You know the basics for good sleep: You're not supposed to watch TV or play on your iPad before bedtime, caffeine in the afternoon is a bad idea, a completely dark room is ideal ... And for goodness' sake, put your phone on Do Not Disturb!
Good sleep hygiene, while important, is only part of the solution. For people who suffer through chronic insomnia, not getting enough zzzz's can be an issue—even when they've established good habits.
"People who have chronic insomnia have been experiencing trouble getting to sleep or getting back to sleep for three nights a week, for three months or more," explained Dr. Courtney Golding, Ph.D., Sleep Psychology Fellow at Spectrum Health Sleep Clinic.
Golding provides Cognitive Behavior Therapy – Insomnia (CBT-I) to patients with chronic sleep insomnia, which can affect your heart health, risk for stroke, cognitive function and even memory. CBT-I could be your ticket to better shut-eye.
On the "behavioral" side, CBT-I has patients look at many factors, including these three biggies:
- Sleep schedules. Structure and consistency are key: That means going to bed and getting up at the same time every day. Also, be sure you're not climbing into bed too early, allowing more time for sleep than necessary. "If you're historically a six-hour sleeper, it doesn't make sense to have a sleep window that's nine hours long," Golding explained.
- Plan what you'll do if you can't sleep. "We want your brain to associate your bed with sleep, instead of watching TV, lying there frustrated, worrying about your finances, planning your day or reading," said Golding. "If you're awake for more than 15 to 20 minutes? It seems counterintuitive, but the best thing you can do is to get up and do something else until you're sleepy."
- Changing your daytime habits.
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- Start by eliminating caffeine and exercise late in the day. Although the ideal timeframe varies for everyone, Golding has some general guidelines. "For caffeine, I usually recommend stopping no later than eight hours before bedtime. The earlier you can cut it off the better. For exercise, I would say don't do it any closer than three to five hours before bed."
- Not drinking alcohol close to bedtime helps. Be realistic: Recognize that if you're drinking later, you'll have trouble sleeping. Make an informed decision: Commit to getting up at the regular time and getting back on track the next day.
- If you take a prescription medication that might interfere with sleep, talk to your prescriber and physician about the dosage and timing of your medication.
- Skip the nap! "When you're already struggling with sleep, you want to take any sort of propensity your body has for sleep and shove it into your desired sleep window, which is at night," said Golding. The one exception is if you're driving or operating heavy machinery and feel yourself dozing off. Then? "Pull off and nap!"
- Start by eliminating caffeine and exercise late in the day. Although the ideal timeframe varies for everyone, Golding has some general guidelines. "For caffeine, I usually recommend stopping no later than eight hours before bedtime. The earlier you can cut it off the better. For exercise, I would say don't do it any closer than three to five hours before bed."
The "cognitive" part of CBT-I therapy comes into play because, when you're not sleeping well, your brain can subscribe to dysfunctional beliefs about sleep and actually contribute to the problem. "If you're in the middle of a bad night, your brain may be telling you, 'Tomorrow's going to be a disaster!'—which makes you frustrated, anxious and less likely to sleep well," Golding said. She works with patients to re-evaluate and readjust their beliefs about sleep, track their sleep habits, and talk about what sleep is supposed to be and what really happens if you have a poor night of sleep.
"If getting poor sleep is less scary and you're not anxious, you might actually get some sleep!"
Patients who seek CBT-I for chronic insomnia get an individualized plan based on their triggers, sleep and wake habits, and lifestyle. "This therapy is difficult but effective," said Golding. "It's a bigger short-term commitment because you have to commit to two to three months of regimented sleep structure and changes. But there is hope. I'd say that at least 75 percent of motivated people, who do the treatment, see improvement."
Need a refresher on good sleep hygiene? Read "7 Tips for Getting a Better Night's Sleep," available at http://bit.ly/7SleepTips.
Kirsetin Morello is a Michigan-based author, speaker, writer, travel-lover, wife and grateful mom of three boys. Read more about her at www.KirsetinMorello.com.
