Worrying and Insomnia

Worrying can be a big contributing factor in insomnia. We can lie in bed, worrying about things that happened during the day, unable to sleep because we can’t slow our minds down. Or maybe we’re worrying about what we have to do tomorrow, these thoughts racing around in our heads and keeping us awake. Or maybe we’re just worrying in general about whatever pops into our minds. Regardless of what we’re worrying about, worrying can make it difficult to sleep.

One of the best ways to reduce worrying and make it easier to fall asleep at night, is to spend some time going over our worries in the evening. We look at what we’re worrying about. And we ask ourselves if there’s anything we can about whatever’s worrying us. And if there is, we do it. But if there isn’t, then we just try to let our worries go for today, since there’s nothing we can do about them now, except continue to worry about them, and give ourselves insomnia tonight.

The Best Tip To Reduce Worrying

If worrying is contributing to your insomnia, you’ll find more posts about how to reduce worrying in my Self-Help Course for Anxiety. If you have any questions or comments, please leave them on the YouTube video page.

Cognitive Defusion for Insomnia

In Acceptance and Commitment Therapy (ACT), cognitive fusion refers to when we become so stuck in our heads, we become fused with our thoughts. When we’re in a state of cognitive fusion, it can be hard to quiet our minds enough to fall asleep, and so cognitive fusion can contribute to insomnia.

The opposite of cognitive fusion is cognitive defusion . Cognitive defusion allows us to un-fuse ourselves from our thoughts. And then we can let our thoughts go and quiet our minds enough to be able to fall asleep. So if our thoughts are keeping us up at night and giving us insomnia, cognitive defusion is a great way to clear our heads so we can get to sleep.

Cognitive Defusion

Worries are one of the most common types of thoughts that keep us awake at night. If worrying is contributing to your insomnia, you’ll find a number of posts about how to reduce worrying in my Self-Help Course for Anxiety. If you have any questions or comments, please leave them on the YouTube video page.

The Thought Record in CBT

The most effective way to practice cognitive restructuring is to complete a thought record or thought diary. The thought record is one of the foundational tools of CBT. In the thought record we write down:

  • Our automatic negative thoughts
  • The situations that triggered them
  • The moods, emotions, feelings, and physical symptoms or sensations we experience in response.

Then we identify the automatic negative thought most responsible for how we feel, and use cognitive restructuring to come up with alternative and more balanced thoughts. The thought record is the main tool we use in CBT to change the way we think. It helps us see things from a different perspective, and as a result, change the way we feel.

The Thought Record in CBT

There are a couple of different formats of the thought record you can download below. The first is based on Mind Over Mood by Dennis Greenberger and Christine A. Padesky. The second is based on the thought diary from the Centre for Clinical Interventions. For this format there is a full two-page thought record, a condensed one-page version, and a filled out example of a completed thought record:

If you have any questions or comments, please leave them on the YouTube video page.

Insomnia and Letting Go of Thoughts

It can hard to sleep if our minds are racing. Perhaps we’re worrying about tomorrow, planning our days and going over things in our heads as we try to fall asleep. Or we’re stuck dwelling on something that happened earlier in the day, ruminating and thinking in circles, unable to quiet our minds. Or maybe we’re just lying in bed thinking about how hard it is to fall asleep.

No matter what sorts of thoughts are keeping us up and giving us insomnia, we don’t have to keep thinking about them. We can learn to just watch our thoughts and let them go. And when we’re able to do this, our insomnia will start to improve, and we’ll be able to get to sleep.

Letting Go Of Thoughts

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

We have tens of thousands of thoughts a day but most of them barely register. And the ones that we do notice often aren’t even related to anything we’re doing at the time. Usually the best way to deal with automatic negative thoughts is to not give them your attention in the first place.

They’re like a clickbait headline that looks like it’s gonna be really interesting, but once you click there’s really nothing worth seeing and the best course of action is to just not click on them in the first place. But sometimes we can’t resist and we click anyway. And then we find ourselves going down that rabbit hole and keep clicking on another and another and another, at which point it can take quite a bit of effort to pull ourselves back out.

And the same is true once we start following our automatic negative thoughts. A big part of mindfulness is about learning to let go of these types of thoughts and refocus our attention in the present moment. But that’s often easier said than done for a couple of reasons.

First we tend to believe that if we have a thought it’s somehow interesting or important and something we should pay attention to, so we don’t want to just let it go. But of our tens of thousands of thoughts every day, most of them are just noise in our head, mindless distractions that don’t need our attention at all. And once we come to terms with this it’s a lot easier to just allow these thoughts to pass from our mind without even thinking about them.

But secondly, the thoughts that we tend to notice are the ones that provoke an emotional reaction. And these are not as easy to simply let pass from our minds, because as we’ve seen once our thoughts and emotions start interacting together, they feed into and reinforce each other. And as a result thoughts that carry some emotional weight are much more difficult to just let go, as the emotion acts as a kind of magnet, and keeps pulling these thoughts back into our head.

