to-do' item comes to mind as you're trying to sleep, simply jot it down. This act of transferring your thoughts onto paper can be mentally liberating. It reassures your brain that the thought has been acknowledged and will be addressed, but at a more appropriate time. This can help clear your mind and ease the transition into sleep.
By consciously choosing to set aside problem-solving for the daytime, you reinforce the bed as a sanctuary for sleep and relaxation. This clear demarcation can significantly improve your sleep quality, as your mind learns to associate the bed with tranquility and rest, rather than with the stresses and challenges of your waking life.
Establishing a Wind-Down Routine for Better Sleep
Transitioning smoothly into sleep requires giving your body and mind the opportunity to shift down gears from the day's activities to a state of restfulness. Creating a dedicated wind-down period about an hour or so before bedtime can significantly enhance this transition. This is a time to signal to your body that the day is ending and restful sleep is approaching.
During this wind-down time, it can be beneficial to disengage from stimulating activities, particularly those involving screens like TVs, computers, or mobiles phones. The blue light emitted by these devices can interfere with the production of melatonin, the hormone responsible for regulating sleep.
Instead, focus on activities that promote relaxation. Engaging in progressive muscle relaxation is an excellent way to release physical tension. This technique involves systematically tensing and then relaxing different muscle groups in your body, fostering a state of physical and mental calm.
Listening to soothing music can also be a part of your wind-down routine. Choose melodies or sounds that you find calming, whether it's gentle classical music, ambient soundscapes, or even white noise. The key is to select audio that helps you detach from the day's stresses.
Reading a book is another effective way to relax before bed. Opt for books that are engaging but not overly stimulating or distressing. The act of immersing yourself in reading can be a gentle way to shift your focus away from daily worries.
Additionally, consider incorporating a warm bath into your routine. The warmth of the bath can be incredibly soothing, and the subsequent drop in body temperature after you get out can help signal to your body that it's time to sleep.
By establishing a consistent wind-down routine, you create a clear and calming transition from wakefulness to sleep. This not only prepares your body for rest but also sets a peaceful tone for your mind, paving the way for a more restful and rejuvenating night's sleep.
Timing and Choice of Evening Meals for Optimal Sleep
The old adage 'Don't dine after nine' holds significant truth when it comes to promoting better sleep. Eating your evening meal earlier in the night can greatly impact the quality of your sleep, as going to bed on a full stomach can lead to discomfort and indigestion, which may disrupt your sleep cycle. Digestion slows down during sleep, so a heavy meal right before bedtime can lead to a restless night.
Moreover, the type of food you consume in the evening can also play a role in how well you sleep. Certain foods are known to have sleep-inducing properties, which can be beneficial in your pre-sleep diet. For instance, rice and oats contain small amounts of melatonin, a hormone that regulates sleep-wake cycles and signals to your body that it's time to rest. Including these in your dinner can subtly encourage your body to enter a state of sleepiness.
Dairy products are another category of food that can aid in sleep. They contain tryptophan, an amino acid that plays a crucial role in the production of melatonin. Tryptophan is a precursor to serotonin, a neurotransmitter that gets converted into melatonin in the brain. This process can be enhanced in the presence of carbohydrates, which is why a light, balanced meal that includes both dairy and a carbohydrate source can be particularly effective as a pre-sleep meal.
However, it's important to balance this with the understanding that overly rich or heavy foods can have the opposite effect, leading to discomfort and restlessness. Opt for a meal that is satisfying but not overly large or rich in fats and spices, as these can cause heartburn or indigestion.
Cultivating a Sleep-Conducive Bedroom Environment
The principle of using your bedroom exclusively for sleep is rooted in the psychological concept of conditioning. By reserving your bedroom primarily for sleep, you strengthen the mental association between this space and the act of sleeping. This conditioning can significantly improve your ability to fall asleep quickly and enjoy uninterrupted rest.
To foster a bedroom environment that is synonymous with sleep, it's important to limit activities that can interfere with this association. Watching TV, for instance, not only engages your brain in stimulating content but also exposes you to blue light, which can disrupt your natural sleep-wake cycle. Similarly, eating in bed can lead to a subconscious connection between your sleeping space and food, which might trigger wakefulness or even discomfort due to digestion.
Working in the bedroom is another activity to avoid. The presence of work-related materials can keep your mind in a state of alertness or stress, counteracting the relaxation needed for sleep. The mental association of your bedroom with work can make it difficult to wind down and prepare your body and mind for rest.
Instead, aim to create a bedroom environment that is a sanctuary for relaxation and sleep.
By consciously limiting non-sleep activities in your bedroom, you reinforce its role as a place of rest. This clear distinction helps your mind to automatically shift into a state of relaxation and readiness for sleep upon entering the bedroom, paving the way for a more restful night.
Ensure you have a good pillow and supportive mattress
Having a good pillow and a supportive mattress is fundamental to achieving high-quality sleep. These elements are the foundation of your sleep environment, directly impacting your comfort and spinal alignment.
