Month: July 2021

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Not being able to sleep can be one of the most frustrating things in the world. This video presents an overview of the cognitive behavioral therapy for insomnia program developed by Dr Greg Jacobs at harvard medical school for more detailed information about his online cbt for insomnia program please visit cbtforinsomnia.com.

Cognitive behavioral therapy for insomnia is probably the most effective tool we have to help us sleep better and in this video we’ll be looking at the cognitive aspect of cbt for insomnia how our thoughts affect our sleep and then in my other video on insomnia we’ll be looking at the behavioral aspect and how we can change our behaviors and habits to help promote better sleep

There are two types of thoughts that keep us awake at night. The first are thoughts related to our lives: dwelling on things that happen during the day; or worrying about stuff that’s coming up; or just whatever’s been on our minds all day that we’re finding difficult to let go. And then the second category of thoughts our thoughts related to our sleep, or more specifically thoughts about the fact that we can’t sleep.

So first let’s look at everyday thoughts. If we’re lying in bed stressed out our minds racing about things going on in our lives, we need to find a way to leave these thoughts behind before we go to bed in order to be able to fall asleep. The most effective way to do this is to learn to manage stress anxiety and negative thoughts better during the day, so that they’re not still affecting us by the time we try to fall asleep. You’ll find a number of videos with strategies that can help with this in my free self-help for insomnia course.

But they’ll still be times when these thoughts linger and stick around. And if you tend to worry or dwell on things at night when you’re trying to get to sleep i really recommend scheduling in a worry or thinking period in the early evening, where you spend 20 minutes to half an hour addressing whatever negative thoughts have been accumulating throughout the day, doing whatever planning or problem solving you can about them, and then setting these thoughts aside afterwards for the rest of the evening when there’s nothing more that you can do about them tonight except worry and dwell on them and keep yourself up. And i have a whole video that describes how to use a worry period that i’ll link to in the description.

And just because a thought pops into our heads doesn’t mean we need to pay attention to it or think about it at all. So practice letting go of your thoughts when they’re not related to whatever you’re doing at the time. And when we’re trying to fall asleep we don’t need to be having any thoughts, so we can just try to let all of our thoughts go. And i have a couple of videos that describe how we can do this in the description. But inevitably there’ll be times when these thoughts pop back into our heads at night and keep us awake.

So if we find ourselves lying in bed at night with our minds racing unable to sleep we need to find something to help us clear our minds and relax. And a great way to do this is with a relaxation exercise called the relaxation response. And you’ll find a link to a guided audio version of the relaxation response in the description. So if you’re having trouble relaxing and quieting your mind enough to fall asleep you can go into another room and listen to the relaxation response and then once you’ve relaxed and are feeling sleepy go back to bed. Or you can play it in bed as you try to fall asleep to it.

And you can also use the relaxation response during the day either at a regularly scheduled time when you have a break in your da, or just whenever you’re starting to feel stressed or anxious or overwhelmed and need to take some time to relax. And using it in this way will help prevent stress and worries from accumulating so much throughout the day, which means that you’ll be more relaxed at night when you’re getting ready to go to sleep than if you’ve done nothing to address your stress earlier in the day.

And before you start using the relaxation response at night to help you sleep it’s important to get comfortable using it during the day to help you relax, because if your first attempts at using it are focused on trying to get to sleep, this can end up not being a very relaxing experience because you’re struggling so hard to fall asleep to it, that it becomes frustrating rather than relaxing. So make sure you’re already accustomed to using it to help you relax before you try using it to fall asleep.

Now the other thoughts that we have that interfere with our sleep are our thoughts about our insomnia and our inability to fall asleep. And we call these negative sleep thoughts, and it’s these negative sleep thoughts that are often our biggest impediment to getting a good night’s sleep.