One way to let go of thoughts is to treat them as if they were just sounds going on in the background. We generally don’t pay attention to these sounds or think about them very much, and we just allow them to pass in one ear and right out the other. And we can do the same sort of thing with our thoughts, not give them any undue attention and think about them or try to figure out what they mean, and just treat them like mental noise in the background allow them to pass into our mind and then right out again.

Another metaphor for this way of relating to our thoughts is to simply treat our thoughts as if they were clouds passing through the sky, noticing as a cloud or a thought passes into our field of awareness, sticks around for a while, and then continues to float through the sky or through our mind until it passes away.

Or sitting back and observing our thoughts as if we were at the movies and watching our thoughts being projected on the screen in front of us, not actively participating or getting caught up in the action on the screen that is our thoughts, and just sitting back and watching them as they unfold.

But often it’s not that easy to just sit back and watch our thoughts, and in the next video we’ll learn some additional strategies and techniques we can use to help us step back from our thoughts and let them go called cognitive defusion.

If you have any questions or comments, please leave them on the YouTube video page.

Cognitive Restructuring and Reframing Thoughts

In CBT we use a technique called cognitive restructuring to modify our automatic negative thoughts to make them better reflect reality. With cognitive restructuring we’re not trying to engage in “positive thinking.” Positive thinking isn’t helpful because it doesn’t reflect reality either. Instead, cognitive restructuring involves reframing our negatively biased thoughts in order to see things from a more balanced perspective.

When we modify our thoughts with cognitive restructuring, we end up with alternate ways of looking at things that:

  • More accurately describe the situations we find ourselves in
  • We can believe because they make sense to us and aren’t just trying to force positive thinking
  • Improve our moods and how we feel because they’re not negatively biased or distorted

Cognitive Restructuring and Reframing Thoughts

Cognitive restructuring is one of the most important CBT techniques because it enables us to change the way we think, which, as we’ve discussed, is one of the keys to changing the way we feel. If you’d like to practice cognitive restructuring, you’ll find the questions from the video in the Cognitive Restructuring Worksheet (PDF):

In the next post we’ll look at the thought record, which guides us through the process of cognitive restructuring in detail. If you have any questions or comments, please leave them on the YouTube video page.

Automatic Negative Thoughts

We constantly have all sorts of thoughts automatically popping into our heads. In CBT, it’s our automatic negative thoughts (sometimes referred to as ANTs) that we’re most concerned with. Automatic negative thoughts play a huge role in both initiating and maintaining our negative moods. And they often set off vicious cycles and downward spirals that are extremely difficult to break out of. If we struggle with depression, anxiety, or any number of mental health issues, we can experience an endless barrage of automatic negative thoughts all day long.

Automatic Negative Thoughts

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

A lot of our thoughts are automatic. A thought just pops into our head without us even thinking about it. Some of our automatic thoughts can be pleasant or neutral, but more often than not they tend to be negative.

Automatic negative thoughts have a strong effect on our mood and how we’re feeling, and learning how to respond to our automatic negative thoughts in ways that help us feel better is an important part of mindfulness based cognitive therapy. So now we’re gonna look at some common automatic negative thoughts that people have that tend to be associated with depression, anxiety and anger.

When we’re feeling depressed we tend to have very negative thoughts. And these thoughts center around three themes: negative thoughts about ourselves, negative thoughts about the world, and negative thoughts about the future. Examples of automatic negative thoughts about ourselves are things such as: I’m such a loser. I’m no good. I keep disappointing everyone. What’s wrong with me? I can’t do anything right. I’m a failure. I feel so helpless. Nobody even cares about me.

And automatic negative thoughts about the world, which is just a general sort of negativity about everything: life is so unfair. Things should be easier. The whole world’s falling apart. Everything’s so stupid. Life stinks.

And automatic negative thoughts about the future: things are never gonna work out for me. There’s nothing i can do about it. I’m always going to feel this way. I’m never going to be happy. There’s no point in trying anymore. It’ll never get any better.

And when we’re feeling anxious we tend to have thoughts that overestimate the likelihood that something bad will happen. And we overestimate the severity of what will happen. And we underestimate our ability to cope with things.

And so we have automatic negative thoughts about threats and danger: oh no! What’s happening? This is terrible.

And automatic negative thoughts about our ability to cope with things: i can’t handle this. I’m never gonna be able to do this. People are gonna wonder what’s wrong with me. This is just too much. What am i gonna do? I should just quit now.

And all sorts of what-ifs which are probably the most common types of thoughts people have when they’re feeling anxious or worried what if this happens what if that happens what if what if what if

And when we’re feeling anxious, our thoughts are too a future-oriented, and we end up spending a lot of time and energy worrying about how things might be in the future. And even though these things haven’t occurred yet and may never occur, we tend to respond as if they’ve already happened, or that they’re inevitable. And so we wind up suffering the consequences right now. And even if the things we’re dreading never actually occur, we’ve already made ourselves pay the price and suffer over them whether they actually happen or not.

Our automatic negative thoughts that are associated with anger are things around the need for fairness and respect; becoming aggravated, frustrated or losing patience; violations of rules; and revenge.

This is so unfair. Why does this keep happening to me? I can’t stand this anymore. What’s wrong with him? You can’t treat people that way. He’ll pay for that!

