Candice Seti, PsyD
Candice Seti, PsyD, a clinical psychologist in private practice in San Diego, California. Visit her website at www.theinsomniatherapist.com
Most of us think of sleep as necessary for everyday refreshment and regeneration: If we don’t get enough, we’re tired the next day. But sleep does much more than recharge the body for daily activity: It protects health, too.
In a recent 10-year sleep study published in Neurology, researchers analyzed health data from nearly 500,000 people with an average age of 51. They found that those who had three symptoms of insomnia—trouble falling asleep or staying asleep, waking up too early in the morning, or trouble staying focused during the day due to poor sleep—were 18 percent more likely to have had a heart attack or stroke. In fact, having even a single one of these three symptoms was associated with a higher risk:
Another study, published in the March 2020 issue of the Journal of Neurology, Neurosurgery and Psychiatry, analyzed data from more than 50 studies on sleep and cognition and found a significant link between poor sleep and a higher risk of cognitive decline and dementia.
Fortunately, there’s a simple, straightforward, science-proven way to restore good sleep: cognitive behavioral therapy for insomnia (CBTI). Hundreds of scientific studies show that CBTI is effective in overcoming poor sleep by teaching you to change your thinking and your actions. Here are essential strategies from CBTI that you can use if you’re sleeping poorly.
Acute insomnia is sleeping poorly for a night or two. Common causes include traveling, consuming caffeine late in the day, or a disruption to your regular sleep schedule. Whatever the cause, if you begin to believe you won’t fall asleep quickly because you haven’t slept well for a night or two—your negative sleep thoughts can turn acute insomnia into chronic insomnia. Negative sleep thoughts come in many forms:
Instead of believing these negative sleep thoughts, substitute thoughts that promote a rational sleep perspective:
The body thrives on routine. Do the same relaxing thing every night at bedtime, whether it’s reading, watching TV, listening to music, or taking a hot bath. Your body will associate those activities with falling asleep.
To sleep well, establish a sleep schedule: Go to bed and get up at the same time every day. If you sleep seven hours a night, the schedule could be 10 p.m. to 5 a.m., midnight to 7 a.m., or 2 a.m. to 9 a.m.—whatever works best for you.
Many people struggle to maintain a sleep schedule on the weekends, when they go to bed late and sleep in. This creates the common phenomenon of Sunday Night Insomnia. You’ve gotten up later than you usually do on Saturday and Sunday, so when you’re trying to go to sleep at your scheduled time on Sunday night, your body isn’t ready. That’s because the neurotransmitter adenosine builds up in the brain every hour you’re awake. As it rises, you experience drowsiness, heavy eyelids, and bodily warmth to help you sleep. When you get up later than usual, you don’t have enough adenosine in your system at your scheduled bedtime. The solution: Do your best to stick to your sleep schedule over the weekends, too.
Short naps are restorative, but naps longer than 30 minutes can impair your ability to sleep at night. And don’t nap after 2 p.m., which can interfere with nighttime sleep.
Your brain associates certain spaces with certain activities. When you’re in your office, it’s time to work. When you’re in your kitchen, it’s time to eat. When you’re in your bed, it’s time to sleep. But if you use your bed to work, watch TV, talk on the phone, or play with your dog, your brain does not associate your bed with sleep—making it harder to fall asleep when you get in bed.
To optimize your bed as a sleep cue, get in bed only to go to sleep and get out of bed when you wake up. (Sex is the exception.) This will improve your sleep efficiency score—the percentage of time you sleep when you’re in bed. Aim to be asleep for 90 percent of the time you’re in bed.
If you find yourself awake in the middle of the night, practice what sleep experts call the 20-20 rule. Get out of bed after 20 minutes of wakefulness and spend 20 minutes in a side chair or couch before getting back into bed. This ensures that you won’t associate your bed with wakefulness.
Finally, keep your bedroom dark and quiet, the ideal conditions for sleep. Again, the most important factor in sleeping well is consistency. For consistent levels of darkness, wear an eye mask. For consistent levels of quiet, wear earplugs.
The “blue light” wavelength from screens such as smartphones, computers and TVs suppresses the production of melatonin, the hormone that helps control the sleep-wake cycle. If you use your phone before bedtime (but not in bed!), turn on the blue light filter. If you use your computer or watch TV in the hours before bedtime, consider wearing a pair of glasses that block blue light.
Sleeping pills are problematic for several reasons. They sedate the brain so that you can get to sleep, but the sleep you get isn’t natural: It’s disrupted, with less restorative deep sleep and dreaming (REM) sleep. There’s also the issue of psychological dependence: If you take a sleeping pill every night, you start to believe that you can’t sleep without it—whether that belief is true or not.
Alcohol helps you fall asleep, but it doesn’t help you stay asleep or achieve deep, high-quality, restorative sleep. That’s because once the alcohol is metabolized, you wake up and can find yourself tossing and turning all night, unable to get to the deeper, restorative layers of sleep. It takes three to four hours to metabolize alcohol, so stop drinking alcoholic beverages four hours before bedtime.
Caffeine works, in part, by blocking adenosine, the neurotransmitter that induces sleepiness. That’s great for earlier in the day, but problematic in the evening. Like napping, don’t ingest caffeine after 2 p.m. If a 2 p.m. cup of coffee interferes with sleep, stop even earlier.
Exercising any time during the day helps you get to sleep at bedtime. But because exercise raises body temperature, it can be problematic for sleep if you exercise two to three hours before bedtime. Exercise earlier in the day—ideally, the same time every day.
Many medical conditions can interfere with sleep, such as sleep apnea, restless legs syndrome, hyperthyroidism, prostate problems, and chronic pain. If you suspect that a medical problem is causing your insomnia, talk to your doctor.
If you get a good dose of sunlight in the morning, you’ll suppress melatonin—which will build up later in the day, helping you sleep. There are many ways to get morning sunlight. Exercise outside. Sit on your patio and sip a cup of tea. And don’t wear your sunglasses—unfiltered sunlight has to go in through your eyeball to suppress melatonin.