Negative sleep thoughts are things; like i’m never going to be able to fall asleep; or we wake up and check our clocks and think it’s only 4 00 am and i’m wide awake i have to be up in a few hours and i’m never going to be able to get back to sleep; i’m not going to be able to function tomorrow, i need my 8 hours of sleep; my insomnia is ruining my health; what’s wrong with me, how can i not know how to fall asleep?; i’ll never learn to sleep better; i haven’t slept the wink in days. And we toss and turn our minds racing with thoughts about how we’re not sleeping, making it even harder for us to fall asleep.

In order to get better sleep we need to learn to modify these negative sleep thoughts. Now the opposite of negative sleep thoughts are positive sleep thoughts. But because it’s so easy to hear positive sleep thoughts and think it’s just going to be some superficial form of positive thinking, i prefer to call them sleep promoting thoughts, because they’re not necessarily positive, they just have a positive effect on our sleep. And when we’re able to replace these negative sleep thoughts with sleep promoting thoughts our insomnia usually improves and we start to sleep better.

And so to change the way we think about our sleep we use a cbt technique called cognitive restructuring. And if you’re not familiar with cognitive restructuring you can learn more about it from the video i link to in the description. The key to cognitive restructuring is to recognize that our negative sleep thoughts, although they have some truth to them, are biased: they tend to present only the negative side of things. So we need to come up with a more balanced perspective. And that’s where sleep promoting or positive sleep thoughts come in.

And the key to coming up with sleep promoting thoughts is that they have to be based in our own realities. Replacing a negative sleep thought with a positive sleep thought that we just don’t buy isn’t going to work. The sleep promoting thoughts have to make sense to us; we have to be able to believe them. So in order to help us understand the ways in which our negative sleep thoughts are biased it helps to look at and dispel some of the common myths about sleep that feed into our negative sleep thoughts.

One of the most prevalent myths is that we need eight hours of sleep a night. Most of us don’t need eight hours, and in terms of our health, people who sleep seven hours a night live longer on average than people who sleep eight or more hours. And sleeping for just five and a half hours a night has about the same risk of mortality as sleeping for eight.

I won’t be able to function if i don’t get enough sleep. A lack of sleep can impact daytime functioning primarily on tasks involving problem solving or memory, but these effects generally don’t happen after just one or two nights of poor sleep. And studies on people with insomnia show that sleep loss doesn’t affect them in these areas as much as normal sleepers.

I’ll be miserable if i don’t get enough sleep. Lack of sleep does affect our mood, and this is usually the main way it affects us rather than impacting our performance, but there isn’t a simple cause and effect relationship between poor sleep and a bad mood. If we have a good reason for our loss of sleep it doesn’t affect our mood as much, or sometimes even at all the next day. If we’ve lost sleep due to caring for a newborn or being on call for a job we value we can frame it as an acceptable sacrifice for something that’s important to us. And then it’s easier to accept being tired and it doesn’t affect us as much as if our lack of sleep is simply due to insomnia.

And if we’re tired because we had a late night out with our friends or flew home overnight from a vacation, we might still be basking in a good mood from the events that caused us to lose sleep even if we’ve barely gotten any sleep the night before. And so we can be in a good mood despite getting very little sleep. And this is important because if our thoughts about our poor sleep can have as much or more of an effect on our mood than the actual number of hours we slept, if we can manage any negative sleep thoughts we have during the day better, we reduce the effects of our insomnia on our daytime mood and even our functioning.

So if you find yourself having negative sleep thoughts throughout the day—like why can’t i ever get any sleep? Why am i always so tired? I know i’m not going to be able to sleep again tonight; it’s not fair—if you can find ways to counter these thoughts through cognitive restructuring, or learn to just let go of these thoughts without dwelling on them, then your lack of sleep will have less of a negative impact on your days.

How much sleep do we actually need. For most people performance on alertness memory and problem solving tasks can be maintained for extended periods of time with only about five and a half hours of sleep or what’s called core sleep. We experience four stages of sleep: two stages of light sleep, followed by stage three deep sleep, followed by rem sleep which is a stage in which we dream.