And in the next couple of videos we’ll learn how we can improve our mood and help ourselves feel better by managing our automatic negative thoughts through cognitive diffusion and letting go of thoughts and with cognitive restructuring.

The first step towards reducing both the frequency of our automatic negative thoughts, and how detrimental they are, is to learn to recognize and record these automatic negative thoughts when they arise. This is part of what we do in the CBT Interrelationships worksheet from the first post in this course. In addition to completing this worksheet, it’s good practice when learning CBT to just pay attention for and write down automatic negative thoughts whenever they come up.

The next step is to assess the accuracy of these ANTs. Then we can reframe our thoughts to look at things from different perspectives that don’t have such a negative impact on our moods. And as a result, we start feeling better. We’ll look at how we can do this in the next few posts. If you have any questions or comments, please leave them on the YouTube video page.

Thoughts Are Not Facts

One of the main things we focus on in CBT is how we can modify our negative thoughts in order to improve how we feel. But why is it okay to change our thoughts? If we have a thought, isn’t it important? Shouldn’t we listen to our thoughts and what they say?

Well it is important to be aware of our thoughts and what they’re telling us. But it’s also important that we recognize that, in most cases, our thoughts are not facts. Our thoughts are just our subjective interpretations of our environments, situations and experiences. When we use CBT techniques to dispute and modify our thoughts, we’re not trying to change the facts. We’re not denying reality, or forcing ourselves to believe things that aren’t true. We’re just reframing our understanding of situations and looking at things from different perspectives.

And the reason we can do this is that our thoughts are not facts. Given the same facts about a situation, it’s possible to have different thoughts about that situation. If we’re having thoughts that are making ourselves feel bad or making things difficult for ourselves, we have the ability to change these thoughts. We can see things from a different light, and as a result start to feel better and make things less hard for ourselves.

Thoughts Are Not Facts

If you have any questions or comments, please leave them on the YouTube video page.

Guided Relaxation Meditation for Insomnia and Sleep

In this 20-minute Guided Relaxation Meditation we connect with our breathing while moving our attention through our bodies, relaxing each part as we go. You can listen to it as you fall asleep or just to help you relax before going to bed.

This relaxation exercise in adapted from the CBT-I program developed by Dr. Gregg Jacobs at Harvard Medical School. For more detailed information about his online CBT-I program, please visit https://www.cbtforinsomnia.com.

Guided Relaxation Exercise for Sleep and Insomnia

If you have any questions or comments, please leave them on the YouTube video page.

CBT for Insomnia: Positive and Negative Sleep Thoughts

There are two elements to Cognitive Behavioral Therapy for Insomnia (CBTI). In this post we’ll look at the cognitive aspect of CBTI and how our thoughts impact our sleep. In the next post we’ll look at the role of behavior on our sleep.

Negative thoughts about sleep are often a big contributing factor to insomnia. The video below explains negative sleep thoughts (NSTs) and how they interfere with our ability to sleep. And then it looks at how to replace negative sleep thoughts with positive sleep thoughts (PSTs) that help us sleep better.

This video presents an overview of the CBT for Insomnia program developed by Dr. Gregg Jacobs at Harvard Medical School. For more detailed information about his online CBT-I program, please visit www.cbtforinsomnia.com.

Cure Insomnia and Sleep Better with CBTI

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.

You’ll find the video that describes how to use a Worry or Thinking Period in the last post of this insomnia course. If you have any questions or comments, please leave them on the YouTube video page.

CBT for Insomnia: Sleep Hygiene and Sleep Efficiency

The behavioral element in Cognitive Behavioral Therapy for Insomnia (CBTI) has two components, sleep hygiene and sleep efficiency. Sleep hygiene involves developing habits and routines that reduce insomnia. And we also create an environment that is conducive to sleep and helps us sleep better.

Our sleep is also better when we have a consistent sleep schedule. Going to bed and waking up at approximately the same time every day improves sleep. But sometimes that’s not enough, and we need to improve our sleep efficiency.

Sleep efficiency refers to the amount of time we spend in bed compared to the amount of time we’re actually asleep. People with insomnia often spend a great deal of time lying in bed awake, trying to fall asleep. And this leads to very inefficient sleep and contributes to insomnia. In order to increase sleep efficiency, we reduce the amount of time we spend in bed. This is known as sleep restriction therapy.

In sleep restriction therapy we decrease our sleep windows, by either going to bed later or getting up earlier, until our sleep becomes more efficient, and we spent a greater proportion of our time in bed actually sleeping. So at first we may get slightly less sleep than we’re used to (hence the term sleep restriction therapy), but we also spend considerably less time lying in bed awake. And then as our sleep becomes more efficient, we can increase our sleep windows, allowing ourselves to get more sleep, while still spending less time in bed.

This video presents an overview of the CBT for Insomnia program developed by Dr. Gregg Jacobs at Harvard Medical School. For more detailed information about his online CBT-I program, please visit www.cbtforinsomnia.com.

Sleep Hygiene and How to Sleep More Efficiently

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.

If you have any questions or comments, please leave them on the YouTube video page.