A well-chosen pillow supports the neck and shoulders, reducing the likelihood of waking up with stiffness or pain. Similarly, a supportive mattress is crucial for maintaining proper spine alignment, distributing your body weight evenly, and minimising pressure points.
Together, they create an ergonomic sleeping environment that not only enhances comfort but also promotes uninterrupted sleep. Investing in a quality pillow and mattress can significantly improve your overall sleep experience, leading to better rest and greater well-being.
Managing Blue Light Exposure for Better Sleep
In today's tech-driven world, our evenings are often illuminated by the glow of screens. However, the blue light emitted by these devices can have a significant impact on our sleep quality. Blue light is particularly stimulating to the brain and has been shown to suppress the release of melatonin, a hormone that plays a crucial role in regulating our sleep-wake cycle.
To mitigate the impact of blue light on your sleep, it's advisable to create a tech-free zone in the hour or two leading up to bedtime. This means setting aside your phone, turning off the TV, and stepping away from the computer. This practice not only reduces blue light exposure but also helps your mind disengage from the constant stream of information and stimulation that technology provides, allowing you to wind down and prepare for sleep.
However, completely disconnecting from technology can be a challenging habit to adopt for many. If you find it difficult to completely turn off your devices before bed, there are still effective ways to reduce blue light exposure. Most modern mobiles and computers come with a built-in blue light filter, often referred to as “Night Shift” on iPhones or similar settings on other devices. Activating this feature shifts the screen's display to warmer tones, which are less stimulating and less likely to interfere with melatonin production.
Another option is to use blue light blocking glasses in the evening. These glasses are designed to filter out the blue light emitted by screens, helping to protect your eyes and maintain your natural sleep cycle.
Additionally, reducing the brightness of your screens can further decrease the amount of blue light reaching your eyes. This simple adjustment can make a significant difference, especially in dimly lit or dark environments where the contrast between the screen's brightness and the surrounding darkness is more pronounced.
Implementing the 20-Minute Rule for Restful Sleep
The 20-minute rule is a practical and effective strategy for those who find themselves struggling to fall asleep or waking up in the middle of the night. The premise is simple: if you've been tossing and turning for more than 20 minutes, it's time to get out of bed. This approach is based on the principle that staying in bed while unable to sleep can lead to frustration and anxiety, which only further impedes your ability to fall asleep.
When you decide to get up, it's important to keep the environment conducive to returning to sleep. This means minimizing your exposure to bright lights, as excessive light can signal to your brain that it's time to wake up, further disrupting your sleep cycle. Use dim lights if you need to navigate your way around.
A visit to the bathroom, a quiet sip of water or looking out the window at the nights sky can be a good way to break the cycle of restlessness. These simple actions offer a gentle distraction and a moment to reset your mind and body.
After that, engage in a low-stimulus activity. This could be something like practicing some deep breathing or light stretching, or even engaging in a brief mindfulness or meditation exercise. The key is to choose an activity that is calming and not mentally taxing. Avoid checking your phone or other screens, as this can stimulate your brain and make it harder to return to sleep.
Spend about 5-10 minutes on this activity, or just enough time to feel your body and mind start to relax. Then, make your way back to bed to try sleeping again. The goal of the 20-minute rule is to break the association between being in bed and feeling awake and anxious. By getting up and engaging in a calming activity, you're resetting this association and giving yourself a better chance to fall asleep upon 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).
Minimising light exposure before bedtime is essential. Darkness triggers the production of melatonin, the hormone responsible for regulating sleep. Blackout curtains or a sleep mask can be beneficial for blocking out any disruptive light, especially in urban settings or during the longer daylight hours of summer.
Keep your bedroom cool
Generally speaking temperatures much above 24 degrees Celsius cause unwanted wake-ups from sleep. A cooler room helps lower your core body temperature, a signal to your body that it's time to sleep.
The Impact of Caffeine on Sleep.
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.
Overcoming Night-time Anxiety for Better Sleep - Key Takeaways
Night-time anxiety is a widespread issue, often intensified by the stillness of the night, leading to disrupted sleep patterns. However, as I've discussed in this article, there are practical and effective methods that may help.
Actively reframing anxious thoughts before going to bed can significantly improve the quality of your sleep. Embracing a more relaxed mindset during the evening hours can also help ease the pressures that contribute to sleep difficulties.
Cognitive Behavioural Therapy (CBT) is highly effective in breaking the cycle of anxiety and insomnia. CBT equips you with the tools to recognise and modify counterproductive thought patterns, fostering more positive and realistic ones in their place. This cognitive shift not only enhances sleep quality but also boosts overall mental health.
If you're struggling with sleep issues, remember that you don't have to face this alone. My Therapist Online is here to support you. We offer access to expert therapists who specialise in sleep disorders and related problems. Our skilled professionals can help you unravel your sleep challenges, guiding you towards not only better sleep but also a more serene and content state of mind. Don't hesitate to reach out to us at My Therapist Online for support in transforming your sleep and enhancing your overall quality of life.
CBT, ACT, CFT & EMDR Therapist
Director of My Therapist Online
All images used in the article are from Pexels.com
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