Our core sleep allows us to get 100 percent of the stage 3 or deep sleep that we need which is the most important stage of sleep, and 50 percent of our rem sleep the second most important stage of sleep. And if we don’t get our required core sleep one night we make up for it the next: our brain will reduce how much time we spend in stage one and stage two sleep in order to give us more time in stage three and rem sleep; our bodies adjust and prioritize getting the stages of sleep we need the most.

And studies show that people with insomnia average just under 6 hours of sleep a night yet don’t have worse daytime performance or alertness than good sleepers. And this is because we can still get all of our core sleep even if we’re only sleeping for five and a half hours a night.

And we tend to underestimate how much sleep we get. Studies consistently show that people with insomnia overestimate how long it takes them to fall asleep by an average of 30 minutes per night, and underestimate total sleep time by one hour. This is because we perceive light sleep as still being awake and because time passes slower under unpleasant conditions, so when we’re lying awake it tends to seem longer than it actually is.

So understanding these general facts about sleep can help us counter our negative sleep thoughts with sleep promoting or positive sleep thoughts. And even if you’re an exception to some of the things we’ve looked at and your negative sleep thoughts are more accurate than they are for some, reframing your thoughts about your insomnia in a less negative perspective will still tend to improve the quality and quantity of your sleep as well as your mood the next day.

So let’s consider how we might modify our negative sleep thoughts and replace them with sleep promoting thoughts. And remember the key is to replace your negative sleep thoughts not with what i tell you you should think but with sleep promoting thoughts that you can believe

I’ll never fall asleep. I’ll fall asleep eventually as i get more tired and my body strives to get its core sleep.

It’s only 3 am, i’m wide awake, i’ll be up in a few hours, and i’ll never get back to sleep. We’re often very alert when we first wake up especially from a dream, but if we haven’t gotten our core sleep yet drowsiness usually follows not long after. I’m alert because i’ve gotten my core sleep for the night so if i don’t fall back asleep it’ll be okay.

I’m not going to be able to function tomorrow. I might be irritable and in a bad mood but my ability to function won’t be affected that much if at all.

I need my eight hours of sleep. Most people average seven hours of sleep and five and a half hours gives me my core sleep. And even if i don’t get that tonight my body will make it up tomorrow.

What’s wrong with me why can’t i sleep? Most people experience insomnia at some point in their lives and at any given time it’s likely that 20 to 30 percent of adults are struggling with insomnia. And these numbers keep rising year after year, so if you have insomnia you’re not alone and there’s nothing wrong with you except, like about 30 percent of the population, you have difficulty sleeping

I’ll never learn to sleep better. Insomnia is most often due to learned thoughts and behavior and these can be modified to improve sleep like we’re learning in this video.

I’m so tired today’s going to be unbearable. I’ll be able to make it through the day. I have insomnia all the time and i still manage to function. If i’m miserable it’s not just due to lack of sleep my thoughts about my insomnia influence how i feel throughout the day, and i do have some control over them.

I haven’t slept all night. I probably did get some sleep without being aware that i was asleep. And if i didn’t get my core sleep tonight it’ll be easier to get it tomorrow.

So modifying our thoughts and especially our negative sleep thoughts is one of the most effective things we can do to combat insomnia. And the other thing we can do is to modify our behavior and instil habits that are more conducive to sleep and you can learn how to do this for my other video on insomnia.

This transcription was auto-generated by YouTube. I’ve only added minimal editing, so I apologize for any errors, run-on sentences, etc.

Struggling with insomnia or having difficulty sleeping can have a really negative effect on our quality of life. This video presents an overview of the cognitive behavioral therapy for insomnia program developed by Dr Greg Jacobs at Harvard medical school For more detailed information about his online cbt for insomnia program please visit cbtforinsomnia.com.

In this video we’re going to learn how to sleep better through sleep hygiene techniques and with sleep scheduling strategies that help us sleep more efficiently. And in my other video on insomnia we learn how to improve our sleep by quieting our minds and reducing our negative sleep thoughts. And you’ll find a link to that video in the description.

