Healthy Sleep (Insomnia CBT Class)

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NOTE: these notes from are from my insomnia counseling that I went to

Healthy Sleep Class

Purpose of Sleep

  • mood
  • memories
  • physical recovery
  • hormones
  • cognition
  • REALLY: we don’t really know why, but we know it is needed

Insomnia: disruptions of sleep that impacts daytime function

  • difficulty falling and staying asleep and waking up too early

Sleep Cycles

Awakenings: 2-3 brief awakenings are natural/normal during sleep (9-10 micro-awakenings)

  • N1: fragile, transitionary stage of sleep (can easily be awaken)
  • N2: stronger sleep stage (only drastic noises or lighting)
  • N3: [deep sleep] most restful – usually overhyped – frontend of sleep
  • REM: dreams, emotions, mood, energy, and memories – backend of sleep

Sleep

  • sleep drive: builds over time of the day (don’t go to sleep early since it can cause insomnia) – usu. 16 hrs but can be more
    • naps are similar to “snacks” for sleep
  • circadian rhythm: consistency

Sleep Hygiene

  • sleep environment: noise, light, temp
  • reduce caffeine (none within 10 hrs of bedtime OR in other words, none after noon)
  • no watch the clock, phones, or TV
  • no large meals, exercise, alcohol, and nicotine within 4 hrs of bedtime

Insomnia Coach

  • within 2hrs of wakeup and NOT in bed
  • perception of sleep is more accurate than smart device
  • dont use sleep recommendation – will make it manually in class

SESSION 2

Sleep Efficiency training: goal of 85%

Sleep Window: total sleep + 30 min (e.g. 5.5 hrs asleep = 6 hrs in bed)

  • takes 2 weeks to re-acclimate

Slowly increase sleep window to increase total sleep time

Sleep Drive: 24 hrs - [TIME ASLEEP] +/- 30 mins

Wakeup time: anchor for sleep drive and circadian rhythm

Sleep Time: bedtime 0100 to wakeup 0730

7 Sleep Rules:

  1. I must get out of bed at [WAKEUP] time: 0730
  2. Got to bed when sleepy by not before [BEDTIME]: 0130
  3. Get up when you can’t sleep
  4. Use bed only for sleeping – BED IS ONLY FOR SLEEP (NOT BED IS PLACE TO BECOME SLEEPY)
  5. Avoid napping
  6. Create wind-down routine before bed
  7. Don’t occupy mind/think in bed

SLEEPY: eyes heavy, head nodding

STAY AWAKE UNTIL EARLIEST BEDTIME: do something standing up, boring but not too engaging (nothing that increases/fluctuates body temperature)

SLEEP CHANGES TAKE: 10-14 days (first 7 days are “tantrum phase” to reconfigure pattern) to build consistency

SESSION 3

Conditioning: can have conditioned insomnia where laying in bed results in doing everything but sleeping (thinking, worrying, etc.) ** very difficult to break once conditioned: break pairing with everything and then re-pair for bed + sleep only

Stimulus Control and Conditioning:

  • 30-60min BEFORE bed/sleep: slow and not too active activities
  • In Bed
  • BED: sleep only
  • only go to bed when sleepy
  • get out of bed if unable to sleep after 15-20mins, do something relaxing, return to bed when sleepy, common first 2-3weeks of re-conditioning
  • 30-60min AFTER bed/sleep

SESSION 4

Bedtime: 0000-0730

  • Try breathing/relaxation exercises during most restful time in order to train parasympathetic nervous system
  • Worry time: if we don’t give ourselves the chance to worry before bedtime, then we will worry/think at bedtime
  • Do worry time BEFORE Buffer/Winddown zone
  • WORRY TIME is without: tech, music, distractions, anything stimulating
  • –> do some journaling maybe; give it 10 min timeframe; then do relaxation afterwards; STOP after timer 10min goes off
  • worry time isn’t meant to be productive!!
  • give it a schedule – anchor it to something; after work in car, after lunctime, etc.

Cognitive Model

SITUATION/EXPERIENCE -> [AUTO] THOUGHT -> EMOTION -> BEHAVIOR occurance -> interpretation -> feeling -> action

FRAMING

How do you frame your bad sleep? GOAL is to not frame it so negatively – instead of “I’m so tired because i slept so well i won’t make it” turn that into “i’ve survived tired days before and i can do it again! i’m doing the best i can”

HOMEWORK

  • note/jot down any negative thought about sleeping – how do I talk about it?
  • 3 mins of nice steady breathing
  • daily worry time

SESSION 5

stick to bedtime: 0000-0730

homework: 1-2 to improve on sleepwise from checklist

SESSION 6

  • Keep improving sleep: track and strive for 85% efficiency (time asleep/time in bed)
  • Move up sleep bedtime by +15min increments
  • Sleep tracker only necessary when sleep improvement is desired
  • Flexiblity (i.e. sleeping in): only when stable, do 1x/week, don’t over do it (e.g. just sleep in 1 hr) <– eliminate sleeping flexibility when disturbances start happening again
  • Plateau: stablizing for 2+ weeks; maybe hitting natural limit; diet, stress, physical activity, change winddown nighttime activity