Sleep hygiene involves modifying our behaviors to create an environment and establish habits that make it easier for us to fall asleep and to stay asleep. One of the main goals of sleep hygiene is to learn to associate being in bed with being asleep. And so the first rule of sleep hygiene is to only use your bedroom for sleeping and intimacy.

You want to train your mind to associate the bedroom and especially your bed with sleeping and nothing else, because most people who sleep poorly associate being in bed with lying awake not being able to fall asleep. And we really want to train our bodies to associate being in bed with sleeping because that makes it much more likely that we’ll fall asleep when we go to bed.

So don’t bring your laptop or phone to bed. Don’t study or work in your bed. Don’t have a long problem-solving session with your partner in bed. And don’t laze around in bed once you wake up. If it helps you to fall asleep you can read or watch tv in bed for up to 30 minutes before you go to sleep but no longer than this. If you like to read or watch tv for longer than half an hour to help you wind down at night then start off somewhere else in the living room on the couch and then only move into your bedroom and bed once you’re ready to fall asleep.

And only go to bed once you’re already feeling drowsy otherwise you’ll just lie there in bed unable to sleep. And then if you’ve been in bed for more than 20 to 30 minutes without having fallen asleep lying in bed any longer is unlikely to bring on sleep anytime soon. You’re just teaching your body to associate being in bed with lying awake rather than falling asleep. So after 20 to 30 minutes of being in bed unable to sleep get up and move to a different room and do something relaxing for 20 to 30 minutes—like reading a book or listening to some quiet music; or doing a relaxation exercise like the one i link to in the description— and then return to your bed only once you’re feeling sleepy.

And try to keep your bedroom dark quiet and relatively cool. Our bodies cool down at night as we prepare for sleep so if we keep our bedrooms too warm it interferes with this process and most people find they sleep best at a room temperature in the mid to high 60s.

And sleeping well isn’t just about what happens once you go to bed the hours leading up are important as well. Try to stay off your computer or phone for 30 minutes to an hour before bed and use a blue light filter on any devices you can as bedtime approaches. And don’t eat a big meal drink alcohol or caffeine close to your bedtime. And nicotine is a stimulant so avoid smoking right before bed.

And try to have a night-time routine that involves some relaxation before you get into bed: doing some yoga or meditation, or taking a bath, or just reading or watching tv, or even cleaning up the kitchen if you find that relaxing. We all need something to help us unwind before bed. If you’re working right up until bedtime, or dwelling on things that went on during the day, or worrying about tomorrow when you get into bed, you’re probably not going to be able to quiet your mind enough to fall asleep.

And now we’re going to look at sleep scheduling and how that can help us sleep better. One of the most important things we can do to promote good sleep is to keep a regular sleep schedule. Our bodies rely on a consistent 24-hour routine or circadian rhythm to regulate our sleep wake cycle. Our bodies get used to going to bed at a certain time and waking up at a certain time, that’s why if we get up at the same time every day we often wake up just before our alarm goes off—our body knows that it’s time to wake up it doesn’t need an alarm to tell it.

The more we can stay consistent and let our bodies get into the habit of knowing it’s time to go to sleep and it’s time to wake up the better our sleep will be. The less regular our sleep schedule is the less we can rely on our body’s internal clock to help us sleep, and the more we start fighting against it. And so keeping a consistent sleep schedule is one of the best things you can do for your sleep. And that’s one of the things that makes sleeping so difficult for shift workers, or new parents whose sleep schedules are constantly getting disrupted, or when we travel across time zones, or experience the effects of daylight savings time.

And it’s important to try to maintain the same sleep schedule even on weekends. If you’re so tired at the end of the week that you need to sleep in try to limit it to no more than half an hour. If you’re sleeping in a few extra hours on the weekend, when you try to get back to your regular routine on sunday night you’re probably going to find it hard to fall asleep. And difficulty sleeping sunday night is one of the reasons we can be so cranky on monday mornings.

And if you need to take a nap these are fine earlier in the day but try to keep them to under 45 minutes, otherwise it can disrupt your sleep at night. And having a nap later in the day makes it more difficult to get to sleep at night, so a nap in the morning or after lunch should be fine, but a nap after work or after dinner can make it harder to fall asleep when you go to bed.

So maintaining a consistent sleep schedule is the first aspect of sleep scheduling but there’s another element and this involves sleep efficiency. Sleep efficiency refers to the amount of time you spend to sleep compared to the amount of time you spend in bed. So if you fall asleep as soon as your head hits a pillow and then sleep right until your alarm goes off, your sleep efficiency is 100%.

If you go to bed at 11 and set your alarm for seven you’ve allotted eight hours for sleep, and if you sleep seven hours that’s 7/8ths efficiency or 87.5%

Good sleepers average 95% sleep efficiency. The average person has about 90% sleep efficiency which would be allotting eight hours of sleep and then sleeping for seven and a quarter.

Poor sleepers average only about 65% sleep efficiency which would be, for example, only about five and a half hours of sleep over a period of eight and a quarter hours allotted for sleep.

Now as we talked about with sleep hygiene we want our beds to be strongly associated with sleeping and for good sleepers being in bed is a strong cue for sleep, but for poor sleepers who might spend two or three hours or even longer lying awake in bed each night that becomes a strong cue for being awake. So in order to overcome insomnia we need to find ways to sleep more efficiently and to make our beds a stronger cue for sleep.

Now if you practice better sleep hygiene and sleep scheduling and learn to quiet your mind and reduce negative sleep thoughts like i talk about in my other video on insomnia, your sleep efficiency will improve. But sometimes it still doesn’t improve enough, in which case we can further improve our sleep efficiency by reducing the amount of time we spend in bed.

Now usually when people have trouble sleeping they increase the amount of time they spend in bed, which makes sense, you want more sleep so you spend more time in bed. But unfortunately this has the opposite effect of what’s desired, because now you’re spending more time in bed, and your sleep is even less efficient, and you find it even more difficult to fall asleep once you’re in bed.

And spending too much time in bed interferes with our body’s natural rhythm. The longer we thin awake the stronger we feel the pressure for sleep due to increased physical activity and exposure to light, and due to increased accumulation of adenosine, which is a chemical our body produces that makes us sleepy. And our levels of adenosine increase the whole time we’re awake, and so if we sleep in or go to bed earlier, by spending more time in bed we find it more difficult to sleep because our bodies haven’t had enough time to do all the things they need to do in order for us to start feeling sleepy again.

So paradoxically if we’re having trouble sleeping, instead of spending more time in bed, we need to start spending less time in bed. And we start by giving ourselves one hour longer in bed than we tend to sleep. So if you’re averaging six hours of sleep a night, then give yourself seven hours of time for sleeping. And this may result in having a little less sleep at first as your body adjusts to having less time in bed. So if you’re tired during the day you can take a nap as long as it’s before 4 pm and lasts less than 45 minutes.

And if after a week your sleep efficiency hasn’t improved you can reduce your allotted sleep time even more, but don’t ever give yourself less than five and a half hours to sleep so you always have enough time to get your core sleep. And then once your sleep efficiency has reached 85% for at least two weeks you can increase your allotted time for sleep by half an hour a week as long as you’re still maintaining 85% sleep efficiency.

Now i understand that reducing the amount of time you spend in bed when you’re already having trouble sleeping can sound a little ridiculous and can be a hard thing to convince yourself to try, so you can always use a more gradual approach and try going to bed just 15 minutes later at night, or getting up just 15 minutes earlier in the morning so just decreasing the amount of time allotted for sleep by 15 minutes and you’ll probably find that you’re still getting the same amount of sleep overall. And then you can further reduce the amount of time allotted for sleep in 15 minute increments until your sleep efficiency has improved to at least 85%. And if you follow the sleep hygiene and scheduling guidelines as well as the strategies for quieting your mind and reducing negative sleep thoughts that i talk about in my other video on insomnia, it probably won’t be too long until you start to notice at least some improvements in your sleep.